Restriction and Prevention OF SCARLET FEVER ISSUED BY THE HOP. CAROLINA BOARD OF HEALTH. RALEIGH : News & Observer, State Printer and Binder. 1881. RESTRICTION AND PREVENTION OF SCARLET FEVER. ISSUED BY THE NORTH CAROLINA BOARD OF HEALTH. Restriction and Prevention: OF SCARLET FEVER. The presence of scarlet fever in several towns in the Stat6 makes it necessary to issue this warning, accompanied by preventive suggestions. Scarlet Fever is one of the most contagious diseases, and it is necessary that the most scrupulous care should prevail when it is known to exist in a community. It is known by various names, Scarlatina, Scarlet Bash, and Canker Rash, and in all degrees of intensity it is equally catching. One attack of the disease usually prevents subsequent ones. The greatest number of deaths from the disease is of children under ten years of age, although grown persons sometimes take it; but it must not be forgotten, that chil- dren and grown persons no longer liable to the disease by reason of having had one attack, can carry the disease in their clothing, if allowed to go in and out the sick room where there are scarlet fever patients. Scarlet fever poison is better known than any except small-pox, and there is no doubt that it is a special contagium or poison, which can be communicated to persons who have never had it by means of personal contact, by infected clothing, (more especially woollen clothing,) by rags, by books, by bed-room furniture, carpets, curtains, valances, &c., &c., and particularly by dis- charges from the body of the sick person. 4 The discharges from the throat, nose and mouth are considered extremely dangerous, and those from the skin, (even when dry and branny) eyes, ears, kidneys and bowels are also dangerous, and the length of time they will remain so has not been determined ; it is only certain that the con- tagium or poison may remain active a long time, as is proven by sudden outbursts in communities where it could be accounted for by opening old trunks and wardrobes where the clothing of persons who had died of scarlet fever had been stored. Ventilation and Sunlight are necessary in the room of the scarlet fever patient, to aid a favorable recovery, and ensure good health to the nurses who must live in the sick room. The Interval of Time which may elapse after exposure to scarlet fever, during which a person so exposed may ex- pect to be taken sick, varies from one to fourteen days. Separation of the Sick from the Well. Whenever a child has sore throat and fever, and especially when this is accompanied by a rash on the body, the child should be immediately separated as completely as possible from other members of the household, and from other persons, until a physician has seen it and determined whether the disease is scarlet fever. This warning is necessary whether there be cases of the fever in the community or not. All persons known to be sick with this disease should be prompt- ly and thoroughly isolated from the public.* The room into which one sick with this disease is placed should previously be cleared of all needless clothing, carpets, drapery and other materials likely to harbor the poison of the disease, except such articles as are essential to the well being of the patient. The sick room should have *That this is of more importance than in the case of small-pox is indicated by the fact of the much greater number of cases of sickness and of deaths from scar- let fever—a disease in winch there is no such a preventative known as vaccina- tion. 5 no carpet, or only pieces which can afterward be destroyed. Provision should be made for the introduction of a liberal supply of fresh air and the continual change of the air of the room without sensible currents or drafts. Pocket-handkerchiefs, that need to be saved, should not be used by the patient; small pieces of rag should be substituted therefor, and after being once used should be immediately burned. Soiled bed and body linen should be placed in vessels of water containing chlorinated soda, chlorinated lime or other disinfectant before removal from the sick room. For this purpose chlorinated soda is the neatest and most convenient, because it can be used with soap, but it is apt to lose its disenfecting properties by age. Chlorinated lime, if used too freely, may destroy articles of clothing with which it comes in contact, but if properly used it is the safest as a disinfectant. The discharges from the patient should all be received into vessels containing “ chloride of lime,” copperas, or some other known disinfectant—carbolic acid in dilute form, as generally used, is not a good disinfectant—and the same buried at once, and not by any means be thrown into a run- ning stream, nor into a cesspool or a water-closet, except af- ter having been thoroughly disinfected. All vessels should be kept scrupulously clean and disinfected. Perfect cleanliness of nurses and attendants should be enjoined and secured. As the hands of nurses of necessity become frequently contaminated by the poison of the dis- ease, a good supply of towels and two basins—one contain- ing solution of chlorinated soda (Labaracque’s solution), chloride of lime or other disinfecting solution, and another for plain soap and water, should be always at hand and freely used. Persons who are attending upon children or other per- sons suffering from scarlet fever, and also the members of 6 the patient’s family, should not mingle with other people nor permit the entrance of children into their house. Funerals of those dying from scarlet fever should be strictly private and the corpse not exposed to view. To avoid mistakes notices of such deaths in the papers should state that the deceased died of scarlet fever, that there may be a full comprehension of the character of the disease. No form of scarlet fever is devoid of danger however simple the early symptoms, or trifling the course of the disease, for most serious results have followed the most simple cases. All persons recovering from scarlet fever should be considered dangerous, and therefore should not attend school, church, or any public assembly, or use any public conveyance, so long as any scaling or peeling of the skin, soreness of the eyes or air passages, or symptoms of dropsy remain. No person recovering from scarlet fever should thus endanger the public health nor appear in public until after having taken four times, at intervals of two days, a thorough bath. This cleansing, however, should be deferred until the physician in charge considers it prudent. After recov- ery from scarlet fever, no person should appear in public wearing the same clothing worn while sick with, or recov- ering from, this disease. Gaseous disinfection, or fumigation, can only be com- pletely and entirely effectual in the absence of living per- sons, as fumes strong enough for the purpose are destructive of human life. This need not deter from doing as much as possible, without injury to sick persons, for the purification of the air of rooms occupied by them—a liberal supply of pure air should be secured; but after the sick have recover- ed, the room, furniture, and other contents not to be de- stroyed, should be thoroughly exposed for several hours to strong fumes of chlorine gas, or to fumigation by burning sulphur; or the paper on the walls, if any, removed and burnt, the furniture scrubbed or polished, and the room thoroughly scrubbed and whitewashed. 7 When a room and contents are to be disinfected, all articles therein should be spread out so as to expose the greatest amount of surface to the action of the disinfectant, and all openings to the room should be dosed. To generate chlorine, take J lb. chloride of lime (to be obtained at any drug store), place in an earthen dish and add a tablespoonful,of hydrochloric acid (sometimes called muriatic acid), to it. Care should be taken not to inhale the gas. After being certain that continuous evolution of chlo- rine has been secured, leave the room and close the door of exit. The bleaching properties of chlorine may destroy the color of colored goods exposed to it, but as a disinfectant, it is one of the best. To generate sulphurous acid gas, put live coals on top of ashes in a metallic pan, and place on the coals sulphur in powder or fragments. Of the two, sulphurous acid gas is equally efficient and avoids the risk of bleaching colored cloths. A convenient way is to place the coals and sulphur on a heated stove plate or cover turned bottom upward in a pan half filled with ashes. To disinfect 100 cubic feet of air re- quires the thorough combustion of about one and one-half ounces of sulphur. Rooms should be kept closed and subjected to the action of the disinfecting gas for six or eight hours, and afterward thoroughly aired by opening doors and win- dows. Heat as a disinfectant.—It is believed that heat suffi- cient to be disinfectant for this disease may be secured with- out destroying ordinary articles of clothing, say at 240° to 250° F. Whenever a case of this disease occurs in a locality, prompt and vigorous action should be taken for the restric- tion of the disease, by early isolation of those sick with the 8 disease, and by the destruction or disinfection of all articles likely to be infected. Plain and distinct notices should be placed upon the premises or house in which there is a person sick with scarlet fever, and no child that has not had the diease should be allowed to enter, or to associate with persons who do enter such house or room. Householders, physicians, and boards of health, have duties to the public, and in order that the guardians of the public health may have early warning, it is important that every case of scarlet fever be promptly reported to the local board of health. The local board of health and the physician in charge of cases of this disease should co-operate for its restriction. The local board of health should particularly guard against its spread where no intelligent physician is employed. All clothing, carpets, curtains, furniture, and other substances that are to be destroyed should be dealt with in a way to avoid conveying the poison to any person in the process; they should not be simply thrown away, or into some stream or body of water; and if burned should be completely burned and not simply heated or dealt with in a way to diffuse the poison of the disease. All such infected substances which are not destroyed should be thoroughly boiled, subjected to a dry heat of 250°F. in a closed room or disinfecting oven, or be thor- oughly exposed to fumes of chlorine or of burning sulphur. Books and furs that have been handled by those convalescing from this disease are jiarticularly liable to convey the poison to children who have never had the disease. Great care should be used to thoroughly disinfect any such articles that are not destroyed ; and caution should be exercised before allow- ing children who have not had scarlet fever to handle any such articles that have been used by persons liable to com- municate the disease. The Massachusetts State Board of 9 Health state that prolonged boiling of clothing and bedding thoroughly disinfects them. Fresh Air.—Although not so active for the destruction of the contagium as is chlorine or sulphurous acid gas, pure air, in liberal amount, is a very useful and important agent for the dilution and destruction of the poison of the disease; it should be employed freely; but with this as with other procedures for the safety of the unaffected, great care should be taken not to increase the danger to those already sick from any cause, who are usually endangered by exposure to drafts of cold air, and this is especially true of persons con- valescing from scarlet fever.