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108
provide special accommodation for such patients, separate from the
ordinary infirmary ward, but according to replies (printed in my report
for 1902) furnished by the Boards, nothing in this way seems to have
been attempted by the Guardians of the three Unions in the City.
Regular visitation of home cases is necessary in order to see that
precautions are being carried out. Patients who have been in a
hospital or sanatorium have learned their importance, and are, as a rule,
careful; but the great majority of affected persons have not had this
training, and many of them take no precautions whatever. I appeal
to the medical practitioners in the City to help in this matter. They
can urge upon relatives the extreme importance of cleanliness and
fresh air, of spitting into proper receptacles, of destroying the
expectorated matter, of the patient having a separate bed, and where
practicable a separate room, and can explain how these simple precautions
which are essential may be carried out. Consumptives appear
to change their addresses with some frequency, forced often by the rreed
of obtaining cheaper rooms; it is important to know when rooms are
vacated by such persons in order to secure thorough cleansing before
new tenants occupy them.
Disinfection and Cleansing.—The necessity for disinfection at
intervals during the progress of the disease, as well as after rooms have
been vacated, has been amply demonstrated, even with the most
careful patient. The matter which is coughed up from the lungs and
throat swarms with the tubercle bacillus, but even in the act of
speaking or coughing it is found that the fine spray which is
thrown off in the breath contains these organisms which may be
thrown a distance of about four feet from the patient. These soon dry
up and are converted into a fine dust which may be readily thrown into
the air and inhaled by other people. The tubercle bacillus is a very
resistant organism, and is not killed by drying, and if kept in a dark
badly ventilated room will survive for long periods without losing its
virulence.
These facts show the danger of continuous close contact with
consumptives and the need for the frequent removal of this infected
dust in a manner which will not distribute it throughout the air of
the room. They also show the need for admitting fresh air and
sunshine, because, although the bacillus can stand drying, it cannot
survive fresh air and sunshine for many hours. The danger of infection
may thus be reduced to an almost negligible degree.
If these precautions could only be enforced, we should witness a
startling reduction in the number of cases. Berlin hopes to get rid of
consumption in ten years. If Berlin can do so, London might do so also.
Methods of Disinfection.—The tubercle bacillus is not so reaildy
destroyed by chemical disinfectants as it is by direct sunshine, and