canal by means of the food and drink. Reflection will show, and experience teaches, that there are many ways in which our food and drink may become contaminated with the germs. Some of the more frequent ways are these: The discharges are thrown into the privy or upon the ground, whence they soak, sometimes long distances, through the soil into the family well. The soiled clothes of the patient are washed, and the water carried by a loose and leaky drain which runs too near the well. Some kinds of food and drink are very absorptive of disease germs, and being kept too near the patient, become contaminated. Cases are known where milkmen, with fever at their own homes, have caused serious outbreaks of the disease among their customers, by keeping the milk, before it was distributed, too near the sick, by diluting it with contaminated water, or even by rinsing the cans with such water. PREVENTION. 1. Keep your premises at all times in a good sanitary condition. Filth is the nidus in which the cause, or germ of of the disease may be developed. Of all forms of filth none others are so dangerous to our homes as the "hole-inthe-ground" privy, and the sink drain. The former should never be tolerated, nor the latter, either, in its usual forms. Filth in its sanitary signification, includes not only the grosser forms but also the less tangible and more respectable kinds which are too often ignored. The impalpable but not inodorous air of unventilated bedrooms is disgusting and dangerous; the sewer-air which leaks from faulty waterclosets or defective drain pipes in the homes of the wealthy consigns many to the tomb; the emanations from rotting chips or sawdust; the exhalations from decaying vegetables in the cellar, all these may dangerously pollute the air, and should be avoided. 2. All discharges from the fever patient should be received in a vessel containing a pint or more of Solution No. 1, and kept covered by the disinfectant three or four hours, and then buried in the earth where they cannot by any possibility find their way into wells, springs, or brooks. They should never be allowed to mingle with any kind of filth, in a privy or elsewhere. The clothing, both of bed and patient, should be disinfected by dropping it into a tub containing several gallons of Solution No. 2, and should be kept therein until it can be boiled. After death or recovery disinfect the room by sulphur fumigation followed with washing the floors and other woodwork with Solution No. 1, or No. 2. 3. As far as concerns the personal hygiene of nurses and attendants, it may be said that, if the foregoing preventive measures are carefully carried out, there is hardly a possibility of their taking the disease; in fact, under such conditions, cases in which the attendants have taken the disease from the patient are almost if not quite unknown. Typhoid fever goes through families because all have been exposed to the diseaseproducing cause; or the first cases contaminate the water supply, or "seed down" the privy-vault and the house surroundings with the disease germs. Nurses and others in the family should eat nothing in the room where the patient is, nor anything which has been there. The food for the attendants and family should be prepared and kept as far from the sick as possible. Thorough boiling will kill all disease germs; so, while the fever is in the house, it is safer to boil all water and milk just before it is used. Bodies of those dead from typhoid fever should be wrapped in a cloth wet with either Solution No. 1, or Solution No. 2, and at once buried. The room in which there has been a case of typhoid fever, whether fatal or not, should, with all its contents, be thoroughly disinfected by exposure for twenty-four hours to strong fumes of burning sulphur immediately after it has ceased to be occupied by the patient, and then it should for several hours, if possible for days, be exposed to currents of fresh air. Upon the discovery of a case of typhoid fever by the attend ing physician, he should immediately notify the local board of health and should coöperate with the board to restrict the disease. Upon receiving such notice the local board of health should: 1. Give public notice of infected places, so that no person may unguardedly drink water or take food from a source likely to be contaminated or unduly expose themselves to the disease. 2. Investigate the probable source and mode of origin of the disease. If probably from a contaminated well or general water supply, see that measures are taken by stopping its use, by boiling it, or otherwise to prevent further cases being caused in the same manner. If connected with the sewer, see that the plumbing is in good order and all fixtures properly trapped. 3. Order and enforce the disinfection of all discharges from the bowels of patients sick with typhoid fever. It is safest that the discharges of all persons who have diarrhoea shall be disinfected.* 4. Disinfect the contents of the privy on the premises, or any other that has been used by the patient. † 5. Order and secure the disinfection of all articles of clothing or bedding that have been soiled by discharges from the patient. 6. Secure the coöperation of the people in the prevention of this disease, by teaching them its modes of spreading, the best methods for its prevention, and the greater importance of efforts for its prevention in times of drought and low water in wells. 7. See that the premises are properly disinfected after the death or recovery of the patient. *For this purpose use disinfectant No. 1 freely. † To keep a privy-vault disinfected during the progress of an epidemic, sprinkle chloride of lime freely over the surface of its contents daily, or use a quart of Solution No. 1 daily. + Wells are more dangerous at times of low water, because the area of drainage to the well is greatest when the water is the lowest. All clothing or bedding soiled by the patient's discharges, must be removed at once, and placed in boiling water, to be boiled for half an hour; or they may be immersed in the following solution, allowing them to remain for two hours, when they may be rung out and sent to the laundry to be thoroughly boiled: Sulphate of zinc,. Water, Solution No. 2. one pound. one half pound. four gallons. Nurses and attendants should observe perfect cleanliness, and their hands should be frequently bathed in Solution No. 2. Fumigation with Sulphur has ever been regarded as a reliable method of disinfecting a house, and should be resorted to after a case of small pox, diphtheria, scarlet fever, or typhoid fever, and in such other cases as the attending physician may think best. To do this, the house must be vacated. Heavy clothing, blankets, bedding, and other articles which cannot be treated with solution, should be opened and exposed during fumigation, as follows: Close the room as tightly as possible, place the sulphur in iron pans supported by 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 *For a free and general use in privy-vaults, sewers, sink drains, refuse heaps, stables, and wherever else the odor of the disinfectant is not objectionable, this is one of the cheapest and most effective disinfectants and germicides available for general use. Chloride of lime ought to be obtained anywhere for ten cents a pound. In some places it can be obtained for five cents a pound. This is one of the best disinfectants known. square, at least three pounds of sulphur should be used; for larger rooms, proportionally larger quantities. Heavy woolen clothing, silks, furs, stuffed bed covers, beds, and other woolen articles, which cannot be treated with disinfectants, should be hung in the room during fumigation, their surfaces thoroughly exposed, and their 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 and their contents spread out and thoroughly fumigated. Carpets are best fumigated on the floor, but they should afterward be removed to the open air and thoroughly beaten. REMARKS. The Disinfection, following every infectious or contagious disease, should be carried out under the supervision of the local board of health, or by some competent person authorized by the board. Much of the so called disinfection practiced by many families is wholly inefficient and useless. odor of burning coffee, tar, sulphur, or any other substance in the sick-room, or other part of the house or premises, in the presence of the patient, or other persons, operates only as a deodorizer, and does not destroy the germs of the disease. This is an important fact that every family should understand.* CAUSES OF TYPHOID FEVER. Typhoid fever is perhaps more than any other disease dependent upon unsanitary conditions for its prevalence. We have repeatedly shown this fact in the former reports of this Board. The testimony of the physicians in this State year after year adds home evidence to the extensively recorded causes of this disease. All the records of typhoid fever epidemics in this country and elsewhere abound with the most *The foregoing paper is issued in pamphlet form by the State Board of Health for gratuitous distribution throughout the State. A copy may be obtained by applying to the Board. |