the name and address of patients shall be omitted; then the special form required by statute for this class of diseases must be used in reporting. Reports shall be made by telephone or telegram when practicable and shall also always be made in writing. REG. 5. Reporting when no physician is in attendance.—Superintendents or persons in charge of hospitals, sanatoria, dispensaries, or other institutions, nurses, midwives, teachers, dairy managers, heads of private households, and proprietors and keepers of hotels, boarding houses or lodging houses, or other persons either treating or having knowledge of a reportable disease shall be required to report such disease coming under their observation, when no physician is in attendance. REG. 6. Actinomycosis (lumpy jaw).— 1. Infective agent: Actinomyces bovis (ray fungus). 2. Source of infection: The nasal and bowel discharges, and the infected material from lesions in human and animal cases of the disease. Uncooked meat from infected animals may serve as a source of infection. 3. Mode of transmission: By contact with the discharges or with articles freshly soiled with the discharges from animal or human cases. 4. Incubation period: Unknown. 5. Period of communicability: As long as open lesions remain, as proved by the presence of the infective agent by microscopic or cultural tests. 6. Methods of control: (A) The infected individual and his environment 1. Recognition of the disease Clinical symptoms, confirmed by microscopic examination of discharges from the lesions. 2. Isolation-None, provided the patient is under adequate medical supervision. 3. Immunization-None. 4. Quarantine-None. 5. Concurrent disinfection-Of discharges from lesions and articles soiled therewith. 6. Terminal disinfection-By thorough cleansing. (B) General measures 1. Inspection of meat, with condemnation of carcasses, or infected parts of carcasses, of infected animals. 2. Destruction of known animal sources of infection. REG. 7. Angina, Vincent's. 1. Infective agent: A spirillum together with a fusiform bacillus. 2. Source of infection: Discharge from the pharynx, less frequently from the glans penis and vulva.. 3. Mode of transmission: Directly by personal contact; indirectly by articles freshly soiled with discharges from the lesions. 4. Incubation period: Unknown. 5. Period of communicability: Until complete healing of the lesions has taken place. 6. Methods of control: (A) The infected individual and his environment 1. Recognition of the disease-Clinical symptoms, confirmed by bacteriological examination. 2. Isolation of the infected person, in cases when it is deemed advisable, until the lesions are healed. 3. Immunization-None. 4. Quarantine-None. 6. Methods of control-Continued. (A) The infected individual and his environment-Continued. 5. Concurrent disinfection of discharges from lesions and of articles soiled by discharges. 6. Terminal disinfection-Thorough cleansing. (B) General measures-Arsenic by mouth or intravenously, is curative. REG. 8. Anthrax (malignant pustule, wool sorter's disease).— 1. Infective agent: Bacillus anthracis. 2. Source of infection: Hair, hides, flesh, and feces of infected animals. 3. Mode of transmission: Inoculation as by accidental wound or scratch, inhalation of spores of the infective agent, and ingestion of insufficiently cooked infected meat. 4. Incubation period: Within seven days. 5. Period of communicability: During the febrile stage of the disease and until lesions have ceased discharging. Infected hair and hides of infected animals may communicate the diseasse for many months after slaughter of the animal, and after curing of hide, fur, or hair, unless disinfected. 6. Methods of control: (A) The infected individual and his environment 1. Recognition of the disease-Clinical symptoms, confirmed by bacteriological examination. 2. Isolation of the infected individual until the lesions have healed. 3. Immunization-None. 4. Quarantine-None. 5. Concurrent disinfection of the discharges from lesions and of articles soiled by the discharges. 6. Terminal disinfection-Thorough cleansing. (B) General measures 1. Animals ill with a disease presumably anthrax should be placed immediately under the care of a veterinary surgeon. Proved animal cases of the disease should be killed promptly and the carcasses destroyed, preferably by fire. 2. Isolation of animals affected with the disease. 3. Immunization of exposed animals under direction of Federal or State department of agriculture. 4. Post-mortem examinations should be made only by a veterinary surgeon, or in the presence of one. 5. Milk from an infected animal should not be used during the febrile period. 6. Control and disinfection of effluents and trade wastes and of areas of land polluted by such effluents and wastes from factories or premises, where spore-infected hides or other infected hide and hair products are known to have been worked up into manufactured articles. 7. A physician should be constantly employed by every company handling raw hides, or such companies should operate under the direct supervision of a medical representative of the health department. 8. Every employee handling raw hides, hair, or bristles who has an abrasion of the skin should immediately report to a physician. 9. Special instruction should be given to all employees handling raw hides in regard to the necessity of personal cleanliness. 6. Methods of control-Continued. (B) General measures-Continued. 10. Tanneries and woolen mills should be provided with proper ventilating apparatus so that dust can be promptly removed. 11. Disinfection of hair, wool, and bristles of animals originating in known infected centers before they are used or assorted. 12. Any shaving brushes found in the market which do not bear the name or the trade-mark of the manufacturer should be regarded with suspicion, and should be returned to the source from which they were secured, or should be disinfected. For the sterilization of brushes the following procedure is believed to be effective: The brush should be soaked for four hours in a 10 per cent solution of formalin (by formalin is meant a 40 per cent solution of formaldehyde). The solution should be kept at a temperature of 110° F. and the brush so agitated as to bring the solution into contact with all hair or bristles. 13. The sale of hides from an animal infected with anthrax should be prohibited. The inspection and disinfection of imported hides are under the supervision of the United States Bureau of Animal Industry. In the event that infection is introduced the State veterinarian has jurisdiction over infected animals, and the local or State health authorities have jurisdiction over infected persons. REG. 9. Botulism.— 1. Infective agent: Bacillus botulinus A and B. 2. Source of infection: Decomposed foods, such as sausage and other meats, fish, vegetables rich in protein, such as beans and peas; also in ripe olives. 3. Mode of transmission: By ingestion of infected foods. 4. Incubation period: 4 to 65 hours; usually 20 to 24 hours. 5. Methods of control: (A) The infected individual and his environment 1. Recognition of the disease-By clinical symptoms with confirmation of [by?] bacteriological examination of suspected foods and also by biological tests on animals. The clinical symptoms briefly stated are: Nausea, gastric pains, vomiting, burning thirst, difficulty in swallowing; symptoms referable to the nervous system such as dimness of vision, amounting in some cases almost to blindness, dilatation of pupils with loss of reaction to light, ptosis, extreme muscular weakness. Cases with these symptoms should be given large doses of polyvalent botulism antitoxin intravenously with promptness. 2. Isolation-None. 3. Quarantine-None. 4. Immunization in exposed cases by large doses of a polyvalent botulism antitoxin used intravenously. (B) General measures 1. Greater care in preserving and handling nitrogenous foodstuffs. Heat destroys the toxin, but it must be sufficient and must penetrate throughout the mass; also the cooking must be recent for the spores develop well in cooked foods. REG. 10. Chicken pox (varicella).— 1. Infective agent: Unknown. 2. Source of infection: The infectious agent is presumably in the lesions of the skin and of the mucous membranes; the latter lesions, appearing early and rupturing as soon as they appear, render the disease communicable early, that is, before the exanthem is in evidence. 3. Mode of transmission: Directly from person to person. 4. Incubation period: Two to three weeks. 5. Period of communicability: Until the primary scabs have disappeared from the mucous membranes and the skin. 6. Methods of control: (A) The infected individual and his environment 1. Recognition of the disease-Clinical symptoms. The differential diagnosis of this disease from smallpox is important, especially in people over 15 years of age. 2. Isolation-Placard and isolate during period of communicability. Exclusion of patient from school, and prevention of contact with nonimmune persons. Heads of families and others who have had this disease may go and come, provided they do not come in direct contact with the patient. Children who have had chicken pox may continue in school, provided they do not come in direct contact with the patient. Children not so immune must be excluded from school for 21 days. 3. Immunization-None. 4. Quarantine-None. 5. Concurrent disinfection of articles soiled by discharges from lesions. 6. Terminal disinfection-Thorough cleansing. (B) General measures-None. REG. 11. Cholera, Asiatic. 1. Infective agent: Vibrio cholerae. 2. Source of infection: Bowel discharges and pomits of infected person, and feces of convalescent or healthy carriers. Ten per cent of contacts may be found to be carriers. 3. Mode of transmission: By food and water polluted by infective agent; by contact with infected persons, carriers, or articles freshly soiled by their discharges; by flies. 4. Incubation period: One to five days, usually three days, occasionally longer if the healthy carrier stage, before development of symptoms, is included. 5. Period of communicability: Usually 7 to 14 days or longer and until the infectious organism is absent from the bowel discharges. 6. Methods of control: (A) The infected individual and his environment 1. Recognition of the disease-Clinical symptoms, confirmed by bacteriological examination of the stools.. 2. Isolation of patient in hospital or screened room. Placard. 4. Quarantine-Contacts for five days from last exposure, or 6. Terminal disinfection-The room in which a sick patient was |