ounce of bichloride of mercury in the powdered form, in two ounces of
common hydrochloric acid (not the dilute hydrochloric acid used in
medicine), be obtained. This is a violent poison, and it must be kept
out of the reach of children and careless persons. Two teaspoonfuls of
this solution in an ordinary wooden bucket filled with water to within
two inches of the rim makes the disinfecting mixture. A wooden washtub
nearly filled with this disinfectant, mixed in the bucket as directed,
should be kept near the door of the room, and all towels, sheets, and
soiled linen must be soaked in this tub for twenty-four hours. After
that any one may handle these articles with perfect safety. The
articles that have been soaked for twenty-four hours should be rinsed
in ordinary water to remove the acid, and they may then be washed. The
nurse should not touch the outside of the tub with infected articles
while putting these in the disinfectant. Do not make the disinfectant
stronger than directed here, or it will destroy the articles soaked in
it, and for the same reason do not leave them in it longer than
twenty-four hours.
If the attendant can be kept isolated with the patient there will be
less liability of carrying the infection through the house. In a
majority of cases in families, however, the mother is obliged to care
for the patient and to attend also to her household duties. In the
last case, let her keep near the door of the room a cotton wrapper
which can be put on over her dress whenever she enters the room. She
had better tie a towel over her hair. In the room a china-stone basin
should be kept, containing a gallon of water, in which there is a
teaspoonful of the acid bichloride. Every time the attendant touches
the patient let her wash her hands in this mixture, using no soap. She
should remove her finger rings or they will be blackened. The patient
should not be handled except when absolutely necessary, to avoid
needless exposure to infection; it is also injurious to a child ill
with diphtheria to lift it up. The nurse's covering wrapper should be
soaked in the tub as often as possible. Some ignorant persons give as
an excuse for a lack of care in {192} handling patients having
contagious diseases like diphtheria, that they are not afraid of the
infection. Fear has nothing to do with the matter.
Food is to be taken to the door of the sick-room by some one other
than the attendant. The tray should not be carried into the room.
After the meal, take to the door a pan containing water, and let the
attendant set the dishes, knives and forks, and the food handled by
the child, under the water without touching the rim or sides of the
dish-pan. Then any one may carry the pan to the kitchen, where it is
to be set upon the stove, and the water holding the dishes and the
rejected food is boiled for an hour. After that process the contents
of the pan are safe, and they may be handled for washing. Cloths used
in wiping the mouth of the patient are to be wrapped in paper and
burned. Dejecta should be covered with fresh chlorinated lime, one
part to two of water.
After the patient begins to convalesce the danger of infection grows
greater. When the membrane has disappeared, and the child is able to
run about the room, the attendant ceases commonly to use the
throat-spray because the process is troublesome. In such cases the
diphtheria bacillus remains in the patient's mouth for some time--from
a few days to weeks. During the most of this time the child is as
dangerous to others as it was while it was ill. In one case in my own
experience, the bacillus remained present for eleven weeks from the
date of diagnosis, and I then lost sight of the child. In the tenth
week the bacillus present when in pure culture killed a guinea-pig in
thirty-six hours. This is, of course, an exceptional occurrence; but
the routine practice is to keep the patient isolated for three weeks
after the membrane has disappeared, unless a bacteriological
examination shows that the bacillus is absent. The bacillus remains
after the use of antitoxin just as if antitoxin had not been used.
When a child is to be released from the sick-room, bathe it carefully
with soaped warm water, washing out the hair and under the
finger-nails carefully. Then wet a towel with the disinfectant (the
acid bichloride of mercury,--a {193} teaspoonful to a gallon of water)
and go over the body with it; afterward rinse with ordinary water. Do
not let the disinfectant enter the child's mouth or eyes. Next,
without allowing the child to touch anything in the room, especially
avoiding the door-knob, send it to another room and dress it in
clothing that has not been near the sick-room. If, after this process,
other children are infected, the explanation is that the child had
been released too soon--before the bacillus had disappeared.
It commonly happens that a child has been going about the house for
some days before a physician has been called in. In that event you
have the house to disinfect. You must then wet with bichloride
everything the child has touched, and boil all eating utensils.
As to the disinfection of the room and its contents: the irritation of
diphtheria causes a large quantity of saliva to flow from the
patient's mouth; this infected saliva runs down upon the pillows and
soaks into them. It may also soak into the mattress. If a town has a
steam disinfecting plant, there is no trouble in dealing with bedding
and carpets after diphtheria and other contagious diseases; such a
plant, however, costs at the least $6000. It is safer, in the absence
of steam disinfection, to destroy pillows by fire; but if these are
opened and the filling put into tubs or barrels containing two
teaspoonfuls of the acid bichloride of mercury to each gallon of water
and soaked for about two days they will be safe. The ticking in this
case should be boiled in a wash-boiler, and the filling is to be
rinsed before drying. The mattress is less liable to infection but it
may be infected. If a piece of oil-cloth or rubber sheeting is spread
beneath the bed-clothes under the patient and the mattress is kept
well covered during the course of the disease, the filling of the tick
will most probably be not infected. The loss of a good feather or hair
mattress is considerable in the house of a poor man, and these often
may be saved. To disinfect the surface of a mattress place it on
chairs in a small room or in a closet and pour upon a cloth under it
500 cc. of formalin for each 1000 cubic feet of air-space in the room
or closet--multiply the length by the height by {194} the width of the
room or closet to get the cubic feet of air-space. Leave the room or
closet shut tightly for twenty-four hours. The Trenner-Lee
formaldehyde disinfector is a good apparatus for disinfecting. The
smaller size costs twenty-five dollars.
If anything is to be sent out of a room to be burned, spread a piece
of old carpet, bagging, or similar useless cloth outside the room
door, set on this the articles to be destroyed, wrap them carefully in
the fabric, tying all with cords; then take the bundle outside the
town in a covered wagon, pour kerosene oil on the package without
opening it, and set it afire. Afterward wash the wagon with the acid
bichloride.
Wet the furniture and floors of the room with the acid bichloride. Do
not merely sprinkle the solution about, flood everything with it,
because the germ is killed only by direct contact; and remember that a
diphtheria bacillus magnified 800 times is not larger than the eye of
a needle. The bichloride will spoil gilt picture-frames, therefore use
a 10 per centum solution of pure carbolic acid on these and all other
metallic surfaces. Coins should be boiled, and paper money should be
dipped in the 10 per centum carbolic acid solution and dried at a
stove. Money is frequently found in smallpox rooms under the patient's
pillow.
Formalin is the best disinfectant for wall-paper unless the child has
spat upon it--then use the bichloride. Sometimes the bichloride will
not injure the wall-paper, but if there are gilt figures upon it these
will be blackened. Sulphur fumes are no better than formalin--not so
good, and they injure and blacken tinted and gilded wall-paper, silks,
satins, and other fabrics. If you determine to have the room
repapered, wet it with bichloride before you bring in the workmen.
It is difficult to disinfect a carpet except by steam, and on this
account the carpet should be removed from the room before the patient
is brought into it. If it has been kept in the room, wet it thoroughly
with the bichloride, when you are disinfecting, if you can not have it
disinfected by hot steam. The wetting commonly spoils the carpet,
consequently it may be necessary to bum it.
{195}
Keep cats, dogs, and especially kittens, out of a diphtheria room.
Kittens will take the disease easily, and cats and dogs will carry
about the contagion. If a valuable dog should get into the room,
disinfect its hair thoroughly with the acid bichloride and then rinse
the hair. Be careful to disinfect its feet.
While using the bichloride do not forget the window-panes, the
door-knobs, and that part of the chair-legs which touches the floor.
After you have used the bichloride expose the room to the gas from
formalin. Hang up sheets wet with 500 c.c. of formalin for each 1000
cubic feet of air-space, and close all keyholes and cracks; then leave
the room shut for twenty-four hours.
As to the use of antitoxin as a preventive and cure for diphtheria,
too much praise cannot be given to that wonderful discovery. Reliable
diphtheria antitoxin, used in proper quantity and early enough, is
almost an absolute cure. Where it fails it has been used too late or
not in the proper dose. In any case its only evil effect may be an
attack of nettle-rash or hives. The few deaths that have occurred in
its use were caused by an ignorant use of the syringe. If you find a
physician opposed to the use of antitoxin this simply means that he is
a quack. One serious disadvantage in the use of antitoxin is that it
leaves the dangerous bacillus in the throat of the patient about as
long as an unaided convalescence would leave it. The membrane often
will disappear in twenty-four hours where antitoxin has been used, and
the child will be playing about the floor. Then the mother will say
the child never had diphtheria; she will not disinfect, and she will
let the child run about the house.
The free book system that prevails in some schools is a prolific
source of infection. Books are infected at home or by children from
infected houses, and mixed with other books in the school. The
diphtheria bacillus will cling to a book for at least a year. If books
are given to the children, give them outright; do not let the books be
mixed in the schoolroom.
Drinking-cups used in common are another source of {196} infection.
Let each child have its own tin cup. The clothes-rack in a school also
spreads infection. Room enough should be given to each hook to keep
the hat and coat of one child from touching those of another, and a
wooden partition standing out from the wall about eight inches should
separate hook from hook. The janitor should wash the clothes-racks
with the acid bichloride solution every time he sweeps.
Suppose a child having diphtheria is found in school, or one is
discovered as coming from a house where he was in contact with
diphtheria. The discovery is made commonly after the child has been
spreading infection for some days. Do not frighten the youngster, but
find out from him what parts of the school-building he has been
visiting. Then send him and the other children home. Rooms in which
the child has not been are not infected, and only that which he has
touched is infected in any case. Wet everything in the building and
outhouses with which he possibly could have come in contact with the
acid bichloride. Burn his books and papers, or, if this action may
cause difficulty with parents, let him take his books home and inform
the health officer of that fact. When he returns to school be sure of
the history of his books. Use formalin or sulphur in the infected
rooms, and classes may be begun again the next day. If within the week
any child shows signs of sore throat send it home immediately.
Sulphur must be burned when used as a disinfectant, and to be
effectual four pounds should be burned for every 1000 cubic feet of
air-space in the room. A teaspoonful of sulphur when burned will fill
a house with choking, dangerous fumes, but two pounds of sulphur
burned in an ordinary bedroom will have no effect whatever on the
diphtheria bacillus and very little on any other disease. Sprinkling
disinfectants about a house, and setting saucers containing
disinfectants in rooms is nonsense--the quantity must be sufficient
and be in actual contact with the contagion. A deodorant does not
disinfect because it removes a stench.
To burn sulphur set a coal-hod or an old tin pan on two bricks in the
middle of the room, but see that there are no {197} holes in the
bottom of the hod or pan through which burning sulphur could drip to
the floor. For a like reason see that the pan is not too narrow nor
too shallow. It is safer to set the bricks in a tub filled with water
up to the top of the bricks. Use powdered sulphur in preference to the
cakes sold by the druggists, and fire this sulphur with a red coal.
The room should be moist with steam when the sulphur is set afire so
that the fumes will act effectually. Leave it shut tightly for
twenty-four hours.
In the Northern States diphtheria is most prevalent in October,
November, and December; scarlet fever is an April disease, but it may
occur at any time. It is easier to spread the infection of scarlet
fever and measles than that of diphtheria, but it is not so difficult
to disinfect after scarlet fever and measles as after diphtheria. The
contagion of scarlet fever does not resist the fumes of sulphur or
formalin. Disinfect a room after scarlet fever as for diphtheria but
be sure to use also either sulphur or formalin because the contagion
can float about a room. Eruptive contagious diseases like scarlet
fever, smallpox, and measles so affect the skin that during
convalescence the cuticle scales off. In severe cases of smallpox and
scarlet fever the entire outer skin of the hand may peel off like a
glove. The contagion is always found in the scaling skin. As the
patient grows stronger the scales become finer, until at last they lie
as mere mealy dust in the hollows of the elbows or other parts of the
body. Down to the very last these scales are infectious, and they will
retain the infection for months, probably for a year or more. The
scales float in the air of a sick-room, fall on the clothing of
visitors, are carried away by the shoes of those that leave the room.
The scaling may continue for three weeks--it commonly does. These
three diseases are infectious before the scaling begins, sometimes
before the rash is well out. A very light attack of any of these
diseases in one child may infect another fatally. Insist upon keeping
a scarlet fever or measles patient out of school until all scaling has
ceased.
Chickenpox is almost a harmless disease, but it is more infectious
than even measles. Be cautious with it because {198} nearly every
epidemic of smallpox begins through some one mistaking smallpox for
chickenpox, although there is little or no similarity between the
diseases.
A child with tuberculosis of the lungs or a child infected with acute
syphilis should not be permitted to go to school under any
circumstance.
In the chapter on The Priest in Infectious Diseases will be found an
account of the necessity of vaccination as a precaution against
smallpox.
Tinea Favosa, or favus, is a contagious and a very stubborn disease of
the skin, caused by the fungus _Achorion Schoenleinii_. It produces
yellowish crusts about the hairs of the scalp and other parts of the
body, and it destroys the hair. It attacks also the finger-nails and
the skin that is without hair. In the later stages of the disease
there is a foul odour. It is one of the most difficult of the
scalp-diseases to cure; months and sometimes years are required to get
rid of it.
A child with tinea should be kept away from school; and his desk and
what he touches should be washed with the bichloride of mercury
solution. Burn his books and papers.
Ringworm is a kind of tinea, and it is caused by various mould fungi.
Tinea Tonsurans is ringworm of the scalp; Tinea Circinata is ringworm
of the body; Barber's Itch is another form; there is also a ringworm
of the finger-nails; and Pityriasis Versicolor is still another form.
All are contagious, and some are difficult to cure because the
parasite gets down between the skin and the hair-follicles and an
antiseptic can not reach it. Children affected with these diseases
should be kept away from school until they have been cured.
The presence of lice and of the Acarus Scabiei can bring about acute
and severe skin eruptions. The Acarus Scabiei causes itch, but
fortunately it is rare in America. These parasites go from person to
person, hence a child having either should be kept from school until
he is clean. A thorough washing will remove lice if they have not yet
inflamed the skin, but itch requires a more vigorous {199} treatment.
The desks of such patients should be disinfected and their clothing
should be baked. They will probably be reinfected at home if the
treatment is not applied to other members of the family.
Contagious Impetigo, or porrigo, as it was formerly called, is a skin
disease common among children, and it may affect adults. It appears to
be of parasitic origin, but the specific organism that causes it has
not been isolated. The lesions in this disease are commonly
discrete--separate one from another--but they may be crowded together.
They are vesico-pustular and they are sunken at the top in the typical
form. If they are not broken by scratching, they dry into a yellowish
crust. The disease affects only the skin, but as it is contagious a
child affected with it should be kept from school until cured. The
desk and articles used by the child should be disinfected, and his
books are to be burned.
Whooping-cough is very infectious, and, contrary to the popular
opinion, it is frequently a fatal disease. There is a period of
incubation for from seven to ten days, then a catarrhal stage follows
in which the child has the symptoms of an ordinary "cold." In about
another week the dry cough becomes paroxysmal with the characteristic
"whoop" when the air is drawn in after the fit of coughing. When there
is an epidemic of whooping-cough, children with "colds" should be sent
home from school. The objects used by a child that has whooping-cough
should be disinfected, and its books and papers are to be burnt.
Mumps can be a serious and a very painful disease and it is infectious
to a marked degree. The specific organism is not known. Boys are more
liable to this disease than girls are, and recurrence is rare. After a
period of incubation, which lasts from two to three weeks, there is
fever, pain under one ear, and the parotid gland swells. The disease
is commonly mild, but it may affect a child seriously. The patient is
to be quarantined, what it has touched should be disinfected, and its
books are to be burnt.
There are a number of infectious eye diseases that occur among
school-children. Acute Contagious Conjunctivitis, {200} or "pink eye,"
is one of the most important. One form of acute Contagious
Conjunctivitis is caused by the Koch-Weeks Bacillus; it is "pink eye,"
properly so called, and it is very infectious. Objects handled by the
patient can infect others and spread the disease. The attack is
severe, but the prognosis for full recovery is good. The child should
be strictly quarantined until all secretion from the eyes has ceased,
and whatever he has touched is to be carefully disinfected.
Another form of Acute Infectious Conjunctivitis, less contagious than
that caused by the Koch-Weeks bacillus, is brought about by the
introduction into the eye of the bacteria that give rise to pneumonia.
Commonly the pneumonia bacteria do not cause conjunctivitis unless the
patient is susceptible in a special manner. As it is difficult to
differentiate this second form from the first, the same precaution
should be used.
Trachoma, called also granular conjunctivitis, Egyptian ophthalmia,
and military ophthalmia, is a very serious inflammatory disease of the
external eye which has of late years become prevalent in American
cities, whither it has been brought by immigrants from eastern and
southeastern Europe. Persons that have this disease on landing in the
United States are deported, but despite this precaution it has crept
in and is now endemic. It is contagious, and when well established it
is extremely difficult to cure. If untreated it lasts for years and it
may destroy the cornea and consequently the sight. A trachomatous
child should be kept from school until it has been cured, and that
cure will take a very long time.
The Gonococcus can be carried into the eye by handling objects like
soap, towels, wash-basins, which have been used by persons afflicted
with gonorrhoea. The infection of the eye is very severe and
dangerous, and the usual quarantine is to be observed. The ophthalmia
of the new-born is gonorrhoeal.
The Diphtheria Bacillus also may get into the eye, and set up a
primary infection there. A membranous conjunctivitis, too, is at times
induced by pus organisms. {201} Xerosis Epithelialis, tuberculosis,
leprosy, and syphilis may affect the eye primarily, and additional
forms of eye-diseases are found that are infectious. The general rule,
then, is that children with any inflammation of the eyes are to be
kept out of school until a physician pronounces them harmless.
AUSTIN OMALLEY.
{202}
XVI
SCHOOL HYGIENE
Priests have to put up buildings for parochial schools, colleges,
seminaries, orphan asylums, convents, and the like, but in such work
sanitation is commonly given only a passing thought in connection with
sewer-traps and these are left to the wisdom of a plumber. The
physical welfare of youth is almost as important as its mental
training, and there are many factors beside sewer-traps involved in
the effort to sustain it.
If there is freedom of choice as regards the site of a schoolhouse or
similar building, the top of a small elevation is to be selected. Such
a position affords the best natural drainage, removes dampness, avoids
inundations, gives full sunlight and the purer air. The top of a high
hill may be too exposed to the wind.
Next to the top of a knoll, the southerly slope of a hill is to be
chosen. The building should not be overshadowed by a hill, especially
on the western side. Trees are not to be planted close to a building
in which children live, and ivy and similar plants should not be
permitted to cover the walls.
If a building is set in a hollow it will be surrounded with chill air
and mists in the cold seasons, even if a costly drainage system keeps
the cellar and basement dry.
A gravelly or sandy soil beneath a building is the best, provided this
soil is not already saturated with organic matter, or is not close
above a dense layer of clay or rock. Clay, marl, peat, and made soils
should be avoided if possible, because they are full of organic
matter; they are cold, and they infect the ground air. Rock does not
make a good building site--its seams carry water.
{203}
The subsoil should be drained four or six feet below the cellar floor,
and this floor is to be laid in concrete and cement. At the level of
the ground there should be a course of hollow vitrified brick to
exclude dampness and to give ventilation.
Limestone walls conduct more heat in and out than an equal thickness
of glass, bricks, plastering, and wainscoting. The porosity of the
building material determines the interchange of the air through the
walls, and it affects the temperature of the rooms. If there is water
in the pores of the walls heat is conducted rapidly, but air is not
permitted to pass. Brick as a building material has many
disadvantages, but on the whole it is best for schools, and it resists
fire better than most stones. The harder the brick the better it
is--vitrified brick is the best. Hard-pressed brick of a light colour
makes an excellent outer wall-surface.
It is very doubtful that sewer gas escaping into a house will directly
carry the micro-organisms of diseases like typhoid and diphtheria, but
such gas is poisonous, depressant, and it renders the inmates of a
house liable to disease; lessens their power of resistance. The
typhoid bacillus and other bacteria can, of course, be carried into a
cellar by the seeping in of drainage water. Infants kept in the upper
story of a house in hot weather are more liable to intestinal diseases
than are those that live on the lower floors, but here the weakening
agent is heat. Tuberculosis, scrofula, rheumatism, neuralgias,
bronchial, and kidney affections are made worse in damp houses.