“The room chosen for home nursing care must be clear, well ventilated and as far away from living quarters as possible. “
These words were published 80 years ago and written by my grandfather, Dr. John Davy Rolleston, in his book Acute Infectious Diseases – A Handbook for Practitioners and Students. In those dark days of Covid-19, some practices remained timeless – the use of soap, scrub and fresh air – while others sound good, from a bygone era.
“The type of open fireplace is not only cheerful,” reads the chapter on isolation methods, “but offers a quick and easy way to remove soiled swabs and other small fomites. »Fomite? What are fomites on Earth? According to Google, these are objects likely to carry an infection, such as clothing, kitchen utensils and furniture. “Carpets, draperies and stuffed items are removed. Simple washable furniture is more suitable for the sick room. Advice that is probably still valid today.
The good doctor is long gone, but with the approach of World War II, he was one of the foremost British authorities for infectious diseases like smallpox, typhus and scarlet fever. In the 1930s, Dr. Rolleston was medical superintendent at the Western Hospital in London and this week my daughter found a third edition of her 1940 book, co-authored with Dr. Ronaldson, hidden in my old book collection deceased mother.
“Family circumstances may allow home treatment for scarlet fever or measles,” they wrote, “but in a highly contagious state like smallpox, isolation in hospital is necessary for public safety.” As an epidemiologist, my grandfather did a special study on deadly infectious diseases like smallpox, which had ravaged London periodically, and he is the author of a work on the 1870-1874 pandemic of smallpox. killed more than 20,000 soldiers during the Franco-Prussian War.
For those who isolate themselves at home, his advice from the 1940s included details that seem rather strange to us eight decades later. “The ambient temperature,” he says, “should be maintained between 55 and 60F. What? It is between 12 and 15C. I know we are always told that people were made of tougher things at the time, but keeping someone in such a cold room could not have done much for their morale.
“On the outside landing (the quarantined person’s room),” he continues, “the usual bath filled with disinfectant solution will be placed; the traditional “carbolized” sheet can be hung in front of the door. »Charred? I also had to look for that one. Apparently, this is an obsolete term referring to the use of carbolic acid as a disinfectant to kill germs. “The bath… is intended for soaking the linen which has been removed from the sick room. “
Commenting on today’s advice, Dr. Frank Cross, until recently a consultant surgeon at the Royal London Hospital, points out that it was written when there was no treatment for deadly infectious diseases like tuberculosis, syphilis and smallpox. “The fomites include the sheets,” he says. “Keeping them clean was especially important in diseases that involve infectious pustules like smallpox. “
Surprisingly, the 1940s manual says that total sterilization or “terminal disinfection” of a roommate’s room in quarantine is “no longer in favor” but for streptococcal infections (like scarlet fever or the most common form) pneumonia) “liberal use of soap, water and sun exposure will be effective. “
But what about the risk of infection in hospitals? Writing in 1940, the directive was that a third of all hospital accommodation should be made up of isolation beds. “The real danger to the patient in an open ward of a fever hospital … comes from fellow patients in the ward itself. “
Even then, it seems, there was an awareness of the dangers of asymptomatic carriers infecting others, in the same way that Covid-19 does today in the general population. The book warns of the dangers of the coexistence of more than one infection and the risk posed by “the patient who is admitted to the incubation stage of a second disease”. But isolating each patient, says the book, is not yet a practical proposition.
“There has never been a treatment for smallpox and its mortality rate was 30%,” says Dr. Frank Cross. “And there is no treatment for Covid-19, although a number of controlled trials are performed using various combinations of existing antivirals. Advice on washing fomites and washing hands has never been more appropriate. “
Today, the dark blue cover of my grandfather’s wartime infectious disease manual is bleached by time and probably needs to be bound. Now, when political leaders remind us that we are in another, very different war, I wonder what he would have done with social distancing, closures and police enforcement to limit the spread of the new Coronavirus. I suspect he probably would have approved wholeheartedly.
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