HH62/1/DUNBAR/47

Transcription

[Page] 46

Regarding hospital questions generally, under the Local Govern-
ment Act, much interest attaches to an Opinion of Counsel lately
obtained by the Lasswade District of Midlothian. The opinion is
briefly as follows:- (1) Parishes as such cannot be assessed for
hospitals; the assessment must be over the county District as a
whole, even if the hospital be in practice available only for a
part of the District. (2) Strictly speaking, Districts cannot com-
bine for a joint hospital open to only part of their population. In
theory, every joint hospital must be open to receive patients from
even the most distant parts of each of the Districts whose Local
Authorities have a share in the hospital.
There has been a tendency to take this Opinion as destructive
of all such joint proposals as are set forth above. For the fol-
lowing reasons it appears to me that this is not so, however;
and the Midlothian Council has evidently arrived at a similar
finding, as it is going on with arrangements for a joint hospital
for parts of two separate Districts and two police burghs.
(1) Clearly enough, under the Public Health and Local Govern-
ment Acts, a District must be assessed as a whole. But if hospital
accommodation is provided, as it ought to be, for all parts of a District,
the assessment will tend to equalise itself. Supposing that my sug-
gestions were carried out, it is true that East Kilpatrick, using the
Knightswood hospital, would be rated also for the Kirkintilloch
hospital. But, on the other hand, the rest of the parishes in the
District would be assessed for Knightswood hospital, on account of
its being used by the people living in East Kilpatrick.
(2) Though in theory every hospital in which any District has a
share must be open to all the infectious cases in the District, in
practice every case will go to the nearest hospital. There is no
likelihood of a man in Cumbernauld wanting to be taken to
Knightswood instead of to Kirkintilloch. And in arranging terms
of combination between two or more Local Authorities the practice
and not the theory would naturally be kept in view. If, as is
suggested in my Report, the main basis of payment per Local
Authority were the number of cases sent in annually by each, the
agreement as to cost of site and buildings should not be very
difficult to arrive at.

[Page] 47

INFECTIOUS DISEASES.
Western District. - In the Western District the Infectious
Disease (Notification) Act is not yet in operation, though its
adoption has been agreed on by the Committee. Several outbreaks
of disease have, however, come to my knowledge during the year.

Typhus. - The most important outbreaks have been of typhus
fever in the Vale of Leven. Unfortunately, owing partly to the
absence of compulsory notification, and partly to the difficulty
which was naturally experienced in recognising the nature of the
earlier attacks, in two of the outbreaks several cases occurred
before the Public Health Department became cognisant of the
matter.
On March 23rd, a case of typhus was discovered at 34A Napier-
ston Terrace, Jamestown, by Dr. McLelland. On the same evening
Mr. Lindsay, the Sanitary Inspector for the parish had the case
removed to Dunbarton fever hospital. The patient was a
woman who had come from Greenock, and Mr. Lindsay at once
communicated with the Sanitary Inspector there, where it turned
out that another case had occurred in the same house.
In the house in Jamestown, which in the meantime had been
placed under observation, a second case occurred and was sent to
Dunbarton hospital. I caused the remaining inmates to be removed
for quarantine to a separate ward in the same building. One of
these developed the disease eight days after admission, and a girl
who had stayed in the house for a night or two, and who had then
gone to Greenock, subsequently became ill and was isolated there.
From the house in Napierston Terrace all infected articles were
removed by Mr. Dunbar to Belvidere hospital for disinfection, with
the exception of some bedding which had to be burned. The disease
did not extend beyond these limits. The house is on the top flat
of a modern and well built three-storey tenement. There was
distinct want of cleanliness indoors, and the windows seemed to be
seldom opened. But there was no overcrowding, though the limit
of air space - 400 cubic feet per head - was very closely approached.
In Renton, in August, a more serious outbreak began.
The first cases to which I was called, on September 14th,
occurred under quite typical circumstances. In a house of two small
apartments, in a crowded locality, there were no less than twelve