RULES TO BE OBSERVED IN THE TREATMENT OF CONTAGIOUS DISEASES
Every mother should know the elementary principles involved in the treatment of contagious diseases. They are contagious because they may be conveyed from one individual to another or because a person nursing a victim of a contagious disease may carry that disease to another person without having the disease herself. For this reason, certain rules have been established by the medical profession, which experience has taught are necessary in order to preserve the health of the community when such diseases are prevalent.
The very first rule to which the physician will direct the mother's attention, when there is a contagious disease, will be that the child must be "isolated."
What Isolation Means.—Isolation means the complete seclusion of the patient in a room by himself, so that no one will see him or come in contact with him except the physician and the nurse or mother who will tend him during the entire course of the disease. Isolation implies more than it would seem to mean. It implies that every article used during the sickness will be thoroughly disinfected before it leaves the room in which the patient himself is isolated. Mothers must always remember that every article used by the patient may carry the germs of the disease to some other member of the family or to some other individual. These articles are the clothing of the child, the bedclothes, napkins, handkerchiefs, towels, dishes, knives and spoons, rags, the various discharges—sputum, urine, and bowel passages—and, we may add to this list, flies, insects, and domestic animals. Every precaution must, therefore, be taken to safeguard any dissemination of the disease by means of these articles.
Thorough isolation also implies that the nurse shall frequently bathe and disinfect her person and her clothing, and that the sick-room itself shall be carefully dusted with a moist cloth and disinfected from time to time.
The Contagious Sick-Room.—The contagious sick-room will be prepared in exactly the same way as the ordinary sick-room which has been previously described. In addition, however, it will be safeguarded in the following manner. A wet sheet will be hung up outside the door. This sheet will be kept constantly moistened with a solution of chloride of lime. One-half pound to an ordinary house-pail of water is the strength of the solution to use. Every window must be effectively screened to prevent the ingress and egress of flies and other insects.
Conduct and Dress of the Nurse.—She will remain in the sick-room all the time unless when she takes outdoor exercise. Her dress will consist of a long gown which will entirely cover her person from the neck to the shoes and will be of plain, white, easily washed material, without tucks or ruffles or adornment of any kind. She should wear an ordinary pair of house slippers made of light leather. Her cap will be large enough to cover and include her hair and head. When she leaves the room, she will remove her cap, gown, and slippers, disinfect her hands in a disinfecting solution and wash her face, neck, and hands in soap and water. She should go directly out and in, without coming in contact with any occupant of the home.
Feeding the Patient and Nurse.—The meals for the patient and nurse should be left on a table outside the door of the sick-room, from which place the nurse will then take them into the room. The utensils used for these meals should not be used by other members of the family during the entire sickness. After the patient and nurse have eaten, the utensils should be placed in a chloride of lime solution for disinfection. If any of the food is left over it should be put into a jar in which it may be disinfected and rendered harmless before being disposed of.
How to Disinfect the Clothing and Linen.—All bed and body linen, towels, handkerchiefs, napkins, etc., should be immediately put into a large receptacle—a wash boiler, or tub, will answer the purpose admirably—containing a five per cent. solution of carbolic acid in which an adequate quantity of soft soap has been dissolved. They should remain in this mixture for two hours, after which they may be wrung out and taken to the laundry.
How to Disinfect the Urine and Feces.—The urine and the stools should be passed into vessels containing a solution of four ounces of carbolic acid to the gallon of water. This vessel should be covered and the mixture allowed to stand for one hour, after which time it may be thrown out.
How to Disinfect the Hands.—Any of the following solutions may be used for disinfection of the nurse's hands: Creolin, one teaspoonful to the quart of water; chloride of lime, one-half pound to a pail of water; formalin, thirty-two drops to a quart of water. A basin containing one of the above solutions should be constantly kept standing for the frequent disinfection of the nurse's hands. After disinfection, the hands should be washed in plain water and soap.
Disinfection of Room Necessary.—The room in which a contagious patient is confined requires systematic attention on the part of the nurse. Every other day all flat or projecting surfaces should be disinfected. Mantels, window-sills, door knobs, picture moldings, furniture, chairs, and bed-railings, should be wiped with cloths moistened in a disinfecting solution. A suitable solution for this purpose is one containing one ounce of carbolic acid to the quart of water.
How to Disinfect the Mouth and Nose.—In the course of all contagious diseases the mouth and throat of the patient and nurse should be thoroughly disinfected as a matter of routine. It should be done at least twice daily unless more frequent disinfection is called for because of the nature of the disease. In measles and diphtheria, for example, the nasal and throat conditions will undoubtedly call for more frequent and more thorough disinfection than twice daily. This may also apply to scarlet fever if the throat is involved as is often the case.
Pocket handkerchiefs should never be used by a patient suffering from a contagious disease. The nose and mouth should be wiped with pieces of gauze or cheesecloth, cut into small squares for this purpose. These should be immediately burned after being used.
To disinfect the throat, a solution of formalin, six drops to six ounces of water, is effective. To disinfect the nose, a solution of Glyco-Thymoline is suitable. These applications should be made by means of an atomizer, a different atomizer being used for the patient and nurse.
Receptacle for the Sputum.—A cuspidor, or basin, should be constantly kept at the side of the bed in which the patient may conveniently expectorate. This utensil should contain the chloride of lime solution previously mentioned.
Care of the Skin in Contagious Diseases.—As in all other sick conditions, the skin of the patient should be bathed frequently with an alcoholic solution. In the later stages of measles and scarlet fever it is essential to anoint the skin while the patient is scaling. This may be done with carbolated vaseline. Mothers should understand why this is necessary. These diseases have a distinct rash or eruption. This eruption practically kills the skin cells and at a certain period these cells are cast off by the new growth of skin underneath. This process is called scaling. In measles the scales are small, and are cast off in the form of bran like dust. In scarlet fever, the cells adhere together and are cast off in large scales. These scales are contagious. They are very light and will float in the air if dry. The movement of the patient, changing the bed clothing, etc., will waft a multitude of these contagious scales into the air of the room and infect every article they may land on. This would make the disinfection of the room difficult and tedious. In order to obviate this tendency experience has taught us that much of the difficulty and nearly all of the risk of contagion may be overcome by rubbing some oily or sticky substance on the skin. By this method the dust and scales are rendered heavier than the air, stick together and will not float. During the scaling period there is a constant itch present which irritates the little patient. By using carbolated vaseline to anoint the skin we accomplish two purposes. The carbolic acid in the vaseline relieves the itch, and the vaseline itself greases the skin so that the scales remain in the bed. Each day the nurse changes the bed-sheet, gathers the scales in the sheet and puts all in the disinfecting solution.
Convalescence After a Contagious Disease.—Complete isolation must be kept up until all danger from contagion is passed. In diphtheria this period is not reached until the examination of the throat contents under the microscope is returned negative. In diseases Which have a rash this period is not reached until all scaling is completed. Even then, and for a number of days or weeks, the patient may be taken out for exercise daily, but must not be allowed to play with other children until his strength justifies active exercise. It takes a much longer period to rid the system of the poison of a contagious disease than most mothers appreciate. Many children have died from heart failure after they were considered well simply because the active exercise overtaxed the heart before the system was wholly free from the poison of the disease.
Before the child is removed from the sick-room for the first time he should have a disinfecting bath. This bath should be in a solution of bichloride of mercury, the strength of which should be one part to five thousand parts of water. The towels used to dry the patient after the bath should be fresh and should not have been in the sick-room. He should then be dressed in clothing which has never been in the sick-room.