Whooping cough.-Particularly communicable in the early catarrhal stages before the characteristic whoop makes the diagnosis possible, and during the active spasmodic stage of the disease, at least two weeks after the whooping begins.

Note 1.-In cases where the organism persists for an unduly long time after convales. cence, cultures should be submitted for a virulence test to a laboratory approved by the State department of health, or the advice of the State department should be sought.

Note 2. It is desirable where possible, to release cases of dysentery (amebic), dysentery (bacillary), typhoid fever, only after the disappearance of the infective organisms has been shown by laboratory examinations of the excreta.

REG. 16. Reports by the health officer to the State department of health.—The local health officer shall report in writing within 24 hours to the State department of health, on the forms provided by the State department of health, every case of communicable disease of which he has knowledge occurring within his jurisdiction or on the waters adjacent thereto, and on or before the 8th of each month the total number of cases of each communicable discase reported to him during the preceding month, with such other information as may be required by the State department of health.

REG. 17. Special reports by telephone or telegraph.-Any local health officer having knowledge of a case or suspected case of anthrax, cholera (Asiatic), glanders, leprosy, plague, typhus fever, yellow fever shall immediately report such case to the office of the State commissioner of health by telephone or telegraph; and having knowledge of a case or suspected case of cerebrospinal meningitis, diphtheria, dysentery (amebic), dysentery (bacillary), paraty phoid, poliomyelitis, scarlet fever, septic sore throat, smallpox, typhoid fever shall, when such case resides on, or is connected with, any farm, dairy, or other establishment where milk, cream, or ice cream is produced or handled, and the products therefrom are sold or consumed elsewhere than within his jurisdiction, immediately report to the State commissioner of health, giving the name and location of such farm, dairy, or establishment and the place or places where said products are sold or consumed.

REG. 18. General measures for control of communicable discases.-The local health officer in instituting measures for the control of communicable disease. (a) shall make, or cause to be made, such investigation as may be necessary for the purpose of securing data regarding contacts and, if possible, the time, place, and source of infection; (b) shall establish and maintain quarantine, isolation, or such other measures for control as required by statute, the sanitary code, or special instructions of the State department of health; (c) shall provide, directly or indirectly, for the instruction of persons affected, and their attendants, in the proper methods of concurrent disinfection; (d) shall make, at intervals during the period of communicability, inquiry, or investigation to satisfy himself that the measures instituted by him for the protection of others are being properly observed; (e) shall introduce such other measures, consistent with the sanitary code and the instructions of the State department of health, as may be deemed advisable because of wide-spread infection or threatened epidemic.

REG. 19. General measures for control of presumably communicable disease.— It shall be the duty of the health officer on receiving a report of a disease presumably communicable to confer with the physician or other person making such report, make such further examination or investigation as he deems necessary, and advise, recommend, or establish such isolation measures as may be necessary to protect public health until the character of the disease is definitely determined.

REG. 20. Methods of isolation of certain diseases.-The local health officer upon receiving a report of a case of any of the diseases designated in this regulation shall promptly institute and maintain control during the period of communicability by the method hereinafter designated:

(a) When the disease is anthrax, cholera (Asiatic), glanders, leprosy, plague, typhus fever, yellow fever, the premises where such disease exists shall be placarded and all occupants and frequenters of the same shall be quarantined until specific directions are received from the State commissioner of health.

(b) When the disease is diphtheria, poliomyelitis, scarlet fever, smallpox, the apartment or premises where such disease exists shall be placarded and the affected person and attendants shall be isolated and quarantined therein. (c) When the disease is cerebrospinal meningitis, chickenpox, dysentery (amebic), dysentery (bacillary), measles, paratyphoid fever, pneumonia (lobar), septic sore throat, typhoid fever, the room or apartment where such disease exists, shall be placarded and the affected person shall be effectively isolated without quarantine.

(d) When the disease is conjunctivitis (infectious), favus, German measles, mumps, rabies, trachoma, whooping cough, the person affected shall be subjected to restriction of movement, without placard of the room or premises and without quarantine.

(e) When the disease is gonorrhea, syphilis, tuberculosis, the person affected shall when necessary be isolated or restricted in accordance with statute law and specific regulations in this chapter of the sanitary code.

Provided, (1) When a case of any of the diseases mentioned in this regulation is under hospital care satisfactory to the health officer, quarantine restrictions and placard may be omitted.

(2) When chickenpox or measles is epidemic placarding may be omitted by order of the health officer after notice to the State commissioner of health.

(3) When two or more rooms in any house are considered by the health officer to be satisfactory for the isolation of diphtheria, poliomyelitis, scarlet fever, they may be considered as an apartment.

(4) When a health officer finds it impossible to maintain proper control of any individual case of communicable disease by the methods designated, he may quarantine and placard or employ such other measures as are proper for the protection of public health, reporting such action to the State commissioner of Fealth.

REG. 21. Methods of isolation of contacts.-It shall be the duty of the health officer in instituting measures for the control of contacts of cerebrospinal meningitis, chickenpox, diphtheria, measles, mumps, poliomyelitis, scarlet fever, smallpox, whooping cough to isolate or restrict the movements of such contacts in the manner prescribed for the disease to which the contact had been exposed for a period of time equivalent to the maximum period of incubation of said disease, except where laboratory methods determine the absence of the disease at an earlier date. The health officer may modify the restrictions placed upon contacts when such contacts are known to be immunes, and adult contacts of cases of chickenpox and whooping cough may ordinarily be treated as immunes. (See regulation 14.)

REG. 22. Presumably exposed persons may be examined and controlled.— When a health officer has reasonable grounds to believe that a person or persons may have been exposed to a communicable disease, he may control them as known contacts, making such examinations and adopting such measures as he deems necessary and proper for the protection of public health and the preven tion of the spreading of disease.

REG. 23. Methods of isolation of carriers.-Carriers of the infectious agent of cholera (Asiatic), dysentery (bacillary), paratyphoid, typhoid fever shall be controlled by isolation or restriction of movement until repeated examinations of excreta show the absence of the infectious agent.

Carriers of the infectious agent of diphtheria shall be isolated until two suecessive cultures from both the nose and throat, taken at least 24 hours apart, show the absence of the Klebs-Loeffler bacillus. (See regulation 15, note 1.) Carriers of the infectious agent of cerebrospinal meningitis shall be isolated until examination of the nasal and throat discharges show the absence of the specific diplococcus.

REG. 24. Removal to hospital of certain cases.-When in the opinion of the health officer or the State commissioner of health proper isolation or quarantine of an affected person or persons, carriers, or contact is not or can not be effectively maintained on the premises occupied by such person or persons by methods designated in this chapter, he may remove or require the removal of such person or persons to a hospital or other proper place designated by him; or he may employ such guards or officers as may be necessary to maintain effective isolation or quarantine.

REG. 25. Health officer to give specific instructions.-It shall be the duty of the local health officer or other health authority, in instituting measures for the control of communicable diseases, to supply, directly or indirectly, such information and literature as may be required by law and the instructions of the State department of health, and when possible to issue instructions and orders in writing or on printed forms. Quarantine notices and placards should be so placed as to effectively warn and protect.

REG. 26. Use of milk and water containers restricted.-It shall be the duty of the health officer in charge of a case or suspected case of cerebrospinal meningitis, diphtheria, dysentery, scarlet fever, septic sore throat, smallpox, paratyphoid, poliomyelitis, typhoid fever to forbid the return of milk or water containers to the distributor when such containers have been within a quarantined area, or have been handled or presumably handled by anyone in attendance upon a person affected, or believed to be affected, with any one of the diseases mentioned, until the termination of the disease or the removal of the patient, at which time empty containers may be returned after being sterilized by boiling water or live steam, or in any other manner satisfactory to the health officer.

REG. 27. Food and food handlers restricted.—When a case of any of the diseases mentioned in the preceding regulation, or a case of tuberculosis, gonorrhea, or syphilis, occurs on the premises where milk or food likely to be consumed without subsequent cooking is produced, kept, handled, or sold, it shall be the duty of the health officer to institute such measures as he deems necessary to protect such foods from being contaminated; and he shall require all uninfected persons who reside on premises where any such disease exists and who handle milk or food elsewhere, to remain away from such premises so long as the disease is present.

REG. 28. Concurrent disinfection. It shall be the duty of the physician in attendance on any case or suspected case of cholera (Asiatic), dysentery (amebic or bacillary), paratyphoid fever, typhoid fever, to give detaile instructions to the nurse or other person in attendance in regard to the dis infection and disposal of the urine and bowel discharges; and it shall be the duty of the physician in attendance on any case or suspected case of cere brospinal meningitis, diphtheria, measles, pneumonia (lobar), poliomyelitis, scarlet fever, septic sore throat, smallpox, whooping cough, to give detailed

instructions to the nurse or other person in attendance in regard to the disinfection and disposal of the discharges from the nose and mouth and any suppurative discharges or lesions which may occur.

Such instructions should be given on the first visit and should conform to the special rules and regulations of the State department of health. It shall be the duty of the nurse or person in charge to carry out the disinfection in detail until isolation is terminated by the local health officer.

REG. 29. Terminal disinfection.-It shall be the duty of the health officer when a case of communicable disease ceases to be infectious or after the death or removal of such case, to institute and have properly executed such terminal disinfection and cleansing as may be necessary as an added precaution, but terminal disinfection should in no case be employed as a substitute for concurrent disinfection.

Cleansing with soap and water, sterilization with boiling water or steam, and the use of antiseptic solutions should be employed where practicable. Renovation may be required in certain cases.

Fumigation alone should not be depended upon, and should rarely be employed except in insect-borne diseases.

REG. 30. Measures for control in schools. It shall be the duty of the health officer in the event of an outbreak of a communicable disease in any public, private, parochial, or Sunday school to make a prompt and thorough investigation and, where possible, to control such outbreak by individual examinations of pupils and teachers and, in certain cases, by the taking of cultures, employing such assistance as may be necessary.

When any school child has been affected with, or is a carrier of, a communicable disease, or has been excluded from school because of having been in contact with a communicable disease, it shall be the duty of the health officer to issue to such child a permit to reenter school, when in his opinion such child is no longer infectious.

In the event of an outbreak of a communicable disease in any school, school physicians and school nurses must conform to the orders, regulations, and restrictions imposed by the local health officers.

REG. 31. General measures for control; common carriers.-In the event of the epidemic prevalence of a communicable disease, and a written declaration to that effect having been made by the State commissioner of health, it shall be the duty of any common carrier operating within the State, or on the waters thereof, to strictly comply with any order issued by the State commissioner of health for the purpose of preventing the introduction into the State, or the transmission from one point to another within the State, of any person or persons, animals, insects, or materials liable to convey the disease.

REG. 32. Observance of quarantine and instructions.-Every person, who is Effected with a communicable disease, who is a carrier of the germs of a communicable disease, or who is suspected of having come in contact, directly or indirectly, with a case of communicable disease, shall strictly observe and comply with all orders, quarantine regulations and restrictions given or imposed by the local health authority or the State commissioner of health, in conformity with law.

REG. 33. Invasion of quarantined areas and needless exposure of others.— No person other than the attending physicians and authorized attendants shall enter, and no one shall permit any other person to enter, any room, apartment, or premises quarantined for a communicable disease, nor shall any person needlessly expose a child or other person to a communicable disease.

No person shall remove any article from a quarantined area without the permission of the health authority.

REG. 34. Duty of health officer when infected persons leave his jurisdiction without permission.-It shall be the duty of the local health officer to immediately report to the State commissioner of health by telegraph or tele phone the name, address, probable destination and route of departure of any person who is affected with, or has presumably been exposed to any one of the following diseases, and who has left his jurisdiction without his cousent: Anthrax, cholera, diphtheria, glanders, leprosy, plague, poliomyelitis, scarlet fever, smallpox, typhoid fever, typhus fever, yellow fever.

REG. 35.—Method of control of tuberculosis.—When a licensed physician or hospital superintendent reports a case of tuberculosis and agrees to assume the responsibility for the proper instruction of the patient and the taking of measures necessary for the protection of others, the health officer need not take action other than prescribed by chapter 79 public acts 1909.

Every physician thus assuming the control of a case of tuberculosis shall report to the local health officer on or before the first day of each month, stating whether or not such case is still under his care, and if such report is not made, the health officer shall investigate and take such measures as he deems necessary for the protection of public health.

When a physician or hospital superintendent declines to assume such re sponsibility, it shall be the duty of the health officer to supply the afflicted person with printed instructions and take such other action as may be neces sary and proper for the protection of public health.

REG. 36. Control of refractory persons affected with tuberculosis,~When it comes to the attention of a health officer that a person is affected with tuberculosis and is a menace to the public health or is liable to jeopardize the health of any person or persons in or on the premises occupied or frequented by the affected person, he shall immediately investigate and take proper measures to prevent the spread of such disease for the protection of public health, and if necessary may cause the removal of such person to an isolation hospital or other proper place, there to be received and kept until he shall no longer be a menace to the public health.

REG. 37. The control of venereal disease.—When any physician or hospital superintendent reporting a case of gonorrhea or syphilis agrees in writing to assume the responsibility for the proper instruction of the patient, the health officer shall supply such physician or hospital superintendent with printed instructions for such patient.

It shall be the duty of the physician or hospital superintendent who has thus signified his willingness to assume control of such patient, to report to the local health officer on or before the first of each month a statement to the effect that such patient is or is not still under his care. When such patient neglects or refuses to follow the prescribed instructions, discontinues treatment, or is discharged as cured, the physician or superintendent shall immediately notify the health officer.

In investigating cases or suspected cases of the above mentioned diseases, the health officer shall treat all information as confidential, but such course shall not preclude the making of reports to the State department of health.

REG. 38. Control of careless or refractory persons affected with venereal dir cases.—When it comes to the attention of a health oflicer that a person is suffering or presumably suffering from gonorrhea or syphilis in an actively contagious form and is liable to jeopardize the health of any person or persone in or on the premises occupied or frequented by the affected person, he shall