BOARD OF HEALTH.

Globe, Volume XXIII, Issue 2282, 26 July 1881, Page 3

BOARD OF HEALTH.

A meeting of the Board of Health was held at 5 p.m. yesterday. Present—Messrs K. J. 8. Harman (chairman), J. Y. Boss, H. J. Tancrod, E. Hobbs, H. J. Hall, and W. White.

The Chairman said he bad been instructed to reply to the Government with respect to to the outbreak of typhoid fever, and he had done so as follows :

July 21st, 1881. To the Honorable tha Premier, Wellington. Sir,—l have the honor to acknowledge the receipt of Mr Cooper’s letter of 22nd June, No. 887, written in reply to my letter of the 6th May, addressed to yourself. The great importance of the subject will, I hope, be a sufficient excuse for my again troubling you upon the subject. The Board have received Mr Cooper’s letter with very great regret. An experience in the working of the Public Health Act, extending over several years, has fully satisfied them that its provisions, if strictly carried out, will not provide sufficient protection for the public; and they feel confident that no experience in the working of the Act on the part of the Central Board can have led to such a conclusion as that expressed in Mr Cooper’s letter. _ The Board venture to hope that a consideration of the very important reports which I enclose herewith may induce the Government to accept the conclusions arrived at by practical experience, in preference to those based probably on legal opinion, unaided by experience in the working of the Act. I enclose herewith, in print—l st. A report by Dr. Prankish, acting for the time as health officer in place of Dr. Nedwill, dated July 9th, 1881. 2nd. A report by Dr. Nedwill, dated July Hth. 3rd. A report by Dr. Townend. dated July 11th. The above all have reference to an outbreak _ of typhoid fever, the cause of which, in the opinion of tha medical men whose names appear above, has been traced conclusively to the milk supplied by one dairyman. Up to yesterday thirty-two cases had occurred amongst persons who had been using the same milk. May I coll your attention to the fact that while the medical men referred to above are satisfied that the outbreak of typhoid fever is due to the milk in question, it has never been pretended, as far as I am aware, by any scientific authority that in such cases an analysis of the milk would disclose the poison which is convoyed into the human system by its use; and if not, there is no clause in the Health Act which will enable the Board to stop the sale of such milk, or, in other words, to protect the public health. I have, &o. t E. J. S. Harman, Chairman. The Chairman said :—Members of the Board will not have failed to notice that the newspapers have reported a question bearing upon the subject of unwholesome milk, as having been asked by Mr Stevens, one of the members for Christchurch, and replied to by the Colonial Secretary on the 20th inst. The exact words of the question are not reported, but tho answer is given in the following words :—“The law, as it stood, was sufficient to prevent tho public health being endangered by impure milk supplied to customers. The Health Boards had power to inspect and clean dairies, and take what action might otherwise appear to be necessary for the public protection.’’ This reply has been considered in some quarters as deciding tho question, and our Board is urged to proceed at once to take the necessary steps for securing the protection of the public. But it appears to me that far too much importance is attached to a reply given in general terms. It is not, of course, for me to say that tho opinion of the law officers of the Government is incorrect, but I may at least hazard an expression of opinion that the reply would have been far more reliable if it had been made in answer to a question having reference to some doubtful case which had come under the notice of the Board, and as to which the Board believe the powers conferred by the Health Act to be insufficient. So strongly have I felt this, that I have myself submitted, through Mr Stevens to the Government, a question of the more specific character to which I hare referred. The question was as follows : —“ Docs the Public Health Act empower Boards of Health to prevent tha sale of milk by persons engaged in dairying in whoso families an infectious disease may be present.’’ The reply I have received is as follows : “ SolicitorGeneral thinks there is no specific power to enable Local Boards of Healths to inspect and regulate dairies per se, and if Board desires power of inspection and control, whether disease exists or not, fresh legislation is necessary ; but (tho Solicitor-General thinks that) the incidental power is sufficient, and that section 56, respecting nuisances, appears to empower Local Boards to do everything necessary touching removal and abatement of nuisances, whether affecting animals or premises." Tho Board will, I think, agree with me that the positive terms used by the Colonial Secretary in his reply to Mr Stevens are certainly, to ssy the least, much modified by the Solicitor-Gene-ral. But quite apart from my own ideas as to the correctness of the opinion expressed by the Government, I think there is abundant evidence to show that tho Public Health Act in England, which our New Zealand Act closely follows, is insufficient to prevent the public health being endangered. A very valuable memorandum by Dr. Nedwill will be read to you explaining under what Act the milk and dairy question is dealt with in England. By this, it appears that it has been found necessary to make use of tho provisions contained in tho Contagious Diseases of Animals Act, 1878, and that under the 34th and other clauses of that Act, Orders in Council have been issued which are, I believe, known as tho “Dairies Orders,” and which seem to meet, to a very considerable extent, but not wholly, the difficulties of such cafes a that which we have lately encountered. In the face of this fact it is very difficult to believe that tho Public Health Act is sufficient for tho public protection in the matter of the sale of milk. The question thus arises, is it possible for us to adopt tho same course as has been found advisable in England, and rely upon the Contagious Diseases of Animals Act for meeting tho diffioullies of the milk question. The answer to this question will depend upon tho fact whether the Act referred to is in force in New Zealand. I very much doubt that it is so, but, in order to make sure on tho point, I have along with my other questions asked whether such is the case. I have received no reply to tho question ; the Solicitor-General appears to hare not understood the object of the inquiry, and I may probably find it necessary to ask the question again. It is, however, clear, I think, from what has passed, that unless we can fall back upon the powers conferred by the Contagious Diseases of Animals Act, fresh legislation is necessary to ensure a proper control of dairies and the sale of milk.

The following report of the Medical Officer was read :

Christchurch, July 21st, 1831. The Chairmen, Board of Health. Sir, —I have the honor to again report on the

recent outbreak of typhoid fever caused by milt supplied from a dairy on the Lincoln road. In my communication to yon oa this subject on the 11th of July, I stated that two ty-three cases had occurred, namely, fifteen in the asylum list, and light in private houses situated in different parts of the district. Since that time twelve fresh cases have been reported, two from the Asylum, two from Addington gaol, one from Latimer square, three from one family in Chester street, one from Manchester street south, two from one bouse on the South belt and one from the Lincoin road. In all up to this date there have been reported thirty-fire cases, amongst them three deaths, in which the milk was procured from the same dairy. Seven other cases of typhoid fever havo been notified to the Board snring the time covered by the cases which are the subject of this report, bat in these it is worthy of note that the milk supply came from seven separate dairies. I might hero state that as the dairyman who supplied the Lunatic Asylnm and other places with milk where typhoid fever has been present, has pnt down an artesian well, procured out offices, and fenced off and cleansed the bank of the (’reek (iu a former report I said Jackson’s Creek, whereas I should have r aid a small creek at the head waters of the Heathcote), which was bef. u'cd, it will be quite safe for the public to use his milk, provided no communication takes place between his homestead and dairy, and that no member of ell family who has been recently ill engage in any way at any work which may bring him in contact with the milk. As a good deal of misapprehension exists as to the manner in which milk becomes tha conveyor of such infectious diseases as typhoid fever and scarlet fever, it may be as well to explain that it is due to its remarkable readiness to absorb disease germs, whether conveyed by the atmosphere or introduced through the medium of water. Traces of excremental matter which find their way into water used either for washing milk pails or for diluting milk are the commonest means of contamination in typhoid fever ; while in scarlet fever the skin, which peels off in the form of fine dust, is absorbed from the air, or may be shaken into the milk from the clothes. Bnt in addition to milk absorbing specific disease germs it undergoes, in tha presence of offensive emanations, rapid changes, which are largely responsible for many cases of infantile diarrhoea, a complaint above all others which indicates tha amount of filth in tha atmosphere. It is needless for me to dwell upon the fact that it is necessary by law to protect from contamination an article of diet in all but universal use, for since my first report to the Board I have urged this view, nor is it necessary for me to create a feeling of nausea among the public by again repeatii g a list of the abominably disgusting surroundings at some of the dairies which I have visited. Dairies hewever in all their surroundings may he clean and yet if persons engaged in the occupation cf supplying milk be allowed to continue their trade during the time they are suffering from an infections disease, or attending on others who are ill, they mi-y be the cause of widespread epidemics. I have appended to this report all the information 1 can gather with respect to dairies, from which it appears that in Engiand they are regulated by the provisions of the 34th clause of the Contagious Diseases (Animals) Act. and certain Orders in Council. It is hardly likely that this course would have been taken if it had not been found that the English Health Act, of which our own is a transcript, had not given the local authorities sufficient power to enable them to take precautions against milk becoming infected, Intimately connected with the dissemination of infectious diseases by milk is the limitation of their spread by a system cf compulsory notification to sanitary authorities ; and here I would pause to impress upon the Board tha comparative uselessness of having dairies licensed and inspected, to long as the Public Health Act throws the responsibility of reporting alone on the householder, and does not make the medical practitioner answerable, so soon as he becomes aware of the infectious nature of the disease. The Public Health Act here, as in England, has been found in this respect very worthless. 1 have already directed the attention of the Board to cases which had not been reported, and to other nnreported cases where even death certificates had been given for infectious diseases. Although in some of these cases the Board employed counsel to appear in Court and consulted its solicitor in others, yet the prosecutions have broken down or been abandoned and the Board has been defied. It has been kept in ignorance of the sanitary state of the district, and has been powerless to protect the public. It must, however, be a source of gratification to the Board to know that, with few exceptions, its medical practitioners have always most willingly,without any remuneration, assisted the Board in its endeavors to become acquainted with the sanitary condition of the district. It is equally gratifying to know that other practitioners who had formerly ceased to report have been for some considerable time past reporting. But although it is very desirable that tha Board should have tha hearty co operation of the profession, it is monstrous Ito continue a system of reporting which places the responsibility on the householder, and leaves it optional with the practitioner to obstruct. It is therefore universally acknowledged that if reporting is left to the householder the sanitary authority is often only a name instead of a reality. In many cases in England and in Scotland private Acts of Parliament have been brought into force to compel the practitioner under penalty to report within twenty-four hours. In America the law invariably looks to the physician, and visits neglect to report with fine and imprisonment, or both. Want of promptitude in reporting is nearly as blameable as not reporting at all. For instance, had the first cases in this epidemic been reported without delay, my attention would necessarily hive been long ago directed to the milk as a cause, as it is my invariable practice in all cases of typhoid fever, scarlet fever, and diphtheria reported to the Board to find out the name of the dairyman who supplies the milk. Dilatoriness in reporting is a cause of complaint I have had over and over again to make to the Board. Daring this epidemic, in one cane the patient died a few hours after my visit, in another case the patient died a few hours before my visit, and at the Hospital, where the authorities might reasonably be expected to act with promptitude, two patients had died, one three and tha other five days before the cases were reported. What would be the result of such neglect, I might ask, it wo had a visitation of smallpox f Kcgligence such as described, in the event of a serious outbreak of an epidemic disease, would paralyse tha efforts of any Board. I would, therefore, strongly urge upon the Board to again move the Government to have the present Health Act amended—first, with reference to the licensing and inspection of dairies, and, second, with regard to the reporting of infectious diseases. The Norwich plan, in which the practitioner is compelled to fill np a card, and the householder held responsible for its delivery, seems to work well, and has the approval of the " Lancet,” the representative journal of the profession. It is the system this Board baa been trying to carry out for the last eighteen mouths, and notwithstanding that two most important items have been wanting, namely, the authority of law and the payment of the practitioner for reporting, enough encouragement has been received to enable the Board to warmly recommend its acceptance by the Legislature

I have, COUETNEY NEDWILE, M.D., Medical Officer.

Memorandum. INSPECTION OF DAIRY FARMS,

By a provision of the Contagions Diseases (Animals) Act, section 34, it is provided that the Privy Council may from time 'to time mate such general or special orders as they think fit, subject and according to the provisions of the Act, for the following purposes or any of them —namely: for the registration with the local authority of all persons carrying on the trade of cowkeepers, dairymen, or purveyors of milk ; for the inspection of cattle in dairies, and for prescribing and regulating the lighting, ventilation. cleansing, drainage, and water supply of dairies and cowsheds in theoccupation of persons following the trade of cowkeepers or dairymen; for securing the cleanliness of milk stores, milk shops, and of milk vessels used for containing milk for sale by such persons ; for prescribing precautions to be taken for protecting milk against infection or contamination, and for authorising a local authority to make regulations for the pnrposos aforesaid, or any of them, subject to such conditions (if any) as the Privy Council may prescribe. The above order came into force on September 30th, 1878. A new order was dated on July 9th, 1879, and revoked the previously existing orders, consolidating their provisions and adding to them. The additions provided for a month’s notice to be given to the local authority of the intention to occupy any buildings for cowkeeping and dairy purposes not so occupied at the making of the order ; for debarring the eowkeeper, dairyman, or purveyor of milk, if himself sick of an infections sickness, or having recently been _ in contact with infections sickness, from taking part in the conduct of his trade or business, as far as regards the production, distribution, or storage of milk (the general provision to this effect in the first issued order appearing to have been insufficient); for preventing the keeping of swine in cowsheds or buildings used for keeping cows, or in milk stores or other places used for keeping milk for sale; for local authorities giving public notice from time to time of the necessity for registration of cowkeepers, dairymen and purveyors of milk, and of the mode of registration ; and for exempting from the operation of the order persons who sell milk of their own cows in small guantitiea to workmen or neighbors for their accommodation. Local authorities in England can issue regulations, appending to them the provisions of the order. For instance, the borough of Sunderland, under the Dairies’ Order of 1879, issues regulations providing for the thorough cleansing of cowsheds and their attached yards with water twice a day ; the maintenance of cleanliness of troughs, mangers, grain tubs, and other receptacles for feeding; the provision of proper-covered places cf dopcsit for dung and other refuse ; the re-

moval of this dung or rofnao at least once aweok ; the lime-washing of the inner walls of cowsheds once in every quarter, and of dairies or milk shops once in every month, the floors of the latter to bo well scrubbed and cleansed daily: the cleansing of all vessels used for the reception and delivery of milk with soda und water after each time of being used; and for thn inspection of the places hy an officer of the loca' authority at fitting times, with the view of ascertaining the observance of the regulations. The Chairman said that appeared to ho the state of tho law in England, 110 had not been able to ascertain whether tho law referred to was in force in England.

Mr Ross wished to ask whether the inspector of nuisances had visited the dairies? The Chairman said no special visit had been paid. Toe dairies spoken of wore outside thoir district.

Mr Tanored pointed out that the Board of Health Act gave po>vcr to thn Board to deal with dairies outside their district. The Chairman said the only protection for tho public was tho withdrawal of a license at once from a dairyman where the milk had been found to bo contaminated.

..Air Boas laid that be should like to see the inspactoi* go round tho dairies at once. It was resolved that this should be tU Qe . .Mr Sobb" said that h? thought the thanks of the Board WBte dfle tC the chairman and the ihedical offi.'bf for the trouble and zeal displaced bjr them in the matter. He thought they should instruct the chairman to at once put himself in communication with the Government, and got an amendment of the Public Health Act introduced by tho Government. Ho thought, perhaps, that the solicitor should be asked to draft the clauses here. Mr Tancred said he thought tho Government should be asked to take the matter up. Under the Health Act they were empowered to deal with unsound or unwholesome milk, but how were they to know when milk had the germs of typhoid fever in it ? Mr Boss and Mr White spoke strongly in favour of the medical practitioners being made responsible for reporting the cases of infectious diseases. Mr Hobbs then moved—” That a cordial vote of thanks be tendered to the chairman and medical officer for their zeal and assiduity in dealing with this question, and that the chairman be requested to place himself in communication with the Government as to improved legislation with regard to the Board of Health Act, and that clauses be drawn up here on the basis of regulation and_ licensing of dairies, and the reporting of infectious diseases by the medical practitioners.” The motion was seconded by Mr White, and agreed to. A letter was read from the house surgeon of the Hospital, explaining why the case of Gerald Eilleul was not reported to the Board of Health.

Tho Board then adjourned at 5.30 p.m.