STATE OF WASHINGTON 
Department of Health 
SEATTLE 
Book II 
Rules and Regulations 
OF THE 
State Board of Health 
CONTROL OF COMMUNICABLE AND OTHER 
DISEASES DANGEROUS TO THE PUBLIC HEALTH 
Revised and Adopted Nov. 24, 1943 
STATE PRINTING PLANT 
OLYMPIA STATE OF WASHINGTON. 
Department of Health 
SEATTLE 
Book II 
Rules and Regulations 
OF THE 
State Board of Health 
CONTROL OF COMMUNICABLE AND OTHER 
DISEASES DANGEROUS TO THE PUBLIC HEALTH 
Revised and Adopted Nov. 24, 1943 
STATE PRINTING PLANT 
OLYMPIA STATE BOARD OF HEALTH 
L. E. Powers, M. D., Chairman Seattle 
A. H. Peacock, M. D Seattle 
Richard Bailey, M. D Spokane 
H. E. Wight, D. D. S Yakima 
George L. Sorenson Seattle 
Albert Bailey, Ph. D., Secretary Seattle 
STATE OF WASHINGTON, DEPARTMENT OF HEALTH 
Table of Manuals 
Book 1. Washington Laws Relating to Public Health. 
Book 2. Rules and Regulations of the State Board of Health. 
Control of Communicable and Other Diseases Dangerous to the 
Public Health. 
Book 3. Rules and Regulations of the State Board of Health. 
Public Health Laboratory. 
Book 4. Rules and Regulations of the State Board of Health. 
Public Health Nursing. 
Book 5. Rules and Regulations of the State Board of Health. 
Sanitation. 
Book 6. Laws, Rules and Regulations of the State Board of Health. 
Vital Statistics. STATE OF WASHINGTON, 
COUNTY OF KING. 
ss. 
I, L. E. Powers, M. D., Director of Health of the State of Washington, 
hereby certify that the following and attached rules and regulations of the 
State Board of Health are true and correct copies of the rules and regulations 
of the State Board of Health adopted by the said Board of the State of Wash- 
ington on the 24th of November, 1943, as shown by the minutes of the meeting 
of the said State Board of Health, on file at the office of the Secretary of the 
State Board of Health in the City of Seattle, County of King, State of Wash- 
ington, and said rules and regulations are now in full force and effect. 
November, 1943. 
In testimony whereof, I have hereunto set my hand this 24th day of 
L. E. POWERS, M. D., 
State Director of Health, 
ALBERT BAILEY, Ph. D., 
Secretary. SUMMARY POWER OF STATE BOARD OE HEALTH 
Sec. 1. In any case not covered by statute or by these rules and regu- 
lations, and in order to receive correct vital statistics, prevent the spread 
of communicable diseases, remove or prevent contamination of any water 
supply, enforce quarantine, declare certain diseases communicable, arrest 
epidemic or unusually prevalent diseases which may become general or apply 
to certain localities, better the condition in hospitals, poor farms, sanatoria, 
baby homes, boarding-out homes for babies, homes for wayward girls, de- 
linquent boys, or indigent orphans, make and enforce closures, abate nuis- 
ances, prevent improper removal, transportation, interment or disinterment 
of dead human bodies, or regulate the treatment or control of venereal dis- 
eases, the State Board of Health has power, through the Director of Health 
to act summarily, and to issue rules and make and enforce regulations as 
any case may require. 
Sec. 2. If, in the opinion of the State Board of Health, adequate pro- 
vision has not been made for the proper notification and investigation and 
control of communicable diseases and in localities in which the local health 
authorities fail to carry out the provisions of any of the laws of Washington 
relating to public health, or any of the rules and regulations of the State 
Board of Health, the Director of Health may appoint properly qualified sani- 
tary officers to act as local health officers and to prevent the spread of diseases 
in and from such localities and to enforce the provisions of any of the laws of 
Washington relating to public health, and the provisions of these rules and 
regulations: Provided, That salaries and other expenses incurred under the 
provisions of this section shall be paid by the local authorities where such 
sanitary officer is appointed to act. 
Sec. 3. Whenever it becomes necessary in the opinion of the State Board 
of Health, on account of the unusual prevalence of any communicable disease 
or when such disease becomes epidemic, the Director of Health may issue 
orders to county and city health officers directing them to make a closure, and 
in order to prevent the further spread of such communicable disease or such 
epidemic, to direct the closing of and prevent all public gatherings in all 
schools, churches, lodges, theaters, pool and billiard halls, swimming pools, 
stores and other places of business, or any one or more public places; and to 
this end said county and city health officers shall have the power to deputize 
persons as guards and such deputized persons shall have the power of deputy 
state health officers, and shall maintain and strictly enforce such closing 
order. 
Board—Powers—Duty of Local Officers. The State Board of Health shall 
have supervision of all matters relating to the preservation of the life and 
health of the people of the state. The board shall have supreme authority in 
matters of quarantine, and may declare and enforce it when none exists, may 
modify, relax or abolish it when it has been established. The board may have 
special or standing orders or regulations for the prevention of the spread of 
contagious or infectious diseases, and for governing the receipt and convey- 
ance of remains of deceased persons, and such other sanitary matters as admit 
of and may best be controlled by universal rule. It may also make and en- 
force orders in local matters, when in the opinion of the State Board of Health, Rules and Regulations of the State Board of Health 
6 
an emergency exists and the local board of health has neglected or refused to 
act with sufficient promptness or efficiency, or when no such local board has 
been established, and all expenses so incurred shall be paid by the county in 
which such services are rendered out of the general fund of said county. It 
shall be the duty of all local boards of health, health authorities and officials, 
officers of the state institutions, police officers, sheriffs, constables, and all 
other officers and employees of the state, or any county, city or township 
thereof, to enforce such quarantine and sanitary rules and regulations as may 
be adopted by the State Board of Health, and in the event of failure or refusal 
on the part of any member of said boards or other officials, or persons in this 
section mentioned to so act, he or they shall be subject to a fine of not less than 
fifty dollars, upon first conviction, and upon conviction of second offense of 
not less than one hundred dollars. The board shall make careful inquiry as to 
the cause of disease especially when contagious, infectious, epidemic or 
endemic, and take prompt action to control and suppress it. It shall respond 
promptly, when called upon by the state or local government and municipal 
or township boards of health, to investigate and report upon the water supply, 
sewerage, disposal of excreta, heating, plumbing, or ventilation of any place 
or public building. 
Violations—Removal of Officers—Penalties. Any health officer who shall 
refuse or neglect to obey or enforce the provisions of this chapter or the rules 
or regulations or orders of the State Board of Health or shall refuse or neglect 
to make prompt and accurate reports to the county health officer or to the 
State Board of Health may be removed as health officer by the State Board of 
Health and shall not again be reappointed except with the consent of the 
State Board of Health. 
Any member of a city or county board of health who shall violate any of 
the provisions of this chapter or refuse or neglect to obey or enforce any of 
the rules, regulations or orders of the state or county boards of health made 
for the prevention, suppression or control of any dangerous, contagious or in- 
fectious disease or for the protection of the health of the people of this state, 
shall be guilty of a misdemeanor, and upon conviction shall be fined not less 
than ten dollars nor more than two hundred dollars. Any physician who shall 
refuse or neglect to report to the proper health officer within twelve hours 
after first attending any case of contagious or infectious disease or any 
diseases, required by the State Board of Health to be reported or any case 
suspicious of being one of such diseases, shall be guilty of a misdemeanor, and 
upon conviction shall be fined not less than ten dollars nor more than two 
hundred dollars for each case that is not reported. 
Any person violating any of the provisions of this chapter or violating or 
refusing or neglecting to obey any of the rules and regulations or orders made 
for the pi’evention, suppression and control of dangerous contagious and in- 
fectious diseases by the county board of health or health officer or State Board 
of Health, or who shall leave any pesthouse or isolation hospital or quaran- 
tined house or place without the consent of the proper health officer, or who 
evades or breaks quarantine or conceals a case of contagious or infectious 
disease or assists in evading or breaking any quarantine or concealing any case 
of contagious or infectious disease, shall be guilty of a misdemeanor, and upon 
conviction thereof shall be subject to a fine of not less than twenty-five dollars 
nor more than one hundred dollars or to imprisonment in the county jail not 
to exceed ninety days or to both fine and imprisonment. RULES AND REGULATIONS GOVERNING THE CONTROL 
OF COMMUNICABLE AND OTHER DISEASES DAN- 
GEROUS TO THE PUBLIC HEALTH 
Sec. 4. No person shall willfully expose himself to another, or to any 
animal affected with, or a carrier of any communicable disease, in any public 
place or thoroughfare, except in a manner not dangerous to the public health, 
and every person so affected shall not expose any person thereto without his 
knowledge. 
BOOK 2 
Sec. 5. Whenever any laboratory or clinical diagnosis discloses that any 
disease is of a communicable nature, the person making such diagnosis shall 
immediately take such action as is necessary in order to prevent the spread of 
such disease, and shall make a report of such action to the jurisdictional 
health officer. Such person shall, in addition to such report, be prepared to 
take any such further steps as may be deemed necessary by the State Direc- 
tor of Health and shall report such case, and all connected therewith, to the 
jurisdictional health officer, or to any person or institution designated by the 
State Director of Health. Pending official action by the jurisdictional health 
officer, the attending physician or other person practicing the science of heal- 
ing shall establish and maintain quarantine rules and regulations as prescribed 
by the State Board of Health. 
All laboratories shall make weekly reports to the county health officer or 
in the instance of cities of the first class, to the city health officer, on the 
Thursday of every week, listing the names of the patients or cases, the con- 
dition suspected, the diagnostic procedure used, and the result of such analy- 
sis, and the name of the physician, for all conditions listed as reportable in the 
Rules and Regulations of the State Board of Health. County health officers 
and health officers of the cities of the first class shall every Saturday mail to 
the State Department of Health, the laboratory reports received by him from 
the laboratories, and may for his own purpose keep a tabulation of such re- 
ports in his own files. These reports shall be made on forms supplied by the 
State Department of Health and signed by the director of said laboratory. 
Sec. 6. (a) When the diagnosis or release of a case, contact or carrier of 
a communicable disease is dependent upon laboratory findings, the health 
officer shall x'equire such findings to be obtained by a State Department of 
Health laboratory or a laboratory approved by the State Department of 
Health. The health officer shall by himself or his agent secure and submit 
final cultures or specimens for examination. 
(b) Every person, firm or corporation operating or maintaining a labora- 
tory in wThich body fluids, secretions or excretions are examined for the deter- 
mination of the presence or absence of an infectious agent in the material 
examined or in the person or animal from which it was secured, shall register 
annually with the State Department of Health giving the name of such labora- 
tory, its location and the name of the person or persons owning or operating 
the same. Laboratories operated by physicians for their personal convenience 
need not register. 
Sec. 7. It shall be and is hereby made the duty of all health officers within 
the state, to keep currently informed of the occurrence, geographic distribution 
and prevalence of preventable diseases throughout the state and to carefully 8 
Rules and Regulations of the State Board of Health 
and systematically make reports of such diseases as may be required by these 
rules and regulations. 
REPORTS OF DISEASE BY ATTENDING PHYSICIANS AND OTHERS 
Sec. 8. 
A. It shall be the duty of every physician or practitioner, every superin- 
tendent or manager of a dispensary, hospital or clinic, or any person in 
attendance on a case of a reportable disease or a case suspected of being 
a reportatole disease, to report the case immediately to the local health 
officer. 
B. The submitting of laboratory specimens shall not be considered as a 
report of any case. 
C. When no physician is in attendance, it shall be the duty of any in- 
dividual having knowledge of a person suffering from a disease pre- 
sumably communicable or suspected of being communicable to report 
forthwith to the local health officer all the facts relating to the case, 
together with the name and address of the person who is ill. 
D. It shall be the duty of any person who may be interrogated to answer 
correctly and to the best of his knowledge all questions put to him 
which may be necessary to elicit any information needed to verify or 
complete any report of a case of a known or suspected communicable 
disease or any disease dangerous to the public health or to enable 
measures to be taken to prevent the spread of any such disease. 
E. It shall be the duty of the physician in attendance on a case considered 
to be an infectious or communicable disease, to give detailed instruc- 
tions to the members of the household in regard to precautionary 
measures to be taken, for preventing the spread of the disease. Such 
instructions shall conform to the regulations of the State Department 
of Health and the ordinances in effect in the local community. 
F. The health officer or his medical deputy may accept or may, at his dis- 
cretion, verify diagnosis made by a physician. The diagnosis of diseases 
reported from other sources must be verified by the health officer or 
medical deputy before instituting control measures. 
G. A reported case, unless otherwise specified, shall be accepted as a final 
diagnosis, and the diagnosis can be changed only by the health officer 
or his authorized agent; a suspected case may be reported with pro- 
visional diagnosis, and may be changed by the physician in attendance 
after notifying the health officer. Provisional diagnosis shall be changed 
to final diagnosis within forty-eight hours after being reported as pro- 
visional. 
H. It shall be the duty of local health officers to keep all physicians within 
their jurisdiction supplied with the proper forms upon which to report 
diseases as required. It is also his responsibility to acquaint the physi- 
cians with the list of reportable diseases and to stimulate interest in and 
encourage good reporting. 
Sec. 9. The State Board of Health does hereby declare the following 
diseases dangerous to the public health and they are hereby declared reportable 
by law strictly in accordance with the procedure indicated in Section 10 here- 
inafter. Rules and Regulations of the State Board of Health 
9 
A. 1. Actinomycosis 
2. Ancylostomiasis 
3. Anthrax 
4. Ascariasis 
5. Chancroid 
6. Chickenpox 
7. Cholera 
8. Coccidioidal Granuloma 
9. Conjunctivitis, Acute infectious 
10. Conjunctivitis, Acute kerato 
11. Dengue fever 
12. Diarrhea or Enteritis 
(a) of the newborn 
(b) Etiology undetermined 
(over 1 year) 
13. Diphtheria 
14. Dysentery, amebic 
15. Dysentery, Bacillary 
(Shigella group infection) 
16. Echinococcus infection 
17. Encephalitis, infectious 
(a) Lethargic (Vienna Type, 
von Economo type; 
(b) Non-lethargic (Encephalo- 
myelitis) 
(c) Post infectious (Post 
Febrile, etc.) 
18. Erysipelas 
19. Favus 
20. Filariasis 
21. Food infections, intoxications 
and poisonings (including 
botulism) 
22. German measles 
23. Glanders 
24. Gonorrhea—all types 
25. Granuloma Inguinale 
26. Impetigo Contagiosa 
27. Influenza 
28. Jaundice-Ictero-hemorrhagic 
29. Leprosy 
30. Lymphogranuloma venereum 
B. Reportable Poisonings: 
1. Aniline Poisoning 
2. Arsenic Poisoning 
3. Benzine Poisoning 
4. Benzol Poisoning 
5. Bisulphide of Carbon Poisoning 
6. Brass Poisoning 
7. Carbonmonoxide Poisoning 
C. Occupational (industrial) Diseases 
31. Malaria 
32. Measles 
33. Meningococcus meningitis 
34. Mumps 
35. Paratyphoid fever 
36. Plague 
37. Pneumonia 
(a) Acute lobar 
(b) Broncho pneumonia 
(acute) 
(c) Virus type (pneumonitis) 
38. Poliomyelitis 
39. Psittacosis 
40. Puerperal infection 
41. Rabies (human and animal) 
42. Rat-bite fever 
43. Relapsing fever 
44. Rheumatic fever 
45. Ring worm (dermatophytosis) 
46. Rocky Mountain Spotted fever 
(Tick fever) 
47. Scarlet fever 
48. Schistostomiasis 
49. Septic sore throat 
50. Silicosis 
51. Smallpox 
52. Syphilis 
53. Tetanus 
54. Thrush 
55. Trachoma 
56. Trichinosis 
57. Tuberculosis 
(a) Pulmonary 
(b) Other than pulmonary 
58. Tularemia 
59. Typhoid fever 
60. Typhus fever 
61. Undulant fever 
(Brucellosis) 
62. Vincent’s infection 
63. Whooping cough 
64. Yellow fever 
8. Dinitrobenzine Poisoning 
9. Naphtha Poisoning 
10. Lead Poisoning 
11. Phosphorus Poisoning 
12. Tetraethyl lead Poisoning 
13. Turpentine Poisoning 
14. Wood Alcohol Poisoning 
Occupational diseases occurring in the State of Washington are com- 
pensible and therefore should be reported to the Department of Labor 
and Industries at Olympia. Through an arrangement with this De- 
partment, the Division of Industrial Hygiene of the State Department 
of Health receives copies of those reports which are then followed up. 10 
Rules and Regulations of the State Board of Health 
REPORTS OF HEALTH OFFICERS 
Sec. 10 
A. The following diseases are to be reported immediately by telegraph 
or telephone (preferably) as soon as suspected or diagnosed; 
1. Any sudden or extraordinary outbreak of serious illness 
2. Cholera 
3. Plague 
4. Typhus fever 
5. Outbreaks of food infection or poisoning 
Such telephonic or telegraphic reports are to be followed by completed 
individual report cards mailed at the close of each week. 
B. The following diseases are to be reported- by number of cases only, 
such report being made on the “minor disease” report card and mailed 
at the close of each week as specified below: 
1. Chicken pox 5. Mumps 
2. German measles 6. Ring Worm 
3. Impetigo contagiosa 7. Vincent’s infection 
4. Measles 
C. All other diseases are to be reported on completed individual report 
cards, mailed at the close of each week as specified below: 
D. 1. Health officers of cities below the first class (population 20,000) 
are under the supervision of the County Health Officer. Such City 
Health Officers shall report to the County Health Officer such 
diseases as are listed under paragraph A. above and in the manner 
specified therein. 
2. Such City Health Officers (in cities below the first class) shall sub- 
mit the weekly report of “minor diseases” and the individual report 
cards of all other diseases reported to the County Health Officer 
each week on Thursday. 
3. Health Officers of cities of the first class will submit reports as in- 
dicated in paragraphs A, B, and C above, directly to the State De- 
partment of Health, as indicated and each week on Saturday. 
4. County Health Officers will submit reports for the area under then- 
jurisdiction to the State Department of Health as indicated and each 
week on Saturday. 
5. In case no reports have been received by a health officer during the 
week, he is to submit a report of “no cases” on the report cards 
ordinarily used. 
6. All health officers shall immediately, upon receipt of a report of any 
disease listed as reportable in these rules and regulations, enter 
same in a record book, or other means, provided for that purpose in 
his office. Rules and Regulations of the State Board of Health 
11 
Sec. II. 
PLACARDS 
A. Quarantine Placard. A “Quarantine” placard, as hereinafter illustrated, 
shall be of yellow cardboard, not less than 6 inches by 10 inches in size 
and all letters shall be in black. The letters forming the word “Quar- 
antine” shall not be less than one and five-sixteenths inches in height 
printed across the length of the card. The stroke of said letters shall 
not be less than one-fourth inch for down stroke, and one-eighth inch 
for up stroke and shall be of solid black. The letters of the words 
“Keep Out” shall be not less than one-half of the height of those in the 
word “Quarantine” nor less than one-half the strokes mentioned above. 
QUARANTINE 
KEEP OUT 
All persons, not occupants of this apartment, are hereby notified of the 
presence of a communicable disease within, and are warned not to enter. The 
person having the disease and all others who have been placed under quar- 
antine in this home MUST NOT LEAVE THE APARTMENT until this card 
has been removed by the Health Officer. 
This card must not be concealed from public view, must not be mutilated 
or defaced and MUST REMAIN POSTED ON THESE PREMISES UNTIL RE- 
MOVED BY THE HEALTH OFFICER. Any person who violates these rules 
subjects himself to a fine not to exceed S100 for each offense or imprisonment 
in the county jail not to exceed 30 days, or both. 
List of Diseases Requiring Quarantine Placard: 
Health Officer 
1. Cholera 
2. Diphtheria 
3. Plague 
4. Scarlet fever (Warning Placard 
may be used at discretion of 
Health Officer) 
5. Smallpox 
6. Typhus fever 
7. Tuberculosis—under certain con- 
ditions 
B. Warning Placard. A “WARNING” placard, as hereinafter illustrated, 
shall be of white cardboard, not less than 6 inches by 10 inches in size 
and all letters shall be in black. The letters forming the word “WARN - 
ING” shall be not less than one and five-sixteenths inches in height 
printed across the length of the card. The stroke of said letters shall 
not be less than one-fourth inch for the down stroke and one-eighth 
inch for the upstroke and shall be of solid black. The letters of the 
words “Keep Out” shall be not less than one-half of the height of 
those in the word “WARNING” nor less than one-half the strokes 
mentioned above. 
WARNING 
KEEP OUT 12 
Rules and Regulations of the State Board of Health 
Al! persons, not occupants of this apartment, are hereby notified of the 
presence of a communicable disease within and are warned not to enter. The 
person having the disease must not leave the apartment until this warning 
sign has been removed by the Health Officer. 
This warning card must not be concealed from the public view, must not 
be mutilated or defaced and MUST REMAIN POSTED ON THESE PREMISES 
UNTIL REMOVED BY THE HEALTH OFFICER. 
Any person who violates these rules subjects himself to a fine of not over 
$100 for each offense or imprisonment in the county jail not to exceed 30 days 
or both. 
Health Officer 
List of Diseases Requiring Warning Placard: 
1. Chicken pox (at the discretion of 
Health Officer) 
2. Dengue fever 
3. Encephalitis 
4. Leprosy 
5. Measles (at discretion of Health 
Officer) 
6. Meningitis 
7. Mumps (at discretion of Health 
Officer) 
8. Poliomyelitis 
9. Psittacosis 
10. Septic Sore Throat (or Quaran- 
tine Placard, at discretion of 
Health Officer) 
11. Tuberculosis—under certain con- 
ditions and at discretion of 
Health Officer 
12. Typhoid fever group 
13. Whooping Cough (at discretion 
of Health Officer) 
14. Yellow fever 
DEFINITIONS 
Sec. 12. 
A. Carrier is a person who, without symptoms of a communicable disease, 
harbors and might disseminate the specific causative agent of a com- 
municable disease. 
B. Cleaning shall signify the removal by scrubbing and washing as with 
hot water, soap and washing soda, of organic matter on which and in 
which the causative agents of communicable disease may find favor- 
able conditions for prolonging their life and virulence; also the removal 
by the same means of the causative agents of communicable disease ad- 
hered to surfaces. 
C. Contact is a person or animal known to have been sufficiently near an 
infected person or animal to have been presumably exposed to transfer 
of infectious material directly, or by articles freshly soiled with such 
material. 
D. Delousing is the process by which a person and his personal apparel are 
treated so that neither lice nor their eggs survive. 
E. Disinfection is the destroying of the vitality of the causative agents of 
communicable disease by chemical or physical means. 
1. Concurrent—carried on continuously during the illness of the 
patient and consisting of the disinfection by chemical or physical 
means of discharges of the patient or any articles soiled by such in- 
fectious discharges. 
2. Terminal—The elimination of the infectious agent in an appropriate 
manner from the personal clothing, belongings and the immediate Rules and Regulations of the State Board of Health 
13 
physical environment of the patient at the time when he has become 
no longer a source of infection and is about to be released from iso- 
lation. 
F. Disinfesting- is any process such as the use of dry or moist heat, gaseous 
agents, poisoned food, trapping, etc., by which insects and animals 
known to be capable of conveying or transmitting infection may be de- 
stroyed. 
G. Fumigation is a process by which the destruction of insects, as mos- 
quitos and body lice, and animals, as rats, is accomplished by the em- 
ployment of gaseous agents. 
H. Renovation in addition to cleaning, is treatment of the walls, floors, and 
ceilings of rooms or houses as may be necessary to place the premises 
in a satisfactory sanitary condition. 
I. Susceptible. The person or animal who is not known to have become 
immune to the particular disease in question by natural or artificial 
process. 
J. Isolation. Separation of cases or carriers from other persons in such 
places and under such conditions as will prevent the direct or indirect 
spread of the infectious agent to susceptible persons. 
K. Quarantine. Limitation of freedom of movement of persons who have 
been exposed to a communicable disease for a period equal to the 
longest usual incubation period of the specific disease. 
L. Communicable Disease is a disease capable of being transmitted by con- 
tact with an individual suffering from it or with some secretion or ex- 
cretion of such an individual or secondary host or with an object 
touched by such an individual. 
ISOLATION AND QUARANTINE PROCEDURES 
Sec. 13. 
A. Placarding. The appropriate placard as set forth by the rules and regu- 
lations shall be placed in a conspicuous place, both front and back of the 
household affected. 
B. The following techniques are recommended as a guide to follow in 
carrying out certain isolation procedures: 
1. The patient shall have an isolated room screened against flies and 
other insects. 
2. All persons except those caring for the patient shall be excluded. 
3. Persons caring for the patient shall avoid coming in contact with 
other persons in the household until every precaution has been 
taken to prevent the spread of the infectious material from the 
patient’s room. This can be accomplished by the following tech- 
niques: 
a. All necessary articles shall be assembled before entering the 
patient’s room, so it will not be necessary to leave the room until 
care is completed. 
b. Attendants shall wear an outer garment such as a gown, smock, 
or large apron while caring for the patient. Technique for 
handling such an outer garment is as follows: Collar and shoulder 14 
Rules and Regulations of the State Board of Health 
area of the garment shall be considered not contaminated and 
this area should not be touched except when the hands are clean, 
and should be protected from contamination by the patient or 
other articles in the isolation room. Before removing the gar- 
ment, hands should be thoroughly washed with soap and water, 
or other disinfectant solutions as may be prescribed by the health 
officer. This garment should be kept in the isolation room at all 
times, and should be hung so that the contaminated side is out- 
ward and also in such a position that the attendant may place his 
or her hands on the uncontaminated or inner side of the garment. 
After removal of the garment and before leaving the isolation 
room, the hands should be thoroughly washed again. 
c. Feeding of the patient. Patient’s dishes may be handled in 
either of two ways: (1) Dishes may remain in the room and be 
washed there after each usage, or (2) if removed after each 
feeding they may be placed outside of the isolation room in a 
dishpan containing water. They should be boiled for fifteen 
minutes before being washed. Food scraps should be placed in 
paper or paper bags in the isolation room following which they 
should be burned if facilities for incineration are available. 
If such facilities are not available, the scraps wrapped in a news- 
paper, should be placed in a heavy paper bag which should then 
be tied to prevent the contents from escaping. 
d. Linen and clothing. Containers should be placed immediately 
outside of the isolation room containing either water and/or a 
suitable disinfectant solution, and all linen and clothing should be 
placed in this container. If soap and water is to be used, such 
linen or clothing should be boiled immediately; those articles 
which cannot be boiled or disinfected by a solution should be 
thoroughly aired for a period of twelve hours. In cities in which 
laundry service for contaminated articles is available, such linen 
or clothing should be placed in a heavy bag, securely tied and 
distinctly marked “Infectious.” 
4. Additional procedures for upper respiratory diseases. 
a. Mouth and nasal discharges should be destroyed. Clean cloth 
or paper handkerchiefs should be used and discarded into paper 
bags attached to the bed, and then burned. 
5. Additional procedures for enteric diseases. 
a. Waste food from the patient’s meals should be strictly handled 
as indicated above. 
b. Nasal discharges during certain periods of specific diseases 
should be handled as under the respiratory group. 
c. Bowel and urine discharges should be disinfected before throw- 
ing them into the toilet or privy. Disinfection can be carried out 
by thoroughly mixing equal parts of stool with a ten per cent 
solution of chloride of lime or other satisfactory chlorine solution, 
ten per cent formaldehyde solution, or five per cent tricresol in 
the bedpan and allow it to stand for one hour. Rules and Regulations of the State Board of Health 
15 
C. Procedures for Quarantine. 
1. In addition to carrying out all the above isolation px’ocedures and 
the quarantine of the premises, the health officer shall define the 
area wherein the patient is to be isolated, define the quarantine area 
and affix the specified placard in a conspicuous place, and determine 
contacts that are subject to quarantine and issue instructions ac- 
cordingly. 
D. Procedure for terminating isolation or quarantine. 
1. Examination of the patient, and members of the household or insti- 
tution where patient is confined to determine freedom from infec- 
tion or capability of transmitting the infection for which isolation 
was imposed. 
2. The patient should be bathed and dressed in uncontaminated clothing. 
3. The room should be thoroughly cleaned and aired. 
a. Hot water and soap should be used whenever possible. 
b. All other articles such as mattresses, blankets, toys, books, etc., 
should be aired for a period of twelve houx*s. If these articles 
are soiled they should be cleaned before being used again. 
c. On release of quarantine, very badly soiled school and library 
books shall be destroyed. Others must be cleaned, sunned and 
placed on end, opened, on an open shelf for four weeks, before 
they are used again. 
d. No milk bottles shall leave quarantined premises until the termi- 
nation of quarantine and then shall not be returned until boiled 
in water for at least fifteen minutes. 
E. No persons, except the health officer and his authorized representatives, 
physicians, authorized attendants or police shall enter the quarantine 
area, and no one shall permit any other person to enter any room, 
apartment, or premises quarantined for a communicable disease, nor 
shall any person needlessly expose a child or any other person to a com- 
municable disease. The clergy may be permitted to enter the quaran- 
tine area for administration of last rites. 
F. Wage earners constituting the principal support of a family in which 
there is a communicable disease may be granted liberty to pursue their 
occupation if, in the opinion of the jurisdictional health officer, they 
will not be the means of spreading infection. 
G. No person shall interfere with or obstruct the entrance to any premises 
or the inspection or examination of any occupant thereof by any 
health officer, his authorized representative, or a representative of the 
State Board of Health in the proper discharge of his duties. 
H. Quarantine or isolation shall be released only upon permission of the 
jurisdictional health officer. Guards may be employed for the enforce- 
ment of said quarantine or isolation where deemed necessary. 
FOOD HANDLING 
Sec. 14. 
A. When a case of diphtheria, septic sore throat, smallpox, tuberculosis, 
typhoid fever, poliomyelitis, scarlet fever, meningococcus meningitis, 
amebic or bacillary dysentery exists on any farm or dairy producing 
milk, cream, butter, cheese or other products likely to be consumed 16 
Rules and Regulations of the State Board of Health 
raw, no such food shall be sold or delivered from such farm or dairy 
except under the following provisions: 
1. That such foods for sale are not brought into the house where such 
case exists. 
2. That all persons coming in contact with such foods, eat, sleep and 
work wholly outside of such house and not come in contact in any 
way with such house or its inmates or contents. 
3. That all inmates are properly isolated and separated from all parts 
of said farm or dairy. 
4. That a permit be issued by the health officer, and such premises be 
open to his inspection at all times. 
B. No person affected with any communicable disease shall handle food 
or food products intended for sale. All persons handling or preparing 
food stuffs or beverages for sale shall have a physical examination by 
a doctor of medicine for the purpose of determining the presence of a 
communicable disease, whenever desired and requested by the state or 
local health officers. Particular emphasis should be placed on the de- 
tection of tuberculosis and the typhoid-paratyphoid-dysentery diseases. 
TRAVEL 
Sec. 15. 
A. Persons afflicted with a communicable disease shall remain on the 
premises to which they have been confined until the restrictions have 
been terminated by the health officer or his permission given for their 
removal to another place. 
B. No individual with a communicable disease nor any contact of a com- 
municable disease case subject to isolation or quarantine, shall be 
transported from one place to another without the permission of the 
jurisdictional health officer, and no case may be transported outside 
the area of jurisdiction of the health officer until the permission of the 
health officer into whose territory the case is being taken, is obtained. 
When transportation involves travel through several counties the per- 
mission as to travel shall be obtained from the State Department of 
Health. 
C. The regulations made by the United States Public Health Service for 
the control of common carriers engaged in interstate business are 
hereby declared to be part of these regulations of the State Board of 
Health of Washington and shall apply to intrastate transportation. 
D. No person knowingly afflicted with a dangerous communicable disease 
shall use any public conveyance, and no person or persons knowingly 
shall assist such afflicted person by the use of any such public con- 
veyance. 
E. All railroads, vessels or other common carriers, and the owners, con- 
signees, or the assignees of any railroad, vessel, stage or other vehicle 
used for the transportation of passengers, baggage or freight, shall sub- 
mit to any rules or regulations imposed by the State Board of Health; 
they shall submit to any examination required by the health authorities Rules and Regulations of the State Board of Health 
17 
respecting any circumstances or events touching the health of the crew, 
operatives or passengers and the sanitary condition of the baggage or 
freight. 
F. Should discovery be made of the existence among passengers, opera- 
tives or crew of a public conveyance, of any case or cases of communi- 
cable disease, the State Director of Health, his deputies or the local 
health officer shall have power to cause the detention of such con- 
veyance, to isolate the sick or remove them to a suitable place for 
treatment, to establish a suitable station to cause the passengers, opera- 
tors or crew, in such infected public conveyance to be subject to dis- 
infection and cleaning before proceeding, and to offer free immuniza- 
tion in those diseases to which such prophylactic treatment is appli- 
cable, to all persons exposed. If the person or persons so removed are 
unable to pay, the same shall be a valid claim against and be refunded 
by the owners, agents or assignees of the public conveyances from which 
said person or persons were removed. 
G. It shall be the duty of the person in charge of any public conveyance 
going into a place or port within the State of Washington, to imme- 
diately notify, by telegraph or telephone, the State Department of 
Health of any case or suspected case of cholera, diphtheria, smallpox, 
scarlet fever, typhoid fever, typhus fever or plague occurring on such 
public conveyance within the State of Washington. 
Sec. 16. 
SCHOOLS AND PUBLIC GATHERINGS 
A. It shall be the duty of every teacher in any school, public or private, 
within the State of Washington to report forthwith to the principal or 
person in charge of such school all facts relating to the illness and physi- 
cal condition of any child in such school who appears to be affected 
with a disease, presumably communicable. It shall be the duty of the 
principal or person in charge of every such school to report forthwith 
to the local health authorities all facts relating to the illness or physical 
condition of any child attending such school, who appears to be affected 
with any disease, or infestation presumably communicable, together 
with the name, age and address of such child. Such child shall be at 
once sent home or isolated. 
B. It shall be the duty of the principal or other person in charge of any 
public, private or Sunday School to exclude therefrom any child or 
other person affected with a disease or infestation, such as scabies or 
pediculosis, presumably communicable, until such child or other person 
shall have presented a certificate issued by the health officer, or by the 
attending physician and countersigned by the health officer, stating 
that such child or other person is not liable to convey infective or in- 
festing agents. 
HEALTH CERTIFICATES—SCHOOL EMPLOYEES 
Sec. 17. 
A. No person employed in any public, parochial or private school, includ- 
ing colleges and universities, in this state shall work at such employ- 
ment while suffering from any communicable disease. No contract of 18 
Rules and Regulations of the State Board of Health 
any school employee (teacher, bus driver, janitor, clerk, or other em- 
ployee) who comes in direct contact with the students in any school 
shall become operative until such employee has filed with the local 
superintendent of schools and/or president of college or university, a 
health certificate, issued by the State Department of Health. The 
word “operative” may be understood to mean that salary warrants 
shall not be issued until this evidence is properly filed and recorded 
with the superintendent of schools and/or president of college or uni- 
versity. 
B. For the purpose of this regulation, each school employee who comes in 
direct contact with students shall submit a roentgenogram of his chest 
to the State Department of Health at the time of the employee’s appli- 
cation for initial employment in this state, and all employees under 
thirty-five years of age shall submit one every two years thereafter, 
and all thirty-five years of age or over, each fifth year following the 
initial examination. 
C. Roentgenograms unsatisfactory for diagnostic purposes shall be re- 
turned to the physician or agency by whom they were made and such 
physician or agency shall submit a satisfactory roentgenogram of the 
chest to the State Department of Health without additional charge to 
the employee. 
D. When such roentgenograms show no questionable evidence of active 
pulmonary tuberculosis as interpreted by a boai'd of radiologists and 
tuberculosis specialists appointed by the Director of the State Depart- 
ment of Health, the latter will issue a health certificate, the duration 
of which shall not exceed two years for employees under thirty-five 
years of age and shall not exceed five years for employees over thirty- 
five years of age. In cases of doubtful diagnosis when the interpreting 
board deems it necessary, additional roentgenograms of the chest shall 
be required. Miniature X-Ray films will be accepted for screening 
purposes. If the miniature film reveals no evidence of pulmonary 
disease, certification shall be granted for a calendar year. If the minia- 
ture film reveals evidence of pathology, whether obvious or question- 
able, then a full size roentgenogram shall be requested. 
E. For renewal of certification a new roentgenogram should be submitted 
not less than thirty days prior to expiration of the certificate: Provided. 
These regulations shall not apply to casual substitutes, teachers who do 
not teach more than 30 calendar days in any school year. 
F. The employee shall file the health certificate with the County Superin- 
tendent of Schools, and/or president of college or university, except in 
districts of the first class when such certificates shall be filed with the 
City Superintendent of Schools. Whenever an employee transfers 
from one district to another, the local Superintendent of Schools, and/or 
president of college or university, shall return to the employee his 
health certificate, which shall be filed with the Superintendent of 
Schools and/or president of college or university in the new locality. Rules and Regulations of the State Board of Health 
19 
BARBERS AND COSMETICIANS 
Sec. 18. No person shall act as a barber or cosmetician who is afflicted 
with a communicable disease. All persons acting as a barber or cosmetician 
shall have a physical examination by a doctor of medicine for the purpose of 
determining the presence of a communicable disease, whenever desired and 
requested by the state or local health officers. 
No person suffering from a disease of the skin, scalp, or hair or other com- 
municable disease, unless such customer is provided with utensils for ex- 
clusive use, shall be served in a public shop. The hands of the barber or cos- 
metician shall be washed with soap and water before serving each customer. 
SPECIAL REGULATIONS CONCERNING VENEREAL DISEASES 
Set. 19. 
A. The State Department of Health shall make free laboratory examina- 
tions for venereal disease for the physicians of the state in places 
where no approved laboratory exists and for patients not having funds 
to pay for such examination. When specimens are submitted to a 
laboratory for examination for syphilis, gonorrhea or other venereal in- 
fection, they must be submitted under the name or serial number used 
in reporting the case to the health officer. When the examination is com- 
pleted, the laboratory shall mail to the health officer having jurisdiction, 
a copy of the report made to the attending physician, excepting those 
that are negative, and such report shall be attached to and become a 
part of the report of the case on file in the health office. 
B. Whenever a case of syphilis, gonorrhea or other venereal infection is 
under the care of a legally qualified and licensed physician, such 
physician shall, in addition to reporting the case as provided in these 
rules and regulations, instruct the patient as to the communicability 
of the disease; that he is required by law to refrain from any act that 
may transmit the disease to another, and to give such person literature 
relative to such disease as shall be provided by the State Department 
of Health, the United States Public Health Service and the Washing- 
ton Social Hygiene Society. 
C. All health officers shall investigate and examine, or cause to be ex- 
amined, all cases within their jurisdiction, whom they have reason to 
suspect are infected with syphilis, gonorrhea, or other venereal infec- 
tion, and such investigation shall include the submission of specimens 
to an approved laboratory for examination. All persons infected with 
syphilis, gonorrhea, or other venereal infection shall be required to 
report for treatment to a doctor of medicine and continue treatment 
until cured, or to submit to treatment provided at public expense until 
cured. When in the judgment of the local health officer it is necessary 
to protect the public health, isolation or quarantine shall be instituted. 
D. All persons who have active lesions of syphilis in such a place upon 
their bodies so that it may be easily transmitted by the touch, or 
handling of foodstuffs, utensils, towels, etc., and all persons who have 
active lesions of syphilis within the mouth or upon the lips shall be 
quarantined by the health officer having jurisdiction. 20 
Rules and Regulations of the State Board of Health 
E. No physician, laboratory technician or other person shall issue a cer- 
tificate or statement that any person is free from any venereal disease 
infection, and no health officer shall accept any certificate from any 
physician whatsoever stating that the person suspected of suffering 
from any disease mentioned in these regulations, as evidence that such 
person is not so infected. 
F. No person shall advertise or publish any advertisement intended to 
imply or to be understood that he will restore manly vigor, treat or cure 
lost manhood, lost power, stricture, gonorrhea, chronic discharges, vari- 
cocele or syphilis. No person shall advertise any medicine, medical 
preparation, remedy or prescription for any of the ailments or diseases 
enumerated in these sections. No owner or managing officer of any 
newspaper shall print or permit to be printed any such advertisement 
as described in this section. It shall be unlawful for any person or 
persons, firm or corporation, or association, except boards of health or 
agencies approved by the State Director of Health, to publish, deliver, 
or distribute, or cause to be published, delivered or distributed in any 
manner whatsoever, any newspaper advertisement or any printed or 
written matter calling attention or giving prominence to any medicine, 
article, or thing to be used as a cure for venereal diseases, or to any per- 
son who can cure any of the acute diseases of men or any of the diseases 
mentioned in these regulations. 
G. No person shall treat or diagnose or prescribe for venereal diseases, or 
any one of them, unless he or she shall have first obtained a license 
to practice medicine and surgery, as provided by law, within the State 
of Washington. 
H. Prenatal Blood Test. Every physician attending a pregnant woman in 
the State of Washington during gestation shall at the time of first exami- 
nation obtain a sample of blood of such woman and submit it to a 
laboratory approved by the State Director of Health for the perform- 
ance of a standard serological test for syphilis. If the pregnant woman 
first presents herself for examination after the fifth month of gestation, 
the physician shall, in addition to the above, advise and urge the patient 
to receive medical examination and blood test before the fifth month 
of any subsequent pregnancies. Every pregnant woman found infected 
shall begin immediately to receive the accepted course of anti-syphilitic 
treatment. 
RULES AND REGULATIONS GOVERNING VENEREAL DISEASE 
TREATMENT CENTERS 
Sec. 20. 
A. In compliance with Section 6107, Remington’s Revised Statutes, Laws 
Pertaining to Public Health, the State of Washington is hereby divided 
into two Venereal Disease Quarantine Districts. 
District No. 1 This shall include the Seattle area. 
District No. 2. This shall include the remainder of the State of Wash- 
ington. 
1. In District No. 1, there will be established an institution known as 
“Seattle Treatment Center.” In District No. 2, there will be estab- 
lished an institution known as “Washington Infirmary.” The func- Rules and Regulations of the State Board of Health 
21 
tions of such centers shall be to quarantine and treat persons in- 
fected with venereal diseases, for the preservation of the public 
health of the people in the State of Washington. 
B. It is further provided that nothing herein shall prevent the transfer of 
patients from one district to another as the need may warrant. 
C. The Seattle Treatment Center, located in Quarantine District No. 1 will 
be operated by the City of Seattle, under the jurisdiction of the City 
Health Department. 
D, The Washington Infirmary for Quarantine District No. 2 shall be a rapid 
treatment center operated by the State of Washington. General policies 
concerning the management of the Washington Infirmary shall be ar- 
rived at jointly by the authorized representatives of the State Depart- 
ment of Health, the State Department of Finance, Budget and Business, 
and the State Department of Social Security. 
1. The State Department of Health through the medical officer of the 
Washington Infirmary shall be responsible for providing treatment 
of those infected with venereal disease. 
2. A sliding scale of allotment of beds to each major locality will be 
based on need and available space as determined by the State Direc- 
tor of Health. 
3. Admissions will be at the discretion of the State Director of Health 
and the medical officer of the institution. 
4. Admissions on an involuntary basis will be limited to those who 
show evidence of infection with a venereal disease, by reason of 
which the patient is considered a menace to the health, safety and 
welfare of the armed forces, war industrial workers, or the com- 
munity surrounding war activities. Because of the mobility of 
workers, armed forces, and of persons following these groups, ad- 
mission will not necessarily be restricted to residents of the State 
of Washington. 
5. Patients may be paroled at the discretion of the medical officer of 
the institution. 
E. Procedure of Admissions 
1. Admissions will be of both a voluntary or involuntary nature. 
2. Involuntary admissions shall be in compliance with Sections 6101 
and 6107 of Remington’s Revised Statutes, Laws Pertaining to Public 
Health. 
3. Admission shall be certified by the State Director of Health or his 
duly authorized deputies. Certification shall be made in accordance 
with Section 6101, Section 6105, Section 6106, and Section 6107 of 
Remington’s Revised Statutes, Laws Pertaining to Public Health. 
F. Treatment and Quarantine 
1. Quarantine shall be for the period of treatment and such further 
period of observation as deemed necessary by the medical officer. 
2. Treatment procedures shall be in accordance with those prescribed 
by the medical officer and with the approval of the State Director 
of Health. 22 
Rules and Regulations of the State Board of Health 
G. Records and Reports 
Records and reports shall be in accordance with those prescribed by 
the State Director of Health. 
H. Transportation 
Transportation of patients to the Washington Infirmary shall be pro- 
vided by the county and/or city where diagnosis is made. 
I. Discharges 
Discharges will be made only upon the written recommendations of 
the medical officer to the superintendent of the project. A guidance 
committee composed of the superintendent, chief medical officer, and 
the placement specialist will discuss each case within a reasonable 
period before discharge in order that the most suitable plan possible may 
be made for the social readjustment of each patient. 
FUNERALS 
Sec. 21. Funeral services for individuals who have died of a communicable 
disease shall be conducted under the supervision of the jurisdictional health 
officer. In quarantinable diseases and diseases requiring restriction of con- 
tacts, a public funeral service may be permitted only in those instances 
wherein the casket remains closed and members of the family and the con- 
tacts are segregated from the public. For further information refer to 
Book 6, Laws, Rules and Regulations of the State Board of Health, Vital 
Statistics. Rules and Regulations of the State Board of Health 
23 
RULES AND REGULATIONS GOVERNING SPECIFIC 
DISEASES DANGEROUS TO THE PUBLIC HEALTH 
Sec. 22. 
1. ACTINOMYCOSIS 
Regulations: Reportable only. 
Disinfection of discharges from lesions and articles soiled therewith. 
Sale of milk from infected animals prohibited. 
Recommendations: 
Destruction of known animal sources of infection. 
Information: 
ETIOLOGICAL AGENT. Actinomyces bovis. 
SOURCE OF INFECTION. The nasal and bowel discharges and the 
material from lesions of infected animals or human case. Un- 
cooked meat from infected animals. 
MODE OF TRANSMISSION. By contact with discharges or with 
articles freshly soiled with discharges from animal and human cases. 
INCUBATION PERIOD. Undetermined and variable. 
PERIOD OF COMMUNICABILITY. As long as open lesions remain, 
as proved by the presence of the infectious agent on microscopic 
or cultural examinations. 
IMMUNIZATION. None. 
2. ANCYLOSTOMIASIS (Hook Worm) 
Regulations: Reportable only. 
Disinfection—Sanitary disposal of bowel discharges. 
Recommendations: 
EDUCATION as to dangers of soil pollution and methods of prevention. 
PREVENTION OF SOIL POLLUTION by installation of sanitary dis- 
posal system for human discharges, especially sanitary privies in 
rural areas. 
PERSONAL PROPHYLAXIS is cleanliness and the wearing of shoes. 
Information: 
ETIOLOGICAL AGENT. Necator Americanus, rarely ancylostoma 
duodenale. 
SOURCE OF INFESTATION. Feces of infested persons. 
MODE OF TRANSMISSION. Larval forms pierce the skin, usually 
of the foot. By drinking water containing larvae; by eating soiled 
food; by hand to mouth transmission of ova or larvae from objects 
soiled with infected discharges. The chief source of infestatious 
materials is contaminated soil. 
INCUBATION PERIOD. Two to ten weeks. 24 
Rules and Regulations of the State Board of Health 
PERIOD OF COMMUNICABILITY. As long as the parasite or its 
ova are found in the bowel discharges. Contaminated soil may 
remain infestatious for five months in the absence of freezing. 
IMMUNIZATION. None. 
3. ANTHRAX 
Regulations: 
PLACARD. None. 
ISOLATION. Until lesions have healed. 
QUARANTINE. None. 
CONCURRENT DISINFECTION of discharges from lesions and ar- 
ticles soiled therewith. (Note: Spores can be killed only by 
special measures such as steam under pressure or burning.) 
TERMINAL DISINFECTION. Thorough cleaning. 
SALE OF MILK, MEAT, HIDES AND HAIR from infected animals 
prohibited. 
Recommendations: 
Every person handling raw hide, hair, wool, fur or bristles who has 
an abrasion of the skin should immediately report to a physician. 
DISINFECTION of hides, hair, fur, wool or bristles of animals origi- 
nating in known infected centers before they are used or sorted. 
Information: 
ETIOLOGICAL AGENT. Anthrax bacillus. 
SOURCE OF INFECTION. Discharges from open lesions of human 
and animal cases and hair, hides, flesh and feces of infected animals. 
MODE OF TRANSMISSION. Inoculation as by accidental wound or 
scratch, inhalation of spores of the infectious agent, ingestion of in- 
sufficiently cooked infected meat, and mechanically by flies and 
mosquitos. 
INCUBATION PERIOD. Within seven days. 
PERIOD OF COMMUNCABILITY. During the febrile stage of the 
disease and until lesions have ceased discharging. Infected hair 
and hides of infected animals may communicate the disease 
many months after slaughter of the animal and after curing of hide, 
fur or hair, unless disinfected. 
4. ASCARIASIS (Round Worm Infestation) 
Regulations: Reportable only. 
DISINFECTION. Sanitary disposal of feces and washing hands with 
soap and water after defecating and before eating. 
R ecommendations: 
Sanitary disposal of feces. Rules and Regulations of the State Board of Health 
25 
Information; 
ETIOLOGICAL AGENT. Ascaris lumbricoides. 
SOURCE OF INFESTATION. Excreta of infested persons, particu- 
larly children, and articles soiled with excreta from such persons. 
MODE OF TRANMISSION. By direct or indirect transmission of the 
embryonated eggs from soil or other polluted material to the mouth. 
INCUBATION PERIOD. Woi'ms reach maturity in the body about 
two months after infestation. 
PERIOD OF COMMUNICABILITY. As long as mature female worms 
live in the intestine. 
IMMUNIZATION. None. 
5. CHANCROID 
Regulations: 
PLACARD. None, provided the patient is receiving adequate medical 
treatment and not exposing others to the infection. 
ISOLATION. None, provided the patient is receiving adequate medi- 
cal treatment and not exposing others to the infection. 
QUARANTINE. None, provided the patient is receiving adequate 
medical treatment, and not exposing others to the infection. 
CONCURRENT DISINFECTION of all discharges from lesions and 
articles soiled therewith. 
TERMINAL DISINFECTION. None. 
See Special Regulations, Sections 19 and 20. 
Recommendations: 
Clinical symptoms should be confirmed by microscopic examination of 
discharges. Syphilis should be ruled out by darkfield examination 
of lesion and the case should be followed up by blood tests. 
Education in matters of sex hygiene should be given. 
Information: 
INFECTIOUS AGENT. Probably bacillus Ducrey. 
SOURCE OF INFECTION. Discharges from lesions and articles 
freshly soiled therewith. 
MODE OF TRANSMISSION. Direct personal contact (usually sexual) 
with infected persons and indirectly by contact with discharges 
from lesions. 
INCUBATION PERIOD. One to five days. 
PERIOD OF COMMUNICABILITY. As long as lesions are open. 
6. CHICKEN POX 
Regulations: 
PLACARD. “WARNING” placard at discretion of the health officer. 
ISOLATION. Until all scabs have disappeared from the body, ex- 
clusive of the scalp. 26 
Rules and Regulations of the State Board of Health 
QUARANTINE. None. Attendance at school is forbidden for any 
child of the family for a period of three weeks after the disappear- 
ance of the scabs from the body of the case to which the child has 
been exposed, unless the child has been vaccinated against small- 
pox within the past five years, or can present satisfactory evidence 
of having had smallpox. 
DISINFECTION. Isolation procedure. Refer to Section 13. 
Recommendations: 
Differentiation of this disease from mild smallpox is important, es- 
pecially in persons over fifteen years of age. 
Information: 
ETIOLOGICAL AGENT. A specific filterable virus. 
SOURCE OF INFECTION. The infectious agent is presumably present 
in the lesions of the skin and of the mucous membranes; the latter 
appearing early and rupturing soon after they appear, render the 
disease very communicable. 
MODE OF TRANSMISSION. Directly from person to person; in- 
directly through articles freshly soiled by discharges from an 
infected person. 
INCUBATION PERIOD. Two to three weeks. 
PERIOD OF COMMUNICABILITY. Until the primary scabs have dis- 
appeared. 
IMMUNIZATION. None. 
7. CHOLERA 
Regulations: 
PLACARD. “QUARANTINE” placard, telegraphic report. 
ISOLATION OF PATIENT. Hospital or screened room until stools 
are negative for cholera bacilli. 
QUARANTINE. Contacts for five days from last exposure and until 
stools are found to be negative for cholera vibrio. Quarantine car- 
riers until free from infective agent. 
DISINFECTION. Prompt and thorough quarantine procedure. Refer 
to Section 13. 
TERMINAL DISINFECTION. Bodies of those dying from cholera 
must be cremated, or wrapped in a sheet thoroughly wet with a 
five per cent Phenol solution or a ten per cent Formaldehyde solu- 
tion, and placed in a water-tight casket. 
Recommendations: 
Rigid personal prophylaxis of attendants by scrupulous cleanliness, 
disinfection of hands each time after handling patients or touching 
articles contaminated by dejecta, the avoidance of eating or drink- 
ing anything in the room of the patient, and the prohibition of those 
attendant on the sick from entering the kitchen. The bacteriologi- 
cal examination of the stools of all contacts to determine carriers. 
Isolation of carriers. Water should be boiled if used for drinking Rules and Regulations of the State Board of Health 
27 
or toilet purposes, or if used in washing dishes or food containers, 
unless the water supply is adequately protected against contami- 
nation or is so treated, as by chlorination, that the cholera vibrio 
cannot survive in it. Careful supervision of food and drink; 
where cholera is prevalent, only cooked foods should be used. 
Food and drink after cooking or boiling should be protected 
against contamination, as by flies and human handling. 
EPIDEMIC MEASURES. Inspection service for early detection and 
isolation of cases; examination of persons exposed in infected cen- 
ters for detection of carriers, with isolation or control of carrier’s; 
cleaning of rooms occupied by the sick, and the detention, in suit- 
able camps for five days, of those desirous of leaving for another 
locality. Those so detained should be examined for detection of 
carriers. 
Information: 
ETIOLOGICAL AGENT. Cholera vibrio. 
SOURCE OF INFECTION. Bowel discharges and vomitus of infected 
persons and feces of convalescent or healthy carriers. Ten per cent 
of contacts may be found to be carriers. 
MODE OF TRANSMISSION. By food and water polluted by the in- 
fectious agent; by contact with infected persons, carriers, or articles 
freshly soiled by their discharges; by flies. 
INCUBATION PERIOD. One to five days, usually three days, occa- 
sionally longer if the healthy carrier stage, before development of 
symptoms, is included. 
8. COCCIDIOIDAL GRANULOMA (Valley Fever) 
Regulations: Reportable only. 
DISINFECTION. All discharges from skin lesions, necrotic lymph 
nodes, sputum and articles soiled therewith. 
Information: 
ETIOLOGICAL AGENT. Coccidioides immitis. 
SOURCE OF INFECTION. Soil and vegetation contaminated by dis- 
charges and with the spores of the micro-organism. 
MODE OF TRANSMISSION. Through wounds of the skin smeared 
with contaminated soil or vegetation, or the inhalation of spores 
from dried soil and vegetation. 
INCUBATION PERIOD. Not determined. 
PERIOD OF COMMUNICABILITY. As long as open lesions persist. 
IMMUNIZATION. None. 
Case fatality, nearly one hundred per cent. 28 
Rules and Regulations of the State Board of Health 
9. CONJUNCTIVITIS, ACUTE INFECTIOUS 
Regulations: 
PLACARD. None. 
ISOLATION. Exclusion of children from school and isolation until 
recovery is complete. 
QUARANTINE. None. 
DISINFECTION. Isolation procedures. Refer to Section 13. 
PROPHYLAXIS. Silver nitrate solution 1 per cent shall be placed in 
the eyes of the newborn immediately after birth. 
Recommendations: 
Carry out the measures indicated in methods of control for gonorrheal 
ophthalmia. 
Information: 
ETIOLOGICAL AGENT. The gonococcus or some member of a group 
of pyogenic organisms. 
SOURCE OF INFECTION. Discharges from the conjunctivae or 
adnexa or genital membranes of infected persons. 
MODE OF TRANSMISSION. Contact with infected persons or articles 
freshly soiled with discharges of such persons. 
INCUBATION PERIOD. Usually thirty-six to forty-eight hours. 
PERIOD OF COMMUNICABILITY. Until the discharges from the 
infected mucous membranes have ceased. 
10. CONJUNCTIVITIS, EPIDEMIC KERATOCONJUNCTIVITIS 
Regulations: 
PLACARD. None. 
ISOLATION. Exclusion of patient from occupation and isolation until 
recovery is complete. 
QUARANTINE. None. 
DISINFECTION. Strict isolation procedure. 
Recommendations: 
1. Particular cleansing of the hands of all persons treating or other- 
wise exposed to the disease, including physicians and nurses. 
2. Assignment of personal protective devices, such as respirators and 
goggles, to an individual for his exclusive use, (Such devices must 
be thoroughly sterilized before being assigned to another worker.) 
3. Isolation of infected patient, and instruction on hygienic measures 
to prevent spread to fellow workers and members of his family. 
4. Removal of infected patient from work until recovery from con- 
junctivitis is complete. 
Information: 
ETIOLOGICAL AGENT. Presumably a virus. 
SOURCE OF INFECTION. Contaminated objects—hands, goggles, 
respirator, and instruments; nasal and eye discharges of infected 
persons. Rules and Regulations of the State Board of Health 
29 
MODE OF TRANSMISSION. Contact with infected person, or articles 
freshly soiled with discharges of such person. 
INCUBATION PERIOD. Five to twelve days, average eight days. 
PERIOD OF COMMUNICABILITY. Until all evidence of inflamma- 
tion of the eyes has disappeared. 
11. DENGUE FEVER 
Regulations: 
PLACARD. “WARNING” placard during period of communicability 
and until mosquitoes have been destroyed. 
ISOLATION. Patient must be kept in a screened room during period 
of communicability. 
QUARANTINE. None. 
DISINFECTION. Isolation procedure; particular emphasis placed on 
screening. 
R ecommendations: 
Measures directed toward elimination of mosquitoes. 
Screening of rooms. 
Information: 
ETIOLOGICAL AGENT. A filterable virus. 
SOURCE OF INFECTION. Blood of infected persons. 
MODE OF TRANSMISSION. By bite of infected mosquito (aedes 
aegypti). 
INCUBATION PERIOD. Three to ten days. 
PERIOD OF COMMUNICABILITY. From the day before the onset 
to the fifth day of the disease. 
12. DIARRHEA AND ENTERITIS 
A. Of the newborn—under 1 year of age (epidemic) 
Regulations: 
PLACARD. None. 
ISOLATION. If in hospital or nursery, until recovery. 
QUARANTINE. None. Infants should not be admitted to a nur- 
sery in which diarrheal cases are being cared for. 
CONCURRENT DISINFECTION. Careful attention to aspetic 
technique involved in preparing formulae, sterilizing bottles and 
nipples. Proper refrigeration of prepared formulae. Careful 
isolation technique, with emphasis on hand washing with soap 
and warm water after handling each infant, particularly after 
diapering. 
Recommendations: 
Avoid diapering immediately preceding feeding time. 
Use individual containers of solution for cleansing breasts and 
avoid contamination of it. 30 
Rules and Regulations of the State Board of Health 
Nurseries are urged to use only completely equipped individual 
units, including a separate thermometer, for each infant. 
Criteria for diagnosis: 
Suspicious—more than one loose stool in one day. 
Definite case—loose stools persisting for two or more days. 
Laboratory examinations: 
Obtain cultures from supposedly sterilized nipples, bottles and 
formulae and cleansing solution used for breasts. 
Submit stool specimens for culture immediately upon suspicion. 
Information: 
ETIOLOGICAL AGENT. Variable. 
SOURCE OF INFECTION. Contaminated nipples, bottles, formu- 
lae or solution for cleansing breasts. 
INCUBATION PERIOD. One to seven days. 
MODE OF TRANSMISSION. The infection is usually not passed 
from infant to infant directly but more probably is transmitted 
through a common intermediate source. 
B. Etiology Undetermined—over 1 year of age, 
Regulations: 
PLACARD. None. 
ISOLATION. As in Section 13 for enteric disease. 
QUARANTINE. None. 
CONCURRENT DISINFECTION. Particular attention should be 
paid to hand washing with soap and warm water after contact 
with patient. Disinfect bowel discharges if open privy is used. 
Recommendations: 
Protect food from flies, use proper refrigeration. 
Eliminate flies by adequate screening and other methods. 
Information: 
ETIOLOGICAL AGENT. Variable. 
SOURCE OF INFECTION. Bowel discharges of infected persons. 
MODE OF TRANSMISSION. By drinking contaminated water, 
by eating infected foods, and by hand to mouth transfer of in- 
fected material; from objects soiled with discharges of an 
infected person; by flies, other insects and rodents. 
INCUBATION PERIOD. Commonly two to seven days. Occasion- 
ally longer. 
PERIOD OF COMMUNICABILITY. Until recovery. 
13. DIPHTHERIA 
Regulations: 
PLACARD. “QUARANTINE” placard. 
ISOLATION. Minimum period of fourteen days and until two suc- 
cessive cultui’es from the nose and two from the throat taken not 
less than 24 hours apart fail to show the presence of virulent diph- 
theria bacilli. Rules and Regulations of the State Board of Health 
31 
QUARANTINE. All intimate contacts until shown by bateriological 
examination not to harbor diphtheria bacilli or, if such are found, 
if they prove to be avirulent. Upon obtaining permission from the 
health officer, children and teachers may continue to attend school 
if a nose and throat culture is found to be negative: Provided, They 
are removed to another address where there are no children: And 
provided, They are kept under daily observation for five days 
following such removal. 
The wage-earner may be given permission by the health officer 
to continue his work: Provided, That two successive cultures from 
the nose and throat are negative, and that he moves to another 
address where there are no children. 
CARRIERS. 
(A) Contact carriers are to be quarantined and isolated in the 
same manner as a case, and efforts instituted to clear up the 
infection. 
(B) Casual carriers (not related to a case). Confirmatory labora- 
tory procedures for the identification of the diphthomorphic 
organisms must be carried out, and if found to be confirmed, 
a virulence test should be performed. Such a carrier must 
be isolated until the results of such laboratory work may be 
obtained. 
DISINFECTION. Strict quarantine and isolation procedure. Refer to 
Section 13. 
Recommendations; 
ACTIVE IMMUNIZATION of all children by end of first year of life 
without prior Schick testing. This same procedure should be 
applied to all children at or below six years of age if immunization 
has been neglected in infancy. 
PASTEURIZATION OF MILK. 
In treatment of a case, it is recommended that large doses of anti-toxin 
be used initially. The usual accepted minimum dose is 40,000 units. 
This dose will vary upward according to the severity of the disease 
and the size of the patient. Always check patient for horse-serum 
sensitization. 
VIRULENCE TEST. In the case of convalescent and contact carriers, 
the fact that the clinical disease is or was present in the presumed 
source of infection is presumptive evidence that the diphtheria 
bacilli recovered from such carriers are virulent. 
Experience has shown that such organisms remain virulent in the 
majority of cases for at least three months (if they persist that 
long). In view of this, virulence tests upon cultures should be con- 
fined to the following: 
1. Release-cases not less than six weeks after onset, and after 
treatment fails to clear the nose and throat of diphthomorphic 
organisms as shown by repeated cultures. 
2. Contacts which fail to respond to local treatment. 
3. Casual carriers that fail to respond to local treatment. 32 
Rules and Regulations of the State Board of Health 
4. If the virulence test is positive and organisms continue to per- 
sist, it is of little value to repeat the virulence test and cer- 
tainly not advisable to repeat it until at least four weeks after 
the specimen for the first virulence test was obtained. 
Information: 
ETIOLOGICAL AGENT. Diphtheria bacillus. 
SOURCE OF INFECTION. Discharges from diphtheritic lesions of 
nose, throat, conjunctiva, vagina and wound surfaces. Secretions 
from the nose and throat of carriers of the bacillus. 
MODE OF TRANSMISSION. By direct personal contact and by ar- 
ticles freshly soiled with discharges or through infected milk or 
milk products. 
INCUBATION PERIOD. Within seven days, usually less than four. 
PERIOD OF COMMUNICABILITY. Until virulent bacilli have dis- 
appeared from the secretions and lesions. 
IMMUNIZATION. Passive, with diphtheria anti-toxin; active, with 
toxoid. 
14. DYSENTERY, AMOEBIC 
Regulations: Reportable only. 
DISINFECTION of bowel discharges. 
INFECTED PERSONS AND CARRIERS are prohibited from handling 
milk or other foods. 
Recommendations: 
Boil drinking water unless known to be free from contamination. 
Protect water supply against contamination and supervise all foods 
eaten raw. 
Sanitary disposal of excreta. 
Location and supervision of carriers. 
Information: 
ETIOLOGICAL AGENT. Endamoeba histolytica. 
SOURCE OF INFECTION. Bowel discharges of infected persons. 
MODE OF TRANSMISSION. By drinking contaminated water and 
by eating infected material; from objects soiled with discharges 
of an infected individual, or of a carrier; by flies. 
PERIOD OF COMMUNICABILITY. During course of infection and 
until repeated microscopic examination of stools shows absence of 
the endamoeba histolytica (either trophozoites or cysts). Chronic 
cases and carriers are the chief sources of spread. 
13. DYSENTERY, BACILLARY (Shigella Group infections) 
Regulations: 
PLACARD. None. 
ISOLATION. Until bowel discharges are free from dysentery bacilli. 
QUARANTINE. None. Rules and Regulations of the State Board of Health 
33 
CONCURRENT DISINFECTION of bowel discharges. 
TERMINAL DISINFECTION. Thorough cleaning. 
SALE OF MILK from premises prohibited unless milking is per- 
formed and the dairy products and milking utensils are handled 
by persons entirely disassociated from the infected family, and the 
premises on which the family is confined. 
Recommendations: 
Rigid personal prophylaxis of attendants. Search for carrier's and 
proper control of same. Water supply supervision. Excreta dis- 
posed of in sanitary manner. Protection of patient and discharges 
against flies. 
Information: 
ETIOLOGICAL AGENT. Dysentery bacilli (Shigella group) 
SOURCE OF INFECTION. Bowel discharges of infected persons. 
MODE OF TRANSMISSION. By drinking contaminated water, by 
eating infected foods and by hand to mouth transfer of infected 
material; by objects soiled with discharges of an infected individual 
or of a carrier; by flies. 
INCUBATION PERIOD. Two to seven days. 
PERIOD OF COMMUNICABILITY. During the febrile period of the 
disease and until the organism is absent from the bowel discharges. 
IMMUNIZATION. Dysentery bacillus vaccine. (Seldom used.) 
16. ECHINOCOCCUS INFECTION 
Regulations: Reportable only. 
17. ENCEPHALITIS 
A. Lethargic (Vienna type, von Econoxno, Type A) 
Regulations: 
PLACARD. “WARNING” placard 
ISOLATION. During febrile stage of disease. 
QUARANTINE. None. 
DISINFECTION of discharges of nose and throat and articles soiled 
therewith. 
Recommendations: 
To differentiate type of encephalitis and to confirm diagnosis, it is 
advisable to submit blood specimens to a laboratory capable 
of performing tests for the identification of virus diseases. 
These specimens may be submitted through the Division of 
Laboratories of the State Department of Health. At least two 
specimens should be submitted, an early specimen (within the 
first week of illness), and a late specimen (about a month 
after recovery). 
Search for prior and unreported cases in the community. 34 
Rules and Regulations of the State Board of Health 
Information: 
ETIOLOGICAL AGENT. Probably a filterable virus. 
SOURCE OF INFECTION. Probably discharges from nose and 
throat of carriers or infected persons. 
MODE OF TRANSMISSION. Probably by direct contact with a 
carrier or infected person. 
INCUBATION PERIOD. Unknown. 
PERIOD OF COMMUNICABILITY. Unknown. Probably at a 
maximum during acute stage. 
The lethargic (Vienna) type is the most chronic and variable in 
course, often with a mild febrile onset, later with symptoms of 
brain or nerve involvement, such as slight meningeal irrita- 
tion, somnolence, restlessness, diplopia or evident paralysis of 
eye muscles, insomnia, twitching, myoclonia, catatonia, with 
or without fever; and still later at times, slow semi-rigid move- 
ments, coarse tremor, mask-like expression or other disturb- 
ances of motility, psychic or behavior disturbances, often with 
exacerbations and remissions over several years. 
B. Non-Lethargic (Equine Encephalomyelitis, St. Louis type, Japanese 
B type, Type B) Arthropod-borne. 
Regulations: 
PLACARD. “WARNING” placard. 
ISOLATION. During febrile stage of disease, in mosquito-proof 
quarters. 
QUARANTINE. None. 
Recommendations: 
1. Differentiate type of encephalitis and confirm diagnosis by sub- 
mitting blood specimens as indicated under Lethargic type 
“Recommendations.” 
2. Immunization of individuals whose work causes them to be 
exposed to mosquitoes and animals in endemic ai'eas. 
3. Eradication of mosquito-breeding places where possible. 
4. Proper screening of homes. 
5. In endemic areas where mosquitoes are prevalent, people 
should be advised to remain indoors or within screened quar- 
ters after sundown as the mosquito vector does not come out 
until then. 
6. Persons who cannot remain indoors during these hours should 
wear protective clothing or netting or use insect repellants. 
7. Enforce zoning restrictions to eliminate domestic stock and 
fowls in cities or villages in endemic areas. 
8. Vaccination of domestic animals and pets. 
Information: 
ETIOLOGICAL AGENTS. Certain specific filterable viruses. 
SOURCE OF INFECTION. Reservoir of infection in many animals 
and fowl, both wild and domestic. Rules and Regulations of the State Board of Health 
35 
MODE OF TRANSMISSION. By the bite of infected mosquitoes, 
principally the culex and aedes varieties. 
INCUBATION PERIOD. 4 to 21 days in St. Louis type. (Probably 
also applicable to other types.) 
PERIOD OF COMMUNICABILITY. Probably only during incuba- 
tion period. 
IMMUNIZATION. Available for Equine types. 
In the St. Louis type and western equine type, the onset is usually 
more abrupt as to fever and headache, with drowsiness rather 
than deep sleep, disorientation, motor disturbances but very in- 
frequent paralysis of the eye muscles. Meningeal irritation with 
an increase of cells in the spinal fluid more uniformly than in 
Vienna type, and usually complete and fairly prompt recovery 
in the non-fatal cases. 
The Eastern equine type has been a more severe and fatal disease 
in humans and is likely to leave nervous and mental sequellae in 
the patients who survive. 
C. Post-Febrile (Post-infectious, post-influenzal, post-vaccinal) 
Regulations: Reportable only. 
Information: 
This type of encephalitis follows or accompanies such infections 
as measles, influenza, chickenpox or vaccinia. The patient 
usually recovers after a short period of time. 
18. ERYSIPELAS 
Regulations: 
PLACARD. None. 
ISOLATION. Until recovery. 
QUARANTINE. None. 
CONCURRENT DISINFECTION of discharges from lesions and ar- 
ticles soiled therewith. 
TERMINAL DISINFECTION. Thorough cleaning. 
Recommendations: 
In hospitals (especially maternity) the isolation should be especially 
strict. 
Information: 
ETIOLOGICAL AGENT. Streptococcus haemolyticus. 
SOURCE OF INFECTION. Infected persons or carriers or articles 
freshly soiled with discharges from a case. 
MODE OF TRANSMISSION. Direct contact with a patient or articles 
soiled by discharges from a patient. Contact with a carrier. 
INCUBATION PERIOD. Two to seven days. 
PERIOD OF COMMUNICABILITY. Until recovery of patient and 
lesions have healed. 36 
Rules and Regulations of the State Board of Health 
19. FAVUS 
Regulations: 
PLACARD. None. 
ISOLATION. Until lesions have healed. 
QUARANTINE. None. 
CONCURRENT DISINFECTION of discharges from lesions and ar- 
ticles soiled therewith. 
TERMINAL DISINFECTION. Thorough cleaning. 
Recommendations: 
Elimination of common towels, hair brushes and combs 
Information: 
ETIOLOGICAL AGENT. Achorion schoenleinii fungus. 
SOURCE OF INFECTION. Discharges from lesions. 
MODE OF TRANSMISSION. Direct contact with patient; indirectly 
through contaminated articles. 
INCUBATION PERIOD. Unknown. 
PERIOD OF COMMUNICABILITY. Until lesions are healed as 
shown by the absence of scaling and erythema, to be confirmed by 
microscopic examinations and culture. 
IMMUNIZATION. None. 
20. FILARIASIS 
Regulations: Reportable only. 
Recommendations: Mosquito control. 
Information: 
ETIOLOGICAL AGENT. Wuchereria bancrofti in the United States. 
SOURCE OF INFECTION. Embryos circulating in the blood of in- 
fected persons. 
MODE OF TRANSMISSION. By various mosquitoes of which certain 
culex varieties and aedes variegatus are most notorious. 
INCUBATION PERIOD. A few months to many years. 
PERIOD OF COMMUNICABILITY. Not sooner than 9 months after 
exposure and indefinitely thereafter. 
IMMUNIZATION. None. 
21. FOOD INFECTIONS AND POISONINGS 
Regulations: Report only. 
Recommendations: 
Specimens of food suspected should be secured and used for labora- 
tory examination. 
The vomitus and feces of patients should be collected for bateriologi- 
cal and chemical examination. Rules and Regulations of the State Board of Health 
37 
Persons concerned with the preparation and serving of foods should 
be brought under observation for medical and bacteriological ex- 
amination to determine the possible origin, whether from bowel 
discharges or infections of the skin. 
Epidemiological inquiries should include particular study of water 
and milk used by the persons affected. 
Information: 
Outbreaks of food poisoning are produced in three general ways: 
I. Food Infections. By eating food containing bacteria which pro- 
duce the illness after growing and mutiplying following ingestion. 
This is produced by such bacteria as streptococci and other or- 
ganisms which are generally classified as the paratyphoid group 
(salmonella), and the dysentery bacilli (shigella). 
II. Food Intoxication. By eating food containing toxins that have 
been produced by certain bacteria that have contaminated the 
food. The difference here is that the bacterium itself does not pro- 
duce the illness, but the toxin that the bacteria have manufac- 
tured is responsible. This is produced by such organisms as cer- 
tain varieties of the staphylococcus and the botulinus bacillus. 
Another type of food intoxication is produced by eating cer- 
tain shell-fish which manufacture or contain a poison or toxin. 
III. Chemical Poisoning. By eating food contaminated with various 
poisonous chemicals, such as certain roach powdei’s, insecticides, 
etc. 
A detailed discussion of the characteristics of each of these types follows: 
I. Food Infections: 
(A) Those caused by certain organisms of the salmonella group. 
(1) Symptoms: Headache, nausea, vomiting, abdominal 
cramps and diarrhea. Frequently accompanied by some 
fever. Not all individuals react in the same way and the 
severity of the illness does not always depend upon the 
quantity of contaminated food eaten. In some cases the 
illness may be mild, while in others it may be severe 
enough to cause the death of the patient. The onset is 
usually sudden; as the attack progresses, the patient may 
become very weak, thirsty and drowsy. 
(2) Incubation Period: As a rule, from 12 to 24 hours elapse 
between the time the patient eats the contaminated food 
and the symptoms develop. However, symptoms some- 
times appear as early as 7 hours, or as late as 30 hours, 
after eating such food. The time factor is a valuable 
clue in determining the cause of the outbreak. 
(3) Common Sources of Infection: The bacteria that cause 
this disease also infect animals. Thus, if meat from an 
infected cow is eaten without being thoroughly cooked, 
it is capable of causing the infection in the person who has 
eaten it. It can be seen that eating raw or only partially 38 
Rules and Regulations of the State Board of Health 
cooked meat products (such as sausage), particularly such 
products that have been manufactured at home or on the 
farm, may lead to an outbreak of food poisoning if the 
meat was actually obtained from a diseased animal. 
Milk and cheese may also become contaminated with 
these organisms. Efficient pasteurization will destroy the 
bacteria and prevent the disease. However, if such con- 
taminated milk or cheese is consumed raw, the illness 
may develop. 
Other factors which may be responsible for the con- 
tamination of food supplies are, first, that rats and mice 
become infected with these organisms and excrete them 
in their droppings. If such infected rats or mice come 
into contact with food supplies, they are able to contami- 
nate them. Second, it is also known that flies are capable 
of conveying these bacteria and can infect food. 
(4) Investigation: Information must be obtained from the 
persons who have been made ill to determine the 
following: 
(a) At what places have they eaten during the preced- 
ing 12 to 36 hours; 
(b) How soon after their last meal did the onset of 
illness occur; 
(c) What foods were eaten during a period of from 12 to 
36 hours preceding the onset of illness; 
(d) What were the symptoms of the illness; 
(e) Had the persons who became ill been together as a 
group; 
(f) What factors are common to the majority of the 
group. 
The above information may point towards a common 
source of the illness and this cource must then be investi- 
gated. This may involve obtaining samples of suspected 
food, milk or water for laboratory examination, examina- 
tion of food handlers, general investigation of the sus- 
pected food-vending establishment, which would include 
such items as information in regard to how the food was 
prepared, source of the raw materials, what persons 
handled such materials, how many individuals were 
served each item, facilities and methods for dish-washing 
and refrigeration, source of milk and water supply, spe- 
cific history as to how certain food items were prepared 
or stored, search for presence of rodents and rodent 
poison, and a survey of the sanitary plumbing, including 
toilets, wash-bowls, and drains. 
(B) Those caused by the dysentery bacilli (Shigella group). 
(1) Symptoms: Begins with abdominal pain which seems to 
come on suddenly and is soon followed by diarrhea and 
fever. The illness may be mild or very severe and the 
mortality rate may be as high as 30%. Within 24-48 Rules and Regulations of the State Board of Health 
39 
hours after the onset the patient begins to pass blood and 
mucous in the stools. 
(2) Incubation Period: Onset of symptoms usually begins 
within 48 hours of ingestion of contaminated food, but 
may vary anywhere between 1 and 7 days. 
(3) Common Sources of Infection: Practically always from 
a human carrier, who may be actually ill or who has re- 
cently recovered. However, the organisms do not remain 
in the body very long after recovery and frequently are 
not obtained from stool cultures if there has been a delay 
of as short a period of time as two days after recovery; 
thus, it is highly important to obtain such specimens 
early. Flies are able to contaminate food if they have 
access to both food and infected stools, and probably this 
source of infection is of great importance in outbreaks 
occurring in poorly sanitated camps during the height of 
the fly season. 
(4) Investigation: General routine procedures must be fol- 
lowed as outlined under section 4 of paragraph “A” above. 
The specific etiologic diagnosis will depend upon recovery 
of the organism from stool specimens obtained from 
patients during the early stage of the illness. It will not 
always be possible to find the original source of the in- 
fection. An attempt to find this source must be directed 
primarily towards the examination of the food handlers 
involved. 
II. Food Intoxication: 
(A) Staphylococcus Food Poisoning; 
(1) Symptoms: Nausea, vomiting, retching, abdominal 
cramps, diarrhea, and headache. In severe cases the 
patient may be prostrated. Usually not fatal and re- 
covery takes place within 1 to 3 days. The degree of 
severity varies. 
(2) Incubation Period: Onset of symptoms usually begins 
within 2 to 3 hours after eating the infected food, but 
may be delayed as much as six hours. 
(3) Common Sources of Infection: Cured meat products, 
cold meats, cream-filled bakery products, or meringue- 
covered pies or layer cakes, cheese, gravies, hollandaise 
sauce, liver sausage, are some of the foods that have 
been incriminated. However, these foods have been in- 
fected by human beings. Persons recovering from colds, 
having a sore throat or sinus trouble, are known to con- 
vey the causative organism and are able to contaminate 
food by droplet infection. Food handlers, bakery cooks, 
pastry cooks and butchers having pimples and boils are 
able to contaminate their fingers with the organism and. 
in turn, contaminate the food. The organism grows well 40 
Rules and Regulations of the State Board of Health 
in the foods mentioned, particularly if they are not re- 
frigerated. 
Not all types of staphylococci are able to produce food 
poisoning. The special type that produces this illness has 
the ability to manufacture a toxin. It is this so-called 
“enterotoxin” that produces the illness. The detection 
of this toxin is a difficult laboratory procedure. How- 
ever, the characteristics of the food outbreak, affecting 
most of the people who consumed the incriminated food, 
and coming on after only a few hours, point to staphy- 
lococcus intoxication, provided chemical poisoning may 
be ruled out. 
(4) Investigation: Again routine procedures must be carried 
out. It will be important to have samples of the various 
items of food examined by the laboratory. The persons 
involved in the preparation or handling of the food should 
be examined, particularly for evidence of staphylococcic 
infections. 
(B) Botulism; 
(1) Symptoms: Usually begins with a feeling of weakness, 
accompanied by dizziness or headache (later thei'e may 
be visual disturbances such as drooping of lids, unsteady 
vision or double vision), difficulty in swallowing or talk- 
ing and, in some instances, difficulty in breathing. Gen- 
eral muscular weakness occurs quite early and the patient 
may not even be able to raise his arms. The patient re- 
mains mentally clear until a short time before death, if 
this occurs. If the patient survives for the first ten days 
of illness, he is apt to recover. In some cases, complete 
recovery is a matter of months. The death rate varies be- 
tween 50% and 85% on an average. 
(2) Incubation Period: The onset of symptoms occurs 
usually between 18 and 36 hours after eating the con- 
taminated food. However, they may begin as early as 
2 hours or as late as 8 days after this time. 
(3) Common Sources of Infection: Home-canned foods have 
been responsible for most cases. String beans, corn, 
spinach, beets, asparagus, olives, peas, figs, apricots, 
tomatoes, mushrooms, okra and pears have caused out- 
breaks. About 25% of the outbreaks have been due to 
home-canned meat products. 
(4) Investigation: It is necessary to obtain specimens of the 
suspected food. Unconsumed portions of the food are 
preferable. The empty container sometimes may be of 
use, or other cans from the same lot. A check should be 
made to learn if any of the suspected food has been fed 
to chickens or other domestic animals. If so, these may 
be observed for the effects of poisoning. Rules and Regulations of the State Board of Health 
41 
(C) Chemical Poisoning 
(1) Symptoms: Almost invariably the illness begins with 
nausea and vomiting, usually followed by abdominal 
cramps and diarrhea. 
(2) Incubation Period: The onset of symptoms is very sudden 
and very shortly after the poisoned food has been con- 
sumed—in some cases within 2 minutes and, as a rule, 
not longer than 30 minutes. 
(3) Common Sources of Poisoning: 
Antimony—Foods cooked in cheap, gray-enameled 
utensils 
Arsenic—Roach powders or fly-poison bait 
Cadmium—Usually acid drinks prepared in cadmium- 
plated utensils (lemonade, etc.) 
Fluoride—Roach or ant powder 
Lead—Paint, plumbing 
(4) Investigation: If a considerable number of individuals 
have been affected, a general routine investigation should 
be made with particular effort directed towards search 
for the source of the poison. 
22. GERMAN MEASLES 
Regulations: 
PLACARD. None. 
ISOLATION. For 48 hours after disappearance of rash and catarrh. 
QUARANTINE. None. 
CONCURRENT DISINFECTION of discharges from nose and throat 
and articles soiled therewith. 
TERMINAL DISINFECTION. Thorough cleansing. 
Recommendations: 
Careful differential diagnosis should be made between this disease and 
scarlet fever. 
Information: 
ETIOLOGICAL AGENT. Unknown. Presumably a filterable virus. 
SOURCE OF INFECTION. Secretions of mouth and nose. 
MODE OF TRANSMISSION. By direct contact with the patient or 
with articles freshly soiled with the discharges from the nose or 
throat of the patient. 
INCUBATION PERIOD. Fourteen to twenty-one days 
PERIOD OF COMMUNICABILITY. From the onset of catarrhal 
symptoms for at least four days, but not more than seven. 42 
Rules and Regulations of the State Board of Health 
23. GLANDERS 
Regulations: 
PLACARD. None. 
ISOLATION. Until lesions have healed. 
QUARANTINE. None. 
CONCURRENT DISINFECTION of discharges from lesions and ar 
tides soiled therewith. 
TERMINAL DISINFECTION. Thorough cleaning. 
Recommendations: 
Confirm diagnosis by laboratory tests. 
Skin contact with the lesions in the living or dead body should be 
scrupulously avoided. 
Information: 
ETIOLOGICAL AGENT. Pfeifferella mallei. 
SOURCE OF INFECTION. Discharges from open lesions of mucous 
membranes, or of the skin of human or equine cases (i. e., pus and 
mucous from the nose, throat, and bowel discharges from infected 
man or horse). 
MODE OF TRANSMISSION. Contact with a case or with articles 
freshly soiled by discharges from a human or equine case. 
INCUBATION PERIOD. Usually one to five days. 
PERIOD OF COMMUNICABILITY. Until causative bacilli disappear 
from discharges or until lesions have healed. 
24. GONORRHEA 
Regulations: 
PLACARD. None, provided that the patient is x’eceiving adequate 
medical treatment and is not exposing others to the infection. 
ISOLATION. None, provided that the patient is receiving adequate 
medical treatment and is not exposing others to the infection. 
QUARANTINE. None, provided that the patient is receiving adequate 
medical treatment and is not exposing others to the infection. 
CONCURRENT DISINFECTION of discharges from the lesions and 
articles soiled therewith. 
TERMINAL DISINFECTION. None. 
See PROPHYLAXIS Conjunctivitis, Acute Infectious, Regulation 9. 
Recommendations: 
See Special V. D. Regulations, Sections 19 and 20. 
Information: 
ETIOLOGICAL AGENT. Gonococcus. 
SOURCE OF INFECTION. Discharges from mucous membranes and 
glands of infected persons. Rules and Regulations of the State Board of Health 
43 
MODE OF TRANSMISSION. By direct contact with infected persons 
(usually sexual), and indirectly by contact with articles freshly 
soiled with discharges of such person. 
INCUBATION PERIOD. One to eight days. 
PERIOD OF COMMUNICABILITY. As long as the gonococcus per- 
sists in any of the discharges. 
IMMUNIZATION. None. 
25. GRANULOMA INGUINALE 
Regulations: 
PLACARD. None, provided that the patient is receiving adequate 
medical treatment and is not exposing others to the infection. 
ISOLATION. Exclusion of infected person from sexual contacts and 
from serving of food during period of communicability. 
QUARANTINE. None, provided that the patient is receiving adequate 
medical treatment and is not exposing others to the infection. 
DISINFECTION. Disinfection of discharges or articles soiled thex'e- 
with. 
Recommendations; 
See Special V. D. Regulations, Sections 19 and 20. 
Education in matters of sex hygiene and the nature of the communi- 
cability of the disease. 
Information: 
ETIOLOGICAL AGENT. Possibly so-called “Donovan bodies,” prob- 
ably protozoans, strictly tissue parasites of man. 
SOURCE OF INFECTION. Discharges from the lesions. 
MODE OF TRANSMISSION. Direct contact by skin and mucous 
membranes, most probably by sexual relations with infected per- 
sons, or articles soiled with discharge of lesions of such persons. 
The disease is commonly one of the negro. 
INCUBATION PERIOD. Probably from one to twelve weeks. Lo- 
calized area of induration is usually developed with softening 
noted in 35 to 46 days, followed by a gradual breakdown and 
ulceration. 
PERIOD OF COMMUNICABILITY. As long as there are open lesions 
on the skin or mucous membranes. 
IMMUNIZATION. None. 
26. IMPETIGO CONTAGIOSA 
Regulations; 
PLACARD. None. 
ISOLATION. Until lesions are healed 
QUARANTINE. None. 
CONCURRENT DISINFECTION of discharges from lesions and ar- 
ticles soiled therewith. 
TERMINAL DISINFECTION. None. 44 
Rules and Regulations of the State Board of Health 
Recommendations: 
Avoid use of common toilet articles among children. 
Prompt treatment to prevent extension to new sites. 
Information: 
ETIOLOGICAL AGENT. A variety of staphylococci or streptococci. 
SOURCE OF INFECTION. Lesions of the skin of an infected person. 
MODE OF TRANSMISSION. By direct contact with infected persons 
and indirectly with articles recently soiled by discharges from skin 
lesions of infected persons. 
INCUBATION PERIOD. Two to five days. 
PERIOD OF COMMUNICABILITY. Until lesions are healed. 
IMMUNIZATION. None. 
27. INFLUENZA 
Regulations: 
PLACARD. None, 
ISOLATION. During the acute stage of the disease. 
QUARANTINE. None. 
CONCURRENT DISINFECTION of discharges from the nose and 
throat of the infected person. 
TERMINAL DISINFECTION. None, 
Recommendations: 
During epidemics, efforts should be made to reduce opportunities for 
direct contact infection, as in crowded halls, stores, and streetcars. 
Kissing, the use of common towels, glasses, eating utensils or 
toilet articles should be avoided. In isolated towns and institu- 
tions infection has been delayed and sometimes avoided by strict 
exclusion of visitors from already infected communities. The 
closing of the public, parochial and private schools has not been 
effective in checking the spread of infection. The judicious use 
of masks by nurses and other attendants may prove of value in 
preventing infection in hospitals. Scrupulous cleanliness of dishes 
and utensils used in preparing and serving food in public eating 
places should be required, including the subjection of such articles 
to disinfection in hot soapsuds. In groups which can be brought 
under daily professional inspection, the isolation of early and sus- 
picious cases of respiratory tract inflammation, particularly when 
accompanied by a rise in temperature, may delay the spread of 
the disease. To minimize the severity of the disease and to protect 
the patient from secondary infections and thus reduce mortality, 
patients should go to bed at the beginning of an attack and not 
return to work without the approval of their physician. Crowding 
of beds in hospitals and institutions to accommodate increased num- 
bers of patients and other inmates is to be especially avoided. In- 
creased spacing between beds in wards and dormitories should be 
carried out to reduce the risk of attack, and of the occurrence of 
pneumonia. Rules and Regulations of the State Board of Health 
45 
Information: 
ETIOLOGICAL AGENT. A filterable virus. 
SOURCE OF INFECTION. Probably discharges from the mouth and 
nose of infected persons and articles freshly soiled by such dis- 
charges. 
MODE OF TRANSMISSION. Probably by direct contact, by drop- 
let infection, or by articles freshly soiled with discharges from 
nose and throat of infected persons. 
INCUBATION PERIOD. Two to thre days. 
PERIOD OF COMMUNICABILITY. Undetermined 
IMMUNIZATION. None. 
28. ICTEROHEMORRHAGIC JAUNDICE 
Regulations: 
Report only. 
Disinfection of urine. 
Recommendations 
Rat extermination. 
Rat-proofing of buildings 
Information: 
ETIOLOGICAL AGENT. Spirochaeta icterohemmorrhagiae. 
SOURCE OF INFECTION. The urine of rats, and articles, particu- 
larly food-stuffs, contaminated by rats. 
MODE OF TRANSMISSION. By ingestion of foods contaminated by 
rat urine or other rat discharges, and by contact with moist soil 
polluted by rat discharges where temperatures are moderate. 
INCUBATION PERIOD. Undetermined. 
PERIOD OF COMMUNICABILITY. As long as the urine of an in- 
fected person contains the infecting micro-organism which may 
continue for many weeks or several months. The wild rat to the 
extent of 10 to 40 per cent harbors the organism in the kidney 
and is a persistent carrier. 
29. LEPROSY 
Regulations: 
PLACARD. “WARNING” placard. 
ISOLATION. Until six months after lesions have healed. 
QUARANTINE. None. 
CONCURRENT DISINFECTION. Of discharges and articles soiled 
therewith. 
TERMINAL DISINFECTION. Thorough cleaning. 
Rec ommendations: 
Where at all practicable, lepers should be isolated in the National 
Leprosarium. Rules and Regulations of the State Board of Health 
Information: 
ETIOLOGICAL AGENT. Leprosy bacillus. 
SOURCE OF INFECTION. Discharges from lesions. 
MODE OF TRANSMISSION. Intimate and prolonged contact with 
infected individuals. 
INCUBATION PERIOD. From one to several years. 
PERIOD OF COMMUNICABILITY. Until lesions are healed. 
IMMUNIZATION. None. 
30. LYMPHOGRANULOMA VENEREUM 
Regulations: 
PLACARD. None, provided that the patient is receiving adequate 
medical treatment and is not exposing others to the infection. 
ISOLATION. Exclusion of infected persons from sexual contacts 
and from preparation and serving of food during period of com- 
municability. 
QUARANTINE. None, provided that the patient is receiving adequate 
medical treatment and is not exposing others to the infection. 
CONCURRENT DISINFECTION of discharges and articles soiled 
therewith. 
TERMINAL DISINFECTION. None. 
Recommendations: 
Education in matters of sex hygiene and the danger of transmitting 
the disease. 
Confirm diagnosis by Frei test. 
Information: 
ETIOLOGICAL AGENT. A specific filterable virus. 
SOURCE OF INFECTION. Discharges from lesions. 
MODE OF TRANSMISSION. Direct contact almost exclusively in 
sexual relations with infected persons, or indirectly by articles 
soiled with discharges from the lesions of such persons. 
INCUBATION PERIOD. One to four weeks. Glandular enlargement 
follows the initial lesion in one to two weeks. 
PERIOD OF COMMUNICABILITY. As long as there are open lesions 
of the skin or mucous membranes. 
IMMUNIZATION. None. 
31. MALARIA 
Regulations: 
PLACARD. None. 
ISOLATION. None except protection of patient from mosquitoes by 
screening bedroom or house until blood is rendered free from 
malaria parasites through treatment. 
QUARANTINE. None. Rules and Regulations of the State Board of Health 
47 
CONCURRENT DISINFECTION. None. Destruction of all mosqui- 
toes in the sickroom. 
TERMINAL DISINFECTION. Destruction of all mosquitoes in the 
sickroom. 
Recommendations: 
Mosquito abatement. 
Information: 
ETIOLOGICAL AGENT. Plasmodium vivax (tertian); Plasmodium 
malariae (quartan); Plasmodium falciparum (aestivo-autumnal). 
SOURCE OF INFECTION. Blood of an infected person. 
MODE OF TRANSMISSION. By bite of infected anopheles mosquito. 
INCUBATION PERIOD. Varies with type of plasmodium. 
PERIOD OF COMMUNICABILITY. As long as the sexual form of the 
malaria micro-organism exists in the patient’s blood in sufficient 
quantities to infect mosquitoes. 
IMMUNIZATION. None. 
32. MEASLES 
Regulations: 
PLACARD. “WARNING” placard at discretion of health officer. 
ISOLATION. Minimum of 5 days after appearance of rash and until 
all abnormal mucous discharges and rash have disappeared. 
QUARANTINE. None. 
CONCURRENT DISINFECTION of all articles soiled with secretions 
of nose and throat. 
TERMINAL DISINFECTION. Thorough cleaning. 
Recommendations: 
Daily examination of exposed children or other possibly exposed per- 
sons. Schools should not be closed or classes discontinued where 
daily observation of children by nurse or physician is provided for. 
Information: 
ETIOLOGICAL AGENT. A specific filterable virus. 
SOURCE OF INFECTION. Mouth and nose secretions. 
MODE OF TRANSMISSION. Direct contact with infected person, 
and indirectly through articles freshly soiled with nose and mouth 
discharges of infected person. 
INCUBATION PERIOD. Eight to fourteen days. 
PERIOD OF COMMUNICABILITY. Minimum nine days and until 
the cessation of abnormal mucous secretion. 
IMMUNIZATION. By convalescent measles serum. 48 
Rules and Regulations of the State Board of Health 
33. MENINGOCOCCUS MENINGITIS 
Regulations: 
PLACARD. “WARNING” placard. 
ISOLATION. For two weeks after onset. 
QUARANTINE. Wage-earner contact may continue to work pro- 
vided it does not bring him into close association with other per- 
sons and provided he is receiving prophylactic treatment. Chil- 
dren in the household must be confined to the premises for seven 
days from last exposure to the patient, or they may be removed 
from the household to be kept under observation and may return 
to school after three days of prophylactic treatment (sulfonamide 
therapy). Patients may be released from isolation earlier than two 
weeks by negative cultures of the nasopharynx if sulfonamide 
therapy is continued for the remainder of the two-week isolation 
period. 
DISINFECTION. Of all articles soiled with secretions of nose and 
throat. 
Recommendations: 
Associates and contacts should be treated prophylactically with sul 
fonamide drugs. 
Measures may be taken to prevent overcrowding in living quarters, 
working places and places of public assembly during epidemics at 
the discretion of the jurisdictional health officer. 
Information: 
ETIOLOGICAL AGENT. Meningococcus. 
SOURCE OF INFECTION. Discharge from the nose and throat of 
infected person and carriers. 
MODE OF TRANSMISSION. By direct contact with infected person 
and carriers and indirectly by contact with articles freshly soiled 
with the nose and throat discharges of such persons. 
INCUBATION PERIOD. Two to ten days. 
PERIOD OF COMMUNICABILITY. Until meningococcus is no longer 
present in the nose and throat. 
IMMUNIZATION. None. 
34. MUMPS 
Regulations: 
PLACARD. “WARNING” placard at discretion of health officer. 
ISOLATION. Until swelling of salivary or other glands has subsided. 
QUARANTINE. Children in the family who have not had the disease 
may be allowed to attend school at the discretion of the health 
officer and subject to daily inspection. 
CONCURRENT DISINFECTION of all articles soiled with secretions 
of nose or throat. (Refer to Section 13.) 
TERMINAL DISINFECTION. None. Rules and Regulations of the State Board of Health 
49 
Recommendations: 
Exposed susceptible persons should be regularly inspected for the on- 
set of the disease. 
Advise one week extra rest after isolation period for patients beyond 
adolescence. 
Information: 
ETIOLOGICAL AGENT. A specific filterable virus. 
SOURCE OF INFECTION. Discharge from nose and mouth of in- 
fected person. 
MODE OF TRANSMISSION. By direct contact with an infected per- 
son or with articles freshly soiled with the discharges from nose 
and mouth of such infected person. 
INCUBATION PERIOD. Twelve to twenty-six days. 
PERIOD OF COMMUNICABILITY. Unknown. 
IMMUNIZATION. None. 
35. PARATYPHOID FEVER A and B 
Regulations; Same as for Typhoid Fever Group. 
36. PLAGUE (Bubonic, Pneumonic and Septicemic) 
Regulations: 
PLACARD. “QUARANTINE” placard. 
ISOLATION. In a screened room which is free from vermin until 
convalescence is well established. 
QUARANTINE. Contacts of pneumonic cases, seven days. 
CONCURRENT DISINFECTION of all discharges and articles soiled 
therewith. 
TERMINAL DISINFECTION. Thorough cleaning followed by fumi- 
gation to destroy rats and fleas. 
Recommendations: 
Extermination of rats and other rodents 
Supervision of autopsies of all deaths during epidemics. 
Supervision of dead during epidemics. 
Information: 
ETIOLOGICAL AGENT. Plague bacillus. 
SOURCE OF INFECTION. Infected rodents and fleas and, in pneu- 
monic type, intensely communicable, by the sputum of infected 
persons. 
MODE OF TRANSMISSION. Direct, in pneumonic type and by bites 
of infected fleas in bubonic type. 
INCUBATION PERIOD. Three to seven days. 
PERIOD OF COMMUNICABILITY. Pneumonic type during acute 
symptoms. Bubonic type not communicable from person to person. 
IMMUNIZATION. Ordinarily not practicable. 50 
Rules and Regulations of the State Board of Health 
37. PNEUMONIA 
A. Acute Lobar 
Regulations: 
PLACARD. None. 
ISOLATION. Of patient during clinical course of the disease. 
QUARANTINE. None. 
CONCURRENT DISINFECTION of discharges from the nose and 
mouth of the patient. 
TERMINAL DISINFECTION. Thorough cleaning. 
Recommendations: 
Specific infecting organisms should be determined by serological 
and bacteriological tests early in the course of the disease, as 
this will give a basis for specific serum therapy. 
All attendants should be masked when caring for patients. 
Information: 
ETIOLOGICAL AGENT. Various pathogenic bacteria commonly 
found in the nose, throat and mouth, as the pneumococcus, the 
bacillus of Friedlander, the hemolytic streptococcus, the influ- 
enza bacillus, etc. 
SOURCE OF INFECTION. Probably discharges from the mouth 
and nose of an infected person or carrier and articles freshly 
soiled with such discharges. 
MODE OF TRANSMISSION. By direct contact with an infected 
person or carrier or articles freshly soiled with the discharges 
of the nose and throat of such persons, and possibly from in- 
fected dust of rooms occupied by infected persons. 
INCUBATION PERIOD. One to three days. 
PERIOD OF COMMUNICABILITY. Unknown. 
B. Acute Broncho-Pneumonia 
Regulations: 
PLACARD. None. 
ISOLATION of patient during clinical course of the disease. 
QUARANTINE. None. 
CONCURRENT DISINFECTION. Of discharges from the nose 
and mouth of the patient. 
TERMINAL DISINFECTION. Thorough cleaning. 
Recommendations: 
Specific infecting organisms should be determined by serological 
and bacteriological tests early in the course of the disease, as 
this will give a basis for specific serum therapy. Rules and Regulations of the State Board of Health 
51 
Information: 
ETIOLOGICAL AGENT. Various pathogenic bacteria commonly 
found in the nose, throat and mouth, as the pneumococcus, the 
bacillus of Friedlander, the hemolytic streptococcus, the influ- 
enza bacillus, etc. 
SOURCE OF INFECTION. Probably discharges from the mouth 
and nose of an infected person or carrier and articles freshly 
soiled from such discharges. 
MODE OF TRANSMISSION. By direct contact with an infected 
person or carrier or articles freshly soiled with the discharges 
of the nose and throat of such persons, and possibly from in- 
fected dust of rooms occupied by infected persons. 
INCUBATION PERIOD. One to three days. 
PERIOD OF COMMUNICABILITY. Unknown. 
C. Virus Pneumonia (Virus Pneumonitis) 
Regulations: 
PLACARD. None. 
ISOLATION of patient during clinical course of the disease. 
QUARANTINE. None. 
CONCURRENT DISINFECTION of discharges from the nose and 
mouth of the patient. 
TERMINAL DISINFECTION. Thorough cleaning. 
Recommendations: 
All attendants should be masked while caring for patient. 
Information: 
ETIOLOGICAL AGENT. Believed to be a filterable virus. 
SOURCE OF INFECTION. Probably same as for lobar pneumonia. 
MODE OF TRANSMISSION. Probably same as for lobar pneu- 
monia. 
INCUBATION PERIOD. Not known. 
PERIOD OF COMMUNICABILITY. Not known. 
38. POLIOMYELITIS (Infantile Paralysis) 
Regulations: 
PLACARD. “WARNING” placard. 
ISOLATION. For two weeks from date of onset in a room kept free 
of flies and other insects. Refer to Section 13, “Enteric Diseases.” 
QUARANTINE. Of children in household, and adults whose vocation 
brings them in contact with children or close association with 
other persons, or who are food handlers, for two weeks from last 
exposure to a recognized case. 
CONCURRENT DISINFECTION of nose and throat discharges and 
articles soiled therewith and of bowel discharges, with a strong 
oxidizing solution, for at least six hours before final disposal. 
TERMINAL DISINFECTION. Cleaning. 52 
Rules and Regulations of the State Board of Health 
Recommendations: 
Examination of spinal fluid. 
Early physical therapy. 
During epidemics the following measures are recommended: 
(1) Isolate all children ill with a fever pending definite diagnosis. 
(2) Encourage parents to restrict children to their own neighbor- 
hood and usual playmate contacts. 
(3) Advise people to avoid public gatherings and against unneces- 
sary travel. 
(4) Caution against nose and throat surgery during such periods. 
(5) Since the concentration of chlorine must reach a very high level 
before it is effective against the virus, it is not feasible to purify 
swimming pools and wading pools by chlorination. Therefore 
it is inadvisable to allow the use of such pools during epidemic 
periods. 
Information: 
ETIOLOGICAL AGENT. A specific filterable virus. 
SOURCE OF INFECTION. Not known definitely. Possibly nose, 
throat and bowel discharges of infected persons (cases or carriers), 
or contaminated food or drink (fecal contamination). The pos- 
sibility of an insect or other vector exists. 
MODE OF TRANSMISSION. Probably by direct contact with an in- 
fected person (presumably by droplet infection) or by fecal con- 
tamination of food or drink. 
INCUBATION PERIOD. Seven to fourteen days. 
PERIOD OF COMMUNICABILITY. Unknown. Apparently chiefly 
during the latter part of the incubation period and the first two 
weeks after clinical onset. The virus is recoverable from the feces 
for months after recovery from the disease. 
39. PSITTACOSIS 
Regulations: 
PLACARD. “WARNING” placard. 
ISOLATION. During febrile and acute clinical stage of the disease. 
QUARANTINE. Buildings which house birds shall be quarantined 
until thoroughly disinfected. 
CONCURRENT DISINFECTION. Of all discharges from infected per- 
sons. 
TERMINAL DISINFECTION. Thorough cleaning. 
R ecommendations: 
Education of community in the danger of making house pets of birds 
of the parrot family. 
Information: 
ETIOLOGICAL AGENT. Specific filterable virus 
SOURCE OF INFECTION. Infected parrots, parrakeets, love-birds 
or canaries. Rules and Regulations of the State Board of Health 
53 
MODE OF TRANSMISSION. Direct contact with infected birds or 
their recent surroundings. Occasionally a human case. 
INCUBATION PERIOD. Six to fifteen days. 
IMMUNIZATION. None. 
40. PUERPERAL INFECTION 
Reflations: 
PLACARD. None. 
ISOLATION. Of patients during clinical course of disease. 
QUARANTINE. None. 
CONCURRENT DISINFECTION of discharges, especially in hospitals 
and maternity homes. 
TERMINAL DISINFECTION. Thorough cleaning, especially in hos- 
pitals and maternity homes. 
Recommendations: 
Better education of physicians, nurses and midwives in the science 
and art of midwifery. 
Information: 
ETIOLOGICAL AGENT. Usually a hemolytic streptococcus. 
INCUBATION PERIOD. One to three days. 
PERIOD OF COMMUNICABILITY. Until complete recovery 
IMMUNIZATION. None. 
41. RABIES 
Regulations: 
PLACARD. None 
ISOLATION. None if patient is under adequate medical supervision. 
QUARANTINE. None. 
CONCURRENT DISINFECTION of saliva of patient and articles soiled 
therewith. Refer to Section 13. 
TERMINAL DISINFECTION. Thorough cleaning. 
Recommendations: 
Immediate antirabic treatment of all persons bitten by dogs or by other 
animals suspected or known to have rabies, regardless of local 
treatment. The wound from a rabid animal should be treated at 
once to the depths with tincture of green soap. 
Search for rabid animal, and for animals bitten by it. 
ANIMALS SUSPECTED OF HAVING RABIES SHOULD BE ISO- 
LATED FOR OBSERVATION A MINIMUM OF TEN DAYS. 
AFTER THIS PERIOD, SHOULD IT BECOME NECESSARY 
TO KILL THE ANIMAL, IT SHOULD NOT BE SHOT THROUGH 
THE HEAD. SHOOT THROUGH THE HEART. THE DEAD 
ANIMAL’S HEAD SHOULD BE PACKED IN ICE AND SENT TO 
THE STATE DEPARTMENT OF HEALTH LABORATORY, 54 
Rules and Regulations of the State Board of Health 
SEATTLE, FOR DIAGNOSIS. THE LOCAL LAW ENFORCE- 
MENT AGENTS SHOULD BE MADE ACQUAINTED WITH THIS 
RECOMMENDATION. 
Information: 
ETIOLOGICAL AGENT. A specific filterable virus. 
SOURCE OF INFECTION. Saliva of infected animals, chiefly dogs. 
MODE OF TRANSMISSION. Inoculation with saliva of infected ani- 
mals through abrasion of skin or mucous membrane, almost always 
by bites or scratches. 
INCUBATION PERIOD. Usually two to six weeks. May be pro- 
longed to six months or more. 
PERIOD OF COMMUNICABILITY. For fifteen days in the dog 
BEFORE the onset of clinical symptoms and throughout the clini- 
cal course of the disease. 
IMMUNIZATION. Preventive inoculation. 
42. RAT-BITE FEVER 
Regulations: 
Reportable only. 
Recommendations: 
Rat eradication. 
Information: 
ETIOLOGICAL AGENT. Spirochaeta morsus muris. 
SOURCE OF INFECTION. Bite of wild rat, cat, dog, weasel, ferret 
or bandicoot. 
MODE OF TRANSMISSION. During the bite, some of the animal's 
blood escapes from the injured or diseased buccal mucosa into the 
wound, or the conjunctival secretion of the animal may contami- 
nate the wound. 
INCUBATION PERIOD. Four to twenty-five days. 
PERIOD OF COMMUNICABILITY. Not transmitted from man to 
man. 
IMMUNIZATION. None. 
43. RELAPSING FEVER 
Regulations: 
Reportable only. 
Recommendations: 
Tick and louse eradication 
Information: 
ETIOLOGICAL AGENT. Spirochaeta recurrentis. 
SOURCE OF INFECTION. Ticks and lice. 
MODE OF TRANSMISSION. By tick or louse bite. Rules and Regulations of the State Board of Health 
55 
INCUBATION PERIOD. Average seven days. 
COMMUNICABILITY. From man to man is not apparent. 
IMMUNIZATION. None. 
44. RHEUMATIC FEVER 
Regulations: Reportable only. 
45. RING WORM (Dermatophytosis—Athlete’s Foot) 
Regulations: 
PLACARD. None. 
ISOLATION. Exclusion from gymnasiums and swimming pools. Ex- 
clusion from school in cases of ring worm of scalp. 
QUARANTINE. None. 
CONCURRENT DISINFECTION. Cleanliness of body and disinfec- 
tion of underclothing, and especially socks and towels and bedding 
TERMINAL DISINFECTION. None. 
Recommendations; 
Protection of feet against contamination in showers and dressing rooms 
and areas used by people with bare feet. The use of disinfecting 
solutions may prove useful in connection with common bathing 
and dressing rooms. 
Information: 
ETIOLOGICAL AGENT. Trichophyton. 
SOURCE OF INFECTION. Lesions on bodies of infected persons or 
articles carrying the fungus or its spores. 
MODE OF TRANSMISSION. Direct skin-to-skin contact with lesions 
of infected persons, and indirectly by articles of wearing apparel, 
towels, and bedding, or by surfaces contaminated by scurf or scal- 
ings of hair from lesions. 
INCUBATION PERIOD. Undetermined. 
PERIOD OF COMMUNICABILITY. As long as the fungus or its 
spores can be found at the site of the lesions. Transmission is easy 
in ordinary conduct of home or recreational pursuits, particularly 
those carried on indoors. 
IMMUNIZATION. None. 
46. ROCKY MOUNTAIN SPOTTED FEVER 
Regulations: 
PLACARD. None. 
ISOLATION. None. 
QUARANTINE. None. 
CONCURRENT DISINFECTION. All ticks on patient should be 
destroyed. 
TERMINAL DISINFECTION. None. 56 
Rules and Regulations of the State Board of Health 
Recommendations: 
Wearing of tick-proof clothing. 
Destruction of ticks. 
Destruction of small mammalian hosts of ticks, such as ground squir- 
rels, chipmunks and meadow mice in endemic areas. 
Immunization of persons who live, work, hunt or fish in endemic areas. 
Information: 
ETIOLOGICAL AGENT. Rickettsia rickettsi. 
SOURCE OF INFECTION. Ticks. 
MODE OF TRANSMISSION. Bite of infected tick or mashing in- 
fected tick on skin. 
INCUBATION PERIOD. Three to ten days. 
PERIOD OF COMMUNICABILITY, Not communicable from man. 
ACTIVE IMMUNITY. By Spencer-Parker vaccine. Available from 
the Rocky Mountain Laboratory, Hamilton, Montana. 
NOTE: TICK PARALYSIS. In connection with the bite of ticks of 
the Genus Ixodes and the Genus Dermacentor, a flaccid paralysis 
of the legs has been described. Children usually are affected, and 
curiously enough, if the tick is found and removed promptly, the 
child gets well within twenty-four hours; but if not, the paralysis 
may spread to the arms, stupor may come on, and the child may 
die of wide-spread paralysis. In adults sometimes there are pains, 
and erythematous rash and vertigo. This paralysis appears to be 
a toxic effect of the parasite and not an infection. 
47. SCARLET FEVER 
Regulations: 
PLACARD. “WARNING” or “QUARANTINE” placard may be used 
at the discretion of the jurisdictional health officer. 
ISOLATION. Cases are to be isolated until the end of the period of 
communicability. Uncomplicated cases may be released at the 
discretion of the jurisdictional health officer after disappearance of 
all symptoms. 
QUARANTINE. Teacher or child contacts are to be excluded from 
school, and food handlers are to be excluded from their work unless 
they are removed from the home of the case, or the case is removed 
from the home. If separated from the case, the contacts need not 
be excluded, provided there is a daily check for the development 
of signs or symptoms of scarlet fever made throughout the maxi- 
mum incubation period (seven days) following last exposure, 
and provided that it is possible to make this daily check in a man- 
ner satisfactory to the jurisdictional health officer. If this can not 
be complied with, the contacts are to be isolated in some place 
other than the household of the case for seven days from their last 
contact with said case. Rules and Regulations of the State Board of Health 
57 
CONCURRENT DISINFECTION. Of all articles which have been in 
contact with the patient or soiled with his discharges. (Refer to 
Section 13.) 
TERMINAL DISINFECTION. Thorough cleaning. Food handling 
restricted as specified in Section 14. 
Recommendations: 
DAILY EXAMINATION of exposed children and other possibly 
exposed persons for a week after last exposure. Encourage re- 
moval of young and susceptible contacts in the family to homes of 
adult friends for duration of communicable stage of the patient. 
SCHOOLS should not be closed where daily observation of the chil- 
dren by a physician or nurse can be provided. 
PASTEURIZATION of milk supply. 
LONG PERIOD OF CONVALESCENCE is recommended to avoid 
complications. 
Information: 
ETIOLOGICAL AGENT. A hemolytic streptococcus. 
SOURCE OF INFECTION. Discharges from the nose, throat, ears, 
abscesses or wound surfaces of sick or convalescent patients, and 
articles freshly soiled therewith. Carriers. 
MODE OF TRANSMISSION. Directly by contact with an infected 
person; indirectly by articles freshly soiled with discharges of an 
infected person, or through contaminated milk or milk products, 
not by desquamation. 
INCUBATION PERIOD. Two to seven days. Usually three to four. 
PERIOD OF COMMUNICABILITY. Until all abnormal discharges 
have ceased and all open sores or wounds have healed. 
IMMUNIZATION. Exposed susceptibles as determined by Dick test 
may be promptly passively immunized with scarlet fever anti- 
toxin, or actively immunized with scarlet fever toxin. 
Note: Scarlet fever and scarlatina are two names for the same disease. 
48. SCHISTOSOMIASIS (Swimmer’s Itch) 
Regulations: 
Reportable only. 
CONCURRENT DISINFECTION. Sanitary disposal of feces. 
TERMINAL DISINFECTION. Chemical and other treatment of in- 
fested waters to destroy snails. 
Recommendations: 
Regulation of sewage disposal. 
Cleansing of banks of infested water supplies to remove snail shelters 
Filtration of drinking water from infected sources. 58 
Rules and Regulations of the State Board of Health 
Information: 
ETIOLOGICAL AGENT. Animal parasites of the class Trematoda 
genus Schistosoma. 
SOURCE OF INFESTATION. Waters containing the intermediary 
molluscan host, contaminated by human excrement containing 
the ova of the parasite. 
MODE OF TRANSMISSION. Ova hatch in water and enter mollusc. 
In the mollusc they multiply and develop into larval forms called 
“cercariae” which, on leaving the mollusc penetrate the skin of 
man and certain animals drinking and coming in contact with 
water containing cercariae. 
INCUBATION PERIOD. Three to five weeks. May be within a few 
days following massive larval infestation. 
49. SEPTIC SORE THROAT 
Regulations: 
Same as for Scarlet Fever. See Paragraph 47, Section 22 
K ecommendations; 
Investigation of source of infection. Search for cases and carriers 
among milkers and other handlers of unpasteurized milk, and for 
mastitis in milk cows. 
Pasteurization of all milk. 
Exclusion of suspected milk supply from public sale or use until pas- 
teurized. 
Information: 
ETIOLOGICAL AGENT. Streptococcus (hemolytic type). The 
bovine type of streptococcus is not a cause of septic sore throat in 
human beings. 
SOURCE OF INFECTION. The human naso-pharynx, usually the 
tonsils, any case of acute streptococcus inflammation of these 
structures being a potential source of infection, including the 
period of convalescence of such cases. The udder of the cow in- 
fected by a milker is a common source of infection. In such 
udders, the physical signs of mastitis may be absent. 
MODE OF TRANSMISSION. Direct or indirect human contact, con- 
sumption of raw milk contaminated by case or carrier or from an 
infected udder. 
INCUBATION PERIOD. One to three days. 
PERIOD OF COMMUNICABILITY. In man, during continuance of 
clinical symptoms; in the cow, during the continuance of dis- 
charge of the streptococci in the milk. A carrier stage may follow 
convalescence. 
IMMUNIZATION. None. 
50. SILICOSIS 
Regulations: Reportable only. Rules and Regulations of the State Board of Health 
59 
51. SMALLPOX 
Reflations: 
PLACARD. "QUARANTINE” placard. 
ISOLATION. During period of communicability, preferably in hos- 
pital. 
QUARANTINE of all exposed persons for twenty-one days after last 
exposure, provided contacts may be released to take up residence 
elsewhere (a) when showing immunity reaction after being vac- 
cinated; and (b) if vaccinated within twenty-four hours after 
FIRST exposure, when vaccinia reaches height. 
CONCURRENT DISINFECTION. Thorough cleaning and disinfec- 
tion of premises. 
Recommendations: 
Careful differentiation from chicken pox. Tests for immunity may 
prove useful. 
General vaccination in early infancy and re-vaccination of children 
on entering school. 
Provision for free vaccination in time of epidemic 
Information: 
ETIOLOGICAL AGENT. A specific filterable virus. 
SOURCE OF INFECTION. Lesions of mucous membrane, and skin 
of infected persons. 
MODE OF TRANSMISSION. By direct personal contact; by articles 
soiled with discharges from lesions. The virus may be present in 
all body discharges including feces and urine. It may be carried 
by flies. 
INCUBATION PERIOD. Eight to sixteen days occasionally twenty- 
one days. 
PERIOD OF COMMUNICABILITY. From first symptoms to disap- 
pearance of all scabs and crusts. 
IMMUNIZATION. Vaccination. 
52. SYPHILIS 
Regulations: 
PLACARD. None, provided that the patient is receiving adequate 
medical treatment and is not exposing others to the infection. 
ISOLATION. Cases shall be isolated as long as there are open sores 
upon the body, provided, release from isolation may be permitted 
by the jurisdictional health officer. 
QUARANTINE. None, provided that the patient is receiving adequate 
medical treatment and is not exposing others to the infection. 
CONCURRENT DISINFECTION of discharges and of articles soiled 
therewith. 
TERMINAL DISINFECTION. None. 
See Special Regulations, Sections 19 and 20. 60 
Rules and Regulations of the State Board of Health 
Recommendations: 
Clinical symptoms should be confirmed by laboratory tests in every 
case. 
Information: 
ETIOLOGICAL AGENT. Treponema pallidum. 
SOURCE OF INFECTION. Discharges from the lesions of the skin 
and mucous membranes, the blood of infected persons, and articles 
freshly soiled with such discharges or blood. 
MODE OF TRANSMISSION. By direct personal contact with infected 
persons and indirectly by contact with discharges from lesions or 
with the blood of such persons, by sexual intercourse chiefly, and 
by kissing; congenitally from syphilitic mother through the 
placenta. 
INCUBATION PERIOD. About three weeks, minimum ten days; 
occasionally six weeks or longer. 
PERIOD OF COMMUNICABILITY. As long as lesions are open upon 
the skin or mucous membranes, and until the body is free from 
the infecting organism. 
53. TETANUS 
Regulations: Reportable only. 
Recommendations: 
Prophylactic use of tetanus anti-toxin where wounds have been ac- 
quired in regions where the soil is known to be heavily contami- 
nated, and in all cases where wounds are ragged and penetrating. 
Tetanus toxoid may be used for active immunization. 
Information: 
ETIOLOGICAL AGENT. Tetanus bacillus. 
SOURCE OF INFECTION. Animal manure, human feces, soil, and 
street dust. 
MODE OF TRANSMISSION. Wound infection. 
INCUBATION PERIOD. Commonly four days to three weeks, de- 
pendent somewhat upon the character, extent and location of the 
wound. Longer periods of incubation have been noted. Subse- 
quent operative interference or local tissue changes may initiate 
the activity of quiescent bacilli at even lengthy intervals after the 
original wound infection. 
PERIOD OF COMMUNICABILITY. Patient not infectious except in 
rare instances where wound discharges are infectious. 
IMMUNIZATION. Ordinarily a subcutaneous injection of tetanus 
anti-toxin (1,500 units) given on the day of the wound. A second 
injection within ten days may be desirable in certain instances. 
Artificial passive immunity for about ten days from use of tetanus 
anti-toxin. 
Active immunity by tetanus toxoid. Rules and Regulations of the State Board of Health 
61 
54. THRUSH (Mycotic or Parasitic Stomatitis) 
Regulations: 
PLACARD. None. 
ISOLATION. Strict isolation of all infants until lesions in the mouth 
are healed. 
QUARANTINE. None 
DISINFECTION. See Upper Respiratory section on isolation pro- 
cedure—Section 13. 
Recommendations: 
Thrush is more readily prevented than removed. The child’s mouth 
should be scrupulously clean, and, if artificially fed, the bottle 
should be thoroughly sterilized. Lime water, or two per cent solu- 
tion of sodium bicarbonate, may be employed for a rinsing of the 
bottles. 
Gastro-intestinal upsets of infants should be given care, as this is one 
of the more important predisposing causes. 
Careful sterilization of all ai’ticles coming in contact with the child’s 
mouth must be carried out. 
Information: 
ETIOLOGICAL AGENT. Oidium (monilium) albicans, a member of 
the yeast fungi group. Miscroscopic examination shows the pres- 
ence of a characteristic fungus in the whitish membrane on the 
tongue and in the mouth. 
SOURCE OF INFECTION. Discharges from mouth of infected infant. 
MODE OF TRANSMISSION. Contact with infected infant or articles 
freshly soiled with their mouth discharges. Most commonly trans- 
mitted by dirty feeding bottles, food, etc. 
INCUBATION. Unknown. 
PERIOD OF COMMUNICABILITY. Until all lesions on the tongue 
and in the mouth have healed. 
55. TRACHOMA 
Regulations: 
PLACARD. None. 
ISOLATION. Exclusion of all cases from school and restriction to 
their home premises until a minimum course of accepted treat- 
ment has been administered, followed by a re-examination by the 
jurisdictional health officer. The patient may be released from 
isolation when such re-examination does not reveal the presence 
of a purulent discharge from the conjunctiva or adnexed mucous 
membranes or other evidence indicating infectivity. 
QUARANTINE. None. 
CONCURRENT DISINFECTION. Of discharges and articles soiled 
therewith. 
TERMINAL DISINFECTION. None. 62 
Rules and Regulations of the State Board of Health 
R ecommendations: 
(A) Since the results of treatment do not become apparent until a 
considerable period of time has elapsed after its administration 
it is impossible for the health officer to determine whether the 
case is still infectious immediately after completion of such treat- 
ment. To assist the health officer in controlling these cases, the 
following recommendations are made: 
1. The minimum course of treatment should be carried out as 
recommended by the Indian Service and the ophthalmologists 
concerned with the Trachoma Program of the Division for 
the Blind of the Department of Social Security. 
2. Modified isolation and exclusion from school for thirty days 
to be followed by a five-month period of parole for ob- 
servation, during which time the patient must return to the 
the ophthalmologist monthly for re-examination. 
3. At the conclusion of this six-month period, if in the judg- 
ment of the opthalmologist the disease has reached the stage 
of arrest or cure, the patient may be released from parole, 
but must be re-examined annually. 
4, At any time the case is re-examined and found to be in an 
active state according to the judgment of the opthalmologist, 
the patient is again subject to isolation and exclusion from 
school. 
(B) Annual survey of school children in areas of prevalence. 
(C) Educational efforts in communities involved, directed towards 
acquainting the public with the nature of the disease, its method 
of spread, and the character of its treatment. 
(D) Follow-up of cases, directed towards urging adults in the homes 
of cases, to submit to examination and, if necessary, care for 
trachoma and to observe proper hygienic precautions in regard 
to this disease. 
Information: 
ETIOLOGICAL AGENT. Undetermined. 
SOURCE OF INFECTION. Secretions and purulent discharges from 
the conjunctivae and adnexed mucous membranes of infected 
persons. 
MODE OF TRANSMISSION. By direct contact with infected persons 
and indirectly by contact with articles freshly soiled with the 
infective discharges of such persons. 
PERIOD OF COMMUNICABILITY. During persistence of lesions of 
conjunctivae and of adnexed mucous membranes or of discharges 
from such lesions. 
IMMUNIZATION. None. 
56. TRICHINOSIS 
Regulations: Reportable only. 
DISINFECTION. Sanitary disposal of feces. Rules and Regulations of the State Board of Health 
6 3 
Recommendations: 
Thorough cooking of all pork products at a temperature of 160 degrees 
F. or over. 
Refrigeration of pork at 5 degrees F. for twenty days before sale. 
Extermination of rats around meat shops, slaughter houses and hog 
pens. 
Information: 
ETIOLOGICAL AGENT. Trichinella spiralis. 
SOURCE OF INFECTION. Insufficiently cooked pprk, rarely meat of 
other animals. 
MODE OF TRANSMISSION. Direct from meat to man through con- 
sumption of under-cooked infected pork products. 
INCUBATION PERIOD. About one week. 
PERIOD OF COMMUNICABILITY. Not transmitted from man to 
man. 
IMMUNIZATION. None. 
57. TUBERCULOSIS 
A. Pulmonary 
Regulations: 
PLACARD. None, unless “open” case refuses to observe precau- 
tions to prevent spread of disease, in which event the jurisdic- 
tional health officer may use a “WARNING” or a “QUARAN- 
TINE” placard. 
ISOLATION. Of such “open” cases as do not observe the pre- 
cautions to prevent the spread of the disease. 
QUARANTINE. None, unless the jurisdictional health officer 
deems it necessary in the interest of protection of the public, 
in uncooperative cases who refuse to observe precautions recog- 
nized as necessary to prevent the spread of this disease. 
CONCURRENT DISINFECTION. Of sputum and articles soiled 
therewith. Particular attention shall be paid to prompt dis- 
infection or disposal of the sputum itself, of handkerchiefs, 
cloths or papers soiled therewith, and the eating utensils 
used by the patient. 
TERMIAL DISINFECTION. Thorough cleaning and aeration. 
EXAMINATION OF PERSONS SUSPECTED OF BEING TU- 
BERCULOUS. In order to prevent the dissemination of tuber- 
culosis, the state, county or municipal health officers, or their 
respective deputies, who are licensed physicians, within their 
respective jurisdictions, are hereby directed and empowered, 
when in their judgment it is necessary to protect the public 
health, to make adequate examination of persons reasonably 
suspected of being tuberculous. It shall be the duty of local and 
state health officers to investigate thoroughly the sources of 
infection of tuberculosis within their jurisdiction. 64 
Rules and Regulations of the State Board of Health 
Recommendations: 
Provision of adequate sanatorium care for all active cases. 
Examination of contacts of known cases. 
Follow-up of arrested cases. 
Separation of minors from parents with active tuberculosis. 
Information: 
ETIOLOGICAL AGENT. Mycobacterium tuberculosis (Hominis). 
Occasionally the bovine type. 
SOURCE OF INFECTION. Sputum, discharges from open tuber- 
culosis lesions, discharges from the intestinal and genito- 
urinary tracts, or from lesions of the lymph nodes, bone and 
skin, and articles soiled with any of the aforesaid discharges. 
MODE OF TRANSMISSION. Usually through the discharges of 
the respiratory tract, occasionally through those of the diges- 
tive tract, by direct or indirect contact with infected persons, 
by means of coughing, sneezing or other droplet infection, by 
kissing, by the use of contaminated eating and drinking utensils, 
and possibly by contaminated flies and dust. Infection rarely 
occurs from casual contacts, but usually results from the con- 
tinued type of exposure characteristic of family relationships. 
INCUBATION PERIOD. Variable, and dependent upon the type 
of the disease. 
PERIOD OF COMMUNICABILITY. Exists as long as the specific 
organism is eliminated by the host. 
IMMUNIZATION. None. 
B. Other than Pulmonary 
Regulations: Reportable only. 
58. TULAREMIA 
Regulations: 
PLACARD. None. 
ISOLATION. None. 
QUARANTINE. None. 
CONCURRENT DISINFECTION. Of discharges from the ulcer, lymph 
glands or conjunctival sac. 
TERMINAL DISINFECTION. None. 
Recommendations: 
Use of rubber gloves by persons engaged in dressing small wild ani- 
mals wherever taken. 
Thorough cooking of meat of small wild animals. 
Information: 
ETIOLOGICAL AGENT. Pasteurella tularensis. 
SOURCE OF INFECTION. Wild rabbits and hares, horse-fly 
(Chrysops discalis), wood tick (Dermacentor andersoni and Der- 
macentor variabilis), woodchuck, coyote, muskrat, opossum, tree Rules and Regulations of the State Board of Health 
65 
squirrel, quail, skunk, water rats, cat, deer, dog, fox, hog, sage 
hen, and bull snake. 
MODE OF TRANSMISSION. By bites of infected flies and ticks and 
by inoculation through handling infected animals, or by fluids from 
infected flies, ticks or animals. 
INCUBATION PERIOD. Twenty-four hours to ten days, average 
slightly more than three days. 
PERIOD OF COMMUNICABILITY. There is no authentic record of 
transfer of the disease from man to man. The infection has been 
found in the blood of man during the first two weeks of the 
disease; in conjunctival scrapings up to seventeen days; in the 
primary lesions on the finger up to twenty-one days; in the sputum 
on the twelfth day; in lymph glands up to five months; in ascitic- 
fluid (taken during life), three months after onset; in pleural 
fluid four* months after onset; in spinal fluid sixteen days after 
onset; in the spleen, taken at autopsy, up to thirty days. Flies are 
infective for fourteen days; ticks throughout their lifetime. Re- 
frigerated rabbits kept constantly frozen at minus -15 degrees C. 
may remain infective for three years. 
IMMUNIZATION. None. 
59. TYPHOID FEVER GROUP (Typhoid Fever, Paratyphoid Fever A 
and B) 
Regulations: 
PLACARD. “WARNING” placard. 
ISOLATION. In a fly-proof room. Release from isolation shall be 
determined by three successive negative cultures of feces and 
urine specimens collected not less than 24 hours apart and no 
sooner than 2 weeks after the temperature of the patient has re- 
turned to normal. Specimens submitted should be either semi- 
solid or liquid. A saline cathartic should be administered if neces- 
sary. 
CARRIERS. Definitions: Convalescent—up to three months after 
cessation of fever. Temporary—from three months to one year 
after cessation of fever. Chronic—after one year following cessa- 
tion of fever. 
(A) Convalescent. If the causative organism is recovered from 
cultures obtained from the patient within two weeks after 
cessation of fever, the patient is to be restricted as a con- 
valescent carrier within the following limitations: 
1. He may not leave the jurisdiction of the local health 
officer, except by permission from such health officer. 
2. He may not engage in any occupation which involves the 
personal handling of food, milk or milk products or any 
beverage. 
3. He must continue to dispose of his excreta in a manner 
specified by the health officer. 66 
Rules and Regulations of the State Board of Health 
A second series of specimens is to be submitted ten weeks 
after the first series, if a positive result was obtained in the 
first. If the causative organism is again recovered in the 
second series, the patient is to be classified as a temporary 
carrier, subject to the restrictions stated above. 
(B) Temporary. A temporary carrier shall remain under the same 
restrictions imposed on a convalescent carrier. A series of 
specimens for release may be submitted every three months 
during this period. 
(C) Chronic. If in a series of three specimens submitted in the 
same manner as specified under “Isolation” above, one year 
after cessation of fever, the causative organism is isolated, 
the patient is classified as a chronic carrier and is then sub- 
ject to parole. He then may be given a limited release by 
the jurisdictional health officer upon signing an agreement 
to abide by the regulations of such restrictions. Copies of the 
forms of these agreements are to conform with that specified 
and supplied by the State Department of Health, which shall 
include the following provisions: 
1. The carrier shall agree not to have any part in the prepara- 
tion, serving or handling of food which may be consumed 
by any person other than members of his immediate 
family; nor shall he be engaged in any occupation which 
brings him in contact with milk, milk products, milk 
bottles, or milk utensils; nor shall he participate in the 
management of a dairy or other milk-distributing plant, 
boarding house, restaurant, food store, or any place where 
food is prepared or served; nor shall he x'eside on the 
premises of any such food-handling establishment or 
dairy. 
2. The carrier shall agree to wash his hands thoroughly 
with soap and water after using the toilet and before 
handling food in his home. 
3. If the premises on which the carrier resides is provided 
only with an outdoor privy, the carrier shall have on hand 
at all times an adequate supply of quicklime and use it as 
instructed. The privy shall be kept at all times in a sani- 
tary condition and screened against flies. 
4. The carrier shall keep the local health officer informed at 
all times of his address and occupation, and notify the 
health officer at once of any contemplated change in his 
address or occupation. 
5. The carrier shall communicate with the health officer be- 
fore submitting to any type of treatment intended for the 
cure of the carrier condition. 
6. The carrier shall report to the health officer immediately 
any cases of illness suggestive of typhoid or dysentery in 
his family or among his immediate associates. Rules and Regulations of the State Board of Health 
Any person whose feces or urine contains typhoid bacilli but 
who gives no history of recently having had the disease shall 
also be classified as a chronic carrier and shall be subject to 
the same regulations as stated above. 
(D) Follow-up. The jurisdictional health officer or his authorized 
representative shall visit each chronic carrier at least twice 
each year to check on the address, occupation and other ac- 
tivities of the carrier, and to determine if all instructions are 
being carried out; and a report of such investigation shall be 
forwarded to the State Department of Health. 
(E) Release of Chronic Carriers. Such carriers may be released 
following eight successive negative feces and urine specimens 
each submitted one month apart. 
(F) Authenticity of Specimens. All specimens submitted for re- 
lease examination shall be obtianed under the supervision of 
the health officer, under such conditions that he will be able 
to certify that they are the authentic specimens of the in- 
dividual being examined. 
CONCURRENT DISINFECTION. Of all bowel and urinary dis- 
charges and articles soiled therewith. 
TERMINAL DISINFECTION. Cleaning. 
Recommendations: 
Protection and purification of water supplies. 
Pasteurization of milk supplies. 
Supervision of food supplies and of food handlers 
Prevention of fly breeding. 
Sanitary disposal of human excreta. 
Extension of immunization by vaccination, as far as practicable, in 
communities where the disease is prevalent. 
Information: 
ETIOLOGICAL AGENT. Typhoid fever; Eberthella typhi, para- 
typhoid fever, A or B; Salmonella paratyphi; Salmonella schott- 
mulleri. 
SOURCE OF INFECTION. Bowel discharges and urine of infected in- 
dividuals. Healthy carriers are common. 
MODE OF TRANSMISSION. Conveyors of the specific micro-or- 
ganism by direct or indirect means are contaminated water, milk, 
shellfish and flies. 
INCUBATION PERIOD. Three to thirty-eight days, usually seven to 
fourteen days. 
PERIOD OF COMMUNICABILITY. From the appearance of pro- 
domal symptoms, throughout the illness and relapses during con- 
valescence and until repeated bacteriological examinations of the 
discharges show persistent absence of the infecting organism. 
IMMUNIZATION. Of susceptibles in the family or household of 
patients who have been exposed or may be exposed during the 
course of the disease. 68 
Rules and Regulations of the State Board of Health 
60. TYPHUS FEVER 
Regulations; 
PLACARD. “QARANTINE” placard. 
ISOLATION. In vermin-free room. 
QUARANTINE. Of contacts for fourteen days after delousing follow- 
ing last exposure. 
CONCURRENT DISINFECTION. Destroy all lice and louse eggs on 
the clothing and in the hair of the patient. 
TERMINAL DISINFECTION. Fumigation of premises to exterminate 
all rodents, fleas and lice. 
Recommendations: 
Elimination of rats. 
Delousing of persons, clothing and premises 
Information: 
ETIOLOGICAL AGENT. Rickettsia prowazeki is believed to be the 
causative agent. 
SOURCE OF INFECTION. The only known source is the blood of 
infected persons or of infected rats. 
MODE OF TRANSMISSION. The infectious agent is transmitted from 
man to man by lice (pediculus corporis), and from rat to rat or 
man by fleas (xenopsylla cheopis). 
INCUBATION PERIOD. Five to twenty days, most often twelve days. 
PERIOD OF COMMUNICABILITY. In the presence of lice, highly 
communicable until thirty-six hours have elapsed after the tem- 
perature reaches normal. 
IMMUNIZATION. Methods not yet available for general application. 
61. UNDUE ANT FEVER (Brucellosis) 
Regulations; 
PLACARD. None. 
ISOLATION. For duration of acute symptoms 
QUARANTINE. None. 
DISINFECTION. Of body excretions as prescribed under Section 13, 
“Enteric Diseases.” 
Recommendations: 
Pasteurization of milk, whether from goats or cows 
Elimination of infected animals from herds. 
Information: 
ETIOLOGICAL AGENTS. Brucella melitensis (goat), Brucella abor- 
tus (cattle), Brucella suis (swine). 
SOURCE OF INFECTION. Tissues, blood, milk and urine of infected 
animals, especially goats, cattle and swine. Also from human 
excretions during acute stage of illness. Rules and Regulations of the State Board of Health 
69 
MODE OF TRANSMISSION. Drinking of milk from infected ani- 
mals and by direct contact with infected humans (during acute 
stage), animals or animal products. 
INCUBATION PERIOD. Six to thirty days or longer. 
PERIOD OF COMMUNICABILITY. In man, only during acute stage 
of systemic infection. 
IMMUNIZATION. None 
62. VINCENT’S INFECTION 
Regulations: 
PLACARD. None. 
ISOLATION. Exclusion from school and common eating facilities 
unless under active treatment. 
QUARANTINE. None. 
DISINFECTION. All discharges from nose and mouth. 
Recommendations: 
Sterilization of eating and drinking utensils, especially in public 
places. More attention to proper nutrition, with an adequate in- 
take of vitamins. 
Information: 
ETIOLOGICAL AGENT. Possibly the dual effect of the treponema 
vincenti plus the bacillus fusiformis in the presence of predisposing 
conditions such as inadequate nutrition and poor oral hygiene. 
SOURCE OF INFECTION. Discharges from the lesions of infected 
persons and from carriers. 
MODE OF TRANSMISSION. Direct contact with infected persons or 
carriers and probably by articles freshly soiled by such persons. 
INCUBATION PERIOD. Variable and undetermined. 
PERIOD OF COMMUNICABILITY. As long as the infecting organism 
is found in the mouth. 
IMMUNIZATION. None. 
63. WHOOPING COUGH (Pertussis) 
Regulations: 
PLACARD. “WARNING” placard at discretion of jurisdictional health 
officer. 
ISOLATION. Separation of patient from susceptible children and ex- 
clusion from school and public places for period of communi- 
cability. 
QUARANTINE. Limited to the exclusion of susceptible children from 
school and public gatherings for ten days beginning 7 days after 
their first exposure to a recognized case. During period of com- 
municability, insusceptible children may be released by the juris- 
dictional health officer to attend school. Rules and Regulations of the State Board of Health 
CONCURRENT DISINFECTION. Discharges from the nose and throat 
of the patient and articles soiled with such discharges. 
TERMINAL DISINFECTION. Cleaning. 
Recommendations: 
EDUCATION as to the dangerous nature of this disease. 
IMMUNIZATION of all children in home over six months of age. 
Information: 
ETIOLOGICAL AGENT. Hemophilus pertussis. 
SOURCE OF INFECTION. Discharges from the laryngeal and bron- 
chial mucous membranes of infected persons. 
MODE OF TRANSMISSION. Contact with an infected person or with 
articles freshly soiled with discharges of such person. 
INCUBATION PERIOD. Seven to ten days and not exceeding sixteen 
days. 
PERIOD OF COMMUNICABILITY. Particularly communicable in 
the early catarrhal stage before the characteristic whoop makes 
a clinical diagnosis possible. After the characteristic whoop has 
appeared, the communicable period continues for at least three 
weeks. The communicable stage must be considered to extend 
from seven days after exposure to three weeks after the develop- 
ment of the characteristic whoop. A positive diagnosis may be 
made by bacteriological examination of laryngeal discharges as 
early as one week before development of the characteristic whoop. 
IMMUNIZATION. Recommended for all children in the home over 
six months of age. 
64. YELLOW FEVER 
Regulations: 
PLACARD. “WARNING” placard. 
ISOLATION. From mosquitoes in thoroughly screened room. Iso- 
lation necessary only for first four days of fever. 
QUARANTINE. None. 
CONCURRENT DISINFECTION. Thorough destruction of mosquitoes. 
TERMINAL DISINFECTION. None, except for destruction of mos- 
quitoes by gaseous fumigation. 
Recommendations: 
Mosquito eradication. 
Information: 
ETIOLOGICAL AGENT. A specific filterable virus. 
SOURCE OF INFECTION. Blood of infected persons. 
MODE OF TRANSMISSION. Bite of infected aedes aegypti mos- 
quitoes. 
INCUBATION PERIOD. Three to six days. 
PERIOD OF COMMUNICABILITY. First three days of fever. 
IMMUNIZATION. By modified living virus and human immune 
serum. INDEX 
Actinomycosis 23 
Amebic dysentery 32 
Ancylostomiasis (hookworm) 23 
Aniline poisoning 9 
Anterior poliomyelitis 51 
Anthrax 24 
Arsenic poisoning 9 
Ascariasis (round worm infestation) 24 
Bacillary dysentery 32 
Barbers and cosmeticians 19 
Benzine poisoning 9 
Benzol poisoning 9 
Bisulphide of carbon poisoning 9 
Botulism 40 
Brass poisoning 9 
Brucellosis 68 
Burial and funerals 22 
Carbonmonoxide poisoning 9 
Chancroid 19, 20, 25 
Chickenpox 25 
Cholera 26 
Coccidiodal granuloma 27 
Conjunctivitis, acute Infectious 28 
Conjunctivitis, acute kerato 28 
City health officers, duties, etc - 5,7,10 
Common carriers I6 
County health officers, duties, etc 5,6,7,10 
Definitions 12 
Dengue fever 29 
Dinitrobenzine poisoning 9 
Diarrhea and enteritis—of newborn 29 
Diarrhea—etiology undetermined 30 
Diphtheria 30 
Director of Health 5 
Dysentery, amebic 32 
Dysentery, bacillary 32 
Echinococcus infestation 33 
Encephalitis—lethargic 33 
Encephalitis—non-lethargic 34 
Encephalitis—post-febrile - 35 
Erysipelas 35 
Favus •• 36 
Filariasis 36 
Food infections and poisonings 36 
Food handling 15 
German measles 41 
Glanders 42 
Gonorrhea 19, 20, 42 
Granuloma inguinale 19,20,43 
Hookworm (ancylostomiasis) 23 
Health officers—duties, etc 5, 6, 7, 10 
Health certificates—school employees 17 
Icterohemorrhagic jaundice 45 
Impetigo contagiosa 43 
Influenza 44 
Isolation and quarantine procedures 13 
Page 72 
Index 
Laboratories 
Reports 7, 8 
Approval of 7 
Lead poisoning 9 
Leprosy 45 
Lymphogranuloma venereum 19. 20, 46 
Malaria 46 
Measles 47 
Meningococcus meningitis 48 
Mumps 48 
Naphtha poisoning 9 
Paratyphoid fever A & B 49,65 
Phosphorous poisoning 9 
Pertussis (whooping cough) 69 
Placards and placarding 11,12 
Plague 49 
Pneumonia 
Acute lobar ... 50 
Acute broncho 50 
Virus 51 
Poliomyelitis (infantile paralysis) 51 
Psittacosis 52 
Puerperal infection 53 
Public gatherings 17 
Quarantine 
Placarding 11 
Isolation and quarantine procedure 13 
V. D. treatment centers 21 
Travelers ... 16 
Rabies 53 
Rat-bite fever 54 
Relapsing fever 54 
Reportable diseases and poisonings, list 9 
Reports of disease 
By attending physician and others 8 
By health officers 6, 7,10 
Rheumatic fever 55 
Ringworm (Epidermophytosis) 55 
Rocky mountain spotted fever 55 
Scarlet fever (scarlatina) 56 
Schistosomiasis (swimmer’s itch) 57 
Schools and public gatherings." 17 
Septic sore throat 58 
Silicosis 58 
Smallpox 59 
State Board of Health, powers, etc 5 
Syphilis 19,20,59 
Tetanus 60 
Tetraethyl poisoning 9 
Thrush 61 
Trachoma 61 
Travel, travelers and common carriers • 16 
Trichinosis 62 
Tuberculosis, pulmonary 63 
Tuberculosis, other than pulmonary 64 
Tularemia 64 
Turpentine poisoning 9 
Page Index 
Typhoid fever group 65 
Typhus fever 68 
Undulant fever (brucellosis) 68 
Venereal diseases 19,20 
Vincent’s infection 69 
Whooping cough (pertussis) 69 
Wood alcohol poisoning 9 
Yellow fever 70 
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