SUGGESTIONS 
FOR 
PREVENTING THE SPREAD OF SCARLET-FEVER. 
A Circular from the State Board of Health of Massachusetts. 
Scarlet-fever, scarlatina, scarlet-rash, canker-rash, and rash- 
fever are names of a contagious and infectious disease of varying 
degrees of severity; but in which all the forms are capable of con- 
veying the most severe type. A person may become ill with fatal 
scarlet-fever from association with another who had so mild an at- 
tack of the disease as not to keep him in the house, much less in 
bed. 
The hypothesis of a “germ” in scarlet-fever, analogous to the 
spores of minute vegetable growths, which is of organic nature 
and capable of indefinite multiplication outside of the bod}', is 
maintained by some scientific observers, but is held by other au- 
thorities to be at variance with many observed facts. 
It is generalty agreed among sanitarians, that scarlet-fever is 
conveyed from one person to another by means of the epithelium 
or thin superficial covering which extends over the whole bod}’, 
under the name of epidermis, cuticle, or scarf-skin, and which also 
lines the inner passages of the body. The exhalations from the 
outer and inner surfaces of the various parts of the body, and 
from the excretions also, are capable of transmitting the disease. 
Upon whatever the contagious matter depends for its dangerous 
character, it is capable of retaining its power to carry the disease 
for a long time — certainly many months, and possibly for a year 
or more — unless destroyed. 
The means of transporting the contagium of scarlet-fever may 
be furnished by any thing that has come in contact with an infected 
person or object, — air, food, clothing, sheets, blankets, whiskers, 
hair, furniture, toys, library-books, Avail-paper, curtains, cats, dogs, 
&c. Funerals have occasionally spread the disease, the exhala- 
tions from the dead body being also dangerous. 
The period from exposure which results in scarlet fever, to the 
time when the symptoms manifest themselves, varies from several hours to three, and possibly four, weeks. The average time is 
variously given from six to eight or ten da3*s. 
The time at which one who has been ill with scarlet-fever ma}' 
safely mingle with other people is not always easy to determine ; 
but it is, for convenience, usually placed by sanitarians at four 
weeks from the commencement of the illness, as that covers the 
vast majority of cases, and it is best to have some arbitrary rule. 
A physician’s certificate, however, should be always required. 
It would be well to designate every house where scarlet-fever 
exists, by some mark not too conspicuous, and jTet sufficient to’ 
give the proper information. 
The first principle of treatment is in isolation, which can be no- 
where so well observed as in a hospital, provided the patient is old 
enough to go there. Otherwise he should be placed in a room as 
much separated from the rest of the house as possible, and commu- 
nicate with no more members of the household than is absolutely 
necessary, If an outward draught of air from the sick-room to the 
entry occurs, a curtain may be formed by a sheet which is soaked 
in some disinfectant; those which have not a disagreeable odor, 
and do not stain clothing, being preferred. 
The sick-room should be well warmed and ventilated (by an 
open fireplace with a fire or a lamp in it, if possible). It should be 
open to the sun, as free as possible from noise, dust, &c., and not 
u aired” by cold draughts, which are often more dangerous than a 
foul atmosphere. 
All carpets, upholstered furniture, window-hangings, and, in- 
deed, unnecessary objects of every kind, especially woollen, should 
be removed from the room. Bits of carpet may be used, and 
burned after the need for them has passed. 
The discharges from the throat, nose, and mouth of the patient 
may be put in a vessel containing a strong solution of some “ dis- 
infectant,” which shall be frequently washed with hot water: they 
should not be received upon any thing which is to be kept. Pieces 
of soft cloth, which should be at once burned, may be used in place 
of pocket-handkerchiefs. The breath should be kept as pure as 
may be, by cleansing gargles and washes for the mouth (chlorinated 
soda, permanganate of potash, &c.). The discharges from the 
kidneys and bowels should be disinfected with boiling water, to 
which some deodorizer (nitrate of lead, chloride of zinc, sulphate 
of iron, carbolic acid, chloride of lime, &c.) may be added. Car- 
bolic acid may be added as a disinfectant” to the slops, and to 
the water in which the patient has washed, before throwing it out. 
The skin is usually more comfortable in feeling if cosmoline, &c.., or sweet-oil, with a couple of grains of camphor to the ounce, is 
used for anointing it; the scales of the epidermis are also thereby 
prevented, to a considerable degree, from escaping freely into the 
air. The bed-clothes, towels, &c., when disused, should be re- 
moved with proper care, and be boiled for a couple of hours. The 
food left uneaten should never be carried where it may infect other 
persons. 
While the sick-room is occupied, it is doubtful whether any 
disinfectant can be used of sufficient strength to destroy the con- 
tagium. Many substances, however, do destroy organic matter by 
oxidation, and in that way at least contribute to cleanliness if 
nothing more. For that purpose it is desirable to use nitrate of 
lead, chlorinated soda, chloride of zinc, permanganate of potash, 
&e., because they do not stink of themselves. It has been 
thought that the ancient custom of burning aromatic balsams, &c., 
contributed powerfully to disinfection. 
Attendants on the sick should be as few as possible, and should 
not communicate with other persons any more than can be helped. 
They should wear only such clothing as may be readily washed. 
Clothes used in the sick-room should be boiled before being worn 
elsewhere. Gargling or washing the mouth occasionally with a 
cleansing fluid is a useful measure for those who must be exposed 
to contagion ; and in washing the hands, a little Condy’s fluid 
(permanganate of potash) may be placed in the basin. 
After recovery, the patient should not mingle with other per- 
sons, use lounges, carriages, public rooms, &c., liable to be used 
by others, until all roughness of the skin has disappeared, and 
until he has taken warm baths for several days. 
After the sick-room is no longer needed as such, all the clothing 
and other matters used in it, that can be washed, should be soaked 
in boiling water ; others should be placed in a hot-air chamber, and 
kept at a temperature of 212° F. for several hours. Any articles 
of trifling value may be destroyed by fire. The wall-paper should 
be soaked with carbolic acid, removed and burned. The ceiling 
should be washed with soap and hot water, or scraped. The 
room should then be closed as tight as possible, and as much sul- 
phur burned in it as the air will allow (a pound is an abundant 
amount for an ordinary room) ; it should be kept closed from six 
to eight hours, and then opened for several days to the air and 
sunshine. The floor and wood-work should then be thoroughly 
washed with soap and hot water. Scraping and repainting would 
not be considered an excess of caution in time of epidemics. 
Should the sick person die, the body ought not to.be removed 4 
from the sick-room until it has been sealed in the coffin, with car- 
bolate of iron, carbolized earth, or some similar agent. It is 
advisable that the funeral should be as private as possible, and not 
attended by children. 
Any thing which deteriorates health tends to render the system 
liable to any disease; and in that sense filth may be considered to 
promote scarlet-fever, or to increase its mortality. Perfect clean- 
liness should therefore be enjoined. Sewer-gas, of course, is a 
kind of filth which may bring to one person’s chamber, if it has 
access thereto, the contagium brought from another chamber and 
not disinfected. Overcrowding is one of the most active ways of 
propagating contagious disease. Finally, fresh air is one of the 
best disinfectants. 
In our State, there is a local board of health in every town, 
although in too many cases consisting of a body of men who are 
sufficiently occupied with other duties, and avIio in their character 
of selectmen act ex officio as guardians of health. To each one 
of these boards the law gives full authority to take eveiy step that 
is needed in the preventive measures to be adopted in case of scar- 
let-fever. The sections with regard to isolation are from Chapter 
26 of the General Statutes, and as follows : — 
Section 47. When a householder knows that a person within his 
family is taken sick of . . . any . . . disease dangerous to the public 
health, he shall immediately give notice thereof to the . . . board of 
health of the town in which he dwells. If he refuses or neglects to give 
such notice, he shall forfeit a sum not exceeding one hundred dollars. 
Section 48. When a physician knows that any person wdiom he is 
called to visit is infected with . . . any disease dangerous to the public 
health, he shall immediately give notice thereof to the . . . board of 
health of the town; and if he refuses or neglects to give such notice he 
shall forfeit for each offence a sum not less than fifty nor more than one 
hundred dollars. 
The Board of Health of Boston at present require small-pox, 
scarlet-fever, diphtheria, and typhus-fever to be reported to them. 
Sufficient power is given to school committees also, to restrict the 
attendance at school of children from infected houses. 
These rules for the prevention of scarlet-fever should be carried 
out only under the direction of physicians or boards of health. 
We are full}* aware that many individual cases of scarlet-fever 
occur without any spread of the disease; but the rule is to the 
contrary, and we have no means of knowing that we are safe, 
without taking precautions which a different course might occasion- 
ally have proved to be unnecessary.