For Isolation at Home a couple of rooms are required, preferably on a higher floor or in a detached wing of the house. The w.c. used for the dejecta of the patient must not be used by any other members of the household. All linen, towels, handkerchiefs, etc., should be immersed in actually boiling water containing some washing soda, before leaving the sick-room. Other articles to be washed, if they will be deteriorated by soaking in boiling water or a chemical disinfectant, must be tightly wrapped in bundles, and covered with a clean wet sheet saturated with a strong disinfectant solution (page [331]). Solid and liquid excreta, expectoration and other discharges must be treated as described on page [331]. The nurse should not eat her meals in the patient’s room. She should wear a cotton dress to be changed before going out for a walk. Her hands must be thoroughly washed and brushed after handling or helping the patient, particularly in enteric fever. It is advantageous if the nurse has previously had the patient’s complaint. Attention on the part of the nurse to minute detail is essential, especially in view of the possibility of receiving infection from infected articles as well as directly from the patient. The measures required for the subsequent disinfection of the sick-rooms and of clothing, bedding, books, etc., are given on page [332].

The use of hospital isolation has rapidly increased in recent years, thus releasing private families from a serious burden. The number of beds which a Local Authority should supply for their district is usually stated as one for every 1,000 inhabitants, but in poorer districts this does not suffice. The site of the hospital should be well removed from houses. There must be a minimum zone of 40 feet between all infected buildings and the boundary walls, and the same distance between neighbouring buildings. A wall at least 6 ft. 6 in. high should enclose the hospital site. The hospital is divided into separate detached pavilions for the treatment of different infectious diseases. A floor space of 156 square feet should be allowed for each bed. The height of the ward should be about 13 feet, its width from 24 to 26 feet, and the total cubic space for each patient should be 2,000 cubic feet for scarlet fever, 2,500 for diphtheria. The lavatories and water-closets are separated from the main ward by a cross-ventilated lobby. In an isolation hospital every surface should be washable; all corners should be rounded off, and all projections on which dust can lodge avoided. The proportion of window space should be about 1 square foot to every 70 cubic feet. Special isolation pavilions are required for cases of doubtful diagnosis. The ventilation and warming of wards must be carefully regulated. Cross-ventilation by windows open on opposite sides of the ward can be maintained in nearly all weathers. The temperature of the ward should be maintained at 55°-60° F.

Ambulances are usually provided by the Local Authority for the removal of infectious patients. The ambulance should be cleansed and disinfected after each journey. The use of private conveyances for infectious patients is forbidden, except under special limitations.

The hospital isolation of small-pox is beset with special difficulties. There is a considerable body of evidence indicating that small-pox may be aerially carried from patients in hospitals to people living within a zone of half a mile, or possibly further. Without accepting the view that aerial dissemination of small-pox to considerable distances from the patient frequently occurs, it still remains true that, either by this means or by errors in the administration of small-pox hospitals, they do frequently constitute a source of danger to persons living in the vicinity. The Local Government Board recommended that a Local Authority should not contemplate the erection of a small-pox hospital. (a) On any site where it would have within a quarter of a mile of it as a centre either a hospital, whether for infectious diseases or not, or a workhouse, or any similar establishment, or a population of 150-200 persons; (b) on any site where it would have within half a mile of it as a centre a population of 500-600 persons, whether in one or more institutions or in dwelling-houses.

QUARANTINE.

This term has been chiefly employed to denote the limitation of the movements of vessels coming from infected ports, for a term which, as the name indicates, was formerly forty days, but is now shorter. It may be conveniently employed, however, to signify the restriction of the movements of all persons who have been apparently exposed to infection, or who continue to live in infected dwellings. In this sense we may speak of:

Domestic Quarantine, to a varying extent, is desirable for the members of a family of which one member has been attacked by an infectious disease. For small-pox every member of a household should be kept under strict watch until sixteen days have elapsed since the last contact with the case of small-pox, or until successful vaccination has been secured. For enteric fever this strict watch would be unnecessary, but the remaining members of the household should be warned to call in a doctor on the first symptom of malaise.

Quarantine is specially indicated for certain occupations. Thus if the child of an out-door labourer had been removed to a hospital with scarlet fever, it would be unnecessary to keep the latter away from work during the following week. If, however, he were a milk-carrier, or a tailor, or an assistant in a sweet-stuff shop this would be a desirable measure.

The Quarantine of School Children is more necessary than that of adults, because the former are more susceptible to infection. Children are kept from school: