Chapter XV: Introduction (6)

From the earliest ages the grains or cereals have formed a portion of man’s diet. Wheat has always been the most esteemed, and some varieties of it may be grown in every climate except the very hottest and coldest. Barley, rye and oats may be grown much farther north, but are less digestible. Oatmeal cannot be made into bread, rye bread is rapidly being displaced by wheat, and barley has almost entirely fallen into disuse, except for the purposes of the brewer and distiller. In the tropics rice is the chief cereal. It consists almost entirely of starch, and is thus unfit for bread making. Our own corn, which we inherit from the Indians and have immensely improved, is of all the cereals the nearest approach to a perfect food.

Among roots the potato holds the most prominent place. Potatoes are wholesome only when the starch granules, which compose them, are healthy, as shown by their swelling out during boiling, bursting their covering, and converting themselves into a floury mass, easily broken up. They contain from twenty to twenty-five per cent of nutriment, but this is almost entirely starch, and as a food in combination with meat, cheese or other vegetables, they are not equal to rice. Parsnips, beets and carrots are wholesome and nutritious, and should be used much more than they are. Turnips are not so valuable. Cabbages and their kindred have but little food value, although the salts they contain are excellent in the preservation of health. As regards green vegetables in general the importance of having them fresh is not sufficiently realized. When they have been cut some days changes occur just as truly as in animal food, and the freshness should be carefully watched, except with those specially adapted for storing.

Salads are useful in maintaining the health, although many of them are very indigestible, those of radishes, celery and cucumbers among the list. Fruits are prized chiefly for their taste. Grapes alone, among fresh fruits, contain any large proportion of food stuff. As an aid to digestion, however, they all are properly highly prized. Fruits should be fully ripe, but without any trace of decomposition.

Stimulants and condiments of high seasoning have little food value of their own, but they have value as aids to digestion when used moderately, and in making simpler foods more palatable. Alcoholic liquors, whether mild or strong, hardly need to be considered here. It is to be gravely doubted if such beverages are ever necessary or of value in the diet, and in this place we are not considering them from any other point of view.

It is equally difficult to speak positively and generally in reference to tea and coffee. It is safe to say, however, that many people drink these tempting beverages to excess, with harm resulting to themselves from it. Tea and coffee alike act as exciters of the nerve centers, accelerating and strengthening the heart’s action and respiration, causing wakefulness, and increasing the secretion of the kidneys and skin. Tea and coffee are far superior to alcohol in enabling man to resist the depressing influence of fatigue and exposure to cold, and are admirably adapted to the needs of soldiers on the march or men on outdoor night duty. Cocoa, chocolate and their preparations contain some active elements similar to those of tea and coffee, but the proportion of nutritive material is so much greater that they are to be looked on rather as food than drink.

The considerable use of ice and iced drinks is to be avoided. Small quantities are of service in relieving thirst and vomiting, and in cooling the body when exposed to great heat. But since ice causes the mucous membrane of the stomach to become temporarily pale and bloodless, it checks or altogether suspends the flow of the gastric juice. Thus iced drinks at meals interfere seriously with digestion. Observe also that there is no truth in the popular notion that frozen water or ice is always pure. Water is not purified by freezing, and may be even more polluted than it was before.

CLOTHING AND ITS RELATION TO HEALTH

Having considered thus briefly the matter of food and its relation to health, the question of clothing and personal hygiene now rises for attention. Besides serving for covering and adornment and guarding the body from injury, the use of clothing is to help in preserving the proper animal heat in spite of external changes. In health the normal temperature of the body, ninety-eight to ninety-nine degrees Fahrenheit, is invariable. In order that this temperature shall be maintained with the least strain on the vitality, the clothing should be such that heat is not readily conducted to or from the body.

Cotton and linen keep off the direct rays of the sun and favor the loss of heat from the body, but being bad absorbers of moisture they are apt to interfere with evaporation from the skin, and cause dangerous chills. Linen and cotton are good conductors of heat, especially the former, and do not readily absorb moisture. Silk and wool are bad conductors. Wool has also a remarkable power of so completely absorbing moisture that it feels dry when cotton or linen would be wet and cold. Its value as a non-conductor, retaining internal heat and excluding external heat, is shown by the fact that we wrap ice in blankets to keep it from melting, and cover teapots with woolen “cosies” to keep them from getting cold. These qualities together render it the most perfect material for clothing under all conceivable circumstances.

The young and the old, the rheumatic, all persons liable to colds or weak in lungs, or who have suffered from kidney diseases, those who are exposed to great heat or cold or are engaged in laborious exercises, ought to wear woolen next to the skin and, indeed, everyone would be better for doing so. Rheumatic persons and those liable to cold feet will find it a great luxury to sleep in blankets in winter instead of sheets, and young children who are apt to get uncovered at night should wear flannel night-gowns next the skin in the winter and over cotton ones in the summer.

The color of clothing is a matter of little importance in the shade, but in the sun the best reflectors are coolest, such as white and light grays, while blue and black are the worst, absorbing the most heat. Dark colors also absorb odors more than light colors do. Indeed, for every-day use light-colored garments of whatever material, provided it can be washed, are to be recommended, though dark colors are too often preferred because they do not show the dirt. What woman would like to wear a cotton waist and skirt six months without washing? Yet it would not be half so dirty as the more absorbent dark woolen dress that she would wear as long without a scruple.

Beds and bedding are likewise elements of importance in the general health, although not always sufficiently considered. Soft, and especially feather, beds are weakening. The harder a bed, consistent with comfort, the better. Good hair mattresses are the most wholesome. Coverings should be light, porous enough to carry off the evaporations from the body, and yet bad conductors of heat. Most blankets are too heavy, and thick cotton counterpanes are heavy without being warm. Flannel night-dresses are much preferred to cotton at all times, both for comfort and for health. Warmer in winter, they obviate the chill of the cold sheets; while in summer they prevent the more dangerous chill when in the early morning hours the external temperature falls, when the production of internal heat in the body is at its lowest ebb and the skin perhaps bathed in perspiration—a chill which otherwise can be avoided only by an unnecessary amount of bed clothes.

THE BATH AND ITS IMPORTANCE

The dirt of the skin and underclothing consists of the sweat and greasy matters exuded from the pores, together with the cast-off surface of the skin itself, which is continually scaling away. The importance of frequent bathing will be better appreciated when we remember what are the functions of the skin, and the amount of solid and fluid matter excreted thereby. The quantity varies greatly according to the temperature and moisture of the air, the work done, and the fluids drunk, but is probably never less than five pounds or half a gallon daily, and with hard labor and a high temperature this amount may be multiplied many times. From one to two per cent of this consists of fatty salts, without taking into account the skin scales.

A good cistern, spring or well of wholesome water is a positive necessity on every farm. A bath-tub and its frequent use are quite as essential to the welfare of the farmer.

In the cities, where soot and dense coal smoke soil linen and mulch the lungs and air passages, there is necessarily a greater regard for cleanliness on the part of the inhabitants than may be observed in the country, where the agencies which oppose cleanliness are of an entirely different composition and productive of different results.

The farmer during the summer season is lightly clad—a straw or hickory hat, a strong shirt, a pair of overalls, socks and heavy shoes constituting his bodily protection. The absence of underwear—sometimes socks—is excused upon the ground that the lighter the harness the less energy is diverted from the performance of work.

Clothed as he is, the farmer when working in the fields or engaged in any farm work, soon not only gets his clothing soiled, but the pores of his skin fill with particles of dust and this retards their normal and vitally necessary functions. No vocation in life makes frequent bathing unnecessary. Farmers and miners, perhaps more than any other class of laborers, who are continually in contact with the earth, need the elevating influence, physical and spiritual, of a daily bath.

From a moral and hygienic standpoint the matter of cleanliness, which is next to godliness, is of great importance, and it is fine evidence of intellectual progress and spiritual growth when men use more water and soap at the end of the day’s work.

For purposes of cleanliness a bath without soap and friction is perfectly useless, and warm water is more effectual than cold. The shock of a cold plunge or sponge bath, however, has a powerful invigorating influence on the nervous system, and helps it guard against the risks of catching cold. The purpose of health and cleanliness alike will be best served by the daily bath with cold water and once a week with warm.

Speaking of cold baths, we may take note of a popular error as to what this means. The temperature of the body is always a little under one hundred degrees F. If, then, in summer, a bath at sixty degrees F., or forty degrees below that of the body, is considered cold and gives the desired amount of shock, it will do the same in winter, and to insist on plunging into water still colder than that is, to say the least unreasonable. The cold bath, then, is one at forty degrees below the temperature of the blood, and is the same in January as in July. To bathe in water from which the ice is broken, as some do, is a result of misunderstanding or folly, and may be followed by dangerous consequences.

It is dangerous to bathe after a full meal, and also when fasting. An hour or two after breakfast is a good time, but if one wishes to bathe earlier, a bit of food should be taken first. Again it is dangerous to bathe when exhausted by fatigue, but the glow of moderate exercise is a decided advantage. A light refreshment and a short run or brisk walk are the best preparations for a swim, which should not be prolonged until fatigue and chill are felt, and should be followed by a rub-down, speedy dressing and a quick walk home.

When the resisting and rallying power and the circulation generally are weak, as shown by shivering, coldness of the extremities, and sense of exhaustion, river or sea bathing should be given up. So, too, persons whose lungs and hearts are weak, and above all those who have any actual diseases of those organs, should not attempt it. There is a general tendency among those who enjoy outdoor bathing to stay in the water too long. Boys in summer remain for hours at lake or river side, most of the time in the water. This is an exceedingly weakening practice. Half an hour is ample for all the benefit that can be derived from such a swim, and a longer time in the water is apt to be distinctly injurious.

HOT WEATHER BATH SUGGESTIONS

A good health preservative, especially in summer and in warm climates, is to sponge the body with water which contains a small amount of ammonia or other alkali. The ammonia combines with the oil or grease thrown out by the perspiration, forming a soap which is easily removed from the skin with warm water, leaving the pores open and thus promoting health and comfort.

SLEEP AND ITS VALUE

No general rule can be laid down as to the number of hours which should be passed in sleep, since the need of sleep varies with age, temperament, and the way in which the waking hours have been employed. The infant slumbers away the greater part of its time. Young children should sleep from six to seven in the evening, until morning, and for the first three or four years of their life should also rest in the middle of the day. Up to their fourteenth or fifteenth year the hour of retiring should not be later than nine o’clock, while adults require from seven to nine hours. Some can do with two or three hours less than this, but they are so few that they offer no examples for us to follow.

Insufficient sleep is one of the crying evils of the day. The want of proper rest of the nervous system produces a lamentable condition, a deterioration in both body and mind. This sleepless habit is begun even in childhood, when the boy or girl goes to school at six or seven years of age. Sleep is persistently put off up to manhood and womanhood.

Persons who are not engaged in any severe work, whether bodily or mental, require less sleep than those who are working hard. Muscular fatigue of itself induces sleep, and the man who labors thus awakes refreshed. But brain work too often causes wakefulness, although sleep is even more necessary for the repair of brain than of muscular tissue. In such cases the attention should be forcibly withdrawn from study for some time before retiring to rest, and turned to some light reading, conversation or rest before going to bed. A short brisk walk out of doors just before bed time may aid the student in inducing sleep. Drugs should be avoided.

After a heavy supper, either sleep or digestion must suffer, but the person who goes to bed hungry will not have sound and refreshing sleep. If one works after supper, through a long evening, he should eat a light lunch of some sort an hour or two before bed time.

Ordinarily persons do best to retire at ten or eleven, and the habits of society which require later hours are to be regretted. Brain work, however, after midnight is most exhausting, and though sometimes brilliant, would probably be better still if diverted to earlier hours. Whatever be the explanation, it is an undoubted fact that day and night cannot be properly exchanged. About one or two o’clock in the morning the heart’s action sinks, and nature points to the necessity for rest. Sleep in the day time does not compensate for the loss of that at proper time, and slumbers prolonged to a late hour do not refresh the mind or body as does sleep between the hours of eleven and six or seven, the normal period for rest.

Old persons require, as a rule, less sleep than those of middle age, just as they require less food, because their nutritive processes are less active than when they were younger, and perhaps because their mental efforts also are less forced and attended by less exertion and more deliberation. Women, generally speaking, require more sleep than men, at least under like circumstances, apparently because in their case the same efforts involve greater fatigue.

VENTILATION OF BEDROOMS

Rooms which are to be slept in after having been occupied during a whole evening must be thoroughly ventilated before the occupant prepares for bed. Doors and windows must be thrown open for several minutes, the gas or lamp put out, and the air completely changed, no matter how cold it may be outside. This is the only way to obtain refreshing sleep. On going to bed the usual ventilating arrangements should then be followed, but the great point is to change the air thoroughly first.

REGULARITY OF HABITS

The importance of regularity and punctuality in every circumstance of daily life is not sufficiently realized. The more often and regularly any act is performed the more automatic it tends to become, and the less effort, whether mental or physical, attends its performance. This is a matter of daily experience and observation, and is true not only of mental work and manual or mechanical exercises, but of the organic functions of the body. Quite apart from the harm done by too frequent eating or too prolonged periods between meals or want of rest, the brain finds itself ready for sleep, the stomach for digestion and the bowels for action at the same hour every day, when these acts are performed with unbroken punctuality, and the strain upon the system to adjust itself to new conditions is therefore reduced to a minimum.

_GENERAL HEALTH CONDITIONS_
_Guard Your Water Supply—How Diseases Are Classified—How to Prevent
Contagion—Care of the Sick Room—Disinfection, Its Importance and Its
Methods—Period of Isolation or Quarantine—Duty of All Households Where
Sickness Has Invaded, to Guard Others Against Its Spread._

Man cannot preserve his health entirely by his own caution as to his food and personal habits. His surroundings enter into the matter at all times. By this is meant the house in which he lives, its situation and conditions, as well as the community itself. Fortunately, in this country we have not yet become so overcrowded as to forbid ordinary care in the matters of drainage, light, ventilation and other requisites. Americans should congratulate themselves that their ample country and general prosperity enable them to regulate their food, their habits and the conditions around them in high degree. At the same time the fact that these things are so generally within our control places upon us the obligation to do what we can for the community to maintain the general health.

Let us note now, briefly, some points of primary importance in the conditions that assure general health. Air, warmth and light must be provided for the dwelling. In cities we cannot always choose, but in smaller communities and in the country we can in large degree control such things for ourselves. Some things require only to be suggested to be clearly understood. A house should stand where the character of the soil and the contour of the surface will provide the best drainage. Hollows should be avoided. When a house is built on a hillside the ground should not be dug out so that a cliff rises immediately behind. Trees may afford valuable shelter, not only from cold winds, but from fogs. But it is not generally wise to have them close around a dwelling, at least in large numbers, since they impede the free circulation of the surrounding air, and retain dampness beneath their shade. In the country a house may be sheltered from cold winds on the side from which they prevail, by trees. Exposure of each side of a house in succession to the rays of the sun helps to keep the outer walls dry, to warm it in winter and to aid ventilation in the summer. The north wall may be made with advantage a dead wall, and ventilating pipes and soil pipes may be carried up through it, but chimneys carried up through a north wall, being warmed with difficulty and apt to smoke, should not project but be built inside the house. Attics with slanting ceilings and dormer windows are cold in winter and hot in summer.

Once occupied, the most important thing in the house is fresh air. The most common impurity in the atmosphere of rooms is carbonic acid gas, which is thrown off by the lungs of the occupants, and must be disposed of by ventilation in order that health shall be assured. The lamps or gas lights used in the room likewise give off carbonic acid, which is formed at the expense of the oxygen of the air, the vital element, which we require to breathe. Crowded rooms, or any rooms improperly ventilated, become tainted in this manner, and the headaches and faintness which we experience under such circumstances are direct and natural results of carbonic acid poisoning. School rooms are particularly trying upon pupils and teachers, unless their ventilation is especially guarded. It is considered that the proper degree of purity in the air of a room can be maintained only by introducing at least 2,500 cubic feet of pure air per hour for each person, this being a virtual minimum. In mines it has been noticed that the men require not less than 6,000 cubic feet per hour, and that when the quantity falls to 4,000 cubic feet there is a serious falling off in the work done. Manifestly the better and tighter the building the more need there is for special means of ventilation.

In the days when open fireplaces were almost the only means of heating houses they were of great value in aiding ventilation. Nowadays our stoves, radiators and furnaces do not help us in this matter, and we must take additional pains to see that ventilation is provided in some other way. Of course the simplest and most perfect method is to permit the free passage of the wind through open doors and windows. Every room should have its air thus completely renewed at least once a day. The mere renewal is done in a few minutes, but a longer time is required to dislodge the organic vapors and other impurities that lurk in the corners and behind furniture. In schools and work shops this should be done during the intervals for meals, and in churches between services. But in our climate it is not possible to have windows and doors open during all the time a room is occupied, except in very warm weather. It is seldom, however, that the window of a bedroom cannot be opened for a few inches all night without direct benefit to the occupant of the room. His bed, of course, must not be immediately in the draught. Curved pipes, ventilating shafts and slides under the windows are substitutes easy to use when windows cannot be actually opened.

GUARD YOUR WATER SUPPLY

Water supplies differ greatly in purity and composition, and are of the utmost importance in their effect upon the general health of a household. There is nothing which requires to be guarded more carefully. Absolutely pure water is almost unknown. Rain water collected in open countries is the purest, though even it takes up matters in its passage through the air, and in towns may be strongly acid. All waters which have been in contact with the soil dissolve out of it numerous inorganic and organic substances. Waters are described as hard or soft, hardness being the popular expression for the property of not easily forming a lather with soap. It is due to the presence of salts of lime and magnesia. Hard waters, if their hardness be not excessive, are agreeable and wholesome for drinking, but not well adapted for laundry or bathing purposes. They tend to harden vegetables cooked in them, and do not make as good tea as soft water. Rain water is, of course, the softest, but as a rule lakes yield waters also quite soft. When a good and wholesome water cannot be obtained from springs or rivers, as in malarial districts, and when there is reasonable ground for thinking the ordinary sources are contaminated by epidemics, it is well to fall back on the rainfall for drinking purposes, with special care that it is collected in a cleanly manner.

Surface wells are always to be viewed with suspicion when they are in the vicinity of stables and cesspools, farm yards, cemeteries and anywhere in the towns. The filtration of the water through the soil removes the suspended matters, so that it may be clear enough to the eye, but it has no power to remove impurities actually dissolved. The eye cannot be trusted to judge the impurities of drinking water. Water which appears absolutely clear may be unwholesome in the extreme, and water with sediment floating in it may be in no way unwholesome. Nothing but an analysis of the water can settle this with absolute certainty. Deep wells and artesian wells which penetrate the surface strata are likely to be safe. Marsh waters carry malaria and should never be drunk without boiling. Indeed suspicious water of all sorts may be made safe by boiling, although it is not sufficient always merely to bring it to a boil. Thirty minutes above the boiling point is a safe rule to follow. Typhoid, diphtheria, dysentery, cholera, diarrhea and other dangerous diseases are caused by impure water, either by suspended mineral matters acting as irritants, by suspended vegetable and animal matters, or by dissolved animal impurities. Sewer gases dissolved in water, in addition to these diseases, cause sore throats, boils and other ailments.

It must not be forgotten that water closets, stable yards, manure piles, decaying kitchen slops and all sorts of filth are responsible for many of the most serious diseases, either by draining into the well and so contaminating the water supply, or by direct breeding of disease germs carried as dust and inhaled. Health is one of the rewards for household cleanliness of the most careful kind.

HOW DISEASES ARE CLASSIFIED

In one sense most diseases are preventable, if all the circumstances which tend to spread them could be absolutely controlled by a single wise authority, and if all the physiological laws would be obeyed by all persons at all times. But as this happy condition is not in effect, we have to reckon with various kinds of diseases, as well as the accidents and injuries which come to us in health. The various diseases are classified into general groups.

Endemic diseases are those which are constantly present in a community because of certain unfavorable conditions, such as malaria in swampy regions, rheumatism from bad climatic conditions, and diseases resulting from unhealthy employments. Miasmic diseases are those due to conditions of the soil, and comprise the various forms of intermittent fevers, agues and the like. Infectious diseases, on the other hand, belong to the people, and not to the place. They are communicated from one person to another through the air, or by means of infected articles of clothing, etc., and they attack the strong and healthy, no less than the weak. Among such are smallpox, scarlet fever, measles, etc. Various branches of infectious diseases are recognized in addition, as combining some of the characteristics of the classes already named. For instance, erysipelas and other blood poisons are generated with the body of the individual who, so to speak, infects himself and may then infect others. Typhoid, cholera and yellow fever are miasmic diseases, but they are also capable of being carried by human intercourse, infected clothes, polluted water, etc., within certain limits of space and time. Hydrophobia, glanders and such diseases are communicated only by actual contact of body. Rickets and scurvy are preventable, though not communicable diseases, being direct results of mal-nutrition or imperfect nourishment, and consequently are diseases of diet.

Bacteria are those minute organisms which under various names are the active causes not only of diseases but of all putrefaction, fermentation and like changes in dead organic matter. Like all living things they may be killed, and on this is based the whole theory of disinfection. Some are more hardy than others, under conditions which are frequently supposed to be unfavorable to them. Merely to destroy an unpleasant odor or to admit fresh air into a room does not mean to disinfect, and it is necessary to understand this clearly in the effort to purify rooms in the event of infection.

Contagion is communicated sometimes with the utmost ease, if the new victim be in a receptive condition, and in the presence of any disease, even the most simple, it is well to take every precaution. The mucous surfaces are peculiarly ready to absorb infection of many kinds. Measles is easily absorbed from pocket handkerchiefs, as are also scarlet fever, whooping-cough and other diseases. By inhalation through the nostrils or mouth, scarlet fever, measles, whooping-cough, mumps, diphtheria, dysentery, cholera and even pneumonia and meningitis may be communicated. By eating or drinking something which contains the germs of cholera, typhoid, malaria, tuberculosis or consumption, diphtheria and scarlet fever, these diseases are communicated.

HOW TO PREVENT CONTAGION

It is an undoubted fact that not enough attention is paid to isolation in times of sickness. There is too much visiting in the sick room, too many people share the care of the patient, the nurse mingles too freely with other members of the family, and there is not enough care to keep the soiled bedding, garments and refuse of the sick room absolutely separated from that of the rest of the house. Scarlet fever is a noteworthy instance of a disease which constantly spreads by carelessness. Just as long as the scaling or shedding of the outer skin continues contagion may be carried, for it is these scales which bear it. It is nothing less than criminal, therefore, to permit the patient who is recovering to mix with other persons, except those who have been caring for him already. In the early stages of the disease the infection is chiefly in the breath, and in the secretion of the nostrils. During the disease pocket handkerchiefs should never be used, soft linen or cotton rags being substituted and immediately burned.

Most of the same things are true as to measles, whooping-cough, mumps and German measles, which are constantly spread by sheer carelessness because people do not realize the obligation resting upon them to guard others from contact with disease. These ailments are highly infectious before they are certainly recognized, and for that reason it is not possible always to isolate cases in time, but at least after the fact is clearly understood there should be no further carelessness.

Another prevalent disease in which carelessness is responsible for much of its spreading is tuberculosis, phthisis, or consumption, as it is more familiarly known. It is not possible yet to isolate every person suffering with this insidious disease, nor is that suggested. But at least it may be urged that every such sufferer shall thoughtfully guard in every way in his power against communicating it to his own neighbors and family. The bacilli, or bacteria, of consumption swarm in the spittle of the patient, and are diffused by the wind as dust as soon as they are dried. To guard against infection from this cause, spittoons should be used, which can be absolutely disinfected, or cloths which can be promptly burned.

Smallpox is perhaps the most infectious of diseases. Yet in vaccination we have a means of protection which we have not in any other. As long as a large unvaccinated population exists, however, we shall have epidemics from time to time. Before the introduction of vaccination nearly everyone had smallpox, just as now almost all persons have measles at some time or other. The heaviest mortality occurred within the first five or ten years of life, the deaths in later periods being very few, since the population had mostly been rendered immune by having had it already.

Measles is a well-defined disease, intensely infectious, occurring but once in a lifetime. It is very rarely fatal, nearly all the deaths credited to it being really due to bronchitis and inflammation of the lungs, the results of neglect and exposure to cold. No age is exempt. The only reason why it is looked on as a disease of childhood is that being in the highest degree infectious from the beginning, when its nature is not suspected, few children in the schools can hope to escape it, but if by chance they do, they are just as susceptible to it in afterlife.

Whooping-cough is a highly infectious disease, occurring but once in a lifetime, but at any age, though most frequently in childhood. The frequent belief that children suffering from whooping-cough should be as much as possible in the open air is an entirely mistaken one, as it leads not only to continuing the disease longer, but to danger of bronchitis and pneumonia. As in diphtheria and scarlet fever the mucus is the chief vehicle of contagion, and pocket handkerchiefs should be forbidden, pieces of soft rag being substituted and burned as soon as used.

Typhoid or enteric fever is slow and uncertain in its onset, a full month in duration, and the return of health is usually tedious. It is like diphtheria, directly a result of unsanitary conditions. Danger of direct infection from the patient is slight, but the poison remains in the evacuations from the bowels and is propagated by them. By this means a reservoir or river has been known to infect a whole town. Broken or defective drains, the entrance of sewer gas into houses, wells polluted by cesspool drainage, and milk diluted with infected water, are among the principal means of spreading the disease. It is an absolute rule that all bedding which becomes soiled should be destroyed, and the refuse of the sick room should be instantly disinfected and removed from the dwelling.

CARE OF THE SICK ROOM

Although it is quite possible that few may be able to follow every instruction or precaution advised to guard against the spread of diseases, we may at least outline the conditions to be aimed at and secured as nearly as possible. In spite of the additional labor that it makes, the ideal place for a sick room in a private house is as far from the ground as possible. To be of any service at all isolation must be real and complete. A room should be selected in the topmost story, the door kept closed, a fire, large or small, according to the weather, kept burning, and the windows open as much as possible. Even in the winter this can be done without danger under most circumstances by lowering the upper sash and breaking the draught by a blind or a screen. The staircase and hall windows should be kept open day and night. The other inmates of the house should keep their own rooms thoroughly ventilated. The persons nursing the patient should on no account mix with other members of the family, or if that cannot be helped they should take off their dresses in the sick room, and after washing their hands and faces, put on other dresses kept hanging outside the room, or in an adjoining apartment.

All dishes used in the room should be washed separately, and not with others in the kitchen. The room itself, except in case of measles and whooping-cough, the poison of which does not retain its vitality for any length of time, should be as scantily furnished as possible, containing nothing which can retain infection. All woolen carpets, curtains and bed hangings should be removed, and only wooden or cane-bottomed chairs kept. There should be no sofa, and iron bedsteads are better than wood. A straw mattress of little value, which may be destroyed afterwards, is better than a hair one, which can be disinfected, but feather beds and such coverings should be absolutely forbidden.

In scarlet fever, diphtheria, smallpox and typhoid, all soiled clothing and bedding should be immediately put into an earthenware vessel, containing a solution of corrosive sublimate (one drachm to a gallon of water) and left to soak for some hours before being washed. On being taken from this disinfecting solution they must, even at risk of spoiling flannels, be thrown into boiling water and boiled for some minutes before soaping and washing. No infected clothes should, under any circumstances, be sent out of the house, unless all of these precautions are absolutely guarded.

In cases of typhoid and scarlet fever the vessel which receives the passages from the bowels should have in it a solution of corrosive sublimate or of carbolic acid. The contents then should be stirred with a poker before being poured into the water closet, and the same disinfectant should be sprinkled liberally into the closet.

After the peeling in scarlet fever or the shedding of scabs in smallpox has set in, the patient should take, at intervals of three or four days, hot baths with soft soap, the hair, previously cut short, being well scrubbed with the same. In scarlet fever and diphtheria the mouth and throat should be frequently sprayed, washed out or gargled with a pretty strong solution of permanganate of potash or a weak one of chlorinated soda.

DISINFECTION, ITS IMPORTANCE AND ITS METHODS

There are few subjects on which greater ignorance exists, not only among the public but among medical men as well, than on that of disinfectants. The word is used vaguely to mean deodorants, which destroy bad odors; antiseptics, which prevent the spread of injury by putrefaction in a wound; and germicides, which actually destroy the bacteria or microbes which produce contagion in a disease. In some cases one of these may serve the function of another, but that is merely incidental. Deodorants may be such simple things as perfumery, tobacco smoke or camphor, and they serve very useful purposes in masking bad smells, but they are entirely useless in preventing disease.

Permanganate of potash, or “Condy’s fluid,” as the druggists call it, is a powerful antiseptic, instantly destroying the matter that is beginning to putrefy by what is really a burning process. It sweetens the foul discharges from wounds and bad throats, but is nearly powerless to destroy the living germs of disease.

The disinfectants of most practical value, which are at the same time germicides, are carbolic acid, chloride of zinc, sulphurous acid, chlorine and corrosive sublimate. Carbolic acid, when strong enough, is fairly satisfactory. Five per cent solutions (one part in twenty) stop the activity of bacteria, but do not actually destroy their vitality. Solutions twice as strong do, but water will not dissolve so much, and the odor that remains is an objection to their use for disinfecting linen. Chloride of zinc is far more powerful. If too strong a mixture is used it may injure cloth, so that this wants to be guarded against.

Sulphurous acid (the fumes of burning sulphur) is a most convenient disinfectant. Shut the windows down tight, leave all the clothing in its place and open trunks and drawers. Put a thick layer of ashes in an old iron pot, over which place a shovel of live coals; throw a teacup of pulverized sulphur on the coals and run out, closing the doors in your exit. Stay out several hours. On returning open all doors and windows, and the odor will soon be gone, also the bugs, insects and the germs of any disease that may be lodged in the clothing, etc.

The following instructions, published in the Hospital Gazette, were prepared by a board of eminent physicians and surgeons for public information, and on the general proposition of disinfection they can hardly be surpassed: Three different preparations are recommended for use to make the purifying of a house, where infection has been, complete. The first is ordinary roll sulphur or brimstone, for fumigation; the second is a copperas solution, made by dissolving sulphate of iron (copperas) in water in the proportion of one and one-half pints to one gallon, for soil, sewers, etc.; the third is a zinc solution, made by dissolving sulphate of zinc and common salt together in water in the proportion of four ounces of the sulphate and two ounces of the salt to one gallon, for clothing, bed linen, etc. Carbolic acid is not included in the list, for the reason that it is very difficult to determine the quality of what is found in the stores, and the purchaser can never be certain of securing it of proper strength. It is expensive when of good quality, and it must be used in comparatively large quantities to be of any use. Besides it is liable, by its strong odor, to give a false sense of security. Nothing is commoner than to see saucers of carbolic acid and other disinfectants in a sick room. Considering the vitality of bacteria, and that they require carbolic solutions of more than five per cent or several hours of intense heat or similar heroic measures to kill them, it must be evident that such feeble vapors as can be tolerated in the sick room are utterly useless. Here are the instructions in full:

=In the Sick Room=, the most valuable agents are fresh air and cleanliness. The clothing, towels, bed linens, etc., should, 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. All discharges should either be received in vessels containing the copperas solution, or, when this is impracticable, should be immediately covered with the solution. All vessels used about the patient should be cleansed or rinsed with the same. Unnecessary furniture—especially that which is stuffed—carpets and hangings should, when possible, be removed from the room at the outset; otherwise they should remain for subsequent fumigation, as next explained.

=Fumigation.=—Fumigation with sulphur is the method used for disinfecting the house. For this reason the rooms to be disinfected must be vacated. Heavy clothing, blankets, bedding and other articles which cannot be treated with the zinc solution, should be opened and exposed during fumigation, as next directed. Close the rooms tightly as possible, place the sulphur in iron pans supported upon 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 twenty-four hours. For a room about ten feet square at least two pounds of sulphur should be used; for larger rooms proportionally increased quantities.

=Premises.=—Cellars, stables, yards, gutters, privies, cesspools, water closets, drains, sewers, etc., should be frequently and liberally treated with the copperas solution. The copperas solution is easily prepared by hanging a basket containing about sixty pounds of copperas, in a barrel of water. (This would be one and one-half pounds to the gallon, or about that. It should all be dissolved.)

=Body and Bed Clothing, Etc.=—It is best to burn all articles which have been in contact with persons sick with contagious or infectious diseases. Articles too valuable to be destroyed should be treated as follows: Cotton, linen, flannels, blankets, etc., should be treated with the boiling hot zinc solution, introduced piece by piece; secure thorough wetting, and boil for at least half an hour. 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 the fumigation, their surfaces thoroughly exposed, and the 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, 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.

=Corpses.=—Corpses of those dying from infectious diseases should be thoroughly washed with a zinc solution of double strength; should then be wrapped in a sheet wet with zinc solution and buried at once. Metallic, metal-lined, or air-tight coffins should be used when possible, certainly when the body is to be transported for any considerable distance. Of course a public funeral is out of the question.

In addition to these disinfectants of long standing, which have been recognized in medicine for many years, another of great value is now coming into high favor. This is formalin, which, in its various forms, is convenient, economical and highly effective. Under the name of formaldehyde, one preparation of this disinfectant is widely but improperly used as a preservative for milk, meat and some other perishable foods. In almost every instance this is illegal, and properly so, for the substance is a poison and even when diluted cannot fail to be injurious. From formalin various disinfecting substances are made, and may be had at the drug stores, some as liquids and others in tablets to evaporate over a lamp for the general disinfection of rooms or houses. The latter may be recommended in the highest degree as a safe, economical and absolutely sanitary process.

Corrosive sublimate is, perhaps, the most powerful germicide known, a solution of one part in a thousand, or a little more than a drachm to a gallon of water, being amply sufficient for all practical purposes. It does not injure or stain wood, varnish, paint, plaster or ordinary fabrics, and if the ceiling be whitewashed with a genuine lime wash, and the walls, floors, doors and furniture of the room be washed down with the mixture, no microbes can possibly escape. It attacks metals, but iron bedsteads are protected by the enameling.

Poisonous as corrosive sublimate is, the danger from it is easily guarded against. The smallest dose of it known to have proved fatal, even to a child, would require no less than a quarter of a pint of the solution of one in a thousand parts. A mouthful of this would not cause more than temporary discomfort, while the taste would prevent a second being swallowed. Still, as a further safeguard it might be well to add a little laundry bluing to give color to the mixture, and a little wood alcohol to give it a smell. Then with a proper poison label on it surely no one would be endangered by it.

PERIOD OF ISOLATION OR QUARANTINE

A person who has had any infectious disease and has been thoroughly disinfected, with his clothes, may be allowed to mix freely with his fellows, in school, for instance, after the following periods. Scarlet fever: Not less than eight weeks from the appearance of the rash, provided peeling has completely ceased, and there be no sore throat. Six weeks is not enough, as there are cases of direct infection after seven weeks when all symptoms have entirely disappeared. Measles and German measles: In three weeks, provided all peeling and coughing have ceased. Smallpox and chickenpox: A fortnight after the last scab has fallen off; the hair, in case of smallpox, having been cut short and scrubbed with carbolic soap or soft soap. Mumps: Four weeks from the attack if all swelling has disappeared. Whooping-cough: Six weeks from recognition of the whoop if the cough has entirely lost its spasmodic character, or four weeks if all cough whatever has ceased. Diphtheria: In a month if convalescence be complete, there being no trace of sore throat or discharge from the nose, eyes, etc. Ringworm: When the whole scalp, carefully examined in a good light, shows no stumpy broken hairs or scaly patches.

It has been very difficult to impress upon communities and individuals the extreme importance of strict obedience to the foregoing rules. There is an unfortunate tendency in too many instances for households to fail in guarding their neighbors from contact with their own members who are convalescing from disease. Even such common and simple diseases as whooping-cough, chickenpox, mumps and others that are considered especially to belong to children, frequently prove fatal to those who are susceptible to them, and it is truly wicked to permit by carelessness such an infection to reach a school or elsewhere where weaker children may suffer as a result.

COMMON SENSE IN THE SICK ROOM
Ventilation, Light, Temperature and Furnishings—Care of the Patient—His
Temperature and Pulse—Bed Sores—The Characteristics of Fever—Simple
Household Remedies—What to Put in a Remedy Cupboard—How to Keep the Baby
Well

To every living person air must be furnished every moment if life is to be preserved. The vital element of the air is oxygen gas, the life-giving medium, and this is diluted with nitrogen, because the oxygen itself, breathed alone, would be too stimulating for our lungs. In the delicate cells of the lungs the air we have inhaled gives up its oxygen to the blood, thus purifying it, and receives in turn carbonic acid gas and water, foul with waste matter, which the blood has absorbed during its passage through the body and which we now exhale. The blood is red when it leaves the heart, pure. It returns to the heart purple from the impurities it has picked up, and by the oxygen is once more changed to red.

Manifestly if this process is so important to a person in health, it must be doubly so to one who is sick. The impurities of a sick room consist largely of organic matter, including in many instances enormous numbers of the disease germs themselves. If we uncover a scarlet fever patient in the direct rays of the sun a cloud of fine dust may be seen to rise from the body, the dust which carries the contagion itself. In an unventilated place this is but slowly scattered or destroyed, and for many days it retains its poisonous qualities. “The effect of rebreathing the air cannot be overestimated,” says Martin W. Curran of Bellevue Hospital, New York City. “We take back into our bodies that which has been just rejected, and the blood thereupon leaves the lungs bearing, not the invigorating oxygen, but gas and waste matter, which, at the best, is disagreeable to the smell, injurious to the health, and may contain the germs of disease.”

Fortunately rooms may be ventilated by means of windows in several different ways with little risk of draught. For instance, the lower sash of the window may be raised three or four inches, and a plain bar of wood an inch in thickness, extending the whole breadth of the window, may be put below the window sash, entirely filling the space. By this means the air current enters above, between the two sashes in an indirect line, and it is gradually diffused through the room without a draught. Here is a simpler way of doing the same thing. Take a heavy piece of paper or cloth, about twelve inches wide, and long enough to reach across the window. Tack it tightly at both ends and the lower edge to the frame, and raise the lower sash of the window a few inches. The air entering will be diverted by the cloth. If the air is very cold it must not be admitted at the bottom of the room, but from the top of the window, and should be directed toward the ceiling so as to fall and mix gradually with the warmer air of the room.

The influence of the sun’s rays upon the nervous system is very marked. That room is the healthiest to which the sun has freest access. The sick room should be kept looking bright and cheerful, unless the disease be one that requires the eyes to be specially guarded from the light. The eyes are weaker, however, in all sickness, and the bed should be turned so that the patient does not look directly toward the bright light of the open window.

The proper temperature for a sick room is sixty-eight degrees above zero. In the hot days of summer when this temperature is greatly exceeded, or the air is too dry, hang some thin muslin, soaked in ice water, across the opening in the windows, which will moisten the air, cool the room, and keep out many particles of floating dust. If the floor of the sick room is carpeted and the illness is serious, cover the carpet with sheets and sprinkle on them a weak solution of carbolic acid at intervals. The sheets can be changed as often as necessary. The cleanest wall is one that is painted, which can be washed and disinfected in any way desired. Nurses consider papered walls the worst ones, and plastered the next, but the latter can be made safe by frequent lime washings and occasional scraping.

Have as little furniture as possible in the sick room, and all of this of wood, metal or marble, kept clean by being wiped with a cloth wrung out of hot water. A small, light table should be placed for the patient’s use, from which he may reach his own glass of water. The bed should not be placed with one of the sides against the wall, as a nurse should be able to attend to a patient from either side.

CARE OF THE PATIENT