dollars; and it was the conclusion to which Dr. Lee arrived that fully ninety per cent of the cases and ninety-seven and one-half per cent. of the deaths could have been avoided, which would have reduced the actual necessary cost for sickness, deaths, and disability to about three-quarters of a million. Averaging the value of a human life he finds that the actual loss sustained by reason of sickness, deaths, and disability was nearly sixteen and a half million of dollars. These figures are not the product of the imagination but the outcome of a careful study of all the facts entering into the history of this disease when it fastens itself upon a city in a malignant and epidemic form, and they are strikingly suggestive of the great necessity that exists in every community for a more perfect observance of preventive measures. It is in keeping a population thoroughly vaccinated and revaccinated that the real economy of life and health and money lies. OTHER PREVENTIVE MEASURES AGAINST SMALL-POX. When a case of small-pox is discovered in any community, the first care should be to isolate it. This is a measure not always easy to be accomplished. The case should be at once reported to the local Board of Health, or Health Officer of the town, who should co-operate with the attending physician in all measures necessary to confine the disease to the locality where it may first have appeared. If the case occurs in a compact community or city, and among the poorer classes who live in crowded rooms and houses, it may be necessary to remove it to a hospital or building used temporarily for that purpose. But when a well-ventilated and convenient room can be given up to it, there may be no necessity for such a removal, although the case may be situated in a locality densely populated. Better that those who are well be remoyed and suffer the inconveniences and discomfort of a separation from home for a season than that the unfortunate member, already overtaken by a great and sudden calamity, should have super-added needless exposure, inadequate conveniences, meager comforts, with indifferent and often incompetent attendants. The burden should always be made. to rest as lightly as possible upon the sick, while those who are well should cheerfully bear the inconvenience imposed by the calamity. The sick person, if in his own house, should occupy a room as elevated as possible, or as is consistent with good ventilation, and he must be secluded during the whole progress of the disease, and so long as it may be possible for him to convey the disease to others. All carpets, unnecessary bed clothing, wearing apparel and furniture not essential for the comfort of the sick, or convenience of the attendants, should be at once removed from the room, and after the patient has recovered, no article or bedding, clothing or furniture should be removed from the room until the same has been thoroughly disinfected. Those who are the nurses and attendants must have been thoroughly protected against the disease by thorough * See monograph on vaccination, by W. C. Chapman. M. D., p. 2. vaccination or a previous attack of the disease, so that they shall be incapable of contracting it, and in that degree non-conductors to others. All persons, young and old, who have been exposed, or may in any way have come into possible contact with the sick one, should be at once thoroughly and carefully vaccinated, and this without reference to any previous operation. To guard against any possible error in the operation, or any want of vigor in the virus used, it is well to repeat the operation upon the second or third day, and if possible with a new package of virus. This operation should be extended to all persons within the radius of a block, and should include every person, without reference to any previous vaccination or revaccination. Should any party, known to have been exposed, have left the locality, his whereabouts should be ascertained and his unconscious danger made known to him, with a view to measures for his greater safety. The bodies of those who haye died from small pox are capable of conveying the disease; hence all funeral services should be omitted. Should, however, no such environments to the case be made as we have indicated, or should these barriers be passed and new cases be developed, the same general course should be pursued, coupled with the utmost care and vigilance. In the larger cities, it is seldom that an epidemic of this disease comes upon the people without timely warning. The disease spreads slowly, and it is generally many weeks before there is anything like an "epidemic diffusion." This is the opportune moment-the hour for action, and it depends entirely on whether advantage is taken of this interval or not, whether there shall follow the distress and loss which marks the pathway of an epidemic of this disease. At such times the local health officers-the town or municipal authorities, and the medical profession should heartily co-operate and vigorously and fearlessly institute such measures as we have indicated, or as may seem to them best. The public attention should early. and earnestly be called to the necessity of thorough vaccination and revaccination. All legal authority should be exercised by the local health officer to secure as complete an observance of this practice as possible. At such times every citizen is especially called upon, not only to protect his person and family from this pestilence, but also the community in which he lives. Whatever the circumstances under which we are compelled to encounter this disease, and whatever its stage of diffusion, we have in vaccination and revaccination, the means of controlling and subduing it, and with these means together with disinfection, the power to eradicate it. DISINFECTION. This is one of the three efficient measures to be adopted in checking the spread of this disease. To be of value it must be thorough. The accepted methods are simple and not attended with great expense and may be made very effective. Three agents only are absolutely necessary; namely-boiling water, sulphur fumigation, and ventilation. Many other agents can be used, but these are cheap, always available, and when used with thoroughness, reliable. As before advised, all articles used about the patient, such as sheets, pillow-cases, blankets, and clothes must remain in the sickroom until thoroughly disinfected. The New York Board of Health advise that they be soaked for one hour in the following solution before being placed in boiling water for washing. Sulphate of zinc, eight ounces. Carbolic acid, one ounce. Water, three gallons. They also recommend that a piece of muslin a foot or more square, kept wet with this solution, be suspended in the sick-room and in the hall or passageway leading to it. The infecting element of small-pox is absolutely destroyed by boiling water or an equivalent degree of heat otherwise used. All articles which can be conveniently treated by boiling water should be thoroughly boiled while such as cannot be so treated must be subjected for a time to a temperature of at least 2129. Dry heat when it can be applied is the most efficient of all disinfectants. Feather beds and pillows, mattrasses and heavy woolen articles must be subjected to sulphurous fumigation and should be left in the room until that is done. Straw beds should be burned. The floors and the walls of the room, together with such articles of furniture as can be subjected to such a process without damage, should be thoroughly scalded with boiling water. To fumigate a room with sulphurous acid, close all the openings into the room, such as doors, windows and chimney flues, and ignite from two to three pounds of sulphur, placed in a convenient and safe vessel. This amount will be sufficient for an ordinary sized room. The room should be kept closed for ten or twelve hours. After this it should be well ventilated by the introduction of fresh air from all available openings, the current being quickened by a brisk fire in the stove or fire-place for a time. To complete the process the ceiling should be whitewashed, and also the walls, or repapered.* These plain and simple rules of procedure have been found effectual under the severest test. They can be understood and practiced by all, and are commended for a trial by those who may be so unfortunate as to require the use of such ineasures. See history of Small-pox epidemic in Mobile, Alabama, by Jerome Cochran, M. D., 1875. |