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Return to School.
If quarantine is observed, the other children and teachers in the family who are insusceptible (have had the disease), or who have no diphtheria bacilli in their throats (as shown by culture) and have been immunized, are not excluded from school. If they are susceptible, they must reside for a suitable period at another address before being allowed to return to school (scarlet fever for five days; measles for fourteen days).
After ending of quarantine, a school certificate will be issued to the patient by the Department of Health Nurse, and other children in the family who have remained on the premises but have not had the disease, can then return to school (after five days in scarlet fever; fourteen days in measles).
Patients suffering from diphtheria must be quarantined until a culture from the nose and throat no longer shows diphtheria bacilli.
If antitoxin is given on the first day and in large enough dose, 99 out of 100 patients get well.
All other persons in family should be protected against the disease by the immediate injection of small doses of diphtheria antitoxin. If cultures from their throats do not show diphtheria bacilli, and quarantine is satisfactory, they may then return to school.
Patients suffering from scarlet fever must be quarantined until declared well by a Department doctor.
This will be in from four to six weeks.
Patients suffering from measles will be quarantined until five days after appearance of the rash, if otherwise well.
The chief danger is pneumonia. To avoid it, see that the room is properly ventilated and doctor's orders carefully observed.
During the illness all unnecessary furniture, such as curtains, carpets and pictures should be removed from the sick-room.
Dogs, cats and other pets should be kept out of the sick-room, as they often carry the disease to others.
Discharges from the mouth, throat and nose should be received on cloths and immediately burned or boiled.
Bed linen, towels, napkins, etc., should be disinfected by soaking in a solution of 21⁄2 per cent. carbolic acid. This should be done before goods are removed from sick-room. These goods should then be boiled in soap suds for one-half hour. The patient's night gowns, sheets, etc., should be soaked in the solution of carbolic acid and washed in hot soap suds.
Dishes and utensils used by the patient should be kept in the sick room until recovery, unless scalded with boiling water before removal.
The nurse or attendant, while in the sick-room, should wear a special gown or other outer garment, completely covering her clothing. On leaving the room, she should soak her hands in a disinfecting solution and then wash them in hot soap suds.
Urine and stools, immediately after being received in a vessel, should be covered with an equal quantity of a solution of one tablespoonful of chloride of lime in one quart of water, and allowed to stand fifteen minutes before emptying.
Upon recovery, the patient should be bathed and hair washed in warm soap suds, then dressed in clean clothes which have not been in the sick-room.
Disinfection After Illness is Over.
In scarlet fever, when patient recovers, the Department of Health fumigates the rooms and bedding used by the patient. In private houses this may be done under the supervision of the family physician, but he must furnish a certificate to that effect. In diphtheria and measles. when the patient recovers, the sick-room must be thoroughly cleaned and aired. All woodwork and floors in the sick-room should be scrubbed with a hot solution of one pound of washing soda to three gallons of hot water. The patient's night gown, sheets, etc., should be first soaked in the carbolic solution and then boiled in soap suds for one-half hour. Books and toys used by the patient should be destroyed by burning.
If the patient dies or is removed to a hospital, the room with all its contents must be immediately closed up until fumigated by the Department of Health.
If the patient dies, burial within twenty-four hours is required. None but the immediate members of the family may attend the services which must be held at the house. The Department of Health, in order to prevent the spread of the above dis
1. Placards the door of the premises.
2. Excludes from school all susceptible persons living in quarantined premises, 3. Prohibits work of any kind being done in the rooms of the family, such as tailoring, laundering, etc. Closes stores that have connection with the sick-room. 4. Compels susceptible persons living in infected premises whose occupation has to do with milk or food, to stop work or reside elsewhere.
A Nurse of the Department of Health visits the premises at suitable intervals to see that the above regulations are complied with. If they are disobeyed, the Department of Health will, in its judgment, remove the patient to one of its hospitals.
DEATH RATE FOR WEEK ENDING AUGUST 9, 1913.
During the past week there were reported 1,390 deaths against 1,269 deaths during the corresponding week of last year, the respective rates being 13.50 and 12.73. This increase of 121 deaths and .77 in the rate is to be attributed to the exceptionally warm weather that prevailed during the past week, the mean temperature for the week being approximately 8 degrees higher than that of the corresponding week of last year. This is borne out by the increased number of deaths reported from diarrhoeal diseases and sunstroke. There was also an increase of 36 deaths from violence, under which heading falls from windows and fire-escapes, accidental drownings, and other deaths which may be indirectly attributed to the warm weather, are included. The increased number of deaths from diarrhoeal diseases is reflected in the number of deaths of children under one year of age, which heading shows a slight increase. Deaths from heart diseases show an increase of 35 deaths, although this is somewhat offset by the reduction in the number of deaths reported from Bright's disease and nephritis. There was a slight increase in the number of deaths from measles, but the other infectious diseases showed a reduction.
Notwithstanding the fact that the death rate for the past week was 77 of a point higher than the death rate for the corresponding week of last year, there were relatively only 79 more deaths, when we take into consideration the increase in the population. The death rate for the first 32 weeks of 1913 is lower than that for the corresponding period of last year, the rates being 14.57 and 14.74, respectively.
DEATH RATE FOR WEEK ENDING AUGUST 16, 1913.
During the week just ended there were 1,250 deaths reported with a rate of 12.14, against 1,362 deaths with a rate of 13.73 for the corresponding week of last year. There were actually 112 fewer deaths; but if the increase of the population is taken into consideration, there was a saving of 160 lives. The deaths from diarrhoea were 42 fewer; the deaths under one year of age also show a gratifying decrease. There were no deaths reported from sunstroke. There were 4 more deaths reported from pulmonary tuberculosis than were reported during the corresponding week of last year. The rate, however, is lower for the past week. Comparing the past week with the week ending August 9, 1913, there were 140 fewer deaths reported, the reduction in the number of deaths from diarrhoeal diseases and of deaths under one year of age being largely responsible for this reduction in the mortality. The death rate for the first 33 weeks of 1913 is lower than that of the coresponding period of 1912. the rates being 14.57 and 14.79 respectively.
Summary for Week Ending Saturday, 12 M., August 16, 1913.
56 15.13 12.82 12.69
12.25 11.05 11.05
11.08 12.61 14.21
I 26.46 19.59 17.41
†The presence of several large institutions, the great majority of whose inmates are non-residents of the city, increases considerably the death-rate of this Borough. Deaths by Principal Causes, According to Locality and Age.
Total, all cause s..... 1,250 1,362 678
1. Typhoid Fever.... 10
3. Malarial Fever...
6. Scarlet Fever..
13. Tuberculosis Pul
14. Tuberculous Men
15. Other forms of Tuberculosis...
16. Cancer, Malignant Tumor...
17. Simple Meningitis. Of which
17a. Cerebro Spinal Meningitis.....
18. Apoplexy, Softening of the Brain
19. Organic Heart Diseases....
20. Acute Bronchitis.. 21. Chronic Bronchitis. 22. Pneumonia (ex-) cluding Broncho Pneumonia)...
22a. Broncho Pneumonia 23. Other Respiratory Diseases..
24. Diseases of the Stomach (Cancer excepted)..
25. Diarrhoeal diseases (under 5 years)
26. Appendicitis and Typhilitis.....
27. Hernia. Intestinal
28. Cirrhosis of Liver.. 29. Bright's Disease
30. Diseases of Women (not Cancer)
31. Puerperal Septícæmia..
32 Other Puerperal Diseases..
bility and Mal
37. All other causes...
38. Ill-defined causes..
*If the deaths under one month, numbering 101, from all causes, be deducted from the total deaths under one year, the resultant rate will be 92 deaths of infants per 1,000 births (weekly average July 1, 1912 to July 1, 1913)
Corrected Mortality Among Children. Week Ending August 16, 1913.
City of New York... 340
55-3 52 92 463
42.2 185 16.9
Includes Small Pox, Measles, Scarlet Fever, Diphtheria and Whooping Cough. Deaths According to Cause, Annual Rate per 1,000 and Age, with Meteorology and Number of Deaths in Public Institutions for 14 Weeks.
Week Ending-May May May June June June June July July July July
Total deaths.... 1,531 1,572 1,323 1,447 1,303 1,370 1,182 1,291 1,270 1,250 1,249 1,310 1,390 1,250 12.14 12.13 12.72 13.50
Mean barometer. 29.90 29.87 29.77 29.88 30.00 29.89 29.89 29.89 29.76 29.80 29.88 29.93 29.91 29.99 Mean humidity.. 55-7 70.9 66.7 69.4
ture (Fahr- 55.9° 60.7° 61.3° 69.1° 65. 72.9 73 4° 79.° 73.6 75.9° 75.° 77.3 74.9 72.9°