consumption, made the publication of Circular No. 54 a necessity. It is believed that a wide diffusion of the information which it contains would result in the saving of many lives every year.

CIRCULAR No. 53.

STATE BOARD OF HEALTH OF MAINE.

CHARACTERISTICS OF THE INFECTIOUS DISEASES.

The purpose of this circular is to set forth, for the use of teachers, school officers, and non-medical members of local boards of health, the principal characteristics of the infectious diseases and of their infection, and to give brief hints in regard to preventing their spread.

Note of Definition.-The period of incubation is the time which elapses after the reception of the infection until the first, or premonitory symptoms occur. Period of invasion, time from the first symptoms until the disease is declared, or, in the eruptive fevers, till the appearance of the eruption. Vesicle, an elevation of the cuticle containing clear watery fluid. Pustule, same as "vesicle"

excepting it contains pus or colored serum.

Chicken-pox. Period of incubation, 13-14 days, may be shorter or may be prolonged to 18 or 19 days. Period of invasion very A disease of childhood, but occasionally occurring in adults. The eruption consists of clear watery blisters or vesicles, scattered irregularly over the body. The eruption is often the first thing noticed. Premonitory symptoms are often overlooked as also are often the small red spots preceding the vesicles. The "blisters" reach their full development in 24 or 36 hours. Successive crops of vesicles and unequal development of them on the same parts of the body. With the appearance of the eruption, the fever increases. (Compare small-pox.)

Consumption (Pulmonary Tuberculosis.) The investigations of the last few years make it certain that this is an infectious disease, and also make it likely that the only serious source of danger is the sputum, or expectoration. While the sputum is moist it is practically harmless; after it is dried, pulverized, and floated in the atmosphere, so that it may be inhaled, it is dangerous. Avoid, therefore, spitting upon floors, in handkerchiefs, or upon other things within doors, where the infectious sputum will be dried and pulverized. Use a spit-cup. Tuberculous or consumptive children

should not be allowed to attend school, and persons with this disease should not teach. (See Circular No. 54, Prevention of Consumption.)

Croup. Membraneous croup is now generally regarded as diphtheria of the air passages, and the same precautions are applicable to it as in ordinary diphtheria.

Diphtheria. Period of incubation 2-7 days, but may be longer or shorter. The distinctive feature of the disease is the false membrane which invades the mucous membrane, more frequently of the throat. The false membrane appears at first as a whitish patch, or there may be several such spots, which may gradually or rapidly increase in size and coalesce. The condition and appearance of the false membrane, as first discovered, may remain stationary for awhile, or gradually disappear. Occasionally in cases of diphtheria the false membrane is absent, or in localities where it is not to be seen. When diphtheria is prevalent, it is safer to regard all cases of sore throat as diphtheria, and to require a reasonable amount of care until they are pronounced non-diphtheritic, and non-infectious by a physician. "Diphtheritic sore throat" is diphtheria.

The diptheritic infection is much more dangerous to children than to adults. Many persons are not susceptible to it; and, on the other hand, articles and rooms infected with it may retain their dangerous qualities for a long while. Children who have had diphtheria should not be re-admitted to school earlier than three or four weeks after recovery, or not until precautions in the way of thorough disinfection, etc., have been taken which are satisfactory to the local board of health. The infection may be carried by those who have not had the disease. (See Circular No. 44, Diphtheria.)

Dysentery. Some forms at least of this disease appear to be infectious. The infection is undoubtedly given off in the discharges from the bowels, and it is often spread, as typhoid fever is, by the contamination of drinking water. Period of infection, said to be from 3-7 days.

Erysipelas. Infection usually gains admission to the system through a wound or abrasion of the skin or mucous membranes. The infection may be carried by the clothing, or the hands of attendants. The period of incubation is very short.

German Measles (Rotheln.) This eruptive disease has no relation to measles and scarlet fever with which it is sometimes confounded. Its period of incubation is long, two to three weeks.

The eruption appears earlier than in measles, often within 24 hours after the first symptoms. The rash fades about the third day or earlier and the fever gradually disappears with the rash. Desquamation is absent or very slight. The eruption is not so "blotchy" as that of measles; sometimes resembles that of scarlet fever. Incubation is longer than that of measles, and much longer than that of scarlet fever. Period of invasion, shorter than that of measles. Catarrhal symptoms not so severe as in measles. not so marked a feature as in scarlet fever. return to school until two weeks after recovery. Measles and Scarlet Fever.)

Throat symptoms Patient should not (Compare further

Glanders. An infectious disease of horses which may be communicated to man. A horse with glanders is too dangerous to be permitted to live. Period of incubation from three days to several months.

Measles. Period of incubation 8 days on an average, or 12 days to the appearance of the rash. Eruption preceded by catarrhal symptoms, like those of a severe cold. Fever falls rapidly after the eruption is fully out. Rash usually begins on the face as slightly raised red spots which form crescentic groups, coalescing into patches of irregular outline. Eruption more distinctly "blotchy" than in scarlet fever and a duller red instead of scarlet. Measles is infectious in its earliest stages before the rash has appeared. The infection may be carried by clothing. Children should not return to school for at least two weeks after recovery. (Compare German Measles, Scarlet Fever and Small-pox.)

Mumps. In most cases the period of incubation is from 14 to 21 days, but may be shorter. The distinctive characteristics of the disease are the fever, and the swelling and tenderness of the glands just below and in front of the ear. The swelling o ten extends upon the face or down upon the neck. The history of a possible infection should be taken into account. The patient is infectious for at least three weeks after the swelling of the glands, and possibly sometimes before the swelling begins.

Pneumonia. Many observations seem to show that pneumonia, at least sometimes, is contagious. In all cases it would be prudent to receive the sputum in a cup or vessel so that it may all be destroyed or disinfected. The sputum is undoubtedly the sole source of infec

tion.

Rash, Canker Rash,

The onset of the symp

Scarlet Fever, (Scarlatina, Scarlet "Rash.") Period of incubation 2-5 days. toms is usually sudden. The rash appears within 24 or 48 hours after the first symptoms (earlier than in measles and small-pox), usually coming out first on the neck and chest, afterward extending to the limbs. The fever does not abate suddenly, after the appearance of the eruption, as in measles and small-pox. Rash consists of a multitude of fine red or scarlet points, the color of which is diffused over the whole surface. Sore throat is almost always an early and prominent symptom. The tongue usually presents a peculiar appearance designated as "strawberry tongue." Cases are infectious as soon as the eruption has appeared, and until the completion of the desquamation, or peeling, which is often not before 6 or 8 weeks. The infection may come directly from the patient, or be carried upon the person or in the clothing of those who have not had the disease. Infected clothing, furniture, rooms, etc., may retain their dangerous qualities for a long while, unless very careful disinfection is done. Children from 2 to 7 years of age are more likely to take the disease, and when they do, are more endangered by it, than persons at other stages of life. After 10 or 12 years of age there is a rapid diminution of susceptibility to the infection of scarlet fever. (See Circular No. 48, Scarlet Fever.)

Small-pox. Period of incubation 10 to 12 days. In about three days more (sometimes on the second) the eruption begins to show as small red spots or specks, and then as pimples or papules, at first on the face and wrists, gradually passing over the body. Sometimes at this stage a diffused rash appears. The papules are changed in about 24 hours into vesicles, which, when they are sufficiently developed, show a characteristic depression in the center, that is, are "unbilicated." The contents of the vesicles gradually become yellow, and the eruption has then become pustular. In varioloid, the eruption aborts at various stages. Severe pain in the back is somewhat characteristic of small-pox. There is usually a marked diminution of the fever after the eruption is out. Smallpox is intensely infectious, but less so in the earlier stages of the eruption. The small pox patient is infectious until the skin is cleared of all crusts and careful disinfection is done.

Vaccination not only lightens small-pox, if one happens to take it, but, when well done and not too remotely, insures almost absolute protection from taking the disease. (Compare Chicken-pox, Scarlet Fever and Measles.)

Typhoid Fever. Period of incubation 14 to 21 days, but may be shorter, especially in cases with a severe and rapid course. The natural duration of the disease is 3 or 4 weeks, but severe cases may end fatally even in 10 or 12 days, or mild cases may recover in two or three weeks. The infection is given off by the patient principally in the dejections, therefore, if a proper disinfection and disposition of these is secured, the patient will not endanger others. Typhoid fever is usually "caught" by drinking water contaminated with the infectious matter of the typhoid discharges, or by breathing the air from privy vaults or other places which are similarly polluted and infected. (See Circular No. 46, Typhoid Fever.)

Whooping Cough. May be communicated either directly from the patient or through the medium of infected clothing, etc. Period of incubation about 6 days. The peculiar cough is characterized by a series of quick, short, forcible expirations with flushed face, then recovery of the breath with a long, shrill whoop, or a succession of such. The "whooping" begins in the second week of the disease; sometimes later. The earlier symptoms are like those of a common cold with a cough of ordinary character. Infection lasts 6 or 8 weeks after the disease is declared.

NOTE. Children, who have been exposed to infectious diseases, should be excluded from schools and other gatherings for a period exceeding by a little, at least, the period of incubation for the given disease. For instance, if the disease is measles, children who have never had this disease, but who have been exposed to its infection, should be kept from school or two weeks after the last exposure; or, if it is scarlet fever, one week, at least.

One attack of diphtheria does not exempt from subsequent attacks.

PRESERVE THIS FOR FUTURE REFERENCE.

CIRCULAR No. 54.

STATE BOARD OF HEALTH OF MAINE.

ON THE PREVENTION OF CONSUMPTION.

That insidious disease, which we call Consumption, Phthisis, or Tuberculosis of the lungs, is the most terrible destroyer of lives with which civilization has to contend.

Centuries ago consumption was regarded as an infectious disease in Southern Europe, and extravagantly rigorous laws were in existence regulating communication with consumptive patients.