RESTRICTION and prevention 
OF 
SCARLET FEVER. 
Sometimes called “ Scarlatina,” “ Scarlet Rasli,” “ Canker Rash,” or “ Rash Fever.” 
DOCUMENT ISSUED BY THE MICHIGAN STATE BOARD OF HEALTH. 
| |Q 
Fourteenth Edition (10,000 copies), March, 1899. 206,000 Printed. 
1. Scarlet fever is one of the most contagious diseases. One 
attack usually prevents subsequent attacks. The greatest number of 
deaths from this disease is of children under ten years of age. Adult 
persons sometimes have the disease; and even though they have it in 
many instances in a milder form, yet they may communicate the disease 
in a fatal form to children. The isolation of those mildly sick with, and 
convalescent from, scarlet fever is important. 
2. Scarlet fever is believed to be caused by a special contagium or 
poison which may be conveyed, to persons previously unaffected, by 
personal contact, by infected clothing, rags, hair, or paper, or by any of 
the discharges from the body of a person afflicted with the disease. 
3. The discharges from the threat, nose, and mouth are considered 
extremely dangerous, but those from the skin, eyes, ears, kidneys, and 
bowels, are also dangerous, and remain so for a considerable time. . 
4. Communication. It is believed that the disease may be communi- 
cated by a person recovering therefrom so long as the usual subsequent 
scaling or peeling of the skin continues, which sometimes is not completed 
before the lapse of seventy or eighty days. The poison may also remain 
in clothing, etc., for a long time, possibly for years, especially if woolen 
and packed away in drawers or trunks. 
5. Filth, uncleanliness, and imperfect ventilation may increase 
the danger of spreading the disease. 
6. Period of incubation. The interval of time which may elapse 
after exposure to the contagium of scarlet fever and during which a 
susceptible person so exposed may expect to be taken sick with the disease, 
varies from one to fourteen days. 
7. Separation of the sick from the well. Whenever a child has 
sore throat and fever, and especially when this is accompanied by a rash 
on the body, the child should immediately be isolated as completely as pos- 
sible from other members of the household, and from other persons, until 
a physician has seen it and has determined whether it has scarlet fever. 
All persons known to he sick with this disease (even those hut 
mildly sick), should he promptly and thoroughly isolated from the 
public. 
That this is of more importance than in the case of small-pox is indicated by the fact of the much 
greater number of cases of sickness and of deaths from scarlet fever,—a disease for which no such 
preventive as vaccination is yet known. 
8. Persons who are attending upon children or other persons suffer- 
ing from scarlet fever, and also the members of the patient’s family, 
should not mingle with other people nor permit the entrance of children 
into their house. 
9. Plain and distinct notices should he placed on the premises 
or house in which there is a person sick with scarlet fever; the placard 
should remain so long as there is in the premises contagium which may 
communicate the disease; and no child that has not had the disease 
should he allowed to enter, or to associate with persons who do enter 
such house or room. 2 
DUTIES OF HOUSEHOLDERS AND PHYSICIANS. 
10. Children believed to be uninfected may be sent away from the 
house in which there is scarlet fever, to families in which there are no 
persons liable to the disease, or to previously disinfected convalescent 
wards in hospitals; but in either case they should be isolated from the 
public until the expiration of the period of incubation, counting from the 
time of their removal. 
11. Householders and physicians must immediately give notice of 
the first case, and of every case of scarlet fever, to the health officer. 
This is required by sections 1734 and 1735, Compiled Laws of Michigan, 
1871 ( § 1675 as amended by Act approved March 28, 1889, and § 1676, 
Howell’s Statutes, as amended by Act No. 11, Laws of 1883, and by Act 
No. 158, Laws of 1895), which are as follows:— 
(1734.) Sec. 43. Whenever any householder, hotel keeper, keeper of a hoarding house or tenant 
shall know, or shall be informed by a physician, or shall have reason to believe that any person in 
his family, hotel, boarding house or premises is taken sick with small-pox, cholera, diphtheria, scar- 
let fever, or any other disease dangerous to the public health, he shall immediately give notice in 
writing thereof to the healih officer of the township, city or village in which he resides Said notice 
shall state the name of the person sick, the name of the disease if known, the name of the house- 
holder. hotel keeper, keeper of boarding house or tenant giving the notice, and shall, by street and 
number, or otherwise, sufficiently designate the house in which he resides or the room in which the 
sick person may be; and if he shall refuse or willfully neglect immediately to give such notice, he 
shall be deemed guilty of a misdemeanor, and upon conviction thereof, he sh all b • punished by a fine 
of not exceeding one hundred dollars and the costs of prosecution; or in default of payment thereof, 
by imprisonment not exceeding ninety days in the county jail, in the discretion of the court: Pro- 
vided, chat such fine or imprisonment shall not hs enforced if the physician in attendance has given 
to the hsalth officer or other officer hereinbefore mentioned an immediate notice of said sick person 
and true name of the disease, in accordance with the requirements of this section. § 1675, Howell’s 
Statutes.—As amended by Act 37, Laws of 1889, and by Act No. 158, Laws of 1895. 
(1735.) Sec. 44. Whenever any physician shall know that any person whom he is called to visit, 
or who is brought to him for examination, is infected with small-pox, cholera, diphtheria, scarlet 
fever, or any other disease dangerous to the public health, he shall immediately give notice thereof 
to the health officer of the township, city or village in which the sick person maybe; and to the 
householder, hotel keeper, keeper of a boarding house, or tenant within whose house or rooms the 
sick person may he. The notice to the officer of the board of health shall state the name of the dis- 
ease, the name, age and sex of the person sick, also the name of the physician giving the notice; and 
shall, by street and number, or otherwise, sufficiently designate the house or room in which said sick 
person may be. And every physician and person acting as a physician, who shall refuse or neglect 
immediately to give such notice shall forfeit for each such offense a sum not less than ten nor more 
than fifty dollars:* Provided, That this penalty shall not be enforced against a physician if an- 
other physician in atte idance has given to the healih officer, or other officer hereinbefore men- 
tioned, an immediate notice of said sick person, and the true name of the dis-'ase, in accordance 
with the requirements of this section.—§ 1676, Howell's Statutes, as amended by Act No. 11, Laws of 
1883, and by Act No. 168, Laws of 1895. 
12. Upon receipt of such notice, the local board of health has 
duties to perform in taking measures to restrict the spread of the disease, 
which it is a great violation of public trust for the board to neglect or 
postpone. The law is very plain as to the nature and the importance of 
these duties. Three sections of the law are as follows:— 
(1732.) Secs. 41. When the small-pox or any other disease dangerous to the public 
health, is found to exist in any township, the board of health shall use all possible care 
to prevent the spreading of the inf return, and to give public notire of infected places to 
travelers by such means as in their judgment shall be most effectual for the common 
safety. § 1673 Howell’s statutes. 
(1706.) Sec. 15. When any person coming from abroad, or residing in any township 
within this State, shall be infected, or shall lately before have been infected, with the 
small-pox, or other sickness dangerous to the public health, the board of health of the 
township where such person may be shall make effectual provision in the manner in 
which they shall judge best for the safety of the inhabitants, by removing such sick or 
infected person to a separate house, if it can be done without danger to his health, and 
by providing nurses and other assistance and necessaries, which shall be at the chargi of 
the person himself, his parents, or other persons who may be liable for his support, if 
able; otherwise at the charge of the county to which he belongs: Provided, Tnat the 
health board shall keep and render an itemized and sepai ate statement of expenses 
incurred in so caring for each person. § 1647 Howell’s statutes, as amended by Act No. 
97, approved April 26, 1895. 
(1707.) Seo. 16. If any such infected pprson cannot be removed wi'hiut danger to his 
health, the board of health shall make provision for him as directed in the preceding 
section, in the house in who h he may be, snd in such case they may cause the persons in 
the neighborhood to be removed, and may take su'-h other measures as they may deem 
necessary for the safety of the inhabitants. § 1648 Howell’s statutes. 
Notice of in- 
fected places. 
Board to make 
provision to 
prevent spread 
of disease, 
At expense of 
person or 
county, 
3 Mich. Rep., 
475. 
Provision in 
case infected 
persons cannot 
be removed, 
* Supervisors must prosecute for all such forfeitures; township officers ran«f give notice to super- 
visor; prosecuting attorn »y to conduct suit if requested; see sections 8439, 814o and 8442, Howell’s 
Annotated Statutes. Health officers of villages and cities must notify prosecuting attorney of all 
violations of this section,—see 8 1884, Howell’s Statutes; the prosecuting attorney must prosecute for 
all such forfeitures incurred within his county,—see § 8412, Howell’s Statutes. DUTIES OF LOCAL HEALTH OFFICERS. 
3 
13. Some of the duties of the local board of health, and of the 
health officer, relative to the restriction and prevention of diseases, are 
treated in Circular 120 from the State Board of Health. In order that 
no time may be lost, it is the duty of every board of health to make pro- 
vision for prompt action by its health officer, authorizing and directing 
him to be prepared at all times, as executive officer of the board, to take 
certain action without waiting for a meeting of the board, whenever a 
case of scarlet fever, diphtheria, small-pox, or other disease dangerous to 
the public health occurs within its jurisdiction. Some of these duties of 
the health officer may be briefly suggested as follows: He should— 
a. Promptly investigate the subject, and report to the Secretary of the 
State Board of Health. 
b. Secure isolation of those sick with or exposed to such a disease. 
c. Give notice of infected places, by placard, and otherwise if necessary. 
d. Notify teachers or superintendents of schools. 
e. Regulate funerals of persons dead from scarlet fever, etc. 
/. Disinfect rooms, clothing and premises. 
These duties are required by Act No. 137, Laws of 1883. This act, as 
amended by Act No. 34, Laws of 1889, provides that “ whoever shall 
knowingly violate the provisions of section one of this act, or the orders 
of the health officer made in accordance therewith, shall be deemed guilty 
of a misdemeanor, and, upon conviction thereof he shall be punished by a 
fine not exceeding one hundred dollars, and the costs of prosecution, or in 
default of payment thereof, by imprisonment not exceeding ninety days 
in the county jail, in the discretion of the court.” 
1-4. The local board of health and the physician in charge of cases 
of this disease should cooperate for its restriction. The local board of 
health should especially guard against its spread by cases where no physi- 
cian is employed. 
15. The room in which one sick with thi^disease is to be placed 
should previously be cleaned of all needless clothing, carpets, drapery, 
and other materials likely to harbor the poison of the disease, except 
such articles as are essential to the well-being of the patient, but, except 
after thorough disinfection, nothing should be moved about which has 
already been exposed to the contagium of the disease. The sick room 
may have no carpet, or only pieces which can afterwards be destroyed. 
Provisions should be made for the introduction of a liberal supply of fresh 
air and the continual change of the air of the room without sensible cur- 
rents or drafts. 
16. Handkerchiefs, that need to be saved, should not be used by the 
patient; small pieces of rag should be substituted therefor, and after being 
once used should be immediately burned. 
17. Soiled clothing, towels, bed-linen, etc., on removal from the 
patient, should at once, before removal from the room, be placed in a pail 
or a tub of zinc-solution, made in proportions as follows: water, one gallon; 
sulphate of zinc, four ounces; common salt, two ounces. 
18. The discharges from the throat, nose, mouth, and from the kidneys 
and bowels of the patient should be received into vessels containing chlor- 
inated lime (commonly called “chloride of lime”),* or the zinc-solution 
* Carbolic acid in dilute form, as generally used, is not believed to be a distntectant, and there is 
question of the reliability of sulphate of Iron. “.Standard Solution No. 1,” recommended by a com- 
mittee of the American Public Health Association, is probably the most reliable, and is made as fol- 
lows: To each gallon of soft water add four ounces of chloride of lime of the best quality, which 
should contain at least 25 per cent of available chlorine. “Use one quart of this solution for the dis- 
infection of each discharge from the bowels.” 4 
DISINFECTION OF CLOTHING, DISCHARGES, ETC. 
mentioned in paragraph 17, and in cities where sewers are used, thrown 
into the water-closet, elsewhere the same should be buried at once at least 
100 feet distant from any well, and should not by any means be thrown 
into a running stream, nor into a cesspool or privy, except after having 
been thoroughly disinfected. Discharges from the bladder and bowels may 
be received on old cloths, which should immediately be burned—or dis- 
infected and buried. All vessels should be kept scrupulously clean and 
disinfected. Discharges from the nose, ears, etc., may be received on soft 
rags or pieces of cloth, which should immediately be burned. 
19. If the attending physician shall think best for the patient, an effort 
to prevent the spreading of the contagious particles thrown off from the 
skin may be made by annointing the body with oil, vaseline, etc., as the 
physician may direct. 
20. All cups, glasses, spoons, etc., used in the sick-room, should at 
once on removal from the room be washed in the zinc-solution mentioned 
in paragraph 17, and afterwards in hot water, before being used by any 
other person. 
21. Food and drink that have been in the sick-room, or otherwise 
infected with scarlet fever, should be destroyed or buried. It should not 
be put in the swill-barrel. 
22. Perfect cleanliness of nurses and attendants should be enjoined 
and secured. As the hands of nurses of necessity become frequently con- 
taminated by the poison of the disease, a good supply of towels and basins, 
—one containing a solution of chlorinated soda (Labarraque’s solution), 
chlorinated lime, or the disinfecting zinc-solution, and another for plain 
soap and water,—should always be at hand and freely used. 
23. Persons recovering from scarlet fever should be considered 
dangerous, and therefore should not attend school, church, or any 
public assembly, or use any public conveyance, so long as any scaling 
■or peeling of the skin (see paragraph 4), soreness of the eyes or air-pas- 
sages, or symptoms of dropsy remain. A person recovering from scarlet 
fever should not thus endanger the public health nor appear in public 
until after having taken four times, at interyals of two days, a thorough 
bath. The hair should be thoroughly washed. This cleansing, however, 
fshould be deferred until the physician in charge considers it prudent. 
After recovery from scarlet fever, no person should appear in public 
wearing the same clothing worn while sick with or recovering from this 
disease, except such clothing as has been thoroughly disinfected, and this 
without regard to the time which has elapsed since recovery. Nor should 
a person from premises in which there is or has been a case of scarlet 
fever attend any school, Sunday-school, church, or public assembly, or be 
permitted by the health authorities or by the school board to do so, until 
after disinfection of such premises and of the clothing worn by such per- 
son if it shall have been exposed to the contagion of the disease. 
24. The body of a person who has died of scarlet fever should be 
wrapped in a cloth wet with a zinc-solution of double the strength stated 
in paragraph 17; and, with as little delay as possible, be privately buried. 
25. In order to prevent attendance at the funeral or visits to the house, 
newspaper notices of such deaths should state that the deceased person 
died of scarlet fever. 
26. Burial of the dead from scarlet fever should be private, and the 
ibody should not be exposed to view. DANGER FROM CONVALESCENTS, CLOTHING, BOOKS, ETC. 
5 
27. Clothing, carpets, curtains, furniture, and other substances 
that are to be destroyed should be dealt with in a way to avoid conveying 
the poison to any person in the process; they should not be simply thrown 
away, or into some stream or body of water; and if burned should be com- 
pletely burned and not partly burned and partly warmed or dealt with in 
a way to spread the poison of the disease. The glowing furnace under a 
large engine-boiler, or a quick, strong fire in the open air, far from dwell- 
ings, is a good place for the burning. 
28. All infected substances which are not destroyed, should be 
either thoroughly boiled, subjected to a dry heat of 250° F. in a disinfect- 
ing oven, or be thoroughly exposed to formaldehyde gas, or to fumes of 
burning sulphur, and afterwards exposed to open air currents for some 
hours, or days if practicable. Books and furs that have been used or 
handled by those convalescing from this disease are particularly liable 
to convey the poison to children who have never had the disease. Great 
care should be used to thoroughly disinfect any such articles that are not 
destroyed; and caution should be exercised before allowing children who 
have not had scarlet fever to handle any such articles that have been 
used by persons liable to communicate the disease. 
DESTRUCTION OR DISPOSAL OF CLOTHING, BOOKS, FURS, ETC. 
DISINFECTION OF BOOMS, CLOTHING, ETC. 
29. Aerial disinfection can be completely and entirely effectual only 
in the absence of living persons, as heat or fumes strong enough for the 
purpose are destructive of human life. This need not deter from doing so 
much as is possible, without injury to sick persons, for the purification 
of the air of rooms occupied by them, -a liberal supply of pure air should 
be secured; but after the death or recovery from scarlet fever, the room in 
which there has been a case of this disease, the furniture, and other con- 
tents not to be destroyed, should be thoroughly exposed for several hours 
to formaldehyde gas, or to fumes of burning sulphur, and then, if possible, 
it should for several hours or days be exposed to currents of fresh air. 
Because of the law of diffusion of gases, and the numerous crevices 
through which sulphur fumes may pass, the fumes do not remain in 
a room sufficiently strong long enough, unless the combustion of 
sulphur is somewhat rapid. It should be rapid, and continue a con- 
siderable time. The best results are obtained by using roll brim- 
stone broken up, or flowers of sulphur, burning the sulphur in shallow 
pans of sufficient number and size to rapidly fill the room with the fumes, 
and having quantities sufficient to last for several hours. Experience 
of the health officers in Michigan, seems to have demonstrated that, 
in the ordinary homes of the people, in the manner above mentioned, and 
without the presence of the vapor of water, the specific cause of scarlet 
fever is rendered incapable of causing scarlet fever. This is a very im- 
portant fact, because it enables us to disinfect rooms without the des- 
truction of much property which would be entirely ruined if the vapor of 
water were present. 
Experiments by a member of this State Board, with germs of other 
diseases than scarlet fever, indicate that formaldehyde gas is even 
more reliable than sulphurous fumes as a disinfectant. By means of a 
still, devised by him, the solution of formaldehyde may be distilled 
hrough the keyhole, using eight ounces of the solution to each thousand 6 
DISINFECTION OF ROOMS, CARPETS, AND BEDDING. 
cubic feet of space in the room to be disinfected. “ Teachers’ Sani- 
tary Bulletin ” No. 9, December, 1898, issued by this State Board of 
Health, contains details of formaldehyde disinfection. 
30. When a room and contents are to be disinfected, all articles 
therein should be spread out so as to expose the greatest amount of 
surface to the action of the disinfectant, and all openings to the rooms 
should be closed. 
a. Because of the innumerable ways in which the contagium may be 
scattered about the house and premises where there has been for some 
little time a case of scarlet fever, the entire house and out-buildings, 
including cellar, garret, wood-shed, and privy, will usually need to be dis- 
infected, and always should be aired by opening them to the air for 
several days as thoroughly as possible. 
b. Booms to be disinfected must be vacated. Heavy clothing, blankets, 
bedding, and other articles that cannot be treated with the zinc-solution, 
should be spread out so as to be thoroughly exposed during fumigation, 
which should take place in the room where the clothing, etc., have been 
used in connection with the patient. For a room about ten feet square, 
at least three pounds of sulphur should be used; for larger rooms, pro- 
portionately increased quantities, at the rate of three pounds for each 1,000 
cubic feet of air space. 
c. Close all openings into the room as tight as possible, place the sul- 
phur in an iron pot or pan supported upon bricks, set it on fire by hot 
coals or with the aid of a spoonful of alcohol lighted by a match, be care- 
ful not to breathe the fumes of the burning sulphur, and when certain the 
sulphur is burning well, leave the room, close the door, and allow-the room 
to be closed for twenty-four hours. 
d. Care should be taken to secure the complete burning of as much of 
the sulphur as possible. To avoid danger of fire, the iron pot or pan in 
which the sulphur is to be burned should be free from leaks, and should 
be placed over water in a tub or pan. 
e. Body and bed clothing, etc.—It is best to burn all articles of small 
value which have been in contact with persons sick with scarlet fever. 
Articles too valuable to be destroyed should be exposed in a disinfecting- 
oven for one hour to a moist heat of 212° F. or a dry heat of from 240° F. 
to 250° F., or be treated as follows: (See also paragraphs 27 and 28). 
/. Cotton, linen, flannels, blankets, etc., should be treated with the boil- 
ing-hot zinc-solution, introducing them piece by piece, securing thorough 
wetting and boiling for at least half an hour. Heavy woolen clothing, 
silks, furs, stuffed bed covers, beds, and other articles which cannot be 
treated with the zinc-solution, should be hung in the room during fumiga- 
tion, pockets being turned inside out and the whole garment being thor- 
oughly exposed. Afterward they should be hung in the open air, beaten 
and shaken. Carpets are best fumigated on the floor, but should afterward 
be removed to the open air and thoroughly beaten. Pillows, beds, stuffed 
mattresses, upholstered furniture, etc., after being disinfected on the out- 
side, may be cut open and their contents again exposed to fumes of burn- 
ing sulphur. In no case should the thorough disinfection of clothing, 
bedding, etc., be omitted. Infected clothing and bedding have been known 
to communicate scarlet fever months after their infection. 
31. Fresh air.— Although not so active for the destruction of the con- 
tagium as is sulphurous acid gas, pure air, in liberal amount, is very useful 
for the dilution of the poison of the disease; it should be employed freely; AVOIDANCE AND PREVENTION OF SCARLET FEVER. 
7 
but with this as with other procedures for the safety of the unaffected, 
great care should be taken not to increase the danger to those already sick, 
who are usually endangered by exposure to drafts of cold air, and this is 
especially true of persons convalescing from scarlet fever. 
TEMPORARY SHELTER DURING DISINFECTION. 
32. Disinfection of a room always necessitates vacating it, and some- 
times makes it impossible to remain in adjoining rooms, therefore, in some 
cases it seems essential to have hospital, tent, or other temporary shelter 
for the inmates of infected houses, where bathing, disinfection and wash- 
ing can be done while such houses are being disinfected and put in order. 
On this subject local boards of health should be consulted, and should be 
prepared to act, in accordance with § 1671, Howell’s Statutes. 
HOW TO AVOID AND PREVENT SCARLET FEVER. 
33. Avoid the special contagium of the disease. This is especially 
important to be observed by children and all whose throats are sore from 
any cause. Children under ten years of age are in much greater danger 
of death from scarlet fever than are adults; but adult persons often get 
and spread the disease, and sometimes die from it. Mild cases in adults 
may thus cause fatal cases among children. Because of these facts it is 
frequently dangerous for children to go where adult persons go with 
almost perfect safety to themselves. 
34. Do not let a child go near a case of scarlet fever. Do not permit 
any person or animal to come, or anything to be brought, directly from a 
case of scarlet fever to a child. Unless your services are needed, keep 
away from the disease yourself. If you do visit a case, bathe yourself and 
change and disinfect your clothing before you go where there is a child. 
35. It is probable that the contagium of scarlet fever may retain its 
virulence for some time, and be carried a long distance in various sub- 
stances and articles in which it may have found lodgement. Do not 
permit a child to enter a privy or water-closet, or breathe the air from a 
privy, water-closet, cesspool, or sewer, into which non-disinfected dis- 
charges from persons sick with scarlet fever have entered, nor to drink 
water or milk which has been exposed to such air. 
36. Do not permit a child to ride in a hack or other closed carriage 
in which has been a person sick with scarlet fever, except the carriage has 
since been thoroughly disinfected with fumes of burning sulphur, as 
specified in paragraphs 29 and 30. 
37. Among the conditions external to the body liable to spread scarlet 
fever, perhaps the most common is the inhalation of the contagium given 
off from an infected substance or person; but all influences which cause 
sore throats probahly tend tD promote the taking and spreading of this 
disease. Because of this and as a means of lessening the danger of con- 
tracting other diseases, the following precautions should always be taken, 
but more particularly during the prevalence of any such diseases as scarlet 
fever:— 
38. Avoid exposure to wind and to breathing cold, dry air; also the 
use of strong vinegar or any other substance which tends to make the 
throat raw or tender. 
39. Do not wear or handle clothing worn by persons during their 
sickness or convalescence from scarlet fever. 
40. Beware of any person who has a sore throat. Do not kiss such a 
person, nor take the breath of such a person. Do not drink from the same 
cup, nor use any article that has been used by a person sick with this disease. 8 
RESTRICTION AND PREVENTION OP SCARLET FEVER. 
41. Beware of crowded assemblies in unventilated rooms. 
42. Do not permit a child to drink water or take food which comes, 
from a source that renders it liable to contain something derived from 
a person sick with scarlet fever. 
43. Act 15, laws of 1891, provides a penalty of “a fine of not less than 
twenty-five dollars, nor more than one hundred dollars, or by imprison- 
ment in the county jail not less than twenty days, nor more than ninety 
days,” for any person who shall knowingly or willfully subject, or be 
instrumental in subjecting, another person to the danger of contracting 
small-pox, diphtheria or scarlet fever. 
44. An Act approved March 29, 1895, makes it a misdemeanor, punish- 
able by fine or imprisonment, for any person sick with scarlet fever or any 
other dangerous communicable disease, any corpse dead of such disease, 
or any article liable to convey any such disease, to come or be brought into 
any township, city, or village in Michigan, without the special permit of the 
board of health, or of the health officer of said township, city, or village 
and then only under the supervision of said health officer. 
The following is a proposed form:— 
HEALTH OFFICER’S CERTIFICATE OF FREEDOM FROM LIABILITY TO COM- 
MUNICATE SCARLET FEVER. 
I hereby certify that has entirely recovered from scarlet 
(Name.) 
fever, the date of recovery being , 189 ; that disinfection of the 
premises, where the disease has been, occurred ... , 189...; that the 
period of desquamation ceased , 189 ; and that, after the peel- 
ing and scaling of the skin had ceased, the patient’s clothing has been disinfected, 
namely, on , 189...;. and that .-he is now free from liability to 
communicate scarlet fever, and is at liberty to attend school, church and public 
assemblies. 
Health officer of the of 
(Township, city or village.) 
, Mich., , 189... 
With a view of lessening the number of oases and deaths from scarlet fever in Michigan, the f ore- 
going is published by the State Board oi' Health for free distribution throughout the State, 
especially to officers and members of local bo-irds of health. Physicians being to some extent the 
custodians and conservators of the public health, copies of this document are also sent to physicians 
in Michigan, in the hope that they will aid in diffusing amorg the people such knowledge of the 
nature of scarlet fever as will enable the people better to cooperate with them and with Boards of 
Health for the restriction of the disease and a decrease of sickness and deaths therefrom. 
It cannot be expected that the distribution by the State Board will readh all of the more than two 
millions of people in Michigan, therefore the State Board of Health recommends that local boards 
of health procure and distribute copies of this document within their health districts when scarlet 
fever is near, especially to all neighbors of h ousts placarded for scarlet fever. 
Any communication upon the subject may be addressed to: Office of State Board of Health, 
Lansing, Michigan, from which, on application, any person may obtain a copy of this document, 
or of a similar document on the Restriction and Prevention of Diphtheria. 
In order that this document may do the greatest possible good, it is hoped that each one who 
receives it will not only make such use of it as will tend to disseminate most widely the suggestions 
and statements of fact contained therein, but will also act for the restriction or prevention of this dis- 
ease in accordance with its suggestions, or by other effective measures. 
After reading this document with sufficient care to remember 
the principles involved, please preserve it for future reference.