COLUMBIA LIBRARIES OFFSjTE 
 
 HEALTH SCIENCES STANDARD 
 
 
 
 HX64076598 
 
 RA644.D6 IL6 1 907 Diphtheria, its prev 
 
 RECAP 
 
 Illinois. Dept. of public health. 
 Diphtheria. 
 
CoUcse of ^fjpgicianiS anb ^urgeong 
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DIPHTHERIA 
 
 ITS 
 
 PREVENTION, RESTRICTION AND SUPPRESSION 
 
 ISSUED BY 
 
 THE ILLINOIS STATE BOARD OF HEALTH 
 
 1907. 
 
 REVISED EDITION 
 
 Please P^-e serve for Ftiiure Use. 
 
 Should a case of Diphtheria occur near you, you can do yourself 
 
 and your community a gfreat gfood by seeing: that 
 
 the family has one of these pamphlets. 
 
 Copies can be obtained by any resident of Illinois, without cost, by addressing 
 the Secretary at Springfield. 
 
 Springfield, III. 
 
 Illinois State Register 
 
 1907 
 
E-xamples of tHe Manner in "WKicK DipKtKeria 
 May be Contracted. 
 
 A teacher developed diphtheria from passing the night in a room in 
 which three weeks hefore a fatal case had occurred. A child developed 
 diphtheria after putting on the clothing worn by a child which had 
 died of diphtheria two months before. In a number of isolated dwellings 
 diphtheria developed nearly a year after previous outbreaks^ without 
 there being any apparent possibility of a new infection taking place 
 from the outside. I have met with a number of cases where the 
 infected bedding or clothing has undoubtedly been the source of the 
 infection. — From American System of Practical Medicine, Loomis- 
 Thompson. 
 
 DISIXFECTIOX OF HOUSES. 
 
 A very wholesome practice that bids fair to become an established 
 custom is the disinfection of a rented house before a new family moves 
 into it. This is done, now, where a case of very contagious disease, say 
 smallpox, or diphtheria, has been known to exist; but how can we feel 
 sure that the house we are about to move into and live in has not had in 
 it an imrecognized or a suppressed case of measles, scarlet fever, or 
 tuberculosis or typhoid fever ? Disinfection, after these diseases is of the 
 highest importance. Then, again, there are those diseases that are not 
 fatal, perhaps, but, being communicable, may become certainly afiiic- 
 tions, nuisances. This precaution therefore should be demanded of 
 every landlord by those who are planning to rent the house. — Public 
 Health, Michigan. 
 
DIPHTHERIA. 
 
 ITS PIJEVENTIO^, EESTRICTION AND SUPPEESSION. 
 
 Issued by the Illinois State Board of Health. 
 1907. 
 
 ITS SANITARY FEATURES. 
 
 Diphtheria is a highly contagioiis disease, rapidly comiimnicated 
 from person to person. 
 
 The infection of diphtheria is contained in particles or shreds of 
 the diphtheretic membrane or in the expired air. These are communicated 
 by direct contact with the patient, by inhaling the air surrounding him, 
 and by coming in contact with articles used in the sick room, such as 
 carpets, bed clothes, clothing, books and toys. The infection clings 
 tenaciously to these articles. The virus may remain dormant in dwell- 
 ings for a long period, and unless destroyed by disinfection, may give rise 
 to a new outbreak. 
 
 Filth plays a very important part in the spread of diphtheria, for 
 unsanitary conditions tend to lower vitality, and, in consequence, to 
 increase the susceptibility to the disease. There is no doubt, also, that 
 sewer gas may be a carrier of diphtheritic poison and that many out- 
 breaks hold a close relationship with defective drainage, sewers and 
 cesspools. 
 
 Over-crowding, faulty ventilation and filthy conditions of habitation 
 favor the spread of the disease, as do also soil moisture, damp cellars 
 and general dampness of houses. 
 
 "Intentions, like eggs, unless hatched into action, will run into 
 rottenness." 
 
2 
 
 It is possible that diphtheria may be comm-unicated by dogs, fowls, 
 pigeons and the like. It is known that cats are susceptible to human 
 diphtheria and are capable of communicating the disease to other cats 
 and also to human beings. 
 
 Children under fifteen are usually most susceptible to diphtheria, 
 although adults may be attacked with fatal results. The disease is 
 most fatal "between the second and fifth years. A healthy child is not 
 as susceptible to diphtheria as one whose vitality has been weakened by 
 unsanitary conditions. 
 
 A person may have diphtheria more than once. 
 
 Whenever diphtheria exists in malignant form, there will generally 
 be found some obvious cause, such as accumulation of filth, unclean 
 cellars, foul gutters or cesspools or overflowing privy vaults. 
 
 Every case of diphtheria is dangerous to life. A physician should 
 be called early whenever, on examining the throat of a sick child, it is found 
 swollen and red, and if there is evidence of the appearance of white, 
 gray or yellow membrane. A delay may be fatal to the patient. The 
 treatment of diphtheria is most efEective if commenced within twenty- 
 four hours after the appearance of the membrane. 
 
 "Delay always breeds danger." 
 
 Membranous Croup. — The majority if not all cases of so-called mem- 
 branous croup are laryngeal diphtheria, the membrane being usually 
 limited to the upper part of the windpipe. In these cases an inspection 
 of the throat may or may not show, the presence of the membrane. With-' 
 out a bacterial examination, the facilities for which are seldom available 
 except in cities, it is impossible at the onset to differentiate diphtheritic 
 from benign croup. As the majority of cases of membranous croup, 
 however, have been found to be genuine diphtheria, all cases of mem- 
 branous ■ croup should, in the interests of the lives and health of the » 
 children of the state, be considered diphtheria, so far as isolation, quar- 
 antine and disinfection are concerned. 
 
PKEVENTION, RESTRICTION" AND SUPPRESSION. 
 
 Diphtheria is a preventable disease. A rigid observance of the 
 rules of the State Board of Health will often prevent the introduction 
 of the disease, and is always followed by a limitation of the disease to 
 the first case or cases. If diphtheria spreads from one house to 
 another some one is to blame. The parents who permit their children 
 to enter a house in which they know, or suspect, there is a case of diph- 
 theria, or to play or mingle with children from that house, need not 
 attribute the sickness and subsequent death of one of their loved ones 
 to the mysterious dispensation of Divine Providence. The parents who 
 fail to make known the existence of diphtheria in their houses, who 
 allow the children of their families to go to school and mingle otherwise 
 with other children, and who, during the period of sickness, disregard all 
 health laws and sanitary precautions, are morally responsible for what- 
 ever sickness and death may occur through their negligence. 
 
 Observe the Golden Rule. 
 
 The local health authorities, who, after being advised of the presence 
 of diphtheria in a family, fail to quarantine the premises, and to insist 
 on the isolation of the patient and compliance with all precautions neces- 
 sary to prevent the spread of the disease, are gnilty of culpable negligence. 
 
 During the existence of diphtheria or scarlet fever in a community, 
 all cases of sore throat with fever are to be looked upon with suspicion 
 until their innocent character is established. 
 
 Whenever a child has sore throat and fever, he or she should be at once 
 separated from other members of the family until a physician has 
 passed an opinion on the nature of the ailment. This precaution should 
 never be neglected, especially if the child vomits or has a chill, or is 
 sluggish and languid, and looks heavy-eyed. By '^separated" is meant 
 placed in a room apart as far as possible from other rooms in the house. 
 From this room all other children must be kept. 
 
 A child is attacked with diphtheria usually within two or four days, 
 after exposure. The disease may come on within 12 hours after the 
 child has come in 'contact with the poison, and, again, no symptoms may 
 develop until the seventh day. If a child does not show signs of illness 
 by the tenth day it can be safely concluded that the disease has not been 
 contracted. A child known to have been exposed should be carefully 
 watched for a week or ten days, and on the slightest sign of illness, be 
 separated from all others. 
 
4 
 
 Keep away from the sources of contagion. Do not go where the 
 disease is if you can avoid it, and do not let your children go near an 
 infected dwelling or mingle with children or others coming from the 
 premises. If you know that children from infected houses are permitted 
 to attend school, withdraw your children from that school, should they 
 be in attendance, and notify the State Board of Health. Permit no one 
 to enter your house who has been exposed to diphtheria. During the 
 prevalence of diphtheria, in epidemic form especially, avoid all public 
 gatherings and keep your children away from such. 
 
 "To fear the worst often cures the worst." 
 
 At all times, and especially during the prevalence of disease, keep 
 your premises and its surroundings, — your yard, outhouses, cellars, — in a 
 sanitary condition. Allow no filth to accumulate. Draw off all pools 
 of stagnant water. Burn all rubbish. Use disinfectants freely ; they are 
 cheap, sickness is costly. Bear in mind continually that while filth may 
 not cause diphtheria it is nevertheless a fact beyond controversy that the 
 spread of diphtheria is influenced largely by unsanitary conditions, which 
 induce an unhealthy condition of the throat and provide a suitable soil 
 or breeding ground for the germ of the disease. A healthy child, though 
 exposed to diphtheria, may not contract the disease; one whose vitality 
 is weakened through the influence of unsanitary surroundings is very 
 susceptible to the virus. 
 
 When diphtheria prevails in the neighborhood, — and at all times, — 
 warn your children not to use, while in school, the pencils, books, etc., 
 of other children, and especially not to put into their mouths pencils, 
 toys, harmonicas, jewsharps, and the like, which may have been handled 
 by other children. Warn them also to thoroughly rinse the school room 
 drinking cup before using. 
 
 A "sore throat" in an adult may mean diphtheria in a child. Be 
 careful not to allow children to use dishes and other utensils which 
 have been used by adults having "sore throats." Under no circumstances 
 should such adults kiss children. 
 
 It is better, when diphtheria exists in your family, to send the 
 children, who are not affected, elsewhere. Do not, however, run the risk 
 of communicating the disease to other children. In this, and in all 
 other matters relative to disease in your household, consult your physician. 
 
 "Do as you would be done by." 
 
5 
 
 Engage the services of a competent physician earl}' in all contagious 
 diseases. Do not wait until it is too late, when regrets are useless. You 
 may not feel able to incur the necessary expense incident to sickness; 
 you likewise may not feel able to pay those always attendant upon a 
 death. 
 
 Eemember that diphtheria is a preventable disease. Eemember, also, 
 that the period of sickness can be much shortened and the possible bad 
 effects of the disease entirely prevented if competent medical attendance 
 is obtained early. 
 
 Avoid, as you would the presence of evil, those individuals, "old 
 women" of both sexes, who "know more than the doctor"; who insist 
 that your child suffers from "putrid sore throat," and that the ailment is 
 not contagious. Countless graves are filled with the bodies of innocent 
 children, in whose little throats the deadly germ of diphtheria was 
 allowed to prey unmolested, while these oracles in health and hygiene, 
 often persons not knowing even the rudiments of anatomy and physiology, 
 taught in the common schools, gravely diagnosed the ailment as "putrid 
 sore throat." 
 
 "Nothing is more terrible than active ignorance." 
 
 ISOLATION AJs^D DISINFECTIOISr. 
 
 Diphtheria is a most highly contagious disease, readily communicated 
 from person to person. As it is difficult often at the onset of a "'sore 
 throat" to determine whether the ailment is diphtheria or not, to be 
 on the safe side, the sufferer should be isolated until medical advice can 
 be obtained. "An ounce of prevention," here as elsewhere, "is worth a 
 pound of cure." By "isolated" is meant kept away from other persons 
 as much as possible. For this purpose a room on the upper floor, away 
 from the direct line of passage, should be selected. 
 
 The room of a person sick with diphtheria should be large and easily 
 aired. It must be kept well ventilated. There should be taken out of 
 the room all ornaments, carpets, table covers, draperies, plush chairs and 
 other things that are not needed in it. Dogs, cats, birds and fowls should 
 be kept out of the room, and even out of the house. The patient must 
 have plenty of fresh air, night and day. In winter the room should 
 be heated with an open fire. If there is a fireplace have a fire in it, even 
 if you must use other heat. A stove makes the worst kind of heat for a 
 sick room. If a stove must be used, a pan or kettle of water should be 
 
put on it. The bed should be placed near the center of the room, without 
 letting the air blow directly on the. patient. 
 
 A sheet kept wet with a solution of carbolic acid (3^ ounces of 
 acid to one gallon of water) or with Standard Disinfectant No. 3, recom- 
 mended on last pages of this circular, ought to be hung over the door 
 or doors communicating with the sick room. This will prevent, in a 
 great measure, the virus from attaching itself to clothing, bedding, fur- 
 niture, etc., in other rooms, and will obviate the necessity of a thorough 
 disinfection of the rest of the house after the recovery or death of the 
 patient. Hang this sheet on the opposite side from which the door opens. 
 If you can do so, employ a professional nurse for the patient. 
 No other person beside the nurse and necessary attendants should be 
 permitted in the room, and they should take special precautions not to 
 carry the infection. Their communication with the rest of the family 
 should be as restricted as possible. Do not make the sick room a place of 
 family gathering. 
 
 "Life is not to live but to be well." 
 
 Neither the nuTse nor any other person should eat or drink anything 
 in the sick room, or anything which has been there. Food which the 
 patient has left should be burned or disinfected. The dishes which the 
 patient uses should not be used by others, or washed with other dishes. 
 They should be washed by themselves in boiling water. 
 
 While the liberal use of carbolic acid and other disinfectants in 
 the room is recommended, there should not be any attempt to disinfect 
 the room, when occupied, by the use of volatile chemicals agents, such as 
 carbolic acid, chlorine, etc. It cannot be done, and you but waste your 
 time and annoy the patient. Neutralizing odors by creating others does 
 not constitute disinfection. Fresh air and absolute cleanliness are all 
 that is necessary. Your physician may recommend the distillation of 
 carbolic acid in the room by means of boiling water, to prevent the 
 passage of diphtheritic virus in the air. This may be beneficial and can 
 do no harm unless the odor worries the patient. In this, as in all other 
 matters, follow your physician's advice. He desires that his patient shall 
 recover, and recover speedily. 
 
 All discharges from the bowels should be received in vessels contain- 
 ing a quart of Standard Disinfectant No. 1* (acid), or Standard Dis- 
 
 *See pages 26 and 27 for method of making and using thie Standard Disinfectants. 
 
7 
 infectant No, 2. Vomited matter and discharges from the lungs and 
 throat should be received in vessels containing the same solution. Have 
 this disinfectant continually on hand ready for use. 
 
 Standard iDisinfectant No. 1 (acid) or Standard Disinfectant No. 2 
 should be always at hand for washing the floor or bed whenever soiled by 
 discharges. 
 
 The discharges from the throat, mouth and nose are especially dan- 
 gerous and must be cared for at once. It is well to prepare a number of 
 squares of old soft cloth (old sheets or pillow cases) to receive these 
 discharges. The cloth should be burned as soon as soiled. If there is 
 no fire in the sick room, it is convenient to have a small tub, containing 
 the disinfecting solution, to receive these cloths until they can be carried 
 from the room and burned. 
 
 All knives, forks, spoons, glasses, cups and plates used by the patient 
 must be disinfected at once by being put in a carbolic acid solution, and 
 later boiled. 
 
 A wooden pail or tub containing Standard Disinfectant No. 3 should 
 be kept in the room, and all blankets, sheets, towels, pillow slips and 
 other articles used about the patient's room should be put into this as 
 soon as they are used and before they are taken from the room. They 
 should be allowed to soak for two hours, then they must be taken out and 
 boiled at once. Use old blankets on the bed and burn them afterwards. 
 
 Dust and dirt must be removed by cloths dampened with Standard 
 Disinfectant No. 3, as sweeping and dusting are objectionable. These 
 cloths should be at once thrown into the solution or into the fire. 
 
 Books, toys and articles used to amuse the patient when convalescent 
 are best disposed of by burning them in the room. Under no circumstances 
 should toys be borrowed to return to be used by the well. Never return 
 a hooJc taken from a public library. It must be burned. 
 
 "In a serious trust negligence is a crime." 
 
 No person from a house where diphtheria is should go into public 
 assemblies, such as schools, churches, or concerts, or anywhere into the 
 presence of children. No person in said house should leave the premises 
 without first thoroughly washing his hands, face and hair, and brushing 
 his clothing with a whisk broom wet with Standard Disinfectant No. 3. 
 Children who have had diphtheria should not be allowed to go to school 
 
or to mingle in any other ^YaJ with the public while they remain 
 infectious. The period of infection varies from two weeks in a very 
 mild case to six or more weeks in a severe case. 
 
 A person who has had an attack of diphtheria may spread the 
 disease for six weeks from the beginning of the sickness. Such person 
 should not associate with others nor go to school or church, or to any 
 public meeting, until the throat is entirely well, and the sores on the 
 lips and nose are healed. Before going to school or to any meeting, the 
 person should have a certificate from the physician or health officer, 
 setting forth that proper precautions have been taken during the sick- 
 ness, and that the person is believed to be free from danger of conveying 
 the disease to others. 
 
 All persons recovering from diphtheria are dangerous. Dangerous 
 also, and but in a slightly less degree, are all individuals, nurses, attend- 
 ants, parents, brothers, sisters, other relatives, friends, acquaintances, 
 neighbors, who have come in contact with the patient, or who have been 
 in the infected rooms prior to disinfection of the same, unless their 
 clothing and persons have been disinfected. 
 
 In the event of death, the body must be wrapped in a sheet thoroughly 
 soaked in Standard Disinfectant No. 2 and then placed in an air-tight 
 coffin. Public funerals and wakes over such a body are forbidden. The 
 coffin must not 'be opened nor the remains again exposed under any pre- 
 text whatsoever. The body cannot be transported by rail unless pre- 
 pared in accordance with the rules of this Board and placed in an air- 
 tight metallic casket. jSTewspaper notices of such deaths should distinctly 
 state that the deceased died of dijDhtheria. 
 
 "To the living- and not the dead is your duty due." 
 
 "There is no relation letween the severity of the type of the disease 
 in the individual who is the source &f't%e infection arid in the individual 
 who .receives it. The lightest case may cause the most malignant, pro- 
 vided the susceptibility or predisposition of the victim who receives the 
 infection is strong. ' On the other hand, the most severe or malignant 
 case may give rise to a very mild attach in a person whose susceptibility 
 or predisposition, is slight.'' — Twentieth Century Practice of Medicine. 
 
9 
 
 DISIISrFECTION AFTER RECOVERY OR DEATH. 
 
 When an apartment which has been occupied by a person sich luith an 
 infectious disease is vacated, it shoidd be disinfected. 
 
 The object of disinfection in the sick room is the destruction of infec- 
 tious material attached to surfaces, or deposited as dust upon window 
 ledges, in crevices, etc. If the room has been properly cleansed and 
 ventilated while still occupied by the sick person, and especially if it 
 was stripped of carpets and unnecessary furniture at the outset of his 
 attack, the difficulties of disinfection will be greatly reduced. 
 
 The work of disinfection should begin with the beginning of the 
 treatment of cases, and should continue during the whole course of the 
 disease. All articles of bed clothing and of body clothing should be 
 disinfected as soon as they are removed from the bed or from the 
 patient. 
 
 During the entire illness the privy should be thoroughly disinfected 
 with Standard Disinfectant No, 1, four or five gallons of which should 
 be thrown into the vault every day. Instead of the solution, chloride 
 of lime in powder can be used. All woodwork in the vault should be 
 soaked with the solution or covered with powdered lime. Water closets 
 and sinks should be disinfected daily by pouring a quart or more of the 
 solution of chloride of lime or carbolic acid into the pipes. The pipes 
 should be freely flushed in order to avoid injury. 
 
 After the patient has been removed from the room, it should be 
 thoroughly fumigated, with all its contents, by burning sulphur or 
 evaporating formaldehyde, and by a thorough cleansing with a dis- 
 infectant solution. 
 
 "Whatever is Worth Doing is Worth Doing Well." 
 The following mode of procedure* will be found easy of application, 
 economical and effective : 
 
 (a) Have all windows and doors (except doors of egress), tightly 
 closed. Securely paste strips of paper over keyholes, over cracks, above, 
 beneath and at sides of windows and doors, over stove holes and all 
 openings in walls, ceiling and floor. If opening be large, paste several 
 thicknesses of paper over opening. Carefully stop up the fireplace 
 if there be one. There must be no opening through which gas can escape. 
 
 *See pages 22 and 23 for method of disinfection with formaldehyde. 
 
10 
 
 (b) All articles in the room that cannot be washed must be 
 spread out on chairs or racks. Clothing, bed covers, etc., should be 
 hung on lines stretched across the room. Mattresses should be opened 
 and set on edge; window shades and curtains spread out at full length. 
 If there is a trunk or chest in the room, open it, but let nothing stay 
 in it. Open the pillows so that the sulphur fumes can reach th.e 
 feathers. Do not pile articles together. 
 .J (c) Use three pounds of powdered sulphur for every 1,000 cubic 
 
 %■ feet in the room. A room ten feet long, ten feet wide and ten feet high 
 has 1,000 cubic feet. For a closet, use two pounds of sulphur. 
 
 (d) Burn the sulphur in an iron pot or deep pan. Let the pot or 
 pan stand in a large vessel containing water, which vessel should be 
 
 ' ; placed on a table, not on the floor. For example, take a common 
 
 ■' washtub, lay in it three or four bricks, pour in water to the level of 
 
 ^ ' top of bricks, put the pot or pan containing the required amount of 
 
 ■; sulphur on the bricks, place the washtub and contents on a table. The 
 
 I disinfecting ^'apparatus" is then in working order. 
 
 .Moisten the sulphur with alcohol and ignite. When the sulphur 
 . i' begins to burn, leave the room, close the door of egress, and carefully 
 • 1 paste strips of paper over the keyhole and all openings above, beneath 
 and at side of door. Keep the room closed for ten hours at least. 
 
 Sulphur candles can be used instead of crude sulphur, but care must 
 be taken to use sufRcifent candles. The average candle on the market 
 : contains one pound of sulphur. Three of these will be required in the 
 disinfection of a small room, 10x10x10. Do not use a less number, no 
 matter what directions may accompany the candle. The water- jacketed 
 candle is preferable. Partly fill tin around candle with water and place 
 candle in a pan on the table, not on the floor. Let one-half pint of water 
 be vaporized with each candle. In the absence of moisture, the fumes 
 of sulphur have no disinfecting power. 
 
 (e) After the apartments are opened, take out all articles and place 
 them in the sunshine. Carpets should be well beaten and exposed to 
 tlie sun. 
 
 (f ) All surfaces in the room should then be thoroughly washed with 
 Standard Disinfectant No. 3. Walls and ceilings, if plastered, should 
 subsequently be washed with lime. W^ash well all out-of-the-way places, 
 window ledges, mouldings, etc. Floors, particularly should receive 
 
11 
 
 careful treatment, and the solution should wet the dust and dirt in the 
 cracks. 
 
 "Lingering labor often comes to naught." 
 
 (g) After washing, ventilate the rooms, if possible, for several 
 hours. 
 
 (h) It is safer to burn mattresses and pillows. 
 
 (i) It is likewise safer to burn all books, toys and articles of 
 small value which have been handled by the patient. Burn what 
 you cannot boil. Books which have not been handled by the patient 
 can be saved. Lay them on edge on a table with leaves open, in a room 
 while the sulphur is burning. 
 
 Unless all precautions recommended have been taken in the sick 
 room, the entire house must be disinfected in the manner directed for 
 the sick room; otherwise a thorough "cleaning house" exposure of all 
 articles to air and sunshine, the beating of carpets, etc., will be all that 
 is necessary. In case the entire house is disinfected, take out before 
 exposure to sulphur, any pianos, sewing machines, lace curtains, fine 
 paintings or draperies, and expose them to the sun. Sulphur fumes 
 injure these articles. Formaldehyde does not. 
 
 The infection must not remain in the house. It is a menace to the 
 lives and health of the patient, the children, if any, of the family, and 
 your neighbor's children. 
 
 There is one serious objection to the use of sulphur, and this must 
 be fully understood. The fumes of sulphur have a destructive action on 
 fabrics of wool, silk, cotton and linen, on tapestries and draperies, and 
 exercise an injurious influence on brass, copper, steel and gilt work. 
 Colored fabrics are frequently changed in appearance and the strength 
 impaired. Curtains and all articles of cotton or linen can be effectually 
 disinfected by boiling or soaking them in Standard Disinfectant No. 3 
 for several hours, and portable articles of brass, copper, steel and gilt 
 work by washing with a strong solution of carbolic acid (Standard Dis- 
 infectant No. 1). 
 
 Formaldehyde (the 40 per cent solution) may be used instead of 
 sulphur if desired. See pages 22 and 23 for method of application. 
 
 "Whatever thou takest in hand remember the end, and thou 
 shalt never do amiss. ' ' 
 
PUBLIC HEALTH LAWS OF ILLINOIS. 
 
 EXTEACTS FEOM THE EEVISED STATUTES. 
 
 POWERS AND AUTHOEITT OF THE STATE BOARD OP HEALTH. 
 
 ■ (Extract.) 
 
 The State Board of Health shall have the general supervision of 
 the interests of the health and life of the citizen of the state. They 
 shall have charge of all matters pertaining to quarantine ; and shall have 
 authoritjr to make such rules and regulations, and such sanitary investi- 
 gations, as they may from time to time deem necessary for the preserva- 
 tion or improvement of public health; and it shall be the duty of all 
 police officers, sheriffs, constables, and all other officers and employes of 
 the state, to enforce such rules and regulations, so far as the efficiency 
 and success of the Board may depend upon their official co-operation. 
 [Revised Statutes, Chap. 126a, Sec. 2.'] 
 
 POWERS OP CITY COUNCILS IN CITIES AND PRESIDENTS AND BOARDS OF 
 TRUSTEES IN VILLAGES INCORPORATED UNDER THE GENERAL LAW. 
 
 [Revised Statutes, Chap. 2J/., Sec. 62.1 
 (Extracts.) 
 
 Seventy-fifth — To declare what shall be a nuisance, and to abate the 
 same; and to impose fines upon parties who may create, continue or 
 suffer nuisances to exist. 
 
 Seventy-sixth — To appoint a board of health, and prescribe its powers 
 and duties. 
 
 Seventy-eighth — To do all acts, make all regulations which may be 
 necessary or expedient for the promotion of health or the suppression of 
 disease. 
 
13 
 
 Eighty-first — To direct the location and regulate the management 
 and construction of packing houses^ renderies, tallow chandleries, bone 
 factories, soap factories and tanneries, within the limits of the city or 
 village, and within the distance of one mile without the city or village 
 limits. 
 
 Eighty-third — To prohibit any offensive or unwholesome business or 
 establishment within or within one mile of the limits of the corporation. 
 
 Eighty-fourth — To compel the owner of any grocery, cellar, soap or 
 tallow chandlery, stable, pig sty, priv)^, sewer or other unwholesome 
 or nauseous house or place, to cleanse, abate, or remove the same, and 
 to regulate the location thereof. 
 
 Ninety-sixth — To pass all ordinances, rules, and make all regulations, 
 proper or necessary, to carry into effect the powers granted to cities or 
 villages, with such fines or penalties as the city council or board- of 
 trustees shall deem proper: Provided, no fine or penalty shall exceed 
 $200, and no imprisonment shall exceed six months for one offense. 
 
 Territorial Jurisdiction — The city council and board of trustees shall 
 also have jurisdiction in and over all places within one-half mile of the 
 city or village limits, for the purpose of enforcing health and quarantine 
 ordinances and regulations thereof. [Revised Statutes, Chap. 2Jlf, Sec. ^^.] 
 
 POWEES OF COUNTY AND TOWNSHIP BOARDS OF HEALTH. 
 
 [Act approved May 10, in force July 1, 1901. Amended hy act in force 
 
 July 1, 1903.'] 
 
 (Extracts.) 
 
 Section 1. The hoard of county cammissioners in counties not under 
 township organization, and the supervisor, assessor and to^ivn clerh of 
 every town in counties under township organization, shall constitute a 
 board of health, and on the breaking out of any contagious or .infectious 
 disease in their county or town, or in the immediate vicinity thereof, it 
 shall be their duty to make and enforce such rules and regulations tend- 
 ing to check the spread of the disease within the limits of such county 
 or town as may be necessary ; and for this purpose they shall have power 
 to quarantine any house or houses, or place where any infected person 
 may be, and cause notices of warning to be put thereon, and to require 
 the disinfection of the house or place: Provided, that nothing in this 
 act shall apply to any territory lying within the corporate limits of any 
 incorporated city or village: Provided, further, that in case the board 
 of health of any county not under township organization, or of any 
 toAvnship in counties under township organization shall fail, refuse or 
 
14 
 
 neglect to promptly take the necessary measures to preserve the public 
 healthy or in case any such board of health shall refuse or neglect to 
 carry out the rules and regulations of the State Board of Health, that 
 thereupon the State Board of Health may discharge such duties and 
 collect from the county or township, as the case may be, the reasonable 
 costs, charges and expenses incurred thereby, 
 
 § 2. The said board of health shall have the following powers : 
 
 First — To do all acts, make all regulations which may be necessary 
 or expedient for the promotion of health or the suppression of disease. 
 
 Second — To appoint physicians as health officers and prescribe their 
 duties. 
 
 Third — To incur the expenses necessary for the performance of the 
 duties and powers enjoined npon the board. 
 
 Fourth — To provide gratuitous vaccination and disinfection. 
 
 Fifth — To require reports of dangerously communicable diseases. 
 
 § 3. Any person who shall violate, or refuse to obey, any rule or 
 regulation of the said board of health, shall be liable to a fine not 
 exceeding $200 for each offense, or imprisonment in the county jail not 
 to exceed six months, or both, in the discretion of the court. 
 
 All fines collected under the provisions of this act shall be paid into 
 the county treasury of the county in which the suit is brought, to be used 
 for county purposes, and it shall be the duty of the State's attorney in 
 the respective counties to prosecute all persons violating, or refusing to 
 obey, the rules of said local boards of health. 
 
 "In nearly all health and quarantine laws some are put to incon- 
 venience and annoyance and many, to a certain extent, are deprived 
 of their liberty and freedom of action. But, if the public necessity 
 requires it, the convenience or even liberty of the individual citizen 
 must give way for the welfare of the greater number. * * * The 
 good of the many must be preferred to the convenience or supposed 
 welfare of the few." — Decision Appellate Court of Illinois, Second 
 district, Lawbaugh vs. Board of Education, 66 111. App., 159. 
 
15 
 
 RULES AND REGULATIONS FOR PHYSICIANS 
 AND HEALTH AUTHORITIES. 
 
 EECOMMENDATIONS TO PHYSICIANS. 
 
 Use Antitoxin Early. 
 
 As in the diagnosis of all cases of suspected communicable diseases, 
 great care should be exercised in the diagnosis of suspected diphtheria. 
 Osier says, "When a bacteriological examination cannot be made, the 
 practitioner must regard as suspicious all forms of throat affections in 
 children and carry out measures of isolation and disinfection. In this 
 way alone can serious errors be avoided.'^ This mode of procedure 
 however, is more applicable to hospital than to private practice. 
 
 It is wise for the physician to take into consideration the fact of 
 exposure or non-exposure to the disease, and the prevalence or absence of 
 the disease in the vicinity. If in any case exposure to diphtheria is 
 known to have occurred, even a slightly suspicious sore throat should be 
 regarded as probably a mild diphtheria. If on the other hand, no cases 
 of diphtheria have been known to exist in the neighborhood, the ailment 
 should not be termed diphtheria unless clinical characteristics are 
 obvious. 
 
 The most certain evidence of diphtheria is the finding of Klebs- 
 Loeffler bacillus in the membrane, but the absence of diphtheria bacilli 
 in the first culture, especially in cases where the disease is confined to 
 the larynx or bronchi, must not be accepted as conclusive evidence of 
 the non-existence of diphtheria, particularly if there be a striking dis- 
 crepancy between the clinical and the bacteriological diagnosis. The 
 bacilli may be found abundantly in the second culture. 
 
16 ■ 
 
 g^^Eemember that the Laboratory of the State Board of Health 
 at Springfield is ready,, at all times, to afford aid to physicians in 
 establishing diagnoses. Bacteriological examinations are made free of 
 cost. 
 
 When the facilities for making a bacteriological examination are not 
 at hand, or it is not practicable to send a specimen of the membrane to 
 the State Board of Health, dependence must be placed upon the clinical 
 symptoms. There are but two conditions with which diphtheria is liable 
 to be confounded, viz., the different forms of diphtheroid faucitis, includ- 
 ing follicular tonsilitis, and scarlatina. Scarlatina and diphtheria may 
 co-exist, but such cases are exceedingly rare. Scarlatina leads more or 
 less to temporary damage to the mucous membrane of the throat, and in 
 this manner predisposes to the reception of the diphtheria poison, causing 
 a series of diphtheria cases to- follow after a series of scarlatina cases. 
 The diagnosis of a typical pharyngeal diphtheria (the usual form 
 prevailing) will not ordinarily be found difficult if careful attention be 
 given to the history of the case, the constitutional disturbances, the 
 appearance and characteristics of the membrane and exudates and the 
 occurrence of albuminuria. To the seat of the membrane, especial 
 attention must always be given, as to the firm incorporation, in diph- 
 theria, of the exudate with the underl3dng mucoiTS membrane. 
 
 Memlranous Croup. — Unless it has been determined by bacterio- 
 logical tests that the disease is non-diphtheritic, all cases of so-called 
 membranous croup should, in the interest of the public health, be 
 considered diphtheria, for sanitary purposes at least, and should be so 
 reported. It is well known that with a very large proportion of all cases 
 of membranous larjmgitis, the Klebs-Loeffler bacillus is associated, 
 whether an exudate is present in the phar}Tix or not, and it is practically 
 impossible to make a positive diagnosis without a bacteriological test. 
 In view of these facts the public safety demands that the same pre- 
 ventive measures be applied to cases of membranous croup as to cases of 
 recognized diphtheria. It must be remembered that in laryngeal diph- 
 theria, i. e., membranous croup, the diphtheria bacillus nearly always 
 produces its influence fijst on the mucous membrane of the larynx, and 
 in these cases the mucous membrane of the nose and pharjTix may never 
 show any evidence of membrane. 
 
 Use Antitoxin Early. 
 
17 
 
 On being satisfied that diphtheria exists in a family, the attending 
 physicians should direct the observance of all precautions necessary to 
 prevent the further spread of the disease, and should AT ONCE EE- 
 POET the case or cases to the local board of health, if there be one, if 
 not, to the legally constituted health authorities. 
 
 The physician should avoid carrying infection. A very leading man- 
 ner of the conveyance of the bacillus is by fomites. The contagion 
 adheres tenaciously to a great variety of objects, and has been trans- 
 ferred in clothing over great distances, giving rise to the disease long 
 after. The physician should thoroughly disinfect all instru.ments used 
 on a patient and should, especially after close contact with the patient, 
 wash his hair and all exposed cutaneous surfaces with a germicidal 
 solution and thoroughly brush his clothing with a whisk broom wet with 
 the solution. 
 
 On the recovery of the patient the attending physician should notify 
 the local health authorities, in order that the quarantine restrictions 
 can be removed. The physician should also impress upon the local health 
 authorities the absolute necessity for a thorough disinfection of the 
 infected room or rooms, if he has reason to believe that this important 
 feature of preventive medicine will be overlooked. 
 
 Use Antitoxin Early. 
 
 DUTIES OF LOCAL HEALTH AUTHORITIES. 
 
 Isolate, Quarantine, Disinfect. 
 
 Whenever a case of diphtheria or membranous croup is reported, the 
 local health officer, if there be one, or a physician appointed by the 
 city, village or town authorities; should visit the premises and secure 
 prompt compliance with the precautions herein enjoined. Every infected 
 house should be properly placarded, and all children therein confined to 
 the immediate -premises during the prevalence of the disease, and steps 
 should be taken to prevent all unauthorized persons, especially children 
 from visiting the premises. Adults from the infected house should be 
 prohibited from mingling unnecessarily with other people, above all 
 with children, and should be required to disinfect their clothing before 
 going out of the house. 
 
 Prompt reports of the existence of diphtheria in a family should be 
 furnished to all public libraries, and care should be taken that no book 
 from the infected premises be returned to the libraries. 
 
18 
 
 It is not considered necessary to close the schools during the preva- 
 lence of diphtheria in a community unless it prevails in epidemic form, 
 but all schools in the neighborhood should be notified of the existence 
 of the disease, and should any children affected with diphtheria have 
 attended school, the school should be promptly closed until disinfected. 
 
 It is imperative that similar notice be sent also to the superintendents 
 of all Sunday schools, or to the pastors of the churches, for there is no 
 question but that the liability of the dissemination of contagious diseases 
 is greater in Sunday schools, which are used but once a week, than in 
 public schools, which are cleaned and ventilated daily. As a further 
 precautionary measure the local health authorities should see that rooms 
 used for Sunday school purposes be kept in a sanitary condition and 
 freely ventilated at intervals during the week. 
 
 Overdo rather than underdo! 
 
 When should the patient be released from quarantine? The time is 
 variable, depending entirely upon the character of. the disease, and the 
 presence or absence of complications. 
 
 Health officers will ordinarily be justified in raising the quarantine 
 whenever the attending physician certifies that the patient has entirely 
 recovered from diphtheria; that there is no danger of spread of the 
 infection from the patient. As a rule, however, the minimum length 
 of quarantine should be two weeks. In very mild cases, and particularly 
 when antitoxin has been administered, the quarantine may be raised 
 within ten days, provided the physician furnishes the certificate required, 
 and especially if a bacteriological examination of the throat shows no 
 evidence of the presence of the bacilli of diphtheria. 
 
 The quarantine should not be raised, however, until the infected 
 room, and if necessary the entire house, has been properly disinfected. 
 
 On receiving a certificate from the attending physician that the 
 patient has entirely recovered, and that no further quarantine is neces- 
 sary, the local health officer should see that the infected room and 
 premises, if thought necessary, with contents, be DISIISTFECTED as 
 directed herein. To be effective, the disinfection must be thorough. 
 "There can be no partial disinfection of infectious material; either 
 its infectious power is destroyed or it is not. In the latter 
 case there is a failure to disinfect." Deodorants merely remove 
 offensive odors, and may not have any disinfecting power whatever. A 
 
19 
 
 failure to properly disinfect apartments often leads to the recurrence of 
 the disease. 
 
 The bacilli of diphtheria will live on infected substances for weeks. 
 They have been known to live for several months on children's playthings 
 which have been put away. 
 
 In the disinfection of school rooms the burning of sulphur is usually 
 advisable. This fumigation should always be followed by thorough 
 airing for several hours. The floors and all furniture should be washed 
 with a germicidal solution, preferably Standard Disinfectant No. 3; 
 Disinfect. 
 
 Local boards of health and health officers should guard against the 
 introduction or spread of contagious disease by the exercise of proper 
 and vigilant inspection and control of all persons and things coming 
 within their Jurisdiction. They should require prompt reports of all 
 infectious and contagious diseases and the isolation of all persons and 
 'things infected with or exposed to infectious or contagious diseases, and 
 should placard and disinfect infected premises, close schools and assume 
 charge of funerals, if necessary. They should also cause the arrest and 
 imprisonment of all persons violating their orders. The authorities may, 
 in general, take any measure of precaution, however stringent, which 
 they may deem necessary or prudent in the interest of the health of the 
 inhabitants. "The health of the people is the supreme law." 
 
 There is no more liberal law or charter in existence than is given 
 to the councils of cities and the trustees of villages by section 62, chap- 
 ter 24, of the Eevised Statutes, for the almost absolute and unrestrained 
 control of the agencies affecting the public health. Concerning the 
 force and effect of such, the Supreme Court of Illinois, in the case of 
 Mason et al. vs. The City of Shawneetown, 77 111. 533, says: "Where an 
 incorporated town or city has been invested with power to pass an ordi- 
 nance, by the Legislature, for the government or welfare of the munici- 
 pality, an ordinance enacted by the legislative branch of the corporation 
 in pursuance of an act creating the corporation, has the force and effect 
 of a law passed by the legislature, and cannot be regarded otherwise than 
 as a law of and within the corporation. An ordinance is the law of the 
 inhabitants of the municipality." 
 Disinfect. 
 
20 
 
 DISIXFECTIOX. 
 
 "Do it now," and "Do it right." 
 
 The thorough disinfection of infected apartments or dwelling is as 
 important as the maintenance of an efficient quarantine during the prev- 
 alence of the disease. Hence, no agent should be employed in the effort 
 to destroy the germs of disease, upon the efficiency of which, under all 
 circumstances, there rests any doubt or uncertainty. The use of a worth- 
 less disinfectant or the misuse of a valuable one not only involves a waste 
 of time and material, but jeopardizes the health of the community. 
 
 Disinfection of an infected apartment can be successfully performed 
 by thoroughly wetting the floors, ceilings, walls and all exposed surfaces 
 with an efficient germicidal solution. This method, however, is not appli- 
 cable to the contents of the apartment. For these fire is the most 
 reliable disinfectant, yet, as other reliable disinfectants are available, 
 there is little justification for the burning of any article of value, except, 
 for instance, books or mattresses or pillows, which cannot be successfully 
 disinfected except by steam. 
 
 All infected apartments, with contents, should be disinfected by an 
 efficient aerial germicide, and this fumigation should be followed by a 
 thorough washing of the walls, ceilings, floors and exposed surfaces' 
 of the room with a reliable disinfecting solution. 
 
 Fumigation by burning sulphur has for many years been a favorite 
 method of aerial disinfection. As stated in the recently revised Prize 
 Essay of the American Public Health Association, on "Disinfectant and 
 Individual Prophylaxis Against Infectious Diseases," by Surgeon General 
 George M. Sternberg, H. S.. A., "the experience of sanitarians is in favor 
 of its use in yellow fever, small-pox, scarlet fever, diphtheria and other 
 diseases in which there is reason to believe that the infectious material 
 does not contain spores." In the majority of the infectious diseases the 
 specific germ does not form resistant spores, hence sulphur dioxide 
 would seem to be a reliable aerial disinfectant. It must be remembered 
 also that some authorities do not subscribe to the statement that sulphur 
 is powerless to destroy pathogenic organisms containing spores. 
 
 Admitting the impotency of the fumes of sulphur dioxide under 
 certain conditions, and the fact that they may not kill the spores of 
 anthrax or other bacilli, "there is no reason," as stated by Dr. Sternberg, 
 "for rejecting an agent which has been demonstrated by experience to 
 
'21 
 
 be one of great value^ which has been proved by laboratory experiments 
 to be fatal to pathogenic organism in the absence of spore and to destroy 
 the infecting power of vaccine virus," 
 
 Sulphur will be found a thoroughly reliable gaseous disinfectant* 
 of considerable penetrating power if it is intelligently employed. To 
 obtain satisfactory results, the following essentials of successful disin- 
 fection, established by repeated experiments, must be observed : (a) The 
 infected room, or rooms, must be thoroughly closed, every crack and 
 crevice sealed, (b) Sufficient sulphur must be used, (c) There must be 
 ample moisture in the room, (d) The time of exposure must be suffi- 
 cient, ten hours the minimum. 
 
 In the disinfection of stores, halls, school houses and apartments or 
 dwellings in which there are no articles to be injuriously affected by the 
 gas, sulphur is an ideal disinfectant. Its mode of application is simple 
 (the simpler the mode of application, the better); it is cheap; the 
 material is accessible everywhere, and, finally, the most important of all, 
 the action will be invariably found effective when the sulphur is properly 
 used. 
 
 During recent years, formaldehyde gas has, to a very considerable 
 extent, taken the place of sulphur dioxide as a gaseous disinfectant. 
 Various methods for the use of formaldehyde have been devised — all 
 requiring apparatus more or less expensive and complicated — all exploited 
 with extravagant claims of merit and infallibility, l^one of these, how- 
 ever, has proven worthy of the claims made for it, while many have 
 been entirely worthless. The fact that the vast majority of devices, at 
 one time exploited and enjoying wide popularity, and widely purchased 
 fey confiding health officers, have been eventually relegated to the junk 
 heap, indicates clearly the failure of former methods of formaldehyde 
 disinfection to meet the requirements upon them. 
 
 "Any man may make a mistake, but none but a fool will con- 
 tinue in it." 
 
 Almost continuously since 1897 the State Board of Health has experi- 
 m.ented with and investigated the merits of formaldehyde. Every device 
 and every apparatus coming to the attention of the Board has been 
 fairly and thoroughly tested. ' In view of the results obtained with all. 
 
 *See page 9 for simple method of application. 
 
22 
 
 the State Board of Health has been unable to recommend formaldehyde 
 disinfection in the past, and is only able to recommend it now when 
 employed with one method in a proper apparatus. 
 
 The method now unreservedly recommended by the Board con- 
 sists merely in pouring formaldehyde solution over crystals of potassium 
 permanganate. This method primarily offers the advantage of absolute 
 simplicity in operation, requiring no special apparatus and no fire. 
 In addition to this, exhaustive experimental work has demonstrated that, ■ 
 in practical disinfection, the method is unusually efficient, regardless 
 of the conditions of humidit}', temperatures and other factors which 
 materially affect other methods of the use of formaldehyde. 
 
 The only apparatus required is a large open vessel, protected by 
 some non-conductive material to prevent the loss of heat from within. 
 An ordinary milk-pail, set into a pulp or wooden bucket, will answer 
 every purpose, although a special container, devised for physicians and 
 health officers, will be found of considerable advantage. This container 
 or generator consists of a simply constructed tin can with broad, flaring 
 top. Its full height is 15^ inches, the height from the bottom to the 
 flaring top being about 8 inches. The lower or round section is 10 inches 
 in diameter, while the flaring top is 17^ inches in diameter at its top. 
 The container is made of a good quality of bright tin, is supplied with a 
 double bottom with ^ inch air space between the two layers, and is 
 entirely covered on sides and bottom with asbestos paper. The asbestos 
 paper and double bottom serve effectively to retain the heat which is 
 generated by the vigorous chemical reaction occurring within, and 
 which is essential to the complete production and liberation of the gas. 
 This special container can be made by any tinner of ordinary intelli- 
 gence and costs but a few dollars. It is illustrated on page 24. 
 
 With the room sealed, as described on page 9, and, as is essential 
 to any form of aerial disinfection, the crystals of potassium perman- 
 ganate (6f ounces to each 1,000 cubic feet of room space, or 10 ounces 
 when the temperature is below 60° F.) are placed in the container. 
 Over this salt is poured "formalin," or the 40 per cent aqueous solution 
 of formaldehyde (16 ounces to every 1,000 cubic feet of room space, 
 or 24 ounces when the temperature is below 60° F.). The formalde- 
 hyde gas is promptly liberated by the vigorous chemical reaction of the 
 formalin and potassic salt and rises from the generator in immense 
 
23 
 
 volume in the form of an inverted cone. It is consequently necessary 
 that all preparations be made in advance, and that the operator leave 
 the room at once on the combination of the two chemicals. 
 
 The door or window of exit will be promptly closed and sealed, and 
 the room left closed for at least four hours. 
 
 As in all methods of disinfection, success largely depends upon 
 the care which is exercised and the attention which is given to every 
 detail. Simple as the method is, neglect of any of the following points 
 may result in complete failure : 
 
 The sick room is not the place for experiments. 
 
 1. The room should be sealed and prepared as described on page 9. 
 
 2. The potassium permanganate (6f ounces to every 1,000 cubic 
 feet of room space, or 10 ounces at temperature below 60° F.) should be 
 placed in the apparatus or generator. The permanganate must he put in 
 before the formaldehyde solution. 
 
 3. The 40 per cent formaldehyde solution (16 ounces to the 1,000 
 cubic feet of room space, or 24 ounces at temperature below 60° F.) 
 should then be poured over the permanganate. 
 
 4. As the gas is given off in immense volume immediately after the 
 mixture of the formaldehyde and permanganate, the operator must 
 leave the room at once. All preparations must have been finished in 
 advance. 
 
 5. The door or window of exit must be promptly closed and sealed, 
 so that there will be no escape of gas, and the room should be left closed 
 for four hours. 
 
 6. The room should be thoroughly cleaned after disinfection. AH 
 out-of-the-way places, window ledges, mouldings, etc., should be washed 
 with Standard Disinfectant No. 3 (see page 26). The floors should 
 receive careful attention and the solution should thoroughly wet the dust 
 and dirt in the cracks. 
 
 Whenever practicable the special generator previously described 
 should be used, and health officers and physicians should have several 
 such containers on hand. In the absence of such a container, however, 
 a milk pail may be used, as indicated on page 22. In an emergency use 
 any tin pail or crock, of. proper size, but be sure and ivell heat the pail 
 or crock before putting in the chemicals. This heating is very important 
 to the proper generation of the gas. 
 
24 
 
 Care must be taken not to place too much formaldehyde in a single 
 container. The reaction is violent and there is great effervescence and 
 bubbling. If the room is too large to be disinfected with one generator, 
 use as many more as are required and place in each only a reasonable 
 amount. 
 
 The following quantities may be used safely in the containers recom- 
 mended : 
 
 10 or 12 quart milk-pail, Formaldehyde, 16 ounces; 
 
 Permanganate, 6% ounces. 
 14 quart milk-paiL Formaldehyde, 24 ounces; 
 
 Permanganate, 10 ounces. 
 Special apparatus described on page 22, and illustrated below. 
 
 Formaldehyde, 32 ounces; 
 
 Permanganate, 13 1/^ ounces. 
 
 CONTAINER FOR GENERATING FORMALDEHYDE GAS. 
 (Formaldehyde-Potassium nermanaranate method^ 
 
Larger quantities than these should not be used. 
 
 If good results are to be attained, care must be exercised to secure 
 the best quality of formaldehyde solution. Secure the highest grade 
 40 per cent aqueous solution on the market. Good formaldehyde is not 
 expensive. Inferior formaldehyde is dear at any price. Its use may 
 bring about most unfortunate results. 
 
 The fine, needle-shaped crystals of potassium permanganate are better 
 than the rhomboid crystals. See that you get crystals of potassium per- 
 manganate. Do not accept the dust, which often contains impurities. 
 
 Prepare the room and its contents as described on pages 9 and 10, but 
 remember that books cannot be disinfected with formaldehyde gas. 
 
 Don't use "Formaldehyde Candles/' Don't rely on the apparatus 
 which the energetic and anxious-to-mahe-a-sale tradesman tells you is 
 tetter than that recommended by the State Board of Health. 
 
 Entire dependence should not be placed upon any aerial disinfectant, 
 even though its penetrating power be great. There should be a thorough 
 "house cleaning" after the exposure to the gas, and the liberal appli- 
 cation of a solution of corrosive sublimate to all exposed surfaces in the 
 room and a thorough outdoor airing of its contents. 
 
 A copy of this circular, liberal supplies of which can be secured on 
 application to the Secretary of the Board at Springfield, should be 
 furnished to every family in which there is a case of diphtheria or 
 "sore throat," and to other families which may have been exposed to the 
 disease, and also to teachers of public and private schools and pastors of 
 churches. 
 
 If the spirit of the rules and regulations of the State Board of Health 
 be complied with, the disease can be easily controlled and speedily sup- 
 pressed. 
 
 Published by order of the State Board of Health. 
 
 James A. Egan, M. D., 
 
 Secretary. 
 
2G 
 
 STANDARD DISINFECTANTS. 
 
 The following are simple^ cheap and reliable disinfectants. 
 Standard Disinfectant No. 1. 
 
 Dissolve chloride of lime of the hest quality in water, in the propor- 
 tion of six ounces to the gallon. 
 
 Use one quart of this solution for each discharge from a patient 
 suffering from a contagious or infectious disease. Discharges from the 
 mouth and throat should be received in a cup half full of the solution, 
 and those from the nostrils upon soft cotton or linen rags, which should 
 be immediately burned. 
 
 The chloride of lime must le of the best quality. Poor chloride of 
 lime is worthless. The solution should he made when required. 
 
 Instead of chloride of lime, carbolic acid may be used in the strength 
 of six and one-half ounces to the gallon of water. 
 
 Standard Disinfectant No. 2. 
 
 Dissolve corrosive sublimate and muriate of ammonia in water in 
 the proportion of two drachms (120 grains — | ounce) of each to the 
 gallon. Dissolve in a wooden tub, barrel or pail, or an, earthen crock. 
 
 Use for the same purposes and in the same way as No. 1. Equally 
 effective, but slower in action. This solution is odorless, while the 
 chloride of lime solution is often objectionable in the sick room on 
 account of its smell. 
 
 Standard Disinfectant No. 3. 
 
 Dissolve one drachm (60 grains — | ounce) of corrosive sublimate 
 and muriate of ammonia in one gallon of water. Dissolve in a wooden 
 tub, barrel or pail, or an earthen croch. 
 
 Use for the disinfection of soiled underclothing, bed linen, etc. Mix 
 solution and immerse articles for two hours. Then wring them out and 
 boil them. 
 
27 
 Mixed with an equal quantity of water the solution is useful for 
 washing the hands and general surfaces of the bodies of attendants and 
 convalescents. The latter only by direction of the physician. 
 
 Good chloride of lime should contain at least 25 per cent of available 
 chlorine. It may be purchased by the quantity at 3|- cents per pound. 
 The cost of the standard solution recommended is therefore about 1 cent 
 a gallon. A clear solution may be obtained by filteration or by decanta- 
 tion, but the insoluble sediment does no harm, and this is an unnecessary 
 refinement. 
 
 Ji@°= Chloride of lime, carbolic acid and corrosive sublimate are 
 d eadly poisons. 
 
 S^^ Solutions of corrosive sublimate must not be made or kept in 
 a metal vessel. Use a wooden tub, barrel or pail or an earthen crock. 
 
 S^- Solutions of chloride of lime, carbolic acid and corrosive subli- 
 mate will injure lead pipes if passed through them in large quantities 
 without free flushing. 
 
 Standaed Disinfectant IsTo. 4. 
 
 MILK OF LIME (QUICK LIME) , 
 
 Slack a quart of freshly burnt lime (in small pieces) ^ith three- 
 fourths of a quart of water — or, to be exact, 60 parts of water by weight 
 with 100 of lime. A dry product of slack lime (hydrate of lime) 
 results. Make milk of lime not long before it is to be used by mixing one 
 part of this dry hydrate of lime with eight parts (by weight) of water. 
 
 Air-slacked lime is worthless. The dry hydrate may be preserved 
 some time if it is enclosed in an air-tight container. Milk of lime should 
 be freshly prepared, but may be kept a few days if it is closely stoppered. 
 
 Quick lime is one of the cheapest of disinfectants. The solution can 
 take the place of chloride of lime, if desired. It should be used freely, 
 in quantity equal in amount to the material to be disinfected. It can 
 be used to whitewash exposed surfaces, to disinfect excreta in the sick 
 room or on the surface of the ground, in sinks, drains, stagnant pools, etc. 
 
28 
 
 IMPORTANT NOTICE. 
 
 The Illinois State Board of Health has published a circular on the 
 CAUSE AND PEEVENTION OF CONSUMPTION,a preventable and 
 curable disease^ but one which kills between 8,000 and 9,000 persons in 
 Illinois every year, — kills men and women in their prime. 
 
 This circular contains chapters on the following subjects : The 
 Cause of Consumption, The Symptoms of Consumption, How to 
 Avoid Consumption, How the Sputum May Be Destroyed, If You 
 Have Consumption, The Hygiene of the Sick-room, Consumption 
 in Schools, As to Change of Climate, and As to the Treatment 
 of Consumption in Illinois. 
 
 Copies of this circular will be sent free of charge to any resident of 
 Illinois who applies to the Secretary at Springfield. 
 
 J|@°'In consumption, as in all diseases, it is essential that the prem- 
 ises be kept in a sanitary condition. All decaying animal and vegetable 
 matter and every kind and source of filth in and about the house should 
 be removed and disinfectants freely used. Surface drains and gutters, 
 out houses, privies, shelters for domestic animals, fowls, etc., and base- 
 ments and cellars should receive close and constant attention and 
 Standard Disinfectants No. 1 or 4 should be used freely and regularly 
 in such cases. 
 
 The Illinois Circular on Consumption. 
 
 "We have received a copy of a circular just issued by the Illinois 
 State Board of Health on 'The Cause and Prevention of Consumption.' 
 We regard it as the most complete and compact statement of the cause 
 and prevention of this all-too-universal and fatal disease that we have 
 seen. If a copy of it could be put in every home in the land and was 
 read and its precepts heeded, consumption would be reduced fifty per 
 cent in ten years." — From Iowa Health Bulletin, August, 1904, pub- 
 lished by the Iowa State Board of Health. 
 
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