treated with a strong solution of carbolic, lysol, bichloride of mercury or some other efficient disinfectant. In case a glass, china, porcelain or metal sputum cup or flask is employed, it should be cleansed after use with a strong disinfectant and should be boiled for a period of not less than 15 minutes.

A tuberculous person or consumptive shall not spit upon floors, streets, walks or other public or private places nor should he use spittoons or dispose of his sputum in any other way than as prescribed heretofore.

A tuberculous person or consumptive should not cough without covering his mouth with paper, cloth or other material, which paper, cloth or material should be promptly burned.

RULE 7. Sale of milk, groceries and provisions.-Whenever an open case of pulmonary tuberculosis or consumption is found to exist in premises where milk, groceries, vegetables, meats or other foodstuffs are either produced, handled or sold, the sale, exchange or distribution in any manner whatsoever of any milk, cream or other milk products, groceries or vegetables, meats or other foodstuffs is strictly prohibited until the case is terminated by arrest.of the disease or by removal or death and the premises have been thoroughly disinfected: Provided, That when, in the opinion of the health officer, based upon personal inspection of the premises, the individual suffering from pulmonary tuberculosis or consumption is so isolated that he does not come in contact with any milk, cream or other milk products, groceries, vegetables, meats or other foodstuffs offered for sale, barter, exchange or distribution and does not come into the room or rooms in which such foodstuffs are stored, held or offered for sale, barter, exchange or distribution, and where all other precautionary measures are carried out in such a way as to safeguard the public and the members of the household, the health officer, may, at his discretion, modify the provisions of this paragraph. A person suffering from pulmonary tuberculosis or consumption will not be permitted to engage in any manner in the handling or preparation of foodstuffs, milk or milk products, groceries, vegetables or meats until it has been ascertained that such person is not an open case and is in no danger of spreading the infection.

RULE 8. Exclusion from schools.-No person suffering from open pulmonary tuberculosis or consumption as defined in rule 5 shall be employed as a teacher in any 'school nor shall such a tuberculous or consumptive person be employed or be permitted to serve in any capacity in or about a school building.

No child or young person suffering from open pulmonary tuberculosis or consumption shall be permitted to attend school or mingle with other children in or about school buildings.

RULE 9. Nurses.-No person suffering from open pulmonary tuberculosis or consumption, as defined in rule 5, shall engage in the nursing, attendance or care of young children or of sick persons.

RULE 10. Notification of death or removal.-It is the duty of the owner or agent of any premises in which a patient suffering from pulmonary tuberculosis or consumption has resided, to promptly notify the local health officials of the death or removal of the tuberculous person or consumptive and such owner or agent shall not rent, lease or sell such premises or permit same to be occupied by any other person or persons than the family or household of the tuberculous person or consumptive until the premises have been disinfected as hereinafter provided.

RULE 11. Disinfection.-Upon the removal of a person suffering from pulmonary tuberculosis or consumption, either by arrest of the disease, by death or by removal to other premises, the sick room and all other rooms that have been occupied by the tuberculous person or consumptive shall be disinfected. The room or rooms must be thoroughly aired and all woodwork thoroughly scrubbed and the walls cleaned. The bed clothing must be disinfected by boiling or by immersion in an approved disinfectant. Grossly soiled articles, which can not be disinfected by the usual methods, should be burned.

Typhus Fever-Notification of Cases-Precautions by Physician or Attendant-Delousing-Placarding-Quarantine-Removal of Infected Persons-DisinfectionNotification of Persons or Premises Infested with Body Lice-QuarantinePlacarding. (Reg. Bd. of H., Jan. 1, 1917.)

RULE 1. Reports.-Every physician, attendant, parent, householder, or other person having knowledge of a known or suspected case of typhus fever must immediately report the same to the local health authorities.

The local health authorities upon receipt of such report shall immediately report the same by telegraph or telephone to the State board of health and shall proceed to enforce the rules as hereinafter provided.

Note 1.-A brief description of the disease as commonly observed in the United States is here given (Brill, Pierce, Anderson). A feeling of malaise, fatigue, anorexia and dull headache lasting from a few hours to as long as 14 days (very rarely) (Brill) commonly precedes the acute symptoms. The usual period of prodromes is about one or two days. Frequently it is entirely absent.

The onset is usually abrupt and is most constantly marked by fever and headache. Chills are very common at first but are not constant. The fever reaches its height within three days and remains quite constantly high, seldom remitting more than one degree between evening and morning. It is usually 103 or 104 though lower and occasionally higher temperatures are seen. The fall is usually by crisis, i. e., within 24 hours, or by rapid lysis, i. e., within 48 hours. Brill states that in no case has it required more than 60 hours for the temperature to reach normal. After reaching normal it does not again rise except for a few hours in rare instances.

The headache is very marked (usually intense) and persists throughout the febrile period. Pain in the back and limbs is complained of. There is a very marked mental apathy and confusion. Delirium is common in the epidemic form, uncommon in the milder endemic form (Brill's disease). There is usually considerable deafness.

Pulmonary symptoms are common in the epidemic form, the cases sometimes closely simulating bronchopneumonia. Brill does not mention any pulmonary symptoms in his series.

The most distinctive feature of the disease is the rash. This appears from three to five (possibly seven) days after the onset and is first seen on the abdomen. Thence it spreads rapidly over the back, chest, thighs, legs, arms and forearms. It rarely involves the face and yet more rarely the palms and soles. (Brill.) The rash is maculo-papular, is usually fully out within 24 to 36 hours and remains visible until after the temperature returns to normal. The spots vary from the size of a small match head to the size of a dime, are but slightly raised and have irregular and indistinct outlines. While most or all of the lesions may fade markedly on pressure in the early stages, some fade little if at all. As time passes fewer and fewer disappear on pressure, the eruption becoming petechial as it grows older. The tongue is coated at first. In all except the mild cases it becomes dry and brown later.

The pulse usually rises with the temperature though in the first few days this may not be noticeable. The patients even in mild cases appear very sick during the febrile period. The disease usually runs its course in 12 to 16 days terminating as stated above by crisis or rapid lysis. Convalescence is usually rapid and relapses are unknown.

RULE 2. Any physician, nurse or other person, who attends a case known or suspected to be typhus fever shall ta e such precautions as may be necessary to prevent infected body lice gaining access to his or her clothing.

Note 2 (a).-Typhus fever is transmitted from persons sick with the disease to susceptible persons by the body louse (Pediculus vestimenti). It is possible that the head louse (Pediculus capitis) occasionally transmits the disease. The crab louse (Pediculus pubis) never does. It is not known to be transmitted by any other means in nature and preventive measures based on "delousing" procedures have proven adequate. The disease has been transmitted experimentally from cases during the entire febrile period and for 6 hours after a return to normal temperature. While louse transmission experiments have been successin only during the febrile period, yet the possibility of later infection should not be disregarded. Previons to delousing procedures and the placing of the patient in a vermin free environment, the physician and attendants should take the following precaution

(b) A clean washable outer garment with short (elbow) sleeves should be worn. The sleeves should be closely sealed with adhesive tape above the elbows and the hands and forearms up to the tape should be bared and oiled with kerosene. As additional precautions the shoes may be immersed in kerosene or a narrow band of Canada Balsam or other sticky substance smeared around the waist of the shoes. The bottoms of the trousers should be sealed tightly to the shoe with adhesive tape. If there are no carpets, the floor may be saturated with 50 per cent emulsion of kerosene in soapsuds. A 5 per cent ointment of naphthalin in vaselin may be applied to the neck or kerosene alone may be used. The outergarment, tapes, etc., should be removed outside the house. The tapes should be burned and the outer-garment immersed in gasoline (out of doors, remember!) or sprinkled with gasoline or kerosene and enclosed in a tight box, or the garment may be ironed with a hot iron or boiled for 10 minutes. Dry heat is more efficacious than moist. Phenol solutions in ordinary strengths are not efficacious.

RULE 3. Any physician attending a known or suspected case of typhus fever shall instruct the patient and other members of the family in the measures necessary to destroy lice on or about the patient, his clothing and environment: Provided, That where the local health authorities are competent to discharge this duty the same shall devolve upon them. Such measures shall include the following as minimum requirements.

(a) The clothing of the patient and of all contacts shall be removed and immediately placed in a tub, washboiler or other suitable receptacle which has been rubbed on the inside with kerosene and be boiled or completely submerged in gasoline (out of doors). Boiling must be continued for at least 10 minutes; submersion in gasoline must be for at least 2 minutes. Shoes, belts and other leather goods and fabrics that may be damaged by boiling should be treated by immersion in gasoline for two minutes. Use gasoline only in the open air away from any flame.

(b) The head and entire body of the patient and of contacts shall be bathed with (1) kerosene, or (2) a 50 per cent emulsion of kerosene in soapsuds, or (3) a 50 per cent emulsion of kerosene in vinegar. The last named method (3) is effective in removing nits but is difficult to keep properly mixed. Following this the bed clothing of the patient shall be changed, a soap and water bath given following which clean louse-free clothing shall be put on.

(e) Following the delousing procedures specified in paragraphs (a) and (b) the patient shall be removed to a louse-free room or hospital subject to the provisions of rule 7. Such room shall thereafter be kept vermin free by daily treatment of the floor with kerosene and by repeating the procedures specified in paragraph (b) every fourth day.

(d) Following the removal of the patient as specified in paragraph (c) the room which has been occupied by the patient shall be deloused. The floors and the woodwork to a height of 4 feet should be given a preliminary treatment of kerosene if this has not already been done (rule 2, (b)). Washable goods shall be boiled, sterilized with steam (for 30 minutes), treated with dry heat (180° F. for 20 minutes), or immersed in gasoline for two minutes—or all clothing, bedding and other fabrics may be placed in heavy muslin, cretonne or other closely woven cloth bags, the opening of which shall be securely closed, tied and saturated with kerosene after which it may be transported to a dry cleaning establishment under the direct surveillance of an officer of the State board of health—and there immersed for not less than two minutes in gasoline, naphtha or distillate. Where capacious steam sterilizing or dry heating chambers are not available, mattresses shall be burned or fumigated with sulphur (dioxide) using 4 pounds of sulphur to each 1,000 cubic feet of air space. Bedding and other nonwashable articles may be similarly treated.

Precautions.-Articles treated with dry heat or sulphur (dioxide) must be suspended so that all surfaces are exposed to the heated air or the gas. See that for sulphur fumigation all crevices are properly sealed (see pp. 7 and 12 circular on disinfection). Do not use added moisture for destroying lice or other insects.

Do not use gasoline or other volatile hydrocarbons indoors. A disastrous explosion may result.

Prior to the return of articles removed from the house the floors, woodwork, beds, and bunks shall be mopped or sprayed with kerosene.

RULE 4. Whenever a case of suspected typhus fever is reported to the local health authorities they shall affix at the outside of all entrances to the building, house, flat or bunk car, as the case may be, a warning card not less than 10 by 15 inches in size, on which shall be printed in black with bold-faced type, at least the following: "Typhus fever" in type nor less than 34 inches in height, and "Keep out" in similar type not less than 24 inches in height. Defacement of such placards, or their removal by any other than the local health authorities, or the duly authorized representatives of the State board of health is strictly prohibited.

RULE 5. All cases of typhus fever shall be quarantined until two days after the tem perature of the patient shall have returned to normal. Persons who have been exposed to typhus fever shall be quarantined for two weeks following the delousing procedures specified in rule 3, subject to the condition that they shall have since been domiciled in vermin-free quarters, shall not have been exposed to typhus fever after the delousing procedures and shall be found free from vermin after the expiration of the above mentioned period of two weeks: Provided, That in the discretion of a representative of the State board of health contacts may be permitted to work subject to the condition that they shall be strictly prevented from coming in contact with persons not included in the "contact" quarantine or with objects which may be infested with lice. All persons continuing to reside on the infected premises shall be confined to the infected building, house or apartment until quarantine has been raised, excepting as herein elsewhere provided.

No one but the necessary attendant, the physician, the health officer and the representative of the State board of health may be permitted to enter or leave the infected premises. They must take all precautions necessary to prevent the spread of the disease. The nursing attendant may leave the premises only in cases of absolute necessity. Quarantine may be terminated only by the local health authorities, or by a duly authorized representative of the State board of health.

Note 3.-This rule is designed to prevent the spread of the disease by

(a) Preventing the reinfestation of the patient during the febrile period which is the infectious period; (b) The reinfestation of contacts who may become ill with typhus during the incubation period thus infecting many lice and possibly thereby other contacts.

RULE 6. Removals.-No person affected with typhus fever shall be removed from the premises upon which he is found, unless consent to such removal be first obtained from the local health authorities or the State board of health, and then only after strict compliance with the provisions of these rules.

No person affected with typhus fever shall be removed from any city, village, township or county in which he is found unless consent to such removal be first obtained from the State board of health.

RULE 7. Whereas typhus fever has been introduced into Illinois and in all probability will be reintroduced from time to time despite the precautions that are being used against it, and whereas there is great danger of its rapid spread when body lice are present, the State board of health hereby declares the body louse (Pediculus vestimenti) a menace to public health.

Physicians, nurses, employees, lodging-house keepers, section foremen, teachers, or other persons having knowledge that any person, persons, or premises are infested with body lice shall forthwith report the name and location of such persons or the location of such premises. Local health authorities shall quarantine any person or premises known to be so infested until the delousing procedures specified in rule 3 have been carried out under the supervision of the local health authorities. Placards not less than 10 by 15 inches in size, bearing the word "Pediculosis," printed in black with bold-face type not less than 34 inches high, shall be affixed at the outside entrances of the house, flat, tenement, bunk car or other habitation so quarantined. No such placards shall be defaced or removed by any other than the local health authorities or the duly authorized representative of the State board of health.

RULE 8. Disinfection.-Terminal disinfection for typhus fever is not required. The local health authorities shall see, however, that the delousing procedures prescribed in rule 3 are effectively carried out at the time of establishing quarantine. Terminal delousing procedures identical with those prescribed in rule 3 shall be performed if any possibility of reinfestation shall have occurred during the period quarantined.

Measles-Quarantine. (Reg. Bd. of H., Mar. 24, 1917.)

The last two paragraphs of rule 3 of the regulations of the State board of health pertaining to measles, effective Feb. 16, 1915, Public Health Reports Reprint 338, page 195, have been amended to read as follows:]

Quarantine of patient must be maintained for 14 days from date of report and until all infectious discharges from nose, ears and throat have disappeared and the cough has ceased: Provided however, That if there are no other susceptibles in the family and the patient is free from infectious discharges, the quarantine may be raised by the health officer whenever the patient's temperature has been normal for 48 hours. Adult members of the family who have had the disease and who comply with the foregoing provisions may go about their usual business.

Venereal Diseases—Notification of Cases-Placarding-Quarantine-Investigation— Control. (Reg. Dept. of Pub. H., Nov. 1, 1917.)

1. Reports. Every physician, nurse, attendant, hospital superintendent, druggist or other person having knowledge of a known or suspected case of venereal disease (syphilis in the infectious stages, gonococcus infection, or chancroid) must immediately report the same to the local health authorities, the report to be in accordance with the following form and setting forth at least the information therein provided for:

(Form of report.)

REPORT OF VENEREAL DISEASE.

(To be treated as confidential so far as is consistent with public safety and the Rules for the Control of Venereal Diseases.)

.years;

(4) Name of patient...........

(Case or key number may be given instead of correct name under certain circum-
stances. See rule 1, Rules for Control of Venereal Diseases in Illinois.)
...; (6) Color.....

(5) Sex....
(8) Single, married, widowed, divorced.

(9) Address of patient....

.; (7) Age.

(Street and house number may be omitted under certain circumstances, but name of
city, town, or village must be given in accordance with rule 1.)

10) Is living at home, in boarding house, hotel, hospital, or elsewhere?

(11) Occupation.

(12) Employer..

(Specify which.)

-; (13) Address.

(Name and address of employer may be omitted under certain circumstances, in
accordance with rule 1.)

(14) Does patient handle milk, milk products, or foodstuffs?.

(15) Has patient discontinued employment?..

(16) Probable source of infection....

(Where a prostitute is the probable source of infection, give name and address in full.)

(17) Probable date of infection......