----------+---------+-------+-----------+---------+---------_Spons' Household Manual A treasury of domestic receipts and a guide for home management

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pox. | | | pimples, | |

| | | and | | surgical operations

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In scarlet fever, infection is due to the particles which peel

off from the skin, the patient should be anointed once a day with

carbolic oil, made with 1 part carbolic acid to 50 of olive oil. The

efflorescence (peeling off) occurs first on the skin of neck and

arms, sometimes as early as the fourth day. The anointing should

include the head, the oil being freely applied to the roots of the

hair, and continued for 6 weeks, a warm bath being given weekly

during that time. After 6 weeks, the patient may mix with the other

members of the family; but children should not return to school for 2

weeks longer.

In measles, the same rules are to be observed, with the addition that

the discharges from mouth and nostrils should be received on rags and

destroyed by burning.

In typhoid fever, the poison is chiefly contained in discharges

from the bowels. These may infect the air of the sickroom, the bed,

body-linen, w.c., and drains, and, by soaking into wells, they poison

the drinking-water--a common and dangerous way by which this fever

spreads. The discharges should be disinfected immediately on their

escape from the body as will be directed.

Typhus fever is very infectious, and is apt to attack those who are

much exposed to it for the first time; therefore engage a nurse who

has been previously attacked. The poison is thrown off by the skin

and lungs and readily affects clothing, furniture, and everything in

contact with the air of the room.

Efficient protection from smallpox is proper vaccination, known by

a large mark or scar. Re-vaccination after the fourteenth year is

advisable. Smallpox affects at a greater distance than any other, the

poison escaping chiefly by the skin and mucous membrane.

Diphtheria poisons by the breath and expectoration; and to avoid

contact with these is absolutely necessary. The expectoration should

be received into a vessel containing Condy’s fluid, or on rags that

may be at once burnt. Gargle the throat frequently with a solution of

the same, of the strength of 1 small teaspoonful to 1 qt. water.

Whooping-cough is a disease which is most fatal to children under 2

years of age. The poison comes chiefly from the mucous secretions of

the lungs and air passages, and is readily imparted to the clothes of

those who nurse the patient; the secretions are infectious from the

beginning.

Asiatic cholera rarely visits this country. As in typhoid fever, it

spreads by means of the bowel discharges, and the same precautions

are needed.

In any infectious disease, where the home has no accommodation for

fully carrying out the precautions, the patient should be removed at

once to a fever hospital. No time should be lost in obtaining medical

advice.

One other source of danger may be mentioned here, and that is

the poisonous vapours arising from broken gas mains, which will

cause illness and even death from the carbonic oxide present. As a

precaution against ground air contaminated with illuminating gas

entering houses, open all cellar windows, as well as those on the

ground floor of threatened houses, so as to prevent directly sucking

in the ground air or render it harmless by dilution. The smell of gas

should serve as a warning.

The following advice is addressed to those who have to visit or

attend upon infectious cases. Always have the window open before

entering the patient’s room or ward. Never stand between the patient

and the fire, but always between him and the open window. If possible

change your coat before entering the room. Do not go in for any

unnecessary physical examination. Stay as short a time as possible in

the room. Never, while in the room, swallow any saliva. After leaving

the sickroom, wash the hands with water containing an antiseptic.

Rinse out the mouth with diluted “toilet sanitas” or Condy’s fluid;

also gargle the throat with it, and bathe the eyes, mouth, and

nostrils. Expectorate and blow the nose immediately on leaving the

sickroom. Keep up the general health by good food, exercise, and

temperance. Filter all the air you breathe while in the sickroom or

ward through an antiseptic medium, such as a McKenzie inhaler over

the nose and mouth; carefully soak the sponge in a strong solution of

carbolic acid before entering the sickroom; all the air breathed must

necessarily come through this sponge, and the expired air is emitted,

by a valve action, at another place.

Nurses should keep themselves and their patients as clean as

possible, remembering that the more the infection accumulates, the

more dangerous does it become. Special care should be taken, in

changing sheets and clothing, not to shake or disturb them more than

is absolutely necessary to remove them; as these acts disseminate the

particles of skin which are removed with them, and which convey the

germs of disease, they should be removed carefully, folded together,

and immediately disinfected.

Whatever the nature of a malady, so soon as it is pronounced to be

infectious the same precautions should in all cases be taken. Let

it at once be decided who is to nurse the patient, and make all

arrangements by which nurse and patient may be isolated from the rest

of the household. If possible, 2 rooms communicating should be given

up to them, and over the outer doors of these rooms sheets should be

hung, which must be kept constantly saturated with disinfectants,

either Condy’s fluid or carbolic acid in water. No servant in

communication with the rest of the household must enter the sickroom;

if she does so, she should be isolated like the nurse, and any

message that may require to be given must be spoken through the

sheet. The best plan is to have a regular nurse from one of the many

excellent institutions which provide them; they make the patient more

comfortable, take entire charge of the arrangement of the sickroom,

and know exactly what is required to be done in an emergency, and

for disinfection. At the very commencement all curtains should be

taken down, and at once sent out of the house to be disinfected by

properly qualified persons; the same course should be pursued with

the carpets (woollen articles hold infection beyond any others), and

then the floors can be kept sprinkled with disinfectants, besides

having a broom steeped in them passed over every morning. Linen used

in the sickroom should always be put into water with either carbolic

or Condy, before leaving the room; but, even with this precaution,

it is far better to send it to be disinfected than to allow it to go

to a laundry. The windows should be open, top and bottom, but more

especially at the top, during the entire day, and if possible at

night also; a thorough draught through the room is most desirable,

if the patient can be kept out of the direct line of it. As much

as possible, all cups, basins, jugs, and glasses should be kept

upstairs; but those that must occasionally be sent down should be

carefully washed in Condy and water, and at once placed outside

the door, and again passed through disinfectant on their arrival

downstairs. The clothes that may have been worn for the day or two

before the disease absolutely declared itself should be sent for

disinfection, but those which have only been in casual contact may be

disinfected at home. A small room should be chosen for the purpose,

and the dresses, petticoats, shawls, or other articles hung up, so

as to be fully exposed. The doors, windows, and all other apertures

must be kept closed, and the disinfection may be effected either by

chlorine, which is formed by pouring hydrochloric acid on chlorate of

potash, or else by burning sulphur. In either case the quantity must

be sufficient to render the atmosphere of the room unbearable to a

human being, or otherwise the disease germs will not be destroyed.

The bedding and blankets must be sent for proper disinfection at

the close of the illness. Nothing should be kept in the room except

for use. Clothes in a wardrobe under such circumstances have been

known to spread infection 10 years after. Handkerchiefs should be

replaced by rags, burnt when used. Letters from the patient should

be backed, or written on postcards dipped in carbolic; they are

capable of spreading disease otherwise. A thing in which people are

often lamentably careless is in allowing books that have been used by

the patient to be afterwards used by others. It cannot be too often

impressed on the minds of those who have to do with illness, that

every book, paper or magazine used by an infectious patient must be

burnt without leaving the sickroom. Infection is very often spread by

allowing books from a circulating library to be returned to it after

use by a person suffering from an infectious disorder.

Infection ceases in the individual as soon as the skin has thoroughly

peeled--a process which takes a longer or shorter time in different

individuals. The danger after this lies in the clothes, furniture,

and rooms, and if these are at once thoroughly disinfected all danger

is absolutely at an end. It is impossible to reprobate too strongly

the conduct of those who wish and endeavour to shirk the expense and

trouble of proper disinfection. It would be well if in such cases

doctors would always avail themselves of their power to report the

existence of a case of infectious disease to the sanitary officer

of the district, when official pressure would at once be brought to

bear, and all that is necessary be effected under compulsion.

The cured patient on the day of leaving home should go into a fresh

room to dress, and put on things either new or disinfected, not

returning to the sickroom. Brushes and sponges, as coming most in

contact with hair and skin, are best destroyed. While a patient is in

the infectious stage it is best that no letters should be written;

but if, as is sometimes the case, some communication in writing must

be made, danger is obviated by holding the paper and envelope in the

fumes of chlorine.

A few words would not be amiss respecting those in the house who do

not enter the sickroom. However great the precautions taken, the

air of a house in which there is a case of infectious disease can

never be absolutely safe, and it is far better to err on the side of

caution than the reverse. Visitors should not be allowed to enter the

house, and it is far better and more honest for the servants to state

clearly at the door what disease is in the house. Special attention

should be paid to the health of each member of the household. Any

slight disorder is liable to predispose to infection.

There is a great variety of good disinfectants, and as many different

ways of using them. A good plan, both effective and economical, is

as follows:--Freely use moistened chloride of lime all through the

house, and even in the sickroom, if the fumes are not found to be

irritating; secondly, place in various parts of the room 5 or 6

soup-plates, or other flat vessels, containing Condy’s fluid; or

hang about in the room as many perforated boxes filled with solid

iodine; thirdly, keep the windows opened freely but the doors as

seldom as possible; guard it both inside and outside with a large

sheet, hung up to at least the height of the door, and at about 1 ft.

distant from it, and kept constantly well moistened with a solution

of carbolic acid (strength, about 1 of the acid to 40 of water); and,

most important of all, receive as soon as possible all discharges,

excreta, soiled linen, and all such matters, in vessels containing

a strong solution of Condy’s fluid, chloralum, or carbolic acid.

Many infectious diseases have (in addition to their common property

of infecting the air through the effete products of respiration

from the lungs and skin) some special channel of transmission. In

cholera, typhoid (enteric) fever, and, in a less degree, typhus and

relapsing fevers, it is principally by the excreta from the bowels

and kidneys. These should be received at the very moment of their

issue from the body into vessels fully charged with disinfectants. In

diphtheria, it is by the throat. In erysipelas, hospital gangrene,

and puerperal fever, by discharges peculiar to each. In smallpox, by

pustular exudation from the skin. In scarlet fever, measles, &c., by

desquamation (peeling off of the skin), rendered harmless by slightly

moistening the surface of the body once or twice a day with ordinary

olive oil or camphorated oil, or a weak solution of glycerine and

carbolic acid. Never mix disinfectants; for instance, Condy’s fluid

and carbolic acid act in precisely opposite ways, and might decompose

each other.

The nurse must not neglect proper precautions for her own safety. She

should use disinfectants freely about her own person, be sure that

she has a sufficient quantity of undisturbed rest and regular meals,

and avoid coming into unnecessary close contact with the patient.

She should at once give up the occupation if she feel her general

health at all injured. She must also be careful not to undertake a

non-infectious case after being in attendance upon an infectious one

for a considerable time; and until she has put herself through a

complete process of disinfection, and done the same with all clothes

worn at the time which she has not discarded altogether. Nothing must

induce her to go near a confinement for several (at least 3) months.

Disinfection.--The most useful agents for the destruction of

spore-containing infectious materials are:--

(1) Fire: Complete destruction by burning.

(2) Steam under pressure: 230°F. for 10 minutes.

(3) Boiling in water for 1 hour. This temperature does not destroy

the spores of _Bacillus subtilis_ in the time mentioned, but is

effective for the destruction of the spores of the anthrax bacillus,

and of all known pathogenic organisms.

(4) Chloride of lime: a solution of 4 in 100 containing at least 25

per cent. of available chlorine.

(5) Mercuric chloride: a solution of 1 in 500 containing at least 3

per cent. of available chlorine.

For the destruction of infectious material which owes its infecting

power to the presence of micro-organisms not containing spores:--

(1) Fire: Complete destruction by burning.

(2) Boiling water ½ an hour.

(3) Dry heat: 230°F. for 2 hours.

(4) Chloride of lime: 1 to 4 in 100 solution, containing at least 25

per cent. available chlorine.

(5) Solution of chlorinated soda: 5 to 20 in 100 solution, containing

at least 3 per cent. available chlorine.

(6) Mercuric chloride: a solution of 1 in 1000 to 1 in 4000.

(7) Sulphur dioxide: exposure for 12 hours to an atmosphere

containing at least 4 volumes per cent. of this gas, preferably in

presence of moisture. This will require the combustion of 3-4 lb.

sulphur for every 1000 cub. ft. of air space.

(8) Carbolic acid: 2 to 5 in 100 solution.

(9) Sulphate of copper: 2 to 5 in 100 solution.

(10) Chloride of zinc: 4 to 10 in 100 solution.

Following are recommendations with reference to the practical

application of these agents:--

For Excreta.

(_a_) In the sickroom:

For spore containing material:

(1) Chloride of lime in solution, 4 in 100.

(2) Mercuric chloride in solution, 1 in 500; addition of an equal

quantity of potassium permanganate as a deodorant, and to give colour

to the solution, is to be recommended.

In the absence of spores:

(3) Carbolic acid in solution, 5 in 100.

(4) Sulphate of copper in solution, 5 in 100.

(5) Chloride of zinc in solution, 10 in 100.

(_b_) In privy vaults:

Mercuric chloride in solution, 1 in 500. A concentrated solution

containing 4 oz. mercuric chloride and 1 lb. cupric sulphate to 1

gal. water is recommended as a standard solution; 8 oz. this solution

to 1 gal. water will give a diluted solution for the disinfection of

excreta, containing about 1 in 500 of mercuric chloride and 1 in 125

of cupric sulphate.

(_c_) For the disinfection and deodorisation of the surface of masses

of organic material in privy vaults, &c.:

Chloride of lime in powder, diluted with plaster of Paris, or with

clean, well-dried sand, in the proportion of 1 part to 9.

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.

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