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17
small-pox, and the disease therefore would almost certainly
spread from the hospital to the surrounding neighbourhood.
The removal would also probably fail to have the intended
effect, as measles is infectious before the rash appears; indeed,
it is said, before the patient shows any special symptoms, so
that those in the house liable to it would be infected before the
removal could be effected. For the same reason it is useless to
shut up a school on account of measles having broken out
amongst the scholars, unless this is done at the commencement
of the outbreak. In that case, that is to say as soon as a few
cases have occurred, the school should be closed for at least
three weeks if it be done at all. It is also possible that closing
a school may cause an increased spread of the disease in the
localities from which the children are drawn, by affording an
opportunity for infected children mixing in the streets with the
non-infected. The isolation of measles in hospitals appears to
me to be too doubtful a proceeding for adoption until more is
known about the mode and time of the spreading of this disease.
Besides, measles, the same as scarlet fever, differs in the intensity
of its virus in different years, so that in one epidemic it may be
almost innocuous, whilst in others severe inflammations of the
lungs rapidly destroy the patient. It is also another objection
to the aggregation of a number of cases in a hospital, that we
do not know how far an aggregation of cases in one large ward
may aggravate the intensity of the virus both to those outside
as well as inside the hospital.
Scarlet Fever.—In my last report I stated that in my
opinion, if the various localities in this district were occupied by
the same class of people and were equally densely inhabited,
and if my figures gave an equal proportion of the attacks in all
parts of the district, they would be decisive in regard to the
question as to whether or not the hospital was a cause of spreading
the disease. But as these suppositions do not agree with
the reality, and as the results of the investigations are not alike
for every year, too great weight must not be given to the