HH62/1/FIFE/29

Transcription

[page] 28

and increase their chance of recovery, but quite the reverse, as quietness
and abundance of fresh air - essential parts of the treatment of all cases
of infectious disease - cannot be obtained under these conditions. In
few words, patients removed to an hospital are removed generally from
the some insanitary to the most sanitary condition, and these determine
the issue, to a very great extent. To represent as a ratio the difference in
results of house treatment and hospital treatment for infectious cases,
I quote from the Medical Officer of Health's Report for Staffordshire.

SCARLET FEVER, DIPHTHERIA, AND FEVERS.
Total Cases, -- 1394 | Total Deaths, -- 100
Cases treated at home, per centage mortality, -- 8.3
Cases treated at hospital, per centage mortality, -- 2.8

The above results show the advantage to the persons affected.
The advantages to the general community cannot be thus represented,
but are unquestionably very great, as every person who suffers from
an infectious disease runs, in the first place, a great risk of dying
under it, or has a debilitated constitution if he recovers. Every life,
young or old, has a certain economic value. If the ordinary work or
business of life is interrupted by ill health from fevers, this is always a
serious matter. If the bread-winner of a large family is ill, say, from
typhoid fever, how can the suffering to the family in consequence be
recompensed? and such cases can, without doubt, be prevented from
occurring by isolating the infected from the healthy.
I trust that in Cupar District the question of the hospital accom-
modation is not disposed of, and that before the Report for 1892 falls
to be written, the wants of the District in this respect will have been
attended to.

SUMMARY OF ACTION IN REGARD TO PREVENTION
OF INFECTIOUS DISEASES.
Prior to the adoption of the Notification of Infectious Disease Act
in the District, it was matter of extreme difficulty to hear of new cases
of infectious diseases, as the population is widely scattered. It will be
useful to give a resumé of the procedure adopted since the Act was
adopted. When any case is notified to me, the Sanitary Inspector
visits the place, and ascertains the following particulars:- Age of
patient, occupation, date of rash (if any), school and Sunday school
attended, milk supply, water supply, drainage, water closet, or other
form of accommodation, number of rooms in the house, number of
children under 14 years, any sanitary defects, remarks. When I receive
these, they are copied in a book, and become permanent records of all
infectious cases in the District. Notices are sent prohibiting attendance
at school and Sunday school till risk of infection is passed. Any sanitary
defects which have been discovered are attended to. When the Sani-
tary Inspector visits, he gives instructions as to disinfection, and the
procedure to be adopted to prevent the spread of infectious disease.
Printed instructions for dealing with infectious cases, drawn up by me,
are left in the houses where infectious cases have occurred. The pro-
cedure adopted is the same in all the districts, except that in Kirkcaldy

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District suitable cases are removed to hospital, one being in opera-
tion. In Cupar District there have not been many cases to deal with,
but unfortunately there have been several cases of diphtheria; but in-
vestigation did not reveal any serious insanitary conditions to account
for them. Two cases occurred in a house which was sanitarily as nearly
perfect as possible, and no disease of cows, cats, or fowls - sometimes
associated with diphtheria - could be ascertained. Both cases recovered.
In another house, not far from these two cases, two other cases
occurred, one of which died. The school where the affected children
attended was far from being in a sanitary state, from a very foul privy;
and the water supply from a well was also most suspicious. These defects
have been dealt with so far, but nothing short of a gravitation water
supply will altogether meet the other want. There was no connection
to be traced between the occurrence of these cases in the two different
houses, except that members of both families attended the same church.

STATEMENT OF INFECTIOUS DISEASES NOTIFIED SINCE
1ST OCTOBER 1891.
Cupar District - Smallpox, 0; Scarlet Fever, 1; Diphtheria, 3; Erysipelas, 1;
Typhus Fever, 0; Typhoid Fever, 0; Continued Fever, 0; Puerperal Fever, 0;
Measles, 0; Whooping Cough, 0 - Total Cases, 5.

MORTALITY STATISTICS OF CUPAR DISTRICT.
My difficulties in regard to obtaining the necessary returns of births
and deaths from the Registrars of the District have been so often
before the Committee, that it is not necessary to say more regarding
these; but the result is that the Report is deprived of the all important
information obtained from mortality statistics. A mere crude death-
rate is not sufficient; and this cannot even be obtained now, nor till
some time after this Report ought to be in your hands. What is
wanted is to know what diseases predominated and proved fatal; where
they occurred; and were they preventable or not. A mere crude death-
rate gives no such information, and is accordingly comparatively value-
less. With considerable labour I have gone over the mortality returns
of Cupar District for 10 years, and in the table are given the crude
death-rates of the various parishes; but what diseases produced these
could only be obtained by a search of the Registrar-General's books in
Edinburgh. This information would be very vauable, and would well
repay the small cost of it, as then the District Committee could direct
their efforts to diminish the mortality, which could fairly be considered
preventable, with much better chance of success. To reduce the death-
rate is the object and aim of every Local Authority, and all available
means should be utilised in this direction.