830 THE MILK SITUATION IN THE DISTRICT OF COLUMBIA. 



in position and removed as necessary. Often he requires injection into the 

 bowel ; sometimes he has involuntary discharges before a bedpan can be placed 

 in position. Sometimes his temperature must be taken in the bowel. After 

 the use of the bedpan or urinal it is difficult to clean his body thoroughly, and 

 even after an amount of washing which removes all visible dirt, the infection 

 remains as numerous particles of matter on the skin or sheet or night clothes. 

 As the patient tosses about in bed these particles are spread from skin to sheet 

 and back again, until the whole lower part of the patient's body and legs be- 

 come infected with more or less particles of excrement and urine very small 

 particles and very thin, no doubt, leaving not even a stain to show their pres- 

 ence, but present all the same. A particle of excrement, spread out upon the 

 skin so thin as to be invisible, may contain millions of the bacteria which 

 produce the disease. 



Dangers to the attendant. It must be perfectly clear to everyone who con- 

 siders these facts for a moment that no attendant can touch the body or bed- 

 clothes or urinal or bedpan or injecting syringe or thermometer or anything 

 else which comes into contact with the patient's body or legs or sheets, without 

 great chance of transferring at least a few of these bacteria to the hands. 

 Now, everyone's hands go often to the lips and mouth every day, consciously or 

 unconsciously. Watch anyone and see, or notice how often you do this your- 

 self. If there be on your hands any of the discharges of a typhoid patient, 

 consider how extremely likely it is that you will transfer them to your mouth. 



Dangers to visitors. The patient's own hands also touch his own body, his 

 own sheets, etc., as much or more than the attendant's hands do, and the pa- 

 tient's hands therefore become infected likewise. The patient touches his own 

 face, pillow, books, medicine glass, spoons, plates, etc., with his infected hands, 

 and these, in turn, become infected. If the patient shakes hands with a visitor, 

 or if the visitor touches only the patient's forehead with the fingers, infection 

 is likely to be transferred to the visitor's hands. Merely shaking up a pillow 

 or settling the sheets to make the patient more comfortable is likely to infect 

 the hands of the one who does it. 



Dangers from the nurse to others. But the persons who come into contact 

 with the typhoid patient directly are not the only ones who are in danger. 

 Anyone who eats food handled by a person who has been in contact with the 

 typhoid patient is likely to take into the mouth the infected material from that 

 person's hands ; for instance, it has happened over and over again that a hotel 

 or restaurant waitress, nursing a sick relative and also waiting on table, has 

 transferred typhoid fever from the patient to the boarder by handling the 

 boarder's food just after she has emptied the sick person's bedpan. In private 

 families the mother often acts as nurse for the sick person and at the same 

 time prepares meals for the rest of the family. 



Food. The hands of the house nurse, infected with discharges from the pa- 

 tient, transfer some of it to the bread as she slices it for the table, to the spoons, 

 forks, plates, etc., as she lays the table; so, too, as she breaks up ice for the 

 ice- water jug, or washes greens, or opens a can of fish or tongue, to be served 

 cold. In 50 ways her hands touch utensils or go into food continually while 

 preparing the meal. The handling of the food does no great harm, if the food 

 is afterwards cooked and is not again handled before it is served, because the 

 heat of cooking kills the infection, but the handling of cold foods or drinks 

 which are not to be cooked is very dangerous to those who eat or drink them, 

 while the handling of plates, cups, spoons, etc., is also dangerous because they 

 go to the mouths of different members of the family. In fact, it is almost 

 always true that if secondary cases develop in the family of a typhoid patient, 

 these later cases get it from the first through the hands of the mother or who- 

 ever else is nursing the patient. With a properly trained nurse, however, no 

 such spread should occur, and it is not necessary that it should occur with any- 

 one if the proper precautions are carefully followed. 



Direct handling. Besides giving the disease to others through the food, the 

 mother often directly puts her fingers into her children's mouths, perhaps to 

 prevent them from swallowing a marble, perhaps to extract a piece of gum 

 stuck to the teeth, perhaps to feel an aching tooth, or for other purposes. She, 

 of course, is likely to wash their faces and hands, brush their hair, dress and 

 undress them, and the infection on her hands, even if it does not go directly 

 into their mouths, goes onto their hands, etc., and they, in turn, put their hands 

 into their own mouths. These illustrations are sufficient to call attention to 

 the dangers of hand infection from the nurse to the rest of the family. 



Dangers from helping the nurse. Often, even when a trained nurse is in 

 charge of a typhoid case and almost always when the mother or some other 



