132 REVOCATION 0-F PHYSICIAN'S CERTIFICATE. Rule 29. If any physician fail or neglect to conform to quarantine regulations or to properly report cases of contagious diseases, tq which he has been called professionally, the same shall .be liable to prosecution and revocation of his license, asprovided for by the statutes of thei State of Delaware, and the Local Board of Health, or the local health authorities, or the health authorities in control in the district where the offense has been committed, may bring charges against such physician and prosecute the same. CHAPTER 2. DISINFECTION. Rule r. Definition: The term "Disinfection"· has reference to the destruction of disease producing bacteria. The agents used for such are called "Disinfectants" or "Germicides." An ''.Antiseptic'' is an agent which prevents the development of bacteria, but does not necessarily de.stray them. A ·"Deodorant" is a substance which has power to remove offensive odors, but is not necessarily a disinfectant. "Sterilization" is a term used to designate the destruction of germs by heat, whereas "Disinfection" refers more properly to their destruction by chemical agents. DISEASES· IN V/HICH DISINFECTION IS REQUIRED. Rule 2. Disinfection of the premises, patient, patient's se­ cretions, excretions and oxidates, books, clothing, furniture and everything- used by the patient shall be carried out in the> follow- ing infectious diseases : - Anthrax Asiatic Cholera Bubonic Plague · Cerebra Spinal Meningitis Diphtheria (Membraneous Croup) Leprosy Polio Myelitis Scarlet Fever (Scarletina, Scarlet Rash) 133 Smallpox (Varialoid) Tuberculosis ( Pulmonary and Bronchial) Typhoid Fever Typhus Fever Yellow Fever . and it is stro;1gly recommended that disinfection also be carried out in Influenza. PRELIMINARY PRECAUTION$. Rule 3. Before beginning· disi1~.,fection, the 'requirements prescribed i11tbe following· secti<;ms shall be complied with: Section I. The person employed to do the disinfecting, ex­ cept in Tuberct1losis and Typhoid Fever, shall wea11 a cap and gown so constructed as to completely cover the clothing. After· all arrangements are complete, these garments shall be left on the premises and disinfected in the same maimer as other infedcJ articles, or packed in a satchel and thoroughly sprayed with for- maldehyde: · · Section 2. All holes, cracks and other external apertures shall be sealed by pasting over them pieces o,f paper, or filling theni with clean, damp cotton rags. Section 3. All bedding and· other clothing, carpets and rugs should be hung on chairs, or upon lines stretched across the room for that purpose. Books shall be placed on edge, or hung upon · a line in such a. n1anner as to spread the pages. Drawers, cup-· boards and trunks shall be opened, and while their contents need not be unnecessarily disarranged, they shall be loosened in sud1 a manner as to give free access to the disinfecting gas. vVindows should be securely closed, but left unlocked, in order to admit of their being opened from the outside after the disinfection is com­ plete. Section 4. vVhen using formalcld1yde, no open vessel c.on­ taining water shonlcl be left in the room ( except as provided in Rule 12). Section 5. The temperature of the room shall in no case be below 60 degrees F. (preferably 70 degrees F. or above). If 134 the atmosphere is unusually, dry, the amount of moisture should bl:!increa.secl by boiling a kettle o'f water in the room, or by pour­ ing boiling wate1: from one vessel to another for five or ten min- utes before beginning the disinfection. · .. Section\ 6. A large wash tub should be placed near the center of the room, conveniently situated so as to be seen through · on the windows. In this shoulcli be placed a tin or iron pail about 12 to 16 inches deep. ( It is advisable to cover the outside\ of the pail with asbestos paper, leaving the top open.) · MATERIAL TO BE USED FOR DISINFECTION. Rule 4. For every 1,000 cubic feet of spac~ to be disin- fected, the following materials and quantities shall be used: 40 per cent. Solution of Formaldehyde, 20 ounces. Permanganate· of Potash! ( Fine Crystals), 8,Yi ounces. These quantities are to be used to disinfect premises follow-· ing cases of: Asiatic Cholera Bubonic Plagne Cerebro Spinal Meningitis Diphtheria (,:1\/Iemb~aneous Croup) Scarlet Fever ( Scarlet Rash, Scarletina) Smallpox Tuberculosis ( Consi.unption) Typhoid Fever Typhus F\'!ver Erysipelas . Puerperal Fev,;.r In cases of Chicken Pox M easies ( German Measles) l\1umps .. Vi/hooping Cough Pneumonia ' only haH the above quantities are required. 135 MODE OF OPERATION. Rule 5. ' Section r: , YVhen the room 01: house to be disin­ fected has been properly prepared in accordance with the require­ ments of Rule 3, the propei· quantity of Permanganate· of Potash as prescribed in Rule .f should be placed in the paiL The solt1- tion of 40 per cent. Formaldehyde should be placed in a tin clip­ per qr other vessel cqnvenient for pouring rapidly. The operator,. when everything is in readiness, should pour the Formaldehyde tipon the crystals of Permanganate of Potash contai"ned in the pail, and immediately lea,,e the room, dosing the door and stop­ ping all cracks in the manner indicated in Rule 3. This opera­ tion should be performed quickly, as the gas generates very rap­ idly. The door should be locked in order to prevent accidents, ai1clthe room or building, as. the case may be, kept closed for at least eight hours. At the expiration of that time the win.dows should he opened from outside 1 and in the space of r 5 or 20 rnin- . utes the door may he opened, allo\ving the air to blow through the room. If the odor remaining is very strong, a little ammonia water sprinkled upon the floor will soon neutralize the Formalde­ hyde and hasten the disappearance\ of the odor. Section 2. After the fumigation, as prescribed in this Rule. · . -has been completed, all bedding, .clothing, etc., that will not. be harmecll by boiling, should be boiled for at least half· an hour. When possible mattresses, rugs and heavy curtains should be sterilized by steam under pressure at r20 C. for thirty (30 )1 min- , utes. \1Vhen.this is not possible, these articles should be taken out of doors and thoro11ghly aired and exposed to the rays of the sun for some hours. · Note. In disinfecting, 1t is necessary to see that the shoes worn: or used by the opera~or and all persons upon the premises are properly. disinfected, as these articles are frequently over­ .looked and become the conveyors of infectious diseases. They may be readily disinfected by using Standard Solutions I and 2. ARTICLES TO BE DESTROYED. Rule 6. Under the method prescribed in Rule 5, it is un­ necessary to desttoy any articles .of value. Papers, rugs, cheap books and other. articles of little or no value should be. burned. 136 In cases of Scarlet Fever; Smallpox and Diphtheria, in addition to the requirements of Rule 5, all woodwork and, if possible, the walls should be ,,;ashed with a liquid dsinfectant, such as a solu­ tion of Bichloride of Mercury, one part Bichloride of Mercury. to I ,ooo parts of water. \i\There the ·wall pa pert is loose or delapi­ dated,. it should. be ,removed and burned:. DISINFECTION OF PERSONS WHO HAVE BEEN AFFECTED WITH OR EXPOSED TO INFECTIOl!S. OR CONTAGIOUS DISEASES:. Rule 7. Before the release from guarantine, all persons who have been affected with or exposed to ·an infectious or contagious disease shall be subjected to the following requirements: · They ~hall be removed ~o a room tha.t has been disinfected according to Rule 5. · '.fhe entire body, including the hair, shall be washed with a solution of Bichloride of Mercury, one part Bichloride of Mercury to 3,000 parts of water (see Standard Disinfectant No.· 2r They shall then be subjected to. a full bath with plenty of soap and hot water 1 after which they shall be provided with cloth­ ing that has been properly disinfected, or that has not. previously been upon th_einfected premises. DISINFECTION OF THE DEAD .. Rule 8. The ·remains of all pe1:sons who die from infe~tiou~ or contagious diseases should be thoi·oi1ghly injected with a dis­ infecting embalming· fluid,. External orifices must be securely closed ·with absorbent cotton, and the entire body,. including the hair,. thoroi.1ghly cleansed with a reliable· disinfectant, such as a Standard Soluti_on No. 3. · In cases where it is impracticable to prepare a dead body as indicated by this rule, the body must be wrapped in a sh<;et or . cloth satttrated with Standard Solution No. 3 before being placed in the casket. · · · · DISINFECTION .OF VEHICLE!S. · . Rule 9. Section I: All cabs, hearses and other vehicles used in the removal o,f a patient or the body of a person affected with, or who has died from, any contagious _orinfectious disease, 137 shall be disinfected in the manner defined 111 Section 2 .of this Rule. Section 2. Remove all cushions, curtains and other acces- . sories and place them in _a smaU room or tight cupboard, and dis­ infect them in accordance with the requirements ptescribed in Rule 5. If the vehicle can -be closed up, it should be fumig:itecl in the same manner as prescribed in Rule 5. If this· is imprac:.. ticable it should be washed inside and out with a solution ·of Bichloride of n·Iercury, one part to I,cioo parts of water. PET ANIMALS. Rule IO. All cats and dogs and other pet animals kept upon the premises infected with any contagious. or infectious· disease shall be thproughly washed in a tub of warm water containing I to 2,000 Bichloride Solution.