1.12.2016

The New Household Discovery Series: Vintage Recipes and Processes for the Home - INFECTION AND DISINFECTION

INFECTION  AND   DISINFECTION
Late 1800's and early 1900's.

This is a continuing series and contains excerpts from this publication on infection and disinfection of the times.

Before the germ theory of disease became fully established, a distinction was made between what were called "infectious" as opposed to "contagious" diseases. These words are now used interchangeably.

It was formerly supposed that "infectious" diseases could be "caught" by merely breathing the air in the vicinity of the patient. A superstition to this effect still lingers in some localities. Many persons, otherwise well informed, attempt to hold their breath while passing pest houses or dwellings where patients with virulent communicable diseases are quarantined. This notion that the germs of disease are usually communicated through the air has been completely exploded. On the other hand it was formerly supposed that "contagious" in the sense opposed to "infectious" diseases, could be communicated only by actual contact of the diseased part with the body of another person. Some diseases were thought to be both contagious and infectious. Many cases of the transmission of disease were observed, however, which could not be explained upon either of these theories. Hence there was formerly a good deal of doubt, even among medical men, as to the exact way in which certain diseases were communicated.

This confusion of thought is now to a large extent cleared away. The contact infection theory may be said to be fully established. According to this theory the living bacteria, or germs, which cause contagious diseases are most commonly transmitted from a diseased to a well person within a comparatively short space of time, and through the medium of "some solid object or liquid, rather than through the air.  Two kinds, or types, of infection are loosely distinguished — direct and secondary. Direct infection is, in general, that which gives rise to new cases in families or on premises that have been previously free from disease. Indirect, or secondary, infection is that whereby a disease is communicated from a patient to his nurse or other attendant, or to other members of the same household. Direct infection is thought to occur chiefly through the contamination of the sources of water or milk supply, or by chance contact with persons ih the early stages of a communicable disease, or those suffering from mild cases, or from healthy "carriers." Especial attention has also been directed of late to the part played by insects, especially the house fly, as carriers of disease. The bedbug, the body louse, the various species of fleas, mosquito and ticks have also been found to communicate the germs of disease from certain animals to man and from one person to another.

Direct infection may, and often does, occur from unavoidable accident. But secondary infection is invariably the result of ignorance or carelessness. The most usual vehicles of secondary infection are thought to be the bed covers or clothing of the patient; his handkerchief; his discharges; remnants of food and drink left by him on the tray, or the dishes or other utensils by means of which he is served; and the person or clothing of the nurse or other bedside visitors. The cardinal principle of preventive medicine is that secondary infection must and shall not occur.

According to the contact infection theory all the germs of disease by which healthy persons are infected had quite recent origin in the body of some diseased person. They left the patient through some of his discharges, as his sputum or excreta, possibly through perspiration, or in the case of smallpox, chickenpox, or scarlet fever, through the scabs or scaling of the outer surface of the body. Thence they were transmitted to the neighborhood of the infected person, through some fairly direct route, by the agency of solid bodies or liquids, and under conditions reasonably favorable to germ life. They then found their entrance into his body through some of its main orifices, usually by being breathed in or swallowed. When these essential principles are well understood and sufficiently considered, they will usually enable the responsible head of a family to trace a case of infection to its source. Steps may then be taken to avoid further infection and prevent the spread of the disease.

The open vault, sink drain, or accumulation of garbage or other filth, so located as to contaminate the soil or the sources of the water supply, and the flies or other insects which feed in and about them, may be compared to an unloaded gun. Their deadly possibilities are latent until they become infested (loaded) with the living germs of typhoid or other communicable diseases. Such germs are not the product of putrefaction. They do not develop spontaneously in fecal or decayed matter such as night-soil, garbage, and kitchen slops. Nor do disease germs multiply in such locations. Indeed, the bacteria which cause human diseases will ordinarily die out within a comparatively short time when deliberately added to such substances for the purpose of scientific investigation. When a case of typhoid or other contagious disease occurs, through the pollution of the soil or water supply, or through the medium of flies, by contagion from an open vault or drain or similar nuisance, the real source is often overlooked and disregarded, because these nuisances have existed before the patient was taken sick and no one had previously been made ill by them. The explanation of science is that only at rare intervals and as a consequence of direct infection from some diseased person, do these nuisances become active sources of contagion and deadly menaces to the public health. The danger is that this may happen unknown to the responsible head of the family. The result may be an epidemic in which many lives are needlessly sacrificed.


A good illustration may be found in a case reported by a milk inspector of a western city. An outbreak of typhoid was traced to the milk supply from a certain farm dairy. On investigation it was found that two of the dairyman's children were convalescing from that disease. The family water supply used for drinking purposes and also for cleansing milk pails and other receptacles was a dug well in the farmer's yard. It was located not far from an outhouse of the open vault type. The milk inspector suggested that the well water might be contaminated from this source. The dairyman responded that this could not be the case because the water v/as clear, cold and tasteless. A few days later this farmer called up the milk inspector on the telephone and inquired if the germs of typhoid fever would make water pink. The inspector responded, No! but that if the well water was pink, it might be due to a quantity of red dye which he had poured into the vault of the outhouse. Later, the dairyman himself succumbed to typhoid fever. The milk supply from this dairy having been shut off, further spread of the disease among its patrons was prevented.


A practical suggestion may be drawn from this incident for cases where it is suspected that the source of drinking water may be contaminated from open vaults, drains or similar sources. A bushel or more of coarse salt may be deposited in the vault or drain and care taken to observe whether or not the water, especially after the next heavy rain, tastes in the least salty.

But, as the amount of salt that might be transmitted in solution through the soil may not be enough to be detected when diluted by the contents of a deep well, it is safer and better in all such cases to have a bacteriological test of the water made at the State laboratory. The commissioner of health in most States will forward on request a suitable bottle properly packed for mailing, with full directions how to select and forward the necessary sample. In some States such tests will be made free. But in any case the cost will hardly exceed that of a doctor's visit. The result may be the saving of one or many lives.

The bacteria which cause germ diseases are parasites, that is, they do not normally occur in nature outside the bodies of men or other animals. These they regard as their natural home. Hence they can thrive and multiply only under very similar conditions of warmth, moisture, absence of direct sunlight and presence of a supply of food suitable to their necessities. They are so exceedingly small as to be totally invisible to the naked eye, and are without color, taste or odor. Hence the presence in an ordinary well of bacteria sufficient to kill all the inhabitants of a great city could not be detected without the use of a microscope except through their fatal consequences.

It was formerly supposed that the introduction into the human body of one or more germs of any contagious ailment was certain to result in the contraction of a typical case of the disease. The use of the microscope has proved that this is by no means the case. The germs of pneumonia, diphtheria, tuberculosis and others are often found in the throat and lungs of perfectly healthy persons. The germs of various diseases may be swallowed without injurious results. The likelihood of contagion depends in part upon the number of the bacteria that may gain lodgment in the system, in part upon their vitality, and in part upon the state of health of the afflicted person. Most germs tend to breed and multiply in colonies. They do not live long outside of the human body, or other living host, except under favorable conditions, and the body when in perfect health has considerable power to resist their invasion.

The vitality of different species, or of the same species under different conditions, varies considerably. The germ which causes consumption, the tubercle bacillus, is among the most resistant. The germs expectorated by the consumptive may be found in a state of full vitality, in the dry sputum of the patient, floating in the air as dust. With this exception, however, it is believed that exposure to dry heat and esi^ecially to direct sunlight kills most disease germs or greatly weakens them. The effect of cold is merely to suspend their activities. Freezing for an indefinite time does not injure most germs. But all are destroyed by exposure to heat at or near the temperature of boiling water, or by contact with various substances known as germicides or disinfectants. The most virulent bacteria will die of themselves within a comparatively short time after they are thrown off from the body of a diseased person, unless by chance they find congenial lodgment in warm, dark places such as open vaults or drains or in another human body.

The germs of diphtheria, typhoid and some other diseases will multiply quite rapidly in fresh milk, altlough they are commonly destroyed by the lactic acid which forms in milk in the process of souring. They will, however, live for some time in cheese and butter. Hence contamination of the milk supply is one of the most frequent sources of infection. Bacteria do not appear to multiply in ordinary drinking water. On the contrary, it is believed that the germs of typhoid will die out of wells and cisterns in about a week or ten days if there is no further contamination in that interval. The contamination of water supplies is, however, among the most frequent causes of fatal epidemics of typhoid and some other diseases. The pollution is usually continuous and often increases in amount and virulence until attention is drawn to it by an outbreak of disease.

The discharges of patients suffering from typhoid and similar diseases contain myriads of the living bacteria. When these find their way by seepage, or surface drainage from open vats to streams, springs, wells and cisterns, or through the outflows of sewage being in too close proximity to the intake of water supplies, the number of germs swallowed is almost sure to bring on the disease in its most virulent form.

Other common sources of infection are vegetables, contaminated by polluted soil, pet cats and other animals, and, in short, anything which may serve as a vehicle to transport the living germs in a fairly direct route from one human body to another.

While a person in perfect health may come in contact with the germs of disease with impunity, especially if they are few in number, and if their vitality has been impaired by exposure to drying heat or otherwise, yet every precaution that science can suggest should he taken to avoid such contagion. Persons in the best of health may become susceptible to the attacks of bacteria by the lowering of tone due to over-fatigue, to a sudden cold, or similar causes. Or the disease may be taken in such mild form that its true character may not be recognized. Such an attack may cause the patient little inconvenience, but may result, in the absence of proper precautions, in the spread of the disease to others in its most virulent form. Indeed, such cases, and those called healthy "carriers" are known to be among the most common agencies in the spread of epidemics.

Healthy "carriers" of disease, in medical parlance, are patients who have recovered and become immune to the bacteria of a germ disease, but who are still breeding such germs in large numbers in their bodies. Ordinarily, the germs of disease disappear at or near the time of the patient's recovery, but in exceptional cases persons have been known to be "carriers" for many months or even years. Such persons are especially dangerous, because the liability of infection from them is not usually suspected. Yet, in the absence of absolute cleanliness and proper precautionary measures, they may be the means of infecting others, or contaminating sources of water supply. A typical case is that known to medical men as "Typhoid Mary." This woman is known to have infected about twenty-four persons in six different families where she was employed as a cook. Another recorded instance is that of a dairyman, a carrier of typhoid, who caused no fewer than three epidemics in a western city through the contamination of the water supply which was used by him for cleansing milk cans and other receptacles.

Prevention, of Contact Infection.— There are two distinct lines of action which must be adopted to insure against infection. The first consists in preventing all possibility of the contamination of the soil, pollution of water supply, or transmission of the germs of disease by flies and other insects. This may be done by abolishing all open vaults and drains and by the sanitary disposition of all slops, garbage, dead animals and other household or farm refuse. Statistics show that such steps, if properly taken, will reduce the likelihood of infection about one-half. Thus, in the city of Springfield, 111., the death rate from typhoid continued to increase even after the introduction of an efficient water supply and sanitary sewerage. An investigation by the Board of Health disclosed that only about one-third of the property owners were availing themselves of these improvements. Two-thirds of the families were still dependent upon cesspools and open vaults. When these were abolished by city ordinance, the death rate from typhoid was reduced about one-half. A similar result was observed in the city of Providence after all cesspools and open vaults were abolished by municipal ordinance.

The other line of defense consists in the observance of absolute sanitary cleanliness and the proper use of disinfectants, especially in times of epidemic or when there are cases of contagious illness in the family or neighborhood. It has been proved beyond question that, if proper precautions are taken to avoid infection from milk or water supplies, insects and similar causes, and if sanitary precautions are observed, a patient with any contagious disease may be nursed in his own home without infecting other members of the family. In certain high-class French hospitals, patients suffering from all sorts of contagious diseases, such as diphtheria, smallpox, typhoid fever, scarlet fever and others, are treated in the same open wards and waited upon by the same physicians, nurses and attendants. The only separation of one patient from another is by means of low screens or partitions made of cotton cloth. Even these are sometimes omitted and the space allotted to each patient is defined merely by a line of tape or by marks chalked or painted upon the floor. The object of these is simply to call the nurse's attention to the necessity of observing sanitary precautions before crossing the territory of one patient into that of another.

No object which has touched the person of a patient or been contaminated by any of his discharges is permitted to touch the person of any other patient. The nurse and the attending physicians wash their hands in a disinfectant solution each time they touch or handle the patient or anything which has come into contact with him, before approaching the bedside of another sufferer. Under this plan, which is known as the French cubicle system, instances in which a patient suffering from one contagious disease has become infected with another are extremely rare, while all are being treated in the same room and are breathing the same air.

DISINFECTION

The purpose of disinfection is to kill the germs of contagious diseases after they leave the body of the patient and before they find another victim. This may be done by means of heat by boiling, baking or burning the infected material, or by means of various chemical poisons known as disinfectants or germicides. These are usually applied in liquid or gaseous form. Germs can be killed by heat or disinfectants only under the following conditions: The heat must be sufficiently intense or the disinfectant sufficiently strong; the germs must be thoroughly exposed to the heat or disinfectant; and for a sufficient length of time.

Disinfection by heat may be by fire, boiling water or live steam. No special apparatus is needed if fire or boiling water is used. The infected articles are simply burned or boiled. Articles to be disinfected by boiling should be weighted, if necessary, and kept under the water while actually boiling for not less than half an hour. The addition of common washing soda to the water, at the rate of one moderate tablespoonful to each gallon of water, increases its efficiency.

Steam disinfection, on a small scale, may be accomplished by means of an ordinary wash boiler containing a wooden rack resting upon bricks, or otherwise suspended above the level of the boiling water. Pack the articles to be disinfected closely upon this rack, put the cover on tight and boil briskly at least an hour. Be sure to use enough water so that the boiler will not go dry. Many kinds of clothing and other objects which would be injured by boiling can be safely disinfected in this manner.

All stains should be removed before disinfection by steam or boiling water, as heat tends to fix them.

Disinfection in General. —Most of the so-called disinfection practiced in families is inefficient and useless. The burning of coffee, tar, or other substances in the sick room or elsewhere in the presence of the patient or others, operates at most only as a deodorizer. Such fumes do not destroy the germs of disease. Open vessels containing chloride of lime, carbolic acid or other disagreeable-smelling substances have no value for disinfecting purposes, unless the infected material is actually immersed in them. If bad odors exist, remove the source and admit an abundance of fresh air. Never use disinfectants not vouched for by reliable authorities. Disinfectants, germ killers, and the like, sold like patent medicines are most often expensive and worthless. They should never be relied upon. The following solutions are for use during illness and for general family use as directed.

Allow nothing to go from the sick room in case of communicable diseases without having been disinfected with one of these solutions. It should be an unceasing duty of the nurse or other attendants to see that disinfection as here indicated is carried out to the minutest particular.

STANDARD DISINFECTANT SOLUTIONS

Substances recommended as reli' able disinfectants for general external use in contagious diseases are (1) chloride of lime; (2) quick lime; milk of lime; (3) bichloride of mercury (corrosive sublimate), either with or without the addition of muriate of ammonia, or permanganate of potash; (4) carbolic acid, and (5) solution of formaldehyde (formalin). Such substances as Lysol, Kreolin, Tri-Kresol and other much advertised patented preparations are no better than the above and are too expensive for general external use in sufficient quantities. The following standard disinfectant solutions are those endorsed and recommended by public health authorities throughout the United States. They are the cheapest, best known and most reliable disinfectants. No others need be employed for general external use. Most of these solutions are highly poisonous. None are suitable for washing out the mouth, gargling the throat, or other internal use.

No. 1. Standard Solution of Chloride of Lime (chlorinated lime).— This is one of the most effective and highly recommended disinfectants. It is used in the form of an aqueous solution, i. e., dissolved in water, in strength varying from 3 per cent (weak) to 10 per cent (strong) solution. For a 10 per cent solution add 1 pound of good chloride of lime to 1 gallon of water and mix thoroughly. For a 5 per cent solution use ^ pound to the gallon of water, and for a 3 per cent solution use 1 pound to 3 gallons or 5^ ounces to the gallon. Authorities variously recommend from 5i to 61 ounces chloride of lime to the gallon of water, or a solution of slightly more than 3 per cent, as a standard solution for free general use. Chloride of lime is not fully soluble in water. A clear solution may be obtained by filtration or decantation, but the insoluble sediment does no harm and this is an unnecessary refinement. The solution should stand at least ten minutes before using.

The chloride of lime must be of the best quality. It should contain at least 25 per cent of available chlorine. Poor chloride of lime is useless. Prepare only as needed and keep, preferably, in a stone jug with a tight-fitting stopper. Do not depend upon this solution unless freshly prepared from chloride of lime of good quality. This substance ought to be obtained anywhere for about 10 cents a pound retail or about 3J cents wholesale, making the cost of a 3 per cent solution only about 1 to 3 cents a gallon. Hence, in addition to being among the most effective disinfectants and germicides available for general use, it is also one of the cheapest.

Directions for Use.—Use one quart of the half-strength (5 per cent) solution for each discharge from a patient suffering from any contagious or infectious disease. Mix well and leave in the vessel for an hour or more before throwing into privy vault or water closet. The same for vomited matter. For a very copious discharge, especially in cholera, use a larger quantity; and for solid or semisolid matter, use the full strength (10 per cent) solution. Receive discharges from the mouth or throat in a cup half full of the half-strength (5 per cent) solution, and those from the nostrils upon soft cotton or linen rags. Burn these immediately.

As the fecal discharges of the sick are the chief vehicles of communication in many contagious diseases, their disinfection should be thoroughly performed. Especially should care be taken as to their disposal, so that no portion of them can gain access, either directly or indirectly, by surface drainage, percolation, filtration, or otherwise, to any water-supply.

Use a quart or more of the solution full-strength (10 per cent) each day in an offensive vault, and such quantities as may be necessary in other places. Use it in a sprinkler in stables, and elsewhere. In the sick room place it in vessels, cuspidors, etc. Immerse sheets and other clothing used by the patient in a pail or tub of this solution, diluted one gallon of the full-strength (10 per cent) solution to ten of water, for two hours, or until ready for the wash room or laundry. This solution is non-poisonous and does not injure white clothing. It should be used, however, only for white, cotton or linen fabrics. It bleaches colored goods and injures wool, silk and other animal fibers. Body and bed linen thus treated should afterwards be thoroughly cleansed by boiling for a half hour in soap and water and by two or more rinsings.

It may also be used in one-third strength (3 per cent) solution for washing the hands or parts of the body which may have been exposed to infection from excreta, etc.

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 perhaps tlie cheapest and most effective disinfectant and germicide available for general use. It should be used so freely as to wet everything required to be disinfected. Its odor does not disinfect. It only covers up other odors.

Chloride of lime in dry form may also be applied in large quantities to vaults and cess-pools. Dilute it for this purpose with 9 parts of plaster of Paris or the same proportion of clean dry sand to admit of more convenient application.

No. 2. Standard Solution Milk of Lime (quick lime).—Slake a quart of freshly-burnt lime (in small pieces) with J of a quart of water—or to be exact, 60 parts of water (by weight) with 100 of lime. A dry product of slaked lime (hydrate of lime) results.

Make from this, milk of lime, immediately before it is to be used, by mixing 1 part of this dry hydrate of lime with 8 parts (by weight) of water. The dry hydrate may be preserved for some time if enclosed in a covered fruit jar or other air-tight container. Or, prepare milk of lime by slaking freshly burnt quick lime in about four times its volume of water, i. e., about 1 pound of fresh unslaked lime to 1 gallon of water. Milk of lime must be used within a day or two after preparation or its value as a disinfectant is lost. It should be kept in some air-tight container, preferably an earthenware jug and closely stoppered.

Air-slaked lime has no value as a disinfectant and should not be used for this purpose.

Quick lime is one of the cheapest of disinfectants, and may take the place of chloride of lime if desired. Use freely in a quantity equal in amount to the material to be disinfected. Use also to whitewash ex-l^osed surfaces, to disinfect excreta in the sick room, or on the surface of the ground, in sinks, vaults, drains, stagnant pools and the like.

No. 3. Standard Solution of Bichloride of Mercury (corrosive sublimate). —The most convenient way to prepare this solution is by the use of bichloride of mercury tablets which can be obtained at any drug store. The directions for using these tablets are given on the package. But if large quantities of bichloride solutions are to be used, it will be found cheaper to have a strong solution prepared by a druggist and tlien add at home, under his direction, sufficient water to reduce it to the required strength. Two tablets dissolved in 1 pint of water, or sixteen tablets (3 drams) corrosive sublimate to the gallon, makes a solution of 1 to 500. This may be improved by adding 2 ounces of common salt to the gallon of water.

Or, dissolve corrosive sublimate and muriate of ammonia in water in the proportion of 2 drams, 190 grains or i ounce of each to the gallon.

Or, dissolve corrosive sublimate and permanganate of potash, 2 drams each to 1 gallon of water.

Or, dissolve corrosive sublimate, permanganate of potash and muriate of ammonia in pure soft water in the proportion of 2 drams each to the gallon.

All the above substances may be obtained at any first-class drug store. The simple solution of bichloride in water first mentioned is a good disinfectant and may be preferred whenever it is necessary to practice economy. But, if the additional cost of such substances as muriate of ammonia (sal ammoniac) and permanganate of potash can be afforded, the solution will be more efficient and will keep better. If permanganate of potash is not used, it is a good plan to add a little blue vitriol or common bluing to color the solution. This lessens the danger of its being swallowed by accident.

Cautions. —All the above solutions or others containing bichloride of mercury (corrosive sublimate) will corrode metals and even tarnish gold. In so doing their disinfecting power is lost. Hence, these solutions must be mixed in a wooden tub, barrel or pail, or an earthen crock. They must be kept in a glass or earthenware receptacle—as a glass fruit jar or earthenware jug—tightly stoppered to prevent evaporation, and labeled "Poison". They should never be poured into metal drains without thorough and repeated flushing. Otherwise they will injure plumbing. Nor should they be permitted to come into contact with the metal fixtures of the bath room. The better plan is to bury them, after using, at least one foot deep in the ground. Rings must be removed from the hands before they are immersed in the bichloride solutions.

Use any of the above solutions full strength (1:500) to disinfect excreta in the same manner and quantity as the Chloride of Lime Solution.

No. 1, They are equally as effective but slower in action. Hence it is necessary to let the mixture, disinfectant and infected matter, stand at least four hours. It is best to empty the mixture into a wooden pail and leave it for twenty-four hours. It may then be thrown into a vault or buried. The chief advantage of these solutions over No. 1 is that they possess no odor. Hence they may be preferred for use in vessels, cuspidors and the like, if Solution No. 1 is objectionable on account of its smell. They are not as good disinfectants for vaults, sink drains, sewers and the like as the chloride of lime solution, nor are they trustworthy as a disinfectant of fresh sputum.

Also use any of these solutions one-half strength, that is, diluted with an equal quantity of water (1 :1,000), for the disinfection of soiled underclothing, bed linen and other fabrics. Mix the solution well by stirring and immerse the articles for two hours. Then wring them out and boil at least half an hour. Bichloride solutions tend to fix stains. Hence remove stains by appropriate process before disinfection.

Also use one-half strength (1 : 1,000) i-of any of these solutions for washing all hard surfaces not metallic, as walls, floors, furniture and the like, and for moistening cloths with which to wipe off dust from the woodwork and furniture. For washing metallic surfaces use disinfectant No. 5, 2 per cent solution of formaldehyde.

Also use this solution one-half strength (1 :1,000) for washing the hands and general body surfaces of the attendants and convalescents— the latter, however, only by direction of the physician.

Bichloride of mercury, either in solid form or in mixtures is a violent corrosive poison. One ounce of any of the above solutions, full strength, contains nearly a grain of corrosive sublimate and will quickly cause death by poison if swallowed. Hence all these solutions must be labeled "Poison" and kept out of reach of children. Their use should always be under the direction of some intelligent person.

Antidote. — If by accident one of these solutions is swallowed, send for a physician at once. Do not wait, however, until he arrives. Give the proper antidote quickly. Give freely white of egg mixed with water, or if this is not at hand, give wheat flour mixed with water, or give milk. Try to provoke vomiting so as to empty the stomach. For this purpose give mustard and water, or salt and water, or tickle the back of the throat.


Money, jewelry, letters, valuable papers and similar articles may be disinfected by spraying with a 40 per cent solution of formalin, full strength, by means of a hand atomizer. Place them in a small wooden or pasteboard box with a tight-fitting cover, seal and keep in a warm room for twelve hours. Burn all books, magazines, newspapers and other articles the value of which is not great enough to warrant disinfection.

Bedding-. —Throw straw beds out of the window, empty out and burn the straw, and disinfect the tick as for cotton clothing. Disinfect feather beds, pillows, quilts, comforters and blankets in a steam disinfector when practical, or if not soiled, with formaldehyde in large quantities. If mattresses have been soiled by the patient's discharges and steaming disinfection is not practical, burn them.

Rugs and Carpets. —These should be removed from the sick room before the patient is installed, but if they remain and become infected, disinfect with steam or by soaking in corrosive sublimate or formaldehyde solutions. If their value is slight burn them.

Lounges, Couches and Other TIp-holstered Furniture.—Leave in place when the room is fumigated. Strip off and disinfect the covering as for cotton and linen clothing. Burn the filling and replace with new.

The hands of nurses and others who have attended to the wants of the sick should be disinfected with thorough and prolonged washing and scrubbing with hot soap and water, and then immersed for several minutes in a carbolic, bichloride or formaldehyde solution.

Sputum.—Receive on pieces of paper or rag or in paper sputum cups and burn. Or receive in cuspidors containing carbolic or formaldehyde solutions.

Disinfection of the Dead. —Bodies of persons dying of smallpox, scarlet fever, diphtheria, membranous croup or measles, should be wrapped in several thicknesses of cloth wrung out of full strength corrosive sublimate, carbolic or formaldehyde solution and should not thereafter be exposed to view. The funeral should be private and no persons except the undertaker and his assistant, the clergyman and the immediate family of the deceased should attend. Carriages used by persons attending the funeral ceremony should be fumigated. No person should enter the sick room until it has been thoroughly disinfected.

Rules for the Sick Room. —Sunlight kills disease germs and should be admitted freely to the sick room Hnless the patient is suffering from some condition which renders darkness necessary.

Proper ventilation diminishes the number of disease germs in the sick room by carrying some such germs into the open air. The number of germs likely to pass from an ordinarily well-kept sick room into the open air by means of ventilation is so small that such germs cannot be regarded as dangerous to people on the outside. Moreover, such organisms speedily die because they are not adapted to live in the open air. The ventilation of a sick room should not, however, be such as to permit air to pass from the sick room into the rest of the house.

Have all utensils and materials necessary for disinfection placed where they can be used with the least possible trouble. Failure to disinfect is often due to the fact that proper facilities for disinfecting are not conveniently at hand.

See that every bottle and box containing a disinfectant is properly labeled and see that all such bottles and boxes are kept apart from bottles and boxes containing medicines for internal use. Accidental poisoning may be thus avoided.