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., NEW SERIES. VOL. II. AUGUST 16, 1913. No. 33 NEW PROCEDURE IN RELATION TO CONTAGIOUS DISEASES. A circular of the Department of Health describing the present procedure in the surveillance of diptheria, scarlet fever and measles, which is now being printed, will shortly be ready for delivery and distribution by the nurses and inspectors of the Division of Infectious Diseases to parents and guardians of children suffering from these diseases. In the meantime, in order that physicians, particularly, may take note of the changes in procedure, the circular is printed in this issue of the Weekly Bulletin. The most noteworthy changes in procedure which are indicated in the new circular are as follows: 1. Insusceptible persons (those who have had diphtheria, measles or scarlet fever), will not be excluded from school while a case of infectious disease still exists at home, providing isolation is being satisfactorily carried out. 2. Cases of measles will be terminated five (5) days after the appearance of the rash, provided such a course is warranted by the clinical condition of the case. The circular, as prepared for general distribution, will be printed on heavy buff cards, with brass-bound perforations at the top so that the card may be suspended for ready reference. These cards will be printed in English on one side and in either German, Italian or Yiddish on the other side. The circular will read as follows: HOW TO KEEP FROM GETTING AND SPREADING CONTAGIOUS DISEASES. Diphtheria, scarlet fever and measles are very contagious diseases, and are communicated by the patients, or by articles that have recently come in contact with them, especially in the case of diphtheria and scarlet fever. These diseases must be considered contagious so long as patient is quarantined (kept away from the rest of the family) by the Department of Health. The contagion is mainly carried by the discharges from the nose and mouth. To keep from getting these diseases you must keep away from patients who have them. To keep from spreading these diseases, the sick person must be kept in one room to which no other persons are admitted except the doctor, nurse or attendants. 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). Diphtheria. 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. Scarlet Fever. Patients suffering from scarlet fever must be quarantined until declared well by a Department doctor. This will be in from four to six weeks. Measles. 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. Precautions. 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 hoiled 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 eases 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 Depart ment 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. Boroughs. VITAL STATISTICS Summary for Week Ending Saturday, 12 M., August 16, 1913. Manhattan 2,331,542 2,487,796 430,980 Brooklyn.... 1,634,351 1,845,443 Or eens Richmond.. 284,041 City of New York... 4,766,883 Corrected according to borough of residence. 5,372,983 1,362 1,250 1,250 2,695 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. Week Ending. May May May June June June June July July July July Aug. Aug. Aug. 17. 24. 31. 7. Total...... 2,769 2,904 2,517 2,817 2,344 2,333 2,024 1,360 1,413 1,300 1,099 1,021 |