How to prevent contamination of the air by the respiration, bodily emanations, and excreta of diseased persons.

It is not possible with our present knowledge to prevent the multiplication of morbid germs in the human body, when they are once implanted there, nor to prevent their discharge; but we can destroy them after their exit from the body, and so protect other persons who are not yet affected.

The following instructions for the management of contagious diseases were prepared for the National Board of Health by Professors Chandler, Henry Draper, Barker, Vander Poel, E. G. Janeway, and Ira Remsen.

Instructions for Disinfection.

Disinfection is the destruction of the poisons of infectious and contagious diseases.

Deodorizers, or substances which destroy smells, are not necessarily disinfectants, and disinfectants do not necessarily have an odor.

Disinfection can not compensate for want of cleanliness nor of ventilation.

I. Disinfectants to be employed.

1. Roll-sulphur (brimstone) for fumigation.

2. Sulphate of iron (copperas) dissolved in water in the proportion of one and a half pounds to the gallon; for soil, sewers, etc.

3. Sulphate of zinc and common salt, dissolved together in water in the proportion of four ounces sulphate and two ounces salt to the gallon; for clothing, bed-linen, etc.

II. How to use Disinfectants.

1. In the sick-room. The most available agents are fresh air and cleanliness. The clothing, towels, bed-linen, etc., should on removal from the patient, and before they are taken from the room, be placed in a pail or tub of the zinc solution, boiling-hot if possible.

All discharges should either be received in vessels containing copperas solution, or, when this is impracticable, should be immediately covered with copperas solution. All vessels used about the patient should be cleansed with the same solution.

Unnecessary furniture, especially that which is stuffed, carpets and hangings, should, when possible, be removed from the room at the outset; otherwise they should remain for subsequent fumigation and treatment.

2. Fumigation with sulphur is the only practicable method for disinfecting the house. For this purpose, the rooms to be disinfected must be vacated. Heavy clothing, blankets, bedding, and other articles which can not be treated with zinc solution, should be opened and exposed during fumigation, as directed below. Close the rooms as tightly as possible, place the sulphur in iron pans supported upon bricks placed in wash-tubs containing a little water, set it on fire by hot coals or with the aid of a spoonful of alcohol, and allow the room to remain closed for twenty-four hours. For a room about ten feet square, at least two pounds of sulphur should be used; for larger rooms, proportionally increased quantities.

3. Premises. Cellars, yards, stables, gutters, privies, cesspools, water-closets, drains, sewers, etc., should be frequently and liberally treated with copperas solution. The copperas solution is easily prepared by hanging a basket containing about sixty pounds of copperas in a barrel of water.

4. Body and bed clothing, etc. It is best to burn all articles which have been in contact with persons sick with contagious or infectious diseases. Articles too valuable to be destroyed should be treated as follows:

(a.) Cotton, linen, flannels, blankets, etc., should be treated with the boiling-hot zinc solution; introduce piece by piece, secure thorough wetting, and boil for at least half an hour.

(b.) Heavy woolen clothing, silks, furs, stuffed bed-covers, beds, and other articles which can not be treated with the zinc solution, should be hung in the room during fumigation, their surfaces thoroughly exposed and pockets turned inside out. Afterward they should be hung in the open air, beaten and shaken. Pillows, beds, stuffed mattresses, upholstered furniture, etc., should be cut open, the contents spread out and thoroughly fumigated. Carpets are best fumigated on the floor, but should afterward be removed to the open air and thoroughly beaten.

5. Corpses, especially of persons that have died of any infectious or malignant disease, should be thoroughly washed with a zinc solution of double strength; should then be wrapped in a sheet, wet with the zinc solution, and buried at once.

Metallic, metal-lined, or air-tight coffins should be used when possible; certainly when the body is to be transported for any considerable distance.

Comments.

Section I. 1. Copperas, also called green vitriol.

2. About four tablespoonfuls of the zinc and two tablespoonfuls of the salt, making a solution of the chloride of zinc.

Section II. 1. The windows should be kept open, if possible, but in such a way as to avoid draughts on the bed. A fire should be constantly burning in an open fireplace.

The room should be on the top floor, and all cracks and openings communicating with other rooms should be closed tightly. The door which has to be used should have a wet sheet hanging entirely over it, the windows and fireplace being alone relied on for ventilation.

2. The burning of sulphur produces sulphurous acid, which is an irrespirable gas. The person who lights the sulphur must, therefore, immediately leave the room, and after the lapse of the proper time, must hold his breath as he enters the room to open the windows and let out the gas. After fumigation, plastered walls should be whitewashed, the wood-work well scrubbed with carbolic soap, and painted portions repainted.

3. Or put copperas in a pail of water, in such quantity that some may constantly remain undissolved at the bottom. This makes a saturated solution. To every privy or water-closet, allow one pint of the solution for every four persons when cholera is about. To keep privies from being offensive, pour one pint into each seat, night and morning.

4. (a.) Such articles should never be sent to a public laundry or mingled with the family washing.

(b.) The cutting open of stuffed articles may seem unnecessary, but it is not. The poison of contagious diseases clings to such stuffs (called fomites) with great tenacity for years, and must be destroyed before they are fit to be used again.

5. It is also well to fill a large wad of cotton or fine shavings with coal-tar powder or chloride of lime and place it beneath the hips, to absorb fluids.

Contagious diseases are often caught at the funerals of those who have died of them, and the sanitary code of New York city forbids a public funeral of any person who has died of small-pox, diphtheria, scarlet fever, yellow fever, typhus fever, or Asiatic cholera. It is better to limit the attendance at such funerals to as few as possible.

Additional Precautions in Special Diseases.

Small-pox.—Every one in the vicinity should be vaccinated with fresh virus. Every person should be vaccinated in infancy, again after puberty, and again within four days after exposure to small-pox. Special care should be paid to isolation. Inmates of the house should neither make nor receive visits while the patient is sick.

Diphtheria and Consumption.—Special care should be taken to avoid inhaling the breath of the patient, as the diseases are communicated through the secretions of the nose, throat, and lungs. The matter coughed up should be received on rags and immediately burned.

Scarlet Fever and Measles.—These are communicable during convalescence, as well as during the illness. The body of the patient should be anointed twice a day with sweet-oil, lard, or vaseline, containing ten grains of carbolic acid or thymol to the ounce. This should be continued until all bran-like scaling of the skin is at an end. Before again associating with unprotected persons, the patient should have several complete ablutions, including thorough washing of the hair with soap or borax; and none of the clothing worn for several days before the disease declared itself should be again used until thoroughly disinfected, and ventilated in the open air several days (New York State Board of Health circular).

Typhoid Fever, Asiatic Cholera, and Dysentery.—Poison contained in discharges from the bowels. Particular attention should be paid to the disinfection of such discharges by the zinc or copperas solution.

Yellow Fever.—Poison possibly contained in discharges from stomach and bowels, but requiring special conditions for development outside the body before it can affect other persons. Excreta should be immediately disinfected. Germs may be carried long distances in fomites (clothing, bedding, and other porous substances), and disinfection of such articles must be very thorough.

Typhus Fever.—No visiting to be allowed.

When there is small-pox, diphtheria, scarlet fever, measles, or typhus fever in a house, immediate attendants on the sick should not leave the house without a change of outside clothing.

General Precautions for those entering a Sick-Room.

Never enter a sick-room with an empty stomach, or when very tired.

Never eat or drink anything that has been long exposed to the air of the sick-room.

Breathe through your nose, and keep your mouth shut except when you are talking.