SEC. 15. The auditor shall, upon proper voucher from the secretary of the State board of health, issue his warrant on the treasurer of the State in payment of all salaries and other expenses incurred in the administration of the bureau of sanitation of the board of health for the biennial period beginning April 1, 1917, and ending March 31, 1919: Provided, That vouchers so issued shall be chargeable by the State treasurer only to the sanitary fund and no warrant under this act shall be paid by the State treasurer unless there is funds [sic] to the credit of the sanitary fund of the State board of health sufficient to pay same.

SEC. 16. The rules and regulations promulgated by the State board of health shall be deemed necessary to enforce the provisions of this act and are hereby made a part of this act.

Births and Deaths-Registration Districts-Appointment and Fees of Local Registrars. Marriages-Registration. (Act 149, Mar. 17, 1917.)

SECTION 1. That sections 9, 10 and 11 of an act1 entitled "An act for the better protection of the public health and for other purposes," approved February 25, 1913, be and the same are hereby amended and supplemented so as to read as follows:

SEC. 9. That for the purposes of this act, each township in each county shall constitute a registration district, and the State registrar, with the assistance of the county judge in each county, shall appoint a local registrar in each registration district. Provided, however, That in every township where there is an incorporated town or city, the local registrar shall reside in the incorporated town or city: And provided further, That in the cities now requiring registration of births and deaths, the city clerk shall be the local registrar. In case a vacancy should occur in any registration district, the State registrar shall notify the county judge, who shall, within 10 days after notification, submit the name of some citizen in the district to the State registrar for appointment. If for any reason the county judge fails to submit the name of anyone for appointment the State registrar shall then without delay fill the appoint

ment.

SEC. 10. That each local registrar shall be paid the sum of 25 cents for each birth and each death certified [sic] properly and completely made out and registered with him, correctly recorded and promptly returned by him to the State registrar and a duplicate copy of each certificate filed with the county clerk, as required by the rules and regulation. And in case no births and no deaths were registered during any month, the local registrar shall be entitled to be paid the sum of 25 cents for each report to the State registrar to that effect. but only if promptly made in accordance with the rules and regulations. All amounts payable to a registrar under the provisions of this section, shall be paid annually by the treasurer of the county in which the registration district is located. And each local registrar, with the counter-signature of the State registrar, shall annually certify to the county and probate clerk of his respective county the number of births and deaths properly registered, with the amount due him at the rate herein, and said amount shall be allowed as other claims against the county.

SEC. 11. That the State registrar, or the county clerk, shall upon request furnish any applicant a certified copy of the record of any birth or death registered under the provisions of this act, for the making and certification of which he shall be entitled to a fee of 50 cents, to be paid by the applicant. And any such copy of the record of a birth or death when properly certified by the State registrar or the county clerk, to be a true copy thereof, shall be prima facie evidence in all courts and places of the facts therein stated. For any search of the files and records when no certified copy is made, the State registrar, or the county clerk, shall be entitled to a fee of 50 cents for each hour or fractional part of an hour of time of search, to be paid by the appli

1 Reprint 264 from Pub. Health Repts., p. 29.

cant. And the State registrar and the county clerk shall keep a true and correct account of al fees by them received under these provisions, and the fees thus collected by the State registrar shall be turned over to the State treasurer each month, and the fees thus collected by the county clerk shall be turned over to the county treasurer each month.

SEC. 11. (a). That all marriages occurring within this State shall be registered with the State registrar of vital statistics at the State capitol, as hereinafter provided.

SEC. 11 (b). The forms for license shall be in accordance with section 5198 of Kirby's Digest of the Laws of Arkansas: Provided, They shall contain a part to be detached and forwarded to the State registrar, as hereinafter provided, by the clerks of the county and probate courts of the several counties in this State.

SEC. 11 (c). The clerks of the county and probate courts shall, in addition to the fee of $1 provided in section 5196, Kirby's Digest, collect from the applicant for a marriage license a registration fee of 50 cents, and the additional fees thus collected shall be deposited in the State treasury, monthly, in a fund to be known as the vital statistics fund, which fund shall be used for the maintenance of the bureau of vital statistics at the central office and 'the State auditor is authorized to draw his warrants against such fund, upon vouchers approved by the State registrar, for the payment of salaries, office and other expenses incident to the proper operation of the bureau: Provided, That the amounts so drawn shall not exceed the amounts collected and deposited in the State treasury under provisions of this act.

SEC. 11 (d). The county and probate clerks shall, not later than the 5th day of each month, forward to the State registrar that part of the license which is to be detached and forwarded to him and which shall contain in brief those facts set forth in the license, the detached form to be prescribed by the State registrar.

SEC. 11 (e). That the funds now in the State treasury deposited by the State registrar of vital statistics, in the sum of $122.50, accruing from the certification of births and deaths, and any other funds which may accrue in this manner, be and the same is hereby transferred to the vital statistics fund.

CALIFORNIA.

Rocky Mountain Spotted Fever, Paratyphoid Fever, Lobar Pneumonia-Made Notifiable. (Res. Bd. of H., July 7, 1917.)

Resolved, That the following diseases are required to be reported to the local health authorities and are hereby added to the list of reportable diseases in rule 2 of section 13 of the public health act: Rocky mountain spotted (or tick) fever, paratyphoid fever, lobar pneumonia (substituted in the list for "pneumonia").

Lobar Pneumonia-Substituted for "Pneumonia" in List of Reportable Diseases. (Res. Bd. of H., July 7, 1917.)

Resolved, That the disease pneumonia be stricken from the list of reportable diseases in section 12, rule 2, of the public health act, and the disease lobar pneumonia be substituted in accordance with the provision of the same rule that the list of reportable diseases can be changed at any time by the State board of health or its secretary. Certain Communicable Diseases-Notification of Cases-Instructions to Household-Investigation by Health Authorities-Isolation-Disinfection-Contacts-Attendance at Schools and Children's Gatherings-Incubation Periods. (Reg. Bd. of H., Dec. 1, 1917.)

RULE 1. Notification.-Any person in attendance on a case of chicken pox, measles, German measles, mumps, whooping cough, epidemic cerebrospinal meningitis or acute lobar pneumonia, or a case suspected of being one of these, shall report the case immediately 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. In the absence of local rules permitting notification by telephone the report to the local health officer shall be in writing.

When no physician is in attendance it shall be the duty of the head of a private house or the proprietor or keeper of any hotel, boarding house, lodging house or superintendent of any orphanage or school to report forthwith to the local health officer all the facts relating to the illness and physical condition of any person in any private house, hotel, boarding house, lodging house, orphanage or school under his charge who appears to be affected with any disease presumably communicable, together with the name of such person.

RULE 2. Instruction to household.-It shall be the duty of the physician in attendance on any case suspected by him to be chicken pox, measles, German measles, mumps, whooping cough, epidemic cerebrospinal meningitis or acute lobar pneumonia to give detailed instructions to the nurse or other person in attendance in regard to precautionary measures for preventing the spread of the disease. Such instructions shall be given on the first visit and shall be in general as given in note 1.

Note-1. Ifthe patient is not removed at once to a hospital, he shall have a separate bed in a room screened against flies.

2. All persons, except those having the necessary care of the patient, shall be excluded from the sick room. 3. Animals shall be excluded from the sick room.

4. The room should be kept well aired and clean. It should be freed from unnecessary carpets, draperies, and furniture before the patient is placed in it. Dust should be avoided by frequent moist cleansing of woodwork and floors.

5. The person caring for the patient shall avoid coming in contact with any other person within the household or elsewhere.

6. The person having the care of the patient shall wear a washable outer garment and shall thoroughly wash the hands with soap and water after handling the patient or any object which he may have contaminated. On leaving the room in which the patient is isolated, the attendant shall take off the washable outer garment and leave it in the room until disinfected.

7. All discharges from the nose and mouth shall be burned or disinfected. It is recommended that these discharges be received on pieces of gauze or other soft cloth and be dropped in a paper bag which is conveniently placed. The bag and its contents can be easily burned.

8. Objects which may have been contaminated by the patient, shall be disinfected before being removed to any place where they might become possible sources of infection. Clothing and bedding that have been contaminated by the patient as well as the dishes used by the patient may be sterilized by boiling or by immersion for 20 minutes in 2 per cent carbolic acid or liquor cresolis compositus.

RULE 3. Investigation of cases.-Upon being notified of a case of chicken pox, measles, German measles, mumps, whooping cough, epidemic cerebrospinal meningitis or acute lobar pneumonia, the local health authority shall make an inquiry regarding the probable source of infection. If this source of infection is outside his jurisdiction he shall notify the State board of health in order that it may inform the health authority (local or state) within whose jurisdiction the infection was probably contracted. The local health officer shall determine that the instructions specified in rule 2 are understood and observed and in the event of nonobservance shall take proper legal steps for their enforcement. The health officer shall confirm all diagnoses of chicken pox in adults.

RULE 4. Isolation.-It shall be the duty of the local health officer to see that cases of chicken pox, measles, German measles, mumps, whooping cough, epidemic cerebrospinal meningitis or acute lobar pneumonia are properly isolated, and to define the area in which the patient and his immediate attendants are to be officially isolated. Without permission from the local health officer no person shall carry, remove, or cause or permit to be carried or removed from any hotel, boarding house, lodging house or other dwelling any person affected with chicken pox, measles, German measles, mumps, whooping cough, epidemic cerebrospinal meningitis or acute lobar pneumonia. Isolation in these diseases is defined as that degree of detention necessary to insure noncontact with susceptible persons.

Isolation shall be terminated only by the local health officer. When the isolation is terminated the area of isolation shall be disinfected by the boiling, or immersion in a disinfecting solution, of articles of clothing and bedding of the patient, and the washing with soap and water, or with some disinfectant, of woodwork, furniture, and any other objects that may have been handled by the patient.

RULE 5. Period of isolation. The minimum period of isolation within the meaning of this regulation shall be as follows:

Chicken pox.-Until 12 days after the appearance of the eruption and until the crusts have fallen off.

Measles. Until 7 days after the appearance of the rash and until all discharges from the nose, ears and throat have disappeared and the cough has ceased.

German measles.-Until 7 days after the appearance of the rash.

Mumps.—Until two weeks after the appearance of the disease and until the disappearance of the swelling.

Whooping cough.-Until 3 weeks after the development of the paroxysmal cough. Cerebrospinal meningitis.—Until 2 weeks after onset and until temperature has been normal for one week.

Pneumonia.-Until 1 week after the temperature has returned to normal.

RULE 6. Contacts. When a person affected with chicken pox, measles, German measles, mumps, whooping cough, epidemic cerebrospinal meningitis or acute lobar pneumonia is properly isolated on the premises, adult members of the family or household, who do not come into contact with the patient or with the secretions or excre tions, unless forbidden by the health officer, may continue their usual vocations provided such vocations do not bring them in close contact with children.

Every child or teacher who is an inmate of a household in which there is or has been within 15 days a case of chicken pox, measles, German measles, mumps, whooping cough, epidemic cerebrospinal meningitis or acute lobar pneumonia shall be excluded from every public, private or Sunday school, and from every public or private gathering of children for an amount of time corresponding to the incubation period of the disease concerned and dating from the first recognition of such disease, except upon written permission of the local health officer. Persons excluded from school under this regulation may return only on presentation to the school authorities of a certificate from the local health officer that they are eligible under this rule so to do.

RULE 7. Incubation period.-For the purposes of these regulations the period of incubation (that is, between the date of exposure to the disease and the date of its development) of the following diseases is hereby declared to be as follows:

RULE 8. Exclusion by school authorities.-It shall be the duty of the principal or other person in charge of any public, private or Sunday school to exclude therefrom any child or other person affected with a disease presumably communicable until such child or other person shall have been seen by the school physician or nurse, or shall have presented a certificate issued by the local health officer, or by the attending physician and countersigned by the local health officer, stating that such child or other person is not liable to convey a communicable disease.

Smallpox-Notification of Cases-Precautions by Physician-Instructions to Household-Investigation by Health Officer-Quarantine—Contacts—DisinfectionVaccination. (Reg. Bd. of H., Dec. 1, 1917.)

RULE 1. Notification.—Any person in attendance on, or otherwise in charge of, a case of smallpox, or a case suspected of being smallpox, shall report the case immediately to the local health officer, who shall in turn report weekly, on the prescribed form, to the secretary of the State board of health all cases so reported to him.

When no physician is in attendance it shall be the duty of the head of a private house or the proprietor or keeper of any hotel, boarding house, lodging house or superintendent of any orphanage or school to report forthwith to the local health officer all the facts relating to the illness and physical condition of any person in any private house, hotel, boarding house, lodging house, rphanage or school under his charge who appears to be affected with any disease presumably communicable, together with the name of such person.

Note.-Any person in attendance on a case of smallpox who fails to report the case promptly to the local health authority 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 bealth act, secs. 13 [rule 2], 16, and 21).

RULE 2. Diagnosis.-When the diagnosis is in doubt, the attending physician shall report the case as one of "suspected smallpox." The local health officer shall thereupon investigate with a view to establishing the diagnosis, and if unable to reach a decision, he shall report to the State board of health so that it may conduct an investigation.

Note. When an epidemic of smallpox assumes a mild form even in the unvaccinated, many cases are diagnosed as chicken pox, or "Manila itch," because the vesicles are not umbilicated and are not found on the palms of the hands or soles of the feet. All reports of chicken pox occurring in adults should be investiated