HOSPITALS

FOR

CONTAGIOUS DISEASES,

AND

THEIR PROPER LOCATION.

A PAPER PREPARED BY REQUEST FOR THE STATE MEDICAL SOCIETY, AND PRINTED HEREIN BY ORDER

OF THE STATE BOARD OF HEALTH.

CON

HOSPITALS FOR CONTAGIOUS DISEASES.

THEIR PROPER LOCATION, CONSIDERED MORE ESPECIALLY IN REGARD TO THE SAFETY OF NEIGHBORING DWELLERS FROM THE INFECTION OF SMALL-POX.

No one doubts the great usefulness of these institutions, which, for brevity's sake, shall be called in this paper by the old and significant, but objectionable, name of pest-houses. But when it comes to their location, especially in the suburbs of one of our rapidly growing towns or cities, a very vexed question arises.

The question has two very different aspects, according to the diferent stand-points from which it may be regarded. Sanitary authorities, and physicians generally, having no great dread of small-pox, partly from professional habit and familiarity with the disease, but mostly from an abiding and invincible faith in the entire protection afforded by vaccination, would place the pest-houses as near as possible, both for their own convenience in visiting its inmates, and for the superior facility and safety of the transportation of the latter. On the other hand, the community generally, having a superstitious horror of the disease, and being conscious, in many instances, of their neglect of vaccination, or, if vaccinated, doubtful of its protective powers, would wish the pest-house to be as far out of the city as possible, both on account of safety of persons and of the injury to the value of property.

Just what is the limit of safety to surrounding dwellings from infection by small-pox has never been definitely settled either by experiment or observation. In Johnson's Cyclopædia it is stated that persons have been infected by the "volatile contagion" across a river 150 feet wide. This fact, if it is indeed a fact, has been quoted in a judicial decision in this State. But the medical mind,

by general consent, has been always inclined to reject all such suggestions of infection through the air at long distances, and account for these apparent cases, or attempt to account for them, by some kind of actual material contact or contagion, an explanation so far fetched in many cases it must be admitted, as to require for its admission fully as much credulity or imagination as the other.

But now, fortunately, we are in the possession of such well observed and well authenticated facts, as to be able to make a considerable advance in the solution of this vexed question, but with the result of a great disturbance, if not entire overthrow, of current medical opinions.

For a proper understanding of the subject, it may be proper to call attention to the peculiar virulence of the small-pox contagion, which seems to be almost sui generis, having no like or companion.

“The poison of typhus exanthematicus is very readily got rid of by free ventilation, by means of which it must be a: once diluted and oxygenated, so that a few feet give, under such circumstances, sufficient protection. This is also the case with the poison of oriental plague, while, on the other hand, the poison of small-pox and scarlet fever will spread in spite of free ventilation, and retain their power of causing the same disease for a long time."-Parke's Hygiene, 5th ed., p. 117.

This fact of the superior virulence of small-pox, even over scarlatina, will be more apparent further along when the recent observations in England, on a most extended scale, are narrated, which show that a space of as little as forty feet is sufficient protection against the poison of all diseases usually isolated in hospitals, with the sole exception of small-pox.

OBSERVATIONS IN ENGLAND IN 1880-1.

In 1880, by order of the Local Government Board (which is the English National Board of Health), Dr. Thorne made a series of observations, which were extended into 1881, upon the “Use and Influence of Hospitals for Infectious Diseases." When Dr. Thorne's inquiry was planned, it was not intended that it should extend to the metropolis. But at the end of 1880, when Dr. Thorne's inquiry was in an advanced state, representations were received by the Board that cases of small-pox were occurring in an exceptional fashion round certain of the metropolitan asylum board hospitals; and it was

felt that Dr. Thorne's experience on this subject derived from hospitals in the provinces ought not, without further inquiry, to be accepted as representing the whole truth for hospitals in London.

Accordingly, Mr. W. H. Power was associated with Dr. Thorne for the particular purpose of examining the facts for the neighborhood of Fulham Hospital.

INFLUENCE OF URBAN AND SUBURBAN, OR RURAL HOSPITALS OUTSIDE

OF LONDON.

As to Dr. Thorne's report, the following facts are deduced:

1. Of the 286 hospitals in England for infectious diseases, 67 were inspected, in use by urban, by rural, and by port sanitary authorities; of every variety of locality, size and construction; some thoughtfully devised on a scale adapted to the needs of their districts, and reckoned by those who had provided them as among the most valuable defenses of these districts; others ill-placed or on an altogether insufficient scale, or badly planned, doing duty in default of better, though of flimsy, material and hurried construction.

2. Whether or not any injurious effects upon the health of a population could be traced to the presence of a hospital in its midst was the further problem which Dr. Thorne's inquiry was directed to solve, and his results are chiefly negative. In several cases he found infection communicated through some fault of administration. He also, in the case of small-pox, discovered two instances where infection had appeared to spread from a hospital in a row of houses to other houses, in a way that suggested the conveyance of the infective matter through the atmosphere rather than by means of persons or things. In many other instances the same disease, small-pox, being in question, Dr. Thorne heard of no extension of infection to neighboring streets and houses, in spite of the best inquiries he and officers of health could make. This is all; for the rest, Dr. Thorne, having to tell many a story of hospitals in which the circumstances of site, of construction, and of management, might have been better than they were, has nothing to record of fevers, scarlet, typhus, enteric, or other infectious diseases, spread from the hospital, as such, to its neighborhood. In regard to the danger from these diseases, Dr. Thorne says: "My inquiry will tend to show that in well administered hospitals, having an open space of some forty feet between the hospital wards and any neighboring thoroughfares or buildings, no risk of the spread