USA > Massachusetts > Norfolk County > Norwood > Norwood annual report 1895-1899 > Part 18
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Section 7. All owners of buildings or premises of whatever. description, or their authorized agents, are hereby notified that all such buildings and premises must be cleansed from all nui- sances, sources of filth, and causes of sickness, on or before the thirty-first day of May of the present year. Non-compliance with the above notice will be construed by the Board of Health as a refusal, and the Board, when satisfied upon due examination that any nuisance, source of filth, or cause of sickness does exist, may cause the same to be removed, and all expenses incurred thereby shall be paid by the owner, occupant or other persons, who caused or permitted the same. All complaints to the Board presented in writing, duly signed, will be eonsidered confidential, and receive attention in due course. Anonymous communications. will not be recognized.
Section 8. No person shall remove or carry in or through any of the streets, lanes, courts, or avenues within the town of Nor- wood, the contents of any cesspool, vault, or privy vault, or- deposit the same within the limits of the town, without permis- sion from the Board of Health, or under restrictions of Section 1, as above.
EXTRACTS FROM THE STATUTES CONCERNING CONTAGIOUS DISEASES.
When a householder knows that a person within his family is sick of small pox, diphtheria, scarlet fever, or any other disease dangerous to the public health, he shall immediately give notice thereof to the Selectmen or Board of Health of the town in which he dwells, and upon the death, recovery, or removal of such person, the room occupied and the articles used by him shall be disinfected by such holder in a manner approved by the Board.
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of Health. Any person neglecting or refusing to comply with either of the above provisions shall forfeit a sum not exceeding one hundred dollars.
EBEN C. NORTON, M. D., GEORGE HILL, FRED E. COLBURN, Board of Health of Norwood.
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A CIRCULAR
OF THE
STATE BOARD OF HEALTH RELATIVE TO TUBERCULOSIS OR CONSUMPTION
AND THE
BEST MEANS FOR PREVENTING IT.
The object of the State Board of Health in issuing the following «circular is to furnish information (1) as to the nature of pulmonary con- sumption, (2) the conditions which favor its spread, and (3) the best methods of preventing it.
1 .- AS TO THE NATURE OF CONSUMPTION.
Consumption is the most destructive disease of New England, the number of persons annually dying from this cause in Massachusetts amounting to nearly six thousand. Modern research places it among infectious diseases.
The specific virus or poison of the disease consists of a minute germ, the " bacillus of tuberculosis," which exists in the tissues and expecto- ration of the sick, and which may in various ways enter the bodies of the well and reproduce the disease in them. In the proper care and disposal of the expectoration of the sick, it is probable, lies one of the chief methods of preventing the spread of the disease.
2 .- CONDITIONS WIIICHI FAVOR THE SPREAD OF CONSUMPTION AMONG HUMAN BEINGS.
Defective ventilation. One of the chief conditions which is favorable to the production of consumption is the continuous and habitual breath- ing of unrenewed air. Consequently, in workshops, factories, school rooms, public buildings, halls, churches, and the inhabited apartments of dwellings and tenement-honses the absence of adequate means of ventilation favors the spread of consumption.
Dampness of soil on which the house stands, and dampness of the immediate neighborhood are favorable conditions for the production of consumption. The occupancy as living or sleeping rooms of apartments which are constantly damp or are partly or wholly underground, un- ·doubtedly has a similar effect.
Overcrowding in dwellings, in factories, and in workshops where men and women work for several hours each day, is also a favorable
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condition for spreading the disease. Density of population increases the liability to this disease. Observations in Massachusetts extending over a period of twenty years (1871-90) show that the deaths from con- sumption in densely settled districts, as compared with those in sparsely settled districts of the State stood in the ratio of 1,000 deaths in the former to 727 in the latter.
Another factor which favors the spread of this disease is the pres- ence of dust in the air of apartments, factories, mills and workshops. Hence occupations or trades in whichi men, women or children are exposed to the inhalation of irritating dust increase the liability to. contract the disease among such operatives. An examination of the reports of the Registrar General of England for several successive years shows that fishermen, who are of all classes the least exposed to dust. inhalation, are also comparatively exempt from consumption.
Insufficient and badly selected food. While the influence of improper and insufficient feeding upon the predisposition to consumption is not. so directly proven as are the effects of certain other conditions, there is yet sufficient evidence to show that a restricted diet or one composed exclusively of single elementary constituents, as for example, the starches alone, and these in too limited quantities, probably predisposes to consumption.
Intemperance in the use of alcoliolic stimulants has also been shown to act in the same direction.
Undue physical or mental strain, overwork, worry and anxiety, and the prolonged suckling of infants (beyond ten or twelve months). are conditions contributing to the same end.
3 .- PREVENTIVE MEASURES.
Having the foregoing predisposing conditions in view, tlie measures which are essential for the prevention of this disease may be more clearly understood.
1. The prevention of overcrowding. In tenements and in dwelling- houses the prevention of overcrowding diminishes the liability to con- tract tubercular diseases among the occupants.
Hence the adoption of measures which shall counteract the effect. of overcrowding is desirable. Ventilation is one of the most efficient of such measures. Adequate ventilation should be provided in all fac- tories, halls, schoolhouses and other buildings in which people assemble in considerable numbers. Simple methods of ventilation in the living and sleeping rooms of dwellings are also essential to healthy living. Open fireplaces, movable transoms in sleeping rooms, provision for admitting fresh air at the windows by special mcans are all useful pre- cautions.
2. Household as well as personal cleanliness is essential to the pre- vention of consumption. The removal of dust from floors should be practised and care should be taken that such dust is removed by such means as will ensure the least diffusion through the air of rooms during their occupancy.
3. Occupations. The selection of a healthy occupation is a matter- of no small importance.
Sedentary occupations in ill-ventilated apartments and those which expose the workmen to the inhalation of dust should be avoided. Different sorts of dust vary in harmful effects. The sharp dust pro- duced in the grinding of needles and steel tools and in the mining of
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metals is especially irritating, and the mortality from consumption among operatives in such industries is high. Operatives engaged in such occupations may diminish the liability to harm by wearing "res- pirators" over the mouth and nose, while at work.
In several factories where consumption had made serious inroads upon the operatives, the adoption of measures for the prevention of a dusty atmosphere secured a marked diminution of the prevalence of this disease among the workmen employed in them.
Regular daily exercise in the open air is of the first importance for all persons who are engaged in sedentary occupations:
The owners and superintendents of factories, mills and workshops can accomplish much toward the prevention of tuberculosis among the operatives by the introduction of adequate systems of ventilation and heating, and by the use of hard, smooth floors without cracks or crevices.
The dust should be removed from the floors at night, after working hours, and not during the occupancy of the workrooms. The use of moisture in the removal of dust, and careful wiping with damp cloths is preferable to sweeping up the dust when dry. Spitting upon the floor should be forbidden.
4. Food. As an essential requisite to the prevention of consump- tion, a diet of sound, wholesome food, in which the chief elementary forms of nutriment are harmoniously combined (the fats, starches and proteids) is necessary. Such a diet should consist mainly of bread and the various cereals with butter and other fats in generous measure, together with meat, fish and fruits. This does not imply a luxurious or expensive diet, but rather one that is nutritious and easily digested.
The question of the effect of the use of the meat and milk of tuber- culous animals does not yet appear to be so well settled as to admit of an unqualified conclusion.
In the absence of absolute and definite evidence, it is therefore de- sirable that the meat of all suspected animals should be cooked thor- oughly before using it as food. The milk of such animals should be entirely excluded from the food supply.
5. Overwork, anxiety, worry and exhaustion should be avoided. Mothers should be advised to wean suckling infants by the end of the first year.
DISPOSAL OF SPUTA.
6. With reference to those who are sick with consumption or tuber- culosis, and especially with reference to the possibility that their pres- ence among other human beings may prove a source of danger on account of infection, the following recommendation as to the disposal of the expectoration of consumptives should be especially noted.
Observation and experiments have demonstrated the fact that in this cxpectoration (especially when dried) lies the chief danger of infection, and hence its proper disposal becomes a matter of prime importance. Therefore, sputa should never be allowed to become dry, and should be destroyed as quickly as possible. Consumptives should be instructed not to expectorate about rooms, in streets or highways, in railway or street cars, or in vehicles of any sort, but should spit into rags which can be burned, or into cups or other receptacles containing a little water or other material which may be thoroughly disinfected before the same is allowed to pass into the drain or sewer. Such receptacles should be cleansed with boiling water.
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A healthy person should not sleep in the same room with a con- sumptive.
DISINFECTION.
7. Sputa may best be burned when deposited upon pieces of cloth or rags; and when put into cups or receptacles holding water the whole should be disinfected with a saturated solution of carbolic acid, which may be obtained of any reliable druggist.
Disinfection should be practised in the case of rooms or apartments which have been vacated by consumptives or those in which such per- sons have died. There is a growing belief, supported by observation that rooms which have been inhabited by consumptive families may be- come permanently infected, and ought not to be occupied until radical measures have been taken to cleanse and disinfect them. Each room vacated by a tuberculous patient should be disinfected and especially the floor and lower parts of the walls. For this purpose washing the floor and all woodwork with a corrosive sublimate solution, one part to one thousand (about one teaspoonful to a gallon of water) should be practised, and the bed and clothing of the last occupant should be sub- mitted to steam disinfection or to boiling water. Strong soapsuds also have efficient disinfecting power, and may be used for washing floors and woodwork. The disinfection should be thoroughly done, but espe- cially so in cases where the habits of the consumptive in regard to dis- posal of his sputa have been careless.
As a means of spreading information upon this important subject, local boards of health can undoubtedly accomplish much toward the prevention of consumption, by issuing a circular like the following :-
THE PREVENTION OF CONSUMPTION.
Consumption is the most destructive disease of New England, the number of persons dying annually from this cause in Massachusetts amounting to nearly six thousand.
The disease is infectious, and can be communicated from one person to another. The chief danger exists in the expectoration of the sick, and if this expectoration is carefully destroyed little danger need be feared.
Consumptives should be instructed not to spit upon the floors of rooms, public halls, street and railway cars, and other vehicles, nor in the streets, but into pieces of clothi, or receptacles made for the purpose, containing water, or a saturated solution of carbolic acid (one part of carbolic acid crystals to about fifteen parts of water). Such bits of cloth should be destroyed by fire, before the sputa becomes dry, and other receptacles should be cleansed with scalding water, their contents having been destroyed or otherwise carefully disposed of. Handker- chiefs which may have been used from necessity should be boiled half an hour before washing.
A healthy person should not sleep in the same room with a con- sumptive.
Remember that sputa must never be allowed to become dry.
OFFICE OF THE STATE BOARD OF HEALTH, BOSTON.
Revised January, 1895.
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SUGGESTIONS
FOR PREVENTING THE SPREAD OF DIPHTHERIA.
REVISED, SEPTEMBER, 1893.
A Circular from the State Board of Health.
Diphtheria is a disease of undoubted infectious character. It is communicable either directly by the patient suffering with it, or it may be transmitted through the medium of a third person, or by clothing, or other infected material. The conditions which apparently favor the spread of the disease are, in general terms, infected persons, over- crowding, insufficient ventilation, filth, and possibly polluted water and milk.
Whether or not diphtheria is another form of the disease which is usually called membranous croup, it is certain that the two cannot always be distinguished, and that what had been supposed to be the milder dis- ease has been the means of communicating the most virulent diphtheria. All cases of diphtheria and croup should therefore be treated by the healthı officer with similar precautions.
It is thought that closer contact with the air, person or thing in- fected is necessary in order to produce the disease than in the case of small pox, scarlet fever and measles. The discharges and exhalations from the throat, nose and mouth are particularly dangerous.
The means of transporting the contagium of diphtheria may be furnished by anything that has come in contact with an infected person or object, -air, food, bed and personal clothing, currency, hair. furniture, toys, library-books, wall-paper, curtains, domestic animals, etc.
The period of incubation, from exposure to the time when the symp- toms manifest themselves, varies from several hours to two weeks. The average time is variously given from two to five days.
A physician's certificate of the patient's recovery from diphtheria should always be obtained before attendance at school is resumed by the patient or any member of his household.
It would be well to designate every house where diphtheria exists by some mark sufficient to give the proper information. This plan has been adopted by many local boards with excellent results.
The first principle of treatment is isolation, which can best be ful- filled in a hospital, provided the patient can go there. Otherwise he should be placed in a room as much separated from the rest of the house as possible, and communication with other members of the household should be suspended. If an outward draught of air from the sick-room to the entry exists, a curtain may be formed by a sheet over the door, moistened with a solution of corrosive sublimate .*
* A solution of corrosive sublimate (1 part to 1,000 of water) is recommended by the Committee on Disinfectants of the American Public Health Association for the disinfection of sick-rooms, for disinfecting the walls and wood-work.
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The sick-room should be well-warmed and should be ventilated,- the best inethod being by an open fire-place with a fire or a lamp in it. The room should be cheerful, open to the sun, free from noise, dust, etc., and not " aired " by cold draughts, which are often dangerous. No at- tempt should be made to disinfect the sick-room while it is still occupied by the patient, since it is doubtful whether any disinfectant can be safely employed for this purpose during the occupancy of the room.
Carpets, upholstered furniture, window hangings, and indeed all unnecessary objects (especially those of woollen), which cannot be readily destroyed or disinfected, should be removed from the room. Bits of carpet may be used as rugs, to be burned after the need for them has passed.
Attendants on the sick should be as few as possible, and should not communicate with other persons any more than necessity requires. They should wear only such clothing as may be readily washed. Clothes used in the sick-room should be boiled before being worn elsewhere. Gargling or washing the mouth occasionally with a cleansing fluid is a useful measure for those who must be exposed to contagion.
After recovery, the patient should not mingle with other persons, or use lounges, carriages, public rooms, etc., liable to be used by others, until he has quite recovered and until he has taken warm baths.
After the sick-room is no longer needed as such, all the clothing and other matters used in it that can be washed should be disinfected or placed in boiling water at least a half-hour; others should be placed in a hot-air chamber or steam disinfecting apparatus, and kept at a tem- perature of 240° F. for not less than two hours. Any articles of trifling value should be destroyed by fire. The room should be closed as tightly as possible, and sulphur burned in it in the proportion of three pounds to each thousand feet of air-space; it should be kept closed twelve hours and then opened for several days to the air and sunshine. The floor and wood-work should then be thoroughly washed with soap and hot water. Scraping and re-painting would not be considered an excess of caution in time of epidemics; the wall-paper should then be soaked with a five per cent. solution of carbolic acid, removed and burned, and the ceiling should be washed with soap and hot water, or scraped. Fresh air and an abundance of soap and water are among the best disinfectants.
Should the patient die, the body ought not to be removed from the sick-room until it has been tightly sealed in the coffin, with quick-lime, chloride of lime, or some similar agent. The funeral should be strictly private, and not attended by children.
The infectious principle of diphtheria may be conveyed in filth either in contaminated water-supplies or foul air from privies, cesspools, sink-spouts, unventilated soil pipes, drains or water-closets, etc. Perfect cleanliness should therefore be enjoined. Sewer-gas, of course, is a kind of filth which may bring to a person's chamber, if it has access thereto, the contagium brought from another and infected chamber. Overcrowd- ing is one of the most active ways of propagating contagious disease.
The discharges from the throat, nose and mouth of the patient should be put in a vessel containing a strong solution of some disinfect- ant, and the vessel should be frequently washed with hot water; they should not be received upon anything which is to be kept. Pieces of soft cloth may be used in place of pocket-handkerchiefs, and then at once burned. "The breath should be kept as pure as may be by cleansing gargles and washes for the mouthi (chlorinated soda, permanganate of potash, etc.). The discharges from the kidneys and bowels should be
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disinfected with a strong solution of chloride of zinc or a solution of bichloride of mercury, one part to a thousand of water. Carbolic acid may be added as a disinfectant to the slops, and to the water in which the patient has washed or bathed, before throwing it out. The bed- clothes, towels, etc., when soiled, should be removed with proper care, placed in a hot disinfecting solution, and be boiled for not less than half an hour. The food left uneaten should never be carried where it may infect other persons.
In our State the law gives to each local board of health full author- ity to take every step that is needed in the preventive measures to be adopted in case of diphtheria.
Attention is called to the following statutes enacted in 1884 and 1891, which provide definite and specific requirements in relation to this disease :-
[CHAP. 64, ACTS OF 1884.]
AN ACT to prevent the Spread of Contagious Diseases through the Public Schools.
Be it enacted, etc., as follows:
The school committee shall not allow any pupil to attend the public schools while any member of the household to which such pupil belongs is sick of small pox, diphtheria or scarlet fever, or during a period of two weeks after the death, recovery or removal of such sick person. [Approved March 7, 1884.
[CHAP. 98, ACTS OF 1884, AND CHAP. 188, ACTS OF 1891.] AN ACT concernnig Contagious Diseases.
Be it enacted, etc., as follows :
SECTION 1. When a householder knows that a person within his family is sick of small pox, diphtheria, scarlet fever or any other disease dangerous to the public health, he shall immediately give notice thereof to the selectmen or board of health of the town in which he dwells, and upon the death, recovery or removal of such person, the rooms occupied and the articles used by him shall be disinfected by such holder in a manner approved by the board of health. Any person neglecting or re- fusing to comply with either of the above provisions shall forfeit a sum not exceeding one hundred dollars.
SECT, 2. When a physician knows that a person whom he is called to visit is infected with small pox, diphtheria, scarlet fever or any other disease dangerous to public health, he shall immediately give notice thereof in writing, over his own signature, to the selectmen or board of health of the town; and if he refuses or neglects to give such notice he shall forfeit for each offence not less than fifty or more than two hundred dollars.
SECT. 3. The boards of health in the several cities and towns shall cause a record to be kept of all reports received in pursuance of the preceding sections and such record shall contain the names of all persons who are sick, the localities in which they live, the diseases with which they are affected, together with the date and names of the persons reporting any such cases. The boards of health shall give the school committee immediate information of all cases of contagious diseases reported to them according to the provisions of this act.
SECT. 4. The secretary of the Commonwealth shall furnish the
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boards of health with blank books for the record of cases of contagious diseases as above provided.
SECT. 5. Sections seventy-eight and seventy-nine of chapter eighty of the Public Statutes are hereby repealed. [Approved March 21, 1884. Amended by Chap. 188, Acts of 1891.
The Board of Health of Boston at present requires that cases of small pox, scarlet fever, diphtheria, membranous croup, typhoid fever, measles, cholera and typhus fever shall be reported to it. Sufficient power is given to school committees, as well as to boards of health, to restrict the attendance at school of children from infected houses.
These rules for the prevention of diphtheria should be carried out under the direction of physicians or boards of health.
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DISINFECTION.
So far as diphtheria is concerned, it is believed that moisture renders low organisms and their "germs" or spores more readily destructible. by chemical means.
Effective disinfection by burning sulphur requires three pounds to- each space of one thousand cubic feet. The sulphur should be broken in small pieces, burned over a vessel of water or sand, so as to avoid danger from fire, and, if the room is large, it should be put in separate vessels in different places. The room should be tightly closed for twelve hours and then aired; it is better that the room should be warm than cold, and the air of the room should be moist when exposed to the fumes of sulphur. Most articles may be disinfected if hung up loosely in a room, although it would be an additional safeguard to expose anything thick, like a bed mattress, to prolonged heat at a temperature of about 240º F .; and, indeed, heat and steam must, with our present knowledge, be considered the best disinfectants. With this end in view, local boards of health are advised to procure disinfecting appa- ratus and laundries, as is commonly done in other countries, to be used for the sole purpose of disinfecting articles which have been exposed to the infectious diseases.
Recent observations show that a solution of bichloride of mercury (1 part to 2,000) acts with great efficiency in destroying bacteria which have been placed in it. A solution of chloride of zinc (1 part of liquor zinci chloridi, U. S. P., to 200 of water) also serves a similar purpose, but with less efficiency. Caustic lime serves well, prepared after the ordinary method of making whitewash, and may be used for the disin- fection of excreta or for the drenching of asphalt, concrete and cement floors. Carbolic acid is in sufficient strength to be effective in the pro- portion of 2 parts to 100 of water for the disinfection of clothing, and in the proportion of 5 parts to 100 for the disinfection of excreta. The waste chlorides of commerce may also be used. There can be no better auxiliary to local boards of health than an efficient stationary or portable disinfecting apparatus .*
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