HH62/1/KIRKCU/51

Transcription

APPENDIX.

REPORT ON BALMAGHIE FEVER
CASES.

On the 8th of October the Public Health Office received a
notification of a case of typhoid fever at the parish manse of Balmaghie.
On the 9th of October the Medical Officer and Sanitary Inspector
visited the manse.

REPORT BY MEDICAL OFFICER AND SANITARY
INSPECTOR.

A. - SOURCE OF INFECTION.
The possible sources of infection in the present case were as
follows:- (a) The condition of the soil under and around the house;
(b) The condition of the house arrangements for water and sewage;
(c) The water supply; (d) The milk supply.

(a.) - THE SOIL.
1. - The rise and fall of ground water. - Pettenkofer of Munich has
long maintained that enteric or typhoid fever is causally connected with
the fall of ground water, and, in the absence of any other efficient cause,
one might suggest this as a probable cause in the Balmaghie manse case.
For the situation of the manse borders on the recent river mud and
sand formations of the Dee; the Dee is frequently in flood, and the
floodings must seriously affect the rise and fall of ground water. But in
a single case this, until the theory is further investigated, can properly
be assigned only as a probable predisposing cause.

[Page] 51

2. - The proximity to the churchyard. - This has obviously been a
matter for common remark. The churchyard occupies an eminence,
whose slope is pretty swift downwards towards the manse. It is possible,
though again the porous nature of the soil forbids one to lay too much
stress on the fact, that with the heavy rains and occasional floods the
soil round the manse may have become unhealthy. The soil, however,
to judge by the dryness of an underground cellar, is remarkably dry.
For the present, therefore, these two causes may be set aside. The
persistent recurrence of typhoid in the manse or near it, other causes
being absent, would justify a reopening of the question of soil and ground
water. In this regard it is to be remembered that some years ago a
well within a few yards of the manse was condemned as impure.

(b.) - ARRANGEMENTS FOR WATER AND SEWAGE.
The whole arrangements have the air of an incomplete transition
from antiquated to modern. The water closet is one of the ever popular
pan-closets, which, sometimes a source of disease, are always a source
of nuisance. In the closet itself there is no effort at through ventilation,
and the drainage, which on the whole follows a sound principle, is
inadequate both in ventilation and trapping. The situation of the closet,
which is over the larder, is eminently undesirable. To neither water-
closet nor drains, however, can one indubitably assign the present case.
At the same time such inadequate arrangements always tend to induce
an ever recurrent vital depression, which predisposes to most specific
diseases.

(c.) - WATER SUPPLY.
The water, which is from a gravitation supply from a hill some
half mile away, gave one suspicious indication. When run full from
the tap it came off turpid and sandy; on standing it showed a marked
deposit of coarse sand and earth. This alone indicated some defective
arrangements in the pipes, in the catchment cistern, in the cistern feeder,
or in the spring. Such a defect, if gross enough to admit coarse sand,
would, in special circumstances, readily admit materials of a more
soluble and absorbable nature. It was not surprising, therefore, to
discover that the water contained an amount of polluting material large
enough to justify its unconditional condemnation as a drinking water.
And the origin of the pollution was not far to seek. The water is
brought to the manse from a hill spring; the spring water is conducted
to a collecting tank about a hundred yards farther down the hill; the
tank water is in turn conducted to the manse in iron pipes. The spring
water was to be presumed pure; there was no reason to suspect the iron
pipes; the defect, therefore, was inferred to lie between the spring and

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