upon animals. Cultures from such non-contact carriers may be submitted for virulence tests immediately. When diphtheria, is prevailing, if carriers are discovered who give no history of direct contact with a case or a carrier of diphtheria bacilli, virulence tests will be made immediately upon receipt of a detailed statement of the facts from the Health Officer. When a Health Officer feels that there are extraordinary and urgent reasons for requesting virulence tests upon cultures from a recovered case or contact carrier, he should take the matter up with his sanitary supervisor, or with the Director of the Division of Communicable Diseases. The control of convalescent and contact carriers is an iniportant factor in the prevention of the spread of diphtheria. It should be borne in mind that organisms from mild cases, perhaps simulating tonsilitis, may be highly virulent for other persons. Treatment The treatment recommended for diphtheria carriers is general and local in character. The general treatment consists of fresh air and exercise, sunlight, simple and nourishing diet, and painstaking habits of personal hygiene. In a majority of instances the carrier condition will ultimately yield without other treatment; indeed, in many, without any treatment. Local treatment consists of the correction of abnormalities of the mucous membrane of the nose and throat and topical applications. Whenever topical applications are selected, it should be clearly borne in mind that, to be effective, they must be used thoroughly, systematically and continually, often for a long time, and without at any time irritating the mucous membrane. Frequent, continued and thorough cleansing of the mucous membranes will accomplish more than anything else except operative treatment for the removal of focal points of inflammation. Numerous methods of local treatment have been suggested, all of which have apparently been used with some success in limited numbers of cases, but none of which can be recommended for general application. The following formula has been suggested for an antiseptic wash (Wadsworth; Journal of Infectious Diseases, Vol. 3, 1906, P. 793): For use in mouth and throat dilute with water one to two parts, in the nares four to five parts. NOTE.-When made in quantity the taste improves on standing. The salts should first be dissolved in water before adding alcohol. Precipitates are harmless but may be removed by decanting or filtration. The following solution is somewhat less pleasant to taste but equally effective: Alcohol . 20 per cent. 10 per cent. 70 per cent. For use in the nares, dilute with water, equal parts or more. A 2 per cent solution of dichloramin-T in chlorinated eucalyptol, sprayed into the nose and throat four or five times daily, has also been recommended. Rules and regulations for control of diphtheria carriers 1 A diphtheria carrier is a person who harbors in the secretions of his nose or throat the bacillus of diphtheria, either following recovery from diphtheria or without himself having contracted the disease. A person who still harbors the bacilli as a result of a recent diphtheria infection shall be regarded as a case of the disease, and not as a carrier, until at least five weeks have elapsed after the date of the first release culture. After that time, the Health Officer may, at his discretion, regard such a person as a carrier rather than as a case. 2 The local Health Officer, upon the discovery of the carrier condition shall immediately advise the carrier or his guardians of the condition and give him detailed instructions regarding the precautions to be observed in the disposal of the secretions of the nose and mouth and in his associations with other persons. If the carrier is a child attending school, the Health Officer shall immediately notify the medical school inspector, superintendent, or principal of the school, who shall immediately exclude him from the school. 3 A diphtheria carrier shall not leave the premises upon which he resides except under permission from the Health Officer, who shall issue such permission only for urgent reasons and when he is assured that necessary precautions will be taken for the protection of others. But no diphtheria carrier may be granted permission to attend church, Sunday school, moving picture shows, or other places of public assemblage; and he may be permitted to attend school only when, because of the existence of numerous carriers following an outbreak of diphtheria, classes are conducted in separate rooms and the children who are carriers are prevented from mingling with other children. 4 Without permission from the Health Officer the premises occupied by a diphtheria carrier shall not be visited by children not residing there. When on such premises there are children other than the carrier, who are attending school or Sunday school, the Health Officer shall immediately have cultures taken from their noses and throats for examination; and when any such children are discovered to be free of diphtheria bacilli, they are to be kept apart from the carrier and not permitted to use the same eating utensils, toilet articles, etc., used by the carrier. Pending the report upon the cultures, all such children shall be excluded from school. 5 No diphtheria carrier shall engage in any occupation involving the handling of milk or other food to be consumed by others, except that, if a housewife, she may, with the permission of the Health Officer, continue to prepare food for the family or household, provided each member of the same has been shown, by means of the Schick test, to be immune to diphtheria. Should the carrier reside or be employed upon a farm producing milk for sale, the Health Officer may prohibit the sale of the milk, cream, butter, or cheese from such farm, except as provided in Reg. 37, Chap. II, of the Sanitary Code. 6 When a virulence test upon a culture from a diphtheria carrier has shown the organisms not to be virulent for guinea pigs, the imposed restrictions may be removed by the Health Officer. 7 A diphtheria carrier may be regarded as free of the bacilli and be discharged from observation and restraint when two negative cultures, taken at intervals of not less than 24 hours, have been obtained. 8 Should a diphtheria carrier be unable or unwilling to observe the precautions herein indicated, the Health Officer may take such further action as may be necessary to safeguard public health, pursuant to sections 25 and 326-a of the Public Health Law. A chart presenting rules and regulations, approved by the Departments of Education and Health, for the exclusion of school children exposed to communicable diseases, has been revised and made to include poliomyelitis. A large amount of necessary correspondence has been carried on during the year, an approximate average of 90 letters weekly, exclusive of form and circular communications, having been prepared and sent out. During the latter part of the year, owing to the fact that the newly appointed Supervisor of Tuberculosis has been stationed in New York City, the records of tuberculosis have been in the custody of, and correspondence incidental thereto has been carried on by the Acting Director. In available time the writer has undertaken a study of conditions in the office, relative to the distribution of work among the employees of the Division, with a view to eliminating unnecessary procedures, and increasing efficiency. Something has been accomplished in this direction. We have referred, in discussing the activities of sanitary supervisors, to the problem of keeping supervisors informed as to the prevalence of communicable diseases in their districts. It is equally necessary that the Director of the Division be kept constantly informed as to prevalence throughout the State. After trying more or less intricate methods the writer devised the simple card shown herewith. Reports received each morning from health officers are entered upon the proper cards, which are then placed upon the Director's desk and examined by him daily. When he notes an unusual prevalence of a disease in any municipality a red "X" is placed opposite the figures indicating reported cases, a clerk prepares a postcard notice to be sent to the sanitary supervisor of the district (illustration, page 117) placing a circle about the check mark to indicate that the notice has been sent. Late in the year a request was received from a city official in another state for information regarding communicable disease. isolation hospitals. Detailed information was not available and, through the sanitary supervisors, a survey of the cities of the state was begun. An abstract of the information thus obtained is presented below: ISOLATION HOSPITALS IN CITIES (50,000 POPULATION OR UNDER) OF NEW YORK STATE During the year the Public Health Council has enacted a number of amendments and additions to the regulations of the Sanitary Code relating to communicable diseases (see Public Health Council report, pp. 35-91). Perhaps the most important and far reaching in their effect were those relative to the venereal diseases. |