HH62/2/RENFRE/57

Transcription

[Page] 56

position of affairs in the First District at this point was exceedingly
complicated; we had patients distributed over no fewer than six
hospitals - Belvedere, Knightswood, Shieldhall, Cowglen, Paisley, and
Johnstone - besides which I had to engage a nurse to take charge of
a case of enteric fever in Eaglesham village for which we had no
available accommodation. These exertions were not, we have reason
to believe, without effect; the excessive prevalence of scarlet fever
never assumed what may be termed an epidemic form, and terminated
at an earlier date in the winter than usual. In the Second District
we had, practically, only to deal with sporadic cases of scarlet fever,
the isolation of which received the most careful attention of the
Department, and the year passed without any death from the disease
having to be recorded.
Under the heading of Enteric Fever, I shall only refer to two
outbreaks which were of special interest and importance. - The first
may be termed 'the Eaglesham outbreak.' On the 28th of August I
received notifications of two cases of enteric fever occurring in one
family at Shawland (now in Extended Glasgow); the cases were
visited by the sanitary inspector, and among the other particulars
entered in the office Register of Infectious Diseases, as the result of
his inquiry, it was noted that the persons affected had been resident
in the remote village of Eaglesham up to the 15th of August, and had
derived their milk supply from -- 's dairy there. On the afternoon
of the 31st I received notifications of two cases in the village, and in
view of what had already occurred, I decided to go down to the
village with the sanitary inspector next morning. On inquiry there,
I ascertained that both the cases in the village had obtained their
milk from the dairy already referred. I visited the dairy in question,
and made careful inquiry as to whether there was or had been
any case of illness in the house, but I found there was no one ill
in the house, and it was maintained, in the face of what I regarded
at the time as a skilful and searching cross-examination, that there
had been no illness. In the face of the facts already elicited, how-
ever, I felt it to be my duty to order the dairyman to cease supplying
milk. Before leaving I ascertained the existence of two other cases
in the village, through the resident medical man, Dr. Pollock, who
afforded me great assistance in the course of my subsequent investiga-
tions; here the ordinary milk-supply was from a different source, but
I found that at least on one occasion milk had been obtained at -- 's
dairy. Knowing that Eaglesham was much resorted to by Glasgow

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people in the course of the summer, I communicated with Dr. Russell,
Glasgow, and ascertained that already in respect of one or two cases
in Glasgow, Dr. Russell had had his suspicions directed towards
Eaglesham. At that time, however, I had no idea of the wide-spread
character of the mischief which had been wrought by this unfortun-
ate dairy. It was only as the result of further experience, of infor-
mation received from Dr. Russell, and of a laborious course of inquiry
pursued by the sanitary inspector for the sub-district, that the extent
of the injury to the public health was revealed. The facts of the case
as afterwards ascertained, were these. From first to last no fewer
than 42 persons were prostrated by the disease, of these, all except
the five last cases of the series had partaken of --'s morbific milk; the
five exceptions were persons who had evidently contracted the disease
from previous cases of the series. Of the 42 cases constituting the
series, only twelve sickened in the village; the others had left, bear-
ing the seeds of the disease in their systems, and were prostated,
some in Glasgow, some in Govan, some in Partick, some in Govanhill,
and one, even, in a remote English town. 4 deaths occurred amongst
the cases we were able to follow up; assuming the mortality to have
been at the same rate amongst cases which we were unable to watch,
the fever-tainted milk was the cause of the death of six persons.
The sickening of the first cases, so far as I can speak from researches
carried on a month later, dates from the 10th of August. I find no
fewer than 28 cases must have been laid down by the disease, in or
near Glasgow, prior to the date of my receiving the first notification.
In the fortnight following my appearance on the scene - and I must
here direct attention to the fact that the incubation period, the period
during which the seeds of the disease lie dormant in the system, is
about fourteen days - nine persons were prostrated by the disease.
From the termination of that fortnight, no case occurred having any
association with Eaglesham, with the exception of the five already
referred to, whose infection was clearly traceable to pre-existing cases.
The first of these, who sickened upon the 20th September, had not
been in Eaglesham after the 13th of August, but was brother to, and
lived with, a patient who sickened after returning home from Eagle-
sham. The next two cases, whose illness dates from September 27th,
and October 11th, occurred in a family in which there had already
been two cases. The last two cases were of women who had nursed
prior cases. It will have been remarked that I was unable, at first,
to get behind the milk as a source of infection. I learnt subsequently,