£rc£? ^ ;^ s £ S Q 3 g££ £a3£ esgg5£ 
 
 BRARY OF CONGRESS, 
 
 Ma/>. .!>- Jk:JL 1 
 
 S/;e// ._X g_A _ & -_ 
 
 U ..UNITED STATES OF AMERICA. * 
 
RESTRICTION *nd PREVENTION 
 
 OF 
 
 \0 
 
 DIPHTHERIA. 
 
 ISSUED BY THE 
 
 / 
 
 CONNECTICUT 
 
 State Board of Health 
 
 P]ease read carefully, and Preserve for 
 future reference. 
 
 HARTFORD: 
 The Case, Lockwood & Brainard Co., Printers. 
 
 1879. 
 
 f- 
 
■■.■'■- -w^ 
 
 GENERAL RULES AGAINST INFECTION. 
 
 ©URE AIR, Pure Water, Proper Food, and 
 -L Clothing, are essential conditions of health. 
 Cleanliness, dryness, and ventilation, in and around 
 dwellings and places of public resort, are the surest 
 safeguards. 
 
 No house refuse, filth, excremental matter, or foul 
 dirt should be allowed to remain about inhabited 
 dwellings. 
 
 Filthy, foul, and damp places, saturated with sink 
 or slop water, and shaded by vegetation or otherwise, 
 near dwellings or places of public resort, should be 
 purified, cleansed, and dried, and as free access of 
 air and sunlight provided as possible. They foster, 
 nourish, and render more fatal, if they do not produce, 
 pestilential diseases. 
 
 Your own privy y cesspool, or sink drain should be 
 at least a hundred feet from the well ; the privy dis- 
 infected, so as not to render the air offensive, the 
 cesspool open at the top, so as to ventilate it into 
 the open air, and not into your kitchen by an un- 
 trapped drain pipe. Be sure that your sink drain, 
 house drains, or privy vaults do not by faulty con- 
 struction or leakage leach their contents into your 
 well, and be sure that the surface water does not run 
 directly into the well, carrying a solution of all the 
 filth upon the top of the ground. 
 
 Disinfection should be thoroughly and persistently 
 used at the appearance of a contagious disease. 
 Disinfectants destroy contagion that would otherwise 
 spread and multiply. 
 
 All sewer connections should be trapped and 
 ventilated, and all house drains well looked after. 
 
 Nurses and attendants should spend some time 
 each day in pure air, and take out-of-door exercise 
 whenever possible, but at such times as to avoid 
 contact with others. 
 
DIPHTHERIA 
 
 IS an infectious and contagious disease, though not 
 as contagious as scarlet fever or small pox, still 
 requiring great precaution. Children are more lia- 
 ble than adults, and may convey it to one another, 
 or it may be conveyed to them by adults. The time 
 of attack after exposure is usually within eight days, 
 but may be after a few hours. 
 
 The specific contagion of diphtheria, on which it 
 depends for its spread, is developed by the disease 
 during its progress, and infects a locality in propor- 
 tion to the extent to which the characteristic pro- 
 ducts of the disease are formed. The infection clings 
 to articles in the room where cases have occurred, 
 causing a reappearance of the disease, and after a 
 single case it often breaks out in many places, always 
 within a restricted area, sometimes gathering strength 
 in its passage* Hence the importance of thorough 
 disinfection. Unsanitary conditions favor its spread 
 and increase its malignancy. 
 
 It is contagious by the exhalations from the sick, 
 contaminating the air of the sick room in proportion 
 to the severity of the case, and the extent of the 
 membrane as a rule ; by direct contact with infected 
 articles, e. g., by the use of eating or drinking uten- 
 sils, towels, handkerchiefs, etc., used about the sick. 
 
4 
 
 It is conveyed by the diphtheritic membrane coming 
 into contact with any mucous surface (e. g, mouth or 
 nose), through kissing, sneezing, or coughing. The 
 poison usually enters the system through the throat 
 and upper air passages. 
 
 All persons recovering from diphtheria are to be 
 considered as dangerous ; severe and fatal cases, and 
 even epidemics, have been enkindled from cases that 
 have almost entirely recovered, and had never been 
 severe. No such person should be allowed to attend 
 school, or any public assembly. 
 
 RULES FOR PREVENTION. 
 
 First. Isolate the sick in a well ventilated 
 room, preferably the uppermost room in the house. 
 Place the bed so as to be accessible on all sides. 
 Allow no person to enter except the necessary 
 attendants. In malignant cases allow no one to 
 go from the house to school, or to any public 
 assembly. . 
 
 Second. In preparing the sick room remove all 
 unnecessary articles of furniture. Carpets, cur- 
 tains, and table covers, are especially liable to 
 retain infection. After use the room should be 
 cleansed and ventilated, and, in malignant cases, dis- 
 infected thoroughly. 
 
Third. All bed and body clothing, towels and 
 handkerchiefs used by the sick, as soon as removed, 
 should be placed in vessels containing disinfecting 
 fluids and never be washed with other household 
 articles. All plates, cups, glasses, spoons, and the 
 like, used by the sick, should be rinsed with some 
 disinfectant and washed separately. 
 
 Fourth. Nurses and attendants should wear 
 only washable garments, and use disinfected water 
 for hands, unsparingly. Physicians and clergymen 
 should be provided with disinfected water for their 
 hands on leaving the sick room. 
 
 Fifth. All scraps of linen used in receiving dis- 
 charges from the mouth or nose should be imme- 
 diately burned. All receptacles for filth should be 
 thoroughly disinfected. 
 
 Sixth. Children should not be allowed to attend 
 the funerals of those dying from diphtheria. Dis- 
 infectants should be used freely in the room and 
 about the body while it remains unburied.* The 
 coffin should never be opened at funerals to expose 
 the dead to the public. 
 
 * Burnett's Fluid (solution of chloride of zinc,) is the most efficient. In 
 malignant cases from four to six inches of sawdust saturated with a solution 
 of chloride of zinc should be placed in the bottom of the coffin, (which should 
 be water-tight,) the coffin closed at once, and not again opened. 
 
DISINFECTANTS. 
 
 The following disinfectants are recommended by 
 the Board : 
 
 FOR DISINFECTING PRIVIES, ASH-PITS, CESSPOOLS, DRAINS, 
 AND OTHER OFFENSIVE PLACES: 
 
 Fifty pounds of copperas, (sulphate of iron, green 
 vitriol) to a barrel of water. 
 
 This may be dissolved in a smaller quantity of 
 hot water, and then diluted. It may be used freely 
 and repeated as often as odors arise. It is cheap 
 and efficient. About four gallons are required to 
 disinfect an ordinary vault used by one family. A 
 smaller quantity may then be poured in occasionally. 
 
 FOR SINK PIPES AND WATER CLOSETS: 
 
 One pound of nitrate of lead to a gallon of water. 
 Use freely. May be placed in vessels used for dis- 
 charges from kidneys and bowels. 
 
 FOR ARTICLES OF CLOTHING, ETC., USED ABOUT THE 
 
 PATIENT. 
 
 Sulphate of zinc, eight ounces, crude carbolic 
 acid, one ounce, warm water, three gallons. 
 
 Throw all articles of body linen, sheets, etc., at 
 once into this solution and boil in clear water. In 
 malignant cases such articles should be boiled in 
 this solution, diluted with an equal quantity of water, 
 previous to boiling in soap and water. It can be 
 used freely in the sick room. It does not stain. A 
 towel may be wet with it and hung in the room. 
 A sheet may be hung across the entrance hall or 
 door and kept constantly wet with it. Nurses and 
 attendants will find it well to occasionally wash their 
 hands in this fluid. 
 
Bromo chloralum, diluted with eight to ten parts 
 of water, can be used in the sick-room for wetting 
 towels and sheets, as above described, and for wash- 
 ing the hands, when the odor of carbolic acid is 
 offensive, as it is odorless. 
 
 TO DISINFECT AN ORDINARY ROOM. 
 
 i st. Tightly close the room; place in an open 
 earthen dish four ounces of peroxide of manganese ; 
 pour on this one pound of strong muriatic acid. Be 
 very careful not to breathe the fumes. Leave the 
 room and close the door. This generates chlorine 
 gas. Clocks and metallic articles are supposed to 
 have been removed. 
 
 2d. Place live coals upon ashes in a metallic pan, 
 and place on the coals sulphur in fragments or 
 powder. For an ordinary room two to four ounces 
 of sulphur should be thoroughly burned. The room 
 should be tightly closed as in the other method. 
 This is rather preferable, as the sulphur is as efficient 
 and more easily managed. Considerable heat is 
 produced. 
 
 The room, after being kept closed about six hours, 
 should then be thoroughly aired for a day or two. 
 
 TO WASH FURNITURE AND FIXTURES OF AN INFECTED 
 
 ROOM. 
 
 One pint Labarraque's Solution (chlorinated soda,) 
 in five pints of water. 
 
 The foregoing is published by the State Board of Health with a 
 view to lessening the number of cases and deaths from diphtheria, 
 which has formed a rapidly increasing cause of death of late, caus- 
 ing, as reported, 589 deaths in 1877. 
 
 Any communications upon the subject, with relation to localities, 
 
 may be addressed to 
 
 STATE BOARD OF HEALTH, 
 
 Hartford, Conn. 
 

LIBRARY OF CONGRESS 
 
 022 1 
 
 69 326 7