RULE 16. Reports of cases of sore eyes.-When the infant has or develops sore eyes or any redness, inflammation, or discharge from the eyes, the midwife in attendance, if the family fail to do so, must at once call a physician and must report to the department of health the name and address of the mother and state the time when such condition of the eyes was first noticed.

RULE 17. Midwives to attend cases seven days after labor.-The midwife shall visit her patient at least once daily for seven days after labor, giving the necessary attention to both mother and infant. She shall record the pulse and temperature of the mother at each visit and give proper directions as to feeding of mother and nursing of child during the periods between her visits; she shall give instructions how to keep the air in the patient's room fresh; she shall advise to have the baby sleep in a basket or crib, instead of in the bed with the mother; she shall watch constantly for any symptoms of the complications or abnormalities described in rules 4, 5, 8, and 9. She shall give to the child its daily washing (not a full bath) and attend to the dressing of the cord and cleaning of the mouth and eyes.

RULE 18. Disinfection of midwife's equipment, etc., after infectious disease.— Whenever a midwife has been in attendance upon a patient or in contact with any person suffering from puerperal fever or from any other condition known or believed to be infectious, she must disinfect herself, her clothing, and all the contents of her bag and other appliance before going to any other maternity patient.

In order to disinfect her person a midwife must take a hot bath and wash her hair; she must disinfect her hands as in rule 12; she must make an entire change of clothing and have all garments which she wore while in attendance upon the infected person washed and boiled. Those garments which can not be washed should be well and repeatedly shaken during the course of two days and hung out in the open air so that they may be exposed to the rays of the sun. Care should be taken to change their exposure so as to insure the sun's reaching every part.

After any case of communicable disease the house must be thoroughly cleaned and the floor and surface of the midwife's bedroom scrubbed with soap and water. Carpets, hangings, and other articles which can not be boiled must be sunned and aired.

[No rule 19.]

RULE 20. Reports of births.-Within five days of the birth of the child the midwife must send the report of the birth to the city clerk on one of the blanks issued for that purpose. She must also keep on the stubs of her birth certificate book a record of every birth she attends.

RULE 21. Reporting contagious diseases.-Any disease in the home of the midwife or the patient attended, suspected to be of a contagious nature, such as scarlet fever, whooping cough, measles, chickenpox, puerperal fever, etc., must be reported to the department of health at once and the family advised to summon a physician.

RULE 22. Reporting cases of labor.—Every midwife, when requested by this department, shall notify the department of health of all cases of labor that she is called to attend.

RULE 23. No midwife suffering from the following conditions shall attend a woman in child birth: Tuberculosis, venereal disease, typhoid fever or the typhoid bacillus, diphtheria or the diphtheria bacillus, or any other communicable disease so defined by the sanitary code of the State of New Jersey or the city of Newark.

35495°-21-20

PORT CHESTER, N. Y.

Midwives-Required to Be Licensed. (Reg. Jan. 21, 1918.)

CH. 7. REG. 9. Midwives. No person shall practice midwifery or hold herself out as a midwife within this municipality unless she is duly licensed for that purpose as required by the public-health law and the sanitary code.

WINSTON-SALEM, N. C.

Midwifery-Regulation of Practice of-Reports by Midwives. (Ord. Feb. 21, 1919.)

That ordinance section 471 is hereby repealed and the following is substituted in lieu thereof:

1. Definition. The practice of midwifery shall be construed to mean the conducting of the management of any form or stage of parturient labor by a person not duly licensed by the laws of the State of North Carolina to practice medicine, in consideration for which services, money, or any other thing or service of value is received or intended to be received.

2. On and after September 1, 1919, it shall be unlawful for any person to practice midwifery in Winston-Salem who shall not have applied in person to the city health officer for permission to engage in such practice, making a sworn statement setting forth his or her name, age, residence address, and the amount and character of training received, which information, with such other information as may be required, shall be registered in the office of the health department in a book to be kept for that purpose.

3. Permission will be granted by the city department of health to applicants mentioned in section 2 only with certain restrictions and only after having passed a satisfactory examination before the city health officer or before physicians designated by the city health officer for this purpose.

4. Whenever and wherever deemed advisable, the city health officer will organize and conduct a course of instruction, which it shall be mandatory for midwives to attend, unless excused from this obligation by the city health officer.

5. Permission to practice midwifery will not be granted for a period of more than one year at a time, and the city health officer reserves the right to terminate this permission, for just cause, at any time it may be advisable to do so. 6. No person under 21 years of age will be given permission to practice midwifery.

7. It shall be unlawful for any person while affected with any contagious or infectious disease to attend as a midwife a woman in the discharge of this service. 8. The following further restrictions to the practice of midwifery are im posed:

a. Making a vaginal examination is prohibited.

b. Administration of any drug to hasten the course of labor is prohibited.

c. The wearing of any distinctive uniform is prohibited.

d. The attending of any woman in labor who has had a previous difficult labor is prohibited.

e. The application of grease or any other lubricant to the private parts of the patient is prohibited.

f. All reasonable aseptic precautions must be employed in connection with the case.

g. A record must be kept of the time of onset of labor, which must be presented on demand to any physician who may visit the patient in labor or thereafter.

h. A duly licensed practicing physician must be called in to see the patient at once in case any of the following accidents occur:

1. Convulsions.

2. Collapse.

3. Any sign or symptom of fever.

4. Abnormal presentations; i. e., breech, face, hand, etc., appearing at the vulva.

5. Prolapse of cord (appearing at the vulva).

6. Antepartum or postpartum hemorrhage.

7. When the patient has been in labor more than 12 hours without the birth of the child.

9. Equipment.-Every midwife must take to each case the following:

Nail brush.

Wooden or bone nail cleaner.

Jar of soft castile or green soap.

Tube of vaseline.

Blunt scissors for cutting the cord.
Lysol.

Boric acid powder.

Silver nitrate solution outfit.

Medicine dropper.

Narrow tape for tying cord.

Sterile gauze in small packages for dressing cord.

Sterile cotton (preferably in one-quarter pound packages).

No other instrument shall be used or owned by a midwife or kept in her possession.

10. The equipment specified in section 9 must be carried in either a metal case which can be boiled or in a bag which can be easily cleaned.

11. Stillbirths.-Should the child be born dead, the midwife must call a physician at once and also notify the health department.

12. Use of silver nitrate solution.-As soon as the child is born the eyes should be washed with boric acid solution. One or two drops of a 1 per cent solution of silver nitrate must be dropped into each eye. The silver nitrate solution will be furnished free by the city or State health department.

13. Reports of cases of sore eyes.-When the infant has or developed sore eyes or any redness, inflammation, or discharge from the eyes, the midwife must call a physician at once and must report to the health department every case within six hours after she becomes aware of such condition.

14. Report of birth.-Within five days of the birth of the child the midwife must file the report of the birth with the local registrar on one of the blanks issued for that purpose.

15. Every person in the practice of midwifery shall carry a card showing that he or she is operating under permission granted by the city department of health, as hereinbefore described, and shall present such card to one or both parents of the prospective child upon taking charge of the case.

16. The parents of the prospective child shall be held responsible for the employment of any person in the practice of midwifery who shall not have complied with section 15 of these regulations, and for so doing shall receive the same penalty as the person who practices midwifery unlawfully.

MILK AND MILK PRODUCTS.1

BALTIMORE, MD.

Milk and Milk Products-Production, Handling, and Sale. (Ord. 262, June 1, 1917.)

SECTION 1. That section 55-A of article 14 of the Baltimore City Code of 1906, title “Health," subtitle "Food, food products, and milk." as the same was ordained by ordinance 103 approved May 6, 1908, be, and the same is hereby, repealed and reordained so as to read as follows:

55.-A. Every person or corporation desiring to bottle or handle for sale, or to offer or expose for sale, or to sell, dispose of, exchange, or deliver milk or cream (the words "milk or cream" as herein used being intended to mean milk, cream, skimmed milk, buttermilk, or other fermented milk), or to manufacture for sale ice cream or butter, in the city of Baltimore, shall make application to the commissioner of health for a permit so to do. Such application shall be made on a printed form to be furnished by the commissioner of health upon demand, and the applicant, if an individual, shall state therein his full name and residence, and if a corporation, shall state therein the name of such corporation and the full name and residence of each of its officers, Such application shall also state the location of the place at which it is proposed to carry on the business, and whether the applicant desires to pasteurize or bottle milk or cream, to sell milk or cream in the original unbroken package, or to manufacture for sale ice cream or butter. Such application shall also contain a statement of the number and character of wagons or other vehicles, if any, to be used by the applicant in or about his business; also the number of cows, if any, owned or controlled by the applicant, and such other data concerning the conduct of such business as the commissioner of health may require.

The commissioner of health, upon receipt of such application, shall cause to be investigated the place of business described in such application and the wagons and other vehicles, if any, intended to be used by such applicant. If such places of business and such wagons and other vehicles are found upon such investigation to be in a sanitary condition and fit for the uses and purposes to which they are intended to be put, said commissioner of health shall forthwith register said applicant in a proper record to be kept for the purpose and issue a permit authorizing such applicant to carry on, engage in, and conduct the business applied for in Baltimore City at the place designated in such application. Such permits shall specify the kind or kinds of business to be conducted. All permits granted pursuant to this ordinance my at any time be revoked by the commissioner of health for the persistent, repeated, or willful violation of any law or ordinance or of any regulation of the commissioner of health governing the handling or sale of milk or cream or the manufacture for sale of ice cream or butter in Baltimore City : Provided, how

1 See also Communicable diseases, p. 62; Foodstuffs, eating and drinking places, fond establishments, soda fountains, and ice cream parlors, p. 150; Ice cream and confer tionery, p. 240.

ever, That no such permit shall at any time be revoked by the commissioner of health unless he shall first have given the holder of the same not less than 10 days' notice in writing of his intention to revoke such permit and an opportunity to be heard by him as to why such should not be done, this proviso not to be taken to apply to cases where the sale of milk or cream or the manufacture for sale of ice cream or butter may be temporarily prohibited by the commissioner of health because of disease, temporary insanitary condition, or similar causes. Such permits shall be nontransferable, and no permit issued hereunder shall entitle or authorize the holder thereof to carry on, engage in, or conduct the business in any place or places other than that described and set out in such permit. If any person or corporation having a permit as aforesaid shall change the location of his or its place of business, notice of such proposed change shall be given to said commissioner of health and his consent in writing received to conduct such business at such new location, and no business shall be conducted or carried on at such new location until such new consent has been received.

Any person or persons or any corporation, or officer, agent, or servant thereof, who shall bottle or otherwise handle for sale, or offer or expose for sale, or sell, dispose of, exchange, or deliver, or who shall cause to be bottled or otherwise handled for sale or offered or exposed for sale or sold, disposed of, exchanged, or delivered (or with intent so to do shall have in his, its, or their possession, care, custody, or control in Baltimore City) milk or cream or who shall manufacture for sale ice cream or butter in Baltimore City without having a proper permit so to do as herein required shall be fined not less than $5 nor more than $100 for each offense. The provisions of this section shall not be construed to apply to milk or cream which has been denatured in a manner satisfactory to the commissioner of health and which is not intended for human food.

SEC. 2. That a new section be added to article 14 of the Baltimore City Code of 1906, title "Health," subtitle "Food, food products, and milk," to be designated "section 55-E," to follow immediately after section 55-D hereof, as the same was ordained by ordinance 103, approved May 6, 1908, and to read as follows:

55-E. Every permit heretofore issued under the provisions of section 55-A of this article shall expire five months after the date of the passage of this ordinance, unless an application for renewal thereof be made on or before that date, in which event such permit shall remain in force until the commissioner of health acts upon the application for renewal and notifies the applicant in writing that a renewal has been granted or refused. Permits hereafter granted and permits hereafter renewed shall expire one year after the date on which they are granted or renewed; but if an application for renewal be made any time within 30 days prior to such time of expiration, such permit shall remain in force until the commissioner of health notifies the applicant in writing that a renewal has been granted or refused. An inspection fee of $10 shall be paid to the commissioner of health by each applicant for a permit to pasteurize or bottle milk or cream, and a fee of $2 by each applicant for a permit to sell milk or cream in the original unbroken package or to manufacture ice cream or butter; said fees to be paid at the time of the making of the application, whether it be for an original permit or for a renewal thereof. Only one inspection fee is to be paid where the application is for a permit to pasteurize or bottle milk or cream, and also to sell milk or cream or to manufacture ice cream or butter upon the same premises, and in such cases the fee shall be $10. Ail such inspection fees paid shall be promptly accounted for by the commissioner of health and immediately paid over by him to the comptroller for the use of the city of Baltimore.