EPIDEMIC DISEASES, SANITARY CONTROL OF. 



287 



blood-poisoning, and death is remarkably rapid, 

 without external eruption of buboes, carbun- 

 cles, or spots. In such cases the body has no 

 time to show the 'tokens' before death. In 

 the great majority of cases the disease is pre- 

 ceded by lassitude, loss of strength, anxiety, 

 and afterward by vomiting. The characteristic 

 swellings in the arm-pits and groin follow, 

 petechiaa and carbuncles appear, delirium suc- 

 ceeds, and too frequently death. Pathology 

 shows rather the effects of the poison on the 

 tissues and organs, as shown by enlargement 

 and congestion of the spleen, kidneys, etc., 

 than anything especially characteristic. There 

 are numerous haemorrhagic effusions, and dis- 

 section shows that buboes always result from 

 enlargement and suppuration of the lymphatic 

 glands. It is probable that all the fluids and 

 secretions of the plague - stricken body are 

 contagious " (Dr. Blythe, " Dictionary of Hy- 

 giene "). 



The symptoms of cholera, small-pox, and 

 yellow fever, are so well known that no par- 

 ticular mention need be made of them in this 

 place. 



CONVEYANCE OF INFECTION BY AIR. The 

 atmosphere is essentially a diluent of all gase- 

 ous poisons. It has practically this effect in 

 relation to germ-diseases, for it is evident that, 

 when the germs are scattered through a large 

 quantity of air, the propagation is retarded; 

 for the seeds being less numerous, their effects 

 are not so apparent ; but the distance to which 

 specific germs can be transmitted in the air 

 can not at this time be definitely stated. The 

 air, however, is always infected in the imme- 

 diate vicinity of fomites, which is a rather 

 vague term, meaning any substance which 

 may retain germs from a plague- or fever- 

 stricken patient. Thus there are included in 

 this general term all textile fabrics which 

 have been in contact with patients, such as 

 clothes, rags, bedding, linen, and the like. It 

 is reasonably certain that such fomites, having 

 been in contact with the excreted or vomited 

 matters, perspiration, or other exhalations from 

 the skins of patients affected with some one 

 of the specific diseases, afford a safe place of 

 refuge for the germs ; and if fomites be placed 

 in boxes or trunks, or in bales, they retain the 

 power of propagation through an indefinite 

 period of time ; and such fomites, when placed 

 in favorable conditions, allow the transmission 

 of the germs to the air surrounding them, and 

 thus the contagion is supplied, to be dissemi- 

 nated from one place to another. In the epi- 

 demics of the plague in Asia, it has been dem- 

 onstrated that rugs and the like, when carried 

 to a place quite remote from the original place 

 of infection, and opened out, have been a cause 

 of the development of the disease in a new and 

 before unaffected locality. This also accounts 

 for the sudden outbreak of epidemics in remote 

 points. In the cholera epidemic of 1873, in 

 the United States, the Crow River settlements 

 in Minnesota were free from cholera until the 



opening of baggage at Willmar, brought thither 

 by immigrants from Europe (McClellan, u Chol- 

 era Epidemic of 1873 in the United States," 

 Washington, 1875, p. 441). It is believed to 

 be a fact that the outbreak of yellow fever at 

 Memphis, Tenn., in 1879, originated in the un- 

 packing and airing of certain infected clothing 

 that had been stored away since the terrible 

 epidemic which had visited that city in the 

 previous year ; and such cases have been of so 

 common occurrence as to give cause for a well- 

 grounded fear of retaining year after year, in 

 any house, textile fabrics which have directly 

 or indirectly been in contact with yellow-fever 

 patients. In regard to the general infection of 

 the air, it has been demonstrated that a strong 

 current of air, blowing over infected articles, 

 will convey the germs in sufficient numbers to 

 develop the disease in persons inhaling the 

 infected air; and it has even been known to 

 affect animals. For instance, the widely-known 

 Ceeley case, reported in " Transactions of Pro- 

 vincial Medical and Surgical Association," 

 quoted by Aitken ("Science and Practice of 

 Medicine," vol. i, 1872, p. 400), as follows : 

 " At the village of Oakley, about sixteen miles 

 from the town of Aylesbury, small-pox had 

 been epidemic from June to October, 1840. 

 Two cottages, in which three persons resided 

 during their illness, were situated, one on each 

 of two sides of a long, narrow meadow, com- 

 prising scarcely two acres of pasture-land. One 

 of these three patients, though thickly covered 

 with pustules of small-pox, was not confined 

 to her bed after the full development of the 

 eruption, but frequently crossed the meadow 

 to visit the other patients a woman and a 

 child the former of whom was in great dan- 

 ger from the confluent malignant form of the 

 disease, and died. According to custom, she 

 was buried the same evening ; but the inter- 

 course between the cottages across the meadow 

 was still continued. On the day following 

 death, the wearing-apparel of the deceased, the 

 bedclothes and bedding of both patients, were 

 exposed for purification on the hedges bound- 

 ing the meadow. The chaff of the child's bed 

 was thrown into the ditch, and the flock of the 

 deceased woman's bed was strewed about on 

 the grass over the meadow, where it was ex- 

 posed and turned every night, and for several 

 hours during the day. This purification of the 

 clothes continuedfor eleven days. At that time 

 eight milch-cows and two young heifers were 

 turned into the meadow to graze. They en- 

 tered it every morning for this purpose, and 

 were driven from it every afternoon. When- 

 ever the cows quitted the meadow the infected 

 articles were again exposed on the hedges, 

 and the flock of the bed was spread out on the 

 grass and repeatedly turned. These things 

 remained until the morning, when the cows 

 were readmitted, and the contaminated arti- 

 cles were supposed to be withdrawn. It ap- 

 pears, however, that the removal of the in- 

 fected articles was not always accomplished so 



