REG. 36. Septic sore throat.—

1. Infective agent: Streptococcus (hemolytic type).

2. Source of infection: The human naso-pharynx, usually the tonsils, any case of acute streptococcus inflammation of these structures being a potential source of infection, including the period of convalescence of such The udder of a cow infected by the milker is an occasional source

cases. of infection.

absent.

In such udders the physical signs of mastitis are usually

3. Mode of transmission: Direct or indirect human contact; consumption of raw milk from an infected udder.

4.Incubation period: One to three days.

5. Period of communicability: In man, presumably during the continuance of clinical symptoms; in the cow, during the continuance of discharge of the streptococci in the milk, the condition in the udder tending to a spontaneous subsidence. The carrier stage may follow convalescence and persist for some time.

6. Methods of control:

(A) The infected individual and his environment

1. Recognition of the disease-Clinical symptoms.

Bacteriolog

ical examination of the lesions or discharges from the tonsils and naso-pharynx may be useful.

2. Isolation-During the clinical course of the disease and during convalescence; particularly exclusion of the patient from participation in the production or handling of milk or milk products.

3. Immunization-None.

4. Quarantine-None.

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

6. Terminal disinfection--Cleansing.

(B) General measures—

1. Exclusion of suspected milk supply from public sale or use, until pasteurized. The exclusion of the milk of an infected cow or cows in small herds is possible when based on bacteriological examination of the milk of each cow, and preferably the milk from each quarter of the udder at frequent intervals.

2. Pasteurization of all milk.

3. Education in the principles of personal hygiene and avoidance of the use of common towel, drinking and eating utensils.

Note.-Mastitis in the cow, due to bovine streptococci, is not a cause of septic sore throat in humans unless a secondary infection of the udder by a human type of streptococcus takes place.

REG. 37. Smallpox (variola).

1. Infective agent: Unknown.

2. Source of infection: Lesions of the skin and mucous membranes of infected persons.

3. Mode of transmission: By direct personal contact; by articles soiled with discharges from lesions. The virus may be present in all body discharges, including feces and urine. It may be carried by flies.

4. Incubation period: 12 to 14 days. (Cases with incubation period of 21 days are reported.)

5. Period of communicability: From first symptoms to disappearance of all crusts from the skin lesions.

6. Methods of control:

(A) The infected individual and his environment

1. Recognition of the disease-Clinical symptoms.

2. Isolation-Hospital isolation in screened wards, free from
vermin, until the period of infectivity is over. Placard.
3. Immunization-Vaccination.

4. Quarantine-Segregation for 21 days of all exposed persons
not protected by recent successful vaccination or attack of
the disease: Provided, however, That such persons may
choose to be vaccinated at once and be released after disin-
fection of the person and clothing, with the further pro-
vision that they shall report to the local health officer or to
the family physician for observation for 21 days or until
the vaccination has proved successful. This rule includes
school children.

5. Concurrent disinfection of all discharges and articles soiled therewith.

6. Terminal disinfection-Thorough cleansing and disinfection of premises.

(B) General measures

NOTE.-General vaccination in infancy, revaccination of children on entering school, and of entire population when the disease is prevalent.

a. Successful vaccination will produce immunity in about 8 days. b. It should be borne in mind that any case presenting grippal

symptoms, such as fever, headache, backache, etc., when followed in three or four days by a pustular eruption is almost invariably smallpox and should be so considered. The public is entitled to the protection which this assumption carries with it.

c. Concerning the compulsory vaccination of school children, the following has been furnished to the State board of health by the attorney general's office:

"When smallpox is prevalent, local boards of health may make a regulation requiring all school children to be vaccinated against smallpox, or in lieu thereof remain away from school during the prevalence of smallpox: Provided, That a history of having had smallpox or a recent successful vaccination against smallpox will be held sufficient to permit the child to enter school."

REG. 38. Tetanus.—

1. Infective agent: Bacillus tetani.

2. Source of infection: Animal manure, and soil fertilized with animal manure, and, rarely, the discharges from wounds.

3. Mode of transmission: Inoculation, or wound infection.

4. Incubation period: Usually 9 days; extremes are 1 to 20 days.

5. Period of communicability: Patient not infectious, except in rare instances where wound discharges are infectious.

6. Method of control:

(A) The infected individual and his environment

1. Recognition of the disease-Clinical symptoms; may be conconfirmed bacteriologically.

2. Isolation-None.

3. Immunization-By antitoxin given early in single or repeated doses.

4. Quarantine-None.

5. Concurrent disinfection-None.

6. Terminal disinfection-None.

(B) General measures

1. Educational propaganda such as "safe and sane Fourth of July" campaign.

2. Prophylactic use of tetanus antitoxin when wounds have been acquired in regions where the soil is known to be heavily contaminated, and in all cases when wounds are ragged or penetrating.

3. Removal of all foreign matters as early as possible from all wounds.

REG. 39. Trachoma.—

1. Infective agent: The chief, although not yet known to be the only, infective agents are the hemoglobinophilic bacilli, including the so-called KochWeeks bacillus.

2. Source of infection: Secretions and perulent discharges from the conjunctiva and adnexed mucous membranes of the infected persons.

1

3. Mode of transmission: By direct contact with infected persons and indirectly by contact with articles freshly soiled with the infective discharges of such persons.

4. Incubation period: Undetermined.

5. Period of communicability: During the persistence of lesions of the conjunctivae and of the adnexed mucous membranes and of discharges from such lesions.

6. Methods of control:

(A) The infected individual and his environment

1. Recognition of the disease-Clinical symptoms. Bacteriological examination of the conjunctival secretions and lesions may be useful.

2. Isolation-Exclusion of the patient from school until he is noninfectious.

3. Immunization-None.

4. Quarantine-None.

5. Concurrent disinfection of discharges and articles soiled therewith.

6. Terminal disinfection-None.

(B) General measures

1. Search for cases by examination of school children, of immigrants, and among the families and associates of recognized cases; in addition, search for acute secreting disease of conjunctivae and adnexed mucous membranes, both among school children and in their families, and treatment of such cases until cured.

2. Elimination of common towels and toilet articles from public

places.

6. Methods of control-Continued.

(B) General measures-Continued.

3. Education in the principles of personal cleanliness and the necessity of avoiding direct or indirect transference of body discharges.

4. Control of public dispensaries where communicable eye diseases are treated.

REG. 40. Trichinosis.—

1. Infective agent: Trichinella spiralis.

2. Source of infection: Uncooked or insufficiently cooked meat of infected hogs. 3. Mode of transmission: Consumption of under-cooked infected pork products. 4. Incubation period: Variable; usually about one week.

5. Period of communicability: Disease is not transmitted by human host. 6. Methods of control:

(A) The infected individual and his environment

1. Recognition of the disease-Clinical symptoms, confirmed by microscopic examination of muscle tissue containing trichinae.

2. Isolation-None.

3. Immunization-None.

4. Quarantine-None.

5. Concurrent disinfection-Sanitary disposal of the feces of

the patient.

6. Terminal disinfection-None.

(B) General measures

1. Inspection of pork products for the detection of trichinosis.

2. Thorough cooking of all pork products at a temperature of 160° F. or over.

REG. 41. Tuberculosis.—

1. Infective agent: Bacillus tuberculosis (human and bovine). The bovine variety is found in a fairly large percentage of cases of intestinal glandular and bone tuberculosis.

2. Source of infection: The specific organism present in the discharges, or articles freshly soiled with the discharges, from any open tuberculous lesion, the most important discharge being sputum. Of less importance are discharges from the intestinal and genito-urinary tracts, or from lesions of the lymphatic glands, bones, and skin. Milk from tuberculous cattle and dejecta of tuberculous animals frequently contain the specific organism. 3. Mode of transmission: Direct or indirect contact with an infected person by coughing, sneezing, or other droplet infection, kissing, common use of unsterilized food utensils or contaminated foods, pipes, toys, drinking cups, etc., and possibly by contaminated flies and dust. It appears probable that in a considerable proportion of cases infection takes place in early childhood by contact with either a tuberculous mother or others affected with the disease.

4. Incubation period: Variable and dependent upon the type of the disease. 5. Period of communicability: Exists as long as the specific organism is eliminated by the host. Commences when a lesion becomes an open one, i. e., discharging tubercle bacilli, and continues until it heals or death

occurs.