DISINFECTIONAND

DISINFECTANTS.

Adopted December, 1892.

Health Departmentop the

CITY OF NEWYORK.

1 Form L.

DISINFECTANTSAND

METHODS OF DISINFECTION,AS EECOMMENLIj.O BY TEE

HEALTH DEPARTMENT OF THE CITY OF NEWYORK,DECEMBER, 1892.

DISINFECTION and DISINFECTANTS.Sunlight, pure air and cleanliness are

always very important agents in maintaininghealth and in protecting the body againstmany forms of illness. When, however, itbecomes necessary to guard against suchspecial dangers as accumulated filth or con-tagious diseases, disinfection is essential. Inorder that disinfection shall afford completeprotection, it must be thorough, and perfectcleanliness is better, even in the presence ofcontagious disease, than poor disinfection.

All forms of fermentation, decompositionand putrefaction, as well as the infectious and

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contagious diseases, are caused by minuteliving germs. The object of disinfection is tokill these germs. Decomposition and putre-faction should at all times be prevented bythe immediate destruction, or removal fromthe neighborhood of the dwelling, of all use-less putrescible substances. In order that asfew articles as possible shall be exposed toinfection by the germs causing the contagiousdiseases, it is important that all articles notnecessary for immediate use in the care ofthe sick person, especially upholstered furni-ture, carpets and curtains, should be removedfrom the sick room at the very beginning ofthe illness.

AGENTS FOR CLEANSING ANDDISINFECTION.

Too much emphasis cannot be placed uponthe importance of sunlight, fresh air andcleanliness, both as regards the person andthe dwelling, in preserving health and pro-tecting the body from all kinds of disease.Sunlight and fresh air should be freely ad-mitted through open windows, and personalcleanliness should be attained bywashing the hands and body. NILMj

Cleanliness in dwellings, and in all placeswhere men go, may under ordinary circum-

3stances be well maintained by the use of thetwo following solutions :

I. Soap-suds Solution.—For simple cleans-ing, or for cleansing after the methods of dis-infection by chemicals described below, oneounce of common soda should be added totwelve quarts of hot soap (soft soap) andwater.

2. Strong Soda Solution.—This, which is astronger and more effective cleansing solu-tion, is made by dissolving one-halfpound ofcommon soda in three gallons of hot water.The solution thus obtained should be appliedby scrubbing with a hard brush.

When it becomes necessary to arrest putre-faction or to prevent the spread of contagiousdiseases by killing the living germs whichcause them, more powerful agents must beemployed than those required for simplecleanliness, and these are called disinfectants.The following are some of the most reliabledisinfectants :

3. Heat. —Complete destruction by fire isthe best method of disposing of infected arti-cles of small value, but continued high tem-peratures not as great as that of fire willdestroy all forms of life; thus, boiling orsteaming in closed vessels for one-half hourwill destroy all disease germs.

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4- Carbolic Acid Solution.—Dissolve sixounces of carbolic acid in one gallon of hotwater. This makes approximately a five-per-cent. solution of carbolic acid, which, formany purposes, maybe diluted with an equalquantity of water. The commercial coloredimpure carbolic acid should not be used tomake this solution. Great care must be takenthat the pure acid does not come in contactwith the skin.

5. Bichloride Solution (bichloride of mer-cury or corrosive sublimate). —Dissolve sixtygrains of pulverized corrosive sublimate andtwo tablespoonfuls of common salt in onegallon of hot water. This solution must bekept in glass, earthen or wooden vessels (notin metal vessels).

The Carbolic and Bichloride Solutions arevery poisonous when taken by the mouth,but are harmless when used externally.

6. Milk ofLime.—This mixture is made byadding one quart of dry freshly-slaked limeto four or five quarts of water. (Lime isslaked by pouring a small quantity of wateron a lump of quick-lime. The lime becomeshot, crumbles, and as the slaking is com-pleted a white powder results. The powderis used to make Milk of Lime.) Air-slakedlime has no value as a disinfectant.

57. Dry Chloride of Lime.—This must be

fresh and kept in closed vessels or packages.It should have the strong pungent odor ofchlorine.

The proprietary disinfectants, which are sooften widely advertised, and whose composi-tion is kept secret, are relatively expensiveand often unreliable and inefficient. It isimportant to remember that substances whichdestroy or disguise bad odors are not neces-sarily disinfectants.

Note.— The cost of the Carbolic Solution is much greaterthan that of the other solutions, but generally is to be muchpreferred. When the cost is an important element, theBichloride Solution may be substituted for all purposes forwhich the Carbolic Solution is recommended, except for thedisinfection of discharges, eating utensils and articles madeof metal, and of clothing, bedding, etc., which is very muchsoiled. Its poisonous character, except for external use,must be kept constantly in mind.

METHODS OF DISINFECTION ININFECTIOUS AND CONTAGIOUSDISEASES.

The diseases to be guarded against bydisinfection are Scarlet Fever, Measles,Diphtheria, Tuberculosis (Consumption),Small Pox, Typhoid and Typhus Fever,Yellow Fever and Cholera.

i. Hands and Person.—Dilute the CarbolicSolution with an equal amount of water, or

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use the Bichloride Solution without dilution.Hands soiled in caring for persons sufferingfrom contagious diseases, or soiled portionsof the patient’s body, should be immediatelyand thoroughly washed with one of thesesolutions, and then washed with soap andwater. The nails should always be kept per-fectly clean. Before eating, the hands shouldbe first washed in one of the above solutions,and then thoroughly scrubbed with soap andwater by means of a brush.

2. Soiled Clothing, Towels, Napkins, Bed-ding, etc., should be immediately immersedin the Carbolic Solution, in the sick room,and soaked for twelve hours. They shouldthen be wrung out and boiled in the Soap-suds Solution for one hour. Articles suchas beds, woolen clothing, etc., which cannotbe washed, should be referred to the HealthDepartment for disinfection or destruction.

3. Food and Drink.—Food thoroughlycooked and drinks that have been boiled arefree from disease germs. Food and drinks,after cooking or boiling, if not immediatelyused, should be placed when cool in cleandishes or vessels and covered. In presenceof an epidemic of Cholera or Typhoid Fever,milk, and water used for drinking, cook-ing, washing dishes, etc., should be boiled

7before using, and when Cholera is prevalentall persons should avoid eating uncookedfruit, fresh vegetables and ice.

4. Discharges of all kinds, from the mouth,

nose and bozvels of patients suffering from con-tagious diseases, should be received into glassor earthen vessels containing the CarbolicSolution or Milk of Lime, or they should beremoved on pieces of cloth, which are imme-diately immersed in one of these solutions.Special care should be observed to disinfectat once the vomited matter and the intestinaldischarges from Cholera patients, as thesealone contain the dangerous germs. InTyphoid Fever the intestinal discharges, andin Diphtheria, Measles and Scarlet Fever,the discharges from the throat and nose, allcarry infection and should be treated in thesame manner. The volume of the solutionused to disinfect discharges should be at leasttwice as great as that of the discharge. Afterstanding for an hour or more the disinfectingsolution with the discharges may be throwninto the water-closet. Cloths, towels, napkins,bedding or clothing soiled by the dischargesmust be at once placed in the Carbolic Solu-tion and the hands of the attendants disin-fected, as described above. In convalescencefrom Measles and Scarlet Fever the scales

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from the skin (peeling) are also carriers ofinfection. To prevent the dissemination ofdisease by means of these scales, the skinshould be carefully washed daily in warmsoap and water. After use, the soap sudsshould be thrown into the water-closet andthe vessel rinsed out with a Carbolic Solution.

5. The Sputum from Consumptive Pa-tients.—The importance of the proper disin-fection of the sputum (expectoration) fromconsumptive patients is little understood.Consumption is a contagious disease, and isalways the result of transmission from thesick to the healthy or from animals to man.The sputum contains the germs which causethe disease, and in a large proportion of casesis the source of infection. After being dis-charged, unless properly disposed of, it maybecome dry and pulverized and float in theair as dust. This dust contains the germsand is the common cause of the diseasethrough inhalation. In all cases therefore,the sputum should be disinfected when dis-charged. It should be received into coveredcups containing the Carbolic or Milk of LimeSolution. Handkerchiefs soiled by it shouldbe soaked in the Carbolic Solution and thenboiled. Dust from the walls, mouldings, pic-tures, etc., in rooms that have been occupied

9by consumptive patients, contains the germs,and will produce tuberculosis in animalswhen used for their inoculation. Therefore,rooms should be thoroughly disinfectedbefore they are again occupied. If the sputumof all consumptive patients were destroyedat once when discharged, a large proportionof the cases of the disease would be pre-vented.

6. Closets, Kitchen and Hallway Sinks,etc.—Each time the closet is used for infecteddischarges, one pint of the Carbolic Solutionshould be poured into the pan (after it isemptied) and allowed to remain there. Alldischarges should be disinfected before beingthrown into the closet. Sinks should beflushed at least once daily.

7. Dishes, Knives , Forks, Spoons, etc., usedby a patient should be kept for his exclusiveuse, and not removed from the room. Theyshould be washed first in the Carbolic Solu-tion, then in boiling hot soap-suds, and finallyrinsed in hot water. These washing fluidsshould afterwards be thrown into the water-closet. The remains of the patient’s mealsmay be burned or thrown into a vessel con-taining the Carbolic Solution or Milk of Limeand allowed to stand for one hour beforebeing thrown away.

8. Rooms and their Contents. Roomswhich have been occupied by persons suf-fering from contagious disease should notbe again occupied until they have beenthoroughly disinfected by the Health De-partment. For this purpose either carefulfumigation with sulphur will be employed,or this combined with the following pro-cedure : Carpets, curtains and upholsteredfurniture which have been soiled by dis-charges, or which have been exposed to infec-tion in the room during the illness, will beremoved for disinfection by steam. Wood-work, floors, and plain furniture will bethoroughly washed with the Soap-suds andBichloride Solutions.

9. Rags, Cloths and Articles of SmallValue, which have been soiled by dischargesor infected in other ways, should be burned.

10. In case of Death, the body should becompletely wrapped in several thicknesses ofcloth wrung out of the Carbolic or BichlorideSolution and placed in an hermetically sealedcoffin.

If notified, the Health Department

of New York City will disinfectROOMS AND THEIR CONTENTS WITHOUTCOST TO THE TENANT AFTER THE ROOMSHAVE BEEN VACATED BY PERSONS CONVAL-

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ESCENT FROM ANY CONTAGIOUS DISEASE.Notification should be sent to theChief Medical Inspector, No. 309 Mul-berry Street. TelephoneCall, No. 25 rSpring.

It is important to remember that anabundance of fresh air , sunlight and ab-solute cleanliness not only helps protect theattendants from infection, but also aids in therecovery of the sick.

METHODS OF CLEANLINESS ANDDISINFECTION TO PREVENT THEOCCURRENCE OF ILLNESS.

1. Water-closet Bowls and all Receptaclesfor Human Excrement should be kept per-fectly clean by frequent flushing with a largequantity of water, and as often as necessarydisinfected with the Carbolic or BichlorideSolutions. The woodwork around and be-neath them should be frequently scrubbedwith the hot Soap-suds Solution.

2. Sinks and the Woodwork around andthefloor beneath them should be frequently andthoroughly scrubbed with the hot Soap-sudsSolution,

3. School Sinks.—School sinks should bethoroughly flushed with a large quantity ofwater at least twice daily, and should be

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carefully cleaned twice a week or oftener byscrubbing. Several quarts of the CarbolicSolution should be frequently thrown in thesink after it has been flushed.

4. Cesspools and Privy Vaults.—An abund-ance of Milk of Lime or Chloride of Limeshould be thrown into these daily, and theircontents should be, frequently removed.

5. Cellars and Rooms in Cellars are to befrequently whitewashed, and, if necessary,the floors sprinkled with dry Chloride ofLime. Areas and Paved Yards should becleaned, scrubbed, and, if necessary, washedwith the Bichloride Solution. Street Guttersand Drains should be cleaned and whennecessary sprinkled with Chloride of Lime orwashed with Milk ofLime.

6. Air-shafts.—Air-shafts should be firstcleaned thoroughly, and then whitewashed.To prevent tenants throwing garbage downair-shafts, it is advisable to put wire nettingoutside of windows opening on shafts. Con-crete or asphalt bottoms of shafts should becleaned and washed with theBichloride Solu-tion, or sprinkled with Chloride ofLime.

7. Hydrant Sinks, Garbage Receptacles , andGarbage and Oyster-shell Shutes and Recep-tacles should be cleaned daily, and sprinkledwith dry Chloride ofLime.

138. Refrigerators and the Surfaces around

and beneath them, Dumb-waiters , etc., may-be cleaned by scrubbing them with the hotSoap-suds Solution.

9. Traps.—All traps should be flushed dailywith an abundance of water. If at any timethey become foul, they may be cleaned bypouring considerable quantities of the hotStrong Soda Solution into them, followedby the Carbolic Solution.

10. Urinals and the Floors around andunderneath them should be cleaned twicedaily with the hot Soap-suds Solution, andin addition to this, if offensive, they may bedisinfected with the Carbolic Solution.

11. Stable Floors and Manure-vaults.—Stable floors should be kept clean and occa-sionally washed with the hot Soap-suds, orthe hot Strong Soda Solution. Powderedfresh Chloride of Lime may be used in ma-nure-vaults.

12. Vacant Rooms should be frequentlyaired.

13. The Woodwork in School-houses shouldbe scrubbed weekly with hot soap-suds.This refers to floors, doors, door-handles,and all woodwork touched by the scholars’'hands.

1414- Spittoons in all Public Places should

be emptied daily and washed with the hotSoap-suds Solution, after which a smallquantity of the Carbolic Solution or Milk ofLime should be put in the vessel to receivethe expectoration.

15. Elevated and Surface Cars , Ferry-boatsand Public Conveyances.—The floors, door-handles, railings and all parts touched by thehands of passengers should be washed fre-quently with the hot Soap-suds Solution.Slat-mats from cars, etc., should be cleanedby scrubbing with a stiff brush in the hotSoap-suds Solution.Use of Bromine Solution as a Deo-

dorant.

Slaughter Houses, Butchers' Ice Boxesand Wagons , Trenches, Excavations, StableFloors, Manure-vaults, Dead Animals, Offal,Offal Docks, etc., may be deodorized by aweak Solution of Bromine, which is a valua-ble agent for this purpose. The BromineSolution, however, is only temporary in itsaction and must be used repeatedly. Itshould be applied by sprinkling. Althoughsomewhat corrosive in its action on metals,it is otherwise harmless.

The Solution of Bromine must be prepared with great•care, as the pure bromine from which it is made is danger-

ous. It is very caustic when brought in contact with theskin ; it is volatile and its fumes are extremely irritating ifinhaled. In preparing this solution in large quantities, apound bottle of bromine should be dropped into a barrelcontaining forty or fifty gallons of water, and then brokenunder water with an iron bar. The solution is completedby thoroughly stirring. To prepare a smaller quantity anounce bottle ofbromine may be dropped into a pail contain-ing three or four gallons of water, and broken in the sameway and with the same care.

THE STERILIZATION OF MILK FORFEEDING INFANTS.

Sterilization is the process employed todestroy the germs contained in milk. Germsproduce fermentation (souring) and renderthe milk unfit to be used as an article of foodfor infants. Milk, as it reaches the city, evenif great care has been taken in its collectionand shipment, contains germs, and these willproduce fermentation, although the milk iskept on ice. Unclean vessels hasten thisprocess. No matter how good milk may bein the morning, when comparatively fresh,toward evening, unless it has been partly orcompletely sterilized, it may be dangerousto an infant, and may cause fatal illness, eventhough it still tastes sweet.

Complete sterilization destroys all thegerms in milk, and so prevents permanentlyfermentative changes ; by partial sterilization

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many of the germs may be destroyed, so thatthe milk will remain wholesome for at leasttwenty-four hours in the warmest weather.

Milk is best sterilized for infants by steam.It may be sterilized at a high or low temper-ature ; that is, at the boiling temperature(212 0 F.), which is high sterilization, or at alower degree of heat obtained by modifyingthe steaming process.

It has been found that milk sterilized at ahigh temperature (21 2° F.) is not desirablefor prolonged use, as the high temperaturecauses certain changes in the milk, whichmake it less suitable as a food for infants.These changes are in part avoided if a tem-perature lower than boiling is used. It isrecommended that the lowest temperaturebe used, for partial sterilization, which willkeep the milk wholesome for twenty-fourhours in the warmest weather (Koplik).

The utensils necessary are—

(a) A tin pail or pot, about ten inches deepby nine inches in diameter, provided withthe ordinary tin cover, which has been per-forated with eight holes, each an inch indiameter. The holes should be arranged ina circle, midway between the border of thecover and its centre. The centre is also per-forated with an opening of the same size.

17(I?) A wire basket, with eight nursing bot-

tles (as sold in the shops for this purpose).(c) Rubber corks for the bottles, and a

bristle brush for cleaning them.Directions (Koplik)—Place the milk, pure

or diluted (as the doctor may direct), in thenursing-bottles, and place the latter in thewire basket. Put only sufficient milk for onenursing in each bottle. Do not cork thebottles at first.

Having previously poured about two inchesof water in the tin pail or pot, and brought itto the boiling point, lower the basket ofnursing bottles slowly into the pot. Do notallow the bottles to touch the water, or theywill burst. Put on the perforated cover, andlet the steaming continue for ten minutes ;

then remove the cover and firmly cork eachbottle. After replacing the cover, allow thesteaming to continue fifteen minutes longerin the winter and twenty minutes longer inthe summer. The steam must be allowed toescape freely, or the temperature will risetoo high.

The process of sterilization is now com-pleted. Place the basket of bottles in a cooldark place or in an ice chest. The bottlesmust not be opened until just before the milkis to be used, and then it may be warmed

by plunging the bottle in warm water.If properly prepared the milk will tastebut little like boiled milk. There willnot be a thick ring around the inside of thebottle, and no butter will be seen floating onthe surface.

The temperature attained under the con-ditions stated above will not exceed in ex-treme cases 188° F.

Milk should be sterilized when It is as freshas possible and only sufficient milk fortwenty-four hours should be sterilized at onetime. If, after nursing, the infant leavessome milk in the bottle, this should bethrown away.

Care of the Bottles is Important. —Afternursing, the bottles should be filled with astrong solution of washing soda, allowed tostand 24 hours, and then carefully cleanedwith a bristle (bottle) brush. Minute par-ticles of dry or stale milk allowed to remainin the bottle are dangerous to the infant.The rubber corks and nipples should beboiled after using in strong soda solu-tion for 15 minutes, and then rinsed anddried.

After sterilizing, milk should never be putinto unsterilized bottles, as this will spoil it.

19CONCLUSION.

The general principles of disinfection out-lined in this circular may be applied for thedisinfection of all articles not specificallytreated of, and which are similar in char-acter to those considered.

By order of the Board of Health,

Charles G. Wilson,President.

Emmons Clark,Secretary.