Excerpt from The Retrospect of Practical Medicine and Surgery, Vol. 64: Being a Half-Yearly Journal, Containing a Retrospective View of Every Discovery and Practical Improvement in the Medical Sciences, January 1872

Putting false analogies aside, we may, however, inquire whether there is any reason for assuming that the skin is more likely to be the medium through which the miasm of scarlatina is propagated than the mucous membrane. The two circumstances which, to my mind, offer the strongest presumption in favour of this view are - first, the much greater extent to which the skin is involved in the course of the disease, and secondly, the late period at which infection may be caught from bedding, clothing, &c., In smallpox we have the strongest possible evidence that the most direct element in the propagation of the disease is the ¿uid contained in the pustules on the skin, but, at the same time, I should very much doubt whether an unprotected person would be safe from infection in a confined apartment where a patient was lying in the early stage of fever before vesication had begun. In scarlatina the affection of the skin, though so different in kind, is yet so marked and so extensive, that if the cutaneous secretion take any part at all in the propagation of the disease, it cannot fail to be an important one. And whatever may be said of other modes of transmission, I think we cannot withhold our belief that the skin is in this disease, too, one of the most direct media of infection.

With reference to the period during which miasm will retain its infectious character, if articles of clothing, &c., , be shut up in a box, I have no new facts to add I would merely call attention to the circumstance, as indicating that it must be associated with some substance of a comparatively stable character. In all infectious diseases we know that chemical change will render the miasm innocuous. Vaccine lymph requires certain precautions to be adopted for its preservation and if the miasm of scarlet fever were only carried about in the air or suspended in watery vapour, it would probably very soon lose its infec tions properties through decomposition. It seems, therefore, not unreasonable to conclude, that when the disease has been propagated afresh after a long interval, the miasmatic character has been transferred to some material which was not liable to rapid decomposition, such a material, for example, as the dry cuti cular surface, which, if preserved from moisture, will remain for a very long time without undergoing any great change in chemical character. At first sight it is perhaps difficult to reconcile this condition of chemical stability with what has been already asserted of miasm generally, that it is matter in a state of change. On farther consideration, it appears that the two conditions have no closer relation to each other than is expressed in the statement that chemical stability is absolutely essential to the development of this vital change, that any sub stance rapidly undergoing chemical change is incapable of developing it, and that the chief means we possess of preventing its development is the employment, in the presence of miasm, of such reagents as tend to promote chemical decem position, so that we have no better disinfectant than free oxygen.

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