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Prevention of Communicable Disease: Remove

To Remove Soiled Bed Clothes.- Move the patient to one side of the bed as near the edge as possible, and loosen the sheet beneath him at the head and foot and on the opposite PREVENTION OF COMMUNICABLE DISEASE side. Then roll it up toward the patient and push it well up under him, leaving the side of the bed opposite to that upon which he is lying bare.

Upon this place the new sheet. Tuck this under the edges of the mattress, and pull the patient back over on it.

Now remove the soiled sheet and pull the edges of the fresh one over the portions of the bed still uncovered, and secure in the usual way.

Cleanliness greatly aids recovery, hence the utmost cleanliness of the patient and his surroundings should be the rule. If there is diarrhea, the mattress should be protected by an impervious rubber sheet placed under the linen sheet, or by newspaper pads. Oilcloth cracks and wrinkles too badly to be suitable. Provide two or more rubber sheets so that they can be changed and cleaned as often as required. Sponge the rubber sheets with standard carbolic acid solution No. 4 (5 per cent) and dry and air them in the sun for several hours daily. If the condition of the patient makes it difficult to avoid the soiling of his bed, provide smaller squares of rubber sheeting and folded sheets to be placed above the ordinary sheets. Remove all soiled sheets and clothing promptly before drying occurs. (See Disinfection.) Take care to cleanse and disinfect the patient locally with a solution of corrosive sublimate 1:2,000-half a dram to the gallon of water, or one tablet to the quart.

Bathing.-All patients, if the attending physician approves, should have a daily bath, special attention being given to the hair, teeth, mouth and nails. In many cases it is necessary to wash the patient's mouth frequently with some antiseptic wash. But this should only be done on the express instructions of the doctor.

Disinfection.-A pail or tub should be kept in the room, containing a standard disinfectant solution such as No. 3, 4 or 5 for the purpose of disinfecting every article of clothing before it is carried through the house.

One of these solutions should be kept standing in the tub and renewed at frequent intervals. All blankets, sheets, towels, napkins, bandages and clothing, used either by the patient or the attendant should be at once immersed in this tub and remain at least three hours. After this they should be boiled for at least onehalf hour. The body linen of the patient should be changed daily or oftener if soiled. When removed it should be immersed immediately in this tub. Rags, closet paper or other material used about the person of the patient should be immediately burned. once.

The discharges from the throat, mouth and nose are especially dangerous and must be cared for at It is well to prepare a number of squares of old soft clothold sheets or pillow cases are goodto receive these discharges. These cloths should be burned as soon as soiled. If there is no fire in the sick room, it is convenient to have a small tub containing any strong standard disinfecting solution, to receive these cloths until they can be carried from the room and burned.

The nurse or attendant should wear washable clothing and over all a washable gown, preferably with a hood attachment for the protection of the hair. The gown and hood should be removed and the exposed surface disinfected when leaving the sick room, even though temporarily.

A good rule is to consider that everything which has been brought into the sick room has become infected and should be carefully disinfected before it is carried out.

The hands of the attendant should be immediately washed and disinfected after any contact with the patient or his clothing. A good supply of towels and tin or porcelain basins for this purpose should be kept on hand. Probably the best disinfectant for this purpose is standard solution of corrosive sublimate No. 3, consisting of one gram to one quart of water. No one should ever leave the sick room without first thoroughly washing the hands in a disinfectant solution, or with carbolic or other antiseptic soap, with especial care to clean and scrub the finger nails. It is best to then soak the hands for two or three minutes in half strength disinfectant solution No. 3 or 4, and then wash them off in fresh water.

A large bottle of such a solution should be kept in the sick room for this purpose. Otherwise the nurse may handle something outside the room leaving the germs thereon to be picked up by some one else. It is probable that 90 per cent of all cases of secondary infection are brought about in this manner. The nurse should carefully avoid soiling door knobs or anything else which may be touched by others. While typhoid fever is both contagious and infectious there is no danger of contracting the disease if we prevent the germs from getting into our mouths.

This can be easily done. The only occasion for a second case occurring in a household must come either from ignorance or carelessness. With proper disinfection of the hands and general cleanliness the nurse or attendant may take her meals at the household table. At all events she should not eat in the sick room.

Food and Drink. — The tray, dishes, and other utensils used in the sick room should be set apart for the exclusive use of the patient.

Never wash them in the same pan as other dishes for the family. Use a separate dish cloth and wiping towel.

First immerse these articles for an hour in a half strength standard disinfectant solution No. 3, 4 or 5 and then boil for half an hour and keep apart from all other household utensils. It is best to use paper napkins, which should be burned. If cloth napkins are used they should be immersed in the same disinfectant solution as the bed and body linen. All solid food brought into the sick room and not consumed by the patient should be placed in paper bags to be removed by the attendant and burned. Liquid foods should be poured into a disinfectant. Neither the nurse nor any other person should be permitted to eat any portion of the food remaining. Nothing should be eaten by a well person while in the sick room nor should anything which has been in the room be eaten.

Nurses and attendants should always wash their hands in a disinfectant solution before eating or putting anything into their mouths. It is absolutely necessary that this rule be scrupulously observed. case.

If milk is delivered to the house in bottles, never let these be taken into the room of the typhoid If you do, these bottles may be the means of carrying the disease to someone else. Keep special bottles of your own for the patient's milk. Empty the milk into one of these as soon as received. Then scald out the dairy bottle and keep it as far as possible from the sick room until it is given back to the driver.

Quarantine.-All unnecessary visitors should be excluded from the sick room. If a nurse can be provided, all members of the family should be kept away. Otherwise, one or two persons should be detailed as attendants and all others should be excluded. Certainly there is no need that all the relatives, neighbors and friends should visit the patient. This can do no good but in the majority of instances will do harm, and they take a chance of getting the disease.

The quieter the patient is kept, both during illness and convalescence, the better for him. Children, especially, should be carefully excluded. They have little or no sense of cleanliness and are constantly putting their fingers and other things into their mouths. It has been shown that children contract communicable diseases much more readily than grown persons. If visitors are permitted to see the patient they should touch nothing in the room, or if they do, should wash their hands in a disinfectant solution upon leaving. All visitors, including members of the family, PREVENTION OF COMMUNICABLE DISEASE 157 should be cautioned not to shake hands with or kiss the patient. No one should sit for any length of time in the sick room unless compelled to do so.

Removal of Excretions. - The discharges from the bowels and kidneys should be received into a bedpan or vessel containing at least a quart of full-strength disinfectants No. 1 or No. 2. Enough of the same should be added to cover them and be thoroughly mixed by stirring. Solid masses should be broken up with a stick which can be burned, or a glass rod which can be disinfected. See hat all lumps are thoroughly broken up. Disinfectants cannot kill germs unless they come in contact with them. They should stand in the vessel for not less than an hour. Where there are sewers they may then be emptied into the water closet, taking care not to soil the seats or covers. In the country it is best to deposit the contents of the vessels in a trench. This must be remote, and, if possible, down hill from the well or nearest watercourse. The trench should be about four feet deep and two wide. Each deposit should at once be well covered with quicklime and earth well beaten down. When half filled in this manner the trench should be covered in with earth. But care must be taken that none of the excretions from persons afflicted with typhoid are ever emptied until thoroughly disinfected.

Under no circumstances should these be poured out in the neighborhood of springs or wells. It should also be remembered that the water in which typhoid fever patients are bathed necessarily becomes infected. This should also be thoroughly disinfected before being emptied out. Vomited matter and the sputum from the patient also contains the germs of typhoid and should receive the same care and thorough disinfection. These precautions should be continued for some time after the patient has recovered. About three per cent of all cases are carriers of the disease for many months or even years. It is well to request the attending physician to ascertain by means of blood tests whether or not the germs of typhoid have left the system.

A great responsibility rests upon the household in the management of a case of typhoid fever. To pour out the discharges from a patient in the back yard or expose them in open vaults or drains may be, and often is, equivalent to the murder of innocent neighbors by poisoning. Yet this is being done, in many thousands of instances, as the result of ignorance of the fatal nature of the invisible germs of the disease. In- If Vermin.-Steps should be taken, if necessary, to destroy all such vermin as fleas, bedbugs, lice and especially rats and mice, by means described elsewhere in this volume. The sick room should be carefully screened against flies and mosquitoes. sects worry sick people and hinder recovery. Above everything else flies should not be permitted to enter the room, or, if they get in, should be killed before they get out. Screens are cheaper than additional cases of typhoid in the family. If flies are numerous in the vicinity a number of vessels containing fly poison should be exposed in the room. sticky fly paper is used, it must be burned at frequent intervals. Fly traps may be used if care is taken to destroy the insects with boiling water and to burn their bodies or deposit them in a disinfectant. Or single flies may be killed by means of the ordinary fly swatter and then dropped into a disinfectant solution.

After recovery and during convalescence the patient is to be considered dangerous so long as the intestinal discharges continue to be more copious, liquid and frequent than natural; and these should be disinfected until the attending physician advises that it is no longer necessary.

In the event of death the body must be wrapped in a sheet thoroughly soaked in full-strength Standard Disinfectant No. 3 or 4, and placed in an air-tight coffin. This must remain in the sick room until removed for burial. Public funerals and wakes over such bodies are forbidden. - Quarantine.

It is entirely unnecessary to quarantine a case of typhoid fever, or the premises in which it exists, provided proper care is given to all the details of the sick room, as recommended. The use of placards has been largely discontinued in this disease. If the disinfection is practiced as strictly as it should be, there is no danger of the disease being communicated to others from a given case; but constant cleanliness and disinfection are absolutely necessary to secure such result. Anti-Typhoid Vaccination. - Typhoid fever in normal cases is a selflimiting disease. That is, unless the patient dies, the body develops within itself the power of resisting the virus.

The patient then recoves and regains his health even though the germs are still developed in large numbers in the intestines. In recent years many attempts have been made by scientific men to perfect a serum for anti-typhoid vaccination and a number of different typhoid vaccines are now upon the market. The use of typhoid vaccine was first publicly advocated in 1896 by Pfeiffer and Kolle in Germany and by A.

Wright in England. In 1904 elaborate experiments were made and since that time the results obtained have been very encouraging. The degree of immunization obtained has not yet been equal to that secured by vaccination against smallpox, but statistics indicate that the likelihood of infection is greatly reduced by this means and that the death rate may be reduced at least one-half. It has been shown that, if proper precautions are observed, anti-typhoid vaccination in healthy persons is harmless and that the personal discomfort caused by its application is ordinarily very slight. The duration of immunity is not yet determined, but it is thought to be at least two and a half years and probably longer. It is the most effective method of pro tection yet devised against the chronic bacillus carrier. Every member of the American army from the Secretary of War down is now required to be vaccinated against typhoid.

And this is believed to be the principal cause of the immunity of the troops in recent army maneuvers.