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State Board of Health, 
BOSTON, October 1, 1877. 
Dear Sir : 
In view of the fact that diphtheria, although now less prevalent than in the colder months, 
may be expected to visit a portion of our State during the autumn and winter, it seems important that 
more thorough attempts to control the disease should be made by the local authorities. 
In the first place, as diphtheria is a contagious disease, and under certain circumstances not entirely 
known, very highly so. it is important that all practicable means should be taken to separate the sick from 
the well. As it is also infectious, woolen clothes, carpets, curtains, hangings, etc., should be avoided in the 
sick-room, and only such materials used as can be readily washed. 
All clothes, when removed from the patient, should be at once placed in hot water. Pocket-handkerchiefs 
should be laid aside, and in their stead soft pieces of linen or cotton cloth should be used, and at once burned. 
Disinfectants should always be placed in the vessel containing the expectoration, and may be used some- 
what freely in the sick-room; those being especially useful which destroy bad odors without causing others 
(nitrate of lead, chloride of zinc, etc.). 
In schools there should be especial supervision, as the disease is often so mild in its early stages as not 
to attract common attention; and no child should be allowed to attend school from an infected house, until 
allowed to do so by a competent physician. 
In the case of young children, all reasonable care should be taken to prevent undue exposure to the cold. 
Pure water for drinking should be used, avoiding contaminated sources of supply; ventilation should be 
insisted on, and local drainage must be carefully attended to. Privies and cesspools, where they exist, should 
be frequently emptied and disinfected; slop-water should not be allowed to soak into the surface of the ground 
near dwelling-houses, and the cellars should be kept dry and sweet. 
In cities, especially in tidal districts, basins, baths, etc., as now connected with drains, should never com- 
municate directly with sleeping-rooms. In view of the fact that the majority of our houses are improperly 
supplied with local drainage, and that this is probably at least as great a source of disease as bad sewers; in view of the fact, too, that many cities are likely to appoint boards of health by virtue of the authority conveyed 
upon them by Chapter 133 of the Acts of the General Court of 1877, the Board desire to call attention to the 
following important section of that Act: — 
“ Section 5. Said boards of health, and the board of health of the city of Boston, in addition to the powers 
conferred upon them by existing statutes, are hereby authorized to prepare and enforce, in their respective cities, such 
regulations as they may deem necessary for the safety and health of the people, with reference to house-drainage, 
and its connection with public sewers, where such connection is made.” 
In all cases of diphtheria, fully as great care should be taken in disinfecting the sick-room, after use, as in 
scarlet-fever. 
After a death from diphtheria, the clothing disused should be burned or exposed to nearly or quite a heat 
of boiling water; the body should be placed as early as practicable in the coffin, with disinfectants, and the coffin 
should be tightly closed. 
Children, at least, and better adults also in most cases, should not attend a funeral from a house in which a 
death from diphtheria has occurred. But with suitable precautions, it is not necessary that the funeral should be 
private, provided the corpse be not in any way exposed. 
Although it is not at present possible to remove at once all sources of epidemic disease, yet the frequent 
visitation of such disease, and especially its continued prevalence, may be taken as sufficient evidence of insanitary 
surroundings, and of sources of sickness to a certain extent preventable. 
It should be distinctly understood that no amount of artificial “ disinfection ” can ever take the place of pure 
air, good water, and proper drainage, which cannot be gained without prompt and efficient removal of all filth, 
whether from slaughter-houses, etc., public buildings, crowded tenements, or private residences. In the opinion 
of the Board, this is likely to be done properly only through independent local boards of health, the appointment 
of which in all cases we most respectfully, but earnestly, urge upon the citizens of the State. 
We have the honor to be, 
Very respectfully yours, 
HENRY I. BOWDITCH, 
ROBERT T. DAVIS, 
RICHARD FROTHINGHAM, 
DAVID L. WEBSTER, 
JOHN C. HOADLEY, 
THOMAS B. NEWHALL, 
CHARLES F. FOLSOM, 
Members of the State Board of Health.