As to the disinfection of the room and its contents: the irritation of diphtheria causes a large quantity of saliva to flow from the patient's mouth; this infected saliva runs down upon the pillows and soaks into them. It may also soak into the mattress. If a town has a steam disinfecting plant, there is no trouble in dealing with bedding and carpets after diphtheria and other contagious diseases; such a plant, however, costs at the least $6000. It is safer, in the absence of steam disinfection, to destroy pillows by fire; but if these are opened and the filling put into tubs or barrels containing two teaspoonfuls of the acid bichloride of mercury to each gallon of water and soaked for about two days they will be safe. The ticking in this case should be boiled in a wash-boiler, and the filling is to be rinsed before drying. The mattress is less liable to infection but it may be infected. If a piece of oil-cloth or rubber sheeting is spread beneath the bed-clothes under the patient and the mattress is kept well covered during the course of the disease, the filling of the tick will most probably be not infected. The loss of a good feather or hair mattress is considerable in the house of a poor man, and these often may be saved. To disinfect the surface of a mattress place it on chairs in a small room or in a closet and pour upon a cloth under it 500 cc. of formalin for each 1000 cubic feet of air-space in the room or closet—multiply the length by the height by [{194}] the width of the room or closet to get the cubic feet of air-space. Leave the room or closet shut tightly for twenty-four hours. The Trenner-Lee formaldehyde disinfector is a good apparatus for disinfecting. The smaller size costs twenty-five dollars.
If anything is to be sent out of a room to be burned, spread a piece of old carpet, bagging, or similar useless cloth outside the room door, set on this the articles to be destroyed, wrap them carefully in the fabric, tying all with cords; then take the bundle outside the town in a covered wagon, pour kerosene oil on the package without opening it, and set it afire. Afterward wash the wagon with the acid bichloride.
Wet the furniture and floors of the room with the acid bichloride. Do not merely sprinkle the solution about, flood everything with it, because the germ is killed only by direct contact; and remember that a diphtheria bacillus magnified 800 times is not larger than the eye of a needle. The bichloride will spoil gilt picture-frames, therefore use a 10 per centum solution of pure carbolic acid on these and all other metallic surfaces. Coins should be boiled, and paper money should be dipped in the 10 per centum carbolic acid solution and dried at a stove. Money is frequently found in smallpox rooms under the patient's pillow.
Formalin is the best disinfectant for wall-paper unless the child has spat upon it—then use the bichloride. Sometimes the bichloride will not injure the wall-paper, but if there are gilt figures upon it these will be blackened. Sulphur fumes are no better than formalin—not so good, and they injure and blacken tinted and gilded wall-paper, silks, satins, and other fabrics. If you determine to have the room repapered, wet it with bichloride before you bring in the workmen.
It is difficult to disinfect a carpet except by steam, and on this account the carpet should be removed from the room before the patient is brought into it. If it has been kept in the room, wet it thoroughly with the bichloride, when you are disinfecting, if you can not have it disinfected by hot steam. The wetting commonly spoils the carpet, consequently it may be necessary to bum it.
Keep cats, dogs, and especially kittens, out of a diphtheria room. Kittens will take the disease easily, and cats and dogs will carry about the contagion. If a valuable dog should get into the room, disinfect its hair thoroughly with the acid bichloride and then rinse the hair. Be careful to disinfect its feet.
While using the bichloride do not forget the window-panes, the door-knobs, and that part of the chair-legs which touches the floor. After you have used the bichloride expose the room to the gas from formalin. Hang up sheets wet with 500 c.c. of formalin for each 1000 cubic feet of air-space, and close all keyholes and cracks; then leave the room shut for twenty-four hours.
As to the use of antitoxin as a preventive and cure for diphtheria, too much praise cannot be given to that wonderful discovery. Reliable diphtheria antitoxin, used in proper quantity and early enough, is almost an absolute cure. Where it fails it has been used too late or not in the proper dose. In any case its only evil effect may be an attack of nettle-rash or hives. The few deaths that have occurred in its use were caused by an ignorant use of the syringe. If you find a physician opposed to the use of antitoxin this simply means that he is a quack. One serious disadvantage in the use of antitoxin is that it leaves the dangerous bacillus in the throat of the patient about as long as an unaided convalescence would leave it. The membrane often will disappear in twenty-four hours where antitoxin has been used, and the child will be playing about the floor. Then the mother will say the child never had diphtheria; she will not disinfect, and she will let the child run about the house.
The free book system that prevails in some schools is a prolific source of infection. Books are infected at home or by children from infected houses, and mixed with other books in the school. The diphtheria bacillus will cling to a book for at least a year. If books are given to the children, give them outright; do not let the books be mixed in the schoolroom.