Vienna Sanitary Congress. 189 7. Transmissibility by the Atmosphere alone.-No fact is yet known which proves that cholera can be propagated to a distance by the atmosphere alone, whatever its condition. Moreover, it is a law, without exception, that an epidemic of cholera is not propagated from one place to another in a shorter space of time than it takes man to travel. The surrounding air is the principal vehicle of the generative agent of cholera; but the transmission of the malady by the atmosphere, in the immense majority of cases, is restricted to the close vicinity of the focus of emission. As to facts asserted of transportation to a distance of one or many miles, they are not conclusive. 8. Action of the Air upon the Transmissibility.—It results from a study of the facts that in free air the generative principle of cholera rapidly loses its morbific activity; but that in certain conditions of confinement this activity may be preserved during an undetermined time. Great deserts form a very efficacious barrier against the propagation of cholera. This disease has never been imported into Egypt or Syria, across the desert, by caravans from Mecca. III. Duration of Incubation.-In almost every case the period of incubation that is to say, the time which elapses from the moment when an individual has contracted the choleraic intoxication to the commencement of the premonitory diarrhoea or of confirmed cholera-does not exceed a few days. All the facts cited of a more prolonged period of incubation refer to cases which either are not conclusive, or in which the premonitory diarrhoea has been included in the period of incubation, or in which contamination (the contraction of the choleraic intoxication) has occurred after departure from the infected place. Observation shows that the duration of the choleraic diarrhoea called premonitory-which must not be confounded with other kinds of diarrhoea that may exist where cholera prevails-does not exceed a few days. The facts instanced as exceptional do not prove that cases of diarrhoea of lengthened duration belong to cholera and are susceptible of transmitting the malady, when the person affected is removed from all cause of (choleraic) contamination. IV. Questions as to Disinfection.-Are any means or processes of disinfection known by which the generative or contagious principle of cholera can be certainly destroyed or deprived of its intensity? Are any means or processes of disinfection known by which the generative or contagious principle of cholera can with some chance of success be destroyed or deprived of its intensity? Science does not yet know any certain and specific measures of disinfection; but the great value of hygienie measures, such as ventilation, thorough cleansing, &c., is to be recognized, combined with the use of the substances regarded as disinfectants. Typhoid fever is propagated by means similar to those that cause 190 Prevention of Syphilis. the spread of cholera, as has been shown in the chapter on water, and will be further exemplified in the chapter on diseased and unsound food and drink. Prevention of Venereal Disease.-Public opinion in Great Britain and Ireland is rapidly coinciding with the views of those sanitarians who advocate legislative means for the purpose of arresting the spread of contagious venereal diseases. A few years ago he who would venture to suggest the desirability of state interference in such a matter would be scouted by the non-medical section of the community; but the enormous physical evils which result from untrammelled prostitution are now so patent that all save the most prejudiced admit that they demand a prompt remedy. If the non-recognition of the "social evil" could tend in any way to lessen the vice, there would be some excuse for those whose over-prudishness leads them to object to any interference with prostitutes on the part of the state. But the history of all nations shows that both the moral and physical evils arising from prostitution have been increased instead of lessened by allowing the unhappy creatures who ply this dreadful trade to remain free from the surveillance of the authorities. Efforts have been made from time to time in most civilized countries to eradicate prostitution, but not only did all those attempts prove failures, but they actually, in many instances, induced a general corruption of morals. In the year 1845 all the brothels in Berlin and others of the large Prussian towns were forcibly closed by order of the king, and public prostitution was proscribed under severe penalties throughout the kingdom. Very soon the results of this system became apparent. Illegal prostitution rapidly spread. The public morals became worse than ever. The number of illegitimate children increased. There appeared to be a general profigacy pervading all ranks of society; and finally venereal disease became more virulent and widespread. After six years' experience of this method of stamping out prostitution, the king was prevailed upon to repeal his edict and to allow the re-establishment of brothels under the surveillance of the authorities. 1851 women openly leading unvirtuous lives in Berlin are placed under strict control, and they are periodically inspected by medical men appointed for the purpose. The same system prevails in most parts of the continent. Berlin appears to be a very hot-bed of prostitution, for, according to Dr. Straysma, it contained in 1869 23,855 unfortunates, or 11 per cent. of the female population between the ages of 14 and 60. Since The Contagious Diseases Prevention Acts were passed with the view of protecting the soldiers and sailors from venereal disease. Certain districts are specified in the Act, within the limits of which women who are known to be prostitutes are placed under the supervision of the police, and are obliged to submit to periodical medical examinations. If found to be suffering from venereal disease they are sent to hospital and detained there until Contagious Diseases Prevention Acts. 191 cured. This system has been for some time in operation at the principal military and naval stations in England, and with the best results, as has been clearly shown in the Report of the Select Committee of the House of Lords on the "Contagious Diseases Prevention Act," and the reports of the medical authorities. I trust that the operations of the "Contagious Diseases Prevention Acts" may be extended to the civil population of these countries, amongst whom they would prove as beneficial as they have already in the case of soldiers and sailors. In the interests of the unfortunate women, as well as of the whole community, I express this hope. Those engaged in carrying out the workings of the Acts assure us that they have been productive of moral as well as physical benefit to these unhappy creatures, many of them having, under the influence of hospital discipline, been reformed and restored to their friends. In Japan, where prostitution is a recognized though not respectable occupation, those engaged in it are placed under police supervision; and we learn from an interesting Report, prepared by Mr. George Newton, a surgeon in the Royal Navy, that the Japanese Government has recently established a lock hospital at Yokohamma, and provided it with 150 beds. Here the women are compulsorily examined and detained if found to be diseased. When we find such a State as that of Japan adopting a system of compulsory examination of prostitutes, and providing for their treatment so large an hospital, we surely have a right to expect our Government to do something to prevent the spread of the most loathsome of diseases amongst us. The opponents of these Acts allege that they are wholly useless as a means of preventing the spread of syphilis, whilst they lead to frequent outrages on the modesty of perfectly chaste women. I rather incline to the opinion that the extension of the provisions of these Acts, so as to include the whole population of the country, would be likely to lessen the amount of syphilitic poison in circulation throughout the whole country; but whether or not the cause of morality would be at the same time promoted is not quite so evident. The credible evidence which has been taken relative to the practical working of these Acts certainly fails in proving that respectable women have anything to fear from them. The great question, however, is whether or not a complete system of supervision of prostitutes would be likely to diminish venereal disease. It is stated that such a system has proved an utter failure in Paris and other large cities where there are the strictest laws in relation to the control of prostitution. In Lecour's work on Prostitution, published in 1870, he states that the total number of prostitutes registered in Paris in 1869 amounted to 3,731, whilst the number of those "in circulation," but not registered, was 2,782. In 1865 the registered prostitutes numbered 4,225, and those known to be unchaste, but who were not registered, amounted to 3,313. It would appear that under police regime the brothels of Paris and their inmates are declin 192 Hospitals in the olden time. ing in number, whilst the population of the city has been steadily increasing. M. Le Fort, a French surgeon, who has been much occupied in organizing the system of prostitution inspection in Paris, states that he believes the actual number of women who make a "traffic of their persons is from 40,000 to 50,000. These numbers are too high; for if we assume the latter to be the true one, then it would make every fortieth female in Paris a prostitute. If, then, the venereal disease prevention laws in force in Paris fail in bringing under subversion perhaps from 70 to 90 per cent. of the "unfortunates" of that city, it may be argued would the British contagious disease laws prove more successful if they were extended to the whole population? Dr. Chapman and others assert that they would not prove more successful, and they argue that its sole effect would be to increase the amount of what has been termed "clandestine prostitution." In Dublin there is certainly a large amount of syphilitic poison present amongst the lowest class of unfortunates, and it can hardly be doubted but that the enforced surveillance of those persons would soon lessen the spread of disease. In towns of moderate size clandestine prostitution is not so difficult of detection as in such immense cities as Paris and London. Even if the Contagious Diseases Acts failed in their application to centres of large population, they might prove useful in the numerous moderate-sized and small towns of these countries. CHAPTER XVIII. CONSTRUCTION OF HOSPITALS. It is not improbable that the hospitals of the last century increased the death-rate of the population, instead of diminishing it. They were small, overcrowded, ill-kept and badly ventilated; the patients were not classified according to their maladies-phthisical and fever patients were placed side by side. The dietaries were insufficient, and the nurses too often brutal and ignorant. Smollett (himself a physician) has given us, in chapter xxv. of "Roderick Random," the following description-I have no doubt a perfectly truthful one-of a naval hospital of the last century:"Here I saw about 50 miserable distempered wretches, suspended in rows, so huddled one upon another that not more than 14 inches space was allowed for each with his bed and bedding; and deprived of the light of the day as well as of fresh air; breathing nothing but a noisome atmosphere of the morbid steams exhaling from their own excrements and diseased bodies, devoured with vermin hatched in the filth that surrounded them, and destitute of every convenience necessary for people in that helpless condition." No doubt, the hospitals for soldiers and for the civil population were not in a much better condition than the noisome den so graphically described by Smollett. In the Hotel Dieu, a famous Paris hospital, the wards were so overcrowded that there was hardly one bed for every six persons. The patients enjoyed by turns the luxury of a bed, and when not, its occupant had to restif rest it could be called-on benches. Can we wonder that one out of every four patients died? The condition of London and Dublin hospitals was not much better. In the surgical infirmaries the mortality was frightfully high, the majority of persons on whom the major operations were performed died, not from the mere operation itself, but from blood-poisoning caused by the foul air of the place. If density of population be a factor in producing a high deathrate, surely the crowding of the sick must be the very worst form of human "density." The statistics of the mortality of hospitals, taken in connection with their construction formerly and lately, admit of but one inference-namely, that the excessive aggregation of the sick is a serious cause of mortality amongst them. It might be urged that if this be the case it would be better to substitute for the hospital some other and more efficacious mode of alleviating human suffering in disease; but no such mode likely to be efficacious has been suggested. Hospitals are adjuncts of our civilisation, and cannot be dispensed with; but we should adopt, in their construction, every means likely to promote their object-the cure of disease. There is not wanting plenty of advice on this subject; and whilst a variety of opinions on the details of "sanitary architecture" prevails, every one is agreed that in hospitals abundance of pure air and ample cubical space are prime requisites. The microscopical examination of the solid matters floating in the atmosphere of hospitals, and the dust on its walls and recesses, have not afforded pleasant results. Drs. Dundas Thompson and Rainey found in the air of a ward in St. Thomas's Hospital, London, occupied by cholera patients, sporules, vibriones, in an active state, confervoid fungi, hairs, wool, cotton, &c.1 Reveil and Chalvet' found, independently, large quantities of epithelial cells and organic corpuscles in the air of surgical wards of the hospital of St. Louis, Paris. Dr. Watson found, in the air of a phthisical ward, bodies resembling the degenerate cells of tubercle. M. Lemane3 examined the air of several hospitals, and found in the moisture condensed from it, and the air itself, numerous Annales D'Hygiene Publique, July, 1862; and Revue Médicale, for June 30th, 1866. Report of the Committee for Scientific Enquiries in relation to the Cholera Epidemic of 1854. P. 121. 3 Parkes' Manual of Hygiene. 4th edition. |