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RULE 2. She must keep herself clean, and also her patient, bed, clothing, and all that comes in contact with her.

RULE 3. She must not pass her fingers or any instrument into the birth canal of the woman, for the purpose of making an examination or for any other purpose.

RULE 4. A midwife must endeavor to secure the assistance of a physician if the child is not born after 24 hours of labor.

RULE 5. A midwife is not permitted to give drugs of any kind to hasten or increase labor pains, but may give castor oil or other laxative as needed.

RULE 6. She must not give an injection of any kind into the birth canal without orders from a doctor, but may use an enema of warm water into the bowels to produce a movement.

RULE 7. If the child's hand comes down, the child is lying in a cross position and can not be born alone. Send for a doctor at once, telling him what you have noticed.

RULE 8. If the child's feet or buttocks are born first, it will be smothered in a few minutes unless the head comes out immediately. In such a case, the midwife should lift the body of the child by the feet and hold it up. This will make the delivery of the head quicker. Delay will almost certainly mean the death of the child.

RULE 9. If the mother has a spasm, or bleeds either before or after the child is born, send at once for a physician. Do the same thing if the mother is very weak or her labor is slow. If the mother shows signs of fever send for the physician at once and do not wait until she is worse. Unless treated promptly she may die. Do not rely upon yourself if there is anything unusual about the case-send for the physician as quickly as you can.

RULE 10. Every midwife practicing in Arizona must report the births she attends within five days on the blanks furnished her. There is a fine for failing to report births. Use unfading black ink (writing fluid).

RULE 11. To prevent sore eyes and blindness the midwife or doctor should drop into the eyes of each child as soon as born two drops of 1 per cent nitrate silver solution. The drops will not hurt the baby's eyes but will prevent infection and possible blindness.


Typhoid Fever—Quarantine-Placarding-Restrictions on Food Handling— Control of Carriers. (Reg. Bd. of H., Oct. 2, 1920.)

Resolved, That the regulations for the prevention and control of typhoid fever be amended as follows:

A new rule, No. 4a, is to be added:

If the local health authority, upon making the investigation prescribed in rule 4, is satisfied that the case is one of typhoid fever, he shall establish a quarantine by fixing a placard in a conspicuous place at the principal entrance to the premises. Until removal of the card is authorized by the local health authority, no persons shall enter or leave the premises or remove any article therefrom without the permission of the local health authority.

Note. The local health authority may in his discretion allow members of the family or institution who are not ill to go and come at will, but he should see to it that no employee of the person ill, or of the family,of the patient, or of the institution caring for the patient, shall have any part in the preparation or serving of food of persons not ill with typhoid, if any of his duties bring him in contact with the patient, or the dejecta, or soiled clothing, or utensils of the patient.

Rule 5 is amended to read as follows:

Termination of case and release from quarantine.—When a case of typhoid fever has recovered and the temperature returns to normal, the physician shall notify the local health authority that the case is ready for release. The local health authority, or his representative, shall thereupon make an investigation, and if he finds the case has made a complete clinical recovery, as reported, he shall remove all restrictions except the submission of specimens for laboratory examination. The local health authority shall require the submission of specimens of feces from the patient to the State hygienic laboratory or to any other laboratory that may be approved for this work by the State board of health. Until two successive negative results have been secured from such specimens, taken at intervals of not less than one week and not longer than one month, the health authority shall keep informed as to the whereabouts of the patient, taking such measures as may be necessary to protect the public health.

Rule 7 is amended to read as follows:

Any person who has been free from symptoms of typhoid fever for a month or longer and whose discharges contain typhoid bacilli, will be considered a carrier. Any known or suspected typhoid carrier shall be reported to the local health authority who shall investigate and report the findings to the State board of health. Carriers of typhoid bacilli shall be subject to a modified quarantine by the State board of health and the provisions of this quarantine shall be deemed to be fulfilled so long as the carrier observe the instructions here given, to refrain from engaging in any occupation having to do with the preparation or serving of food for others, and from preparing or serving food for any persons excepting the members of his or her immediate family; he must keep the local health authority informed at all times of any change of address; and submit specimens for examination by the State hygienic laboratory or any laboratory approved by the State board of health, at 43163-23



such times as may be required by the local health authority or the State board of health.

In the event of any known or suspected carrier leaving the jurisdiction of a local health authority, the State board of health shall be notified by the local health authority of the name of the carrier and his destination. Violation of any of the provisions of this regulations shall be deemed the breaking of quarantine and as such punishable under section 377a of the penal code.

Public Health Nurses-Qualifications. (Res. Bd. of H., Apr. 3, 1920.)

Resolved, That the qualifications for employment as a public health nurse, under the provisions of section 3062 of the political code and of section 4225a of the political code, 1919 statutes, shall be as follows:

1. She shall be a registered nurse in California.

2. She shall present certificate of graduation from a school of public health nursing accredited by the National Organization of Public Health Nursing at the time of her graduation, and she shall pass the examination prescribed by the State Board of Health of California.

Provided, During the year following the passage of this ruling, any nurse actively engaged in public health work may register under the following conditions:

1. She shall be a registered nurse in California.

2. She must have been employed in public health nursing work for at least six months prior to the date of her application for registration as a public health nurse in California.

Slaughterhouses-Location, Construction, Maintenance, and Operation. (Reg. Bd. of H., Dec. 4, 1920.)

I. Location of slaughterhouses.-All slaughterhouses shall be located: (1) Where an adequate supply of pure water is available; (2) where proper drainage is obtainable; and (3) where proper disposal of all wastes can be accomplished without creating a nuisance.

II. General construction.-All slaughterhouses must be inclosed on all sides, and all walls, ceilings, roofs, floors, doors, fly screens, drains, sewers, etc., must be kept in good repair.

III. General cleanliness.-The whole premises, that is, the building, together with its contents. the yards, pens, etc., must be kept in clean condition at all times. Rubbish must not be allowed to accumulate, and adequate measures must be taken to prevent the harboring and breeding of rats on the premises.

IV. Light and ventilation.-All rooms must have ample light and ventilation directly to the outside air. All doorways must be fitted with tightly fitting doors, either screen or solid, which must be kept closed at all times except when in actual use. All other openings must be covered with metal fly screen of not less than 14 mesh.

V. Floors.-Floors of all rooms where killing, handling, preparing or storing is done must be impervious and must be constructed of concrete, asphalt, or other nonabsorbent material. All such floors must be coved and carried up the face of the wall to a sufficient height to prevent seepage under the floor. Also all such floors must be made with a pitch or fall of not less than onefourth inch to the foot, and be directly connected with gutters, of the same material, which discharge through properly constructed traps into drain pipes leading to the sewer.

VI. Sewage disposal.-The premises must be connected with a municipal or other public sewer system if the same is available; otherwise a proper septic

tank must be provided of such size as to hold at least two days' sewage. The effluent from this septic tank must be discharged either into properly constructed and tightly covered cesspool or cesspools or into a subsurface irrigation system. The cesspools or subsurface system must be of such capacity that no effluent is ever exposed above the ground or otherwise creates a nuisance.

VII. Disposal of by-products.-Tanking, cooking, preparing, and storing of material not intended for human food shall not be done in the same building where killing, preparing, handling, storing, or cooking of material for human food is carried on. Exhaust pipes from cooking tanks must be so arranged as to efficiently dispose of all odors from same.

Paunch contents shall be finally disposed of at least every other day either for fertilizer by being spread over the ground in a layer not over four inches thick as far distant from human habitation and from the slaughterhouse as possible, or by being buried or burned.

Entrails, hoofs, heads, and other waste must be disposed of within 48 hours after slaughter. If used for hog feed this material must be cooked. Otherwise, it must be disposed of within this time by being tanked and burned or buried in such manner as not to create a nuisance.

However, bones, hoofs, horns, and heads, after being cooked and cleaned, may be dried and stored not less than 50 feet away from the slaughterhouse.

Hides must be removed from the premises or salted down in the hide room within 24 hours after skinning.


VIII. Keeping of animals.—Animals must not be kept, fed, or permitted to roam within 100 feet of the slaughterhouse, except that animals intended for slaughter may be kept in slaughtering pens adjacent to the slaughterhouse for not exceeding 48 hours previous to being slaughtered.

IX. Toilet and washing facilities.-Each slaughterhouse must be provided with a toilet and with apartments for dressing and washing. All changing of clothing must be done in the apartments provided for that purpose, and under no circumstances may clothes be changed, hung, or stored elsewhere in the slaughterhouse.

Apartments, as provided in this section, shall be separate from rooms where killing, handling, cooking, preparing, or storing are carried on. Necessary plumbing therein must be provided and must be connected with the sewer.

Where a vault toilet is the only available accommodation, it must be located at least 50 feet from the slaughterhouse, and the vault and building must each be fly tight.

X. Killing room.-Side walls must be covered with galvanized iron, cement, or other nonabsorbent material, to a height of not less than five feet above the floor; above this height the walls and ceiling must be of smooth construction and shall be painted or lime washed.

An adequate supply of pure clean water shall be provided in this room. Paunches, entrails and their contents upon removal from each carcass must be placed in covered metal or metal-lined receptacles, and the floor shall be kept as clean as possible during slaughtering. Hides, heads, hoofs, etc., must be removed from the killing room at the end of each day's slaughtering.

Carcasses of animals and parts therefrom intended for human food must not be allowed to come in contact with the floor.

Carcasses of animals intended for human must be either removed from the premises or placed in a cooling room within one-half hour after being dressed.

Condemned parts of carcasses must be removed from the killing room at once and tanked or burned within the next 48 hours, and all tools, utensils, con

tainers, floors, hands, etc., which may have come in contact with the diseased parts must be thoroughly washed and cleaned before the next animal is slaughtered.

All tools, utensils, blocks, containers, walls, and floors must be thoroughly washed and cleaned after each day's work.

A knocking pen must be provided, the same to have a solid door swinging inward toward the killing-room floor.

The use of the killing room for any purpose other than for the slaughtering of beeves, sheep, and calves intended for human food is strictly prohibited.

XI. Cooling room.-The walls and ceiling of the cooling room must be of tight T. & G. construction and must be painted or oiled. This room must be entirely separated from all other rooms in the slaughterhouse except for doorways leading to a shipping platform and to the killing room. These doorways must be fitted with solid, tightly fitting doors, which must be kept closed at all times except when in actual use.

The walls, ceiling, floor, doors, hooks, etc., in this room must be kept in clean condition and the use of this room for any purpose other than for the temporary storage of dressed carcasses intended for human food is prohibited.

XII. Hog scalding and scraping.—The scalding and scraping of hogs must be done in a room entirely separated from the main killing room. A doorway, with a solid, tight-fitting door, which shall be kept closed at all times except when in actual use, may be installed between these two rooms. This room and all slaughtering and dressing done therein shall conform to the requirements of the main killing room. (Section X.)

Where hog-sticking platforms are used the same shall be constructed of nonabsorbent material, properly drained and connected with a sewer system.

XIII. Hide room.--The hide room must be tightly partitioned off from the other rooms of the slaughterhouse, except there may be doorways to a shipping platform and to the killing room. These doorways must be fitted with solid, tight-fitting doors, which must be kept closed at all times except when in actual use. The floor and walls of this room up to a height of at least 6 inches above the maximum pile of hides must be solid concrete construction; the floor must be sloped and connected with the sewer.

XIV. Corrals and hog pens.-Water troughs in corrals must be so built or arranged as to permit of no overflow.

A tight-floored feeding platform, preferably of concrete, must be provided in the hog pens. Pens and corrals must be so drained that no accumulation of water may occur therein.

Public Camp or Picnic Grounds-Sanitary Regulation. (Res. Bd. of H., Dec. 4, 1920.)

Resolved, That the following rules shall apply to any city, county, city and county, village, community, institution, person, firm, or corporation, operating, maintaining, or offering for public use within the State of California any tract of land on which persons may camp or picnic, either free of charge or by payment of a fee.

RULE I. A water supply of sanitary quality acceptable to the California State Board of Health shall be provided in ample quantity to meet all requirements of the maximum number of persons using such a tract at any time. Said water supply shall be easily obtainable from its source or from faucets on a pipe distributing system within a distance of 300 feet of any camp or picnic spot within such tract.

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