74 PUBLIC HEALTH 



nursing system was adopted with a view of providing minor medical 

 attention for excluded children and of carrying into the tenement 

 homes some elementary idea of the proper care of the sick, as well 

 as incidental instruction in household sanitation. The school nurse 

 is an adaptation of some of the principles of settlement work to the 

 problem of handling school exclusions for minor contagious ailments, 

 and, when she is a woman of experience and a graduate of some 

 recognized training-school, as we require in New York, the successful 

 results of her work are instantly manifest. One nurse can handle 

 the exclusions from four or five schools, averaging from 500 to 1500 

 pupils each. 



It is not required that the nurse shall give any attention to cases 

 of contagious disease, such as scarlet fever, diphtheria, measles, 

 and the like. That is and should be left to the ordinary operation 

 of the bureau of contagious diseases, which has its established 

 corps of diagnosticians and district medical inspectors. The routine 

 handling of such cases involves, first, a rigid enforcement of rules 

 regarding notification by the family physician of all contagious 

 cases coming under his observation; second, the confirmation of 

 the diagnosis by an expert medical inspector and his decision whether 

 the case can be properly isolated in the home, or whether removal 

 to the isolation hospital is necessary; third, the enforcement by 

 the district medical inspector of the rules requiring a continuance 

 of isolation during the full period of the disease. 



Proper handling of a contagious disease bureau requires not 

 only good judgment and strict obedience to department rules by 

 medical inspectors in their work, but a well-organized system of 

 keeping the records of all cases within the purview of the bureau. 

 Another important aid to successful operation is the transmission 

 daily to all school principals, teachers, librarians, and other per- 

 sons having charge of children in ordinary places of assemblage, 

 of complete and accurate lists of all contagious cases reported, and 

 of the termination of other such cases and the disinfection of pre- 

 mises. This puts such persons on their guard, and undoubtedly 

 checks the spread of contagion. 



In spite of the enormous preponderance of evidence in favor of 

 vaccination, we cannot deny that the prevention of small-pox is 

 still a problem for local boards of health. I say local, for the hand- 

 ling of small-pox varies so greatly in different communities that 

 the efficiency of one is often largely nullified by the neglect of another. 

 Here again is a strong argument for centralization of disease-pre- 

 venting and sanitary work under the control of a federal bureau. 

 For example, in the first months of 1902, we in New York were con- 

 fronted with an outbreak of small-pox which amounted almost to 

 an epidemic. The disease was equally prevalent in other eastern 



