HH62/45/139

Transcription

[Page] 11

Measles caused 7 deaths, against 2 in 1892. Oubreaks of the disease occurred in
various parts of the County during the year. The type of the disease was mild in
most instances, but one outbreak in the Comrie District assumed a very severe and
almost malignant type. In all, 214 cases of the disease were reported, the most
extensive outbreak being in the Muthill neighbourhood. An attempt was made in
one instance to endeavour to prevent the spread of the disease by the prompt
removal of the first case, but it proved unavailing, as the infection had spread widely,
even before the disease was recognised and the patient removed - in fact, infection is
most intense during the first day or two, when the patient seems only to be suffering
from a cold in the head.
Diarrhœa caused 20 deaths, against 6 in 1892. In no instance did the disease
assume a choleraic type.
In 85 cases the cause of death was either uncertified of insufficiently stated.
This list is steadily becoming smaller, as it included 92 cases in 1892.
The arrangement made by the Committees of the Perth, Central, Highland,
and Eastern Districts with the Directors of the Perth Royal Infirmary to provide
accommodation for fever cases, requiring removal, has been found to work very well,
and the facilities afforded by the various Railway Companies to carry the ambulance
waggon, with patients and nurse inside, has been fully taken advantage of, and has
been found to minimise the shaking, and shorten the journey very materially, as well
as to cost less than removal by road. In all, from the four Districts, 78 patients
have been admitted to the Perth Hospital during the year. The Directors of the
Royal Infirmary have spared neither trouble nor expense on fully equipping the Institu-
tion for the work. The laundry and disinfector have been found to give the most
complete satisfaction, and, in addition to the beds already put at the disposal of the
Districts for infectious cases, it has been found possible to add three more for
observation, a very necessary adjunct to the equipment of an institution which admits
all diseases except Smallpox, and even the latter has to be taken in and kept till the
diagnosis is certain.
With the exception of the Highland District Committee, all the Districts have
now made provision for the isolation and treatment of Smallpox cases by means of
iron hospitals, which are kept ready for erection in the event of being required. In
the Western District two of these hospitals (each capable of treating four patients)
has been obtained with a view to treat not only Smallpox, but other infectious
diseases. These have been in use during the year, with most satisfactory results.
The removal of patients, even from a considerable distance, has been accomplished
without any difficulty, and the patients have never suffered from the journey. As an
attendant accompanies the waggon as well as the nurse, there is no need for the
latter to come out of the ambulance to give directions, and thus the risk of infection
to the public is prevented. Two incidents will show the light in which the portable
hospital and the ambulance are now looked upon in the parts where they have been
used. In one District an application was made to obtain the use of a hospital in
which Smallpox had actually been treated, as summer quarters for a family; in
another District, as the ambulance waggon was starting on its journey, a much-
esteemed clergyman stopped it for a few minutes while he offered prayer and
gave thanks that such assistance had been provided. The Infectious Disease
(Notification) Act will be in force throughout the whole landward part of the County
on the 1st of March, and the Medical Officer should then know of all the recognised
cases of infectious disease throughout the County. However, the difficulty in the
past has not been so much with the recognised as with the unrecognised cases, and

[Note] 138

[Page] 12

unless those District Committees who have at present no assistant Medical Officers
make some provision by which country people can obtain medical advice for the
purpose of deciding whether a malady is notifiable or not, there will be difficulty in
obtaining a conviction for failure to notify on the part of a householder. In so
far as medical men are concerned, they have no excuse for failure to notify,
as, in my capacity of District Medical Officer, I am always willing to meet
them in consultation over doubtful cases, and share the responsibility with them.
There can be no blame attached to a man who has not seen much infectious disease
for some years who does not recognise such a disease as Typhus Fever, but he
ought to recognise that he has got a malady out of the ordinary run to deal with,
and ought not to classify it in that limbo of all doubtful cases - Influenza. There
seems, moreover, to be some strange dread of notifying a case which is doubtful.
This is a mistake. It is surely better to notify several doubtful cases, and have the
necessary provision made against infection, than to allow one infectious case to pass,
and so endanger the public. So long as notifications are bona fide, if a medical man
certifies a disease as any of those scheduled under the Act, and proper precautions
are adopted, no question as to the correctness of his diagnosis will be raised. Schools
have been found again and again to be centres of infectious disease. A child is ill
for a day or two, and returns to school saying it has had a cold; in two or three
weeks there is an outbreak of Scarlet Fever, and this child is found to be
desquamating. Again, how quickly what is regarded only as a slight sore throat
may spread the fatal infection of Diphtheria. It ought to be a matter of serious
consideration with School Booards whether they should not pass a law forbidding
children to return to school after any illness, however slight, without a medical
certificate that there is no infection - the cost of such certificate to be borne by the
Local Authority. It would be well-spent money, as many epidemics of infectious
disease would be prevented, and school attendance would be very slightly interfered
with. It would also ensure a medical man seeing every case of illness amongst those
who are most liable to be attacked by infectious disease.
The Registrars of the 82 Registration Districts in the County, have again
during the past year supplied monthly Returns of Births and Deaths, and deserve the
thanks of the community for so courteously supplying data, without which it would
be impossible to produce the Vital Statistics required by the Board of Supervision,
and which are invaluable for guaging the health of the community.

JOHN T. GRAHAM M.D.

March, 1894.

[Note] 139