HH62/2/ROSS/43

Transcription

[Page] 42

shall only trouble the Council with a short summary of these
and a few observations. Everything was right at the Lodge,
and the bothy had been thoroughly disinfected. From careful
inquiry I am satisfied that the disinfection carried out by the
district S. I. was of the most perfunctory character, while that
done subsequently by a woman employed by Mr Platt, from
Stornoway, was, as I have said, most effectual and complete.
At Limerva there were still several cases of fever. I cannot
say positively whether they were typhus or typhoid, but that
they were cases of fever - and of a highly infectious character
- there could be no doubt. Cases had been present, at any
rate from midsummer, without any proper attempt having been
made to check the progress of the epidemic. Disinfection was
a mere farce - the Sanitary Officer simply leaving a bottle of
something with only verbal directions. and not entering the
houses in which the disease had occurred. I could not ascer-
tain whether Dr Macaulay had reported the cases to anybody
but himself. Certainly he had not done so to me, although in
my letter of the 10th, I had specially asked him to report any
fresh cases. Here was an undoubted outbreak of epidemic
disease of a most serious kind without any effectual means having
been taken to check it, and though the notification of Infectious
Disease Act is in force in the island, yet nothing was done to
draw the attention of the County S. I. or M.O.H., or the Board
of Supervision, as laid down in their regulations, to the
occurrence.

It humbly seems to me that the only proper remedy for
this state of matters is to appoint the County S.I. and M.O.H.
respectively Chief District Officers. and so secure that such cases
of infectious disease are not merely notified to the notifier him-
self, or even to one district Medical Officer for the Lewis, but
periodically reported (say once a week) to the head officials -
whose duty it will be to see that thorough means of, as far as
possible, checking the spread of such deadly diseases as typhus
fever, are efficiently carried out.

For this end it will be necessary not only to have a Princi-
pal Sanitary Officer for the Lews. who will devote himself with
skill and energy to the work, but also a sufficient Local Staff
as mentioned in our scheme of sanitary organisation submitted
to the Public Health Committee, and which will probably be
laid before you at your May meeting. Disinfection, we say it
again, is a task which requires time and great attention. The
duties of Sanitary Inspectors must be performed in a very
different spirit from that in which they have hitherto been
carried on in County Districts. The aim must be to follow
the example of such towns as Glasgow and Aberdeen, where

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the inspection and disinfection are most effectively done. All
this will imply attention on the part of District Committees, and
it must be confessed considerable outlay of money. To get
such disagreeable work done it must be well paid for. But I
am confident the return in the improved health of the district
will amply recoup the expenditure.

The fourth epidemic I shall notice is that of an anamalous
outbreak of typhoid which occurred at Achilty. By the kind-
ness of Dr Tregelles Fox I was supplied with full notes of all
the cases. Their great general peculiarity was the mild charac-
ter of the majority of them. Few were ill more than seven
days. But two, at least, were grave; one recovering after be-
ing a very long time in the Hospital at Dingwall, and the other
dying. The outbreak could be traced back to a point where it
seemed highly probable that the milk was the means of dis-
seminating the disease all over the place, but I failed to carry
out the story of the beginning of the epidemic much further.
The drains of the farmhouse were found to be somewhat de-
fective. The proprietor at once had them put in order, and
they are now, I hear from the County Sanitary Inspector, work-
ing satisfactorily. I do not believe the faults found in these
sanitary arrangements go any way to explain the real origin of the
disease, though they may be held to account in some measure for
its spread. While there is great mass of evidence to the
effect that the germs of typhoid live and thrive in water, and
consequently in sewers, where they may possibly escape into
living rooms along with sewer air, yet, on the other hand, facts
are accumulating showing probability of direct bodily trans-
ference, and also that the infective germs find a nidus in clothes,
&c. I made some statistical investigations a quarter of a cen-
tury ago, which I showed to the late Dr Murchison, the great
authority at that time on fevers. They convinced me, at least,
that typhoid fever does frequently spread by direct infection,
exactly as do typhus and the other exanthematous disorders.
If this view be correct we have, as I have already said, one strong
argument more in behalf of thorough disinfection of the right
kind. and the greatest inducement to detect the disease early,
to isolate it if possible, and to, in short, stamp the disease out
entirely. One aspect of the natural history of typhoid must also
be kept in view, that it seems to cling with affection to some
particular places or localities. It is to be hoped that the re-
searches of bacteriologists will show us both the favouring and
unfavouring conditions of the life of the microbe, and thus put
us in a position to cope with its growth and reproduction.

An account of the hospitals for infectious disease must, as
yet, be short. We have only two in the County - first, the