[Page] 26

cidentally by stringent regulation as to cubic space in every
dwelling. But reverting to the point at which we started viz. -
The Distribution of Disease, it will be convenient to con-
sider the remaining diseases, viz. : typhus and diphtheria, in-
cluding croup, puerperal fever and tetanus as they occur; first
on the West Coast and second on the East Coast. As regards
tetanus or lockjaw it is almost unknown on this side and pro-
bably that which occurs in the Lews, and scarcely anywhere
else is the lockjaw of very young infants - newly-born babes.
It is I understand dying out, but the matter requires and will
secure attention by and by. Investigations in St Kilda point
to filth and some absurd notions of dealing with the umbilical
cord as the real cause. It is interesting to know that in
Germany the germs found in persons suffering from tetanus
have been also discovered in garden soil. If this come to be
proved, there need be no difficulty in stamping out the lockjaw
of infants.

With regard to puerperal fever, investigations on the spot
are urgently required. If it be true, as I have been informed
that puerperal fever is even more frequent than the returns
would imply - the great majority of the cases being of a mild
type, it seems from what I hear of the nursing of women in
childbed pretty plain, that here too filth is the great agent in
propagating the disease. I have spoken already of the miser-
able condition of the houses of the crofter fishermen on the
West Coast. Much is due to that state of things, but more
is really owing to habits of sloth and dirt which education
ought to correct - aided it might be by providing well-trained
nurses to play the part of midwives amongst the West Coast
and Island populations.

But the most striking contrast between the East and West
Coasts is the prevalence of typhus and diphtheria to a much
greater extent on the latter side of the County. Let us try
to account for this fact. The question of the origin of in-
fectious disease is in most cases a very difficult one. Typhoid
fever too common, alas, on this side of the county, breaks out
again and again and in spite of our efforts to discover its
vagaries we get lost in our search after its track. But modern

[Page] 27

science by making it plain that these diseases are due to germs
has completely upset all the de novo notions of the source of in-
fections and distinctly settled that every single case is due to a
previously existing one of the same kind. The practical de-
duction is that in every outbreak all the germs should be
killed; and then of course the breed would be stamped out.
A grand result, truly, if possible! alas not practicable but
surely an ideal point to aim at. Disinfection if it be worth
the name at all, must be thorough and complete. Here let me
stop for one moment to say that a great deal of so-called dis-
infection is not only of no avail but does harm. The great
disinfectors are fresh air, clean water, soap and elbow grease.
Without these all the vaunted disinfectants which are usually
only deodorants are utterly useless. Careful experiments
have conclusively proved that dry heat, steam, carbolic acid,
chlorine, corrosive sublimate, and these almost exhaust the list
of real disinfecting agents, will only kill germs and the seeds of
germs when used at a strength which would quickly kill all other
animal life exposed to their action. What then is to be done,
more especially on the West Coast and islands to really destroy
contagion? I fear it must be said that we must destroy the
nest as well as the eggs. The body and bed clothes ought
to be boiled - woollen garments thoroughly baked, steamed,
or exposed for long periods outside to sun, wind and rain, and
everything comparatively valueless burnt; the roof sent to
the fields for manure; the wood work burnt in great measure
or steeped in chloride of lime solution; the floors removed
and replaced with concrete; and the walls knocked down and
built up afresh. Plainly, this cannot be done at the expense
of the tenant. It ought to be carried through at the sight and
charge of the Local Authorities, and if well and completely done
it would pay them to do it. Consider not only the waste of
human life but the expense involved in a serious outbreak of
typhus or diphtheria! Surely if we can afford to slaughter
valueable herds of cattle for the sake of the remaining stock
we can pay for the stamping out of human disease. It seems
to me the difficulty lies in convincing Local Authorities that such
diseases can be prevented. Both philosophy and practice point
decidedly to this result, if only the instruments and means are

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