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9
are willing, removal to hospital is arranged. If, however, the
patient is not willing, nor content to stay at home if removed
there, the powers of the local authority are rather weak, though
perhaps now strengthened by the Rules of Conduct for Shelterers.
Where an infectious disease is only suspected, however, or is one
of those infections for which ordinarily there is no hospital
accommodation, the situation can be met only by the provision
of isolation facilities in the shelter, either by restricting some
shelters or certain portions of shelters to the admission of selected
persons, coupling with an insistence on the removal of the possibly
infectious to these portions, the prohibition of admission there of
other persons.
Apart from air-borne infections, the use of the shelters as
dormitories provides a very real risk of louse infestation with
the attendant risks of the spread of louse-borne diseases. All the
conditions exist for heavy louse infestation which is substantially
increased when the same clothing is worn by day and by night.
Once introduced this is going to be a real problem to eradicate,
more particularly as bedding is left in the shelter during the
day-time and the bunk frames are of a continuous pattern
providing no intervening space either horizontally or vertically
between those portions of the frame used as separate bunks. In
some districts cleansing stations have proved a necessity. Up to
this in this area the magnitude of the problem has never justified
any separate provision. This means that this and similarly
circumstanced areas might be faced with the necessity of improvising.
Lesser degrees of the problem can be dealt with by the facilities
available at the isolation hospital for the steam disinfection of
any clothing with possibly the use of the cleansing sections of the
first aid posts as a means of dealing with persons. If the problem
should assume formidable proportions, however, it might be
necessary to commandeer premises at which can be provided
such arrangements for dealing with persons and articles. The
third of the plagues which might arise is the spread of contact
diseases such as impetigo and scabies. In the autumn it seemed
as though both were becoming more prevalent at least in some
parts of the district, but more recently they have both been less
in evidence.
As yet, however, while at no time have more than a few
trenches been occupied to anything like full capacity, before the
end of the year very little use was being made at all, the shelters
being occupied to about two per cent, capacity. On the occurrence
of the siren during the evening some few more would be added
to the number of regular users, and heavy gunfire occurring
locally would result in still more. While the events of the future
remain unknown, at the time of writing (January) it can be said
that in this district the shelters do not provide a public health
problem. One hopes that even should raiding have more