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Prevention of Communicable Disease: Milk

Infected Milk Supply. -Milk is a very common and dangerous source of infection, because it is what medical men call an excellent "culture medium," that is, germs grow and multiply very rapidly in fresh milk.

Nor do they cause the milk to become sour or in any other way give evidence of their presence. Milk is never infected when it comes from the cow. It is always infected by man. This usually takes place through washing the milk cans or other utensils with polluted water.

Watered milk may contain the germs of typhoid, for a milkman who adulterates milk with water is not usually careful of the quality of his source of supply. The milkers or others who handle the milk may infect it, if typhoid germs are present on their hands or clothing. Or, infected flies may fall into the milk. The germs from infected milk may also be found in butter and cheese. Hence no milk or other dairy products should be sold from a dairy, farm, or house where there is a case of typhoid fever.

Infection from Ice.-The germs of typhoid fever are not destroyed by freezing. Hence ice taken from sewage-polluted rivers or lakes, or ice manufactured from such waters, is unsafe to use.

Infection from Vegetables.-Vegetables often become infected with the germs of typhoid by irrigation with polluted water, by contamination from night-soil used by farmers or market gardeners as a fertilizer, by flies and other insects. Creel, in a careful review of the results of recent scientific investigation, asserts that the typhoid bacillus may retain its vitality in privy vaults or in night-soil used as a fertilizer for a period of several weeks, or even months, and that plants cultivated in contaminated soil may take up the germs on their leaves and stems in the process of growth. He found living typhoid bacilli on the tips of leaves that to the naked eye appeared Where the flies come from. 498 CREAM Where the flies go. free from any particles of soil. He also proved by careful observation that rainfall will not free vegetables wholly from infected material. This source of pollution is especially dangerous in the case of such vegetables as lettuce, radishes and celery, which are eaten raw. The remedy is to thoroughly wash or scrub them free from earth and bacteria by means of a stiff brush. All vegetables should be cleaned in this manner, but the danger of infection is less from cooked vegetables, as most germs of disease are destroyed by boiling.

All fruits, such as grapes, apples, pears, berries and the like, including lemons and oranges, should be carefully washed in at least three waters or for five minutes in running water, especially in times of epidemic disease. Dried figs and dates are very commonly eaten without being cooked or washed, yet they have been exposed for an unknown space of time to all kinds of contagion from dust, flies and dirty hands. Shelled nuts purchased in the market should be washed and scalded before they are used, as they are commonly exposed to similar infection. The Typhoid Fly. - This term has been applied to the common house fly by L. O. Howard to draw attention to the danger of infection from this insect. Flies cannot become the carriers of disease germs unless they have access to some source of infection. Hence the danger is much lessened by the elimination of all nuisances in the neighborhood of our dwellings. However, since flies may travel from considerable distances, the only assurance of safety against infection from them is to exclude them by screening or destroy them by means of traps and poisons. a Flies having access to privy vaults or sources of typhoid infection elsewhere, and then, through unscreened doors and windows, to living rooms, alighting upon food already prepared for the table or to be used without subsequent heating, are a serious danger. Some of these articles, liquid, semi-solid, or with moist surfaces, thus slightly infected, serve as congenial culture media for the rapid multiplication of the infection. A few typhoid germs brought on the hairy feet of flies may increase many fold if deposited in milk or on the surface of boiled potato.

While typhoid is not ordinarily an air-borne disease, care should be taken to avoid the typhoid patient's breath and not to come unneces- PREVENTION OF COMMUNICABLE DISEASE 153 sarily in his immediate vicinity especially if he has pneumonia, or an explosive cough. The sputum bearing infection may be sprayed into the air during coughing, but the range of possible danger is slighthardly more than four or five feet. The disease is also occasionally spread by the dust of dried urine or other excreta, which is carried through the air, thereby contaminating food or water. Some authorities The hairy foot of a fly (magnified). still hold that the disease may be communicated by inhaling these particles by mouth or nostrils. The diarrhœal discharge, when dry, may preserve the poison as effectually as the crusts of smallpox, the scales of scarlet fever, and the dried membrane of diphtheria preserve the specific poisons of those diseases. of Among miscellaneous sources infection may be mentioned bread, pastry, confectionery, fruits, vegetables, meats, etc., handled by infected hands in bakeries, stores, markets and slaughterhouses, or the same articles and milk infected by flies recently arrived from sources of filth.

The general filth conditions in the homes of extremely untidy families favor the spread of typhoid infection, and in such homes or in any homes where there is neglect of the greatest possible cleanliness of the sick person, his bedding, clothing and everything else in the management of him, the danger from secondary infection is serious. THE SICK ROOM Care of a Typhoid Patient.-As typhoid fever is one of the most common of communicable diseases, full instructions will be given here for the management of the sick room in such a way as to preclude the possibility of other members of the family becoming infected. All of these instructions apply equally to other contagious diseases with the addition of especial precautions in certain other ailments which will be mentioned.

Isolation. The first and most essential precaution in the case of typhoid or other communicable disease is that the patient should be completely isolated. Unless this is done, other members of the family are almost sure to contract the malady. The safest course is to send the patient to a hospital. When this is not possible, select a large airy room as the sick room. This should be located on the sunny side of the house, and should have a fire place if the weather be cold. It should be as far from living and sleeping rooms of other persons as possible. It is of the utmost consequence that the room have windows and doors by means of which it can be at all times thoroughly ventilated. At all seasons of the year a room on the lowest floor of the house is more satisfactory, since it is warmer in the winter and cooler in the summer.

The room should not be uncomfortably cold, though it is much better to have the temperature too low than to have it stuffy. In most diseases ventilation is of supreme importance, and should be secured at any cost.

There are no better disinfectants than pure air and sunlight. A temperature of about 70° F., if compatible with thorough ventilation, is generally considered most desirable.