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6. Methods of control-Continued.

(B) General measures-Continued.

2. Enjoining of persons from any unnecessary visiting or contact in any manner whatever.

3. Attendants should wear masks covering nose and mouth. 4. Careful attention to all hygienic requirements.

REG. 22. Leprosy.—

1. Infectious agent: Bacillus leprae.

2. Source of infection: Discharges from lesions.

3. Mode of transmission: By close, intimate, and prolonged contact with infected individuals. Flies and other insects may be mechanical carriers.

4. Incubation period: Prolonged, undetermined.

5. Period of communicability: Infectivity exists throughout the duration of the disease. Where good standards of personal hygiene prevail this disease is but slightly communicable.

6. Methods of control:

(A) The infected individual and his environment

1. Recognition of the disease-Clinical symptoms, confirmed by bacteriological examination.

2. Isolation in national leprosarium, when this is possible, for life or until cure may be effected.

3. Immunization-None.

4. Quarantine-None.

5. Concurrent disinfection-Discharges and articles soiled with discharges.

6. Terminal disinfection-thorough cleansing of living premises of the patient.

(B) General measures

1. Lack of information as to the determining factors in the
spread and communication of the disease makes any but
general advice in matters of personal hygiene of no value.
2. As a temporary expedient, lepers may be properly cared for
in local hospitals, or if conditions of the patient and his
environment warrant, he may be allowed to remain on his
own premises under suitable regulations.

Note. The active principles of chaulmoogra oil are reported to be curative in

some cases.

REG. 23. Malaria.—

1. Infective agent: The several species of malarial organisms.

2. Source of infection: The blood of an infected individual.

3. Mode of transmission: By bite of the infected Anopheles mosquitoes. The mosquito is infected by biting an individual suffering from acute or chronic malaria. The parasite develops in the body of the mosquito for from 10 to 14 days, after which time the sporozoites appear in its salivary glands.

4. Incubation period: Varies with the type of species of infecting organism and the amount of infection; usually 14 days in the tertian variety.

5. Period of communicability: As long as the malaria organism exists in the blood.

6. Methods of control:

(A) The infected individual and his environment

1. Recognition of the disease-Clinical symptoms, always to be confirmed by microscopic examination of the blood. Repeated examinations may be necessary.

2. Isolation-Exclusion of patient from approach of mosquitoes until his blood is rendered free from malarial parasites by thorough treatment with quinine.

3. Immunization-None. The administration of prophylactic doses of quinine should be insisted upon for those constantly exposed to infection and unable to protect themselves against Anopheles mosquitoes.

4. Quarantine-None.

5. Concurrent disinfection-None. Destruction of Anopheles mosquitoes in the sick room.

6. Terminal disinfection-None.

(B) General measures

1. Employment of known measures for destroying larvae of Anophelines and the eradication of breeding places of such mosquitoes.

2. Blood examination of persons living in infected centers to determine the incidence of infection.

3. Screening of sleeping and living quarters; use of mosquito nets.

4. Killing mosquitoes in living quarters.

REG. 24. Measles.

1. Infective agent: A filterable virus.

2. Source of infection: Buccal and nasal secretions of an infected individual. 3. Mode of transmission: Directly from person to person; indirectly through articles freshly soiled with the buccal and nasal discharges of an infected individual. The most easily transmitted of all communicable diseases.

4. Incubation period: 7 to 18 days; usually 14 days.

5. Period of communicability. During the period of catarrhal symptoms and until the cessation of abnormal mucous membrane secretions-minimum period of seven days; from five days before to five days after the appearance of rash,

6. Methods of control:

(A) The infected individual and his environment

1. Recognition of the disease-Clinical symptoms.

Special atten

tion to rise of temperature. Koplik spots and catarrhal symptoms in exposed individuals.

2. Isolation-During period of communicability. Placard.

3. Immunization-None.

4. Quarantine Exclusion of exposed susceptible school children and teachers from school until 14 days from last exposure. This applies to exposure in the household. Exclusion of exposed susceptible children from all public gatherings for the same period.

5. Concurrent disinfection-All articles soiled with the secretions from the nose and throat.

6. Terminal disinfection-Thorough cleansing.

Den-air schools for pretuberculous children.

f housing conditions and the nutrition of the


1 elimination of dust in industrial establishaces of public assembly.

f habits of personal hygiene and betterment of gconditions.

abies from tuberculous mothers at birth.

ort of any change of residence of a person tuberculosis, to the local health officer by the If, the attendant or other person having the


any person while affected with open tubercuaching in any college, university, seminary, or e, parochial, or other private school, or from ed as janitor or otherwise in any school buildClairy; or as a cook or otherwise in any hotel, ospital, sanatorium, or other institution, where mance of his duties he handles, or comes in food or drink for others. Prohibition of any ed with open tuberculosis from serving as n, or caretaker, in whole or in part, of any odge, or club rooms, auditorium or any public any other place used for public assembles or ny character whatsoever.


charges and urine and less frequently vomitus ividuals. Healthy carriers are common.



REG. 26. Mumps.

1. Infective agent: Unknown.

2. Source of infection: Secretions of the mouth and possibly of the nose. 3. Mode of transmission: By direct contact with an infected person or with articles freshly soiled with the discharges from the nose or throat of such infected person.

4. Incubation period: From 4 to 25 days. The most common period, 18 days, accepted as usual. A period of 21 days is not uncommon.

5. Period of communicability: Unknown, but assumed to persist until the parotid gland has returned to its normal size.

6. Methods of control:

(A) The infected individual and his environment—

1. Recognition of the disease-Inflammation of Steno's duct may be of assistance in recognizing the early stage of the disease. The diagnosis is usually made on swelling of the parotid gland.

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. (See 5.) Placard.

3. Immunization-None.

4. Quarantine-Limited to exclusion of nonimmune children from school and public gatherings for 21 days after the last exposure to a recognized case.

5. Concurrent disinfection-All articles soiled with the discharges from the nose and throat of the patient.

6. Terminal disinfection-None.

(B) General measures-None.

REG. 27. Ophthalmia neonatorum, specific and nonspecific.—

1. Infective agent: The gonococcus or some member of a group of pyogenic organisms, including the hemoglobinophilic bacilli.

2. Source of infection: Discharges from conjunctiva, or adnexa, or genital mucous membranes of infected persons.

3. Mode of transmission: Contact with an infected person or with articles freshly soiled with discharges of such person. The most common cause is the presence of gonorrheal infection in the mother at the time of childbirth.

4. Incubation period: Irregular, but usually 36 to 48 hours.

5. Period of communicability: During the course of the disease and until the discharges from the infected mucous membranes have ceased.

6. Methods of control:

(A) The infected individual and his environment

1. Recognition of the disease Clinical symptoms, confirmed where possible by bacteriological examination.

2. Isolation-None, provided the patient is under adequate medical supervision.

3. Immunization-None.

4. Quarantine-None.

5. Concurrent disinfection-Disinfection of conjunctival discharges and articles soiled therewith.

6. Terminal disinfection-Thorough cleansing.

6. Methods of control-Continued.

(B) General measures

1. Enforcement of regulations forbidding the use of common towels and toilet articles. Education as to personal cleanliness and instructions to mother and nurse, concerning methods of avoidance of transmissions of disease, with warning of grave danger of resultant blindness.

2. Use of silver nitrate or some similar solution in the eyes of the new born-one drop of a 1 per cent solution of silver nitrate.

REG. 28. Paratyphoid fever—

1. Infective agent: Bacillus paratyphosus A or B.

2. Source of infection: Bowel discharges and urine of infected persons or of healthy carriers. Healthy carriers may be numerous in an outbreak.

3. Mode of transmission: Directly by personal contact; indirectly by contact with articles freshly soiled with the discharges of infected persons or through milk, water, or food contaminated by such discharges.

4. Incubation period: 4 to 10 days; average, 7 days.

5. Period of communicability: From the appearance of prodromal symptoms, throughout the illness and relapses, during convalescence, and until disappearance of the infecting organism from both urine and feces.

6. Methods of control:

(A) The infected individual and his environment

1. Recognition of the disease-Clinical symptoms, confirmed by
specific agglutination test, and by bacteriological examina-
tion of blood, bowel discharges, or urine.

2. Isolation-In fly-proof room, preferably under hospital condi-
tions, of such cases as can not command adequate sanitary
environment and nursing care in their homes. Placard.
3. Immunization-Of exposed susceptibles by use of paraty-
phoid vaccine.

4. Quarantine-None.

5. Concurrent disinfection-Disinfection of all bowel and urinary discharges and articles soiled with them.

6. Terminal disinfection—Cleansing.

(B) General measures

1. Purification of public water supplies.

2. Pasteurization of public milk supplies.

3. Supervision of other food supplies and of food handlers.

4. Prevention of fly breeding.

5. Sanitary disposal of human excreta.

(See typhoid fever.)

6. Extension of immunization of [by?] use of paratyphoid vaccine as far as practicable.

7. Supervision of paratyphoid carriers and their exclusion from the handling of foods.

8. Systematic examination of fecal specimens, from those who
have been in contact with recognized cases, to detect

9. Exclusion of suspected milk supplies pending discovery of
the person or other cause of contamination of the milk.
10. Exclusion of water supply, if contaminated, until adequately
treated with hypochlorite or other efficient disinfectant,
or unless all water used for toilet, cooking, and drinking
purposes is boiled before use.

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