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have been dwelling or staying therein shall act in compliance with the advice or instructions which may be received from the physician until it is modified or annulled by the local health officer.

RULE 16. The physician to instruct as to the disinfection of excreta in certain diseases. It shall be the duty of the physician in attendance on any case suspected by him to be typhoid fever, paratyphoid fever, dysentery, or Asiatic cholera to give detailed instructions to the nurse or other person in attendance in regard to the disinfection and disposal of excreta. Such instructions shall be given on the first visit and shall conform to the rules and regulations or printed instructions of the State department of health. It shall be the duty of the nurse or person in attendance to carry out the disinfection in detail until its modification or discontinuance is permitted by the local health officer. RULE 17. Physicians shall report cases on dairy farms.-When a case of typhoid fever, paratyphoid fever, scarlet fever, diphtheria, epidemic or septic sore throat, smallpox, poliomyelitis (infantile paralysis), cerebrospinal meningitis, tuberculosis, or Asiatic cholera exists on any farm or in any dairy producing milk, cream, butter, or other dairy products for sale, or when it is learned that any person who is employed or has lately been employed or engaged in handling milk or dairy products, or that any of the members of the family of said person is [affected with] or has recently had any of said diseases, it shall be the duty of the physician in attendance, or who has learned such facts or received such information, to report immediately in writing, and by telephone when practicable, to the local health officer the existence on such farm or dairy of such disease, and said report shall state the nature of the disease, the name of the person who is or has been ill with the disease, the location of the place where such person is or has been ill, and the name of the owner or manager of said dairy premises.

RULE 18. The duty of the owners or persons in charge of dairy farms. When no physician is in attendance it shall be the duty of the owner or persons in charge of any farm or dairy producing milk, cream, butter, cheese, or other food products likely to be consumed raw to report forthwith to the local health officer the name and address and all facts relating to the illness and physical condition of any person who is affected with any disease presumably infectious or contagious, and who is employed or resides on or in such farm or dairy or comes in contact in any way therewith or with its products.

RULE 19. Special reports to the State department of health.-It shall be the duty of the local health officer to report immediately to the State department of health the existence of any of the diseases enumerated in rule 17, on any farm or in any dairy producing milk, cream, butter, or other dairy products for sale, together with all facts as to the isolation of such cases, and giving the names of the localities to which such dairy products are delivered.

RULE 20. Danger of infecting foods.-When a case of diphtheria, typhoid fever, or paratyphoid fever, or a person who is a carrier of either of these diseases, or when a case of epidemic or septic sore throat, dysentery, cerebrospinal meningitis, poliomyelitis, tuberculosis, scarlet fever, or smallpox exists on any farm or in any dairy producing or handling milk, cream, ice cream, butter, cheese, or other foods likely to be consumed raw, or exists in any home or other place where such foods are produced, handled, or sold, no such foods shall be sold or delivered from such farm, dairy, or other place, except under the following conditions:

(a) That such foods are not brought into the house where such case exists: (b) That all persons coming in contact with such foods, eat, sleep, and work wholly outside such house;

(c) That such persons do not come in contact in any way with such house or its inmates or contents;

(d) That said inmates are properly isolated and separated from all other parts of said farm or dairy, and efficiently cared for; and

(e) That a permit be issued by the local health officer.

RULE 21. Household pets.-Householders and those who have the care of the sick shall not allow a cat or a dog in a room where there is a person affected with any communicable disease, and when any of said diseases are present in a house or tenement, these animals shall not be allowed to visit other homes. It shall be the duty of the local health officer to enforce this rule.

RULE 22. Disinfection.-After death, removal, or recovery of a person who has been sick with diphtheria, scarlet fever, typhoid fever, tuberculosis, poliomyelitis, cerebrospinal meningitis, smallpox, or any of the diseases for which full quarantine is required, the rooms which have been occupied by the persons infected with these diseases shall, together with their contents, be thoroughly cleansed and disinfected. All persons, nurses, attendants and others who have occupied such apartments during the period of full or modified quarantine shall have their clothing disinfected and shall take a disinfecting bath before they are released. All disinfection prescribed in this rule shall be done under the supervision of the local health officer and in accordance with the directions for such work which may be given from time to time by the State department of health.

RULE 23. Funerals.-No public funeral shall be held over the remains of any person who has died of diphtheria, scarlet fever, poliomyelitis, cerebrospinal meningitis, or smallpox, or any of the other diseases for which full quarantine is required; nor shall the bodies of such persons be taken into any church, chapel, or any other public place. The funerals of persons dying of these diseases shall be strictly private, and any persons whose presence is not necessary shall not be present, and no person shall invite unnecessary persons to attend such funerals; and it shall be the duty of undertakers to warn families in cases of death from an infectious disease against a public funeral, and no undertaker shall conduct a funeral in violation of the terms of this rule.

RULE 24. Duty of local health officers.-It shall be the duty of local health officers to require that all State health laws, rules, and regulations of the State department of health, and local health ordinances, be strictly enforced in their respective communities, subject to the direction and supervision of the State department of health.

RULE 25. Periods of quarantine, and disinfection for acute communicable dis

eases.

CEREBROSPINAL

MENINGITIS.

Quarantine. The strict quarantine of the patient should be maintained until complete recovery, and, even in the abortive type of the disease, the period of isolation should never be less than two weeks from date of onset.

Wage earners may continue their usual vocations, provided the local health officer can have their faithful and intelligent cooperation in following instruetions to keep away from places which they should not visit, and in complying with the provisions of rule 20 if the character of their work requires it.

All children should remain upon their own premises during the period of quarantine and care should be taken that no other children come near them. In the sick room extra care should be taken to receive upon pieces of cloth or paper toweling all of the discharges from the nasal cavities, which are the principal sources of infection in cerebrospinal meningitis, the pieces then to be promptly burned.

Schools. For those who have had the disease there should be no haste in readmission to school. Three weeks from the onset, even in abortive cases, should be the earliest date for readmission. Other susceptible children in the same family or in other families who have been exposed should not return to school for at least eight days after last exposure.

Disinfection. The same rules for disinfection which are applicable to scarlet fever should be applied.

CHICKEN POX.

Quarantine. The patient should be isolated and not allowed in school until desquamation is complete. Wage earners need not be quarantined or kept from their work.

Schools.-The children in the same home who have had chicken pox need not be excluded from school, but those who have not had the disease should be excluded 20 days. They may, however, go to school the first 10 days after their exposure, if the period of exposure is known and they remain at home the next 10 days.

Disinfection.-There is no need of fumigation, but the parents should be instructed to carry out a careful disinfection of the clothing and bedding which have beeen used by the patient, using those methods which can be resorted to in home washing, boiling, and steaming.

Special. The frequent mistakes in the diagnosis between chicken pox and smallpox emphasize the need of extreme care in differentiating between the two diseases, particularly when smallpox is prevalent or when chicken pox is found in adults.

DIPHTHERIA.

Quarantine.-Patients with diphtheria or who have had diphtheria should be quarantined for not less than 14 days from the disappearance of the false membrane, unless it is shown by two consecutive negative cultures taken from the throat, and preferably from the nose also, that they have ceased to be carriers of infection. The two cultures should be taken not less than two days apart, and the first should be taken not earlier than five days after the membrane has disappeared.

The adult wage earners of the family may attend to their usual business, provided they are without throat symptoms and do not remain exposed to the sick person; but if they have been exposed to the patient they should not go to another dwelling where there are children, nor should they associate with children elsewhere or go to public places or assemblages of people.

If the business of the patient released from the quarantined house is the production or the handling of milk or dairy products, if he is a baker, or if he has anything to do with the handling of other food products which are to be eaten without subsequent cooking, extreme precaution should be insured against the infection of those products.

Schools. If the isolation of the patient is strict, children and teachers who have been immunized and cultures from whose noses and throats are negative may return to school. If not immunized and cultures are not taken and found negative, even though their residence is changed, they should not return to school for seven days. If they remain at their own homes until the case is terminated, they should not be readmitted to school until seven days after the quarantine has been terminated.

Disinfection. At the termination of the quarantine those rooms and clothing, bedding, and other things which have been exposed to infection should have a careful cleansing and disinfection.

Special.-Diphtheria antitoxin used early for its therapeutic effect is a potent life saver, and it should be made promptly available to every child affected with diphtheria, whether the parents are or are not able to pay for the treatment.

EPIDEMIC OR SEPTIC SORE THROAT.

Isolation. It is desirable to provide a reasonable degree of isolation for the patient, and particular care should be taken not to have the infection transmitted to and through food supplies. (See rule 6, "Modified quarantine.")

It does not appear necessary to quarantine or isolate other members of the family who may have come in contact with the patient. It is, however, desirable to avoid promiscuous intercourse with those who are sick with the disease.

Schools.-Persons who have had this throat trouble should not return to school until a week has passed since apparent full recovery and the disappearance of all throat troubles.

Children from the house in which there are cases of septic sore throat should not be allowed to attend school until the sick ones are completely recovered, and there should then be an assurance that the throats of those who have apparently escaped the disease are in a normal condition.

Disinfection.-The most important precautionary measures in this direction are the boiling of the milk supply as soon as it is received, the scalding of all milk bottles (but it is far better that the milkman leave no bottles or containers to be returned), and the careful disinfection of all clothing and bedding used by the patient.

Special. As this disease is so frequently spread through milk supplies, local health officers should make a prompt investigation of the source of the milk supply of a family in which epidemic or septic sore throat appears and should also carefully investigate the condition of things at the home or farm of the milk producer, inquiring particularly as to whether any of the members of the milkman's family or his assistants in the milking or the distribution of the milk have had symptoms referable to the throat, and whether all the cows in the herd have been well, and particularly whether there has been any evidence of inflammation or of a gargety condition of the udders or teats of the cows which have produced the milk.

GERMAN MEASLES.

Quarantine. The patient should be isolated one week from the onset, but there is no need of quarantine for the other adult members of the family. Schools. The patient should be excluded from the school while the quarantine lasts.

Children who have already had an attack of this disease need not be kept from school, but those who are not immune should not be admitted to the schoolroom for three weeks, the maximum period of incubation.

MEASLES.

Quarantine.-There should be a very prompt isolation of persons showing symptoms of measles-the earlier the better. Isolate with the first symptoms of coryza (cold in the head) showing themselves in a child who has never had measles and has been exposed, or has probably been exposed, to the infection; and maintain the placarding and the quarantine of the patient five days after the appearance of the eruption and until the temperature has returned to normal and all discharges from the throat, nose, and ears and the rash have disappeared.

Adult members of the family may attend to their usual work, provided they keep away from the sick and do not associate with children nor go to public places.

Schools. Children and teachers in the family who have had measles may continue at school if the sick one is properly isolated.

Children exposed to measles who have not had the disease must be kept entirely away from other children two weeks after their last exposure.

Disinfection. Fumigation is not required after measles, but instructions should be given that all the clothing, bedding, sheets, pillows, pillow cases, and coverings which can thus be treated shall be boiled or disinfected by soaking in a disinfecting solution.

Special. Two things are of the utmost importance: (1) Isolate the child as soon as the first symptoms appear, for the most infectious stage in measles is in the three or four days before the rash has appeared; (2) special care should be taken to protect babies and children under 5 years of age, for measles claims a much heavier death toll from these young children than it does from older children,

MUMPS.

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Quarantine. The patient should be restrained under observation during his illness and then for at least one week after the swelling has entirely subsided. Other members of the family who have business outside their homes need not be restrained.

Schools. The patient should be excluded from school for the same period as that provided for observation. See rule 6, Observation."

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Children and teachers who have had mumps need not be kept from the schools, but they should keep themselves removed from the immediate presence of the sick ones. Children who have not had the disease should be excluded from school for three weeks.

PARATYPHOID FEVER.

Quarantine.-The degree of isolation of the patient should be that which is prescribed for typhoid fever, and, at the end of the period of isolation, the patient should receive the same precautionary advice as to the danger of the transmission of infection while he may remain a “carrier" during the period of convalescence and for some time afterwards.

Members of the household who remain free from symptoms which suggest the onset or the presence of paratyphoid fever may attend to their usual duties, but if they are handlers of food products the provisions of rule 20 should be applied to them.

Schools. Before pupils who have had paratyphoid fever are permitted to return to their schools, there should be care to insure their complete recovery, bearing in mind that, for a while after convalescence, they may be carriers of infection.

Disinfection. The advice which is given for disinfection in cases of typhoid fever is applicable to paratyphoid fever.

POLIOMYELITIS (INFANTILE PARALYSIS).

Quarantine. In a room which should be carefully screened against 'flies, there should be a rigid isolation of the patient for a period of at least 30 days from the onset of the disease.

The head of the family may be allowed to attend to his usual business, provided he observes reasonable precautions against carrying infection from the

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