3. Mode of transmission: Conveyance of the specific organism by direct or indirect contact with a source of infection. Among indirect means of transmission are contaminated water, milk, shellfish, celery, lettuce, strawberries, and other foods which are eaten in an uncooked or imperfectly cooked state; contaminated flies have been common means of transmission in epidemics. 4. Incubation period: From 7 to 23 days, averaging 10 to 14 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 (Widal) and bacteriological examination of blood, bowel discharges, or urine. 2. Isolation-In fly-proof room, preferably under hospital conditions, of such cases as can not command adequate sanitary environment and nursing care in their homes. Placard. 3. Immunization-Of susceptibles who are known to have been exposed or are suspected of having been exposed. 4. Quarantine-None. 5. Concurrent disinfection-Disinfection of all bowel and urinary discharges and articles soiled therewith. 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. 5. Sanitary disposal of human excreta. 6. Extension of immunization by use of typhoid vaccine as universally as possible. 7. Supervision of typhoid 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 carriers. 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. 11. Prohibition of any person infected with or living in a family where there exists typhoid fever from engaging in any occupation in connection with a dairy; or with the handling of milk, cream, ice cream, or other food products; or from serving as cook, waiter, or otherwise in any hotel, restaurant, or boarding house; or in any hospital, sanatorium, or other institution where in the performance of his duties he either handles or comes in contact with food or drink for others. 43163-23-5 Disinfection in typhoid fever.-The most certain means of destroying the typhoid bacilli in the excreta, including urine, stools, vomitus, and sputum, is by boiling for half an hour. This should be done in a closely covered iron pot remote from any kitchen or other place where food is prepared or stored. It is especially urged upon hospitals, sanatoria, and public institutions of whatever character that they install suitable apparatus for the sterilization by this method of typhoid excreta and unused fragments of food. Where the former method is not possible the following may be substituted: In a large earthen container, or if this is not available, in a galvanized iron or graniteware bucket, in either case having a well-fitting cover, place the excreta or food fragments and cover entirely with boiling water. Then add about one-fourth of the entire bulk of quicklime, which should be broken into pieces and distributed over the mass. Cover and allow to stand for two hours, when it may be deposited in a water-closet or vault. Care must be taken that the water is hot and that the quicklime is fresh. Another fairly effective method is by the use of either milk of lime (1 part freshly slaked lime to 8 parts water), chlorinated lime (6 ounces per gallon of water), carbolic acid (5 per cent), or formalin (10 per cent). The discharges should be received in a vessel containing a portion of the germicidal solution and more should be added so as to cover the mass and be equal to at least twice the volume of the material to be disinfected. The contents of the vessel should then be thoroughly stirred, especial care being taken to disintegrate all solid masses. The vessels should then be closely covered and allowed to stand for at least two hours, when the contents may be placed in the water-closet or vault. These methods are preferred in the order in which they are enumerated. Dishes and utensils of every description, also linen and cloths of every sort used about the bed or the person of the patient, should be sterilized by boiling for at least a full half hour. After every stool the patient should be cleansed, using a compress of cloth or cotton wet with a solution of mercuric chloride (1:2000) or carbolic acid (1:40). When the patient leaves the sick room, the room should be cleansed by the free use of soap and water and opened freely to air and sun, after which all linen, blankets, curtains, etc., should be boiled and all surfaces wiped with carbolic acid (1:20) or formalin (1:10). For nonmetallic surfaces corrosive sublimate (1:1000) may be used. The following is outlined for local health officers as a suggested form of— (8) Character of residence-private house, boarding house, hotel, flat. (9) Kind of store or business connected with house or family. (10) Number of occupants of house. Names of previous typhoid patients. (11) Names of those employed and business. Where? (12) Names of those vaccinated against typhoid. (13) Occupation of patient. (14) Newcomers in family within two months, any had typhoid? (15) Servants' names, addresses. When? (16) Servants had typhoid? When? Contact with others having typhoid? (17) Disposal of sewage; sewer, privy, cesspool, number of feet from well. (18) How is house screened, flies? (19) Sanitary condition of house and yard? (20) Disposal of manure? (21) Absent from city within 30 days? Where? (22) Names and addresses of persons visited. (23) Known cases where visiting. Source of water. (24) Steamers traveled on? When? (25) Bathing-river, creek, pond, lake, bathhouse? Where? (26) Source of drinking water. (27) Source of ice supply. Source of raw vegetables. (28) Where food taken within 30 days? (29) Milk used as beverage? Is milk pasteurized? Source of ice cream. (30) Name and address of milkman. (31) Raw oysters, lettuce, celery, strawberries? (32) Has patient been associated with persons having typhoid? When?' (33) Are stools disinfected? How? (34) How are stools disposed of? REG. 43. Typhus fever (Brill's disease).— 1. Infective agent: Bacillus typhi-exanthematici is claimed to be causative agent; not yet definitely determined. 2. Source of infection: The blood of infected individuals. 3. Mode of transmission. Infective agent transmitted by lice. (Pediculus corporis, P. capitis.) 4. Incubation period: 5 to 20 days, usually 12 days. 5. Period of communicability: Until 36 hours have elapsed after the temperature reaches normal. 6. Methods of control: (A) The infected individual and his environment 1. Recognition of the disease-Clinical symptoms. Confirmation by bacteriological examination of blood claimed by Plotz. 2. Isolation-In a vermin-free room. All attendants should wear vermin-proof clothing. Placard. 3. Immunization-Claimed to be practicable by use of vaccine (Plotz, Oiltsky and Baehr). Not yet generally accepted. 4.. Quarantine Exposed susceptibles for 12 days after last exposure. 5. Concurrent disinfection-None. 6. Terminal disinfection-Destroy all vermin and vermin eggs on body of patient, if not already accomplished. Destroy all vermin and eggs on clothing. Rooms to be rendered free from vermin. (B) General measures Delousing of persons, clothing and premises during epidemics, or when they have come or have been brought into an uninfected place from an infected community. REC. 44. Whooping cough (pertussis).– 1. Infective agent: Bacillus pertussis (Bordet, Gengou). 2. Source of infection: Discharges from the laryngeal and bronchial mucous membrances of infected persons (sometimes also of infected dogs and cats, which are known to be susceptible). 3. Mode of transmission: Contact with an infected person or animal or with articles freshly soiled with the discharges of such person or animal. 4. Incubation period: Within 14 days. 5. Period of communicability: Particularly communicable in the early catarrhal stages before the characteristic whoop makes the clinical diagnosis possible. Communicability probably persists not longer than four weeks after the development of the character [istic] whoop or approximately six weeks after the onset of catarrhal symptoms. 6. Methods of control: (A) The infected individual and his environment 1. Recognition of the disease-Clinical symptoms supported by 3. Immunization-Use of prophylactic vaccination recommended 4. Quarantine-Limited to the exclusion of nonimmune children from school and public gatherings for 14 days after their last exposure to a recognized case. 5. Concurrent disinfection-Discharges from the nose and throat of the patient and articles soiled with such discharges. 6. Terminal disinfection-Cleansing of the premises used by the patient. (B) General measures 1. Education in habits of personal cleanliness and in the dangers of association or contact with those showing catarrhal symptoms with cough. 2. Daily inspection of schools during epidemics of whooping cough with exclusion for 14 days of children with acute catarrhal symptoms. Note. In view of the large number of deaths of children under five years of age, great care should be taken to prevent their contact with cases of this disease and in the event of chance contact immunizaion should be produced at once by prophylactic vaccine. * REG. 46. * * DISINFECTION IN CHOLERA, DYSENTERY, AND PARATYPHOID FEVER. The methods for disinfection in typhoid fever are also designated for use in cholera, dysentery, and paratyphoid fever. Sputum. In all diseases of the respiratory tract, the simplest and best way for disposing of the sputum is to receive it in special paper containers or paper napkins. After use these paper receptacles must be burned. Water-closets.-Disinfection of water-closet bowls and the woodwork about them may be accomplished by using dilute (1:10) formalin. Sublimate solution should not be used about plumbing fixtures. Mattresses and heavy clothes.-Heavy clothing, mattresses, pillows, and similar articles polluted by dejecta and other infective matter should be burned or sterilized by steam. Mattresses containing cheap material may have contents burned and the ticking disinfected by boiling. Carpets are best fumigated on the floor and afterwards beaten or steam-cleaned. Bed linen and light clothing.-Contaminated body linen, bed linen, towels, napkins, washcloths, handkerchiefs, and similar articles should be immersed for one hour in a sublimate solution (1:1000) or a 5 per cent solution of formalin and then boiled for half an hour. Chlorinated lime will damage linens. The infected linens must be removed from the room in a closed vessel or wrapped in a sheet saturated with carbolic acid (1:20) or sublimate solution (1:1000). Upholstered furniture.-Upholstered furniture, after fumigation in the room, should be taken outdoors, well beaten and left for a while exposed to the sunlight. If the furniture is upholstered in leather all parts of it should be well wiped with a cloth wet with sublimate solution (1:1000) or formalin (1:10). Eating utensils.-All eating utensils used by a patient who is suffering from a communicable disease should be boiled. Remains of food must be destroyed. Dogs and cats.-Dogs, cats, or other domestic animals should never be permitted in a house where any communicable disease exists. Any domestic animal supposedly infected by reason of being near a person suffering with a communicable disease, or by being in a room where a communicable disease exists, must be disinfected immediately in same manner as a person is disinfected. Books.-Books belonging to public libraries or schools must not be taken into private homes where a communicable disease exists. Books already in any house in which a communicable disease develops must not be returned to the library or school, but to the local health officer. Library or school books from houses in which scarlet fever, diphtheria, or smallpox exists must be burned. When the infection is due to any other disease than those named above the books must be burned or disinfected, as determined by the health officer. It is extremely difficult to disinfect books successfully. Books are best disinfected by formalin, the books being suspended on wire in a small closed room or box in such a manner as to expose the surfaces of as many leaves as possible. Hands. In nursing patients who are suffering from infectious disease, the hands unavoidably become infected. Immediately following every act by which the hands may become infected, they should be thoroughly washed with soap and water. Sometimes it is well to follow the cleasing by the immersion of the hands in a 1:1000 sublimate solution or carbolic acid (1:20). Disinfection of person.-Wash thoroughly the entire body, including face and scalp, with hot water and soap. Following this by bathing every part with a solution of corrosive sublimate 1 to 4000. Before beginning the disinfection every piece of clothing must be removed from the body. After the disinfection of the body dress the person with absolutely sterile clothing. Cleanliness.-Disinfection alone does not sufficiently protect the people against communicable disease. Perfect cleanliness must be insisted upon at all times. These suggestions apply to persons, clothing, articles within the home, public places, places of business, and the private home. REG. 47. Division of bacteriology.—In the advance of recent years in matters which pertain to the conservation and protection of the public health the work of the bacteriologist has been an important factor; by means of bacteriologic examinations he has been able to determine the presence of communicable disease, dangerous to the public health and impossible sometimes to diagnose |