The first essential is that the patient should have a room to himself. No one except those caring for him should enter the sick-room for any purpose whatever; visitors should be rigidly excluded. At the outset all unnecessary articles should be removed from the sick-room, and it
should be possible to boil, burn, scrub, or otherwise thoroughly clean everything allowed to remain. The windows should be screened in summer, and flies must be excluded. Fresh air is especially needed by patients with communicable diseases, and ventilation of the room must be adequate both day and night. Foul odors plainly indicate that the patient or something in the room is not clean. The remedy is obvious and deodorants are quite unnecessary if the patient and the room are properly cared for. It is highly desirable to reserve a bath room for the exclusive use of the patient and his attendant and also to reserve a room adjoining the patient's room for the exclusive use of the attendant. When it is impossible, as it often is, to give up so much space, each family must make the best arrangement it can to separate the patient and his attendant from the rest of the family.
The attendant must remember that her ten fingers are the ten most active agents in distributing the communicable diseases. After handling the patient or anything that the patient has touched, and whenever she leaves the patient's room, she must scrub her hands thoroughly with warm water, soap, and a nail brush. She should not soil her hands unnecessarily, even though she intends to scrub them later. She must remember for her
own protection to keep her hands away from her mouth and face, and to cleanse them with special care just before eating. If disinfection is needed in addition to the scrubbing, she must use conscientiously whatever solution the doctor orders.
At the same time that she is caring for a patient with a communicable disease, the attendant ought not to care for children or other members of the family, she ought not to prepare food, and she ought not to handle dishes or utensils used by other persons. Every day, however, many women are doing just these things, and it is true that in many instances no bad results are observed. Yet if any arrangement to insure safety can possibly be made, it is inexcusable to run the risk of spreading diseases which kill thousands of persons every year and injure many more for life.
When home conditions render adequate care and strict isolation of the patient impossible, hospital care should be seriously considered. No personal or sentimental objections should be allowed to influence the decision, if removing the patient to a hospital is necessary to safeguard his welfare or the welfare of the family. Hospital care should be considered especially for patients with typhoid fever, because untrained persons cannot safely care for patients so seriously ill. Since a patient with typhoid needs skilled care,
and since he greatly endangers other persons, most authorities consider hospital care essential unless the patient can have the continuous services of a trained nurse and almost ideal home conditions. Many cases of typhoid, it is true, are successfully nursed at home in extremely adverse conditions by visiting nurses; yet in few kinds of sickness is continuous care by a graduate nurse more necessary to protect the community as well as to safeguard the patient himself.
Members of a family in which there is typhoid should be immunized if the doctor advises it. This process, which is performed by the doctor, in the majority of cases renders a person immune to typhoid fever for three or four years.
The question of home or institutional care for persons with tuberculosis must also be carefully considered. In some cases tuberculosis may be cared for at home with comparative safety, and in some other cases the risk is not very great if the patient is intelligent, careful, and well supervised. But everyone should face the fact that all cases of tuberculosis of the lungs involve some risk to others in the family, and most cases involve great risk. The danger to children is greater than to adults. Most tuberculosis infections, it is now believed, are acquired in childhood. The bad results of an infection acquired
in childhood may not show themselves for years, since the germs may remain inactive until the person's resistance is lowered by some unfavorable condition.