HH62/45/59

Transcription

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case had been overlooked by the parents, and it was only when infection spread
that she was discovered to be desquamating. In this instance, fifteen cases in
seven separate houses had been infected before anyone was aware of the presence
of the disease, and it very much owing to the energy displayed by the former
Medical Officer and Sanitary Inspector, whose services have since been dispensed
with by the District Committee, that the outbreak never spread beyond these
houses, and this with only one case removed to Hospital. All the other cases
have been more or less isolated, and their source of infection traced to contact with
a town where Scarlet Fever was prevailing at the time. In ten at least of the
outbreaks the source of the infection was clear. All of these were treated at home,
disinfectants were supplied, and strict isolation of the families insisted upon. In
every instance success crowned the labours of the local staff, and there was not a
single case reported as having spread from those isolated. Where Diphtheria
occurred it was found, as usual, to be associated with faulty drainage.
As yet no definite arrangement has been made for accommodation of infectious
cases in the District, but as a tentative measure, during the year, it was suggested
that they should be removed to the Perth Royal Infirmary. In this institution
there are 40 beds isolated for the treatment of infectious cases, and 20 additional beds
partially so in which Enteric fever cases can be treated. To make the accommoda-
tion complete all that is required is the erection of a proper Steam Laundry and
Steam Disinfector. The matter has been discussed by representatives of the
Infirmary Directors and of the District Committees of Perthshire; and on condition
that the District Committees and the Local Authority of Perth pay one-half of the
cost of erecting the Laundry and Disinfector, the Infirmary Directors are willing to
receive and treat without further charge all the cases (except small pox) which
require removal to Hospital during a period of five years. This is a most generous
offer, and there is every prospect that it will be accepted at an early date by the
Perth District Committee. With a good ambulance waggon, and a nurse to attend
to the patient during the journey, there will be no difficulty in removal from any part
of the District to the Perth Infirmary. Should this arrangement be carried out,
the Committee will have an opportunity of judging during the next five years
whether the accommodation at Perth is sufficient, or if the erection of an Infectious
Diseases Hospital is an absolute necessity. It is intended to erect at the Infirmary
the largest size of Goddard, Massey, & Warner's Combined Hot Air and Steam
Disinfectors, so that beds and such unwieldy articles can be easily dealt with. Those
Disinfectors do their work so thoroughly that the largest articles can be completely
dealt with in half-an-hour, and the goods come out of the apparatus dry and fit for
immediate use. This is achieved by alternate currents of hot air and steam, by
means of which the temperature of the infected article may be raised to the point
necessary for the destruction of infective germs (230° Fahr.), and at the same time
condensation of the steam and consequent dampness is effectually prevented.
During the past months six persons suffering from infectious diseases have been
removed from the Perth District to the Royal Infirmary, viz.:— 3 Enteric and 3
Scarlet Fever cases. These were admitted by the courtesy of the Directors on the
recommendation of your Medical Officer. As it is found, from experience, that the
average cost of treating a case of infectious disease in Hospital, is about £10, the
Perth District Committee will easily perceive that they are considerably indebted to
the Perth Royal Infirmary. As Senior Visiting Surgeon to the Infirmary, I have,
under the Directors, full powers of supervision in the institution, and it is only right
to state that I have always found the Board most anxious to give effect to any
suggestion likely to be of benefit to the patients.

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No ambulance has yet been provided for the District, but during the latter part
of the year a make-shift in the shape of an old carriage has been in use. It has
fulfilled its purpose exceedingly well, but it is not the sort of vehicle suitable for
removing serious cases. By request of the Committee, your officials visited various
places to see the kind of waggon used for removing fever cases. The result of these
investigations went to shew that, for such work as we have in Perthshire, a special
waggon would require to be made - Mr. Holmes, Carriage-Builder, Irvine, has
undertaken to build, and deliver such ambulance in Perth within six weeks of
receiving the order. The waggon proposed at present would carry six patients,
besides the attendant, and would in all respects be the best of its kind to be found
in Scotland.
Much has been done by the Sanitary Inspector, in removing dangerous
nuisances, and infectious cases have either removed to Hospital, or have been
strictly isolated in their own homes. Children of infected families have been
prevented from attending school, and persons in charge have been carefully warned
regarding the special infectious features of the fever. At the expense of the Local
Authority disinfectants have been freely supplied to be systematically used during
the course of the illness, and, at the end of the same, disinfection of the premises has
been carried out under supervision of the local Sanitary Inspector. The Infectious
Diseases (Notification) Act has not, as yet, been adopted in the District, but when
hospital accommodation has been provided, it will be for the District Committee to
seriously consider the matter. So far as the Perth District is concerned, the
experience of last year goes to prove that it is not required.
During the year 86 infectious cases have been reported. The majority have
been of a mild type, and there has been nothing of the nature of a dangerous
outbreak. It is a subject for congratulation that, in all the infectious cases dealt
with by the Local Authority, isolation has been so well carried out that in no case
has the disease spread after precautions had been taken.
Nothing like complete Sickness Returns have been procurable, but from two
very full sets of Returns giving nearly 1000 cases the following is the proportion in
which the various diseases occur. Influenza heads the list with 21% of the total
sickness and 4% of the total deaths. There was a considerable number of cases in
April and May, then the epidemic assumed a less acute form, till September, when
it again became general, and for three months one might say there was no other
disease in the District, judging from the frequency with which it was assigned as the
cause of illness. The deaths ascribed to Influenza have been all caused, not by the
Influenza itself, but by some respiratory complication, and, with only one exception,
these deaths occurred in persons over 60 years of age. It is to be hoped that the
epidemic is now at an end, so far as Perthshire is concerned. Whether it will ever
be possible to isolate Influenza is yet doubtful, spreading as it does with such
rapidity as completely to evade ordinary modes of isolation. Still it ought to be
prominently brought before the mind of the public that Influenza, in itself, is not a
fatal disease, but, that when it is so, this result is due to some complication; and as
a safe-guard against this, the person attacked should be confined to the house at once,
a placed under medical supervision, which alone can ensure the certainty of no
latent pulmonary mischief being overlooked, and the consequent disastrous results
of too early an exposure to chills.
Respiratory diseases form, as might be expected, in our climate, a large
proportion of the sickness and death lists. In the 1000 cases before mentioned, this
group accounts for 14% of the total sickness, and, over the whole District, for 14.6% of
the total deaths.

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