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'^' J \\-j REPORT. - naif] CT -./-^H' ^ J ? ■la 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 fiimish 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 expres 'ion of the society *s opinion, as to <-he 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 compreheixsive 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 ^°°^f^°"'- propagated hy the contact of healthy persons with those who are affectej^ , The contagion of diphtheria, like that of small pox, attaches itself to clothing, bedding, fiirniture, and other articles, rendering them capable of conveying the disease. It may be communicated also by attendants or visitorsMeans^of^con who neglect taking the necessary precautions for the purifi- cation of their clothing or persons after contact with the disease. It must be remembtred also that persons who have hadconvafescents. diphtheria, may during their convalescence communicate the disease to those who are in health. ^ *^*crea8l\1iej"" '^^® spreatl of diphtheria is favored by such insanatory gprewj. conditioas, as the contamination of drinking water, by leakage or soaka^ from drains, pxlvies, sinks, and other places for the reception or carrying away of filth, into *^of drTnkiiur'''^P""^' •'^^*'6*™'^' wells, Or other sources of water supply. wnter. Also by the breathing of air impregnated with effluvia from decomposing vegetable and animal matter, in sewers, cess- uontaminaUonP<^l^''» ^Is.^'itsr^ ^^"s^» bam-yards chip-yards, cellars, etc. of air. In cities and towns by the ove.~:owding in tenements, by imperfectly constructed water closets, untrapped and un- ventilated house drains admitting the return of sewer overcrowding.gaggg jjj^ dwellings and apartments. Knally it may be remarked, a possible means of contagion may be found to exist in milk supplied from sources where diphtheria i« Sewer «*»«»• prevalent. The wUowing recommendations are deduced from the foregoing, and must be regarded as being both , , simple and practicable when compared with the evil which Contamination., .^ i • . • . . . of milk, etc. their object is to counteract. No epeciflc. 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 firsit 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. The nece88lty for medical opinion Separation of the sick. Famiture. Ventilation. Heating. Cleanliness. Destro; articles tt*e<) about the sick. 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- pete, bed, and window curtains, with other unnecessary f\ir- niture, should be removed. The air must be constantly changed ty the admission of fresh supplies through open windows, lliis 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 draughte. The sick should be kept clean, and sheets and body-linen frequently changed. All oJoths, rags, brushes and other articles used for cleansing the diseased surfaces of the patient, or for receiv- %fe ' such insanatoty inking water, by sinks, and other ^ay of filth, into of water supply, with effluvia from sr, in sewers, cess- -yards, cellars, etc. J in tenements, by ntrapped and un- retiun of sewer Knally it may be may be found to ere diphtheria is ions are deduced ed as being both th the evil which ing or known to bheria, and as each naore or less pecu- l observance and ious duty of all ion of an attack, of their medical jlay calling upon in such progress phtheria, persons diately separated large well-lighted leption, and car- ' unnecessary fur- bhe admission of i must be done in : attended with ;he patient pro- 3 and body-linen rticles used for int, or for receiv- 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 '^^ta.'**' 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 ^age.'^tS!* those of middle or advanced age, should not be selected as attendants. required. Visitors to aick. esoenta. Attendants or nurses should take extra care in regard of ^^on^'^nof* cleanliness, food, and rest, that it may enable them to resist "mSiae" 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 conveyance 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 ^V^^ of speedily interred. The visiting of remains and holding "■• 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 ^n*y of gov- and local to take upon themselves the supervision and geMrai°and enforcement of all measures which are necessary for the '"***** eto. pr"**»''-'',; e. fiminlry Into couditiou of potable watur. Pollution pre- vented. Treatment of sewera, etc. Excreta in street drains, Water closets, etc. Removal of refuse. Public schools Libraries. H 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 searchinjj investigation into their drinking water for evidences of pollution. The topoijraphical 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 waterj and constant attention given to their dis- infection. Sewers should be ventilated, and house drains effici- ently trapped, to prevent accumulation of sew^r gases and their entrance into dwellings. In the city the practice of allowing privies and water closets to discharge their contents iiito the surface drairts should be abolished, it being productive of so much injury to public health. Special attention should be given to the construction of water closeis. Those most in use, though well adapted for ordi- nary purposes, yet fiail to prevent the return of foul air into the dwelling. To obviate this evil, the basins, sjrphons, and traps should be inspected by coinpetent persons, who shouldsee that these are constructed, and set in place so as to prevent the leakage of gaseous matter i»wavds- Efficient ventilation of the outlet pipes should be also required and in no instance should the disinfection ^ of these receptacles be negleated. Immediate and thorough removal of ever^ sort of house refuse and other filth which has accumulated in, about, or under houses, of in neglected places, shotild 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 sChoolk 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. . ' 'V^W^fifi*. -. c 7. fore recommended >re diphtheria has lity or district, do eir drinking water )hical relations of lassible sources of rflow from drains, ouses, or from enquired into. If ticable should be anot, the water so : for culinary or ould be inapscted, , they should be given to their dis- house drains effici- sew^r gases and ty the practice of discharge their ibolished, it being alth. e construction of 11 adapted for ordi- m of foul air into sins, syphons, and )ns, who shouldsee 3e so as to prevent Bcient ventilation and in no instance 3 be negleated. sry sort of house ted in, about, or d be carried out, )vented, and lime equently practised house or dWell- •ein should be ex- time of its preva- ic in any locality closed. s should not have , as these books a may become a Tailoring, drcss-mak ing, laundry work or any similar oc- cupation or work dono for the public, should not bo carri- ed on in houses where the di.soarse exists, nor by employees who are exposed to infection. It should be the duty of local govemmiintH and offlceM of hnaltli in the city and in towns throughout the Province to mitigiite the insana- tory conditions re.«ultinj; from overcrowding in tenement courts, allevs, and cidlar lmbifn"*''hs, by limiting the number of inhabitants in tenement houses, &c., by preventing under a penalty impoi^ed up- on landlords, the letting or renting of cellar or underground a,>art- jnents for humrn habitation, by frequent and thorougii inspection of all such places, by enforcing th« 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 vici''ity of their dwellings. The committee also directs attention to the evil of loiating dwell- ings, with almost total disregard of their sanatory necessities, as be- ing of too common c .currence in this Province. The dangers which have already resulted irom 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 tbe inroads of Zymotic diseases. .'.j. , :. '-■■■^—i ; >» .v ». 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 nuestion after recent developments which incontestibly prove the iransmission 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 TnilorliiK nml (IroHHninking. liniiixlry work. Protection IVnm ovnrc.rowilliiR re<, etc. Usinia: rofUse inntter for lllliMK' or grading. Local fiana- tory mspectora. Precautions enquiring into sources of milk supply of their milk supply. ■tiiu-'-rv^ie y crc*l •«y ti r»^i ^'^'^OO 8. SUlnfleetloii Fumigation of furniture and rooms. DISINFECTION. In view of the great importance of disinfection as a sanatory measure, a few simple but eflFective rules nre recommended, viz: — All articles of clothing may be disinfected by platting them in boil, iug water and continuing the boiling for some time. WoUenH may be either fumigated or steeped for a short time in either of the 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, etir brinkly until they become incorporated. Solution 2. — Add two ounces of chlorinated linrle to cases where the ^ and upon a braizer ling coals throw a few nust be vacated and lOurs. The windows ind some time should r therein. After this 3-ubbing the floor and ered, the ceilings, etc., ir the disinfection of ons of garbage, etc. It of fluid carbolic acid jriskly. A pint of this lo»et night and morn* ' garbage or decompos- ubic foot of the mass. portant fact that fresh Eition and cleanliness,, led us for protection and LABOE should not as being wasted, when !^. Parker. M. D. Slayter, M. D. ]!ampbell. M. D. Vomers, M. D. Secretary. } ^ r y