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for the actual inoculation. As to the number of cases treated annually by these
practitioners, 2 state the cases have been numerous, 4 that they have ranged from 10
to 12 per annum, 2 an average of about 6 per annum, 8 estimate the number at 2 to 4
per annum, 3 state they have a few, and 5 do not give any estimate. These estimates
principally relate to contagion produced by shaving.
One must of course be cautious in receiving estimates of this sort since there is a
tendency on the part of patients to attribute a large part of the troubles which attack
this part of the face to the barber, if they happen recently to have been shaved by
one. However, one can gather from these estimates, making allowance for possible
exaggeration, that there is a considerable amount of skin disease attributable to this
source.
As to the danger of inoculation during the process of hair-cutting it is most
difficult to form an opinion. The diseases most likely to be transmitted here are the
different forms of ringworm of the scalp, and also eczema (impetigo), and various
parasites which use the human hair and skin as their hosts. These could be transmitted
by the clippers, brushes, combs, etc. I do not doubt that many of the cases of
ringworm of the scalp, pediculi, etc., occurring in clean children, and often erroneously
attributed to "school," acquire their infection during the fortnightly or three weekly
Saturday morning hair-clipping which most of them undergo. _
To come to the second aspect of the inquiry, viz, the hairdressers' and barbers'
establishments. I have had them all enumerated and inspected. After this was done
I visited personally most of them so as to get some uniformity as to the general
estimation of cleanliness.
There are at present 88 hairdressers and barbers in this Borough, 43 of which are
kept by Englishmen, and 45 by foreigners. This latter fact, however, has not
much bearing on the subject, since there is little to choose between the two as regards
cleanliness.
Of these some 13 or 14 might be designated as "very clean" and leaving little
room for improvement. (I am not here referring to antiseptic precautions.) Fifty-eight
I would call fairly clean, and by this I mean that their premises were kept as
pure as their condition, in the matter of repair, suitability of the fittings, tools, etc.,
would permit. The remaining 17 I would classify as dirty, i.e., the walls, floors,
shelves, brushes, and persons of the barbers themselves might be called dirty and
untidy.
That cleanliness is inexpensive is proved by the fact that those classified among
the very clean did not all live in the neighbourhood of London Bridge, but one or two
could be found in the poor parts of the Borough, where the prices charged were among
the lowest. Among some of the better class hairdressers I found all the precautions
advised in vogue, viz., clean paper for head rests, clean towels for each customer, etc.,
except the use of any antiseptics. I only came across one barber in ope of the poorer
neighbourhoods who adopted the precaution of dipping his razor in an antiseptic
before shaving.
The principal defects in the large majority of places visited were, want of some
impervious material on the floor which could be frequently washed or cleaned,
unsuitability of the shelves, etc., where instruments were placed (in many of the
poorest shops these consist of marble, showing that it was not. an unobtainable
luxury), want of waste pipes to the basins, insufficiency of the water supply, especially
of hot water, which in many cases was kept in very small urns. In about a dozen or
so the water was kept simmering all day in a common pot over a small gas jet. Into
this pot the brush for shaving was -dipped direct. One barber informed me that the
contents resembled a- jelly at the end of the day as it became so impregnated with
soap. They say this cannot convey infection because it is boiling, but this is not so
for I did not see it boiling once, and in a few cases in which I took the temperature it
varied from 60° to 80° C., a temperature which is not guaranteed to get rid of all
germs. The head rests were frequently broken and dirty, and the towels, brushes, etc.,
dirty. Other defects were a want of personal cleanliness of the operators themselves,
deficiency of light and ventilation in the workshops. As to the general results of my
inquiries and visits, I came to the conclusion that there were many possible and even
probable sources of infection to be found in this business.
Having come to these conclusions the next point is to consider the remedies.
I inquired in each the charge for shaving and haircutting, my reason for doing
this being that the regulations suggested should not press too heavily on the humbler
members of the trade. With the exception of a few hairdressers in the neighbourhood
of the railway station, the charges for shaving and haircutting are fairly uniform
throughout the Borough, that for the former being three-half-pence and twopence,
and for haircutting threepence. There are a certain number charge one penny for
shaving, but they are comparatively few, and in scarcely one is it the exclusive charge.
Taking general cleanliness first, I do not think it would be the least hardship to
insist on a general raising of the standard. Some of the poorest shops were above
reproach in this respect, and for this purpose certain regulations as to the structure
of the premises would bo advisable. The floor should be covered with some impervious
material, such as good linoleum, and all shelves, fittings and tables made as directed in
regulation lof the City. All basins should have a properly trapped waste pipe, and