Plague : papers relating to the modern history and recent progress of Levantine plague / prepared from the time to time by direction of the president of the Local Government Board, with other papers ; sented to both House of Parliament by Command of Her Majesty.

Radcliffe, Netten.

Date:: 1879

Credit: Plague : papers relating to the modern history and recent progress of Levantine plague / prepared from the time to time by direction of the president of the Local Government Board, with other papers ; sented to both House of Parliament by Command of Her Majesty. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

73/82 (page 67)

$Subject to the condition that proper hospital accommodation can be offered, the autho- rity ought to be able to enforce, in regard of any dangerous contagious disease, that the sufferer should not be in circumstances which promote the spread of disease to the general population. This power, exercised in seaport towns in relation to the poorer classes who might arrive infected from abroad, would in effect work thus :—such persons would be debarred from resorting to the common lodging houses and crowded tenement houses of the town, and would (as much to their own advantage as to that of others) be constrained to go to the local hospital, there to remain till cured. How far such a power for local authorities would be delegable to them under the Quaran- tine Act, or would requhe special legislation, is perhaps not a question of any ultimate importance, and is one which I am not competent to discuss. It deserves notice, however, that if the power in question were vigilantly used by local authorities, and in conjunction with other sanitary powers, its exercise would not of necessity be only of local effect, but might under some circumstances contribute even importantly, to those national purposes which quarantine is intended to accomplish.* [Note by Assistant Medical Of&cer, Feb. 1879.—It will be seen from the paper which follows on pages 70-74, On the Systematic Action in usein England to prevent the Importation of Infectious Diseases, how much progress has been made by general English legislation since the writing of this report in 1865, a progress which has con- cerned alike imported infections and infections of home origin.] Essentially different from the danger which attends the migration of persons affected with cholera or its premonitory symptoms, is the possibility, illustrated by the Swansea experience of last October, that ships infected with yellow fever may introduce that infection into England. I do not pretend to say that yellow fever is absolutely non-contagious in this country: non-contagious, I mean, in the sense in which typhus and small-pox are contagious; much less do I pretend to say that it is absolutely non-contagious in climates hotter than our own. This doctrine, however, even in the extremest form in which it can be stated, is not only held by many persons of high authority wbo have studied the disease in its trans-atlantic strongholds, but is certainly rendered extremely probable by facts which we have observed in Europe. When Lisbon in 1857 was being so terribly scourged by yellow fever, thousands of its population fled far and wide into surrounding districts; among those who thus fled, numbers were already incubating the disease, and of course fell with it in their respective places of refuge more or less distant from Lisbon; in 182 cases of this de- scription, tlie Portuguese Government caused inquiry to be made whether persons about the sick fugitive had shown any signs of the infection; and the answers were, that in no single case had this occurred. So again in our Swansea experience, nothing like personal contagion seemed probable. And though undoubtedly at St. Nazaire there were a few facts which led M. Melier to impute contagiousness to the disease, the overwhelming majority of facts pointed, even there, to an opposite conclusion, and suggested that in the exceptional instances some source of fallacy had been overlooked. * For obvious reasons it- is only to a small extent that legal restrictions can avail to prevent the spread of such contagions as are once current in the country. They can only apply to conduct by which the public health is manifestly and directly endangered and not to all kinds of such conduct. But in proportion as the physiology of contagion gets to be better understood by the public, the influence of legal restrictions will be increased by the appeals Avhich well-informed persons will be able to make, and to which the example of such persons ought to give force, against all reckless conduct in such matters. Conditions of lodgment, as discussed in the text, are not all that require consideration. Complaints are often made of tlie freedom with Avhich persons imperfectly convalescent from contagious fevers (as, very notably, from small-pox) exjjose themselves in places of common resort; and a careless sending of sick children to school often does much to spread diphtheria, scarlatina, and other contagious diseases ; the careless transmission of infected things to common laundries, and of course the traffic in infected rags, i;;iply dangers of the same sort; and against all such sorts of action the public ought to have some ready means of protecting itself. So, too, as regards the use of public carriages by persons contagiously diseased; no doubt a proper organisation for the conveyance of sick persons ought to form part of the medical relief arrangements of every large town, and the use of the common public carriages ought then to be forl^idden; but if, as often happens in our present circumstances, persons Avho have small-pox and other dangerous contagious diseases cannot be taken lo hospital except in common street cabs, surely the subsequent disinfection of every such carriage might be insisted on. Other (hmgers are for personal, rather than municipal, precaution. For instance, the modes by which puerperal fever is spread, and the extreme and fatal sensibility of puerperal women to tlie contagion of scarlatina, are matters which require, both generally from the public, and specially from persons who visit from one sick room to another, far more thought than is yet given to them. See App. No. 7.,'\ and Sixtli Report, p. 59. Here also, I may observe, for the con- sideration of those whom it concerns, that our new institution of Turkish baths, used in common by swarms of persons—by some moi-e or less for health, but by numbr;rs also for mere enjoyment or curiosity, invo'ves (inter alia) some awkward chances of syphilitic contagion : indeed Turkish baths are now among recognised rneans of treatment for persons with constitutional syphilis, who, in some cases, have local symptoms by v/hich the disease can be communicated : and the question whether such patients take the general run of public baths, and are among tlie numbers who nakedly occupy the seats and couches of cuniuion sweating-rooms, is one which may greatly concern other frequenters of such establishments. X [Not reproduced, in these papers, from the original Report.]$