Provided, That if the disease is typhoid fever, scarlet fever, diphtheria, epidemic dysentery, or epidemic septic sore throat, every such report shall also show whether the patient has been, or any member of the household in which the patient resides is, engaged or employed in the handling of milk, cream, butter, or other dairy products for sale or preliminary to sale.

Puerperal Septicemia and Suppurative Conjunctivitis-Notification of Cases. (Reg, Bd. of H., July 23, 1918.)

SEC. 91. Puerperal septicemia and suppurative conjunctivitis; duty of officers of schools, dispensaries, and other institutions, and of physicians, to report.—It shall be the duty of the manager or managers, superintendent, or person in charge of every sanatorium, day nursery, convalescent home, home for children, reformatory, training school, boarding school, hospital, dispensary, or other institution for the care or treatment of persons, in the city of New York, to immediately report, or cause to be immediately reported in writing, to the department of health, the name, age (so far as can be ascertained), and residence of every person received therein or treated thereat who is affected with pueperal septicemia or suppurative conjunctivis, with the name of the disease with which such person is affected, and it shall be the duty of every physician in the said city to immediately make, or cause to be immediately made, a similar written report to the said department relative to any person found by such physician to be so affected, stating, in each instance, the name of the disease with which said person is affected. Every such manager, physician, and officer shall also report, in writing, the name and address of the physician or midwife in attendance at the time of the onset of the disease, which information it is hereby made the duty of every institution herein specified to obtain and record among its records.

Communicable Diseases-Quarantine and Isolation. (Res. Bd. of H., Jan. 30, 1917.)

Resolved, That section 89 of the sanitary code be amended, to read as follows: SEC. 89. Isolation and quarantine of persons affected with infectious disease. It shall be the duty of every physician, immediately upon discovering a person affected with an infectious disease, to secure such isolation and quarantine of such person, or to take such other action as is or may be required by the regulations of the department of health.

Communicable Diseases

Quarantine Isolation Placarding Hospitalization-Incubation Periods-Care and Treatment of Patient-Disinfection and Cleaning-Requirements in Tuberculosis Cases. (Res. Bd. of H., Dec. 28, 1917.)

Resolved, That the following regulations covering the isolation of persons affected with an infectious disease, relating to section 89 of the sanitary code be adopted, to read as follows:

REGULATION 1. Isolation.-Immediately upon receiving the written report of the existence of a case of acute anterior poliomyelitis (infantile paralysis), anthrax, Asiatic cholera, diphtheria (croup), epidemic cerebrospinal meningitis, glanders, leprosy, plague, scarlet fever, smallpox, typhoid fever typhus fever, whooping cough, or yellow fever, required to be filed with the department of health of the city of New York in accordance with the provisions of sections 86 and 88 of the sanitary code of the board of health of the department of health

of the city of New York, the director of the bureau of preventable diseases of said department shall immediately cause a duly authorized agent of the department of health to investigate the same and secure such isolation of the person affected with the disease and to take such other action as is or may be required by these regulations, the provisions of the sanitary code and the orders of the board of health.

REG. 2. Persons affected with certain infectious disease to be removed to hospital unless quarantined and isolated.-Persons affected with any of the diseases enumerated in sections 86 and 88 of the sanitary code shall be removed to a hospital of or one designated by the board of health of the department of health of the city of New York unless proper quarantine of the premises and isolation of the patient can be established and maintained without danger to the general public or persons residing in the said premises and in conformity with these regulations.

REG. 3. Establishment of quarantine.-Quarantine of the premises occupied by a person affected with an infectious disease shall be established by the personal service of the following quarantine notice upon the head of the family or other person having the charge, custody, or control of the person affected with such disease, to wit:

To:

A report having been filed in the department of health of the city of New York in conformity with the provisions of sections 86 and 88 of the sanitary code of the board of health of the department of health of the city of New York that - age residing at the above-mentioned premises is affected with an infectious disease dangerous to the public health and proper and adequate accommodations and facilities being provided for the isolation of the said person and the quarantine of the said premises in conformity with the provisions of section 89 of the sanitary code and the regulations of the board of health supplemental thereto, permission is hereby granted for such person to remain thereat provided that the provisions of the sanitary code and the regulations of the board of health, copies of which are herewith served upon you, are strictly complied with and no danger to the public health results from the continuance of such person at said premises.

You are hereby warned that failure to comply with said provisions of the sanitary code and the said regulations may result in the removal of the said person affected with the said disease as aforesaid, to a hospital of, or one designated by, the board of health of the department of health of the city of New York, criminal prosecution, or both. By order of the board of health.

Dated:

Commissioner of Health.

Medical Inspector.

REG. 4. Placarding premises.--In all cases of diphtheria, scarlet fever, and acute anterior poliomyelitis (infantile paralysis) a warning placard prepared and issued by the department of health shall be posted or displayed upon the premises occupied by the person affected in the following manner:

a. Tenement houses and apartment houses.-A warning notice or placard shall be affixed to the outer side of the door leading into the apartment occupied by the patient.

b. Two-family houses.-Where there is a common hallway used by both fami lies, the placard shall be affixed to the outside of the door leading from the hallway into the room or rooms occupied by the patient. Where there is a separate entrance provided for each family, the placard shall be affixed to the door leading to the room occupied by the patient.

c. One-family houses.-A placard or notice shall be affixed to the door leading into the room occupied by the patient.

No such warning notice or placard shall be mutilated, destroyed, covered, defaced, interfered with, or removed by any unauthorized person.

REG. 5. Minimum quarantine period.-For the purpose of these regulations the minimum period of quarantine shall be as follows:

a. Diphtheria.-Twelve days from onset, during which time no cultures will be examined; after which, until two consecutive cultures, taken not less than 24 hours apart, and preferably from both nose and throat, fail to show the presence of diphtheria bacilli.

b. Scarlet fever.-Thirty days after the onset of the first symptoms, provided discharges from nose and ears have ceased.

c. Cerebrospinal meningitis.-Fourteen days from the onset.

d. Acute anterior poliomyelitis.—Three weeks from the date of onset.

e. Typhoid fever.-Until 10 days after the patient's temperature reaches normal, and until two specimens of feces, collected at least 24 hours apart, are found to be free from the presence of typhoid bacilli.

REG. 6. Incubation period.—For the purpose of these regulations the maximum period of incubation (the period between the date of the last exposure to the disease and the date of development of the disease) of the following infectious diseases shall be as follows:

a. Diphtheria, seven days.

b. Scarlet fever, seven days.

c. Cerebrospinal meningitis, seven days.

d. Acute anterior poliomyelitis, two weeks.

e. Typhoid fever, two weeks.

f. Smallpox, 21 days.

g. Measles, 14 days.

REG. 7. Isolation, medical care, and treatment.-No person affected with diphtheria, scarlet fever, or acute anterior poliomyelitis (infantile paralysis) shall be permitted to remain at home unless the following accommodations, facilities, and requirements are provided for the isolation, the medical care, and treatment at such premises:

a. There shall be a duly licensed, practicing physician in attendance.

b. Room or rooms where the patient is to be isolated shall be well lighted and ventilated as required by section 54 of the sanitary code. Such room or rooms shall be separate and apart from rooms occupied by other members of the family. All windows of room or rooms must be screened during the fly

season.

c. The family of persons affected with typhoid fever, paratyphoid, and acute anterior poliomyelitis (infantile paralysis) must have a separate toilet for their exclusive use.

d. All eating and drinking utensils used by the patient must be kept apart from those used by the other members of the family and shall be boiled after each use.

e. The personal and bed linen of the patient must be properly disinfected. Proper disinfection, within the meaning of this regulation, shall be the boiling of such linen or by chemical disinfection thereof in the manner and in accordance with the requirements specified in the circular of instruction issued by the department of health.

f. In cases of typhoid fever, paratyphoid fever, and acute anterior poliomyelitis (infantile paralysis) the patient must have a special attendant, who must not do any housework duties for other members of the family. He or she may, however, leave the house provided necessary precautions as to personal disinfection are observed and contact with all children avoided.

REG. 8. Persons to be excluded from isolation room.—No person other than the attending physician, nurse, attendant, or duly authorized agent of the department of health shall enter or be permitted to enter the room or rooms occupied by a person affected with diphtheria, scarlet fever, and acute anterior poliomyelitis (infantile paralysis). Nor shall any such physician, nurse, attendant, or other person cause, suffer, or allow any person affected with any of the said diseases as aforesaid, to leave any such room or rooms unless and until the duly authorized agent of the department of health certifies in writing, as required by regulation 10, that such person may be removed without danger to the public health.

REG. 9. Duty of physician to isolate.-It shall be the duty of every physician immediately upon discovering a person affected with diphtheria, scarlet fever, and acute anterior poliomyelitis (infantile paralysis) to cause such person to be isolated in a room or rooms separate and apart from those occupied by other persons. Such person shall remain so isolated until the duly authorized agent of the department of health establishes quarantine as provided by regulation 3: Provided, however, If the attending physician suspects, but is unable to make a positive diagnosis at the time of his first examination or at any subsequent time, but is of the opinion that the patient may be affected with an infectious disease, he should secure the isolation of such patient and take such other necessary precautions as will prevent danger of the spread of the disease until a positive diagnosis is made.

REG. 10. Disinfection, cleansing, and renovation.-Upon receipt of notice from the attending physician of the complete recovery of any person affected with diphtheria, scarlet fever, and acute anterior poliomyelitis (infantile paralysis), the room or rooms occupied by such person and all furniture and belongings therein, shall be adequately disinfected or cleansed and renovated in conformity with the provisions of section 101 of the sanitary code. Upon completion of the disinfection or cleansing and renovation, a duly authorized representative of the department of health may terminate the quarantine of the premises and isolation of the patient and remove the warning notices or placards from the premises. No such room or rooms shall be occupied by any person until such disinfection, cleansing, or renovation shall have been performed, and the quarantine and isolation terminated as aforesaid.

REG. 11. Circular of instruction.—A circular of instruction and advice issued or approved by the department of health shall be furnished and delivered by the duly authorized representative of said department to all persons responsible for the maintenance of the quarantine of the premises and the isolation of the patient.

REG. 12. Special requirements as to tuberculosis.-No person affected with pulmonary tuberculosis (in communicable form) shall be permitted to remain at home unless the following accommodations, facilities, and requirements are provided thereat.

a. Adequate individual sleeping accommodations must be provided. The room or rooms occupied by the patient for sleeping purposes shall not be so occupied by any other person not suffiering from the same form of tuberculosis, and whose presence is not necessary for the proper care and treatment of the patient.

b. The patient shall strictly comply with the conditions imposed in circular of instruction and advice issued or approved by the department of health and served personally upon him by the duly authorized representative of said department.

c. The room or rooms occupied by such person shall be well lighted and ventilated as required by section 54 of the sanitary code.

d. All eating and drinking utensils used by the patient must be boiled after being used by such person.

e. The expectoration of such persons must be received in suitable receptacles and properly destroyed.

Communicable Diseases-Hospitalization. (Res. Bd. of H., Dec. 28, 1917.)

Resolved, That the following regulations governing the removal and detention of persons affected with infectious diseases be adopted, to read as follows REGULATION 1. Report of medical inspector.-Whenever a medical inspector of the department of health submits a report in writing in conformity with the provisions of section 97 of the sanitary code to the effect that a person affected with an infectious disease is a danger to the lives and health of the persons with whom he or she comes in contact or is associated with, and the director of the bureau of preventable diseases, the sanitary superintendent, or an assistant sanitary superintendent issues an order directing the removal of such person to a hospital under the jurisdiction and control of the board of health, such report and order shall be made upon official blanks approved by the board of health. The report referred to shall contain a detailed statement showing the facts and evidence, including the clinical and bacteriological diagnosis if practicable and facts as to home conditions upon which such medical inspector bases his opinion that such person is a danger to others.

REG. 2. Order. Upon receipt of the report of the medical inspector hereinbefore referred to, the sanitary superintendent, an assistant sanitary superintendent, or the director of the bureau of preventable diseases, as the case may be, shall carefully review the facts and evidence embodied in or accompanying said report and if in his opinion the person referred to therein is under the circumstances a menace to the lives and health of persons residing in the neighborhood or on the same premises with such person, he shall make an order directed to the medical officer in charge of a hospital or of one designated by the department of health to which such person is to be removed, authorizing and directing the removal of such person from the place where he or she may be to such hospital.

REG. 3. Order to be delivered to medical officer.-The original order authorizing and directing the removal of such person to the hospital shall be delivered to the medical officer in charge of such hospital and shall constitute his authority to remove such person and to temporarily detain him or her at such hospital for proper medical care and treatment.

REG. 4. Report and copy of order to be referred to the board of health.-The report of the medical inspector and a copy of the order hereinbefore referred to shall be immediately transmitted, through the proper channels, to the board of health and shall be accompanied by a report recommending that an order of the board of health issue, directing the detention of such person at such hospital for such period of time as the board of health in its discretion determines. REG. 5. The board to order temporary detention.-The board of health, if satisfied that the person so removed is a source of danger to others, may order his or her temporary detention in such hospital until discharged in the manner hereinafter set forth.

REG. 6. Discharge of person removed.-The medical officer in charge of the hospital to which such person has been removed, upon signing and placing among the permanent records of such hospital a statement to the effect that such person has obeyed the rules and regulations of such hospital and that in his judgment such person may be discharged without danger to the lives or 35495°-21-7