Health Department, District of Columbia. 
LAW, REGULATIONS, AND 
INSTRUCTIONS 
RELATING TO PREVENTION OF THE SPREAD OF 
SCARLET FEVER AND DIPHTHERIA. HEALTH DEPARTMENT, DISTRICT OF COLUMBIA 
LAW AND REGULATIONS 
TO 
PREVENT THE SPREAD 
% OF 
Scarlet Fever and DijMeria 
IN THE 
DISTRICT OF COLUMBIA, 
TOGETHER WITH 
Directions as to Disinfection and Disinfectants. 
WASHINGTON, D. C.: 
Ramsey & Bisbee, Printers and Binders. 
1892. 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-J 
ica in Co?igress Assembled, That from and« 
after the passage of this act it shall be the 
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 practitioner be- 
comes 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 of- 
fense 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 dis- 
ease shall make the report above mentioned, 
Duty of Physician, 
parent, guardian, nurse 
or other person in 
charge of patient. 4 
and in case of failure to report shall suffer the 
same penalties as provided for physicians in 
this act. 
: 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 of- 
ficer, and it shall be the duty of the said 
health officer, in conjunction with the attend- 
ing physician, to cause the premises to be 
properly disinfected, and to issue the neces- 
sary instructions for the isolation of the pa- 
tient. 
Sec. 3. That no person shall visit or attend 
any public or private school, or place of pub- 
lic 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 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 
wffiile in attendance upon cases of scarlet fever 
or diphtheria to exercise such reasonable pre- 
cautions to prevent the- spread of the said 
Placard or flag to be 
displayed; unlawful to 
remove same; premises 
to be disinfected. 
Persons affected not 
to attend school nor 
public assemblages, nor 
to appear on streets. 
Health officer to pre- 
scribe regulations. 5 
diseases as may be prescribed by the health 
officer of the District of Columbia in regula- 
tions. 
Sec. 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 attending physi- 
cian shall have furnished a certificate that said 
patient has completely recovered, and that 
there is no danger of infection to other per- 
sons. All persons who shall, after conva- 
lescing from diphtheria or scarlet fever, visit 
schools, seminaries, or colleges, without pro- 
viding themselves with such certificates, shall 
suffer the penalties provided for in section 1 
of this act. 
Sec. 5. That the provisions of this act shall 
apply to every ship, vessel, steamer, boat or 
craft, lying or being in the rivers, harbors, or 
other waters within the jurisdiction 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. 
Sec. 6. That the word “ regulations,” as 
herein used, shall be held to mean also rules,' 
orders, and amendments. The words “ per-1 
sons in charge thereof ” shall be held to mean1 
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 posi- 
tion are charged with the management or care 
Convalescents not to 
attend schools, semina- 
ries, or colleges, except 
upon certificate. 
Where provision of 
the act shall apply. 
What the terms “ reg- 
ulations,” “persons,” 
and “practitioner of 
medicine” shall be held 
to mean. 6 
of the premises, or interested in the person 
afflicted. The words “ practitioner of medi- 
cine/’ or “ practitioner,” shall be held to in- 
clude all persons who undertake to treat per- 
sons afflicted, either gratuitously or for pay. 
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 Dis- 
trict, 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. 
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 procedure 
in the enforcement\>f 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, 1890. 
Penalty for 'making 
false report or certifi- 
cate. 
Jurisdiction for en- 
forcement of act vested 
in Police Court. Regulations. 
The following regulations, provided for in the Act of 
Congress approved December 20, 1890, are promulgated 
for the information 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 
properly disinfected, and to issue the necessary instruc- 
tions for the isolation of the patient”; in Section 3, 
“ That it shall be the duty of physicians, while in at- 
tendance upon cases of scarlet fever and diphtheria, to 
exercise such reasonable precautions to prevent the spread 
of the said diseases as may be prescribed 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 amend- 
ments. ” 
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 
orms provided. 8 
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. 
In cases of death the warning sign shall remain dis- 
played upon premises for a period of not less than seven 
days, and longer, unless the Health Officer is satisfied 
that all proper means have been employed for prevention 
of the spread of the contagion. 
It shall be the duty of the householder, in every case 
where a warning sign has been displayed from the prem- 
ises which he or she occupies, to report promptly the 
removal of such sign at any time within the periods 
given. 
It shall be the like duty of the physician in attendance 
to make such report to the Health Officer of the removal 
of warning signs, unless assured that report has been made 
by some one from the premises where the disease is pre- 
vailing or has prevailed. 
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. 
Children shall not be permitted to return to school 
from infected premises, except upon presentation of the 
proper certificate from the Health Officer. 
All persons suffering from either diphtheria or scarlet 9 
fever are to be isolated in rooms as far removed as possi- 
ble from-those occupied by other persons in the building, 
and upon the top floor, where it is practicable. No per- 
son, other than the physician in attendance, the examin- 
ing official, and the nurse or nurses, shall be admitted to 
such room during the prevalence of the disease. 
Every room occupied by a patient suffering from either 
diphtheria or scarlet fever shall be cleared of all needless 
clothing, carpets, drapery, and other materials likely to 
harbor the poisons of the disease. 
Soiled bed and body linen shall be immediately placed 
in vessels of water containing a solution of bi-chloride of 
mercury, chloride of zinc, or other suitable disinfectant. 
Excremental discharges from the patient shall be re- 
ceived in vessels of water containing such a solution, and 
all vessels used shall be kept scrupulously clean and 
thoroughly disinfected. 
Discharges from the throat, nose, and mouth shall be 
received upon pieces of cloth, which must be immediately 
burned. 
All persons recovering from either diphtheria or scar- 
let fever shall be considered dangerous, and shall not be 
permitted 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 con- 
tagion. 
It shall be the duty of the person in charge of the 
premises where a case of diphtheria or scarlet fever exists, 
to exercise all reasonable care in the prevention of the 10 
commingling of persons who come in contact with the 
patient, or any other persons, whereby the contagion 
might be disseminated. 
The body of a person who has died from either diph- 
theria or scarlet fever shall be immediately disinfected and 
placed in a coffin, which shall be tightly closed, and shall 
not be taken to any church or place of public assembly, 
and shall be buried within forty-eight hours, unless other- 
wise ordered by the Health Officer. 
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. 
Immediately upon the recovery 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 
by exposure for several hours to the fumes of chlorine 
gas, or of burning sulphur, and shall thereafter be thor- 
oughly cleaned and exposed to currents of fresh air. 
All clothing, bedding, carpets, and other textiles which 
have been exposed to the contagion of the disease shall 
be either burned, exposed to super-heated steam, or thor- 
oughly boiled. 
No person shall interfere with or obstruct the entrance, 
inspection, and examination 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 diphtheria therein. Disinfection and Disinfectants. 
The following general directions respecting disinfec- 
tion and disinfectants are the outcome of the labors of 
Dr. George M. Sternberg and his colleagues on the 
committee on disinfectants of the American Public Health 
Association, and are given here for the guidance of the 
public as the best information on the subject extant: 
DlSINFECTION OF EXCRETA, ETC. 
The infectious character of the dejections of patients, 
suffering- from cholera and from typhoid fever is well es- 
tablished ; and this is true of mild cases and of the earli- 
est stages of these diseases as well as of severe and fatal 
cases. It is probable that epidemic dysentery, tubercu- 
losis, and perhaps diphtheria, yellow fever, scarlet fever, 
and typhus fever may also be transmitted by means of 
the alvine discharges of the sick. It is therefore of the 
first importance that these should be disinfected. In 
cholera, diphtheria, yellow fdver, and scarlet fever, all 
vomited material should also be looked upon as infec- 
tious; and in tuberculosis, diphtheria, scarlet fever, and 
infectious pneumonia, the sputa of the sick shall be dis- 
infected or destroyed by fire. It seems advisable also 
to treat the urine of patients sick with an infectious dis- 12 
«ase with one of the disinfecting solutions below recom- 
mended. 
Chloride of lime, or bleaching powder, is perhaps en- 
titled to the first place for disinfecting excreta, on account 
of the rapidity of its action. The following standard so- 
lution is recommended: Dissolve chloride of lime of the 
best quality (good chloride of lime should contain at 
least 25 per cent, of available chlorine. It may be pur- 
chased by the quantity at 3cents per pound. The cost 
of the standard solution recommended is therefore but 
little more than 1 cent a gallon. A clear solution may be 
obtained by filtration or by decantation, but the insoluble 
sediment does no harm, and this is an unnecessary refine- 
ment) in pure water, in the proportion of six ounces to 
the gallon. 
Use one quart of this solution for the disinfection of 
each discharge in cholera, typhoid fever, etc. (for a very 
copious discharge use a large quantity). Mix well and 
leave in the vessel for at least one hour before throwing 
into privy-vault or water-closet. The same directions 
apply for the disinfection of vomited matter. Infected 
sputum should be discharged directly into a cup half full 
of the solution. A 5 per cent, solution of carbolic acid 
may be used instead of the chloride of lime solution, the 
time of exposure to the action of the disinfectant being 
four hours. 
DISINFECTION OF THE PERSON. 
The surface of the body of a sick person, or of his 
attendants, when soiled with infectious discharges, should 
be at once cleansed with a suitable disinfectant agent. 13 
For this purpose solution of chlorinated soda (liquor 
sodae-chlorinate) diluted with nine parts of water, or the 
standard solution of chloride of lime diluted with three 
parts of water may be used. A 2 per cent, solution of 
carbolic acid is also suitable for this purpose, and under 
proper medical supervision the use of a solution of cor- 
rosive sublimate—1 : 1000—is to be recommended. 
In diseases like small-pox and scarlet fever, in which 
the infectious agent is given off from the entire surface 
of the body, occasional ablutions with the above-men- 
tioned solution of chlorinated soda are recommended. 
In all infectious diseases the body of the dead should 
be enveloped in a sheet saturated with the standard solu- 
tion of chloride of lime, or with a 5 per cent, solution of 
carbolic acid, or a 1 : 500 solution of corrosive sublimate. 
Disinfection of clothing. 
Boiling for half an hour will destroy the vitality of all 
known disease germs, and there is no better way of dis- 
infecting clothing or bedding which can be washed than 
to put it through the ordinary operations of the laundry. 
No delay should occur, however, between the time of re- 
moving soiled clothing from the person or bed of the 
sick, and its immersion in boiling water, or in one of the 
following solutions until this can be done: 
Corrosive sublimate, one drachm to the gallon of water 
(about i : 1000), or, 
Carbolic acid, pure, one ounce to the gallon of water, 
(i : 128). 
The articles to be disinfected must be thoroughly 14 
soaked with the disinfecting solution and left in it for at 
least two hours, after which they may be wrung out and 
sent to the wash. 
N. B.—Solutions of corrosive sublimate should not be 
placed in metal receptacles, for the salt is decomposed and 
the mercury precipitated by contact with copper, lead, or 
tin. A wooden tub or earthen crock is a suitable recep- 
tacle for such solutions. 
Clothing or bedding which can not be washed should 
be disinfected by steam in a properly constructed disin- 
fection chamber. In the absence of a suitable steam dis- 
infecting apparatus, infected clothing and bedding should 
be burned. 
DISINFECTION OF THE SICK-ROOM. 
In the sick-room no disinfectant can take the place of 
free ventilation and cleanliness. It is an axiom in sani- 
tary science that it is impracticable to disinfect an occu- 
pied apartment for the reason that disease germs are not 
destroyed by the presence in the atmosphere of any 
known disinfectant in respirable quantity. Had odors 
may be neutralized, but this does not constitute disinfec- 
tion in the sense in which the term is here used. These 
bad odors are, for the most part, an indication of want of 
cleanliness, or ol proper ventilation ; and it is better to 
turn contaminated air out of the window or up the chim- 
ney than to attempt to purify it by the use of volatile 
chemical agents, such as carbolic acid, chlorine, etc., which 
are all more or less offensive to the sick, and are useless 
so far as disinfection, properly so called, is concerned. 15 
When an apartment which has been occupied by a 
person sick with an infectious disease has been vacated, 
it should be disinfected. The object of disinfection in 
the sick-room is mainly the destruction of infectious ma- 
terial attached to surfaces, or deposited as dust upon 
window ledges, in crevices, etc. If the room has been 
properly cleansed and ventilated while still occupied by 
the sick person, and especially if it was stripped of car- 
pets and unnecessary furniture at the outset of his attack, 
the difficulties of disinfection will be greatly reduced. 
All surfaces should be thoroughly washed with the 
standard solution of chloride of lime diluted with three 
parts of water, or with i : 1000 solution of corrosive sub- 
limate. The walls and ceiling, if plastered, should be 
subsequently treated with a lime-wash. Especial care 
must be taken to wash away all dust from window ledges 
and other places wffiere it may have settled, and thor- 
oughly to cleanse crevices and. out-of-the-way places. 
After this application of the disinfecting solution, and an 
interval of twenty-four hours or longer for free ventila- 
lation, the floors and wood-work should be well scrubbed 
with soap and hot water, and this should he followed by 
a second more prolonged exposure to fresh air, admitted 
through open doors and windows. 
As an additional precaution, fumigation with sulphuric 
acid gas is to be recommended, especially for rooms 
which have been occupied by patients with small-pox, 
scarlet fever, diphtheria, typhus fever, and yellow fever. 
But fumigation with sulphurous acid gas alone, as com- 
monly practised, cannot be relied upon for disinfection of the sick-room and its contents, including bedding, fur- 
niture, infected clothing, etc., as is popularly believed. 
When fumigation is practised, it should precede the 
general washing with a disinfectant solution, heretofore 
recommended. To ensure any results of value, it will 
be necessary to close the apartment to be disinfected as 
completely as possible by stopping all apertures through 
which the gas might escape, and to burn not less than 
three pounds of sulphur for each thousand cubic feet of 
air space in the room. To secure complete combustion 
of the sulphur, it should be placed in powder or in small 
fragments, in a shallow iron pan, which should be set 
upon a couple of bricks in a tub partly filled with water, 
to guard against fire. The sulphur should be thoroughly 
moistened with alcohol before igniting it. 
DISINFECTION OF PRIVY-VAULTS, CESSPOOLS. ETC. 
When the excreta (not previously disinfected) of pa- 
tients with cholera or typhoid fever have been thrown 
into a privy-vault, this is infected, and disinfection should 
be resorted to as soon as the fact is discovered, or when- 
ever there is reasonable suspicion that such is the case. 
It will be advisable to take the same precautions *vith 
reference to privy-vaults into which the excreta of yellow 
fever patients have been thrown, although we do not 
definitely know that this is infectious material. 
For this purpose the standard solution of chloride of 
lime may be used in quantity proportioned to the amount 
of material to be disinfected, but where this is consider- 
able it will scarcely be practicable to sterilize the whole 17 
mass. The liberal and repeated use of this solution, or of 
a 5 per cent, solution of carbolic acid, will, however, dis- 
infect the surface of the mass, and is especially to be 
recommended during the epidemic prevalence of typhoid 
fever or of cholera. 
All exposed portions of the vault, and the wood work 
above it, should be thoroughly washed down with the 
disinfecting solution. Instead of the disinfecting solutions 
recommended, chloride of lime in powder may be daily 
scattered over the contents of the privy-vault. 
• 
C. M. HAMMETT, M. D., 
Health Officer..