HH62/2/ROXBUR/13

Transcription

[Page] 12

If there are any children of school age in the infected
house a notice is sent to the master of the the school they attend.
On returning home the information obtained is entered in
a register, and as the advantages of a register are to a certain
extent lost by cutting up the country into small areas and
having a register for each, all the cases in the County are
entered in the same register. The columns in the register
are arranged with a view to easy reference. In the first
column are entered the number of the case, the date of
inspection, and the parish; in the second, the name and
address of the patient; in the third, the date of notification
by the householder, his name and address; in the fourth, the
date of notification by and name of the medical attendant;
in the fifth, the nature of the disease. In the succeeding
columns a number of facts are noted with reference to the
patient's circumstances or those of his family. Of these the
chief are the patient's occupation and the address of his work-
place; a change of residence; the date of the commencement
of the disease; the ages, occupations, and the situations of
workplace or school of the other members of the family;
the name and address of the milkman; the nature of the
water supply. Then follows information as to the state of
the house; the number and size of rooms; the number of
inmates; the condition of walls, floors, and roof; the number,
situation, and kind of sinks, drains, water-closets, ash pits, and
their condition.
Such a register is of the greatest use in practice.
By it one can, on the shortest notice, give information
as to the details of any infectious case; and the infor-
mation is tabulated for reference if it is required to report
to a District Committee. From the view of a medical officer,
its value is chiefly due to the facility with which the
details of a number of cases may be compared, and investi-
gation into the causes of an epidemic assisted. Thus, if the
name of the same dairy appear frequently in the column
devoted to milk supply, an inquiry should be made at that

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dairy; or if the infection is spread from a school or workshop,
attention can hardly fail to be directed to the original cause.
A complete system of investigation, to be carried out in
each case, takes up much time, and I should not advocate or
practise it if I were not convinced that it is only by attention
to details that any success is to be achieved in checking the
spread of fevers. At present, not being supplied with suit-
able means of isolation or disinfecting apparatus, it is impor-
tant to gain a knowledge of the course take by epidemics in
the country and the agencies by which infection is spread, so
that if in one direction much cannot be done, yet information
may be obtained that will ultimately prove useful.
HOSPITAL ACCOMMODATION. - The hospital accommodation
of the County consists of a single bed in the Hawick Fever
Hospital, which is at the service of the Hawick District
Committee by arrangement with the burgh authorities.
In considering the question of what hospital accommodation
is required, it is to be remembered that infectious diseases
vary in their characters, and that the measures to be taken
to prevent their spread also vary. For instance, pure water
and strict dairy inspection prevent enteric fever; for measles
and whooping cough the closure of the schools is perhaps the
most useful measure; scarlet fever is to be met by absolute
isolation of the patients, disinfection of houses, and strict dairy
inspection. Over-crowding and dirty rooms are the great
causes of typhus fever; thorough vaccination renders small-
pox practically harmless; and draining the subsoil has been
proved to lower the mortality from consumption or phthisis.
A defective drain is a common cause of either puerperal fever
or diphtheria.
Although in towns cases of enteric fever are generally
removed to hospital, we have in the country a fair prospect of
lessening the frequency of that disease by improving drainage
and water supplies, and when cases occur home measures
will usually be found sufficient. Phthisis, whooping-cough,
and measles we need not consider at present. If a case of