Sanitary Code, Chapter II

Regulation 4. Reporting cases of disease presumably communicable in schools. When no physician is in attendance, it shall be the duty of every teacher to report forthwith to the principal or person in charge of the school all facts relating to the illness and physical condition of any child in such school who appears to be affected with a disease presumably communicable. It shall be the duty of the principal or person in charge of every school to report forthwith to the local health officer all facts relating to the illness and physical condition of any child attending such school, who appears to be affected with any disease presumably communicable, together with the name, age and address of such child. Such Ichild shall be at once sent home or isolated.

Regulation 26. Exclusion from school of cases of disease presumably communicable. It shall be the duty of the principal or other person in charge of any public, private, or Sunday school to exclude therefrom any child or other person affected with a disease presumably communicable until such child or other person shall have presented a certificate issued by the health officer, or by the attending physician and countersigned by the health officer, stating that such child or other person is not liable to convey infective material.

Regulation 27. Exclusion from schools and gatherings of cases of certain communicable diseases. No person affected with chickenpox, diphtheria, epidemic cerebrospinal meningitis, epidemic or septic sore throat, German measles, measles, mumps, poliomyelitis (infantile paralysis), scarlet fever, smallpox, trachoma, or whooping cough, shall attend or be permitted to attend any public, private, or Sunday school, or any public or private gathering. Such exclusion shall be for such time and under such conditions as may be prescribed by the local health authorities, not inconsistent with the provisions of this code or the special rules and regulations of the state department of health.

Regulation 28. Exclusion from schools and gatherings of children of households where certain communicable diseases exist. Every child who is an inmate of a household in which there is, or has been within fifteen days, a case of chickenpox, diphtheria, epidemic cerebrospinal meningitis, German measles, measles, mumps, poliomyelitis (infantile paralysis), scarlet fever, smallpox, or whooping cough, shall be excluded from every public, private, or Sunday school and from every public or private gathering of children for such time and under such conditions as may be prescribed by the local health authorities, not inconsistent with the provisions of this code or the special rules and regulations of the State Department of Health.

EXAMINATION FOR DISTRICT HEALTH OFFICERS IN MASSACHUSETTS

An examination for district health officers in Massachusetts will be held in Boston on May 25 and 26, 1916, salary from $2,000 to $3,500. Further information may be obtained by writing to Dr. A. J. McLoughlin, Commissioner of Health, State House, Boston, Mass.

MEDICAL INSPECTION IN SCHOOLS AN EDUCATIONAL PROBLEM

WILLIAM A. Howe, M.D.

Medical Inspector of Schools, State Education Department, Albany

There is no education question which is today attracting greater attention, or in which our people are more deeply interested, or which presents greater possibilities, than that pertaining to the conservation of the health and physical condition of the school child. It should be equally as applicable to the teacher as to the pupil and to the home as well as to the school.

It should resolve itself into one comprehensive system of health education. It should teach parents the real meaning of medical inspection, and enlist their cheerful cooperation in its intelligent and efficient administration. It should afford means of preventing many of the unfortunate defects acquired in childhood and teach children not only how to escape much illness but to cultivate strong bodies.

It should do more than any other agency to enable teachers and parents to recognize promptly many of the communicable diseases of childhood and to aid in their suppression.

It should recognize physical, mental, or other defects of children, teachers or janitors, and utilize available agencies to secure the correction of such defects.

It should be so administered as not only to popularize good health but to put a premium on it. We should be permitted to credit our children and teachers with good health, and strong bodies just as we do good attendance and efficient school work.

Special instruction in medical inspection and physical training should be given to the teachers of the State now in active service, and to those in preparation for such profession.

Physicians and dentists should be still further impressed with the importance of the work, and their careful cooperation enlisted in the efficient enforcement of the law.

Dental inspection should be made a regular part of medical inspection, and the dentist compensated for his services.

Medical and dental colleges should receive lectures on this phase of education. Hospitals and nurses should receive special attention, as the well equipped nurse is rapidly becoming an indispensable factor in the successful administration of medical inspection.

Our hospitals should devote particular attention to the preparation of the school nurse as an educator.

Health and educational agencies should unite their efforts on every occasion to spread the gospel of cleanliness, and rightful living, in doing which communicable diseases will eventually be suppressed, and strong bodies be the rule rather than the exception.

HISTORY OF A TYPHOID CARRIER IN ORANGE COUNTY

Sanitary Supervisor Berry reports:

Mr. G., age 55 years, has run a dairy farm in the town of N

on the outskirts of the city, for the past ten years or more. The milk produced on his place has been sold in the city of N

About 16 years ago he had an attack of typhoid fever, has been in good health since that time, and does the work on his farm, including milking, assisted by his son and other members of his family.

The milk was not peddled directly by Mr. G. himself, but was sold to retail milk men, who distributed it with milk from other farms to their customers throughout the city.

In 1912-1913 the milk supply was suspected and examinations were conducted by the local authorities, and by the State Department of Health. Mr. G. was implicated and had a long controversy with the State and local officials, but it could not be ascertained that anything was ever definitely proven against his milk supply.

During 1913, Dr. B- was appointed health officer, and it was due to his activity that the typhoid morbidity was lowered, the cases decreasing from 50-75 a year to 20-30. This was accomplished by following up the milk supply in each outbreak and shutting off the suspicious places. When the outbreaks ceased, these suspicious places would number four to six dairy farms, and Mr. G.'s place was always one of the number.

In 1914 an outbreak of 32 cases occurred which was traced to the ice cream manufactured at C.'s factory in NHere it was thought that an adjacent privy had infected the water of a pond in which the cans were washed and this had caused the epidemic. However, the milk

from which the ice cream was made came from the G. farm. Early in 1915 another outbreak occurred and again was traced to a few farms, one of which was G.'s place. Widal tests were made of all

persons on the farms, and specimens of feces sent from all persons on the G. farm to Albany for examination. Through some delay in transportation the examinations were worthless and other specimens could not be obtained. G. was, however, warned against selling any milk in N

Later in 1915 typhoid broke out again and was traced to a dealer in milk named P. His miik came from a dairy on which one of the helpers had typhoid three years before. A careful examination of blood and fecal specimen from this helper proved negative. It was learned, however, that his own milk supply being short. Mr. P. had been quietly obtaining a couple of cans (80 quarts) of milk per day from Mr. G. and had used this milk in his own family. Two weeks from the time he obtained his first supply from G., one of P.'s family was taken with typhoid, followed shortly after by another. Other cases occurred along the milk route.

The Sanitary Supervisor of the district, with the help of the health officer of the town of Nfinally succeeded in getting a fresh specimen of feces from Mr. G., which was taken to the State Laboratory in New York City within three hours' time. The specimen was found to be teeming with typhoid bacilli.

A specimen of blood from Mr. G. was positive for the Widal reaction. The high typhoid morbidity of the town of N is explained by the above statement, as the water supply has been treated with hypochlorite of lime for the past two years, with no effect on the typhoid outbreaks.

Mr. G. has gone out of the dairy business since the last outbreak.

N

is now under a Commission form of government, and the question of establishing a municipal pasteurizing plant is under consideration.

DIARRHEAL DISEASES

H. L. K. SHAW, M.D.

Director, Division of Child Hygiene

Diarrheal diseases are preventable and largely unnecessary, and their prevalence in any community should brand it with the same stigma which is now attached to an outbreak of typhoid fever. A statistical study of the number of cases of diarrheal deaths under two years, the most susceptible age, which occurred in this State annually since 1907 is most instructive.

It will be noted in Table I that the number of diarrheal deaths in New York City has steadily decreased from 6,360 in 1907 to 3,735 in 1915.

The deaths from diarrhea in the rest of the State are in the aggrega.e much less in number but have not shown the same proportionate decrease. It is noteworthy that while the total population in New York City and the rest of the State is practically the same, there were more than twice as many cases of diarrheal deaths in New York City in 1907 than there were in the rest of the State. The chief factors in the causation of diarrheal deaths are food and heat.

Table II shows the number of diarrheal deaths occurring during the last nine years in the months of June, July, August and September. The great predominance of deaths during these months amply justifies one's dread of summer diarrhea. Unfortunately, statistics are not available showing the number of babies fed on breast milk and those who are artificially fed, but in several places where such investigations have been made the ratio is about one to ten. Extremely hot weather, with a high humidity, lowers the resistance of the child and makes it more susceptible to infections through the alimentary tract. Investigations made by the New York Association for Improving the Condition of the Poor show very conclusively that the prevalence of flies had a marked influence on the number of cases of diarrheal disease. The very striking diminution of diarrheal deaths in New York City can be largely attributed to the improvement of the milk supply. It is fair to assume that the climatic conditions in New York City and the rest of the State were each year the same, and can not be considered as a factor in comparing the two mortalities. All the milk in the City of New York, with the exception of certified milk, is pasteurized, and this precautionary measure has saved literally thousands of lives and prevented hundreds of thousands of cases of nonfatal diarrheal disease.