DWIGHT H. GREEN, Governor STATE OF ILLINOIS RULES AND REGULATIONS for the CONTROL OF COMMUNICABLE DISEASES Revised and in Force Through Illinois SEPTEMBER 1. 1945 Issued by THE DEPARTMENT OF PUBLIC HEALTH ROLAND R. CROSS, M.D., Director Compiled by the Division of Communicable Diseases (Printed by Authority of the State of Illinois) STATE OF ILLINOIS DWIGHT H. GREEN, Governor RULES AND REGULATIONS for the CONTROL OF COMMUNICABLE DISEASES Revised and in Force Throughout Illinois SEPTEMBER 1, 1945 Issued by THE DEPARTMENT OF PUBLIC HEALTH ROLAND R. CROSS, M.D., Director Compiled by the Division of Communicable Diseases JEROME J. SI EVERS, M.D., M.S.P.H., Chief (Printed by Authority of the State of Illinois) AN ACT IN RELATION TO PUBLIC HEALTH (Par. 22-24, Chapter IIIV2, Illinois Revised Statutes 1943.) Par. 22. Power of Department.] Sec. 2. The State Depart- ment of Public Health has general supervision of the interests of the health and lives of the people of the State. It has supreme authority in matters of quarantine, and may declare and enforce quarantine when none exists, and may modify or relax quarantine when it has been established. The Department may make such rules and regulations and such sanitary investigations as it may from time to time deem necessary for the preservation and im- provement of t"he public health, and may regulate the transporta- tion of the remains of deceased persons. All local boards of health, health authorities and officers, police officers, sheriffs, constables and all other officers and employees of the state or any county, village, city or township thereof, shall enforce the rules and regulations so adopted. The Department of Public Health shall investigate the causes of dangerously contagious or infectious diseases, especially when existing in epidemic form, and take means to restrict and sup- press the same, and whenever such disease becomes, or threatens to become epidemic, in any village or city, and the local board of health or local authorities neglect or refuse to enforce efficient measures for its restriction or suppression or to act with sufficient promptness or efficiency, or whenever the local board of health or local authorities neglect or refuse to promptly enforce efficient measures for the restriction or suppression of dangerously con- tagious or infectious diseases, the Department of Public Health may enforce such measures as it deems necessary to protect the public health, and all necessary expenses so incurred shall be paid by the city or village for which services are rendered. Par. 24. Penalties—How Disposed Of.] Sec. 7. Whoever violates or refuses to obey any rule or regulation of the Depart- ment of Public Health shall be liable to a fine not to exceed $200 for each offense or imprisonment in the county jail not exceeding six months, or both, in the discretion of the court. All prosecu- tions and proceedings instituted by the Department of Public Health for violation of its rules and regulations shall be insti- tuted by the Director thereof, and each State’s Attorney shall prosecute all persons in his county violating or refusing to obey the rules and regulations of the Department of Public Health. All fines or judgments collected or received shall be paid to the State Treasurer. RULES AND REGULATIONS FOR THE CONTROL OF COMMUNICABLE DISEASES In accordance with authority vested by law in the State Department of Public Health, I, Roland R. Cross, Director of the Department of Public Health, do hereby promulgate these rules and regulations for the control of communicable diseases, and all previous rules and regulations in conflict with the following rules and regulations are hereby annulled. These rules shall be in force and effect on and after September 1, 1945. OFFICIAL NOTICE In Witness Whereof I have hereunto set my hand and caused the Seal of the De- partment of Public Health to be affixed. Done at the City of Springfield, this First Day of September in the Year of our Lord, Nineteen Hundred and Forty-five. Director of Public Health. TABLE OF CONTENTS I p RULES AND REGULATIONS FOR THE CONTROL OF COMMUNICABLE DISEASES. Chapter I—Reportable Diseases 7 Chapter II—Definition of Terms 8-10 Chapter III—Reporting 11 Chapter IV—General Procedure for the Control of Communicable Diseases 12-17 A. Isolation 12 B. Quarantine 12 C. Removal of Persons under Isolation or Quarantine 12-13 D. Closure of Premises 13 E. Placarding 13-14 F. Disinfection 14-15 G. Control of Milk, Milk Products, and Other Food Stuffs 15-16 H. Schools 16 I. Release Specimens 16-17 J. Hospitalization 17 Chapter V—Detailed Procedure for the Control of Communicable Diseases 18-53 Chapter YI—Conduct of Funerals when Death Occurs from Communicable Diseases 54 RULES AND REGULATIONS FOR THE CONTROL OF VENEREAL DISEASES 55-79 RULES AND REGULATIONS FOR THE TRANSPORTA- TION OF THE DEAD 81-84 CHAPTER I REPORTABLE DISEASES For the purpose of these rules and regulations the following named diseases and disease carriers are declared to be contagious, infectious, communicable, and dangerous to the public health and shall be reportable in accordance with the provisions of these regulations. 1. Actinomycosis. 2. Amebiasis. 3. Ankylostomiasis (hookworm disease). 4. Anthrax. 5. Chancroid. 6. Chickenpox. 7. Cholera. 8. Conjunctivitis of the newborn, acute infectious (ophthalmia neonatorum). 9. Conjunctivitis, acute infectious (over one month of age). 10. Dengue. 11. Diarrhea of the newborn, epidemic. 12. Diphtheria. 13. Dog and other animal bites. 14. Dysentery, bacillary (shigellosis). 15. Encephalitis, acute— a. Infectious. b. Post-infectious. 16. Erysipelas. 17. Food infections. a. Salmonellosis. b. Other. 18. Food poisonings (bacterial intoxi- cations). a. Staphylococcus. b. Botulinus. c. Other. 19. German Measles (rubella). 20. Glanders. 21. Gonorrhea. 22. Granuloma inguinale. 23. Hemorrhagic jaundice (ictero- hemorrhagic spirochetosis; Weil’s disease). 24. Infectious hepatitis (acute catarrh- al jaundice). 25. Impetigo contagiosa (in institu- tions). 26. Influenza. 27. Kerato-conjunctivitis, infectious (superficial punctate keratitis; nummular keratitis). 28. Leprosy. 29. Lymphogranuloma venereum (lym- phogranuloma inguinale; lym- phopathia venereum). 30. Malaria. 31. Measles. 32. Meningococcal meningitis and men- ingococcemia. 33. Meningitis, other. 34. Mumps. 35. Paratyphoid fever. 36. Plague. 37. Pneumonia— a. Pneumococcal. b. Primary bacterial other than pneumococcal. c. Primary atypical or “virus”. 38. Poliomyelitis, acute anterior. 39. Psittacosis and ornithosis. 40. Rabies (hydrophobia). 41. Rheumatic fever, acute. 42. Ringworm of the scalp. 43. Rocky Mt. spotted fever. 44. Scarlet fever and other hemolytic streptococcal infections of the upper respiratory tract. 45. Smallpox. 46. Syphilis. 47. Tetanus. 48. Toxoplasmosis. 49. Trachoma. 50. Trichinosis. 51. Tuberculosis, pulmonary. 52. Tuberculosis, other than pulmonary. 53. Tularemia. 54. Typhoid fever. 55. Typhus fever. 56. Undulant fever (Brucellosis). 57. Vincent’s infections (including Vin- cent’s angina and ulcerative stomatitis). 58. Whooping cough (pertussis). 59. Yellow fever. 7 CHAPTER II DEFINITION OF TERMS For the purpose of these rules and regulations the following shall be the accepted definitions of the terms used herein. 1. ADULT—a person who is 16 years of age or over. 2. AUTHENTIC RELEASE SPECIMEN—a specimen is one collected in such a manner and under such conditions as are approved by the Illinois Department of Public Health. See each disease for details. 3. CARRIER—a person who, without symptoms of a communi- cable disease, harbors and disseminates the specific micro- organisms. a. Incubationary carrier—a person without clinical mani- festations of a disease who is found to be harboring an infectious agent and who later comes down with the disease within the incubation period. b. Convalescent carrier—a person who has recently re- covered from the clinical manifestations of a disease and who is found to be harboring the infectious agent. c. Contact carrier—a person who passively carries infec- tious organisms as a result of contact, direct or in- direct, with a case or carrier. d. Chronic carrier—a person who harbors within himself a focus of reproducing infectious organisms, and dis- seminates them either continuously or intermittently, and who is not ill with the disease. Chronicity is de- fined for each disease in which it is significant. 4. CASE—the single instance of a patient suffering from a given disease. a. Typical case—one which shows the usual signs and symptoms and follows the usual course of the disease in question. b. Atypical case—one in which not all of the usual signs and symptoms of the disease in question are present. c. Missed case—one which had previously escaped recog- nition. 5. CHILD—a person under 16 years of age. If he is 16 years or over and attends school, he shall be considered a school child until after he has completed the twelfth grade. 6. CLEANING—the removal, by scrubbing and washing, as with hot water and washing soda, of organic material on which and in which bacteria may find favorable conditions for prolonging life and virulence; also the removal by the same means of bacteria adherent to surfaces. 8 Definition of Teems 9 7. CONTACT—any person known to have been sufficiently as- sociated with an infected person as to have been presum- ably exposed to infection. 8. DELOUSING—the process by which a person and his per- sonal apparel are treated so that neither the adults nor the eggs of Pediculus humanus survive. 9. DISINFECTION—the destruction of the vitality of patho- genic micro-organisms by chemical or physical means di- rectly applied. a. Concurrent disinfection—the application of disinfection immediately after the discharge of infectious material from the body of an infected person, or after the soiling of articles with such infectious discharges, all personal contacts with such discharges or articles being prevented prior to their disinfection. b. Terminal disinfection—the process of rendering the personal clothing and immediate physical environ- ment of the patient free from the possibility of con- veying the infection to others at a time when the patient is no longer a source of infection. • 10. DISINFESTING—any physical or chemical process by which insects (including ticks and mites) or rodents known to be capable of conveying or transmitting infection and living on the body or in and around human habitation may be destroyed upon the person or his clothing or in his en- vironment. 11. FOOD HANDLER—a person who produces, prepares, pack- ages or sells food which is not contained in a tightly closed container, and which is commonly or usually eaten without further cooking equivalent to boiling, or from which the outside peeling or covering is not usually or commonly re- moved. All persons handling milk, cream, cheese and similar dairy products or whose occupation is that of cook, waiter, or helper in a kitchen or dining room, shall be con- sidered to be a food handler. 12. FUMIGATION—any process by which the destruction of in- sects, as mosquitoes, fleas, bed bugs and body lice, and animals, as rats, is accomplished by the employment of gaseous agents. 13. ISOLATION—the separation of a person suffering from a communicable disease, a carrier of the infecting organism, or a person suspected of having such a disease or of being a carrier, from other persons in such places and under such conditions as will prevent the direct or indirect transmis- sion of the infectious agent. 14. LOCAL HEALTH AUTHORITY—the health authority hav- ing jurisdiction over a particular area, including city, vil- lage, township and county boards of health and health departments and the responsible executive officers of such boards, or any person legally authorized to act for such health authority. 10 Definition of Teems 15. NON-IMMUNE—see “susceptible” below. 16. PATIENT—a person suffering from an attack of a communi- cable disease. 17. PREMISES a. A home or building occupied by one family. b. In an apartment building containing two or more apart- ments—only the immediate apartment in which the case and contacts live. c. In a hotel—the room or suite of rooms occupied by the case, attendant and family contacts. d. In an institution—the entire institution or that physical portion designated as “premises” by the Director of the Illinois Department of Public Health or his au- thorized representative. 18. QUARANTINE—the limitation of freedom of movement of any person who has been exposed to a communicable disease. 19. SUSCEPTIBLE (non-immune)—a person who is not known to have become immune to the particular communi- cable disease in question by natural or artificial pro- cesses. 20. SUSPECT—a person whose medical history or symptoms sug- gest that he may now have or be developing a commu- nicable disease. CHAPTER III REPORTING 1. It shall be the duty of every physician, dentist, other prac- titioner, hospital, attendant, nurse, laboratory, parent, householder, school authority, or any other person having knowledge of a known or suspected case or carrier of com- municable disease or communicable disease death*, to re- port promptly such case, suspected case, carrier or death in writing or by telephone to the local health authority in whose jurisdiction the patient resides. If the identity of the local health authority is not known to the person reporting, the report is to be made to the mayor of the city, the village president, the township super- visor, or a county commissioner. 2. Upon receipt of such report the local health authority shall within 24 hours forward a written'copy of the same to the Illinois Department of Public Health. In cities having a full-time health department the Director of the Illinois De- partment of Public Health may agree in writing to accept daily tabulated reports and monthly and annual statistical reports from such city; however, all epidemiological data requested by the Illinois Department of Public Health shall be furnished. 3. The written report to the Illinois Department of Public Health shall be made on the franked card* furnished for this purpose and shall include the following information: a. Place and date of report. b. Name, exact address, age, sex, color, marital status and occupation of the patient. c. Number of children and adults in the household. d. School attended or place of employment. e. Probable source of infection or origin of the disease. f. Date of onset of illness. If eruptive disease, date of eruption. g. If the disease is smallpox or adult chickenpox, give the type of disease and number of times successfully vaccinated and approximate dates. h. Whether patient or any member of the household is engaged in the production of milk. i i. Name and address of the person making the report. j. Where the patient is confined. * Except venereal diseases for which see special rules. 11 CHAPTER IV GENERAL PROCEDURE FOR THE CONTROL OF COMMUNICABLE DISEASES A. ISOLATION 1. Establishment. Upon being informed of the existence of a case, carrier or suspected case or carrier of a commu- nicable disease, the local health authority having juris- diction over the area in which the patient resides shall immediately establish isolation of the patient when such isolation is required for the specific disease by these rules and regulations. 2. Duration. Isolation shall be maintained for the minimum period of time required for the specific disease by these rules and regulations. 3. Termination. Isolation may be terminated only by the local health authority having jurisdiction over the area in which the patient resides. B. QUARANTINE 1. Establishment. Quarantine of contacts to a case, carrier or suspected case or carrier of a communicable disease shall immediately be established by the local health au- thority having jurisdiction over the area in which the contacts reside when such quarantine is required for the specific disease by these rules and regulations. 2. Duration. Quarantine of contacts shall be maintained for the minimum period of time required for the specific disease by these rules and regulations. 3. Termination. Quarantine may be terminated only by the local health authority having jurisdiction over the area in which the contact resides. C. REMOVAL OF PERSONS UNDER ISOLATION OR QUARANTINE 1. Removal within the same health jurisdiction may be made only with the permission of the local health authority. However, when a case is discovered in a school or other public building the patient may be sent immediately to his home or hospital. 2. Removal from one health jurisdiction to another within Illinois may be made only with the permission of the local health authority of the areas from which and to which removal is desired. Notification of such removal, giving the name and address of the patient before and after removal, shall be sent immediately to the Illinois Department of Public Health. 3. Inter-state removal may be made only with the permission of the Illinois Department of Public Health and the 12 General Procedure for Control 13 health authority of the state from which or to which removal is desired. 4. Removal of a person under isolation or quarantine shall be made by private conveyance or as otherwise ordered by local or state health authorities, due care being taken to prevent the spread of the disease. 5. The removed person shall be isolated or quarantined im- mediately upon arrival at point of destination for the period of time required for the specific disease by these rules and regulations. D. CLOSURE OF PREMISES 1. Whenever a case, carrier or suspected case or carrier of a communicable disease resides on premises connected with any store or place of business, such store or place of business shall be closed, unless isolation of the pa- tient and quarantine of the contacts can be established in a manner satisfactory to the Illinois Department of Public Health or its duly authorized representatives. 2. Whenever required by these rules and regulations closure of premises shall be enforced by the local health au- thority having jurisdiction over the area where such premises are located. E. PLACARDING 1. Whenever these rules and regulations require that a case, carrier or suspected case or carrier of a communicable disease be placarded, the health authority having juris- diction over the area in which said case, carrier or sus- pected case or carrier is isolated shall post a placard in a conspicuous place at each outside entrance of the premises wherein the patient is isolated; However, if the patient is isolated in a general hospital in the man- ner prescribed by these rules and regulations, the pla- card need only be posted at the door of the particular room or ward wherein the patient is isolated and need not bear the name of the disease. 2. Whenever these rules and regulations require that con- tacts to a case, carrier or suspected case or carrier of a communicable disease be quarantined, the premises wherein the contacts reside for the duration of the quarantine period shall be placarded by the local health authority having jurisdiction over the area where the contact is under quarantine. 3. Whenever the premises wherein a case, carrier or sus- pected case or carrier of a communicable disease is un- der isolation are placarded, the placard shall be not less than six by ten inches in size, and shall have printed thereon in black with bold-face type not less than iy2" in height, the name of the disease and the words, “KEEP OUT”, in similar type not less than 1" in height. At the bottom of the card shall appear these words in small type: “All persons who violate these rules sub- ject themselves to a fine of not to exceed $200.00 for 14 General Procedure for Control each offense, or imprisonment in the county jail not to exceed six months, or both.” 4. Whenever the premises wherein contacts are under quar- antine are placarded, the placard shall be as described above except the name of the disease need not be stated. *5. Placards shall not be concealed from public view, shall not be mutilated or defaced, and shall remain posted until the requirements of these rules and regulations relative to the duration of the period of isolation or quarantine for the specific disease have been fulfilled. 6. Placards may be removed only by the health authority having jurisdiction over the area where the case, carrier or contact is isolated or quarantined. F. DISINFECTION 1. Concurrent disinfection. Whenever required by these rules and regulations, concurrent disinfection shall be carried out as follows; a. Normal and abnormal discharges from the eyes, ears, nose, throat, skin lesions and glands shall be disin- fected by being collected in pieces of cloth, cotton, or paper and burned at once. b. In handling body discharges and other infected ma- terials the attendant shall avoid touching or allow- ing any object, which is not to be immediately dis- infected, to touch the infected surfaces. c. The water after being used to bathe the patient shall be boiled or disinfected by adding a sufficient quan- tity of carbolic acid or cresol solution or other equally effective disinfectant. However, if the bath water is disposed of in a drain connected with a sanitary sewer, such water need not be disinfected. d. Bedclothes, pillow slips, sheets, nightgowns, towels, washcloths or any other cloth or clothing of similar kind shall be disinfected by being boiled with soap and water for at least fifteen minutes. e. Dishes, glassware, knives, forks, spoons or any other utensils used in feeding the patient shall be washed and boiled and shall not be used by any other mem- ber of the family but shall be set aside for the use of the patient only. f. Food from the sick room shall not be used by anyone except the patient and shall be collected and burned at once. g. Thermometers, rectal tubes, douche nozzles, etc., shall be washed with soap and water after each use and when not in use shall be kept immersed in 70% alcohol or some other equally effective disinfectant. h. Bowel and bladder discharges shall be disinfected by adding carbolic acid or cresol or other equally effec- tive disinfectant and stirring the mixture until all parts have been thoroughly mixed with the disin- General Procedure for Control 15 fecting agent. This mixture shall be allowed to stand, protected from flies, for thirty minutes before being discharged into a sewer or privy vault. Solid stool shall have one pint of water added and then treated as previously described in this paragraph. i. Bed pans and urinals shall be thoroughly cleaned after each use and left containing a small amount of dry chloride of lime. These receptacles shall also be screened from flies. j. All persons on leaving the room shall scrub their hands thoroughly with soap and water. k. Washable gowns shall be worn by the attendants and shall be removed just prior to leaving the room. 2. Terminal disinfection. Whenever terminal disinfection is required by these rules and regulations, the following procedure shall be carried out at the termination of the period of isolation; a. Bedsteads, chairs, tables, floors, doors, woodwork, windows, etc., shall be scrubbed with soap and hot water. b. All bedclothes, sheets, towels and other washable articles shall be thoroughly boiled. c. Clothing, which cannot be boiled, and mattresses and pillows shall be placed out of doors in the sunlight and air for at least twenty-four hours. d. Milk bottles or food containers shall be boiled for fifteen minutes before they are returned to the dairy- man or grocer. e. Very badly soiled library and school books shall be destroyed. Others may be cleaned and sunned for one day and shall not be used or handled for a pe- riod of one week, after which time they may be re- turned to use. f. Sick room and contents shall be thoroughly sunned and aired for at least one day. G. CONTROL OF MILK, MILK PRODUCTS AND OTHER FOOD STUFFS 1. Whenever a case, carrier or suspected case or carrier of Amebiasis Poliomyelitis Diphtheria Scarlet fever or other Dysentery, bacillary hemolytic streptococcal (shigellosis) infections of the upper Food infection respiratory tract (salmonellosis) Smallpox Meningitis, meningococcal Tuberculosis Paratyphoid fever Typhoid fever exists in the home of a distributor or on any farm or dairy producing milk, cream, butter, cheese or other foods likely to be consumed raw, no such foods shall be sold, exchanged, removed or distributed from such 16 General Procedure for Control home, farm or dairy during the period of isolation or quarantine except under the following conditions: a. A neighbor or tenant farmer, who has not been in contact with the patient and who continues to re- side off the premises, or a home contact who has been released from quarantine in accordance with these rules and regulations for the specific disease, may take care of the milk or food production pro- vided he observes the following restrictions: 1. All milk and cream produced on the farm shall be sent to a pasteurizing plant—otherwise it cannot be shipped. 2. The herd, the workers, the food produced, the utensils, etc., must have no contact, direct or indirect, with the patient, the premises, those residing on the premises, or articles or uten- sils on the premises. 3. A food handler’s permit, furnished by the Illi- nois Department of Public Health shall be signed by the person or persons who will handle production during the illness. The permit shall be counter-signed by the health authority having jurisdiction, stating that he will make weekly inspections of the premises in question to see that regulations are ob- served. 4. Pasteurization shall be continued for one week following the termination of isolation or quarantine. 2. The patient, after recovery, shall not assist in any dairy or food production until he has been released from isolation. H. SCHOOLS 1. When a case of communicable disease occurs in a school, the school should not be closed except in the event of a great emergency and then only after the approval of the Illinois Department of Public Health or its duly authorized representative has been obtained. 2. Whenever a school is closed because of the presence of communicable disease in the school or in the commu- nity, the local health authority shall issue a supple- mentary order requiring all children attending the school to remain upon their own premises. 3. Children infected with a communicable disease shall not be permitted to attend school, unless specifically ex- cepted by the rules and regulations for the specific disease. 4. School children suspected of being infected with an in- fectious disease shall be refused admittance to school. I. RELEASE SPECIMENS 1. Whenever these rules and regulations require the sub- mission of laboratory specimens for release from isola- General Procedure for Control 17 tion or quarantine, such specimens will not be accepted unless they have been examined in a laboratory of the Illinois Department of Public Health or in another offi- cial health department laboratory approved by said Department for the specific tests required. J. HOSPITALIZATION 1. If proper isolation of the patient cannot be accomplished in the home, hospitalization in a contagious disease hospital or in a general or children’s hospital, as pro- vided in paragraph 2 below, may be required by the Illinois Department of Public Health or the local health authority. 2. Cases of communicable disease may be hospitalized in a general hospital or a children’s hospital provided that the patient is isolated in a private room or cubicle or in a ward where none but patients with the same disease are kept and further provided that strict isola- tion technique is observed. The requirements of these rules and regulations for the specific diseases relative to release from isolation must be fulfilled before the patient leaves the hospital. However, the removal of the patient may be permitted provided the requirements of Section C, pages 12 and 13 have been fulfilled. 3. Nurses and attendants caring for a communicable disease patient shall not come in contact with obstetrical or surgical patients until a period of time equal to the in- cubation period of the particular disease has elapsed since the last contact with the patient. CHAPTER V DETAILED PROCEDURE FOR THE CONTROL OF COMMUNICABLE DISEASES ACTINOMYCOSIS Control of Case; (1) Placarding of premises is not required. (2) Isolation is not required. (3) Concurrent disinfection is required. (4) Terminal disinfection is required. Control of Contacts: (1) No restrictions are required. General Measures: (1) Observance of hygiene of oral cavity. (Do not chew straws, grains or grasses.) (2) Inspection of meat, with condemnation of carcasses or in- fected parts of carcasses of infected animals. (3) Destruction of known animal sources of infection. (4) Advising attendants and others that nasal and bowel dis- charges and uncooked meats may be source of infection. AMEBIASIS Control of Case and Carrier: (1) Placarding of premises is not required. (2) Isolation is not required, but case or carrier must submit specimens of feces until three consecutive specimens taken not less than one week apart are negative for trophozoites or cysts of Endamoeba histolytica. Food handling by a case or carrier is prohibited until the above requirements have been fulfilled. All specimens must be examined by a laboratory of the Illinois Department of Public Health or in one approved by it for the diag- nosis of amebiasis. (3) Concurrent disinfection is required. (4) Terminal disinfection is required. Control of Contacts: (1) Household or intimate contacts shall submit at least two specimens of feces taken not less than four days apart, for examination in a laboratory of the Illinois Depart- ment of Public Health or in one approved by it for the diagnosis of amebiasis. Amrbiakis 19 Sale of Food, Milk, etc.; (1) See paragraph G, Chapter IV, pages 15, 16. General Measures: (1) Sanitary disposal of human feces. (2) Protection of potable water supplies against fecal contam- ination, and boiling drinking water where necessary. Chlorination of water supplies as generally used has been found inadequate for the destruction of cysts. (3) Supervision of the general cleanliness and the personal health and sanitary practices of persons preparing and serving food in public eating places, especially moist foods eaten raw. (4) Education in personal cleanliness, particularly washing hands with soap and water after evacuation of the bowels. (5) Control of fly breeding and protection of foods against fly contamination by screening. (6) Avoidance of cross-connections ketAveen public and private auxiliary water supplies and of back-flow connections in plumbing systems. (7) Adequate treatment of patients, and of subclinical cases when discovered, with a view to eradication of the para- site. Effective amebicides for this purpose are now available. (8) Instruction of convalescent and chronic carriers in per- sonal hygiene, particularly as to sanitary disposal of fecal waste, and hand washing after use of toilet. (9) In case of epidemics due to relatively massive doses of in- fectious material, active measures should be employed to discover the source of infection, and to advise the public and the medical profession of the early and characteristic symptoms, of the serious immediate and remote results of such infection, and of the good results of treatment if instituted early. Control of Case: (1) Placarding of premises is not required. (2) Isolation is not required. (3) Concurrent disinfection of bowel discharges is required. (4) Terminal disinfection is not required. Control of Contacts: (1) No restrictions are required. General Measures: (1) Education as to dangers of soil pollution and methods of prevention. (2) Prevention of soil pollution by installation of sanitary dis- posal systems for human discharges, especially sanitary ANKYLOSTOMIASIS (HOOKWORM DISEASE) 20 Ankylostomiasis (Hookworm Disease) privies in rural areas, and education of the public in the use of such facilities. (3) Personal prophylaxis by cleanliness and the wearing of shoes. ANTHRAX Control of Case: (1) Placarding of premises is required. (2) Isolation is required until lesions have healed. (3) Concurrent disinfection is required. (Spores can be killed only by special measures such as steam under pressure or boiling.) (4) Terminal disinfection is required. Control of Contacts: (1) No restrictions are required if patient is properly isolated. General Measures: (1) Animals ill with disease presumably anthrax should be isolated immediately in the care of a veterinarian. Ani- mals proved to have the disease should be killed and promptly destroyed, preferably by incineration. (2) Immunization of exposed animals. (3) Post-mortem examination of animals should be made only by a veterinarian or in the presence of one. (4) Milk from an infected animal should not be used. (5) Control and disinfection of effluents and trade wastes and of areas of land polluted by such effluents and wastes from factories or premises, where spore-infected hides or other infected hide and hair products' are known to have been worked up into manufactured articles. (6) Every shipment of raw hides, wool, hair, or bristles from sources which are not known to be free from anthrax in- fection should be examined by an expert bacteriologist. (7) A physician should be constantly employed by every com- pany handling raw hides. (8) Every employee handling raw hides, hair, or bristles who has an abrasion of the skin should immediately report to a physician. (9) Special instruction should be given to all employees hand- ing raw hides in regard to the necessity of personal cleanliness. (10) Tanneries and woolen mills should be provided with proper ventilating apparatus so that dust is promptly removed before reaching the respiratory tract of human beings. (11) Disinfection of hair, wool, and bristles from sources known to be or suspected to be infected, before they are used or sorted, should be obligatory. (12) The sale of hide from an animal infected with anthrax should be prohibited. OllAJJCKOlD 21 CHANCROID (See special rules for venereal diseases, pages 55-79.) CHICKENPOX Control of Case: (1) Placarding of premises is not required. (2) Isolation is required for not less than fourteen days and thereafter until all crusts have disappeared from the skin. (3) Concurrent disinfection is required. (4) Terminal disinfection is not required. Control of Contacts: (1) No restrictions are required. General Measures; (1) School authorities shall be notified regarding the case and instructed to observe all children carefully for three weeks after exposure for any sign of the disease and to exclude from school any children, with suggestive symp- toms and to notify the local health authority. Control of Case: (1) Placarding of premises is required. (2) Isolation in a screened room is required until three con- secutive specimens of feces and urine taken not less than twenty-four hours apart are negative for cholera vibrio. (3) Concurrent disinfection is required. (4) Terminal disinfection is required. Control of Contacts: (1) Quarantine of contacts is required for five days from last exposure or until two successive stool and urine cultures taken not less than twenty-four hours apart are negative for cholera vibrio. CHOLERA CONJUNCTIVITIS OF THE NEW BORN. ACUTE INFECTIOUS (OPHTHALMIA NEONATORUM) (Includes gonorrheal and pneumococcal ophthalmia.) Control of Case: (1) Placarding of premises is not required. (2) Isolation is required until clinical recovery. (3) Concurrent disinfection is required. (4) Terminal disinfection is required. Control of Contacts: fl) No restrictions are required. 22 Conjunctivitis op the New Born General Measures: (1) The following is an extract of “An Act for the Prevention of Blindness from Ophthalmia Neonatorum: defining ophthalmia neonatorum; designating certain powers and duties and otherwise providing for the enforce- ment of this Act,” approved June 24, 1915, (Sections 3 and 8 amended April 20, 1933.): “It is the duty of all maternity homes and any and all hospitals or places, where women resort for purposes of childbirth, to post and keep posted in conspicuous places in their institution, copies of this Act and to instruct persons professionally employed in such homes, hospitals and places regarding their duties under this Act, and to maintain such records of cases of ophthalmia neonatorum in the man- ner and form prescribed by the Department of Public Health. “It shall be the duty of any physician, midwife or nurse who attends or assists at the birth of a child, to instill or have instilled in each eye of the new' born baby, as soon as possible and not later than one hour after birth, a one per cent (1%) solution of silver nitrate or some other equally effective prophylactic for the prevention of ophthalmia neonatorum approved by the State Department of Public Health.” (2) The Illinois Department of Public Health approves and furnishes only 1% silver nitrate solution as a prophy- lactic for ophthalmia neonatorum, free to all physicians and midwives authorized by law to attend at the birth of any child, upon their application for same. (3) Antepartum treatment of the mother if gonorrhea is sus- pected. CONJUNCTIVITIS. ACUTE INFECTIOUS (OVER ONE MONTH OF AGE) Control of Case: (1) Placarding of premises is not required. (2) Isolation is required until clinical recovery. (3) Concurrent disinfection is required. (4) Terminal disinfection is required. Control of Contacts: (1) No restrictions are required. DENGUE Control of Case; (1) Placarding of premises is not required. (2) Isolation in a screened room is required until complete re- covery. (3) Concurrent disinfection is not required. (4) Terminal disinfection is not required. Control of Contacts: (1) No restrictions are required. General Measures: (1) Measures directed toward elimination of the vector mos- quitoes and their breeding places. (2) Screening of rooms. (3) Use of repellents. Diarrhea op the Newborn, Epidemic 23 DIARRHEA OF THE NEWBORN. EPIDEMIC Control of Case: (1) Placarding of premises is required. (2) Isolation is required. The infected baby shall immediately be removed from the nursery to isolation quarters where the baby shall be cared for by a separate nursing staff, skilled in isolation technique and who do not come in contact with other infants or children. (3) Concurrent disinfection is required. (4) Terminal disinfection is required. Control of Contacts: (1) The contaminated nursery shall immediately be closed to new admissions. (2) Admissions to the maternity service shall immediately be suspended. (3) All exposed babies in the contaminated nursery shall be cared for by a separate nursing staff, skilled in isola- tion technique. (4) Maternity service may be renewed only after discharge of all contact babies and mothers, and after thoroughly cleansing nursery, maternity wards, and equipment. (5) Investigation shall be made of all infants discharged from the hospital in the period two weeks prior to the onset of the initially reported case. (6) Bacteriologic examination of stools is required of all sick and exposed babies, mothers, and maternity service per- sonnel. DIPHTHERIA Control of Case or Carrier: (1) Placarding of premises is required. (2) Isolation is required for at least seven days after the onset of illness or the diagnosis of the carrier state and there- after until two successive cultures from both nose and throat, taken not less than twenty-four hours apart, are negative for diphtheria bacilli, or when a virulence test proves the bacilli to be avirulent. Cultures shall not be submitted for virulence tests until at least twenty-one days after the onset of the disease. (3) Concurrent disinfection is required. (4) Terminal disinfection is required. Control of Contacts: (1) All contacts living on the placarded premises shall remain under quarantine as long as the case or carrier is in isolation and thereafter until a culture from both nose and throat is negative for diphtheria bacilli; except 24 Diphtheria that the wage earner, who has submitted a nose and throat culture negative for diphtheria bacilli, may be permitted to continue his work provided he is over 16 years of age, has no direct contact with the patient and is not a food handler, school teacher or employed around a school or other place where there are children, and provided also that permission is granted in writing by the local health authority. In consideration of this modification of quarantine, the local health authority shall agree to visit and inspect the placarded premises at least twice weekly in order to be assured that adequate isolation is being practiced. It should be understood that this is not a blanket privilege for a wage earner and that permission for this type of modi- fied quarantine will be rescinded by the Illinois Depart- ment of Public Health if the local health authority does not enforce proper isolation of the patient. (2) Immune persons, who have submitted a nose and throat culture negative for diphtheria bacilli, may be removed from the placarded premises to remain away for the duration of the isolation period. (3) Non-immune persons may be removed from the placarded premises to other premises where they shall be quaran- tined for seven days from date of removal and thereafter until a nose and throat culture, negative for diphtheria bacilli, is obtained. (Definition of immunity—a person may be regarded as immune from diphtheria under the following condi- tions: a. For three weeks after early prophylactic inoculation with at least one thousand units of diphtheria anti- toxin. b. If a Schick test performed by a physician is found to be negative.) (4) Contacts outside of the home who have had intimate and long continued exposure to the case shall be handled in the same manner as home contacts. Sale of Food, Milk, etc.: (1) See paragraph G, Chapter IV, pages 15, 16. General Measures: (1) All non-immune persons in the same household should be passively immunized with diphtheria antitoxin. (2) All non-immune children in the same household should be actively immunized with diphtheria toxoid but not until three weeks after the administration of antitoxin. (3) Active immunization is recommended for all chil- dren before the end of the first year of life without prior Schick testing and active immunization of school chil- dren with or without prior use of the Schick test. The board of health, the board of education or the school board is advised and urged to have all unprotected pupils actively immunized against diphtheria. Diphtheria (4) Children immunized during infancy should be given a stimulating dose of diphtheria toxoid on entrance to school. (5) Pasteurization of milk supply. Reports DOG AND OTHER ANIMAL BITES Every instance, in which a person is bitten, scratched or otherwise injured by a dog or other animal, or every instance, in which a person has handled a known or suspected rabid animal, shall be reported promptly to the local health authority. Dog bites are to be reported on franked cards as employed for reporting communi- cable diseases. Investigations: All instances of animal bites shall be investigated promptly by the local health authority, to determine, if possible, whether or not the animal in question had rabies and if the person bitten is in need of prophylactic vaccine. Control of Dogs: Any dog or other animal known to have bitten a human being shall be captured alive, if possible, and shall be detained and observed for a period of fourteen days. If the animal is killed, the head should be detached with- out mutilation and forwarded to a laboratory where examination for rabies can be made. Control of Case: DYSENTERY, BACILLARY (SHIGELLOSIS) (1) Placarding of premises is not required except in the presence of an epidemic. (2) Isolation in a screened room is required of all clinically active cases until two consecutive specimens of feces, taken not less than seventy-two hours apart, are neg- ative for dysentery organisms. All specimens for re- lease purposes must reach an approved laboratory with- in twenty-four hours after passage. (Clinically re- covered cases, whose specimens are still positive, may be granted the same modified quarantine privileges as described on page 26 for carriers.) (3) Concurrent disinfection is required. (4) Terminal disinfection is required. Control of Carrier: Definition of carrier. A bacillary dysentery carrier is a person who is discharging dysentery bacilli in his ex- creta but who shows no symptoms of the disease; or a person who continues to discharge dysentery bacilli at the end of three months after the date of onset of the disease. 26 Dysentery, Bacillary (Shigellosis) (1) Carriers of bacillary dysentery shall be isolated and the premises placarded until they have submitted three suc- cessive specimens of feces at intervals of one week apart which are negative for dysentery bacilli. How- ever, carriers of bacillary dysentery may be granted a modified form of quarantine upon signing in quadrupli- cate the modified quarantine agreement shown below. One signed copy is to be filed with the local health au- thority, two signed copies forwarded to the Illinois De- partment of Public Health and the fourth copy given to the carrier. The local health authority shall visit, or cause to be visited, such carrier as often as is necessary to insure compliance with the agreement. ill. Dated Illinois Department of Public Health, Springfield, Illinois. Gentlemen: I agree to observe the pre- cautions which are required by the Illinois Department of Public Health relative to dysentery (cases or carriers) and request that I be permitted to remain in free communication with other persons as long as I comply with these requirements. I agree not to handle food for my family or for other people and to use the utmost care in my personal hygiene. I will wash my hands with soap and water after every visit to the toilet and will not bathe in any pool of water frequented by any other person. I agree to submit specimens as requested by the local or state health depart- ment, until I am properly released according to the rules for the control of dysentery. I will inform the local health department and the Illinois Department of Public Health at Springfield or any other health jurisdiction, where I may go to live, of any contemplated change from my present address. 1 understand that if I violate any of the above restrictions or endanger the public health in any way that I shall lose the privileges granted me under this permit and I shall be quarantined and the premises placarded. Signed (Case or Carrier) Permission is, hereby, granted to (a case or carrier) of dysentery bacilli, to mingle with the public at large and to resume his usual occupation as (NOT AS A FOOD HANDLER), as long as he complies with the restrictions listed above. Signed Title Health Jurisdiction Dated f Approved M. D. -4 Illinois Department of Public Health L Dated Release of Carrier: (1) A chronic bacillary dysentery carrier shall not be released from observation and the rules of modified quarantine until three successive specimens taken at intervals of not less than one week are negative for bacillary dysen- tery bacilli. No negative reports will be considered if the specimen has been delayed in transit and in no in- stance if more than twenty-four hours have elapsed between collection of the specimen and its examination; however, the Illinois Department of Public Health re- serves to itself the right of passing finally upon all evidence which may be obtained thereby. Dysentery, Bacillary (Shigellosis) 27 Control of Contacts to a Case; (1) All household contacts shall submit two successive speci- mens of feces taken not less than twenty-four hours apart. (2) No other restrictions are required of home contacts unless they are food handlers, in which case they may not engage in their usual occupation as long as they reside on the premises where the patient is in isolation. Sale of Food, Milk, etc.: (1) See paragraph G, Chapter IV, pages 15, 16. General Measures: (1) Protection and purification of public water supplies. (2) Pasteurization of public milk supplies. (3) Supervision of other food supplies and of food handlers. (4) Prevention of fly breeding. (5) Sanitary disposal of human excreta. ENCEPHALITIS. ACUTE INFECTIOUS. (INCLUDING VON ECONOMO'S AND ST. LOUIS ENCEPHALITIS AND EQUINE ENCEPHALOMYELITIS) Control of Case; (1) Placarding of premises is not required. (2) Isolation in a screened room is required during the febrile period. (3) Concurrent disinfection is required. (4) Terminal disinfection is not required. Control of Contacts: (1) No restrictions are required. ERYSIPELAS Control of Case: (1) Placarding of premises is not required. (2) Isolation is required until inflammation has subsided and all purulent discharges have ceased. (3) Concurrent disinfection is required. (4) Terminal disinfection is required. Control of Contacts; (1) No restrictions are required. FOOD INFECTIONS A. Salmonellosis B. Other Control of Case or Carrier: (1) Placarding of premises is not required.