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of the whole body and entire change of clothing. The time for return to society must be regulated by the physicians.
Two weeks after complete recovery from diphtheria or measles is usually sufficient. But by complete recovery—we mean this lapse of time after all symptoms have disappeared. After small-pox or scarlet fever, a longer period must elapse, since the skin is for some time separating its contaminated particles. From four to six weeks is the time generally named, but very much depends as to time upon the home cleanliness of the family and of the person.
When death has occurred from any communicable disease, the body should be washed with a chloride of lead or zinc, or corrosive sublimate solution of double strength of that described under disinfectants, and then be wrapped in a sheet wet with the same. Shavings or “excelsior,” moistened with a disinfectant, may be placed under the body. In no case should the body be exposed to view. In most cases it is desirable to avoid a public funeral, and especially the attendance of children. Much depends on the skill and knowledge of the undertaker. (See Third Report, pp. 111-121.)
DISINFECTION OF HOUSE AND SURROUNDINGS.—The first requisite is the most thorough exposure of the room to air, unless it is in such very close proximity to other buildings as that it is best to fumigate first.
The following directions will guide as to materials and methods of disinfection.
DISINFECTANTS TO BE EMPLOYED.-1. Roll sulphur (brimstone) or chlorine gas 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. (Zinc solution) sulphate of zinc and common salt, dissolved together in water in the proportion of four ounces sulphate and two ounces of salt to the gallon ; for clothing, bed linen, etc.
4. Thymol solution.—Two drams of thymol (crystals) dissolved in ten drams of alcohol, twenty drams of glycerine, and one gallon of hot water.
5. Solution of corrosive sublimate.—One ounce to eight gallons of water.
6. Commercial sulphuric acid.-One pint to eight gallons of water. How to USE DISINFECTANTS IN THE SICK-Room. The most available agents are fresh air and cleanliness. The clothing, towels, bed linen, etc., should at once, 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.
Unnecessary furniture—especially that which is stuffed-carpets and hangings, when possible should be removed from the room at the outset; otherwise, they should remain for subsequent fumigation and treatment.
All discharges should either be received in vessels containing copperas solution, or, when this is impracticable, should be immediately covered therewith. All vessels used about the patient should be cleansed with the same solution.
One-half pound of sulphate of iron (copperas or green vitriol), or one ounce of sulphate of zinc (white vitriol), or one ounce of sulphate of copper (blue vitriol), or one ounce chloride of zinc (butter of zinc), or one ounce of chloride of lime (bleaching powder), put to a quart of water will answer for this purpose.
FUMIGATION with sulphur is a practical method for disinfecting the house. For this purpose the rooms to be disinfected must be vacated. Heavy clothing, blankets, bedding, and other articles which cannot be treated with zinc solution, should be opened and exposed during fumigation, as directed below. Close the room as tightly as possible, place the sulphur in iron pans supported upon bricks placed in wash-tubs containing a litttle water, set it on fire by the hot coals or with the aid of a tablespoonful of alcohol or saltpetre, and allow the room to remain closed for twelve hours. For a room about ten feet square, at least two pounds of sulphur should be used; for larger rooms, proportionately increased quantities, placed at two or three points.
To disinfect an ordinary room with chlorine gas: having tightly closed all the openings of the room, place in it an earthen dish containing four ounces of peroxide of manganese. Pour on this one pound of strong muriatic acid, being careful not to breathe the fumes. When certain that continuous liberation of chlorine is taking place, leave the room and close the door.
Cellars, yards, stables, gutters, privies, cesspools, water-closets, drains, sewers, &c., should be frequently and liberally treated with copperas solution. The copperas solution is easily prepared by hang
ing a basket containing about sixty pounds of copperas in a barrel of water, or by dissolving in hot water a few pounds of copperas.
Corrosive sublimate is cheap and has excellent disinfectant properties, and can be used the same as the iron or zinc sulphates. The vessel containing it should be marked " poison.”
Sulphuric acid has been found very effective for sprinkling and general disinfection.
Where a disinfectant wash of pleasant odor is desired for common use by the person sick or the attendant, the thymol solution, derived from thyme and some other plants, answers a good purpose.
We have not especially referred to carbolic acid and other phenol compounds, because, while useful, they are not preferable to those already named.
BODY AND BED-CLOTHING, &c.—It is often best to burn articles which have been in contact with the persons sick with contagious or infectious diseases (and especially if the disease be small-pox). Articles too valuable to be destroyed should be treated as follows:
a. Cotton, linen, flannels, blankets, &c., 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 cannot be treated with the zinc solution, should be hung in the room during fumigation, their surfaces thoroughly exposed, pockets being turned inside out. Afterward they should be hung in the open air, beaten and shaken. Pillows, beds, stuffed mattresses, upholstered furniture, &c., 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.
After fumigation it is desirable to cleanse all wood-work with soft soap and hot water, to thoroughly brush hard or papered walls and to whitewash the rest. A thorough, general house-cleaning is desirable.
Circular VIII. of this Board, as contained in the third and fourth reports of the Board, pages 85 and 260, gives other important directions as to cleanliness and disinfection.
The question whether beds can be safely fumigated and re-used, will depend upon the amount of soiling or use. All things which are not to be or are found not capable of being thoroughly cleansed, should be at once burned. As contagions are often stored up and kept over because of imperfect airing and cleansing, safety. depends upon what has been done after the cases have ceased.
In these directions it is not claimed that in every case of communicable disease there is to be so much labor and destruction. But the most perfect methods are presented as models, to be varied, if proper, under the advice of the physician, who also thus needs to be reminded of what thorough disinfection means.
SPECIAL DIRECTIONS AS TO VACCINATION FOR THE PREVENTION OF
With the present facilities for travel and the thoroughfare character of this State, there is no reasonable expectancy that any person will reach the age of twenty-one without great risk of small-pox, unless the disease is prevented by vaccination. The person who runs the risk not only endangers his own life and comfort, but imperils others to a degree not justifiable.
By the provisions of the Health Law of March 11th, 1880, all school boards are authorized to vaccinate, at public expense, any pupils attending school who are unable to procure vaccination.
All local Health Boards need to see to it that vaccination is recommended, as well as rapid isolation of cases secured, if any occur. The cost of local epidemics of small-pox is very great, besides the peril to life and public health. The prevention of the disease is within the range and duty of your control. All our local Health Boards and School Boards should co-operate in influence and provision for more general vaccination, and for revaccination of persons who have not been vaccinated since full growth. The heads of large manufacturing establishments need to attend to it, both in the interest of capital and labor.
Bear in mind and act upon the following suggestions :
I. Let every parent see to it that each child is vaccinated before one year of age, and sooner, if possible.
II. Let no teacher or child be admitted to a public school without vaccination.
III. Let provision be made by school trustees and Boards of Health for free vaccination to such as need this provision. (See Chapter 159, Section 10, Laws of 1880.)
IV. Would it not be well, just before each April vacation, to have schools close an hour earlier and thus have a vaccination day, on which all scholars could be invited to be vaccinated by their physicians, at home, or, by some public arrangement, at the school building ?
V. Do not concern yourself about the kind of vaccine or lymph used any more than you would about the source of medicine you take, but hold the physician responsible therefor. Have the sore examined and take a certificate from the vaccinator that, in his judgment, you are successfully vaccinated.
VI. Have vaccination repeated or retried after the age of sixteen. Most persons, if fully vaccinated the first time, will have but little result from the repetition, but it is advisable to have this additional assurance of safety.
VII. If small-pox or varioloid occurs in your house, do not attempt concealment. At once send for your physician and do as he advises you, or notify the Board of Health. Have every member of the family vaccinated. By some means prevent the possibility of persons coming in unawares. If you know of any person who has been exposed, send him word so that he may be vaccinated.
VIII. Where there are factories, the superintendents should advise or direct all their employes to be vaccinated.
Most of our physicians have full confidence in humanized vaccine lymph, which is easily secured. Vaccine lymph directly from the animal is preferred by those who have any fear of communication of other diseases through humanized lymph—a fear that is greatly magnified in the popular mind. It is, nevertheless, due that all have their preference, and that where vaccination is insisted upon as a condition of school attendance, bovine lymph be used, if desired. Many physicians prefer to use this. The New York City Board of Health, 301 Mott street, New York, furnishes it daily by mail. H. A. Martin & Son send it direct from their herd, Roxbury Station, Boston, Mass. Dr. E. L. Griffin, State street, Chicago, is prompt in remittal. Ready supplies can also be had from Philadelphia and other cities. The price per point is about twenty cents, and less in larger quantities. There is reason to believe that much is sold for bovine lymph which is not such, or that there is a failure in effect because of age and imperfect keeping
We urge upon all physicians great exactness in selecting lymph, and upon the people protection from the disease. Its outbreak every