Chapter 19

In Sickness and in Health.

383. Arrangement of the Sick-room. This room, if possible, should be on the quiet and sunny side of the house. Pure, fresh air, sunshine, and freedom from noise and odor are almost indispensable. A fireplace as a means of ventilation is invaluable. The bed should be so placed that the air may get to it on all sides and the nurse move easily around it. Screens should be placed, if necessary, so as to exclude superfluous light and draughts.

The sick-room should be kept free from all odors which affect the sick unpleasantly, as perfumery, highly scented soaps, and certain flowers. Remove all useless ornaments and articles likely to collect dust, as unnecessary pieces of furniture and heavy draperies. A clean floor, with a few rugs to deaden the footsteps, is much better than a woolen carpet. Rocking-chairs should be banished from the sick-room, as they are almost sure to disturb the sick.

A daily supply of fresh flowers tends to brighten the room. Keep the medicines close at hand, but all poisonous drugs should be kept carefully by themselves and ordinarily under lock and key. A small table should be placed at the bedside, and on it the bell, food tray, flowers and other small things which promote the comfort of the patient.

The nurse should not sleep with the patient. Sofas and couches are not commonly comfortable enough to secure needed rest. A cot bed is at once convenient and inexpensive, and can be readily folded and put out of sight in the daytime. It can also be used by the patient occasionally, especially during convalescence.

384. Ventilation of the Sick-room. Proper ventilation is most essential to the sick-room, but little provision is ordinarily made for so important a matter. It is seldom that one of the windows cannot be let down an inch or more at the top, a screen being arranged to avoid any draught on the patient. Remove all odors by ventilation and not by spraying perfumery, or burning pastilles, which merely conceal offensive odors without purifying the air. During cold weather and in certain diseases, the patient may be covered entirely with blankets and the windows opened wide for a few minutes.

Avoid ventilation by means of doors, for the stale air of the house, kitchen smells, and noises made by the occupants of the house, are apt to reach the sick-room. The entire air of the room should be changed at least two or three times a day, in addition to the introduction of a constant supply of fresh air in small quantities.

385. Hints for the Sick-room. Always strive to look cheerful and pleasant before the patient. Whatever may happen, do not appear to be annoyed, discouraged, or despondent. Do your best to keep up the courage of sick persons under all circumstances. In all things keep in constant mind the comfort and ease of the patient.

Do not worry the sick with unnecessary questions, idle talk, or silly gossip. It is cruel to whisper in the sick-room, for patients are always annoyed by it. They are usually suspicious that something is wrong and generally imagine that their condition has changed for the worse.

Symptoms of the disease should never be discussed before the patient, especially if he is thought to be asleep. He may be only dozing, and any such talk would then be gross cruelty. Loud talking must, of course, be avoided. The directions of the physician must be rigidly carried out in regard to visitors in the sick-room. This is always a matter of foremost importance, for an hour or even a night of needed sleep and rest may be lost from the untimely call of some thoughtless visitor. A competent nurse, who has good sense and tact, should be able to relieve the family of any embarrassment under such circumstances.

Do not ever allow a kerosene light with the flame turned down to remain in the sick-room. Use the lamp with the flame carefully shaded, or in an adjoining room, or better still, use a sperm candle for a night light.

Keep, so far as possible, the various bottles of medicine, spoons, glasses, and so on in an adjoining room, rather than to make a formidable array of them on a bureau or table near the sick-bed. A few simple things, as an orange, a tiny bouquet, one or two playthings, or even a pretty book, may well take their place.

The ideal bed is single, made of iron or brass, and provided with woven wire springs and a hair mattress. Feather-beds are always objectionable in the sick-room for many and obvious reasons. The proper making of a sick-bed, with the forethought and skill demanded in certain diseases, is of great importance and an art learned only after long experience. The same principle obtains in all that concerns the lifting and the moving of the sick.

Sick people take great comfort in the use of fresh linen and fresh pillows. Two sets should be used, letting one be aired while the other is in use. In making changes the fresh linen should be thoroughly aired and warmed and everything in readiness before the patient is disturbed.

386. Rules for Sick-room. Do not deceive sick people. Tell what is proper or safe to be told, promptly and plainly. If a physician is employed, carry out his orders to the very letter, as long as he visits you. Make on a slip of paper a note of his directions. Make a brief record of exactly what to do, the precise time of giving medicines, etc. This should always be done in serious cases, and by night watchers. Then there is no guesswork. You have the record before you for easy reference. All such things are valuable helps to the doctor.

Whatever must be said in the sick-room, say it openly and aloud. How often a sudden turn in bed, or a quick glance of inquiry, shows that whispering is doing harm! If the patient is in his right mind, answer his questions plainly and squarely. It may not be best to tell all the truth, but nothing is gained in trying to avoid a straightforward reply.

Noises that are liable to disturb the patient, in other parts of the house than the sick-room, should be avoided. Sounds of a startling character, especially those not easily explained, as the rattling or slamming of distant blinds and doors, are always irritating to the sick.

Always attract the attention of a patient before addressing him, otherwise he may be startled and a nervous spell be induced. The same hint applies equally to leaning or sitting upon the sick-bed, or running against furniture in moving about the sick-room.

387. Rest of Mind and Body. The great importance of rest for the sick is not so generally recognized as its value warrants. If it is worry and not work that breaks down the mental and physical health of the well, how much more important is it that the minds and bodies of the sick should be kept at rest, free from worry and excitement! Hence the skilled nurse does her best to aid in restoring the sick to a condition of health by securing for her patient complete rest both of mind and body. To this end, she skillfully removes all minor causes of alarm, irritation, or worry. There are numberless ways in which this may be done of which space does not allow even mention. Details apparently trifling, as noiseless shoes, quietness, wearing garments that do not rustle, use of small pillows of different sizes, and countless other small things that make up the refinement of modern nursing, play an important part in building up the impaired tissues of the sick.

388. Care of Infectious and Contagious Diseases. There are certain diseases which are known to be infectious and can be communicated from one person to another, either by direct contact, through the medium of the atmosphere, or otherwise.

Of the more prevalent infectious and contagious diseases are _scarlet fever, diphtheria, erysipelas, measles_, and _typhoid fever_.

Considerations of health demand that a person suffering from any one of these diseases should be thoroughly isolated from all other members of the family. All that has been stated in regard to general nursing in previous sections of this chapter, applies, of course, to nursing infectious and contagious diseases. In addition to these certain special directions must be always kept in mind.

Upon the nurse, or the person having the immediate charge of the patient, rests the responsibility of preventing the spread of infectious diseases. The importance must be fully understood of carrying out in every detail the measures calculated to check the spread or compass the destruction of the germs of disease.

389. Hints on Nursing Infectious and Contagious Diseases. Strip the room of superfluous rugs, carpets, furniture, etc. Isolate two rooms, if possible, and have these, if convenient, at the top of the house. Tack sheets, wet in some proper disinfectant, to the outer frame of the sick-room door. Boil these sheets every third day. In case of diseases to which young folks are very susceptible, send the children away, if possible, to other houses where there are no children.

Most scrupulous care should be taken in regard to cleanliness and neatness in every detail. Old pieces of linen, cheese-cloth, paper napkins, should be used wherever convenient or necessary and then at once burnt. All soiled clothing that cannot well be burnt should be put to soak at once in disinfectants, and afterward boiled apart from the family wash. Dishes and all utensils should be kept scrupulously clean by frequent boiling. For the bed and person old and worn articles of clothing that can be destroyed should be worn so far as possible.

During convalescence, or when ready to leave isolation, the patient should be thoroughly bathed in water properly disinfected, the hair and nails especially being carefully treated.

Many details of the after treatment depend upon the special disease, as the rubbing of the body with carbolized vaseline after scarlet fever, the care of the eyes after measles, and other particulars of which space does not admit mention here.

Poisons and Their Antidotes.

390. Poisons. A poison is a substance which, if taken into the system in sufficient amounts, will cause serious trouble or death. For convenience poisons may be divided into two classes, irritants and narcotics.

The effects of irritant poisons are evident immediately after being taken. They burn and corrode the skin or membrane or other parts with which they come in contact. There are burning pains in the mouth, throat, stomach, and abdomen, with nausea and vomiting. A certain amount of faintness and shock is also present.

With narcotic poisoning, the symptoms come on more slowly. After a time there is drowsiness, which gradually increases until there is a profound sleep or stupor, from which the patient can be aroused only with great difficulty. There are some substances which possess both the irritant and narcotic properties and in which the symptoms are of a mixed character.

391. Treatment of Poisoning. An antidote is a substance which will either combine with a poison to render it harmless, or which will have a directly opposite effect upon the body, thus neutralizing the effect of the poison. Hence in treatment of poisoning the first thing to do, if you know the special poison, is to give its antidote at once.

If the poison is unknown, and there is any delay in obtaining the antidote, the first thing to do is to remove the poison from the stomach. Therefore cause vomiting as quickly as possible. This may be done by an emetic given as follows: Stir a tablespoonful of mustard or of common salt in a glass of warm water and make the patient swallow the whole. It will usually be vomited in a few moments. If mustard or salt is not at hand, compel the patient to drink lukewarm water very freely until vomiting occurs.

Vomiting may be hastened by thrusting the forefinger down the throat. Two teaspoonfuls of the syrup of ipecac, or a heaping teaspoonful of powdered ipecac taken in a cup of warm water, make an efficient emetic, especially if followed with large amounts of warm water.

It is to be remembered that in some poisons, as certain acids and alkalies, no emetic should be given. Again, for certain poisons (except in case of arsenic) causing local irritation, but which also affect the system at large, no emetic should be given.

392. Reference Table of Common Poisons; Prominent Symptoms; Antidotes and Treatment. The common poisons with their leading symptoms, treatment, and antidotes, may be conveniently arranged for easy reference in the form of a table.

It is to be remembered, of course, that a complete mastery of the table of poisons, as set forth on the two following pages, is really a physician’s business. At the same time, no one of fair education should neglect to learn a few of the essential things to do in accidental or intentional poisoning.

A Table of the More Common Poisons,

With their prominent symptoms, antidotes, and treatment. Poison Prominent Symptoms Antidotes and Treatment _Strong Acids:_

Muriatic,

Nitric,

Sulphuric (vitriol),

Oxalic. Burning sensation in mouth, throat, and stomach; blisters about mouth; vomiting; great weakness _No emetic_ Saleratus; chalk; soap; plaster from the wall; lime; magnesia; baking soda (3 or 4 teaspoonfuls in a glass of water). _Alkalies_:

Caustic potash and soda,

Ammonia,

Lye,

Pearlash,

Saltpeter. Burning sensation in the parts; severe pain in stomach; vomiting; difficulty in swallowing; cold skin; weak pulse. _No emetic_ Olive oil freely; lemon juice, vinegar; melted butter and vaseline; thick cream. _Arsenic:_

Paris green, Rough on rats, White arsenic, Fowler’s solution, Scheele’s green. Intense pains in stomach and bowels; thirst; vomiting, perhaps with blood; cold and clammy skin. Vomit patient repeatedly, give hydrated oxide of iron with magnesia, usually kept by druggists for emergencies; follow with strong solution of common salt and water. _Other Metallic Poisons_: Blue vitriol, Copperas, Green vitriol, Sugar of lead, Corrosive sublimate, Bedbug poison. Symptoms in general, same as in arsenical poisoning. With lead and mercury there may be a metallic taste in the mouth. Emetic with lead; none with copper and iron; white of eggs in abundance with copper; with iron and lead give epsom salts freely; afterwards, oils, flour, and water. _No emetic with mercury;_ raw eggs; milk, or flour, and water. _Phosphorus from_ Matches, rat poisons, etc. Pain in the stomach; vomiting; purging; general collapse. _Cause vomiting_. Strong soapsuds; magnesia in water. Never give oils. _Opium:_

Morphine, Laudanum, Paregoric, Dover’s powder, Soothing syrups, Cholera and diarrhœa mixtures Sleepiness; dullness; stupor; “pin-hole” pupils; slow breathing; profuse sweat. _Cause vomiting_. Keep patient awake by any means, especially by vigorous walking; give strong coffee freely; dash cold water on face and chest. _Carbolic Acid:_ Creasote. Severe pain in abdomen; odor of carbolic acid, mucous membrane in around mouth white and benumbed; cold and clammy skin. _No emetic._ Milk or flour and water; white of eggs. _Aconite:_ Wolfsbane Monkshood Numbness everywhere, great weakness; cold sweat. _Vomit patient freely._ Stimulating drinks. _Belladonna_ Deadly Nightshade Atropia Eyes bright, with pupil enlarged; dry mouth and throat. _Vomit patient freely._ _Various Vegetable Poisons_

Wild parsley, Indian tobacco, Toadstools, Tobacco plant, Hemlock, Berries of the Mountain Ash, Bitter sweet, etc. Stupor, nausea, great weakness and other symptoms according to the poison. _Cause brisk vomiting_. Stimulating drinks.

393. Practical Points about Poisons. Poisons should never be kept in the same place with medicines or other preparations used in the household. They should always be put in some secure place under lock and key. Never use internally or externally any part of the contents of any package or bottle unless its exact nature is known. If there is the least doubt about the substance, do not assume the least risk, but destroy it at once. Many times the unknown contents of some bottle or package has been carelessly taken and found to be poison.

Careless and stupid people often take, by mistake, with serious, and often fatal, results, poisonous doses of carbolic acid, bed-bug poison, horse-liniment, oxalic acid, and other poisons. A safe rule is to keep all bottles and boxes containing poisonous substances securely bottled or packed, and carefully labeled with the word POISON plainly written in large letters across the label. Fasten the cork of a bottle containing poison to the bottle itself with copper or iron wire twisted into a knot at the top. This is an effective means of preventing any mistakes, especially in the night.

This subject of poisons assumes nowadays great importance, as it is a common custom to keep about stables, workshops, bathrooms, and living rooms generally a more or less formidable array of germicides, disinfectants, horse-liniments, insect-poisons, and other preparations of a similar character. For the most part they contain poisonous ingredients.

Bacteria.

394. Nature Of Bacteria. The word bacteria is the name applied to very low forms of plant life of microscopic size. Thus, if hay be soaked in water for some time, and a few drops of the liquid are examined under a high power of the microscope, the water is found to be swarming with various forms of living vegetable organisms, or bacteria. These microscopic plants belong to the great fungus division, and consist of many varieties, which may be roughly divided into groups, according as they are spherical, rod-like, spiral, or otherwise in shape.

Each plant consists of a mass of protoplasm surrounded by an ill-defined cell wall. The bacteria vary considerably in size. Some of the rod-shaped varieties are from 1/12,000 to 1/8,000 of an inch in length, and average about 1/50,000 of an inch in diameter. It has been calculated that a space of one cubic millimeter would contain 250,000,000 of these minute organisms, and that they would not weigh more than a milligram.

Illustration: Fig. 168.—Examples of Micro-Organisms called Bacteria. (Drawn from photographs.)

A, spheroidal bacteria (called _cocci_) in pairs; B, same kind of bacteria in chains; C, bacteria found in pus (grouped in masses like a bunch of grapes). [Bacteria in A, B, and C magnified about 1000 diameters]. D, bacteria found in pus (tendency to grow in the form of chains). [Magnified about 500 diameters.]

Bacteria are propagated in a very simple manner. The parent cell divides into two; these two into two others, and so on. The rapidity with which these organisms multiply under favorable conditions, makes them, in some cases, most dangerous enemies. It has been calculated that if all of the organisms survived, one bacterium would lead to the production of several billions of others in twenty-four hours.

395. The Struggle of Bacteria for Existence. Like all kinds of living things, many species of bacteria are destroyed if exposed to boiling water or steam, but seem able to endure prolonged cold, far below the freezing-point. Thus ice from ponds and rivers may contain numerous germs which resume their activity when the ice is melted. Typhoid fever germs have been known to take an active and vigorous growth after they have been kept for weeks exposed in ice to a temperature below zero.

The bacteria of consumption (bacillus tuberculosis) may retain their vitality for months, and then the dried expectoration of the invalids may become a source of danger to those who inhale air laden with such impurities (sec. 220 and Fig. 94).

Like other living organisms, bacteria need warmth, moisture, and some chemical compound which answers for food, in order to maintain the phenomena of life. Some species grow only in contact with air, others need no more oxygen than they can obtain in the fluid or semi-fluid which they inhabit.

396. Importance of Bacteria in Nature. We might well ask why the myriads of bacteria do not devastate the earth with their marvelous rapidity of propagation. So indeed they might, were it not for the winds, rains, melting snow and ice which scatter them far and wide, and destroy them.

Again, as in countless other species of living organisms, bacteria are subject to the relentless law which allows only the fittest to survive. The bacteria of higher and more complex types devour those of a lower type. Myriads perish in the digestive tract of man and other animals. The excreta of some species of bacteria act as poison to destroy other species.

It is true from the strictest scientific point of view that all living things literally return to the dust whence they came. While living they borrow a few elementary substances and arrange them in new combinations, by aid of the energy given them by the sun, and after a time die and leave behind all they had borrowed both of energy and matter.

Countless myriads of bacteria are silently at work changing dead animal and vegetable matter into useful substances. In brief, bacteria prepare food for all the rest of the world. Were they all destroyed, life upon the earth would be impossible, for the elements necessary to maintain it would be embalmed in the bodies of the dead.

397. Action of Bacteria. In certain well-known processes bacteria have the power of bringing about decomposition of various kinds. Thus a highly organized fungus, like the yeast plant, growing in the presence of sugar, has the power of breaking down this complex body into simpler ones, _viz._, alcohol and carbon dioxid.

In the same way, various forms of bacteria have the power of breaking down complex bodies in their immediate neighborhood, the products depending upon the substance, the kind of bacteria, and the conditions under which they act. Thus the _bacteria lactis_ act upon the milk sugar present in milk, and convert it into lactic acid, thus bringing about the souring of milk.

Illustration: Fig. 169.—Examples of Pathogenic Bacteria. (Drawn from photographs.)

A, spiral form of bacteria found in cholera (Magnified about 1000 diameters) B, rod-shaped bacteria (called _bacilli_) from a culture obtained in _anthrax_ or malignant fustule of the face. Diseased hides carry this micro-organism, and thus may occasion disease among those who handle hides and wool. (Magnified about 1000 diameters)

Now, while most species of bacteria are harmless, some are the cause of sickness and death when they gain admittance to the body under certain conditions. These disease-producing bacteria (known as _pathogenic_), when established in the blood and tissues of the body, bring about important chemical changes, depending upon the species of bacteria, and also produce a particular form of disease. The production of certain diseases by the agency of bacteria has now been proved beyond all doubt. In yellow fever, erysipelas, diphtheria, typhoid fever, consumption and other diseases, the connection has been definitely established.

The evil results these germs of disease produce vary greatly in kind and severity. Thus the bacteria of Asiatic cholera and diphtheria may destroy life in a few hours, while those of consumption may take years to produce a fatal result. Again, the bacteria may attack some particular organ, or group of organs, and produce mostly local symptoms. Thus in a boil there is painful swelling due to the local effect of the bacteria, with slight general disturbance.

398. The Battle against Bacteria. When we reflect upon the terrible ravages made by infectious diseases, and all their attendant evils for these many years, we can the better appreciate the work done of late years by tireless scientists in their efforts to modify the activity of disease-producing bacteria. It is now possible to cultivate certain pathogenic bacteria, and by modifying the conditions under which they are grown, to destroy their violence.

In brief, science has taught us, within certain limitations, how to change the virulent germs of a few diseases into harmless microbes.

399. Alcoholic Fermentation and Bacteria. Men of the lowest, as well as of the highest, type of civilization have always known that when the sugary juice of any fruit is left to itself for a time, at a moderately warm temperature, a change takes place under certain conditions, and the result is a liquid which, when drank, produces a pronounced effect upon the body. In brief, man has long known how to make for himself alcoholic beverages, by means of which he may become intoxicated with their poisonous ingredients.

Whether it is a degraded South Sea Islander making a crude intoxicant from a sugary plant, a Japanese preparing his favorite alcoholic beverage from the fermentation of rice by means of a fungus plant grown for the purpose, a farmer of this country making cider from fermenting apple juice, or a French expert manufacturing costly champagne by a complicated process, the outcome and the intent are one and the same. The essential thing is to produce an alcoholic beverage which will have a marked physiological effect. This effect is poisonous, and is due solely to the alcoholic ingredient, without which man would have little or no use for the otherwise harmless liquid.

While the practical process of making some form of alcoholic beverage has been understood for these many centuries, the real reason of this remarkable change in a wholesome fruit juice was not known until revealed by recent progress in chemistry, and by the use of the microscope. We know now that the change is due to fermentation, brought about from the influence, and by the action, of bacteria (sec. 125).

In other words, fermentation is the result of the growth of low form of vegetable life known as an organised ferment. The ferment, whether it be the commonly used brewer’s yeast, or any other species of alcoholic ferment, has the power to decompose or break down a large part of the sugar present in the liquid into alcohol, which remains as a poison, and _carbon dioxid_, which escapes more or less completely.

Thus man, ever prone to do evil, was once obliged, in his ignorance, to make his alcoholic drinks in the crudest manner; but now he has forced into his service the latest discoveries in science, more especially in bacteriology, that he may manufacture more scientifically and more economically alcoholic beverages of all sorts and kinds, and distribute them broadcast all over God’s earth for the physical and moral ruin of the people.

Disinfectants.

400. Disinfectants, Antiseptics, and Deodorants. The word disinfectant is synonymous with the term _bactericide_ or _germicide_. A disinfectant is a substance which destroys infectious material. An antiseptic is an agent which may hinder the growth, but does not destroy the vitality, of bacteria. A deodorant is not necessarily a disinfectant, or even an antiseptic, but refers to a substance that destroys or masks offensive odors.

401. Air and Water as Disinfectants. Nature has provided for our protection two most efficient means of disinfection,—pure air (sec. 218) and pure water (sec. 119). The air of crowded rooms contains large quantities of bacteria, whereas in pure air there are comparatively few, especially after rain, which carries them to the earth. Living micro-organisms have never been detected in breezes coming from the sea, but in those blowing out from the shore large numbers may be found.

In water tainted with organic matter putrefactive bacteria will flourish, whereas pure water is fatal to their existence. Surface water, because it comes from that part of the soil where bacteria are most active, and where there is most organic matter, generally contains great quantities of these organisms. In the deeper strata of the soil there is practically no decomposition of organic matter going on, hence, water taken from deep sources is comparatively free from bacteria. For this reason, deep well water is greatly to be preferred for drinking purposes to that from surface wells.

402. Disinfectants. It is evident that air and water are not always sufficient to secure disinfection, and this must be accomplished by other means. The destruction of infected material by fire is, of course, a sure but costly means of disinfection. Dry heat, steam, and boiling water are valuable disinfectants and do not injure most fabrics. These agents are generally used in combination with various chemical disinfectants.

Certain chemical agents that are capable of destroying micro-organisms and their spores have come, of late years, into general use. A form of mercury, called _corrosive sublimate_, is a most efficacious and powerful germicide, but is exceedingly poisonous and can be bought only under restrictions.[54] _Carbolic acid, chloride of lime, permanganate of potash_, and various other preparations made from zinc, iron, and petroleum, are the chemical disinfectants most commonly and successfully used at the present time. There are also numerous varieties of commercial disinfectants now in popular use, such as Platt’s chlorides, bromo-chloral, sanitas, etc., which have proved efficient germicides.

Instructions for the Management of Contagious Diseases.

The following instructions for the management of contagious diseases were prepared for the National Board of Health by an able corps of scientists and experienced physicians.

403. Instructions for Disinfection. Disinfection is the destruction of the poisons of infectious and contagious diseases. Deodorizers, or substances which destroy smells, are not necessarily disinfectants, and disinfectants do not necessarily have an odor. Disinfection cannot compensate for want of cleanliness nor of ventilation.

404. Disinfectants to be Employed. 1. Roll sulphur (brimstone); for fumigation.

2. Sulphate of iron (copperas) dissolved in water in the proportion of one and a half pounds to the gallon; for soil, sewers, etc.

Note. A most useful little manual to consult in connection with this chapter is the _Hand-Book of Sanitary Information_, written by Roger S. Tracy, Sanitary Inspector of the New York City Health Department. Price, 50 cents.]

3. Sulphate of zinc and common salt, dissolved together in water in the proportion of four ounces sulphate and two ounces salt to the gallon; for clothing, bed-linen, etc.

405. How to Use Disinfectants. 1. _In the sick-room._ The most available agents are fresh air and cleanliness. The clothing, towels, bed-linen, etc., should, on removal from the patient, and before they are taken from the room, be placed in a pail or tub of the zinc solution, boiling-hot, if possible.

All discharges should either be received in vessels containing copperas solution, or, when this is impracticable, should be immediately covered with copperas solution. All vessels used about the patient should be cleansed with the same solution.

Unnecessary furniture, especially that which is stuffed, carpets, and hangings, should, when possible, be removed from the room at the outset; otherwise they should remain for subsequent fumigation and treatment.

2. _Fumigation_. Fumigation with sulphur is the only practicable method for disinfecting the house. For this purpose, the rooms to be disinfected must be vacated. Heavy clothing, blankets, bedding, and other articles which cannot be treated with zinc solution, should be opened and exposed during fumigation, as directed below. Close the rooms as tightly as possible, place the sulphur in iron pans supported upon bricks placed in washtubs containing a little water, set it on fire by hot coals or with the aid of a spoonful of alcohol, and allow the room to remain closed for twenty-four hours. For a room about ten feet square, at least two pounds of sulphur should be used; for larger rooms, proportionally increased quantities.[55]

3. _Premises_. Cellars, yards, stables, gutters, privies, cesspools, water-closets, drains, sewers, etc., should be frequently and liberally treated with copperas solution. The copperas solution is easily prepared by hanging a basket containing about sixty pounds of copperas in a barrel of water.[56]

4. _Body and bed clothing, etc_. It is best to burn all articles which have been in contact with persons sick with contagious or infectious diseases. Articles too valuable to be destroyed should be treated as follows:

_(a)_ Cotton, linen, flannels, blankets, etc., should be treated with the boiling-hot zinc solution; introduce piece by piece, secure thorough wetting, and boil for at least half an hour.

_(b)_ Heavy woolen clothing, silks, furs, stuffed bed-covers, beds, and other articles which cannot be treated with the zinc solution, should be hung in the room during fumigation, their surfaces thoroughly exposed and pockets turned inside out. Afterward they should be hung in the open air, beaten, and shaken. Pillows, beds, stuffed mattresses, upholstered furniture, etc., should be cut open, the contents spread out and thoroughly fumigated. Carpets are best fumigated on the floor, but should afterward be removed to the open air and thoroughly beaten.

Books for Collateral Study. Among the many works which may be consulted with profit, the following are recommended as among those most useful: Parkes _Elements of Health_; Canfield’s _Hygiene of the Sick-Room;_ Coplin & Bevan’s _Practical Hygiene;_ Lincoln’s _School Hygiene_; Edward Smith’s _Health_; McSherrys _Health; American Health Primers_ (12 little volumes, edited by Dr. Keen of Philadelphia); Reynold’s _Primer of Health_; Corfield’s _Health_; Appleton’s _Health Primers;_ Clara S. Weeks’ _Nursing_; Church’s _Food_; Yeo’s _Food in Health and Disease;_ Hampton’s _Nursing, its Principles and Practice_; Price’s _Nurses and Nursing;_ Cullinworth’s _Manual of Nursing_; Wise’s _Text-Book of Nursing_ (2 vols.); and Humphrey’s _Manual of Nursing_.