HH62/1/DUMFRI/29

Transcription

[Page] 28

The means at present at our command for preventing the
spread of infectious disorders may be summed up in the words
Notification, Isolation, and Disinfection. The primary object of
Notification is, of course, to secure the other two, but I wish to
correct an impression which seems to exist in the minds of some
people that Notification must at once be followed by removal to an
Isolation Hospital. Notification is valuable inasmuch as it enables
us to give timely notice, among others, to Schoolmasters of the
occurrence of infection in the houses of their pupils. If this infor-
mation be promptly acted upon by excluding all the children of the
household, whether infected or not, much would be gained in
preventing such affections as Scarlet Fever, Diphtheria, and even
Measles, assuming epidemic proportions. These diseases in particu-
lar are apt to be spread by the congress of large numbers of
children in day and Sunday schools. To obviate such results as far
as possible, we now give notice to Headmasters and Clerks of
School Boards whenever we receive a notification from any house
in their respective districts in which there may be children of school
age. I regret to have observed that this information has not
always been acted on as it might, and that children who have been
infected have sometimes been received into school within the pre-
scribed time and without a medical certificate. It would be well
if Boards would instruct their teachers to exercise the utmost care
in this particular, and to lay it down as a hard-and-fast rule that
children from infected houses must not be admitted without a medi-
cal certificate showing that all danger of infection had ceased.
Isolation may in many cases be carried out efficiently at the
patient's home, provided that the house is large enough. It is but
seldom, however, that this is satisfactorily done, and it is question-
able whether it ought to be permitted at all in dairy farm-houses.
A recent correspondence which I have had with the Health Officer
of a large city that receives a considerable quantity of milk from
Dumfriesshire indicates that the Authorities there would not con-
sider such isolation satisfactory. For this and other reasons isola-
tion hospitals are necessary. In a letter* addressed to the Chair-
man of the Public Health Committee, I have advocated that
small hospitals should be placed in each District, providing
accommodation in the proportion of one bed to each 1000 of the
population. This scheme has been subjected to a good deal of
criticism, chiefly of the destructive order, but nothing practicable

*See Appendix

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has been suggested to take its place. It has been urged that the
Dumfries and Galloway Infirmary could amply supply the wants
of the County, and it has even been stated that it has done so in
the past. That it will supply the needs of the Dumfries District in
addition to those of the Dumfries Burgh and certain of the parishes
in the eastern part of the Stewartry of Kirkcudbright is all that
can be hoped for, and then only if certain arrangements which are
at present under consideration be carried out. For the other
County Districts the accommodation is too limited and the distance
too great, and should all the beds reserved for such cases be occu-
pied at any one time the amount of cubic space regarded as proper
for the treatment of fever patients will not be given, there being
only about 1300, instead of 2000, cubic feet to each bed. Any one
who chooses to examine the Detailed Reports of the Registrar-
General and the Infirmary Reports for the ten years 1881-90 will
not fail to observe that the deaths throughout the County from
infectious diseases have been very greatly in excess of the admis-
sions of such cases to the wards of the Infirmary, while the records
show further that the only Local Authorities who during that
period sent cases were those of Dumfries and Troqueer. Even if
it be granted that the accommodation is as ample as is asserted,
the question of distance has to be faced. It is a serious matter
to remove a patient suffering from an infectious fever a long dis-
tance. I do not think that even in a well-constructed ambulance
this distance should as a general rule be greater than six or seven
miles. In some instances it may be as much as ten, but these
should be made as exceptional as possible. It has recently been
urged that this objection might be got over by having an ambulance
waggon which could be trucked by railway. Apart from the
absurdity of this proposal, I have letters from Managers of the
Railway Systems running through Nithsdale and Annandale stating
that they cannot permit the transmission of infectious cases on
their lines in this or any other fashion. The separate provision by
each District remains, therefore, the only feasible plan, if any serious
attempt is to be made to grapple with the problem. I have else-
where urged the peculiar position of Dumfriesshire as a dairy
county as a reason why the utmost care should be taken against
the spread of infection. When one considers that there are at
present 204 dairies on the register, with an aggregate of over 6000
cows, which, taking the average annual yield of milk from each
at 500 gallons, and the average price per gallon at 6d, will bring a