HEALTH DEPARTMENT. DISTRICT OF COLUMBIA

LAW AND REGULATIONS

TO

PREVENT THE SPREAD

OF

SCARLET FEVER AND DIPHTHERIAIN THE

DISTRICT OF COLUMBIA

TOGETHER WITH

Directions as to Disinfection and Disinfectants

PHILADELPHIA

Dunlap Printing Company

1306-8-xo Filbert Street

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AN ACT TO PREVENT THE SPREAD OF SCARLET FEVER ANDDIPHTHERIA IN THE DISTRICT OF COLUMBIA

Be it enacted by the Senate and House ofRepresentatives of the United States of Amer-ica iii Congress Assembled, That from andafter the passage of this act it shall be theduty of every registered practicing physicianor other person prescribing for the sick in theDistrict of Columbia to make report to thehealth officer, on forms to be furnished bythat officer, immediately after such practi-tioner becomes aware of the existence of anycase of scarlet fever or diphtheria in hischarge; and in case such person shall failto so report within twenty-four hours heshall be subject to a penalty of not less thanfive nor more than fifty dollars, and in caseof a second offense the penalty shall be notless than ten nor more than one hundreddollars. In case no physician shall be incharge of such patient the householderwhere such case occurred, or person incharge thereof, the parent, guardian, nurse,or other person in attendance upon the sickperson knowing the character of the diseaseshall make the report above mentioned, and

■ Duty of physician >

parent, guardian,nurse, or other personin charge ofpatient.

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Placard or flag to bedisplayed; unlawfultoremove same; premi-ses to be disinfected.

Persons affected notto attend school norpublic assemblages,nor appearon streets.

Penalty forviolationof provisions of thisact.

Health Officer topre-scribe regulations.

in case of failure to report shall suffer thesame penalties as provided for physicians inthis act.

SEC. 2. That it shall be the duty of thehealth officer co-operating with the attendingphysician to cause a suitable placard, flag, orwarning sign to be displayed from the frontof the premises or apartment where any onecase of scarlet fever or diphtheria is present.It shall be unlawful for any person to removesuch placard, sign, or warning flag, when soplaced, without permission of the healthofficer, and it shall be the duty of the saidhealth officer, in conjunction with the at-tending physician, to cause the premises tobe properly disinfected, and to issue thenecessary instructions for the isolation ofthe patient.

Sec. 3. That no person shall visit or at-tend any public or private school, or placeof public assemblage, or appear on thepublic streets or in the parks while affectedwith scarlet fever or diphtheria, and anyadult person, parent, or guardian of a minorconvicted of having knowingly violated theprovisions of this act shall, upon conviction,forfeit and pay a sum not less than five normore than fifty dollars ; and it shall be theduty of physicians while in attendance uponcases of scarlet fever or diphtheria to exer-cise such reasonable precautions to prevent

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Convalescents not toattend schools, semi-naries, orcolleges, ex-cept upon certificate.

Where provision ofthe act shall apply.

What the terms“regulations,” “per-sons,” and “practi-tioner of medicine”shall be held to mean.

the spread of the said diseases as may beprescribed by the health officer of the Dis-trict of Columbia in regulations.

Sue. 4. That no person who has conva-lesced from diphtheria or scarlet fever shallbe allowed to attend any public or privateschool, seminary, or college until the attend-ing physician shall have furnished a certifi-cate that said patient has completely recov-ered, and that there is no danger of infectionto other persons. All persons who shall,after convalescing from diphtheria or scarletfever, visit schools, seminaries, or colleges,without providing themselves with such cer-tificates, shall suffer the penalties providedfor in section 1 of this act.

Sue. 5. That the provisions of this actyshall apply to every ship, vessel, steamer,boat, or craft tying or being in the rivers,harbors, or other waters within the jurisdic-tion of said District, and to every tent, van,shed, hovel, barn, out-house, cabin, or otherlike place, as if the same were an ordinarydwelling.

Sue. 6. That the word “ regulations,” asherein used, shall be held to mean also rules,orders, and amendments. The words “per-son in charge thereof ’ ’ shall be held tomean the owner, his agent or factor ; thetenant, his clerk or representative; thenurse, or any one or more persons who by

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Pe'nalty for makingfalse report or certifi-cate.

Jurisdiction for en-forcement of act vest-ed in Police Court.

reason of their position are charged withthe management or care of the premises, orinterested in the person afflicted. Thewords “practitioner of medicine,” or “prac-titioner,” shall be held to include all per-sons who undertake to treat persons afflicted,either gratuitously or for pay.

SEC. 7. That any person who shall know-ingly make, sign, or deliver any false reportor certificate herein provided for, upon con-

viction thereof in the police court of saidDistrict, shall be fined not less than five normore than fifty dollars, and, in default ofpayment thereof, be committed to jail fornot less than one nor more than twentydays.

Sec. 8. That the expenses necessarily in-curred in the execution of the provisions ofthis act shall be borne from the general ap-propriation for the maintenanceof the healthdepartment of the District of Columbia, andthe jurisdiction of civil and criminal pro-cedure in the enforcement of this act ishereby vested in the police court of the saidDistrict, with the same right of appeal as inother civil and criminal trials in said District.

Approved, December 20, 18go.

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AN ACT OF THE LEGISLATIVE ASSEMBLY FOR THEPREVENTION OF DISEASES IN THE DISTRICT OFCOLUMBIA, APPROVED JUNE IS, T572

Sec. 4. And be it further enacted, Thatthe proprietor of any tenement house, lodg-ing house, boarding house, or hotel in theDistrict of Columbia shall, in the event ofany person living in such house becomingafflicted with any such disease,* at oncenotify the board of health thereof, in writ-ing. For a refusal to give the notice hereinprovided, the person so offending shall beliable to a fine of not less than ten dollarsnor more than fifty dollars for each offense.

Sec. 5. And be it further enacted, Thatany person suffering from any such infec-tious or contagious disease, who shall wil-fully expose himself in any street, publicplace, or conveyance, or any person havingthe care, charge, or control of such diseasedperson, or any owner or driver of any suchconveyance, who does not immediately pro-vide for the disinfection of the same, afterit has conveyed such diseased person, and

*lnfectious or contagious diseases.

8any person who gives, lends, sells, trans-mits, or exposes any clothing, bedding,rags, or other things which have been ex-posed to infection, shall, on conviction, beliable to a penalty of not less than ten dol-lars nor more than one hundred dollars foreach offense.

Skc. 6. And be it further enacted, Thatany person who shall let to any other per-son any house, room, or part of a house inwhich any patient has been confined byreason of such disease, without having suchroom, house, or part of a house completelydisinfected to the satisfaction of the boardof health, as certified by them, such personshall be liable to a penalty of not less thanten dollars or more than fifty dollars foreach offense.

HEGfjLtRTIO]SIS

The following regulations, provided forin the Act of Congress, approved, December20, 1890, are promulgated for the informa-tion of all concerned :

The Act referred to provides in Section 2,‘ ‘ That it shall be the duty of the HealthOfficer, in conjunction with the attendingphysician, to cause the premises to be pro-perly disinfected, and to issue the necessary

9instructions for the isolation of thepatientin Section 3, “ That it shall be the duty ofphysicians, while in attendance upon casesof scarlet fever and diphtheria, to exercisesuch reasonable precautions to prevent thespread of the said diseases as may be pre-scribed by the Health Officer of the Districtof Columbia, in regulations in Section 6,

‘ ‘ That the word ‘ regulations ’ as hereinused shall be held to mean also rules, orders,and amendments.”

1. The term scarlet fever as applied inthe Act shall be held to include scarlatina,scarlet rash, and canker rash, and each andevery case must be reported upon the formsprovided.

2. The term diphtheria as applied in theAct shall be held to include membranouscroup, unless a bacteriological examinationmade by a competent person, has provedthat the Klebs-Doeffler bacillus is absent,and each and every case must be reportedupon the forms provided.

3. Warning signs shall remain displayedon houses in cases of scarlet fever for aperiod of not less than four weeks, and incases of diphtheria for not less than threeweeks from date of report to the HealthOfficer, and for a longer period unless reportof recovery by the physician in attendancehas been made.

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4- In case of death the warning sign shallremain displayed upon premises for a periodof not less than seven days after the death,and longer, unless the Health Officer issatisfied that all proper means have beenemployed for prevention of the spread ofthe contagion.

5, It shall be the duty of the householder,in every case where a warning sign has beendisplayed from the premises which he orshe occupies, to report promptly the removalof such sign at any time within the periodsgiven.

6. It shall be the like duty of the physi-cian in attendance to make such report tothe Health Officer of the removal of warn-ing signs, unless assured that report hasbeen made by some one from the premiseswhere the disease is prevailing or has pre-vailed.

7. It shall be the duty of the physician inattendance to report, in every instance, onthe forms provided, whether or not childrenin the family or other children in the samebuilding attend school, and at what schoolbuilding or buildings.

8. Children shall not be permitted to re-turn to school from infected premises, exceptupon presentation of the proper certificatefrom the Health Officer.

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9- All persons suffering from either diph-theria or scarlet fever are to be isolated inrooms as far removed as possible from thoseoccupied by other persons in the building,and upon the top floor where it is practi-cable. No person, other than the physicianin attendance, the examining official, and thenurse or nurses, shall be admitted to suchroom during the prevalence of the disease.This room, if possible, should be large, wellventilated, and much exposed to sunlight.

10. Every room occupied by a patientsuffering from either diphtheria or scarletfever shall be cleared of all needless cloth-ing, carpets, drapery, and other materialslikely to harbor the poisons of the diseases.Dishes, spoons, wash rags, combs, brushes,etc., used in' the sick room shall not be usedin any other part of the house, nor shallthey be washed or stored with similar arti-cles from the rest of the house until theyhave been disinfected.

n. Soiled bed and body linen shall beimmediately placed in vessels of water con-taining a solution of acid bi-chloride ofmercury or other suitable disinfectant.

12. Discharges from the bowels and vomi-ted matter shall be received in vessels con-taining at least one quart of such a disin-fecting solution, and all vessels used shallbe kept thoroughly clean and disinfected.

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13. Discharges from the throat, nose andmouth shall be received upon pieces ofcloth, which must be immediately burned.

14. All persons recovering from eitherdiphtheria or scarlet fever shall be con-sidered dangerous, and shall not be permit-ted to leave the sick room, to associate withothers, or to attend school, church, or anypublic assembly, until a certificate has beenfurnished by the Health Officer to the effectthat they may go abroad without danger ofdisseminating the contagion; and thosenursing such patients shall not go to anypublic assembly, as to the market, churches,theatres, shops, or to their own places ofbusiness or work.

15. It shall be the duty of the person incharge of the premises where a case of diph-theria or scarlet fever exists, to exercise allreasonable care in the prevention of thecommingling of persons who come in con-tact with the patient, or any other persons,whereby the contagion might be dissemi-nated.

16. No family shall move away from anydwelling place while a warning card is dis-played thereon, except with permission fromthe Health Officer.

17. The body of a person who has diedfrom either diphtheria or scarlet fever shallbe immediately disinfected and placed in a

13coffin, which shall be tightly closed, andshall not be taken to a church or place ofpublic assembly, and shall be buried withinforty-eight hours, unless otherwise orderedby the Health Officer.

18. No public funeral shall be held in adwelling in which there is a case of eitherdiphtheria or scarlet fever, nor in which a

death from either of said diseases hasrecently occurred. The term public funeralas used in this section shall be held to meanany funeral at which persons other than theofficiating minister, the necessary pall-bear-ers and the immediate family of the deceasedare present.

19. Immediately upon the complete re-covery of a person who has been sufferingfrom either diphtheria or scarlet fever, orupon the death of a person who has been sosuffering, the room or rooms occupied shallbe thoroughly disinfected and shall there-after be thoroughly cleaned and exposed tocurrents of fresh air.

20. All clothing, bedding, carpets, andother textile fabrics, which have been ex-posed to the contagion of the disease shallbe either burned, exposed to super-heatedsteam, thoroughly boiled, or soaked for twohours in a solution containing the properquantity of acid bi-chloride of mercury.

142i. No person shall interfere with or

obstruct the entrance, inspection, and ex-amination of any building or house, by theinspectors or officers of this department,when there has been reported the case of aperson sick with either scarlet fever or diph -

theria therein.

DISINFECTIONa. The vomit and discharges from the

bowels of diphtheria and scarlet feverpatients, should always be disinfected,especially the vomit To do this, dissolveone pound of chloride of lime in two gallonsof water (16 tumblerfuls of water equal agallon) and put a quart of this liquid oneach stool or vomit, mix, and let the mix-ture stand one hour before throwing it intothe water closet or box privy.

b. For two or more weeks after the mem-brane in diphtheria has disappeared thedisease germs may be present in the patient’smouth in swarms, and although he is con-valescent himself he can infect others andany part of the house. Therefore, thepatientshould be kept apart from other persons andnot allowed to go through the house for atleast two weeks after the membrane has dis-appeared. (See section 14,) The virulentgerm has been found in the mouths of thoseaffected nearly three weeks after the mem-

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brane has disappeared. Only a competentbacteriologist can determine whether thepatient has become harmless.

In scarlet fever the infection of others cantake place while the rash is present, andafter the rash has disappeared while the skinis being shed. The outer skin comes off inscales of various sizes, but usually thesescales are like dandruff. The shedding maycontinue for even twenty in somecases, and during this time these skin parti-cles are very infectious. It is well to rub alittle sweet oil over the child’s body fromtime to time, to prevent the scales fromfloating about the room. If patients suffer-ing from diphtheria and scarlet fever arepermitted to walk about the house too soon,it will be necessary to disinfect the entirehouse.

c. As soon as it is suspected that a childis ill with diphtheria or scarlet fever, evenbefore the arrival of a physician, it shouldbe taken away from all other children andbe kept near the top of the house, if possible,in a room from which the carpet, rugs, cur-tains, and every unnecessary article of fur-niture has been removed, and upholsteredchairs must be replaced with plain woodenones. Should the case prove not to bediphtheria or scarlet fever no harm is done.If, however, the disease has not been recog-

16nized until the rash is developed in scarletfever, or the membrane in diphtheria, noarticle should then be removed, because itprobably is infected. (See regulation No.9.) People nursing diphtheria or scarletfever patients should not go to market, toshops, to church, or to any public assembly,until after the final general disinfection, forfear of spreading infection. (See regulationNo. 15.)

d. Disinfecting Solviion.—For body linenand bed linen the most practical and reliabledisinfectant is an acid corrosive sublimatesolution (i. e. one part bichloride of mercuryto two parts of hydrochloric acid,) In prac-tice three ounces of commercial hydrochloricacid and one ounce and a half of bichlorideof mercury will prove sufficient. A physi-cian’s prescription will be necessary. Useone teaspoonful of the solution to each gal-lon of water. The water containing thisdisinfectant must always be put into woodenvessels, as wash tubs or pails, or, if a smallquantity is to be used, into china or earthen-ware vessels, because metals spoil the solu-tion and are in turn destroyed by it.Measure the solution obtained from thedruggist in an old teaspoon or a dose glass.This disinfectant is a very violent poison itswallowed, and care must be exercised inits use. It will not hurt the hands when

17mixed with the water, but it will injurefinger rings, which should, therefore, beremoved before it is used. It is better thancarbolic acid or any other solution and ithas no odor.

After towels, sheets, body linen and likearticles have been used during the course ofthe illness they should be soaked for twohours in this solution (i. e. one teaspoonfulto the gallon of water), next rinsed in cleanwater and dried ; thus they are renderedsafe.

e. Those who are nursing patients ill withdiphtheria or scarlet fever should wash theirhands in the disinfectant solution every timethey touch the patient or any article thathas possibly been infected, then rinse theirhands in clean water. This is to protect thenurse and others. Put half a teaspoonfulof the disinfectant into two quarts of waterin a china wash bowl or earthen-ware dishor wooden bucket for this purpose.f. Do not handle a patient ill with either

of these diseases more than is absolutelynecessary, not only because of the dangerof infection, but for other grave reasons.Diphtheria often affects the heart and onecan then kill a patient by lifting him uproughly. It is, of course, especially dan_gerous to kiss a child ill with these diseases,

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and the nurse must be exceedingly carefullest a diphtheria patient cough into her face.

g. If the patient get soiled with his owndischarges wash him with ordinary waterthen disinfect the wash water and the washrag with the disinfectant (a teaspoonful tothe gallon of water) before throwing themaway. As to the spittle of these patientssee regulation No. 13.

k. Nurses and others caring for patientssuffering from scarlet fever or diphtheriashould wear over the other clothing whilein the sick room a wrapper or gown whichcan be easily removed and left just insidethe sick room. This wrapper should bedipped into the disinfecting solution as oftenas possible, It will be more convenient iftwo such wrappers are provided.

i. When the patient is w7 ell enough toleave the sick room (see regulation No. 14and section h) his clothing is left behind, heis bathed, and then clothed in another room.

j. The best disinfectantfor mattresses andblankets, and indeed everything, is stream-ing steam under pressure. This requiresspecial apparatus and cannot be done athome. Mattresses, bolsters and pillowsmust be pulled apart and steamedif they areworth this. If they are old or cheap it isbetter to burn them. Upholstered furnituremay be steamedentire or the upholstery may

19be removed and burned, the framework beingscoured and then washed with the disinfect-ant solution, (see section d), or the entirepiece may be burned.

k. The sick room must not be sweptduring the illness or during the process offinal disinfection, because germs are liftedup with the dust, to be inhaled at once or tosettleupon the wallsand elsewhere and causeinfection later. Wipe the floor when neces-sary with wet rags, which are afterwards tobe burned.

/. In the final disinfection after thebedding has been removed, and all carpets,rugs, curtains and other textile fabrics whichwere in the room have been soaked in theacid corrosive sublimate solution, or havebeenremoved by or with the authority oftheHealth Department to be steamed, take twoor three loaves of fresh bread, cut these inhalves, and rub down the walls thoroughlyto remove all dust. Burn this bread. Nowscrub the floor and all woodwork withordinary suds. Pour into this suds as manyteaspoonfuls of the disinfectant as there aregallons of scrub water, let it stand for anhour, then throw it away.

m. After scrubbing, thoroughly flood thefloor, woodwork, bedstead, chairs, windows,transoms, bureau, everything in the room,with the disinfectant mentioned in section d.

20Do not sprinkle it on, flood with it. Thendip a still brush into thesolution and stipplethe walls and ceiling (i. e. with thepoints ofthe hairs) till they are thoroughly wetted.The wall paper may be spoiled by thisprocess but this is unavoidable.

n. Do not use the patent disinfectants,they are seldom effective. While the roomis wet sulphur may be burned as an addi-tional precaution, but when used alone k isvery unreliable, especially against the diph-theria germs, and the Health Departmentwill not consider aroom disinfected ifnothingbut sulphur has been used.

o. For any possible good to be accom-plished by sulphur it is necessary (i) thatthe articles to be disinfected be wet and beso placed as to be freely exposed to the fumes,(2) that the sulphur fumes be extremelyconcentrated, and (3) that the contact beprolonged at least 24 hours.

1. Wetting may be accomplished by wash-ing with a wet cloth or by free steaming ofthe room; Closets, cupboards and drawersshould be left wide open.

2. In order to secure concentration of thefumes it is necessary that every opening intothe room be tightly closed. All crevicesabout doors, windows and transoms must befilled withpaper or rags to prevent the escapeof the sulphur fumes and the entrance of air.

213- The room should be left closed after

the sulphur is lighted for at least twenty-four hours.

To burn sulphur, place two or three brickson the bottom of a wash tub or other largevessel and put in water up to near the topof the bricks to prevent fire ; then set atleast three pounds of sulphur on the bricksin an old tin plate or flat piece of metal andignite it with hot coals. Leave the room atonce and close the door.

p. In case of death from diphtheria orscarlet fever, wet a sheet with the disinfectantsolution, using two teaspoonfuls to the gallonof water, and wrap up the body, coveringthe face in this sheet.

q. The directions for disinfection givenhere hold good for all infectious and con-tagious diseases, as tuberculosis, typhoid,small-pox, cholera, infectious pneumonia,measles, the grippe, and the like. Whenthe stools of typhoid fever patients havebeen thrown into privies without disinfection,as may happen before the disease has beenrecognized, cover the surface of the privycontents with chloride of lime, after thor-oughly disinfecting the woodwork with thedisinfecting solution mentioned in para-graph d. If these stools have been throwninto a water-closet disinfect the woodwork

with the bi-chloride solution and then flushthe basin with chloride of lime solution.

DISINFECTING SOLUTION.

Commercial Hydrochloric Acid, . 3 oz.Bi-Chloride of Mercury, . . \]/ z oz.

Sig. :—Poison. Use one teaspoonful tothe gallon of water in a wooden vessel asdirected on page 16.

WM. C. WOODWARD, M. D.,Health Officer.