CROWDS AND HEALTH
By OUR MEDICAL CORRESPONDENT
APART from the problem of shelters, works-dormitories and the tube railways, there are many thousands of houses all over the country that are probably accommodating far more inhabitants than they were designed for This has naturally raised difficult and anxious questions with regard to the pos- sible spread of disease and epidemics, such as typhoid fever, diphtheria, influenza, and the whole group of catarrhal infec- tions. As regards typhoid fever, individuals can of course receive, by inoculation of the appropriate vaccine, a very high degree of protection. But it must be remembered that this disease is usually due to the contamination of food-stuffs, of milk, or of drinking-water at their source by some, often un- conscious and otherwise healthy, human carrier. The mere destruction of a sewer by enemy action is not necessarily likely to cause an epidemic, and the danger of any general typhoid fever epidemic owing to this cause would not seem to be acute. Diphtheria is another disease against which almost complete protection can be conferred by the appropriate vaccine ; and it is still a reproach to this country that there are annually some thousands of unnecessary deaths amongst children due to diphtheria. Overcrowding, assuming the presence of a sufferer or a carrier, might well lead to an increased incidence of diphtheria ; and the protection of the child population against it—already a routine process in many parts of Canada and the United States—should most certainly be urged.
As regards influenza, the virus responsible for true human or, as has been suggested, " A," influenza, has been identified and cultured and a vaccine prepared. But this, although so far promising by laboratory tests, has not yet been established by full clinical trial in a true human influenza epidemic as an efficacious protection. The problem of influenza is also compli- cated by the fact that epidemics of something very like it have apparently been due to other strains of virus, and that yet others have occurred, such as the most recent in this country, for which no characteristic virus could be held responsible. Turn- ing to the common cold and what may be called the catarrhal group of infections, the basic factor is again almost certainly a virus, although this may lead the way to the subsequent invasion, in dangerous numbers, of known micro-organisms, such as the pneumococcus. Although many anti-catarrhal vaccines have been prepared and tried, and although certain individuals have seemed to benefit from some of them, it may be said that the results of large-scale, long-distance observations, in accurate conditions and with a sufficient number of controls, have so far been generally negative.
It is, however, known that those virus and catarrhal infec- tions are spread, by direct person-to-person infection in the shape of groups of the responsible organisms breathed or sneezed out by the sufferer. The effective range of such droplet infection, as it is called, is from three to six feet ; and this is a point that should be borne in mind by all in charge of large numbers of people. If beds or bunks or mattresses cannot, as they should be, be arranged with at least three feet between them, they should be so placed that the head of one sleeper should be at the opposite end to that of the next sleeper, thus securing at least six feet between heads if possible. With regard to air and dust, most of these viruses and patho- genic micro-organisms have a very short life outside the human body, and it is extremely rarely that they are found in ordinary dust or ordinary articles of furniture or in books, letters, and papers—at any rate in numbers that would constitute a menace. That certain bacteria in certain special conditions can, how- ever, adhere for considerable periods to particles of dust has been shown ; and for this reason the less dust there is about the better, since as yet—although a good deal of work is being done on the subject—really effective bactericidal mists or sprays have yet to be found. Practically, the maximum of fresh air should be obtained for all rooms, and shelters—and a lot can be done to prevent draughts 'by the application to windows and ventilators of simple hoppers, as they are called. Regular cleansing by ordinary scrubbing with soap and water should be insisted on, and also the periodical application to floors of dust-allaying, oily or other preparations. Finally, every sensible householder, overseer, matron, or superintendent, should keep a regular look-out amongst his or her charges for the first signs of illness and then if possible isolate the sufferer pending medical advice.
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