'Sc.a.x'IcV r ‘ %t «-r. pllpiill^ i^HS •- < 1 islSlS* :M$WiM i«i m mummm m stihEM&Swy, SCARLET FEVER. (SCARLATINA) ITS Prevention, Restriction and Suppression PUBLISHED BY The Illinois State Board of Health. 1911 . REVISED EDITION. Please Preserve for Future Use. Should a case of Scarlet Fever occur near you, you can do yourself and your community great good by seeing that the family has one of these pamphlets Copies can be obtained by any resident of Illinois, without cost, by addressing the Secretary at Springfield. SPRINGFIELD, ILL. Illinois State Journal Co., State Printers 1911 . “Better that we should err in action than wholly refuse to perform. The storm is so much better than the calm, as it declares the presence of a living principle. Stagnation is something worse than death. It h corruption also.” — Simms . * * * “No man should be so much taken up in the search of truth, as therein to neglect the more necessary duties of active life ; for after all is done it is action only that gives a true value and commendation to virtue.’ — Cicero. (o SCARLET FEVER. (From NothnagePs Encyclopedia of Practical Medicine.) In none of the acute exanthemata does our lack of knowledge of the cause of the disease prove so disturbing a factor as in scarlet fever. A clear conception of the processes that take place in the body in its course is, on account of this fact, rendered in every respect considerably more difficult, and in many particulars altogether impossible. The out- ward-manifestations of the disease are very various, and its inward nature must be an analogous one. Otherwise it were hardly conceivable why, far more frequently than in any other infectious disease, at one time the patient promptly yields to the destroyer, and again, under what appear to us to be similar conditions, he experiences hardly any grave consequences. Between these extremes lies a wide territory of an end- less number of disorders, that can involve nearly all the organs of the body. It is certainly an important consideration that other infections show a more marked tendency to complicate the course of scarlet fever; this being especially true of the septic processes. This fact, however, only renders certain features a little more intelligible. * * ❖ (From Acute Contagious Diseases, Welch and Schamberg.) Scarlet fever is highly contagious during the period of eruption, and usually for some time following the disappearance of the rash. Scarlet fever is not only contagious before desquamation begins, but not infre- quently after it has been completely terminated. It is probable that the prolonged infeetivity manifested by certain cases of scarlet fever is due to the presence of the scarlatinal contagion in the secretions of the throat, or in the nasal and aural discharges. Physicians connected with scarlet fever hospitals not infrequently say patients who have remained in the hospital from eight to twelve weeks, give rise on their return home to other cases in the same household. And this occurs despite the most careful disinfection of the body and the- clothing. ISOLATE QUARANTINE DISINFECT SCARLET FEVER. ( Scarlatina. ) ITS PREVENTION, RESTRICTION AND SUPPRESSION. Published by tile Illinois State Board of Health. 1911 . Scarlet fever, scarlatina, scarlet rash and canker rash are all names for one and the same disease. This disease is scarlet fever, a wide- spread, dangerous, contagious disease, most destructive of child life. Scarlatina (the Latin for scarlet fever) is not a modified or milder form of the disease. It is scarlet fever in either mild or malignant form. There is no such disease as scarlet rash. “Duke’s disease” is a name given to mild cases of scarlet fever which occurred in Chicago in January, 1907. Scarlet fever is scarlet fever, whether it be mild or whether it be malignant. Scarlet fever is one of the most contagious of all diseases. Recoveries from it are frequently incomplete, so that its effects continue throughout all subsequent life, leading often to permanent impairment of health. Such effects not infrequently follow the mildest cases. The disease usually attacks children under ten years of age, but it may occur at any time of life. Children are most liable to contract the disease between the second and tenth year. The contagion of scarlet fever usually comes from direct inhalation of the breath of the patient, or of air charged with minute scaly particles from the skin of the patient. The contagion is in the matters from the skin, mouth and nose, but all the excretions of the patient are more or less contagious. The contagion is mostly to be dreaded at the close of the fever while desquamation (peeling or scaling of the skin) is going on. The poison which is contained in these fine scaly particles, which are diffused with the dust throughout the room, may retain its infective properties for months unless destroyed by proper disinfection. In the 6 absence of daylight and currents of air, and in a moderate temperature, this poison will retain its active properties for years. As in diphtheria and small-pox, the poison will attack itself to the walls of the room and to its contents, to books, clothing, toys, furniture and bedding. Any object which the patient has touched is exceedingly dangerous. The disease may be transmitted by persons who have been in the sick room, although they themselves may escape. Milk may be the carrier of infection, dairies adjoining infected houses having been known to disseminate the poison and give rise to epidemics. Milk tickets and the milkman’s clothing may also convey the disease, and probably often do. Clothing in a laundry may become infected from that of scarlet fever patients. The disease may be disseminated by letters or papers sent by mail, and also by dogs or cats that have been near the patient. Filth, unsanitary surroundings and imperfect ventilation increase the severity of the disease and the danger of its spreading and becoming epidemic, also overcrowding, together with all agencies that depress vitality and strength. As a rule, one attack protects a person from further attacks through life, but exceptions to this are not infrequent. Every case of scarlet fever is dangerous to life and health. A mild case in one person may give rise to a most malignant case in another. Scarlet fever is not one of the diseases to which mothers can safely expose their children on the theory that “it is better for them to have it while they are young.” This theory is indefensible in any disease; its exemplification in scarlet fever is little removed from a criminal act. One reason for warding off scarlet fever is that after childhood this disease is not so fatal, and also after childhood the liability to take the disease is very much lessened. It therefore happens that many escaping the disease in childhood never have it, although many times exposed to it later in life. Because children exposed to scarlet fever do not contract the disease, it must not be concluded that the diagnosis of the physician was incor- rect, or that, as stated by the neighbors, the eruption was nothing but “scarlet rash.” Scarlet fever, although one of the most contagious of diseases, behaves very capriciously at times. The immunity to the disease enjoyed by certain families is inexplicable as is the reason for th& Severity with which it attacks others. In a household where there are several children, some are apt to escape, although all have been equally exposed. Again, the slightest momentary exposure may be sufficient to cause the disease. 7 PREVENTION. Scarlet fever is a preventable disease, notwithstanding its widespread character and the ease with which the infection adheres to articles which may pass from one person to another. Carefulness can keep the infection from being scattered abroad, and disinfection can destroy its power to do harm. Keep children away from the disease and from all persons and things that have been where the disease is. Keep also all persons who have recently been sick with the disease and all who have been where it is, away from your children. If children from an infected family are allowed to attend school, withdraw your children from that school, and notify the State Board of Health. If scarlet fever has occurred in a school and the same school has not been disinfected, take your children out of the school and notify the State Board of Health of the facts. Be careful of books, toys and all articles which may have been handled by a scarlet fever patient. The disease has been spread by circulating libraries, picture books having been taken therefrom to amuse patients, and returned without being disinfected. See that your house and premises are perfectly clean. Look to your cellars, sewers, cess-pools, sinks and water closets, and allow no decaying animal or vegetable matter to poison the atmosphere of your dwelling. Use disinfectants freely; burn all rubbish. Whatever you undertake to do, do at once. “Intentions, like eggs, unless hatched into action, will run into rottenness.” Beware of any one with a sore throat; do not allow your children to be kissed by such a person, or to drink from the same cup. When scarlet fever is present in your community, do not take children to crowded assemblies.. When disease prevails in the neighborhood, and at all times, warn your children not to use, while in school, the pencils, books, etc., of other children, and especially not to put into their mouths, pencils, toys, harmonicas, jewsharps, and the like, which may have been handled by other children. Warn them also to thoroughly rinse the school room drinking cup before using. All persons recovering from scarlet fever are dangerous. Dangerous also, and but in a slightly less degree, are all individuals, nurses, attend- ants, parents, brothers, sisters, other relatives, friends, acquaintances, neighbors, who have come in contact with the patient, or who have been in the infected rooms prior to disinfection of the same, unless their clothing and persons have been disinfected. 8 RESTRICTION. During the existence of scarlet fever or diphtheria in a community, all cases of sore throat with fever are to be looked upon with suspicion until their innocent character is established. Whenever a child has sore throat and fever, he or she should be at once separated from other members of the family until a physician has passed an opinion on the nature of the ailment. This precaution should never he neglected, especially if the child vomits or has a chill, and more especially if the face be flushed or an eruption appears on any part of the body. By “separated” is meant placed in a room apart as far as possible from other rooms in the house. From this room all other children must be kept. A child is attacked with scarlet fever usually within two or four days after exposure. The disease may come on within twenty-four hours after the child has come in contact with the poison, and again no symptoms may develop until the eighth or tenth day. If a child does not show signs of illness by the tenth day, it can be safely concluded that the disease has not been contracted. A child known to have been exposed should be carefully watched for a week or ten days and on the slightest sign of illness be separated from all others. The symptoms of scarlet fever vary with the type and severity of the fever. The onset of the disease ordinarily is sudden and active. The child feels uncomfortable, looks stupid and complains of sore throat, which may be very severe and present all features of a severe diphtheria. There may also be intense swelling of the throat and neck. There is a high fever and vomiting in the majority of cases. The pulse is rapid and hard. A chill rarely occurs, but in young children convulsions are common. Sometimes the patient will have a more or less severe head- ache, pain in the back and limbs, and at first coldness of the skin. Diarrhoea is not uncommon. The face is often flushed, as a rule the skin is very dry and hot, the tongue is furred at the center and red at the edges and tip. The eruption in scarlet fever usually appears first on the neck and chest, hut it may come out on the abdomen, the hack of the hands or the thighs. An eruption following any of the symptoms outlined must be regarded with apprehension, no matter where it appears. It is a dangerous signal, a disregard of which may sacrifice the child’s life. Do not disregard this signal ! Scarlet fever is infectious (contagious, communicable) from the appearance of the earliest symptoms until desquamation (peeling off, scaling) has ceased, and all signs of inflammation in the throat, nose and ears have passed away. 9 SUPPRESSION. Engage the services of a competent physician early in all contagious diseases. Do not wait until it is. too late, when regrets are useless. You may not feel able to incur the necessary expense incident to sickness; you likewise may not feel able to pay those always attendant upon death. Remember that scarlet fever is a preventable disease. Remember also that the period of sickness can be much shortened and the possible bad effects of the disease entirely prevented, if competent medical attendance is obtained early. “Delay always breeds danger.” The Sick Room — The room selected for a patient should be large, easily ventilated, and as far from the living and sleeping rooms of the other members of the family as practicable. A room on the top floor is preferable. This room should be prepared by removing from it all superfluous clothing and furniture, carpets, rugs, draperies, ornaments, books, etc. ; in short, everything not absolutely needed for the comfort of the sick or the convenience of the attendants. Closets connected with the sick room should be emptied of their contents. The doors connecting with halls or with other rooms should be covered with sheets of cheap cotton cloth kept wet with a solution of carbolic acid (two and a half ounces of the strong solution of the acid to one gallon of water) or with Standard Disinfectant No. 3, mentioned on last page of this circular. Over the door to be used the sheet must not be tacked at the bottom nor along the full length of the lock side of the frame, but about five feet may be left free to be pushed aside; this sheet, however, must be long enough to allow 10 or 12 inches to lie in folds on the floor and must also be kept wet with the disinfectant. If time will allow, the room should be thoroughly cleaned before the admission of the patient. Disinfect at once in the manner herein directed, the room previously occupied by the patient. The sick room should be well ventilated, for fresh air is an important agent in rendering the contagious element of scarlet fever less powerful. The patient, however, must be scrupulously guarded against drafts, for cold is often the exciting cause of severe complications in the disease. In cold weather, whenever it is possible, there should be an open fire in the room, even when steam, furnace or stove heat is used. A stove makes the worst kind of heat for a sick room. If a stove be used, a pan oi; kettle containing water should be kept on it. No other person besides the nurse or necessary attendants should be permitted in the room, and they should take special precautions not 10 to carry the infection. Their communication with the rest of the family should be as restricted as possible. Do not permit the sick room to be made a place of family gathering. The attendants should wear only such clothing as can be washed, and should not come in contact with other members of the family, especially children, without first changing clothing and disinfecting the person — the face, hair and hands, especially. Neither the nurse or any other person should eat or drink anything in the sick room, or anything which has been there. Food which the patient has left should be burned or disinfected. The dishes which the patient uses should not be used by others, or washed with other dishes. They should be washed by themselves in boiling water. While the liberal use of liquid disinfectants is recommended, there should not be any attempt to disinfect the room, when occupied, by the use of votaile chemical agents, such as carbolic acid, chlorine, etc. It can not be done, and you but waste your time and annoy the patient. Neutralizing odors by creating others does not constitute disinfection. Fresh air and absolute cleanliness are all that is necessary. Your ' physician may recommend the distillation of carbolic acid in the rooir by means of boiling water to prevent the passage of the virus in the air. This will be beneficial and can do no harm unless the odor worries the patient. In this, as in all other matters, follow your physician’s advice. He desires that his patient shall recover and recover speedily. The contagion is contained in all the excretions of the patient, and in the bran-like scales of the outer skin that are shed so freely in conva- lescence. The matters that come from the head, throat, nose and skin are especially contagious. It is an important point to deal with the contagion at its source and act promptly, under all circumstances. Delay gives opportunity for its diffusion. House flies and other insects, by access to the vessels contain- ing excreta, may carry it about. Drying may convert it into dust to float in the air. Destroy the infection at the point of origin, if possible. “Whatever thou takest in hand remember the end, and thou shall never do amiss.” All discharge from the bowels should be received in vessels containing a quart of Standard Disinfectant No. 1* (either lime or acid), and should be left in the vessel for an hour before being thrown into privy vault or water closet. The vomit matter and discharge from the lungs and throat should be received in vessels containing the same solution. Have this disinfectant continually on hand ready for use. *See last page for method of making and using the Standard Disinfectants. 11 A disinfecting solution (carbolic acid 6^ ounces, water 1 gallon) should be always at hand for washing the floor or bed whenever soiled by discharges. The discharges from the throat, mouth and nose are especially danger- ous and must be cared for at once. It .is well to prepare a number of squares of old soft cloth (old sheets or pillow cases) to receive the discharges. The cloths should be burned as soon as soiled. If there is no fire in the sick room it is convenient to have a small tub, containing the disinfectant solution, to receive these cloths until they can be carried from the room and burned. All knives, forks, spoons, glasses, cups and plates used by the patient must be disinfected at once by being put in a carbolic acid solution and later boiled. A wooden pail or tub containing Standard Disinfectant No. 3 should be kept in the room, and all blankets, sheets, towels, pillow slips and other articles used about the patient’s room should be put into this as soon as they are used and before they are taken from the room. They should be allowed to soak for two hours, then they must be taken out and boiled at once. Use old blankets on the bed and burn them afterwards. Dust and dirt must be removed by cloths dampened with Standard Disinfectant No. 3, as sweeping and dusting are objectionable. These cloths should be at once thrown into the solution or into the fire. Books, toys and articles used to amuse the patient when convalescent are best disposed of by burning them in the room. Under no circum- stances should toys be borrowed to return, to be used by the well. Never return a booh taken from a public library. It must be burned. “In a serious trust negligence is a crime.” Toward the end of the active stage of scarlet fever, the skin usually peels off ; this may occur in flakes of considerable size, in tiny scales, v or in an almost impalpable powder. Whichever may be the case, these particles of skin act as carriers of the disease, floating, as they may do, in the air, or finding lodgment in the clothing, in crevices in the floor or walls, or in undusted corners, whence at some even remote future day they may cause a new outbreak of the disease. Frequent anointing of the entire body of the patient at this period of the disease with cosmoline, sweet oil, fresh lard or some other unguent will prove grateful to him, and by mechanically imprisoning the particles of skin, will do much to prevent danger. This anointing should always be done, and will always be directed by the attending physician. The entire surface of the body may be bathed daily as directed by the physician. 12 No person from a house where scarlet fever is should go into public assemblies, such as schools, churches or concerts, or anywhere into the presence of children. No person in said house should leave the premises without first thoroughly washing his hands, face and hair, and brushing his clothing with a whisk broom wet with Standard Disinfectant No. 3. Persons who have had scarlet fever should not be allowed to go to school or to mingle in any other way with the public while they remain infectious. They should be considered infective for five weeks at least, and in many cases the period of desquamation, or peeling, and of infec- tiousness is extended to six or eight weeks. The period of infectiousness may be prolonged indefinitely when thorough disinfection is neglected. “Nothing is more terrible than active ignorance.” Before going to school or to any meeting, the patient should have a health certificate from the physician or health officer setting forth that proper precautions have been taken during the sickness, and that the person is believed to be free from danger of conveying the disease to others. All clothing of the patient should be disinfected before it is worn again. The clothing the patient was wearing when taken sick should he disinfected at once and put away. In the event of death, the body must be wrapped in a sheet thoroughly soaked in Standard Disinfectant No. 2, and then placed in an air tight coffin. Public funerals and wakes over such a body are forbidden. The coffin must not be opened nor the remains again exposed under any pre- text whatsoever. The body cannot be transported by rail unless prepared in accordance with the rules of this Board and placed in an air tight metallic casket. Newspaper notices of such deaths shalf distinctly state the deceased died of scarlet fever. DISINFECTION OF HOUSES. A very wholesome practice that bids fair to become an established custom is the disinfection of a rented house before a new family moves into it. This is done now, where a case of very contagious disease, say small-pox, or diphtheria, has been known to exist; but how can we feel sure that the house we are about to move into and live in has not had in it an unrecognized or a suppressed case of measles, scarlet fever, or tuberculosis, or typhoid fever? Disinfection after these diseases is of the highest importance. Then, again, there are those diseases that are not fatal, perhaps, but, being communicable, may become certainly afflic- tions, nuisances. This precaution, therefore, should be demanded of every landlord, by those who are planning to rent the house . — Public Heal tli, Michigan. 18 DISINFECTION. When an apartment which has been occupied by a person sick with an infectious disease is vacated it should be disinfected. 1. The work of disinfection should begin with the beginning of the treatment of cases and should continue during the whole course of the disease. All articles of bed clothing and of body clothing should be disinfected as soon as they are removed from the bed or from the patient. 2. During the entire illness, the privy should be thoroughly disin- fected with Standard Disinfectant Xo. 1, four or five gallons of which should be thrown into the vault every day. Instead of the solution, chloride of lime in powder can be used. All woodwork in the vault should be soaked with the solution or covered with powdered lime. Water closets and sinks should be disinfected daily by pouring a quart or more of the solution of chloride of lime or carbolic acid into the pipes. The pipes should be freely flushed in order to avoid injury. The object of disinfection in the sick room is the destruction of infec- tious material attached to clothing, carpets, draperies, furniture or surface of the room, deposited as dust upon the window ledges, in crevices, etc. If the room has been properly cleansed and ventilated while still occupied by the sick person, and especially if it was stripped of carpets and unnecessary furniture at the onset of the attack, the diffi- culties of disinfection will be greatly reduced. After the patient has been removed from the room, it should be thoroughly fumigated, with all its contents, by burning sulphur or evaporating formaldehyde, and by a thorough cleansing with a disin- fectant solution. • The following mode of procedure* will be found easy of application, economical and effective: “Whatever is Worth Doing is Worth Doing Well.” (a) Have all windows and doors (except door of egress) tightly closed. Securely paste strips of paper over keyholes, over cracks, above, beneath and at sides of windows and doors., over stove holes and all openings in walls, ceiling and floor. If opening be large, paste several thicknesses of paper over opening. Carefully stop up the fire place, if there be one. There must be no opening through which gas can escape. (b) All articles in the room that cannot be washed must be spread out on chairs or racks. Clothing, bed covers, etc., should be hung on lines stretched across the room. Mattresses should be opened and set *See pages 26 and 27, for method of disinfection with formaldehyde. 14 on edge. Window shades and curtains spread out at full length. If there is a trunk or chest in the room, open it, but let nothing stay in it. Open the pillows so that the sulphur fumes can reach the feathers. Do not pile articles together. (c) Use three pounds of powdered sulphur for every 1,000 cubic feet in the room. A room 10 feet long, 10 feet wide and 10 feet high has 1,000 cubic feet. For a closet use two pounds of sulphur. (d) Burn the sulphur in an iron pot or deep pan. Let the pot or pan stand in a large vessel containing water, which vessel should be placed on a table, not on the floor. For example, take a common wash tub, lay in it three or four .bricks, pour in water to the level of top of bricks, put the pot or pan containing the required amount of sulphur on the bricks, place the wash tub and contents on a table. The disin- fecting “apparatus” is then in working order. Moisten the sulphur with alcohol and ignite. When the sulphur begins to burn, leave the room, close the door of egress, and carefully paste strips of paper over the keyhole and all openings above, beneath and at side of door. Keep the room closed for ten hours at least. Sulphur candles may be used instead of crude sulphur, but care must be taken to use sufficient candles. The average candle on the market contains one pound of sulphur. Three of these will be required in the disinfection of a small room, 10x10x10. Do not use a less number, no matter what directions may accompany the candle. The water jacketed candle is preferable. Partly fill tin around candle with water and place candles in a pan on the table, not on the floor. Let one-half pint of water be vaporized with each candle. In the absence of moisture, the fumes of sulphur have no disinfecting power. (e) After the apartments are opened, take out all articles and place them in the sunshine. Carpets should be well beaten and exposed to the sun. “Lingering labor often comes to naught.” (f) All surfaces in the room should then be thoroughly washed with Standard Disinfectant No. 3. Walls and ceiling, if plastered, should subsequently be washed with lime. Wash well all out of the way places, window ledges, mouldings, etc. Floors, particularly, should receive careful treatment, and the solution should wet the dust and dirt in the cracks. (g) After washing, ventilate the rooms, if possible, for several hours, then scrub all woodwork with soap and hot water. (h) It is safer to burn mattresses and pillows. 15 (i) It is likewise safer to burn all books, toys and articles of small value which have been handled by the patient. Burn what you cannot boil. Books which have not been handled by the. patient can be saved. Lay them on edge on a table with leaves open, in a room while the sulphur is burning. Overdo rather than underdo. Unless all precautions recommended have been taken in the sick room, the entire house must be disinfected in the manner directed for the sick room; otherwise a thorough “cleaning house” exposure of all articles to air and sunshine, the beating of carpets, etc., will be all that is necessary. In case the entire house is disinfected, take out before exposure to sul- phur any pianos, sewing machines, lace curtains, fine paintings or draperies and expose them to the sun. Sulphur fumes injure these articles. The infection must not remain in the house. It is a menace to the lives and health of the patient, the children, if any, of the family and your neighbor’s children. There is one serious objection to the use of sulphur, and this must be fully understood. The fumes of sulphur have a destructive action on fabrics of wool, silk, cotton and linen, on tapestries and draperies, and exercise an injurious influence on brass, copper, steel and gilt work. Colored fabrics are frequently changed in appearance and the strength impaired. Fabrics, however, can be effectually disinfected by hanging them on a line exposed to the sun and wind for several days. Curtains and all articles of cotton or linen, boiling or soaking them in Standard Disinfectant No. 3 for several hours, and portable articles of brass, cop- per, steel and gilt work by washing with a strong solution of carbolic acid (Standard Disinfectant No. 1). Formaldehyde (the 40 per cent solution) may be used instead of sul- phur, if desired. See pages 26 and 27 for method of application. DISINFECTANTS. Next to isolation , disinfection is of the most importance in restricting the spread of scarlet fever. By the intelligent use of disinfectants the family and the public are protected against the infection of the disease. Much of the so-called disinfection practiced in families is wholly inefficient and useless. The burning of coffee, tar, sulphur, or other substance in the sick room or in any other part of the house or premises in the presence of the patient or other persons operates, at most, only as a deodorizer, and does not destroy the germs of the disease. It should also be known that many of the preparations offered for sale as disinfectants, germ killers, etc., are worthless, or nearly so, and should never be relied upon. — Bulletin New Hampshire State Board of Health. APPARATUS FOR GENERATING FORMALDEHYDE GAS. (Formaldeh) de-Potassium permanganate method. See page 26.) 17 PUBLIC HEALTH LAWS OF ILLINOIS. EXTRACTS FROM THE REVISED STATUTES. Powers and Authority of the State Board of Health. (Extract.) The State Board of Health shall have the general supervision of the inter- ests of the health and life of the citizen of the State. They shall have charge of all matters pertaining to quarantine; and shall have authority to make such rules and regulations, and such sanitary investigations, as they may from time to time deem necessary for the preservation or improvement of public health; and it shall be the duty of all police officers, sheriffs, con- stables, and all other officers and employes of the State, to enforce such rules and regulations, so far as the efficiency and success of the Board may de- pend upon their cooperation. [ Revised Statutes, Chap. 126a, Sec. 2.] POWERS OF CITY COUNCILS IN CITIES AND PRESIDENTS AND BOARDS OF' TRUSTEES IN VILLAGES INCORPORATED UNDER THE GENERAL LAW. [Revised Statutes, Chap. 24, Sec. 62 .] (Extracts.) Seventy- fifth — To declare what shall be a nuisance, and to abate the same; and to impose fines upon parties who may create, continue or suffer nuisances to exist. Seventy-sixth — To appoint a board of health, and prescribe its powers and duties. Seventy-eighth — To do all acts, make all regulations which may be neces- sary or expedient for the promotion of health or the suppression of disease. Eighty-first — To direct the location and regulate the management and con- struction of packing houses, renderies, tallow chandleries, bone factories, soap factories and tanneries, within the limits of the city or village, and with- in the distance of one mile without city or village limits. Eighty-thircl — To prohibit any offensive or unwholesome business or estab- lishment within or within one mile of the limits of the corporation. 18 Eighty-fourth — To compel the owner of any grocery, cellar, soap or tallow chandlery, tannery, stable, pig sty, privy, sewer or other unwholesome or nauseous house or place, to cleanse, abate, or remove the same, and to regu- late the location thereof. Ninety-sixth — To pass all ordinances, rules, and make all regulations, proper or necessary, to carry into effect the powers granted to cities or villages, with such fines or penalties as the city council or board of trustees shall deem proper: Provided, no fine or penalty shall exceed $200, and no imprisonment shall exceed six months for one offense. Territorial Jurisdiction — The city council and board of trustees shall also have jurisdiction in and over all places within one-half mile of the city or village limits, for the purpose of enforcing health and quarantine ordinances and regulations thereof. — [ Revised Statutes, Chap. 2Jf, Sec. 44-] POWEBS OF COUNTY AND TOWNSHIP BOARDS OF HEALTH. {Act approved May 10, in force July 1, 1901. Amended/ by act in force July 1, 1903.1 (Extracts.) Section 1. The board of county commissioners in counties not under town - ship organization, and the supervisor, assessor and town clerk of every town in counties under township organization, shall constitute a board of health, and on the breaking out of any contagious or infectious disease in their county or town, or in the immediate vicinity thereof, it shall be their duty to make and enforce such rules and regulations tending to check the spread of the disease within the limits of such county or town as may be necessary; and for this purpose they shall have power to quarantine any house or houses, or place where any infected person may be, and cause notices of warning to be put thereon, and to require the disinfection of the house or place: Provided, that nothing in this act shall apply to any territory lying within the corporate limits of any incorporated city or village: Provided, further, that in case the board of health of any county not under township organiza- tion, or of any township in counties under township organization shall fail, refuse or neglect to promptly take the necessary measures to preserve the public health, or in case any such board of health shall refuse or neglect to carry out the rules and regulations of the State Board of Health, that thereupon the State Board of Health may discharge such duties and collect from the county or township, as the case may be, the reasonable costs, charges and expenses incurred thereby. § 2. The said boards of health shall have the following powers: First — To do all acts, make all regulations which may be necessary or ex- pedient for the promotion of health or the suppression of disease. Second — To appoint physicians as health officers and prescribe their duties. Third — To incur the expenses necessary for the performance of the duties and powers enjoined upon the board. Fourth — To provide gratuitous vaccination and disinfection. Fifth — To require reports of dangerously communicable diseases. 19 § 3. Any person who shall violate, or refuse to obey, any rule or regula- tion of the said board of health, shall be liable to a fine not exceeding $200 for each offense, or imprisonment in the county jail not to exceed six months, or both, in the discretion of the court. All fines collected under the provisions of this act shall be paid into the county treasury of the county in which the suit is brought, to be used for county purposes, and it shall be the duty of the State’s attorney in the respective counties to prosecute all persons violating, or refusing to obey, the rules of said local boards of health. The expense of quarantine must be borne by the municipality, or township (or county in certain instances in counties not under township organization) but for the board, nursing, medical assistance, and supplies furnished to patients the county is liable if the proper county officer has been advised of the needs of the patients. * * * “In nearly all health and quarantine laws some are put to inconvenience and annoyance and many, to a certain extent, are deprived of their liberty and freedom of action. But, if the public necessity requires it, the con- venience or even liberty of the individual citizen must give way for the welfare of the greater number. * * * The good of the many must be preferred to the convenience or supposed welfare of the few.” — Decision Ap- pellate Court of Illinois, Second District, Lawbaugh vs. Board of Educa- tion, 66 111. App., 159. * * * “Where the public health and human life are concerned the law requires the highest degree of care. It will not allow of experiments to see if a less degree of care will not answer. The keeper of a furious dog or a mad bull is not allowed to let them go at large to see whether they will bite or gore the neighbors’ children. Nor is the dealer in nitro-glycerine allowed, in the presence of his customers, to see how hard a kick a can of it will bear with- out exploding. Nor is the dealer in gunpowder allowed to see how near his magazine may be located to a blacksmith’s forge without being blown up. Nor is one using a steam engine allowed to see how much steam he can possibly put on without bursting the boiler. No more are those in charge of small-pox patients allowed to experiment to see how little cleansing will answer; how much paper spit upon and bedaubed with small-pox virus it will do to leave upon the walls of the rooms where the patients have been con- fined. The law will not tolerate such experiments. It demands the exercise of all possible care. In all cases of doubt the safest course should be pur- sued, remembering that it is infinitely better to do too much than to run the risk of doing too little.” — Decision Supreme Court of Maine, Seavey vs. Preble, 64 Me., 120. 20 GENERAL RULES AND REGULATIONS FOR PHYSICIANS AND HEALTH AUTHORITIES. 1. Reports — All cases of scarlet fever (scarlatina, scarlet rash or canker rash) shall be reported by the attending physician to the local health authorities, city, village, township or county, depending on the location of the patient, and by them to the Secretary of the State Board of Health at Springfield. 2. Placarding — Whenever a case of scarlet fever (scarlatina, scarlet rash or canker rash) shall have been reported, the infected house shall be properly placarded and all children therein confined to the immediate premises during the prevalence of the disease. Steps shall be taken to prevent all unauthorized persons, especially children, from visiting the premises, and adults from the infected house shall be prohibited from mingling unnecessarily with other people, above all with children, and shall be required to disinfect their clothing before going out of the house. 3. Duties of Physicians — The physician attending a case of scarlet fever (scarlatina, scarlet rash or canker rash) may be permitted to visit the infected premises whenever necessary, but must take all necessary precautions to avoid carrying the disease on his clothing or person. 4. Recovery of Patient — The patient shall not be considered “entirely recovered” until pronounced so by a legally qualified physician. 5. Disinfection — The infected premises with all articles of furniture and clothing therein shall be thoroughly disinfected as herein directed before the quarantine shall be raised. 6. Deaths and Funerals — In the event of death, the body must be wrapped in a sheet thoroughly soaked in Standard Disinfectant No. 2, and then placed in an air-tight coffin, which must remain in the sick room until removed for burial. Public funerals and wakes over such bodies are forbidden. The coffin must not be opened nor the remains again exposed under any pretext whatsoever. The body can not be trans- ported by rail unless prepared in accordance with the rules of this Board. Newspaper notices of such deaths should distinctly state that the deceased died of scarlet fever. To the living and not the dead is our duty due. 21 SUGGESTIONS TO PHYSICIANS. A typical form of scarlatina offers few difficulties in diagnosis, for it can not be mistaken for any other disease. In mild or ill-defined cases the diagnosis is not always easy, hut in scarlatina as in all eruptive dis- eases, time is a valuable factor. The eruption of scarlatina is charac- teristic, and that alone will serve to distinguish it from other eruptive fevers. Scarlatina is most readily confounded at the onset of the active period with tonsilitis, diphtheria, rotheln, rubeola, varicella and even variola. Cases of acute exfoliating dermatitis, the various erythema and the exan- thema following the ingestion of certain drugs and articles of food often simulate the disease. The diagnosis between rotheln and scarlatina in mild form is frequently attended with difficulty. In the diagnosis of contagious diseases great care should be exercised and the physician should invariably insist on the temporary isolation of the patient unless he is satisfied that the ailment is of benign character. The interests of the public health require that no less degree of care shall be exercised. On being satisfied that scarlatina exists in a family the attending physician should recommend the observance of all precautions necessary to prevent the further spread of the disease, and should, as soon as practicable, report the case or cases to the local board of health, if there be one; if not, to the legally constituted health authorities. The attending physician should avoid carrying infection. This he can do if, after contact with the patient, he washes his hair, beard and all exposed cutaneous surfaces with a germicidal solution, and thoroughly brushes his clothing with a whisk broom saturated with a strong disin- fectant. The ease with which particles of exfoliated epithelium are disseminated through the air, and the tenacity with which they adhere to textures, clothing, etc., makes this an imperative duty. On the recovery of the patient the attending physician should notify the local health authorities in order that the quarantine restrictions can be removed, and should give the patient proper certificate of recovery. The physician should also impress upon the local health authorities the absolute necessity for a thorough disinfection of the infected room or rooms, if he has reason to believe that this important feature of pre- ventive medicine will be overlooked. When should the patient be* released from quarantine? The time is variable, depending entirely upon the character of the disease and the presence or absence of complications. As a general rule it will be proper to regard five weeks from the rash as the minimum length of isolation. Under no circumstances should the patient be pronounced 22 free from the danger of conveying infection until desquamation has entirely ceased and all signs of inflammation of the mucous membranes have passed away. Even then infection may be conveyed if there is a discharge from the auditory meatus, the dried and purulent matter attaching to which being possibly as infective as any purely cutaneous particles. While all medical authorities do not agree on the subject, it is the opinion of the majority that scarlatina is infectious from the appearance of the earliest symptoms until desquamation has entirely ceased. But there is little doubt that at the very beginning of scarlet fever the con- tagiousness is limited, and that this disease is highly contagious during the period of eruption and desquamation. * ❖ * . Scarlet fever will not attack every individual even though directly exposed to the contagion. Why this is we cannot explain. In fact as stated in the extract from NothnagePs Encyclopedia, published as a preface to this circular, “in none of the acute exanthemata does our lack of knowledge of the cause of the disease prove so disturbing a factor as in scarlet fever.” Speaking on the subject of immunity to scarlet fever, Welch and Schamberg say : “The contagion of scarlet fever is a most capricious one. It may repeatedly spare an exposed individual, only to strike him at some subsequent period.” That the exciting cause of scarlet fever is , a micro-organism there is little doubt, although the body described as the “germ” has not been definitely isolated. But as scarlet fever is so similar in its behavior and manner of transmission to other infectious diseases of proven parasitic origin, we are justified in assuming that the active factor is a micro- organism. We know, beyond doubt, that the degree of mildness or severity of a case does not influence that of another caused by it, the severest cases being at times followed by the mildest forms, and vice versa. In regard to the transmission of scarlet fever through a contaminated milk supply, Welch and Schamberg, than whom there are no better authorities, say: “From the now extensive literature upon the subject, we may conclude that scarlatina may be conveyed through a contami- nated milk supply. The proposition is not proven beyond the peradven- ture of a doubt, but the chain of circumstantial evidence is so strong as to render this conclusion almost irresistible. It would, furthermore, appear that the milk is contaminated through contact with an individual suffering or convalescent from the disease. The view advanced by Klein that the cows themselves suffer from scarlatina remains unproven and is not generally credited.” 23 DUTIES OF LOCAL HEALTH AUTHORITIES. Whenever a case of scarlet fever (scarlatina) is reported by the house- hold or attending physician, the local health officer, if there be one, or a physician appointed by the city, village or town authorities, must visit the premises and secure prompt compliance with the precautions herein enjoined. Every infected house should be properly placarded and all children therein confined to the immediate premises during the prev- alence of the disease, and steps should be taken to prevent all unauthor- ized persons, especially children, from visiting the premises. Adults from the infected house must be prohibited from mingling unnecessarily with other people, above all with children, and should be required to disinfect their clothing before going out of the house. Isolate, Quarantine, Disinfect. It is not considered necessary to close the schools during the preva- lence of scarlet fever in a community unless it prevails in epidemic form, but the local health authorities should notify the principals of public, parochial and private schools in the neighborhood of the existence of the disease, and if any children affected with scarlet fever have attended school since its appearance, such school or schools should be promptly closed until disinfected. It is imperative that similar notice be sent also to the superintendents of all Sunday schools, or to the pastors of the churches, for there is no question but that the liability of the dissemination of contagious diseases is greater in Sunday schools, which are used but once a week, than in public schools, which are cleaned and ventilated daily. As a further precautionary measure the local health authorities should see that rooms used for Sunday school purposes be kept in a sanitary condition and freely ventilated at intervals during the week. On receiving a certificate from the attending physician that the patient has entirely recovered and that no further quarantine is necessary, it will be the duty of the local health officer to see that the infected room and the premises, if thought necessary, with the contents, be disinfected as directed herein. To be effective the disinfection must be thorough. “There can be no partial disinfection of infectious material; either its infectious power is destroyed or it is not. In the latter case there is a failure to disinfect.” Deodorants merely remove offensive odors, and may not possess any disinfecting power whatever. A failure to properly disinfect apartments often leads to the recurrence of the disease. Local boards of health and health officers should guard against the introduction or spread of contagious disease by the exercise of proper and vigilant inspection and control of all persons and things coming 24 within their jurisdiction. They should require prompt reports of all infectious and contagious diseases and the isolation of all persons and things infected with or exposed to infectious or contagious diseases, and should placard and disinfect infected premises, close schools and assume charge of funerals, if necessary. They should also cause the arrest and imprisonment of all persons violating their orders. The authorities may, in general, take any measures of precaution, however stringent, which they may deem necessary or prudent in the interest of the health of the inhabitants. “The health of the people is the supreme law.” There is no more liberal law or charter in existence than is given to the councils of cities and the trustees of villages by section 62, chapter 24, of the Revised Statutes, for the almost absolute and unrestrained control of the agencies affecting the public health. Concerning the force and effect of such the Supreme Court of Illinois, in the case of Mason et al vs. The City of Shawneetown, 77 111., 533, says: “When an incorporated town or city has been invested with power to pass an ordinance, by the Legislature, for the government or welfare of the municipality, an ordinance enacted by the legislative branch of the corpo- ration in pursuance of an act creating the corporation, has the force and effect of a law passed by the Legislature, and can not be regarded otherwise than as a law of and within the corporation. An ordinance is the law of the inhabitants of the municipality.” DISINFECTION. The thorough disinfection of infected apartments or dwelling is as important as the maintenance of an efficient quarantine during the preva- lence of the disease. Hence, no agent should be employed in the effort to destroy the germs of disease, upon the efficiency of which, under all circumstances, there rests any doubt or uncertainty. The use of a worth- less disinfectant or the misuse of a valuable one not only involves a waste of time and material, hut jeopardizes the health of the community. Disinfection of an infected apartment can be successfully performed by thoroughly wetting the floors, ceilings, walls and all exposed surfaces with an efficient germicidal solution. This method, however, is not applicable to the contents of the apartment. For these fire is the most reliable disinfectant, yet as the other reliable disinfectants are available there is little justification for the burning of any article of value, except, for instance, mattresses or pillows, which can not be successfully disin- fected except by steam. 25 All infected apartments, with contents, should be disinfected by an efficient aerial germicide, and this fumigation should be followed by a thorough washing of the walls, ceilings, floors and exposed surfaces of the room with a reliable disinfecting solution. Fumigation by burning sulphur has for many years been a favorite method of aerial disinfection. As stated in the recently revised Prize Essay of the American Public Health Association, on “Disinfectant and Individual Prophylaxis Against Infectious Diseases/’ by Surgeon General George M. Sternberg, I T . S. A., “the experience of sanitarians is in favor of its use in yellow fever, small-pox, scarlet fever, diphtheria and other diseases in which there is reason to believe that the infectious material does not contain spores.” In the majority of the infectious diseases, the specific germ does not form resistant spores, hence sulphur dioxide would seem to be a reliable aerial disinfectant. It must be remembered also that some authorities do not subscribe to the statement that sulphur is powerless to destroy pathogenic organisms containing spores. Sulphur will be found a thoroughly reliable gaseous disinfectant* of considerable penetrating power, if it is intelligently employed. To obtain satisfactory results, the following essentials of successful disin- fection, established by repeated experiments, must be observed : (a) The infected room, or rooms, must be thoroughly closed, every crack and crevice sealed, (b) Sufficient sulphur must be used, (c) There must be ample moisture in the room, (d) The time of exposure must be sufficient, ten hours the minimum. In the disinfection of stores, halls, school houses and apartments or dwellings in which there are no articles to be injuriously affected by the gas, sulphur is an ideal disinfectant. Its mode of application is simple (the simpler the mode of application the better), it is cheap, the mate- rial is accessible everywhere, and, finally, the most important of all, the action will be invariably found effective when the sulphur has been properly used. During recent years, formaldehyde gas has, to a very considerable extent, taken the place of sulphur dioxide as a gaseous disinfectant. Various methods for the use of formaldehyde have been devised — all requiring apparatus more or less expensive and complicated — all exploited with extravagant claims of merit and infallabilitv. None of these, however, has proven worthy of the claims made for it, while many have been entirely worthless. The fact that the vast majority of devices, at one time exploited and enjoying wide popularity, have been eventually *See page 13 for simple method of application. 26 relegated to the junk heap, indicates clearly the failure of former methods of formaldehyde disinfection to meet the requirements upon them. Almost continuously, since 1898, the State Board of Health has expe- rimented with and investigated the merits of formaldehyde. Every device and every apparatus coming to the attention of the Board has been fairly and thoroughly tested. In view of the results obtained with all, the State Board of Health has been unable to recommend formaldehyde disinfection in the past, and is only able to recommend it now when employed with one method, and only when this method is carried out as directed. The method now unreservedly recommended by the Board consists merely in pouring formaldehyde solution over crystals of potassium permanganate. This method primarily offers the advantage of absolute simplicity in operation, requiring no special apparatus and no fire. In addition to this, exhaustive experimental work has demonstrated that, in practical disinfection, the method is unusually efficient regardless of the conditions of humidity, temperature and other factors which materially effect other methods of the use of formaldehyde. The only apparatus required is a large open vessel, protected by some non-conductive material to prevent the loss of heat from within. An ordinary milk-pail, set into a pulp or wooden bucket will answer every purpose, although a special container, devised for physicians and health officers will be found of considerable advantage. This container or generator consists of. a simply constructed tin can with broad flaring top. Its full height is 1 5% inches, the height from the bottom to the flaring top being about 8 inches. The lower or round section is 10 inches in diameter, while the flaring top is 17% inches in diameter at its top. The container is made of a good quality of bright tin, is sup- plied with a double bottom with % inch air space between the two layers and is entirely covered on sides and bottom with asbestos paper. The asbestos paper and double bottom serve effectively to retain the heat which is generated by the vigorous chemical reaction occurring within and which is essential to the complete production and liberation of the gas. This special container can be made by any tinner of ordinary intelligence and costs but a few dollars. It is illustrated on page 16. With the room sealed, as described on page 13, and as essential to any form of aerial disinfection, the crystals of potassium permanganate (6% ounces to each 1,000 cubic feet of room space, or 10 ounces when the temperature is below 60° F.) are placed in the container. Over this salt is poured “formalin,” or the 40 per cent aqueous solution of for- 27 maldehyde (16 ounces to every 1,000 cubic feet of room space, or 24 ounces when the temperature is below 60° F.). The formaldehyde gas is promptly liberated by the vigorous chemical reaction of the formalin and potassic salt and rises from the generator in immense volume in the form of an inverted cone. It is consequently necessary that all prepara- tions be made in advance and that the operator leave the room at once on the combination of the two chemicals. The door or window of exit will be promptly closed and sealed and the room will be left closed for at least four hours. As in q 1 ! n.eihods of disinfection, success largely depends upon the care which is exercised and the attention which is given to every detail. Simple as the method is, neglect of any of the following points may result in complete failure. The sick room is not the place for experiments. 1. The room should be sealed and prepared as described on page 13. 2. The potassium permanganate (6% ounces to every 1,000 cubic feet of room space, or 10 ounces at temperatures below 60° F.) should be placed in the apparatus or generator. The permanganate must be put in before the formaldehyde solution. 3. The 40 per cent formaldehyde solution (16 ounces to the 1,000 cubic feet of room space, or 24 ounces at temperatures below 60° F.), should then be poured over the permanganate. 4. As the gas is given off in immense volume immediately after the mixture of the formaldehyde and permanganate, the operator must leave the room at once. All preparations must have been finished in advance. 5. The door or window of exit must be promptly closed and sealed, so that there will be no escape of gas, and the room should be left closed for four hours. 6. The room should be thoroughly cleaned after disinfection. All out-of-the-way places, window ledges, mouldings,, etc., should be washed with Standard Disinfectant No. 3 (See last page). The floors should receive careful attention and the solution should thoroughly wet the dust and dirt in the cracks. “Whatever is Worth Doing is Worth Doing Well.” Whenever practicable, the special generator, previously described, should be used, and health officers and physicians should have several such containers on hand. In the absence of such container, use a milk- pail, as described on page 26. If this cannot be done, use a milk-pail, or any tin pail, or an earthen crock, but thoroughly heat the pail or crock .before putting in the chemicals. 28 Care must be taken not to place too much formaldehyde in a single container. The reaction is violent and there is great effervescence and bubbling. If the room is too large to be disinfected with one generator, use as many more as may be required. The following quantities may be used safely in the containers recom- mended : 10 or 12 quart milk-pail, Formaldehyde, 16 ounces; Permanganate, 6% ounces. 14 quart milk-pail, Formaldehyde, 24 ounces; Permanganate, 10 ounces. Special apparatus (Described on page 22), Formaldehyde, 32 ounces; Permanganate, 13 y 2 ounces. If good results are to be attained, care must be exercised to secure the best quality of formaldehyde solution. Get the highest grade 40 per cent aqueous solution on the market. Good formaldehyde is not expensive. Inferior formaldehyde is dear at any price. Its use may bring about most unfortunate results. The fine, needle-shaped crystals of potassium permanganate are better than the rhomboid crystals. See that yon get crystals of potassium permanganate. Do not accept the dust which often contains impurities. Prepare the room and its contents as described on pages 13 and 14, but remember that books cannot 'well be disinfected with formalde- hyde gas. Entire dependence should, however, not be placed upon any aerial disinfectant even though its penetrating power be great. There should be a thorough “house cleaning” after the exposure to the gas, and the liberal application of a solution of corrosive sublimate to all exposed surfaces in the room. A copy of tliis circular, liberal supplies of which can be secured on application to the Secretary of the Board at Springfield, should be furnished to every family in which there is a case of scarlet fever (scarlatina) and to other families which may have been exposed to the disease, and also to teachers of public and private schools and pastors of churches. If the spirit of the rules and regulations of the State Board of Health be complied with, the disease can be easily controlled and speedily suppressed. Published by order of the State Board of Health. James A. Egan, M. D., Secretary. 29 STANDARD DISINFECTANTS. The following are simple, cheap and reliable disinfectants : Standard Disinfectant No. 1. Dissolve chloride of lime of the best quality , in water , in the proportion of 51/2 ounces to the gallon. Use one quart of this solution for each discharge from a patient suffer- ing from a contagious or infectious disease. Discharges from the mouth and throat should be received in a cup half full of the solution, and those from the nostrils upon soft cotton or linen rags which should be immedi- ately burned. The chloride of lime must be of the best quality. Poor chloride of lime is worthless. The solution should be made when required. Instead of chloride of lime, carbolic acid mav be used in . the strength of 6i/ 2 ounces to the gallon of water. Standard Disinfectant No. 2. Dissolve corrosive sublimate, and muriate of ammonia in water, in the proportion of two drachms (120 grains — 1/lf ounce) of each to the gallon. Dissolve in a wooden tub , barrel or pail or an earthen crock. Use for the same purposes and in the same way as No. 1. It is equally effective, but slower in action. This solution is odorless, while the chloride of lime solution is often objectionable in the sick-room on account of its smell. Standard Disinfectant No. 3. Dissolve one drachm (60 grains — 1/8 ounce) of corrosive sublimate and muriate of ammonia in one gallon of water. Dissolve in a wooden tub, barrel or pail or an earthen crock. Use for the disinfection of soiled underclothing, bed linen, etc. Mix solution and immerse articles for two hours. Then wring them out and boil them. 30 Mixed with an equal quantity of water the solution is useful for washing the hands and general surfaces of the bodies of attendants and convalescents. The latter only by direction of the physician. Chloride of lime, carbolic acid and corrosive sublimate are deadly poisons. ^ Solutions of corrosive sublimate must not be made or kept in a metal vessel. Use a wooden tub, barrel or pail or aft earthen crock.