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the requisite length of time, varying, we are told, from three weeks to
as many months, until the scabs and scales have fallen off; and a3 a rule
they have not facilities for bathing and skin disinfection. Necessary
precautions— disinfection of the sick chamber, of the excreta, and of
drains, &c., destruction of dust and debris of food; are for the most
part not taken: they are either impracticable, not understood, or disregarded,
and especially in the most perilous of all cases— the mild and
the concealed. The alleged dangers of the public hospital are multiplied
indefinitely in these private hospitals; and when we take into consideration
the number of them (and probably concealed cases are as
numerous as those which are disclosed) the marvel is not that the
disease in epidemic times is so rife, but that so many people escape !
Small-pox is intensely contagious. A competent authority has lately
said of it that, "the isolation and the general precautions which are
sufficient in the other infectious diseases are insufficient in this one.
It attacks at once all susceptible persons immediately on their
exposure to it Where it strikes it strikes at once In an
ordinary pavilion-hospital fevers may be treated in pavilions situated
side by side, with a laundry in common. The blankets, bedding, and
linen of these different fevers may be used with impunity for either
fever indifferently after being washed; but the same cannot be said of
clothing which has been used for small-pox because small-pox,
when treated in the same conditions as the other contagious diseases,
spreads, whilst these do not. If, for instance, one case of small-pox
arise in an hospital, or by mistake be admitted into one, more are sure
to follow, and that not necessarily in the ward in which the first case
appeared, or into which it had been admitted, but in the different and
widely separated parts of a large building.- Thus if the first case
appear in the extreme east the second may appear in the extreme west,
or possibly somewhere between these two points. Or if the first case
appear at the top of the house the second may appear at the bottom,
and so on and this occurs when patients have not left their
wards or even their beds. The precautions, then, which are
sufficient for the other contagious diseases are not sufficient for
this one."*
* "On some public health points in the management of a small-pox hospital."—
Paper by Dr. Collie, Medical Officer to the Homerton Fever Hospital. Read before
the Society of Medical Officers of Health, May 21st, 1880.