HH62/1/DUMFRI/49

Transcription

[Page] 48

communicated with a room in which the children were allowed to
play while in the peeling stage.
Further, there can be little doubt that a case quickly notified
and speedily isolated will tend to prevent the outbreak of what
might otherwise prove to be a widespread epidemic.
The question of how to provide such accommodation is one on
which I anticipate some diversity of opinion. It may be well to
consider some suggestions that have been made since it began to
be mooted. One of the most important emanated from the Gover-
nors of the Dumfries and Galloway Infirmary, and ought therefore
to receive some attention from us. The Governors offered to enter
into an arrangement with the various District Committees for the
reception of cases of Infectious Disease occurring within their re-
spective areas. Sixteen beds were to be set apart for the treatment
of infectious cases, but these beds were to be open to the Burgh
Authorities as well as to those in the Stewartry. Admission was
to be decided by priority of application. I have objected to this
proposal on two distinct grounds - 1st, the distance of Dumfries
from certain parts of the County for which provision must be made;
and 2nd, the inadequacy of the provision offered by the Governors.
A further objection which may be raised is the tendency of the pre-
sent day to keep hospitals for infectious diseases apart altogether
from general hospitals. The experience of Sanitary Authorities -
e,g., in Manchester and Southport - seems to be against the use of
general hospitals for sanitary purposes. Another proposal has been
to build one hospital for the whole County in some central part.
The objection of distance will apply here also, though not so
strongly as in the case of the Dumfries and Galloway Infirmary.
On this point I may be allowed to quote again from Dr Thorne
Thorne's report. "It is not," he says, "that removal for a distance
"of some 5, and even, in isolated instances, 8 and 10 miles in a well-
"constructed ambulance and over ordinary good roads, has ap-
"peared to do harm to the particular patient, provided the removal
"has been effected at an early stage of the disease. By far the
"greatest difficulty in the matter of distance has been found, as a
"rule, to lie with the relatives and friends of the patients, who
"assent much more readily to removal to hospital if it be within
"such distance as to enable them without much trouble and with-
"out material interference with their business and other vocations
"to make frequent enquiry as to the patient's welfare. In rural
"districts the question of distance is usually less thought of than

[Page] 49

"in urban districts, especially when the hospital to which removal
"is effected is in or near some centre to which the population often
"travel in connection with their daily or occasional pursuits." We
may then safely assume that the hospital should not, if at all pos-
sible, be placed further from the more populous parts of the area
it is intended to supply than 5 or 6 miles, and if this can be secured
there is not likely to be any great objection raised by patients or
relatives on the score of distance. I therefore think that each
District Committee should provide hospital accommodation within
its own area, and, with the exception of Thornhill, one building
situated in some central part will probably be found sufficient. A
suggestion has been made to me that in some of the Districts the
Combination Poorhouses might be utilised. There are two object-
tions to this proposal. The first is that it does not appear to be
legal to use these buildings for any other purpose than the recep-
tion of paupers, and the second is that, even if there were no
doubt as to the legality of doing so, it would be unwise, inasmuch
as the people who are not in a position to require parochial relief
naturally object to be removed to buildings that are specially
intended for paupers. I am of opinion that the best solution of the
problem will be found in a combination between each District and
the Burgh or Burghs within its area. Either a new hospital might
be built, which would be much the more satisfactory method, or
existing buildings might be purchased or rented and adapted.
The question of the amount of accommodation that will require
to be provided is one of some difficulty. If we accept the standard
recommended by Dr Buchanan of the Local Government Board,
which is one bed to every 1000 of the population, and assume that
the Burghs are willing to combine with the Districts, we shall find
that in Moffat 6 beds will be necessary, in Langholm 8, in Locker-
bie 10, in Annan 15, in Thornhill 14, and in Dumfries 30. In the
latter it may be that some difficulty will be experienced in effecting
a combination with the Burghs of Dumfries and Maxwelltown, and
and in that case for the District alone 12 beds will be required.
The arrangement of these will not depend merely on the separa-
tion of the sexes. The diseases demanding isolation must also be
taken into account. These are in particular Smallpox, Typhus,
Typhoid, Scarlatina, and Diphtheria. It may also happen that cases
of Measles and Erysipelas must sometimes be isolated. It is neither
necessary nor desirable that accommodation should be provided for
all of them. Some (e.g., Smallpox and Typhus) will occur with