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six days before the appearance of symptoms; therefore it is possible for a dog with no evidence of the disease at the time of the biting to communicate rabies.
If a dog or other animal which has bitten a person either dies from rabies or is killed because of the disease, the head should be severed from the body close above the shoulders, care being taken by the person doing this not to become infected in the act. The head should be wrapped in strong muslin; it should then be chilled, or, better, frozen at once, and be kept as cold as possible until time of shipment. In preparing it for shipment the head, already wrapped in muslin, must be repacked in ice and sawdust in a small water-tight keg or candy pail, using sufficient ice to insure that it will be kept very cold during transit. Having marked the package "perishable" it must be sent by express, prepaid, to the State bacteriologist, Denver, Colo., at the same time sending a message by telephone or telegraph notifying him of the shipment. Do not ship so that it will arrive in Denver on a Saturday, Sunday, or a holiday, but be certain to keep it well iced until it can be shipped. Be sure to place on the package also the name and address of the consignor. A letter should be mailed at once giving the following data:
a. Name, residence, and post-office address of owner of dog (or other animal). b. Details of illness of the dog, noting unusual behavior as shown by change in disposition, unnatural appetite, etc.; also symptoms showing development of the disease.
c. Date of earliest symptom and date of death of the dog.
d. If the dog was killed, give reason for killing; manner and time of killing. e. Name, residence, and post-office address of other persons known to have been bitten by this same animal, with date of biting.
f. Any other known facts concerning persons or animals in any way related to this case.
Not all persons bitten by a rabid animal die, chiefly because the clothing partially protects them from the entrance of the virus, but the danger is very grave; therefore all persons who have been scratched, bitten, or lacerated by the teeth or claws of an animal known to be rabid should be given the Pasteur preventive treatment. Also all persons having on the hands, face, or elsewhere on the body wounds which may have become infected from contact with the saliva of a rabid animal; or who have been exposed in any manner to possible infection from a known rabid animal; or who have been exposed to possible infection from an animal suspected of rabies, or from one which, being suspected, has disappeared from home, has died, or has been killed, should receive the preventive treatment. The necessity for preventive treatment exists in all persons who have been bitten or otherwise subjected to possible infection by an animal within two weeks previous to the date when it was known to have been rabid; those bitten longer than two weeks before are in no danger. It should be understood that this is a preventive treatment only; it has no curative value if used during the course of the disease.
Supplies.-There shall be established by each local health officer, either at his own office or at some other convenient location, as he may determine, a local station where all swabs and other bacteriological supplies shall be kept, and the local health officer shall make known to all other practicing physicians in his territory the location of such station. All bacteriological supplies will be sent directly to the local health officer, who shall at all times control their distribution and shall be responsible for their safe-keeping. He should be careful to report from time to time to the State board of health, so that he may not be without such supplies as are necessary.
Hospitals, Dispensaries, Maternity Homes, etc.-Licenses-Keeping of Records-Making of Reports-Sterilization of Bedding, Clothing, and Utensils-Nurses-Approval of Building Plans. Maternity Patients-Care of. (Reg. Bd. of H., Nov. 8, 1920.)
REG. 56. Hospitals, sanatoria, lying-in hospitals, maternity homes, dispensaries, and other similar institutions. RULE 1. Any hospital, sanatorium, lying-in hospital, maternity home, dispensary, or other similar institution shall be considered within the purpose of this regulation if it announces in any way that it will receive and care for, or if it is to be operated for, or if it is a matter of public knowledge that it is established to receive and care for persons who are sick or injured or any woman or girl approaching or during childbirth.
RULE 2. Any corporation, association, person, or persons, before opening such institution shall apply for a license to do so to the State board of health, which will supply proper blanks for such application. A fee of $1 must accompany each application. This will be returned if the license is not granted. Licenses are issued only by order of the board at a regular or special meeting. A license must be posted in the office or other conspicuous place where it can be seen easily at all times. Any licensee discontinuing business must surrender his license to the board without delay.
RULE 3. All applicants for licenses must be of good moral character, capable, and trustworthy; they must also have a suitable place for conducting their business. The board will determine after inspection whether the place is suitable for such business.
RULE 4. For sufficient reason licenses may be refused or revoked: Provided, That notice of time and place of hearing concerning same shall be giv to applicants or licensees.
RULE 5. Licensees whose principal business is receiving and caring for tuberculous patients must receive tuberculous patients only.
RULE 6. Licensees who receive maternity patients are prohibited from advertising their business in any daily or weekly newspaper.
RULE. 7. All maternity patients when in labor and for at least one week thereafter must be attended by a regularly licensed physician or licensed midwife and the moral and professional standing of either physician or midwife must be satisfactory to the board. When a change is to be made in the employment of a physician, regularly a member of the staff, notice of such change must be given to the board at once.
RULE 8. "No child shall be sold or otherwise disposed of for any valuable consideration by any of the persons subject to the provisions of this act," nor shall any child be given away for adoption or otherwise disposed of except by strict compliance with the statute governing such cases.
RULE 9. All applicants must give the name and address of the staff of physicians and surgeons in regular attendance upon the institution.
RULE 10. All licensees must keep a record in suitable form giving the name, address, date of admission, date of departure, and nature of sickness of each patient. In case of maternity patients the record must also show the expected date of labor, actual date of labor, name and sex of child, and what disposition has been made of the child. A record must be made immediately on admission of a patient and such record must be kept up to date by making additional entries each day as events occur. Said record shall be open at all times for inspection by officers or duly accredited inspectors of the State board of health. Said named officers and inspectors shall at all times have the right to enter any licensed institution for the purpose of inspection and investigation.
RULE 11. All institutions coming within the provision of this regulation, in addition, "shall quarterly, on the 1st day of January, April, July, and October
make a report to the State board of health of the number and names of the people in charge or employed in such institution, and if physicians," their name and address. Adequate nurses both in numbers and qualifications must be provided; noncompliance with this rule may cause the license to be revoked.
RULE 12. It is required that a general healthful and sanitary condition shall be maintained at all times about both the bui ings and grounds and that a recognized average cubic-foot air space per patient be provided with adequate means for ventilation. Especial attention shall be given to the cleanly and sanitary character of all baths, toilets and water-closets, and to methods of sewage disposal.
RULE 13. Some efficient means, approved by the board, shall be provided for the disposal of garbage and refuse. All garbage and refuse from institutions receiving or caring for tuberculous cases must be burned; institutions of this sort should construct an incinerator for this purpose.
RULE 14. All hospitals and sanatoria should have two separate diet kitchens; one for the preparation of food for managers, superintendents, resident physicians, nurses, and other attendants; the other for the preparation of foods for the patients. Fragments of food should not be returned to the diet kitchen but to an incinerator for this purpose. (See also regulation 65.)
RULE 15. Sufficient provision should be made for the sterilization of soiled bedding, clothing, and utensils used in typhoid fever and other similarly communicable diseases. Nurses should be carefully instructed concerning the danger of "infection by contact."
RULE 16. All hospitals and sanatoria should have constructed for them a suitable container in which to sterilize by boiling, the excreta of all patients affected with typhoid fever, paratyphoid, cholera, dysentery, tuberculosis, or other diseases in which infection is carried in urine or stools. Such sterilizer should be remote from the kitchen or any other place where food is either prepared or stored.
RULE 17. Nurses caring for this class of cases must not be permitted to attend to any duties in the diet kitchen in connection with the preparation of food for others.
RULE 18. Since the occurrence of typhoid fever is from 10 to 20 times as frequent in those nursing typhoid as in other persons not so exposed, and since paratyphoid is also of frequent occurrence, is transmitted by the same means, and can not be clinically differentiated in most cases, it is required that probationer nurses, on entering upon their duties in a hospital or other institution where typhoid cases are received, shall be given a combined prophylactic typhoid and paratyphoid vaccine unless they have either had these two diseases or have been so vaccinated within two years previous; and this shall be repeated every two years during their stay in the institution. It is required also that in any hospital or sanatorium, if any probationer nurse has not been successfully vaccinated against smallpox within five years previous, such vaccination shall be done immediately upon her entrance upon her duties.
RULE 19. Suspected "carriers" of disease of any sort must be excluded from service in kitchens, dining rooms, or dairies belonging to or in connection with any hospital, sanatorium, or other similar institution.
RULE 20. Ample fire escapes shall be provided in all hospitals, sanatoria, and other simliar institutions for the care of the sick and injured, and patients shall be given any necessary instruction concerning the manner of reaching such fire escapes.
RULE 21. Plans for the erection of hospitals, sanatoria, and similar institutions should receive the approval of the State board of health before the work of construction is begun.
State Institutions-Reports to State Board of Health-Isolation or Removal of Communicable Disease Patients—Air Space Per Person. (Reg. Bd. of H., Nov. 8, 1920.)
REG. 58. State institutions.-RULE 1. The regular physician of every State institution where men, women, or children are kept at the expense of the State, as children of industrial schools, dependent children, inmates of institutions for the insane or feeble-minded persons and inmates of penal institutions, must report annually to the State board of health such information as may be required.
RULE 2. When any communicable disease appears in any State institution, the patient or patients must be properly isolated and if necessary removed from the institution to a place of safety where they shall have proper medical attention and care until they may be safely returned.
RULE 3. In order that the health and lives of the inmates of any and all of the State institutions may be properly protected it is required that all buildings for State institutions be supplied with fireproof stairways and fire escapes as required by law for other buildings.
RULE 4. Inmates of State institutions must at all times be supplied with a sufficient amount of fresh air. In calculating the cubic-foot air space per person, the height of the room should not be measured beyond 12 feet above the floor.
Since a child in proportion to its weight exhales about twice as much carbon dioxide as an adult, it should generally be provided with as much air space as is required by an adult.
Under ordinary conditions a complete change of air in a room can not be made more often than three times each hour without causing too much draft. Upon the rapidity with which the air is changed will depend the cubic space necessary for each person occupying a room.
On account of varying circumstances it is impossible to specify the definite cubic-foot air space required for each inmate of any institution, but a general idea of the floor area, cubic space, and fresh-air supply per inmate is given in the following table:
Milk and Cream—Production, Handling, and Sale. (Reg. Bd. of H., Nov. 8, 1920.)
REG. 55. Sanitation of dairies and the sale of milk and cream.-RULE 1. All buildings used for stabling cows for dairy purposes shall be properly constructed, well lighted, well ventilated, and provided with a suitable solid floor of plank, cement, or other impervious material that can be readily cleansed, and laid with proper grades and channels to carry off all drainage.
RULE 2. No water-closet, privy, cesspool, urinal, inhabited room, or workshop shall be located within any building or room for stabling cows, or for the storage of milk or milk products; nor shall any fowl, hog, horse, sheep, goat, or other animal be kept in any room used for milking or for storing milk or milk products.
RULE 3. All rooms and stables in which cows are milked shall be thoroughly cleaned and in good repair, and shall be painted or whitewashed once each year.
RULE 4. All manure shall be removed at least once daily from the room or stable in which cows are milked, and shall not be stored where odor from the same will be noticeable at the stable or milk room.
RULE 5. All persons keeping cows for the production of milk for sale shall cause each cow to be kept clean and groomed.
RULE 6. The sale of watered or adultered milk; or milk from cows kept upon garbage, sugar-beet pulp, swill, or other substances in a state of fermentation or putrefaction; or milk from cows kept in connection with a family in which there exists any communicable disease which may be carried by milk, is prohibited.
RULE 7. Every person using any premises for keeping cows shall cause the yard or pasture in connection therewith to be provided with a proper receptacle for drinking water for such cows, and none but fresh, clean, pure water shall be stored in such receptacle: Provided, That this shall not apply in case of a pasture through which runs a stream of pure water.
RULE 8. Any inclosure in which cows are kept shall be graded and drained so as to keep the surface reasonably dry and to prevent the accumulation of water therein, and no garbage, urine, fecal matter, or similar substances shall be placed or allowed to remain in such inclosure, and no open drain shall be allowed to run through it.
RULE. 9 All milk shall be removed, as soon as drawn, from the stable to the milk room. The milk room shall be separate from the stable in which the cows are kept and shall not be used as a living or sleeping room, but shall serve for the handling and keeping of milk and cream exclusively. It shall be sanitary in construction, properly screened, supplied with proper ventilation, light, and pure water, and suitable facilities for straining, cooling, and storing milk or milk products. Ample provision shall be made for washing and sterilizing all utensils and apparatus in which milk is removed, stored, and delivered.
RULE 10. All utensils used for the reception, storage, or delivering of milk or cream shall be made of glass, stoneware, glazed metal, or tin plate free from rust and of sanitary construction.
RULE 11. All cans, pails, strainers, coolers, dippers, separators, bottles, churns, butter workers, and other dairy utensils shall be cleansed from all remnants of milk and scalded with boiling water or live steam after each use.
RULE 12. All milk shall be strained through clean 80-mesh wire strainers, or properly sterilized cloth, and shall be cooled to 60° F. or below within one hour after it is drawn from the cow. It shall be kept at 60° F. or below until it leaves the farm, and if retailed to the consumer, until de vered. Warm milk shall not be mixed with cold, but shall be kept in separate vessels until properly cooled.
RULE 13. All milk or cream cans delivered to creameries or dealers in cities shall be covered with tight-fitting lids, and when conveyed in open wagons shall be covered with clean canvas while being so conveyed.
RULE 14. No person, firm, association, or corporation buying, storing, or receiving milk for the purpose of selling the same for consumption as such, or for manufacturing it into butter, cheese, ice cream, condensed milk, or other human food, shall keep the same in utensils, cans, vessels, or rooms that are