The Management of the Sick-room and Patient requires careful and conscientious attention to detail. Certain details are given on page 319. All unnecessary furniture, carpets, and hangings should be removed as soon as the nature of the illness is known; but unless these articles have been contained in close trunks or drawers, and not opened since 경산오피 before the onset of the illness, they must be disinfected. Food left over from the patient’s meals must be burnt, if solid, in the patient’s room; if liquid, emptied down the water-closet. Dry sweeping of the floors is to be avoided, only wet brushing or cloths being used. Volatile aerial disinfectants during the sickness are valueless.

The Treatment of Discharges from the Patient is the most important point in the management of infection. The stools should be received into a bed-pan containing a 5 per cent. solution of332 carbolic acid, a 3 per cent. solution of cresol or lysol, or a 5 per cent. solution of chloride of lime. Milk of lime (20 per cent. strength) is very reliable, when added like the preceding solutions in bulk equal to that of the stool to be disinfected. The urine and vomit, if any, should be treated in exactly the same way. The infection of enteric fever is often spread by undisinfected urine.

Discharges from the throat, nose and mouth of patients should be received into a solution of

lysol 5 oz. to 1 gallon of water, or
carbolic acid 7 oz. to 1 gallon of water,
The efficacy of the carbolic acid solution is increased by adding 2 oz. of, or 12-14 oz. of to each gallon. Pocket-handkerchiefs must be avoided, linen rags being employed instead, and placed at once in one of the above solutions or burnt.

The skin may scatter infection, especially in small-pox and scarlet fever. Frequent baths and inunction with vaseline or oil are useful.

The disinfection of hands is most important for all attendants on the infectious sick. A solution of corrosive sublimate 1-1000, or one of the above solutions may be used for this purpose; but this is to be supplemented by the free use of the nail-brush and soap and water. The treatment of linen has been described (page 329).

Woollen articles of underclothing, and blankets can be disinfected by steam, which shrinks them less than boiling water. The ordinary laundry processes appear, however, to suffice to rid them of infection, without boiling.

Bedding, curtains, and carpets should be disinfected by steam. Certain precautions are required in removing these to the disinfecting station. Surface disinfection of the room must have been first effected (see below); and the infected bedding should be encased in canvas bags or sheets. When a steam disinfector is inaccessible, the mattress and pillows should be taken to pieces, the covers washed, and their contents disinfected by spraying with formalin solution (1 in 40) or solution (1 in 1,000), and subsequently exposing to sun and air. For disinfection of suits of clothes, current steam may be improvised as follows:—Over two bricks at the bottom of the kitchen “copper” thin floor-boards are placed, above the level of 2 or 3 inches of water previously placed at the bottom of the copper. The cover of the copper is put on, and by means of a brisk fire steam is kept streaming through the clothes. This is continued for an hour, and the clothes then hung out to dry.

Furniture, when wooden, can be washed. If upholstered it can be disinfected by spraying (see p. 333), and then beating and dusting in the open air.

Furs, Boots, and Shoes are spoilt by steam. For the first, spraying freely with formalin (1 in 40), or exposure over a formalin lamp (page 326) is recommended. Boots and shoes should be filled and washed with a solution of , chinosol, or formalin.


Fig. 58.
Equifex Spray Disinfector in Use.
The sick-room can only be efficiently disinfected after the patient has left it. The aim is surface disinfection. Aerial disin333fection is sufficiently effected by open windows. Four chief methods of surface disinfection are practised. (a) Fumigation by SO₂, formalin, cresol, or other vapours (see page 326). (b) Spraying the ceiling, walls, floor, and furniture with a disinfectant solution is probably the most convenient method of disinfection. It is more effectual than fumigation, less laborious than rubbing down walls, etc., by bread or wet cloth, and less likely to damage wall-papers than brushing a disinfectant solution on them. Solutions of 1 in 1,000, or chinosol 1 in 1,200, or formalin 1 in 40 are efficient. A special spray apparatus (Fig. 58) is usually employed. A practical point is to spray the wall from below upwards, to prevent the solution running down the wall and producing streaks of discolouration. (c) Washing ceiling and walls with the disinfectant solution may be substituted. A one per cent. solution of hypochlorite of lime is largely used for this purpose, applied by a long-handled334 whitewash brush. (d) Attrition of walls, etc., by means of bread or dough sterilises them by mechanically removing microbes. The bread is cut into pieces suitable for grasping in the hand, the cut surface being applied to the wall. The crumbs must afterwards be burnt in the room. This is the official method in Germany.

Floors may be treated like walls and ceiling after the patient has left the room. During his occupancy of the room, tea-leaves or sawdust thoroughly impregnated with lysol or cresol should be sprinkled on the floor before it is swept, or washing substituted for sweeping. Scrubbing with soap and water constitutes the best disinfectant for floors and all other washable surfaces.

Books are difficult of disinfection. Steam damages leather. The penetrating power of dry heat is doubtful. Cheap books should be burnt. Abel discovered virulent diphtheria bacilli on toys six months after the patient, to whom they belonged, had diphtheria. Formalin and phenol vapours have been used to disinfect books in closed chambers, the books being stood on end. Letters can be rendered safe by steam disinfection.

Corpses of infectious patients should be placed in the coffin and buried as early as possible. A thick layer of sawdust saturated with lysol or cresol should be placed at the bottom of the coffin, and the corpse enveloped in cotton wool. Cremation is better than burial.

335

CHAPTER XLVIII.
VITAL STATISTICS.
Vital Statistics is the science of numbers applied to the life-history of communities. Its significance is similar to that of the more recently coined word—Demography—though the latter does not necessarily confine itself strictly to study of life by statistical means. Another term has been frequently used in recent years—“Vital and Mortal Statistics.” The continued use of the word “mortal” in this connection is undesirable and objectionable. The term “Vital Statistics” is comprehensive and complete, as death is but the last act of life.

Of the problems of life with which the science of Vital Statistics is concerned, population, births, marriages, sickness, and deaths, possess the chief importance; and in the following sketch of the subject I shall concern myself chiefly with these. The subject naturally divides itself into two sections: the sources of information, and the information derived from these sources, and both of these will require consideration.

The importance of numerical standards of comparison in science increases with every increase of knowledge. The value of experience, founded on an accumulation of individual facts, varies greatly according to the character of the observer. As Dr. Guy has put it: “The sometimes of the cautious is the often of the sanguine, the always of the empiric, and the never of the sceptic; while the numbers 1, 10, 100, and 100,000 have but one meaning for all mankind.” Hence the importance of an exact numerical statement 경산오피 of facts. The sneering statement that statistics cannot be made to prove anything can only be made by one ignorant of science. In fact, nothing can be proved without their aid, though they may be so ignorantly or unscrupulously manipulated as to appear to prove what is untrue. Instances of fallacious use of figures will be given as we proceed.

An accurate statement of population forms the natural basis of all vital statistics. Thus the comparison of the number of deaths in one with the number of deaths in a second community has no significance unless we know also the number living out of which these deaths occurred. Even then our knowledge would be defective, without further particulars as to the proportion in each population living at different ages, and the number dying at the corresponding ages. For other purposes we should require to know336 the number married and unmarried, the number engaged in different industries, and so on; in order that the influence of marital conditions, of occupation, etc., on the prospects of life may be calculated. The first desideratum of accurate vital statistics is a census enumeration of the population at such intervals as will not cause the intervening estimates of population to be very wide of the mark. In this country a decennial census is taken, the last occurring in 1901. In the intervals the population of the entire country, and of each town or district is estimated. Various methods of estimating the population have been adopted. (1) If a strict record of emigration and immigration is kept, then in a country in which a complete registration of births and deaths is enforced, the population can be easily ascertained by balancing the natural increase by excess of births over deaths, and the increase or decrease due to migration. This is done in New Zealand, but is impracticable in England, as no complete account of migration can be kept.

(2) The increase of inhabited houses in a district being known year by year, the increase of population may be estimated on the assumption that the number of persons per house is the same as at the last census. This may not be strictly accurate. In 1901 it was found that in England and Wales the average number of persons per house was fractionally less than in 1891.

(3) It may be assumed that the annual increase during the present decennium will be 1 ∕ 10 of the increase during the last decennium 1891-1901. If so, the population, e.g. in 1905, is the enumerated population in 1901 plus 4¼; times the annual increase occurring during 1881-91. (The fourth is required because the census is taken early in April, and the population is estimated to the middle of the year). This method is fallacious, because it makes no allowances for the steadily increasing numbers who year by year attain marriageable age and become parents. It assumes, in other words, simple interest, when compound interest is in operation.

(4) The Registrar-General’s method, the one generally adopted, assumes that the same rate of increase will hold good as in the preceding intercensal period, i.e. that the population increases in geometrical progression, and not in arithmetical progression as under (3).

The application of this method will be best understood by an example. If the census population of a town is 32,000 in 1891, and 36,000 in 1901, what is the mean population in 1905?

(a) Find the rate of increase in 1891-1901.

If P = population at census 1891,
and if P1 = population at census 1901,
and if R = rate of increase of population, then
P1 = P + Rn in the nth year.
log P1 = log P + 10 log R.
1 ∕ 10(log P1 - log P) = log R.
(4·556303 - 4·505150) ∕ 10 = ·0051153 = log R.
337

(b) Apply this to the increase in the next 4¼ years.

Here P1905 = P1901 R(17 ∕ 4)
log P1905 = 4·556303 + (17  ∕  4)(·0051153)
= 4·578043.
By consulting the table of logs, the population corresponding to this number will be found to be 37,848 = population at the middle of 1905.

Estimates made by the last-named “official” method are liable to error, even for the entire country, and still more when applied to special districts. Thus the decennial rate of increase of the population of England and Wales in the 100 years has varied from 15·8 per cent. in 1821-31 to 11·6 per cent. in 1891-1901. The anomalies are even greater when the official method is applied to great towns. In one decennium such a town may, owing to brisk trade, have a rapid increase of working population with many children, and in the next decennium in consequence of emigration or transmigration there may be little or no increase. The declining birth-rate, which is having a greater effect on the number of population than the declining death-rate, is another cause of disturbance which increases the difficulty in forming a correct estimate of the population in intercensal periods. A quinquennial census is highly desirable, in order to avoid the doubts necessarily associated with estimates of population in the later years of a decennium, and with the birth and death-rates which are based on these estimates.

The Registration of Births and Deaths.—Civil registration of births and deaths began in 1837, but was not compulsory till 1870. It will be going beyond the scope of this chapter to give details of the enactments as to registration. It suffices to state that it is the duty of the practitioner to give a certificate stating the cause of death of his patient to the best of his knowledge and belief. There is no registration of still-births in this country. Many deaths are registered of which the cause of death is not medically certified, and the value of our national vital statistics is considerably diminished on this account. Much improvement is desirable in the medical certification of causes of death. Every medical student ought to receive instruction on this subject before the completion of his studies. Names of symptoms as dropsy, hæmorrhage, convulsions; and obscure names, as abdominal disease, should be avoided. If the patient has recently suffered from injury, or recently passed through childbirth, or had a specific febrile disease, this must not be omitted from the certificate.

The Registration and Notification of Sickness forms another valuable source of information. Various attempts have been made to secure a general registration of disabling sickness, but with only partial success. District and workhouse medical officers appointed since February, 1879, are required to furnish the medical officer of health with returns of pauper sickness and deaths. 경산오피 This source of information might with advantage be more fully utilised by medical officers of health. Sec. 29 of the Factory and Workshops Act,338 1895, requires that every medical practitioner attending on or called in to visit a patient whom he believes to be suffering from lead, phosphorus, or arsenical poisoning, or anthrax, contracted in any factory or workshop, shall send to the Chief Inspector of Factories at the Home Office, London, a notice stating the name and full postal address of the patient, and the disease from which he is suffering; a fee of 2s. 6d. being payable for each notification, and a fine not exceeding 40s. being incurred for failure to notify.

The Compulsory Notification of Infectious Diseases is enforced by the Act of 1889, which now applies to the whole country. The list of diseases to be notified is as follows:

“Small-pox, cholera, diphtheria, membranous croup, erysipelas, the disease known as scarlatina or scarlet fever, and the fevers known by any of the following names: typhus, typhoid, enteric, relapsing, continued, or puerperal, and also any infectious disease to which the Act has been applied by the Local Authority in manner provided by the Act.”