DEPARTMENTAL PROCEDURE 
FOR THE CONTROL OF 
COMMUNICABLE DISEASES 
LOS ANGELES COLMgH^^^>^®fi6JUU^£ENT 
808 Nort 
12, California 
Form X—No. 35 
January 1, 1947 
Superseding and Cancelling Form X—No. 35 Dated August 1, 1944 DEPARTMENTAL PROCEDURE 
FOR THE CONTROL OF 
COMMUNICABLE DISEASES. 
LOS ANGELES COUNTY HEALTH DEPARTMENT 
808 North Spring Street 
Los Angeles 12, California 
Form X—No. 35 
January 1, 194? 
Superseding and Cancelling Form X—No. 35 Dated August 1, 1944 LOS ANGELES COUNTY HEALTH DEPARTMENT 
BUREAU OF GENERAL ADMINISTRATION 
January 1, 1947 
TO: 
District Health Officers 
C. D. Physicians 
Clinic Physicians 
M.C.H. Physicians 
C. D. Inspectors 
Sr. C. D. Inspectors 
Head Sanitarians 
Sanitarians 
Sanitary Inspector Aids 
Bureau Directors 
Div’n and Section Chiefs 
Supervising Nurses 
Public Health Nurses 
M.S.S. Workers 
Registrars 
Business Office Clerks 
SUBJECT: Quarantine Rules and Regulations Form X No. 35 
These are the Quarantine Rules and Regulations of the Los Angeles 
County Health Department, giving departmental procedure for the control 
of communicable disease. 
Especial care of these copies is required. They are charged to you and 
are to be accounted for in case of termination of service. 
ALL PREVIOUS ISSUES OF THESE RULES AND REGULATIONS 
ARE TO BE DESTROYED. 
L. A. COUNTY HEALTH OFFICER 
R. O. Gilbert, M.D. 
A FOREWORD 
These regulations are the standardized communicable disease control 
procedure for the L. A. County Health Department, and shall be adhered 
to by all its employees. Employes of the County Health Department shall 
familiarize themselves with the contents of this bulletin, insofar as the in- 
structions contained therein apply to their respective duties. 
A HEALTH OFFICER MAY CALL UPON ANY AVAILABLE 
EMPLOYEE OF THE DEPARTMENT FOR NECESSARY COMMUNI- 
CABLE DISEASE CONTROL WORK: Hence, these rules and regulations 
should be in the possession of all field workers at all times, and also should 
be in the hands of all information clerks and others handling communicable 
disease records or answering inquiries regarding them. A copy must be avail- 
able at all times at each health center, in the care of the Deputy Registrar. 
These regulations are based generally on the Health and Safety Code of 
the State of California, and the rules and regulations of the State Depart- 
ment of Public Health. This order is the interpretation of these laws, rules 
and regulations as made by the County Health Officer, with supplementary 
regulations authorized by Article 3, Section 2560, of Chapter 6 of the Health 
and Safety Code. The expression "Health Officer’’ used in this Order means 
District Health Officer or Communicable Disease Physician officially acting in 
his place, or Head Public Health Physician. 
The definition of any term used and not defined herein shall be the 
same as defined in "The Control of Communicable Diseases” pub- 
lished by the American Public Health Association. 
The Chief C.D. Inspector is charged with the general enforcement of 
these Rules and Regulations and with the responsibility of promoting the 
understanding and enforcement by all members of the Department. 
L. A. County Health Officer 
C INDEX 
Letter of transmittal Page A 
Foreword Page C 
Index Page Dl-D2 
SECTION I — GENERAL 
SECTION II QUARANTINE REGULATIONS Page No. 
Reporting cases of communicable disease 1 
Reporting births and deaths 2 
Telephone reports 2 
Special Epidemiological reports 2 
Special reports required by the State Dept 3 
Initialing "State Board Cards” 3 
Telegraph reports required by the State Dept 4 
Quarantine placards 4 
Quarantine passes 4 
Precautions to be observed 5 
Release of Quarantine 5 
Determination of Quarantine Release date 5 
Release of nurses 5 
Chief C.D. Inspector 3 
Violations of quarantine 6 
Procedure on quarantine cases 6 
School books, etc., in quarantine homes 7 
Recommendations to schools and libraries 7 
School exclusions 7 
School re-admission cards 8 
Moving to new location 8 
Hospitalization 8 
Arrangements for parents to visit hospital 9 
Communicable disease on a dairy or in the home of a food handler 10 
Milk 10 
Food handlers, school teachers, etc 10 
Factory workers, etc 10 
C.D. contacts in Armed Services 11 
Communicable disease in Mountain Sanitation area 11 
Laundry 11 
Quarantine classifications 11 
SECTION 111 COMMUNICABLE DISEASES 
Reference List of Communicable Diseases 13 
State Board classifications 16 
Chickenpox 17 
Cholera 18 
Diarrhea, Epidemic (of the newborn) 19 SECTION 111 COMMUNICABLE DISEASES (Continued) Page No. 
Diphtheria 19 
Diphtheria—Casual carriers 22 
Diphtheria carriers 22 
Dysentery (Amoebic—Bacillary) 22 
Encephalitis (epidemic) 25 
Food poisoning 25 
German measles 28 
Influenza 29 
Leprosy 29 
Measles 31 
Meningitis, Epidemic 32 
Mumps 33 
Paratyphoid fever (See typhoid fever) 58 
Plague 34 
Poliomyelitis 36 
Psittacosis 38 
Rabies 38 
Instructions to Shelters and Pounds 47 
L. A. County Cooperative Agreement 48 
Vicious Dogs 48 
Scarlet Fever (Scarlatina) 49 
Scarlet Fever (Surgical) 52 
Septic sore throat 52 
Smallpox 53 
Tuberculosis 56 
Tvphoid fever and paratyphoid fever 58 
Typhoid & paratyphoid fever carriers 61 
Typhus fever (Epedemic—louse borne) 63 
Typhus fever (Endemic—flea borne) 66 
Venereal Diseases 66 
Whooping Cough 68 
Yellow fever 69 
Note—See pages 13-17 for diseases not listed above 
SECTION IV FUNERALS 
Instructions to Funeral Directors 71 
Instructions to Cemeteries 74 
D2 LOS ANGELES COUNTY HEALTH DEPARTMENT 
BUREAU OF GENERAL ADMINISTRATION 
RULES AND REGULATIONS FOR THE CONTROL OF 
COMMUNICABLE DISEASES 
In quarantine work the Department is under a two-fold obligation: 
FIRST: To impose and enforce quarantine as soon as possible after 
report of a case or suspected case is received. 
SECOND: To release quarantine without delay as soon as regulations 
and the safety of the public permit. 
It shall be the duty of the Health Officer personally or through a 
qualified representative, as soon as possible after the receipt of a report of a 
case or a suspected case of communicable disease, to make an investigation 
and determine that instructions for preventing the spread of the disease are 
understood and observed. This regulation does not preclude the placing of 
a placard on suspected cases by authorized representatives pending examina- 
tion and final diagnosis by the Health Officer. 
Our job is to instruct and explain the regulations necessary to prevent 
the spread of the disease so that the quarantined family will cooperate and 
comply. Secure results by education, not by the use of legal force. Private 
physicians are not official public health workers. To relieve the pressure of 
emergency on the medical staff the Public Health Nurse is required to call 
within 24 hours. It is her duty to educate and explain, and on her falls the 
success or failure of the control of communicable diseases. 
REPORTING CASES OF COMMUNICABLE DISEASE 
It shall be the duty of every physician or other person engaged in the 
treatment of the sick to report to the Health Officer each such patient affected 
with a communicable disease, with his full name, age, sex, and address, 
together with the name of the disease or suspected disease, if known, within 
24 hours of the time the case is first seen by him. Such report preferably 
should be made by telephone and shall be confirmed in writing within 24 
hours by mailing standard report on a card prepared by the State Board of 
Health. 
Private physicians and nurses should be encouraged to report by tele- 
phone any case or suspected case of communicable disease on any dairy or in 
the home of any dairy worker, food handler, school teacher, etc. 
Venereal diseases do not need to be reported by telephone and will be 
reported in writing within 24 hours by filling out and mailing a special 
venereal disease report card prepared by the State Board of Health. 
When no physician is in attendance, it shall be the duty of any midwife, 
nurse, the head of any private household, the person in charge of any institu- 
tion, hotel, camp, or any other such person, to report immediately to the 
Health Officer the name and address of any person in his charge affected 
with any diseases which presumably may be communicable. Until the Health 
Officer investigates such case and takes official action regarding it, strict isola- 
tion of the patient shall be maintained. 
Failure to report any case of communicable or suspected communicable 
disease, shall immediately be reported to the Chief C.D. Inspector . 
1 REPORTING BIRTHS AND DEATHS 
State law requires that "the birth of each child born in this State shall 
be registered” (Section 10150, Health and Safety Code), and "every death 
occurring in this State shall be reported” (Section 10350, Health and Safety 
Code). 
"No person shall inter in any cemetery unless (a) there has been 
obtained and filed a certificate and (b) he has obtained 
a burial permit”. (Section 7406, H. & S. Code) 
"No person shall inter or permit the interment of any body 
unless it is accompanied by a burial or cremation permit.” (Section 7410— 
H. & S. Code) 
Any violation of the foregoing laws shall be immediately reported to the 
Chief C.D. Inspector for investigation and enforcement. 
TELEPHONE REPORTS 
Each morning, Monday through Friday, the District Deputy Registrar 
shall telephone the quarantine status of her respective Health District to the 
Morbidity Section, Division of Vital Records, Central Office. This report 
shall include for each quarantinable disease the number of deaths since the 
last report, the number of cases released from quarantine, the number of 
cases hospitalized, the number of cases continued in quarantine, the number 
of new cases placed under quarantine, and the total cases now under quaran- 
tine in the District. Further, all deaths from those diseases that would be 
recorded on PD cards shall be reported on the morning call. 
Report of any extensive outbreak whether of known or unknown 
etiology, must be phoned immediately to the Epidemiologist or the Chief 
C.D. Inspector, Central Office. 
Cases or suspected cases of the following diseases are to be reported 
immediately by telephone to the Chief C.D. Inspector, Central Office. 
Anthrax 
Botulism 
Cholera 
Dysentery (Epid.) 
Food Poisoning 
Glanders 
Leprosy 
Meningitis (Epid.) 
Paratyphoid (Epid.) 
Plague 
Psittacosis 
Rabies in humans 
Smallpox 
Septic Sore Throat (Epid.) 
Typhoid Fever (Epid.) 
Typhus Fever 
Yellow Fever 
Any communicable disease on a dairy or in the family of a dairy worker 
or milk handler must also be reported immediately by telephone to the Chief 
C.D. Inspector, Bureau of Preventable Diseases. 
When cases which require special telegraphic notice to the State Depart- 
ment of Public Health are reported, the Chief C.D. Inspector will make such 
report to the State Department. 
SPECIAL EPIDEMIOLOGICAL REPORTS 
The Health Officer who encounters a case of communicable disease 
which presents features of rare occurrence or is of special epidemiological 
2 interest, shall file a written report of such case with the Bureau Director. 
These instances include, for example, remarkably short or long periods of 
incubation, the incidence of communicable disease in persons previously 
immunized, and any unusual developments in our program for handling 
casual carriers. 
SPECIAL REPORTS REQUIRED BY THE STATE DEPARTMENT 
Section 2571, Health and Safety Code requires special written reports 
to the State Department (on special State Board forms) for the following 
diseases: 
Anthrax (human) 
Botulism 
Coccidoidal Granuloma 
Dysentery (Bacillary) 
Encephalitis 
Food Poisoning 
Leprosy 
Malaria 
Paratyphoid Fever 
Poliomyelitis 
Psittacosis (human) 
Rabies (human) 
Relapsing Fever 
Rocky Mountain Spotted Fever 
Tularemia 
Typhoid Fever 
Typhoid Fever Carrier (casual and 
convalescent) 
Typhus Fever 
Undulant Fever 
NOTE: Reports of Sanitary Surveys and State Board forms shall be 
made in triplicate: 
2 copies to the Morbidity Section, Division of Vital Records, Central 
Office—one for transmission to the State Department of Health and one for 
file. 
1 copy for District files. 
(On Undulant fever—one extra copy for the Dairy Division.) 
INITIALING "STATE BOARD CARDS” 
Since the California State Department of Public Health expects local 
health officers to use reasonable care in insuring the correct diagnosis in cases 
of reportable diseases, and to make official a procedure which is already fol- 
lowed in a large part of Los Angeles County Health Department territory 
with respect to "State Board Cards”, it is hereby ordered: 
1. All cards reporting cases of quarantinable diseases or chickenpox 
in persons over 12 years of age be initialed by a District Health 
Officer or Senior Physician M.D. (C.D.) after the person who is to 
initial any such card has satisfied himself as to the correctness of the 
diagnosis, unless the card was originally signed by the District 
Health Officer concerned. 
2. All cards reporting cases of non-quarantinable diseases except chick- 
enpox in persons over 12 years of age be initialed as above described 
unless signed by a physician. 
Initialing such cards does not require that the District Health Officer 
must see the patients named thereon, but may be done without 
seeing them if in his judgment the persons signing the cards are 
capable of making correct diagnoses. 
3. District Registrars do not send in to the Division of Vital Records 
in the Central Office any "State Board Cards” until they are initialed 
as above directed. 
3 TELEGRAPH REPORTS REQUIRED BY THE STATE DEPARTMENT 
Section 2569, Health and Safety Code, requires Telegraphic reports to 
the State Department of every discovered or known case of the following 
diseases: 
Asiatic Cholera 
Plague 
Typhus Fever (louse borne) 
Yellow Fever 
In such cases the State Department requires within 24 hours after inves- 
tigation, a written report of the cause, source, extent of contagion and infec- 
tion, and all acts done and measures adopted. Forward such reports (in 
triplicate) to the Chief C.D. Inspector, Central Office. 
Note: See last paragraph of "Telephone Reports”, on page 2. 
QUARANTINE PLACARDS 
The State law requires that when all or any part of the building, house, 
structure or tent is quarantined because of a contagious, infectious or com- 
municable disease, the Health Officer shall fasten firmly on its most conspic- 
uous part a yellow placard upon which shall be printed the following words: 
"Keep out. These premises have been quarantined by order of the 
County Health Officer,” 
Note: "Under the provisions of the Health and Safety Code of .the 
State of California anyone entering or leaving these premises without the 
permission of the Health Officer is guilty of a misdemeanor.” 
Placards shall always be posted at the front, or principal entrance to 
premises plainly visible on approaching the house (more than one placard 
if necessary). PLACARDS MUST BEAR THE NAME OF THE DISEASE, 
OR SUSPECTED DISEASE, THE NAME OF THE HEALTH OFFICER, 
SIGNATURE OF DEPUTY POSTING, DATE OF POSTING, DISTRICT 
OFFICE ADDRESS AND TELEPHONE NUMBER. 
Yellow quarantine placards must be posted for classifications A, B and 
C, and the red quarantine placards shall be used for quarantine G. For 
quarantines D, E and F, refer to specific instructions under quarantine on 
page 12. 
Employees must bear in mind that no quarantine is established until a 
placard is posted or written instructions given to the patient or contacts. 
There is no such thing as an "oral quarantine.” 
QUARANTINE PASSES 
Permission to enter or leave a quarantined premises must always be in 
writing and is given to wage earners for economic reasons only. In no case 
should a food handler or person in charge of the patient have a pass. Holders 
of quarantine passes must not, at any time during the period of quarantine 
come in contact with the patient or his environment. 
Violation shall be cause for immediate revocation of the pass. No passes 
are allowed in smallpox, or other class "A” quarantine cases, where the 
patient remains on the premises. 
When circumstances prevent issuing a quarantine pass, arrangements 
will be made at the time of quarantine to see that groceries, etc., will be 
delivered as required, either by neighbor, nurse or other member of the 
Health Department staff. 
4 Special passes may he issued in emergencies, subject to supervision of 
the Health Officer. For funerals, see Section entitled "Instructions to Funeral 
Directors, page 71. 
PRECAUTIONS TO BE OBSERVED 
Physicians and nurses in attendance upon a quarantinable case shall take 
such precautions as may be necessary to avoid contamination of their hands 
or clothing. Unless otherwise specified in the State Department Bulletin for 
the particular disease, the following shall apply: 
Whenever it is necessary to come in close contact with the patient, the 
physician shall wear a washable outer garment and should also wash his 
hands immediately after leaving the room. 
RELEASE OF QUARANTINE 
Terminal fumigation and/or spraying is unnecessary except in the dis- 
eases where vermin are carriers. Householders should be instructed regarding 
concurrent disinfection and isolation at the time of quarantine. 
Where a nurse is available for assistance in quarantine work, she shall 
supervise terminal disinfection, which shall include the rendering of personal 
clothing and immediate physical environment free from the possibility of 
conveying the infection to others. 
The State law provides that persons in contact with the patient "shall 
be required to take a thorough antiseptic bath, and put on clothing free from 
contagion”, A general thorough cleaning of the dwelling place shall be 
required—linen, etc., boiled, and other bedding, mattresses, etc., exposed to 
the direct sunlight before the quarantine placard is removed. 
Specific instructions for release from quarantine are given under each of 
the quarantinable diseases. 
DETERMINATION OF QUARANTINE RELEASE DATE. 
The earliest date upon which quarantine may be released shall be com- 
puted by adding to the date of onset the minimum number of days of quar- 
antine required by regulations of this department for the specific disease 
involved. 
RELEASE OF NURSES 
a. Nurses on quarantined cases may be released subject to inspection by 
the Health Officer before taking another case. Flowever, they are subject to 
any and all necessary restrictions from handling obstetrical or child cases 
until the period of incubation expires. 
b. Nurses on quarantined diphtheria cases are handled as ordinary con- 
tacts except nurses leaving cases of diphtheria before the patient is released. 
In such cases nurses must have a negative throat culture before release but are 
not permitted to attend a child or obstetrical case until after a second nega- 
tive culture taken at least 7 days after last contact with patient. 
CHIEF C.D. INSPECTOR 
The Chief C.D. Inspector is specifically charged with the enforcement of 
these rules and regulations. (See foreword by County Health Officer.) 
The Chief C.D. Inspector and his staff are available at all times for 
consultation and assistance in the handling of quarantinable diseases. Mem- 
5 bers of the C.D. Inspections staff may be reached in the usual way through 
the Central Office during working hours; and after working hours, nights, 
week-ends and holidays one or more of them can always be located through 
the County telephone exchange (MU. 9211), In case of question as to rules 
of procedure on quarantinable disease control, the C.D. Inspection Division 
should be consulted immediately. 
Note: Ail employees of the Department shall comply with all orders, 
instructions or requests of the Chief C.D. Inspector in the performance of 
these duties. 
VIOLATIONS OF QUARANTINE 
All violations of quarantine regulations shall be immediately reported 
to the Chief C.D. Inspector for investigation, and legal enforcement if nec- 
essary. 
PROCEDURE ON QUARANTINE CASES 
All correspondence with other Health jurisdictions relative to quarantine 
and violations (including tuberculosis and venereal disease) will be handled 
by the Chief C.D. Inspector. Copies of such correspondence will go to inter- 
ested parties. 
The courts recognize only quarantine by placard, not "oral notice.” 
Note: See 'Quarantine Placard” section, page 4. 
Any employee who establishes a quarantine is instructed to promptly 
report full details to the Deputy Registrar, and the following procedure shall 
apply. 
The District Registrar shall prepare the PD 7 (case card) and PHN 
ft 3 (progress card) for the Health Officer. 
The Health Officer shall inscribe his findings on the PD ft! and 
inscribe directions on the PHN fj:3, returning both to the District Registrar. 
The District Registrar shall prepare a duplicate PD #7 and place same 
in the office file pending completion of case. 
The District Registrar shall immediately refer PD and PHN #5 to 
the Supervising Nurse, and the District Nurse shall within the first working 
day after quarantine make a home call to see that the family understands and 
is carrying out isolation precautions. The Public Health Nurse shall record 
her observations, recommendations and services rendered on the PHN ±f:3, 
as well as date and sign the PD #7 where required, then return the cards 
promptly to the Health Officer. 
The Health Officer, after noting the report of visit and appraising the 
situation, shall inscribe directions and date on the progress card (PHN #5) 
for the next visit, then return both cards immediately to the District Regis- 
trar, who will place cards in her "Tickler file”. The first thing in the 
morning of the required date the Registrar shall pull the cards and deliver 
them to the Health Officer or the Supervising Nurse for use as outlined 
above. 
(When indicated or when requested by the Health Officer, the P.H.N. 
shall make additional calls, but in every case the P.H.N. shall make a second 
home call not later than the day before release is due to give terminal disin- 
fection instructions.) 
6 The Health Officer shall make a final visit for release in accordance with 
procedures for the specific disease, complete data on face of PD #7, enter 
date of release visit and name, and return cards to Registrar who will com- 
plete data on duplicate PD #7, forward duplicate to Central Office, Mor- 
bidity Section, and file original PD #7 with PHN -t£s (attached) in District 
C.D. file. 
SCHOOL BOOKS, ETC., IN QUARANTINED HOMES 
The transmission of communicable disease by means of books is a sub- 
ject of a highly controversial character. In the opinion of the Los Angeles 
County Health Officer, there is very little danger of transferring disease 
through objects of this kind. However, no books, papers, etc., may be per- 
mitted to leave the quarantined premises until release of quarantine. After 
this time, school books, library books, etc., shall be withdrawn from circula- 
tion for a period of three months in those cases where books have been 
exposed to cases of the less virulent communicable diseases. 
Books, magazines, etc., exposed to such virulent diseases as smallpox, 
septic sore throat, spinal meningitis and anthrax shall be destroyed. 
State Health Department regulations require that "school books which 
have been grossly soiled by scarlet fever patients shall be destroyed.” 
RECOMMENDATIONS TO SCHOOLS AND LIBRARIES 
A generally accepted practice for handling books which have been in 
contact with communicable disease cases is to thoroughly dust such books 
with a blower, expose them to sunlight and fresh air for 48 hours and then 
store them for three months before returning them to circulation. 
Books in the home but not in contact with a case of communicable dis- 
ease should be dusted with the blower, exposed to fresh air and sunlight for 
48 hours and may then be returned to circulation. 
SCHOOL EXCLUSIONS 
The State law makes the matter of excluding a child from school the 
duty of the school officials. Every employee who is concerned with the 
preparation of the school exclusion notices or their transmission to their 
intended destination shall address or deliver all such notices to the Principal 
of the school concerned, or to some other person properly acting in his place, 
and to nobody else. (Section 2564, Health and Safety Code) 
To prevent delay, notice of exclusion shall be made immediately by tel- 
ephone, and confirmed later by the written exclusion form. 
If the disease in question is tuberculosis or a venereal disease, the 
decision as to whether or not the stage of the disease is such as to make the 
person concerned properly subject to exclusion from school shall be the 
responsibility of the Chief Tuberculosis Physician or the Chief Venereal Dis- 
ease Physician, as the case may be. 
The policy of the County Health Department with regard to attending 
school, shall be "to exclude therefrom any child or other person affected 
with a disease presumably communicable until such child or other person 
shall have been seen by the school physician or nurse, or shall have presented 
a certificate issued by the local health officer, or by the attending physician, 
7 and countersigned by the local health officer, stating that such child or other 
person is not liable to convey a communicable disease.” (Quotation from 
Regulations of the State Department of Public Health) 
SCHOOL RE-ADMISSION CARDS 
Cards signed by the Health Officer or his duly authorized agent must 
be given to school children or their parents or guardians upon release from 
quarantine for transmission to the principal of the school concerned or some 
other person properly acting in his place. (Section 2564, Health & Safety 
Code) 
MOVING TO NEW LOCATION 
If it is necessary for persons in quarantine to move to another location, 
permission in writing must first be obtained from the new owner or his 
agent and inspection of the proposed place of quarantine by the Health De- 
partment must be made to see that quarantine can be made effective. Moving 
is to be under the personal supervision of the Health Officer or his repre- 
sentative, and the record card corrected. When the move is to the jurisdiction 
of another health officer, his permission in writing must first be obtained. 
Moving into an apartment house or bungalow court can seldom if ever be 
permitted. If the move cannot be made without passing through another 
health district, the patient must bear the expense of a guard to be assigned 
by the Chief C.D. Inspector to accompany the patient or persons in quar- 
antine. 
Note: All cases mentioned in the above section shall be immediately 
reported to the Chief C.D. Inspector, and no final action taken without his 
consent and approval. 
HOSPITALIZATION 
The Los Angeles County General Hospital is the only institution in 
Los Angeles County properly equipped and permitted by the Los Angeles 
County Health Department to handle cases of quarantinable disease—except 
in cases of typhoid fever and paratyphoid, which may be placed in private 
institutions, but in such cases the patient must not be housed in the same 
room with patient suffering from any other ailment. (For veneral disease 
cases, see page 66.) 
In sending a case to the General Hospital, the Health Officer is respon- 
sible for the tentative diagnosis. In addition, when referring persons with 
contagious diseases (other than tuberculosis or venereal diseases) to the 
General Hospital, Los Angeles County Health Department physicians should 
use Form X-15, and the following information should be written in the space 
headed "Reason for Referral”: 
1. Age, sex and race of patient. 
2. Name of disease suspected. 
3. Date of onset of illness. 
4. Brief notes of any treatment that may already have been given. 
5. Brief items of history and symptoms that referring physician 
thinks may aid the hospital physician in study and final diagnosis 
of the case. 
Requests for hospitalization of cases of communicable disease shall be 
made by the District Health Officers directly to the Admitting Room in the 
8 Los Angeles General Hospital (Capital 3161), including requests for an 
ambulance. Under authorization of the Health Officer of L.A. City dated 
April 12, 1943, it is unnecessary to secure permission from the City Health 
Department for such hospitalization, (with the exception of cases of, or 
suspected cases of plague, smallpox or cholera, which must have the approval 
of the L.A. City Health Department for hospitalization). 
In case of an extreme emergency (such as diphtheria requiring intuba- 
tion, etc.) the case may be brought or sent direct to the C.D. Building of 
the General Hospital. 
When a District Health Officer or a private physician sends a case of 
communicable disease to the General Hospital by private conveyance or 
otherwise (except in a General Hospital ambulance), specific instructions 
should be given to the patient’s attendant on the following points: 
1. Notify the C.D. Office as to approximately when and how the 
patient will arrive. 
2. Instruct the attendant to go to the old entrance at 1100 Mission 
Road. The C.D. Office will inform the watchman at the gate to 
direct the patient to the C.D. Building. 
3. Instruct the attendant that where a private conveyance is used, to 
wrap the patient in a sheet to prevent contamination of the vehicle; 
place the patient alone in the back seat; go direct to the Mission Road 
entrance of the C.D. Building without contacting other persons. 
Under no conditions permit a patient with a communicable disease 
to go to the Admitting Room in the main building and expose other 
patients and attendants to the disease. 
The Morbidity Section of the Division of Vital Records, Central Office 
(Station 3574), may be called upon to secure statements or diagnosis or other 
information, and it is desirable that as many contacts as practical between 
this Department and the General Hospital be made through this channel. 
Note: In every case of communicable disease sent to the Los Angeles 
General Hospital, a report of such case must be made to the Morbidity Sec- 
tion, Division of Vital Records, Central Office, not later than the "morning 
call” of the next working day. 
It is recommended that hospitalization be urged for patients having any 
of the following diseases: 
Botulism 
Cholera 
Diphtheria 
* Leprosy 
Meningitis 
* Plague 
Poliomyelitis 
Rabies (human) 
Scarlet Fever (severe) 
Smallpox 
Typhoid Fever 
Typhus Fever 
Whooping Cough (under age 3) 
* Hospitalization mandatory 
ARRANGEMENTS FOR PARENTS TO VISIT HOSPITAL 
When a patient suffering from a quarantinable disease is sent to the 
General Hospital, directions for necessary visits from members of the family 
shall be given by the Health Officer. While the home is in quarantine during 
the period of incubation dating from last contact or because of another case 
9 in the home, persons subject to quarantine may go to the hospital only when 
the condition of the patient is critical and approval is given by the office of 
the communicable disease Superintendent of the General Hospital. In such 
cases, persons from the quarantined house are to travel only by private con- 
veyance from the quarantined home to the General Hospital and back to 
their home, and they are to be admitted to the communicable disease building 
under the supervision of the hospital staff. (This does not apply when visits 
are made alone by holders of quarantine passes.) 
In case of emergency calls from the General Hospital when the patient 
is critically ill, the Chief C.D. Inspector is to be notified when the family 
has no means of transportation. If the Chief C.D. Inspector is not available, 
or is unable to furnish transportation, the district shall make immediate 
provision for transportation of the necessary members to the hospital by a 
C.D, Inspector, nurse, sanitary inspector or physician. 
COMMUNICABLE DISEASE ON A DAIRY OR IN THE HOME OF A 
FOOD HANDLER 
All cases of communicable disease, including septic sore throat and 
dysentery, on a dairy or in the family of milk or food handlers, must be 
reported immediately to the Chief C.D, Inspector, who will supervise the 
quarantine. See the section under each specific disease to cover these cases 
and contacts. 
MILK 
State law forbids the removal of milk bottles or other receptacles for 
milk from quarantined premises until disinfection is approved by the Health 
Officer. If milk is delivered in glass bottles, the bottles must be retained on 
the quarantined premises, and the health officer will be responsible for their 
disinfection before the bottles are returned to their owner. 
Health Department employees should encourage all quarantined families 
during the period of quarantine to use milk delivered in cartons. When such 
cartons are used they must be destroyed by burning. 
FOOD HANDLERS, SCHOOL TEACHERS, ETC. 
"Food handlers” include those persons who handle or prepare food for 
others, with special reference to milk. Garden and ranch workers and those 
handling packaged goods only need not be classes as such if, in the opinion 
of the Health Officer there is no public menace in permitting them to con- 
tinue their occupation and provided they are subject to observation. 
Contacts coming under these classifications are provided for by specific 
instructions under the rules for each of the quarantinable diseases. 
School teachers who are contacts of a scarlet fever case may be permitted 
to move out of the quarantined premises and continue teaching provided 
arrangements are made for daily medical observation for seven days after 
last exposure. (See "Contacts—Scarlet fever” page 49.) 
FACTORY WORKERS, ETC. 
State law provides that those who are not permitted to go on with their 
regular occupations are teachers, food or milk handlers, or those who are 
associated with large numbers of people. The last classification must be 
solved by investigation of the specific case. 
10 While plant managers are naturally anxious to keep every individual 
worker on the job, they are more interested in preventing a possible spread 
of infection to other workers in the plant. They are not in favor of taking 
the chance on a too early return of the patient, or permit a contact who may 
possibly come down with a disease to go back into a factory. The procedure 
should be to try to get a contact out of the house so that contact will be 
broken and the person could get back to work sooner than if he stayed in 
the home until the end of quarantine. 
C.D. CONTACTS IN THE ARMED SERVICES 
The United States armed services do not wish any contact of a case of 
communicable disease to be at large; therefore all such service contacts should 
be immediately quarantined and the Chief C.D. Inspector notified of the 
case, including the name of the commanding officer and the military unit, 
for transmission to the proper authorities. Further, at the end of the quaran- 
tine period every serviceman should be given a written release addressed to 
his commanding officer, stating the reason for quarantine and the date of 
termination. This automatically clears the man’s service record when he 
returns to duty. 
COMMUNICABLE DISEASES IN MOUNTAIN SANITATION AREA 
Communicable diseases in the mountain sanitation area shall be handled 
by the Health Officer of the district where the case occurs. An immediate 
report of such case or cases shall be made to the Chief C.D. Inspector, who 
will assist in the investigation and quarantine enforcement. The Health Offi- 
cer or Chief C.D. Inspector may, if he so desires, call on the Section of 
Mountain and Rural Sanitation for assistance. 
LAUNDRY 
No laundry may be sent from the quarantined premises of any case of 
smallpox, plague or typhoid fever. In all other quarantine cases, and with 
the approval of the health officer, laundry may be sent out provided all 
articles of clothing, etc., that are used or touched by the patient are boiled 
for 20 minutes before leaving the premises. 
If boiling is inconvenient, clothes may be soaked overnight in two per 
cent lysol, or bichloride solution—one tablet (7y2 grain) bichloride to a 
gallon of water. 
QUARANTINE CLASSIFICATIONS 
SPECIAL QUARANTINE 
All cases where patients suffering from tuberculosis or veneral disease or 
any other communicable disease not specifically listed under quarantinable 
diseases, who refuse to observe orders and instructions given to prevent the 
spread of disease must be reported to Central Office, Chief C.D. Inspector, 
with a view to quarantine or such other restraint as may be necessary. 
Any violation of quarantine or isolation orders or of pass privileges 
must be reported at once to the Division of C.D. Inspections, Central Office. 
11 Any release of veneral disease or tuberculosis patients from quarantine 
or isolation in the General Hospital will be only on a written order from the 
Division of C.D. Inspections; or such permission may be given by phone and 
confirmed in writing later (giving name of person granting the permission by 
telephone). 
QUARANTINE A 
Absolute quarantine by placard, no passes under any circumstances. 
After death or removal of the patient from the premises in cases originally 
classed as Quarantine A, allow passes to wage earners (not food handlers or 
teachers) as in Quarantine B, for the period of incubation. 
QUARANTINE B 
By placard. Quarantine passes to wage earners employed in gainful 
occupations, and over sixteen years of age, who are not food handlers and 
do not come in contact with large numbers of persons and are not employed 
in barred occupations. (See special regulations under individual diseases.) 
Quarantine established by written order of the Health Officer in 
instances where patient and contacts fail to observe isolation orders relative 
to communicable diseases not regularly classified as quarantinable is also class- 
ified as Quarantine B. (See Form P.D. No. 41.) 
QUARANTINE C 
Quarantine by placard on area of isolation. Where instructions regard- 
ing isolation and disinfection are obeyed, no restrictions are placed on other 
members of the household who have no connection with the preparation of 
food for others. 
QUARANTINE D 
Quarantine of person or persons who have been in contact with a case 
of quarantinable disease, using form on file. (Applies to contacts only and 
diseases not classified for Quarantine A.) (See Form P.D. No. 41.) 
QUARANTINE E 
This class of quarantine is established by serving a copy of definite 
orders given by the Health Officer in writing to the patient or contact, and 
quarantine requirements are met by the patient or contact observing the 
orders. These orders are those given typhoid fever convalescents or carriers, 
requiring submission of specimens and notification of change of address, and 
also ordering patient to refrain from food handling. 
QUARANTINE F 
Confining tuberculosis or venereal disease patients to certain premises or 
ordering their removal to a hospital, sanatorium or other specified location. 
This quarantine is imposed by special order signed by the District 
Health Officer. 
QUARANTINE G 
Quarantine placed on animals having rabies or suspected rabies or 
having been exposed to rabies. 
12 REFERENCE LIST OF COMMUNICABLE DISEASES 
ANTHRAX (human) : Quarantine—none. 
Isolation of the patient until lesions have healed. Investigation of the 
source of infection. Concurrent and terminal disinfections. 
BOTULISM: Quar.—none. 
If commercial product notify S.D.P.H. at once, (See Food poisoning.) 
CHANCROID: Quar. **F” as needed. 
Use special card. (See Venereal diseases) 
CHICKENPOX: Quar. "B’ 
See Chickenpox. 
CHOLERA; Quar. "A”. 
Report by telephone or telegraph to S.D.P.H, (See Cholera.) 
COCCIDIOIDAL GRANULOMA: Quar.—none. 
Report only. 
CONJUNCTIVITIS: (Newborn) Quar.—none. 
Report only. 
Also Gc. Ophthalmia and sore eyes. 
Prophylaxsis shall be administered immediately after birth. 
DENGUE; Quar.—none. 
Isolate patient during first five days in thoroughly screened room, elimi- 
nating mosquitoes. Search for unreported or undiagnosed cases and for 
mosquitoes and their breeding places. 
DIARRHEA, EPIDEMIC (of the new-born): Quar. "C”. 
See Diarrhea, Epidemic (of the new-born). 
DIPHTHERIA: Quar. "B”. 
See Diphtheria. 
DIPHTHERIA CARRIERS: Quar. "B”. 
See Diphtheria. 
DYSENTERY (Amoebic) : Quar. "C”. 
See Dysentery (Amoebic) 
DYSENTERY (Bacillary) : Quar. "C”. 
See Dysentery, (Bacillary). Specify type, if known. 
ENCEPHALITIS; Quar. "C”. 
Infectious, all types. See Encephalitis. 
EPILEPSY: Quar.—none. 
Report only. "Any condition which brings about momentary lapses of 
consciousness and which may become chronic shall be considered report- 
able under the term epilepsy.” 
FAVUS; Quar.—none. 
See Ringworm. 
FOOD POISONING: Quar.—none. 
See Food Poisoning. 
13 GERMAN MEASLES: 
See German Measles. 
Quar. "B”. 
GLANDERS: 
Report by telephone or telegraph. 
Isolate patient; no restriction on contacts 
Quar.—none. 
GONORRHEA: 
See Venereal Diseases. Use special card. 
GRANULOMA INGUINALE: 
Quar. "F” as needed. 
Quar, "F” as needed. 
IMPETIGO: Quar.—none. 
May attend school (No gymnasium or swimming pools) on recom 
mendation of Health Officer, if lesions are treated and adequately cov- 
ered to prevent spread. 
Use special card. (See Venereal Diseases.) 
INFLUENZA: Quar.—none. 
See Influenza. 
JAUNDICE: Quar.—none. 
Hepatitis, infectious and ictero hemorrhagic spirochetosis (Weil’s dis 
ease). 
Report only. Isolate patient during acute symptoms. 
LEPROSY: Quar. "A 
See Leprosy. 
LYMPHOPATHIA VENEREUM: Quar. "F” as needed. 
Use Special Card. (See Venereal Diseases.) 
MALARIA: Quar.—none, 
Isolate patient in mosquito-free room. 
MEASLES: Quar.—none 
See Measles. 
MENINGITIS, EPIDEMIC Quar. "C 
See Meningitis. (Epidemic) 
MUMPS: Quar. "B” as needed. 
See Mumps. 
OPHTHALMIA NEONATORUM: Quar.—none. 
(Also Gc. Ophthalmia and Conjuctivitis.) Adequate medical attention, 
PARATYPHOID FEVER: Quar. "C”—on dairy ”A”. 
Specify A or B. See Typhoid fever. 
PEDICULOSIS: Quar.—none. 
Patient may be excluded from school until free from parasites and eggs 
PLAGUE: Quar. "A”. 
Report by telephone or telegraph to S.D.P.H, See Plague. 
PNEUMONIA: Quar.—none. 
Specify type of pneumococcus, if known. Isolate patient until recovery 
POLIOMYELITIS: Quar. "B”. 
(Acute anterior.) See Poliomyelitis. 
14 PSITTACOSIS: Quar. "C”. 
See Psittacosis. 
RABIES (In animals) : Quar, "G”. 
Use special card. See Rabies. 
RABIES (In humans) : Quar.—none. 
See Rabies. 
RELAPSING FEVER: Quar.—none. 
Report only. 
RHEUMATIC FEVER: Quar.—none. 
Report only. 
RINGWORM: Quar.—none. 
May attend school (No gymnasium or swimming pools) on recom- 
mendation of Health Officer, if lesions are treated and adequately 
covered to prevent spread. 
ROCKY MOUNTAIN SPOTTED Quar.—none. 
(OR TICK) FEVER 
Report only. 
SCABIES: Quar.—none. 
May attend school (No gymnasium or swimming pools) on the rec- 
ommendation of Health Officer, if lesions are treated and adequately 
covered to prevent spread. 
SCARLET FEVER: (Scarlatina) 
See Scarlet Fever. 
Quar. "B”. 
SEPTIC SORE THROAT; 
See Septic sore throat. 
Quar. "C—on dairy "A”. 
SMALLPOX: 
See Smallpox. 
Quar. "A 
SYPHILIS: 
Use special card. See Venereal Diseases 
TETANUS: 
Quar. "F” as needed 
Quar.—none. 
Report only. Ordinarily a subcutaneous injection of tetanus antitoxin 
(1500 units) given on the day of the wound. Refer patient for proper 
medical follow-up because a second injection within ten days may be 
desirable in certain instances. 
TRACHOMA: Quar. *C” as needed. 
Exclude from school, re-admission by permit from Health Officer. 
TRICHINOSIS: Quar.—none. 
Reportable only. Education in thorough cooking of pork. 
TUBERCULOSIS: Quar. "F” as needed. 
Use special card. See Tuberculosis. 
15 TULAREMIA: Quar.—none. 
Report only. Education: The use of rubber gloves by persons engaged 
in dressing wild rabbits whenever taken or when performing necropsies 
on infected laboratory animals. Employment of immune persons for 
dressing wild rabbits or conducting laboratory experiments. Thorough 
cooking of meat of wild rabbits. 
TYPEIOID FEVER: 
Quar. "C”—on dairy ”A”. 
TYPHOID FEVER CARRIER: 
See Typhoid Fever. 
See Typhoid Fever. 
Quar. "E”. 
TYPHUS FEVER: 
See Typhus Fever. 
Quar, "A” (epidemic) 
Quar.—none (endemic) 
Quar.—none. 
UNDUE ANT FEVER: 
Reportable only. Special Epidemiological report required. No restric- 
tions on case or contacts. 
WHOOPING COUGH: Quar. "B” as needed. 
See Whooping cough. 
YELLOW FEVER: Quar. "A”. 
Report by telephone or telegraph to the State Department of Public 
Health. See Yellow Fever. 
STATE BOARD CLASSIFICATION 
'"Section 2571, Health and Safety Code, permits quarantine whenever necessary any 
of the reportable diseases. Lists subject to change by S.D.P.H. at any time. 
*Reportable only: 
Anthrax (human) 
Botulism 
Coccidoidal Granuloma 
Dengue 
Epilepsy 
Food Poisoning 
Glanders 
Jaundice 
Malaria 
Pneumonia (specify type) 
Relapsing Fever 
Rheumatic Fever 
Rocky Mountain Spotted Fever 
Tetanus 
Trichinosis 
Tularemia 
Undulant Fever 
* Reportable and subject to isolation 
Chancroid 
Chickenpox 
Diarrhea, Epidemic 
(of the new-born) 
Dysentery (amoebic) 
Dysentery (bacillary) 
German measles 
Gonorrhea 
Granuloma Inguinale 
Influenza 
Lymphopathia Venereum 
Measles 
Meningitis (Epid.) 
Mumps 
Ophthalmia Neonatorum 
Psittacosis 
Rabies (animal) 
Rabies (human) 
Septic Sore Throat (Epid.) 
Syphilis 
Trachoma 
Tuberculosis 
Whooping cough 
16 ■Quarantinahle: 
Cholera 
Diphtheria 
Encephalitis 
Leprosy 
Parahyphoid Fever 
Plague 
Poliomyelitis (acute anterior) 
Scarlet Fever 
Smallpox 
Typhoid Fever 
Typhus Fever 
Yellow Fever 
CHICKENPOX 
NOTIFICATION: 
Any person in attendance on a case of chickenpox or a case suspected of 
being chickenpox shall report the case immediately to the local Health 
authority. 
.Note: All cases or suspected cases of chickenpox in persons 12 years or 
older, or any case during a smallpox epidemic, must be seen and 
the diagnosis verified by the Health Officer. 
INVESTIGATION OF CASES: 
Upon being notified of a case of chickenpox, the Health Officer shall 
make such inquiry as he sees fit regarding the probable source of infection, 
and shall see that the attendant and other members of the household are 
given and understand detailed instructions in regard to precautionary meas- 
ures for preventing the spread of the disease. In the event of persistent non- 
observance of instructons given by any member of the Departmnt staff 
regarding such precautionary measures, an immediate report to the Division 
of C.D. Inspections shall be made. 
ISOLATION; 
It shall be the duty of the Health Officer to see that cases of chickenpox 
are properly isolated. Isolation in this disease is defined as that degree of 
detention necessary to insure non-contact with susceptible persons. 
QUARANTINE "B”: 
As and when needed: 
CONTACTS; 
When a person affected with chickenpox is properly isolated, adult 
members of the family or household who do not show any symptoms of the 
disease are not subject to any restrictions. 
Children who give evidence satisfactory to the Health Officer of having 
had chickenpox, if given written consent of the Health Officer, are not 
subject to restrictions. 
Non-immune children shall be isolated and kept under observation for 
a period of 3 weeks, except; 
That after a diagnosis of chickenpox satisfactory to the Health 
Officer has been made, and isolation of the patient has been 
effected, in school districts having a medical and/or nursing inspec- 
17 tion service which the Health Officer considers adequate, school 
age contacts be permitted to attend school whether known to be 
immune or not. 
It is specifically recognized that the official in charge of any school 
has the legal right to exclude any non-immune contact of a case of 
chickenpox for the full incubation period or the last week of it if 
he sees fit to do so. Nothing in this order shall be construed in 
such a way as to take away that right. 
EXCLUSION BY SCHOOL AUTHORITIES: 
It shall be the duty of the principal, or other persons in charge of any 
public, private or Sunday School, to exclude any children infected with a dis- 
ease that is communicable until such children or other persons shall have 
been seen by the school physician or nurse, or shall have presented a certifi- 
cate issued by the Health Officer, or by the attending physician, and counter- 
signed by the Health Officer, stating that such children or other persons are 
not liable to convey a communicable disease. 
RELEASE FROM ISOLATION: 
The minimum period of isolation shall be 12 days after the appearance 
of the eruption, and until the primary crusts have fallen off. 
DISINFECTION: 
All discharges from the nose and mouth of the patient shall be burned. 
Objects which have been contaminated by the patient shall be disinfected 
before being removed to any place where they might become possible sources 
of infection. Clothing, bedding, and dishes used by the patient shall be 
sterilized by boiling, or immersion for 20 minutes in 2% carbolic acid. 
TERMINAL DISINFECTION: 
Terminal disinfection shall consist of a thorough cleansing by scrubbing 
and washing with hot water and soap. 
CHOLERA 
QUARANTINE "A”: 
When a case or suspected case of cholera is reported or recognized, an 
immediate quarantine is to be established, and immediate report made to the 
Chief C.D. Inspector, Central Office. 
PATIENT: 
Patient is to be isolated in a hospital or in a separate, thoroughly 
screened room which must be free from flies. 
CONTACTS: 
Contacts to be quarantined pending receipt of special instructions from 
the State Board of Health. 
IMMUNIZATION: 
Prophylactic immunization of contacts is useful and advisable. 
18 INVESTIGATION OF SOURCE OF INFECTION: 
Search for contaminated food and water, for common origin of groups 
of cases, and for unreported cases and carriers. 
GENERAL MEASURES; 
Rigid personal prophylaxis of attendants by scrupulous cleanliness, dis- 
infection of hands after handling patient or contaminated articles. Avoid 
eating or drinking anything in the room of the patient, and prohibit attend- 
ant from entering the kitchen. Provide for examination of stools of contacts 
to detect carriers, and isolation of carriers. 
Boiling of drinking water, if not adequately protected against contami- 
nation as by chlorination. 
Note: Special epidemiological measures may be instituted. 
DIARRHEA, EPIDEMIC 
(of the new-born) 
QUARANTINE "C 
In addition to these regulations the rules and regulations pertaining to 
maternity homes and hospitals shall be followed. 
INVESTIGATION OF CASE: 
Upon being notified of a case of epidemic diarrhea, the Health Officer 
shall make inquiry regarding the case. A reportable case shall be defined as; 
"Diarrhea in the new-born up to three weeks of age occurring in a 
hospital giving maternity service. Diarrhea shall be suspected to exist when 
an infant has more than one liquid stool in 24 hours, and shall be consideerd 
definitely present if this persists for more than two days, except in the case 
of entirely breast-fed infants, who show no signs of illness and who are 
gaining weight.” 
ISOLATION: 
It shall be the duty of the Health Officer when a diagnosis of epidemic 
diarrhea has been made to see that the infant patient shall be immediately 
placed in strict isolation until discharged from the hospital. 
If two or more cases occur, the nursery shall be quarantined, and no 
new-born infants shall be admitted until all exposed infants have been dis- 
charged and the nursery thoroughly cleaned. 
DIPHTHERIA 
QUARANTINE "B”: 
Quarantine is established when a positive culture is reported on a case 
with suspicious symptoms, or when a physician reports a case as "clinical 
diphtheria”—even if there has been no culture—if the Health Officer con- 
firms the diagnosis. When so quarantined, the case is released on two 
negative cultures from the nose and throat, after clinical recovery. (See 
paragraph "Release from Quarantine” for details.) Any suspected case which 
calls for the administration of antitoxin shall be quarantined pending investi- 
gation and laboratory report. 
19 Physicians are required to submit swabs or cultures of nose and throat 
to the Health Officer for laboratory examination on cases of suspected diph- 
theria. The Health Officer shall note the amount of antitoxin given the 
patient, when and by whom, the method used, and if the patient is sent to 
the hospital this information must accompany the patient. 
Direct contacts of a clinical case living outside the patient’s quarantined 
premises, and not eligible for quarantine passes, must be held in quarantine 
for at least 8 days after last contact. After 7 or more days these contacts 
shall be cultured, and released the following day if cultures from the nose 
and throat are negative. 
Any patient or contact who refuses to permit cultures of his or her nose 
and throat to be taken shall be kept in quarantine 21 days. 
VIRULENCE TEST: 
This is made when a patient has been in quarantine for a period of one 
month, and still shows positive cultures, or when a person is a casual carrier. 
In the event that a patient has been in quarantine for a period of four 
weeks, virulence tests should be made on the case and the contacts, and those 
found to be avirulent may be considered as negative cultures. Those found 
to have virulent cultures may then be considered diphtheria carriers and 
treated as such. 
QUARANTINE PASSES AND ACTIVITIES PERMISSIBLE 
TO CERTAIN CONTACTS: 
Quarantine passes are allowed to wage earners 16 years old or older if 
patient has been effectively isolated in the household and such arrangements 
have been made as will remove the danger of the wage earners transferring 
the infection to persons outside the quarantined area. Such wage earners 
may then be given a pass under the following conditions: 
A. If their nose and throat cultures are negative. 
B. If their occupations do not involve handling milk, or food that is 
consumed raw, or whose work brings them in contact with large 
numbers of persons, especially young children. 
C. If the pass is only for the purpose of going to and from work, and 
to carry on such other duties as the Health Officer deems essential. 
Wage earner contacts may be cultured and permitted to move elsewhere 
(where there are no children) and continue their occupations provided: 
A. They do not handle milk, or food that is consumed raw, or their 
work does not bring them in contact with large numbers of persons, 
especially young children. 
B. They shall remain under continued observation for 8 days, and if 
suspicious symptoms arise during this period of observation, the 
contacts will immediately be returned to quarantine. 
Contacts employed as barbers, cosmeticians, ice wagon drivers, and 
similar occupations may be cultured and permitted to leave the quarantined 
premises if arrangements are made for close supervision for not less than 8 
days after last contact, the end of the supervision period to depend on receipt 
of a negative report of a culture taken not less than 7 days after last contact. 
20 SCHOOL TEACHERS, FOOD HANDLERS, ETC. 
Diphtheria contacts under these classifications are prohibited from work- 
ing at these occupations until a throat culture taken 7 days or longer after 
last contact is reported as negative. (Definition of "food handler” given on 
page 10.) 
Release cultures shall not be taken until clinical recovery of the patient. 
Cultures from the nose and throat of the patient alone (except for 
diagnostic purposes) shall be taken until one negative culture is obtained; 
then after at least 24 hours all persons, including the patient, who live in the 
house shall be cultured. 
Release cultures from the nose and throat of the patient shall be taken 
by the Health Officer or communicable disease physician, but the Health 
Officer may delegate this task to a Public Health Nurse or to the family phys- 
ician if he is still in attendance. 
If the patient has two negative cultures, and all contacts one negative 
culture, quarantine is released. If not, then two successive negative cultures 
taken not less than 24 hours apart must be obtained from each person who 
has shown a positive culture. 
Cultures for release must be taken at frequent intervals, not exceeding 7 
days, after the culture for release has begun. 
Release cultures must he thned so that Sunday laboratory work will not 
be required. 
RELEASE FROM QUARANTINE: 
LABORATORY CULTURES: 
Culture slips must be completely filled in with the full name, date, ad- 
dress, etc., for the guidance of the laboratory workers in testing and reporting 
to the proper authorities. 
DAIRY WORKERS: 
Specific instructions as to the handling of quarantine on a dairy or in 
the family of a dairy worker are impossible. Such cases shall be immediately 
reported to the Chief C.D. Inspector, who will supervise the quarantine. 
(See section on a communicable disease in a dairy, or in the home of a food 
handler or dairy worker, page 10.) 
HOSPITALIZATION OR DEATH: 
In the event of the death of a patient, or the removal of the patient to 
the hospital, when there are no children or food handlers or persons subject 
to similar restrictions residing in the household, the adult contacts may be 
cultured immediately and the quarantine released as soon as negative results 
are shown and the premises are disinfected; but these adult contacts shall be 
kept under observation for 8 days. If there are food handlers or children 
remaining in the household, they shall be held in quarantine until negative 
results are obtained on cultures from the nose and throat, taken 7 days or 
longer after last exposure. 
Where a tonsillectomy is desired before release from quarantine, and 
the tonsillectomy is to be done locally, the arrangements must be approved 
and supervised by the Health Officer. 
21 In the event of death, funerals shall be handled as outlined under "In- 
structions to Funeral Directors,” page 71. 
CASUAL CARRIERS: 
A casual carrier is a person who carries diphtheria organisms in the nose 
or throat, has had no known contact with a clinical case of diphtheria, and 
who shows no symptoms of diphtheria. Cases originating from routine cul- 
tures at the General Hospital and Juvenile Hall, cultured preparatory to ton- 
sillectomy or for institutional admissions, will be ignored, so far as official 
reports of cases to the Central Office are concerned. 
When the casual diphtheria carrier remains in a hospital or institution, 
inspection of the family contacts at the home shall be made by the Health 
Officer or nurse. 
Cultures of the nose and throat of such contacts will be taken only when 
indicated by a history of recent illness or suspicious clinical appearance of the 
individuals, or when there is a milk handler in the home; otherwise, no 
quarantine card and no culture. For the protection of the school authorities, 
healthy contacts of school age shall be given school re-admission permits. 
The Health Officer shall also give the patient a school re-admission permit 
on release from the hospital. 
When the casual diphtheria carrier is in the home, cultures of the car- 
rier’s nose and throat shall be taken immediately, and if positive, tested for 
virulence. The patient shall be released as soon as possible, on either a 
negative virulence report or two negative cultures from the nose and throat. 
Contacts of the casual carrier in the home are not cultured unless physi- 
cal examination indicates the necessity, or a positive virulence is obtained 
from the carrier. A milk handler shall be cultured and excluded from work, 
but may resume work on two negative cultures from the nose and throat, or 
a negative virulence report. 
District deputy registrars shall retain casual carriers’ records (P.D. No. 
7) in a special file, and shall not report the casual carriers to the Central 
Office or on a State Board card, unless quarantine is necessary, or a positive 
virulence is established. 
DIPHTHERIA CARRIERS 
Any person who has been free from symptoms of diphtheria for four 
weeks or longer, and who harbors virulent diphtheria bacilli, is a carrier. The 
patient only shall be confined to the premises, except that no member of the 
household shall be permitted to have any part in the preparation or serving 
of food to persons other than members of the patient’s immediate family; 
nor shall they be engaged in any occupation or activity which brings them 
in contact with milk, milk products, milk bottles, or milk utensils; nor shall 
they in any way be in contact with children or large groups of people. 
DYSENTERY (AMOEBIC—BACILLARY) 
Amoebic Dysentery 
PROCEDURE: 
An immediate investigation of the source of infection shall be made by 
the Health Officer. Miscroscopic examination of stools of the household 
and/or associates of infected persons and other suspected contacts shall be 
22 required by him, and this examination should be supplemented by search for 
evidence of direct contamination of water and food by humans. 
An immediate sanitary survey of the premises shall be made by a sani- 
tary inspector. This inspection shall be made if possible in company with 
the Health Officer. Orders shall be issued for immediate abatement of all 
conditions which may contribute to the spread of the disease. Stress shall be 
given to sanitary disposal of bowel discharges, and hand washing after use 
of the. toilet. 
Special care shall be given for protection of the potable water supply 
against fecal contamination, and the boiling of drinking water where it is 
necessary. In the sanitary survey, attention shall be directed to the control of 
fly-breding and the protection of foods against fly contamination. 
QUARANTINE ”C”; 
No general quarantine. The patient should be isolated and the excreta 
disinfected. Strict quarantine is required in cases of patient living on the 
premises of a dairy. 
FOOD HANDLERS: 
Contacts who are food handlers shall be examined and excluded from 
the premises of the patient. 
EPIDEMIC MEASURES: 
In case of an epidemic, active measures should be employed to discover 
the source of infection and warn the public and the medical profession of the 
early and characteristic symptoms, and of the serious immediate and remote 
results of such infection. 
REPORTS TO THE BUREAU OF PREVENTABLE DISEASE: 
An immediate telephone report to the Epidemiologist or the Chief C.D. 
Inspector is required in case of epidemic dysentery. A copy of the report of 
the sanitary inspector on the sanitary survey, etc., shall be filed with the 
Morbidity Section, Division of Vital Records, Central Office, together with 
the epidemiological report made by the Health Officer on all cases of 
dysentery. 
RELEASE: 
Patients are released from isolation upon clinical recovery. They are 
released from observation after three negative stool specimens, taken at least 
three days apart. 
BACILLARY DYSENTERY 
PROCEDURE: 
Procedure shall be substantially the same as given for amoebic dysentery. 
An investigation of the source of infection shall be made, for the common 
source of contaminated food and water and for carriers, particularly among 
food handlers. Specimens of the bowel discharges of infected persons shall 
be secured by the Health Officer and submitted to the Health Department 
laboratory for examination. 
23 QUARANTINE "C”: 
No general quarantine. The infected individual shall be isolated during 
the communicable period of the disease, and the attendants shall be instructed 
as to rigid personal precautionary measures. 
The excreta shall be disinfected. 
Strict quarantine shall be enforced when a case of bacillary dysentery 
occurs on a dairy, unless the patient moves away from the dairy premises. 
GENERAL MEASURES: 
Give special attention to the following: 
1. Protection and purification of water supplies together with pre- 
vention of subsequent contamination. 
2. Pasteurization of milk supplies and use of boiled milk for infant 
feeding. 
3. Prevention of fly-breeding. 
4. Sanitary disposal of human excreta. 
5. Persons known to be infected, and their attendants, shall be excluded 
from handling food for public or for family consumption. 
6. The exercise of rigid precautions on known cases of dysentery is 
required, but is inadequate as a safeguard against infection from concealed 
sources. As a precautionary measure, all cases of infantile diarrhea should 
be regarded as bacillary dysentery. 
SANITARY SURVEY AND REPORTS; 
Same as outlined for Amoebic Dysentery. 
RELEASE: 
Patients are released from isolation upon clinical recovery and after two 
negative stool and urine specimens, taken at least 3 days apart and at least 3 
days after discontinuing sulpha drugs. 
RELEASE OF CARRIERS: 
Any person whose feces or urine contain the bacilli causing this disease 
and who is not ill, shall be reported as a carrier. 
Any person who has been free from the symptoms of this disease for 
one month and whose feces or urine contain bacilli causing this disease shall 
be reported as a convalescent carrier. 
Any convalescent carrier whose feces or urine continue to contain any 
of these bacilli after one year following clinical recovery, or who gives no 
history of recently having had the disease, shall be recorded as a chronic 
carrier. 
Carriers of bacillary dysentery bacilli shall not be released from restric- 
tions until at least five successive negative feces specimens, taken at not less 
than weekly intervals, have been obtained. 
A bacillary dysentery carrier shall be subject to isolation and the pro- 
visions of the isolation shall be fulfilled during such period as he complies 
with instructions of the Health Officer, which shall be as outlined for typhoid 
fever carriers on pages 
24 ENCEPHALITIS (EPIDEMIC) 
SPECIAL MEASURES MAY BE ADOPTED FOR EPIDEMICS. 
QUARANTINE ”C”: 
INVESTIGATION: 
Recognition of the disease is largely clinical. When there is doubt on 
the part of the Health Officer as to whether the case is one of poliomyelitis 
or infectious encephalitis, the control measures instituted shall be the same 
as for poliomyelitis. 
ISOLATION: 
The period of isolation shall be for 7 days from the onset and the 
patient shall be kept in a room satisfactorily screened against insects. 
CONTACTS: 
No restrictions when the patient is properly isolated. 
GENERAL MEASURES: 
Mosquito control if practical. Aedes vexans which has been suspected 
in the spread of Eastern equine virus to human cases, would usually be diffi- 
cult to control. Search for prior cases in the community and for unreported 
cases among associates of the patient may develop useful epidemiological 
information. 
FOOD POISONING 
THE TIME ELEMENT IS MOST IMPORTANT IN FOOD POI- 
SONING INVESTIGATIONS. 
INVESTIGATION: 
All known or suspected cases of food poisoning must be reported by 
telephone immediately to the Chief C.D. Inspector. If the initial report is 
received at the Central Office it shall be immediately transmitted to the 
proper District office and the Chief Food and Drug Inspector. If received in 
a District office, the Deputy Registrar shall immediately relay the information 
to the Chief C.D. Inspector and the Chief Food and Drug Inspector. 
An immediate investigation shall be made by the Health Officer or by 
the Communicable Disease Physician authorized to act in his stead, for the 
purpose of establishing diagnosis. If no Health Officer or Communicable 
Disease Physician belonging to the District concerned is available, the nearest 
available Health Officer shall be called to handle the case and estab- 
lish diagnosis. At the same time immediate steps shall be taken by the first 
qualified staff member available, under the supervision of the Health Officer, 
to quarantine suspected sources of poisoning and to obtain vomitus, feces, 
urine, garbage, suspected food, or other pertinent specimens, for laboratory 
examination. 
The services of the Chief Food and Drug Inspector are available on 
request to assist in this preliminary investigation; and, if not requested, it is 
25 understood that the Health Officer is assuming responsibility for the outcome 
of all phases of such investigation. 
In the investigation, the facts of the case shall be ascertained and re- 
corded on the State Board form (Food poisoning or botulism). A copy of 
this form must be submitted to the laboratory with the specimens, for guid- 
ance in laboratory examination, and two copies sent to the Morbidity Section, 
Division of Vital Records, Central Office, with the report of the case. 
Note: After working hours, the Director of the Bureau of Preventable 
Disease, the Chief C.D. Inspector and the Chief Food and Drug 
Inspector must be notified direct by telephone. 
"If a commercial canned product is suspected, an immediate report by 
telegraph or telephone to the State Department of Health is required.” (Reg- 
ulations—State Board of Health, April 3, 1943.) 
The definition of a reportable case of food poisoning shall be as follows: 
1. Poisoning from organic poisons present in normal animal and plant 
tissues, including mushrooms, fish and mussels. 
2. Poisoning following the consumption of food into which mineral 
or organic poisons or preservatives, including arsenic, lead, cadmium, 
fluorine, have been introduced by accident or with the intent to im- 
prove the appearance or the keeping quality. 
3. Infections due to the consumption of food containing bacteria of 
the Salmonella group. 
4. Poisoning due to the deleterious substances (toxins) produced in 
food by the growth of bacteria, molds, or similar organisms. 
5. Individual idiosyncrasy, (allergy, etc.) 
CHIEF FOOD ANT) DRUG INSPECTOR: 
As above stated, all information on a case or suspected case of food 
poisoning must be promptly submitted to the Chief Food and Drug In- 
spector. However, the Chief Food and Drug Inspector shall not work inde- 
pendently, but shall report to the Health Officer, or in his absence to his 
authorized representative, for information and counsel before beginning work 
on a case, and while working on it. When engaged in food poisoning work, 
the Chief Food and Drug Inspector is automatically working as a staff mem- 
ber of the Bureau of Preventable Disease under the supervision of the Bureau 
Director, and in cooperation with the Health Officer, in the same category 
as other Division or Section Heads of the Bureau. 
As stated, the time element is most important in food poisoning investi- 
gations and all employees shall cooperate for immediate action. The Health 
Officer and the Chief Food and Drug Inspector shall coordinate their efforts 
to that end, utilizing the knowledge and experience of the Chief Food and 
Drug Inspector to the best advantage commensurate with the economic factor 
of time and mileage. If, after the initial investigation the facts indicate the 
need for further routine sanitary supervision or correction, the necessary in- 
formation shall be referred to the Area Chief of the Sanitation District 
involved for continued follow-up and abatement. 
If, after completing his part of the investigation, the Chief Food and 
Drug Inspector thinks that court action should be taken, he shall first counsel 
with the Health Officer and the Head Sanitarian concerned. If the three do 
26 not agree, he shall not institute court proceedings without the consent of the 
County Health Officer. 
LABORATORY SPECIMENS: 
IT IS IMPERATIVE THAT ALL SPECIMENS SUBMITTED TO 
THE LABORATORY BE PLAINLY LABELED AND THE PURPOSE 
OF EXAMINATION BE MADE CLEAR IN ORDER THAT THE LAB- 
ORATORY MAY KNOW WHAT TO LOOK FOR. 
Further, the State Board form (giving the facts and cross-hatched record 
of food consumed) must accompany the laboratory specimens when sub- 
mitted. 
PROCEDURE: 
The investigation of food poisoning cases must vary with the type 
encountered. Procedure in cases where the suspected food is of commercial 
origin must be much more exhaustive than the ordinary case of carelessness 
in cooking or handling food. However, every case must be carried through 
until a diagnosis is established, the cause determined if possible, and food 
supplies controlled, if necessary. 
The following factors should alivays he determined in the investigation 
of food poisoning; 
A. Secure a complete list of the cases. 
Obtained by: 
1. An inquiry at the homes of the known infected households. In 
the course of the investigation a special article of food will 
probably be mentioned as suspected. 
2. Inquiries among fellow physicians as to similar cases of illness. 
3. House to house inquiries in the implicated area. 
4. If the outbreaks are extensive the health officers of adjacent 
areas should be consulted. 
B. The individual cases of illness. 
1. Clinical features. 
2. Date and time food had been eaten by each person. 
3. Quantity of suspected food eaten by each person. 
4. Time interval between consumption and onset of symtoms. 
C. The vehicle of infection or poison. 
1. Establish a complete list of the dietary for at least four days 
preceding the illness. 
D. A detailed study of the history of the implicated food. 
1. Those inquiries should be instituted both in the houses of the 
sufferers and at the place of preparation. 
2. Nature of the food. 
3. If compounded, establish the different ingredients. 
4. Determine source of the food; if of animal origin, trace back to 
the animal itself. 
5. Particulars as to any treatment or preparation of the food before 
consumption. 
6. Methods of preservation, if any, and by whom carried out. 
7. Ascertain whether the particular food was fully or inadequately 
cooked. 
27 8. Ascertain the dates of purchase and of any domestic treatment. 
9. Record details as to extent to which the food presented abnor- 
malities of taste, smell or appearance during the different stages 
of preparation. 
E. Evidence as to the source of infection of the food. 
1. Particular attention should be paid to the sanitary conditions 
under which food was made, prepared for consumption, cooled 
or stored. Opportunities for specific contamination must be 
looked for, such as contamination by gut scrapings, excreta, 
large animals, rats or mice. 
2. In cases of meat or milk, inquiries should be made as to evidence 
of healthiness or illness of the animal supplying. The price at 
which the food was sold may indirectly throw light upon this 
matter. 
3. The possibility of a human carrier—this inquiry is greatly facil- 
itated by bacteriological examinations. 
F. Coincident illness or deaths among domestic animals (chickens, cats, 
dogs, etc.) 
1. Which had access to the suspected food. 
2. Determine symptoms and number of deaths. 
G. Autopsy or Coroner’s report, if available. 
GERMAN MEASLES 
NOTIFICATION: 
Any person in attendance on a case of German measles or a case sus- 
pected of being German measles shall report the case immediately to the 
Health Officer. 
INVESTIGATION OF CASES: 
Upon being notified of a case of German measles, the Health Officer 
shall make such inquiry as he sees fit regarding the probable source of infec- 
tion, and shall see that the attendant and other members of the household 
are given and understand detailed instructions in regard to precautionary 
measures for preventing the spread of the disease. In the event of persistent 
non-observance of instructions given by any members of the Department staff 
regarding such precautionary measures, an immediate report to the Division 
of C.D. Inspections shall be made. 
ISOLATION: 
It shall be the duty of the Health Officer to see that cases of German 
measles are properly isolated, until clinically recovered. Isolation in this dis- 
ease is defined as that degree of detention necessary to insure non-contact 
with susceptible persons. 
QUARANTINE "B”; 
As and when needed. 
CONTACTS: 
When a person affected with German measles is properly isolated, 
members of the family or household are not subject to any restriction, 
whether immune or not. 
28 EXCLUSION BY SCHOOL AUTHORITIES: 
See page 7. 
DISINFECTION: 
All discharges from the nose and mouth of the patient shall be burned. 
Objects which have become contaminated by the patient shall be disinfected 
before being removed to any place where they might become possible sources 
of infection. Clothing, bedding and dishes used by the patient shall be steril- 
ized by boiling, or by immersion for 20 minutes in 2% carbolic acid solution, 
or its equivalent. 
TERMINAL DISINFECTION: 
Terminal disinfection of the room and furniture used by the patient 
shall consist of a thorough cleaning by scrubbing and/or washing with hot 
water and soap. 
RE-ADMITTING PATIENTS TO SCHOOL; 
SCHOOL CHILDREN WHO HAVE HAD GERMAN MEASLES 
MAY BE RE-ADMITTED ON CLINICAL RECOVERY BY A SCHOOL 
DOCTOR, A SCHOOL NURSE OR A HEALTH DEPARTMENT PHYS- 
ICIAN WHENEVER THE SERVICE OF SUCH PEOPLE IS AVAILABLE. 
In examining children to determine whether or not clinical symptoms 
have disappeared, attention should be paid to four points: First, all catarrhal 
symptoms should have disappeared; second, there should be no fever; third, 
all signs of the rash should have disappeared; fourth, enlargement of the 
postauricular glands should have entirely subsided. All four criteria may be 
fulfilled in many cases within four or five days from the onset of the disease. 
If, as may be true in some districts, somebody who is not included in the 
classes of persons above indicated must take the responsibility for readmission 
following German measles, exclusion should be for a full seven days follow- 
ing the onset of the disease. 
RECOGNITION of the disease by clinical symptoms only. 
INFLUENZA 
ISOLATION of the patient only, during the acute stage of the disease. 
VISITING SHOULD BE DISCOURAGED. 
CONCURRENT DISINFECTION: 
Burning of discharges from nose and throat of patient 
RELEASE on complete recovery. 
SPECIAL RULES WILL APPLY DURING EPIDEMICS. 
QUARANTINE "A”: 
LEPROSY 
When a case of leprosy or one suspected of being leprosy is reported, 
both the case and home contacts shall be immediately quarantined by the 
Health Officer where found. Smears from the nose, throat and lesions of the 
29 patient shall be taken by the Health Officer and forwarded to the County 
Health Department laboratory for examination. An immediate notification 
by telephone shall be made to the Chief C.D. Inspector, who will arrange 
for transportation of the case or suspected case to the Los Angeles County 
General Hospital, where provision is made for isolation and diagnosis, 
including laboratory report from the L. A. City Bacteriologist, pending 
release, removal to a Government institution or deportation, as the case may 
require. 
The case shall be held at the Los Angeles County General Hospital 
pending final diagnosis and release or placement. 
A LABORATORY POSITIVE SMEAR FROM THE NOSE, 
THROAT OR LESION IS THE ONLY ACCEPTED BASIS FOR AD- 
MISSION TO THE UNITED STATES GOVERNMENT LEPROSARIUM. 
(The Los Angeles County General Hospital is the only institution in 
Los Angeles County which is equipped and authorized by the Los Angeles 
County Health Department to handle such cases.) 
CONTACTS: 
Contacts in the home are held in quarantine. Smears from the nose and 
throat of such contacts shall be taken and sent (with a laboratory slip plainly 
marked with the name, address, etc., and "leprosy contact”), to the County 
Health Department laboratory for examination. 
If the smears from the nose and throat are negative and the contacts 
show no clinical symptoms of leprosy, contacts are released from quarantine 
after disinfection of the premises is completed. 
Note: Contacts shall be kept under observation over a period of years 
to determine if they have become infected. 
QUARANTINE PASSES: 
None. 
DISINFECTION: 
All discharges and articles soiled with discharges shall be destroyed by 
burning, or disinfected with some strong disinfectant such as lysol, etc. The 
living premises of the patient shall be thoroughly cleaned before release of 
quarantine. 
HOSPITALIZATION AND DEATH. 
Patients shall be hospitalized immediately as noted above. 
Funerals of persons dead from leprosy are strictly private, as outlined 
under "Instructions to Funeral Directors,” page 71. 
Note: The Health Officer shall make a thorough investigation of the 
source of infection, and shall make it promptly in cases of recent 
origin. It is important to determine where the patient came 
from, and how long in the community, as well as past move- 
ments of the patient, in view of the long incubation period of 
this disease. 
30 MEASLES 
NOTIFICATION: 
Any person in attendance on a case of measles or a case suspected of 
being measles shall report the case immediately to the Health Officer. 
INVESTIGATION OF CASES: 
Upon being notified of a case of measles, the Health Officer shall make 
such inquiry as he sees fit regarding the probable source of infection, and 
shall see that the attendant and other members of the household are given 
and understand detailed instructions in regard to precautionary measures for 
preventing the spread of the disease. In the event of persistent non-observ- 
ance of instructions given by any member of the Department staff regarding 
such precautionary measures, an immediate report to the Division of C.D. 
Inspections shall be made. 
ISOLATION: 
It shall be the duty of the Health Officer to see that cases of measles are 
properly isolated. Isolation in this disease is defined as that degree of deten- 
tion necessary to insure non-contact with susceptible persons. 
QUARANTINE "B”: 
As needed. 
Note: No person shall carry, remove, or cause to be carried or removed 
from any hotel, boarding house, lodging house or other dwell- 
ing, any person affected with measles without the permission of 
the Health Officer. 
CONTACTS: 
When a person affected with measles is properly isolated, adult members 
of the family or household who do not show symptoms of the disease are 
not subject to any restrictions. 
Children who give evidence satisfactory to the Health Officer of having 
had measles, if given written consent of the Health Officer, are not subject 
to any restrictions. 
Non-immune children shall be isolated and kept under observation for 
a period of two weeks, except that after a diagnosis of measles satisfactory to 
the Health Officer has been made, and isolation of the patient has been 
effected, in school districts having a medical and/or nursing inspection serv- 
ice which the Health Officer considers adequate, school age contacts be per- 
mitted to attend school whether known to he immune or not. 
It is specifically recognized that the official in charge of any school has 
the legal right to exclude any non-immune contact of a case of measles for 
the full incubation period or the last week of it if he sees fit to do so. 
Nothing in this order shall be construed in such a way as to take away that 
right. 
RELEASE FROM ISOLATION: 
The minimum period of isolation shall be from 4 days before the ap- 
pearance of the rash (that is, during the early catarrhal symptoms, on suscep- 
tibles known to have been exposed) until 7 days after the appearance of the 
rash. 
31 EXCLUSION BY SCHOOL AUTHORITIES: 
It shall be the duty of the principal or other persons in charge of any 
public, private or Sunday school to exclude any children infected with a dis- 
ease that is communicable until such children or other persons shall have 
been seen by the school physician or nurse, or shall have presented a certifi- 
cate issued by the Health Officer, or by the attending physician, and counter- 
signed by the Llealth Officer, stating that such children or other persons are 
not liable to convey a communicable disease. 
DISINFECTION: 
All discharges from the nose and mouth of the patient shall be burned. 
Objects which have become contaminated by the patient shall be disinfected 
before being removed to any place where they might become possible sources 
of infection. Clothing, bedding, and dishes used by the patient shall be 
sterilized by boiling or by immersion for 20 minutes in 2% carbolic acid 
solution. 
TERMINAL DISINFECTION: 
Terminal disinfection shall consist of a thorough cleansing by scrubbing 
and washing with hot water and soap. 
MENINGITIS (EPIDEMIC) 
(Meningococcic, including meningococcemia) 
QUARANTINE "C”: 
INVESTIGATION OF CASE: 
Upon being notified of a case of epidemic meningitis, or a case suspected 
of being epidemic meningitis, the Health Officer shall make an investigation 
to establish a diagnosis. This investigation shall include inquiry regarding 
the probable source of infection. If this source of infection is outside his 
jurisdiction, he shall notify the Morbidity Section, Division of Vital Records, 
Central Office, in order that it may inform the health authority within whose 
jurisdiction the infection was probably contracted. 
QUARANTINE: 
No general quarantine. The patient shall be isolated until the end of 
the febrile period and until all acute symptoms have subsided. 
Any other cases of respiratory or intestinal disease found in a family 
where there is a case of epidemic meningitis, should be regarded as probable 
epidemic meningitis, unless definitely diagnosed otherwise. 
The Los Angeles County General Hospital is the only hospital in the 
County properly equipped to handle cases of epidemic meningitis, and every 
reasonable effort should be made where a case is found, to send the patient 
to General Hospital. 
CONTACTS; 
If the case is properly isolated, quarantine of contacts is not required. 
However, if the patient remains in the home, school children shall be 
excluded from school and confined to their premises under isolation restric- 
tions for the duration of the illness. 
32 School teachers and school cafeteria workers shall be referred to the 
school health authorities for permission to work. 
The County Health Department recommends chemotherapy under med- 
ical supervision for all close contacts. 
MUMPS 
NOTIFICATION: 
Any person in attendance on a case of mumps shall report the case 
immediately to the Health Officer. 
INVESTIGATION OF CASES: 
Upon being notified of a case of mumps, the Health Officer shall make 
such inquiry as he sees fit regarding the probable source of infection, and 
shall see that the attendant and other members of the household are given, 
and understand, detailed instructions in regard to precautionary measures for 
preventing the spread of the disease. In the event of persistent non-observ- 
ance of instructions given by any member of the Department staff regarding 
such precautionary measures, an immediate report to the Division of C.D. 
Inspections shall be made. 
ISOLATION: 
It shall be the duty of the Health Officer to see that cases of mumps 
are properly isolated. Isolation in this disease is defined as that degree of 
detention necessary to insure non-contact with susceptible persons. 
QUARANTINE "B”: 
As and when needed. 
CONTACTS: 
When a person affected with mumps is properly isolated, adult members 
of the family or household are not subject to any restrictions. 
Child contacts who give evidence satisfactory to the Health Officer of 
having had mumps are, by written consent of the Health Officer, not subject 
to restrictions. 
Non-immune child contacts shall be isolated and kept under observation 
for three weeks, except that after a diagnosis of mumps satisfactory to the 
Health Officer has been made, and isolation of the patient has been effected, 
in school districts having a medical and/or nursing inspection service which 
the Health Officer considers adequate, school age contacts be permitted to 
attend school whether known to he immune or not. 
It is specifically recognized that the official in charge of any school has 
the legal right to exclude any non-immune contact of a case of mumps for 
the full incubation period or the last week of it if he sees fit to do so. Noth- 
ing in this order shall be construed in such a way as to take away that right. 
RELEASE FROM ISOLATION: 
The period of isolation shall be until the swelling of the salivary glands 
has subsided. 
EXCLUSION BY SCHOOL AUTHORITIES: 
See page 7. 
33 DISINFECTION: 
All discharges from mouth and nose of the patient shall be burned. 
Objects which have become contaminated by the patient shall be disinfected 
before being removed to any place where they might become possible sources 
of infection. Clothing, bedding, and dishes used by the patient shall be 
sterilized by boiling or by immersion for 20 minutes in 2% carbolic acid 
solution. 
TERMINAL DISINFECTION: 
Terminal disinfection shall consist of a thorough cleaning by scrubbing 
and washing with hot water and soap. 
PLAGUE 
QUARANTINE "A”: 
In any case or suspected case of bubonic or pneumonic plague, an imme- 
diate and absolute quarantine of the household and contacts must be es- 
tablished. 
An immediate report by telephone of the case or suspected case must be 
made to the Chief C.D. Inspector, who will supervise the quarantine, fumiga- 
tion, disinfestation and the release from quarantine of contacts and premises. 
HOSPITALIZATION; 
In all cases or suspected cases of bubonic or pneumonic plague, immedi- 
ate removal of the patient to the Los Angeles County General Hospital, after 
obtaining permission from the L. A. City Health Department, is required. 
PERIOD OF QUARANTINE AND RELEASE: 
The period of quarantine shall be until 2 days after complete recovery 
of the patient, and on contacts shall be for a period of not less than 7 days 
after the date of last exposure. 
FUMIGATION AND DISINFESTATION: 
The following procedure must be followed by all persons working on 
a case of plague in the area controlled by the County Health Department. 
This includes doctors, nurses, C.D. Inspectors, sanitary inspectors, fumigators, 
guards or other persons. 
1. No building of any character where a positive case of bubonic or 
pneumonic plague is known to have existed shall be entered by any 
person unless attired as follows; 
(a) Each such person shall wear a long-sieved gown and a mask as 
approved by the County Health Department. 
(b) Rubber gloves must be worn and the wrist or gauntlet of the 
glove pulled well over the cuffs of the gown. 
(c) A surgeon’s skull cap must be worn in a manner that will cover 
the hair and scalp. 
(d) Knee boots, either leather or rubber, or high topped shoes with 
leather puttee leggings shall be worn. 
2. The shoes shall be sprayed with kerosene each time before entering 
the building. 
34 3. All mattresses, bedding, rugs, or other materials which have come 
in direct contact with the patient shall be burned. (Where a 
wooden frame bed has been used, it shall be burned.) 
4. A complete record must be kept of all articles that have been de- 
stroyed and notations made as to the probable age, condition and 
value of such articles. 
5. Infested clothing which is washable may be soaked in 10% solution 
of lysol or its equivalent for two hours. All other infested clothing 
shall be burned. 
6. On entering the building, the worker shall spray the floor as he goes 
with a solution of at least 10% lysol or its equivalent. The whole 
entrance of the building shall be sprayed, particular attention being 
paid to get the solution under and around the baseboards, doors, 
door knobs, door jambs, or other parts of the room to a height of 
at least 4 feet or any part which may have come in contact with the 
hands of the patient. 
When this spraying is completed, the fumigator shall seal all outside 
doors, windows, and other openings, making the building as nearly 
gas-tight as possible. Before starting actual fumigation, the fumigator 
shall ascertain that no human being or domestic animal remains in- 
side the premises to be fumigated or in close proximity thereto. 
7. In sealing up the building for the purpose of fumigation, provision 
must be made for the opening of two or more doors or windows 
from the outside. 
8. Sulphur gas shall be used as a disinfectant, at least 7 pounds of 
flowers of sulphur per 1000 cubic feet of air space. This sulphur 
shall be placed in a pan or pans and heaped cone-shaped. The pans 
shall be placed in tubs which contain at least 4 inches of water, and 
the pans placed on bricks or other suitable support in the water. 
Care shall be taken that the tubs are placed in a clear space in the 
room, so as to prevent possible danger of fire. The sulphur shall 
then be ignited at the top of the cone by means of a small quantity 
of alcohol lighted by a match. (Hydrocyanic gas may be used for 
fumigation, but in California the State law requires that this type 
of fumigation may be done only by a licensed fumigator. Health 
Department regulations require its use only under arrangements 
made by and under the direct supervision of the Chief C.D. In- 
spector.) 
9. A chemical fire extinguisher (Underwriters approved type) shall be 
kept on every job of fumigation, and be easily accessible to the 
fumigator or guard. 
10. After fumigation the building shall be kept closed for at least five 
hours. 
11. At least two men shall remain on guard on the premises at all times 
during the process of fumigation, and all premises must be suitably 
placarded, with special fumigation signs. 
12. The fumigator only, or the guards, under his direction, are permitted 
to re-open the building after fumigation. 
35 13. When the fumigation has been completed, the fumigated premises 
must be aired at least two hours, and permission of the Chief C.D. 
Inspector must be obtained before any persons other than the fumi- 
gating crew are allowed to enter. 
POLIOMYELITIS 
QUARANTINE "B”: 
DURING AN EPIDEMIC, SPECIAL REGULATIONS WILL BE 
PUT IN EFFECT. CALL THE BUREAU OF PREVENTABLE DIS- 
EASES, CENTRAL OFFICE, FOR SUCH SPECIAL REGULATIONS. IN 
SPORADIC INDIVIDUAL CASES THE FOLLOWING WILL APPLY. 
INVESTIGATION OF CASE: 
Upon being notified of a case of poliomyelitis, or a case suspected of 
being poliomyelitis, the Health Officer shall make an investigation to estab- 
lish a diagnosis. This investigation shall include inquiry regarding the prob- 
able source of infection. If this source of infection is outside his jurisdiction, 
he shall notify the Morbidity Section, Division of Vital Records, Central 
Office, in order that it may inform the health authority within whose juris- 
diction the infection was probably contracted. 
QUARANTINE; 
If the Health Officer is satisfied that the case is one of poliomyelitis or 
is strongly suggestive of poliomyelitis, he shall establish a quarantine on the 
patient and contacts. The minimum period of quarantine on a case of polio- 
myelitis is 14 days from the date of onset. 
Any other cases of respiratory or intestinal disease found in a family 
where a case of poliomyelitis exists should be regarded as probable polio- 
myelitis, unless definitely diagnosed otherwise. 
The Los Angeles County General Hospital is the only hospital in the 
County properly equipped to handle cases of poliomyelitis, and every reason- 
able effort should be made, where a case is found, to send the patient to the 
General Hospital. 
When giving instructions on preventive measures, all persons in quar- 
antine or under observation should be warned to avoid any exercise or activity 
that may cause fatigue or lowered resistance. 
The use of common towels or of common drinking or eating utensils 
is forbidden. 
QUARANTINE PASSES: 
None. 
CONTACTS; 
Persons who have been in frequent contact with the patient and are 
members of the same household shall be subject to the quarantine until it is 
terminated. 
The wage earner may be excluded from the area of quarantine on the 
following conditions: 
(a) That he shall not have been in attendance on the patient at any 
time since the beginning of the disease. 
36 (b) That he shall observe adequate precautions and shall not re-enter 
the premises or come in contact with the patient or other persons 
on the quarantined premises. 
(c) That he shall not engage in any occupation or practice which 
would bring him in contact with large numbers of persons, especi- 
ally children. (See section entitled "Food handlers etc., page ). 
Persons, including food handlers and school teachers, who have come 
in contact with an individual who has a case of poliomyelitis, and who are 
not members of the same household, shall be kept under observation by the 
Health Department for a period of 14 days from the last contact, and shall 
not be permitted to engage in any occupation or practice which would bring 
them in contact with large numbers of persons, especially children. 
If any person who has come in contact with a patient afflicted with, or 
suffering from poliomyelitis wishes to leave the jurisdiction of the Health 
Officer within 30 days after the last exposure, the Health Officer shall notify 
the Bureau of Preventable Diseases of his name and proposed destination so 
that it may notify the health authority at the point of destination. 
When any persons come into the area of jurisdiction of the Health Offi- 
cer, from a region in which poliomyelitis is prevalent, the Health Officer 
shall regard them as contacts and shall keep them under observation for a 
period of 14 days after arrival, and shall subject them to the restrictions pro- 
vided above for contacts. 
RELEASE FROM QUARANTINE AND DISINFECTION: 
When quarantine of a case of poliomyelitis is released (release shall be 
not less than two weeks from the beginning of the disease), the patient and 
the attendants shall bathe and wash their hair with soap and water, and put 
on clean clothes, and the objects in the area of isolation shall be disinfected. 
The Health Officer shall determine the minimum amount of disinfection 
required, and shall see that it is properly done. 
HOSPITALIZATION AND DEATH: 
In the case of hospitalization or death of a person from poliomyelitis, 
the Health Officer may release from quarantine adult persons who do not 
have any symptoms of the illness, but they shall he kept under observation 
for 14 days. 
If there are children under 16 years of age in the family, they shall be 
quarantined for a period of 14 days from the last exposure. Food handlers, 
and persons who come in contact with children, are to be excluded from their 
occupation for a period of 14 days. 
FUNERALS: 
Funerals of persons dead from poliomyelitis are private and subject to 
the procedure as outlined in "Instructions to Funeral Directors”, page 71.) 
INSTITUTIONS: 
Cases of poliomyelitis occurring in institutions will be governed by 
special quarantine rules. In any and all such cases, refer to the Bureau of 
Preventable Diseases for procedure to be followed. 
37 PSITTACOSIS 
QUARANTINE "C”: 
PROCEDURE: 
This disease requires special enforcement of isolation, with the technique 
as required for typhoid. 
An immediate report by telephone to the Chief C.D. Inspector is re- 
quired on all cases or suspected cases of human psittacosis. The Health 
Officer shall immediately secure a specimen of sputum, and if the case is dis- 
covered sufficiently early, a specimen of the patient’s blood (collected as for 
a Widal test). Such specimens shall be mailed immediately in the approved 
mailing containers to the California State Department of Health, Hygienic 
Laboratory, Life Sciences Building, Berkeley, California. 
The patient must be immediately isolated and cared for with approved 
Communicable Disease technique, and the attendants must not come in con- 
tact with others. The patient should be sent to the Los Angeles County 
General Hospital, if possible, where proper technique is assured; but he may 
be sent to any other hospital provided he and his attendants are isolated in a 
private room. Period of isolation is until clinical recovery. 
CONTACTS: 
If the patient dies or is removed, all contacts must be kept under obser- 
vation for 10 days and immediately isolated if suspicious symptoms develop. 
BIRD QUARANTINE: 
All suspected birds shall be immediately quarantined on the premises 
where they are found, and attendants warned to use extreme care in feeding 
and caring for these birds, and always to wear gloves in handling them. 
The State rules and regulations covering psittacine birds and their avi- 
aries have been the object of much change and modification. Specimens for 
laboratory diagnosis of suspected birds are under the direct jurisdiction of 
the State Department of Public Health, and all questions concerning these 
aviaries and suspected birds shall be referred to the Chief C.D. Inspector, 
who shall secure rulings, etc., on individual cases from the Inspector of 
Psittacosis Control, State Department of Public Health. 
FUNERALS; 
No restrictions are placed on the funerals of persons dead from psit 
tacosis. 
RABIES 
ANIMAL BITES AND SUSPECTED RABIES: 
ANY ANIMAL WHICH BITES A HUMAN BEING IS TO BE SUS- 
PECTED OF HAVING RABIES UNTIL PROVEN OTHERWISE. 
THEREFORE, ALL REPORTS OF DOG BITES OR SUSPECTED RABIES 
ARE EMERGENCY CALLS AND MUST BE GIVEN IMMEDIATE 
ATTENTION. 
38 RABIES CONTROL—WHY. 
The sole purpose of rabies quarantine is to hold and observe the animal 
involved for symptoms of rabies in order that the attending physician may 
be guided in his treatment of the human beings. 
PASTEUR TREATMENT IS PREVENTION, NOT CURE hence, 
quick and positive information regarding the animal is essential for the care 
of the human. 
The circumstances under which the bite occurs may immediately rule out 
rabies with only a brief investigation. However, in the presence of a high or 
rising incidence of animal Rabies, the Health Officer shall use extreme care 
and judgment in ruling out rabies without a full and complete investigation. 
Face bites, when the circumstances of the injury plainly indicate carelessness 
or ignorance on the part of the person bitten, or that the bite was provoked, 
do not necessarily indicate rabies, nor do they necessarily require Pasteur 
treatment. Bites by animals that are usually caged, (such as monkeys, rabbits, 
white rats, mice, squirrels, etc.) may in most cases be ruled out as "not 
rabies” unless unusual or suspicious circumstances indicate otherwise. 
REPORTING: 
Reporting of rabies and other diseases of animals which may be trans- 
mitted to humans is required by the State Department of Public Health. Sup- 
plementing this requirement the following rules have been adopted by the 
Los Angeles County Health Department for the territory served by the 
Department: 
PHYSICIANS or others called upon to treat patients for bites of dogs 
or other animals shall report such cases immediately by telephone to the 
Health Officer, giving name, address of patient, and such information as is 
available regarding nature and extent of injuries, circumstances under which 
bite occurred, description and ownership of dog or other animal. The 
Weekly Bulletin of the California State Department of Public Health, issue 
of March 5, 1938, says: "Cauterization of the wound with fuming nitric 
acid, which is the only reliable cauterizing agent, is also of prime importance 
in preventing the development of rabies.” To be effective, cauterization 
should be done as soon as possible after the bite, and should be followed 
immediately by the application of a neutralizing solution. 
VETERINARIANS or others having under observation or treatment 
any dog or other animal which has bitten a human being shall immediately 
report the case by telephone to the Health Officer and shall hold such animal 
under observation until release by the Health Officer. 
VETERINARIANS or others harboring or owning any animal suspected 
of rabies shall report immediately by telephone to the Health Officer and 
hold such animal subject to his orders. Under this order a veterinarian is not 
permitted to release a dog suspected of having rabies even to its owner until 
permission is obtained from the Health Officer and arrangements are made 
to supervise its removal; neither may any rabid animal or suspected rabid 
animal be destroyed without permission of the Health Officer. 
RECEIVING REPORTS: 
If a report is received in a District Office, the clerk or other person 
receiving such report MUST MAKE EVERY EFFORT TO GET THE IN- 
39 FORMATION COMPLETE AT THAT TIME, USING FORM P.D. 
No. 30. 
If the report is received at the Central Office, follow the same procedure 
and transmit the information at once to the proper District Office. As soon 
as possible after receipt of a report of an animal bite, the person receiving 
the report will assign the case to an inspector, who will investigate the case, 
complete the information indicated on the P.D. No. 30, quarantine the 
animal or animals involved, and report the circumstances at once to the 
Health Officer, 
If the person bitten reports to the Health Officer or the clinic, the 
patient shall be referred to the clerk designated to handle such reports, in 
order that no detail of information shall be missed. Further, every report of 
an animal bite must pass over the desk of the clerk designated to handle 
such work. 
In cooperating cities maintaining a poundmaster or a patrolman assigned 
to such work who has been sworn in as a special deputy health officer, such 
poundmaster may receive reports of dog bites or suspected rabies and will 
have full authority for apprehending and quarantining the animal and post- 
ing animal quarantine card (P.D. No. 58). Reports should go through 
regular channels to an inspector, who will immediately follow up the search 
for human and animal contacts and carry out general instructions. 
QUARANTINE PERIODS 
ANIMAL BITE: 
A minimum of fifteen days from the date of the bite (and for such 
additional time as may be required by local ordinances). 
KNOWN CONTACTS: 
For animals which have been bitten by, or are known to have been in 
direct contact with, another animal which is found to be rabid, the period 
shall be 90 days from date of bite or last contact, during which time the 
animal must be confined on the premises of the owner or custodian in a 
cage, enclosed paddock or on a chain leash in a manner to prevent possible 
contact with persons or other animals. Animals so quarantined must be ob- 
served weekly for the first four weeks, and monthly thereafter. 
In all cases of known animal contacts of a rabid animal, every reason- 
able effort should be made to induce the owner or custodian of such animals 
to have them destroyed. If they agree, have a relinquishment signed (Pound 
Dept. Form P.D. fill), then telephone the Pound Department or Humane 
Society, and have the animal or annuals picked up as soon as possible. 
CASE PROCEDURE ON ANIMAL BITES 
IMPORTANT: The inspector making the first inspection of an animal 
who has bitten a human being will quarantine the animal and report the 
facts to the Health Officer, who will determine whether rabies is suspected. 
If the case is obviously not rabies, it may be closed by the Health Officer, 
whose signature must appear on the P.D. #3O. The following are essential 
in each case: 
40 1. When a case of dog bite is assigned, the inspector shall investigate 
to get names and addresses of all persons bitten, and ascertain that all victims 
have had proper treatment. If any doubt exists, recommend that they see 
the Health Officer or a private physician; have P.D. No. 39 signed, and 
return the No. 39 to the Health Officer as soon as possible. If the patient 
has already contacted his private physician, investigation shall be made re- 
garding the extent of the injury and whether or not fuming nitric acid was 
used. 
2. Locate and quarantine animal; note symptoms carefully and indicate 
on the bite card. Fill out P.D. No. 30-B and serve on owner or custodian. 
Post "red” Animal Quarantine card P.D. No. 58 securely in a conspicuous 
place (See P.D. No. 58). Inform the owner or custodian that the quarantine 
is for a minimum period of 15 days, and warn the owner against removing 
or destroying the card, taking or allowing the animal to be taken off the 
premises during the quarantine period. Inform the owner or custodian that 
if the dog gets loose it is his responsibility, regardless of the circumstances. 
3. If investigation shows there have been no human contacts with a 
dog diagnosed as rabid, the animal may be destroyed with the permission of 
the Health Officer, and the case (dog or other animal) reported as "clinical 
rabies”. The head will, or will not be taken to the laboratory for exami- 
nation, at the option of the Health Officer. 
4. The owner or custodian of any quarantined animal shall always be 
instructed to notify the Health Department immediately if there is any 
change in the appearance or actions of the animal or any suspicious develop- 
ment, or if the animal escapes. 
RE-VISITS: 
The incidence of rabies in a district will regulate the need for re-visits 
on any ordinary animal bite. In cases where rabies is suspected or the circum- 
stances warrant, more frequent re-visits are required, and the orders of the 
Health Officer shall regulate the procedure in all such cases. 
If the case is ordinary—victim teased animal, tried to take food from 
animal, entered premises where dog was guarding property, etc., and the 
inspector has good reason to expect cooperation on the part of the owner, 
one visit to quarantine, and one to release on final diagnosis is all that is 
necessary. (However, in such cases the Health Officer may close the case if 
he desires, and sign Form P.D. #30.) 
If a case of suspected rabies in a dog originates in one district, and with 
the knowledge and consent of the Health Officer, said suspected dog is taken 
to another district to be impounded and kept under observation, all history 
of the case is to be transferred to the second district, giving date of transfer 
and location of dog. From there on the second district will handle the case 
•—either release the dog or in case it dies, take the head, if necessary, to the 
laboratory for examination. 
PASTEUR TREATMENT: 
Immediate Pasteur treatment is recommended in cases of face, head or 
neck bites, if for any reason rabies is suspected, or if the animal cannot be 
found for observation. 
41 When a Health Department employee contacts a patient under any of 
these circumstances, he should refer such patient to the Health Officer and 
have a P.D. No. 39 signed by the patient (if patient is a minor, get the sig- 
nature of a parent or legal guardian), If patient or guardian refuse to sign, 
the inspector will sign as the Health Department representative, and have the 
signature witnessed if possible. 
When Pasteur treatment is prescribed, the Health Officer will note the 
fact on Form P.D. #5O and he (the Health Officer) will be responsible for 
seeing that the patient takes such treatment as is advised; otherwise he will 
have a new release (P.D. No. 39) signed by the patient or his guardian. 
If Pasteur treatment has been started on a patient, treatment may be 
stopped if the dog is located and/or is found to be normal after 15 days 
from date of bite. 
In cases of animal bite where rabies is known,ot suspected, the inspector 
will instruct the patient or guardian: 
1. Inform the patient that State and County Health authorities urge 
that fuming nitric acid be used for cauterization as soon as possible after the 
bite occurs. Instruct the patient to see the Health Officer immediately for 
cauterization. Get a P.D. #59 signed, or if the patient refuses to accept the 
recommendation, so state on the #39 and sign the form yourself (having 
your signature witnessed, if possible). In the event the wound is not cau- 
terized, write an explanation on P.D. #3O under "Remarks”. 
2. In reporting laboratory findings to patients or others outside the 
Department, always use the terms "positive” or "none found”—never use 
the term "negative”. 
Emphatically, a "positive” report from the laboratory should be the 
only absolute laboratory confirmation of a clinical suspicion. A "negative” 
or "none found” laboratory report has no weight in deciding the need for 
Pasteur treatment, as the clinical manifestations of a suspected dog are always 
of primary importance. Quarantine of animal contacts should always follow 
where the animal in question shows clinical rabies even though the laboratory 
report may be "none found” or "negative”. 
If there is evidence of rabies, use every reasonable means to have patient 
or contact see the Health Officer or a private physician. You may say that 
in such cases the Health Department urges Pasteur treatment, but official rec- 
ommendation to take treatment must come only from the Health Officer or 
private physician. 
CAUTION: Remember, the lay employee does not prescribe, nor does 
he instruct the patient to take treatment. He is simply calling attention to the 
laws, rules, regulations and recommendations of the State, the County and 
the County Health Department. 
In any case of "human rabies”, an immediate and independent investi- 
gation shall be made by the Chief C.D. Inspector under the direction of the 
Bureau Director. 
CAUTERIZATION OF BITES: 
"Cauterization of animal bites should be done as soon as possible after 
the wound has been inflicted. Fuming nitric acid is the most effective cauter- 
izing agent, especially when applied within 48 hours. While the actual 
42 cautery is effective so far as it reaches the parts of a wound, the fuming 
nitric acid has the advantage of penetrating deep crevices which the iron 
cannot reach. Fuming nitric acid is superior in the treatment of 
wounds made by rabid animals. Such lesions should not be sutured.” U.S. 
Public Health Reports, August 16, 1935. 
Cauterization with fuming nitric acid should be followed immediately 
by the application of a neutralizing solution. 
In order to avoid injury to the eyes or other tissues in face wounds it is 
important to secure immobility of the patient, if necessary, under a general 
anaesthetic. 
Eminent authorities affirm that cauterization applied by careful technique 
produces scars no worse than if such wounds were treated by other methods. 
If and when complications arise through administering anti-rabic treat- 
ment or in cauterizing dog bites, the Health Officer will be responsible for 
such after-treatment as may be necessary, in the same manner as he is respon- 
sible for complications or severe "takes” following vaccination. 
INSTRUCTIONS TO FIELD WORKERS: 
1. No animal known to have, or suspected of having rabies shall be 
transported from one point to another in that portion of Los Angeles County 
under the Los Angeles County Health Department jurisdiction, except in 
regularly-constructed "dog wagons”, and under the supervision of a licensed 
veterinarian, or a poundmaster—the only exception being with the written 
permission of the County Health Officer, or the Director of the Bureau of 
Preventable Diseases. 
2. When it is necessary to handle a live animal suspected of rabies, use 
equipment provided for that purpose. Do not take unnecessary chances of 
being bitten. 
3. Remember that the saliva of an infected animal is virulent and may 
contaminate anything contacted. 
4. When a rabid animal is found to be insecurely confined, it is the 
duty of the inspector to stand guard over such animal until the pick-up 
wagon arrives, to prevent contact by humans or animals with the infected 
animal and to prevent its escape. 
5. If it should be necessary to have any suspected animal shot, instruct 
the person doing the shooting that the brain must be kept intact for labora- 
tory examination, and request that the animal be shot through the heart if 
possible. 
6. In removing head from a suspected animal after death, always use 
the rubber gloves provided for that purpose. Use a sharp "boning” knife 
as provided, severing the neck in the first joint back of the skull. 
7. Wrap the head in several thicknesses of paper, while wearing the 
gloves; next, remove and wrap gloves and knife in another package; then 
place a final wrapping of clean paper outside of each package and take 
or send to the laboratory at once. Label each package plainly and specify 
whether for laboratory examination or for sterilization. A laboratory slip 
must accompany the head; and the slip must give a description of the animal, 
with the name and address of the owner, to identify the specimen. Do not 
send decomposed heads to the laboratory. 
43 8. Inform the custodian that if the carcass is buried, it must be buried 
under at least three feet of earth. 
INSTRUCTIONS FOR SENDING HEAD TO LABORATORY: 
A. A complete set of rabies equipment shall be maintained at each 
health center for emergencies. This set shall consist of: 
1 pair heavy rubber gloves 
1 boning knife 
Supply of heavy wrapping paper 
County issue 
The inspector assigned to rabies work in the district will be responsible 
for keeping this equipment available and in proper condition at all times. 
B. In routine work the inspector assigned to rabies work shall remove 
the head from the carcass of any animal that has died or been killed, if rabies 
is known or suspected. (Exception—paragraph "D” below). 
C. Employees, especially nurses and physicians, assigned for emergency 
work (week ends, holidays, etc.) when notified by a Humane Society, vet- 
erinarian, or the owner or custodian, of the death of a suspected rabid animal, 
shall take this emergency equipment with them when calling for the head. 
It shall be the duty of the custodian of the animal to remove the head from 
the carcass, properly wrap it and the tools in separate packages and present 
them to the Health Department employee for delivery to the laboratory. 
D. Veterinarians, kennels, dog and cat hospitals, etc., shall surrender 
the carcass of a rabid, or a suspected rabid animal, or such portion of the 
carcass as may be demanded. 
RABIES FORMS IN USE 
FORM P.D. NO. 30—ANIMAL BITE CARD: 
To be used in every case or suspected case of rabies reported, for each 
animal bite on a human reported, and/or for each human contact of a rabid, 
or suspected rabid, animal. 
1. The original animal bite card, (Form P.D. d£3o) will serve as the 
sole record of the bite and the investigation, and will be retained in the 
District Office files subject to inspection by the Chief C.D. Inspector and/or 
the Division of Vital Records. 
As the original card will be the only permanent departmental record, the 
employees using the card must use ink or indelible pencil, keeping the card 
neat and legible. Further, the card must be kept in the District Office files 
except when being used in the field, and returned promptly to the files from 
field use. 
2. The use of Form CD-VR 23 will be continued and shall be for- 
warded weekly to the Division of Vital Records, Central Office, as in the 
past, thus providing a weekly record of the number of bites and the number 
of Pasteur treatments. This form shall be forwarded each week at the same 
time the usual morbidity reports are sent. 
3. Rabid animals will be reported on State morbidity cards as usual. 
The procedure as outlined will provide satisfactory records and will 
eliminate considerable clerical work in the districts provided employees 
44 charged with the handling of these records use proper care in making the 
cards, adding entries thereto, and returning the cards promptly to their 
proper file. 
FORM P.D. 30-B—NOTICE OF ANIMAL QUARANTINE: 
To be served, properly filled out, on the owner or custodian of an 
animal at the time the quarantine is imposed. 
FORM P.D. No. 36—RABIES CASE RECORD: 
To be used in each case of animal rabies, or cases suspected of being 
rabies if the animal dies. Each question must be answered and the symp- 
toms and type of rabies indicated on the reverse side, which must be filled 
out in full in all cases where the brain is not examined, or when no negri 
bodies are found in the laboratory test. Each item must be checked "Yes” 
or "No”. (Each P.D. No. 36 sent to the Chief C.D. Inspector must be 
accompanied by a copy of the P.D. No. 30 properly filled out, if a human 
has been bitten, or if there have been any human contacts of the rabid 
animal.) 
FORM P.D. No. 39—WAIVER OF RESPONSIBILITY: 
This form is for the protection of the employees and the Department 
and is to be used: 
1. By the field worker when he refers to a Health Officer or private 
physician, a person who has been bitten by an animal, or who is a contact 
of a known or a suspected rabid animal, and such person has not had the 
necessary preventive treatment. 
To save time and mileage, get this form signed on the first call on every 
case—unless the patient has already consulted the Health Officer or a private 
physician. 
NOTE: If the patient is a minor, the signature of parent or legal guard- 
ian must be secured. The signature of any relative who is not the legal guard- 
ian, is worthless. 
FORM P.D. NO. 48-A—QUESTIONS AND ANSWERS ON RABIES: 
Educational material for the owner, custodian, physician, or any person 
interested. 
FORM P.D. NO. 49—REPORTING OF ANIMAL BITES AND/OR 
SUSPICIOUS ANIMALS: 
To be given to physicians or others who may be called upon to treat a 
person bitten by an animal; also, to veterinarians, animal hospitals, etc. Form 
is to be signed by the Health Officer. When investigating a case of non- 
reporting, always give a copy to the person involved. 
FORM P.D. NO. 56 —STRICT RABIES QUARANTINE (AREA 
PLACARD): 
An area quarantine, the same as Form P.D. 57 below, except that it 
covers a strict confinement for all dogs in the area and does not permit 
"leashing” or any other variations. 
This is intended for use chiefly in incorporated cities, by agreement with 
the City Council, etc., before the quarantine is declared. 
45 FORM P.D. NO. 57—RABIES QUARANTINE AREA PLACARD: 
If rabies becomes epidemic within a given area, an area quarantine may 
be declared by the County Health Officer by posting this form at the various 
outside boundaries and at prominent spots throughout the area. You will 
note the form provides that the area must be specified in detail. The rest of 
the form is self-explanatory. 
An Area Quarantine shall be for a minimum period of 90 days and 
shall not be released by the County Health Officer until at least 90 days after 
the last known case of rabies in the quarantined area. 
FORM P.D. NO. 58—ANIMAL QUARANTINE (RED CARD): 
In each case of animal quarantine (except permanent quarantine), the 
red card must be placed in a conspicuous place as a warning to any person 
entering the premises where the animal is quarantined. Always warn owner 
or custodian that removing, defacing or destroying the card is a violation of 
State laws. The red card (P.D. No. 58) must be removed by a deputized 
employee at termination of the quarantine. 
FORM P.D. No. 81—TRANSFER OF ANIMAL BITE CASE: 
To be used when a case of animal bite or quarantine is transferred from 
one district to another. Also, for inter-district communication regarding ani- 
mal bite cases. 
FORM P.D. NO. 28—ANIMAL QUARANTINE ORDER: 
To be used when impounding animals for observation. The following 
is from Bureau Order dated Nov. 2, 1943: "Effective 7-1-41 all matters 
having to do with the impounding of dogs under Ord. 2550 will be under 
the administrative management and control of the County Poundmaster—a 
full-time officer not connected with the Health Department.” 
When it becomes necessary for the Health Department to quarantine a 
dog or other animal in a contract humane society shelter, the Health De- 
partment must provide the humane society with proper authority in the shape 
of Animal Quarantine Order (our Form P.D. No. 28), accurately and com- 
pletely filled in. 
The Health Department does not pay impounding fees unless the animal 
is held for observation under our Quarantine Order. If the owner is known, 
an "Animal Relinquishment” (Form P.D. No. 11) signed by the owner 
must be held either by the Health or Pound Department, under which the 
destruction of the animal, if and when necessary, is authorized. 
Note: The owner is expected to maintain the quarantine at his home 
if possible; otherwise, the owner is expected to pay the contract humane 
society the necessary impounding and boarding fee. Follow procedure as 
outlined in above order. 
POUND DEPARTMENT FORM NO. 11—ANIMAL RELINQUISH- 
MENT; 
To be used in all cases involving a suspected or known rabid animal or 
a known animal contact of a rabid animal where the owner or custodian is 
46 willing to relinquish ownership of such animal. This form must be signed 
by the owner or custodian. 
Note: Employees who in their work have occasion to use these forms 
should study them carefully, in order that they may be properly used. 
HUMANE SHELTERS AND POUNDS 
On holidays or week ends, when any animal in the custody of a Humane 
Society dies, and rabies is known or suspected—the Humane Society shall 
notify by telephone the inspector assigned to rabies control work in that 
district. If unable to contact that employee a report of the case shall be made 
immediately to the Division of CD. Inspections through the county tele- 
phone operator (MUtual 9211). 
The following rabies control regulations have been adopted for Pounds 
and Animal Shelters in the area served by this Department: 
1. It is recommended that all pound men wear leather gauntlet gloves 
and leather leggings or high-topped shoes when engaged in their work. 
2. All "come alongs’’ and other equipment used in the handling of 
rabid or suspected rabid animals (including drinking pans, etc.) shall be 
properly disinfected. This can be done by keeping a bucket or tank of lysol 
solution convenient and by immersing or thoroughly swabbing said utensils 
with the disinfectant. 
3. All pounds shall provide special kennels for rabid animals, suspected 
rabid animals or known contacts of rabid animals. Such kennels should be 
maintained for that purpose only. 
4. Immediately upon vacancy all kennels occupied by rabid (or sus- 
pected rabid) animals, should be disinfected with 10% formaldehyde 
solution; all other kennels should be regularly disinfected with any of the 
kreso disinfectants. 
5. All pick-up wagons should be cleaned and disinfected (with a kreso 
disinfectant) as often as may be necessary, but at least once weekly. At any 
time a rabid (or suspected rabid) animal is picked up, the truck should be 
immediately disinfected. 
6. All pounds shall be maintained in a clean and sanitary manner at 
all times, and shall be equipped with a suitable incinerator. It is unlawful to 
allow to remain on any premises of any pound any offal, garbage, dead 
animal or any putrid or offensive animal or vegetable matter; to maintain any 
building or premises in such manner as to permit the breeding or harboring 
therein or thereon of rats, fleas, lice, flies or other vermin. All garbage, offal 
and vegetable matter shall be placed in a water-tight metal container pro- 
vided with handle and tight-fitting cover. 
All Humane Societies and Pounds are hereby prohibited from destroying 
any dog from the area served by the Los Angeles County Health Department, 
at the owner’s request unless the owner in person shall sign a dated statement 
to the effect that the dog has not to the oivner’s knowledge, bitten any person 
during the fifteen days immediately preceding. 
47 COOPERATIVE AGREEMENT 
(Los Angeles City) 
In cases of suspected rabies in animals diagnosed or dying in territory 
served by the L. A. County Health Department, the heads will be examined 
by the L. A. County Health Department laboratory, and whenever the animal 
comes from L. A. City or there have been human or animal contacts in L. A. 
City, such information will be transmitted by telephone immediately to the 
L. A. City Health Department. 
In cases of suspected rabies in animals diagnosed or dying in L. A. City 
territory, the head will be examined by the L. A. City Health Department 
laboratory, and if animal originated in County Health Department territory 
or there were human or animal contacts in County territory, such information 
will be telephoned immediately to the L. A. County Health Department. 
In any case of suspected rabies originating in L. A. County territory and 
going to L. A. City territory, the L. A. County Health Department will make 
a laboratory examination, if the L. A. City Health Department will give 
notice that it does not care to make such examination. 
L A. County Ordinance #1371 (N.S.) 
VICIOUS DOGS 
Invoking Ordinance No. 1371 should follow instances of a second bite 
in County territory if an affidavit can be obtained. The same procedure may 
also be used in those incorporated cities which have a similar ordinance. Under 
such quarantine no quarantine card (Form 58) is posted. The dogs must be 
permanently restrained, and movement is only with the permission of the 
County Health Department. 
An approved form of "Affidavit of Bite”, and an approved form of 
"Notice to the Dog Owner”, shown on pages 48 and 49 should be used. 
(This form is not numbered and not stocked. Make out on typewriter 
as needed.) 
STATE OF CALIFORNIA, 
COUNTY OF LOS ANGELES. 
ss 
Personally appeared before me 
deposes and says that on or about. 
of 
who 
19- 
a 
certain. 
dog owned and harbored 
by 
bit. 
at 
Subscribed and sworn to before me, 
of.. 
a Notary Public 
19- 
day 
NOTARY PUBLIC IN AND FOR THE COUNTY 
OF LOS ANGELES, STATE OF CALIFORNIA 
48 (This form is not numbered and not stocked. Make out on typewriter 
as needed.) 
Date 
Mr. John Doe, 
123 E. Fourth Street, 
Alhambra, California 
By authority of Ordinance No .1371 N.S., County of Los Angeles ,you 
are hereby notified to keep your dog, 
known as at all 
times on the property or premises at 
where you reside, or to cause this 
dog to be kept on these premises or upon the premises of such person to 
whom you may give custody of this dog or to hold said dog securely or 
cause said dog to be held securely by a leash or other device or means to 
prevent said dog from wandering, straying or getting beyond control of 
yourself or the custodian of said dog. In case custody of said dog is given 
to another person other than a resident of your premises at 
, notification must be given 
the Health Officer before such change is made. Or in case the dog is de- 
stroyed, written evidence of such destruction must be given the Health 
Officer. 
Complying with Ordinance No. 1371 N.S., this office has on file an 
affidavit from , 
stating that your dog has bitten 
Very truly yours, 
L. A. County Health Officer 
B 7 V- 
Title 
cc.: District Health Officer 
Pound Department 
File 
SCARLET FEVER (SCARLATINA) 
NOTE: ANY CASE OF SCARLET FEVER ON A DAIRY OR IN 
THE HOME OF A DAIRY WORKER OR FOOD HANDLER, MUST 
BE REPORTED IMMEDIATELY TO THE CHIEF C.D. INSPECTOR. 
QUARANTINE "B”: 
INVESTIGATION OF CASE: 
Immediately upon the report of a case or a suspected case of scarlet 
fever, the Health Officer shall do whatever he considers necessary to establish 
a diagnosis, which as a rule will require his examination of the patient, and 
he shall make an investigation which shall include inquiry regarding the 
possible source of infection. If the source of infection is outside his juris- 
diction, he shall notify the Morbidity Section, Division of Vital Records, 
Central Office, in order that it may inform the Health authorities within 
whose jurisdiction the infection was probably contracted. 
Care should be taken to note and report secondary cases. Health Officers 
should not assume the responsibility of reversing the diagnosis of the report- ing physician when they do not see the patient until several days after def- 
inite symptoms have subsided. 
If the Health Officer, upon making the investigation is satisfied that the 
case is one of scarlet fever or suspected scarlet fever, explicit isolation 
instructions shall be given to the members of the household. 
PERIOD OF QUARANTINE AND CONDITIONS OF RELEASE: 
The quarantine shall be for a minimum period of 7 days from the onset 
of the disease, but shall continue until complete disappearance of inflamma- 
tion of the nose and throat and the cessation of discharge from the nose, 
throat, ears and suppurating glands. 
Release is not predicated on desquamation. (See page 5 for figuring 
release date.) 
Scarlet fever patients are released only after inspection by the Health 
Officer or his authorized agent. THE RESPONSIBILITY HOWEVER 
RESTS UPON THE HEALTH OFFICER. 
QUARANTINE PASSES: 
When the case has been effectively isolated and such arrangements have 
been made as will remove the danger of transmitting the disease to persons 
outside the quarantine area, such persons over 16 years of age (except school 
teachers, food handlers and dairy workers) who do not show any symptoms 
of the disease and who are not attending school, may be given a quarantine 
pass to enter and leave the quarantined premises. 
CONTACTS: 
1. Contacts in the home are restricted for the period of quarantine 
except as provided under "Hospitalization and Death”, page 
2. Contacts of scarlet fever who are children living outside the quar- 
antined premises are kept under medical observation for seven days after last 
contact. Where daily medical supervision is available at the school, such 
contact may be permitted to attend school providing the proper school author- 
ity is informed of this action. 
3. School cafeteria workers who are contacts but living outside the 
quarantined premises shall be referred to the school medical service for per- 
mission to return to duty. 
4. School teachers or other persons who in their occupations come in 
contact with children, and who are direct contacts of a case of scarlet fever, 
or reside on the premises of a case of scarlet fever, may arrange residence 
outside the quarantined premises and continue their occupations providing 
arrangements are made for medical observation for seven days after last 
exposure, and continuance of their occupations shall be subject to approval 
by the Health Service of the Board of Education. 
SCHOOLS AND INSTITUTIONS: 
When a case or a suspected case of scarlet fever appears in a school or 
institution, control measures shall include daily medical inspection of all 
persons in contact with the case, and the exclusion or isolation of every per- 
son having sore throat, fever, headache, vomiting or any other symptoms of 
the beginning of febrile disease. 
50 Children, when so excluded, may be re-admitted only after being in- 
spected by the Health Officer. 
SCHOOL EXCLUSIONS AND SCHOOL RE-ADMISSIONS; 
School exclusions—See instructions on page 7. 
School re-admissions—See instructions on page 8. The Health Officer 
should not issue school re-admission permits until he is satisfied beyond doubt 
that the patient is in a non-infectious state. 
FOOD HANDLERS: 
Persons handling or preparing food that is to be consumed by others 
than members of their own households, who are direct contacts of a case of 
scarlet fever, or reside on the premises of a case of scarlet fever, may arrange 
residence outside the quarantined premises and continue their occupations 
under medical observation. 
DAIRY WORKERS; 
In view of the involved procedure when scarlet fever appears in the 
family of the owner or a worker on a dairy, or when a patient is a dairy 
worker himself, it is impossible to write a prescribed set of rules. Therefore 
an immediate report of such a case shall be made to the Chief C.D. Inspector, 
who will assist in working out the details of quarantine to the least economic 
disadvantage of the persons involved. 
Under no conditions is a contact permitted to handle or come in contact 
with milk or any of the utensils or equipment used in the handling or sale 
of milk. Under certain conditions the Chief C.D. Inspector may make pro- 
visions for the dairy worker contact to work the "head end” of the cow. 
HOSPITALIZATION OR DEATH: 
In cases where a patient dies or is sent to the hospital, and there are no 
children or food handlers in the household, quarantine may be released as 
soon as the premises are disinfected, provided no adults show suspicious 
symptoms. Children in the family may be released 7 days after the onset of 
the case. 
In case of death, funerals and contacts shall be handled as outlined 
under the section entitled, "Instructions to Funeral Directors”, page 71. 
TERMINAL DISINFECTION: 
When a case of scarlet fever has been released from quarantine, disin- 
fection of the entire area of isolation shall be done. This cleansing shall 
consist of the scrubbing with soap and water of all woodwork and furniture 
which can be reached by the persons in the room. There is no necessity for 
washing ceilings or the upper parts of high walls. 
A representative of the Health Department shall instruct the quaran- 
tined family as to the procedure necessary in the renovation of the house at 
the end of the quarantine. When necessary, in the opinion of the Health 
Officer, this representative of the Health Department shall supervise the 
renovation. 
51 SURGICAL SCARLET FEVER: 
In view of the record of communicability in some cases of "surgical 
scarlet fever”, "burn scarlet fever” and "wound scarlet fever”, such cases 
shall be handled in the same manner as ordinary scarlet fever. When the 
patient develops evidence of such infections in the hospital, there shall be 
no quarantine of home contacts provided the rash appears 24 hours or more 
after the patient has left the home. 
When a case of "surgical scarlet” occurs in a hospital, it shall immedi- 
ately be reported to the Chief C.D. Inspector who, in collaboration with the 
Health Officer shall give specific instructions governing the individual case. 
SEPTIC SORE THROAT 
QUARANTINE: 
"A” on a dairy; otherwise "C”. 
All cases or suspected cases of septic sore throat shall be held on clinical 
symptoms pending final diagnosis. In all suspected cases the Health Officer 
shall immediately take a smear and a culture from the throat of the patient 
and submit same to the laboratory for examination. (Note details on lab- 
oratory slip for guidance of technician.) A second smear and culture from 
the throat shall be taken not less than 24 hours later, and submitted to the 
laboratory for examination. 
When a case or suspected case of septic sore throat occurs or is reported 
on a dairy or in the family of a dairy worker, a telephone report shall be 
made immediately to the Chief C.D. Inspector and the dairy quarantined 
(A) pending final diagnosis. 
INVESTIGATION OF CASE: 
Careful search and examination should be made for other cases or car- 
riers among milkers or other handlers of milk as well as among the contacts 
of the patient. Early recognition of the disease is the most important factor, 
in view of its explosive character. On dairies, the Chief C.D. Inspector will 
supervise the quarantine, regulation of milk supply, etc. No milk from a 
suspected dairy shall be sold or used until properly pasteurized under the 
supervision of the Chief C.D. Inspector. 
CONTACTS: 
On dairies or in other places where milk is handled, contacts shall be 
held under quarantine and observation of the Health Officer. 
In other cases (Quarantine C), no restrictions after the patient is iso- 
lated, but should be observed three days after last contact for clinical 
symptoms. 
DISINFECTION: 
Concurrent for patient and terminal for patient’s quarters. 
RELEASE: 
Only after complete clinical recovery. Patient should be checked by 
smear and culture for carrier stage after clinical recovery. 
52 SMALLPOX 
QUARANTINE "A”: 
An immediate telephone report to Central Office, Bureau of Preventable 
Diseases, is required in all cases of smallpox or suspected smallpox. 
In the control of smallpox the immediate vaccination or quarantine of 
all contacts is of vital importance, all other measures being of little value. 
Following is the procedure for the control of smallpox; 
QUARANTINE PROCEDURE: 
Immediately upon the report of a case or a suspected case of smallpox 
the Health Officer shall quarantine the patient and contacts. Where diagnosis 
cannot be made certain on the first visit, notify the Chief C.D. Inspector and 
proceed with the vaccination of contacts pending positive diagnosis. 
Upon being notified of a case of smallpox, or a case suspected of being 
smallpox, the Health Officer shall make an investigation which shall include 
an inquiry regarding the probable source of infection. If the source is outside 
his jurisdiction, he shall notify the Morbidity Section, Division of Vital Rec- 
ords, Central Office, in order that it may inform the health authorities within 
whose jurisdiction the infection was probably contracted. 
If the Health Officer, upon making the investigation, is satisfied that the 
case is one of smallpox or suspected smallpox, he shall instruct the members 
of the household in the technique to be followed during the period of quar- 
antine. In the event of non-observance of these instructions, an immediate 
telephone report shall be made to the Chief C.D. Inspector, who shall take 
the necessary legal steps for their enforcement. 
CONTACTS: 
Any person who shall have been exposed to the risk of contracting 
smallpox by proximity to a person suffering from that disease, may be 
released from quarantine only upon the following conditions: 
First; Such contact shall prove to the satisfaction of the Health Officer 
that he has had smallpox, or 
Second: He shall prove to the satisfaction of the Health Officer that he 
has been successfully vaccinated against smallpox ivithin the past five years, or 
Third: He shall submit to vaccination against smallpox. 
When a non-immune contact is moved to a new location during the 
period of incubation, all persons in the household to which such person is 
moved must first be vaccinated in a manner satisfactory to the Health Officer. 
Contacts who are unable to show a good scar shall be kept under obser- 
vation until immunity is established by vaccination. Such contacts who are 
vaccinated more than 72 hours after exposure, if released, shall be required 
to report daily until immunity is established, and shall be placed under quar- 
antine immediately if suspicious symptoms develop. 
If there is a large number of contacts of a case of smallpox, it is some- 
times possible to save considerable time by ordering the contacts in writing 
to report to the Health Officer for vaccination, at a given time and place. 
This can be done by the use of the form shown on page 55 made in 
duplicate, one copy served upon the contact, and the other copy retained for 
Health Department files. 
53 This form is especially useful in case of an outbreak in a school, or 
institution, on a large work project or in a factory, after arrangements have 
been made for a vaccination program. 
Violation of the Health Officer’s order for observation, or his order to 
report for observation or vaccination shall result in immediate quarantine. 
Under some circumstances in such quarantine, it may be desirable to use the 
special quarantine notice, Form P.D. :#4l. 
CASUAL CONTACTS: 
Any person who has been exposed to the risk of contracting this disease 
by proximity to a case or to a suspected case of smallpox, shall be placed in 
quarantine for a period of 14 days from the last date of exposure. 
Such persons may be released if evidence of protection against smallpox 
is proven to the satisfaction of the Health Officer, 
VACCINATIONS: 
The Health Officer shall offer free vaccination to all persons who have 
been exposed to a case of smallpox or a case suspected of being smallpox. 
Persons refusing to cooperate with the Health Department, or who refuse 
vaccination, or who fail to quilify for release from quarantine as outlined 
before, shall be retained in quarantine until immunity is established, or until 
14 days have elapsed since last contact. 
Un-vaccinated persons in the household shall be held in quarantine for 
12 days after the patient is released, or is ready for release. Contacts may 
be vaccinated by their own physician if the County Health Department vac- 
cine is used in the presence of the Health Officer or his deputy. Otherwise, 
such contacts shall be re-vaccinated by the Health Officer or held in quaran- 
tine. In every vaccination done by the Health Department, instructions for 
home care after vaccination (PD d£4) must be given to the patient, parent 
or guardian at the time of vaccination. 
SCHOOL TEACHERS, STUDENTS, FOOD HANDLERS, ETC. 
Contacts coming under this group whose immunity has been established, 
who have moved outside the quarantine premises and who do not come in 
contact with the patient or other persons in quarantine are not subject to any 
restrictions. 
NURSES AND ATTENDANTS: 
Nurses or others engaged to attend patients must be vaccinated in a 
manner satisfactory to the Health Officer before they are permitted to enter 
the premises. 
QUARANTINE PASSES: 
None. 
PERIOD OF QUARANTINE AND RELEASE: 
As soon as a patient has recovered from smallpox, i.e. when the scabs 
have separated and scars have completely healed, and the recovery of the 
patient has been verified by the Health Officer, the patient and attendants 
may then be released from quarantine, but any un-vaccinated person remain- 
ing on the premises shall be held in quarantine for 12 days after the termina- 
tion of the quarantine of the patient. 
54 HOSPITALIZATION OR DEATH: 
Only two classes of smallpox cases may be sent to the Los Angeles 
County General Hospital. (Permission to send cases to the hospital must be 
obtained through the Bureau of Preventable Diseases or the Chief C.D. In- 
spector.) These two classes are: 
A. Cases that cannot properly be quarantined at home, such as those in 
apartment houses, rooming houses, bungalow courts, hotels, etc. 
B. Severe cases where need for hospital treatment is imperative. 
Funerals of persons dead from smallpox are strictly private under super- 
vision of the Division of C.D. Inspections. 
DISINFECTION AFTER RELEASE FROM QUARANTINE: 
Each person released from quarantine shall bathe and wash the hair 
with soap and water, and put on clean clothes. Areas of isolation shall be 
disinfected under the supervision of the Health Department after termination 
of the quarantine. 
Disinfection shall be a thorough cleaning of the entire area of isolation. 
This cleaning shall consist of scrubbing with soap and water of all woodwork 
and furniture. There is no necessity for washing ceilings or upper part of 
the walls. Upholstered furniture, carpets and hangings must be exposed to 
the sunlight for several days. The persons who carry out the cleaning of the 
rooms must be protected by vaccination with fresh smallpox vaccine before 
undertaking such disinfection. 
In cases of hemorrhagic or confluent smallpox, the Division of C.D. 
Inspections will supervise the disinfection and release. 
LOS ANGELES COUNTY HEALTH DEPARTMENT 
BUREAU OF PREVENTABLE DISEASE 
To. 
Having been in contact with a case of smallpox, you are hereby ordered 
to report to the Health Officer at 
Street 
A.M 
.P.M 
194. 
Cily 
at 
Failure to comply will make quarantine necessary. 
L. A. COUNTY HEALTH OFFICER 
By. 
Title 
Date. 
55 TUBERCULOSIS 
Active cases of pulmonary tuberculosis shall be excluded from the hand- 
ling of food products and from such occupations as barber or cosmetician, 
teacher, or person caring for children, by the Health Officer, and may be 
re-admitted only by written orders of the Health Officer or his authorized 
agent. Ail active cases of pulmonary tuberculosis among school children 
shall be referred to the Chief Tuberculosis Physician for decision as to ex- 
clusion from school. 
POSITIVE SPUTUM CASES; 
Regardless of apparent cooperation, all frankly positive sputum cases 
shall be reported direct to the Tuberculosis Registry, Central Office. On the 
15th of each month, the Tuberculosis Registry shall furnish various District 
workers, namely, the supervising nurses, medical social workers and tuber- 
culosis clinicians, with a list of all positive sputum cases in the District. These 
employees shall then make the regular routine calls as specified for their 
respective bureaus, to ascertain: 
1. If patient and the contacts understand thoroughly the instructions 
for the control of the spread of tuberculosis. 
2. That home conditions are satisfactory for the prevention of spread 
of tuberculosis. 
3. That proper provision is made for the disposal of sputum. 
These visits shall be repeated once a week or oftener if necessary, until 
correctable problems are solved in the province of each visitor, and then the 
intervals may be extended up to one month in clinic cases or one year in 
private cases, as the visitor’s judgment dictates. 
LEGAL ORDERS: 
Requests for issuance of Legal Orders for examination of patients or 
contacts or requests for isolation of patients shall be originated by the clin- 
ician and made up by the medical social worker in the District. They shall 
then be endorsed by the various other District workers as indicated on Form 
P.D. No. 27, and forwarded to the Division of C.D. Inspections. 
1. In making up such requests (Form P.D. #27), it is essential that 
the correct street address and city or precinct be given in each case, as well 
as the nearest cross street. 
2. To prevent possible legal complications as to incorrect service or 
false arrest, a detailed description of the individual to be served shall be 
noted on the Farm P.D. No. 27—particularly any outstanding identifying 
marks, such as scars, moles, etc. 
3. To facilitate handling, the "facts of the case” or reasons why such 
action is necessary, should he full and complete for the information of the 
Chief Tuberculosis Physician in approving or disapproving the request. 
4. The Chief Tuberculosis Physician shall approve the Form P.D. No. 
27 and turn it over to the Division of C.D. Inspections for further action; or, 
5. Veto the request, giving his reasons, and return the form via C.D. 
Inspections to the District medical social worker. 
6. After a case has been referred to the Division of C.D. Inspections 
for action on a "Legal Order”, the Chief C.D. Inspector shall be advised of 
56 all actions in the case thereafter, and no action affecting the legal status of 
the case shall be taken without his knowledge and consent. 
The County Health Officer and his agents are ethically and legally re- 
sponsible for any case of tuberculosis resulting from neglect in applying 
authorized and mandatory measures to prevent known cases from spreading 
the disease, but extreme care must be exercised, as far as considerations of 
public health will permit, to avoid parading our authority, or any display of 
threats, anger or persecution. We must, however, insist on both the kind 
and degree of isolation that are necessary to protect the public. Anyone not- 
ing frequent new cases occurring in a restricted area shall so inform the Chief 
Tuberculosis Physician, who shall give the situation special attention. 
ROUTINE PLACEMENTS: 
Form d+27 is unnecessary for routine placements, and these patients 
will be expected, as far as possible, to make their own transportation ar- 
rangements. The District workers should not ask the Division of C.D. 
Inspections to transport patients except as a last resort when all other 
attempts to arrange transportation have failed. 
Definition: When a patient’s family does not cooperate, or there are 
repeated cases in a household, or the patient is recalcitrant—such cases con- 
stitute a public health menace and shall be placed under an Order of Isola- 
tion as an enforced placement. 
All details of the handling of enforced placements shall be taken care 
of by the Division of C.D. Inspections as soon as the request (Form P.D. 
27) has been approved by the Chief Tuberculosis Physician. 
When the Chief Tuberculosis Physician approves the medical basis for 
action, the Division of C.D. Inspections shall make out the necessary Isola- 
tion Order, secure the signature of the Health Officer or other authorized 
deputy Health Officer, and serve and execute the Order, using its best judg- 
ment in the details thereof for the best interests of the community, the 
patient and the Department. 
In emergencies, the Health Officer or the clinician may contact the Chief 
Tuberculosis Physician or the Chief C.D. Inspector by telephone to secure 
the necessary action. All requests for beds for the isolation of tuberculosis 
patients must be made through the Chief Tuberculosis Physician or the Chief 
C.D. Inspector when they are available; and when not available, a report of 
any action taken, with the circumstances surrounding same, shall be made to 
the Chief Tuberculosis Physician at the earliest possible moment. 
An Order of Isolation will be terminated upon receipt of a statement 
from the institution that the case is no longer communicable, according to 
the standards adopted February 15, 1945. or upon a statement by the Health 
Officer that the case can be satisfactorily isolated elsewhere. 
ENFORCED PLACEMENTS: 
1. In all correspondence about a patient, always show the Department 
case number for the patient; e.g., East Los Angeles it3B-720-2. 
2. Whenever a Form P.D. No. 27 requests both an X-ray and a physi- 
cal examination—the place and hour shall be designated when and where 
SPECIAL INSTRUCTIONS TO ALL WORKERS 
57 both examinations can be given by one visit by the patient to a Health 
Center. This must be done even though an adjoining District Health Center 
must be used. Technically, any person must comply with all orders of the 
Health Officer, but the Court is influenced by a patient’s statement that he 
acted as directed in filling a single appointment, and thought such action 
was sufficient. 
3. After a patient has been referred to the Division of C.D. Inspections 
for legal action through P.D. #27, use lettergrams only for further follow- 
up on the case. 
TYPHOID FEVER AND PARATYPHOID FEVER 
QUARANTINE "C”__("A” ON A DAIRY); 
NOTIFICATION: 
Any person in attendance on a case of typhoid fever or paratyphoid 
fever, or a case suspected of being typhoid or paratyphoid fever shall report 
the case to the Health Officer within 12 hours. 
Note: This notification should, if possible be made by telephone, but 
in that case it shall be confirmed afterwards in writing. (The 
written report must be made within 24 hours.) 
INVESTICtATION OF THE CASE; 
Upon being notified of a case or a suspected case of typhoid fever or 
paratyphoid fever, the Health Officer shall make an investigation which shall 
include stool and urine specimens for laboratory examination from the close 
contacts, and an investigation regarding the probable source of infection, 
particularly for carriers among the members of the family or household 
visitors. If this probable source of infection is outside his jurisdiction, he 
shall notify the office of the Morbidity Section, Division of Vital Records, 
Central Office. 
INSTRUCTIONS TO HOUSEHOLD: 
It shall be the duty of the Health Officer to see that the members of 
the household of a person having or suspected of having typhoid fever or 
paratyphoid fever are instructed in precautionary measures for preventing 
the spread of the disease. The instructions must be understood and observed. 
In the event of their non-observance, the Chief C.D. Inspector must be 
notified; and he shall take proper legal steps for their enforcement. 
INSTRUCTIONS: 
(a) Patient to have a separate bed in a room screened against flies. 
(b) Unnecessary visitors are to be excluded from the sick room. 
(c) The attendant shall wear a washable outer garment while waiting 
on the patient, and wash the hands thoroughly with soap and water 
after handling the patient or contaminated objects. The washable 
outer garment shall not be taken from the room until disinfected 
as directed in (g), below. 
(d) The attendant must not prepare or serve food for any person 
other than the patient. 
58 (e) Feces, urine and other discharges from the patient shall be imme- 
diately disinfected: "Pour one quart of water in the feces recep- 
tacle, then one heaping cupful of quick-lime (calcium oxide), or 
use one quart of 5% lysol, then cover and allow to stand for two 
hours.” 
(f) Contaminated objects must be disinfected before being removed 
from the sick room. 
(g) Clothing, bedding, dishes and other utensils, may be disinfected by 
boiling in water for one hour or soaking for one hour in a 5% 
lysol solution or a 10% formalin solution. 
(h) Food remnants shall be burned, or, if liquid, disinfected (by mix- 
ing with equal quantities of either 5% lysol solution or of 10% 
formalin solution.) 
QUARANTINE "C—("A” ON A DAIRY): 
If after making the investigation the Flealth Officer is satisfied that the 
case is one of typhoid fever or paratyphoid fever or is strongly suggestive 
of typhoid fever or paratyphoid fever, he shall establish a quarantine by 
placard. Because it is illogical to give quarantine passes to many persons in 
typhoid fever or paratyphoid fever cases, it is desirable whenever possible 
to placard only the area of isolation. 
EPIDEMIOLOGICAL INVESTIGATION: 
Epidemiological investigations and reports on special State Board forms 
shall include a sanitary survey made by a Sanitary or C.D. Inspector in com- 
pany with the Health Officer. Immediate abatement of all conditions which 
may contribute to the spread of the disease is required. The Sanitary In- 
spector shall be advised of all orders issued by the Health Officer pertaining 
to sanitation and he will be held responsible for immediate enforcement and 
continued observation of such orders until the case is released from ob- 
servation. 
REPORTS TO CENTRAL OFFICE: 
The report of the Sanitary Inspector or C.D. Inspector on the survey, 
abatement, enforcement and results shall be included in the epidemiological 
report of the Health Officer. If the case occurs in a modern home in an 
urban locality, the report may simply state modern home, sanitary plumbing, 
sewer or cesspool, approved garbage disposal, regular collection, water com- 
pany recent test, etc., together with a brief description of the general sanitary 
conditions, under "Remarks”. The epidemiological report shall be made by 
the Health Officer on the State Board forms for "Enteric Fevers”. The case 
record should contain information as to whether immunization was given 
the contacts or refused. 
Important: The proper State Board form must be used to report the 
results of the investigation. 
CONTACTS: 
No restrictions except for those in "restricted occupations”, such as food 
handlers, milk handlers, bartenders, ice manufacturers, beverage and water 
59 producers and others who could infect food, drink or other substances to be 
ingested by humans. Contacts in these restricted occupations shall: 
1. Move to another location. 
2. Be excluded from work for two weeks. 
3. Have two successive negative stool and urine specimens taken at least 
48 hours apart. 
So long as contacts remain on the premises they shall not work at re- 
stricted occupations until after the patient has been released and the contacts 
have had two negative stool and urine specimens, taken at least 48 hours 
apart. 
As soon as the necessary stool and urine specimens have been secured, 
close contacts should he urged to take anti-typhoid-paratyphoid vaccination. 
MILK; 
If a case or a suspected case of typhoid fever or paratyphoid fever occurs 
on the premises of a milk producer or distributor, the Chief C.D. Inspector 
shall be notified immediately, and the Health Officer shall forbid the distri- 
bution or use of the milk until he or the Chief C.D. Inspector has visited 
the premises and determined that the following regulations are understood 
and will be strictly observed: 
1. No person who is engaged in the production or distribution of milk 
or who comes into contact with the bottles or other utensils shall 
have access to the building housing the patient. 
2. No person living in or entering the building housing the patient 
shall enter any part of the plant used in the production or distribu- 
tion of milk, nor shall he come in contact with any utensils associ- 
ated with the production of milk. 
3. No milk or cream from these premises shall be distributed or used, 
nor shall the milk or cream be manufactured into milk products, 
unless pasteurized according to Division 4, Chapter 4, Article 1, 
Sections 631-637 of the Agricultural Code of California. 
Pasteurization will not be permitted upon the premises mentioned. 
4. If the patient has been removed from the premises and the Health 
Officer has determined that the other members of the household are 
free from infection (see Contacts), and that the water supply used 
in the production of milk is not a potential source of typhoid fever 
or paratyphoid fever, he may permit the distribution of milk. 
HOSPITALIZATION AND DEATH: 
If the patient dies or goes to the hospital and other members of the 
family are free from infection, they may be released from supervision, except 
food handlers and dairy workers. 
TERMINATION OF CASE AND RELEASE FROM QUARANTINE: 
When a patient suffering from typhoid fever or paratyphoid fever has 
recovered and the temperature returns to normal, the physician shall notify 
the Health Officer that the patient is ready for release. The Health Officer 
shall thereupon make an investigation and if he finds that the patient has 
made a complete clinical recovery as reported, the Health Officer shall require 
the furnishing of specimens of feces and urine from the patient for labor- 
60 atory examination, and until two successive negative results have been secured 
from such specimens taken at intervals of not less than five days, nor more 
than one month, the Health Officer shall keep informed as to the whereabouts 
of the patient, taking such measures as may be necessary to protect the public 
health. 
FOOD HANDLERS—RELEASE: 
If the patient’s occupation involves the handling of food, or, if the 
quarantined premises include any type of public eating place, a dairy or milk 
distributing plant, the quarantine may be lifted after clinical recovery of the 
patient, but the following restrictions shall remain in force: 
The patient shall not have any part in the production, preparation or 
serving of milk or food until three successive negative results have been 
secured from feces and urine specimens from said patient, which specimens 
shall be taken at intervals of not less than five days nor more than one 
month. 
All contacts shall have had two negative stool and urine specimens, 
taken at least 48 hours apart. (See Contacts, page 59.) 
Also, all milk, cream or other milk products shall continue to be taken 
from these premises and pasteurized as specified under "MILK” until the 
three successive negative results have been secured from the patient. 
Note: Lack of cooperation on the part of the patient may be immediate 
cause for continuance of quarantine. 
FUNERALS: 
In case of death from typhoid fever or paratyphoid fever, where there 
is immediate terminal disinfection, the private funeral requirement may be 
waived. 
TYPHOID AND PARATYPHOID FEVER CARRIERS 
QUARANTINE "C” OR "E”: 
DEFINITIONS: 
CARRIERS: 
Any person whose feces or urine contains the bacilli causing 
typhoid or paratyphoid fever and who is not ill, shall be reported as a 
carrier. 
CARRIERS—CONY ALESCENT; 
Any person who has been free from symptoms of either of these 
diseases for one month, and whose feces or urine contains the bacilli 
causing these diseases, shall be reported as a convalescent carrier and 
requires a case history report on Special State Board Form "Convalescent 
Typhoid Carrier History.” 
CARRIERS—CHRONIC: 
Any convalescent carrier whose feces or urine continues to contain any 
of these bacilli after one year following clinical recovery, shall be reported 
as a chronic carrier, and any person whose feces or urine contains any of these 
61 bacilli but gives no history of recently having had the disease shall be re- 
corded as a chronic carrier, and requires a case history report on special 
State Board form "Casual Typhoid Carrier History”. 
GENERAL: 
The Health Officer shall visit each carrier in his District at least tivice 
a year to check on the occupation, address and other activities of the carrier 
and to determine if all instructions are being carried out. 
All laboratory specimens for such carriers shall be taken under the 
supervision of the Health Officer under such conditions that he can certify 
as to their being authentic specimens of the individual. 
When any known or suspected carrier of these diseases is reported to 
or determined by, the Health Officer, he shall make an investigation, obtain 
specimens of feces and urine for laboratory confirmation and submit a report 
to the State Department of Public Health. Any known, or suspected carrier 
of these diseases shall be subject to modified isolation (Quarantine E), and 
the provisions of this isolation shall be fulfilled during such period as he 
complies with the following requirements. 
A. Every member of the carrier’s family should be immunized against 
typhoid or paratyphoid fever, and such immunization should be repeated at 
least every three years. 
B. If the premises on which the carrier resides are provided 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 sanitary condition and screened against flies. 
C. The patient shall sign the following agreement in quadruplicate 
(one copy for the patient and one copy for the local District; 2 copies to be 
sent to the Morbidity Section, Division of Vital Records, Central Office— 
one of which shall be the file copy and the other to be forwarded to the 
State Department of Public Health). 
TYPHOID CARRIER AGREEMENT 
I have been informed that my excreta contains typhoid bacilli and that 
unless unusual precautions are taken, persons will contract typhoid fever 
from me. Realizing this danger I hereby agree to observe the precautions 
stated below, that I may be permitted to remain in free communication with 
other persons. 
1. I will take no part in the preparation, serving or handling of food 
which may be consumed by any person other than my own imme- 
diate family. I shall not engage in any occupation which brings me 
in contact with milk, milk products, milk bottles, or milk utensils, 
nor will I 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 will I reside on the 
premises of any such food handling establishment. 
2. I will wash my hands thoroughly with soap and hot water and a 
nail brush after using the toilet and before handling food in my 
home. 
62 3. I will keep the Health Officer informed at all times of my address 
and occupation and will notify the Health Officer at once of any con- 
templated change in my address or occupation. 
4. I will communicate with the Health Officer before submitting to 
any type of treatment intended for the cure of the carrier condition. 
5. I will report to the Health Officer immediately any case of illness 
suggestive of typhoid or dysentery in my family or among my im- 
mediate associates. 
Signed 
Address 
Witness 
Date 
District Health Officer 
If the carrier refuses to sign this Agreement, the Health Officer shall 
continue with Quarantine "C”. 
RELEASE: 
Typhoid and paratyphoid fever carriers usually continue to be carriers 
for life. Specimens for laboratory examination are unnecessary after the fact 
of the carrier state is established and a signed carrier’s agreement is secured. 
State law provides for the release of carriers only by the Director of 
the State Department of Public Health. For details of such releases, refer 
to the "Regulations for the control of Communicable Diseases adopted April 
3, 1943”, and amendments thereto by the State of California Board of Public 
Health. 
TYPHUS FEVER 
(Epidemic Type—Louse borne) 
QUARANTINE "A’ 
Upon being notified of a case of epidemic typhus fever or a case sus- 
pected of being epidemic typhus fever the Health Officer shall make an 
immediate investigation; and, if he finds that the case is or may be epidemic 
typhus fever, he shall establish an absolute quarantine of the patient and 
contacts. 
An immediate telephone report to Central Office, Chief C.D. Inspector, 
must be made, and the Chief C.D. Inspector shall supervise the delousing 
and disinfestation and release of home quarantine. 
State Department rules require an immediate communication from the 
Health Officer on each such case. 
PROCEDURE: 
In a case of typhus fever the patient shall be removed as soon as possible 
to the General Hospital and in case thorough investigation by the Health 
Officer and/or the Chief C.D. Inspector indicates that lice were or may have 
been involved in transmitting the disease, the following procedure for dis- 
infestation shall be carried out. 
FUMIGATION. 
The fumigation of the premises shall be done with hydrocyanic 
acid gas, by a licensed fumigator under the direction of and in accord- 
63 ance with arrangements made by the Chief C.D. Inspector. 
A careful check of the premises must be made to see that no per- 
son, domestic animal or pet remains in the area to be fumigated. 
The Chief C.D. Inspector shall maintain at all times suitable 
guards (C.D. Inspectors or others assigned to the task) for the premises 
as a protection to life and property during fumigation processes and 
while such premises are the direct responsibility of the County Health 
Department. 
Further, the Chief C.D. Inspector shall see that the premises are 
turned over on completion of fumigation to the owner or custodian, or 
his authorized representative. 
DELOUSING. 
The Chief C.D. Inspector shall be responsible for the supervision 
of the delousing of the persons of contacts, which shall be done by a 
public health nurse for women and children, and by a C.D. Inspector 
or other male person assigned for men. 
Contacts shall remain in quarantine for 14 days after last exposure. 
The Chief C.D. Inspector or his representative shall deliver to the 
quarantined premises the necessary supplies (gowns, sheets, delousing 
materials, etc.), for the completion of the work required. 
The persons conducting the delousing shall wear long-sleeved 
gowns with surgical rubber gloves drawn up over the cuffs of the 
gowns, and the nurses shall wear surgeons’ skull caps while cleaning 
up contacts. After using, place the gowns, etc., in a paper bag marked 
"CONTAMINATED”, to be steam-sterilized on return to the Health 
Center. 
CLOTHING WORN BY CONTACTS. 
All clothing, bedding, shoes, etc., worn by contacts shall remain 
in the quarantined home until fumigation is completed. 
The clothing, shoes, etc., necessary for apparel of contacts after 
the delousing shall be removed from the quarantined house and disin- 
fected under the direction of the Chief C.D. Inspector. 
PHYSICAL EXAMINATION OF CONTACTS: 
HEAD: 
Inspect the head for lice, bites or nits. Where infestation is evident, 
wash the head thoroughly as follows: 
Loosen nits from the hair and scalp with a 10% vinegar solution. 
Shampoo the scalp and hair with hot soapy water containing 25% 
kerosene and then rinse thoroughly. 
Comb the hair well with a fine comb, and brush out nits. 
BODY: 
Inspect the body for evidence of louse bites, particularly the axilla, 
neck line, clavicle, waist line, perineal and inguinal region. Carefully 
inspect the clothing that has been removed for lice, particularly around 
the seams, cuffs and folds. Then proceed as follows: 
64 (a) Give each contact a complete sponge bath with a solution of 
kerosene 50% and gylcerine 50% (approximately 4 ounces of solution 
is required if applied with a cotton sponge), 
(b) The entire body is shaved if infested. 
(c) A complete soap and water bath must then be taken. 
(d) Clothing to be put on must first be inspected for lice, par- 
ticularly along the seams or in the cuffs or folds. 
WARNING: 
Nurses or others conducting the delousing procedure must use extreme 
caution to prevent skin burns from the kerosene or other materials used, and 
must see that the clothing to be put on is free of kerosene, gasoline, etc. The 
contacts must be warned against the use of belts, tight girdles, trousers, etc., 
until the evaporation of the liquids used is complete. 
BED, WALLS AND FURNITURE IN ROOM OCCUPIED BY PATIENT: 
Wash thoroughly with soap and water after fumigation. 
CARE OF PATIENT 
The Los Angeles County General Hospital procedure for the initial care 
of typhus fever patients is presented herewith as a guide for procedure if 
the patient cannot be hospitalized. 
CLOTHING WHICH HAS BEEN REMOVED, AND BEDDING: 
Clothing and bedding must be steam-sterilized in a metal container with 
lid. Support clothes on rack one foot above bottom of container—six inches 
of water in bottom of can. Place can over fire, heat to boiling point and keep 
boiling. Clothing should remain 45 minutes after steam begins to escape 
around top of can. 
Nurse wears long-sleeved gown and gloves to clean up patient, and 
these are sterilized with patient’s clothing. 
SHOES, LEATHER BELTS, HATS: 
Inspect for evidence of infestation. If infested, wash with 5% creosol 
in water, or immerse in white gasoline and let dry. 
PATIENT; 
The patient’s head is not shaved, but is looked over carefully and 
washed. 
Patient is given complete sponging with solution of: 
Kerosene 50% (requires approximately 4 ounces). 
Glycerine 50% (if applied with cotton sponge). 
Entire body, with exception of head, is shaved; patient is then given 
complete soap and water bath and put into a clean bed. 
The second day the patient is given a complete bath and put into another 
clean bed, and the old bed washed thoroughly with soap and water. The 
mattress is steam-sterilized. 
If patient is moved to another room, walls of vacated room and all 
furniture therein are washed thoroughly with soap and water. 
65 FUNERAL; 
In the event of death, funerals are private as outlined under "Instruc- 
tions to Funeral Directors”, page 71. 
Exception: See "Instructions to Funeral Directors”, page 74. 
(Endemic Type—Fiea borne) 
TYPHUS FEVER 
Upon being notified of a case of endemic typhus fever, or a case sus- 
pected of being endemic typhus fever, the Health Officer shall make an 
immediate investigatinn and, if he finds that the case is, or may be, endemic 
typhus fever, he shall see that the patient is properly isolated in a vermin-free 
room until clinically recovered. If the premises where the patient resides are 
vermin free and fleas are not present, no control need be exercised over the 
contacts. 
An immediate call shall be made to the Cihef C.D. Inspector, who shall 
investigate the premises for vermin and supervise the disinfestation and the 
releasing of home contacts. 
VENEREAL DISEASES 
Venereal Disease Control requires close cooperation in a Health De- 
partment especially of the Division of Venereal Disease Control, Division of 
C.D. Inspections, public health nurses, medical social workers, among others. 
The following rules concern cases or problems in which the Division of 
C.D. Inspections is involved: 
1. Senior C.D. Inspectors (VD) have been assigned to the Division of 
Venereal Disease Control and for convenience have been termed "Venereal 
Disease Investigators”. 
All cases reported by private physicians as delinquent in treatment and 
all cases reported as venereal disease suspects, either alleged sources or con- 
tacts, shall be referred to the Chief, Division of Veneral Disease Control, 
who shall decide the extent and type of investigation needed and shall direct 
the Venereal Disease Investigators in their activities. 
2. In the rare cases where a P.D. 27 is not indicated, and the district 
may desire the services of a C.D. Inspector instead of the nurse or Venereal 
Disease Investigator, a lettergram will be directed to the Chief, Division of 
Venereal Disease Control, who will request the service of the Division of 
C.D. Inspections. A lettergram report of the results will be forwarded to the 
district by the Division of Venereal Disease Control on information fur- 
nished by the Division of C.D. Inspections. 
3. A procedure has been established in the District for follow-up on 
Selective Service selectees who have been referred to a Venereal Disease 
clinic. All selectees which this procedure fails to bring to clinic shall be 
referred to the Division of C.D. Inspections, using Form P.D. #27 for legal 
enforcement. 
LEGAL ENFORCEMENT: 
Whenever legal enforcement is requested, the approval of the Chief, 
Division of Venereal Disease Control, must be secured. Form P.D. #27 has 
been provided for this purpose, and when the clinician so requests on the 
66 patients’ chart, the medical social worker shall see that this form is prepared, 
properly signed, and forwarded to the Chief C.D. Inspector. In cases where 
rapid action is imperative, this request may be by telephone, confirmed by 
forwarding Form P.D. #27 as quickly as possible thereafter. 
On these requests for legal action, it is incumbent upon the medical 
social worker preparing such requests to give a full and complete address 
and detailed information as to action desired and reasons for same; also, 
show laboratory reports, date and name of laboratory making same. A 
detailed description of the patient, always noting any identifying marks such 
as scars, etc., must at all times be furnished to prevent the Department from 
being placed in the position of having to defend itself against a charge of 
"mistaken identity” or "false arrest”. 
When a case has been referred to the Division of C.D. Inspections for 
legal enforcement, the medical social worker shall keep the Chief C.D. In- 
spector informed of anything pertinent to this case which may occur there- 
after; and no further action changing the status of the case may be taken 
by any member of the Department without the knowledge and approval of 
the Chief C.D. Inspector. Report of action taken by the Division of C.D. 
Inspections is on the yellow copy of P.D. #27 when returned to the 
District. 
Persons infected with gonorrhea or syphilis in an infectious stage shall 
not be permitted to work in any barber shop, beauty parlor, food establish- 
ment, except with the permission of a health officer or a Venereal Disease 
physician. The names, addresses, diagnosis, and place of employment of 
such persons excluded shall be reported in writing to the Chief, Division of 
Venereal Disease Control. Exclusion of any person from school for venereal 
disease shall be ONLY over the signature of the Chief, Division of Venereal 
Disease Control. 
REPEAT OFFENDERS: 
If a #27 has previously been forwarded to the Division of C.D. Inspec- 
tions, and repeated or additional offenses make further action necessary, do 
not send a second if 27. Instead, the medical social worker shall forward to 
the Division of C.D. Inspections a letter with a brief recapitulation of the 
action requested on the previous #27, the date of the #27, and the date 
of any legal orders which were served, etc., in order that the Division of 
C.D. Inspections may readily locate the old file and refer the case to the 
Chief, Division of Venereal Disease Control, for instructions. Once a legal 
order is served, it remains in force indefinitely, and failure to comply with 
the order thereafter is a violation of quarantine laws. 
ISOLATION IN GENERAL HOSPITAL: 
When it is considered necessary to isolate a venereal disease patient in 
the General Hospital, the following procedure must be followed: 
A request must be made to the Chief C.D. Inspector as previously out- 
lined in "Legal Enforcement”, using Form P.D. #27. This Form #27 
must give a brief clinical history with laboratory confirmation, naming the 
laboratory, and a brief social history which states the facts rendering the 
patient a public health menace and the conditions which make necessary 
isolation in the hospital. 
67 It is understood that only acutely infectious cases which cannot be 
handled locally shall constitute a public health menace and are to be included 
in this procedure. 
The Chief C.D. Inspector, after approval of the Chief, Division of Ven- 
ereal Disease Control, will make the necessary arrangements for a patient to 
enter the L. A. County General Hospital. If and when such bed is available, 
the Chief C.D. Inspector shall proceed to deliver the patient to the ward 
designated. When the patient provides his or her own transportation the 
Division of C.D. Inspections will serve the Order of Isolation at the hospital. 
However, the District medical social workers shall furnish the latter class of 
patients a reference slip (Form X-15) containing pertinent data (and for- 
ward Form P.D. #6 in the usual manner). 
It is further provided that in case of emergency a Health Officer or the 
Chief, Division of Venereal Disease Control may proceed in the same manner 
in the place of the Chief C.D. Inspector. 
WHOOPING COUGH 
RECOGNITION: 
The Health Officer must satisfy himself as to the correctness of the 
diagnosis on reported or suspected cases of whooping cough. 
INVESTIGATION: 
The Health Officer or his authorized representative shall make every 
reasonable effort to locate undiagnosed or unreported cases among close 
contacts. 
ISOLATION: 
A person suffering from a case of whooping cough or symptoms 
strongly suggestive of whooping cough must be isolated, and the parent, 
guardian or attendant instructed to prevent contact of patient with non- 
immune children. 
WARNING: 
Members of the household shall be warned that failure to observe 
proper isolation (with respect to other children) will result in quarantine 
of the home and family of the patient (Quarantine "B”). 
RELEASE: 
On recovery, with a minimum period of three weeks after development 
of paroxysmal cough. (Usually held for six weeks after date of onset). 
CONTACTS (HOME); 
Non-immuae children must be excluded from school and contact with 
other children for 10 days after the last exposure except: 
That after a diagnosis of whooping cough satisfactory to the Health 
Officer has been made, and isolation of the patient has been effected, in 
school districts having a medical and/or nursing inspection service 
which the Health Officer considers adequate, school age contacts be 
permitted to attend school whether known to he immune or not. 
68 It is specifically recognized that the official in charge of any school 
has the legal right to exclude any non-immune contact of a case of 
whooping cough for the full incubation period if he sees fit to do so. 
Nothing in this Order shall be construed in such a way as to take away 
that right. 
Exposed children who have had whooping cough as proven by the rec- 
ords of the Health Department may go to school as usual, if the patient is 
kept isolated from them. 
CONTACTS (outside of home): 
Exclude non-immune children from school or public gatherings for a 
minimum period of 10 days from last exposure. However, if adequate 
nursing supervision is provided in school and these children are carefully 
inspected daily for 10 days before being permitted to mingle with other 
school children, they may attend school. 
SPECIAL REPORT: 
The Health Officer shall make a special report to the Epidemiologist 
whenever whooping cough is found in a patient who has had prophylactic 
treatment. 
IMMUNIZATION; 
Use of prophylactic vaccination should be recommended. 
YELLOW FEVER 
QUARANTINE "A": 
NOTIFICATION: 
An immediate telephone report of the case shall be made to the Chief 
C.D. Inspector for telegraphic notification to the State Department of Health 
(see page 4). 
INVESTIGATION OF CASE: 
When a case or a suspected case of yellow fever is reported or recog- 
nized, patient and contacts shall be immediately quarantined. 
ISOLATION: 
The patient shall be isolated in a separate, thoroughly screened room, 
free of mosquitoes, for a period of four days after the onset of the fever. 
CONTACTS; 
Contacts shall be kept under observation for a period of seven days after 
last exposure. 
SANITARY SURVEY; 
Particular care must be taken to rid the quarantined premises of mos- 
quitoes. An immediate request shall be made to the Bureau of Sanitation 
for a mosquito survey of the premises and neighborhood for abatement 
thereof as indicated. 
69 RELEASE: 
Release on clinical recovery. 
Note: In the vicinity of places of incidence, work or travel of a known 
case, search for and destruction of mosquitoes of species capable of trans- 
mitting the infection are the principal factors of control. 
TRAVEL FROM YELLOW FEVER AREAS: 
Areas where yellow fever is known to exist have been brought into 
close relationship to this country by airplane passenger transportation. Federal 
regulations require travelers from those areas to be kept under surveillance 
by the Health Officer for a period of 8 days after arrival at any U.S. port 
of entry. 
An immediate report by telephone shall be made to the Chief C.D. 
Inspector, should such a traveler become ill during this period of sur- 
veillance. 
70 INSTRUCTIONS TO FUNERAL DIRECTORS 
GENERAL: 
The Health Department desires to assist funeral directors in the com- 
pliance with State laws. In case of question call on the Deputy Registrar 
for advice and assistance. 
Funeral directors are requested to apply for burial permits, etc., as soon 
as possible after the death to permit corrections in death certificates, notifi- 
cations to cemeteries, investigations or action by the coroner, and better 
service by the Health Department. 
Attention is called to the following statutes: 
Section 10401, Health & Safety Code. 
"The physician shall within 15 hours after the death deposit the cer- 
tificate at the place of death or deliver it to the attending funeral director at 
his place of business or at the office of the physician.” 
If such death certificate is not received, the case must be referred to the 
coroner. 
Section 7406, Health & Safety Code. 
"No person shall inter in any cemetery any human body unless (a) 
there has been obtained and filed a certificate signed by a physician 
or a coroner and (b) he has obtained a burial permit.” 
Section 10450, Health Sc Safety Code. 
'The funeral director, or person acting as funeral director, shall file the 
certificate of death with the local registrar of the district in which the death 
occurred and obtain an interment or removal permit prior to any disposition 
of the body.” 
Section 7410, Health Sc Safety Code. 
"No person in charge of any premises on which interments or crema- 
tions are made shall inter or permit the interment or cremate or permit the 
cremation or other disposition of any body unless it is accompanied by a 
burial or cremation permit.” 
Funerals in which the cause of death is from a quarantinable disease 
(excepting typhoid fever) are PRIVATE, and conducted as directed under 
"Funerals”. 
Funeral directors who SERVE THE TERRITORY OF THE LOS 
ANGELES COUNTY HEALTH DEPARTMENT (both unincorporated 
areas and cities under contract') ARE REQUIRED TO OBSERVE THE 
FOLLOWING RULES AND REGULATIONS for the control of communi- 
cable diseases (Sections 2554 and 2560, Health & Safety Code). 
1. EVERY FUNERAL DIRECTOR OR EMBALMER WHO IS 
CALLED FOR A KNOWN OR SUSPECTED COMMUNICABLE DIS- 
EASE CASE must immediately report the case to the Health Officer (Section 
7302, Health & Safety Code). 
The body may be removed from the house to the undertaker’s parlors 
only with the permission of the Health Officer. 
71 2. PERMISSION FOR THE REMOVAL OR TRANSPORTATION 
OF THE BODY of any person dead from a quarantinable disease must be 
obtained FROM THE HEALTH OFFICER (Section 7404, Health & Safety 
Code). 
3. MATERIAL USED IN CASKETS FOR TRANSPORTATION OF 
THE DEAD. 
Wherever in Section 7351, 7353 or 7354 or other Sections of the Health 
& Safety Code, it is required that metal-lined caskets or metal-lined trans- 
portation cases be used for the transportation of dead bodies, this require- 
ment is hereby modified under the authority of Section 7351, Health & 
Safety Code, to provide for the use of caskets or receptacles made of any 
material which shall be watertight and which can be closed in such a 
manner as to prevent the escape of any fluids, odors or other objectionable 
substances. (Sub-chapter 4, Article 2, Section 908, California Administra- 
tive Code, Title 17, Public Health, August 15, 1945). 
4. No person shall embalm the body of any person dead from an un- 
known cause, except with the written permission of the Health Officer. 
(Section 7300, Health & Safety Code). 
5. In any case of supposed "croup”, laryngitis, tonsillitis, quinsy, 
mumps, or where there is a suspicion of diphtheria and diagnosis has not 
been established by bacteriological test, the funeral director must immedi- 
ately notify the Health Officer and REFRAIN FROM THE USE OF 
FORMALDEHYDE OR ANY OTHER DISINFECTANT UNTIL THE 
HEALTH OFFICER LIAS AN OPPORTUNITY TO TAKE A SPECIMEN 
FOR LABORATORY EXAMINATION. 
6. Any funeral director or embalmer who is called when a person has 
died from an unknown cause shall immediately notify the coroner and be 
guided by his orders. (Sections 7300, 7301, 10425 and 10426, Health & 
Safety Code). 
7. PUBLIC FUNERALS ARE FORBIDDEN IN ANY AND ALL 
CASES WHERE DEATH IS FROM A QUARANTINABLE DISEASE. In 
case of death from a quarantinable disease or any death in a house that is 
under quarantine, the undertaker must notify the Health Officer immediately 
and necessary instructions and permits will be issued regarding the disposi- 
tion of the body, when in the territory served by the Los Angeles County 
Health Department. 
Note carefully the list of quarantinable diseases. If in doubt, call the 
HEALTH OFFICER. 
8. When the Health Officer is not available, the Deputy Registrar or 
the Chief C.D. Inspector can be contacted through the County telephone 
exchange (MU. 9211) and may give the necessary permission, subject to 
later confirmation. 
FUNERALS: 
It is impractical to make a definite set of rules for conducting the 
funeral of a person dead of a communicable disease. 
1. In general, the following procedure will apply, except in cases of 
smallpox, plague and cholera, for which no services are permitted and burial 
is under strict supervision of the Health Department. 
72 A. All requests to hold "private funerals” and all questions by under- 
takers or others planning communicable disease funerals or trans- 
portation of human bodies dead of a communicable disease, shall 
be referred to the Health Officer or the Chief C.D. Inspector. 
B. No restrictions are placed on funerals for bodies (particularly of 
deceased servicemen shipped into this county in "sealed caskets”) 
where there is no question of attendance by quarantined contacts 
provided a "sealed casket” is used and the casket remains sealed at 
all times. 
C. After the body is prepared for burial, the parents or adults of the 
immediate family may be permitted to visit the undertaker’s estab- 
lishment to identify the body. Identification of the deceased should, 
be through a glass partition, but under no conditions are THE 
PERSONS MAKING THE IDENTIFICATION PERMITTED 
TO CONTACT THE BODY. Immediately after identification, 
the CASKET IS CLOSED AND SEALED, AND REMAINS SO 
PERMANENTLY THEREAFTER. 
D. ONLY MEMBERS OF A QUARANTINED HOUSEHOLD 
OVER 16 YEARS OF AGE MAY BE GRANTED A PASS BY 
THE HEALTH OFFICER FOR THE PURPOSE OF IDENTIFY- 
ING THE DECEASED. Such trips to and from the quarantined 
premises must be made in a private conveyance and further arrange- 
ments made so that these persons will not at any time, come in 
contact with other persons outside of the quarantined premises. 
E. NO PERSON SHALL CONVEY, OR PERMIT TO BE CON- 
VEYED INTO ANY CHURCH, FUNERAL CHAPEL OR 
OTHER PUBLIC HALL OR PLACE, THE BODY OF ANY 
PERSON DEAD FROM ANY QUARANTINABLE DISEASE 
EXCEPT AS PROVIDED UNDER "B” ABOVE. 
2. If the family wish to have services at the grave the following rules 
must be observed: 
A. Persons over 16 years of age may be granted a pass by the Health 
Officer provided there is in the quarantined home during such 
absence a suitable guardian for the restricted children. Such persons 
from the quarantined premises must be transported in a private 
conveyance or car furnished by the undertaker. 
B. The family from the quarantined home must remain separate and 
apart from any others who attend the services, and friends or other 
relatives must remain at least 20 feet away on the other side of the 
grave. 
C. Members of the family in quarantine are to return by the same 
private conveyance or car furnished by the undertaker direct to the 
quarantined home. 
D. All flowers and other articles coming in contact with the casket must 
be put into the grave with the casket (Section 7353, Health & 
Safety Code). 
73 E. All undertakers are required to notify the cemetery that such 
funerals are "private” and the cemeteries are required to assist the 
undertakers in carrying out these regulations. 
The following is a list of quarantinable diseases wherein funerals must 
be conducted in accordance with these rules and regulations: 
Cholera, Asiatic 
Diphtheria 
Encephalitis (Epidemic) 
Leprosy 
♦Meningitis 
♦Paratyphoid Fever 
Plague 
Poliomyelitis (Infantile paralysis) 
Scarlet Fever 
Smallpox 
♦Typhoid Fever 
♦♦Typhus Fever (louse borne) 
♦♦Typhus Fever (flea borne) 
Yellow Fever 
*Typhoid, paratyphoid fever and epidemic meningitis call for a modified quar- 
antine and restrictions on funerals are not necessary. 
**No restrictions on funeral if patient had been hospitalized and deloused before 
death. 
HEARSE OR MORTUARY CAR; 
It shall be unlawful for any funeral director or other person to use, or 
cause or permit to be used, any vehicle other than a hearse or mortuary car 
for conveyance of any dead body, except that of a stillborn infant or of an 
infant not over one year of age dead of other than a communicable disease, 
and except when a patient dies en route. The use of any ambulance as a 
mortuary car or hearse, or the use of a mortuary car as an ambulance, is 
specifically forbidden. 
INSTRUCTIONS TO CEMETERY AUTHORITIES 
Section 7410, Health & Safety Code. 
"No person in charge of any premises on which interments or crema- 
tions are made shall inter or permit the interment or cremate or permit 
the cremation or other disposition of any body unless it is accompanied 
by a burial or cremation permit.” 
1. No cemetery authority shall accept for interment the body of any 
dead person, unless such body shall be accompanied by a burial permit or 
the funeral director will have properly delivered to the cemetery authority 
the necessary burial permit. (Sections 10475-10476, Health & Safety Code). 
2. No cemetery authority shall accept for interment the body of a 
person dead from a quarantinable disease, unless they shall have received a 
burial permit wffiich shall be suitably marked by stamp or other device, with 
the words "Private Funeral” on the face thereof. (Section 7404, Health & 
Safety Code). 
3. All cemetery authorities shall immediately report to the local health 
officer all requests received from funeral directors or others for interment of 
a body dead from a communicable disease. (Sections 8306, 8307, 8308, 
Health & Safety Code). 
4. All cemetery authorites shall aid and assist the funeral directors 
and be governed by the rules and regulations for funeral directors, for 
services at the grave of persons dead from a quarantinable disease (Section 
7404, Health & Safety Code). 
74