HEALTH DEPARTMENT. DISTRICT OF COLUMBIA 
LAW AND REGULATIONS 
TO 
PREVENT THE SPREAD 
OF 
SCARLET FEVER AND DIPHTHERIA 
IN THE 
DISTRICT OF COLUMBIA 
TOGETHER WITH 
Directions as to Disinfection and Disinfectants 
PHILADELPHIA 
Dunlap Printing Company 
1306-8-xo Filbert Street 3 
AN ACT TO PREVENT THE SPREAD OF SCARLET FEVER AND 
DIPHTHERIA IN THE DISTRICT OF COLUMBIA 
Be it enacted by the Senate and House of 
Representatives of the United States of Amer- 
ica iii Congress Assembled, That from and 
after the passage of this act it shall be the 
■ Duty of physician > 
parent, guardian, 
nurse, or other person 
in charge of patient. 
duty of every registered practicing physician 
or other person prescribing for the sick in the 
District of Columbia to make report to the 
health officer, on forms to be furnished by 
that officer, immediately after such practi- 
tioner becomes aware of the existence of any 
case of scarlet fever or diphtheria in his 
charge; and in case such person shall fail 
to so report within twenty-four hours he 
shall be subject to a penalty of not less than 
five nor more than fifty dollars, and in case 
of a second offense the penalty shall be not 
less than ten nor more than one hundred 
dollars. In case no physician shall be in 
charge of such patient the householder 
where such case occurred, or person in 
charge thereof, the parent, guardian, nurse, 
or other person in attendance upon the sick 
person knowing the character of the disease 
shall make the report above mentioned, and 4 
in case of failure to report shall suffer the 
same penalties as provided for physicians in 
this act. 
Placard or flag to be 
displayed; unlawful to 
remove same; premi- 
ses to be disinfected. 
SEC. 2. That it shall be the duty of the 
health officer co-operating with the attending 
physician to cause a suitable placard, flag, or 
warning sign to be displayed from the front 
of the premises or apartment where any one 
case of scarlet fever or diphtheria is present. 
It shall be unlawful for any person to remove 
such placard, sign, or warning flag, when so 
placed, without permission of the health 
officer, and it shall be the duty of the said 
health officer, in conjunction with the at- 
tending physician, to cause the premises to 
be properly disinfected, and to issue the 
necessary instructions for the isolation of 
the patient. 
Persons affected not 
to attend school nor 
public assemblages, 
nor appear on streets. 
Sec. 3. That no person shall visit or at- 
tend any public or private school, or place 
of public assemblage, or appear on the 
public streets or in the parks while affected 
with scarlet fever or diphtheria, and any 
adult person, parent, or guardian of a minor 
convicted of having knowingly violated the 
Penalty for violation 
of provisions of this 
act. 
Health Officer to pre- 
scribe regulations. 
provisions of this act shall, upon conviction, 
forfeit and pay a sum not less than five nor 
more than fifty dollars ; and it shall be the 
duty of physicians while in attendance upon 
cases of scarlet fever or diphtheria to exer- 
cise such reasonable precautions to prevent the spread of the said diseases as may be 
prescribed by the health officer of the Dis- 
trict of Columbia in regulations. 
5 
Sue. 4. That no person who has conva- 
lesced from diphtheria or scarlet fever shall 
be allowed to attend any public or private 
school, seminary, or college until the attend- 
Convalescents not to 
attend schools, semi- 
naries, or colleges, ex- 
cept upon certificate. 
ing physician shall have furnished a certifi- 
cate that said patient has completely recov- 
ered, and that there is no danger of infection 
to other persons. All persons who shall, 
after convalescing from diphtheria or scarlet 
fever, visit schools, seminaries, or colleges, 
without providing themselves with such cer- 
tificates, shall suffer the penalties provided 
for in section 1 of this act. 
Sue. 5. That the provisions of this acty 
shall 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 other 
like place, as if the same were an ordinary 
dwelling. 
Where provision of 
the act shall apply. 
Sue. 6. That the word “ regulations,” as 
herein used, shall be held to mean also rules, 
orders, and amendments. The words “per- 
son in charge thereof ’ ’ shall be held to 
What the terms 
“regulations,” “ per- 
sons,” and “practi- 
tioner of medicine” 
shall be held to mean. 
mean the owner, his agent or factor ; the 
tenant, his clerk or representative; the 
nurse, or any one or more persons who by reason of their position are charged with 
the management or care of the premises, or 
interested in the person afflicted. The 
words “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. 
6 
Pe'nalty for making 
false report or certifi- 
cate. 
SEC. 7. That any person who shall know- 
ingly make, sign, or deliver any false report 
or certificate herein provided for, upon con- 
viction thereof in the police court of said 
District, shall be fined not less than five nor 
more than fifty dollars, and, in default of 
payment thereof, be committed to jail for 
not less than one nor more than twenty 
days. 
Jurisdiction for en- 
forcement of act vest- 
ed in Police Court. 
Sec. 8. That the expenses necessarily in- 
curred in the execution of the provisions of 
this act shall be borne from the general ap- 
propriation for the maintenance of the health 
department of the District of Columbia, and 
the jurisdiction of civil and criminal pro- 
cedure in the enforcement of this act is 
hereby vested in the police court of the said 
District, with the same right of appeal as in 
other civil and criminal trials in said District. 
Approved, December 20, 18go. 7 
AN ACT OF THE LEGISLATIVE ASSEMBLY FOR THE 
PREVENTION OF DISEASES IN THE DISTRICT OF 
COLUMBIA, APPROVED JUNE IS, T572 
Sec. 4. And be it further enacted, That 
the proprietor of any tenement house, lodg- 
ing house, boarding house, or hotel in the 
District of Columbia shall, in the event of 
any person living in such house becoming 
afflicted with any such disease,* at once 
notify the board of health thereof, in writ- 
ing. For a refusal to give the notice herein 
provided, the person so offending shall be 
liable to a fine of not less than ten dollars 
nor more than fifty dollars for each offense. 
Sec. 5. And be it further enacted, That 
any person suffering from any such infec- 
tious or contagious disease, who shall wil- 
fully expose himself in any street, public 
place, or conveyance, or any person having 
the care, charge, or control of such diseased 
person, or any owner or driver of any such 
conveyance, who does not immediately pro- 
vide for the disinfection of the same, after 
it has conveyed such diseased person, and 
*lnfectious or contagious diseases. any 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, be 
liable to a penalty of not less than ten dol- 
lars nor more than one hundred dollars for 
each offense. 
8 
Skc. 6. And be it further enacted, That 
any person who shall let to any other per- 
son any house, room, or part of a house in 
which any patient has been confined by 
reason of such disease, without having such 
room, house, or part of a house completely 
disinfected to the satisfaction of the board 
of health, as certified by them, such person 
shall be liable to a penalty of not less than 
ten dollars or more than fifty dollars for 
each offense. 
HEGfjLtRTIO]SIS 
The following regulations, provided for 
in the Act of Congress, approved, December 
20, 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 Health 
Officer, in conjunction with the attending 
physician, to cause the premises to be pro- 
perly disinfected, and to issue the necessary instructions for the isolation of the patient 
in Section 3, “ That it shall be the duty of 
physicians, while in attendance upon cases 
of scarlet fever and diphtheria, to exercise 
such reasonable precautions to prevent the 
spread of the said diseases as may be pre- 
scribed by the Health Officer of the District 
of Columbia, in regulations in Section 6, 
‘ ‘ That the word ‘ regulations ’ as herein 
used shall be held to mean also rules, orders, 
and amendments.” 
9 
1. The term scarlet fever as applied in 
the Act shall be held to include scarlatina, 
scarlet rash, and canker rash, and each and 
every case must be reported upon the forms 
provided. 
2. The term diphtheria as applied in the 
Act shall be held to include membranous 
croup, unless a bacteriological examination 
made by a competent person, has proved 
that the Klebs-Doeffler bacillus is absent, 
and each and every case must be reported 
upon the forms provided. 
3. Warning signs shall remain displayed 
on houses in cases of scarlet fever for a 
period of not less than four weeks, and in 
cases of diphtheria for not less than three 
weeks from date of report to the Health 
Officer, and for a longer period unless report 
of recovery by the physician in attendance 
has been made. 10 
4- In case of death the warning sign shall 
remain displayed upon premises for a period 
of not less than seven days after the death, 
and longer, unless the Health Officer is 
satisfied that all proper means have been 
employed for prevention of the spread of 
the contagion. 
5, It shall be the duty of the householder, 
in every case where a warning sign has been 
displayed from the premises which he or 
she occupies, to report promptly the removal 
of such sign at any time within the periods 
given. 
6. It shall be the like duty of the physi- 
cian in attendance to make such report to 
the Health Officer of the removal of warn- 
ing signs, unless assured that report has 
been made by some one from the premises 
where the disease is prevailing or has pre- 
vailed. 
7. It shall be the duty of the physician in 
attendance to report, in every instance, on 
the forms provided, whether or not children 
in the family or other children in the same 
building attend school, and at what school 
building or buildings. 
8. Children shall not be permitted to re- 
turn to school from infected premises, except 
upon presentation of the proper certificate 
from the Health Officer. 11 
9- All persons suffering from either diph- 
theria or scarlet fever are to be isolated in 
rooms as far removed as possible from those 
occupied by other persons in the building, 
and upon the top floor where it is practi- 
cable. No person, other than the physician 
in attendance, the examining official, and the 
nurse or nurses, shall be admitted to such 
room during the prevalence of the disease. 
This room, if possible, should be large, well 
ventilated, and much exposed to sunlight. 
10. Every room occupied by a patient 
suffering from either diphtheria or scarlet 
fever shall be cleared of all needless cloth- 
ing, carpets, drapery, and other materials 
likely to harbor the poisons of the diseases. 
Dishes, spoons, wash rags, combs, brushes, 
etc., used in' the sick room shall not be used 
in any other part of the house, nor shall 
they be washed or stored with similar arti- 
cles from the rest of the house until they 
have been disinfected. 
n. Soiled bed and body linen shall be 
immediately placed in vessels of water con- 
taining a solution of acid bi-chloride of 
mercury 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 shall 
be kept thoroughly clean and disinfected. 13. Discharges from the throat, nose and 
mouth shall be received upon pieces of 
cloth, which must be immediately burned. 
12 
14. All persons recovering from either 
diphtheria or scarlet fever shall be con- 
sidered dangerous, and shall not be permit- 
ted to leave the sick room, to associate with 
others, or to attend school, church, or any 
public assembly, until a certificate has been 
furnished by the Health Officer to the effect 
that they may go abroad without danger of 
disseminating the contagion; and those 
nursing such patients shall not go to any 
public assembly, as to the market, churches, 
theatres, shops, or to their own places of 
business or work. 
15. It shall be the duty of the person in 
charge of the premises where a case of diph- 
theria or scarlet fever exists, to exercise all 
reasonable care in the prevention of the 
commingling 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 any 
dwelling place while a warning card is dis- 
played thereon, except with permission from 
the Health Officer. 
17. The body of a person who has died 
from either diphtheria or scarlet fever shall 
be immediately disinfected and placed in a 13 
coffin, which shall be tightly closed, and 
shall not be taken to a church or place of 
public assembly, and shall be buried within 
forty-eight hours, unless otherwise ordered 
by the Health Officer. 
18. No public funeral shall be held in a 
dwelling in which there is a case of either 
diphtheria or scarlet fever, nor in which a 
death from either of said diseases has 
recently occurred. The term public funeral 
as used in this section shall be held to mean 
any funeral at which persons other than the 
officiating minister, the necessary pall-bear- 
ers and the immediate family of the deceased 
are present. 
19. Immediately upon the complete re- 
covery of a person who has been suffering 
from either diphtheria or scarlet fever, or 
upon the death of a person who has been so 
suffering, the room or rooms occupied shall 
be thoroughly disinfected and shall there- 
after be thoroughly cleaned and exposed to 
currents of fresh air. 
20. All clothing, bedding, carpets, and 
other textile fabrics, which have been ex- 
posed to the contagion of the disease shall 
be either burned, exposed to super-heated 
steam, thoroughly boiled, or soaked for two 
hours in a solution containing the proper 
quantity of acid bi-chloride of mercury. 14 
2i. No person shall interfere with or 
obstruct the entrance, inspection, and ex- 
amination of any building or house, by the 
inspectors or officers of this department, 
when there has been reported the case of a 
person sick with either scarlet fever or diph - 
theria therein. 
DISINFECTION 
a. The vomit and discharges from the 
bowels of diphtheria and scarlet fever 
patients, should always be disinfected, 
especially the vomit To do this, dissolve 
one pound of chloride of lime in two gallons 
of water (16 tumblerfuls of water equal a 
gallon) and put a quart of this liquid on 
each stool or vomit, mix, and let the mix- 
ture stand one hour before throwing it into 
the water closet or box privy. 
b. For two or more weeks after the mem- 
brane in diphtheria has disappeared the 
disease germs may be present in the patient’s 
mouth in swarms, and although he is con- 
valescent himself he can infect others and 
any part of the house. Therefore, the patient 
should be kept apart from other persons and 
not allowed to go through the house for at 
least two weeks after the membrane has dis- 
appeared. (See section 14,) The virulent 
germ has been found in the mouths of those 
affected nearly three weeks after the mem- brane has disappeared. Only a competent 
bacteriologist can determine whether the 
patient has become harmless. 
15 
In scarlet fever the infection of others can 
take place while the rash is present, and 
after the rash has disappeared while the skin 
is being shed. The outer skin comes off in 
scales of various sizes, but usually these 
scales are like dandruff. The shedding may 
continue for even twenty in some 
cases, and during this time these skin parti- 
cles are very infectious. It is well to rub a 
little sweet oil over the child’s body from 
time to time, to prevent the scales from 
floating about the room. If patients suffer- 
ing from diphtheria and scarlet fever are 
permitted to walk about the house too soon, 
it will be necessary to disinfect the entire 
house. 
c. As soon as it is suspected that a child 
is ill with diphtheria or scarlet fever, even 
before the arrival of a physician, it should 
be taken away from all other children and 
be 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 upholstered 
chairs must be replaced with plain wooden 
ones. Should the case prove not to be 
diphtheria or scarlet fever no harm is done. 
If, however, the disease has not been recog- 16 
nized until the rash is developed in scarlet 
fever, or the membrane in diphtheria, no 
article should then be removed, because it 
probably is infected. (See regulation No. 
9.) People nursing diphtheria or scarlet 
fever patients should not go to market, to 
shops, to church, or to any public assembly, 
until after the final general disinfection, for 
fear of spreading infection. (See regulation 
No. 15.) 
d. Disinfecting Solviion.—For body linen 
and bed linen the most practical and reliable 
disinfectant is an acid corrosive sublimate 
solution (i. e. one part bichloride of mercury 
to two parts of hydrochloric acid,) In prac- 
tice three ounces of commercial hydrochloric 
acid and one ounce and a half of bichloride 
of mercury will prove sufficient. A physi- 
cian’s prescription will be necessary. Use 
one teaspoonful of the solution to each gal- 
lon of water. The water containing this 
disinfectant must always be put into wooden 
vessels, as wash tubs or pails, or, if a small 
quantity 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 the 
druggist in an old teaspoon or a dose glass. 
This disinfectant is a very violent poison it 
swallowed, and care must be exercised in 
its use. It will not hurt the hands when mixed with the water, but it will injure 
finger rings, which should, therefore, be 
removed before it is used. It is better than 
carbolic acid or any other solution and it 
has no odor. 
17 
After towels, sheets, body linen and like 
articles have been used during the course of 
the illness they should be soaked for two 
hours in this solution (i. e. one teaspoonful 
to the gallon of water), next rinsed in clean 
water and dried ; thus they are rendered 
safe. 
e. Those who are nursing patients ill with 
diphtheria or scarlet fever should wash their 
hands in the disinfectant solution every time 
they touch the patient or any article that 
has possibly been infected, then rinse their 
hands in clean water. This is to protect the 
nurse and others. Put half a teaspoonful 
of the disinfectant into two quarts of water 
in a china wash bowl or earthen-ware dish 
or wooden bucket for this purpose. 
f. Do not handle a patient ill with either 
of these diseases more than is absolutely 
necessary, not only because of the danger 
of infection, but for other grave reasons. 
Diphtheria often affects the heart and one 
can then kill a patient by lifting him up 
roughly. It is, of course, especially dan_ 
gerous to kiss a child ill with these diseases, and the nurse must be exceedingly careful 
lest a diphtheria patient cough into her face. 
18 
g. If the patient get soiled with his own 
discharges wash him with ordinary water 
then disinfect the wash water and the wash 
rag with the disinfectant (a teaspoonful to 
the gallon of water) before throwing them 
away. As to the spittle of these patients 
see regulation No. 13. 
k. Nurses and others caring for patients 
suffering from scarlet fever or diphtheria 
should wear over the other clothing while 
in the sick room a wrapper or gown which 
can be easily removed and left just inside 
the sick room. This wrapper should be 
dipped into the disinfecting solution as often 
as possible, It will be more convenient if 
two such wrappers are provided. 
i. When the patient is w7ell enough to 
leave the sick room (see regulation No. 14 
and section h) his clothing is left behind, he 
is bathed, and then clothed in another room. 
j. The best disinfectant for mattresses and 
blankets, and indeed everything, is stream- 
ing steam under pressure. This requires 
special apparatus and cannot be done at 
home. Mattresses, bolsters and pillows 
must be pulled apart and steamed if they are 
worth this. If they are old or cheap it is 
better to burn them. Upholstered furniture 
may be steamed entire or the upholstery may 19 
be removed and burned, the framework being 
scoured and then washed with the disinfect- 
ant solution, (see section d), or the entire 
piece may be burned. 
k. The sick room must not be swept 
during the illness or during the process of 
final disinfection, because germs are lifted 
up with the dust, to be inhaled at once or to 
settle upon the walls and elsewhere and cause 
infection later. Wipe the floor when neces- 
sary with wet rags, which are afterwards to 
be burned. 
/. In the final disinfection after the 
bedding has been removed, and all carpets, 
rugs, curtains and other textile fabrics which 
were in the room have been soaked in the 
acid corrosive sublimate solution, or have 
been removed by or with the authority of the 
Health Department to be steamed, take two 
or three loaves of fresh bread, cut these in 
halves, and rub down the walls thoroughly 
to remove all dust. Burn this bread. Now 
scrub the floor and all woodwork with 
ordinary suds. Pour into this suds as many 
teaspoonfuls of the disinfectant as there are 
gallons of scrub water, let it stand for an 
hour, then throw it away. 
m. After scrubbing, thoroughly flood the 
floor, woodwork, bedstead, chairs, windows, 
transoms, bureau, everything in the room, 
with the disinfectant mentioned in section d. Do not sprinkle it on, flood with it. Then 
dip a still brush into the solution and stipple 
the walls and ceiling (i. e. with the points of 
the hairs) till they are thoroughly wetted. 
The wall paper may be spoiled by this 
process but this is unavoidable. 
20 
n. Do not use the patent disinfectants, 
they are seldom effective. While the room 
is wet sulphur may be burned as an addi- 
tional precaution, but when used alone k is 
very unreliable, especially against the diph- 
theria germs, and the Health Department 
will not consider a room disinfected if nothing 
but sulphur has been used. 
o. For any possible good to be accom- 
plished by sulphur it is necessary (i) that 
the articles to be disinfected be wet and be 
so placed as to be freely exposed to the fumes, 
(2) that the sulphur fumes be extremely 
concentrated, and (3) that the contact be 
prolonged at least 24 hours. 
1. Wetting may be accomplished by wash- 
ing with a wet cloth or by free steaming of 
the room; Closets, cupboards and drawers 
should be left wide open. 
2. In order to secure concentration of the 
fumes it is necessary that every opening into 
the room be tightly closed. All crevices 
about doors, windows and transoms must be 
filled with paper or rags to prevent the escape 
of the sulphur fumes and the entrance of air. 21 
3- The room should be left closed after 
the sulphur is lighted for at least twenty- 
four hours. 
To burn sulphur, place two or three bricks 
on the bottom of a wash tub or other large 
vessel and put in water up to near the top 
of the bricks to prevent fire ; then set at 
least three pounds of sulphur on the bricks 
in an old tin plate or flat piece of metal and 
ignite it with hot coals. Leave the room at 
once and close the door. 
p. In case of death from diphtheria or 
scarlet fever, wet a sheet with the disinfectant 
solution, using two teaspoonfuls to the gallon 
of water, and wrap up the body, covering 
the face in this sheet. 
q. The directions for disinfection given 
here hold good for all infectious and con- 
tagious diseases, as tuberculosis, typhoid, 
small-pox, cholera, infectious pneumonia, 
measles, the grippe, and the like. When 
the stools of typhoid fever patients have 
been thrown into privies without disinfection, 
as may happen before the disease has been 
recognized, cover the surface of the privy 
contents with chloride of lime, after thor- 
oughly disinfecting the woodwork with the 
disinfecting solution mentioned in para- 
graph d. If these stools have been thrown 
into a water-closet disinfect the woodwork with the bi-chloride solution and then flush 
the basin with chloride of lime solution. 
Commercial Hydrochloric Acid, . 3 oz. 
Bi-Chloride of Mercury, . . \]/z oz. 
DISINFECTING SOLUTION. 
Sig. :—Poison. Use one teaspoonful to 
the gallon of water in a wooden vessel as 
directed on page 16. 
WM. C. WOODWARD, M. D., 
Health Officer.