houses from contact with yourself or children. The disease is often spread by thoughtless persons who visit the sick-room, and even kiss the infected patients, and then, without any precautions in the way of disinfection, fondle healthy children in other places, and, perhaps, transmit by a kiss the infectious material which has adhered to their lips. The possibility of transmission by pet animals is also to be borne in mind.

TUBERCULOSIS.

Recent researches have demonstrated that tubercular consumption, is an infectious disease, and that the sputa of those effected with it, injected into susceptible animals, reproduces in them the same disease. This sputum is, therefore, infectious material, and should be destroyed by burning, or by the use of chemical disinfectants. There would be little danger of infection from the moist masses of sputum, but in a desiccated condition this material is liable to reach the lungs of susceptible individuals, and to induce the disease. It is well known that there is a great difference in susceptibility to pulmonary consumption, and that in certain families this disease carries off one member after another, while it is unknown in other families. Those who have this hereditary predisposition should pay special attention to individual prophylaxis. They should avoid intimate association with consumptive persons, should live under the best hygienic conditions, in dry, wellventilated apartments, and should select an occupation which will keep them in the open air, rather than one which keeps them confined in the house. Above all, they should avoid respiration of an atmosphere loaded with organic impurities, or with irritating inorganic particles-dust of various kinds. Out-of-door life on the high and dry plains in the center of the continent, or in the mountains, will, in most instances, enable them to overcome the predisposition, if commenced before infection and the resulting tubercular lesions have occurred!

Those who are engaged in occupations which require them to pass some hours each day in an atmosphere loaded with dust will do well to wear a respirator for filtering the suspended particles from the air; for it is demonstrated that, independently of hereditary predisposition, the respiration of such an atmosphere predisposes to tubercular disease of the lungs.

TYPHOID FEVER.

In this disease, as in cholera, the infectious agent is contained in the alvine discharges of the sick. In the interest of self-preservation, as well as in that of the public good, every individual who has charge of cases should see that the evacuations from the bowels are thoroughly disinfected before they are thrown out.

The drinking of water contaminated with such infectious discharges is recognized as a very frequent mode of infection; and individual prophylaxis demands an intelligent consideration of the source from which a supply of drinking water is obtained for personal or family use. If there is the least reason to suspect that this supply may be contaminated by typhoid material, or if it contains an undue amount of organic impurities, it should be rejected entirely, or boiled shortly before it is used.

Typhoid epidemics have in several instances been traced to using milk which had been contaminated by infected water, added to it directly, or used at the dairy to wash the vessels containing it. The remedy in this case is to verify the purity of the source of supply of all milk used for drinking, or to boil it immediately before it is used. The water of wells located within the limits of a city or village

should not, as a rule, be used for drinking purposes, for the soil is almost certain to be polluted; and it often occurs that the contents of privy vaults and cess-pools pass into the same porous stratum of sand or gravel from which the well-water is obtained, or that surface drainage finds its way into shallow wells. It will be necessary, also, to regard with suspicion the water of small streams and ponds which are so situated that they may receive the drainage from the collections of filth upon their margin. Next to impure water we must place impure air as a factor in the etiology of typhoid fever. There is good reason to believe that the germs of the disease may be carried by the foul gases which are given off from sewers, privies, etc., when these become infected, and the disease may be induced by the respiration of such a contaminated atmosphere. At all events the breathing of a vitiated atmosphere, and insanitary surroundings generally, constitute predisposing causes which should be avoided.

In typhoid fever, as in yellow fever and cholera, depressing mental emotions, such as grief, despondency or fear, and physical exhaustion from excessive fatigue, insufficient food, etc., are predisposing causes which may induce an attack in the presence of the infectious agent.

CONCLUDING REMARKS.

This chapter might be greatly extended, but having passed in review the principal measures of individual prophylaxis against those infectious diseases which are most fatal, we shall not dwell upon precautions to be taken in other contagious diseases, such as measles and whooping cough. These precautions will not differ from those already recommended in the cases of small-pox and scarlet fever. So, too, in regard to the infectious skin diseases. These are communicated by personal contact, and rarely occur except among those who neglect personal cleanliness, as well as other sanitary laws. Soap and water will generally suffice for individual prophylaxis. By avoiding filthy persons as well as filthy places, the danger of contracting these and certain other unmentionable infectious diseases will be reduced to a minimum.

SUGGESTIONS FOR THE RESTRICTION AND PREVENTION

OF

Diphtheria, Scarlatina, Small-Pox and Typhoid Fever.

DIPHTHERIA, SCARLATINA and SMALL-POX are all INFECTIOUS as well as CONTAGIOUS diseases, hence the strict observance of the following precautions is of very great importance:

1. When a child or a young person has a sore throat, bad odor to its breath, and especially if it has fever, it should immediately be kept separated from all other persons, except necessary attendants, until it be ascertained whether or not it has diphtheria or scarlet fever.

2. Every person known to be sick with diphtheria, scarlatina or small-pox should be promptly and effectually isolated from the public; no more persons than are actually necessary should have charge of or visit the patient, and they should be restricted in their intercourse with other persons. Every case of either of these diseases should immediately be reported to the Board of Health, as the lam requires.

3.

Remember that VACCINATION and RE-VACCINATION, with fresh bovine virus, are SAFE and SURE PREVENTIONS of SMALL-POX.

4. The room into which one sick with diphtheria, scarlet fever or small-pox is placed should previously be cleared of all needless clothing, carpets, drapery, and other materials likely to harbor the poison of the disease. This room should constantly receive a liberal supply of fresh air, without currents or drafts upon the patient. It will be well also to have the sun shine directly into the room.

5. The discharges from the throat, nose and mouth are extremely liable to communicate these diseases, and should be received in vessels containing standard solutions Nos. 1, 2 or 3, or on soft rags or pieces of cloth, which should be immediately burned.

6. The discharges from the kidneys and bowels are also dangerous, and should be passed into vessels containing one of the standard solutions, and then buried at least 100 feet distant from any well; or when this is impracticable, they should be passed on old cloths, which should be immediately burned.

7. The clothing, towels, bed linen, etc., on removal from the patient, should at once, before removal from the room, be disinfected. See Standard Solution No. 4.

8. Nurses and attendants should be required to keep themselves and their patients as clean as possible; their own hands should frequently be washed and disinfected by chlorinated soda. See formula No. 3.

9. All persons recovering from these diseases should be considered dangerous; therefore such a person should not be permitted to associate with others, or to attend school, church or any public assembly until the throat and any sores which

may be on the lips, nose or body are healed, nor until, in the judgment of a careful and intelligent physician, he can do so without endangering others; nor until after all his clothing has been thoroughly disinfected, and this without regard to the time which has elapsed since recovery, if the time is less than one year. In case of small-pox all infected clothing or bedding should be burned. Nor should a person from premises in which there is or has been a case of either of these diseases attend any school, Sunday-school, church or public assembly, or be permitted to do so, until after disinfection of such premises and of the clothing worn by such person if it shall have been exposed to the contagion of the disease.

10. The body of a person who has died of diphtheria or scarlet fever should be saturated with Standard Solution No. 2, wrapped in a sheet, and at once be buried. In no case should the body be exposed to view. In case of death from small-pox, the body should, unclothed and unwashed, be wrapped in a heavy sheet, saturated with the solution, and immediately buried.

11. No public funeral should be held at a house in which there is a case of, or in which a death from one of these diseases has recently occurred.

12. Avoid in every possible manner the special contagion of these diseases. This is especially important with children, who are always more susceptible to disease than adults. Mild cases in adults, however, communicate fatal cases to children.

13. Do not let a child go near a case of diphtheria, scarlatina or small-pox. Do not permit any person or thing, or a dog, cat or other animal to come direct from a case of these diseases to a child. Unless your services are needed, keep away from them yourself. If you do visit a case, bathe yourself and change and disinfect your clothing before you go where there is a child, or into a public assembly.

14. The contagion of these diseases retains its virulence for some time, and can be carried a long distance in various substances and articles in which it may have found lodgment. While it is not definitely proved that the germs of these maladies are propagated in any substance outside the living human or animal body, it is possible that they may be found to be thus propagated. Therefore, and because the breathing of air laden with the emanations from decaying fruit, vegetables or meat, or from se wers, cesspools, sinks and other receptacles of filth, is believed to endanger health, great care should be taken to have the house, premises and everything connected with dwellings kept clean and dry; to have sewer connections well trapped and house drains constantly well ventilated, and to have all carriers of filth well disinfected. Do not permit a child to enter privy, water-closet, or breathe the air from a privy, water-closet, cesspool or sewer into which discharges from persons sick with these diseases have entered, nor to drink water or milk which has been exposed to such air.

15. Do not permit a child to ride in a hack or other closed carriage in which has been a person sick with diphtheria, scarlatina or small-pox, except the carriage has since been thoroughly disinfected.

16. All influences which cause sore throats or any impairment of health probably tend to promote the taking and spreading of these diseases. Among the conditions external to the body liable to cause the spread of them, perhaps the most common are: infected air, infected water, and contact with infected substances or persons. Because of this, and as a means of lessening the danger of contracting other diseases, the following precautions should always be taken, but more particularly during the prevalence of any such disease.

17. Do not wear or handle clothing worn by a person during sickness or convalescence from an attack of either the diseases.

18. Beware of any person who has a sore throat. Do not kiss, or inhale the breath of such a person. Do not drink from the same cup, blow the same whistle, or put his pencil or pen in your mouth.

19.

Beware of crowded assemblies in unventilated rooms.

20. Do not drink water which has a bad taste or odor, or which comes from a source that renders it liable to be impure, especially if there is reason to believe it may contain something derived from a person sick with diphtheria or scarlet fever. Especially be careful about the cleanliness and purity of the milk supplied by your dairyman. Numerous epidemics of scarlet fever and diphtheria have originated with careless dairymen.

TYPHOID FEVER.

I. ITS SANITARY FEATURES.

21. Typhoid fever is a zymotic disease, infectious and insidious in its nature, with a specific poison contained in the intestinal discharges of those affected, and by air and water may be introduced into the system of susceptible healthy individuals, where it will produce the same disease.

22. If the poison obtains access to a water supply, or to articles of food or drink, an outbreak of typhoid will follow among those partaking of such water or food. Repeated instances of this kind have been traced to the use of water from an infected well and to infected milk.

23. The diarrheal discharges, when dry, may preserve the poison as effectually as the crusts of small-pox, the scales of scarlet fever, and the dried membrane of diphtheria, preserve the specific poisons of those diseases.

24. These discharges, coming into contact with putrid animal matter, as by being thrown into water-closets and privies, are capable of saturating such matter with the typhoid fever poison in its most concentrated and virulent form.

II-PREVENTION OF ITS SPREAD.

25. When a case of typhoid fever is known to exist in a neighborhood, a strict examination should be made regarding the surroundings and character of the water supply of the locality. If there be any reason to suspect that this may be possibly contaminated from the case, its use should be forbidden until the proper measures can be taken to protect it against such contamination, and the question of its safety be definitely settled. The location of wells, with reference to the privy into which typhoid discharges are thrown, the inclination of the ground between such points, and the character of the soil, should all be taken into consideration. Wells into which surface-washings from the infected premises might find their way by the natural slope of the ground, and wells within a given distance (one hundred feet) should be at once abandoned.

26. Scrupulous cleanliness in every portion of the premises should be enforced. All decaying animal and vegetable matter, and every kind and source of filth in and around the house, should be removed and disinfectants be freely used. Surface drains and gutters, areas, out-houses, privies, etc., should receive close and constant attention, and Standard Solution No. 4 be used freely and regularly in every such place. (See General Directions.)

27. Within the infected house itself the important matter to attend to is the prompt disinfection of the discharges from the patient, and of everything liable to come in contact with such discharges.