HH62/45/35

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infectious cases were treated in their own homes, under the supervision of the local
Medical and Sanitary Officials. In many of the scarlet fever cases the infection
was discovered to have been brought into the District by visitors, coming thither
too soon after convalescence. In none of these instances did infection spread -
thanks to the energetic measures adopted. In two groups of diphtheria cases, the
action of the local Officials was successful in confining the disease to its original
limits.
7. With regard to the Distribution of Diseases, from partial Returns received from
the local Medical Officers, it is found, as might be expected in our changeable
climate, that diseases of the Respiratory System form a large proportion of the total -
26 per cent. of the above Sickness Returns, and 20 per cent. of the total deaths.
Tubercular Diseases also form a large proportion of the deaths, viz., 10.8 per
cent. Of these. more than two-thirds were caused by consumption. As it has now
been proved that, in this form of tubercular disease, the infection passes from one to
another just as in fever, the public generally cannot be too soon warned to treat such
cases as they would an infectious fever. In consumption the chief danger from
infection lies in the expectoration, which should be carefully collected in proper
spittoons containing some disinfectant, and thereafter disposed of by washing the
spittoon with boiling water. The chief danger lies in the allowing the expectoration to
become dried, when, in the form of dust, it may be breathed by lungs which have not
the normal power of resisting infection. The habit of expectorating into handker-
chiefs, and on the floor, should be forbidden in all cases. The room of a patient
suffering from consumption should be well ventilated, and there should be no over-
crowding by visitors; the patient should also occupy a separate bed.
With regard to other forms of tubercular disease, it has been found that milk
from a cow suffering from tuberculosis can be made to cause tubercule in the lower
animals, and, reasoning by analogy, it is as likely to cause this disease in the human
species. Now, in the case of bottle-fed children, it is customary to use the milk of
one cow, and should this cow be tuberculous, the danger of infection will be great.
It is recommended, therefore, that in all cases in which bottle-feeding is used, the
milk should be boiled, as that process will effectually destroy disease and other germs,
and consequently the milk will be not only safer, but will keep better.
Diseases of the Digestive System, caused 26% of sickness in the above Returns,
and 3.4 per cent. of the total deaths. As this class of diseases is largely due
to constipation, it is fully expected, that with improved sanitation, and the training
of the rising generation to regular habits, such sickness will be much reduced.
Diseases of the Circulatory System account for, in the above-mentioned Returns,
5.4 per cent. of the sickness, and for 9 per cent. of the total deaths in the District.
These diseases are in many cases due to attacks of Rheumatism in early life, which,
in turn, are caused by dampness of the soil around houses, and this can only be
removed by proper drainage.
Influenza has in this District, as in all other parts of the country, caused a great
amount of illness. It had two culminating periods in its progress, - one in May, and
the other in December, - and at times it seemed as if there was not a house free from
the scourge. The death rate, however, only indicates 6 per cent. of the total, or 19
deaths to have been caused by influenza, and of these, 14 were deaths of persons
above 60 years of age. It is probable that the disastrous effects of the epidemic are
not yet fully known, as, in many cases, although the disease has not proved
immediately fatal, the constitution has been so shattered as to leave little ground

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to anticipate a permanent recovery. There seems to be now no doubt that influenza is
an acute infectious disease, communicable from person to person, that it has a very short
period of incubation, and that during that period it is also infectious. In future
occurrences of influenza it would be well to isolate cases at the outset, and that will
now be the more easily done, as the public has conceived a due respect for the
unwelcome visitor.
8. Appended is a Tabular Statement of the Sickness and Mortality in the District,
in the form required by the Board of Supervision, as well as a detailed Statement
of the various Diseases occurring in the Registration Districts into which the Central
District is divided by the Registrar-General.
The Registrars of the District have, with one exception, furnished me with
particulars of deaths, but unfortunately, in 6.8 per cent. of the total deaths, the cause
was uncertified. It is to be hoped that in future years this deficiency will be
remedied.
In so far as they could render assistance to Sanitary Science, the Registrars have
done their best, and deserve the thanks of the community for so doing.

JOHN T. GRAHAM, M.D.,
Chief District Medical Officer.
February 29th, 1892.

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