(c) All statutes relating to the public health and to vital statistics.

Second-Report to the secretary of the State board of health at Sacramento at such times as the State board may require:

(a) The sanitary condition of his locality.

(b) The number of deaths, with the cause of each, as near as can be ascertained, within his jurisdiction during the preceding month.

(c) The presence of epidemic or other dangerous, contagious, or infectious diseases and such other matters within his knowledge or jurisdiction as the State board may require.

SEC. 4. Section 3064 of the Political Code is hereby amended to read as follows:

3064. The board of supervisors must fix the salary or compensation of health officers, and provide for the expenses of enforcing the provisions of this article. If the board of supervisors or board of trustees, council, or other corresponding board of any incorporated town, neglects to provide a health officer by the first day of July, 1887, the State board of health may direct the district attorney of the county to begin an action against such board of supervisors, or board of trustees, or corresponding board, to compel the performance of their duty, or may appoint a health officer for such town or city, and the expenses of such health officer shall be a charge against the incorporated city or town for which such appointment shall be made; and when the appointment is made for unincorporated towns, the expenses of the health officer are a charge against the county. Poliomyelitis and Cerebrospinal Meningitis-Required to be Quarantined. (Res. Bd. of H., July 7, 1917.)

Resolved, That the following diseases are hereby declared quarantinable and are added to the list of diseases which are required to be quarantined by the first paragraph of rule 1 of section 13 of the public health act: Poliomyelitis and epidemic cerebrospinal meningitis.

Leprosy-Transportation of Infected Persons-Escape from Isolation to be Reported. (Reg. Bd. of H., Mar. 3, 1917.)

No leper shall be transported, or encouraged to go from one county to another, or to a foreign country, without previous permission being obtained from the State board of health; and the escape of any leper from the isolation provided in accordance with section 2952 of the Political Code shall be reported at once to the State board of health.

Venereal Diseases-Notification of Cases-Specimens for Diagnosis-Instructions to Patient-Local Health Officers Appointed Inspectors-Investigation and Control by Local Health Officers-Reports of Unusual Prevalence or Conditions. (Reg. Bd. of H., Oct. 6, 1917.)

RULE 1. Notification.-Any person in attendance on a case of syphilis or gonococcus infection, or a case suspected of being one of syphilis or gonococcus infection, shall report the case immediately, by office number only, to the local health officer, who shall in turn report at least weekly on the prescribed form to the secretary of the State board of health all cases so reported to him.

Note 1.-In reporting by office number, an identifying number or initial shall be used which refers definitely to the physician's record of the case.

Note 2.-All cases of ophthalmia neonatorum, whether the infecting agent is the gonococcus or not, must be reported to the local health officer within 24 hours after the knowledge of the same, as required by chapter 724, Statutes of 1915. Copies of this statute may be obtained by application to the State board of health, Sacramento, or the bureau of venereal diseases, 325 Market Street, San Francisco. All physicians, midwives and other persons lawfully engaged in the practice of obstetrics may obtain, without cost, the prophylactic for ophthalmia neonatorum (silver nitrate solution in wax ampoules), together with directions for its use, by applying to the bureau of communicable diseases, Berkeley.

Note 3.-An" person in attendance on a case of syphilis or gonococcus infection who fails to report the case promptly to the local health officer is guilty of a misdemeanor, punishable by a fine of not less than $25 nor more than $500, or by imprisonment for a term of not more than 90 days, or by both such fine and imprisonment. (See Public Health Act, sections 13 (rule 2), 16, and 21.)

Note 4.-Physicians attending cases of syphilis and gonococcus infection are expected to furnish to the health officer at the times of reporting the case, any available useful data regarding the sources of infection, in order to assist in the control of these diseases.

RULE 2. Diagnosis.—The local health officer may require the submission of specimens from cases of syphilis or gonococcus infection, or cases suspected of being cases of syphilis or gonococcus infection, for the purpose of examination at a State or municipal laboratory. It shall be the duty of every physician attending a case of syphilis, or gonococcus infection, or a case suspected of being one of syphilis or gonococcus infection, to secure specimens for examination when required to do so by the local health officer.

Note 1.-Examinations of blood for syphilis by the Wassermann test, and microscopic examinations ofsmears of pus for gonococci are made without charge by the bureau of communicable diseases at Berkeley if the specimens are properly taken and mailed in the containers furnished by the bureau of communicable diseases. It is expected that the larger cities will provide adequate laboratory facilities. (See directions for sending material to the laboratory.)

RULE 3. Instructions to the patient.—It shall be the duty of the physician in attendance on a person having syphilis or gonococcus infection, or suspected of having syphilis or gonococcus infection, to instruct him in precautionary measures for preventing the spread of the disease, the seriousness of the disease, and the necessity for prolonged treatment, and the physician shall, in addition, furnish approved literature on these subjects.

Note 1.-Approved literature for distribution to patients may be secured from the bureau of venereal diseases of the State board of health, 525 Market Street, San Francisco.

Note 2.-The following instructions are required as a minimum by rule 2:

(a) To patients having syphilis:

1. Syphilis or pox is a contagious disease. It can usually be cured, but it requires two or more years of treatment.

2. You must not marry until a reputable physician has pronounced you cured.

3. Avoid all sexual relations.

4. Always sleep alone.

5. Do not kiss anyone.

6. Never permit anyone to use anything which has been in your mouth, such as toothpicks, toothbrushes, pipes, cigars, pencils, spoons, forks, cups, etc., or anything else that you have contaminated. 7. Il you have to see a dentist, tell him about your disease before he examines your teeth.

8. Avoid patent medicines, so-called "medica. institutes” and advertising "specialists."

9. Consult a reputable physician, or, in case of financial inability, the city or county physician, or a reputable dispensary such as is found in connection with most large public hospitals, and follow directions absolutely.

(b) To patients having gonorrhea:

1. Gonorrhea, "clap," or gleet, is a serious contagious disease. If properly treated it can usually be cured.

2. You must not marry until a reputable physician has pronounced you cured.

3. Avoid all sexual relations.

4. Always sleep alone, and be sure that no one uses your toilet articles, particularly your towels and wash c.oths.

5. Always wash your hands thoroughly after handling the diseased parts The discharge, in carried to your eyes, may cause blindness.

6. Avoid patent medicines, so-called "medical institutes” and advertising "specialists."

7. Consult a reputable physician, or, if financially unable to do so, the city or county physician, or a reputable dispensary such as is ound in connection with most large pubic hospitals, and ol.ow directions absolutely.

Note--I any person has knowledge that a person infected with syphilis or gonococcus infection is ailing to observe adequate precautions to prevent spreading infection, he shal. report the facts at once to the local health officer.

RULE 4. Health officers designated inspectors.-All city, county and other local health officers are, for the purpose of the control and suppression of venereal diseases, hereby

designated and appointed inspectors, without salary, of the State board of health of California, under the provisions of section 2979 of the Political Code.

Note 1.-The following paragraph is quoted from section 2979 of the Political Code:

"It (the State board of health) shall have general power of inspection, examination, quarantine and disinfection of persons, places and things, within the State, and for the purpose of conducting the same may appoint inspectors, who, under the direction of the board, shall be vested with like powers: Provided, That this act shall in nowise conflict with the national quarantine laws."

RULE 5. Investigation and control of cases.-All city, county and other local health officers are hereby directed to use every available means to ascertain the existence of, and immediately to investigate, all reported or suspected cases of syphilis in the infectious stages and gonococcus infection within their several territorial jurisdictions, and to ascertain the sources of such infections.

In such investigations said health officers are hereby vested with full powers of inspection, examination, isolation and disinfection of all persons, places and things, and as such inspectors said local health officers are hereby directed:

(a) To make examinations of persons reasonably suspected of having syphilis in the infectious stages or gonococcus infection. (Owing to the prevalence of such diseases among prostitutes, all such persons may be considered within the above class.) (b) To isolate such persons whenever, in the opinion of said local health officer, the State board of health or its secretary, isolation is necessary to protect the public health. In establishing isolation the health officer shall define the limits of the area in which the person reasonably suspected or known to have syphilis or gonococcus infections and his immediate attendant, are to be isolated, and no persons, other than the attending physicians, shall enter or leave the area of isolation without the permission of the health officer.

(c) In making examinations and inspections of women for the purpose of ascertaining the existence of syphilis or gonococcus infection, to appoint women physicians for said purposes where the services of a woman physician are requested or demanded by the person examined.

(d) In cases of quarantine or isolation, not to terminate said quarantine or isolation until the cases have become noninfectious or until permission has been given by the State board of health or its secretary.

Cases of gonococcus infection are to be regarded as infectious until at least two successive smears taken not less than 48 hours apart fail to show gonococci.

Cases of syphilis shall be regarded as infectious until all lesions of the skin or mucous membranes are completely healed.

(e) Inasmuch as prostitution is the most prolific source of syphilis and gonococcus infection, all health officers are directed to use every proper means of repressing the same, and not to issue certificates of freedom from venereal diseases, as such certificates may be used for purposes of solicitation.

(f) To keep all records pertaining to said inspections and examinations in files not open to public inspection, and to make every reasonable effort to keep secret the identity of those affected by venereal disease control measures as far as may be consistent with the protection of the public health.

RULE 6. Report of unusual prevalence.-When the local health officer, through investigation, becomes aware of unusual prevalence of syphilis or gonococcus infection, or of unusual local conditions favoring the spread of these diseases, he shall report the facts at once to the bureau of venereal diseases, 525 Market Street, San Francisco.

Venereal Diseases-Standards for Dispensaries and Hospitals. (Reg. Bd. of H., Oct. 6, 1917.)

DISPENSARIES TREATING SYPHILIS.

1. Special department.-Syphilis shall be treated in a special department or the department of dermatology.

2. Number of sessions.--The dispensaries shall be open at least three times a week, day or evening.

3. Staff-The staff shall be adequate in number and training.

4. Equipment. Enough well-arranged rooms, laboratory facilities and equipment, with instruments and apparatus, shall be provided.

5. Beds. Every dispensary shall have at its disposal beds for isolation or treatment. 6. Records. Adequate records of all cases shall be kept.

7. Social service required.—A social service department shall be maintained and adequate measures adopted to secure a regular attendance of patients.

8. Information to patients.-Clinicians shall devote the amount of time necessary for intelligently informing new patients of the seriousness of their disease, the necessity for prolonged treatment, and the precautions necessary to prevent the spread of infection to others, and the clinics shall, in addition, furnish approved literature on these subjects. (This literature can be secured from the bureau of venereal diseases.) 9. Microscopic examinations.—Microscopic examinations of suspected initial lesions shall be made.

10. Wassermann tests.-Wassermann tests shall be performed in the dispensary laboratory or other approved laboratory.

11. Administration of salvarsan or equivalents.—Salvarsan or accepted equivalents shall be administered to all cases where there are no contraindications. (Salvarsan or approved substitutes may be obtained without cost from the bureau of venereal diseases, 525 Market Street, San Francisco, for the treatment of infectious cases of syphilis in approved dispensaries.)

12. Procedure covering the discharge of patients.—Suitable tests and observations shall be made of all patients for a period of not less than two years after the conclusion of adequate treatment. (See pamphlet "Modern Treatment of Syphilis," obtainable from the bureau of venereal diseases.)

13. Transfer of patients.-If it becomes necessary for any reason to discharge a patient still uncured, the patient shall be referred to an approved dispensary or a reputable physician.

14. Annual report.-An annual report of work done in the dispensary shall be made. It is suggested that this include the number of new and old patients and number of visits made, the number of patients continued under observation and treatment from one year into the next, the number of doses of salvarsan or equivalent administered (with a separate list of free doses), and the number of patients discharged as cured.

DISPENSARIES TREATING GONORRHEA.

1. Number of sessions.-Dispensaries shall be open at least three times a week, day or evening.

2. Staff. The staff shall be adequate in number and training.

3. Equipment.-Enough well-arranged rooms, laboratory facilities and equipment, with instruments and apparatus, shall be provided.

4. Beds. Every dispensary shall have at its disposal beds for isolation or treatment. 5. Records. Adequate records of all cases shall be kept.

6. Social service required.—A social service department shall be maintained and adequate measures adopted to secure a regular attendance of patients.

7. Information to patients.-Clinicians shall devote the amount of time necessary for intelligently informing new patients of the seriousness of their disease, the necessity of treatment until cured, and the precautions necessary to prevent the spread of infection to others, and the clinic shall, in addition, furnish approved literature on these subjects. (This literature can be secured from the bureau of venereal diseases.)

8. Microscopic examination.-Systematic microscopic examination of discharges shall be made in departments treating patients affected with gonorrhea.

9. Facilities for asepsis and antisepsis.—All departments treating patients affected with gonorrhea shall be equipped with adequate facilities for asepsis and antisepsis. 10. Urethroscopic and cystoscopic examination.-Facilities for urethroscopic and cystoscopic examination shall be provided and regularly employed by the attending clinicians.

11. Procedure governing discharge of patients.-Patients shall be discharged as cured only after repeated negative clinical and microscopic examinations.

12. Transfer of patients.—If it becomes necessary for any reason to discharge a patient still uncured, the patient shall be referred to an approved clinic or reputable physician.

13. Annual report.-An annual report of work done in the dispensary shall be made. It is suggested that this include the number of new and old patients, the number of visits made, the number of patients continued under observation and treatment from one year into the next, and the number of patients discharged as cured.

HOSPITALS TREATING SYPHILIS AND GONORRHEA.

1. No discrimination against venereal diseases.-Patients having venereal diseases must be accepted under the same conditions as other patients.

2. General standard of hospital.—The hospital shall be properly equipped and well conducted.

3. Staff and equipment.-There shall be adequate staff and equipment for the diagnosis, treatment and keeping of records in cases of syphilis or gonococcus infection in general accord with the standards indicated for approved dispensaries.

4. Follow-up.-Social service and follow-up work shall be carried on as indicated for approved dispensaries, either by the hospital or by an approved dispensary to which patients are transferred.

Communicable Diseases-Pesthouses or Hospitals-Prohibition Against Maintcnance in Cities and Towns Removed. (Ch. 44, Act Apr. 5, 1917.)

SECTION 1. Section 373 of the Penal Code is hereby repealed.

The section repealed read as follows:

SEC. 373. Every person who establishes or keeps, or causes to be established or kept, within the limits of any city, town, or village, any pesthouse, hospital, or place for persons affected with contagious or infectious diseases, is guilty of a misdemeanor.

Occupational Diseases-Act Requiring Reporting of, Repealed. (Ch. 227, Act May 11, 1917.)

SECTION 1. An act entitled "An act to provide for the reporting of occupational diseases," approved April 21, 1911, is hereby repealed.

Rodents, Insects, and Other Vermin-Extermination. (Ch. 531, Act May 18, 1917.)

SECTION 1. Section 2 of an act' entitled "An act to prevent the introduction, and provide for the investigation and suppression of contagious or infectious diseases, and appropriating money to be used for such purpose," approved June 7, 1913, is hereby amended to read as follows:

Pub. Health Repts. Reprint 264, p. 64.