RULES AND REGULATIONS FOR THE PREVENTION OF THE SPREAD OF SMALL-POX. 1. Vaccination.-Upon the first appearance of a case of small-pox in a given locality, systematic vaccination or revaccination must be at once resorted to-raccination and revaccination in all cases where the operation has not been successfully performed within the past year. Recent experience has shown such an unusual susceptibility, both to the small-pox poison and to the vaccine virus, that it is not prudent to rely on an old vaccination, no matter how typical the scar may be The inconvenience of vaccination is trifling compared with an attack of small-pox. If it doesn't "take," one may be assured of his safety it exposed-provided, the operation has been properly performed. If it does "take," it is conclusive evidence that the individual was in a condition to have contracted small-pox if exposed. Vaccination should in all cases be performed by a legally qualified physician; and too much care cannot be exercised in the selection of virus and the performance of the operation. It is recommended that a certificate be given to each person vaccinated, and the STATE BOARD Will, on certain conditions, furnish blanks for this purpose on application. It is further recommended to managers, directors, superintendents, and others employing or having control of numbers of persons-as railroads, commercial and manufacturing establishments, private schools, colleges, universities, penal and reformatory institutions, asylums, public offices, steam-boats, etc.-that they make vaccination obligatory upon all such persons. Local boards and health authorities have the right to order compulsory vaccination at any time, and their orders may be enforced under penalty; or persons refusing to be vaccinated may be quarantined and otherwise treated as small-pox patients or "suspects," until the period of danger has passed. Where such persons (that is, those refusing to be vaccinated.) are known to have been exposed to the contagion-as, by visiting or living in close proximity to infected houses-they must, in all cases, be secluded from observation during the usual period of incubation. 2. Isolation and Quarantine.-Whenever it is made known that any person is sick with small-pox or varioloid, isolation of the individual must be promptly and rigidly enforced. Every one in the house must be vaccinated or revaccinated, no matter how recently this may have been done, nor how mild the disease may appear. In view of the recognized difficulty of a positive diagnosis in every case, any reasonable doubt should be resolved in favor of wise precaution. It is by no means necessary that a case should present all the typical symptoms in order to initiate a malignant epidemic-even a mild case, with little or no eruption, may do this. Local health authorities cannot too strongly insist upon this important point. In towns or cities where there are small-pox hospitals, it is better that the patient should be removed to such at once. Where there is no such provision, the infected house should be strictly quarantined, and, if necessary, the police authority must be invoked to secure proper restrictions. Under no circumstances should the inmates of such a house be allowed to go away from the premises, except by written permission of the health authorities. An improvised hospital will be an absolute necessity if the case occurs in a crowded family or tenement-house, where proper isolation cannot be secured. In such case, a barn, outhouse or other building can usually be made sufficiently comfortable for the patient, at small expense; or, if the weather be mild enough, a tent may be used. A yellow flag or placard, bearing the words. "SMALL-POX HERE!" should be prominently displayed upon the house, and not removed until permission is given by the health authorities. Isolation and non-intercourse are matters of the utmost impor ance. (See page 2, [526] concerning the transfer of patients from one locality to another.) 3. The Sick-Room.-The room selected for the sick should be large, easily ventilated, and as far from the living and sleeping-rooms of other members of the family as it is practicable to have it. All ornaments, carpets, drapery, and articles not absolutely needed in the room, should be removed. A free circulation of air from without should be admitted, both by night and day-there is no better disinfectant than pure air. Place the bed as near as possible in the middle of the room; but care should, of course, be taken to keep the patient out of draughts. If the room connects with others which must be occupied, lock all but one door for entrance and exit, and fasten to the door-frame-top, bottom and sides-sheets of cheap cotton cloth, which must be kept wet with thymol water (see page 8 [5311), or chloride of zinc solution-two drachms of chloride zine to a half gallon of water. Over the door to be used, the sheet must not be tacked at the bottom nor along the full length of the lock-side of the frame, but about five feet may be free to be pushed aside; this sheet, however, must be long enough to allow ten or twelve inches to lie in folds on the floor, and must, also, be kept wet with the disinfectant. 4. Precautions in the Sick-Room.-All discharges from the nose and mouth of the patient should be received on rags and immediately burned, and the same precaution should be taken with the crusts as they fall off. Night-vessels should be kept supplied with a quart or so of the Copperas Disinfectant (see page 8 (5311), into which all discharges should be received. All spoons, dishes, etc., used or taken from the sick-room, should be put in boiling water at once. A pail or tub of the Zinc Disinfectant (see page 8 (5311) should be kept in the sick-room. and into this all clothing, blankets, sheets, towels, etc., used about the patient or in the room, should be dropped immediately after use, and before being removed from the room. They should then be well boiled as soon as practicable. 5. Attendants.-Not more than two persons-one of them a skillful, professional nurse, if possible-should be employed in the sick-room, and their intercourse with other members of the family must be as much restricted as possible, and with the public only by written permission of the health authorities. All attendants should be revaccinated before taking charge of a small pox patient. In the event that it becomes necessary for an attendant to go away from the house, a complete change of clothing must be made using such as has not been exposed to infection: the hands, face and hair should be washed in thymol water, or chloride of zine solution. Following this, free exposure to the open air should be secured before approaching any one. 6. Physicians and Visitors.-Physicians and other necessary visitors, before entering the sick-room, should put on an outer garment, closely buttoned up, and a handker chief or wrap about the throat and neck. Such outer garment may be a linen duster or rubber overcoat; and this, together with the neck-wrap, should be taken off in the open air immediately after leaving the sick-room, and either be dipped in the Zinc Disinfectant, or hung up in an out-of-the-way place exposed to the air, until the next visit. Safety consists in exposing to the open air every article of clothing that has been in any way subjected to the contagion. Whenever practicable, the precautions above prescribed (Rule 5) for an attendant leaving the sick-room, should be observed by the physician or visitor. Doctors and clergymen may convey contagion as ready as the laity under similar conditions; they should, therefore, take the same precautions. This advice applies also to revaccination at the beginning of an outbreak. Several instances of physicians and clergymen falling victims to the disease, have come to the attention of the BOARD. It should be remembered that, whereas the average period of incubation for small-pox is from twelve to fourteen days, vaccination acts in from six to eight. By vaccination, therefore, one may guard against the result of an exposure, even for some days after. Physicians and clergymen may do much toward securing an intelligent compliance with these rules, both by precept and example, and their assistance should be invited in all cases. 7. Miscellaneous. No inmate of the house, during a continuance of the disease, should venture into any public conveyance, or assemblage, or crowded building, such as a church or school; nor, after its termination, until permission is given by the health authorities. Letters must not be sent from the patient, and all mail matter from the house should first be subjected to a dry heat of 250-260° F. Domestic animals, dogs, cats. etc.. should not be allowed to enter the room of the patient, or, better still, should be excluded from the house. During the entire illness the privy should be thoroughly disinfected with the Copperas Disinfectant, three to five gallons of which should be thrown into the vault every three or four days. Water-closets should be disinfected by pouring a quart or so of this disinfectant into the receiver after each use. 8. Care after Recovery.-After recovery has taken place, the patient should be bathed daily, for three or four days, in a weak disinfectant-the thymol water or a solution of chloride of zinc (two drachms of the salt to a half gallon of water). The head should be thoroughly shampooed during each bath, and the convalescent be then clothed in fresh, clean garments that have been in no way exposed to the infected air. Patients should be kept in the house at least two weeks after the crusts have all disappeared. .. Death and Funerals.-In the event of death, the clothing in which the body is attired should be sprinkled with thymol water, the body wrapped in a disinfectant cere-cloth (a sheet thoroughly soaked in the Zinc Disinfectant, double strength,) and placed in an airtight coffin, which is to remain in the sick-room until removed for burial. No public funeral must be allowed either at the house or church, and no more persons should be permitted to go to the cemetery than are becessary to inter the corpse." The local authorities must take charge of burials, and superintend the preparation of the bodies. 10. Disinfection and after Treatment of Premises.-After recovery or death, all articles worn by, or that have come in contact with, the patient, together with the room and all its contents, should be thoroughly disinfected by burning sulphur.. To do this, have all windows, fire-places, flues, key-holes, doors and other openings securely closed by strips or sheets of paper pasted over them. Theu place on the hearth or stove, or on bricks in a wash-tub containing an inch or so of water, an iron vessel of live coals, upon which throw three or four pounds of -ulphur. All articles in the room and others of every description that have been exposed to infection, which cannot be washed or subjected to dry heat, and are yet too valuable to be burned, must be spread out on chairs or racks; mattresses or spring beds set up so as to have both surfaces exposed; window-shades and curtains laid out a full length, and every effort made to secure thorough exposure to the sulphur fumes. The room should then be kept tightly closed for twenty-four hours. After this fumigation -which it will do no harm to repeat-the floor and wood-work should be washed with soap and hot water, the walls and ceiling whitewashed, or, if papered, the paper should be removed. The articles which have been subjected to fumigation should be exposed for several days to sunshine and fresh air. If the carpet has unavoidably been allowed to remain on the floor during the illness, it should not be removed until after the fumigation: but must then be taken up. beaten and shaken in the open air, and allowed to remain out of doors for a week or more. If not too valuable, it should be destroyed; but, whenever practicable, it should be removed from the room at the beginning of the illness. After the above treatment has been thorougnly enforced, the doors and windows of the room should be kept open as much as possible for a week or two. Where houses are isolated, articles may be exposed out of doors. The entire contents of the house should be subjected to the greatest care, and when there is any doubt as to the safety of an article, it should be destroyed. All this work must be done-both the disinfection and the destruction of propertyunder the direct supervision of the local authorities. 11. Treatment of Clothing, Bedding, etc.-Such articles of clothing, bedding, etc., as can be washed, should first be treated by dipping in the Zinc Disinfectant; they should then be immediately and thoroughly boiled. The ticking of beds and pillows used by the patient should be treated in the same manner, and the contents, if hair or feathers, should be thoroughly baked in an oven. If this cannot be done, they should be destroyed by fire, as should, in any event, all straw, husk, moss or "excelsior" filling. The clothing of nurses should be thoroughly fumigated and eleansed before it is taken from the house, or, better still, burned, if feasible. In this connection, attention is called to the fact that the disease has already been conreyed between widely-distant points, during this epidemic, through the medium of rags and paper-stock. In the present emergency, authorities will do well to quarantine shipments of these articles, unless accompanied by a certificate of their disinfection under competent supervision. In any event, it is incumbent upon owners of establishments in which such articles are handled to insist upon the vaccination or revaccination of all persons engaged in the work. 12. Finally, if, from neglect or delay in enforcing precautionary measures, the disease shows a tendency to become epidemic, the public and private schools must be closed, church services suspended and public assemblages of people, as at shows, cireuses, theatres, fairs, or other gatherings, be prohibited. Neighboring communities are justifled in declaring and maintaining a non-intercourse quarantine against any place in which, by neglecting the enforcement of this ORDER, small-pox is allowed to assume epidemic proportions. BEST DISINFECTANTS. Sunlight, fresh air, soap and water, thorough cleanliness-for general use. For special purposes the following are the most efficient, the simplest and the cheapest. I.-Copperas Disinfectant. Sulphate of iron (copperas). .....one and one-half pounds. A convenient way to prepare this is to suspend a basket containing about sixty pounds of copperas in a barrel of water. The solution should be frequently and liberally used in cellars, privies, water-closets, gutters, sewers, cesspools, yards, stables, etc. Roll sulphur (brimstone).. II.-Sulphur Disinfectant. ..two pounds. To a room ten feet square, and in the same proportion for larger rooms. See Rule 10 for mode of use. Made by adding one tablespoonful Spirits of Thymol to a half a gallon of water. Spirits of Thymol is composed of Thymol... one ounce. .....three ounces. May be used for all the disinfectant purposes of carbolic acid; it is quite as efficient and has an agreeable dor. See Rules 3, 5, and 9. for application and uses. Where thymol is not available, chloride of zinc solution may be used-half an ounce of chloride of zine to one gallon of water. This Order should be Preserved for Reference.. NOTE TO THE LAST EDITION. THE first edition of this Circular was published in March, 1881, since_which time some 75,000 copies have been printed and distributed throughout the State. The fifth and last edition-that of May, 1882-contains some allusions which are now out of date, those, for example, to the "past winter"-to the "mild and favorable weather"-and to the "proposed sanitary inspection of immigrants." Aside from these, the comments, advice and instructions of this edition are as applicable now as when originally published. Their practical test in numerous instances, has proven their sufficiency, and the remainder of this edition is now being distributed, as occasion requires, with no other change or addition than as contained in this Note. With reference to the rights, duties and powers of health authorities in the matters of Vaccination, Isolation and Quarantine (see Rules 1 and 2.) it may be noted that in the early part of December, 1882. a suit was tried in the Mercer County Circuit Court, in which the plaintiff charged the Board of Health of Cable with trespass and false imprisonment-damages $10,000. The damages were alleged to have been sustained by the enforcement of the quarantine rules and regulations of the local board, which were based upon the rules and regulations of the STATE BOARD, contained in this Circular. During the trial the question arose as to the authority to make and enforce such rules and regulations. The verdict of the jury was rendered in favor of the local board, thus sustaining its authority to enforce such measures as, in the exercise of a wise discretion, were deemed necessary for the protection of the public health. * Still more recently, in charging the Grand Jury at Paterson, N. J., Judge Dixon called attention to the case of a man employed as nurse in a small-pox hospital, and who without proper precautions, visited his family, communicating the disease to his children, one of whom died herefrom. Hereupon Judge Dixon says: "If a man, conscious that he carries about with him the germs of a contagious disease, recklessly exposes the health and lives of others, he is a public nuisance and a criminal, and may be held answerable for the results of his conduct. If death occurs through his recklessness he may be indicted for manslaughter. It is held that where a person knowingly communicates a contagious disease to another, and death results, the crime is manslaughter." Applying the law to the nurse's case, the judge instructed the jury that the man might be indicted for manslaughter, if it was found that there had been criminal negligence on his part; and that he might be indicted for spreading the disease by conscious exposure of others thereto, by his presence in public places, as on the streets, in halls, etc.-and this even though no evil consequences had followed, on the charge of being a public nuisance endangering the public health. "The law provides some penalty for such offense against the public safety." In other and older phrase: THE WELL-BEING OF THE PEOPLE IS THE SUPREME LAW. These instances are cited in answer to frequent inquiries addressed to the BOARD, as to the extent to which courts and juries will sustain health authorities in their efforts to prevent the spread of epidemic contagion or infection. The plaintiff appealed from the judgment in the Circuit Court: but at the May, 1883, term of the Appellate Court of the Second District, the judgment was affirmed. See ante, pp. 279-282. |