Part 30

In the days when open fireplaces were almost the only means of heating houses they were of great value in aiding ventilation. Nowadays our stoves, radiators and furnaces do not help us in this matter, and we must take additional pains to see that ventilation is provided in some other way. Of course the simplest and most perfect method is to permit the free passage of the wind through open doors and windows. Every room should have its air thus completely renewed at least once a day. The mere renewal is done in a few minutes, but a longer time is required to dislodge the organic vapors and other impurities that lurk in the corners and behind furniture. In schools and work shops this should be done during the intervals for meals, and in churches between services. But in our climate it is not possible to have windows and doors open during all the time a room is occupied, except in very warm weather. It is seldom, however, that the window of a bedroom cannot be opened for a few inches all night without direct benefit to the occupant of the room. His bed, of course, must not be immediately in the draught. Curved pipes, ventilating shafts and slides under the windows are substitutes easy to use when windows cannot be actually opened.

GUARD YOUR WATER SUPPLY

Water supplies differ greatly in purity and composition, and are of the utmost importance in their effect upon the general health of a household. There is nothing which requires to be guarded more carefully. Absolutely pure water is almost unknown. Rain water collected in open countries is the purest, though even it takes up matters in its passage through the air, and in towns may be strongly acid. All waters which have been in contact with the soil dissolve out of it numerous inorganic and organic substances. Waters are described as hard or soft, hardness being the popular expression for the property of not easily forming a lather with soap. It is due to the presence of salts of lime and magnesia. Hard waters, if their hardness be not excessive, are agreeable and wholesome for drinking, but not well adapted for laundry or bathing purposes. They tend to harden vegetables cooked in them, and do not make as good tea as soft water. Rain water is, of course, the softest, but as a rule lakes yield waters also quite soft. When a good and wholesome water cannot be obtained from springs or rivers, as in malarial districts, and when there is reasonable ground for thinking the ordinary sources are contaminated by epidemics, it is well to fall back on the rainfall for drinking purposes, with special care that it is collected in a cleanly manner.

Surface wells are always to be viewed with suspicion when they are in the vicinity of stables and cesspools, farm yards, cemeteries and anywhere in the towns. The filtration of the water through the soil removes the suspended matters, so that it may be clear enough to the eye, but it has no power to remove impurities actually dissolved. The eye cannot be trusted to judge the impurities of drinking water. Water which appears absolutely clear may be unwholesome in the extreme, and water with sediment floating in it may be in no way unwholesome. Nothing but an analysis of the water can settle this with absolute certainty. Deep wells and artesian wells which penetrate the surface strata are likely to be safe. Marsh waters carry malaria and should never be drunk without boiling. Indeed suspicious water of all sorts may be made safe by boiling, although it is not sufficient always merely to bring it to a boil. Thirty minutes above the boiling point is a safe rule to follow. Typhoid, diphtheria, dysentery, cholera, diarrhea and other dangerous diseases are caused by impure water, either by suspended mineral matters acting as irritants, by suspended vegetable and animal matters, or by dissolved animal impurities. Sewer gases dissolved in water, in addition to these diseases, cause sore throats, boils and other ailments.

It must not be forgotten that water closets, stable yards, manure piles, decaying kitchen slops and all sorts of filth are responsible for many of the most serious diseases, either by draining into the well and so contaminating the water supply, or by direct breeding of disease germs carried as dust and inhaled. Health is one of the rewards for household cleanliness of the most careful kind.

HOW DISEASES ARE CLASSIFIED

In one sense most diseases are preventable, if all the circumstances which tend to spread them could be absolutely controlled by a single wise authority, and if all the physiological laws would be obeyed by all persons at all times. But as this happy condition is not in effect, we have to reckon with various kinds of diseases, as well as the accidents and injuries which come to us in health. The various diseases are classified into general groups.

Endemic diseases are those which are constantly present in a community because of certain unfavorable conditions, such as malaria in swampy regions, rheumatism from bad climatic conditions, and diseases resulting from unhealthy employments. Miasmic diseases are those due to conditions of the soil, and comprise the various forms of intermittent fevers, agues and the like. Infectious diseases, on the other hand, belong to the people, and not to the place. They are communicated from one person to another through the air, or by means of infected articles of clothing, etc., and they attack the strong and healthy, no less than the weak. Among such are smallpox, scarlet fever, measles, etc. Various branches of infectious diseases are recognized in addition, as combining some of the characteristics of the classes already named. For instance, erysipelas and other blood poisons are generated with the body of the individual who, so to speak, infects himself and may then infect others. Typhoid, cholera and yellow fever are miasmic diseases, but they are also capable of being carried by human intercourse, infected clothes, polluted water, etc., within certain limits of space and time. Hydrophobia, glanders and such diseases are communicated only by actual contact of body. Rickets and scurvy are preventable, though not communicable diseases, being direct results of mal-nutrition or imperfect nourishment, and consequently are diseases of diet.

Bacteria are those minute organisms which under various names are the active causes not only of diseases but of all putrefaction, fermentation and like changes in dead organic matter. Like all living things they may be killed, and on this is based the whole theory of disinfection. Some are more hardy than others, under conditions which are frequently supposed to be unfavorable to them. Merely to destroy an unpleasant odor or to admit fresh air into a room does not mean to disinfect, and it is necessary to understand this clearly in the effort to purify rooms in the event of infection.

Contagion is communicated sometimes with the utmost ease, if the new victim be in a receptive condition, and in the presence of any disease, even the most simple, it is well to take every precaution. The mucous surfaces are peculiarly ready to absorb infection of many kinds. Measles is easily absorbed from pocket handkerchiefs, as are also scarlet fever, whooping-cough and other diseases. By inhalation through the nostrils or mouth, scarlet fever, measles, whooping-cough, mumps, diphtheria, dysentery, cholera and even pneumonia and meningitis may be communicated. By eating or drinking something which contains the germs of cholera, typhoid, malaria, tuberculosis or consumption, diphtheria and scarlet fever, these diseases are communicated.

HOW TO PREVENT CONTAGION

It is an undoubted fact that not enough attention is paid to isolation in times of sickness. There is too much visiting in the sick room, too many people share the care of the patient, the nurse mingles too freely with other members of the family, and there is not enough care to keep the soiled bedding, garments and refuse of the sick room absolutely separated from that of the rest of the house. Scarlet fever is a noteworthy instance of a disease which constantly spreads by carelessness. Just as long as the scaling or shedding of the outer skin continues contagion may be carried, for it is these scales which bear it. It is nothing less than criminal, therefore, to permit the patient who is recovering to mix with other persons, except those who have been caring for him already. In the early stages of the disease the infection is chiefly in the breath, and in the secretion of the nostrils. During the disease pocket handkerchiefs should never be used, soft linen or cotton rags being substituted and immediately burned.

Most of the same things are true as to measles, whooping-cough, mumps and German measles, which are constantly spread by sheer carelessness because people do not realize the obligation resting upon them to guard others from contact with disease. These ailments are highly infectious before they are certainly recognized, and for that reason it is not possible always to isolate cases in time, but at least after the fact is clearly understood there should be no further carelessness.

Another prevalent disease in which carelessness is responsible for much of its spreading is tuberculosis, phthisis, or consumption, as it is more familiarly known. It is not possible yet to isolate every person suffering with this insidious disease, nor is that suggested. But at least it may be urged that every such sufferer shall thoughtfully guard in every way in his power against communicating it to his own neighbors and family. The bacilli, or bacteria, of consumption swarm in the spittle of the patient, and are diffused by the wind as dust as soon as they are dried. To guard against infection from this cause, spittoons should be used, which can be absolutely disinfected, or cloths which can be promptly burned.

Smallpox is perhaps the most infectious of diseases. Yet in vaccination we have a means of protection which we have not in any other. As long as a large unvaccinated population exists, however, we shall have epidemics from time to time. Before the introduction of vaccination nearly everyone had smallpox, just as now almost all persons have measles at some time or other. The heaviest mortality occurred within the first five or ten years of life, the deaths in later periods being very few, since the population had mostly been rendered immune by having had it already.

Measles is a well-defined disease, intensely infectious, occurring but once in a lifetime. It is very rarely fatal, nearly all the deaths credited to it being really due to bronchitis and inflammation of the lungs, the results of neglect and exposure to cold. No age is exempt. The only reason why it is looked on as a disease of childhood is that being in the highest degree infectious from the beginning, when its nature is not suspected, few children in the schools can hope to escape it, but if by chance they do, they are just as susceptible to it in afterlife.

Whooping-cough is a highly infectious disease, occurring but once in a lifetime, but at any age, though most frequently in childhood. The frequent belief that children suffering from whooping-cough should be as much as possible in the open air is an entirely mistaken one, as it leads not only to continuing the disease longer, but to danger of bronchitis and pneumonia. As in diphtheria and scarlet fever the mucus is the chief vehicle of contagion, and pocket handkerchiefs should be forbidden, pieces of soft rag being substituted and burned as soon as used.

Typhoid or enteric fever is slow and uncertain in its onset, a full month in duration, and the return of health is usually tedious. It is like diphtheria, directly a result of unsanitary conditions. Danger of direct infection from the patient is slight, but the poison remains in the evacuations from the bowels and is propagated by them. By this means a reservoir or river has been known to infect a whole town. Broken or defective drains, the entrance of sewer gas into houses, wells polluted by cesspool drainage, and milk diluted with infected water, are among the principal means of spreading the disease. It is an absolute rule that all bedding which becomes soiled should be destroyed, and the refuse of the sick room should be instantly disinfected and removed from the dwelling.

CARE OF THE SICK ROOM

Although it is quite possible that few may be able to follow every instruction or precaution advised to guard against the spread of diseases, we may at least outline the conditions to be aimed at and secured as nearly as possible. In spite of the additional labor that it makes, the ideal place for a sick room in a private house is as far from the ground as possible. To be of any service at all isolation must be real and complete. A room should be selected in the topmost story, the door kept closed, a fire, large or small, according to the weather, kept burning, and the windows open as much as possible. Even in the winter this can be done without danger under most circumstances by lowering the upper sash and breaking the draught by a blind or a screen. The staircase and hall windows should be kept open day and night. The other inmates of the house should keep their own rooms thoroughly ventilated. The persons nursing the patient should on no account mix with other members of the family, or if that cannot be helped they should take off their dresses in the sick room, and after washing their hands and faces, put on other dresses kept hanging outside the room, or in an adjoining apartment.

All dishes used in the room should be washed separately, and not with others in the kitchen. The room itself, except in case of measles and whooping-cough, the poison of which does not retain its vitality for any length of time, should be as scantily furnished as possible, containing nothing which can retain infection. All woolen carpets, curtains and bed hangings should be removed, and only wooden or cane-bottomed chairs kept. There should be no sofa, and iron bedsteads are better than wood. A straw mattress of little value, which may be destroyed afterwards, is better than a hair one, which can be disinfected, but feather beds and such coverings should be absolutely forbidden.

In scarlet fever, diphtheria, smallpox and typhoid, all soiled clothing and bedding should be immediately put into an earthenware vessel, containing a solution of corrosive sublimate (one drachm to a gallon of water) and left to soak for some hours before being washed. On being taken from this disinfecting solution they must, even at risk of spoiling flannels, be thrown into boiling water and boiled for some minutes before soaping and washing. No infected clothes should, under any circumstances, be sent out of the house, unless all of these precautions are absolutely guarded.

In cases of typhoid and scarlet fever the vessel which receives the passages from the bowels should have in it a solution of corrosive sublimate or of carbolic acid. The contents then should be stirred with a poker before being poured into the water closet, and the same disinfectant should be sprinkled liberally into the closet.

After the peeling in scarlet fever or the shedding of scabs in smallpox has set in, the patient should take, at intervals of three or four days, hot baths with soft soap, the hair, previously cut short, being well scrubbed with the same. In scarlet fever and diphtheria the mouth and throat should be frequently sprayed, washed out or gargled with a pretty strong solution of permanganate of potash or a weak one of chlorinated soda.

DISINFECTION, ITS IMPORTANCE AND ITS METHODS

There are few subjects on which greater ignorance exists, not only among the public but among medical men as well, than on that of disinfectants. The word is used vaguely to mean deodorants, which destroy bad odors; antiseptics, which prevent the spread of injury by putrefaction in a wound; and germicides, which actually destroy the bacteria or microbes which produce contagion in a disease. In some cases one of these may serve the function of another, but that is merely incidental. Deodorants may be such simple things as perfumery, tobacco smoke or camphor, and they serve very useful purposes in masking bad smells, but they are entirely useless in preventing disease.

Permanganate of potash, or “Condy’s fluid,” as the druggists call it, is a powerful antiseptic, instantly destroying the matter that is beginning to putrefy by what is really a burning process. It sweetens the foul discharges from wounds and bad throats, but is nearly powerless to destroy the living germs of disease.

The disinfectants of most practical value, which are at the same time germicides, are carbolic acid, chloride of zinc, sulphurous acid, chlorine and corrosive sublimate. Carbolic acid, when strong enough, is fairly satisfactory. Five per cent solutions (one part in twenty) stop the activity of bacteria, but do not actually destroy their vitality. Solutions twice as strong do, but water will not dissolve so much, and the odor that remains is an objection to their use for disinfecting linen. Chloride of zinc is far more powerful. If too strong a mixture is used it may injure cloth, so that this wants to be guarded against.

Sulphurous acid (the fumes of burning sulphur) is a most convenient disinfectant. Shut the windows down tight, leave all the clothing in its place and open trunks and drawers. Put a thick layer of ashes in an old iron pot, over which place a shovel of live coals; throw a teacup of pulverized sulphur on the coals and run out, closing the doors in your exit. Stay out several hours. On returning open all doors and windows, and the odor will soon be gone, also the bugs, insects and the germs of any disease that may be lodged in the clothing, etc.

The following instructions, published in the Hospital Gazette, were prepared by a board of eminent physicians and surgeons for public information, and on the general proposition of disinfection they can hardly be surpassed: Three different preparations are recommended for use to make the purifying of a house, where infection has been, complete. The first is ordinary roll sulphur or brimstone, for fumigation; the second is a copperas solution, made by dissolving sulphate of iron (copperas) in water in the proportion of one and one-half pints to one gallon, for soil, sewers, etc.; the third is a zinc solution, made by dissolving sulphate of zinc and common salt together in water in the proportion of four ounces of the sulphate and two ounces of the salt to one gallon, for clothing, bed linen, etc. Carbolic acid is not included in the list, for the reason that it is very difficult to determine the quality of what is found in the stores, and the purchaser can never be certain of securing it of proper strength. It is expensive when of good quality, and it must be used in comparatively large quantities to be of any use. Besides it is liable, by its strong odor, to give a false sense of security. Nothing is commoner than to see saucers of carbolic acid and other disinfectants in a sick room. Considering the vitality of bacteria, and that they require carbolic solutions of more than five per cent or several hours of intense heat or similar heroic measures to kill them, it must be evident that such feeble vapors as can be tolerated in the sick room are utterly useless. Here are the instructions in full:

=In the Sick Room=, the most valuable agents are fresh air and cleanliness. The clothing, towels, bed linens, 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 the copperas solution, or, when this is impracticable, should be immediately covered with the solution. All vessels used about the patient should be cleansed or rinsed with the same. 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, as next explained.

=Fumigation.=—Fumigation with sulphur is the method used for disinfecting the house. For this reason the rooms to be disinfected must be vacated. Heavy clothing, blankets, bedding and other articles which cannot be treated with the zinc solution, should be opened and exposed during fumigation, as next directed. Close the rooms tightly as possible, place the sulphur in iron pans supported upon bricks placed in wash-tubs 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 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.

=Premises.=—Cellars, stables, yards, gutters, privies, cesspools, water closets, drains, sewers, etc., should be frequently and liberally treated with the copperas solution. The copperas solution is easily prepared by hanging a basket containing about sixty pounds of copperas, in a barrel of water. (This would be one and one-half pounds to the gallon, or about that. It should all be dissolved.)

=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: Cotton, linen, flannels, blankets, etc., should be treated with the boiling hot zinc solution, introduced piece by piece; secure thorough wetting, and boil for at least half an hour. 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 the fumigation, their surfaces thoroughly exposed, and the 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.

=Corpses.=—Corpses of those dying from infectious diseases should be thoroughly washed with a zinc solution of double strength; should then be wrapped in a sheet wet with zinc solution and buried at once. Metallic, metal-lined, or air-tight coffins should be used when possible, certainly when the body is to be transported for any considerable distance. Of course a public funeral is out of the question.

In addition to these disinfectants of long standing, which have been recognized in medicine for many years, another of great value is now coming into high favor. This is formalin, which, in its various forms, is convenient, economical and highly effective. Under the name of formaldehyde, one preparation of this disinfectant is widely but improperly used as a preservative for milk, meat and some other perishable foods. In almost every instance this is illegal, and properly so, for the substance is a poison and even when diluted cannot fail to be injurious. From formalin various disinfecting substances are made, and may be had at the drug stores, some as liquids and others in tablets to evaporate over a lamp for the general disinfection of rooms or houses. The latter may be recommended in the highest degree as a safe, economical and absolutely sanitary process.