MEMCAL SOCIETY OF NOVA SCOILL 
11 E P O R T 
UPON 
The Preventive Measures 
TO BE USED IN 
LIMITING THE EXTENSION 
OF 
DIPHTHERIA 
WITHIN THE PROVINCE 
HALIFAX, N. S.: 
Robert T. Murray, Queen’s Printer. 
1879. REPORT. 
Recognising the great mortality caused by Diphtheria, and its con- 
tinued existence in this Province, the Medical Society of Nova 
Scotia, as the representative of the regular profession of medicine, 
in the absence of any body legally authorized to enforce 
sanatory measures, deeming it to be its duty to furnish such recommen- 
dations as are desirable and necessary for the conservation of the 
public health, upon due consideration, by an unanimous vote passed at 
its Annual Session held in the City of Halifax, June 19th, 1878, ap- 
pointed, and empowered a committee of its body to prepare, and 
furnish for the guidance of the Provincial Government, and of the 
general public, a special report, which would convey an authoritative 
expression of the society’s opinion, as to the direct contagiousness of 
Diphtheria, and of the measures which it recommends for adoption, in 
order to mitigate the severity, and if possible limit the extension, of the 
disease. 
In furtherance of this object, after due consideration upon many 
questions relating to the natural history, propagation, and treatment 
of Diphtheria, having also taken a comprehensive review of the sana- 
tory measures which may modify or arrest its spread, the committee 
prepared and now submit the subjoined report:— 
Diphtheria is like smallpox, a contagious disease, and is Con^f*ous' 
propagated by the contact of healthy persons with those 
who are affected. The contagion of diphtheria, like that of 
small pox, attaches itself to clothing, bedding, furniture, and 
other articles, rendering them capable of conveying the 
disease. 
It may be communicated also by attendants or visitorsMeana of con 
who neglect taking the necessary precautions for the purifi- veyance- 
cation of their clothing or persons after contact with the 
disease. 
It must be remembered also that persons who have had Conr»ieacenla. 
diphtheria, may during their convalescence communicate the 
disease to those who are in health. 4. 
Causes that in- 
crease the': 
spread. 
Contamination, 
of drinking 
water. 
Contamination 
of air. 
Overcrowding. 
Sewer gases. 
Contamination 
of milk, etc. 
No specific. 
The necessity 
for medical 
opinion 
Separation of 
the sick. 
Furniture. 
Ventilation. 
Heating. 
Cleanliness. 
Destroying 
articles 
used about the 
; sick. 
The spread of diphtheria is favored by such insanatory 
conditions, as the contamination of drinking water, by 
leakage or soakage from drains, privies, sinks, and other 
places for the reception or carrying away of filth, into 
springs, streams, wells, or other sources of water supply. 
Also by the breathing of air impregnated with effluvia from 
decomposing vegetable and animal matter, in sewers, cess- 
pools, slaughter 4 houses, barn-yards chip-yards, cellars, etc. 
In cities and towns by the overcrowding in tenements, by 
imperfectly constructed water closets, untrapped and un- 
ventilated house drains admitting the return of sewer 
gases into dwellings and apartments. Finally it may be 
remarked, a possible means of contagion may be found to 
exist in milk supplied from sources where diphtheria is 
prevalent. The following recommendations are deduced 
from the foregoing, and must be regarded as being both 
simple and practicable when compared with the evil which 
their object is to counteract. 
As there is no medicine or drug possessing’ or known to 
possess a specific curative effect upon diphtheria, and as each 
case may develop in its course symptoms more or less pecu- 
liar to itself, “ which will require special observance. and 
care,” it becomes the first and most obvious duty of all 
heads of families etc., upon the least suspicion of an attack, 
to avail themselves at once of the services of their medical 
adviser, and not as is too often the case, delay calling upon 
him until the disease has had time to attain such progress 
as to elude his skill. 
Recognizing the contagious nature of diphtheria, persons 
attacked with the disease must be immediately separated 
from those in health. Where practicable a large well-lighted 
upper room should be selected for their reception, and car- 
pets, bed, and window curtains, with other unnecessary fur- 
niture, should be removed. 
The air must be constantly changed by the admission of 
fresh supplies through open windows. This must be done in 
winter as well as in summer, and is never attended with 
danger when the room is kept warm and the patient pro- 
tected from draughts. 
The sick should be kept clean, and sheets and body-linen 
frequently changed. 
All cloths, rags, brushes and other articles used for 
cleansing the diseased surfaces of the patient, or for receiv- 5. 
ing discharges therefrom, must be destroyed by being burnt. 
This should be enforced with great rigidity, as such articles 
can spread the disease. 
All excreta must be removed at once from the sick room 
and in no case should these discharges be emptied into sinks, 
cesspools, drains, ash heaps, or upon the ground, without 
being thoroughly disinfected. 
Young persons, being more liable to take the disease than 
those of middle or advanced age, should not be selected as 
attendants. 
Attendants or nurses should take extra care in regard of 
cleanliness, food, and rest, that it may enable them to resist 
an attack. They should refrain from visiting friends, etc., 
and from attending churches or public gatherings. When 
going out for exercise, etc., they should previously take 
extra care so to purify themselves from contagion as not 
to be the media for infection. 
Members of the family or friends not required to act as 
nurses, should be excluded from the sick room. 
Convalescents or persons recovering from the disease being 
for a variable time liable to infect persons in health, com- 
munication should not be allowed until deemed safe by the 
medical attendant. 
When death from diphtheria occurs, the body should be 
speedily interred. Tne visiting of remains and holding 
wakes require striet prohibition. 
Wearing apparel, bedding, furniture and utensils used in 
the sick room, should be cleaned and disinfected before be- 
ing used. The room should be also cleansed, disinfected, ven- 
tilated and unoccupied for some time. 
These precautions are chiefly applicable to the cases of 
disease occurring in families, and if followed faithfully will 
limit its spread. Heads of families should also take steps to 
remove from their dwellings, etc., all the insanatory condi- 
tions that favor the spread of this disease. As however 
there are in all communities persons who, either from ignor- 
ance or carelessness, will not observe the sanatory obligations 
which they owe to their neighbors: 
It becomes the duty of the governing bodies both general 
and local to take upon themselves the supervision and 
enforcement of all measures which are necessary for the 
Treatment of 
excreta. 
Attendants 
age, etc. 
Carefulness 
on part of 
nurse 
required. 
Visitors to 
sick. 
Conveyance 
by conval- 
escents. 
Cases of 
death, 
disposal 
of body. 
Disposal of 
furniture, etc. 
Steps which 
should be 
taken to re- 
move insana- 
tory condi- 
tions. 
Duty of gov- 
ernment 
general and 
local. 6. 
protection of the public health. It is therefore recommended 
that such bodies, in every instance where diphtheria has 
attacked or threatens to attack a community or district, do 
institute a searching investigation into their drinking water 
for evidences of pollution. The topographical relations of 
wells, streams, springs, etc., to such possible sources of 
contamination as leakage, soakage, or overflow from drains, 
privies, compost heaps, slaughter houses, or from 
pastures or manured lands, should be enquired into. If 
pollution is discovered, everything practicable should be 
done to prevent its continuance, or if it cannot, the water so 
contaminated should not be used either for culinary or 
drinking purposes. 
All sewers, house and surface drains should be inspected, 
and defects remedied. When practicable, they should be 
flushed with water, and constant attention given to their dis- 
infection. Sewers should be ventilated, and house drains effici- 
ently trapped, to prevent accumulation of sewer gases and 
their entrance into dwellings. In the city the practice of 
allowing privies and water closets to discharge their 
contents into the surface drains should be abolished, it being- 
productive of so much injury to public health. 
Special attention should be given to the construction of 
water closets. Those most in use, though well adapted for ordi- 
nary purposes, yet fail to prevent the return of foul air into 
the dwelling. To obviate this evil, the basins, syphons, and 
traps should be inspected by competent persons, who shouldsee 
that these are constructed, and set in place so as to prevent 
the leakage of gaseous matter inwards. Efficient ventilation 
of the outlet pipes should be also required and in no instance 
should the disinfection of these receptacles be neglected. 
Immediate and thorough removal of every sort of house 
refuse and other filth which has accumulated in, about, or 
under houses, or in neglected places, should be carried out, 
and further accumulations of the kind prevented, and lime 
washing of uncleanly premises should be frequently practised 
When diphtheria manifests itself in any house or dwell- 
ing, the children of all families living therein should be ex- 
cluded from the public schools during the time of its preva- 
lence. When the disease becomes epidemic in any locality 
or district, the schools should be promptly closed. 
People having diphtheria in their houses should not have 
books from public or circulating libraries, as these books 
passing subsequently to other households may become a 
means for conveyance of the disease. 
Enquiry’into 
condition 
of potable 
water. 
Pollution pre- 
vented. 
Treatment of 
sewers, etc. 
Excreta in 
street drains. 
Water 
closets, etc. 
Removal of 
refuse. 
] 
i 
Public schools. 
i 
] 
( 
Libraries. 7. 
Tailoring, dress-making, laundry work or any similar oc- 
cupation or work done for the public, should not be carri- 
ed on in houses where the disease exists, nor by employees 
who are exposed to infection. 
It should be the duty of local governments and officers of health in 
the city and iD towns throughout the Province to mitigate the insana- 
tory conditions resulting from overcrowding in tenement courts, 
allevs, and cellar habitations, by limiting the number of inhabitants 
in tenement houses, &c., by preventing under a penalty imposed up- 
on landlords, the letting or renting of cellar or underground apart- 
ments for human habitation, by frequent and thorough inspection of 
all such places, by enforcing the observance of cleanliness upon 
landlord and tenant, by removing and preventing the accumulation 
of garbage, &c., and special care should be taken to prevent the peo- 
ple from depositing slops “ often containing discharges from the sick ” 
in the stieets and passages in the vicinity of their dwellings. 
The committee also directs attention to the evil of locating dwell- 
ings, with almost total disregard of their sanatory necessities, as be- 
ing of too common occurrence in this Province. The dangers which 
have already resulted from this will be necessarily augmented by 
increased population unless measures are taken for its abatement. 
In selecting sites for dwellings it is obvious that in all low, and 
marshy places, where the subsoil is wet constantly, and efficient drain- 
age unattainable, the whole soil will in time become saturated with 
organic matter giving off vapors which will injure the health of the 
inhabitants, and render them more susceptible to the inroads of 
Zymotic diseases. 
The danger resulting from close proximity of stables, pigerries, hen- 
erries, compost heaps, &c., to the dwelling house andwell, so frequent in 
agricultural districts is surpassed only, by the city practice of utilizing 
the contents of ash-bins, and street sweepings with their contained 
animal, vegetable, and other material for grading public pleasure 
grounds, or what is still worse in a sanatory way, using the same 
kind of material for soil upon which to rear the foundations of 
residences in the healthy suburbs. 
As a way of obviating the above, the committee suggests the 
selection of some competent county official, one of whose duties 
would be that of sanatory inspector. His instructions should em- 
power him to take cognizance of all new erections, “ as to situation, 
drainage, wells for water supply, and other sanatory necessities,” 
and make and enforce such recommendations as are necessary to 
meet the requirements of the case. 
The conveyance of diphtheria by milk can be scarcely called in 
question after recent developments which incontestibly prove the 
transmission of measles, scarlet fever, small-pox, typhus and typhoid 
fevers by this means. In view of these facts the public cannot be 
too careful about enquiring into the sanatory conditions of the source 
of their milk supply. 
. Tailoring and 
dressmaking. 
Laundry 
work. 
. Protection 
from 
overcrowding 
required. 
Inspection of 
tenements. 
Location of 
dwellings. 
Selection o 
sites for 
dwellings. 
Situation of 
outhouses, 
etc. 
Using refuse 
matter for 
filling' 
or grading. 
Local sana- 
tory 
inspectors. 
Precautions 
enquiring 
into sources 
of milk 
supply 8. 
DISINFECTION. 
Disinfection. 
Fumigation 
of furniture 
and rooms. 
In view of the great importance of disinfection as a sanatory 
measure, a few simple but effective rules are recommended, viz:— 
All articles of clothing may be disinfected by placing them in boil, 
ing water and continuing the boiling for some time. Wollens 
may be either fumigated or steeped for a short time in either of 
following solutions previous to being washed. 
Solution 1.—Add eight, ounces of sulphate of zinc and three 
ounces of carbolic acid to three gallons of water, stir briskly until 
they become incorporated. 
Solution 2.—Add two ounces of chlorinated lime to one gallon of 
water and stir. Pieces of muslin wetted -vith either solution should 
be suspended constantly and kept moist in the sick room and ad- 
joining passages. These solutions should be used for disinfecting the 
vessels and utensils used about the patient, and for mixing with the 
discharges. 
The following is the method for fumigating the furniture of the 
sick room as well as the room itself applicable to cases where the 
disease has terminated. Close all the openings and upon a braizer 
or some convenient receptacle containing burning coals throw a few 
ounces of crushed brimstone. The room must be vacated and 
should remain closed from eight to twelve hours. The windows 
may then be opened from outside the house, and some time should 
elapse before any person is allowed to enter therein. After this 
the room should be thoroughly cleansed by scrubbing the floor and 
wall* if painted or removing the paper if papered, the ceilings, etc., 
whitewashed. 
The following solution is recommended for the disinfection of 
water closets, privies, drains, stacks or col'ections of garbage, etc. 
Mix eight pounds of dry copperas and a pint of fluid carbolic acid 
in five gallons of water, and stir the mixture briskly. A pint of this 
should be thrown into every sink and water closet night and morn- 
ing. The proportion to be used for masses of garbage or decompos- 
ir g matter should be one pint of fluid to a cubic foot of the mass. 
Quicklime may be used also for this purpose. 
The people should not lose sight of the important fact that fresh 
air, pure water, and sunlight, constant ventilation and cleanliness, 
are the natural and most rational means afforded us for protection 
from Zymotic or infectious diseases, and time and labor should not 
be regarded as lost, nor expense incurred as being wasted, when 
they are used to obtain this end. 
rD. MeN. Parker. M. I). 
W. B. Slayter, M. 1). 
D. A. Campbell. M. 1). 
John Somers, M. D. 
__ Secretary. 
Committee.