HH62/2/ROXBUR/15

Transcription

[Page] 14

smallpox occur, absolute isolation is essential; but the disease
can only become epidemic if vaccination, the first line of
defence, is neglected. If the District Committees absolutely
prohibit the over-crowding of cottages, the possibility of
typhus is reduced to a minimum. Puerperal fever will always
be treated at home. It is usually best for persons attacked
with diphtheria to be removed to a healthy place in their own
interest; but the total number of cases ought to be much
lessened as the drainage of houses is improved. The above
diseases may, of course, be removed to hospital, and in many
large towns cases of enteric fever, typhus, measles, diphtheria,
etc., are as far as possible removed from their homes. In the
country the conditions of life are very different, and improved
sanitation will do more to lower the zymotic mortality than
the provision of hospital accommodation.
Scarlet fever is, however, very different from the other
zymotic diseases. At the beginning of the illness the patient
is not in a highly infectious state, but later the poison is
disseminated in dust and flakes of skin, and clothing and
furniture retain it for a long period; and the patient is
dangerous to others for eight or nine weeks. The disease
spreads from farm to farm and from village to village until
the supply of susceptible persons is exhausted, and it then
ceases, to return again a few years later.
The only method of successfully combating it is to take all
patients at the beginning, and strictly isolate them, and then
thoroughly disinfect the house, clothing, furniture, etc.
Although in many instances person suffering from in-
fectious diseases can be induced voluntarily to go to a fever
hospital for the sake of better accommodation than they have
at home, it is to be remembered that the Local Authority has
power, under section 42, Public Health Act, to remove a sick
person against his will on the order of the Sheriff or a
magistrate. If a Local Authority is to act with the support
of public opinion in exercising this power it is necessary to
provide such a means of transit and accommodation that a

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patient is not exposed by removal or retention in hospital to
any avoidable risk.
A suitable conveyance would therefore have to be provided,
so constructed that it may run easily, and after a journey
admit of being thoroughly disinfected. Then the hospital to
which the patient is taken must be so arranged that the
sufferers from one infectious disease are not exposed to the
infection of another.
In addition to the above, some form of disinfecting ap-
paratus is required, so that all the infected bedding and
clothing may be purified, both that brought from the hospital
and that brought from the patient's home.
There is no doubt that (apart from hospital accommodation)
such an apparatus should be at the service of each Local
Authority in the county, and as the expense would be con-
siderable an attempt might be made to enter into and arrange-
ment with the burghal authorities.
A similar arrangement may prove to be the most economical
by which to provide sufficient hospital accommodation, if an
agreement can be come to for the joint control of the
institution. The great distance some patients would have to
be brought would prove the chief obstacle to districts uniting,
and when a sufficiently large population to justify the exist-
ence of a hospital could be found by joining with a burgh in
the district, that arrangement would appear preferable.
At present it would be difficult to accurately estimate the
amount of accommodation required, as no records of the
number of cases in epidemics of past times are available, and
the usual estimate of one bed to 1000 persons might prove
misleading. A few years' experience of the Act for the
Notification of Disease would go far to remove the difficulty.
GENERAL SANITATION. - Under this heading two important
subjects fall to be considered - namely, the general water
supply and drainage of the district. Few countries have
naturally as plentiful a supply of water, and any difficulty
that is experienced in obtaining water is due to the pollution