pfi menl> of J. eft'. N(. tD., 
A Com of eKectltli. 
Form 32, 
\ / 1885. 
RESTRICTION AND PREVENTION 
- OF - 
DIPHTHERIA, SCARLET PEVER. MEASLES, 
CHOLERA, 
And other Contagious or Infections Diseases. 
ISSUED BY THE 
Department of Health of Brooklyn, N.Y. 
J. H. RAYMOND, M. D., Commissioner. SANITARY TREATMENT 
Dittm, Scarlet Fever, Measles, Cbolera, Small-Pox, 
AND OTHER CONTAGIOUS OR INFECTIOUS DISEASES. 
Diphtheria, Scarlet Fever, Measles and Small-Pox are 
highly contagious diseases, attacking persons of all ages, 
and may be contracted from those who are already affected, 
from the clothes that they have worn, and from everything 
which has been in the room with them. The infection 
clings to the body even after death, and these diseases 
may therefore be contracted from the bodies of those 
who have died with them. Even the walls of the room 
may be a source of infection to persons coming into 
it after the patient has left it, unless the infectious 
material is destroyed. In order to prevent the spread of 
these diseases in a family or house where they exist, and 
to promote the recovery of the sick, the following simple 
measures should be conscientiously and rigidly carried out, 
thereby preventing much suffering and saving human life. 
An upper, sunny room, provided if possible with an 
open fire-place, and with no children on the same floor, 
should be arranged for the patient by removing everything 
from it which can possibly be spared, such as books,clothing, 
carpets, upholstered furniture, and window curtains ; also 
plants, birds and other pets, remembering that when once 
the patient has entered the room, nothing can with safety 
be removed until disinfected. By thus stripping the room 
of all articles except those absolutely necessary, the subse- 
quent disinfection is much more easily performed. If it is 
deemed necessary, a few small rugs will take the place of 
the carpet. 
Tiie fire-place serves a double purpose: first, as a means of 4 
ventilation and second, by keeping a small lire burning 
therein, when the weather will permit, the pieces of soft 
muslin or other materia], which should always be used in- 
stead of towels or handkerchiefs in wiping the secretions 
from the mouth or nose, especially in diphtheria, can readily 
be destroyed by lire, and thus contagion by their means 
prevented. 
One or two adults should take .the entire charge of the 
patient, under no circumstances coming in contact with 
other persons, especially children. Kissing and ''taking 
the breath"- of persons having contagious diseases are 
especially dangerous, and should always be avoided. Open 
windows and open fire-places, with fire in them day and 
night, avoiding draughts and chilly air, protect the sick and 
those who nurse them. 
Nothing should be removed from the room when the 
patient has once entered it, until it has been thoroughly 
disinfected. 
Books, scrap-books, toys or other playthings should 
always be destroyed at the termination of the sickness, as 
being undoubted carriers of contagion. Locks of hair and 
other keepsakes have also been known to spread contagion. 
Nurses should keep themselves and their patients as clean 
as possible, remembering that the more the infection accu- 
mulates, the more dangerous does it become. Special care 
should be taken in changing sheets and clothing, not to 
shake them or disturb th6m more than is absolutely neces- 
sary to remove them ; as these acts disseminate the parti- 
cles of skin which are removed with them, and which convey 
the germs of disease, they should be removed carefully and 
folded together and immediately disinfected. 
DISINFECTION. 
It is a popular idea that anything which destroys an 
offensive odor is a disinfectant. This is not only erroneous, 
but harmful, as reliance is thus placed on substances that 5 
in nowise act as destroyers of infectious materia], which 
latter substances are the only true disinfectants. The 
methods recommended in this circular are, to a considera- 
ble extent, based upon the results of the work of the Com- 
mittee on Disinfectants of the American Public Health 
Association. 
DISINFECTANTS. 
The agents recommended herein for disinfection are- 
1. Fire. 
2. Boiling water. 
3. Chloride of Lime or Chlorinated Lime, either dry, or in 
solution as Standard Solution No. 1. 
4. Solution of Chlorinated Soda, diluted as Standard 
Solution No. 3. 
5. Sulphur. 
6. Bichloride of Mercury. 
Bichloride of mercury, or corrosive sublimate, a powerful disinfectant, 
is included in the above list for one purpose only ; that is, for the disinfec- 
tion of privy-vaults which contain a large amount of material believed to 
be infected. As this circular is intended for general distribution, the 
writer hesitates to recommend for general use an agent which may, 
through improper use, endanger life. 
Fire.-As already directed, the materials used in wiping 
away the discharges of the sick may be burned in the open 
fire-place, if such there be. In genera], this method of dis- 
posal is to be recommended for all substances which have 
been exposed to infection, which cannot be treated with 
boiling water, and, could it be carried out in all cases, would 
make disinfection a very simple matter. If it is desired to 
burn substances suspected of being infected, and there is 
no fire in the room, such substances may be wrapped in a 
sheet soaked with Standard Solution No. 3, hereafter re- 
ferred to, and in this condition conveyed to the fire in the 
furnace or elsewhere. 
Boiling Water.-Experiment has demonstrated that boil- 
ing in water for half an hour will destroy the vitality of all 6 
known disease germs. This is therefore recommended as 
the best means'to be employed in the disinfection of all 
articles which can be thus treated, such as the body-clothing 
of the patient, the bed-clothes, towels, etc. All utensils 
which are used in the room in the feeding of the patient, 
such as plates, tumblers, spoons, knives, forks, etc., 
should likewise be treated with boiling water before being 
removed from the room. Food itself, not consumed by the 
patient, should not be used by others, as it is liable to be- 
come infected in the sick room. 
If, as will often be the ease, there are no facilities for 
treating articles with boiling water in the sick room, they 
may with, safety be removed to another part of the house 
for this treatment if they are carefully enveloped in a 
towel or sheet, as the case may require, which has been 
thoroughly soaked with either Standard Solution No. 1 
or Standard Solution No. 3 Thus enveloped they should 
be put in the water, and boiled for the required time. 
• Chloride of Lime.-This substance, also called Chlorinated 
Lime, to be effective as a disinfectant must be of the best 
quality, and in purchasing it only that should be accepted 
which is enclosed in glass bottles, as when packed in paper 
or wooden boxes, it is liable to have so deteriorated,as to 
be worthless for disinfecting purposes. When dissolved in 
water, in the proportion of four ounces to the gallon, it 
forms the Standard Solution No. 1, recommended by the 
Committee on Disinfectants. The solution thus prepared 
is to be used in the disinfection of discharges in contagious 
diseases, especially in typhoid fever and cholera. One pint 
should be well mixed with each discharge ; after ten min- 
utes disinfection is completed, and the contents of the 
vessel may be then safely thrown into the privy-vault or 
water-closet. The expectorated matter of those sick with 
consumption should be discharged into a cup half filled 
with this solution or with Standard Solution No. 3. 
To thoroughly disinfect a privy-vault containing but a 
small amount of material, Standard Solution No. 1 should 7 
be used in tlie proportion of one- gallon for each gallon 
of material in the vault. When thus disinfected, the 
contents should be removed. Subsequently, the mate- 
rial in the vault should be daily covered with the dry 
chloride of lime. It is only necessary to employ this large 
quantity in solution when there is reason to believe that 
the vault is infected, as with cholera or typhoid fever; when 
it is desired simply to deodorize it, a less quantity will 
probably accomplish the purpose. The cost of the Solution 
No. 1 is about three cents a gallon. 
Solution of Chlorinated Soda.-To be effective this Solu- 
tion must contain at least three per cent, of available chlo- 
rine, and in purchasing it care should be exercised to obtain 
such a quality. This is sometimes spoken of as Labarra- 
qlie's Solution ; but, as this latter substance is too weak to 
act as a disinfectant, the name is liable to mislead and is 
therefore here not used. The Standard Solution No. 3, of 
the Committee, is made by adding five parts of water to one 
part of the Solution of Chlorinated Soda. The cost of this 
solution is about ten cents a gallon. When thus diluted it 
may be used for all the purposes for which Standard Solu- 
tion No. 1 was recommended, and is of a somewhat more 
agreeable odor, though more expensive. 
This solution should be used to cleanse portions of the 
body soiled with discharges of those sick with infectious 
diseases, or the hands of attendants similarly soiled. 
Bichloride of Mercury Sublimate), is recom- 
mended in this circular to be used only in the disinfection 
of privy-vaults which contain so much material, believed 
to be infected with the germs of typhoid fever or cholera, 
that the disinfection by Chloride of Lime would be imprac- 
ticable. In using this it should be dissolved in the pro- 
portion of one ounce of Bichloride of Mercury to one gallon 
of water; this quantity will disinfect four gallons of in- 
fected excremental matter. 8 
TREATMENT OF THE BODY OF THE PATIENT 
AFTER RECOVERY OR DEATH. 
When the patient has recovered, he should be first sponged 
over with the Solution of Chlorinated Soda, diluted in the 
proportion of one part to twenty parts of water; and, indeed, 
during the course of the illness occasional sponging of the 
body with this very dilute solution, under the direction 
of the attending physician, will be of value in preventing 
the escape from the surface of the body of infectious mate- 
rial. When, after recovery, the body has be.en th us sponged, 
not omitting the head and hair, a thorough washing of the 
body with soap and warm water should follow, and the 
patient dressed in clothes which have not been exposed to 
infection. This should take place in another room than the 
one occupied during the illness. 
Should the case result fatally, the body should be thor- 
oughly sponged with either Standard Solution No. 1 or 
No. 3, and then wrapped completely in a sheet saturated 
with one of these solutions, and enclosed in a coffin, which 
is to be closed, and the interment must take place within 
twenty-four hours, and be strictly private. If the inter- 
ment is to take place at a distance requiring transportation 
by any other means than a hearse, the coffin must be of 
metal, or metal-lined, and hermetically sealed. 
DISINFECTION OF THE CLOTHING AFTER 
RECOVERY OR DEATH. 
The clothing of the patient should be treated in the 
manner already described as necessary during the sickness. 
Whatever can be boiled in water should be thus disinfected ; 
articles which cannot be boiled should, if circumstances 
will permit, be burned; all other articles should be left 
in the room to be subjected to the fumigation hereafter to 
be described, and until thus treated, the room and its con- 
tents should be closed with lock and key, to prevent any one 9 
from entering. If it is desired to burn any articles, and 
facilities for it do not exist in the house, the Department 
of Health should be notified, and an officer will call and 
remove the articles for destruction. 
DISINFECTION OF ROOM AND CONTENTS 
The room, having been vacated by the patient, should first 
be fumigated by burning sulphur. This fumigation should 
be done under the supervision of the physician or some 
other intelligent person. Upon application, it will be done 
by the Department of Health. Nothing should be re- 
riioved from the room until this is completed, unless it has 
been disinfected in the manner already described. Every- 
thing to be fumigated should be so opened and exposed 
that the sulphur fumes can come in contact with all por- 
tions thereof. All cracks of doors and windows, fire-places 
or other channels by which the gas may escape, should be 
tightly closed, using cotton wadding when necessary. For 
a room ten feet in all its dimensions-that is, one containing 
one thousand cubic feet of air space-two pounds of broken 
sulphur and one pound of flowers of sulphur should be pro- 
vided, and an increased amount for larger rooms, in the 
same proportion. This quantity is important, as less will 
not so efficiently accomplish the desired disinfection. The 
sulphur should be put in an iron pot, and this placed 
on bricks in a large wash-tub half filled with water, or in 
a large coal-scuttle containing wet ashes. This precaution 
is necessary to prevent setting fire to the floor, which 
would occur if the pot were placed directly on the floor or 
carpet. The vessel containing the sulphur should not be 
one with soldered joints, as the intense heat would melt 
the solder. A pot capable of holding one gallon is about 
the right capacity for three pounds of sulphur. The pot 
should be placed in the center of the room ; if the room is 
a large one, containing several thousand cubic feet of air 
space, several pots should be provided, distributed at 
different points. Everything being in readiness, sufficient 10 
alcohol to moisten the sulphur should be poured on it, a 
lighted match applied, and when it is seen that the sul- 
phur is well ignited, the room should be left and the door 
shut, and al] cracks outside, including the key-hole, closed 
by paper, cotton, or other material. At the end of ten 
hours the fumigation is completed. Great care should be 
exercised in emptying the room of the sulphur fumes, 
as these cannot be safely breathed and are excessively 
irritating to the eyes and throat. If possible a window 
should be opened from the outside, and through this the 
fumes permitted to escape ; if this is impracticable, all the 
windows and doors of adjoining rooms should be opened, 
and then the door of the fumigated room, and through 
these outlets the fumes allowed to find an exit. Thorough 
airing will remove the slight odor which remains. 
The fumigation being completed, all wood work, as of 
floors, windows and doors, and the walls and other surfaces 
should be washed over with Standard Solution No. 3; par- 
ticular attention being paid to cracks, crevices and out-of- 
the-way places, in which dirt ordinarily finds a lodgment 
and from which it is with difficulty removed. A subsequent 
washing with hot water and soap will complete the cleans- 
ing process, and the room may be considered again habita- 
ble. 
ADDITIONAL PREVENTIVE MEASURES, 
TO BE EMPLOYED IN THE ABSENCE AS WELL AS IN THE 
PRESENCE OF CONTAGION. 
See that the whole house, from cellar to attic, is clean. 
Keep the cellar dry, well ventilated and well white-washed, 
and never allow, even for a day, garbage or other filth to 
be kept in it. 
Open the windows of sleeping rooms every day for as 
long a time as possible, and in every way obtain as much 
fresh air as possible. 
Abolish the privy in the yard if there is a sewer in 
the street, and substitute a well-flushed water-closet; if 11 
there is no sewer see that the vault is water-tight, emptied 
frequently, and kept inoffensive and innocuous by the 
abundant use of the Standard Solution No. 1, previously 
referred to, and subsequently sprinkling the dry chloride 
of lime freely over the surface of the contents daily. 
Be sure that there are no leaks or defective traps or joints 
in the drain-pipes of the house, through which the gases 
from the decomposing filth contained therein can enter to 
pollute the air you breathe. 
The people of Brooklyn are especially fortunate in having 
a pure water supply ; all the public pumps furnishing im- 
pure water having been permanently closed. Should there 
at anytime be any suspicion cast upon the drinking water, 
ns when citizens are away from home, the drinking water 
should be boiled ; this is to be rigidly carried out in 
epidemics of typhoid fever or cholera. 
Unripe or stale fruit and vegetables, and those of difficult 
digestion, should be avoided at all times, particularly dur- 
ing the prevalence of cholera. 
When the children complain of sore throat, send promptly 
for a competent physician; a few hours' delay may cost 
their lives. If the disease is pronounced contagious, see 
that it is reported at once to the Department of Health, and 
keep the other children from schools of all kinds until a 
permit is procured for their return. Members of the family 
should not attend social or other gatherings so long as the 
disease continues. Keep the patient and the attendants 
quarantined from other members of the family and house. 
The Inspector of the District in which you live will cal] at 
your house as soon as the Department is notified, and will 
give all possible advice and assistance, and will, upon ap- 
plication, furnish the school permits when the danger is 
passed. ' 
SCHOOL PERMITS 
School permits will be given, on application, by the in- 
spector, as soon as the patient has fully recovered and the 12 
sick-room lias been disinfected ; in cases of Scarlatina and 
Measles this will not be until desquamation-or peeling off 
of the skin-is completed. 
The measures here recommended are to be used in all 
contagious diseases, whether diphtheria, scarlet fever, 
measles, small-pox, or others. 
USF0 Read this carefully, and preserve it for reference 
in the sick room, reading it over when you have nothing 
better to do, and burn it when the case is terminated. 
Additional copies can be had on application. 
NAME AND ADDRESS OF INSPECTOR OF YOUR DISTRICT.