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of others he must be strictly isolated or quarantined. By isolating or quarantining a patient is meant making such arrangements that germs expelled by the patient are necessarily destroyed before they can enter the body of another person. Isolation, therefore, includes disinfection, and while methods vary according to the nature of the particular disease, yet the principles given below are applicable in most cases.

The first essential is that the patient should have a room to himself. No one except those caring for him should enter the sick-room for any purpose whatever; visitors should be rigidly excluded. At the outset all unnecessary articles should be removed from the sick-room, and it should be possible to boil, burn, scrub, or otherwise thoroughly clean everything allowed to remain. The windows should be screened in summer, and flies must be excluded. Fresh air is especially needed by patients with communicable diseases, and ventilation of the room must be adequate both day and night. Foul odors plainly indicate that the patient or something in the room is not clean. The remedy is obvious and deodorants are quite unnecessary if the patient and the room are properly cared for. It is highly desirable to reserve a bath room for the exclusive use of the patient and his attendant and also to reserve a room adjoining the patient's room for the exclusive use of the attendant. When it is impossible, as it often is, to give up so much space, each family must make the best arrangement it can to separate the patient and his attendant from the rest of the family.

The attendant must remember that her ten fingers are the ten most active agents in distributing the communicable diseases. After handling the patient or anything that the patient has touched, and whenever she leaves the patient's room, she must scrub her hands thoroughly with warm water, soap, and a nail brush. She should not soil her hands unnecessarily, even though she intends to scrub them later. She must remember for her own protection to keep her hands away from her mouth and face, and to cleanse them with special care just before eating. If disinfection is needed in addition to the scrubbing, she must use conscientiously whatever solution the doctor orders.

At the same time that she is caring for a patient with a communicable disease, the attendant ought not to care for children or other members of the family, she ought not to prepare food, and she ought not to handle dishes or utensils used by other persons. Every day, however, many women are doing just these things, and it is true that in many instances no bad results are observed. Yet if any arrangement to insure safety can possibly be made, it is inexcusable to run the risk of spreading diseases which kill thousands of persons every year and injure many more for life.

When home conditions render adequate care and strict isolation of the patient impossible, hospital care should be seriously considered. No personal or sentimental objections should be allowed to influence the decision, if removing the patient to a hospital is necessary to safeguard his welfare or the welfare of the family. Hospital care should be considered especially for patients with typhoid fever, because untrained persons cannot safely care for patients so seriously ill. Since a patient with typhoid needs skilled care, and since he greatly endangers other persons, most authorities consider hospital care essential unless the patient can have the continuous services of a trained nurse and almost ideal home conditions. Many cases of typhoid, it is true, are successfully nursed at home in extremely adverse conditions by visiting nurses; yet in few kinds of sickness is continuous care by a graduate nurse more necessary to protect the community as well as to safeguard the patient himself.

Members of a family in which there is typhoid should be immunized if the doctor advises it. This process, which is performed by the doctor, in the majority of cases renders a person immune to typhoid fever for three or four years.

The question of home or institutional care for persons with tuberculosis must also be carefully considered. In some cases tuberculosis may be cared for at home with comparative safety, and in some other cases the risk is not very great if the patient is intelligent, careful, and well supervised. But everyone should face the fact that all cases of tuberculosis of the lungs involve some risk to others in the family, and most cases involve great risk. The danger to children is greater than to adults. Most tuberculosis infections, it is now believed, are acquired in childhood. The bad results of an infection acquired in childhood may not show themselves for years, since the germs may remain inactive until the person's resistance is lowered by some unfavorable condition.

The Children's Diseases.

—The so-called children's diseases are probably the most familiar and the least regarded of all those belonging to the communicable group. Most persons, it is true, realize that scarlet fever is serious; everyone should also realize that measles and whooping-cough are serious. For example, in the State of New York during the year 1916, more children died from each of these diseases than from scarlet fever: in that year 745, or four times the number that died of scarlet fever, lost their lives from whooping-cough, while 913 died of measles. If diseases that kill hundreds of children every year are not serious, one is at a loss to know what a serious disease is.

Some parents even expose children unnecessarily to these infections on the fatalistic theory that they must have the diseases sometime, and therefore the sooner the better. Nothing could be more mistaken; the diseases are not inevitable, and there is no advantage whatever in having them if escape is possible. Moreover, serious as the children's diseases are in themselves, their after-effects may be even more serious. At this very moment hundreds of people are going through life handicapped by weakened hearts or kidneys, by defective sight or hearing, merely because their parents considered the children's diseases necessary. The common belief that children should have these diseases as early as possible is also erroneous, since statistics show that the younger the child the more likely is the disease to prove fatal.

Every mother should realize that the children's diseases are most infectious in the early stages. Early symptoms include fever, sore throat, and nasal discharge, and the trouble at first often resembles a severe cold. During this stage the diseases are most easily communicated. Measles in particular is generally not recognized until its most infectious stage has passed. The moral to be drawn is that sore throats, coughs, and colds should never be regarded lightly, and that their spread should be prevented by all possible means.

The accompanying table taken from the regulations of the New York State Department of Health, gives symptoms of communicable diseases among children, and rules for isolation and exclusion from school.

It may be added that the ways by which poliomyelitis, or infantile paralysis, is spread are not definitely known at the time of writing. We are justified, however, in believing that investigation now in progress will make exact information available in the near future.

"The weight of present opinion inclines to the view that poliomyelitis is exclusively a human disease, and is spread by personal contact, whatever other causes may be found to contribute to its spread. In personal contact we mean to include all the usual opportunities, direct or indirect, immediate or intermediate, for the transference of body discharges from person to person, having in mind as a possibility that the infection may occur through contaminated food.

"The incubation period has not been definitely established in human beings. The information at hand indicates that it is less than two weeks, and probably in the great majority of cases between 3 and 8 days."—(Report of Special Committee on Infantile Paralysis, American Journal of Public Health, November 1916.)

DISINFECTION

Specific directions for disinfecting in every kind of communicable disease would be too extended to be given here. In each case the attendant should learn from the doctor just how that particular disease is communicated, just what discharges, utensils, linen, etc., need to be disinfected, and just what disinfectants he prefers to have used. The following general methods are now in use, but it must be remembered that from time to time new methods are devised and new disinfectants are discovered.

Care of Nose and Throat Discharges.

—The care of handkerchiefs has already been described on page 239. Cloths or cotton used to wipe the eyes or to receive any other bodily discharge including vomitus, should be collected in the same way and burned. Everyone should be taught in early childhood to cover the nose and mouth with a handkerchief during coughing and sneezing; if the patient has not already learned to do so he must be taught now. If the amount of expectoration is great, waterproof receptacles should be provided, which should be burned with their contents.

Care of Discharges from the Bowels and Bladder.

—At the present time the following preparations are commonly used to disinfect stools and urine: 5% solution of carbolic acid; chloride of lime solution, made freshly whenever needed by mixing thoroughly ½ pound of chloride of lime with one gallon of water; and unslaked lime to which is added hot water. The amount of carbolic solution used should be about equal in bulk to the amount of material to be disinfected; the chloride of lime solution should be at least twice, and the unslaked lime at least one-eighth the bulk. Fecal masses should be broken up so that the disinfectant may reach every part; they may be stirred with tightly twisted toilet paper, which should be left in the bedpan and disinfected with the stools. If these substances are used, disinfection is considered complete at the end of an hour, and the contents of the bedpan may then be emptied into the toilet with safety. It may be necessary to provide two bedpans so that one may be available for use while the contents of the other is being disinfected. Bedpans and urinals should be boiled daily and kept thoroughly clean at all times.

In places having no sewerage system, disinfected discharges may be emptied into a trench situated at a distance from the well, and then covered with earth. As an extra precaution, the disinfected discharges may be mixed with sawdust or kerosene and burned in the trench. Directions for installing a sanitary privy may be found in Bulletin 68 of the United States Public Health Service.

Bath water  

and water that has been used for cleansing the teeth and mouth may be disinfected in the same way as urine, or it may be emptied into a suitable receptacle and boiled ten minutes.

Care of the Hands.

—Disinfectants for the hands should be used in addition to scrubbing with soap and water, not as a substitute. The hands may be disinfected after scrubbing by soaking them for three minutes in one of the following solutions: alcohol 70%, carbolic acid solution 2½%, or a solution made by adding one teaspoonful of lysol or of creolin to a pint of water. These disinfectants are poisons if taken internally; the bottles must be carefully labeled and kept in a safe place. It is a good plan to wear rubber gloves when handling infective material; the gloves should afterward be boiled for ten minutes.

Care of Utensils.

—A sufficient number of dishes, spoons, tumblers, basins, etc. must be reserved for the patient's exclusive use; these utensils must be washed separately and dried

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