METROPOLITAN ASYLUMS (TRENCH FEVER, MALARIA, AND
DYSENTERY) ORDER, 1919.
In accordance with the powers vested in them by Section 80 of the
Public Health (London) Act, 1891, the Local Government Board issued the above
regulations empowering the Managers of the Metropolitan Asylums Board to
admit into their hospitals any person, not being a pauper, who is reasonably
believed to be suffering from Trench Fever, Malaria or Dysentery.
The regulations are contained in four articles of which the following is a brief
Article 1. Ensures priority being given to pauper patients.
Article 2. Provides
(a) For the admission of persons to whom this order applies, only on the
recommendation of the Medical Officer of Health for the district of the Sanitary
Authority in which such person is residing at the time when the question of the patient's
removal to hospital arises.
(b) For recommendation of Medical Officer of Health to be accompanied by such
information as the Metropolitan Asylums Board may reasonably require.
(c) For admission by the Clerk of the Metropolitan Asylums Board in emergency, of
any person to whom the order applies, without recommendation of Medical Officer
Article 3. Provides that the interests of the public health are to be considered when any question
of priority of admission arises
Article 4. Title of Order.
In April, 1919, the Local Government Board issued a memorandum on the
procedure recommended to be followed in the event of persons being bitten by
dogs suspected to be rabid.
In June, 1919, a revised memorandum was issued of which the following is a
brief resume :—When a person is bitten by a dog in any area in which rabies in
dogs is suspected, the wound should be treated as soon as possible with undiluted
carbolic acid, undiluted Izal or some similar disinfectant. The disinfectant should
be allowed to come into contact with all parts of the wound which should then be
washed out with water or dilute disinfectant. If no disinfectant of the kind is
available, the wound should be thoroughly washed and irrigated with hot or cold
water. When it is possible to get the immediate services of a doctor, the treatment
should be placed in his hands. Provision is made for notification to all the authorities
If upon examination, diagnosis of rabies in the dog is confirmed, the person
bitten is urged to secure specific anti-rabic treatment as soon as possible, irrespective
of what local treatment has been applied to the bite. This specific anti-rabic
treatment can be administered at a number of centres ; that for London is the
Department of Pathology, St. Thomas's Hospital, Westminster Bridge, S.W.
The following is a summary of the principles which should guide a Medical
Officer of Health in recommending specific anti-rabic treatment :—
(a) There should be evidence that the bite penetrated the skin and caused bleeding.
(b) Treatment should be strongly urged on all persons who have been bitten by animals
which are in the view of the Board of Agriculture and Fisheries affected with rabies.
(c) As regards persons bitten by animals captured and killed or kept under observation in
which there is no clinical or post mortem evidence of rabies, treatment should, as
a rule, be dispensed with as unnecessary.
(d) As regards the treatment of persons bitten by untraced stray dogs or other animals,
distinction should be made between :—
(i) Cases occurring in the scheduled or immediately adjoining areas where
presumably there is a greater risk of the dog being rabid—to cases in this
category, treatment should be recommended.
(ii) Those occurring outside the scheduled areas—here treatment should be
offered but not pressed.