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HOW TO CHECK THE SPREAD OF CONTAGIOUS or INFECTIOUS DISEASES
HOW TO CHECK THE SPREAD OF CONTAGIOUS or INFECTIOUS DISEASES SCARLET FEVER, DIPHTHERIA, SMALLPOX, ETC.(No 4..) Document issued by the Provincial Board of Health of Ontario. These diseases are spread by means of infectious particles going from person to person, and can be stopped if care and systematic means are taken to destroy these disease germs, and to prevent their being carried from one person to another.
Those parts of the body which are the breeding' places of the con tagious particles give off the poison in the greatest amount-for example :-
In Scarlet Fever, the mouth, throat, nasal passages and skin.
In Diphtheria, the mouth, throat and nasal passages.
In Small-Pox, the pustules, chiefly of the skin.
In Measles, the skin and air passages.
In Whooping Cough, the air passages.
In Typhoid Fever and Cholera, the discharges from the bowels.
The portions of the body thrown off, and containing the contagion, may pass into the air, or find their way into water or food, and in this way be introduced by breathing, drinking or eating, or through broken surfaces of the body.
It will be seen that the first five diseases in the above enumer ation are very readily communicable through the atmosphere. The contagion of the first three remains virulent for a great length of time and at great distances; and as these diseases are very serious in their effects, our consideration will at present be chiefly directed to them in the following rules for checking their spread :-
What the General Public may reasonably expect from persons afflicted with Contagious Diseases, from their Friends, and from the Municipal Authorities.1. When anybody, especially a child or young person, has sore throat, bad breath or fever, he should be kept separated from all other persons except necessary attendants, until it be ascertained whether he has Scarlet Fever, Diphtheria or some other communicable disease.
2. Every case of Diphtheria, Scarlet Fever or small-Pox should be at once reported to the Health % Officer appointed by Local Board of Health. (See Sees. 18, 19 and 20, Public Health Act of 1882.) 3. On receipt of such notices, the Local Health Officers should immediately verify the reports of cases. If the medical attendant reports the case this will be sufficient verification.
The Board should secure the isolation of those sick with or exposed to these diseases ;
Give notice of infected places ;
Regulate funerals of persons dead from infectious diseases ;
Disinfect rooms, clothing and premises ;
Give certificates of recovery and of freedom from liability to com municate the disease.
4. Every person known to be sick with Scarlet Fever, Diphtheria or Small-Pox, should be promptly and effectually isolated from the public; no more persons than are necessary should have charge of patient, and these should be restricted in their intercourse with other persons.
5. Notices should be placed on the house in which a case of Scarlet Fever, Diphtheria or Small Pox exists, arid no unnecessary persons allowed to enter.
(In regard to above, see Public Health Act, 1882, and Caps. 190 and 174, R.S.O.) Management of the Sick Room and Duties of Attendants.
6. The bed room of a person sick with Scarlet Fever, Diphtheria, Small-Pox or any other infectious disease should be cleared of all need less clothing, carpets, drapery, or any material liable to harbour the poison of the disease. The room should be large, having an absolute air space of at least 1,000 cubic feet for each individual, and should have a liberal supply of fresh air-at least 3,000 cubic feet per head per hour. In summer the supply should be unlimited; windows thrown open, and draughts on the patient prevented by a fine gauze or wire net ting, slanting from the top of the sash to within two inches of the ceiling.
7. Discharges from throat, nose and mouth should be received, or immediately placed, in vessels containing some of the disinfectants named for that purpose in sec. 8 ; if on rags or handkerchiefs, these should be immediately burned.
Likewise, the discharges from kidneys and bowels should be passed into vessels containing a pint of disinfectant, and immediately buried at least a hundred feet from any well or other drinking-water supply. If these precautions are impracticable, let the discharges be passed on old cloths, which should immediately be burned.
8. For convenience, a few disinfectants are here grouped together:-
(1) Solution of chlorinated Soda (or lime).
(2) " chloride of zinc : water, 1 gal.; sulphate of zinc, 4 ozs.; common salt, two ozs.
(3) * chloride of lead : dissolve two drachms of nitrate of lead in a quart of water,-then, in a larger vessel containing a gallon of water, dissolve two table- spoonfuls of common salt (chloride of sodium) ; mix the two solutions together and store for daily use.
The above will answer for all purposes of disin fection ; discharges, linen, cups, etc.
(4) Carbolic acid solution-say one part in twenty to forty of water, for discharges and clothes, scrubbing floors, etc., and washing hands.
(5) CorJperas solution-one and a-half pounds commercial sulphate of iron to one gallon water.
(6) Carbolate of lime.
The two last for discharges ; the copperas very good for privies ; the carbolate of lime for sprinkling dry in rooms, sheds, etc.
The carbolic acid solution may be made to permeate the air by spray from an atomizer, and to destroy germs in breathable air by actual contact.
9. Purification of Clothes and Bedding. The best plan, where practicable, is by the agency of heat. Dr. Henry, of Manchester, disin fected scarlet fever clothing by exposure to 2120 F. for one hour. A brick oven or portable furnace will answer the purpose, the clothes to be disinfected being hung on wires. Boiling clothes is not so good as baking, but still is useful. To every ten gallons of boiling water ' add half or three-quarters of a gallon of commercial solution of chlor ide of lime ; or the clothes may be laid for twenty-four hours in a solu tion of sulphate of zinc in the proportion of i to 120, or of chloride of zinc in the proportion of I to 240, or in the chloride of lead solution (Sec. 8), and then should be washed with soap and water if they cannot be baked.
10. Nurses and Attendants should be required to keep themselves and their patients as clean as possible, disinfecting their hands frequently by chlorinated soda or other disinfectant.
Attendants should also wear cotton or linen (not woollen) clothes or overalls, to which particles will not so readily adhere, and which may be more easily disinfected.
11. Every person recovering from Diphtheria should be considered dangerous, and should not be permitted to associate with others, or attend any public assembly until the throat and sores on the lips and nose are healed for some days; nor before, in the judgment of the physicians, he can do so without endangering others, nor until all his clothing has been thoroughly disinfected. These restrictions, of course, extend to churches, schools, etc. Every apartment of the house must also be thoroughly disinfected before patient is permitted to go at large.
After recovery from Scarlet Fever and Small-Pox, a still longer time must elapse to allow all particles of disease-bearing skin to be thrown off.
12. The body of a person who has died of Diphtheria, Scarlet Fever or Small-Pox, should be washed with a strong chloride of lead or zinc solution, double the strength of those in Sec. 8, wrapped in a sheet wet with the same, and at once buried. In no*case should the body be exposed to view ; no public funeral held, and as few persons as possible should attend.
Disinfection of Dwellings and Premises after Recovery or Death.
13. In addition to thorough cleansing of all wood work with soft soap, and with water to which carbolic acid has been added, (one pint of the common liquid to four gallons of water), and to removing and washing all fabrics which can be removed in the manner described in Sec. 9, and brushing the walls, the rooms should be fumigated for a period varying from three to twenty-four hours with sulphurous acid.
A metallic dish should be suspended over a tub of water, or should have ashes placed in it. All doors, windows, and the chimney being tightly closed, sulphur, mixed with a little saltpetre, is to be then placed into the dish and lighted. The proportions should be two pounds of sulphur for every 1,000 cubic feet of space. In a very long room it is best to have the sulphur in two or more places. After the fumigation is completed, the doors and windows should be opened, and kept open for several hours. In disinfecting in this manner with sulphurous acid, the person setting fire to the saltpetre and sulphur must make a precipitate escape from the room the instant the sulphur is burning. Carpets fumigated on the floor by this method ^should afterwards be removed to the open air and thoroughly beaten. Pil lows and feather beds, mattrasses, and upholstered furniture, after being disinfected on the outside, should be cut open and their con tents exposed to the fumes of burning sulphur. In no case should the disinfection of clothing and bedding be omitted. Where articles of clothing, towels or anything used by sick persons are considered too valueless to be kept, they must not be burned in the house or open air before they have been completely disinfected. A bad epide mic at Philadelphia resulted from neglect of this precaution.
Precautions for Well People to avoid Scarlet Fever, Diphtheria and Small-Pox.14. Avoid exposure to special contagion. There is more danger for children than for adults ; do not, therefore, let a child go near a case.
Do not permit any person or thing, dog, cat or other animal, plaything, letters, etc., to come direct from a case of these diseases to a child, unless previously disinfected under competent supervision. If you do visit a case, bathe yourself, especially your hands, face and hair, in a dis infectant solution, and change and disinfect your clothing before you go where thefe is a child. See that your residence, prejnises etc., are kept clean and dry; that the sewer connections are well trapped and drains well ventilated. Never allow the passages from any person sick with the disease to be placed, without previous disinfection, in water closets or privies, but have them attended to as in Sees. 7 and 8. Give special attention as to the purity of your milk supply. Do not allow a child to ride in any vehicle zvhere there is suspicion of infected persons having travelled. Avoid exposure to high winds and cold, dry air. Do not wear or handle clothing worn by a person during sickness or con valescence from these diseases. Beware of any person who has a sore throat or running at the nose. Do not kiss or take the breath of such a person. Do not drink from the same cup or put in your mouth any thing used by a person who has any of the above diseases. This should be especially attended to in the case of children.
15. In case of all of these diseases, remember that the contagion may be stored up from 071e season to another if not destroyed. Do not let it be so stored ; and see that your children do not visit a house where one of the above diseases has been, even though some months have since elapsed, unless you know that the house, clothes, etc., have been thoroughly disinfected.
16. In the case of SMALLPOX, too much care cannot be taken to see that every person who has not been vaccinated within seven years be vaccinated or re-vaccinated.
17. If vaccination has " taken well " a few years before, this is, if anything, an extra reason for re-vaccination. Persons who have had Small-Pox may take it again.
18. With regard to all these diseases, remember that a mild form in one person may originate a severe form in another.
19. In connection with this subject, it should be remembered that too much attention cannot be paid to surroundings in general, such as drainage, ventilation, food, warmth, etc. Temperature and rainfall have much to do with the spread of some of these diseases. Diph theria, for example, is generally least prevalent in August, increases until January, and declines again with the same regularity until August. It is also most fatal in the lowest and worst drained parts of cities. Examine the relative positions of wells and privies. Where city water is used, investigate the source of water supply, and the place of debouchure of sewers. (An outbreak of Diphtheria in Naples, 1872, was clearly traced to contaminated water.) In country districts iso lated outbreaks, traceable to cesspool effluvia, are not at all uncommon.
Frequently the water-closet drain will be found discharging into a cess pool cleaned out only at rare intervals, the gases generated in the cesspool having no outlet except through the water-closet and into the house. Proper attention to the trapping of waste pipes leading to sewers is too frequently taken for granted, hence examine carefully into the arrangement and ventilation of drains. Ascertain whether, in consequence of attention not having been duly paid to the trapping of overflow, lavatory, and every other waste pipe, gases are not being conveyed in sundry ingenious ways into the various apartments from which they were presumed to be excluded ; that, in other words, the house drains and sewers have not been ventilated into the bed rooms.
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