RELAPSING FEVER. 257 



their misfortune, as it was when a house was on fire, to call in the 

 assistance of the neighbourhood." The shutting up of infected houses 

 was condemned in the strongest terms, and a system of notification and 

 isolation was proposed on the lines originally suggested by Dr. Hodges. 



1. A Council of Health was to be established, and entrusted with such 

 powers as might enable them to see all their orders executed with im- 

 partial justice. 



2. Notification. — The ignorant old women employed as searchers were 

 to be replaced by understanding and diligent men, who were to report 

 cases immediately to the Council of Health. 



3. Isolation. — Physicians were at once to be despatched to visit the 

 suspected cases, and when the suspicion of plague was confirna^ed, all the 

 families in which the sickness occurred were to be isolated. The sick 

 were to be separated from the sound, and isolation houses to be provided 

 three or four miles out of the town. i 



The removal of the sick was to be made at night, so as to avoid the 

 danger of spreading infection, and all possible care was to be taken to 

 provide such means of conveyance for the sick that they might receive no 

 injury. The poor were to be isolated in houses provided for the purpose, 

 but the rich were to be allowed to be in their own homes provided that 

 care was taken to separate the healthy from the sick, and no pains were 

 to be spared to provide clean and airy apartments. All expenses were to 

 be paid by the public, and a reward was to be given to the person who 

 made the first discovery of infection in any place. 



Mead further pointed out that general sanitation must be carefully 

 attended to. Ofiicers were to see that the streets were washed and kept 

 clean from filth, carrion, and all manner of nuisances. Beggars and idle 

 persons were to be taken up, and such miserable objects as w^ere fit 

 neither for the hospitals nor for the workhouses, were to be provided for 

 in an establishment for incurables. Houses also were to be kept clean, 

 and sulphur was to be used as a disinfectant. 



After centuries of experience we have learnt that the necessary 

 conditions for avoiding the plague are more accurate knowledge on 

 the part of the profession and the public of the way in which the 

 disease spreads, and the adoption of sanitary precautions, which must 

 include personal cleanliness, sanitary dwellings, absence of overcrowd- 

 ing, immediate notification, prompt separation of the sick from the 

 healthy, disinfection of infected dwellings, destruction of infected 

 clothing, and extra-mural burial«or, better still, cremation. It was 

 because the very reverse of these sanitary conditions existed that 

 the virus of the plague found a suitable environment in Old London 

 and in recent times in Hong-Kong. 



Relapsing Fever. 

 Relapsing or famine fever is a contagious disease producing a 

 state of high fever lasting about seven days, followed by apparent 



17 



