Part 142

For Clothing, Bedding, &c.

(_a_) Soiled underclothing, bed linen, &c.:

(1) Destruction by fire, if of little value.

(2) Boiling at least ½ hour.

(3) Immersion in a solution of mercuric chloride of the strength of 1 in 2000 for 4 hours. The blue solution containing sulphate of copper, diluted by adding 2 oz. concentrated solution to 1 gal. water, may be used for this purpose.

(4) Immersion in a 2 per cent. solution of carbolic acid for 4 hours.

(_b_) Outer garments of wool or silk, and similar articles, which would be injured by immersion in boiling water or in a disinfecting solution:

(1) Exposure to dry heat at a temperature of 230° F. for 2 hours.

(2) Fumigation with sulphurous acid gas for at least 12 hours, the clothing being freely exposed, and the gas present in the disinfection chamber in the proportion of 4 volumes per cent.

(_c_) Mattresses and blankets soiled by the discharges of the sick:

(1) Destruction by fire.

(2) Exposure to superheated steam--25 lb. pressure--for 1 hour. Mattresses to have the cover removed or freely opened.

(3) Immersion in boiling water for 1 hour.

(4) Immersion in blue solution (mercuric chloride and sulphate of copper) 2 fl. oz. to 1 gal. of water.

Fire.--Materials used in wiping away discharges may be burned in the open fireplace of the sickroom. In general, this method is to be recommended for all substances which have been exposed to infection, which cannot be treated with boiling water, and, could it be carried out in all cases, would make disinfection a very simple matter. If there is no fire in the room, such substances may be wrapped in a sheet soaked with solution, carbolic acid, and in this condition conveyed to a fire elsewhere.

Boiling Water.--Boiling in water for ½ hour will destroy the vitality of all known disease germs. This is therefore the best means for all articles which can be thus treated, such as body-clothing of the patient, bed-clothes, towels, &c. All utensils used in the room in feeding the patient should likewise be treated with boiling water before being removed from the room. Food itself, not consumed by the patient, should not be used by others, as it is liable to become infected in the sickroom. If there are no facilities for treating articles with boiling water in the sickroom, they may with safety be removed to another part of the house for this treatment if they are carefully enveloped in a towel or sheet, as the case may require, which has been thoroughly soaked with carbolic acid solution. Thus enveloped, they should be put in the water, and boiled for the required time.

Chloride of Lime.--To be effective as a disinfectant this must be of the best quality, and in purchasing it, only that should be accepted which is enclosed in glass bottles, as, when packed in paper or wooden boxes, it is liable to have so deteriorated as to be worthless for disinfecting purposes. Dissolved in water, in the proportion of 4 oz. to 1 gal., it forms a standard solution recommended to be used in the disinfection of discharges in contagious diseases, especially in typhoid fever and cholera; 1 pint should be well mixed with each discharge; after 10 minutes, disinfection is completed, and the contents of the vessel may be then safely thrown into the water closet. The expectorated matter of those sick with consumption should be discharged into a cup half filled with this or carbolic acid solution.

Solution of Chlorinated Soda.--To be effective, this solution must contain at least 3 per cent. of available chlorine, and care should be exercised to obtain such a quality. This is sometimes spoken of as Labarraque’s solution; but, as this latter is too weak to act as a disinfectant, the name is liable to mislead. A standard solution is made by adding 5 parts water to 1 of the solution of chlorinated soda. The cost of this solution is about 5_d._ a gallon. When thus diluted it may be used for all the purposes for which chloride of lime was recommended, and is of a somewhat more agreeable odour, though more expensive. It should be used to cleanse portions of the body soiled with discharges of those sick with infectious diseases, or the hands of attendants similarly soiled.

Bichloride of Mercury (corrosive sublimate) is recommended to be used only in the disinfection of privy vaults which contain so much material, believed to be infected with the germs of typhoid fever or cholera, that the disinfection by chloride of lime would be impracticable. In using this, it should be dissolved in the proportion of 1 oz. bichloride of mercury to 1 gal. water; this quantity will disinfect 4 gal. infected excremental matter.

For Clothing after Recovery or Death.

The clothing of the patient should be treated in the manner already described as necessary during the sickness. Whatever can be boiled in water should be thus disinfected; articles which cannot be boiled should, if circumstances will permit, be burned; all other articles should be left in the room to be subjected to the fumigation hereafter to be described, and until thus treated, the room and its contents should be closed with lock and key, to prevent any one from entering. If it is desired to burn any articles, and facilities for it do not exist in the house, the authorities should be notified, and an officer will call and remove the articles for destruction.

Permanganate of potash (commonly known as Condy’s fluid), Burnett’s fluid, and chloride of lime, can all be mixed with water, and used for clothing if care is taken. Carbolic soap is excellent for scrubbing. Sulphate of zinc and common salt, dissolved together in water in the proportion of 4 oz. sulphate and 2 oz. salt to 1 gal. will do for clothing, bed-linen, &c.

Armfield & Son, 15 Lower Belgrave Street, London, W., and Victoria Bridge Road, S.W., disinfect and clean articles after fever, &c., by means of special apparatus.

For Furniture and Articles of Wood, Leather, and Porcelain.

Washing several times repeated with:

(1) Solution of mercuric chloride 1 in 1000. The blue solution, 4 oz. to 1 gal. water may be used.

(2) Solution of chloride of lime, 1 per cent.

(3) Solution of carbolic acid, 2 per cent.

For articles of metal use No. 3.

For the Person.

The hands and general surface of the body of attendants of the sick, and of convalescents at the time of their discharge from hospital:--

(1) Solution of chlorinated soda diluted with 9 parts of water (1 in 10).

(2) Carbolic acid, 2 per cent. solution.

(3) Mercuric chloride, 1 in 1000; recommended only for the hands, or for washing away infectious material from a limited area, not as a bath for the entire surface of the body.

For Body of the Patient after Recovery.

When the patient has recovered, he should be first sponged over with the solution of chlorinated soda, diluted in the proportion of 1 part to 20 of water; and, indeed, during the course of the illness occasional sponging of the body with this very dilute solution under the direction of the attending physician, will be of value in preventing the escape from the surface of the body of infectious material. When, after recovery, the body has been thus sponged, not omitting the head and hair, a thorough washing of the body with soap and warm water should follow, and the patient dressed in clothes which have not been exposed to infection. This should take place in another room than the one occupied during the illness.

For the Dead.

Envelope the body in a sheet thoroughly saturated with

(1) Chloride of lime in solution, 4 per cent.

(2) Mercuric chloride in solution, 1 in 500.

(3) Carbolic acid in solution, 5 per cent.

The body should be thoroughly sponged with either (1) or (3), and then wrapped completely in a sheet saturated with one of these solutions, and enclosed in a coffin, which is to be closed, and the interment must take place within 24 hours, and be strictly private. If the interment is to take place at a distance requiring transportation by any other means than a hearse, the coffin must be of metal, or metal-lined, and hermetically sealed.

When danger is to be apprehended from this source, the body should be, when coffined, surrounded with sawdust, in which these solutions have been placed. Carbolic sanitas powders also present effective means whereby disinfection of the dead body may be performed when coffined; and nitrous acid fumes form the best disinfectant for mortuaries or apartments in which the dead have lain for some time.

Room and Contents.

The room, having been vacated by the patient, should first be fumigated by burning sulphur. This fumigation should be done under the supervision of the physician or some other intelligent person. Nothing should be removed from the room until this is completed, unless it has been disinfected in the manner already described. Everything to be fumigated should be so opened and exposed that the sulphur fumes can come in contact with all portions thereof. All cracks of doors and windows, fire-places, or other channels by which the gas may escape should be tightly closed, using cotton wadding when necessary. For a room 10 ft. in all its dimensions--that is, one containing 1000 cub. ft. of air space--2 lb. broken sulphur and 1 lb. flowers of sulphur should be provided, and an increased amount for larger rooms, in the same proportion. This quantity is important, as less will not so efficiently accomplish the desired disinfection. The sulphur should be put in an iron pot, and this placed on bricks in a large washtub half filled with water, or in a large coal-scuttle containing wet ashes. This precaution is necessary to prevent setting fire to the floor, which would occur if the pot were placed directly on the floor or carpet. The vessel containing the sulphur should not be one with soldered joints, as the intense heat would melt the solder. A pot capable of holding 1 gal. is about the right capacity for 3 lb. sulphur. The pot should be placed in the centre of the room; if the room is a large one, containing several thousand cub. ft. of air space, several pots should be provided, distributed at different points. Everything being in readiness, sufficient alcohol to moisten the sulphur should be poured on it, a lighted match applied, and when it is seen that the sulphur is well ignited, the room should be left and the door shut, and all cracks outside, including the key-hole, closed by paper, cotton, or other material. At the end of 10 hours the fumigation is completed. Great care should be exercised in emptying the room of the sulphur fumes, as these cannot be safely breathed, and are excessively irritating to the eyes and throat. If possible, a window should be opened from the outside, and through this the fumes permitted to escape; if this is impracticable, all the windows and doors of adjoining rooms should be opened, and then the door of the fumigated room, and through these outlets the fumes allowed to find an exit. Thorough airing will remove the slight odour which remains.

The fumigation being completed, all woodwork, as of floors, windows, and door, and the walls and other surfaces, should be washed over with solution of chlorinated soda, particular attention being paid to cracks, crevices, and out of the way places, in which dirt ordinarily finds a lodgment and from which it is with difficulty removed. A subsequent washing with hot water and soap will complete the cleansing process, and the room may be considered again habitable.

(_a_) While occupied, wash all surfaces with:--

(1) Mercuric chloride in solution, 1 in 1000. The blue solution containing sulphate of copper may be used.

(2) Chloride of lime in solution, 1 per cent.

(3) Carbolic acid in solution, 2 per cent.

(_b_) When vacated:--

Fumigate with sulphur dioxide as described in the next paragraph.

A pleasant disinfectant for rooms is 20 parts camphor, 50 each hypochlorite of lime, alcohol, and water, 1 each eucalyptus and clove oils. The ingredients must be mixed slowly in a spacious vessel kept cool. A few drops on a plate will suffice to disinfect a chamber pleasantly.

Carbolic acid, when combined with water and boiled, evaporates with the steam in a constant ratio, and the steam contains the same relative quantity of the acid as the water from which it evaporates. Pour 20-40 drops of a mixture of equal parts turpentine and carbolic acid into a kettle of water, which keep simmering over a slow fire, so that the air of the sick room will be constantly impregnated with the odour. An excellent vaporiser for disinfecting purposes is made by Savory and Moore.

To purify the air in a sickroom, place in the bed a small basket or other porous article, containing wood charcoal, for the purpose of absorbing the foul air which, if diffused throughout the surrounding atmosphere, would be constantly returned to the lungs.

In a sickroom in which infants are sleeping, put a box or basket containing a piece of quicklime and some wood charcoal, for the purpose of fixing the carbonic acid exhaled from the lungs, and of absorbing all the foul air generated in the system, and given off by exhalation from the skin or otherwise.

Cellars, yards, stables, gutters, privies, cesspools, water-closets, drains, sewers, &c., should be frequently and liberally treated with copperas (sulphate of iron) solution. The copperas solution is easily prepared by hanging a basket containing about 60 lb. copperas in a barrel of water, or say 1½ lb. per gal. It stains linen.

Another good solution is made thus. Dissolve ½ dr. nitrate of lead in 1 pint boiling water; dissolve 2 dr. common salt in a pail of cold water. Pour the two solutions together, and allow the sediment to subside. Areas, dustbins, heaps of refuse, w.c.’s, or close rooms are all alike benefited by this mixture, which has the advantage of being without smell. Cloths dipped in the solution and hung up in a room will sweeten a fetid atmosphere immediately. It is cheap, nitrate of lead being procurable at about 6_d._ a lb.

_Rheumatism._--This common ailment is essentially due to damp or being chilled. One of the easiest and most satisfactory means of treatment is to apply a flannel bandage, pretty tightly, round the chest, in order to restrain the movements of the chest wall. Soothing liniments may also be laid on the side, such as belladonna and chloroform liniments, mixed in equal proportions, or the liniment of turpentine, or cajeput oil mixed with olive oil. Some of the popular domestic remedies for lumbago (rheumatism in the back), are not to be despised, such as ironing with a hot smoothing iron (with the interposition of a double layer of flannel between the skin and the iron), the efficacy of which is heightened by wrapping the flannel round the hot iron, and moistening the flannel with vinegar. The iron, thus guarded, is left in contact with the skin for ¼ minute, at various points. Another good remedy is the application of turpentine, effected by taking a doubled piece of flannel, say 12-14 in. long by 8-10 in. wide, and dipping it into boiling water. It is then wrung firmly, and turpentine is sprinkled liberally over it. This is applied to the loins, and kept on for 20-30 minutes. When removed, cotton-wool is applied to the skin. At the outset a strong effective purge ought to be taken.

A good hot bath (104° F.) is very beneficial, and it may be advantageous to make it alkaline, by adding about 6 oz. carbonate of soda (washing soda) to the bath before entering it; this will be specially efficacious in stiffness of the joints or muscles. Of the many drugs which have the effect of inducing free perspiration, solution of acetate of ammonia may most safely be used in tablespoonful (adults) doses freely diluted with water. The bowels may be opened by a mild aperient, preferably saline, taken largely diluted in hot water, and early in the morning. The action of the kidneys ought to be kept up by diuretics, the simplest being water, say a tumblerful drunk slowly in the morning, while dressing, or it may be rendered more energetic by the addition of 1 teaspoonful cream of tartar.

Diet ought to be restricted to light forms of solid food, e.g., fish, soups, chicken, puddings, vegetables, fruit, milk. Beer and wines should be avoided; ærated waters may be taken freely; smoking is prejudicial. Finally, persons who suffer from rheumatism ought always to wear flannel next the skin, and encourage perspiration. Most alkalies are useful in relieving rheumatism. Potash, or soda bicarbonate may be freely used in doses of ½ teaspoonful, in ½ tumbler of ærated water, twice daily, for 3-4 weeks at a time.

_Sea-sickness._--Many people, as soon as sea-sickness commences, have recourse to oranges, lemons, &c. Oranges are very much to be avoided, on account of their bilious tendency, and even the juice of a lemon should only be allowed in cases of extreme nausea. Champagne, too, is a very common remedy, and, without doubt, in many cases does good; but this appears to be chiefly due to its exhilarating effects, as, if it be discontinued, the result is bad, and a great amount of prostration follows. Creosote is an old, but still good, remedy, and, in cases accompanied by great prostration, is very useful; but if given in the early stages of sea-sickness, it is often followed by very bad results, and even increases the nausea. Bicarbonate of soda is useful in slight cases, as it relieves nausea, and checks the frequent eructations which often follow attacks of sea-sickness; but in severe cases it is absolutely useless, and, in fact, it very often prolongs the retching. A very good remedy in the earlier stages of sea-sickness is a teaspoonful of Worcester sauce; it relieves the symptoms, and renders the patient easier. Its action is probably of a stimulant nature. Hydrocyanic acid is of very little service, and most acid mixtures are to be avoided, except that perhaps for drinking purposes, when it is best to acidulate the water with a small quantity of hydrochloric acid. Of all drugs the most effectual is sodium bromide. When sodium bromide is given in doses of 10 gr., 3 times a day, the attacks entirely subside, the appetite improves, and the patient is able to walk about with comfort. In sea-sickness it is very desirable that the patient should take sufficient food, so that at all times the stomach may be comfortably full, for by this means over-straining during fits of retching is prevented, and the amount of nausea is diminished. The practice of taking small pieces of dry biscuit is not of much use, as although the biscuit is retained by the stomach, yet the amount taken is never sufficient to comfortably fill the stomach. Soups, milk-puddings, and sweets are to be avoided, as they increase the desire to be sick, and are followed by sickening eructations. Fat bacon is easily borne, and does much good, if only the patient can conquer his aversion to it. When taken in moderate quantity it acts as a charm, and is followed by very good results. Of all food, curry is the most useful in sea-sickness, and is retained by the stomach when all other food has been rejected. Next to curry come small sandwiches of cold beef, as they look nice on the plate, and are usually retained by the stomach. Brandy should be used very sparingly, as, in many cases, it induces sea-sickness; and its chief use is confined to those cases where the prostration is very great, and even then champagne is more effectual. (Dr. Kendall, _Brit. Med. Jour._)

_Skin complaints._--Many of these are of a character to demand the early attention of the doctor, but there are others which can readily be combated by home treatment.

Pimple (Acne).--These are a frequent trouble in young people and may be very disfiguring. They arise from inefficient action in the fat (sebaceous) glands of the skin. Generally they can be dislodged by squeezing with the thumb nails. To promote healthy action of the glands and prevent formation of the pimples, Dr. Liveing recommends the following plan.

(_a_) Steam the face every night by holding it over a basin of hot water for a few minutes. (_b_) Rub the skin for 5-10 minutes with soap (preferably terebene) and flannel, or with a soft nailbrush; then sponge off the soap with warm water. (_c_) When the face has been dried, a lotion should be thoroughly applied, composed as follows: ½ oz. precipitated sulphur, 2 dr. glycerine, 1 oz. spirits of wine, with 3 oz. each rose-water and lime-water. This is allowed to dry on the skin and to remain on all night. In the morning the face is cleansed with warm oatmeal and water or weak gruel. If, for any reason, an ointment seems preferable to a lotion, a combination of precipitated sulphur and vaseline is very useful. The treatment must be modified or suspended for 2 or 3 nights if the skin becomes sensitive and somewhat tender. If this plan be unsuccessful, try application of potash soap in the form of a lotion. The lotion is composed of 1 oz. each soft soap and rectified spirits of wine, and 7 oz. rose (or distilled) water. This should be rubbed in vigorously with a piece of flannel for a short time, taking care not to make the skin sore. According to Dr. Liveing, the worst cases of acne will yield to the soft soap treatment if practised with necessary caution.

Something is often required to be done during the daytime to pacify the heat and throbbing, which are part of the usual history of acne. An excellent lotion is made by combining oxide of zinc, calamine, prepared chalk, lead lotion, and lime-water, to which may be added a small quantity of glycerine. Let the bottle containing this be gently waved about so as to diffuse the materials, which are only held in suspension; then pour a little into a saucer, and with a sponge (reserved for the purpose) sprinkle the face from time to time. Wipe off, when necessary, with a bit of fine muslin the powder which remains on the skin after the evaporation of the fluid, and the face may be washed occasionally with a little starch gruel. The cases are not a few in which it is better not to use any kind of soap as part of the evening ceremonial. After the face has been steamed, put on a medicated jelly composed of zinc oxide, gelatine, and glycerine. It must be liquefied by putting the vessel that holds it into hot water, and then applied with a brush. Some sensitive skins are intolerant of sulphur in any guise. When this is so, try combinations of lead, chalk and zinc, blended as a quasi-ointment with the finest vaseline. Dr. McCall Anderson’s formula of bismuth oleate with vaseline and white wax has been aptly described as “one of the most healing of salves.” Sometimes nothing agrees better than the old-fashioned but capital substance called Kirkland’s “neutral cerate,” which is composed essentially of lead plaster and olive oil.

Nettlerash.--A form of nettlerash seen in little children, showing itself as slightly raised red blotches, worst in the night, is referred to “teething,” and that is thought sufficient reason for neglecting it. The best treatment is strict attention to cleanliness and diet. The child should get a tepid bath night and morning. Take care that no part of the dress irritates the skin, flannel not being allowed to touch it; and let the patient enjoy fresh air and sunshine. If itching continues, instead of a simple tepid or warm bath at night, an alkaline bath should be given in this bath: in 8-10 gal. water as warm as the hand; dissolve 1-2 oz. soda bicarbonate. Bathe the child for a few minutes, do not be too exact in drying, and put to bed immediately. Nettlerash in adults requires medical treatment.