TYPHOID FEVER 
ITS 
Cause, Prevention and Suppression 
ISSUED BY 
The Illinois State Board of Health. 
1912. 
REVISED EDITION. 
Please Preserve For Future Use. 
Should a case of Typhoid Fever occur near you, you can do 
yourself and your community A GREAT GOOD, by 
seeing that the family has one of these 
pamphlets. 
Copies may be obtained by any citizen of Illinois, without cost, 
by addressing the Secretary at Springfield. A CAUSE 
A CONSEQUENCE 
Q privy vault 50ft or less from a well is dangerous 
It may be dangerous at 500ft. Qll defends on the soil and 
the direction of theflow^ 
Q sandy soil is least dangerous: Q seamy rock, soil The most 
• ItconndTbesoidthatonysoil within 1000 ft oTo privy vault 
wilU)rotect awell Asandysoil may, a rocky soil will not~ 
The connection between a privy vault ana awell may be 
slow, but once established it is exceedingly sure • 
Thepnvy vault should go, It has caused the death of count- 
lessthousonds There isjittle excusetor its existence in the 
country There is none inthe city that hos a sewerage system 
SOME PACTS TYPHOID FEVER. 
Its Sanitary Features-Precautions to be Taken to Avoid 
the Disease-Rules for Its Prevention, 
Restriction and Suppression. 
ITS SANITARY FEATURES. 
TYPHOID FEVER IS A COMMON AND VERY FATAL DIS- 
EASE. One person out of every eight or ten attacked by the disease 
dies. In some epidemics it is fatal to one of every three affected. In 
many patients even after recovery from the acute attacks, there still per- 
sists serious impairment of the heart and other organs. 
Typhoid fever exists at all seasons of the year, but it is most pre- 
valent in the autumn. The greatest number of deaths occur in Septem- 
ber and October. The time between infection and the appearance of 
the disease is usually from 9 to 14 days. 
During the year 1910, 1,039 deaths were reported from typhoid fever 
in the state of Illinois. There were probably over 15,000 cases of the 
disease, and yet TYPHOID FEVER IS A PREVENTABLE DIS- 
EASE. It can not be prevented, however, unless the necessary precau- 
tions be taken in the sick room. 
The war against typhoid fever must be fought at the bedside of the 
patient. 
Typhoid fever is due to a specific germ (Bacillus typhosus) which is 
passed from the body in the discharges from the bowels and the bladder, 
and from the mouth and nose. If these discharges be properly disin- 
fected in the sick room, or on infected premises, there will be no further 
infection. 
It must be borne in mind that the URINE of a typhoid fever patient 
is even more dangerous than the stools. 
The discharges from the typhoid fever patients reach drinking water 
supplies through sewage, the drainage from privies, or otherwise. 
Water thus infected is a prime cause of typhoid fever. 
TYPHOID FEVER IS IN ALL CASES CAUSED ONLY BY 
THE GERMS BEING SWALLOWED. IT IS CAUSED IN NO 
OTHER MANNER. 
-2 T F 4 
INFECTED WATER IS A CHIEF SOURCE OF TYPHOID. 
In the now famous epidemic at Plymouth, Pa., involving the sickness 
of 1,104 persons and the death of 114, and an actual outlay in money 
of $67,100.11, the outbreak was traced to the use of water polluted by 
the fecal discharges of one imported case of the disease. In a more 
recent epidemic at Maidstone, England, (a city of 35,000), 1,900 cases 
of typhoid fever occurred during a period of two months, all due to 
contaminated water supply. 
Well Water is frequently a cause of the disease. Too often we find 
a privy, or rather a hole in the ground containing fecal and urinary 
discharges, in close proximity to a well, often on higher ground than 
the well. Unless the soil possesses good filtering properties, and this is 
frequently not the case, the well will certainly become contaminated. 
Typhoid fever germs do not live long in streams or rivers, but they will 
retain their vitality for months in suitable soil or in decomposing fecal 
matter. 
Discharges thrown on the ground may be washed into the well or 
spring by the first rain storm. 
A water which has a bad taste or odor, or one coming from a source 
that renders it likely to be impure, may be dangerous, but unfortunately, 
dangerously contaminated water may be, and often is found to be clear 
and colorless and to have no bad taste or odor. The "sparkling water" 
of the well is often a type of the latter. 
Ice taken from a sewage polluted river or lake is liable to 'cause an 
outbreak of typhoid fever. The germs of typhoid fever in the water 
may not be destroyed by the freezing. 
Polluted water is the chief source of typhoid fever, but it is not the 
only source. The disease has been traced to milk, oysters, meats, 
vegetables and other articles of food which have been contaminated by 
the germ, probably through the agency of polluted water, or by hands 
soiled with typhoid discharges. Vegetables may be infected also by 
unclean hands, by flies, or perchance through fertilization of the soil 
with human excreta. 
MILK INFECTED WITH TYPHOID GERMS IS ALSO AN IM- 
PORTANT MEANS OF CARRYING THE DISEASE. There are 
several ways in which the milk may become infected. In a careless family, 
the same person who nurses the typhoid fever patient, may, through 
ignorance of the danger, milk the cows or handle the milk in some man- 
ner, and with hands or clothing soiled with discharges from the patient, 
contaminate the milk. Milk may be diluted or the pails and vessels 
washed with water contaminated with typhoid germs. These may lie 
the means of carrying typhoid germs to it. The typhoid germs do not 
come from the cow. Cows do not have typhoid. 
FLIES ALSO SPREAD TYPHOID FEVER. In fact, much of the 
spread of typhoid fever is caused by flies. Flies feed on discharges from 
the bowels in open vessels, in the privy vault, and on the ground, if the 
discharges be thrown there, and carry the disease to the food supply or 
to the person. The flies carry the typhoid fever germs on their feet, and 
also in their bodies, and deposit the germs on anything on which they 
alight. 5 
It is not pleasant to contemplate that a fly which alights on our 
food, may a few minutes before, have come from a privy vault or a cess- 
pool, but this is frequently the case. Milk is easily infected by flies, and 
the germ of typhoid fever rapidly increases in milk. 
THE DISEASE MAY BE CONVEYED BY THE PERSON AT- 
TENDING THE SICK, either to herself or other persons. For 
example, the nurse's hands will become contaminated. It is not difficult 
for her to carry the germs to her own mouth or to the food or drink of 
others. 
Typhoid fever may be spread from person to person, and from house 
to house, by infected bedding, clothing and household articles soiled by 
discharges from the patient. Infected discharges foolishly thrown upon 
the ground may be brought into the house on the feet of man or dogs 
or cats, and thus cause an outbreak of the disease. 
"TYPHOID CARRIERS" MAY SCATTER THE DISEASE. By 
"typhoid carriers" is meant persons who have apparently recovered from 
the disease, or have the disease in mild form, yet are throwing off 
typhoid germs from their bowels and bladder. A small per cent of all 
typhoid convalescents are capable of infecting others for weeks or 
months. They may be most active factors in the infection of water, 
milk and other food supplies. 
From the foregoing it is evident that the important sanitary precau- 
tion to be taken during the existence of a case of typhoid fever is to 
subject the intestinal discharges, the urine and other secretions of the 
patient to such process of disinfection as will destroy the specific germs 
contained, and to do this promptly and efficiently. (See last pages for 
disinfectants.) 
In this work Boards of Health can do little, unaided by the family 
physician. Upon him rests the responsibility of seeing that thorough 
disinfection is carried out in every case of typhoid fever he may be 
called upon to treat. 
A stable fly (Muscina stabulans): Adult, larva, and details. All enlarged. 6 
PRECAUTIONS TO BE TAKEN TO AVOID TYPHOID FEVER. 
(One of the best methods for the prevention of the spread of typhoid 
fever is the thorough disinfection of all discharges from the bowels and 
bladder of a typhoid fever patient.) 
Do not drink unboiled or unfiltered water which may have received 
sewage. An observance of this precaution will result in the saving of 
many lives and the prevention of much sickness and distress. Remem- 
ber that practically all streams receive more or less sewage. 
Do not eat, if you can avoid it, raw vegetables or fruit which have 
been washed with unboiled or unfiltered water of questionable purity. 
Thoroughly wash, in boiled or filtered water, all vegetables and fruits 
before eating them. 
Boil, if you cannot properly filter, all suspected water before drink- 
ing. Boiling kills the germs. 
Do not place full dependence on the household filter. The ordinary 
faucet filter is often worthless. A filter of stone or charcoal is dangerous 
unless cleaned daily. Buy no filter until it has been endorsed by some 
well known chemist or bacteriologist. Keep your filter clean. 
Ice from a stream, river or lake which receives sewage, should never 
be used for domestic consumption. All natural ice should be looked 
upon with suspicion, especially during the prevalence of typhoid fever, 
unless it be known that the supply comes from a source free from 
sewage contamination. It is better not to allow natural ice of any kind 
to come in direct contact with food or water. Ice is often taken from 
waters which are never used for domestic supply by those who live near 
them. 
Beware of well water, unless you are certain of its purity. Hideous 
death is often concealed in the "old oaken bucket," and the chain pump 
of the day. A well situated within 100 feet of a privy vault, in a 
porous soil, is dangerous. There may be danger at a greater distance, 
owing to crevices in rock strata or a pervious soil. 
Waters from the well known springs* of the United States are used 
very extensively in Illinois. There is much to be said in favor of the 
use of these waters, but they must be handled cleanly. 
Avoid receptacles from which the typhoid fever patient drank. Avoid 
a well on or near the premises on which there is, or has recently been, 
a case of typhoid. 
A close, or maybe a cursory, examination may reveal the exciting 
cause of the disease. In the city a defective sewer or cesspool; in the 
country, a close proximity to privy vaults. 
Do not, if you can avoid it, use impure water for toilet purposes. 
Typhoid fever has been transmitted by washing the teeth or gargling 
with contaminated water. 
WATER AND ICE. 
* There are quite a number of mineral springs in Illinois. Some of these produce waters excellently 
adapted for the table. The waters from these springs are very similar to those coming from springs in 
other states which have acquired much reputation. It has been said that in Illinois there can be found 
close counterparts of the best foreign springs, that Carlsbad and other European spas have their analogues 
in our own state. 7 
Do not drink water from taps, fountains or water coolers in stores, 
trains or shops, when typhoid fever is prevalent, unless you know that 
the water is pure. The drink of polluted water may mean your own 
illness or death, and the infection'of your family. 
An enidemic of typhoid fever in Illinois resulted from passing a jug 
of water from man to man among a "threshing gang"-"one of the men 
felt badly for several days, and later was Taken down' with typhoid 
fever." 
Keep your premises in a sanitary condition. Good water, good sewer- 
age and drainage help to ward off typhoid fever. 
MILK. 
Milk is not an uncommon source of typhoid, but the disease does not 
come from the cow. The contamination of milk usually results from 
the washing of the cans and utensils in polluted water. It may occur, 
however, through the infected hands of the milkman, who is a so-called 
"typhoid carrier," or who has been in close contact with a patient. A 
watered milk may contain the germs of typhoid, for the milkman who 
violates the law and adulterates his milk with water, is not usually care- 
ful of the quality of the water. The typhoid germ grows and multi- 
plies rapidly in milk. Milk which is contaminated with water, con- 
taining only a few bacteria, quickly becomes exceedingly dangerous. 
Do not take milk from a dairy or family where a member of the 
family is "down with the fever." When you buy milk, get it in bottles 
from a dealer who properly cleanses his bottles in boiling water or that 
near the boiling point. 
FLIES. 
Wire screen doors and windows properly fitted are an excellent pro- 
tection against typhoid fever. The kitchen and dining room, and any 
place where milk and other foods are kept or handled, should be 
especially guarded against flies which may carry to the food typhoid 
fever germs from a nearby dung heap or privy. KEEP THE FLIES 
OUT ! KILL THOSE THAT GET IN ! KILL THE FLY! A bit of 
wire netting attached to a wooden handle is a convenient weapon. Keep 
it handy. 
Prevent the breeding of flies by destroying their usual breeding 
places. Keep the premises clean. House flies are bred and born in 
filth-in the privy, open garbage can, manure pile. In stables where 
manure can not be carted away daily, use chlorid of lime freely each 
day. Besides screening the privy, pour kerosene over the contents of 
the vault frequently and in liberal amounts. These means will kill the 
larvae (maggots) which later would become the flies which infest your 
home, drop into your milk- or coffee, drag over the butter and infect 
your food with the germs carried on their feet and legs from the privy 
vault. 8 9 
Typhoid fever is a self-limited disease, i. e., if the patient does not 
die, the body reacts against the invading germs with the production of 
"antibodies" which limit the disease to a variable number of wee'ks, after 
which recovery takes place and the germs disappear from the body. 
This fact led to the discovery in recent years that by injecting 
under the skin a small quantity of dead typhoid culture of known 
strength, the body would react against these organisms (germs) the 
same way as against the living typhoid germs in the bowels, resulting in 
increased antibodies which persist for a considerable time, making the 
person resistant to typhoid infection. The method has been thoroughly 
tried out in the British, Japanese and American Armies. It has been 
so successful in preventing typhoid fever, that today in the U. S. Army 
nearly every officer and enlisted man has been inoculated. 
In 1898, in the Seventh Army Corps, stationed at Jacksonville, Fla., 
consisting of 10,759 men, there were 1,729 undoubted cases of typhoid 
fever, and 2,693 thought to be typhoid-a total of 4,422 cases, with 248 
deaths. In the maneuvers at San Antonio, Texas, in 1911, there were 
12,801 men, all inoculated against typhoid fever. The troops remained 
in their several camps from March 10, 1911, to the middle of July, a 
period of approximately four months, and during that time there were 
two cases of typhoid with no deaths. Yet civilians, uninoculated, died 
from typhoid in the same vicinity. 
The vaccine may be purchased from the leading biological firms in 
this country. 
Persons subjected to the dangers of tynhoid infection should receive 
the protective treatments. It requires three treatments, extending over 
a period of 20 days, the treatments being 10 days apart. 
Antityphoid vaccination in healthy persons is a harmless procedure. 
It confers almost absolute immunity against infection. 
It was, as stated, the principal cause of the immunity of our troops 
against typhoid- in the recent Texas maneuvers. 
The duration of the immunity is not yet determined, but is assuredly 
two and one-half years, and probably longer. 
Only in exceptional instances does its administration cause an ap- 
preciable degree of personal discomfort. ' 
It apparently protects against the chronic bacillus carrier, and is, 
at present, the only known means by which a person can be protected 
against typhoid under all conditions. 
All persons whose profession or duty involves contact with the sick 
should be immunized. 
The general vaccination of an entire community is feasible and 
could be done without interfering with general sanitary improvements, 
and should be urged wherever the typhoid rate is high. 
Antityphoid vaccine is destined to- play an important part in the treat- 
ment of typhoid fever. 
ANTITYPHOID VACCINATION. 10 
In army camps, in mining camps, and in great public works, bringing 
together large numbers of men for a longer or shorter time, there is sel- 
dom the proper care of excreta, and the carriage of typhoid germs from 
the latrines and privies to food by flies is common and often results in 
epidemics of typhoid fever. 
And such carriage of typhoid by flies is by no means confined to these 
great temporary camps. In farmhouses in small communities and even 
in the badly cared-for portions of large cities typhoid germs are carried 
from excrement to food by flies, and the proper supervision and treat- 
ment of the breeding places of the house fly become mos't important ele- 
ments in the prevention of typhoid. 
In the same way other intestinal germ diseases are carried by flies. 
The Asiatic cholera, dysentery, .and infantile diarrhea are all so carried. 
Nor are the disease-bearing possibilities of the house fly limited to 
intestinal germ diseases. There is strong circumstantial evidence that 
tuberculosis, anthrax, yaws, ophthalmia, smallpox, tropical sore, and 
parasitic worms may be and are so carried. Actual laboratory proof 
exists in the cases of a number of these diseases, and where lacking is 
replaced by circumstantial evidence amounting almost to certainty.-- 
U. S. Department of Agriculture, Farmers' Bulletin 459. 11 
CARE OF A PATIENT-STEPS NECESSARY TO PREVENT A 
SPREAD OF THE DISEASE. 
Every case of typhoid fever should be reported to the proper health 
authority by the attending physician or head of the family. 
Painless diarrhoea, or simple "looseness of the bowels," occurring in 
one who has never had typhoid fever should excite suspicion while this 
disease exists in a neighborhood. The disease varies in the intensity of 
its symptoms, so that mild, walking cases are not uncommon. It is ad- 
visable, therefore, that all diarrhoeal discharges should be disinfected 
during the existence of typhoid fever in a community. 
EVERY CASE OF SO-CALLED "TYPHO-MALARIA FEVER" 
and every case of FEVER OF DOUBTFUL ORIGIN CONTINUING 
MORE THAN SEVEN DAYS, SHOULD BE REPORTED to the 
local health officer, and the same precautions taken as in positive cases 
of typhoid. 
While typhoid fever may not be "contagious," in a strict sense, it is 
unquestionably "communicable," and the disease has been communicated 
from the patient at times when the contact of others with him was, 
seemingly, very slight. No persons, except those necessary to the care of 
the patient, should come in contact with him. 
WITHIN THE INFECTED HOUSE itself the important matter 
to attend to is the prompt disinfection of all discharges from the patient 
and of everything liable to come in contact with such discharges. The 
following details should be observed: 
THE SICK ROOM-The sick room should be large, easily venti- 
lated and as far from the living and sleeping rooms of other members 
of the family as it is practicable to have it. All ornaments, carpets, 
drapery and articles not needed in the room should be removed. A free 
circulation of air from without should be admitted both by night and 
by day. Pure air is an effective disinfectant. The bed should be pro- 
tected with a rubber sheet over the mattress. The physician should be 
constantly consulted as to details. 
NURSES-Not more than two persons, one of them a skilled, pro- 
fessional nurse, if obtainable, should be employed in the sick room and 
their intercourse with other members of the family should be properly 
restricted. The person or persons nursing or attending the patient must 
not handle or prepare food for other members of the household. If 
possible, the attendants should be selected from those who have already 
had typhoid fever. 
PERFECT CLEANLINESS of nurses and attendants should be en- 
joined. As the hands of nurses may become contaminated, a good sup- 
ply of towels and basins, one containing equal parts of soft water and 
Standard Disinfectant No. 3, (see last page) should always be on hand. 
SCREEN THE WINDOWS, not only to save the patient annoyance 
from flies, but, to prevent flies from carrving the infection elsewhere. 
Kill any flies which may get in. Don't allow them to escape from the 
house. Don't "shoo" them out. They may carry the disease to others. 
Delay Always Breeds Danger. 12 
Do As You Would Be Done By. 
CARE OF DISCHARGES-The most scrupulous care should be 
taken, from the commencement of the illness, of the discharges from 
the bowels and bladder. The stools or urine should be received in a 
vessel containing at least a quart of Standard Disinfectant No. 1, 
(chlorid of lime or carbolic acid) or Standard Disinfectant No. 2. Let 
the discharges, after thorough mixing with the disinfectant, stand in 
the vessel for at least one hour. 
When practicable-instead of being thrown into a privy or water 
closet, the discharges after being thoroughly disinfected should be 
buried in the ground at least 100 feet away from any well or source of 
water supply. In any event, the discharges must be thoroughly disin- 
fected before disposal. 
The discharges from the throat, mouth and nose are dangerous 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 disin- 
fecting solution, to receive these cloths until they can be carried from 
the room and burned. 
Water closets in houses should be freely disinfected with Standard 
Disinfectant No. 1 (carbolic acid). 
DISINFECTION IN THE SICK ROOM-A pail or tub of Stand- 
ard Disinfectant No. 3 should be kept in the sick room, and into this 
all clothing, blankets, sheets, towels, etc., used about the patient or in 
the room should be dropped immediately after use and before being 
removed from the room. They should then be boiled as soon as prac- 
ticable. Rags, toilet paper or other material used about the person of 
the patient should be immediately burned. All water which has been 
used for bathing the patient should be disinfected before being thrown 
out. One-half pound of fresh chlorid of lime added to a tub of water 
is sufficient to disinfect, allowing one hour to act. 
All knives, forks, spoons, glasses, cups and plates used by the patient 
must be disinfected at once, by being put into a carbolic acid solution, 
(Standard Disinfectant No. 1), or by being thoroughly boiled. 
Dust and dirt should be removed with cloths dampened with Standard 
Disinfectant No. 3, as sweeping and dusting are objectionable. 
KEEP THE PREMISES CLEAN-All decaying and vegetable mat- 
ter and every kind and source of filth in and around the house should 
be removed, and disinfectants freely used. Surface drains and gutters, 
areas, outhouses, privies, shelters for domestic animals, fowls, etc., 
should receive close and constant attention and Standard Disinfectant 
No. 1, or No. 4 should be used freely and regularly in every such place. 
CARE AFTER RECOVERY-After apparent recovery and during 
convalescence, the patient is to be considered dangerous to others so long 
as the intestinal discharges continue to be more copious, liquid and fre- 
quent than natural; and disinfection should be carried on until the 
attending physician advises that it is no longer necessary. 
Whatever thou takest in hand remember the end, and thou shalt 
never do amiss. 13 
DEATHS. 
In the event of death the body must be wrapped in a sheet thoroughly 
soaked in Standard Disinfectant No. 3, and placed in an air-tight coffin, 
which must remain in the sick room until removed for burial. Public 
funerals and wakes over such bodies should not be held. 
DISINFECTION AFTER RECOVERY OR DEATH. 
When an apartment which has been occupied by a person sick of a 
dangerously communicable disease is vacated, it should be disinfected. 
Don't occupy an apartment or house in which there has been a case 
of typhoid, unless it was subsequently properly disinfected. 
'i* 
The object of disinfection in the sick room is the destruction of in- 
fectious material attached to surfaces, or deposited as dust upon window 
ledges, in crevices, etc. If the room has been properly cleansed while 
still occupied by the sick person, and especially if it was stripped of un- 
necessary furniture at the outset of the attack, the difficulties of disin- 
fection will be greatly reduced. 
The work of disinfecting articles should begin with the beginning of 
the treatment, and should continue during the whole course of the dis- 
ease. All articles of bed clothing and of body clothing should be disin- 
fected as soon as they are removed from the bed or from the patient. 
FUMIGATION, OR GASEOUS DISINFECTION can be per- 
formed either with formaldehyde gas or with the fumes of burning 
sulphur. 
Regardless of the disinfectant adopted, the following preparatory 
steps should be taken: 
(a) Have all windows and doors (except door 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 fire place if 
there be one. There must be no opening through which gas can 
escape. 
(b) All articles in the room that cannot be boiled must be spread 
out on chairs or racks. Clothing, bed covers, etc., should be hung on 
lines stretched across the room. Matresses 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 the feathers. Do 
not pile articles together. 
* Use moistened soap for pasting paper strips, so they may later be washed off easily. 14 
FORMALDEHYDE DISINFECTION-In formaldehyde disinfec- 
tion, the method recommended, 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 15 
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 good 
quality of bright tin, is supplied with a double bottom with y± 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 pro- 
duction and liberation of the gas. This special container can be made 
by any tinner of ordinary intelligence, and costs but a few dollars. It 
is illustrated on preceding page. 
With the room sealed, as described above, as is essential to any form 
of aerial disinfection, crystals of potassium permanganate (6% ounces 
to each 1,000 cubic feet of room space, or 10 ounces when the temper- 
ature is below 60° F.), are placed in the container. Over these is 
poured "formalin," or 40 per cent aqueous solution of formaldehyde 
(16 ounces to every 1,000 cubic feet or room space or 24 ounces when 
the temperature is below 60° F.)., The formaldehyde is promptly liber- 
ated by the vigorous reaction of the formalin and potassium perman- 
ganate, and rises from the generator in immense 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 should be promptly closed and sealed, and 
the room left closed for at least four hours. 
The sick room is not the place for experiments. 
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 re- 
sult in complete failure: 
1. The room should be sealed and prepared as described. 
2. The potassium permanganate (6% 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 be 
put in before the formaldehyde solution. 
3. The 40 per cent formaldehyde solution (16 ounces to every 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. 
Whenever practicable, the special container, 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. The milk pail should be set, so as to fit 
snugly into a wooden or pulp bucket or it may be wrapped tightly with 16 
several layers of asbestos paper. This is done to retain the heat within 
the generator and is very important to the proper generation of the gas. 
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 container; 
Formaldehyde, 32 ounces; 
Permanganate, 13% ounces. 
Larger quantities than these should not be used. 
If good results are to be obtained, 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 bet- 
ter than the rhomboid crystals. See that you get crystals of potassium 
permanganate; do not accept the dust, which often contains impurities. 
Don't use "Formaldehyde Candles/' Don't rely on the apparatus 
which the energetic, and anxious-to-make-a-sale-tradesman tells you is 
better than that recommended by the State Board of Health. 
SULPHUR DISINFECTION. 
If sulphur is preferred for aerial disinfection, it may be used in the 
following manner: 
Use 3 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. 
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 wash tub, 
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 wash tub and contents on a table. The disinfecting 
"apparatus" is then in working order. 
Moisten the sulphur with alcohol and ignite. When the sulphur be- 
gins to burn, leave the room, close the door of egress, and carefully 
paste strips of paper, as previously described, over the keyhole, and all 
openings above, beneath and at sides of door. Keep the room closed for 
ten hours at least after starting the fumes. 
Sulphur candles can be used instead of crude sulphur, but care must 
be taken to use sufficient candles. The average candle on the market 17 
contains one pound of sulphur. Three of these will be required in the 
disinfection of a small room, 10x10x10. Do not use a smaller number, 
no matter what directions may accompany the candle. The water 
jacketed candle is preferable. Partly fill tin around candle with water 
and place candles 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. 
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. Fabrics, however, can be effectually disinfected by hanging 
them on a line exposed to the sun and wind for several days. Curtains 
and all articles of cotton or linen can be disinfected by boiling or soak- 
ing them in Standard Disinfectant No. 3 for several hours, and portable 
articles of brass, copper, steel and gilt work by washing them with a 
solution of carbolic acid (Standard Disinfectant No. 1). 
The room should be thoroughly cleansed after disinfection. All out- 
of-the-way places, window ledges, mouldings, etc., should be washed with 
Standard Disinfectant No. 3. The floors should receive careful attention 
and the solution should thoroughly'wet the dust and dirt in the cracks. 
If it is desired, a solution of formaldehyde can be employed instead 
of Standard Disinfectant No. 3, using six and one-half ounces of for- 
maldehyde to one gallon of water. 
After the apartments are opened, take out all articles and place in 
the sunshine. Carpets should be cleaned (preferably by the use of a 
vacuum cleaner), and exposed to the air. Mattresses and pillows soiled 
by discharges should be burned. 
A copy of this circular, liberal supplies of which can be secured on 
application to the Secretary of the Board at Springfield, should be in 
every family in which there is a case of typhoid fever, and in other 
families which may have been exposed to the disease, and should also be 
furnished 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. 18 
Two Methods of Arranging Books for Disinfection. 19 
ILLINOIS STATE BOARD OF HEALTH. 
Official Rules Concerning the Prevention and Suppression 
of Typhoid Fever. 
Office of the Secretary, 
Springfield, III., Oct. 1, 1912. 
To Health Authorities and Attending Physicians: 
The ever-increasing difficulties in sewage disposal, and the more 
general contamination of water supplies, incidental to the rapidly grow- 
ing population in all parts of the State, necessarily lead to wider pre- 
valence of water-borne diseases, of which, in recent years, typhoid fever 
has become by far the most important. The spread of this disease 
generally throughout the state, renders necessary the freer distribution 
of information as to its prevention and restriction, and advances in 
medical science require the complete revision of the literature formerly 
used by the State Board of Health. The appended rules and regula- 
tions, originally published in February 1883, and republished in revised 
form, by special resolution of the Board, in January 1904, have been 
entirely rewritten, and are distributed with the knowledge that wherever 
they are thoroughly carried out, typhoid fever will either be prevented 
where it threatens, or readily controlled and suppressed where it has 
already appeared. 
This action of the Board in promulgating its rules and regulations 
concerning preventable, communicable disease, is taken in conformity 
with the statute, which vests the State Board of Health with supreme 
authority in all matters pertaining to quarantine, and with the duty of 
making all necessary rules and regulations for the preservation or im- 
provement of the public health, and such rules and regulations have, 
therefore, the weight and authority of law. By the same statute the en- 
forcement of these rules is made binding upon all health authorities in 
the state. Such authorities embrace: 
1. City councils, or presidents and boards of trustees, or the 
regularly constituted boards of health of incorporated cities, towns and 
villages. 
2. Supervisors, assessors and town clerks of townships. 
3. County commissioners of counties not under township organiza- 
tion. 
-3 T F 20 
The rules and regulations which follow are believed to cover every 
important detail, and are part and parcel of this order, to be strictly 
enforced in appropriate cases. A copy should be left in every house 
where there is a case of typhoid fever, and the republication of the rules 
in the local papers, wherever the disease appears, is recommended. 
By order of the State Board of Health. 
James A. Egan, M. D., 
Secretary. 
PUBLIC HEALTH LAWS OF ILLINOIS. 
Extract from the Revised Statutes. 
§ 2. Powers and authority of the board.] The State Board of 
Health shall have the general supervision of the interests of the health 
and lives of the people of the state. They shall have supreme authority 
in matters of quarantine, and may declare and enforce quarantine when 
none exists, and may modify or relax quarantine when it has been estab- 
lished. The Board shall have authority to make such rules and regula- 
tions and such sanitary investigations as they may from time to time 
deem necessary for the preservation and improvement of the public 
health, and they are empowered to regulate the transportation of the 
remains of deceased persons. It shall be the duty of all local boards of 
health, health authorities and officers, police officers, sheriffs, constables 
and all other officers and employes of the state or any county, .village 
or township thereof, to enforce the rules and regulations that may be 
adopted by the State Board of Health. 
It shall be the duty of the State Board of Health to investigate into 
the cause of dangerously contagious or infectious disease, especially 
when existing in epidemic form, and to take measures to restrict and 
suppress the same, and whenever any dangerously contagious or in- 
fectious disease shall become, or threaten to become epidemic, in any 
village or city, and the local board of health or local authorities shall 
neglect or refuse to enforce efficient measures for its restriction or sup- 
pression or to act with sufficient promptness or efficiency, or whenever 
the local board of health or local authorities shall neglect or refuse to 
promptly enforce efficient measures for the restriction or suppression of 
dangerously contagious or infectious diseases, the State Board of Health 
or their secretary, as their executive officer, when the Board is not in 
session, may enforce such measures as the said. Board or their executive 
officer may deem necessary to protect the public health, and all neces- 
sary expenses so incurred shall be paid by the city or village for which 
services are rendered. 
§ 7. Any person who violates or refuses to obey any rule or regu- 
lation of the State Board of Health shall be liable to a fine not to 
exceed $200.00 for each offense or imprisonment in the county jail not 
exceeding six months, or both, in the discretion of the court. All prose- 21 
cutions and proceedings instituted by the State Board of Health for 
violation of their rules and regulations shall be instituted by the Board 
or by their executive officer, and it shall be the duty of the State's At- 
torney in each county to prosecute all persons in his county violating or 
refusing to obey the rules and regulations of the State Board of Health. 
All fines or judgments collected or received shall be paid over to the 
State Treasurer and credited to the fund created for the support of 
the State Board of Health. 
POWERS OF CITY COUNCILS IN CITIES AND PRESIDENTS 
AND BOARDS OF TRUSTEES IN VILLAGES INCOR- 
PORATED UNDER THE GENERAL LAW. 
[Revised Statutes, Chap. 2^, Sec. '62.'] 
(Extract.) 
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-eight-To do all acts, make all regulations which may be 
necessary or expedient for the promotion of health or suppression of 
disease. 
Eighty-third-To prohibit any offensive or unwholesome business or 
establishment within, or within one mile of, the limits of the corpora- 
tion. 
Eighty-fourth-To compel the owner of any grocery, cellar, soap or 
tallow chandlery, tannery, stable, pig sty, privy, sewer or other unwhole- 
some or naseous 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 regula- 
tions, 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 $200.00, 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 quaran- 
tine regulations thereof. (Revised Statutes, Chap. 2Jf., Sec. 44-) 22 
POWERS OF COUNTY AND TOWNSHIP BOARDS OF HEALTH. 
[Act approved May 10, in force July 1, 1901. Amended by Act in force 
July 1, lOOS.} 
(Revised Statutes, Chap. 34.) 
(Extracts.) 
116. Section 1. The board of county commissioners in counties 
not' under township organization, and the supervisor, assessor and town 
clerk of every town in counties under township organization, shall con- 
stitute a board of health, and on the breaking out of any dangerously 
communicable diseases in their county or town or in the immediate 
vicinity thereof, it shall be their duty to make and enforce such rules 
and regulations tending to check the spread of the disease within the 
limits of such county or town, as may be necessary; and for this pur- 
pose 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: Pro- 
vided, 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 town- 
ship organization, or of any township in counties under township or- 
ganization shall fail, refuse or neglect to promptly take the necessary 
measures to preserve the public health, 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. 
117. Section 2. The said boards of health shall have the follow- 
ing 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. 
Fourth-To provide gratuitous vaccination and disinfection. 
Fifth-To require reports of dangerously communicable diseases. 
118. Section 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 $200.00 for each offense, or imprisonment in the 
county jail not exceeding 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 attor- 
ney in the respective counties to prosecute all persons violating, or re- 
fusing to obey, the rules of said local boards of health. 23 
RULES AND REGULATIONS. 
DUTIES OF ATTENDING PHYSICIAN AND HEALTH 
AUTHORITY. 
Immediately upon receipt of notice of the existence of a case of 
typhoid fever, the health officer should visit the locality and secure 
prompt compliance with the precautions set forth herein. 
He should- 
1. Make a careful investigation as to the probable cause of the dis- 
ease. If due to an infected milk supply or ice, the use of such supply 
should be immediately stopped. If probably from a contaminated well 
or general water supply, see that measures are taken, by boiling the 
water or stopping its use, to prevent further cases being caused in the 
same manner, and communicate with the State Board of Health as to 
water analysis. 
2. Give public notice of every infected place so that no person may 
unguardedly drink water or take food from a source likely to be con- 
taminated, or in any manner contract the disease. 
3. Order the disinfection of the urine and all discharges from the 
bowels, mouth and nose of patient sick of typhoid fever. 
4. Order the disinfection of the contents of the privy on the prem- 
ises, or any other that has been used by the patient. 
5. Order that the premises be kept in a sanitary condition. Allow 
no filth to accumulate. Have all rubbish burned. See that all breeding 
places of flies are removed. Recommend the free use of disinfectants. 
See that the house is screened, if possible. But the patient's room and 
the discharges at least must be protected from flies at all hazards. 
6/ Order the disinfection of all articles of clothing or bedding that 
have been soiled by discharges from the patient, and of the water after 
being used in bathing the patient. 
7. Secure the cooperation of the people in the prevention' of this 
disease, by teaching them its mode of spread, and the best methods for 
its prevention. 
QUARANTINE SHOULD BE UNNECESSARY. It is unneces- 
sary to quarantine a case of typhoid fever, or the premises in which it 
exists, provided proper care is given to all the details of the sick room, 
as recommended, but general visiting of the sick should be restricted as 
much as possible. 24 
THE "L. R. S " PRIVY.* 
(Devised by L. L. Lumsden, Passed Assistant Surgeon, Norman Roberts, 
Passed Assistant Surgeon, and Ch. Wardell Stiles, Professor of Zoology, 
United States Public Health and Marine-Hospital Service.) 
* Described in Bulletin of State Board of Health February, 1911. 25 
The use of placards has been largely discontinued in this disease, and 
is not required by the State Board of Health. 
If disinfection is practiced as strictly as it should be, there is no dan- 
ger of the disease being communicated to others from a given case; but 
constant cleanliness and disinfection are absolutely necessary to secure 
such results. 
CLEANLINESS-Scrupulous cleanliness of the premises should be 
enforced. All decaying animal and vegetable matter, and every kind 
and source of filth in and around the house should be removed and dis- 
infectants be freely used. Surface drains and gutters, areas, outhouses, 
privies, shelters for domestic animals, fowls, etc., should receive close 
and constant attention and Standard Disinfectant No. 1 or No. 4 should 
be used freely and regularly in every such place. 
The precautions recommended to prevent the extension of the infec- 
tion to other localities are of even more importance than there upon 
the premises where a case of typhoid fever exists. Here is the greatest 
danger of the poison finding lodgment in the soil which favors its 
growth and intensity-namely, filth in any form. Therefore, the ad- 
vice given above should be rigidly carried out in its every detail upon 
the infected premises. 
THE WATER SUPPLY-A strict examination should be made of the 
character of the water supply of the locality. If there be any reason to 
suspect that this may be possibly contaminated from the patient, its use 
should be forbidden till the proper measures can be taken to protect it 
against such contamination, and the question of its safety be definitely 
settled. The location of wells, with reference to the privy into which 
typhoid discharges are thrown, the inclination of the ground between 
such points, and the character of the soil, should all be taken into con- 
sideration. Wells into which surface washings from the infected prem- 
ises might find their way by the natural slope of the ground, and wells 
within a given distance of the privy of such premises, should be at once 
abandoned. The contaminating distance varies according to the nature 
of the soil and the depth of the well; in a loose, porous soil a well 30 
to 40 feet deep will be dangerous if within 100 feet of typhoid premises. 
If the case exists in a sewered neighborhood, every householder whose 
premises connect with a sewer in common with the infected house 
should have a thorough inspection made of the drainage of his own 
premises. If the sewer connection be not broken by a proper ventilating 
shaft, extending above the highest point of the roof, such shaft should 
be provided forthwith. All interior plumbing should be examined, de- 
fective joints repaired, traps put in order and the flushing devices of 
water closets made effective. 
The health officer should also superintend the disinfection of rooms, 
clothing and premises, and finally, cooperating with the attending 
physician, give official certificate of recovery and of freedom from lia- 
bility to communicate the disease to others. Until such certificate is 
issued a system of isolation should be maintained with regard to an 
infected house and its contents-persons and things. 
In a serious trust negligence is a crime. 26 
Rear and side view of a single-seated sanitary privy. 
(Described in Bulletin, State Board of Health, September, 1911.) 27 
In the event of death from a malignant case, or where there are a 
number of severe cases in one house or locality, the health officer should 
exercise even greater authority than here indicated. He should enforce 
disinfection, cleansing of premises, protection against flies, abandon- 
ment of suspected water and other measures-even quarantine, arbi- 
trarily if necessary, and should enforce the prohibition of public funerals 
and wakes. 
EXAMINATION OF WATER SUPPLIES-The State Water Sur- 
vey, acting in conjunction with the State Board of Health, will make 
a sanitary-chemical and bacteriological-examination of public or pri- 
vate water supplies, free of charge, whenever there is reason for sus- 
pecting contamination, and the samples are collected by or under the 
direction of the State Water Survey or the State Board of Health. For 
other water analyses, the State Water Survey will make a charge to 
cover actual cost of such examinations. 
EXAMINATIONS ARE MADE AT URBANA, not at Springfield. 
Directions for collecting samples and proper containers for their trans- 
mission may be secured by making application to Dr. Edward Bartow, 
Director of the State Water Survey, Urbana, Illinois. Before samples 
are sent for analysis the sender should communicate with Dr. Bartow. 
No samples, except those sent in the containers furnished by the State 
Water Survey, will be examined under any circumstances. Those desir- 
ing analyses will be expected to pay transportation charges on the con- 
tainers from Urbana, and on the containers and samples to Urbana. 
EXAMINATIONS OF THE BLOOD-Physicians are reminded 
that the State Board of Health will assist in the diagnosis of typhoid 
fever, by means of the WIDAL test. Examinations are made free of 
charge, at the laboratory of the Board at Springfield. Plates and in- 
structions for the transmission of specimens may be obtained upon appli- 
cation to the laboratory. 
STANDARD DISINFECTANTS. 
The following are simple, cheap and reliable disinfectants: 
Standard Disinfectant No. 1. 
Dissolve chlorid of lime of the best quality, in water, in the propor- 
tion of five and one-half ounces to the gallon. 
Use one quart of this solution for each discharge from a patient. Dis- 
charges 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. Chlorid of lime in powder 
can be used freely in privy vaults. 
The chlorid of lime must be of the best quality. Poor chlorid of 
lime is worthless. The solution should be made when required. 
Instead of chlorid of lime, carbolic acid may be used in the strength 
of six and one-half ounces to the gallon of water. 28 
Standard Disinfectant No. 2. 
Dissolve corrosive sublimate, and muriate of ammonia in water, in 
the proportion of two drachms (120 grains-y± ounce) of each to the 
gallon. Dissolve in a wooden tub, barrel or pail, or in an earthen crock. 
Use for the same purposes and in the same way as No. 1. It is 
equally effective, but slower in action. This solution is odorless while 
the chlorid 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) each of corrosive subli- 
mate and muriate of ammonia in one gallon of water. Dissolve in a 
wooden tub, barrel or pail, or in an earthen crock. 
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. 
Good chlorid 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 Alteration or by 
decantation, but the insoluble sediment does no harm, and this is an 
unnecessary refinement. 
^Chlorid of lime, carbolic acid and corrosive sublimate are deadly 
poisons. 
^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. 
^Solutions of chlorid of lime, carbolic acid and corrosive sublimate 
will injure lead pipes if passed through them in large quantities with- 
out free flushing. 
Standard Disinfectant No. 4. 
MILK OF LIME (QUICK LIME). 
Slack a quart of freshly burnt lime (in small pieces) with 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) re- 
sults. 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. 
Quicklime is one of the cheapest of disinfectants. 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, vaults, drains, stag- 
nant pools, etc. 29 
SANITARY ADVICE FOR SUMMER TOURISTS 
AND SANITARY ADVICE FOR KEEPERS 
OF SUMMER RESORTS. 
SANITARY ADVICE FOR SUMMER TOURISTS.1 
By W. C. Rucker, Assistant Surgeon General, Public Health 
and Marine-Hospital Service. 
With the advent of warm weather and the consequent closing of 
schools comes the thought of leaving the city for the cool country. The 
tired teacher and the over-worked clerk, the restive school boy, anxious 
to leave his books for the great out of doors, the society matron, bored 
by the constant round of social duties, all long to get away from the 
city and to spend the summer in some shady rural retreat. Too fre- 
quently the realization of this happy anticipation is a hasty return to 
the city and a long stay in the hospital, to be followed, perhaps, by the 
death of some loved one. Much of this may be avoided if reasonable 
care is exercised in the choice of the place to spend the summer. 
Ordinarily the questions which are asked when one is seeking for 
such a place include the character of the food and beds, the extent and 
nature of the social life, the temperature of the air, and the opportun- 
ities for, bathing. All of these are important, but they are of secondary 
consideration as compared with the question of the healthfulness of the 
locality in which it is intended to spend the warm months. Therefore, 
in choosing a summer residence the first thing to have in mind is the 
sanitary environment in which this time is to be spent. 
Every autumn there is a rise in the number of typhoid cases in the 
cities, and when this is investigated it is frequently found that they 
are simply cases which have been imported from the country. Persons 
have left the city in search of health, and, as they are accustomed to 
think that health may be obtained and maintained best in the country, 
they accept it without question as the place to get health. 
Typhoid fever is a disease which summer tourists frequently contract; 
therefore it is always well to bear the avoidance of this disease in mind 
in choosing a summer residence. Typhoid fever is a disease of man. 
The germ which causes it leaves the body of the person sick with the 
i Reprint from the Public Health Reports, Vol. XXVII, No. 21, May 24, 1912. 30 
disease in his discharges, and when these are taken by a well person a 
secondary case of the disease is caused. The germs of typhoid fever are 
carried from the sick to the well in water and food and by flies and the 
fingers. If one does not take into his system the discharges of another 
person having typhoid fever he does not get typhoid fever. At the 
present time typhoid fever is essentially a disease of the country, be- 
cause in the country the opportunities for the transference of the germs 
of the disease from the sick to the well are greater than they are in the 
city. Therefore in the choice of a place to spend the summer one should 
inquire into the occurrence of typhoid fever in the community in which 
it is intended to stay, and one should determine the opportunities which 
exist there for the carrying of the germs of typhoid fever from the sick 
to the well visitor. 
Since the germ is carried in the discharges of persons sick with 
typhoid fever, a.careful inspection should be made of the facilities for 
disposing of human excrement. A place which has a surface privy to 
which the domestic animals and fowls have free access should not be 
chosen. Places which have a pit privy or a cesspool situated only a 
short distance from a well should be avoided. Places which take their 
drinking water from streams which receive the drainage of outhouses 
or from buildings should likewise be regarded with suspicion. Other 
things being equal, places having a water supply from artesian or deep- 
driven wells should be given the preference. Unscreened toilets, because 
of the flies which they breed, and because of the chance which these 
insects have to pick up the germs of typhoid fever therein and carry 
them to the boarder's food, are particularly dangerous. It is equally 
important, both for the comfort and the health of the guest, that the 
house also be screened. 
It has been shown in the foregoing paragraphs how the fly may carry 
the germs of typhoid fever from the toilet to the kitchen and there in- 
fect the food which people eat. There is another way in which it may 
infect food, and this is particularly important from the standpoint of 
the child. The source of the milk supply should always be investigated 
in choosing a place of summer residence, and if it is found, aS is too 
frequently the case, to be from dirty, fly-infested stables, in which dirty 
cows are milked by dirty hands, it is best to give the place a wide berth. 
Another insect to be avoided is the mosquito. It used to be thought 
that malaria was caused by night air, but nowadays it is known that 
the only bad, thing about night air is the mosquito which it contains. 
This insect infects people with malaria by biting them and injecting 
the germ as 'it bites. Therefore when a place of summer residence is 
chosen it should not be an unscreened house, nor should it be in a1 
swampy region, nor in a locality in which there are small pools of water 
well adapted to the breeding of mosquitoes. 
Finally, if there is any doubt in the mind of the summer tourist let 
him consult the local health officer of the locality under consideration. 31 
SANITARY ADVICE FOR KEEPERS OF SUMMER RESORTS.1 
By W. C. Rucker, Assistant Surgeon General, Public Health 
and Marine-Hospital Service. 
Until comparatively recent years if a keeper of a summer resort pro- 
vided good housing and feeding facilities, suitable and proper social 
diversions, and a reasonable amount of rest and quiet, the keeper of 
the resort considered that he had done his duty well, and other things 
being equal was reasonably sure that he would have a fair return for 
his investment and effort. While all of these points are of no mean 
weight in the minds of persons who go to the seashore, the mountains, 
or the country to avoid the heat and discomforts of the city, they have 
become secondary, and the question which is now asked first of all is 
as to the healthfulness of the resort in question. Aside from the finan- 
cial loss which the manager of a summer pleasure ground may sustain 
from an outbreak of sickness among his guests, there is a moral obliga- 
tion to protect and further as far as possible their health interests. 
In a general way it may be stated that disease is carried from the sick 
to the well, either directly by persons or indirectly by food and drink, 
dust, and insects. If the avenues for disease germs are closed there.need 
be comparatively little disease. It is thus seen that most disease is 
environmental, and it is therefore the duty of persons who are in charge 
of summer resorts to maintain the environment of their guests in as 
healthful a condition as possible. 
The great source of disease in a summer resort is the toilet. In 
many localities it is of the most primitive pattern, and maintained in a 
condition of noisome filth which would not be tolerated under any other 
circumstances. Frequently it is merely a'surface privy, to which the 
barnyard fowls and domestic animals have free access. Again there 
may be a pit privy, or a cesspool which drains into the well, or into the 
stream which furnishes the water for the establishment. 
Inasmuch as typhoid fever, a disease which by preference spends the 
warm months at a summer resort, is caused by a germ which is peculiar 
to man, and which leaves the body of the sick patient in his discharges, 
it may be seen that any method of disposing of human excrement which 
does not absolutely insure that it will not be carried to well persons is 
faulty, not to say priminal. After the germ of typhoid fever has left 
the body of the sick patient in his discharges, it is carried to well per- 
sons in food or drink, or through the intermediation of flies or dirty 
fingers. 
It is the duty of every keeper of a summer resort to provide clean, 
well-screened places of easement for his guests, and to see to it that the 
fecal material deposited in this place can not escape and find entrance 
into the food and drink of the guest. If there is a cesspool, or a pit, it 
must not leak, and it must be guarded against flies, because these in- 
sects, which are bred in filth and lead a life of sin and iniquity, carry 
the germs on their feet to the food stuffs in the kitchen or dining room, 
thus delivering the germs in a live and virulent condition to well people. 
i Reprint from the Public Health Reports, Vol. XXVII, No. 22, May 31, 1912 32 
The selection of a water supply is of the utmost importance. It 
should not be from a stream which receives the drainage of human 
habitations. In this connection it may be remarked that the old theory 
of the self-purification of streams has been exploded. If well water is 
used, it should not be from a shallow surface well, nor should it be 
from a well which by any chance may receive the drainage of human 
dwellings. Other things being equal, driven or artesian wells are far 
preferable. 
If there is any doubt as to the purity of the water, it should be 
sterilized, either by boiling or by the addition of calcium hypochlorite 
prior to using. 
Mention has been made of the carriage of the germs of typhoid fever 
by dirty fingers. This does not necessarily mean fingers which are 
mechanically dirty. It has been found in recent years that a large num- 
ber of persons who have had typhoid fever continue to pass the germs 
of that disease in their discharges for a considerable period after their 
recovery from the disease. These persons are called typhoid carriers. 
It is of course an impossibility for the manager of a summer resort to 
examine all of his employes to determine whether or not they may be 
carriers, but it is his duty, when selecting persons who are to be em- 
ployed in the preparation and serving of food or cleaning the dishes 
and kitchen utensils, to inquire whether or not they have had typhoid 
fever recently, and to employ none who have been afflicted with that 
disease within three or four months. 
It has been shown that flies carry disease. The model summer resort 
has no flies. This condition of affairs may be brought about by pre- 
venting their breeding, and by screening the hostelry against them. 
Flies breed in manure. Therefore the barnyard or stables should be 
kept scrupulously clean, and the manure stored in well-screened metal- 
lined bins. The stable itself should also be screened. This adds not 
only to the comfort of the guests, but also saves the horses and cattle a 
great deal of energy, which would otherwise be expended in fighting 
flies. 
One of the things which city people most desire when going to the 
country is milk. Milk which is produced by dirty cows in a dirty 
stable, and secured and handled by dirty dairy hands, is unfit for human 
consumption. The best advertisement that any country resort can have 
is a clean, airy, wholesome dairy, in which clean cows are milked by 
clean laborers, and in which the processes to which the milk is subjected 
follow a cleanliness of levitical scrupulosity. 
It has been recommended that all of the buildings of a summer resort 
be screened. This not only excludes flies, but it also prevents the 
entrance of mosquitoes.. Aside from the fact that these insects act as 
the producers of insomnia and irritating inflammations, they are also 
the purveyors of malaria, which they introduce into the system of the 
guests by biting them. While it is desirable that they be excluded, it is 
even more necessary that they be prevented from breeding. Most sum- 
mer resort keepers breed their own mosquitoes, and a careful survey of 33 
the premises will discover small pools of water, unscreened rain-water 
barrels, and small collections of water in tin cans, flower pots, and other 
easily overlooked small receptacles, all of which may contain "wigglers," 
which are the immature forms of mosquitoes. If these are emptied or 
oiled, or have a considerable .quantity of salt placed in them, they will 
cease to be producers. In fountains and ornamental pools, to which 
none of these methods may be applied, the planting of small fish will 
destroy the mosquito larvae, and thus prevent their multiplication. 
The careful tuberculosis patient may be quite harmless in a summer 
hotel, but those who are careless and expectorate promiscuously are a 
positive danger, and while such persons are always to be regarded with 
consideration and charity, it may become necessary to recommend that 
they spend their summer in a sanitarium, rather than in a public resort 
where they may endanger others. 
There are two sorts of. vermin which may be disease carriers, and 
with which the summer resort keeper is at constant war; these are the 
rat and the cockroach. 
Rats stay where they can get food. Therefore if all food supplies in- 
tended for human beings, and all remnants of human food, be guarded 
against them their numbers will fall off considerably. Furthermore, if 
stables are maintained in a cleanly condition, and if the rats are ex- 
cluded from feed rooms, they will find that they must move on or be 
starved to death. Those which remain may be killed off, either' by 
poisoning with some reliable agent, such as phosphorus or arsenic paste. 
Traps will take off a good many, and a good active terrier makes an 
excellent agent for the extermination of these pests. 
Cockroaches may be gotten rid of by starvation, that is, the protection 
of foodstuffs against them, absolute cleanliness, or by the use of some 
agent which kills cockroaches but is harmless to man. Borax mixed 
with sugar has been recommended for this purpose. 
Finally let it be stated that if the keeper of a summer resort has any 
doubt as to the sanitary condition of his premises, or if he is brought 
face to face with any sanitary problem with which he does not know 
how to deal, it is his duty to consult the local health officer. 34 
FLIES. 
There is a move on foot to knockout the house fly. The scientists, 
bacteriologists, and health officers are after the house fly, and say that 
it is only a question of time until they have her going South. 
Our sympathies are entirely with the knockers, but we are not betting 
on them. If we were to bet at all, we would place our hard-earned cash 
on the house fly. 
The female house fly, which is really the only member of the family 
worth considering, is a bird of great perseverance and marvelous pro- 
ductive power. She can rise in the morning, knock the dust out of her 
eyes with her front legs, then settle down to business, and by evening be 
the mother of some seven million anxious and energetic children. By 
the third day all of these offspring are ready to start in business on their 
own hook. It is very hard to keep up with a productive female of that 
kind. It is believed, however, that by doctoring the breeding places of 
the house fly her eggs can be destroyed before they are hatched, and in 
this way the family can be gradually exterminated. 
As we have said, our sympathies are entirely with the knockers. The 
house fly has no redeeming traits of character that we have ever' dis- 
covered. She is the personification of insolence, and as a butter-in is 
without a peer. She is a foe to health and religion. She scatters dis- 
ease and provokes unseemly profanity. 
Crude oil is said to be fatal to *the offspring of the fly. Crude oil 
mixed with the manure heap would make it impossible for the fly to 
build her nest there and rear her young. Down with the house fly!- 
The Farmer's Mail. 35 
THE WAY TO FIGHT THE FLY. 
"Swat the fly" where he breeds, rather than where he basks. 
Flies swarm about kitchens, meat markets, groceries and other places 
where food is kept. But they don't come into being there except in 
undisturbed filth. So seek them where they start! 
Flies will breed in filth as they feed on filth, but the heap of horse 
manure brings forth the greater number. Kill them there! 
One stable in which a horse is kept will supply house flies for the 
neighborhood, unless the manure is properly cared for. 
But it is not difficult for a city to do away with the plague of flies. 
Though a fly may go a mile or more in search of food, it will not fly 
more than a few blocks away from food, except when it "flips" a wagon 
or some other moving vehicle. Consequently nearly all flies found in 
the city come to life there. 
From egg to fly is ten to twelve days. If manure is carted away once 
every week the egg will not have time to develop. If the manure is 
spread on the ground the sun will kill the eggs and maggots. 
All cities and villages in the State of Illinois are clothed with power 
to abate nuisances dangerous to the public health. It is easy, therefore, 
for local health authorities to enact and enforce reasonable rules covering 
the care of stables and the keeping and disposal of manure. 
Flies breed also in human excrement, thus becoming very dangerous 
to human beings, as they carry intestinal diseases, such as typhoid and 
dysentery. 
The back yard privy is not only a nuisance but a decided menace to 
public health. If the open privy cannot be abolished it should be regu- 
lated. The breeding of flies can be prevented by the use of kerosene 
thrown on the excreta. 
The garbage heap, too, contributes to the number of flies. Indeed, 
there will be flies so long as there is filth. No filth, no flies. 
The fly is a carrier of typhoid, tuberculosis and other diseases. It is 
a leading agent in the spread of summer dysentery and is responsible 
for the death of many babies. Every practical means, therefore, should 
be taken by municipalities to rid themselves of flies. 
A municipality should not call upon its people to kill the fly, and at 
the same time permit manure heaps to lie in the alleys from north to 
south, east to west, during the fly season; provide breeding places for 
flies in untreated privy vaults, and allow wide-mouthed garbage boxes, 
many overflowing, some without covers, others with covers constantly 
open, to remain unemptied for months at a time. SWAT 
here 
father than 
here! 
Kill them where 
tel