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and direct discharge into stream ( (with or without sterilization) to the passage of sewage through grit chambers, screen chambers and house, primary Imhoff settling tanks, dosing house and tank, sprinkling filters or contact beds, secondary Imhoff settling tanks, sand filters, sludge drying beds, etc.
RULE 6. Applications for the board's advice and directions regarding the discharge of sewage directly into a stream or as to the construction of sewage treatment works, must state the ultimate number of persons who will use the sewer, and be accompanied by a certificate of the State engineer, giving the rate of discharge of the stream, in cubic feet per second, at time of minimum flow in the stream.
RULE 7. Should the board require the construction of a sewage treatment plant, full detailed working plans and specifications must be prepared by an expert in designing and in construction of sewage treatment works; said plans and specifications must be presented to the board for inspection, consideration, and approval. Plans and specifications approved by the board must be closely followed in building the treatment works, and any failure to so follow the plans, etc., will subject the works to condemnation by the board.
Schools-Location, Construction, and Cleanliness-Toilets and Wash RoomsWater Supply—Ventilation, Heating, and Lighting—Seats-Employment of Teachers or Janitors Infected with Communicable Diseases ProhibitedPhysical Examination of Pupils-Cleaning or Disinfection of School Rooms. (Reg. Bd. of H., Nov. 8, 1920.)
REG. 59. School hygiene.—The attention of all physicians, and especially of health officers, is called to the importance of physical examination of every child before entering school and also of medical inspection at short intervals during the entire school year. These examinations may be made either by their private physicians, by the health officers, or school inspectors, as may seem desirable. In this work the State must count on the cooperation of the medical profession, as well as of health officers.
School buildings.-The site of a school building should be well drained, either by nature or artificially; it should not be near enough to railroads or noisy factories to interfere with work; it should have ample playground space; it should have some shade; the surface should be graveled or turfed.
Foundation.—The foundation must be impervious to soil water in order that capillarity must not dampen the walls.
Basement. If there is a basement, it should rise sufficiently high above the ground for light and air to penetrate to every part of it, and should never be allowed to become a dump for refuse of any kind. If no basement is provided, the foundation walls should be pierced in appropriate places and guarded with gratings in order to allow a circulation of air below the floors.
Cloakrooms. These should always be provided in order to avoid the stuffy and disagreeable odor of clothing in damp weather. In the country shelves for dinner pails should also be provided.
Toilets. These must be separate for the sexes, well screened, well painted or whitewashed, and kept clean. If privies are used, they should be constructed under regulation 63. If water-closets are used, a type should be selected which can easily be scrubbed, and an automatic flush is desirable. Urinals must be placed in the toilets allotted to boys.
Wash rooms. It is patent that children should be afforded an opportunity for cleansing the hands and face after play or visits to the toilet and be taught its importance. For this, if pipe water is available, the ordinary porcelain
basins with a run-off to the sewer connection should be installed. In case it is not available, ordinary granite or enameled basins, with a water supply in buckets or tanks, should be possible to any school. Paper towels or individual towels must be used. The use of a roller or common towel is prohibited by law.
Water supply.—All water used in schools must be from deep wells or city or town water supplies. No surface water or water from shallow wells should be tolerated. Complying with the antidrinking cup law, wherever it is possible, drinking fountains, at least two in number for the different sexes, should be erected, either in the building or [at] some point on the grounds where freezing will not be possible. The use of the common drinking cup is prohibited by law. At the beginning of each year, and at intervals of three months thereafter, water should be examined by the State chemist.
Schoolrooms; space. Not less than 225 cubic feet of space should be allowed to each person in the schoolroom, including the teacher. Rooms not affording this amount of space are overcrowded and transfers should be made until the condition is relieved. Twelve-foot ceilings are best for all purposes.
Ventilation.-Whatever means are used should provide for a complete change of air in about 20 minutes.
Heating. Whatever system of heating is employed should maintain the temperature of every part of the schoolroom between 60° and 70° F., with a relative humidity of at least 40 per cent. School can not safely be continued in a room where the temperature falls below 60°.
Humidity. Some means, even if only the placing of pans of water on stoves or radiators, should be provided for adding to the moisture in the air; since air that is too dry is unpleasant and unhealthful to breathe.
Light. The room should be lighted from one side only, or by properly softened skylights, and the lighting area should not be less than one-sixth of the floor area. Prismatic glass in the upper sash is an advantage, since it diffuses the light to the opposite side of the room.
Seating.-Seats must be adjustable to the bodies of the children. It is nothing short of criminal to compel the child to adjust itself to the seat. Good work can not be done by an uncomfortable child, and lasting eye trouble or bodily deformity, such as spinal curvature, may come from this practice.
Blackboards.-These should be always dull finished. hard on the eyes. Erasers should be dusted outside. be cleaned each evening by the janitor.
A glossy blackboard is The chalk racks should
Care of the building.-Floors may be oiled with a small amount of floor dressing. Dry sweeping and dusting should not be permitted while school is in session. Oiled sawdust is a good allayer of dust and is prepared by dissolving a teacupful of floor oil in a quart of gasoline and thoroughly and quickly mixing it with as much sawdust as will absorb it cleanly. Oiled dustcloths are made by adding an ounce of floor oil to a quart of gasoline, out of which cloths are wrung. These are allowed to dry and may be washed when necessary. On account of the inflammability of the gasoline, it is necessary that these operations be conducted out of doors. The floors of buildings should be scrubbed at least weekly, on Friday evenings, and before the beginning of the school year should have a thorough cleaning.
Teachers and janitors.-No teacher or janitor shall be employed who is infected with any disease which would debar a child from the school. This is especially true of open tuberculosis and syphilis, and school medical inspectors and health officers should instantly require the resignation of any person employed in the schools who is suffering from one of these diseases.
Rules. Each school board, together with the health officer of each town or city, should formulate rules and regulations for the examination, both
physical and mental, of all children who may apply for admission to either public or parochial schools.
a. Such regulations should embrace an examination and report of the condition of the eyes, ears, nose and throat, teeth and gums, physical or mental defects, for evidence of communicable diseases, such as scarlet fever, diphtheria, measles, mumps, trachoma, also skin diseases and pyorrhea. Such report must be presented to the superintendent, principal, or teacher in charge of such school.
b. If such report shows evidence of communicable disease, the child must immediately be refused admission to school and a statement of facts furnished parents. If defects in hearing or vision be present or other conditions requir ing correction or operation, parents should be notified by superintendent, principal, or teacher of school, and the same should receive proper attention. The child should present certificate from a licensed physician showing proper corrections before he is admitted to school. Any superintendent, principal, or teacher shall not permit any child who has been affected by communicable disease to return to school without proper certificate from the attending physician or the local health officer.
c. A schoolroom in which a case of diphtheria, scarlet fever, or smallpox has occurred must be thoroughly cleaned or disinfected according to the method designated in regulation 46.
Public Conveyances and Stations-Sanitary Regulations Governing. (Reg. Bd. of H., Nov. 8, 1920.)
REG. 67. Public conveyances.-RULE 1. No person having reason to believe that he is suffering from cholera, diphtheria, plague, scarlet fever, smallpox, erysipelas, measles, leprosy, or chicken pox shall enter, nor shall any person permit anyone under his care so affected to enter, any public conveyance or common carrier, except a hack, wagon, carriage, or automobile, and then only after having notified the person in charge of such infection or exposure. Any conveyance so used must be thoroughly fumigated.
RULE 2. All conductors of railroad trains and street cars, if they have any reason to suspect any passenger to be suffering from any disease enumerated in rule 1, shall immediately notify the nearest health officer located on their route, by the most direct and speedy means possible, of their belief, and the health officer must meet such railroad trains at the station or such street car at the nearest possible point to determine, if possible, whether the disease exists.
RULE 3. When the health officer notified as provided in rule 2 shall find any person in a car or other public conveyance to be affected with any disease named in rule 1 the public conveyance shall be turned over to the health officer, who shall treat such conveyance as infected premises. When in the judgment of the health officer the case is in such early stage of development that other passengers are not endangered, the patient shall be removed from the conveyance and it shall be allowed to proceed. If the health officer shall deem that the exposure is such as to have infected other passengers he shall call upon the person in charge to remove the infected conveyance from service at the first place where suitable accommodations can be secured, and such health officer shall notify the health officer in whose jurisdiction the infected conveyance is left.
RULE 4. The drinking water and ice supply used in stations and on public conveyances shall be free from anything deleterious to health. In the construction of new equipment all receptacles for drinking water should be so con
structed that they can not be opened readily by anyone except those having charge of them. Nothing but ice and water shall be placed in receptacles used for the storage of drinking water. The receptacle for drinking water shall be kept thoroughly clean at all times and shall be drained and flushed at car cleaning terminals.
Persons employed place ice and water the receptacles mus have clean hands and must rinse the ice immediately before depositing it in the vessel. When a water-borne disease has developed in epidemic form in a municipality, water from such place for car tanks shall not be used without the approval of the State board of health.
RULE 5. The use of the common or public drinking cup is prohibited on all public conveyances and in waiting rooms.
RULE 6. All public conveyances, including toilet rooms therein, shall be kept in a reasonably clean condition at all times. Dry sweeping and dusting of occupied conveyances is strictly prohibited.
RULE 7. At cleaning terminals all passenger equipment shall be thoroughly cleaned and aired, and after such cleaning the hoppers, urinals, and toilet floors shall be mopped with a 14 per cent solution of formalin.
RULE 8. Upon arrival at cleaning terminals, sleeping cars shall be cleaned as follows:
The windows, doors, and ventilators shall be opened; the upper births let down; the seat bottoms and backs lifted out; the mattresses, blankets, pillows, curtains, etc., loosely arranged for airing. If the weather permits, the removable articles mentioned above shall be taken out of the car, dusted and aired in the open, and exposed to the sunlight for a time. The rest of the cleaning of the car shall be carried out as directed for day coaches under rule 7.
RULE 9. Thorough cleansing and renovation takes the place of fumigation. RULE 10. In all public conveyances the food boxes, refrigerators, lockers, drawers, and cupboards shall be kept thoroughly clean at all times.
RULE 11. The use of the common roller towel on common carriers and in waiting rooms is prohibited.
RULE 12. All toilet rooms, water-closets, urinals, and toilet appliances in stations shall be cleaned daily, and when vaults or surface receptacles are used in connection with closets at stations, such vaults or surface receptacles shall receive at least weekly treatment with fresh lime or some other agent approved by the local health officer.
Births and Deaths-Registration—Burial and Removal Permits. (Reg. Bd. of H., Nov. 8, 1920.)
REG. 69. Division of vital statistics.-RULE 1. The State board of health is authorized by law to make such rules as are necessary "to insure the faithful registration" of all births and deaths in the incorporated towns, cities, and counties, and in the central bureau of vital statistics.
RULE 2. The secretary of the State board of health is ex officio State registrar of vital statistics and has general supervision over all local registrars and the central bureau of vital statistics. The State board of capitol managers is required by law to provide suitable apartments for the said bureau, including a properly equipped fireproof vault and filing cases.
RULE 3. Each city, each incorporated town, and each county exclusive of such cities and towns constitutes a registration district.
RULE 4. Any local registrar who fails or neglects to discharge efficiently the duties of his office or who fails to make prompt and complete returns of births and deaths to the State registrar will be promptly removed from his office.
Each local registrar must appoint a deputy who shall serve in case of absence, serious illness, or other disability of the registrar. In case of removal or disability of the deputy, the registrar must immediately name a new deputy and report the name to the State registrar. Registrars must likewise send to the State registrar name and address of every subregistrar appointed. (See section 238.)
RULE 5. A burial or removal permit must be obtained from the local registrar of the registration district where the death occurred before the body of such person shall be interred, deposited in a vault or tomb, cremated, or removed into any other registration district. The local registrar must not issue a permit for the burial, cremation, removal, or shipment of the dead body until there has been filed with him a complete and satisfactory death certificate: Provided, That a lawful transit permit issued at the place where the death occurred, whether in this or in another State, may be accepted by the local registrar in lieu of a death certificate as a basis upon which to issue a local permit. The local registrar shall not at any time sign in blank a permit of any character whatsoever. When a transit permit is the basis upon which a burial permit is issued that fact and place of death must be written on the face of the permit and a copy forwarded to the State registrar. When a dead body is removed from one registration district to an adjacent or near-by district for burial, not requiring a common carrier or issuance of a transit permit, then the removal permit of the registrar where the death occurred may be accepted as authority for burial.
RULE 6. Stillbirths must be reported and registered in usual manner as births and also as deaths. The word "stillbirth" shall be used in the birth certificate instead of the name of the child and the same word should be used in the death certificate as the cause of death. If the stillbirth is premature, the period of uterogestation, if known, must be stated in months. The cause of death as stillbirth must be stated, if known, in the death certificate. In case of a stillbirth a burial or removal permit is required as in other cases. The attending physician may sign a death certificate for a stillborn child. If there has been no attending physician, the case must be managed as provided in rule 8 for deaths without medical attendance. Midwives must not sign death certificates for stillborn children.
RULE 7. All death certificates must be made on blank forms furnished by the State registrar, clearly indicating the numerous points of information to be furnished as required by law. Valuable instructions are printed on the back of each blank for death certificate. When death is caused by accident, the nature of the accident must be stated. If there is a contributory cause, it must be stated in addition to the immediate cause of death. The duration of the disease and where contracted, whether direct or contributory cause, must be stated. It is also important that each certificate contain the registration or district number as well as the registered number, beginning a new series always with the 1st day of January. Reasonable effort must be made to have every item of information supplied in the certificate, and all incomplete certificates will be returned by the State registrar to the local registrar unless it is clearly shown that the omitted information could not be obtained.
RULE 8. When any death occurs without medical attendance, the undertaker must immediately notify the local registrar of the registration district in which the death occurred. The local registrar must immediately notify the local health officer and the coroner. The body should not be removed from the place where it is found without permission of the coroner. The body of a person who has died without medical attendance must not be embalmed without consent of the coroner. The coroner must immediately make an investigation and must