Places Where Food is Manufactured, Prepared, Stored, or Sold-Sanitary Regulation-Employees. (Reg. Bd. of H., Apr. 30, 1920.)

REGULATION No. 1. Sanitation required.-Every building, room, basement, or cellar, occupied or used as a bakery, confectionery, cannery, packing house, slaughterhouse, restaurant, hotel, grocery, meat market, or other place or apartment used for the production, preparation for sale, manufacture, packing, storage, sale, or distribution of any food, shall be properly lighted, drained, plumbed and ventilated, and conducted with strict regard to the influence of such conditions upon the health of the operatives, employees, clerks, or other persons therein employed, and the purity and wholesomeness of the food therein produced, kept, handled, or sold; and for the purpose of these regulations the term "food" shall include all articles used for food, drink, confectionery, or condiment, whether simple or compound, and all substances and ingredients used in the preparation thereof.

REG. NO. 2. Protection of foodstuffs.—The floors, side walls, ceilings, furniture, receptacles, utensils, implements, and machinery of every establishment or place where food is manufactured, packed, stored, sold, or distributed, shall at no time be kept in an unclean, unhealthful, or unsanitary condition; and for the purposes of these regulations, unclean, unhealthful, and unsanitary conditions shall be deemed to exist if food in the process of manufacture, preparation, packing, storing, sale, or distribution is not securely protected from flies, dust, dirt, unsanitary conditions, and from all other foreign or injurious contamination; and if the refuse, dirt, and the waste products subject to decomposition and fermentation incident to the manufacture, preparation, packing, storing, selling, and distributing of food are not removed daily; and if all trucks, trays, boxes, baskets, buckets, dishes, pans, and other receptacles, cloths, towels, chutes, platforms, racks, tables, shelves, and all knives, saws, clevers, and all other utensils, receptacles, and machinery used in moving, handling, cutting, chopping, mixing, canning, and all other processes used in the preparation of food, are not thoroughly cleaned daily; and if the clothing of operatives, employees, clerks, and other persons therein employed is unclean, or if they dress or undress, or leave or store their clothing therein.

REG. NO. 3. Persons infected with certain diseases prohibited from handling foodstuffs. No employer shall require, permit, or suffer any person to work, lodge, sleep, or remain, nor shall any person work, lodge, sleep, or remain in a building, room, basement, cellar, place, or vehicle occupied or used for the production, preparation, manufacture, packing, storage, sale, distribution, or transportation of food, who is afflicted or affected with any venereal disease, smallpox, diphtheria, scarlet fever, yellow fever, tuberculosis, consumption, bubonic plague, Asiatic cholera, leprosy, trachoma, typhoid fever, influenza, epidemic dysentery, measles, mumps, German measles, whooping cough, chicken pox, or any other infectious or contagious disease.

REG. NO. 4. Dogs and other animals prohibited.—It shall be unlawful for any person to bring into, or for any employer or employee to allow any dog, cat, or other domestic animal to enter or remain within any place of business occupied and used for any of the purposes described in regulation No. 1 hereof. REG. NO. 5. The foregoing regulations shall be considered as additional to and not as amendments of the present sanitary code.

1 This regulation is worded in, exact accordance with the copy furnished to the Public Health Service.

ILLINOIS.

Influenza-Reports of Cases-Placarding-Isolation-Precautions to Prevent Spread Quarantine-Regulations Governing Cases in Hospitals-Duty of Attending Physician-Removal of Cases-Attendance at Schools and Gatherings-Burial—Disinfection-Spitting Prohibited in Public Places. (Reg. Dept of Public H., Effective Jan. 12, 1920.)

RULE 1. Influenza to be reported; by and to whom.-Every physician, nurse, or other attendant, superintendent of any hospital, asylum, orphanage, jail, or similar institution, teacher in any school, proprietor of any drug store, proprietor of any hotel, lodging or boarding house, parent, guardian, householder, or any other person having knowledge of a known or suspected case of influenza, shall within 12 hours of such knowledge of such known or suspected case coming to his notice report the same in writing or by telephone to the local health authority. Every case reported by telephone shall be followed with a written report within 12 hours. Every case developing on the premises subsequent to the first reported case shall likewise be reported.

Note. The terms "the local health authority' as employed in these rules shall be understood to mean the local health officer, health commissioner, or chairman of the board of health, as the case may be.

If the municipality has no health officer, reports must be made to the mayor of the city, president of the village, or the official designated by ordinance to receive the same. Cases occurring in territory outside of the limits of a municipality must be reported to the persons designated by the rules of the township or county board of health to receive such reports, or, if there be no such person designated, reports must be made to the supervisor of the township or, in counties not under township organization, to the county board of health.

Upon receipt of such report the local health authority shall immediately forward a copy of the same to the Illinois Department of Public Health, Springfield, Ill.

RULE 2. Information to be given in report. The written report of a known or suspected case of influenza, required by these rules, shall set forth at least the following information: (1) Place and date of report; (2) name, exact address, age, sex, color, and occupation of the diseased person; (3) number of children and adults in household; (4) schools attended or places of employment, giving names and addresses of employers and mentioning particularly any engaged in handling milk or foodstuffs; (5) type of the disease; (6) date of onset of illness; (7) date of quarantine established; (8) precautions taken to prevent spread of infection; (9) name and address of person making the report.

RULE 3. Placarding.—Whenever a case of influenza is reported to the local health authority he or his authorized representative shall affix in a conspicuous place at each outside entrance of the building, house, or flat, as the case may be, a red warning card not less than 10 by 14 inches in size, on which shall be printed in black, with bold-faced type, at least the following: "Influenza " in type not less than 3 inches in height, and "Keep out" in similar type not less than 2 inches in height. Defacement of such placards or removal by any other than the local health authority, his authorized representative, or the duly

authorized representative of the Illinois Department of Public Health is strictly prohibited. The health officer shall hand the attendant or some responsible member of the household a copy of these rules and instruct such person in their requirements.

RULE 4. Isolation of patient and other necessary precautions.-Any person having influenza, together with the necessary nursing attendant, shall be confined to a large, well-ventilated room of proper temperature, remote from other occupants of the premises.

The period of isolation shall continue during the course of the disease and until all clinical manifestations of the disease have disappeared and the temperature has been normal for five successive days.

None other than the necessary medical and nursing attendants shall enter the sick room or come in contact with the patient. The attendant shall avoid contact with other members of the household. He should wear a face mask of gauze or other approved material when in attendance upon the patient, and such mask shall not be removed from the sick room until it has been properly sterilized.

Visiting on premises on which a known or suspected case of influenza exists is strictly prohibited.

All discharges from the respiratory tract, mouth, throat, and nose of the patient shall be received in cloths, which shall be burned immediately after using or placed in vessels containing an approved disinfecting solution.

Soiled body and bed clothing shall be disinfected by boiling or by immersion in an approved disinfecting solution, such as a 5 per cent compound cresol solution. Any article used by the patient or attendants, such as knives, forks, spoons, glasses, cups, plates, etc., must be disinfected before leaving the sick room. Floors, furniture, and woodwork should be wiped up daily, employing cloths moistened with an approved disinfecting solution.

When the foregoing precautions are properly observed, other occupants of the premises who show no evidence of illness need not be confined to the premises. It is required, however, that persons residing on premises on which a case of influenza exists shall refrain from attending public gatherings and avoid unnecessary contact with other persons.

It shall be the duty of the local health authority to determine if the foregoing precautions are being observed, and wherever it is discovered that proper observance is not exercised to immediately place the premises and all inmates thereof under strict quarantine, prohibiting inmates from leaving the premises and others from entering the premises, excepting the necessary medical attendant.

Whenever a case of influenza is found in an indigent family, the same shall be promptly reported to the overseer of the poor (usually the supervisor) in order that such family may be provided with necessities.

RULE 5. Hospital regulations.-Whenever influenza is epidemic or threatens to become epidemic in the community visitors shall be excluded from hospitals, asylums, and other similar institutions, except in case of actual emergency, such as impending death, and shall be admitted then only when every precaution has been taken to protect the patient, attendants, and other inmates, the visitor, and the public.

Whenever patients suffering from influenza are treated in a hospital housing patients suffering from other diseases, the quarters assigned to influenza patients shall be so isolated as to avoid contact with uninfected persons.

When more than one patient suffering from influenza is housed in a ward or room, sneeze sheets of approved pattern shall be employed for each patient.

Whenever any patient suffering from influenza develops pneumonia, that patient shall be promptly removed from the quarters occupied by other influenza patients and properly isolated, either in a private room or with other patients who have developed pneumonia in association with or following influenza.

RULE 6. Instruction; duty of physicians.—It shall be the duty of every physician attending a case of influenza to see that the patient and attendant are properly isolated in accordance with these rules, to advise the patient, the members of the family and household, and the attendant as to the nature of the disease, the means whereby infection may be avoided, and the provisions of these rules.

RULE 7. Removals.-No case of influenza shall be removed from the premises on which found unless consent to such removal be first obtained from the local health authority or from the Illinois Department of Public Health.

No case of influenza shall be removed from any city, village, township, or county in which it is found unless consent to such removal be first obtained from the health authorities of the jurisdiction from and to which removal is contemplated, and from the Illinois Department of Public Health: Provided, however, That whenever a contagious disease hospital maintained by a municipality or county is located in another health jurisdiction from that in which the case is found, the patient may be removed to such contagious disease hospital without first obtaining the permission of the Illinois Department of Public Health.

RULE 8. Exclusion from school, public and private gatherings.-It shall be the duty of the principal or any other person in charge of any private, public, parochial, or Sunday school to exclude therefrom any child, teacher, or other person afflicted with influenza or suspected influenza until such child, teacher, or other person shall have presented a certificate issued by the local health authority, if he is a physician, or by the attending physician, countersigned by the local health authority, certifying that such child, teacher, or other person is noninfectious.

Any child, teacher, or other person who is an inmate of a household in which there is any person suffering from influenza shall be excluded from any private, public, parochial, or Sunday school and from public or private gatherings, until the termination of the quarantine of the premises.

RULE 9. Disposal of the dead.-Disposal of the body of anyone dead from influenza shall be effected within 48 hours. The undertaker or person acting as such shall wash the body with an approved disinfecting fluid and close all orifies with absorbent cotton. The body shall then be placed in the casket or coffin which shall be immediately closed and shall remain in the sick room until removal for burial or other disposal. The casket or coffin shall be air-tight and permanently sealed and must not be opened under any pretext whatever: Provided, however, That a plate of glass of sufficient size to disclose the face of the decedent may be fitted into the coffin cover in such manner as to be airtight and not removable.

Prior to the removal of the body the undertaken or person acting as such shall secure a burial permit from the local registrar of vital statistics in accordance with the provisions of the statutes.

Every human body dead from influenza, interred in any burying ground or cemetery in Illinois shall be buried so that the top of the outside coffin shall be at least 4 feet below the natural surface of the ground and shall be immediately covered with at least 4 feet of earth, soil, or sand: Provided, That this shall not apply where bodies are placed or buried in properly constructed private vaults so as to prevent the escape of gases therefrom.

When the body of anyone dead from influenza is to be transported by railroad or by other common carrier, the official rules of the Illinois Department of Public Health for the transportation of the dead shall be strictly observed. In preparing the body the undertaker or person acting as such shall take such precautions as not to cause, contribute to, or promote the spread of the disease.

Public funerals are permissible in deaths from influenza when the foregoing conditions are observed.

RULE 10. Terminal disinfection.—Upon the termination of the case, the premises occupied by the patient shall be given a thorough cleansing, airing, and sunning.

RULE 11. Spitting in public places.-Inasmuch as the infective organism of influenza is harbored in the respiratory tract, nose, mouth, and throat, discharges from same shall not be cast in public places. All such discharges should be received in handkerchiefs or cloths which, after using, shall be burned or be disinfected by boiling or immersion in any approved disinfectant.

Trachoma-Reports of Cases-Isolation-Information to Be Given Patient and Members of Household-Precautions by Patient-Duties of Local Health Authorities-Removal of Patient to Another Health JurisdictionAttendance at Schools and Gatherings. (Reg. Dept. of Public H., Effective Oct. 1, 1920.)

RULE 1. Reports.—Every physician, nurse, or other attendant, superintendent of any hospital, asylum, orphanage, jail, or similar institution, teacher in any school, proprietor of any drug store, proprietor of any hotel, lodging or boarding house, parent, guardian, householder, or any other person having knowledge of a known or suspected case of trachoma, shall within 12 hours of such knowledge of such known or suspected case of trachoma coming to his notice, report the same in writing or by telephone to the local health authority. Every case reported by telephone shall be followed with a written report within 12 hours. Upon receipt of such report the local health authority shall within 12 hours forward copy of the same to the State department of public health, Springfield, Ill. Every case developing on the premises subsequent to the first reported case shall likewise be reported.

Note. The term "the local health authority," as employed in these rules shall be understood to mean the local health officer, health commissioner, or chairman of the board of health, as the case may be.

If the municipality has no health officer, reports must be made to the mayor of the city, president of the village, or the official designated by ordinance to receive the same. Cases occurring in territory outside of the limits of a municipality must be reported to the persons designated by the rules of the township or the county board of health to receive such reports, or, if there be no such person designated, reports must be made to the supervisor of the township or, in counties not under township organization, to the county board of health.

RULE 2. Information to be given in report to health authorities.-The written report of a known or suspected case of trachoma, required by these rules, shall set forth at least the following information: (1) Place and date of report; (2) name, exact address, age, sex, color, and occupation of the diseased person; (3) number of children and adults in household; (4) school attended or place of employment, giving names and [addresses of] employers and mentioning particularly any engaged in handling milk or foodstuffs; (5) type of disease; (6) date of onset of illness; (7) precautions taken to prevent spread of infection; (8) name and address of person making the report.

RULE 3. Isolation.-Unless the person suffering from trachoma is under the care of a physician and complies with the rules governing the control of the