CHAPTER XII_American Red Cross Text-Book on Home Hygiene and Care of the Sick

CARE OF PATIENTS WITH COMMUNICABLE DISEASES

The first chapter of this book described the ways in which communicable

diseases are carried from person to person, and also some principles

underlying methods of prevention. This chapter aims to show how these

principles apply in the actual care of patients whose diseases are

transmissible. In order to apply them intelligently, it is necessary to

keep in mind certain facts in regard to the transmission of infections.

A brief summary of these facts follows.

Disease germs are present in the bodies of persons suffering from

communicable disease, but they may also exist in the bodies of persons

in good health; if present in the body, they may leave it in any bodily

discharge. While every kind of germ does not leave the body by all the

different routes, it is nevertheless true that most germs expelled from

the body are carried in discharges from the nose, throat, bladder or

bowels. Germ-laden discharges of an infected person may be distributed

to other persons by water, milk and other foods, by certain insects, by

unclean hands, by common drinking cups, towels, handkerchiefs, and

similar articles, and directly by nose and throat spray. After they have

been thus conveyed to other persons, the germs make their entrance into

the body of their new victims through the digestive tract, through the

nose, throat, and other mucous membranes, or through breaks in the skin.

Prevention of communicable diseases, therefore, depends upon the measure

of success attained in blocking the transit of germs from person to

person; but methods of prevention, though easy to understand, are

unfortunately sometimes difficult to carry out. In order to carry them

out effectively one must devote to the problem great accuracy,

unremitting care, considerable intelligence, and a highly developed

conscience.

Care of a patient suffering from transmissible disease is adequate only

when it accomplishes two definite results. One result, which concerns

the patient primarily, is to bring about his recovery as rapidly and as

surely as possible; the other result, which concerns the community

rather than the individual, is to make it impossible for the patient to

infect others with his disease. In every case of communicable disease,

from a slight cold in the head up to serious cases of pneumonia or

typhoid fever, both the patient and the community must be constantly

safe-guarded.

INCUBATION PERIOD.--The interval between the moment when pathogenic

germs enter the body, and the time when symptoms first appear and the

patient begins to feel ill, is called the incubation period. Incubation

periods vary according to the disease from a few hours to two or three

weeks. The length of the period also varies somewhat in different cases

of the same disease.

CARE OF PATIENTS WITH COLDS OR OTHER SLIGHT INFECTIONS.--The usual

symptoms of infectious diseases include fever, chill, sore throat, nasal

discharge, cough, headache, vomiting and other digestive disturbances,

and a general feeling of being sick all over. When one or more of these

symptoms appear, unless they are very slight, a doctor should be sent

for. The patient, whether child or grown person, should go to bed in a

room alone and should stay in bed at least as long as the fever and

symptoms of cold in the head continue, in order to protect others as

well as himself. Persons in active life, it is true, are not always able

to go to bed during colds; but there is no doubt that ultimately they

would save time by doing so. It is especially necessary for children to

remain in bed when suffering from colds, not only to insure their own

well-being but also to protect others, since children are notably

careless in regard to coughing, sneezing, and borrowing handkerchiefs.

The patient needs mental rest as well as physical, and should not be

allowed to work in bed.

The patient's nose and throat discharges should be received only in

material that can be burned, like old linen or muslin, gauze, or paper

napkins. As soon as they are soiled these handkerchief substitutes

should be placed in strong paper bags and afterward burned. Soiled

handkerchiefs lurking under pillows or in other parts of the bed may

infect other people or re-infect the patient. Handkerchiefs that may not

be burned should be placed as soon as soiled in a covered receptacle

filled with cold water containing a little washing soda; when several

have been collected they should be boiled in the same covered receptacle

for 20 minutes. After boiling they may go to the regular laundry.

The patient's diet at first should be liquid or semi-solid. Large

amounts of nourishment are not necessary during the first day or two,

especially if the illness is likely to be short, but water should be

taken as freely as possible. Cold drinks are generally acceptable during

the feverish stage, but lemonade and other acids should be used with

caution, since they sometimes irritate a sore throat. When the active

symptoms have subsided the patient will need more food than usual, and a

liberal, nourishing diet for a few days will do much to prevent the

weakness and depressed vitality that often follow colds, tonsilitis, and

other comparatively slight infections.

The bowels should be carefully regulated, and a mild cathartic is often

beneficial at the outset.

Even during slight illness a patient should receive the daily care

already described, and should be made as comfortable as possible. As in

any illness, sponging and alcohol rubs are refreshing. An ice bag or

cold compress may relieve headache, and hot applications or a cold

compress on the throat are often soothing. The throat may be gargled

with a solution of one teaspoonful of common salt dissolved in a pint of

boiled water. If the patient perspires profusely he should be rubbed

with a towel until dry, and provided with fresh warm, night clothes. An

alcohol rub may well follow. It is most unwise for a patient who is

perspiring freely to get up in a cold room and attend to himself.

Common colds are far more serious than they are usually supposed to be.

"More people suffer from common colds than from any other

single ailment.... Could the sum total of suffering,

inconvenience, sequelæ, and economic loss resulting from

common colds be obtained, it would at once promote these

infections from the trivial into the rank of the serious

diseases.... Colds are contracted from other persons having

colds, just as diphtheria is contracted from diphtheria.

Arctic explorers exposed to all the conditions ordinarily

supposed to produce colds do not suffer from these ailments

until they return to civilization and become infected by

contact with their fellowmen.... While common colds are

never fatal, the complications and sequelæ are serious.

These are rheumatic fever, pneumonia, sinusitis, nephritis,

and a depressed vitality which favors other infections and

hastens the progress of organic diseases.

"Common colds are perhaps most contagious during the early

stages. If persons isolate themselves by remaining in bed

during the first three days of a cold, they would not only

benefit themselves, but would largely prevent the spread of

the infection. The contagiousness and severity of colds

differ in different epidemics and in different seasons of

the year, depending upon the particular micro-organism

involved and other factors not well understood.

"PREVENTION.--The prevention of colds consists, first in

avoiding the infection, and, secondly, in guarding against

the predisposing causes. Contact should be avoided with

persons who have colds, especially in street cars, offices,

and other poorly ventilated spaces where the risk of

persons coughing or sneezing directly in one's face is

imminent. Contact with the infection may further be guarded

against by a careful self-education in sanitary habits and

cleanliness, based upon the modern conception of contact

infection.

"Colds, like other diseases conveyed in the secretions from

the nose and mouth, are often conveyed by direct and

indirect contact through lack of hygienic cleanliness and a

disregard of sanitary habits. Kissing, the common drinking

cup, the roller towel, pipes, toys, pencils, fingers, food,

and other objects contaminated with the fresh secretions

will transmit the disease."--("Preventive Medicine and

Hygiene," Rosenau.)

CARE DURING MORE SERIOUS INFECTIONS.--When a patient is suffering from

serious transmissible disease, he needs the most skillful care

available, and for the sake of others he must be strictly isolated or

quarantined. By isolating or quarantining a patient is meant making such

arrangements that germs expelled by the patient are necessarily

destroyed before they can enter the body of another person. Isolation,

therefore, includes disinfection, and while methods vary according to

the nature of the particular disease, yet the principles given below are

applicable in most cases.

The first essential is that the patient should have a room to himself.

No one except those caring for him should enter the sick-room for any

purpose whatever; visitors should be rigidly excluded. At the outset all

unnecessary articles should be removed from the sick-room, and it

should be possible to boil, burn, scrub, or otherwise thoroughly clean

everything allowed to remain. The windows should be screened in summer,

and flies must be excluded. Fresh air is especially needed by patients

with communicable diseases, and ventilation of the room must be adequate

both day and night. Foul odors plainly indicate that the patient or

something in the room is not clean. The remedy is obvious and deodorants

are quite unnecessary if the patient and the room are properly cared

for. It is highly desirable to reserve a bath room for the exclusive use

of the patient and his attendant and also to reserve a room adjoining

the patient's room for the exclusive use of the attendant. When it is

impossible, as it often is, to give up so much space, each family must

make the best arrangement it can to separate the patient and his

attendant from the rest of the family.

The attendant must remember that her ten fingers are the ten most active

agents in distributing the communicable diseases. After handling the

patient or anything that the patient has touched, and whenever she

leaves the patient's room, she must scrub her hands thoroughly with warm

water, soap, and a nail brush. She should not soil her hands

unnecessarily, even though she intends to scrub them later. She must

remember for her own protection to keep her hands away from her mouth

and face, and to cleanse them with special care just before eating. If

disinfection is needed in addition to the scrubbing, she must use

conscientiously whatever solution the doctor orders.

At the same time that she is caring for a patient with a communicable

disease, the attendant ought not to care for children or other members

of the family, she ought not to prepare food, and she ought not to

handle dishes or utensils used by other persons. Every day, however,

many women are doing just these things, and it is true that in many

instances no bad results are observed. Yet if any arrangement to insure

safety can possibly be made, it is inexcusable to run the risk of

spreading diseases which kill thousands of persons every year and injure

many more for life.

When home conditions render adequate care and strict isolation of the

patient impossible, hospital care should be seriously considered. No

personal or sentimental objections should be allowed to influence the

decision, if removing the patient to a hospital is necessary to

safeguard his welfare or the welfare of the family. Hospital care should

be considered especially for patients with typhoid fever, because

untrained persons cannot safely care for patients so seriously ill.

Since a patient with typhoid needs skilled care, and since he greatly

endangers other persons, most authorities consider hospital care

essential unless the patient can have the continuous services of a

trained nurse and almost ideal home conditions. Many cases of typhoid,

it is true, are successfully nursed at home in extremely adverse

conditions by visiting nurses; yet in few kinds of sickness is

continuous care by a graduate nurse more necessary to protect the

community as well as to safeguard the patient himself.

Members of a family in which there is typhoid should be immunized if the

doctor advises it. This process, which is performed by the doctor, in

the majority of cases renders a person immune to typhoid fever for three

or four years.

The question of home or institutional care for persons with tuberculosis

must also be carefully considered. In some cases tuberculosis may be

cared for at home with comparative safety, and in some other cases the

risk is not very great if the patient is intelligent, careful, and well

supervised. But everyone should face the fact that all cases of

tuberculosis of the lungs involve some risk to others in the family, and

most cases involve great risk. The danger to children is greater than to

adults. Most tuberculosis infections, it is now believed, are acquired

in childhood. The bad results of an infection acquired in childhood may

not show themselves for years, since the germs may remain inactive until

the person's resistance is lowered by some unfavorable condition.

THE CHILDREN'S DISEASES.--The so-called children's diseases are probably

the most familiar and the least regarded of all those belonging to the

communicable group. Most persons, it is true, realize that scarlet fever

is serious; everyone should also realize that measles and whooping-cough

are serious. For example, in the State of New York during the year 1916,

more children died from each of these diseases than from scarlet fever:

in that year 745, or four times the number that died of scarlet fever,

lost their lives from whooping-cough, while 913 died of measles. If

diseases that kill hundreds of children every year are not serious, one

is at a loss to know what a serious disease is.

Some parents even expose children unnecessarily to these infections on

the fatalistic theory that they must have the diseases sometime, and

therefore the sooner the better. Nothing could be more mistaken; the

diseases are not inevitable, and there is no advantage whatever in

having them if escape is possible. Moreover, serious as the children's

diseases are in themselves, their after-effects may be even more

serious. At this very moment hundreds of people are going through

life handicapped by weakened hearts or kidneys, by defective sight or

hearing, merely because their parents considered the children's diseases

necessary. The common belief that children should have these diseases as

early as possible is also erroneous, since statistics show that the

younger the child the more likely is the disease to prove fatal.

Every mother should realize that the children's diseases are most

infectious in the early stages. Early symptoms include fever, sore

throat, and nasal discharge, and the trouble at first often resembles a

severe cold. During this stage the diseases are most easily

communicated. Measles in particular is generally not recognized until

its most infectious stage has passed. The moral to be drawn is that sore

throats, coughs, and colds should never be regarded lightly, and that

their spread should be prevented by all possible means.

The accompanying table taken from the regulations of the New York State

Department of Health, gives symptoms of communicable diseases among

children, and rules for isolation and exclusion from school.

NEW YORK STATE DEPARTMENT OF HEALTH

COMMUNICABLE DISEASES AMONG CHILDREN

RULES FOR ISOLATION AND EXCLUSION FROM SCHOOL

HERMAN M. BIGGS, M.D.

Commissioner

Issued by the

Division of Public Health Education

=======================================================================

DISEASE | PRINCIPAL SIGNS | METHOD OF |

| AND SYMPTOMS | INFECTION |

-------------+------------------------------+-------------------------+

CHICKENPOX | Rarely begins with fever. | Contact with discharges |

| Rash appears on second day | from nose and throat of |

| as small pimples, which in | a patient. |

| about a day become filled | |

| with clear fluid. This fluid | |

| becomes yellow colored, a | |

| crust forms and the scab | |

| falls off in about 14 days. | |

| Successive crops of papules | |

| appear until tenth day. | |

-------------+------------------------------+-------------------------+

DIPHTHERIA | Onset may be rapid or | Contact with discharges |

| gradual. The back of the | from nose and throat, |

| throat, tonsils, or palate | occasionally by |

| may show patches. The most | drinking infected milk. |

| pronounced symptom is sore | |

| throat. There may be hardly | |

| any symptoms at all. | |

-------------+------------------------------+-------------------------+

MEASLES | Begins like cold in the | Contact with discharges |

| head, with running nose, | from nose and throat |

| sneezing, inflamed and | of a patient. |

| watery eyes and fever. | |

| Mulberry-tinted spots appear | |

| about the third day; rash | |

| first seen behind the ears, | |

| on forehead and face. The | |

| rash varies with heat; may | |

| almost disappear if the air | |

| is cold, and come out again, | |

| with warmth. | |

-------------+------------------------------+-------------------------+

MEASLES | Illness usually slight. | Same as above. |

(LIBERTY) | Onset sudden. Lymph nodes in | |

| back of neck enlarged. Rash | |

| often first thing noticed; | |

| no cold in head. Usually | |

| have fever, sore throat, and | |

| the eyes may be inflamed. | |

| Rash sometimes resembles | |

| measles and scarlet fever, | |

| variable. | |

-------------+------------------------------+-------------------------+

MUMPS | Onset may be sudden, | Same as above. |

| beginning with sickness and | |

| fever, and pain about the | |

| angle of the jaw. The | |

| parotid glands become | |

| swollen and tender. Opening | |

| the mouth is accompanied by | |

| pain. | |

-------------+------------------------------+-------------------------+

POLIOMYELITIS| Onset sudden, fever, | Contact with discharge |

| excitable, pain on bending | from nose, throat or |

| neck forward, pain on being | bowels of a patient |

| handled, headache, vomiting. | or carrier. |

| Sometimes sudden development | |

| of weakness of one or more | |

| muscle groups. | |

-------------+------------------------------+-------------------------+

SCARLET | The onset is usually sudden, | Discharges from nose |

FEVER | with headache, fever, sore | and mouth, suppurating |

| throat, and often vomiting. | glands or ears of a |

| Usually within twenty-four | patient. |

| hours the rash appears as | Milk may convey |

| fine, evenly diffused, and | infection. |

| bright red dots under skin. | |

| The rash is seen first on | |

| the neck and upper part of | |

| chest, and lasts three to | |

| ten days, when it fades and | |

| the skin peels in scales, | |

| flakes, or even large | |

| pieces. | |

-------------+------------------------------+-------------------------+

SMALLPOX | Onset sudden usually with | All discharges of a |

| fever and severe backache. | patient and particles |

| About third day upon | of skin or scabs. |

| subsidence of constitutional | |

| symptoms red shot-like | |

| pimples, felt below the | |

| skin, and seen first about | |

| the face and wrists most on | |

| exposed surfaces, develop. | |

| They form little blisters | |

| and after two days more | |

| become filled with yellowish | |

| matter. Scabs form which | |

| begin to fall off about the | |

| fourteenth day. | |

-------------+------------------------------+-------------------------+

SORE THROAT, | Begins with sore throat and | Discharges from nose |

ACUTE, | weakness. Throat diffusely | and mouth of a |

SEPTIC | reddened and may show | patient. |

| patches like diphtheria. | |

-------------+------------------------------+-------------------------+

WHOOPING | Begins with cough which is | Discharges from nose |

COUGH | worse at night. Symptoms may | and mouth of a |

| at first be very mild. | patient. |

| Characteristic "whooping" | |

| cough develops in about 2 | |

| weeks, and the spasm of | |

| coughing sometimes ends with | |

| vomiting. | |

=======================================================================

===============================================================

| EXCLUSION FROM SCHOOL |

|-------+-------------------+--------------------+

| | OTHER CHILDREN | OTHER SCHOOL |

| | OF SAME | CHILDREN |

DISEASE | | HOUSEHOLD | ESPECIALLY EXPOSED |

| +--------+----------+--------+-----------+

| | Non- | | Non- | |

| | | | | |

-------------+-------+--------+----------+--------+-----------+

CHICKENPOX | Yes | Yes | No | Yes | No |

-------------+-------+--------+----------+--------+-----------+

DIPHTHERIA | Yes | Yes | Yes | Yes | Yes |

-------------+-------+--------+----------+--------+-----------+

MEASLES | Yes | Yes | No | Yes | No |

-------------+-------+--------+----------+--------+-----------+

MEASLES | Yes | Yes | No | Yes | No |

-------------+-------+--------+----------+--------+-----------+

MUMPS | Yes | Yes | No | Yes | No |

-------------+-------+--------+----------+--------+-----------+

POLIOMYELITIS| Yes | Yes | Yes | Yes | Yes |

-------------+-------+--------+----------+--------+-----------+

SCARLET | Yes | Yes | Yes | Yes | Yes |

-------------+-------+--------+----------+--------+-----------+

SMALLPOX | Yes | Yes | Yes | Yes | No |

-------------+-------+--------+----------+--------+-----------+

SORE THROAT, | Yes | No | No | No | No |

-------------+-------+--------+----------+--------+-----------+

WHOOPING | Yes | Yes | No | Yes | No |

===============================================================

================================================================================

| DURATION OF EXCLUSION FROM DATE OF ONSET |

+--------------+------------+-------------------------+------------+

DISEASE | +------------+------------+------------+ |

| | of | who | household | at |

------------+--------------+------------+------------+------------+------------+

CHICKENPOX | Until all | Exclude if non-immune until |Exclude |

| scabs are | 21st day after child last |from |

| shed and | saw patient. |school if |

| disinfection | |non-immune |

| of person; | |during |

| at least | |11th to 22d |

| 12 days. | |days after |

| | |child last |

| | |saw patient.|

------------+--------------+--------------------------------------+------------+

DIPHTHERIA |Until | Until two cultures at least 24 | |

|patient is | hours apart are reported | |

|recovered | negative. Those showing | |

|and has two | diphtheria bacilli should not | |

|cultures | necessarily be immunized | |

|from throat | unless symptoms appear. | |

|and nose which| | |

|contain no | | |

|diphtheria | | |

|bacilli; | | |

|cultures not | | |

|to be taken | | |

|until 9 days | | |

|from date of | | |

|onset. | | |

|Disinfection | | |

|of person. | | |

------------+--------------+--------------------------------------+------------+

MEASLES | Until | Exclude non-immunes until |If |

| recovery and | 15th day after child last |non-immune |

| disinfection | saw patient. |exclude |

| of person; | |from school |

| at least 7 | |during 8th |

| days from | |to 15th |

| onset. | |day after |

| | |child last |

| | |saw patient.|

------------+--------------+--------------------------------------+------------+

MEASLES | Until | Exclude if non-immune until |Exclude from|

(LIBERTY) | recovery and | 22d day after child last |school if |

| disinfection | saw patient. |non-immune |

| of person; | |during 11th |

| at least 8 | |to 22d days |

| days. | |after |

| | |child last |

| | |saw patient.|

------------+--------------+--------------------------------------+------------+

MUMPS |Two weeks | Exclude 15th to 22d day after |Exclude |

|after onset | child last saw patient. |from 15th |

|and one week | |to 22d day |

|after | |after child |

|disappearance | |last saw |

|of swelling | |patient. |

|and after | | |

|disinfection | | |

|of person. | | |

------------+--------------+------------+------------+------------+------------+

------------+--------------+------------+------------+------------+------------+

------------+--------------+------------+------------+------------+------------+

| |and |and |and |may return |

------------+--------------+------------+------------+------------+------------+

SORE THROAT,|Until | | |

ACUTE, |recovery. | | |

SEPTIC | | | |

------------+--------------+--------------------------------------+------------+

WHOOPING |Eight weeks | Fourteen days provided no cough | |

COUGH |or until 1 | develops. | |

|week after | | |

|last | | |

|characteristic| | |

|cough and | | |

|disinfection | | |

|of person. | | |

================================================================================

=================================================================

DISEASE | Remarks |

| |

-------------+--------------------------------------------------+

CHICKENPOX | A mild disease and seldom any after effects. |

-------------+--------------------------------------------------+

DIPHTHERIA | Very dangerous, both during attack and from |

| after effects. When diphtheria occurs in a |

| school all children suffering from sore throat |

| should be excluded and the health officer |

| notified. The medical school inspector or |

| health officer should take cultures from all |

| inflamed throats and noses. There is great |

| variation of type, and mild cases are often |

| not recognized, but are as infectious as |

| severe cases. There is frequently no immunity |

| from further attacks. |

-------------+--------------------------------------------------+

MEASLES | After effects often severe. Period of greatest |

| risk of infection three days, before and after |

| the rash appears. Great variation in type |

| of disease. Dangerous in children under 2 |

| years of age. During an outbreak all children |

| having a temperature over 99°F. should |

| be sent home and the health officer notified. |

-------------+--------------------------------------------------+

MEASLES | After effects slight. Regulations strict, |

(LIBERTY) | because frequently confused with scarlet fever. |

-------------+--------------------------------------------------+

MUMPS | Seldom leaves after effects. Very infectious. |

| Inflammation of genital organs of male or |

| female may occur. |

-------------+--------------------------------------------------+

POLIOMYELITIS| Disease is most communicable in the early |

| stages. After effect is paralysis of certain |

| muscle groups, transitory or permanent. |

| Death is due usually to paralysis of |

| respiratory muscles. |

-------------+--------------------------------------------------+

SCARLET | Dangerous both during attack and from after |

FEVER | effects. Great variation in type of disease. |

| Slight attacks are as infectious as severe |

| ones. Many mild cases not diagnosed and |

| many concealed. A second attack is rare. |

| When scarlet fever occurs in a school, all |

| cases of sore throat should be sent home and |

| health officer notified. Most fatal in |

| children under ten years. |

-------------+--------------------------------------------------+

SMALLPOX | Peculiarly infectious. When smallpox occurs |

| in connection with a school or with any of |

| the children's homes all persons exposed |

| must be vaccinated or quarantined for a |

| period of 20 days. Cases of modified smallpox |

| in vaccinated persons, may be, and often |

| are, so slight as to escape detection. Fact |

| of existence of disease may be concealed. |

| Mild or modified smallpox is as infectious as |

| severe type. |

-------------+--------------------------------------------------+

SORE THROAT, | Often leads to serious results, affections of |

ACUTE, | heart, kidneys, etc. Very apt to occur in |

SEPTIC | epidemics due to milk contaminated by a |

| patient suffering from the disease. |

-------------+--------------------------------------------------+

WHOOPING | After effects often very severe and disease |

COUGH | causes great debility. Relapses are apt to |

| occur. Second attack rare. Specially |

| infectious for first week or two. If a child |

| vomits after a paroxysm of coughing, it is |

| probably suffering from whooping cough. |

| Great variation in type of disease. Often |

| fatal in young children. |

=================================================================

[3] Immunes are those who have had the diseases or in smallpox, who

have been successfully vaccinated within a year.

DISINFECTION: The cleansing and disinfection of the person includes

washing the entire body and the hair with soap and water; thorough

brushing of the teeth; rinsing the mouth; gargling the throat, and

douching and spraying the nose with an antiseptic solution; and

finally, a complete change of clothing (or a change of underwear and

a thorough shaking and brushing of the outer garments out of doors

before these are put on again). (_Facing p. 247_)

It may be added that the ways by which poliomyelitis, or infantile

paralysis, is spread are not definitely known at the time of writing.

We are justified, however, in believing that investigation now in

progress will make exact information available in the near future.

"The weight of present opinion inclines to the view that

poliomyelitis is exclusively a human disease, and is spread

by personal contact, whatever other causes may be found to

contribute to its spread. In personal contact we mean to

include all the usual opportunities, direct or indirect,

immediate or intermediate, for the transference of body

discharges from person to person, having in mind as a

possibility that the infection may occur through

contaminated food.

"The incubation period has not been definitely established

in human beings. The information at hand indicates that it

is less than two weeks, and probably in the great majority

of cases between 3 and 8 days."--(Report of Special

Committee on Infantile Paralysis, American Journal of

Public Health, November 1916.)

DISINFECTION

Specific directions for disinfecting in every kind of communicable

disease would be too extended to be given here. In each case the

attendant should learn from the doctor just how that particular disease

is communicated, just what discharges, utensils, linen, etc., need to be

disinfected, and just what disinfectants he prefers to have used. The

following general methods are now in use, but it must be remembered that

from time to time new methods are devised and new disinfectants are

discovered.

CARE OF NOSE AND THROAT DISCHARGES.--The care of handkerchiefs has

already been described on page 239. Cloths or cotton used to wipe the

eyes or to receive any other bodily discharge including vomitus, should

be collected in the same way and burned. Everyone should be taught in

early childhood to cover the nose and mouth with a handkerchief during

coughing and sneezing; if the patient has not already learned to do so

he must be taught now. If the amount of expectoration is great,

waterproof receptacles should be provided, which should be burned with

their contents.

CARE OF DISCHARGES FROM THE BOWELS AND BLADDER.--At the present time the

following preparations are commonly used to disinfect stools and urine:

5% solution of carbolic acid; chloride of lime solution, made freshly

whenever needed by mixing thoroughly ½ pound of chloride of lime with

one gallon of water; and unslaked lime to which is added _hot_ water.

The amount of carbolic solution used should be about equal in bulk to

the amount of material to be disinfected; the chloride of lime solution

should be at least twice, and the unslaked lime at least one-eighth the

bulk. Fecal masses should be broken up so that the disinfectant may

reach every part; they may be stirred with tightly twisted toilet paper,

which should be left in the bedpan and disinfected with the stools. If

these substances are used, disinfection is considered complete at the

end of an hour, and the contents of the bedpan may then be emptied into

the toilet with safety. It may be necessary to provide two bedpans so

that one may be available for use while the contents of the other is

being disinfected. Bedpans and urinals should be boiled daily and kept

thoroughly clean at all times.

In places having no sewerage system, disinfected discharges may be

emptied into a trench situated at a distance from the well, and then

covered with earth. As an extra precaution, the disinfected discharges

may be mixed with sawdust or kerosene and burned in the trench.

Directions for installing a sanitary privy may be found in Bulletin 68

of the United States Public Health Service.

BATH WATER and water that has been used for cleansing the teeth and

mouth may be disinfected in the same way as urine, or it may be emptied

into a suitable receptacle and boiled ten minutes.

CARE OF THE HANDS.--Disinfectants for the hands should be used in

addition to scrubbing with soap and water, not as a substitute. The

hands may be disinfected after scrubbing by soaking them for three

minutes in one of the following solutions: alcohol 70%, carbolic acid

solution 2½%, or a solution made by adding one teaspoonful of lysol or

of creolin to a pint of water. These disinfectants are poisons if taken

internally; the bottles must be carefully labeled and kept in a safe

place. It is a good plan to wear rubber gloves when handling infective

material; the gloves should afterward be boiled for ten minutes.

CARE OF UTENSILS.--A sufficient number of dishes, spoons, tumblers,

basins, etc. must be reserved for the patient's exclusive use; these

utensils must be washed separately and dried with towels not used for

other dishes. Mistakes frequently occur by which other persons use the

patient's dishes, and in consequence his dishes should not be kept in

the cupboard with other dishes; if no other safe place can be found,

they had better stay in the patient's room covered with a clean cloth or

napkin. The dishes should be scalded daily and at the termination of the

illness they must be boiled briskly for ten minutes before they are

returned to general use. Food left on the patient's tray should be

burned; it should not be eaten by any one else, nor placed in the pantry

or refrigerator with other food.

CARE OF LINEN.--A satisfactory way to disinfect towels, night gowns, bed

linen, etc. is to place the articles immediately in a wash boiler filled

with cold water to which a little washing soda has been added, and then

to boil them in the same water for twenty minutes; they can afterward

go safely into the regular laundry. The boiling may be done once a day;

articles soiled in the meantime may be left to soak in the cold water

and soda.

DISINFECTION OF THE PERSON.--"The cleansing and disinfection of the

person includes washing the entire body and the hair with soap and

water; thorough brushing of the teeth; rinsing the mouth; gargling the

throat, and douching and spraying the nose with an antiseptic solution;

and finally, a complete change of clothing (or a change of underwear)

and a thorough shaking and brushing of the outer garments out-of-doors

before these are put on again."--(New York State Department of Health.)

TERMINATION OF QUARANTINE.--After the patient has recovered, he and the

attendant should, if the doctor thinks it necessary, disinfect

themselves as directed above before they mingle again with other people.

The exact time when it is safe for a person to come out of quarantine

and resume ordinary life varies in different diseases. Moreover, opinion

differs in regard to quarantine periods for the same diseases, so that

the regulations of Boards of Health in different cities show wide

variations. It is of course impossible to say at just what moment every

patient, or even the majority of patients, will stop expelling germs.

Quarantine periods are intended to protect the community as completely

as possible without causing unnecessary hardship to individuals. In any

given case, the local regulations should be strictly observed but

release from quarantine is not a guarantee that the patient is not still

discharging germs, and extreme care should still be taken to prevent the

spread of saliva and other discharges.

TERMINAL DISINFECTION.--A room that has been occupied by a patient with

a communicable disease should be thoroughly cleaned at the termination

of the illness. Dishes, utensils, bed linen, etc. should be cared for in

the ways already described. The floor, bedstead, and other furniture

should be washed with hot water, soap, and washing soda. The walls,

windows, etc., should be wiped with a cloth wrung out of hot water, soap

suds, and soda. The mattress, unless badly soiled with discharges,

should be scrubbed with the same solution and a stiff brush, and left

out-of-doors in the sunshine for a day or two, or until dry. If badly

soiled, it is best to destroy the mattress unless the Board of Health

has facilities for steam sterilization. Ordinary washing is all that is

generally required for blankets, but if badly soiled they should be

sterilized by steam or burned. The room should then be thoroughly

sunned and aired for a day or two, with the windows wide open both day

and night. Sunning and airing are among the most important measures in

disinfecting a room, and should not be slighted. If there has been gross

pollution, as when a careless consumptive persists in spitting on the

floor and walls, it may be necessary to remove the old paint and paper

and have the room done over. The room may safely be occupied after all

these measures have been taken.

FUMIGATION.--Many Boards of Health have abandoned fumigation after

communicable diseases, except after those which like typhus and yellow

fever, are carried by vermin or insects. Dry formaldehyde gas, which was

formerly used for fumigation, has a violent effect on mucous membranes,

but its power to kill bacteria, even on surfaces, appears to be weak,

while its penetrating power is not sufficient to disinfect bedding,

carpets, upholstered furniture, and other fabrics. Since fumigation is

costly, troublesome, and ineffectual there seems to be no good reason

for using it. Moreover, its use gives a false sense of security, so that

really effective measures like sunning, airing, and scrubbing are likely

to be neglected.

Theory and practice of disinfection, it is clear, have radically

changed in recent years. Modern knowledge requires concurrent

disinfection, or the destruction of germs from the moment when symptoms

are first noticed; all the time, day and night, this disinfection must

go on with unremitting care. Today wet sheets are not hung in doorways

nor are chemicals left about in open dishes to disinfect quite harmless

air, but scrupulous cleanliness at all stages of disease is recognized

as one of the most important measures, if not the most important

measure, in disinfection.

EXERCISES

1. Summarize the ways in which infectious diseases are spread.

2. What is meant by the incubation period? State the length of the

incubation period in measles; Liberty measles; whooping-cough; scarlet

fever; chicken-pox; diphtheria; mumps; typhoid fever.

3. Name some of the early symptoms common to most infectious diseases.

If such symptoms appear, what should be done while waiting for the

doctor to come?

4. Discuss the importance, prevention, and treatment of common colds.

5. What measures should be taken to isolate a patient who is suffering

from a communicable disease?

6. What special care should the attendant of a patient with a

communicable disease give to her own clothing and person?

7. Why are the children's diseases more serious in reality than they are

commonly supposed to be?

8. Describe the symptoms of each of the following: Measles, scarlet

fever, chicken-pox, mumps, whooping-cough, and diphtheria.

9. How should bowel and bladder discharges be disinfected?

10. How should dishes and other utensils be disinfected?

11. How should linen be disinfected?

12. Describe measures necessary for concurrent disinfection.

13. Describe measures necessary for terminal disinfection.

FOR FURTHER READING

Preventive Medicine and Hygiene--Rosenau.

The New Public Health--Hill, Chapters VII-XVII.

Essentials of Medicine--Emerson, Chapters XII-XV.

Health and Disease--Roger I. Lee, Chapter X-XIV.

Disease and Its Causes--Councilman, Chapters V-IX.

Publications of the New York State Department of Health, Albany,

entitled: The Teacher and Communicable Disease; A Method for the Control

of Communicable Diseases in Schools; Regulations and Instructions for

Cleansing and Disinfection; The Conduct of an Isolation Period for

Communicable Disease in a Home; Tuberculosis; Typhoid Fever; Scarlet

Fever; Measles; Whooping-cough; Diphtheria; Poliomyelitis, Acute

Anterior (Infantile Paralysis); Smallpox; Septic Sore Throat; Venereal

Diseases. (Any of the above pamphlets will be sent upon receipt of a

three cent stamp.)

American Red Cross Text-Book on Home Hygiene and Care of the Sick · 第 12 / 15 章