|Submitted by: Jennifer Ammons|
The list found below is of medical examination questions that have been used to illustrate the idea of fairness the board has toward all applicants, who wish to become licensed doctors. The required percentage is 66 2-3 in each branch.
It is the object and aim of the Medical examining Board to keep up the standard of examinations and not only keep them up to their present height, but to raise it. Examinations are only held before a full board, and only in writing, and each member is expected to furnish questions at least six months prior to the date of their usage; as well as to grade each paper and place his markings there.
These results are filed in the Presidents office as a part of the medical history of Oklahoma Territory.
I wish to speak something about the Territorial Medical Examining Board, its formation and duties.
The Secretary and Superintendent of Public Health by virtue of this office becomes the President of the examining board; the other two members are appointed by the Territorial board of health the same as the County boards are appointed.
In making up this board great care was exercised and I always feel free to appeal to them in knotty problems arising in matters to registration and examination, demanding some judgement in settling. Dr. Grant Cullimore, of Oklahoma City, Secretary, and Dr. J. A. Overstreet, of Kingfisher, Treasurer, were solicited to accept the places above mentioned and the Territorial Board of Health has had numerous opportunities to congratulate itself upon such efficient help in the managing of one of the most difficult branches of its business.
It occurs to me that there are about three things that are of equal importance in the welfare of this Territory, 1st, the church. 2nd. the school. 3rd the medical department. The first two I will not touch upon as they will be handled by some one more competent. Great railroads have systemized their medical staff to as fine a working department as any of their departments. Not long since they did not have such a thing on record as a surgical staff as they call it, and in fact some of the smaller systems have not yet instituted such a department. This department consists of a Chief Surgeon and he appoints his assistants up and down the line. This is done at a great expense, yet these railway systems find that its a money maker for them. Besides the caring for their injured the surgeon saves them money in the settlement of claims brought against them for injuries or fancied injuries received by employees or patrons. Now the question comes what has all this to do with this Territory. Just this--If the medical department were eliminated from the offices of the Territory, the population would as rapidly decrease as if it were the church or the school. Now let me place a proposition against this statement, the physicians are here to make a living and something more if possible, and they are not going to do anything to hurt their practice unless compelled to do so. Have an efficient medical staff, one that will not compel the doctors to make reports of contagion even if in their own families and we have the diseases secreted and the public constantly exposed. The railroads use the Surgical staff as an advertiser. The Territory has been using its health department for such ever since it had one, and I dare say has not given it a serious thought. If the railroad can afford to make improvements for its staff I am sure this great Territory can afford it and will do so when such improvements are shown to it and the good that will come of them. People coming here or to any country will inquire as to the water, climate, and which is the condition of the cities and towns in the way of "sickness." I have such inquiries from every state in the United States and from Canada. I have given a favorable answer to all; but here comes the biggest proposition that has faced the health department in Oklahoma. That of sewerage.
The lay people as you will see by so many reports from the Superintendents are not in sympathy with the department in its work of keeping down contagion and infection.
It would seem that when this department is of so much importance to the growth and welfare of a community we should have the hearty co-operation of all. There seems to be that aversion to having premises placard, and it is an unnecessary aversion, for all who are fair, will not want their children to contract diphtheria. As the towns grow and assume city airs they must have sewers and water supply to flush them. The building of sewers is in all cases more or less experimental in towns never having enjoyed them before; and this is what will cause us to have more typhoid fever and scarlet fever. The officials that have such improvements to make are very liable to be better educated in some other vocation. They will not be in a position to say what shall be the proper size of tributary pipe to use to drain a nine room house, or if the main is sufficiently flushed, or if the gas trap is the proper make or one that has been discarded as not sufficiently effective to perform its duty. Then again there is the terminal--we have no crematories in the Territory, nor have we streams of water of enough volume to carry off the sewerage of a town having a population of 2,500. In Enid there is an open creek that has carried the sewerage around 1/3 of the town and following its course there has been more or less typhoid fever and small-pox during the last year than all other parts of town. The new sewerage system will do away with this menace.
Take it on the other hand some of our good people have courted small-pox on account of its mildness, and the once having, causes immunity. In fact some have told me they wanted their children to have it and be through.
The doctors of one of our large towns concluded that the dear people's wishes should be gratified and did not report a case for some weeks. This was told me by them some six months afterward. And that is why we had such a hard time to get it under control in that county.
These are some of the causes that can be remedied. Now comes some sources of contagion that are wholly unavoidable, among them immigration to our country by wagon. These people are poorly fed and clothed and in some instances their bedding and wagons are veritable hot-beds for germs -are on the road so long that their systems like their teams show their ribs. They do not stop long enough to be quarantined unless too ill to travel and then if they know the disease is small-pox they will keep away from towns and doctors. By the time the patient gets in the most dangerous stage (as far as transmitting the diseases is concerned) he is able to travel and he leaves a track of the same behind him wherever people come in contact with him. The railroad building is a cause of much trouble in the way of contagion. The superintendents have had a serious time in keeping small-pox under control in these camps. The disease comes from sanitation and poor water, as well as exposure to the elements when the system is at low ebb.
The entire health department met in session during the summer and at that time the advisability of new methods was discussed as was the better using of the means at hand for keeping contagion under control. At this meeting discussion was free and I am of the opinion all who were not thoroughly posted on these matters left for home having a good understanding of their duties and feeling prepared to meet any emergency.
The following are some hints on Disinfectants and Disinfection that are of great value to any one. They are taken from the last report.
A disinfectant is an agent capable of destroying the infective power of infectious material.
The object of disinfection is to prevent the extension of infectious diseases by destroying the specific infectious material which gives rise to them. This is accomplished by the use of disinfectants.
There can be no partial disinfection of such material; either its infecting power is destroyed, or it is not.
The popular use of the term has led to much misapprehension, and the agents which have been found to destroy bad odors--deodorizers,--or to arrest putrefactive decomposition--antiseptic--have been confidently recommended and extensively used for the destruction of disease germs in the excreta of patients with cholera, typhoid fever, etc.
The injurious consequences which are likely to result from such misapprehension and misuse of the word disinfectant will be appreciated when it is known that recent researches have demonstrated that many of the agents which have been found useful as deodorizers, or as antiseptics are entirely without value for the destruction of disease germs.
This is true, for example, as regards the sulphate of iron or copperas, a salt which has been extensively used with the idea that it is a valuable disinfectant. As a matter of fact, sulphate of iron in saturated solution does not destroy the vitality of disease germs, or the infecting power of material containing them. This salt is, nevertheless, a very valuable antiseptic, and its low price makes it one of the most available agents for the arrest of putrefactive decomposition in privy vaults, etc.
While an antiseptic agent is not necessarily a disinfectant, all disinfectants are antiseptics.
Disinfection:--It will be our aim in the present chapter to give reliable practical directions with reference to the use of disinfectants, and the best methods of disinfection: keeping this object in view, we shall recommend for disinfecting purposes only those agents named in the following list:
- 1. Fire.
- 2. Boiling water.
- 3. Formaldehyde gas.
- 4. Chloride of lime (in solution.)
- 5. Mercuric chloride (in solution.)
- 6. Carbolic acid (5 per cent solution.)
- 7. Caustic lime (quicklime.)
- 8. Sulphur dioxide.
- 9. Copper sulphate (in solution.)
All of these agents, properly used, are effective for the destruction of the "germs" of the following named diseases; Tuberculosis, diphtheria, typhoid fever, yellow fever, cholera, small-pox, measles, pneumonia, epidemic influenza, erysipelas, hog cholera, chicken cholera, swine plague, infectious pleuro-pneumonia of cattle, and, in general, all infectious diseases in which the specific germ does not form spores.
1. Fire: This method of disinfection is always to be recommended, when practicable or consistent with a due regard for economy and the rights of individuals. As a rule, articles of little value, which have been soiled with the infectious material, had better be burned; and this is especially true of old clothing and bedding. But we have other efficient methods of disinfection, which make it unnecessary to sacrifice articles of value except under unusual circumstances.
2. Boiling: In the absence of spores, bacteria are quickly killed at a temperature considerably below the boiling point of water, and it is safe to say that boiling for half an hour will destroy all known disease germs, including the spores of anthrax, which have less resisting power than the spores of certain harmless and widely distributed bacili, which have been found to resist boiling for several hours.
3. Formaldehyde Gas: This gas is now largely used for the disinfection of clothing, hospital wards, etc., as a substitute for steam or sulphur dioxide. But like these agents its action is superficial and it cannot be depended upon for the disinfection of mattresses, pillows, rolls of clothing or bedding, etc. As is the case with chlorine and sulphur dioxide its germicidal power is increased by the presence of moisture, and by a high temperature. By means of a vacuum chamber in which the articles to be disinfected can be placed and the air exhausted prior to the admission of the disinfectant, the necessary penetration can be secured for such articles when they are properly arranged. But the disinfection of clothing and bedding by these agents (steam, sulphur dioxide and Formaldehyde,) calls for special apparatus and the supervision of an expect in the practical use of such apparatus. Formaldehyde gas is irritating to the mucus membrane of the eyes and nose, but it is not poisonous.
In the absence of any apparatus satisfactory results have been obtained by the Department of Health of the city of Chicago, as follows:
Ordinary bed sheets were employed to secure an adequate evaporatory surface, and these, suspended in the room, were simply sprayed with a 40 per cent solution of formalin through a common watering pot rose-head. A sheet of the usual size and quality will carry from 150 to 180 cc. of the solution without dripping, and this quantity has been found sufficient for the disinfection of 1,000 cubic feet of space. Of course, the sheets may be modified to any necessary number.
Surface disinfection was thorough, while a much greater degree of penetration was shown than that secured by any other method.
We would remark, that in the absence of suitable appliances for disinfection, and in general when the disinfected articles are of little value, consumption by fire furnishes the readiest and safest method of disposing of such articles.
4. Chlodide of Lime (chlorinated lime, bleaching powder.) This is one of the cheapest and most efficient of disinfectants. It should be packed in air-tight and moist-proof receptacles, --glass preferable, --and should contain at least 25 per cent of available chlorine. It should be used in solution, which had better be made as required. An insoluble residue will be left, which may be removed by filtration or decantation. This however, is not at all necessary. Chlorinated lime owes its disinfecting power to the presence of the hypo-chlorite of lime, a salt which is freely soluble in water, and which is quickly decomposed by contact with organic matter.
Germs of all kinds, including the most resistant spores, are destroyed by this solution, but it must be remembered that the disinfectant itself is quickly decomposed and destroyed by contact with organic matter, and that if this is present in excess, disinfection may not be accomplished, especially when the germs are embedded in masses of material which are left after the hypo-chlorite of lime has all been exhausted in the solution.
5. Mercuric Chloride (bichloride of mercury, corrosive sublimate.) This salt is well known as a deadly poison, which has long been used in domestic practice as a "bug poison." It has germicide powers of the first order, and it is consequently a disinfectant which may be recommended for certain purposes, due regard being had to its poisonous nature, and to the fact that it is decomposed by contact ride. Its potency in dilute solutions (1:500 to 1:4000) makes it comparatively cheap, and the danger of accidental poisoning from such dilute solutions is not very great. The concentrated solutions should be colored, as a precaution against accident for they have neither color nor odor to reveal their deadly nature.
It must be remembered, in using this and any other disinfecting solution, that the condition relating to the time of exposure to the action of the disinfecting agent is an important one. The experimental evidence relating to the germicide power of mercuric chloride shows that the time of exposure being two hours, this salt may be safely recommended for the destruction of pathogenic organisms in the absence of spores in the proportion of 1:2000, or even less, provided that the micro-organisms to be destroyed are fairly exposed to its action.
6. Carbolic acid. The disinfecting power of carbolic acid has been fixed by experiments upon vaccine virus; and upon various pathogenic organisms.
For excreta it is to be used in five per cent solution, and for clothing, etc., in two per cent solution. The experimental evidence upon record indicates that it may be relied upon in this proportion.
7. Caustic Lime (Quicklime) For disinfection of excreta, in the sick room or in sinks, privy vaults, etc. freshly prepared "milk of lime" should be used, containing about one part, by weight, of hydrate of lime to eight parts of water. This should be used freely,--in quantity equal in amount to the material to be disinfected. The white-washing of exposed surfaces is a satisfactory method of destroying any disease germs which may have lodged upon such surfaces.
8. Sulphur Dioxide (sulphurous acid gas.) Fumigation with burning sulphur has long been a favorite method of disinfection. The experience of sanitarians is in favor of its use in yellow fever, small-pox, scarlet fever, diphtheria, and other diseases in which there is reason to believe that the infectious material does not contain spores.
The material to be disinfected shall be freely exposed to its action for a considerable time, in a receptacle which does not permit the gas to escape. To secure any result of value, it will be necessary to close the apartment to be disinfected as completely as possible, by stopping all apertures through which the gas might escape, and to burn at least three pounds of sulphur for each thousand cubic feet of air space in the room. To secure complete combustion of the sulphur, it should be placed, in powder or in small fragments, in a shallow iron pan, which should be set upon a couple of bricks in a tub partly filled with water, to guard against fire. The sulphur should be thoroughly moistened with alcohol before igniting it.
9. Copper Sulphate. This salt has been largely used as a disinfectant in France, and experiments show that in the proportion of one per cent it is a reliable agent for the destruction of micro-organisms, in the absence or spores. It is much below mercuric chloride in germicide power but is a better deodorant--not a better antiseptic--than the more poisonous salt. When we take in to account its efficiency, it is comparatively cheap, and is to be recommended for certain purposes.
Disinfection of Excreta, etc. The dejections of patients suffering from an infectious disease should be disinfected before they are thrown into a water-closet or privy vault. This is especially important in cholera, typhoid fever, yellow fever, and other disease in which there is evident that the infectious agent is capable of self-multiplication, in suitable pabulum, external to the human body. Vomited matters, and the sputa of patients, with these and other infectious diseases, should also be promptly disinfected. This is especially important in cholera, diphtheria, scarlet fever, whooping cough, and tuberculosis. It is advisable, also to treat the urine of patients sick with an infectious disease with a disinfecting solution.
For the disinfection of excreta, etc., in the sick-room, a solution of chloride of lime is to be recommended. This is an excellent and prompt deodorant, as well as a disinfectant.
As chloride of lime is quite cheap, it will be best to keep on the safe side, and to make the solution for the disinfection of excreta by dissolving eight ounces of chloride of lime in a gallon of water. This solution should be placed in the vessel before it receives the discharge. The material to be disinfected should be well mixed with the disinfecting solution by agitating the vessel, and from thirty minutes to an hour should be allowed for the action of the disinfectant, before the contents are thrown into a water-closet or privy vault.
For the disinfection of liquid discharges in cholera, typhoid fever, dysentery, etc., a five per cent solution of carbolic acid may be used.
The solution should be used in an amount as least equal to the material from the mouth and nostrils of patients with diphtheria. (Part of the paragraph is missing) ...sary to insure disinfection was fixed by the committee at four hours.
Milk of lime, made by slacking fresh quick lime with water and mixing the resulting hydrate of lime with eight parts of water, is one of the best and cheapest agents for the disinfection of excreta in the sick room, on the surface of the ground, in open sinks, etc. This milk of lime should be used in an amount at least equal to the quantity of material requiring disinfection.
It will be best to burn cloths used to wipe away discharges of the sick, and especially those used in wiping away the infectious material from the mouth and nostrils of patients with diphtheria or scarlet fever; bits of old muslin may be used for this purpose, and should at once be thrown upon an open fire or gas stove arranged in the fire place for this purpose.
Infected sputum may be discharged directly into a cup half full of the solution of chloride of lime recommended for excreta, or of Labarraque's solution.
Handkerchiefs, napkins, and towels used in wiping away infectious discharges, if worth preserving, should at once be immersed in one of the following solutions: Chloride of lime, 2 per cent; carbolic acid, 2 per cent; mercuric chloride, 0.1 per cent (1:1000.)
Cloths used for washing the general surface of the body should also be disinfected with one of the above mentioned solutions, and attendants should invariably disinfect their hands by washing them in hope of these solutions, when they have been solid by the discharges of the sick.
Disinfection of the Person. Labarraque's solution, dilute with twenty parts of water, is a suitable disinfecting solution for bathing the entire surface of the body of the sick, of convalescents, or of those whose duties take them into the sick-room; or a 2 per cent solution of carbolic acid, may be used, or a solution of mercuric chloride (corrosive sublimate) of 1:1000. The poisonous nature of this solution must be kept in mind.
Disinfection of Clothing and Bedding. The cheapest and best way of disinfecting clothing and bedding, which is not injured by the ordinary operations of the laundry, is to immerse it in boiling water for half an hour or longer. It should be placed in boiling water as soon as removed from the person or bed of the sick, and if it is necessary to remove the articles from the room in order to accomplish this, they should be wrapped in a sheet or a towel thoroughly saturated with a disinfecting solution. If it is impracticable to disinfect such infected clothing and bedding immediately by boiling, it will be necessary to immerse it in one of the following disinfecting solutions, in which it should be left for four hours: Mercuric chloride, 1:2000: or the "blue solution" of this salt and sulphate of copper, dilute by adding two fluid ounces of the concentrated solution to a gallon water; or a 2 per cent solution of carbolic acid.
Finally, the valuable germicidal properties of direct sunlight have been demonstrated by numerous carefully conducted experiments and the time-honored domestic practice of hanging infected clothing and bedding in the open air is to be recommended. This should supplement disinfection by Formaldehyde or sulphur dioxide.
Disinfection of the Sick Room. Every effort should be made to prevent a room occupied by patients sick with an infectious disease from becoming infected. Carpets, stuffed furniture, curtains and other articles difficult to disinfect, should be removed at the outset. Indeed, nothing should be left in the room which is not absolutely required, and all furniture and utensils should be of such character that they can be readily disinfected by washing with boiling water or with a disinfecting solution. Abundant ventilation and scrupulous cleanliness should be maintained, and a disinfecting solution should always be at hand for washing the floor, or articles in use, the moment they are soiled by infectious discharges. For this purpose a solution of chloride of lime may be used (4 per cent.)
It is impracticable to destroy infectious material in an occupied apartment by means of gases or volatile disinfectants, for to be effective these must be used in a degree of concentration which would make the atmosphere of a room quite irrespirable. These agents are therefore useful only as deodorants. They are all more or less offensive to the sick and will seldom be required, even as deodorants, when proper attention is paid to cleanliness and ventilation.
Daily wiping of all surfaces--floors, walls, and furniture--with a cloth wet with a disinfecting solution, is to be recommended. For this purpose a solution of chloride of lime (2 per cent), or of carbolic acid (2 per cent), or mercuric chloride (1:1000), may be used.
Disinfection of the vacated room, then, consists in the destruction of all infectious particles which remain attached to surfaces, or lodged in crevices in interstices of textile fabrics, etc. The object in view may be accomplished by thorough washing with one of the disinfecting solutions heretofore recommended; but most sanitarians think it advisable to disinfect a room with a gaseous disinfectant, such as Formaldehyde or sulphur dioxide. If the "fumigation" with sulphur dioxide is resorted to the directions given by the Committee on Disinfectants of the American Public Health Association should be followed, i. e. three pounds of sulphur should be burned for every 1,000 cubic feet of air-space. But, as already stated, disinfection with Formaldehyde gas is to be preferred.
At the end of from twelve to twenty-four hours doors and windows should be opened, and the room freely ventilated. After this fumigation, all surfaces should be washed with a disinfecting solution (chloride of lime 2 per cent, carbolic acid 2 per cent, or mercuric chloride 1:1000) and afterwards thoroughly scrubbed with soap and hot water. Plastered walls should be whitewashed.
Disinfection of Privy Vaults, Cesspools. The contents of privy vaults and cesspools should never be allowed to accumulate unduly or to become offensive. By frequent removal, and by the liberal use of antiseptics, such necessary receptacles of filth should be kept in a sanitary condition. The absorbent deodorants, such as dry earth or pounded charcoal, --or the chemical deodorants, and antiseptics, such as chloride of zinc, sulphate of iron, etc., will under ordinary circumstances, prevent such places from becoming offensive.
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