In a boarding-school or family when a diphtheria patient is found, select a room set off as far as possible from the rooms commonly used, and before putting the patient into this room remove all curtains, upholstered furniture and carpets from it that are not so cheap or so worn that they may be destroyed after the patient's convalescence, or which are of such texture that they will not be destroyed by water or disinfection by heat. In any case the less there is in the room the easier the disinfection will be.
Use the mattress upon which the patient had slept before you discovered the nature of the disease. Books should be removed, because an infected book can not be disinfected except upon the outside. The room is not to be swept while the patient is in it,—dust may be wiped up with a damp cloth. The cloth is to be disinfected before it is sent out of the room.
The popular notions regarding sulphur as a disinfectant after diphtheria are erroneous. Sulphur fumes in certain definite quantities will disinfect after smallpox, scarlet fever, measles, and some other diseases; these fumes will also kill the diphtheria bacillus, if the bacillus is wet and exposed directly; but if it is buried in sputum or in clothing the fumes will have no effect whatever upon it. The disinfectants to use are acid bichloride of mercury and heat. Formaldehyde does not penetrate well enough to be reliable in diphtheria.
When the patient is taken to the room prepared, let a mixture of one ounce of bichloride of mercury in the powdered form, in two ounces of common hydrochloric acid (not the dilute hydrochloric acid used in medicine), be obtained. This is a violent poison, and it must be kept out of the reach of children and careless persons. Two teaspoonfuls of this solution in an ordinary wooden bucket filled with water to within two inches of the rim makes the disinfecting mixture. A wooden washtub nearly filled with this disinfectant, mixed in the bucket as directed, should be kept near the door of the room, and all towels, sheets, and soiled linen must be soaked in this tub for twenty-four hours. After that any one may handle these articles with perfect safety. The articles that have been soaked for twenty-four hours should be rinsed in ordinary water to remove the acid, and they may then be washed. The nurse should not touch the outside of the tub with infected articles while putting these in the disinfectant. Do not make the disinfectant stronger than directed here, or it will destroy the articles soaked in it, and for the same reason do not leave them in it longer than twenty-four hours.
If the attendant can be kept isolated with the patient there will be less liability of carrying the infection through the house. In a majority of cases in families, however, the mother is obliged to care for the patient and to attend also to her household duties. In the last case, let her keep near the door of the room a cotton wrapper which can be put on over her dress whenever she enters the room. She had better tie a towel over her hair. In the room a china-stone basin should be kept, containing a gallon of water, in which there is a teaspoonful of the acid bichloride. Every time the attendant touches the patient let her wash her hands in this mixture, using no soap. She should remove her finger rings or they will be blackened. The patient should not be handled except when absolutely necessary, to avoid needless exposure to infection; it is also injurious to a child ill with diphtheria to lift it up. The nurse's covering wrapper should be soaked in the tub as often as possible. Some ignorant persons give as an excuse for a lack of care in [{192}] handling patients having contagious diseases like diphtheria, that they are not afraid of the infection. Fear has nothing to do with the matter.
Food is to be taken to the door of the sick-room by some one other than the attendant. The tray should not be carried into the room. After the meal, take to the door a pan containing water, and let the attendant set the dishes, knives and forks, and the food handled by the child, under the water without touching the rim or sides of the dish-pan. Then any one may carry the pan to the kitchen, where it is to be set upon the stove, and the water holding the dishes and the rejected food is boiled for an hour. After that process the contents of the pan are safe, and they may be handled for washing. Cloths used in wiping the mouth of the patient are to be wrapped in paper and burned. Dejecta should be covered with fresh chlorinated lime, one part to two of water.
After the patient begins to convalesce the danger of infection grows greater. When the membrane has disappeared, and the child is able to run about the room, the attendant ceases commonly to use the throat-spray because the process is troublesome. In such cases the diphtheria bacillus remains in the patient's mouth for some time—from a few days to weeks. During the most of this time the child is as dangerous to others as it was while it was ill. In one case in my own experience, the bacillus remained present for eleven weeks from the date of diagnosis, and I then lost sight of the child. In the tenth week the bacillus present when in pure culture killed a guinea-pig in thirty-six hours. This is, of course, an exceptional occurrence; but the routine practice is to keep the patient isolated for three weeks after the membrane has disappeared, unless a bacteriological examination shows that the bacillus is absent. The bacillus remains after the use of antitoxin just as if antitoxin had not been used.
When a child is to be released from the sick-room, bathe it carefully with soaped warm water, washing out the hair and under the finger-nails carefully. Then wet a towel with the disinfectant (the acid bichloride of mercury,—a [{193}] teaspoonful to a gallon of water) and go over the body with it; afterward rinse with ordinary water. Do not let the disinfectant enter the child's mouth or eyes. Next, without allowing the child to touch anything in the room, especially avoiding the door-knob, send it to another room and dress it in clothing that has not been near the sick-room. If, after this process, other children are infected, the explanation is that the child had been released too soon—before the bacillus had disappeared.
It commonly happens that a child has been going about the house for some days before a physician has been called in. In that event you have the house to disinfect. You must then wet with bichloride everything the child has touched, and boil all eating utensils.