“Bubo Plague. The measures would probably be the same as for typhus.
“Enteric (typhoid fever). The bowels’ discharges are believed to be the chief, if not the sole agents in spreading the disease; the effluvia from them escape into the air, and will adhere to walls and retain power for some time, or the discharges themselves may get into drinking-water. Every discharge should be at once mixed with a powerful chemical agent; of these, chloride and sulphate of zinc have been chiefly used, but sulphate of copper (which Dougall found so useful in stopping the growth of animalculæ), chloride of aluminium, or strong solution of ferrous sulphate (1 ounce to a pint of water), or carbolic acid. After complete mixing the stools must be thrown into sewers in towns; but this should never be done without previous complete disinfection. In country places they should be deeply buried at a place far removed from any water supply; they should never be thrown on to manure heaps or on to middens, nor into earth closets, if it can be possibly avoided. As the bedclothes and beds are so constantly soiled with the discharges, they should be baked, or, if this cannot be done, boiled immediately after removal with sulphate or chloride of zinc. It would be less necessary to employ air purifiers in this case than in others.
“Cholera. There can be little doubt that
the discharges are here also the active media of the conveyance of the disease, and their complete disinfection is a matter of the highest importance. It is, however, so difficult to do this with the immense discharges of cholera, especially when there are many patients, that the evidence of the use of the plan in the last European epidemic is very disappointing.
“The ferrous sulphate (green vitriol), which has been strongly recommended by Pettenkofer as an addition to the cholera evacuations, was fully tried in 1866 at Frankfurt, Halle, Leipzig, in Germany, and at Pill, near Bristol, and in those cases without any good result. In other places, as at Baden, the benefit was doubtful. It seemed to answer better with Dr Budd and Mr Davies at Bristol; but other substances were also used, viz. chlorine gas in the rooms, and chloride of lime and Condy’s fluid for the linen. On the whole it seems to have been a failure. Ferric sulphate, with or without potassium permanganate, has been recommended by Kühne instead of ferrous sulphate, but I am not aware of any evidence on the point. Carbolic acid was largely used in England in 1866, and appeared in some cases to be of use, as at Pill, near Bristol, and, perhaps, at Southampton. It failed at Erfurt, but, as it is believed the wells were contaminated by soakage, this is perhaps no certain case. Chloride of lime and lime were used at Stettin without any good result, and, on the whole, it may be said that the so-called disinfection of the discharges of cholera does not seem to have been attended with very marked results. At the same time it cannot be for a moment contended that the plan has had a fair trial, and we can easily believe that unless there is a full understanding on the part of both medical men and the public of what is to be accomplished by this system, and a conscientious carrying out of the plan to its minutest details, no safe opinions of its efficacy or otherwise can be arrived at. It would be desirable to try the effect of chromic acid or bichromate of potash.
“With regard to air purifiers little evidence exists. Chlorine gas diffused in the air was tried very largely in Austria and Hungary in 1832, but without any good results. Nitrous-acid gas was used in Malta in 1865, but apparently did not have any decided influences, although Ramon da Luna has asserted that it has a decided preservative effect, and that no one was attacked in Madrid who used fumigations of nitrous acid. But negative evidence of this kind is always doubtful. Charcoal in bulk appears to have no effect. Dr Sutherland saw a ship’s crew severely attacked, although the ship was loaded with charcoal.
“Carbolic-acid vapour diffused in the atmosphere was largely used in 1866 in England; the liquid was sprinkled about with water, and sawdust moistened with it was laid on the floors and under the patients. The effect in preventing the spread of the disease was very uncertain.
“Yellow Fever. In this case the discharges, especially from the stomach, probably spread the disease, and disinfectants must be mixed with them.
“Fumigations of nitrous acid were employed by Ramon da Luna, and it is asserted that no agent was so effectual in arresting the spread of the disease.
“Dysentery. It is well known that dysentery, and especially the putrid dysentery, may spread through an hospital from the practice of the same close stool or latrines being used. As long ago as 1807, fumigations of chlorine were used by Mojon to destroy the emanations from the stools, and with the best effects. The chlorine was diffused in the air, and the stools were not disinfected; but this ought to be done as in enteric fever, and especially in the sloughing form. It is probable that carbolic acid in large quantity would be efficacious.