THE MILK SITUATION IN THE DISTRICT OF COLUMBIA. 331 



relative is acting as nurse, members of the family, not regularly engaged in the 

 nursing, " help out " by sitting with the patient at times, carrying out the soiled 

 dishes, bedclothes, etc, or emptying the bedpans or urinals. The latter, es- 

 pecially, is often done by the father or older brother. Those persons who thus 

 assist, perhaps only by receiving a tray of dishes at the door and conveying it 

 to the kitchen, run spme risk; those who handle the bedclothes or empty the 

 discharges, if careless, run great risk, even though they handle them for but 

 a moment. 



Dangers from infected articles. Another danger from a typhoid patient lies 

 in the washing of the dishes, bedclothes, bedpans, urinals, etc. Often these are 

 carried to the kitchen and allowed to remain piled upon the table or floor, per- 

 haps mixed with the dishes, bedclothes, etc., of the rest of the family and 

 washed with them. It is true that the usual process of washing clothes with 

 soap and water, the clothes being boiled, will kill the infection, so that the 

 clothing is free from danger after it is clean; but there is also a real danger, 

 first, to the person who does the washing, handling the clothes, etc.; next, 

 during the washing, the one who does it may, with her hands wet with the 

 infected wash water, take up kitchen utensils, receive food from the delivery 

 man at the door; possibly after a hurried drying on the kitchen towel (which 

 she infects in the process so that the next person who uses it becomes infected 

 also) she prepares some article of food or drink, wipes the dishes, lays the 

 table, or otherwise spreads the infection about the place. (The writer has seen 

 the common kitchen hand towel, after being used to dry the family hands, used 

 also to dry the family dishes.) 



Flies. Another possible danger to the family and neighbors consists in admit- 

 ting flies to the sickroom or to dishes, bedclothes, or discharges in the sick- 

 room or after removal from it. Flies may easily carry discharges upon their 

 feet from the bedpan or bedclothes to the family food or drink. A fly's feet 

 and legs are covered with small hairs, and particles of feces easily stick to 

 these. If the fly with typhoid feces on his feet falls into the milk or walks over 

 the cake, he leaves a trail of typhoid infection behind him. Hence the room and 

 the whole house should, if possible, be well screened. If the slops or wash 

 water are thrown upon the ground, the chances of infection are increased. So 

 also if the privy vault is open or if the contents overflow. Not only may human 

 beings get excrement on their feet, but hens may carry it to the doorstep, and 

 the cat or dog may bring it into the house. The man who buries the discharges 

 may carelessly get his feet soiled and carry infection into the house in this way. 

 If he washes the bedpan or urinal at the pump, the washings may go through 

 the curb or run in under it from the side, thus infecting the well. 



Precautions. The trained nurse and the physician should know how to pro- 

 tect themselves and should go through typhoid outbreaks without contracting 

 the disease. This is done simply by always regarding everything in a patient's 

 room as infectious and never handling anything that is in or comes from the 

 patient's room unless it has first been disinfected. If it is impossible to avoid 

 handling the material before disinfection and, of course, it must be handled 

 during disinfection then always immediately disinfect the hands. These rules 

 faithfully lived up to day by day, hour by hour, minute by minute, always and 

 in every case will entirely prevent infection from spreading by way of the 

 hands. 



Most important of all, it must be remembered that persons are infectious even 

 before the disease is developed, and that many cases are up and about and are 

 so mild that no doctor is called, or he fails to recognize it. Also remember that 

 the germs may remain in the body long after recovery and are sometimes found 

 in people who have never been sick. Perhaps the new hired man or a visitor or 

 the summer boarder is such a " carrier " of germs. Therefore, as one can never 

 tell when he will come in contact with typhoid germs, he should always be on 

 his guard. Is it not worth while to try to not let any other person's excrement, 

 no matter how tiny a speck, get into one's mouth, and to also try to not let 

 one's own excrement get into another's mouth? It is not such a hardship, after 

 all, to be clean. 



It may be asked how, if there are so may ways of infection, does anyone man- 

 age to escape. As a matter of fact, the excrement is not always so teeming with 

 bacteria ; they may be few at times, and they may not b6 evenly distributed, so 

 that many particles contain none at all. Often even hurried washing removes 

 practically all from the hands. The germs often die rapidly when exposed to 

 light and air. People are not always and continuously so careless as has been 

 described. They generally do wash their hands and do not always put the 

 fingers in the mouth. Then, again, probably sometimes when only a few germs 



