QUARANTINE IN CONTROL OF INFECTIOUS DISEASES 61 



A patient ill with diphtheria in New York City must be 

 kept isolated for at least two weeks, and even then the 

 patient may not be discharged until after two consecutive 

 negative cultures have been obtained from both nose and 

 throat. 



In contrast to this logical termination of isolation in 

 diphtheria by means of cultures, the period of isolation 

 in scarlet fever is very nearly arbitrary. In New York 

 City isolation is maintained until at least thirty days from 

 the appearance of the rash. Desquamation is no longer 

 held to be of any special significance in the conveyance 

 of infection. Suppurative processes, on the other hand, 

 are more seriously regarded and often serve to confine the 

 patient for several weeks " beyond the period named. 

 It is possible that the recent observations of ]Mallory 

 (page 122) will furnish a more definite basis for fixing the 

 duration of isolation necessary in this disease. 



In measles the patient may be released from isolation 

 and allowed to return to school five days after the appear- 

 ance of the rash. Formerly the period of isolation was 

 much longer, but experiments on monkeys by Anderson 

 and Goldberger showed that five days was sufficient. To 

 be sure, this applies only to patients who are free from 

 serious catarrhal or pneumonic complications. 



In typhoid fever there is no fixed time limit to the 

 period of isolation. Stool examinations for typhoid bacilli 

 should be made after the patient's temperature has been 

 normal for at least ten days. In the case of food handlers 

 (cooks, waiters, dairymen, etc.) return to work is pro- 

 hibited so long as the stools contain typhoid bacilli. 

 Accordingly, at least two consecutive stool examinations 

 made a week apart should fail to show typhoid bacilli 



