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All communications relating to the publications of the Department of Health should be addressed to the Commissioner of Health, 149 Centre Street, New York

Entered as second class matter May 7, 1913, at the post office at New York, N. Y.,
under the Act of August 24, 1912.

NEW SERIES. VOL. II.

AUGUST 9, 1913.

No. 32

RULES AND REGULATIONS GOVERNING MANAGEMENT OF INFECTIOUS DISEASES BY HOSPITALS AND DISPENSARIES.

In the Weekly Bulletin of July 12, 1913, there appeared certain rules and regulations of the Department of Health which were to be observed by hospitals and dispensaries in regard to infectious diseases. The article contained some errors and omissions and, in order that no misapprehension may exist on the part of such institutions as to the methods to be pursued in their relation to these diseases, the rules are again published with additions and corrections.

Hospitals.

1. All infectious diseases must be reported immediately to the Department of Health by telephone and a postal card sent for each individual case. Postal cards will be furnished hospitals by the Department upon request.

2. Adequate isolation room must be provided and maintained as required by section 140 of the Sanitary Code.

3. Wards in which infectious diseases develop will be quarantined as follows: Diphtheria, quarantine is not required if all patients present or admitted are immunized and cultures do not show diphtheria bacilli, otherwise 10 days; scarlet fever, 5 days: measles. 14 days. Patients exposed to diphtheria, scarlet fever or measles, and desiring to return to their homes, may be discharged if their address is forwarded to the Department of Health. Small-pox, 21 days. In cases of small-pox, all patients in hospitals and all employces should be vaccinated. No patients are admitted to or discharged from the quarantined ward during this period.

4. Cases exposed to infectious diseases should be examined by a physician as follows: Diphtheria-should have a trial culture made from the nose and throat; scarlet fever should be examined each day for a period of 5 days; measles-should be examined daily from the 10th to the 14th day, subsequent to exposure; small-poxall persons exposed to small-pox shall be examined daily for a period of 21 days and should be revaccinated.

4-a. Persons suffering from milder infectious diseases, such as chicken-pox. mumps, whooping cough and German measles, may be discharged (to their homes) if the address of the patient is furnished to the Department of Health. The ward will not be quarantined, but should be cleaned and ventilated.

5. Written notice will be sent to the manager or superintendent of the institution, the Board of Education, the Society for the Prevention of Cruelty to Children, and the State Board of Charities, by the Department of Health on placing or raising quarantine for diphtheria, scarlet fever, measles and small-pox.

6. On removal of a case of infectious disease from a ward, the infected furniture and surroundings will be washed with a solution of washing soda, one pound in three gallons of hot water.

7. Should the manager of an institution desire fumigation of infected ward, and the same be deemed necessary by the Department, the Department will fumigate.

Nurseries.

1. Infectious diseases must be reported immediately by telephone.

Substitute: All infectious diseases must be reported immediately to the Department of Health by telephone and a postal card sent for each individual case. (Postal cards will be furnished by the Department of Health on request.) Patients will not be allowed to leave the building until seen by the Department of Health Inspector unless they reside in the immediate vicinity of the nursery, are able to secure proper care at home, and desire to return home.

2. All patients suffering with contagious diseases must be removed by the Department of Health ambulance to the Department of Health Hospital.

Substitute: All patients suffering with diphtheria, scarlet fever, or measles, who do not reside in the immediate vicinity of the nursery and do not desire to return home must be removed by Health Department ambulance to the Health Department Hospital, unless proper isolation can be provided and maintained at the institution. All cases of small-pox must be isolated at the nursery until seen and disposed of by the Department of Health Inspector.

3. The nursery is quarantined until thorough disinfection can be performed by the Department of Health.

4. The children exposed to the particular diseases are excluded from the nursery during the incubation period of the disease.

5. Adequate isolation room must be provided and maintained as required by section 140 of Sanitary Code.

Asylums and Homes for Children.

The same requirements exist as for hospitals, with the exception that for children attending public school, a certificate issued by the Department of Health must be furnished.

Dispensaries.

1. All infectious diseases must be reported immediately to the Department of Health by telephone and a postal card sent for each individual case. Postal cards will be furnished dispensaries by the Department of Health on request. Patients will not be allowed to leave the building until seen by the Department of Health Inspector, unless they reside in the immediate vicinity of the institution, are able to secure proper care at home, and desire to return home.

2. With the above exception, all patients suffering from diphtheria, scarlet fever or measles, must be seen by a Department of Health Inspector, who will order their removal by ambulance either to their homes or to Department of Health hospitals. All cases of chicken-pox in persons over 16 years of age and cases of small-pox, must be isolated at the institution until seen and disposed of by the Department of Health Inspector.

3. Adequate isolation room must be provided and maintained as required by section 140 of the Sanitary Code.

4. Infected rooms must be properly disinfected by person in charge.

IMPORTANT DECISION IN REGARD TO DIRTY MILK.

A milk dealer in the City of Washington was tried before the Police Court of the District of Columbia for having sold milk that was adulterated, in that it "consisted in whole or in part of filthy, decomposed and putrid animal and vegetable substance" and had thereby violated the National Food and Drugs Act. The milk in question contained large numbers of colon bacilli and streptococci, indicating insanitary production or handling of the milk. The defendant was found guilty and appealed, but the Court of Appeals of the District of Columbia, sustained the conviction in a decision rendered February 25, 1913. Mr. Justice Van Orsdel in delivering the opinion of the court stated in part as follows:

"The facts established by the evidence are that on February 27, 1911, a pint bottle of milk was purchased from one of the defendant's wagons, and taken to the laboratory

of the Bacteriological Bureau of the Health Department, where it was analyzed and found to contain 4,500,000 bacteria on ordinary agar, 37 degrees centigrade, grown for 24 hours, and 89,400,000 bacteria per cubic centimeter. On ordinary agar, 25 degrees centigrade, grown 48 hours, it contained 83,000 bacteria per cubic centimeter of the colon group. It showed gas fermentation in one ten-thousandth of a cubic centimeter, approximately 15 drops and one streptococcus to one ten-thousandth of a cubic centimeter."

"It appears that the bacterium known as B. coli or colon bacillus originates in and is a normal constituent of the colon of all warm blooded animals, is discharged in the excreta and found in milk as the result of fecal contamination. When present in milk it always occurs from either direct or indirect fecal deposit therein; directly from carelessness in permitting particles of feces to get into the milk during the process of extracting the milk from the cow, or in handling it afterwards; indirectly, from dust, vegetation, water and air, where the bacillus is found-originally derived, however, from animal feces. The evidence discloses the state of the science to be that colon bacillus is a vegetable formation originating in animal intestines, and nowhere else. It is not found in air, dust, water or vegetation under conditions indicat ing different origin or its original derivation from the substances with which it is thus associated. Under favorable conditions colon bacillus will multiply and develop in milk with great rapidity. The present analysis, in the light of the evidence, reveals the presence of colon bacillus to have resulted from a direct deposit of feces in the milk, due to uncleanly methods in handling the milk."

"It is urged that since it is impossible to produce milk entirely free from bacteria, the statute imposes a duty impossible of performance, and cannot, therefore, be applied to milk; or, if possible of performance, it could only be complied with at so great a cost as to result in the destruction and confiscation of the business. It is not clear from the evidence that the enforcement of the act will produce this result. The present case does not present this difficulty, except in theory; since the contamination was so great as to place it within the statute beyond the domain of speculation. Not only did the milk in question contain bacteria of the colon group, but, as incident thereto, fecal matter, all of which, it appears, may be eliminated by the adoption of cleanly methods in handling the milk. In fact, it appears that samples from the dairy of plaintiff in error have been analyzed, which were free from bacteria of the colon group. One witness testified that he has encountered milk, samples of raw milk and samples of pasteurized milk, free from bacteria of the colon group; has seen samples of defendant's that did not contain them, milk sold as raw milk and analyzed on that assumption."

"We are not dealing with a regulation relating to milk alone, but with an act generally regulating the sale of food products. Milk is a food product; and, if found to be impure, it will be held to be 'adulterated' within the provisions of the ac.. There is evidence that it is impossible to produce raw milk which does not contain bacteria; that a limited number of bacteria in milk are practically harmless. It is unnecessary to decide whether, under such circumstances, milk would be held to come within the act, since in the present case adulteration is clearly established. The dividing line between pure and impure or adulterated food is in each instance a question of fact; but, because of the scientific distinctions involved, and the impossibility of producing raw milk entirely free from bacteria, it may be much more difficult of ascertainment in the case of milk than of other food products. Owing to the great difficulty which may be encountered in justly enforcing the law, in the absence of a fixed standard defining what is marketably pure and impure milk, in a case where the adulteration consists alone in the presence of comparatively small numbers of so-called harmless bacteria, it may well be that Congress should give attention to this subject, as has been done in many of the States, and establish a fixed standard for marketable milk, whereby milk found to contain a greater number of bacteria than that fixed by the act should come within the condemnation of the law."

This decision is of importance to the City of New York, not only in-so-far as that part of its milk supply which comes under the domain of Interstate commerce is concerned, but also in regard to that part of the supply which is not so governed. Subdivision 8, of section 53, of the Sanitary Code of the Department of Health, states that milk shall be regarded as adulterated "which has been diluted with water or any other fluid, or to which has been added, or into which has been introduced, any foreign substance whatever, or which consists in whole or in part of filthy, decomposed or putrid animal or vegetable substance; or if it is the product of a diseased animal." This section is therefore supported by the decision quoted above.

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Borough

VITAL STATISTICS

Summary for Week Ending Saturday, 12 M., August 9, 1913.

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Corrected according to borough of residence.

12 73 13 50

↑ 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.

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10.

17. 24. 31.

7.

14.

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Richmond

Total.

Cases of Infectious and Contagious Diseases Reported.

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Week Ending. May May May May June June June June July July July July Aug. Aug.

Tuberculosis...

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481 352 423 495 397 414
224 228 187 192

381

96

544 522

Scarlet Fever..

300 294 292

224 228 169

185

93

77

Smallpox.......

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Chickenpox...

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Typhoid Fever

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Whooping

Cough...

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167 175

69 !

172 50

88

37

Cer.-Spinal)

6

Meningitis..

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