and anything of that nature which are known to be retentive of disease-germs.

"(2.) Measures of disinfection should be used as early and as thoroughly as possible. Carbolic acid in solution, or as carbolate of lime, is especially useful, to sprinkle on the floor, and with which all parts of the room may be washed prior to cleansing and limewhiting; and all articles to be washed ought to be soaked first in a solution of carbolic acid.

"(3.) A basin charged with chloride or carbolate of lime, or some other convenient disinfectant, is to be kept constantly on the bed for the patient to spit into, and which must be emptied and replaced at regular intervals.

"(4.) A large vessel (a tub) containing water impregnated with Condy's fluid or carbolic acid solution should always stand in the room (or near by), for the reception of all bed and body linen on its removal from the person or contact with the patient.

(5.) In place of using pocket-handkerchiefs, use small pieces of rag for wiping the mouth and nose, so that each piece, after being used, may be at once burned.

(6.) Two basins, one containing Condy's fluid or carbolic solution, and another containing plain soft water, and a good supply of towels, must always be ready and convenient, so that the hands of nurses may be at once washed after they may have been soiled by specific excreta. The dresses of nurses and attendants should be of linen, or smooth washable material.

"(7.) Glasses, cups, and other vessels used by or about the patient, are to be scrupulously cleaned before being used by others.

"(8.) The discharges from the bowels and kidneys

are to be received, on their very issue from the body, into vessels charged with disinfectants.

"(9.) To prevent the minute particles of desquamation from flying off as impalpable powder, their power for evil must be destroyed in situ, by anointing the surface of the body (the scalp included) twice a day with olive oil. It may be slightly impregnated with camphor, which Dr. Budd considers sufficient, or carbolic acid. The process relieves the itching of the skin, and is very soothing to the patient. So soon as efflorescence is observed on the skin of the neck and arms (as early sometimes as the fourth day), which marks the first liberation of the germ-carriers of the specific disease poison, the employment of the oil is to begin, and ought to be continued until the patient is well enough to take a warm bath, in which the whole person (scalp included) is well scrubbed, carbolic acid soap (Calvert's or Macdougall's) being abundantly used during the process. These baths are to be repeated every second day until four have been taken, when, as far as the skin is concerned, the disinfection may be regarded as complete, although a further quarantine of a week may be advisable.

"(10.) The chamber in which the sick person has been must now be thoroughly washed out, using freely carbolic acid and soft or black soap (which may now be got combined for the purpose)." (Aitken's Science and Practice of Medicine, 6th edition.)

It is not too much to say that were it possible that these precautionary measures could be carried out in every instance, the disease would soon be stamped out altogether.

7. Measles. This disease, like scarlet fever, is

U

eminently communicable. The contagium may be conveyed by fomites, or by means of the contaminated air of the sick-room. The disease attacks persons of all ages and of both sexes, but is much more frequent amongst children. The risk of infecting commences with the primary fever, and is greatest when the specific eruption is fully developed. As a rule, a patient who has once suffered from the disease is no longer liable to a second attack.

8. Hooping-Cough. The susceptibility to this disease is so strong that few persons have passed the age of childhood without having contracted it. Moreover, the infecting distance of the contagium appears to be very considerable, inasmuch as domestic isolation is frequently found to be of little avail in preventing the disease from attacking other members of the family who have not been protected by a previous illness. That the contagium may likewise adhere to clothing, and may in this way propagate the disease, has been clearly proved by numerous instances.

Such being the mode of propagation of measles and hooping-cough, the precautionary measures which are indicated comprise,-isolation of the patient, if other members of the family have not been protected by a previous attack; careful attention to the hygiene of the sick-room; and disinfection of the clothing, bedding, etc. And here it may be pointed out that the prevalence of these two diseases is in great measure attributable to the culpable neglect, arising from the popular belief, amounting almost to fatalism, that children must contract them some time, and that there is therefore little use in endeavouring to take any protective steps when either disease is epidemic. The consequence is

that the epidemic continues to spread so long as susceptible victims are to be found in the community, and only dies out for a time when almost all these have been attacked. How far the medical profession are to blame in allowing this popular delusion to retain its hold on the public mind, it would be difficult to say, but until they unite in striving to get rid of the listless apathy which it engenders, the prevalence of such epidemic diseases will continue to be an opprobrium to sanitary science. Nor must it be forgotten that medical men, in the hurry of practice, do sometimes, though unwittingly, convey the contagium of an infectious disease from one patient to another. For example,

instances are not at all uncommon in which scarlet fever has been propagated in this way, and the records of puerperal fever contain the histories of many painful cases which could never have occurred had greater care been taken to guard against such fatal mishaps.

With regard to other infectious diseases which are not so liable to spread in an epidemic form, little need be said. Diphtheria requires that the sputum and handkerchiefs or rags used to wipe the mouth of the patient should be disinfected or destroyed, and injunctions should be given to attendants not to bend over the patient, so as to run the risk of inhaling the breath. Further, as there are good grounds for believing that the disease is sometimes propagated by impure water or defective sewerage, these should both be looked to and remedied.

In these remarks on the mode of propagation of infectious disease, it has been assumed throughout that the body of the diseased person is the soil in which the germs of the disease are multiplied; that these

germs, whatever be their nature, are given off by the patient, and may contaminate the air or drinking-water, or may adhere to clothing, bedding, furniture, or walls of a room; that, either directly or after remaining dormant for an unknown period of time, they may infect other persons; and that, by adopting suitable measures, they can be destroyed altogether, or rendered inoperative to a large extent. So far also these remarks have had special reference to the precautionary measures which form a part of personal and domestic hygiene, and which fall under the control and regulation of the private medical attendant. The general proceedings which should be carried out under the advice of a health officer in places attacked or threatened by epidemic disease, have been summarised by Dr. Aitken from a memorandum drawn up by Mr. Simon as follows (see Aitken's Science and Practice of Medicine, 6th edition) :

"1. Wherever there is prevalence or threatening of cholera, smallpox, diphtheria, typhus, or any other epidemic disease, it is of more than common importance that the powers conferred by the Nuisance Removal Acts, and by various other laws for the protection of the public health" (see Appendix I.), "be vigorously but at the same time judiciously exercised by those in whom they are vested; and with regard to armies, that the instructions relative to the guidance of the medical officer in sanitary matters, contained in the army regulations, be duly carried out on the principle that the executive should act under authority, in order to carry out the required measures efficiently.

"2. If the danger be considerable, it will be expedient that the local authorities in civil life, and the commanding officers of armies, brigades, divisions, and