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cleanliness, and to promote a better ventilation of places where from
other circumstances the disease is most likely to spread. The crowding
of many families into a house (I am not speaking of what is commonly
called oner-crowding) it is beyond our power to rectify; we must take
such things as we find them. But, are we therefore powerless ?
Certainly not. In the first place, wherever it can be effected, every
case that occurs in a family might be isolated. Amongst the poor the
proper thing to do is to remove the patient to the hospital, and I have
written to all the District Medical Officers urging this step upon them
where it is practicable to take it. Next, it is quite possible in the
majority of instances, to remove from the sick apartment all superfluous
woollen or textile matters, such as carpets, curtains, &c., which are
likely to retain the germs of the disease. These two measures of
precaution cannot be taken or put in force too early in any case. A
suspicious sore throat should at least lead to the prohibition of communicati6n
with persons who have not had the disease. In the third
place, the germs of the malady given off from the sick should be
followed up by disinfectants, by the use of means adapted to destroy
their vitality. And here comes the grand difficulty. In cholera we
know where to find the germs, namely, in the discharges which we
can see and often collect; in scarlatina they are diffused into the
atmosphere and attach themselves everywhere. Hence the difficulty of
extirpating infection in a house once contaminated by scarlatina. Still
measures of disinfection should be used as early, as thoroughly, and as
extensively as possible. Of all the trustworthy agencies for the
disinfection of rooms, perhaps the most convenient is carbolic acid,
which may be sprinkled upon the floors, even when the patient is in the
apartment, and with which all parts of the room may be washed as well
as the furniture after his removal, and prior to cleansing and limewhiting.
Clothing, bedding, &c., are best disinfected by dry heat, but where
this is not practicable (as unfortunately it is not in Islington) all such
articles as are to be washed might be soaked for a time in a dilute
solution of the same substance. Accordingly it is this which, under
the powers given by the Sanitary Act, we are attempting now.
EDWARD BALLARD, M.D.,
Medical Officer of Health.
Vestry Offices,
October, 1867.