ISOLATION HOSPITALS.-A MEANS OF PUBLIC PROTECTION. By C. A. LINDSLEY, M. D. PROFESSOR OF THE PRACTICE OF MEDICINE, MEDICAL DEPARTMENT OF STATE BOARD OF HEALTH.* I have been invited to speak to you to-night on the advantages which would result from the establishment of a hospital for contagious diseases, as a means of diminishing the prevalence of epidemics. I cannot conceive of any topic of more vital importance to the welfare of the public, because nothing is so destructive to the prosperity and happiness of communities, of families, and of individuals, as sickness and death. As the question apparently presents itself to the popular mind it naturally divides into two parts. First: Will the establishment of such a hospital materially and appreciably lessen the amount of sickness from contagious diseases as a whole, in the town? Second: If so, will there not be some increase of sickness in the immediate vicinity of the location of the hospital? I shall endeavor to confine myself as closely as possible to the consideration of these two points. All the maladies with which mankind are afflicted may be divided into two classes. The first class: The contagious and infectious diseases. The second class: The non-contagious and non-infectious diseases. We are chiefly concerned with the first class. It is from contagious and infectious diseases that we have epidemics; and here let me lay down a proposition, which is practically the basis of all which I may have to say to you, and which is this: The prevalence of every epidemic from which we suffer is due in almost every instance, to conditions which are under human control. I say that epidemics of contagious diseases owe their prevalence to conditions which are under man's control. This may seem a bold statement, but I think there are facts which are sufficiently pertinent to sustain it. Let us revert briefly to some past epidemics. Without going as far back as the Middle or Dark Ages and taking note of the Plague and the Black Death which carried off so many thousands *Address delivered at the United Church, New Haven, Ct., Sunday evening, January 5, 1896. and hundreds of thousands of the human race in those days, I will briefly call your attention to the epidemics of more recent date, which are more or less familiar to you from personal experience or from your reading. If there are any here to-night who can remember back fifty or sixty years, you will recollect in your childhood that you rarely saw an immigrant from Ireland whose face was not decorated with those peculiar tracings and indentations which small-pox so often leaves upon the features of its victims. It was in 1796, just one hundred years ago this very year, that the immortal Jenner performed the first human vaccination. Previous to that date, and for many years after, small-pox was the most destructive disease that then afflicted the human race. It decimated whole communities at frequent intervals and almost everyone in those days took the disease in his childhood or youth; because it is the inost contagious disease we are subject to, and it was so universally prevalent that none could escape for any considerable time an exposure to the contagion. Hence it prevailed generally in the old countries. What is the fact in regard to it at the present day? The Registrar-General of Ireland in his annual report in the middle of the year 1894, stated that since the last quarter of the year 1891, including that quarter, there had not been a single death from small-pox in all Ireland. The armies of Europe have excluded that disease from among them by vaccination and revaccination of their recruits. In many places in Europe vaccination is compulsory, and where it is practiced thoroughly the disease is extinguished. It can therefore be truly said of small-pox that it is under human control. years. Now let me call your attention to another very fatal disorder of the past of which you have all heard though few of you have seen it. I refer to the Scurvy. Formerly it was an exceedingly destructive disease to sailors and soldiers. It was the scourge of the army and navy from the time of the discovery of America by Columbus (who taught the maritime nations of the world that long voyages were practicable), and until within the past fifty When long voyages of months and even years in duration, were not uncommon, (that was in former times before the invention of steam navigation), it was said to be not unusual to find vessels at sea floating about at the mercy of the winds and waves without a living soul on board, everyone dead of the scurvy. But scurvy has disappeared. We know now how to prevent it, and if it occurs we know how to cure it. So that we can truly say that scurvy, that dread pestilence of the past, is under human control. You have all heard more or less of Typhus Fever, a disease which was formerly greatly dreaded, whose ravages have caused many thousand deaths. It was sometimes called jail fever and ship fever. But you can count upon the fingers of one hand all the cases of Typhus Fever which have occurred in Connecticut within the last ten years. Man has practically exterminated Typhus Fever. More than one hundred years ago, in 1794, Yellow Fever appeared for the last time in New Haven. The epidemic continued from June until November, and in the small population which then existed in the city, claimed sixty-four victims by death. Yellow Fever has been an annual visitor at New Orleans, and many other Southern cities, for many years, but Gen. Butler, when he had possession of that city, during the late rebellion, said that it was an unwelcome visitor, and demonstrated his ability to shut it out, and Dr. Holt, late President of the State Board of Health of Louisiana afterwards devised a system of quarantine that has completely excluded that disease from New Orleans. So we may count yellow fever as another pestilence under human control. For the last eight or ten years this country has been in a state of semi-alarm lest cholera should gain admission and become epidemic. If there are any among you as old as I am, you will remember the panic and terror which was excited, particularly in the city of New York, in 1832, when it first appeared in this country. The state of fright was unparalleled at that time, and has never been again equalled, unless it may have been at Memphis from yellow fever in 1878. I was a resident at that time in the village of Orange, N. J., an agricultural district then, fifteen miles from New York. Stage loads of refugees came daily from the terror stricken city, seeking lodging and food, bringing their families with them. Every resident of the village who had a spare room in his house felt it a charitable duty to take them in and provide for them. My father's house was full, and it was a task imposed on me to run out every evening, about seven o'clock, when the New York stage came to the village store, and ask the driver, "how many deaths to-day in New York from the cholera?" But cholera never can prevail in New York again as it did then, even if there were no quarantine precautions whatever. At that time New York had no water supply, except from the wells dug in the back yards of city lots, or in the streets. It had no sewer system, and its sewage was disposed of in the back. yards of city lots, and in the streets. But now they have the Croton water, a good system of sewers, and Col. Waring to keep the streets clean. A more perfect method of spreading cholera from what we know at the present time of its means of spreading, could not have been devised than were provided by the conditions existing at that time. But cholera does not exist in this country now, nor anywhere where proper regulations are observed, and we may surely say that cholera too is under human control. Thus we see that Small-pox, Scurvy, Typhus Fever, Yellow Fever and Cholera, five of the most fearful pestilences of past times have been practically stamped out of existence. Now all this has been brought about by those general hygienic observances which pertain mostly to communities. Such as a wholesome water supply, a proper method of disposal of sewage, better ventilation of our houses, and in a general way a better and more salubrious mode of life than was common among our ancestors. But the recent wonderful discoveries of science have thrown a flood of light upon this subject and revealed a more direct and positive mode of controlling epidemic diseases than we have known before. If sanitary science has taught us anything it has taught us that the actual cause of contagious diseases is the disease itself, and nothing else. I mean to say that if a member of one of your families should be taken down with Scarlet Fever, you may be absolutely sure that the patient has within about a week, more or less, somewhere and somehow been exposed to the infection produced by a previous scarlet fever patient. In other words, there are no conditions in nature by means of which scarlet fever can be produced spontaneously. It must come as the result of a previous case of scarlet fever, because the real cause is a living germ, reproduced in each scarlet fever patient, and can only be reproduced by other like living germs. It is not necessary that the new subject of scarlet fever shall have been in the presence of a scarlet fever patient, but he must have been near some thing or things that had been infected by the scarlet fever patient. Things infected by scarlet fever or diphtheria, and some other diseases, will retain the infection under favorable conditions for an indefinite period of time, for weeks, months, and even years. An infected garment may hold the infection to contribute the disease when brought in contact with it years after the patient who infected the garment has died or recovered. This simplifies very much the methods by which we may control the spread of infectious diseases. It gives a directness to our efforts and a certainty of results that was never possessed before. It teaches two things as essential to success: First, that the patient shall be isolated so that he cannot personally communicate the disease to others by his presence, and, Second, the disinfection of infected things, because he does and must necessarily infect things about him, his clothing, the things in his room, whatever he may handle, so that more than isolation is required. These things must be disinfected before they are permitted to come into the presence of other susceptible people. Hence the whole theory and practice of protection from contagious diseases can be described in just two words, isolation and disinfection. This leads at once directly to the question, How can a hospital for contagious diseases aid us in this practice? We can best illustrate by a special case, which is by no means wholly imaginary. Mr. Patrick Smith devotes his energies daily to the assistance of the selectmen of New Haven in their efforts to keep the highways in a tolerably passable condition. He receives for such services $1.50 a day. He has a wife and four small children; they occupy three rooms in a tenement house, with five other families. He has ingeniously used these rooms for a kitchen, dining-room, parlor, bedrooms, laundry and smoking room, and when Pat is at home in the evening it is most all smoking room. When one night he comes home his wife tells him that one of the children is very sick, and Patrick takes a look at the child and says that he will go for the doctor. The doctor tells them that the child has scarlet fever and must be kept away from the other children. "And how can that be done?" says Patrick. The doctor does not know, nor is it possible to isolate the patient under these conditions. It is unnecessary for me to enlarge upon the dangers and consequences of the situation. It is quite evident that isolation is impossible; it is equally certain that if not isolated one or more of the other children will take the disease; nor is that all. There are five other families in this tenement house, with an average of three children a piece, making fifteen or twenty children in one house, now exposed to scarlet fever, and some of them are school children. These must all be excluded from the public schools, because they come from a house in which there is scarlet fever. What else can happen under these circumstances than an epidemic of scarlet fever in this tenement; and as a center of infection, how many other tenement houses may suffer from the contagion? But it is not only the lower grades of the social scale, for which a hospital is needed. Let us take the case of Mr. Astorbilt, who lives quite in the vicinity of Hillhouse Avenue. He has an elegant residence, expensively and luxuriously furnished, with all the modern appliances for domestic comfort. He is interested in real estate and railroad stocks. His family consists of himself, wife and three children, but he has also a coach |