HH62/2/RENFRE/59

Transcription

[Page] 58

however, from outside sources that a daughter of the dairyman's,
employed in an adjoining parish, had been staying with her father
for a time, and it was alleged that she had been suffering from illness.
Cross-examined on this story, the dairy people admitted to me that
the daughter had been staying with them, but denied that there had
been anything the matter with her. I obtained, with considerable
difficulty, a rather vague address as the present residence of this
daughter. Mr. Little undertook to find this woman before there
could be any communication between her parents and her; he
succeeded, and obtained from her own lips a statement that she had
felt ill and given up work on the 13th June, and had returned home;
that she had suffered from headache, sickness, and diarrhea, that she
had been entirely confined to bed for a week, and that she had not
felt able to return to work until the 10th of August. No medical
man will fail to recognise in this case, probably a mild case, of
enteric fever. The most remarkable circumstance in connection with
this outbreak is that the facts show that the milk had not obtained
its infective quality during the illness of the girl. The largest pro-
portion of the cases did not sicken until more than a clear fortnight
had elapsed since the departure of the girl, and her resumption of
work in perfect health; while the earliest cases of all, which sickened
on the 10th of August, the date upon which the girl returned to
work, must, according to all we know of the disease, have become in-
fected one or two weeks after the girl herself had ceased to be infec-
tive. How are we to explain this circumstance? Only upon the
hypothesis that the infection lingered about the premises, and for
some reason only obtained access to the milk at a later period. Was
there anything in the circumstances of the premises to furnish a
material basis for this hypothesis? The dairy was in a bad sanitary
condition, the structure of the byre was defective, and there was a
dung-pit sunk in the ground beside it, which was the natural recep-
tacle for the excreta of the patient. Typhoid excreta thrown into
such a receptacle, in the warm month of July, would find there the
most favourable conditions for the development and multiplication of
the infectious germs. The water-supply was derived from a boiler
sunk in the ground, fed by two pipes, believed to be the overflow
from springs higher up. The overflow from this boiler was into a
built drain. Into this drain, a foot or two lower down in its course,
the drain from the dung-pit discharged. Under ordinary circum-
stances the liquid from the dung-pit would enter the main drain lower

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down in its course than the overflow from the boiler; but should the
outfall of the dung-pit drain become in any degree clogged up, the
sewage matter would be dammed back, and overflow through the un-
joined pipes into the boiler, from which the water-supply of the dairy
was drawn. I have, therefore, no difficulty in accepting it that the
water was, in all probability, the medium through which the milk
obtained its infectivity. - It seemed contrary to all the canons of
morality that the persons in charge of the dairy should escape punish-
ment for the part they had played in the matter. I considered the
question whether they should not be proceeded against for having
failed to notify a case of infectious disease occurring in the house-
hold; but I was advised that in all probability a prosecution would
fail. - The proprietor was notified that he would no longer be per-
mitted to let the premises for dairy purposes.
The other outbreak was of a less serious character. At Neilston,
beginning in the end of September, there occurred a dropping series
of cases of enteric fever. As time went on it appeared that these
cases, with the exception of one, had one point in common, they were
all reported as deriving their water-supply from the "Chapel Well."
The one exception was that of a boy, whose household was supplied
from the 'Big Well,' - of course, a boy roaming about the streets
might very well have drunk from another well. On the other hand,
it was alleged that the people in question were acting misleadingly,
that they really drew their water from other wells, but claimed the
Chapel Well as their water-supply, as being the most reputable well
in the place. I was unable to accept this view of the case and I took
the somewhat summary course of causing the sucker of the pump to
be removed. I am afraid my action was not approved in the village,
the well being very conveniently situated, but I had the satisfaction
of finding that no further cases of enteric fever occurred. There were
in all, nine cases in the course of this outbreak.
During the year there occurred outbreaks of scarlet fever upon six
dairy-farms in the county; in every case our first effort was to secure
the removal of the cases to hospital, and the thorough disinfection of
the premises. Failing that, my next requirement was that no milk
should be sent out from the farm; and that in theory, at least, the
patient should be thoroughly isolated; relying upon our own super-
vision for the fruition of theory in practice. In addition to the
Eaglesham case above referred to, we had three outbreaks of enteric
fever upon dairy-farms. In one case I secured the transference of