1870 The Lancet  
736 not compare with the newer establishments of the same kind in this and other countries, it appeared to be well managed, and to be conducted on the modern system. I did not observe any appliances for restraint in the wards, though I was told that they make use of the strait-jacket. A maniacal patient was in a padded room when I visited the asylum. In connexion with the institution there is an admirable bathing establishment; there is also a good garden for the patients to take exercise in,
more » ... take exercise in, and a small theatre is provided where performances take place for their amusement. Altogether much seemed to be done to alleviate the condition of the patients, and the establishment had very much less of the prison-like character than some which I have gone over. PHYSICIAN TO THE QUEEN'S AND CHILDREN'S HOSPITALS, BIRMINGHAM. AT the beginning-of this year the in-patient department of the Birmingham Children's Hospital was removed to a much more suitable building and locality than it had previously enjoyed. This division consists, as formerly, of a contagious and a non-contpjgious department. Into the former only cases of scarlet fever and diphtheria are admitted. Its beds amount to thirteen. Occasionally, under great pressure, fourteen or fifteen patients have been at one time in the contagious ward. The precautions taken in order to ensure the isolation of the inmates of the ward appear to me to be as complete as the circumstances will admit of. In our old building', though very ill-fitted for a hospital, the diffusion of scarlatina among the ordinary patients was exceedirgly rare. In fact, as about five hundred children under ten years of age passed through the general beds annually, we were entitled to declare that the chance of one of them catching this disease was not appreciably greater than is incidental to the same number of young children taken indiscriminately. The washing of the clothes was done outside the establishment for several years before we quitted the building at the end of 1869; that belonging to the scarlatina ward being sent to one laundress, and that belonging to the general cases to another. Scarcely had the institution been transferred to its new abode when the medical officers were alarmed at the frequency with which scarlet fever made its appearance in the general wards, both medical and surgical. As the year advanced the evil increased, and several cases of operation were followed by more or less severe attacks of the disorder. From July 21st I am enabled to give an exact account of all the cases, having had the advantage of a report furnished by the present resident medical officer, Dr. Underhill. For convenience, I have placed them in the following tabular form :-It was to no purpose that the medical officers consoled themselves with the reflection that all the cases caught in the hospital were followed by recovery. That ten cases of scarlet fever occurred in the general wards in but little more than two months was in itself a very painful circumstance, and could not but engender reflections on the management. Attention was directed to the subject, and the first thing investigated was the washing department. The whole of the washing was executed in the laundry of the hospital, lying immediately behind the centre block. The drying yard lay immediately behind Wards 1 and 5. Ward 6 closely adjoins Ward 5; and both these wards are under the charge of the sister who -was the subject of the first case. The whole of the clothing of the contagious ward was taken first to a tub in the garden contiguous thereto, in which was regularly placed some Condy's fluid. From time to time the foul linen, which had been subjected to the action of the nuid, was removed to the laundry, where it was washed on a different day from that on which the clothes of the general wards were done. It is, however, important to notice that the whole washing process took place in the same room, and was performed by the same persons. At the same time and in the same room that the non-contagious clothes were being folded and mangled, the contagious clothes were washed. This is the utmost limit of their separation that can be admitted, and it is probably more than actually existed. On the IGth of September chloride of lime was put into the wash-tub of the contagious clothes instead of Condy's fluid; but a full consideration of the remarkable immunity from scarlet fever in the old building, where no washing was done during the latter period of its occupation, induced the medical officers to order that the contagious clothes should be sent away from the institution to a laundress who took in no other washing', the ordinary clothes being -washed in the hospital laundry as usual. This order took effect on the 28th of September. From that date no case of scarlet fever has occurred in the wards. Ten cases broke out between July 26th and Sept. 28th, when the clothes of the contagious department were washed and dried in the institution. Between this last date and the present day (Nov. 22n.d), being seven weeks and six days, no case has occurred; no circumstances having intervened different from those previously existing, with the exception of the withdrawal of the clothes of the contagious ward from the laundry. These facts give a strong support to the opinion of many sanitary authorities, that the laundry is a means whereby scarlet fever is greatly propagated. It would be a wonder were it otherwise, for nothing is better established than the tenacity with which the contagium of scarlet fever adheres to clothing. Unfortunately, this knowledge has been to a great degree sterile of practical good owing to a re-
doi:10.1016/s0140-6736(02)60100-x fatcat:nkdnnawzznchffngkhkdtn4oxa