HH62/2/RENFRE/53

Transcription

[Page] 52

of our existence, in a country district, we should have been able to
secure the removal to hospital of so large a proportion of cases. I
am indebted to the medical men in the county for their kind assist-
ance in this matter. But so favourable a result is mainly due to the
enthusiasm, tact, and perseverance of the chief and subordinate
sanitary inspectors, who wrought early and late - disregardful of
'office-hours,' in fair weather and foul, to attain a solution of the case
so satisfactory alike to the patients and the public, as removal to
hospital. Few people have any idea of the amount of diplomacy, of
the patient waiting, of the persuasive arguing-out of the matter,
which is required in connection with the removal to hospital of a
large proportion of the cases. The inspectors were careful never to
push the matter to extremes, having regard to my standing instruc-
tion that until we had obtained the confidence and goodwill of the
people, stringent measures were never to be resorted to, even in the
most clamant cases, except under my direct supervision. Under
these circumstances, upon grounds of general policy, a considerable
number of cases were left at home when their removal to hospital was
urgently called for in the interests of the public health.
Before leaving this part of the subject, I may be permitted to
explain what occurs upon the receipt of the notification of a case.
The inspector within whose district it occurs visits the premises
immediately, obtains the particulars required for his enquiry-form -
occupation of patient or parents, school attended, water-supply, milk-
supply, sanitary condition of premises, etc. - with as little of an in-
quisitorial air as possible; if it is a suitable case for removal
to hospital he does all he can to persuade the friends to consent to
removal. If the case is to remain at home, he gives minute instruc-
tions and hints as to isolation and disinfection, and if necessary
supplies disinfecting fluid and soap. I have prepared a simple-
written statement of the dangers and the precautions to be taken in
the case of scarlet fever and enteric fever, respectively, a printed copy
of which is left with the friends. I have in course of preparation
similar sheets for measles and diphtheria. If there is anything
exceptional or urgent in connection with the case I am wired for,
or if not so urgent I hear of it next morning. If any of the family
are attending school, the head of the school is communicated with by
means of a printed form, and a period defined during which no mem-
ber of the family is to be allowed to school. If the case is to be
removed to hospital, the inspector's first duty is to fill in a form

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directed to the medical man in attendance, informing him that the
necessary steps are being taken, so that he may be saved an unavailing
visit. If the patient remains at home the house is kept under such
supervision as is possible, so long as it remains in an infectious con-
dition.
The circumstance of greatest importance in connection with the
prevalence of infectious diseases during the year was the epidemic
prevalence of Measles in various parts of the county - at Kil-
barchan, Bridge-of-Weir, and Inkermann, the disease spread with
alarming rapidity, and its prevalence was attended by great
fatality. At Cathcart, also, there was a sharp outbreak of the dis-
ease, but owing probably to the early closure of the school, the
disease never assumed the proportions of an epidemic, and the
mortality was small. - Measles is now becoming the most fatal and
wide-spread disease of the zymotic class. I desire to take this oppor-
tunity of explaining clearly my view of the methods by which we
may hope to control the extension of the disease. The first point to
note is that measles, unlike most of the other infectious diseases, is
most infectious in its early stages - is, indeed, highly infectious in the
premonitory stage of the disease, before the characteristic rash has
appeared. This suggests a fundamental difference in respect of pre-
ventive treatment. With other infectious diseases the essence of the
efforts to prevent their spread is hospital isolation. By the prompt
removal of the first case occurring in a family, one has every reason
to anticipate that the disease will be stamped out in as far as that
family is concerned. Not so here. The chances are that before the
disease in any case has assumed a characteristic form, all or several
of the other juvenile members of the family have become infected.
Further, it is the case, in poorer-class localities at least, that in cases
of measles, frequently no medical man is called in, the nature of the
disease may not, indeed, be recognised; in spite of compulsory noti-
fication there will always be a proportion of undiscovered cases.
Again, in any outbreak of measles there will always be a consider-
able proportion of infants attacked; these cannot be removed to
hospital unless their mothers accompany them, and with the present
average condition of public opinion that is not to be hoped for.
Further, generally speaking, under existing circumstances the dis-
ease spreads so rapidly that no practicable amount of hospital accommo-
dation would serve to meet the requirements of the case. So that in
this case hospital accommodation must be regarded as only an

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