| C H A P T E R
III
PRELIMINARY OBSERVATIONS
Upon arrival of
the Department of Public Health personnel at the institution,
a survey was made of the existing control measures in
order to determine their efficiency and to institute whatever
additional measures were necessary to control the epidemic.
WATER SUPPLY.
It was found that all of the water for the institution
was being obtained from Well No. 4, which had its source
of supply in the shallow Niagaran limestone. This
well was cased only through 18 feet of drift and 1 foot
into the limestone. An emergency chlorinator had
just been installed. Chlorine was being fed into the pump-suction
line at a point approximately 15 feet from the high-service
pump. Due to the fact that the high-service pumps
discharged directly into the distribution system, the
retention period provided between the point of application
of chlorine and points where the water was consumed was
not adequate to provide proper disinfection. Analyses
of samples of this water showed that contamination still
persisted after chlorination.
TYPHOID WARD WASTE
DISPOSAL. A survey of the method of handling wastes
from the typhoid patients showed that it was not
satisfactory, because the wastes were in some instances
being placed directly into the sewer, and, other instances
the material was collected in cans and hauled to a field
for burial.
No attempt had
been made to close off the sewers in the isolation buildings
to keep contaminated material from going to the sewer
and sewage-treatment works.
TYPHOID WARD LINEN.
THe handling of linens from the typhoid wards was found
to be unsatisfactory, Large piles of soiled linens
were found lying on the porches of the typhoid wards,
where they were exposed directly to flies. Soiled
sheets were lying on the floor in the typhoid wards proper
and in the bathrooms.
SEWERAGE.
The plumber was contacted to determine id any serious
sewer stoppage had occurred. He advised that a sewer
stoppage on the First Avenue in front of Silvis Hall had
been remedied a few days before. Upon examination
and checking with dye, it was found that sewage from the
sanitary sewer was finding its way to the storm sewer,
which sewer was approximately 12 feet from the sanitary
sewer. It was found, also. that there was a stoppage
of the sanitary sewer located in the street between the
power house and Well No. 4, and that sewage was standing
to a depth of several feet in the manhole located approximately
80 feet from Well No. 4. Details on these sewer
stoppages will be found in Chapter IV.
DIETARY DEPARTMENT.
A hurried check revealed that there was a serious fly
situation in the central kitchen and the dining rooms
and the kitchen was extremely dirty. Patients who
were working in the kitchen were dirty, It was noted
that brooms used for scrubbing floors were later used
for cleaning the cooking utensils and the meat block where
meat was carved. An objectionable odor nuisance
also existed both inside and outside the kitchen.
A dishwashing machine
in use in the central kitchen provided only a 12-second
interval from the time the dishes entered until they were
discharged. The same method of dishwashing was used in
the majority of the ward kitchens. In ward kitchens,
where no dishwashing machines were provided, dishes were
washed by hand. No attempt was made to sterilize
the dishes after washing by either method. Dish
towels were used throughout the institution by patients
in drying dishes; also, a great deal of difficulty was
encountered in securing a sufficient number od towels.
Cans used for transporting food from the central kitchen
to the ward kitchens were returned, in many instances
to the central kitchen without having been cleaned.
Food-handlers,
both patients and employees, had not been checked to determine
whether or not they were carriers of infectious disease.
Several discarded
bathtubs were being used in the basement of the central
kitchen as receptacles for vegetables which were being
prepared, The enamel was badly chipped on these
tubs and they were otherwise in a poor sanitary condition.
The situation prevailing in this room was not satisfactory
because of overcrowding of inmate workers and the necessity
of preparing, at times, 100 bushels of potatoes for a
meal together with other vegetables which were required,
The drainage facilities in the peeling rim were also inadequate;
and , as a result, the floor was flooded at times.
In bringing the
vegetables from the peeling room to the central kitchen,
they were transported around the building, a distance
of approximately 500 feet, by a small hand truck.
In the process of transporting these vegetables were subjected
to flies, dust, dirt and other contaminating substances.
The milk supply
coming to the institution was from an approved milk-pasteurization
plant; however, there were approximately 100 gallons of
raw milk produced on the institution farms each day.
This raw milk was used only for cooking and in a boiled
ice-cream mix.
Dishes used by
hospitalized patients and employees, which included typhoid
patients and typhoid suspects besides the ordinary population,
were being returned to the hospital kitchen from the besides
without proper disinfection.
It was found that
relatives and friends visiting employees in the hospital
who were ill with typhoid fever were going from the typhoid
patient's bedsides into the hospital kitchen and were
handling dishes, food, etc.
GARBAGE.
Garbage at the institution was being collected by a horse-drawn
wagon, and the garbage box provided was not watertight.
As a result, whenever the garbage wagon stopped for collection,
pools of garbage were formed, thereby creating fly-breeding
and odor nuisance over the entire grounds. Garbage
cans from the individual ward kitchens were set along
the roadway and in most instances the areas around the
garbage cans were covered with garbage that had been spilled.
Also, there was a lack of lids for these garbage cans
and no attempt was made to wash the cans after the garbage
had been collected.
At the central
kitchen, garbage was placed in galvanized iron cans on
the rear platform of the kitchen, and if the cans were
not available the garbage was dumped directly onto the
ground. Here again, a serious fly and odor nuisance
existed.
RUBBISH.
Rubbish from the institution was collected with a horse-drawn
vehicle and taken to the north farm where it was deposited
near the garbage dump. On windy days the paper and
other material were blown over the landscape and presented
a very untidy, ill-kept appearance. Tin cans from
the kitchen were not charred and crushed, and,again, an
excellent feeding place for flies was created. Attempts
were made to burn the rubbish; however, this was not possible
on windy days.
RODENT CONTROL.
Very little attention was paid to rodent control at the
institution and as a result many mice and rats were present.
An ample food supply for rodents was available around
the garbage cans and at the garbage dump.
There was a very
bad infestation of rats at the sewage-treatment plant,
where screenings from the barscreen were dumped and not
properly covered.
FLY AND INSECT
CONTROL. At the start of the epidemic the institution
was infested with flies and cockroaches. There was
profuse fly breeding at the sewage-screenings dump, garbage
cans throughout the institution, manure piles, and at
places where fecal matter had been deposited by patients
(particularly behind bushes around the buildings and in
the grove behind the power house). Probably the
worst condition existed at the sewage-screenings dump
where it was noted that the entire dump was literally
alive with maggots. Cockroaches were so prevalent
that they were noted in the sleeping rooms and even in
the beds of some of the various wards.
The central kitchen
was infested with flies, due partly to the remodeling
activities which made it possible to have all openings
properly screened and partly to the fact that traffic
was through one outside door.
The hospital, including
the operating and post mortem rooms, was over-run with
flies due to improperly fitted screens. |
