BOARD OF HEALTH.

Globe, Volume XXIII, Issue 2182, 22 February 1881, Page 3

BOARD OF HEALTH.

A meeting of the Board of Health was held yesterday at 2.30 p.m. Present—Messrs ' B. J. S. Harman (ohairman), W. White, 1 jun., F. Hobbs, J. V. Boss, J. B. Brown, H. J. Hall, and O. E. Blakiston. The medical ( officer, Dr. Nedwill, was also present. The Chairman said the connections with the sewer in New street were being proceeded 1 with. As regarded the matter between the Sydenham Borough Council and the Biccarton Baud Board, there was considerable difficulty in coming to an arrangement, but the matter had not been lost sight of. The annual report of the medical officer was o ad as follows : Christchnrcb, February 11th, 1881. The Chairman Board of Health. Sir,—l have the honor to report on the health of the district for the quarter ending December 31st, 1880, and also for the year terminating at the same time. The following are the nnmbers of householders who reported cases of infectious diseases for the three months : Typhoid Diph- Pcarlet Fever, theria. Fever. Christchurch... 17 2 4 Sydenham ... 9 1 2 Avon 3 10 4 Heathcote ... 10 1 1 Biccarton ... 0 2 0 39 16 11 , And according to the mouths they wero distributed thus:— Typhoid Diph- Scarlet Fever, theria. Fever. October ... 5 4 3 November ... 19 1 5 December ... 5 11 3 For the corresponding three months of last year there were reported only 18 cases —6 of typhoid fever and 2 of scarlet fever from Christchurch ; 1 of diphtheria and 1 of scarlet fever from Sydenham ; 2 of typhoid fever and 2 of diphtheria from Avon; and 4of scarlet fever i from Heathcote. The mortality from all causes within the city was per 1000 of the population monthly:— October, 0.79; November, o.Brf ; December, 1.32. And for tho corresponding months of 1879 —October, 1.20 ; November, 1.06; December, 1.19. In Sydenham the mortality was, for October 0.38, November 1.67, December 0.64, and for ' tho corresponding months of 1879—October 1.08, November 1.23, December 1.84. That 66 \ cases of infectious disease were reported during ' the last quarter as against 18 for the correspond- ' iog quarter of 1879 is, I think, very gratifying, ' for two reasons; it shows that the public and ' the profession are becoming alive to the im- ' portance of reporting cases, and it also shows that, notwithstanding the greater number of cases known to the Board of Health, the mor- ' tality is less, being at the rate of 11 88 per 1000 annually, as compared with 12.81. The deaths ' from zymotic or " preventible" diseases in ' Christchurch registered during the quarter were ' 11, and for the corresponding quarter of 187!) 13. Unfortunately the Begistrar-General's j fttatictics do not tabulate the different diseases ' from which deaths occur in Sydenham. As the j population of Sydenham is about one-half as ' large as that of Christchurch, and as Sydenham ' itself is intimately connected with Christchurch, : it should be included under the same heading ' and treated in the same way in the vital sta- \ tistics. Indeed, it would facilitate tho sanitary ' advancement of the district if the registration j area was conterminous with the health area. ' During the year 1880 281 householders reported j cases of infectious diseases as against 195 in tho year 1879. This excess may be due in a ' small degree to increase of population. There ' were reported during the past year, 50 cases of ; typhoid fever, 22 of diphtheria, and 14 of scarlet ' fever, more than in 1879. lhe estimated po- ' pulation of Christchurch for January, 1880, was 15,156. The births for the year were 671, giving a birth rate of nearly 45 per 1000. The deaths ! from all causes were 270, giving a death rate of 1 17.98 per 1000. 94 of tho deaths occurred in 1 children under one year of age, twenty-four in i children over one year and under five, and 152 1 at ages beyond five. Zymotic diseases carried < off 86 victims, 53 under one year of age, ' and 33 between one and five, or in ' other words " preventible " diseases had a death i rate amounting to 5.6 per 1000 of the population. : Of course the proportion of old to young in new > colonies is so small that zymotic diseases, which ; rarely attack the old, will appear unfairly large. ' The principal cases of death from zymotic I diseases were—typhoid fever, 13; dysentery, ] 27; diarrhoea, 31; diphtheria, 2; scarlet fever, i 2; and whooping cough, 4. Infant mortality 1 being a true test of the sanitary condition of 1 any district, it is a matter of the utmost im- j portance that the mode of calculating it should i be beyond cavil. The "Lancet"says—"The 1 proportion of deaths of children to total deaths 1 in populations differently constituted as to age i distribution can never be usefully compared as I evidence of infant mortality, ond this source of ' error is most marked in new colonies, where i papulations are abnormally constituted as to i age distribution." This objectionable manner f of reckoning infant mortality prevails, I believe, 1 in some parts of Australia and in New Zealand, > and leads to the opinion that we are more un- i healthy than we are. Infant mortality, which ( can be correctly measured only by the propor- ] tion of deaths under one year to births regis- < tered, has an average for the year 1880 of 140 i per 1000. TMb is favorable in comparison with < English statistics. However, the fast remains I that 80 children under five years of age died : during the year from " preventible " diseases. J Ihe death rate for the year 1879 was 20.15 per i 1000, as compared with 17.98 for 1880. The I estimated population for 1879 being 14,186, the < births 636, and deaths under one year 120, it < follows that infantile mortality during 1879 was ; greater than for 1880. the rate being 188.6 per 1000. Sydenham, with a population in January, ) 1880, of 7796, had 460 births registered, which ' gives it the extraordinary high birth rate of 59 I per 1000. This birth rate is so excessive that the population can scarcely be in a normal condition in regard to age. Although it is recorded that New Zealand stands highest of all the Australian colonies in birth rates, it may not generally be known that Sydenham possesses a population in which there must be an overwhelming disproportion of young and vigorous adults. If Sydenham is not jubilant it ought I to be. Tho deaths from all causes during the year were 125, or at the rate of 16.3 per 1000. The excess of births over deaths being nearly 43 per 1000; 62 of the deaths were among infants under one year, 26 above one year and under five, and 37 at five years and over. The infant mortality was 131.7 per 1000 of those born. For the first eleven months of tho year 1880 in England in about 200 urban sanitary districts, with a population amounting to seven or eight millions of inhabitants, the birth rate was 35.5 per 1000 ; the death rate 21.4; the death rate from zymotic diseases was 3.4 per 1000 ; and infant mortality 175 per 1000 of registered births. The death rate for the year in the four principal towns of New Zealand was: —Auckland, 13.81; Dunedin, 14 38; Christchurch. 17.98; and Wellington, 18.40. Dunedin, with a population of 23,959, lost by deaths 53, or at the rate of 2.2 per 1000, of zymotic diseases ; Auckland, with a population of 15,022, lost 52, or 3.4 per 1000 ; Wellington, with a population of 21,582, lost 139, or 6.4 per 10J0 ; and Christchurch, with a population of 15,156. lost 85, or 5.6 per 1000. This gives an average death rate from zymotic diseases for the four principal towns of New Zealand of 4.4, while in Kngland the rate was only 3.4. It wili be gathered from what I have said that New Zealand's general death rate and birth rate and infant mortality compare most favourably, as they ought to do, with English rates, but as regards zymotic diseases, we occupy a poor position, and, unfortunately, Christchurch stands lowest but one among New Zetland towns, Wellington alone being more unhealthy Typhoid fever, dysentery, and diarrhoea are the complaints which swell our bills of mortality ; they deserve our close attention; they are dirt diseases, and, consequently, most amenable to sanitary control. Typhoid fever during the year was not confined to any particular part of the district; it is, unquestionably, endemic amongst us, and, as usual, several cases of it came under notice during the year for which there did not exist any apparent cause. Dirt, most frequently excremental, was generally present, and in a few cases pollution of water by sewage brought on the disease. Other cases were cau?ed directly by persons sufferirg from typhoid fever using closctß- in common with healthy families. The chief interest, however, attached to typhoid fever during the year was its connection at Avonside with a milk origin, and its apparent connection in another outbreak with milk supplied from cows that had access to sewage water. Dysentery was very prevalent during the first quarter of the year, and assumed a very severe form, not only amongst children, but in adults. In almost all the cases that I was aware of bad sanitary conditions wero the prominent surronnding circumstances. People living on charitable aid in old, badly ventilated houses, built on ground without drainage, and without the means or desire of having their closets properly attended to, wero mostly those who suffered from this complaint. Diarrhoea, as usual, was very prevalent during the hot soason of tho year. To the removal of filth in all its forms, and to a better and more correct knowledge in the feeding and management of children, we must look alone for a decrease in the mortality from this disease. Diphtheria, scarlet fever, and whooping cough have been of a very mild type, and have caused only a few deaths. An outbreak of the former disease of a more virulent character has, howover, quite lately appeared at Papanui, and demands immediate attention in consequence of the undraiuedttate of the village. The hoalth of tho

district has decidedly improved during the yeai", and the Board may congratulate itself on this beinjr due to its efforts in various ways. Christchurch and its suburbs, however, are so flat and their drainage naturally so difficult, that some considerable time niußt elapse before the district, saturated as it has been for years with excre mental human filth and house slops, can be

made as healthy as the climate would entitle us to expect. During the year cesspits in Christchurch have been entirely abolished ; in Sydenham they are faßt disappearing, and in all the populous suburbs pans are gradually taking their place. Side-channelling has been carried out in many private streets in the city and several miles of it in the suburbs; in tho Heathcote district alone over four and a half miles of it have come into use. Mho

deep Eewers are also advancing, over eight and three-quarter miles of them having already been completed in Christchurijb, and four and a-balf miles in tho Aven district. Honse connections with the sewers are being pushed on, and I believe in another year we may cxpeot the pumping station for the removal of sewage to be#in work. The south drain is almost filled in, and Jackson's creek is slightly improved. Many improvements have, however, to be carried out before all has been done that can be done for the health of the district. If the pail system for night soil removal is to be continued, a less objectionable method than the present ought to he adopted, at loast in Christchurch. Pans should be more frequently emptied, more especially at all public buildings, such as schools and hotels, and the use of dry earth should be made compuleory. How can CbristcSurch expect to be healthy when only 300 out of its 3269 householders ever think of employing the dustman, and when to this small number his visits are paid in many instances only once every quarter ? This is bad enough for Christchurch, but it will scarcely be credited that outside the town belts, tha duetman is on visiting terms with only six houses, As the nightman is responsible to only 130 householders in the whole of Sydenham, including Addington ; sixty in Papanui road, St. Albans, and Knigbtstown ; and eighty in Avonside, Phillipstown, and Ferry road, it will be apparent that there must be a regular army of private scavengers, whose work, if scamped, will becotre a new source of danger to the community. In fact, the suburbs are now undergoing the same process of befoulment that went on in Christchurch before the pail Byetem was introduced, and like Christchurch, in the course of time, they will reap the result in typhoid fever and otber filth diseases. Thero is no provision for milk inspection, and not only water, but germs of typhoid fever, scarlet fever, and diphtheria may be conveyed to us every day without let or hindrance. Slaughter-yards are, I believe, not so disgusting as they were, but no step has been taken to establish abattoirs. Our magnificent artesian water is gradually failing, but nothing has been accomplished in the way of supplementing it. So long as the supply was delivered by natural overflow above the surface, no element of danger could lurk in it, but now that it has sunk, and is still sinking below the surface, it is liable to contamination. As I write this report lam informed in a letter which I have just received from Dr. Irving, that three cases of typhoid fever, Jecently under his care, were caused by ewage finding its way into the drinking water. Our artesian water should be economised for household use, and another supply should be obtained at once for flushing and other purposes. Houses are continually being built on madeground, on land so low as not to be much above the water-level, without drainage and without any provision to keep damp exha'ations arising from the surface, so thatjit is use'ess to expect the unfortunate occupiers of such tenements to remain healthy. Proprietors of old houses saturated with filth and scarcely habitable should be compelled to renovate or destroy them. Sections of land to be cut up into building allotments should be drained before permission could be obtained to build on them. Old gullies in populous parts should be filled up to the street level, and neither gullies nor excavations should become receptacles for burying organio refuse. Candle manufactories and other offensive trades should be prohibited from creating nuisances, when it is quite within the power of the owners to prevent them by using improved machinery. I have over and over aga : n urged upon the Board the necessity for having all cases of infectious diseases promptly reported. To prevent these diseases in the first place, and to limit their spread, is the chief end of all sanitary enactments. In England, for some considerable time past, the subject has been receiving a great deal of attention. Many sanitary authorities have obtained Acts, and others are obtaining them, to compel under penalty the reporting of these cases. Some Acts throw the responsibility of reporting on the medical practitioner, others make the householders and practitioners conjointly responsible. The Edinburgh Act contains a clause relating to infectious diseases to tho following effect: — " In order to secure more prompt action in dealing with infectious diseases, it Js ,'provided that every medical practitioner practising within the burgh shall, within twenty-four hour* of the same coming to hia knowledge, report to tho medical officer of health every case of cholera, typhus fever, typhoid fever, diphtheria, small-pox, scarlet fever, and measles occurring in his practice, and state the honse or place where the patient is being treated, under a penalty not exceeding 40a; and if it be found on enquiry by the medical officer of health that the diagnosis of such practitioner was correct, such practitioner shall be paid the sum of 2s 6d for each case reported and verified, and in order to facilitate the making of such report, every Buch practitioner shall, from time to time, be furnished, on application to the medical officer of health, with printed forms, stamped for postal transmission." On the 2nd of December, 1880, a number of medical men interested in this subject had a conference with the Lord Mayor and Corporation of Dublin, "and the majority of the speakers considered that if the compulsory notification of infections diseases is to be thoroughly successful, it must be carried out by the practitioner in attendance, and not left to the head of the family where the contagious disease exists." On the 27th of January, 1860, I advised the Board to carry out the plan in force in Norwich, where both the huseholder and the practitioner are made responsible under penalty. The latter is obliged to fill up a card, stating name, disease, and residence, and the former is made responsible for its delivery. I also advised the Board to carry out the clause in this Act, which provides that a fee be paid to the medical practitioner for reporting. I still advise that this Act be followed in any alteration of the Public Health Act which this Board may recommend. I feel certain that _ this is a popular method with medical practitioners, and no reasonable man could object to it. I would again draw the attention of the Board to the urgent necessity of having a separate ward, however small, for the treatment of cases of infectious disease. Cases are continually coming under the notice of medical practitioners wheie infectious diseases must of _ necessity spread in consequence of isolation being impossible. That the district should be without a disinfecting apparatus, seems almost incredible. It is well known that public schools often become the medium for conveying infections diseases, and it requires to be constantly repeated that the heads of families are not nearly particular enough in preventing children from going to school from houses where other children are either suffering from an infectious disease, or have only recently recovered from one. During the last few days I have become acquainted with two cases where children from houses in which diphtheria was present had continued to attend public schools. Grave consequences may arise from such neglect, and it behoves masters to satisfy themselves that the absence of any child is not due te any infectious disease before allowing other children of the same family to mix in the (school. To prevent the spread of typhoid fever, it is necessary that all the bowel discharges should be disinfected and removed at short intervals. Two years ago Dr. Powell, your then medical officer, writing on this subject said, " I need hardly point out the very great importance of proper sanitary arrangements, where hundreds of children are assembled together for several hours of the day, more especially in a town where typhoid fever is endemic." He then went on to advise that the closet pails should be emptied twice a week, and a disinfectant used. As this advice has_ not been carried out, I consider it my duty to direct the attention of the Board of Health to this subject. Is it too much to expect that the Education Board will set the community a good example, or will it require an epidemic of cholera or the plague to arouse them out of their apathy ? On a former occasion I reported to the Board that vaccination in very many cases was indifferently performed, and I now repeat this statement. I feel confident that if small-pox were unfortunately to visit us, great discredit would be thrown on vaccination. Ihe instruction issued in England by tho Local Government Board for vaccinators is that "at least four separate, good-Eized vesicles, or local effects equal to lour, should be produced." Mothers not knowing what they ask frequently beg that only one mark be made on the arm, and their wishes are sometimes respected. Indeed, they prefer going to such and such a practitioner, •' because he vaccinates only in one place." I have, &c, Courtney Nedwill, Medical Officer.

Mr Hall said the report was so voluminous and important that he thought it should be considered before the Board wont into the matter. He should move that tho consideration of the report be adjourned till next meeting. Mr Brown seconded tho motion. Mr Blakiston thought that tho thanks of the Board were due to the medical officer for tho very able report he had furnished them with. Mr Hobbs agreed with Mr Blakiston, and suggested that copies of the report be forwarded to the City Counoil, Board of Education, and the various local bodies and School Committees. . The motion was agreed to, and the Chairman requested to forward the copies as suggested by Mr Hobbs. Mr Brown called attention to tfce fact that the medical offioer had beon present and argued the matter with the members of the Board. Ho did not think this should be

allowed, as he did not see that the Board should discuss the report of tho officer of health in his presence. Mr Boss said the Board might feel that they were not competent to discuss the questions raised in his report without the advice of the medical officer.

Mr Hall said that he had always noticed that the medical officer was remarkably retiofnt whenever he was attending the Board. Mr Brown said all he wished to state was that he declined to disouss the report of the medical officer in his presence. The matter then dropped. A letter was read from Mr T. Forest, complaining of a nuisance existing in Free'e creek, owing to the inhabitants north of his section throwing refuse of all kinds into it.

The matter was referred to the inspector. A letter was read from the Biccarton Boad Board with reference to a nuisance said to exist on the Lincoln road, near Upjohn'e property. The letter pointed out that the road in question was a boundary road, and under the control of the Sydenham Borough Council. The Board would, however, pay half the oost of concrete channelling at the place referred to. The Chairman said he desired to take further legal advice with regard to this matter, and therefore he would ask that it be deferred to nrxt Board meeting. Tho matter w-»s accordingly deferred.