In London the different vestries and district boards are the sanitary authorities, and each of them is empowered to provide hospitals for infectious diseases when they exist.

But as a matter of fact the great fever hospitals, under the control of the Metropolitan Asylums Board, and intended for paupers only, are made use of by almost all classes. Many persons object to go to these hospitals because they are pauper hospitals, but I think when such a serious thing is concerned the matter ought to be separated from connection with pauperism. A person affected with an infectious disease ought to be taken to an infectious hospital whether he can afford to pay for it or not, but he ought not to be made a pauper of by that fact. (An Act since passed has accomplished this.)

I say, then, isolation is the first thing; the next is disinfection; by this I mean the destruction of the poison. We are perfectly certain now, by direct experiment, that the poisons of some of these diseases can be destroyed by certain agents. There are a good many agents that have been long in use as disinfectants. The first is dry heat; this is capable of destroying such of these poisons as have been experimented on, and it has been practically shown that heat is capable of destroying the poisons of all of these diseases. Practically the baking of clothes in a disinfecting oven, raising the heat to about 240° Fahr., a temperature which will not singe the clothes, is sufficient. I do not mean to say, however, that burning the clothes would not be the safer and better plan of getting rid of infected articles if you can spare them, but when you consider the amount of clothing that would have to be destroyed during an epidemic of smallpox, you will see that this is often a practical impossibility.

I maintain, further, that it is a thing which need not be carried out. I have never known an instance where clothes, that have been disinfected in a hot oven, have been the means of spreading disease.

It has been shown that sulphurous acid gas, nitrous acid, and chlorine, are all agents that may be used for disinfecting purposes. Sulphurous acid is an agent that can be relied upon. For disinfecting masses of matters, both liquid and semi-solid, such as discharges from the intestinal canal, green copperas or sulphate of iron, in the form of a solution of a pound of green copperas to a gallon of water, is very effective. Strong carbolic acid is likewise good, and, under certain circumstances, chloride of lime.

When a person is suffering from one of these infectious diseases, the first thing to do is to change the air of the room as often as possible without causing any draught; that is best done by having a small fire in the room and the windows open in the house.

All articles, especially woollen drapery and curtains, should be removed from the room as soon as the person is put into it, and they will not be infected if removed at once.

All discharges from the patient should be received in vessels containing a disinfectant, as carbolic acid, or better still, a strong solution of green copperas. The cup which is provided for the patient to spit in should also contain a disinfectant.

All bed-clothes, linen, etc., should be placed in water containing a disinfectant before they are taken from the room; pocket handkerchiefs should not be used, but small pieces of rag, which should be burnt. All glasses and cups used should be very carefully cleansed in hot water before being used by any one else.

Nurses should not wear woollen garments, but glazed cotton dresses, and should wash their hands in water containing chloride of lime before leaving the room.

In scarlet fever and smallpox, when the poison is given off from the skin, it is a very good plan to rub the patient with oil, or, better, camphorated oil; this is soothing to the patient, and it prevents the poisonous matter getting away from the skin and becoming diffused in the air around.

As soon as the patient is well enough he should take a warm bath, in which the whole of his person should be scrubbed, carbolic soap being used, and afterwards the bath should be repeated every other day until four or five have been taken. He should not be allowed to mix with other people until the skin is perfectly clean.

In enteric fever the discharges from the intestinal canal should be disinfected.

In cholera disinfection is much more difficult, owing to the enormous amount of discharge, but it is well in this, as in enteric fever, to adopt the precaution.

After a person has recovered, the room and articles in it require disinfecting. The best way to do this is to paste up the crevices of the windows and fireplace with paper, and then to burn in the room, in an iron vessel, some sulphur. The vessel in which the sulphur is burnt should be suspended over a bucket of water by placing it on a couple of stair rods or a pair of tongs, and the sulphur can be lit by a match, or, still better, by pouring spirits of wine on it and lighting that; the door must then be shut and paper pasted over the crevices outside. The sulphur will burn and form sulphurous acid in such a quantity that a person could not live in the room. It should be left for six hours, and at the end of that time it will have been sufficiently disinfected.

The paper on the walls should be stripped off and burnt, but the sulphur should be burnt in the room before this is done.

The walls of the room should be lime-whited, and the wood-work scrubbed well with water having chloride of lime or some other disinfectant in it; the ceiling should be lime-whited, and the room left unoccupied as long as possible.

Bed and bed-linen should be sent to the hot air chamber and baked.


In no instance where these precautions have been taken have I known the same disease to break out again in a room, and that is, I think, a proof that the method is a good one, and it is a method supported by some admirable experiments recently made with1 agents for the destruction of the poisons of epidemic diseases.