of js?t. %onis 
 
 §Ualttt Qzpavttnsnt 
 
 November 20th, 1895. 
 
 In submitting this pamphlet, it is my intention to give to 
 the public, in a plain and condensed form, the sanitary precau¬ 
 tions to be observed in contagious diseases, and I have also 
 included the rules and ordinances enacted by the Municipal 
 authorities to govern such cases. 
 
 I earnestly recommend that the instructions and prevent¬ 
 ive measures be strictly carried out, and request the hearty 
 co-operation of all citizens in the work of suppressing contagious 
 diseases. 
 
 Health Commissioner. 
 
 
DIPHTHERIA. 
 
 1. Where hygienic conditions are bad, diphtheria will spread 
 from a single case and become endemic (confined to a circum¬ 
 scribed locality) or epidemic (prevailing generally in a com¬ 
 munity). The malady differs in intensity from the mildest 
 form, which resembles a simple sore throat, to the worst type of 
 blood-poisoning, which is intractable from the beginning. 
 
 2. How the Disease is Communicated.— Diphtheria is 
 communicable in all its forms, either by contagion or through 
 the medium of an infected atmosphere ; and when it has once 
 broken out in a house, it is liable to spread through the air of 
 the apartments, especially in overcrowded and badly ventilated 
 habitations. Children are much more liable to the disease than 
 adults, and are more subject to its violent forms. Adults may 
 have it so lightly as not to be aware of its existence, and thus 
 they may disseminate it ignorantly among children. All diph¬ 
 theria patients and persons in contact with them should be con¬ 
 sidered dangerous, and should not associate with others until it 
 is decided by a careful and intelligent physician that they can do so 
 without endangering others. This applies especially to children 
 attending schools, churches, or assemblies of any kind. Persons 
 in intimate contact with diphtheria cases are very liable to have 
 the bacillus in their throat secretion, and are therefore danger- 
 
 7 O 
 
 ous members of the community, for although showing no symp¬ 
 toms of the disease themselves, may be the means of trans¬ 
 mitting it to others. The disinfection of houses before it is 
 positively ascertained that the diphtheria bacillus is entirely ab¬ 
 sent from the throat should not be requested. 
 
 3. Active Measures of Prevention. —These consist (1) 
 in avoiding the special contagion; (2) in avoiding all crowded 
 assemblies in illy ventilated rooms during the prevalence of the 
 disease; (3) in maintaining thorough cleanliness of person and 
 premises; (4) in the speedy removal of all vegetable and animal 
 refuse matters; (5) in keeping cellars clean and dry; (6) in 
 free and thorough ventilation of dwellings, especially sleeping 
 
4 
 
 apartments; (7) in boiling or filtering drinking water when 
 there is any suspicion as to its purity; (8) in the free use of 
 
 disinfectants in all places where foul odors may arise. 
 
 \ * 
 
 4. Kestrictive Measures.— The restrictive measures recom¬ 
 mended are: (1) Prompt isolation of the sick from the well; 
 (2) restriction of nurses in their intercourse with outside per¬ 
 sons ; (3) keeping the sick room free from all needless clothing, 
 carpets, drapery, etc., likely to harbor the poison of the disease; 
 (4) a liberal supply of fresh air in the sick room, taking care 
 to avoid direct draughts; (5) burning or thoroughly disinfect¬ 
 ing and burying, remote from the house and source of drinking 
 water, all discharges from the throat, nose, mouth, kidneys and 
 bowels; (6) placing soiled bed and body linen in boiling water 
 at once, or in water containing a little chloride of lime, soda or 
 zinc, or wash all the soiled linen and bed clothing, as well as the 
 floors of the rooms where the disease has existed, with a solution 
 of Bichloride of Mercury ( Corrosive Sublimate) in the propor¬ 
 tion of one part to two thousand; (7) disinfecting the rooms in 
 which any case or cases of diphtheria have occurred, with all the 
 contents, by exposure for several hours to strong fumes of 
 chlorine gas or burning sulphur, and subsequently to currents of 
 fresh air ; (8) no public funeral should be held in a house in 
 which a death from diphtheria has recently occurred, nor in a 
 church or other place where the body of a diphtheria patient 
 lies dead; (9) the bodies of those who have died of diphtheria 
 should be securely wrapped in a disinfected cere-cloth—a sheet 
 saturated in a solution of chloride of zinc, hfilf a pound of the 
 salt to a gallon of water. 
 
 5. Careful examination of all plumbing of the house, first as 
 to the trapping of the water-closets, and sinks in laundry and 
 kitchen, ventilation of soil pipes, and a careful examination of 
 all plumbing of every description in a cellar in which there is a 
 furnace. Where there are no sewer connections, the vaults in 
 the yard should be kept scrupulously clean and well disinfected. 
 
 6. Where families move from one residence to another, the 
 house into which they move should be well fumigated before the 
 furniture is moved in. If they have had diphtheria in the house 
 out of which they are moving, the house should be fumigated 
 
 * CT 7 O 
 
 before the furniture is removed. 
 
5 
 
 SCARLET FEVER. 
 
 Prevention and Restriction of Scarlet Fever. 
 
 Scarlet Fever is a highly contagious disease, directly com¬ 
 municable from one person to another, or by infected clothing, 
 rags, etc., or by the discharge from the body of a person sick 
 with the disease. It is always attended with a scarlet eruption 
 on the skin, and is generally accompanied by a sore throat. 
 When a child or young person has a sore throat and fever, and 
 especially if it has an eruption of the skin, it should imme¬ 
 diately be separated and kept secluded from all other persons 
 except necessary attendants, until it be determined whether or 
 not it has scarlet fever, or sorge other communicable disease. 
 
 During the progress of this disease, not only the eruption of 
 the skin, but everything that is thrown off from the body of the 
 sick, contains the germs or seeds of the disease, which are 
 capable of propagating it in another person. The discharges 
 from the nose and throat are especially dangerous. The secre¬ 
 tions from the kidneys, which are frequently seriously affected 
 in scarlet fever, and the discharges from the bowels, are also 
 supposed to be capable of spreading the poison, and this power 
 may be retained for a long time. When these secretions have 
 found their way into cess-pools, sewers, heaps of decaying 
 organic matter, etc., they may be still capable of giving off the 
 poison and of spreading the disease. It is, therefore, of the 
 greatest importance to destroy the poison before it leaves the 
 sick room. 
 
 Attendants upon persons suffering from scarlet fever, and also 
 the members of the patient’s family, should not mingle with 
 other people, nor should children be allowed to enter a house 
 in which this disease exists. Children not believed to be infected 
 should be sent away from the house in which scarlet fever exists, 
 to families not liable to the disease; but they should be isolated 
 from the public for at least fourteen days from the time of their 
 removal. Children under ten years of age are in much greater 
 danger of taking the disease, and after they do take it, of dying 
 from it, than are grown persons. But adults sometimes have 
 the disease, and even though it be in a mild form, they may 
 communicate the disease in fatal form to children. 
 
6 
 
 In cases of scarlet fever the following directions should be 
 carried into effect: 
 
 1. Have the patient placed in one of the upper rooms of the 
 house, the furthest removed from the rest of the family, where 
 is to be had the best ventilation and isolation. The room should 
 be instantly cleared of all curtains, carpets, woolen goods and 
 all unnecessary furniture. Keep the room constantly well ven¬ 
 tilated, by means of open windows, and fires, if. necessary. 
 Maintain the utmost cleanliness both with regard to the patient 
 and in the room. A basin charged with chloride of lime, or 
 some other efficient disinfectant, should be kept constantly on 
 the bed for the patient to spit in. Change the clothing of the 
 patient as often as needful, but do not carry it while dry 
 through the house. A large vessel (as a tub) containing a solu¬ 
 tion of carbolic acid, in the proportion of four fluid ounces of 
 clear carbolic acid to the gallon of water, or a solution of 
 chloride of lime, in the proportion of half an ounce of the best 
 chloride of lime to the gallon of water, should always stand in 
 the room, for the reception of all bed and body linen im¬ 
 mediately on its removal from the person or contact with the 
 patient. Pocket handkerchiefs should not be used, but small 
 pieces of rag should be employed instead for wiping the mouth 
 and nose; and each piece after being once used should be im¬ 
 mediately burned. Two basins, one containing a solution of the 
 purer quality of carbolic acid, in the proportion of half a fluid 
 ounce to the quart of water, or of chlorinated soda, in the pro¬ 
 portion of two fluid ounces to the quart of water, and the other 
 containing plain water and a good supply of towels, must always 
 be ready and convenient, so that the hands of the nurse may be 
 at once disinfected and washed after they have been brought in 
 contact with the patient. All glasses, cups, and other vessels 
 used by or about the patient, should be scrupulously cleansed 
 before being used by others. The discharges from the bowels 
 and kidneys are to be received on their very issue from the body 
 into vessels containing some disinfectant, as a solution of four 
 fluid ounces of carbolic acid to the gallon of water, or of four 
 ounces of the best chloride of lime to the gallon of water, and 
 immediately removed. No person should be allowed to enter 
 the room except those who are necessarily attending upon the 
 sick. A sheet moistened with a strong solution of carbolic acid, 
 
7 
 
 
 suspended outside the door of the room or across the passage¬ 
 way leading to it, is useful to complete the isolation of the 
 patient. 
 
 2. Food and drink that have been in the sick room should 
 be at once destroyed or buried. 
 
 3. Do not kiss a person who has a sore throat, nor take his 
 or her breath. Do not drink out of the same cup, nor use any 
 article that has been used by such person. 
 
 4. Body and Bed Clothing, etc.— It is best to burn all 
 articles of small value which have been in contact with persons 
 sick with scarlet fever. 
 
 5. Cotton, linen, flannels, blankets, etc., should be treated 
 with the boiling hot zinc solution, introducing them piece by 
 piece, securing thorough wetting and boiling for at least half an 
 hour. Heavy woolen clothing, silks, furs, stuffed bed covers, 
 beds and other articles which cannot be treated with the zinc 
 solution, should be hung in the room during fumigation, pockets 
 being turned inside out and the whole garment being thoroughly 
 exposed. Afterward they should be hung in the open air, 
 beaten and shaken. Carpets are best fumigated on the floor, 
 but should afterward be removed to the open air and thoroughly 
 beaten. Pillows, beds, stuffed mattresses, upholstered furni¬ 
 ture, etc., after being disinfected on the outside, may be cut 
 open and their contents again exposed to fumes of burning sul¬ 
 phur. In no case should the thorough disinfection of clothing, 
 bedding, etc., be omitted. Infected clothing and bedding have 
 been known to communicate scarlet fever months after their 
 infection. 
 
8 
 
 CONSUMPTION. 
 
 Sometimes called “Tuberculosis,” “Phthisis,” “Phthisis Pul- 
 moualis,” “Tubercular Phthisis,” “Tubercular Con¬ 
 sumption,” or “Pulmonary Consumption.” 
 
 Consumption is known to be a communicable disease, in 
 which frequently the contagium is carried from the dried sputum 
 of a consumptive to the lungs of a susceptible person, where it 
 grows and multiplies and thus produces the disease. The germ 
 which causes consumption is called the bacillus tuberculosis , and 
 it is present in the sputa of consumptives. These bacilli are 
 from about one twenty-thousandth to one ten-thousandth of an 
 inch in length, and have a breadth about one-sixth of their 
 length. (From 1.5 to 3.5, by .4 micromillimeters.) These 
 bacilli have been thoroughly studied, and repeated successful 
 inoculations have been performed on lower animals. Interest¬ 
 ing experiments have been made in this connection by Dr. 
 George Cornet, of the Berlin Hygienic Institute, with the dust 
 of rooms inhabited by consumptives. Dust, collected from those 
 surfaces not likely to be contaminated directly by the spitting 
 or coughing of the patient, was mixed with sterilized bouillon 
 and injected into the peritoneal cavity of guinea pigs. Forty 
 days later the animals were killed, and a careful necropsy 
 was made. Twenty-one hospital wards, in which there were 
 consumptive patients, were examined in this way, and from the 
 dust of fifteen of them tuberculosis was set up in the guinea 
 pigs experimented upon. Private houses where consumptives 
 lived gave similar results; where patients had been in the habit 
 of expectorating on the floor, the dust from the walls was cer¬ 
 tain to yield infectious cultures, but where cloths or spittoons 
 had been used this was not the case. 
 
 The mode of communication of this disease is mainly from 
 the dried sputa from consumptives. The germs in the sputa 
 are carried into the air by sweepings, and deposited upon walls 
 or contents of rooms, or find their way to the lungs of persons. 
 
 Destruction of Sputa.— It is evident that the only certain 
 preventive of consumption is to destroy the sputum from the 
 consumptive before it has an opportunity to dry and scatter the 
 seeds. It is for the consumptive’s own safety to destroy sputa, 
 
9 
 
 because it reduces to a minimum the possibility of re-infection. 
 Any person who has a habitual cough, and raises sputa, should 
 have a microscopical examination of the sputa, to ascertain 
 whether it contains the bacillus tuberculosis. Without waiting 
 for such examination, in all such cases the sputa should be dis¬ 
 infected. 
 
 The consumptive should carry small pieces of cloth (each 
 just large enough to properly receive one sputum) and paraffined 
 paper envelopes or wrappers in which the cloth, as soon as once 
 used, may be put and securely enclosed, and, with its envelope, 
 burned on the first opportunity. 
 
 Destruction of the Dejecta. —All dejecta of a consump¬ 
 tive person should be destroyed or disinfected; because it has 
 been shown that the bacilli are to be found in the urine of per¬ 
 sons having tubercular diseases of the urinary organs, and in 
 the fasces of those having tubercular diseases of the bowels, and 
 they may exist in the faeces of those who swallow sputa containing 
 the bacilli, that is, possibly, of any consumptive. Disinfect 
 each discharge from the bowels by thoroughly mixing with it at 
 least one ounce of chlorinated lime in powder. 
 
 The unwashed clothing of a consumptive should not be min¬ 
 gled with the unwashed clothing of another person ; care should 
 be taken that the handkerchiefs be boiled, that other articles 
 liable to harbor the bacilli should be disinfected, that no virus 
 come in contact with a cut or injured hand. 
 
 No one should sleep in the same room with a consumptive 
 patient; or in a room which has been occupied by a consumptive, 
 unless the room has been previously subjected to the fumes of 
 burning sulphur. A room which has been occupied by a con¬ 
 sumptive person may well (with all its contents) be thoroughly 
 disinfected, first subjecting it, for twenty-four hours, to strong 
 fumes of burning sulphur, and then it should for several hours 
 be exposed to currents of fresh air. 
 
 Upon application to the Health Commissioner , all apart¬ 
 ments that have been lately occupied by cases of consumption, will 
 be subjected to the action of disinfectants , free of charge. 
 
10 
 
 SHALL POX. 
 
 Small pox is always the result of infection. The specific 
 poison which is the cause of the disease is very active—a 
 momentary exposure to it will often result in producing small 
 pox in the unprotected, and the vitality of the infection, under 
 certain circumstances, is capable of being preserved a long 
 time. The disease is dangerous and loathsome in the extreme, 
 giving a high death rate in the unvaccinated, and hideously dis¬ 
 figuring and maiming many who outlive it. 
 
 The present generation from its own observation can have no 
 adequate conception of the terrible devastation which this dis¬ 
 ease caused before the discovery of vaccination. In the large 
 cities one-third of the deaths in children under ten years of age 
 came from small pox. 
 
 Not a decade passed in which this disease did not decimate 
 the inhabitants in one country or another, or over great tracts 
 of country, so that it came to be more dreaded than the plague. 
 
 These facts of historv give some idea of the benefit which has 
 been conferred upon humanity by vaccination. Without the 
 protection which it affords, nearly, if not quite, the olden, fear¬ 
 ful rate of mortality would, in the course of a generation or 
 two, be restored. 
 
 Cleanliness and the observance of the general laws of health 
 might avail a little, but only a little, in restricting the disease, 
 which seems to have its being always in infection. 
 
 In a community or town well and thoroughly vaccinated there 
 would be no possibility of a serious extension of small pox. 
 Neglect of this protection has, even in recent years, sometimes 
 led to very disastrous and unprofitable results, entailing losses 
 amounting to millions- of dollars in human life and paralyzed 
 business. 
 
 The all-important preventive measure is vaccination. In the 
 face of the disease, vaccination, isolation and disinfection 
 must go hand in hand. 
 
 Vaccination. —Every child should be vaccinated in its earliest 
 years, preferably before six months of age, and in case of 
 danger of infection, the vaccination should be done at once, no 
 matter how voung the child is. Vaccination should be done 
 
 t O 
 
11 
 
 again before puberty, and better before ten or twelve years of 
 age. Afterwards vaccination should be tried as often as every 
 six or seven years, or oftener if the person is subjected to prob¬ 
 able danger of small pox contagion. 
 
 Vaccination should be done only by competent physicians, 
 and only with vaccine virus of undoubted reliability and purity, 
 otherwise a sense of security is often felt when in fact protec¬ 
 tion is not obtained. 
 
 In the performance of this operation, scrupulous cleanliness 
 in all respects should be observed, the skin of the selected site 
 should be made aseptic, and the virus used should be of known 
 good quality. 
 
 No blood should be drawn in the process, only the superficial 
 layer of the skin being removed until an oozing of serum ap¬ 
 pears, and insertions of virus carefully worked in should be 
 made in two or three places as, by so doing, the chances of 
 successful inoculation are increased, and experience has shown 
 the enhanced protection afforded by multiple scars of a genuine 
 character. 
 
 In case of the presence of small pox, immediate and careful 
 vaccination should be made of all persons who have not recently 
 been so protected. Even after known exposure to the disease, 
 vaccination should be done any time before the actual appear¬ 
 ance of the eruption. If done within two or three days after 
 exposure it will often prevent the disease, or make it much 
 lighter; and done later, there is reason to believe that even then 
 it has a salutary effect upon the course of the disease. 
 
 Isolation or Quarantine. —When a case appears, enforce 
 immediately strict isolation and quarantine of the patient, and 
 this should be continued for at least two weeks after the recovery 
 of the case and after the crusts have all separated. When the 
 patient cannot be removed to a hospital, but must remain in a 
 private house, secure a room, if possible, on the uppermost floor, 
 and remove from it all articles and furnishings which will not 
 absolutely be needed. For a nurse have some person who has 
 been recently and successfully vaccinated, or who has had small 
 pox. Keep all others away from the room. All other persons 
 in the house and neighborhood should immediately be vaccinated. 
 In case of death the funeral should be strictly private, and con- 
 
12 
 
 ducted in such manner under the regulations of the Department 
 as will insure no danger to the public. 
 
 Disinfection.— The disinfection should also be done under 
 the same authority. During the sickness all discharges from 
 the patient should be plentifully treated with disinfectant solu¬ 
 tions of chlorine or carbolic acid before bein£ thrown into the 
 sewer. All crusts should be burned. 
 
 Clothing should be subjected to steam or sulphur disinfection, 
 or immersed in disinfectant solutions, or subjected to prolonged 
 boiling. All articles which cannot be surely disinfected must 
 be burned. 
 
 If death should occur, the body should be immediately wrapped 
 in a sheet wet with strong bichloride of mercury or carbolic 
 acid solutions, and prepared as soon as possible for private 
 burial. 
 
 The room and house should be very thoroughly fumigated 
 with sulphur or chlorine vapors, and renovated with paper, paint 
 and whitewash. 
 
 TYPHOID FEVER. 
 
 The specific cause of typhoid fever has been found in the air, 
 drinking water defiled with decomposing organic matter and 
 particularly Avith emanations from sewage. The poison of 
 typhoid fever finds its way into wells, cisterns, drains and sewers 
 by means of the dejections of persons ill of the disease. A 
 single case may, in this manner, give rise not only to other 
 cases, but even to extensive epidemics. Defective water closets 
 or leaking drain pipes should be carefully attended to. 
 
 Typhoid fever is pre-eminently an endemic disease, but may 
 become epidemic if proper sanitary precautions are neglected. 
 The greatest care should be observed in the disposition of the 
 discharges from the bowels of typhoid fever patients. 
 
13 
 
 Recommendations. 
 
 Boil all water used for drinking purposes. 
 
 Boil and sterilize or Pasteurize milk. 
 
 Examine all the plumbing of the house and remedy the 
 defects. 
 
 Thoroughly disinfect all closets and vaults. 
 
 Promptly remove all dejections from patients. 
 
 Avoid washing clothing of patient with typhoid fever in con¬ 
 nection with other clothes. 
 
 General contact with patient should be confined only to nurse 
 and doctor. 
 
 Vessels from which patients drink should not be used by any 
 other. 
 
 Disinfection Solutions Recommended. 
 
 For Clothing, Towels, Napkins and Sheets. —Dissolve 
 corrosive sublimate in water in the proportion of four 
 ounces to the gallon, and add one drachm of permanganate 
 of potash to give color to the solution as a precaution against 
 poisoning. One fluid ounce of this solution to the gallon of 
 water is sufficiently strong; articles should be left in it for two 
 hours. 
 
 For the Disinfecting of Water Closets, Sinks and Cess 
 Pools.— Mix one pint of carbolic acid in two gallons of hot 
 water in which there has been dissolved one quart of copperas. 
 Sprinkle dry chloride of lime in privies. 
 
 After a case of typhoid fever has terminated, the premises 
 should be thoroughly disinfected by the Health Department; 
 this will be done whenever the request is made, free of charge. 
 
 Typhoid fever is considered a dangerous communicable dis¬ 
 ease, and as such, comes under the class of diseases that 
 physicians are required by law to report to the Health Com¬ 
 
 missioner. 
 
14 
 
 General Rules for the Prevention and Restriction of 
 
 COMMUNICABLE DISEASES. 
 
 1. Avoid the contagium or special cause of the disease. 
 Unless you are needed to care for the sick, or are protected by 
 having had the disease, or in case of small pox by thorough 
 vaccination, do not go near the sick person. Do not allow your 
 lips to touch any food, cup, spoon or anything else that the sick 
 person has touched or that has been in the sick room. Do not 
 wipe your face or hands with any cloth that has been near the 
 sick person. Do not wear any clothing that the sick person has 
 worn during, just before or just after his sickness. Keep your 
 hands free from discharges from the body or skin of the sick 
 person. Do not touch him with sore or scratched hands. Par¬ 
 ticularly avoid inhaling or in any way receiving into the mouth 
 or nose the branny scales that fall or peel from one recovering 
 from or apparently wholly recovered from scarlet fever. 
 
 2. Restrict the contagium or special cause of disease. 
 Isolate the sick. Separate those sick with any of these diseases, 
 even if they are but mildly sick, from all persons except neces¬ 
 sary attendants. A person sick with any of these diseases 
 should not be permitted to suffer for want of care, food or com¬ 
 fort; but all his wants should be attended to by adults, or by 
 those who are protected by proper vaccination or by having had 
 the disease. Children and those who are not thus pro¬ 
 tected should be kept away from these diseases. Do not 
 go from the sick room to a child or other unprotected 
 person until after change of clothing and thorough wash¬ 
 ing of hands, face, hair or beard. Always wash the 
 hands thoroughly after any handling of the sick person or of 
 anything that has been in contact with the sick person. Keep 
 those who have been exposed to any of these diseases away from 
 schools, churches and other assemblies, and from all children, 
 until it is known whether they are infected; and if they are 
 found to be infected, isolate them till after complete recovery 
 and thorough disinfection. 
 
 3. Keep your house and premises and everything connected 
 therewith clean, but remember that the contagium of these dis- 
 
15 
 
 eases may attach to the cleanest article of clothing, food, drink, 
 book or paper if it is exposed thereto. 
 
 When the death of a person who has died from scarlet fever, 
 diphtheria or small pox is announced in print, the notice should 
 state the cause as “from scarlet fever ,’* diphtheria or small pox, 
 as the case may be, to prevent attendance at the funeral or visits 
 to the house by persons liable to take the disease. 
 
 Provisions and Requirements of Law 
 
 RESPECTING THE DUTIES OF 
 
 PHYSICIANS 
 
 WHEN IN ATTENDANCE UPON A CASE OR CASES OF 
 
 COMMUNICABLE DISEASE. 
 
 [ 17 , 186 .] 
 
 An Ordinance in relation to the reporting of contagious, in¬ 
 fectious and pestilential diseases, and to repeal section three 
 hundred and sixty-one, article eight, chapter fourteen, of the 
 Kevised Ordinances of eighteen hundred and eighty-seven. 
 
 Be it ordained by tlie Municipal Assembly of the City of St. 
 
 Louis, as follows: 
 
 Section 1 . It shall be the duty of each and every practicing 
 physician of the City of St. Louis to immediately report to the 
 Health Commissioner of the city each-case of small pox, typhus 
 fever, croup, cerebro-spinal fever, diphtheria, erysipelas, mea¬ 
 sles, puerperal fever, scarlatina, typhoid fever, yellow fever, 
 whooping cough, cholera and chicken-pox which he may see 
 or be called upon to attend within the limits of the city. 
 
 Sec. 2. In reporting cases of contagious, infectious or pes¬ 
 tilential diseases, the physician shall be required to give the 
 name and residence (street and number), age and color, of each 
 
 case. 
 
16 
 
 Sec. 3. In cases of typhus fever, small pox, diphtheria, 
 scarlatina and cholera, where the house is not placarded within 
 thirty-six hours after the first report, duplicate report must be 
 made. 
 
 Sec. 4. Whenever any case of diphtheria, scarlatina, chol¬ 
 era, typhus fever, typhoid fever, small pox and cerebro-spinal 
 fever has terminated, and there are no other cases in the same 
 house, the physician last attending such cases shall report im¬ 
 mediately the fact to the Health Commissioner, so said prem¬ 
 ises may be disinfected. 
 
 Sec. 5. Any physician violating any of the provisions of 
 this ordinance, or failing to perform the duties required of him 
 by this ordinance, shall be deemed guilty of a misdemeanor, 
 and upon conviction shall be fined not less than fifty nor more 
 than two hundred and fifty dollars, to be recovered for the use 
 of the City of St. Louis before any court having competent 
 jurisdiction. 
 
 Sec. 6. The Health Commissioner shall furnish the proper 
 blank form on which to make the reports, as required by this 
 ordinance. 
 
 Sec. 7. Section three hundred and sixty-one, of article 
 eight, chapter fourteen, of the Kevised Ordinances of eighteen 
 hundred and eighty-seven is hereby repealed. 
 
 0 
 
 Approved April 1st, 1893. 
 
 Only houses in which there is Small Pox, Cholera, Diph¬ 
 theria, Scarlatina, Croup, or Cerehro-Spinal 
 Fever will he placarded. 
 
 N. B.—Every case occurring in the same family must he 
 
 reported. 
 
17 
 
 Provisions and Requirements of Law 
 
 RESPECTING THE DUTIES OF 
 
 • 
 
 The Managers and Principals of Public, Private and 
 Parochial Schools of the City of St. JLouis. 
 
 That in order to check the spread of contagious diseases the 
 Health Commissioner strongly recommends to all superintendents 
 and managers of public, private and parochial schools, the strict 
 enforcement of Secs. 381 and 382, Art. 9, Chap. 14, Rev. Old. 
 1893; and he also recommends the adoption by all managers of 
 schools of the following rules for the government of schools 
 
 o o 
 
 under their charge: 
 
 O 
 
 Regulations in Regard to Small Pox, Diphtheria, Scarlatina, 
 Measles, Whooping Cough, Chicken Pox, 
 Erysipelas and Croup. 
 
 Section 1 . When any member of a family is afflicted with 
 any of the above named diseases,, all children of that family, 
 and all children living in the same house, must be excluded from 
 school. 
 
 Sec. 2. When two or more families use in common the 
 same entrance to a building, or the same yard, or the same water 
 closet, or the same vault, all children of such families must be 
 excluded from school, in case any member of one of these fami¬ 
 lies is afflicted with any of the above named diseases. 
 
 Sec. 3. Children who have been excluded from school, under 
 the above conditions, for small pox, croup, cerebro-spinal fever, 
 diphtheria, or scarlatina, shall be reinstated only upon a certifi¬ 
 cate of the Chief Sanitary Officer of the Health Depart¬ 
 ment that the case or cases in that locality have terminated, and 
 that the premises where the diseases have existed have been 
 thoroughly fumigated by the Health Department. 
 
 Sec. 4. Children who have been excluded from school, under 
 the above conditions, for Measles, Whooping Cough, Chicken 
 Pox or Erysipelas, may return upon the certificate of the 
 attending physician that the child is well. 
 
18 
 
 Sections 381 and 382, Art. 9, Chap. 14, Rev. Ord. 1893, as 
 follows: 
 
 Section 381. The parents or guardians of children attend¬ 
 ing any private or public school, who shall permit them to 
 attend school after it becomes known to said parents or guardi¬ 
 ans that any of their family are infected with any infectious or 
 contagious disease , shall be deemed guilty of a misdemeanor, 
 and upon conviction thereof, shall be fined in a sum of not less 
 than five nor more than ten dollars. 
 
 Sec. 382. Any principal or teacher of any private or public 
 school in the City of St. Louis having official or authentic 
 information of the existence of any infectious or contagious 
 disease in the family of any pupil attending said school, shall 
 immediately cause the removal of said pupil from said school, 
 and until lie (or she) shall have undoubted proof of the premises 
 where the family reside being disinfected and the disease 
 eradicated. Any failure on the part of any principal or teacher 
 complying with the provisions of this article shall be deemed 
 guilty of a misdemeanor, and upon conviction thereof, shall be 
 fined in a sum not less than five nor more than ten dollars. 
 
 The Health Commissioner strongly recommends that all 
 premises in which there has been Diphtheria, Croup, Cerebro¬ 
 spinal Fever, Scarlatina, Measles, Small Pox or Consumption, 
 be thoroughly disinfected on the termination of each case. 
 
 The Health Commissioner also recommends that the funerals 
 of all persons dying of Small Pox, Diphtheria, Croup or Scarla¬ 
 tina, be private, and that on no account shall the placards 
 placed on the houses by order of the Health Commissioner be 
 removed until the person is well or the funeral has taken place 
 and the premises fumigated. 
 
 All premises will be fumigated free of charge upon applica¬ 
 tion to the Health Commissioner. 
 
 Section 379, Article 9, Chapter 14, of the Ordinances of the 
 City of St. Louis. 
 
 Section 379. Whenever any physician shall report to the 
 Health Commisioner any case of small pox or contagious disease 
 in any dwelling or building in the City of St. Louis, the Health 
 Commissioner shall have the power, whenever in his opinion it 
 
is necessary, to cause to be placed on the outside of any build¬ 
 ing or dwelling or door of any room, a printed placard, giving 
 notice of the existence of such contagious disease. Any person 
 who shall remove such placard, placed by order of the Health 
 Commissioner, shall be deemed guilty of a misdemeanor, and 
 upon conviction be fined not less than five nor more than twenty- 
 five dollars. 
 
 The placard must remain until the premises have been disin¬ 
 fected by the Health Department. 
 
 MAX C. STARKLOFF, M. D., 
 
 Health Commissioner . 
 
 November 20, 1895.