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"For fumigating infected rooms and their contents nothing is better than sulphur.
A quarter of a pound of brimstone, broken into small pieces, should be put into an
iron dish (or the lid of an iron saucepan turned upside down), supported by a pair of
tongs over a bucket of water. The chimney and other openings are then closed with
paper pasted on, and a shovelful of live coals is put upon the brimstone. The door is
then quickly shut, the crevices covered with paper and paste, and the room kept closed
for five or six hours. After this a thorough cleansing should be effected ; everything
washable should be washed, and all other things cleansed by proper means.
" Fumigation of clothes, &c., may be easily carried out on a small scale by burning
a sufficient quantity of brimstone matches.
" Provided there be no unsuspected drain, sewer, gulley, watercloset, pipe, or cistern,
or other source whence the inmates receive fresh infection, scarlet-fever can be
and is daily arrested in private houses by the above means carried out in detail; but
only by persons having space, wealth, intelligence, and the wish to save life. It is far
otherwise in the crowded houses of the poor, where the healthy are mixed with the
sick and even with the dead.
" Public hygienic measures are then necessary, and the following are the measures
which the Medical Officers of Health recommend.
"Measures of Public Hygiene, and the present Impediments to their Adoption.
"1. Information should be diffused through every family by printed bills as to the
contagiousness of scarlet-fever, and the mode of preventing it.
" 2. Every ease of scarlet fever, and especially every first case, should be immediately
reported to the sanitary authority. At present this is not done. There is no provision
by which cases of infectious disease, even in poor law and public practice, shall be
made known to the Medical Officers of Health. In some districts, by an act of
courtesy, information is forwarded at more or less prolonged intervals, and so, usually,
at a late period of the illness. It is only when death occurs that the Health Officers
with certainty hear of the occurrence, and by that time (often a week or ten days
after death) the contagion may have spread more or less extensively. They neveT hear
officially of pri vate eases ; it is held to be the interest of all parties to conceal their
occurrence. Without early and ample information, it is impossible to put in force the
provisions of the Sanitary Act directing the disinfection of houses, &c, and forbidding
the exposure of disinfected persons and. articles.
" 3. Every case so reported should be immediately visited by the Medical Officer of
Health or his skilled assistant, who should see that all proper precautions are in
operation. But even with full and early information, adequate precautions could only
be superintended by the devotion of all the time of the Health Officer to public work,
for which the sanitary authorities have made no provision, and by the aid of a staff
of assistants such as was given to few of them even during the cholera epidemic.
"4. The streets and courts, and the yards of infected houses, should be watered
with a disinfectant solution, such as carbolic acid.
" 5. Public day and Sunday schools in an infected district should be authoritatively
closed. The out-patient rooms of hospitals and dispensaries are even more dangerous
than schools. It should be a punishable offence to send a child to any day school, public
or private, from a house or family in which fever exists. There is, however, no power
or authority for this.
" 6. Sufficient hospital accommodation should be provided for the poor, with
arrangements at each hospital for the disinfection of the person and clothing of the
patient on his discharge.
" 7. Where it appears to the Medical Officer of Health necessary that the sick
person should be removed, he should be able to enforce the removal, certainly in any
case where the sick is under no medical care, or is being treated at the public expense.
Very limited powers of this kind are at present conferred by the 26th section of the
Sanitary Act, 1866, and these are only applicable after considerable dangerous delay.
This section is practically useless.
"8. An appropriate carriage should be provided in every district for the conveyance
of the sick to the hospital. At present public cabs are still largely used, because few
local authorities in London have provided appropriate carriages, as they are empowered
to do by the 24 th section of the Sanitary Act, and sometimes because the
sick refuse to use them.
" 9. The Sanitary Act (sections 24 and 38), as it relates to the use and disinfection
of public carriages for the conveyance of persons with infectious diseases should be
enforced : this is not done.
"10. There should be in every district one or more proper mortuary houses for the
reception of the dead of any class of society, and removal thereto should be capable