COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX64170144 R A655 .157 1916 Interstate quaranti .157 1916 TREASURY DEPARTMENT UNITED STATES PUBLIC HEALTH SERVICE MISCELLANEOUS PUBLICATION No. 1 INTERSTATE QUARANTINE REGULATIONS OF THE UNITED STATES Prepared by direction of the Surgeon General "WASHINGTON GOVERNMENT PRINTING OFFICE 1916 COLLEGE OF PHYSICIANS AND SURGEONS LIBRARY Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/interstatequaranOOunit TREASURY DEPARTMENT UNITED STATES PUBLIC HEALTH SERVICE MISCELLANEOUS PUBLICATION No. 1 INTERSTATE QUARANTINE REGULATION! OF THE UNITED STATES 1916 Prepared by direction of the Surgeon General WASHINGTON GOVERNMENT PRINTING OFFICE 1916 Z9- J-J7- ADDITIONAL COPIES OF THIS PUBLICATION MAY BE PROCURED FROM THE SUPERINTENDENT OF DOCUMENTS GOVERNMENT PRINTING OFFICE WASHINGTON, D. C. AT 10 CENTS PER COPY CONTENTS. Quarantine laws of the "United States 7 Act to prevent the introduction of contagious diseases from one State to another and for the punishment of certain offenses. Approved March 27, 1890. (U. S. Stats. A. L., vol. 26, ch. 51, p. 31) 7 Act granting additional quarantine powers and imposing additional duties upon the Marine-Hospital Service. Approved February 15, 1893. (IT. S. Stats. A. L., vol. 27, ch. 114, p. 449) 7 Act to amend section 2 of the act approved February 15, 1893, entitled "An act granting additional quarantine powers and imposing additional duties upon the Marine-Hospital Service, " approved August 18, 1894. (U. S. Stats. A. L., vol. 28, ch. 300, p. 372) 10 Act to amend ' ' An act granting additional quarantine powers and imposing additional duties upon the Marine-Hospital Service, approved February 15, 1893." Approved March 3, 1901. (U. S. Stats. A. L., vol. 31, ch. 836, p. 1086.) 11 Promulgation of interstate quarantine regulations by the Secretary of the Treasury, January 15, 1916 , 13 Interstate quarantine regulations . 15 Section 1. Diseases regarded as contagious or infectious diseases within the meaning of the act of February 15, 1893 15 Section 2. Interstate vehicles to be clean 15 Section 3. Fumigation of forecastles; act approved March 9, 1915 15 Section 4. Cleaning of interstate vehicles 15 Section 5. Bedding furnished for use of interstate passengers 15 Section 6. Ventilation of interstate vehicles 16 Section 7. Toilets and lavatories on interstate vehicles 16 Section 8 . Measures for the prevention of spitting within interstate vehicles. 16 Section 9. Common towels prohibited 16 Section 10. Common drinking cups prohibited 16 Section 11 . Food and drink for interstate passengers 16 Section 12. Milk from infected premises not to be transported 17 Section 13(a) . Pure water for interstate passengers 17 Section 13(b). Ice used for cooling water furnished interstate passengers. .. 17 Section 13(c). Cleansing of water containers 17 Section 14. Water for employees of common carriers — notices to be posted over impure water supplies at or near stations 18 Section 15. Water from harbors not to be furnished to any vessel 18 Section 16. Vessels not to furnish water to passengers from lake or stream over which vessel is being navigated 18 Section 17. Common carriers not to accept for interstate shipment persons suffering from communicable diseases. 19 Section 18. Persons suffering from communicable diseases not to travel in interstate traffic 19 Section 19. Articles known to be infectious or contagious not to be trans- ported 19 Section 20. Outgoing quarantine measures to prevent the spread of plague . . 19 Section 21. Prevention of spread of disease from infected persons or things. 20 3 4 CONTENTS. Interstate quarantine regulations — Continued. Page. Section 22. Sick passengers to be removed at first convenient place — Surgeon General and State and local health authorities to be notified 20 Section 23. Certain infected persons who may not travel 20 Section 24. Interstate carriage of typhoid patients 20 Section 24(a). Rules for nurses accompanying typhoid patients 20 Section 24(b). Disinfection of compartment upon removal of typhoid patient 21 Section 25. Measures to be taken upon occurrence of case of yellow fever en route 21 Section 26. Vessels or vehicles not to be removed from yellow fever localities without permit 21 Section 27. Interstate carriage of diphtheria, measles, or whooping-cough patients 22 Section 27(a). Rules for nurses accompanying diphtheria, measles, or whooping-cough patients 22 Section 27(b). Disinfection of compartment upon removal of case of diph- theria, measles, or whooping cough 22 Section 28. Interstate carriage of tuberculous persons 22 Section 28(a). Articles with which tuberculous person shall be provided while traveling 23 Section 28(b) Disinfection of compartment upon disembarkation of tuber- culous person 23 Section 28(c) Tuberculous passengers not to expectorate except in sputum cup or gauze 23 Section 29. Lepers not to be accepted for interstate transportation without permit 23 Section 30. Lepers not to accept transportation unless permits have been obtained 23 Section 31. Lepers violating section 30 to be returned to State from which they may have departed or removed to Federal quarantine station 24 Section 32. Incubation periods 24 Section 33. Notification of contagious or infectious diseases 24 Section 34. Notification of unusual outbreak of disease 24 Section 35. Interstate sanitary officers to enforce regulations and collect information 25 Section 36. Shipment of animals from localities infected with Rocky Mountain spotted fever 25 Appendix 27-41 Disinfectants 27 Classes of disinfectants 27 Physical disinfectants 27 Burning 27 Boiling . 27 Steam, flowing, not under pressure 27 Steam under pressure without vacuum 27 Steam under pressure with vacuum 27 Gaseous disinfectants _. 27 In general 27 Formaldehyde 28 Formalin-permanganate method 29 Formalin-sheet-spraying method 30 Formalin-aluminum-sulphate-lime method 30 Paraform 31 CONTENTS. 5 Appendix — Continued. Disinfectants — Continued . Gaseous disinfectants — Continued. Page. Sulphur dioxide 32 The pot method 32 Liquid sulphur dioxide 33 Sulphur candles 34 Chemical solutions 34 Bichloride of mercury 34 Formalin, solution of formaldehyde, U. S. P 35 Carbolic acid 35 Crude carbolic acid 36 Tricresol 36 Lysol and creolin 36 Agents for the destruction of vermin 36 In general 36 Sulphur 37 Sulphur dioxide 37 The pot method 37 Liquid sulphur dioxide 37 Sulphur candles 37 Hydrocyanic acid gas 37 Pyrethrum 38 Disinfection of compartments - 39 Disinfection of bed clothes, towels, etc 39 Disinfection of textiles soiled with' discharges of the sick or presum- ably infected 39 Disinfection of cooking and eating utensils 39 Disinfection of living apartments, cabins, and forecastles of vessels. . . 39 Disinfection of mattresses, pillows, and other heavy fabrics 40 Disinfection of holds of vessels 40 iacteriological standard for drinking water 40 ^orm of certificate of examination of water for passengers in interstate traffic . 41 3tructions relative to the certification of water furnished to passengers in interstate traffic 41 QUARANTINE LAWS OF THE UNITED STATES. An act to prevent the introduction of contagious diseases from one State to another and for the punishment of certain offenses. (U. S. Stats, at Large, vol. 26, ch. 51, p. 31. Approved Mar. 27, 1890.) Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That whenever it shall be made to appear to the satisfaction of the President that cholera, yellow fever, smallpox, or plague exists in any State or Territory, or in the District of Columbia, and that there is danger of the spread of such disease into other States, Territories, or the District of Columbia, he is hereby author- ized to cause the Secretary of the Treasury to promulgate such rules and regulations as in his judgment may be necessary to prevent the spread of such disease from one State or Territory into another, or from any State or Territory into the District of Columbia, or from the District of Columbia into any State or Territory, and to employ such inspectors and other persons as may be necessary to execute such regulations to prevent the spread of such disease. The said rules and regulations shall be prepared by the Supervising Surgeon General of the Marine-Hospital Service under the direc- tion of the Secretary of the Treasury. And any person who shall willfully violate any rule or regulation so made and promulgated shall be deemed guilty of a misdemeanor, and upon conviction shall be punished by a fine of not more than five hundred dollars, or imprisonment for not more than two years, or both, in the discretion of the court. Sec. 2. That any officer, or person acting as an officer, or agent of the United States at any quarantine station, or other person employed to aid in preventing the spread of such disease, who shall willfully violate any of the quarantine laws of the United States or any of the rules and regulations made and promulgated by the Secretary of the Treasury as provided for in section one of this act, or any lawful order of his superior officer or officers, shall be deemed guilty of a misdemeanor, and upon conviction shall be punished by a fine of not more than three hundred dollars or imprisonment for not more than one year, or both, in the discretion of the court. Sec. 3. That when any common carrier or officer, agent, or employee of any common carrier shall willfully violate any of the quarantine laws of the United States, or the rules and regulations made and promulgated as provided for in section one of this act, such common carrier, officer, agent, or employee shall be deemed guilty of a misde- meanor, and shall, on conviction, be punished by a fine of not more than five hundred dollars, or imprisonment for not more than two years, or both, in the discretion of the court. An act granting additional quarantine powers and imposing additional duties upon the Marine-Hospital Service. (U. S. Stats, at Large, vol. 27, ch. 114, p. 449. Approved Feb. 15, 1893.) Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That it shall be unlawful for any merchant ship or other vessel from any foreign port or place to enter any port of the United States except in accord- ance with the provisions of this act and with such rules and regulations of State and municipal health authorities as may be made in pursuance of or consistent with this 27165°— 16 -2 7 8 INTERSTATE QUARANTINE REGULATIONS. act; and any such vessel which shall enter, or attempt to enter, a port of the United States in violation thereof shall forfeit to the United States a sum, to be awarded in the discretion of the court, not exceeding five thousand dollars, which shall be a lien upon said vessel, to be recovered by proceedings in the proper district court of the United States. In all such proceedings the United States district attorney for such district shall appear on behalf of the United States; and all such proceedings shall be con- ducted in accordance with the rules and laws governing cases of seizure of vessels for violation of the revenue laws of the United States, Sec. 2. That any vessel at any foreign port clearing for any port or place in the United States shall be required to obtain from the consul, vice consul, or other consular officer of the United States at the port of departure, or from the medical officer where such officer has been detailed by the President for that purpose, a bill of health, in duplicate, in the form prescribed by the Secretary of the Treasury, setting forth the sanitary history and condition of said vessel, and that it has in all respects complied with the rules and regulations in such cases prescribed for securing the best sanitary condition of the said vessel, its cargo, passengers, and crew; and said consular or medical officer is required, before granting such duplicate bill of health, to be satisfied that the matters and things therein stated are true; and for his services in that behalf he shall be entitled to demand and receive such fees as shall by lawful regulation be allowed, to be accounted for as is required in other cases. The President, in his discretion, is authorized to detail any medical officer of the Government to serve in the office of the consul at any foreign port for the purpose of furnishing information and making the inspection and giving the bills of health hereinbefore mentioned. Any vessel clearing and sailing from any such port without such bill of health, and entering any port of the United States, shall forfeit to the United States not more than five thousand dollars, the amount to be determined by the court, which shall be a lien on the same, to be recovered by proceedings in the proper district court of the United States. In all such proceedings the United States district attorney for such district shall appear on behalf of the United States; and all such proceedings shall be conducted in accordance with the rules and laws govern- ing cases of seizure of vessels for violation of the revenue laws of the United States. Sec. 3. That the Supervising Surgeon General of the Marine-Hospital Service shall, immediately after this act takes effect, examine the quarantine regulations of all State and municipal boards of health, and shall, under the direction of the Secretary of the Treasury, cooperate with and aid State and municipal boards of health in the execution and enforcement of the rules and regulations of such boards and in the execution and enforcement qi the rules and regulations made by the Secre- tary of the Treasury to prevent the introduction of contagious or infectious diseases into the United States from foreign countries, and into one State or Territory or the District of Columbia from another State or Territory or the District of Columbia; and all rules and regulations made by the Secretary of the Treasury shall operate uni- formly and in no manner discriminate against any port or place; and at such ports and places within the United States as have no quarantine regulations under State or municipal authority, where such regulations are, in the opinion of the Secretary of the Treasury, necessary to prevent the introduction of contagious or infectious diseases into the United States from foreign countries, or into one State or Territory or the District of Columbia from another State or Territory or the District of Columbia, and at such ports and places within the United States where quarantine regulations exist under the authority of the State or municipality which, in the opinion of the Secretary of the Treasury, are not sufficient to prevent the introduction of such dis- eases into the United States, or into one State or Territory or the District of Columbia from another State or Territory or the District of Columbia, the Secretary of the Treasury shall, if in his judgment it is necessary and proper, make such additional rules and regulations as are necessary to prevent the introduction of such diseases IISTTEKSTATE QUARANTINE REGULATIONS. 9 into the United States from foreign countries, or into one State or Territory or the District of Columbia from another State or Territory or the District of Columbia, and when such rules and regulations have been made they shall be promulgated by the Secretary of the Treasury, and enforced by the sanitary authorities of the States and municipalities, where the. State and municipal health authorities will undertake to execute and enforce them; but if the State or municipal authorities shall fail or refuse to enforce said rules and regulations the President shall execute and enforce the same and adopt such measures as in his judgment shall be necessary to prevent the introduction or spread of such diseases, and may detail or appoint officers for that purpose. The Secretary of the Treasury shall make such rules and regulations as are necessary to be observed by vessels at the port of departure and on the voyage, where such vessels sail from any foreign port or place to any port or place in the United States, to secure the best sanitary condition of such vessel, her cargo, passengers, and crew, which shall be published and communicated to and enforced by the con- sular officers of the United States. None of the penalties herein imposed shall attach to any vessel or owner or officer thereof until a copy of this act, with the rules and regulations made in pursuance thereof, has been posted up in the office of the consul or other consular officer of the United States for ten days in the port from which said vessel sailed ; and the certificate of such consul or consular officer over his official signature shall be competent evidence of such posting in any court of the United States. Sec. 4. That it shall be the duty of the Supervising Surgeon General of the Marine Hospital Service, under the direction of the Secretary of the Treasury, to perform all the duties in respect to quarantine and quarantine regulations which are provided for by this act, and to obtain information of the sanitary condition of foreign ports and places from which contagious and infectious diseases are or may be imported into the United States; and to this end the consular officers of the United States at such ports and places as shall be designated by the Secretary of the Treasury shall make to the Secretary of Treasury weekly reports of the sanitary condition of the ports and places at which they are respectively stationed, according to such forms as the Secretary of the Treasury shall prescribe; and the Secretary of the Treasury shall also obtain, through all sources accessible, including State and municipal sanitary authorities throughout the United States, weekly reports of the sanitary condition of ports and places within the United States, and shall prepare, publish, and transmit to collec- tors of customs and to State and municipal health officers and other sanitarians weekly abstracts of the consular sanitary reports and other pertinent information received by him, and shall also, as far as he may be able, by means of the voluntary cooperation of State and municipal authorities, of public associations and private persons, procure information relating to the climatic and other conditions affecting the public health, and shall make an annual report of his operations to Congress, with such recommen- dations as he may deem important to the public interest. Sec 5. That the Secretary of the Treasury shall from time to time issue to the con- sular officers of the United States and to the medical officers serving at any foreign port, and otherwise make publicly known, the rules and regulations made by him, to be used and complied with by vessels in foreign ports, for securing the best sanitary conditions of such vessels, their cargoes, passengers, and crew, before their departure for any port in the United States and in the course of the voyage, and all such other rules and regulations as shall be observed in the inspection of the same on the arrival thereof at any quarantine station at the port of destination, and for the disinfection and isolation of the same, and the treatment of cargo and persons on board, so as to prevent the introduction of cholera, yellow fever, or other contagious or infectious diseases; and it shall not be lawful for any vessel to enter said port to discharge its cargo or land its passengers except upon a certificate of the health officer at such quarantine station certifying that said rules and regulations have in all respects been 10 INTERSTATE QUARANTINE REGULATIONS. observed and complied with, as well on his part as on the part of the said vessel and its master, in respect to the same and to its cargo, passengers, and crew; and the master of every such vessel shall produce and deliver to the collector of customs at said port of entry, together with the other papers of the vessel, the said bills of health required to be obtained at the port of departure and the certificate herein required to be obtained from the health officer at the port of entry, and that the bills of health herein prescribed shall be considered as part of the ship 's papers, and when duly cer- tified to by the proper consular or other officer of the United States, over his official signature and seal, shall be accepted as evidence of the statements therein contained in any court of the United States. Sec. 6. That on the arrival of an infected vessel at any port not provided with proper facilities for treatment of the same the Secretary of the Treasury may remand said vessel, at its own expense, to the nearest national or other quarantine station, where accommodations and appliances are provided for the necessary disinfection and treatment of the vessel, passengers, and cargo, and after treatment of any infected vessel at a national quarantine station, and after certificate shall have been given by the United States quarantine officer at said station that the vessel, cargo, and pas- sengers are each and all free from infectious disease, or danger of conveying the same, said vessel shall be admitted to entry to any port of the United States named within the certificate. But at any ports where sufficient quarantine provision has been made by State or local authorities the Secretary of the Treasury may direct vessels bound for said ports to undergo quarantine at said State or local station. Sec. 7. That whenever it shall be shown to the satisfaction of the President that by reason of the existence of cholera or other infectious or contagious diseases in a foreign country there is serious danger of the introduction of the same into the United States, and that notwithstanding the quarantine defense this danger is so increased by the introduction of persons or property from such country that a suspension of the right to introduce the same is demanded in the interest of the public health, the President shall have power to prohibit, in whole or in part, the introduction of per- sons and property from such countries or places as he shall designate and for such period of time as he may deem necessary. Sec 8. That whenever the proper authorities of a State shall surrender to the United States the use of the buildings and disinfecting apparatus at a State quarantine station the Secretary of the Treasury shall be authorized to receive them and to pay a reasonable compensation to the State for their use, if, in his opinion, they are nec- essary to the United States. Sec. 9. That the act entitled "An act to prevent the introduction of infectious or contagious diseases into the United States, and to establish a national board of health, ' ' approved March 3, 1879, be, and the same is hereby, repealed. And the Secretary of the Treasury is directed to obtain possession of any property, furniture, books, paper, or records belonging to the United States, which are not in the possession of an officer of the United States under the Treasury Department, which were formerly in the use of the National Board of Health or any officer or employee thereof. An act to amend section two of the act approved February 15, 1893, entitled "An act granting additional quarantine powers and imposing additional duties upon the Marine-Hospital Service." (U. S. Stats, at Large, vol. 28, ch. 300, p. 372. Approved Aug.-18, 1894.) Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That section two of the act approved February fifteenth, eighteen hundred and ninety-three, entitled "An act granting additional quarantine powers and imposing additional duties upon the Marine-Hospital Service," is hereby amended by adding to the end of said section the following: INTERSTATE QUARANTINE REGULATIONS. 11 The provisions of this section shall not apply to vessels plying between foreign ports on or near the frontiers of the United States and ports adjacent thereto; but the Sec- retary of the Treasury is hereby authorized, when, in his discretion, it is expedient for the preservation of the public health, to establish regulations governing such vessels. An act to amend '"An act granting additional quarantine powers and imposing addi- tional duties upon the Marine-Hospital Sendee," approved February 15, 1893. (U. S. Stats, at Large, vol. 31, ch. 836, p. 1086. Approved Mar. 3, 1901.) Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That "an act granting additional quarantine powers and impos- ing additional duties upon the Marine-Hospital Service," approved February 15, 1893, be amended by addition of the following sections: Sec. 10. That the supervising Surgeon General, with the approval of the Secretary of the Treasury, is authorized to designate and mark the boundaries of the quarantine grounds and quarantine anchorages for vessels which are reserved for use at each United States quarantine station; and any vessel or officer of any vessel or other per- son other than State or municipal health or quarantine officers, trespassing or otherwise entering upon such grounds or anchorages in disregard of the quarantine rules and regulations, or without permission of the officer in charge of such station, shall be deemed guilty of a misdemeanor and subject to arrest, and upon conviction thereof be punished by a fine of not more than three hundred dollars or imprisonment for not more than one year, or both, in the discretion of the court. Any master or owner of any vessel, or any person violating any provision of this act or any rule or regulation made in accordance with this act, relating to inspection of vessels or relating to the prevention of the introduction of contagious or infectious diseases, or any master, owner, or agent of any vessel making a false statement relative to the sanitary condi- tion of said vesssel or its contents or as to the health of any passenger or person thereon, shall be deemed guilty of a misdemeanor and subject to arrest, and upon conviction thereof be punished by a fine of not more than five hundred dollars or imprisonment for not more than one year, or both, in the discretion of the court. Sec. 11. That any vessel sailing from any foreign port without the bill of health required by section two of this act, and arriving within the limits of any collection district of the United States, and not entering or attempting to enter any port of the United States, shall be subject to such quarantine measures as shall be prescribed by regulations of the Secretary of the Treasury, and the cost of such measures shall be a lien on said vessel, to be recovered by proceedings in the proper district court of the United States and in the manner set forth above as regards vessels from foreign ports without bills of health and entering any port of the United States. Sec. 12. That the medical officers of the United States, duly clothed with authority to act as quarantine officers at any port or place within the United States, and when performing the said duties, are hereby authorized to take declarations and administer oaths in matters pertaining to the administration of the quarantine laws and regulations of the United States. INTERSTATE QUARANTINE REGULATIONS. Treasury Department, Office of the Secretary, Washington, January 15, 1916. To medical officers of the United States Public Health Service, State and local health authorities, and others concerned: Upon the recommendation of the Surgeon General of the United States Public Health Service and pursuant to the act of Congress approved February 15, 1893, entitled "An act granting additional quarantine powers and imposing additional duties upon the Marine- Hospital Service," the following interstate quarantine regulations for the prevention of the introduction of contagious and infectious diseases into one State or Territory or the District of Columbia from another State or Territory or the District of Columbia are hereby promulgated for the information and guidance of all concerned. All regulations inconsistent herewith are hereby revoked. W. G. McAdoo, Secretary. 13 INTERSTATE QUARANTINE REGULATIONS. Section. 1 . For the purposes of interstate quarantine . contagious or the following diseases shall be regarded as contagious and eases. Act ap- inf ectious diseases within the meaning of section 3 of the 1893, u. s. stats! act approved February 15, 1893 : Plague, cholera, typhoid ch. 444, p. 114. fever, pulmonary tuberculosis, yellow fever, smallpox, leprosy, typhus fever, scarlet fever, diphtheria, measles, whooping cough, poliomyelitis (infantile paralysis), Rocky Mountain spotted or tick fever, and epidemic cerebro- spinal meningitis; and any person affected with any dis- ease aforesaid, and anything, living or dead, which has been affected with or exposed to the contagion or infec- tion of any such disease, except as otherwise provided in these regulations, shall be regarded as contagious or infec- tious until the contrary has been proven. Sec. 2. Common carriers by land or water, while interstate veM- engaging in commerce between any of the several States or Territories or the District of Columbia, shall maintain at all times in a clean and sanitary condition all cars, vessels, vehicles, or conveyances so being operated by them. Sec. 3. The living quarters for the personnel of vessels Fumigation of shall be fumigated at least once every six months for the approved Mar. 9, extermination of insects and vermin, and also upon the removal of a case or cases of any disease mentioned in section 1. Sec. 4. Common carriers shall not permit, nor cause, cleaning of to be cleaned any car, vessel, vehicle, or other conveyance operating in interstate traffic while the same is occupied by passengers, unless said cleaning is done in such manner as to prevent the distribution of dust. Sec. 5. Any person, firm, or corporation supplying Bedding. sleeping accommodations for passengers traveling in interstate traffic shall furnish the bed, couch, or other appliance used for sleeping purposes with clean sheets and pillowcases which have not been used by any other per- son since last laundered: Provided, That blankets, pil- lows, and mattresses which have not been used by any person suffering from a disease mentioned in section 1, if 27165°— 16 3 15 atones 16 INTERSTATE QUARANTINE REGULATIONS. physically clean and free from vermin, may be used if they are so enveloped as not to come in contact in any way with any occupant of such bed, couch, or other appliance for sleeping purposes. ventilation. Sec. 6. All cars, vessels, vehicles or conveyances oper- ating for the use of passengers traveling in interstate traffic shall be so ventilated as to insure an adequate sup- ply of fresh air. Toilets and lav- g EC> 7 . Toilets and lavatories on cars, vessels, vehicles, or conveyances operating for the use of passengers travel- ing in interstate traffic shall be of adequate size, design, and number, and shall be maintained in a clean and san- itary condition. Prevention of g EC> g # Co mm on carriers by land or water while en- spitttmg. _ J gaging in commerce between any of the several States or Territories or the District of Columbia shall take adequate measures by the use of warning signs or cuspidors, or both, for the prevention of the soiling of cars, vessels, vehicles, or conveyances with sputum, and said cuspi- dors shall be adequate in size and number and suitable in design for the reception of sputum, and shall be main- tamed in a clean and sanitary condition. common tow- g EC# g_ Common carriers shall not provide in cars, Dec. 9, 1912. vessels, vehicles, or conveyances operated in interstate traffic, or in depots, waiting rooms, or other places used by passengers traveling from one State or Territory or the District of Columbia to another State or Territory or the District of Columbia, any towel for use by more than one person: Provided, That towels may be used again after hav- ing been cleansed and sterilized with boiling water, commondrink- g EC# iq. Common carriers shall not provide in cars, mg cup . , t Oct. 30, 1912. vessels, vehicles, or conveyances operated in interstate traffic, or in depots, waiting rooms, or other places used by passengers traveling from one State or Territory or the District of Columbia to another State or Territory or the District of Columbia, any drinking cup, glass, or vessel for common use: Provided, That this regulation shall not be held to preclude the use of drinking cups, glasses, or vessels which are thoroughly cleansed or sterilized after use by each individual, nor shall it be held to preclude the use of sanitary devices for individual use only. rood and drink g EC \\ Persons, firms, or corporations engaging in the for interstate pas- t * ' * m & g t> sengers. business of furnishing food or drink for the use of pas- sengers traveling in interstate traffic shall not supply any article of food or drink, unless the same shall have INTERSTATE QUARANTINE REGULATIONS. been obtained from a source known contagion or infection of the dise^ tion 1, or unless the same shall h teurized, or otherwise treated in s that the article is free from the ' tagion or infection as afores? or drink for said passengers as to prevent contamir> r infection. Sec. 12. After no health authorities or accept for t from premise scarlet f e^ fever, ul that i sur* INTERSTATE QUARANTINE REGULATIONS. ~>n carriers while engaging in interstate "sh to their crews or employees any ong purposes which may contain i likely to cause a contagious or shall such carriers maintain or ->on their vessels or vehicles, or u- other ordinary stopping ve control any tank, cis- ; cle with water which h manner that water med by the crews purposes, unless on said vessels ^k, cistern, ,ok, pool, in con- ^ater d INTERSTATE QUARANTINE REGULATIONS. 19 under date of October 21, 1914 ■} Provided, That water in regard to the safety of which a reasonable doubt exists may be used if the same has been treated in such manner as to render it incapable of conveying disease, and the fact of such treatment is certified by the aforesaid health authority or by the Surgeon General of the United States Public Health Service or his accredited representative. Sec. 17. Common carriers shall not knowingly accept .interstate car- . .r riage ofcommuni- for transportation from one State or Territory or the cable disease. District of Columbia into another State or Territory or the District of Columbia any person suffering from any of the diseases mentioned in section 1, except as herein- after provided. Sec. 18. No person knowing that he is in the communi- Travel of per- t i , n i?i-iv .1" i--< sons having corn- Cable stage oi any ol the diseases enumerated in section 1 municabie dis- shall travel on any car, vessel, vehicle, or conveyance 9 ' engaging in interstate traffic, except as hereinafter pro- vided, nor shall any parent or guardian allow any minor, or other person under his charge who is in the communi- cable stage of any of such diseases, to travel in any car, vessel, vehicle, or conveyance engaging in interstate traffic. Sec. 19. No person, firm, or corporation shall offer for Transportation . . rr- i • things exposed shipment m interstate traffic, and no common carrier to infection. shall accept for shipment, or transport in interstate traffic, any article or thing known to have been exposed to the contagion or infection of any of the diseases enu- merated in section 1, unless a certificate has previously been obtained from the proper health authority 3 that all necessary measures have been taken to render said article or thing free from infection; and in the case of yellow fever, Rocky Mountain spotted or tick fever, or typhus fever, free from mosquitoes, ticks, or lice. Sec. 20. In the event of the appearance of human or outgoing quar- rodent plague in any port or place within the United to tl prev^r , the States, the Surgeon General of the United States p u bUc ( * r< ® dofI * aguo - Health Service shall establish such outgoing quarantine measures as will in his opinion prevent the introduction of the disease into another State or Territory or the Dis- trict of Columbia : Provided, That freight which is known to have originated in rat-free surroundings and is shipped from rat-proof, rat-free warehouses, docks, or wharves, i See Appendix. 2 The term "proper health authority" shall be construed to mean the health officer within whose .jurisdiction the article or thing originates, or during the presence of epi- demic, the officer in charge of the measures to prevent the spread of same. 20 INTER-STATE QUARANTINE REGULATIONS. in rat-proof, rat-free cars, vessels, vehicles, or convey- ances, may be granted pratique for interstate transpor- tation when so certified by the Surgeon General of the United States Public Health Service or his accredited representative. Pr l V of dLeas^ ^ec. ^1« Any person or thing either living or dead, from infected per- w hich has been exposed to or is infected with any of the sons. - 1 . m J diseases enumerated in section 1, if found in any car, vessel, vehicle, or conveyance undergoing interstate trans- portation, shall be subjected to such inspection, disinfec- tion, or other measures as may be necessary to prevent the spread of the infection from them. sick passenger. Sec. 22. In the event of the appearance of any disease mentioned in section 1, with the exception of tuberculosis, in any person en route or aboard any car, vessel, vehicle, or conveyance operating in interstate traffic, the common carrier shall at once isolate the sick person and remove him from the car, vessel, vehicle, or conveyance at the first convenient place at which reasonable provision may be had for the protection of the patient and the public health, and shall immediately notify the Surgeon General of the United States Public Health Service and the State and local health officer of the place at which the person was removed from such car, vessel, vehicle, or convey- ance, and shall disinfect the compartment from which the person was removed. 1 infected per- g EC> 23. No person affected with plague, cholera, sons who may not r . I travel. smallpox, scarlet fever, or yellow fever shall be received upon any vessel, car, vehicle, or conveyance operating in interstate traffic, interstate car- Sec. 24. Commori carriers shall not receive upon any riage of typhoid 1 t • 1 . • • • , • . patients. car, vessel, vehicle, or conveyance operating in interstate traffic any person affected with typhoid fever, unless re- moval and entrance permits have been granted by the State or local health officers at places of departure and arrival, and unless said person is placed in a separate compartment and is accompanied by a properly qualified nurse or attendant, and unless said nurse or attendant shall obligate himself or herself in writing, to the common carrier, to comply with the following regulations while in transit : Ruiesfomurses (©) 1. Communication with the compartment in which accompanying . . . . . . . typhoid patients, the patient is traveling shall be restricted to the minimum consistent with the proper care and safety of the patient. 1 See Appendix. INTERSTATE QUARANTINE REGULATIONS. 21 2. All dishes or utensils used by the patient en route shall be placed in a 5 per cent solution of carbolic acid or in disinfecting fluid of equivalent disinfecting value for at least one hour before being allowed to leave the com- partment. 3. All urine, bowel movements, or other discharges from the patient shall be received into a 5 per cent solu- tion of carbolic acid or disinfecting fluid of equivalent disinfecting value, placed in a covered vessel and allowed to stand undisturbed for at least two hours after the last addition thereto; upon the expiration of the time stated they may be burned, destroyed, or emptied into a common sewer at any convenient port or place. 4. Said nurse or attendant shall use all necessary pre- cautions to prevent access of flies to the patient, and after performing service of any nature to the patient shall at once cleanse the hands by thorough washing in a 2 per cent solution of carbolic acid or other solution of equiva- lent disinfecting value. (&) Immediately upon the disembarkation of the pa- Disinfection of tient the common carrier shall close the compartment compar men ' the patient has vacated, without removal of any of its contents, and shall keep the same closed until disinfected. 1 Sec. 25. In the event of the occurrence of a case of yellow Yellow fever en p , li-i route. lever en route or upon any car, vessel, vehicle, or conveyance operating for the transportation of passengers in inter- state traffic, the case shall be isolated in a compartment or place so screened as to prevent the entrance or exit of mosquitoes, or their access to the patient; and the patient shall not be disembarked in infectible territory unless thoroughly protected from mosquitoes, and unless per- mission for such disembarkation has been obtained from the State and local health officials having jurisdiction over the place of disembarkation, and immediately upon such disembarkation the compartment vacated by the patient shall be fumigated in such manner as to insure the complete destruction of all mosquitoes contained therein. Sec. 26. Common carriers shall neither cause, permit, Transportation or allow to be hauled, removed, or transferred in inter- cies from yellow , , , m li-i p fever localities. state traffic any car, vessel, vehicle, or conveyance from a locality in which yellow fever prevails, unless there has been obtained from the Surgeon General of the United States Public Health Service, or his accredited repre- 1 See Appendix. 22 INTERSTATE QUARANTINE REGULATIONS. sentative, a certificate stating that said car, vessel, vehicle, or conveyance has been fumigated to destroy mosquitoes, or has been so safeguarded as to prevent the entrance of mosquitoes. Transportation Sec. 27. Common carriers shall not receive upon any of diphtheria, i i • i • , j_ . measles, and car, vessel, vehicle, or conveyance operatmg in interstate patients. traffic any person affected with diphtheria, measles, or whooping cough, or any person known to be a carrier of the bacillus diphtheriae, unless removal and entrance per- mits have been granted by the State or local health officers at the places of departure and arrival, and unless said person is placed in a separate compartment and is accom- panied by a properly qualified nurse or attendant and unless such nurse or attendant has pledged himself or herself in writing, to the common carrier, to comply with the following regulations while in transit: (a) 1. Communication with the compartment within which the patient is traveling shall be restricted to the minimum consistent with the proper care and safety of the patient. 2. All dishes or utensils used by the patient en route shall be placed in a 5 per cent solution of carbolic acid or disinfecting fluid of equivalent disinfecting value for at least one hour before being allowed to leave the compartment. 3. All sputum and nasal discharges from the patient shall be received in gauze or paper, which shall be deposited into a closed container and which shall be destroyed by burning or received in a 5 per cent solu- tion of carbolic acid or disinfecting fluid of equivalent disinfecting value placed in a covered vessel and allowed to stand undisturbed for at least two hours after the last addition thereto. (b) Immediately upon the disembarkation of the patient the common carrier shall close the compartment the patient has vacated, without the removal of any of its contents, and shall keep the same closed until disinfection. 1 of Tr Tube°r r cuiou° Sec. 28. Common carriers shall not receive for inter- persons. state transportation any person known -by them to be suffering from pulmonary tuberculosis in a communicable stage unless said person is provided with the following articles : 1 See Appendix. INTERSTATE QUARANTINE REGULATIONS. 23 (a) 1. A sputum cup made of impervious material and so arranged or constructed to admit of being tightly closed when not in use. 1 2. A sufficient supply of handkerchiefs, gauze, or similar articles of sufficient size to cover the nose and mouth while coughing and sneezing. Said handkerchiefs, gauze, or similar articles shall be inclosed in a tight con- tamer after use and shall be destroyed by burning. 3. All sputum and nasal discharges from the patient shall be received in gauze or paper, which shall be depos- ited in a closed container and which shall be destroyed by burning or received in a 5 per cent solution of carbolic acid or disinf ecting fluid of equivalent disinfecting value placed in a covered vessel and allowed to stand undis- turbed for at least two hours after the last addition thereto. (b) Immediately upon the disembarkation of the patient the common carrier shall close the compartment the patient has vacated, without the removal of any of its contents, and shall keep the same closed until disinfection. 2 (c) Passengers in interstate traffic having pulmonary tuberculosis in a communicable stage shall not expec- torate except in the sputum cup or gauze aforementioned. Sec. 29. Common carriers shall not accept for trans- Transportation x of lepers. portation nor transport in interstate traffic any person suf- Amendment of fering from or afflicted with leprosy unless there has been obtained from the Surgeon General of the United States Public-Health Service, or his accredited representative, a permit stating that said person may be received under such restrictions as will prevent the spread of the disease, and said restrictions shall be specified in each instance: Provided, That, in addition to the above, permits shall also be obtained from the health authorities of the States, Territories, or districts to and from which the patient intends to travel. Sec. 30. No person knowing or having reason to be- Mayf^mT 1 ° f lieve that he is a leper shall accept transportation or engage in travel in interstate traffic unless permits have been obtained as set forth in the preceding section and 1 The common carrier should require any such person to refrain from spitting in any place other than the sputum cup above mentioned, and in the event of coughing or sneezing to so cover the mouth and nose with a handkerchief, napkin, or similar device as to prevent the ejection of particles of mucus or saliva into the surrounding atmos- phere. 2 See appendix. 24 INTERSTATE QUARANTINE REGULATIONS. unless said person shall have agreed in writing to com- ply with the restrictions as specified in the permits men- tioned above. Amendment of s EC . 3i. Any person who presents symptoms of lep- rosy and who is traveling or who has left the State where he resides in violation of the above regulations shall be detained and, if proven to be a leper, shall be returned to such State or removed to such Federal station as the Secretary of the Treasury may designate and the proper health authorities notified. incubation Sec. 32. For the purpose of these regulations the fol- peno s. lowing shall be considered as the periods of incubation: Days from Disease. last exposure. Plague 7 Cholera 5 Smallpox 14 Yellow fever 6 Typhus fever 12 Typhoid fever 14 Scarlet fever 7 Diphtheria 4 Whooping cough 10 Measles 14 Notification of Sec. 33. Interstate sanitary officers and State, Territo- fectious diseases, rial, and other health authorities who will undertake to enforce the interstate quarantine regulations, as pro- vided by section 3 of the interstate quarantine law ap- proved February 15, 1893, shall notify the Surgeon Gen- eral of the United States Public-Health Service imme- diately, by telegraph and letter, upon the occurrence of a case or cases of cholera, yellow fever, typhus fever, or plague and shall render monthly reports as to the preva- lence of smallpox, leprosy, scarlet fever, diphtheria, typhoid fever, poliomyelitis (infantile paralysis), epi- demic cerebrospinal meningitis, Rocky Mountain spotted or tick fever, tuberculosis, and other diseases notifiable in their respective jurisdictions. Notification of Sec. 34. Upon the occurrence of an unusual outbreak, unusual outbreak . . .i> i i • . ,-, ■, . ofdisease. or in the event 01 a sudden increase m the number ot cases of smallpox, scarlet fever, diphtheria, typhoid fever, poliomyelitis (infantile paralysis), epidemic cere- brospinal meningitis, Rocky Mountain spotted or tick fever, or epidemic septic sore throat in any locality, the Surgeon General of the United States Public Health Service shall be immediately notified by telegraph and letter of such unusual outbreak or sudden increase by INTERSTATE QUARANTINE REGULATIONS. 25 the officers and authorities mentioned in the preceding section. Sec. 35. Commissioned medical officers of the United interstate sani- States Public Health Service, when detailed as interstate taryofflcers - sanitary officers, shall cooperate with State, municipal, and other health authorities in the execution of their regula- tions, as provided by section 3 of the act of February 15, 1893, and shall enforce these regulations and collect epidemiological and sanitary information and perform such other duties in such manner as the Secretary of the Treasury may approve. Sec. 36. During the period beginning March 15 and shipment ani- , . ? i ■ i mals f rom locali- endmg June 15 oi each year common carriers shall not ties infected with m . . , Rocky Mountain accept lor interstate shipment, and no person shall offer spotted fever. for interstate shipment, any cattle, horses, sheep, goats, elk, deer, or hogs originating in a locality where Rocky Mountain spotted fever is known to exist, unless said shipment is accompanied by a certificate from a Federal, State, or local health authority, or an inspector of the Bureau of Animal Industry of the United States Depart- ment of Agriculture, or a State veterinarian or his deputy, setting forth that the said animals are free of all attached wood ticks, or have been freed thereof by hand picking, spraying, or dipping in a disinfectant solution of sufficient strength and for a sufficient time to kill all ticks attached to the said animals, such hand picking, spraying, or dipping to be accomplished immediately prior to leaving the infected territory. APPENDIX. DISINFECTANTS. Disinfectants are usually divided into the following general classes: 1. Physical agents, including sunlight, dry heat, burning, boiling, steaming, elec- tricity, etc. 2. Gaseous, including formaldehyde, sulphur dioxide, chlorine, etc. 3. Chemical solutions, including bichloride of mercury, formalin, carbolic acid, tricresol, lysol, creolin, potassium permanganate, lime, chlorinated lime, the hypo- chlorites, etc. With the exception of heat, sulphur dioxide is the only one of the above-mentioned disinfectants that is used to any extent as an insecticide, while other substances used for this purpose are hydrocyanic acid gas, pyrethrum, petroleum, etc. PHYSICAL DISINFECTANTS. turning. — Of unquestioned efficiency, but seldom used. -\ — Very efficient and of wide range of applicability. The articles must be ^ed for not less than 10 minutes in water actually boiling (100° C). The ■•mt of carbonate of soda renders the process applicable to polished When formalin is ^ ntS; or toolg ( articles of a i um i num excepted), takes place, accompan, team (not under pressure) . F i owing steam (not under produce a large quantity ,. suitable conditions is an efficient disinfecting agent. The the reaction to begin or aj w minutes after the temperature hag reached 100 o c minute or two, depending ^^ vacuum . Steam under pressure will st erilize, a few minutes and with lg continued 30 minutes after the pressure reaches 15 pounds almost dry. ^ r must be expe v] ed f rom tne appara t U8 a t the beginning of A convenient and efiy cable to obtain the designated pressure, a longer exposure permanganate, or m tr^ resu i t latter^ By using a gre^ ^^ vacuum: steam in a special apparatus with vacuum may be evolved trom t method of applying 8team under pre8sure) the object of the ture of permanganate to expel the air and tQ promote the penetration of the steam comparatively dry stat^^ fm 3Q minutes after ^ pressure reacheg 10 dg to additional permangana' r W F?r mi5n P tnt forn ajUred by 8team ' 8UCh aS leather ' furs ' skins ' rubber ' trunks > or mixmg i oin ound book gdk and fine woo i eng snoidd not De disinfected suitable. Pots or eart „r,- ij u j* • e * j x, £ \i i -, nails on account of at be dlsmfected b ^ formaldehyde gas or by any of I ' . . ,,, these regulations which may be applicable thereto. Those before mixing the forr ■+.. t ul j-- j , ji during the reaction a y wettln ^ should be ^infected by a gaseous agent. formalin and 5 ounces 1 * ^>Wge, clean and in good condition but suspected of be thrown over, so tha< efficientl y and least injuriously disinfected by formalde- to protect the carpet o gaseous disinfectants. in using a pail with a the reaction, which isquantities of disinfectant substances to be used for gaseous placed upon a noninP contents of the space to be disinfected should always be With this method tents are usually expressed in terms of a thousand cubic feet, volume that it is unn 27 28 INTERSTATE QUARANTINE REGULATIONS. A room, each dimension of which is 10 feet, contains 1,000 cubic feet, and the cubic contents of any space can be determined by multiplying together the length, width, and height, expressed in feet, which will give the contents in cubic feet. To prevent the escape of the gas from the inclosure to be disinfected, fireplaces, ventilators, cracks of doors and windows, and other openings can be stuffed with cotton, paper, cloths, etc., but they are best closed by pasting them up, for which purpose strips of newspaper and a paste made from flour can be used. All articles to be disinfected should be well exposed to the action of the disin- fectant, as the penetrating powers of all gaseous disinfectants are more or less limited ; therefore articles should either be hung up or otherwise freely exposed to the gas. FORMALDEHYDE . For disinfection purposes formaldehyde gas is usually produced from the aqueous solution of the gas, the official (TJ. S. P.) name of which is "solution of formaldehyde." The common commercial name for it, however, is "formalin," and since this name has been used in designating one of the principal methods of producing the gas — namely, the "formalin-permanganate" method — the solution will be referred to under the name of "formalin." Formalin is supposed to contain 40 per cent of formaldehyde gas by volume, but from evaporation and deterioration it often falls short of this quantity, seldom con- taining more than 37 per cent of the gas. The gas, when used under favorable con- ditions, is one of the most powerful germicides at our disposal. In addition to its germicidal efficiency it has the unique advantage over most other disinfectant" that it is not injurious to the ordinary household furnishings. Furniture, wall hangings, paintings, wearing apparel, and fabrics, with the possi 1 '" of some of the very delicate aniline colors and polished steel, are v exposures to the action of this gas. It acts quickly as a germicide, but its powers of penetrat it is necessary to have articles freely exposed in order to im On account of lack of penetrating power formaldehyde upon to disinfect mattresses, upholstered furniture, or artii deep penetration ; consequently instead of exposing them \ should be either burned, boiled, steamed (under pressure), q solution in order to make sure of destroying all possible infe^. Unfortunately the germicidal powers of formaldehyde ar climatic conditions. With the temperature and humidity of- the United States its efficiency as a surface disinfectant is unqt temperature is about or below 50° F., or the moisture in the. per cent of saturation, the efficiency of formaldehyde is vej temperature and humidity being below the points stated, pol of the formaldehyde takes place and its power of penetratioi slight, is still further diminished. These effects of low tem may in part be overcome in room disinfection by artificial h« time boiling water in the room, by sprinkling the floors with v an increased quantity of formaldehyde. Formaldehyde gas is useless as an insecticide and should purpose. Flies and mosquitoes are killed by it only after a 1 in concentrated form. It is nontoxic to the higher forms of man, but produces in them an irritation of the respiratory, nat membranes, thus causing coughing, sneezing, and "watering' the exposure is prolonged these effects, however, are only t- when no longer exposed to the gas. Formerly formaldehyde gas was largely produced by means autoclaves, etc., methods requiring special apparatus and a cert APPENDIX. 29 ical skill in operating, but those methods have now largely been supplanted by simpler ones which can be used in any household. In view of this fact, only the following methods of evolving the gas will be described: 1. Formalin-permanganate method. 2. Formalin sheet spraying method. 3. Formalin-aluminum sulphate-lime method. 4. Paraform. Regardless of which method is used, everything should be in readiness before the disinfection process is started. All trunks and drawers should be opened and most of the contained articles hung up or otherwise exposed in the room, particularly if there is a possibility of their being infected. All cupboards, closets, and bookcases should be opened. Fireplaces, ventilators, and cracks of doors and windows to be closed should, with the exception of the doors of exit, be closed before the disinfection process is started. To get rid of the formaldehyde gas remaining after disinfection it is usually sufficient to open the doors and windows and allow it to blow out. Ammonia was formerly used to a limited extent for neutralizing the gas, but as it often causes a portion of it to precipitate in the form of a powder, which when heated or moistened will again give off a certain amount of formaldehyde gas, ammonia is now seldom used for that pur- pose. Even when the formaldehyde is allowed to blow out the odor of the gas is often perceptible for several days following disinfection. This, however, causes no trouble or inconvenience. After disinfection with formaldehyde the quarters can usually be occupied an hour or two after opening the doors and windows. FORMALIN-PERMANGANATE METHOD. When formalin is poured upon crystals of permanganate of potash a vigorous reaction takes place, accompanied by strong ebullition of the liquid and sufficient heat to produce a large quantity of formaldehyde gas, water, vapor, etc . The time required for the reaction to begin, or at least to become apparent, varies from a few seconds to a minute or two, depending upon the temperature. The reaction is apparently over in a few minutes and with proper proportions of substances the residue in the vessel is almost dry. A convenient and efficient proportion to use is two parts of formalin to one part of permanganate, or in the proportion of a quart of the former to a pound (pint) of the latter. By using a greater proportion of permanganate than this, slightly more gas may be evolved from the formalin, but in addition to requiring an increased expendi- ture of permanganate the danger of fire is also increased, as formaldehyde gas in a comparatively dry state is inflammable. The increased oxidation resulting from the additional permanganate is therefore more liable to cause combustion of the gas than when the proportions are used as just stated. For mixing the formalin and permanganate a large galvanized-iron pail is very suitable. Pots or earthern vessels, usually being thick, are not as suitable as thin pails, on account of absorbing much heat from the reaction. The pail may be heated before mixing the formalin and permanganate. On account of the vigorous ebullition during the reaction a 10-quart pail should be used for mixing therein 10 ounces of formalin and 5 ounces of permanganate. Even then a few drops of the mixture may be thrown over, so that it is well to place the pail in a large tin pan or upon something to protect the carpet or floor. To prevent this sputtering over there is some advantage in using a pail with a flared top. As the process is attended with slight danger of fire, the reaction, which is quickly over, should be watched through a window or the pails placed upon a noninflammable surface. With this method the formaldehyde gas is evolved so quickly and in such a large volume that it is unnecessary, in houses with well-fitting doors and windows, to paste 30 INTERSTATE QUARANTINE REGULATIONS. up cracks unless only a portion of the house is to be disinfected and the remainder is to continue to be occupied. Closets, drawers, trunks, etc., should be opened, and when everything is in readi- ness the permanganate is placed in the pail and the formalin poured over it. All inside communicating doors, halls, etc., should be opened and at least one pail placed in each room and hall, unless the rooms are very small. Large rooms may require more than one pail unless a pail proportionately large is used. The quantity of formalin and permanganate to be used per 1,000 cubic feet of room space depends upon conditions. If the atmosphere is warm and humid 10 ounces of f ormalin and 5 ounces of permanganate are sufficient, while if it is dry and cold double these quantities should be used. The pails should be distributed about in the room or rooms as stated and the necessary quantity of permanganate weighed and placed in them. The formalin for each pail should then be measured into a wide-mouthed cup or vessel and placed by the pail in which it is to be used. Do not use narrow- necked bottles or the pouring will require too much time. Although the reaction of formalin with permanganate takes place quickly by making preparations as advised one operator can "set off " a number of pails, there being nothing to do except to pour the formalin over the permanganate. Of course the mixing should begin in the rooms most distant from the door of exit. The time of exposure — that is, the time the premises should be kept closed — should be at least two, and, preferably, four hours. At the end of this time the doors and windows are opened and the gas allowed to dissipate. FORMALIN SHEET-SPRAYING METHOD. This is a very simple and inexpensive method of evolving formaldehyde gas from formalin, and when properly used under favorable conditions is efficient. Formalin, sheets, and a means of spraying the formalin upon the sheets are all that are required in the way of appliances. The sheets should be hung up over a cord or line and allowed to hang at an angle of about 45°, and it is of advantage, too, to slightly dampen them with water before hanging them up, as the formalin will then be quickly absorbed and lessen its tendency to run off the sheets. The formalin should be evenly sprayed upon the sheets, which can be done with any spraying device, a very simple one being a flower-watering pot provided with a sprinkler. The spraying should be done rather quickly, as the gas soon begins to be given off. The process should be carried out in each room. Not over 10 ounces of formalin should be used for eveiy 30 square feet of sheet surface. The area of a sheet is found by multiplying its length by its breadth. This method is particularly applicable where a long exposure may be allowed, as the gas is gradually given off and the percentage of formaldehyde remains compara- tively high during a relatively long time. This method should not be used at tem- peratures below 60° F., as the formalin polymerizes on the sheets and very Little gas is liberated. "With fairly closely fitting doors and windows, pasting of cracks is unnec- essary, unless a strong wind is blowing. However, large openings like fireplaces, openings into chimneys, ventilators, etc., should be closed either by pasting or with bunches of old rags. As this method should be used only during warm months, 10 or 12 ounces of formalin for each 1,000 cubic feet of ah* space are sufficient. The time of exposure should be from four to six hours. Open the doors and win- dows and. when possible, remove the sheets. The sheets are not injured in any way by the formalin. FORMALIN-ALUMINUM SULPHATE-LIME METHOD. In this method 2\ pounds of commercial aluminum sulphate are dissolved in 2 quarts of hot water and allowed to stand for a few hours. To 1 quart of this solution 3 quarts of formalin are added. To evolve formaldehyde gas from this latter solution APPENDIX. 31 it is poured over unslaked lime in the proportion of 10 ounces of the solution to 1 pound of lime. Just before using the lime it should be broken into small particles. It should slake easily in cold water. The lime should be placed in a pail or vessel and the solution poured over it. A few minutes after pouring the formalin-aluminum sulphate solution over the lime, the latter begins to slake and continues for 20 to 30 minutes, during which time formaldehyde, steam, etc., are given off. The percent- age of formaldehyde gas liberated by this method is relatively small as compared with the formalin-permanganate method, but since a small quantity of formaldehyde is efficient when used under favorable climatic conditions this method will then give efficient results. This method should not be used in cold, dry weather. About 15 ounces of formaUn-aluminum sulphate solution, made as described above, and 1J pounds of lime should be used for each 1,000 cubic feet of air space. Cracks should be pasted up and fireplaces and ventilators closed, as the percentage of gas given off is relatively small. The time of exposure should be from four to six hours. The process should be carried out in each room. This method of evolving formaldehyde gas has no advantages, but several disad- vantages, as compared with the formalin-permanganate method, and is now seldom used. It is not as efficient as the sheet-spraying method. PARAFORM. Paraform can be used, particularly for disinfecting small inclosures, under the same conditions of heat and moisture as already stated with regard to the other methods. Paraform is one of the polymeric forms of formaldehyde. It is a white powder and readily burns with a blue flame. For disinfecting purposes it should be heated to convert the paraform into formaldehyde gas, but under no condition should it be allowed to bum, as the combustion destroys practically all of the formaldehyde. A good method of producing formaldehyde gas from paraform is to place the paraform in a metal utensil under which a lamp or alcohol flame can be arranged. A special lamp or device can be obtained for the purpose, but an ordinary pint tin cup will suffice for heating therein an ounce or two of paraform. The paraform is placed in the cup and a flame applied underneath. The flame should not be too strong, for should the paraform ignite no formaldehyde gas will be produced and there will be no disinfection. The space to be disinfected should be tightly closed and all cracks pasted up. For each 1,000 cubic feet of air space 2 ounces of paraform should be used. The time of exposure should be about four hours. If necessary the flame under the utensil containing the paraform can be left burning during the time of exposure. A solution of paraform can be made and used in the same manner that formalin is used in the formalin-permanganate method. For disinfecting 1,000 cubic feet of space 2 ounces of paraform are dissolved in 8 ounces of boiling water. This solution is then poured over 5 ounces of permanganate of potash contained in a 2-gallon pail, the details of procedure being the same as have been described for the formalin- permanganate method. There are many forms of candles and other preparations of paraform made and sold upon the market for disinfection purposes, but it should be borne in mind that any preparation of paraform requiring that the compound be ignited and burned in order to produce formaldehyde gas is useless for disinfection purposes, as the formaldehyde is destroyed by the combustion. In using those preparations of paraform that are heated to produce the gas, due allowance must be made for other ingredients than paraform contained therein, and therefore a larger quantity should be employed than when using pure paraform, as at least 2 ounces of paraform are required for each 1,000 cubic feet of space to be dis- infected. For the reasons stated, the use for disinfection purposes of proprietary prep- arations of paraform of unknown strengths should as far as possible be avoided. 32 INTERSTATE QUARANTINE REGULATIONS. SULPHUR DIOXIDE. In the presence of moisture sulphur dioxide is an efficient surface disinfectant. Ita powers of penetration are limited, and it will not kill spores, but when used under favorable conditions it will kill the contagion of most of the infectious diseases not due to spore-bearing organisms. Dry sulphur dioxide (S0 2 ) is practically without germicidal powers, but in the presence of moisture this gas is converted into sulphurous acid gas (S0 3 ) and sulphuric acid (H 2 S0 4 ), upon which efficient disinfection with sulphur gas depends. While these converted products are destructive to germ life, they are also injurious to household furnishings, fabrics, etc., which is one of the greatest drawbacks to the use of sulphur gas as a disinfectant. These injurious effects and the feeble germicidal properties of the gas in the dry state have greatly limited, its uses, particularly in household disinfection, but it is still especially applicable for destroying rats, flies, fleas, and other vermin that spread contagion, since it is highly fatal to animal life. It is, therefore, applicable and largely used for disin- fecting holds of ships, stables, barns, granaries, freight cars, and structures of this character. Sulphur, either as flowers or in rolls or sticks, can usually be obtained at any drug store or crossroads store. In the presence of moisture sulphur dioxid attacks and causes oxidation of most of the metals, which, however, can be prevented by previously vaselining the exposed surfaces. It bleaches and injures cotton, linen, and woolen fabrics, curtains, etc. It injures flour, except in the closed ("headed up ") barrel. It softens paint and var- nish, particularly if they have been recently applied. It injures soap, coffee, tea, sugar, rice, matches, etc., when they are freely exposed to it. It injures clocks, and it discolors wall paper if moisture is present. The moisture necessary in destroying germ life with sulphur dioxide can usually be artificially produced without difficulty, as it can be added in the form of steam (sulphur furnace), and in the pot method it is automatically produced from the water in the pan in which the sulphur pot is placed. However, when using sulphur dioxide as a disin fectant in damp weather or in disinfecting holds of ships, which are usually damp, the artificial production of moisture is unnecessary. The inclosure to be disinfected with sulphur gas should be made as tight as possible: therefore the cracks of doors, windows, and keyholes should be pasted up; and fireplaces, ventilators, radiators, and all openings should be tightly closed, either by pasting or in some other manner. This should all be done, except the door of exit, before starting the disinfection. For pasting, strips of paper and a paste made from flour can be used. After the disinfection is over the pastings can be moistened with water and washed off. It is necessary, to avoid injury to the articles enumerated above, to remove them from the space to be disinfected. Brass or any metal furnish- ings are not injured, provided they are given a thin coating of vaseline. The principal methods of using sulphur dioxide are: 1. The pot method. 2. Liquid sulphur dioxide. 3. Sulphur candles. THE POT METHOD. This is the cheapest and simplest method of producing sulphur dioxide. The only materials required are pots, sulphur, and a small quantity of alcohol. Sulphur bums when liberally sprinkled with alcohol and lighted. It can also be started burning by placing a shovelful of hot coals of fire into it. As sulphur dioxide is produced by combustion of the sulphur, and as the combustion is dependent upon the available oxygen of the air, it will readily be seen that the rapidity of production of the sulphur gas will be governed by the area of the burning surface. It is therefore very important for rapid production that broad shallow pots be used. APPENDIX. 33 Ordinary "Dutch ovens, " iron buckets, etc., may be used, but the best pot for the purpose is one rath a flat bottom, 12 to 18 inches in diameter, and with sides about 4 inches high. A dish pan answers the purpose very well. Theoretically, the complete combustion of 1 pound of sulphur in a space of 1,000 cubic feet produces 1.15 per cent of sulphur dioxide, though 1 per cent is about what is produced in actual practice. Therefore, as 5 per cent is required to kill nonspore- bearing organisms, it is necessaiy to burn 5 pounds of sulphur for each 1,000 cubic feet of space to be disinfected. After estimating the cubic space to be disinfected the sulphur should be weighed, allowing 5 pounds for every 1,000 cubic feet of space. Sufficient pots should be available so that a depth of not more than 1J to 2 inches of sulphur will have to be placed in each pot, although necessity sometimes requires a greater depth than this. The sulphur should be sloped toward the center so as to form a crater or depression. "When using stick sulphur a portion of it should be pulverized or broken up. The pots should be distributed in the rooms to be disinfected" according to the size of the rooms and number of pots. They may be placed upon the floor, tables, stoves, hearths, etc. It should be borne in mind that the burning sulphur causes the pots to become very hot. and to avoid danger from fire it is necessary to place them upon objects not combustible or injured by heat. As already stated, this is best accomplished by arranging them in pans containing an inch or two of water, as besides the protection the heat produces moisture from the water which is necessary in sulphur disinfection. Pans not being available, the pots may be stood upon earthen or metal surfaces and efficient disinfection done, provided the atmosphere is reasonably damp. Theoret- ically, about 3 ounces of water should be volatilized for each pound of sulphur burned. The sprinkling of the sulphur with alcohol and righting should not be done until everything is in readiness. A convenient and safe method of lighting the alcohol in the pots is to strike a match and before the head is entirely ignited to throw it into the pot. This will cause the alcohol to ignite. After lighting, the sulphur fumes do not begin to come off for a few minutes, so that one operator can start a number of pots. After lighting the pots, observe that they are all burning; then close the door of exit and paste up its cracks. When the sulphur has been burning half an hour, search for sulphur fumes escaping from any openings that may have been overlooked and close them. Leave the apartment or room closed for 12 hours, and then open doors, windows, etc.. and allow the remaining sulphur fumes to blow out. It is well to have the win- dows so they can be opened from the outside, otherwise entrance to the rooms may be impossible for an hour or so. The rooms can usually be occupied in two or three hours after opening the doors and windows. LIQUID SULPHUR DIOXID. The technique of disinfection with liquid sulphur dioxide differs from the pot method only in the manner of production; therefore that is the only phase of the sub- ject that will be described here, the reader being referred to the description already given for further details. The method has the advantage of liberating a large quantity of sulphur dioxide in a short time, but it is far more expensive than burning sulphur by the pot method, the relative cost being about 10 to 1. The method of using liquid sulphur dioxide, however, is very simple and it is free from any danger of fire. The liquid is prepared commercially and is usually obtained in metal cans or casks, which for use only require the simultaneous cutting of the leaden pipes on the tops of the necessary 34 INTERSTATE QUARANTINE REGULATIONS. number of cans and the inversion of the latter in a metal or earthen vessel, when vola- tilization rapidly takes place. To obtain the 5 per cent of sulphur dioxide required for disinfection it is necessary to use 10 pounds of liquid sulphur dioxide for every 1,000 cubic feet of air space. Therefore the space should be estimated and the required quantity of liquid dioxide obtained. Of course, with this method the same preparations and precautions with regard to injury of certain articles should be carried out as with the pot method. If a number of adjoining rooms are to be disinfected it is best to begin opening and inverting the cans in the most distant rooms and work toward the door of exit. It is necessary to have everything in readiness and to work quickly, as the gas is given off rapidly. If the container of the liquid dioxide is provided with a siphon or tube, the liquid can be introduced by means of a tube through the keyhole into a suitable receptacle inside the room. The time of exposure should be 12 hours. One striking disadvantage of this method as compared with the pot method is that it produces no moisture, which is necessary to obtain the maximum disinfecting power of sulphur dioxide. SULPHUR CANDLES. As sulphur candles are applicable only for killing insects and not for disinfection purposes, the method of using them will be described under sulphur as an insecticide. CHEMICAL SOLUTIONS. BICHLORIDE OP MERCURY. This substance is also known as corrosive sublimate, bichloride, and mercuric chlo- ride. In the pure state it is a white crystalline substance and fairly soluble in water, thus differing from calomel (mercurous chloride), which is a white amorphous powder and insoluble in water. The "antiseptic tablets" sold on the market are usually composed of bichloride of mercury. These tablets are generally artificially colored (blue) in order to lessen the chances of accidental poisoning, as bichloride of mercury dissolved in water makes a perfectly clear solution. Bichloride of mercury is one of the most powerful germicides that we possess. It has the disadvantages, however, of corroding metals, forming inert compounds with albuminous matter and of being very poisonous. It is therefore inadvisable to use it for disinfecting sputum, excreta, or under any condition in which it comes in contact with much albuminous or organic matter! since it forms inert compounds with these substances. One part of bichloride of mercury will dissolve in 16 parts of cold water and in 3 parts of boiling water. The bichloride should be pulverized before attempting to dissolve it. Even then it dissolves with some difficulty. The solubility is increased by using sea water for the solution or by adding 2 parts per 1,000 of sodium chloride (common salt) to the water employed. The water used should be free from organic matter, and for dissolving the bichloride it is preferable that the water be hot. The strength of solution used in disinfecting for the infectious diseases is usually 1 part of bichloride to 1,000 parts of water— i. e. , a strength of 1 to 1,000. This solution is made by dissolving 1 ounce of bichloride in 1,000 ounces of water (approximately 8 gallons). A 1 to 500 solution is made by dissolving 1 ounce in 500 ounces of water, and so on for any other strength desired. The solutions are best made in an earthen or wooden vessel, a wash tub or barrel being very suitable. The addition of a little indigo or other coloring matter will avoid the possibility of the solution being drunk by mistake. To disinfect soiled clothing, bed linen, etc., the material should be placed in a tub containing 1 to 1,000 solution and left for an hour. It can then safely be taken out APPENDIX. 35 and rinsed in water and laundered. Bichloride of mercury, however, is a mordant, and clothing containing stains, such as blood, etc., will be permanently stained if immersed in bichloride solution. Eating utensils should not be placed in bichloride of mercury on account of the danger from poisoning. Infected floors, tables, wooden beds, chairs, walls, etc., can be washed with a 1 to 1,000 solution of bichloride of mercury. For applying it a floor mop may be used. Saturate the floors and other surfaces with the solution and allow them to dry. The hands and body, except the face, can be bathed in a 1 to 1,000 solution without injury thereto. As already stated, feces, urine, sputum, and products containing albuminous matter should not be disinfected with bichloride solution unless no other disinfectant is available, in which case a 1 to 500 solution should be used. "Antiseptic tablets" are usually very soluble in water, and the method of obtaining the desired strengths is stated on the label of the container. They are very useful when only a small quantity of bichloride solution is required. A 1 to 1,000 solution is easily prepared from them and is of service for washing the hands after handling the sick or any possibly infected material. The hands should be bathed in the solu- tion for two to five minutes after cleansing them with soap and water. FORMALIN (SOLUTION OF FORMALDEHYDE, U. S. P.). Formalin, a solution of formaldehyde gas in water, is a valuable disinfectant. It has the advantage of bichloride of mercury in that its action is not retarded by albuminous matter. It is not corrosive; articles are usually not injured by it. It is a good deodorant, and it is not so highly poisonous as is bichloride of mercury. Formalin contains from 35 to 40 per cent of formaldehyde gas, but in referring to percentage strengths the percentage of formalin will be stated and not that of the gas. For instance, a 1 per cent solution of formalin contains formalin in the propor- tion of 1 to 100, but it contains formaldehyde gas only in the proportion of 1 to 250, provided the formalin contains 40 per cent formaldehyde gas. Therefore, to make a 5 per cent solution of formalin, 1 volume of formalin is added to 19 volumes of water; and to make a 10 per cent solution, 1 volume of formalin is added to 9 volumes of water, etc. Formalin is well adapted to the disinfection of urine, feces, sputum, and discharges of like character; for, in addition to disinfecting, it also deodorizes them. For this purpose a 5 per cent solution and one hour's exposure are required. The substances should he thoroughly mixed. Allowance must be made for the dilution caused by mixing the formalin solution with the material to be disinfected. For instance, if 1 pint of feces is to be disinfected it should be mixed with 1 pint of a 10 per cent solution of formalin, which gives the 5 per cent strength required. Formalin can not be used in the sick room, as the liberated gas is irritating; nor is it adapted to the washing of floors, walls, etc., for the same reason. Soiled linen and bedclothing can be disinfected by one hour's immersion in a 5 per cent solution of formalin. Disinfection with formalin should be done out of doors, in order to avoid the irri- tating effects of the gas given off. A few drops either of pure or diluted formalin poured into water closet bowls, urinals, sinks, etc., destroy offensive odors. CARBOLIC ACID. This is a very useful disinfectant. It has a penetrating odor, a strong, burning taste, and it is a corrosive poison. Pure carbolic acid crystallizes and becomes solid at ordinary temperatures, but it can be liquefied either by heat or by the addition of a small quantity of water, about 5 per cent. 36 INTERSTATE QUARANTINE REGULATIONS. Carbolic acid is soluble in about 15 parts of cold water; that is, 1 ounce of carbolic acid dissolves in 1 pint of water (16 ounces), which is about a 6 per cent solution. Carbolic acid dissolves in water with some difficulty. Therefore, to insure its solubility, hot water should be used and the mixture well agitated. For disinfection purposes carbolic acid is commonly used in solutions of 3 to 5 per cent. A 3 per cent solution is made by adding 3 volumes of carbolic acid to 97 volumes of water; a 5 per cent solution is made by adding 5 volumes to 95 volumes of water, etc. In these strengths carbolic acid is not destructive to fabrics, colors, metals, etc. Therefore, it has a wide range of usefulness in disinfection. As it does not actively coagulate albuminous matter, it is useful for the disinfection of urine, feces, sputum, etc. For this purpose a 5 per cent solution is added to an equal volume of the excre- tions, the mass then thoroughly mixed, and allowed to stand one hour before final disposal. Soiled linen, bedclothes, etc., are best disinfected by immersion for one hour in a 3 per cent solution, and the same strength solution should be used for mopping floors, walls, etc. After handling the sick or any objects possibly infected, such as bed- pans, sputum cups, etc., the hands may be disinfected by washing them for two to five minutes in a 2\ per cent (1 to 40) solution of carbolic acid. The hands should then be washed or saturated with alcohol in order to avoid the benumbing effect of the carbolic acid. As carbolic acid does not kill spores, it should not be used to destroy the infection of tetanus, anthrax, or malignant oedema. Crude carbolic acid, as sold upon the market, is a black, tarry liquid of veiy varying composition. It contains cresols and other compounds, but although some of these products have greater germicidal powers than pure phenol (carbolic acid) their solu- bility in water is so slight that the use of crude carbolic acid as a disinfectant is greatly limited. The reliability of crude carbolic acid is therefore questionable, and some sanitarians recommend that for excreta it be used in the proportion of not less than two volumes of crude carbolic acid (undiluted with water) to each volume of excreta. Crude carbolic acid has a disagreeable odor, and leaves after use a tarry residue, which is objectionable. The crude article, however, is much cheaper than pure car- bolic acid, and it is hoped that a simple means of increasing its solubility and of eliminating the objectionable tarry residue following its use may soon be found, so that it may at least be employed in the disinfection of urine, feces, sputum, etc. TRICRESOL. Tricresol has practically the same uses in disinfection as pure carbolic acid. It differs from phenol principally in that it -1, is about three times as strong in germicidal powers. It therefore can be depended upon to kill spores. Tricresol is soluble in water up to about 2\ per cent solution — that is, 1 part of tricresol to 40 parts of water. A 1 to 2 per cent solution used under the same conditions and for the same purposes as already stated for carbolic acid is efficient for all ordinary purposes. LYSOL AND CREOLIN. These preparations have practically the same uses in disinfection as carbolic acid and tricresol and belong to the same general class of disinfectants. In germicidal strength they rank with tricresol. Their uses are the same as tri- cresol and carbolic acid, which have been stated. They should be employed in a 1 to 2 per cent solution. AGENTS FOR THE DESTRUCTION OF VERMIN. The destruction of vermin and disinfection are often accomplished simultaneously in the process of disinfection, as most germicides are also destructive to vermin, a notable exception to this being formaldehyde gas, -which, although a good germicide, APPENDIX. . 37 has little or no effect upon animal life. Therefore, in using gaseous germicides (dis- infectants) as insecticides, they are applied in much the same manner when used for the latter as for the former purpose. However, when using them for the destruction of animal lif e only they are ordinarily applied in a weaker strength and for a shorter time of exposure than when they are used for their germicidal effect. In using gaseous insecticides, every care should be exercised to avoid the escape of the vermin from the inclosure during the process of killing; consequently all points of exit should be closed. Closets, bookcases, drawers, etc., likely to harbor or contain animal life, should be opened to allow access of the gas. The following insecticides will be considered: 1. Sulphur. 2. Hydrocyanic acid gas. 3. Pyrethrum. SULPHUR. Sulphur is one of the most valuable and efficient insecticides that we possess. It may be used in several forms. Sulphur dioxide. — The methods of producing this gas have already been described, therefore further description here will consist only of the differences between its uses tind applications as an insecticide and those as a germicide. As an insecticide sulphur does not require the presence of moisture, since it acts equally well in a diy as in a moist atmosphere. Therefore moisture should not be artificially produced, as the drier the atmosphere the less injury there will be to furnishings, colors, etc. With all cracks and crevices closed to prevent their exit, a 1 per cent strength will kill flies and mosquitoes within two hours, and if the atmosphere is reasonably dry very little injury will be done to the ordinary room furnishings. A 2 per cent strength will kill rats within four hours, and a 5 per cent strength will destroy most bedbugs, roaches, lice, etc., within six hours, although some of these insects usually escape by seeking protection in crevices. To obtain the desired strength of sulphur gas it is only necessary to remember that the burning of 1 pound of sulphur in 1,000 cubic feet of space produces approximately 1 per cent of the gas, 2 pounds, 2 per cent, etc. The pot method of production has already been described. In order to burn the sul- phur quickly it should not be placed in the pots to a greater depth than an inch. Water pans are not required, but the pots should be placed upon bricks, sand, stones, or something of that nature as a protection against fire. The pots are arranged and lighted with alcohol, as has been described. Liquid sulphur dioxide is well adapted to the destruction of insect and vermin life, as the gas is liberated in a short time. Two pounds of the liquid are equivalent to 1 pound of sulphur when burnt by the pot method. • The method of liberating the gas has been described. Sulphur candles are sometimes useful for killing flies and mosquitoes, or where only a small percentage of the gas is required. Candles vary in weight, but their weight should be determined; for killing flies and mosquitoes not less than 1£ pounds of candle should be used for each 1,000 cubic feet. The candles require only to be placed upon bricks and lighted ; they usually burn easily. The usual time of exposure (two hours) 13 required. HYDROCYANIC ACID GAS. This gas is very poisonous to all forms of animal life. It kills rats, mice, roaches, flies, fleas, mosquitoes, and bedbugs with great certainty and very quickly. In the hands of the inexperienced it is a very dangerous gas, as the least carelessness with it may 38 INTERSTATE QUARANTINE REGULATIONS. result in the loss of human life, since it is deadly poisonous. It is therefore unsafe and unwise to use in inhabited buildings, but it is useful for destroying all forms of vermin in cars, granaries, stables, barns, poultry houses, and other uninhabited buildings. For this purpose it is used in the following quantities and proportions for each 1,000 cubic feet of air space : Ounces. Potassium cyanide 5 Sulphuric acid (commercial 66B) 5 Water 12. 5 The acid and water are first mixed in an earthen vessel that will withstand heat, as this mixture gets very hot . The cyanide should not be added to it until the liquid has become cool. The required quantity of cyanide should be weighed and put into a gauze bag, and when everything is in readiness the bag is placed in the liquid con- tained in the vessel. The acid destroys the bag and acts on the cyanide with rapid evolution of the gas; and as the gas is deadly poisonous, the operator must leave the room at once. A still safer method of adding the cyanide to the acid than the one just stated is to have the bag of cyanide suspended over the acid by means of a string leading to the door of exit, from which location it can be lowered into the acid when desired. In this manner one or more processes can be set off without danger to the operator. The inclosure should be made as tight as possible to avoid the escape of the gas. The time of exposure should be one hour, though a longer period will minimi ze the danger from the gas in opening the doors and windows. It should be arranged before starting the process, so that the windows and doors can be opened from the outside; and it is best to hold the breath while actually opening a door or window. Under no condition should the building be entered until it has been aired out from 8 to 10 hours. PYRETHRUM. Pyrethrum is only a fairly good insecticide. It Is not poisonous to man, nor are household furnishings of any kind injured by it. Unfortunately, it is not very powerful for the destruction of roaches, flies, fleas, and mosquitoes. Some of these insects are killed, while some are only stupefied, by pyrethrum, so that it is necessary after using it to sweep the insects up and bum them. Pyrethrum maybe used either in powdered form or as fumes resulting from burning. Persian and other insect powders sold upon the market usually contain pyrethrum in some form. As a powder it may be blown about in the closed room with a bellows in sufficient quantity to show perceptibly upon the floor, or it may be dusted into cracks, crevices, dark comers, closets, or special localities likely to be infested with mosquitoes, fleas, bedbugs, etc. After two hours' exposure the insects should, when practicable, be swept up and burned. In burning pyrethrum for killing flies and mosquitoes the room should be closed as tightly as possible. In killing these insects in dwellings it is well to pull down all window shades except one, as the insects will then go toward the fight of the window the shade of which is not drawn, and when they die or become stupefied they can be easily swept up. Pasting of door and window cracks is usually unnecessary. From 2 to 4 pounds of pyrethrum should be burned for every 1,000 cubic feet. The pyrethrum is burned in pots, pans, or iron buckets in the same manner that sulphur is'burned in the pot method. The pots should be used in sufficient numbers so that not more than 4 pounds of pyrethrum will have to be placed in each pot. They should be distributed about in the room upon metal or stone foundations, in order to guard against fire. The pyrethrum is ignited by sprinkling it with alcohol and lighting. After the alcohol has burnt, the pyrethrum smolders and bums, thus liberating the APPENDIX. 39 fumes. The time of exposure is usually two hours, although when working at night the quarters may be left closed until the following morning. As stated, the insects should be swept up and burned as soon as the quarters are opened. Both the fumes and the powdered form of pyrethrum are harmless to man, so there is no danger in entering quarters as soon as they are opened. DISINFECTION OF COMPARTMENTS. Compartments or places in cars, vessels, vehicles, or conveyances operated in inter- state traffic, which have been occupied by persons sick with contagious or infectious diseases, shall, unless otherwise specified in the special regulations, be disinfected prior to further use as follows: The compartment or place, and all articles therein contained, shall be exposed to the action of formaldehyde gas, using 1 pint of a formaldehyde solution (U. S. P.) for each 1,000 cubic feet of space, the gas to be generated by one of the methods hereto- fore described, and the compartment or place so closed or sealed as to prevent the escape or leakage of gas. The minimum number of hours' exposure as given above applies to empty rooms of tight construction containing smooth, hard, surfaces; the maximum number of hours' exposure applying in all cases to textiles and other articles of a similar kind requiring more or less penetration. The stated time of exposure to sulphur dioxide and formaldehyde is sufficient to destroy bacterial infection due to non-spore-bearing organisms, provided the infection is present on the surface. If the room is of peculiar construction, so as to impede the diffusion of the gas, or if the room is a dirty one, or if on account of any other condition rendering the germicidal action of the gas more difficult, the time of exposure should be proportionately increased, or supplanted by other methods. After gaseous disinfection, all bedclothes, towels, and similar articles shall be immersed for at least one hour in a 5 per cent solution of carbolic acid or formaldehyde, or disinfected by boiling or by steam. Mattresses, curtains, carpets, hangings, pillows, or other textile articles shall be burned or disinfected by steam. The floor, walls, and all other objects that will not be injured by liquids shall be mechanically cleaned and thoroughly wetted with a 5 per cent solution of carbolic acid or formaldehyde. Textiles which are soiled with the discharges of the sick, or presumably are infected, must be disinfected by (a) boiling; (6) steam; (c) immersion in one of the germicidal solutions. Cooking and eating utensils are preferably disinfected by immersion in boiling water or by steam, but where these are not available immersion in a 5 per cent carbolic- acid solution for at least one hour, followed by thorough washing and rinsing, shall be practiced. Clothing, fabrics, textiles, curtains, hangings, etc., may be treated by either of the above methods, from (a) to (c), inclusive, as circumstances may demand, or by formaldehyde gas or sulphur dioxide where the article is of a character which will not be damaged by sulphur dioxide. Living apartments, cabins, and forecastles of vessels shall be disinfected by one or more of the following methods: (a) Sulphur dioxide, the destructive action of the gas on property being borne in mind. (6) Formaldehyde gas. (c) Washing with solution of bichloride of mercury, 1:1000, or 5 per cent solution of formaldehyde, or 5 per cent solution of carbolic acid, preference being given to carbolic acid for application to polished woods, bright metals, and other objects injured by metallic salts. The forecastle, steerage, and other living apartments in bad sanitary condition must be disinfected by method (a) followed b}' method (c). 40 INTERSTATE QUARANTINE REGULATIONS. Mattresses, pillows, and heavy fabrics are to be disinfected by one of the following methods: (a) Boiling. (b) Flowing steam (i. e., steam not under pressure). (c) Steam under pressure. (d) Steam in a special apparatus with vacuum attachment. Holds of cargo vessels, when cargo can not be removed, shall be disinfected in so far as possible by sulphur dioxide not less than 4 per cent volume strength, and where possible this should be generated from a furnace to minimize danger of fire in cargo. Holds of iron vessels, empty, shall be disinfected by either of the following methods: (a) Sulphur dioxide generated by burning sulphur, 5 pounds per 1.000 cubic feet of air space, or liberated from 10 pounds of liquid sulphur dioxide, sufficient moisture being present in both cases. Time of exposure 24 hours. (b) Washing with a solution of bichloride of mercury, 1: 1000. BACTERIOLOGICAL STANDARD OF PURITY FOR DRINKING WATER SUPPLIED TO THE PUBLIC BY COMMON CARRIERS IN INTERSTATE COMMERCE. [Promulgated by the Secretary of the Treasury on Oct. 21, 1914.] The following are the maximum limits of permissible bacteriological impurity: 1. The total number of bacteria developing on standard agar plates, incubated 24 hours at 37° C, shall not exceed 100 per cubic centimeter; provided that the estimate shall be made from not less than two plates, showing such numbers and distribution of colonies as to indicate that the estimate is reliable and accurate. 2. Not more than one out of five 10 c. c. portions of any sample examined shall show the presence of organisms of the Bacillus coli group when tested as follows: (a) Five 10 c. c. portions of each sample tested shall be planted, each in a fermenta- tion tube containing not less than 30c. c. of lactose peptone broth. These shall be incu- bated 48 hours at 37° C. and observed to note gas formation. (b) From each tube showing gas more than 5 per cent of the closed arm of fermenta- tion tube, plates shall" be made after 48 hours' incubation upon lactose litmus agar or Endo's medium. (c) When plate colonies resembling B. coli develop upon either of these plate media within 24 hours, a well-isolated characteristic colony shall be fished and transplanted into a lactose-broth fermentation tube, which shall be incubated at 37° C. for 48 hours. * For the purposes of enforcing any regulations which may be based upon these rec- ommendations the following may be considered sufficient evidence of the presence of organisms of the Bacillus coli group: Formation of gas in fermentation tube containing original sample of water (a). Development of acid-forming colonies on lactose litmus agar plates or bright red colonies on Endo's medium plates, when plates are prepared as directed above under (b). The formation of gas, occupying 10 per cent or more of closed arm of fermentation tube, in lactose peptone broth fermentation tube inoculated with colony fished from 24-hour lactose litmus agar or Endo's medium plate. These steps are selected with reference to demonstrating the presence in the samples examined of aerobic lactose-fermenting organisms. 3. It is recommended as a routine procedure, that in addition to five 10 c. c. portions one 1 c. c. portion and one 0.1 c. c, portion of each sample examined be planted in a lactose peptone broth fermentation tube, in order to demonstrate more fully the extent of pollution in grossly polluted samples. APPENDIX. 41 4. It is recommended that in the above-designated tests the culture media and methods used shall be in accordance with the specifications of the committee on standard methods of water analysis of the American Public Health Association, as set forth in "Standard Methods of Water Analysis" (A. P. H. A., 1912). [Form 8921.] Treasury Department, United States Public Health Service. CERTIFICATE OF EXAMINATION OF WATER FOR PASSENGERS IN INTERSTATE TRAFFIC. This is to certify that the water supplied at , for use of passengers in inter- state traffic has been examined and found to conform to the bacteriological standard promulgated by the Secretary of the Treasury on October 21, 1914. Date of examination (Signature of health authority) (Official title of health authority) Address INSTRUCTIONS RELATIVE TO THE CERTIFICATION OF WATER FUR- NISHED TO PASSENGERS IN INTERSTATE TRAFFIC. Samples of water from each and every source of supply should be subjected to bacteriological examination at least once in every six months by the United States interstate sanitary officer or the State or municipal health authority within whose jurisdiction the supply is obtained, or by any person competent to make such exam- inations, and whose results will be accepted by the State or municipal health authority whose duty it is to issue certificates. Officers of the United States Public Health Service are authorized to make bacte- riological and chemical examinations, and to certify to the purity, of water furnished to passengers in interstate traffic. The common carrier desiring a certificate should make application therefor to the State or municipal health authority within whose jurisdiction the water is obtained, or to the United States interstate sanitary officer of the district in which the water is obtained. After the necessary examinations have been made, the certificate should be issued on Form 8921, "Certificate of Examination of Water for Passengers in Interstate Traffic," in triplicate. The certifying authority should retain one copy of the cer- tificate and deliver two copies to the common carrier, who should forward one copy to the Surgeon General, United States Public Health Service, Washington, D. C. Whenever there is an unusual prevalence of typhoid fever, dysentery, infantile diarrhea, or other water-borne disease in a locality from which common carriers receive water, an additional examination of the water should be made and a supple- mental certificate issued by the proper certifying authority and forwarded as above. Certificates of examination of ice are not required. o COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing as provided by the rules of the Library or by special ar- rangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE " ' " " " " * ■ - " -1 C28I1 140) MI 00 COLUMBIA UNIVERSITY LIBRARIES 0047941766