A few brief observations on the control and prevention of infections
diseases, such as small-pox, measles, scarlet fever, typhus fever,
typhoid fever, cholera, &c.
The above-mentioned diseases are capable of being transmitted from
those who are infected to those who are not. It is at once cheering
and obligatory to know that the spread of these infectious diseases
depends upon certain specific conditions, and that these conditions are
primarily within the control of man. This control and prevention of
infectious diseases is one of the latest and greatest achievements of
modern medicine.
Small-pox is one of the most contagious diseases, but it is controlled
by vaccination. Primary vaccination within certain limits, is a
protection against small-pox, but it is a well ascertained fact that
there is a period in the life of persons when the prophylactic or
protective power of vaccinia dies out, or at the least becomes very
feeble, consequently it is advisable for all who are in the proximity
of those suffering from small-pox to be re-vaccinated, for the
following reasons. Re-vaccination will almost without exception restore
the protective power against small-pox: secondary vaccination is
attended with no danger. The operation is so simple and the protection
so certain and valuable.
Scarlet fever and measles, though regarded as the inevitable
diseases of childhood, and for which the mother is considered the
best physician, and kitchen physic the best medicine, are simple in
themselves, but on account of the sequelæ or diseases which generally
follow, really require more attention in a sanitary point of view than
they generally receive.
Typhus, typhoid fevor, and cholera, are contagious diseases, and where
the conditions of a locality are favourable they rapidly spread death
and desolation around. Typhoid fever is generally caused by a specific
miasm of sewers and neglected water closets, &c.
With respect to the cause of cholera, I may mention decomposed and
decomposing animal and vegetable matter in drinking water, but whatever
may be the essential cause or causes of cholera, I must leave for some
future discussion. What is of the most practical value to know is, that
the laws which govern the endemic influence of cholera, are as well
known as those of typhoid fever, and equally under our control. Those
conditions which are favourable to the spread of typhoid fever, are
equally favourable to the spread of cholera when once it shows itself,
and the same sanitary regulations which are applicable to typhoid
fever, are best calculated to prevent and control cholera.
The following suggestions may be observed with advantage to the sick,
and those connected with them:—
1. In cases of contagious diseases _fresh air_ is of primary importance
to both patient and attendant. The room should be well ventilated, care
should be taken that no draught blows upon the patient, but a continual
supply of fresh air enters the room. In cases where it is not expedient
to have both window and door open a fire ought to be lighted, and the
door kept open. A fire not only is a good means of ventilating a sick
room, but it also dries the air and thus renders it a less susceptible
medium for carrying and retaining infectious poisons.
2. Cleanliness is very desirable in health, but it is imperatively
necessary in disease, both the room and the patient should be kept
thoroughly clean. Both body and bed linen should be frequently changed,
and as soon as the soiled linen is removed it should be placed in
water and thoroughly washed, and not rolled up and kept till the
regular washing day. There is a great objection to change the linen of
patients suffering from fever for fear they should catch cold, this
is an ignorant prejudice. Fever patients do not take cold if ordinary
care be employed. The skin of fever patients not only becomes hot and
uncomfortable but dirty. It is often advisable to sponge them with a
little luke-warm vinegar and water. The room ought to be washed out
daily, and thoroughly dried. It is useful to have a little of Condy’s
disinfectant fluid in the water. All carpets, curtains, and woollen
furniture is better removed out of the sick chamber. All discharges
from the patient ought to be immediately emptied, and the utensils
washed out with Condy’s fluid and water; and further, all water closets
&c., ought, at these times, to be daily (at least) well flushed with
water.
3. Nurses, relatives, friends, and visitors, ought to avoid breathing
the patient’s breath, and ought not to remain in close proximity longer
than duty requires. They should not swallow their spittle, and on
leaving the sick chamber, they should clear their mouth and nostrils.
Smoking is only of service in so far as it promotes expectoration; and
snuff, only because it induces sneezing.
With respect to disenfectants I would say, better that they should
never be used, than that their use should tend to supercede fresh air
and cleanliness. In order to disabuse the minds of some who look upon
disinfectants as charms, I give a list of some of them, with their
supposed action:—
Charcoal absorbs moisture and noxious effluvia; its value depends upon
its being _fresh_ and _dry_; it stops meat from becoming putrid.
Bromine is the most efficient antiseptic known, but it requires great
care and caution in its employment, consequently it is best left to
the direction of the medical attendant as to how, when, and where, it
should be employed.
Condy’s disenfectant, Darby’s fluid and ozonized water, are but
solutions of the permanganate of potassa, and it is upon this that
their value as antiseptics and deodorizers depend. Carbolic acid and
coal tar are also antiseptic and deodorant in their action. McDougall’s
powder contains carbolate of lime, and is a very valuable preparation
in arresting putrescence and controlling effluvia. Chloride of lime is
a common disinfectant, and is useful in destroying noxious compound
gases.
Heat is the last disinfectant that I shall mention. It is at once cheap
and effectual, and is by far the most valuable in destroying contagious
virus, transportable infections. All bedding, garments, &c., should be
purified by hot air or steam, as it will effectually destroy cell life,
cryptogamic and infusorial organisms.