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 nfected 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. Iso ation-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. 3. Immunization-None. 4. Quarantine-Contacts for five days from last exposure, or longer if stools are found to contain the cholera vibrio. 5. Concurrent disinfection-Prompt and thorough disinfection of the stools and vomited matter, also of articles used by and in connection with the patient. 6. Terminal disinfection-The room in which a sick patient was isolated should be thoroughly cleansed and disinfected. 6. Methods of control-Continued. (B) General measures 1. Rigid personal prophylaxis of attendants by scrupulous cleanliness. 2. The bacteriological examination of the stools of all contacts to determine carriers. Isolation of carriers. 3. Water should be boiled and foods carefully supervised. REG. 12. Diphtheria.― 1. Infective agent: Bacillus diphtheriae (the Klebs-Loeffler bacillus). 2. Source of infection: Discharges from diphtheritic lesions of nose, throat, conjunctiva, vagina, and wound surfaces. Secretions from the nose and throat of chronic carriers of the bacillus. 3. Mode of transmission: Directly by personal contact; indirectly by articles freshly soiled with discharges; or through infected milk or milk products. 4. Incubation period: Usually two to five days, occasionally longer if a healthy carrier stage precedes the development of clinical symptoms. 5. Period of communicability: Until virulent bacilli have disappeared from the secretions and the lesions. The persistence of the bacilli after the lesions have healed is variable. In fully three-quarters of the cases they disappear within two weeks. In 95 per cent of cases the bacilli disappear in four weeks. In exceptional cases virulent bacilli remain in the throat and discharges for from two to six months. 6. Methods of control: (A) The infected individual and his environment— 1. Recognition of the disease-By clinical symptoms with confirmation by bacteriological examination of discharges. Send culture to State bacteriologist. 2. Isolation-Minimum 21 days, or until two negative cultures are secured on successive days, after the fourteenth day. Known child carriers must remain at home and apart from other children until the virulence test shows them to be noninfective for others. Adult carriers, who take reasonable precautions against transferring excretions of the nose and throat to others, may be permitted to go about their work: Provided, That they are forbidden to handle milk products or to engage in any occupation which brings them in intimate contact with children. Isolation may be terminated in any case if persistent diphtheria bacilli prove avirulent. Placard. 3. Immunization-Exposed persons, not known to be immune, to be promptly immunized by antitoxin. 4. Quarantine all children exposed until shown by bacteriological examination not to be carriers. 5. Concurrent disinfection of all articles which have been in con. tact with the patient and all articles soiled by discharges from the patient, including urine. Use method advised in typhoid. 6. Terminal disinfection-At the end of the illness, airing and sunning of the sick room, with thorough cleansing. (B) General measures 1. Pasteurization of milk supply. 2. Application of the Schick test to all contacts and immunization of all susceptibles. 6. Methods of control-Continued. (B) General measures-Continued. Explanatory note: 3. Application of the Schick test to all children, so far as possible. 4. Immunization by toxin-antitoxin inoculation of all susceptibles. 5. Determination of presence or absence of carriers among contacts, and, so far as practicable, in the community at large. Complete removal of tonsils and adenoids in case of carriers should be done, as the result is commonly satisfactory. 1. Whenever a case of diphtheria occurs in a school, factory, department store, or other place where either children or adults are closely grouped together, throat cultures should be made from all who have been in intimate association or contact with the one who is infected, and from all others who are found to have diseased tonsils, and the Schick test should be applied to determine immunity. Those found susceptible should be given temporary immunity by an appropriate dose of antitoxin, a more permanent immunity being produced later by injection of toxin-antitoxin. Schools need not be closed. 2. Children in the infected household, not ill, should be given an immunizing dose of diphtheria antitoxin, when they may be disinfected and quarantined elsewhere for 10 days, after which permission may be granted them to return to school, provided throat cultures are negative. 1 3. Heads of families and adult wage earners may be disinfected and be permitted to engage in their usual occupations, provided they do not come in any way in contact with the patient. 4. Remember that nearly all cases of membranous croup are in reality laryngeal diphtheria. REG. 13. Dysentery (bacillary) — 1. Infective agent: Bacillus dysenteriae (Shiga and Flexner). 2. Source of infection: The bowel discharges of infected persons. 3. Mode of transmission: By drinking contaminated water, by eating infected foods, and by hand-to-mouth transfer of infected material; by objects soiled with discharges of an infected individual or of a carrier; by flies. 4. Incubation period: Two to seven days. 5. Period of communiciability: During the febrile period of the disease and until the 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 serological and bacteriological tests. In specific case use of Flexner serum. 2. Isolation-Infected individuals during the communicable period of the disease. 3. Immunization-Vaccines give considerable immunity. Owing to severe reactions their use is not universal, nor should it be made compulsory except under extreme emergency. 4. Quarantine-None. 6. Methods of control-Continued. (A) The infected individual and his environment-Continued. (B) General measures 1. Rigid personal prophylaxis of attendants upon infected per sons. 2. No milk or food for human consumption should be sold from a place occupied by a patient unless the persons engaged therein occupy quarters separate from the house where the patient is sick and all utensils used are cleansed and kept in a separate building, and under a permit from the health officer. 3. All attendants upon persons affected with this disease should be prohibited from having anything to do with the handling of food. 4. Necessary precautions against flies. Note.-Amebic dysentery is a disease of the Tropics, is caused by an ameba. Emetine serves a useful purpose in its treatment. REG. 14. Encephalitis lethargica (spurious sleeping sickness).— 1. Infective agent: Believed to be a filterable virus, existing in the spinal fluid and nasopharyngeal secretions. 2. Source of infection: Nose and throat of those affected with the disease. 3. Mode of transmission: Infection probably takes place through the naso pharynx. 4. Incubation period: Probably three weeks, possibly a week or 10 days. 5. Period of communicability: Unknown. 6. Methods of control: (A) The infected individual and his environment 1. Recognition of the disease Clinical symptoms. 3. Immunization-None. 4. Quarantine-None. (B) General measures-None. REG. 15. Erysipelas.— 1. Infecitve agent: Streptococcus erysipelatis. 2. Source of infection: Bacterium found in lympth vessels at periphery of the inflamed area. 3. Mode of transmission: Directly by contact with area involved; indirectly by contact with articles freshly soiled by serum from infected area. 4. Incubation period: 3 to 10 days. 5. Period of communicability: Until the process is ended. 6. Methods of control: (A) The infected individual and his environment 1. Recognition of the disease-Clinical symptoms. 2. Isolation-Until the process is ended. 3. Immunization-None. 4. Quarantine-None. 5. Concurrent disinfection-All contaminated articles must be burned or disinfected. 6. Terminal disinfection-Thorough cleansing and airing of the room and its contents. |