Essays In Pastoral Medicine Part 18

Formalin is the best disinfectant for wall-paper unless the child has spat upon it--then use the b.i.+.c.hloride. Sometimes the b.i.+.c.hloride 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 b.i.+.c.hloride 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 b.i.+.c.hloride, 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 b.u.m it.

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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 b.i.+.c.hloride and then rinse the hair. Be careful to disinfect its feet.

While using the b.i.+.c.hloride do not forget the window-panes, the door-k.n.o.bs, and that part of the chair-legs which touches the floor.

After you have used the b.i.+.c.hloride 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-s.p.a.ce, and close all keyholes and cracks; then leave the room shut for twenty-four hours.

As to the use of ant.i.toxin as a preventive and cure for diphtheria, too much praise cannot be given to that wonderful discovery. Reliable diphtheria ant.i.toxin, used in proper quant.i.ty 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 ant.i.toxin this simply means that he is a quack. One serious disadvantage in the use of ant.i.toxin 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 ant.i.toxin 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.

Drinking-cups used in common are another source of {196} infection.

Let each child have its own tin cup. The clothes-rack in a school also spreads infection. Room enough should be given to each hook to keep the hat and coat of one child from touching those of another, and a wooden part.i.tion standing out from the wall about eight inches should separate hook from hook. The janitor should wash the clothes-racks with the acid b.i.+.c.hloride solution every time he sweeps.

Suppose a child having diphtheria is found in school, or one is discovered as coming from a house where he was in contact with diphtheria. The discovery is made commonly after the child has been spreading infection for some days. Do not frighten the youngster, but find out from him what parts of the school-building he has been visiting. Then send him and the other children home. Rooms in which the child has not been are not infected, and only that which he has touched is infected in any case. Wet everything in the building and outhouses with which he possibly could have come in contact with the acid b.i.+.c.hloride. Burn his books and papers, or, if this action may cause difficulty with parents, let him take his books home and inform the health officer of that fact. When he returns to school be sure of the history of his books. Use formalin or sulphur in the infected rooms, and cla.s.ses may be begun again the next day. If within the week any child shows signs of sore throat send it home immediately.

Sulphur must be burned when used as a disinfectant, and to be effectual four pounds should be burned for every 1000 cubic feet of air-s.p.a.ce in the room. A teaspoonful of sulphur when burned will fill a house with choking, dangerous fumes, but two pounds of sulphur burned in an ordinary bedroom will have no effect whatever on the diphtheria bacillus and very little on any other disease. Sprinkling disinfectants about a house, and setting saucers containing disinfectants in rooms is nonsense--the quant.i.ty must be sufficient and be in actual contact with the contagion. A deodorant does not disinfect because it removes a stench.

To burn sulphur set a coal-hod or an old tin pan on two bricks in the middle of the room, but see that there are no {197} holes in the bottom of the hod or pan through which burning sulphur could drip to the floor. For a like reason see that the pan is not too narrow nor too shallow. It is safer to set the bricks in a tub filled with water up to the top of the bricks. Use powdered sulphur in preference to the cakes sold by the druggists, and fire this sulphur with a red coal.

The room should be moist with steam when the sulphur is set afire so that the fumes will act effectually. Leave it shut tightly for twenty-four hours.

In the Northern States diphtheria is most prevalent in October, November, and December; scarlet fever is an April disease, but it may occur at any time. It is easier to spread the infection of scarlet fever and measles than that of diphtheria, but it is not so difficult to disinfect after scarlet fever and measles as after diphtheria. The contagion of scarlet fever does not resist the fumes of sulphur or formalin. Disinfect a room after scarlet fever as for diphtheria but be sure to use also either sulphur or formalin because the contagion can float about a room. Eruptive contagious diseases like scarlet fever, smallpox, and measles so affect the skin that during convalescence the cuticle scales off. In severe cases of smallpox and scarlet fever the entire outer skin of the hand may peel off like a glove. The contagion is always found in the scaling skin. As the patient grows stronger the scales become finer, until at last they lie as mere mealy dust in the hollows of the elbows or other parts of the body. Down to the very last these scales are infectious, and they will retain the infection for months, probably for a year or more. The scales float in the air of a sick-room, fall on the clothing of visitors, are carried away by the shoes of those that leave the room.

The scaling may continue for three weeks--it commonly does. These three diseases are infectious before the scaling begins, sometimes before the rash is well out. A very light attack of any of these diseases in one child may infect another fatally. Insist upon keeping a scarlet fever or measles patient out of school until all scaling has ceased.

Chickenpox is almost a harmless disease, but it is more infectious than even measles. Be cautious with it because {198} nearly every epidemic of smallpox begins through some one mistaking smallpox for chickenpox, although there is little or no similarity between the diseases.

A child with tuberculosis of the lungs or a child infected with acute syphilis should not be permitted to go to school under any circ.u.mstance.

In the chapter on The Priest in Infectious Diseases will be found an account of the necessity of vaccination as a precaution against smallpox.

Tinea Favosa, or favus, is a contagious and a very stubborn disease of the skin, caused by the fungus _Achorion Schoenleinii_. It produces yellowish crusts about the hairs of the scalp and other parts of the body, and it destroys the hair. It attacks also the finger-nails and the skin that is without hair. In the later stages of the disease there is a foul odour. It is one of the most difficult of the scalp-diseases to cure; months and sometimes years are required to get rid of it.

A child with tinea should be kept away from school; and his desk and what he touches should be washed with the b.i.+.c.hloride of mercury solution. Burn his books and papers.

Ringworm is a kind of tinea, and it is caused by various mould fungi.

Tinea Tonsurans is ringworm of the scalp; Tinea Circinata is ringworm of the body; Barber's Itch is another form; there is also a ringworm of the finger-nails; and Pityriasis Versicolor is still another form.

All are contagious, and some are difficult to cure because the parasite gets down between the skin and the hair-follicles and an antiseptic can not reach it. Children affected with these diseases should be kept away from school until they have been cured.

The presence of lice and of the Acarus Scabiei can bring about acute and severe skin eruptions. The Acarus Scabiei causes itch, but fortunately it is rare in America. These parasites go from person to person, hence a child having either should be kept from school until he is clean. A thorough was.h.i.+ng will remove lice if they have not yet inflamed the skin, but itch requires a more vigorous {199} treatment.

The desks of such patients should be disinfected and their clothing should be baked. They will probably be reinfected at home if the treatment is not applied to other members of the family.

Contagious Impetigo, or porrigo, as it was formerly called, is a skin disease common among children, and it may affect adults. It appears to be of parasitic origin, but the specific organism that causes it has not been isolated. The lesions in this disease are commonly discrete--separate one from another--but they may be crowded together.

They are vesico-pustular and they are sunken at the top in the typical form. If they are not broken by scratching, they dry into a yellowish crust. The disease affects only the skin, but as it is contagious a child affected with it should be kept from school until cured. The desk and articles used by the child should be disinfected, and his books are to be burned.

Whooping-cough is very infectious, and, contrary to the popular opinion, it is frequently a fatal disease. There is a period of incubation for from seven to ten days, then a catarrhal stage follows in which the child has the symptoms of an ordinary "cold." In about another week the dry cough becomes paroxysmal with the characteristic "whoop" when the air is drawn in after the fit of coughing. When there is an epidemic of whooping-cough, children with "colds" should be sent home from school. The objects used by a child that has whooping-cough should be disinfected, and its books and papers are to be burnt.

Mumps can be a serious and a very painful disease and it is infectious to a marked degree. The specific organism is not known. Boys are more liable to this disease than girls are, and recurrence is rare. After a period of incubation, which lasts from two to three weeks, there is fever, pain under one ear, and the parotid gland swells. The disease is commonly mild, but it may affect a child seriously. The patient is to be quarantined, what it has touched should be disinfected, and its books are to be burnt.

There are a number of infectious eye diseases that occur among school-children. Acute Contagious Conjunctivitis, {200} or "pink eye,"

is one of the most important. One form of acute Contagious Conjunctivitis is caused by the Koch-Weeks Bacillus; it is "pink eye,"

properly so called, and it is very infectious. Objects handled by the patient can infect others and spread the disease. The attack is severe, but the prognosis for full recovery is good. The child should be strictly quarantined until all secretion from the eyes has ceased, and whatever he has touched is to be carefully disinfected.

Another form of Acute Infectious Conjunctivitis, less contagious than that caused by the Koch-Weeks bacillus, is brought about by the introduction into the eye of the bacteria that give rise to pneumonia.

Commonly the pneumonia bacteria do not cause conjunctivitis unless the patient is susceptible in a special manner. As it is difficult to differentiate this second form from the first, the same precaution should be used.

Trachoma, called also granular conjunctivitis, Egyptian ophthalmia, and military ophthalmia, is a very serious inflammatory disease of the external eye which has of late years become prevalent in American cities, whither it has been brought by immigrants from eastern and southeastern Europe. Persons that have this disease on landing in the United States are deported, but despite this precaution it has crept in and is now endemic. It is contagious, and when well established it is extremely difficult to cure. If untreated it lasts for years and it may destroy the cornea and consequently the sight. A trachomatous child should be kept from school until it has been cured, and that cure will take a very long time.

The Gonococcus can be carried into the eye by handling objects like soap, towels, wash-basins, which have been used by persons afflicted with gonorrhoea. The infection of the eye is very severe and dangerous, and the usual quarantine is to be observed. The ophthalmia of the new-born is gonorrhoeal.

The Diphtheria Bacillus also may get into the eye, and set up a primary infection there. A membranous conjunctivitis, too, is at times induced by pus organisms. {201} Xerosis Epithelialis, tuberculosis, leprosy, and syphilis may affect the eye primarily, and additional forms of eye-diseases are found that are infectious. The general rule, then, is that children with any inflammation of the eyes are to be kept out of school until a physician p.r.o.nounces them harmless.

AUSTIN oMALLEY.

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XVI

SCHOOL HYGIENE

Priests have to put up buildings for parochial schools, colleges, seminaries, orphan asylums, convents, and the like, but in such work sanitation is commonly given only a pa.s.sing thought in connection with sewer-traps and these are left to the wisdom of a plumber. The physical welfare of youth is almost as important as its mental training, and there are many factors beside sewer-traps involved in the effort to sustain it.

If there is freedom of choice as regards the site of a schoolhouse or similar building, the top of a small elevation is to be selected. Such a position affords the best natural drainage, removes dampness, avoids inundations, gives full sunlight and the purer air. The top of a high hill may be too exposed to the wind.

Next to the top of a knoll, the southerly slope of a hill is to be chosen. The building should not be overshadowed by a hill, especially on the western side. Trees are not to be planted close to a building in which children live, and ivy and similar plants should not be permitted to cover the walls.

If a building is set in a hollow it will be surrounded with chill air and mists in the cold seasons, even if a costly drainage system keeps the cellar and bas.e.m.e.nt dry.

A gravelly or sandy soil beneath a building is the best, provided this soil is not already saturated with organic matter, or is not close above a dense layer of clay or rock. Clay, marl, peat, and made soils should be avoided if possible, because they are full of organic matter; they are cold, and they infect the ground air. Rock does not make a good building site--its seams carry water.

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The subsoil should be drained four or six feet below the cellar floor, and this floor is to be laid in concrete and cement. At the level of the ground there should be a course of hollow vitrified brick to exclude dampness and to give ventilation.

Limestone walls conduct more heat in and out than an equal thickness of gla.s.s, bricks, plastering, and wainscoting. The porosity of the building material determines the interchange of the air through the walls, and it affects the temperature of the rooms. If there is water in the pores of the walls heat is conducted rapidly, but air is not permitted to pa.s.s. Brick as a building material has many disadvantages, but on the whole it is best for schools, and it resists fire better than most stones. The harder the brick the better it is--vitrified brick is the best. Hard-pressed brick of a light colour makes an excellent outer wall-surface.

It is very doubtful that sewer gas escaping into a house will directly carry the micro-organisms of diseases like typhoid and diphtheria, but such gas is poisonous, depressant, and it renders the inmates of a house liable to disease; lessens their power of resistance. The typhoid bacillus and other bacteria can, of course, be carried into a cellar by the seeping in of drainage water. Infants kept in the upper story of a house in hot weather are more liable to intestinal diseases than are those that live on the lower floors, but here the weakening agent is heat. Tuberculosis, scrofula, rheumatism, neuralgias, bronchial, and kidney affections are made worse in damp houses.

The chief defects in plumbing and drainage are the following: (1) Earthen pipe drains become broken or their joints leak, and they saturate the ground under a house with sewage. (2) Tree roots break and clog drain pipes. (3) The pipes sometimes have not fall enough.

(4) Drains without running traps admit sewer gas. (5) Rats burrow along a drain pipe from the sewer into the house and admit sewer gas.

(6) When the soil pipe from a water-closet is exposed in cold weather it may freeze up or be clogged by urinary deposits. (7) Rats gnaw through lead pipes and joints. (8) Two or more closets or sinks with unventilated {204} traps on the same pipe will siphon back sewage. (9) Overflow pipes sometimes have no traps and they let in gas. (10) Ash pits near a house carry moisture to walls, (11) Cesspools leak through the soil.

In planning a school-building the cla.s.srooms and the study-halls are the first things to be considered. The cla.s.srooms should be oblong, with the aisles running lengthwise. Each child should have at the least 15 square feet of floor s.p.a.ce and 200 cubic feet of air s.p.a.ce. A room 30 by 25 feet with a ceiling 13 feet from the floor will serve for 48 pupils and no more. This is the best size for a room when blackboards and maps are used in teaching, because a larger room sets the children in the back seats too far away to see without eye-strain.

Dormitories should have at the least 300 cubic feet of air s.p.a.ce for each child, and great care is to be taken in the ventilation. Children about 10 years of age require 11 hours of sleep; under 13 years, 10-1/2 hours; under 15 years, 10 hours; under 17 years, 9-1/2 hours; under 19 years, 9 hours. Do not make children get out of bed before seven o'clock in the morning; do not let them study before breakfast, and do not force them to work after half-past eight or nine o'clock at night until they are at the least 17 years of age. The hours for work should be: