HH62/1/DUMFRI/31

Transcription

[Page] 30

revenue of at least £75,000 into the county each year, it will
hardly be urged that we should simply stop the trade and take no
further steps. The dairyman is not usually responsible for an out-
break of fever at his house, and it may very reasonably be asked
why should he be subjected to a loss if means of isolation can be
provided for his patient. It is not necessary that the patient
should be accommodated at the entire expense of the ratepayers,
but he ought to have the opportunity of availing himself of and
paying for such accommodation before steps are taken to stop his
trade for a period that in some cases may be ruinous. It is now
held that Local Authorities are the proper parties to provide this
accommodation. Permission to make such provision was given in
the Act of 1867, which also contains a clause that, if put in force
by the Board of Supervision, would render it compulsory during
epidemic periods. When the making of such provision has been
postponed to these times, it has almost invariably turned out
expensive and unsatisfactory, and I can hardly doubt that in the
onward march of sanitation Local Authorities will see that it is to
the interest of their Districts to make the provision before being
compelled to do it at the call of a higher authority or by the panic
caused by an epidemic.
After Isolation will come Disinfection. A partial disinfection
will probably be carried out in well-regulated households during
the illness and convalescence of the patient, but it is only when
he ceases to throw off the infecting material that the complete
process can be performed. This can be most effectually done by
thoroughly fumigating the room or rooms occupied during illness
with sulphurous acid, generated by burning sulphur in the proportion
of 1lb. to every 1000 cubic feet of air-space. To allow of thorough
disinfection, every aperture, chimney, window, door, &c., ought to
be closed, the room being made as nearly air-tight as possible and
the sulphur left to act for twenty-four hours. The addition of
moisture greatly facilitates the process. Koch found in his laboratory
experiments that sulphurous acid, acting in moist air in an air-tight
box, not only destroyed bacilli but also the pores of some of the
more resistant in the time I have specified. It has been said that
sulphurous acid fails in certain cases. There is no doubt this is
true, but I attribute the failure to the difficulties that arise in the
way of securing its prolonged action in an air-tight room. There
are but few of the houses tenanted by the working-classes in which
rooms can be vacated so long as twenty-four hours. We have then

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to be content with a shorter period, but this imposes on us the
necessity of seeing that the articles in the room which have also
been exposed to infection should be treated separately in some
other way. Indeed, this is necessary whether the fumigation can be
carried out for twenty-four hours or not. Washable articles are best
disinfected by being thoroughly boiled, and experience as well as
experiments show that it is quite sufficient. Koch found that
five minutes' boiling completely destroyed the spores of the
anthrax bacillus; and Dr Russell, Medical Officer of Health for
Glasgow, says in a letter, quoted in the 14th Annual Report of the
Local Government Board, that for many years he has used no other
disinfecting method for washable articles than boiling them for
one to three-quarters of an hour with soap and soda. He con-
cluded that this was sufficient, because, though they threw small-
pox, typhus, enteric, scarlet fever, &c., all into one witches'
cauldron, he never heard of any inter-communication or continuity
of infection. For articles that are not washable, disinfection by
hot air or steam is required. Disinfection by steam is more satis-
factory than by hot air. Bulky materials are more readily
penetrated, the diffusion of heat is more uniform, and there is
less risk of injuring articles by scorching. The germicidal effect
is also found to be greater with steam than it is with hot air at the
same temperature. Certain articles, such as leather and water-
proof materials, would be destroyed by steam, and probably they
would be better disinfected by hot air. Though there seems to be
a universal agreement among authorities as to the superior value
of steam, there is not the same unanimity on the question
of how it may be most efficiently and economically applied. Most
of the apparatus now in use are constructed to apply it under
pressure, the earlier experimenters having found that bulky
articles were more easily penetrated, while the increase of tem-
perature coincident with the increase of pressure was supposed to
be an advantage. These high pressure apparatus are, however, so
costly as to be almost prohibitive in rural districts, and while it
must be admitted that they are probably more efficacious, I am
inclined to think we may get all we want from circulating steam
introduced into a chamber at the top and passed out at the bottom.
Such chambers might be constructed at each of the isolation
hospitals, when these are provided, and so made that they could be
utilised for hot air as well as steam disinfection, and that at a very
much smaller cost than the high pressure chambers. When erected