6. Methods of control-Continued. (B) General measures- -Continued. 3. Application of the Schick test to all children, so far as possible. 4. Immunization by toxin-antitoxin inoculation of all sus ceptibles. 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. Explanatory note: 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. 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 pe- 3. Immunization-Vaccines give considerable immunity. Owing 6. Methods of control-Continued. (A) The infected individual and his environment-Continued. 5. Concurrent disinfection-Bowel discharges after method used in typhoid; immediate washing of diapers in case of babies. 6. Terminal disinfection-Cleansing. (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 nasopharynx. 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. 2. Isolation-Until termination of disease. 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. 6. Methods of control-Continued. (B) General measures— Physicians in attendance upon a case of erysipelas should refrain · from obstetric service until the erysipelas is dismissed. REG. 16. Foot and mouth disease (aphthous fever)— 1. Infective agent: An unknown filterable virus. 2. Source of infection: Saliva, milk, tears and various other secretions and excretions, also in the blood until eruption appears. 3. Mode of transmission: Contact with an infected person or animal and the ingestion of milk or milk products from an infected animal; also by contact with hay utensils, drinking troughs, etc., recently soiled with discharges from infected surface. 4. Incubation period: 2 to 6 days, rarely 15 to 18 days. 5. Period of communicability: Until the lesions have completely healed. (A) The infected individual and his environment- 2. Isolation until healing of lesions. 3. Immunization-None. 4. Quarantine-None. 5. Concurrent disinfection-Discharges from all diseased surfaces and of articles freshly soiled. 6. Terminal disinfection-Thorough cleansing. (B) General measures 1. Attention to herds when disease is suspected to be present. 2. Avoidance of contact with surfaces with which diseased animals may have been in contact. 3. Pasteurization of milk when disease is prevalent in a community. 4. Milk from cows sick with this disease must not be used. REG. 17. (German measles rubella, roetheln, rubeola notha, French measles).— 1. Infected agent: Unknown. 2. Source of infection: Secretions of the mouth and possibly of the nose. 3. Mode of transmission: By direct contact with the patient or with articles freshly soiled with the discharges from the nose or throat of patient. 4. Incubation period: From 10 to 21 days. 5. Period of communicability: Eight days from onset of the disease. 6. Method of control: (A) The infected individual and his environment 1. Recognition of the disease-Clinical symptoms. 2. Isolation-Separation of the patient from nonimmune children and exclusion of the patient from school and public places for the period of presumed infectivity. Placard. 3. Immunization-None. 4. Quarantine-None. 5. Concurrent disinfection-Discharges from the nose throat of the patient and articles soiled by discharges. and 6. Terminal disinfection-Airing and cleansing. (B) General measures Note. The reason for attempting to control this disease is that it may be confused with scarlet fever during its early stages; each person having symptoms of the disease should therefore be placed under the care of a physician and the case should be reported to the local department of health. |