BOARD OF HEALTH.

Globe, Volume XXIV, Issue 2665, 21 October 1882, Page 3

BOARD OF HEALTH.

An ordinary meeting of the Christchurch Board of Health was held yesterday afternoon at 3 o’clock. Present Vf. Vincent (chairman), Messrs W. White, J. E. Parker, and W. F. Hubbard.

The report of the medical officer (Dr. Nedwill) was read as follows : Christchurch, October , 1882. Sir, —I have the honor to submit to yon my report on the health of the district for the quarter ending September 30th. The following are tho number of cases of infections diseases reported for tho three months:— Typhoid Diph- Scarlet Fever, theria. Fever. Measles.

E And according to the months they were distributed thus: — Typhoid Diph- Scarlet Fever, theria. Fever. Measles. July 0 15 23 5 August 4 13 10 2 September ... 3 32 9 3 The numbers reported for the corresponding three months of 1881 were — Typhoid Fever. Diphtheria. Scarlet Fever. Measles. 43 14 2 112

The mortality within the city was per 1000 of the population monthly—July, 0.70; Angnst, 1.41; September, 1.47 ; and for the corresponding months of 1881—July, 1.58; August, 1.05; September, 1.84. The mortality in Sydenham was—July, 0.79; August, 0.68; September, 1.12; and for the corresponding period of last year—July, 1.18; August, 1.42; September, 2.24. Zymotic diseases caused 20 deaths during the quarter: 8 from diphtheria; 5 in St. Albans, lin Sydenham, and 2 in Christchurch; 1 from typhoid fever in Sydenham; 2 from diarrhoea, 1 in Heathcote and 1. in St. Albans; 1 from scarlet fever in St. Albans; 7 from erysipelas, 1 in Sydenham,'2 in Heathcote, 1 in Spreydon, and 3 in the Christchurch Hospital; and 1 from puerperal fever in Heathcote. Judging from the number of deaths recorded from erysipelas this disease seems to have been far from uncommon in the district during the quarter. Its chief interest from a public health point of view depends on its having caused three deaths in the Christchurch Hospital. Erysipelas in the wards of a fixed hospital is a very serious thing. That such an infectious disease should have occurred in the Christchurch Hospital has probably arisen from cases being received, which, in the absence of an infectious diseases hospital, could not easily be refused admission. For some time it will require the strictest care on the part of the authorities to make their surgical wards safe for the treatment of open wounds. On glancing over the statistics which I have furnished, it will be observed that both scarlet fever and diphtheria have been more than usually prevalent during this quarter. The cases of scarlet fever have been confined to no particular part of the district. That they have been of a very mild type is evident from the fact that only one death was registered as having occurred from this disease, although forty-two cases were reported. In many of the cases the disease was ascertained to have been caused by visiting houses where it was known that scarlet fever existed.

It will be interesting to enquire into the cause of the increased number of cases of diphtheria which have occurred during the three months under review. In my report to the Board for the quarter ending June the 30th I stated that it was a “ significant fact that of 26honses in St. Alhaus from which cases of diptheria have been reported only 2 of them are connected with a sewer, 17 are in streets in which no sewer has been laid, and the remaining 7 houses are in streets in which there are sewers, but the owners have not connected.’’ In other words, bad in sanitary conditions were the snironnding circumstances. But I also stated that “ the public school was mainly responsible for disseminating the disease." Here the question occurs whether the emanations arising from the filth sodden ground belonging to the cottages in St. Albans would not in all probability predispose children to attacks from diphtheria when exposed to its contagion in the public school. At no less than 35 of the houses in tho combined district from which diphtheria and scarlet fever have been reported neglect of common sanitary precautions was painfully noticeable—cesspits were not abolished, leaky pans allowed the boards of closets to be saturated with filth, there were no house drains to carry slop water, or the drinking water was not protected from contaminationf from soakoge. The particular kind of nuisance which was disclosed in connection with these eases of infections diseases differed somewhat according to the part of the district. In Christchurch bad house drainage was the distinguishing feature, while in Sydenham, St. Albans, and Phillipstown, in addition to defective drainage, there was the nsnal absence of proper closet aocommodation. Towards the latter end of the quarter diphtheria was reported from ten houses where children had been in attendance at the infant school on the South town belt.

Fortunately the first cases were promptly reported by the medical men’in attendance, or there can be no doubt a very serious epidemic would have been the result. Only four cases were reported when I succeeded in getting- the school closed. At this early stage there could be no reasonable doubt that the school was the source from which the disease was being spread. Probably the first case came from a house in Martin street, a small street between Colombo and Manchester streets, a locality where two years ago I found the back yard knee deep in water, and the occupants unable to reach the closet. On my recent visit to this house I found the yard damp and dirty and the closet filthy. At several of the other houses subsequently visited hygienic conditions were at fault. The evidence, however, obtained at one house where matters sanitary were duly attended to pointed clearly to the school as the focus of the mischief. A strong healthy child from a clean house had only joined the school a few days when it was taken ill. At another house I was informed that notwithstanding that one child had been ill in bed a week with diphtheria, two other children of this family were still permitted to attend the school. On visiting the school I ascertained that it was not only badly ventilated, but, what was worse, that none of the windows had been made to open. I therefore advised that the school should bo closed, and that before it was again opened it should be thoroughly disinfected, and the windows so altered that it would be possible to get a current of fresh air to permeate the building. The precautions which were taken seem to have arrested the progress of the disease, bnt not, unfortunately, until five deaths were registered, the type of the complaint having been evidently severe.

Schools are so freqnently the cause of spreading infectious diseases, that grave responsibilities rest on committees and on schoolmasters as well as on parents. The committees should see that their schools are so constructed that free ventilation can he secured, that cloak-rooms form no part of classrooms, and that they also he well ventilated. The schoolmasters should immediately, after school hours, open all the doors and windows, and thus produce strong currents of air through every part of the buildings. They should satisfy themselves as to the nature of any illness which necessitates the absence from school of any child, and they should be on their guard against admitting children excluded from other schools on account of infectious sickness. Parents should on no account send children to school from infected houses, for although not ill themselves, they may carry infection in their clothes. The Board of Health should try to make arrangements for notifying to principals of schools the occurrence of such cases, and it should see that disinfection is properly carried out.

An Infections Diseases Hospital and proper disinfecting apparatus should be provided with the least delay possible. As to school vaccination, it appears that nothing short of a visitation of smallpox will bo likely to move the Government. It is a most anomalous position for a Board of Health to occupy not to be able to ascertain the names of unvaccinated children attending the public schools in its district. The legal process to follow is bo easy that one is astonished at the painful backwardness of the authorities. All that is necessary to be done is to instruct the public vaccinator to visit the schools without previous notice, so as to get the names of all unvacciuated children in attendance. This information being secured, the public vaccinator or vaccination inspector should serve notices on the parents of such children to have vaccination performed. If they fail to comply with the provisions of the law they can then bo summoned before a magistrate. Should smallpox bo introduced into the district grave responsibility will rest with the Government for having taken no action in this important matter. As an instance of the delay which occurs in Wellington in sanitary matters, I would point out that more than twelve months ago, as the then public vaccinator for this district, I recommended the Government to forward to all public vaccinators in New Zealand the instructions issued by Mr John Simon to public vaccinators in England. I was asked by Government to let them have a copy of those instructions for circulation, but although I complied with the request, I have never yet heard of the instructions being forwarded to public vaccinators. I fear there is a great deal of misapprer ension m the district with regard to the intentions of the Board with reference to connections with the sewers for disprging of slop water and water closet dejecta. I treat I am right in assuming that while the Board is, very properly, anxious to see house connections made with the sewers for carrying away filthy household water, it will not permit any person to use a water closet until ho satisfies the Drainage Board that he has an unfailing sufficiency of water properly supplied for flushing; that his water closet is not only of an approved kind, but fixed in a proper place and well ventilated, and that all pipes and traps are properly flushed and ventilated, and disconnected from the main house drain. To neglect these precautions will certainly be to bring discredit on the system, and to endanger the public health. It appears to me quite clear that until an additional water supply is obtained the number of householders will be comparatively small that can with safety be permitted to nso sewers for carrying away solid excreta. It is true that the sowers can be flushed at any time with the artesian wells by merely turning ou taps; hut house drains, being on a much higher level in many parts of the district, cannot bo flushed

by natural overflow from tho artesians. Considerable carefulness in pumping water into tanks, or considerable expenditure for raising water by machinery to a higher level, may enable some to comply with the conditions which it will be necessary to enforce; but' both in Christchurch and its suburbs the pan system of excreta removal, with or without admixture of a disinfectant, such as dry earth or ashes, will have to be, for years with some, and perhaps for ever with others, the one on which they must depend. *° be regretted that this system, even in Christchurch where it has been best attended to, has been carried out in a most barbarous and disgusting fashion. The pans should have had close fitting lids to he used during removal, and when one pan wi s removed another, perfectly clean,.should have taken its place. But even without these precautions the system might have been rendered considerably less unhealthy and offensive it any attempt had been made to use earth or screened ashes; whether in town or country, one or the other could have been easily procured. The use of either would have prevented decomposition (and consequently frequently disease), would have removed offensiveness, and would have saved people from being classified with those whom Mr John Simon considers guilty of “ utter bcastiality of neglect/’ One of the most common and injurious nuisances which can exist in any community is the hole dug in the ground for the accumulation of human excrement. This common privy should not he permitted, more especially in populous neighborhoods. In the sewage area of St. Albans alone over 20P notices to abolish them have been recently served on householders, and tbe inspector informs me the notices have been complied with except in fifteen instances. But although pans have taken their place, the public nightman's work has not been increased.

The great argument in favor of the Ipan system is that it admits of the frequency of removal of deposited excrement. If by neglect these pans are not emptied before decomposition sets in, the main object to be accomplished in bringing them into use will not be gained. In the case of isolated houses with plots of ground, if earth or ashes are used in the pans the contents can safely he got rid of in gardens. I would, however, strongly recommend that in the thickly populated portions of Sydenham, St. Albans, Woolston, and Linwood, it should be made compulsory to employ the public scavenger. Neither in Christchurch nor in the populous suburbs should householders he permitted to accumulate dust bin refuse. Its removal weekly also should be contracted for, and should not depend on the caprice of householders. In places where slops cannot he disposed of by connecting with a sewer, instead of running them into a roadside ditch, or throwing them over the ground at back doors, where they create intolerable nuisances, they might ho easily conveyed into gardens from boxes outside the house having sheet iron pipes to distribute them into holes. As soon as one hole is fall it coaid be covered with earth. Another hole being then dug and the end of tho pipe shifted. I see by the public papers that the question has arisen whether the Board has power to compel householders to dispose of their slops by connecting with a sewer. This is a most important point for the Board. If the Board has not this power it cannot possibly prevent many nuisances from arising, as the only way to abate them is by conneeting. But it conld of coarse go on week by week issuing summonses until connections were made.

As Ihe negotiations for altering the constitution of the Board of Health have broken down I would suggest that the recommendations which I made on the subject of appointing a chief inspector for the whole district should he carried out.

One death from diphtheria in Christchurch has recently been registered, but no report of the case has been forwarded to the Board. As the certifying praotdtitioner in this esse has been repeatedly of late notifying to the Board the occurrence of infections cases in his practice, I have little donbt but chat some satisfactory explanation can be given of the omission. It has been represented to me by a Christchurch practitioner that in the event of a case of infections sickness not having been reported by the medical man in attendance it would bo well for the medical officer of the Board to ask from him an explanation before submitting his name in a public report. This suggestion I mean to follow in the future provided the Board approves of it. Mr Parker said there was one matter referred to in the report which deserved attention, and that was the apathetic way in which the Ga▼ernmest acted in regard to vaccination. A fter the last report of the medical officer the Board represented the matter to the member of the Government, who was at the head of the department concerned, but they had been quietly snubbed and received no satisfaction, the Government simply stating that it was too late in the session to bring in a Bill on the subject. He moved—“ That the Government be written to with respect to vaccination in schools, inquiring what steps, if any, have been taken to enforce vaccination where necessary by the public vaccinator, and to carry out inspection in order to ascertain what children are now nnvaccinated.”

The motion was seconded by Dr. Doyle and carried.

In answer to Dr. Doyle, the Chairman said nothing definite had been done yet ia the matter of establishing a separate hospital for infections diseases. The farther consideration of the medical officer’s report was deferred until next meeting. Dr. Doyle took exception to the practice of a medical man in reporting cases as “ Malignant sore throat.” That was not legally an infectious disease, and the fees should not be paid. It was very wrong that a doctor should mislead the friends of the patients by describing cases of diptheria as “ malignant sore threat,” and such a practice was calculated to encourage the spread of disease. “Malignant sore throat” should be reported under the head of the specific disease of which it was a part. He would move ‘That only those oases reported under the head of infectious diseases according to the Act be paid for. Mr Hubbard seconded, and the motion was carried.

I he following correspondence was read

From the town clerk of ?ydonham, requesting that with a view of providing more effectually against the spread of contagious disease through the medium of the Sydenham borough school, the Board would cause all such cases to be reported to the head master of the school as coon aa passible. Consideration deferred until the m-dioal officer’s report was under discussion. From the town clerk ol the City Council, stating that the resolutions passed by the conference of local bodies on health questions had been considered by the Council and disapproved of.

From tho town clerk cf Sydenham to a similar effect.

From the clerk of the Spreydon Bead Board on tbs tame subject, stating that the Board was satisfied with tho present stats of things as to the management of the Board of Health.

From Mr John Brightling, Cathedral square, denying that the dry rubbish deposited in his gravel pita was *' offensive matter,” as reported by tho medical officer, and asking the Board to inspect the aamo. From W. Farkerson, Eegistrar of Births, Deaths, end Marriages, acknowledging receipt s£ map cf district, and stating that he had received in-tractions to meet tho views of the Board bo an to enable its officers to obtain information of deaths, &c , occurring in certain sub districts. He wonld be glad to furnish any information required. From T. S. Fester, head master of the West Christchurch School, asking that oases of infections disease occurring in houses from which children attended either the Christchurch West School or the side school at Addington, might be reported, and stating that boys from the South Bolt School had attempted to obtain admission to hia school by representing that they had been attending the Normal School. He deemed it right to draw attention to this very objectionable practice. From Dr. Nedwill, the medical officer, dated the 25th September, stating that since Saturday cases of diphtheria from five diffi rent houses had been reported, where the evidence pointed strongly to the infant school on the south belt being the cause of disseminating the disease. The school committee bad consented to close the school at once. He advised that it should be thoroughly disinfected and the ventilation improved. Ha wonld again urge upon tho master the importance of preventing children from infected houses attending school until they received a certificate that it wan safe to do so.

A letter, in reply, was read from the fecretary of the Board of Education, stating that the architect had been instructed to inspect the schoolroom on tho South belt, and report as to the best means of improving the ventilation. With regard to tho Normal School, nene could he more particular than the principal and teachers in preventing the attendance of children team infected houses, but unless the parents and doctors informed the school authorities of every such instance they could not be aware of their existence. In the south belt further attendance of the children had been prohibited until the production of tbe medical certificate. From tbe inspector cf nuisances under the Drainage Board, forwarding a list of notices to abolish privy cesspools and provide pans which had n-.t been complied with. Tho list comprised four persons. It was decided to compel compliance in all cases, and tho chairman was empowered to take proceedings if nocetsary.

Christchurch... 3 17 16 4 Sydenham 3 10 5 5 Avon 0 4 4 0 Heathcote 0 8 10 e Eiocarton 0 0 0 0 Spreydoa 1 1 1 0 St. Albans 0 20 6 1 7 60 43 10 = 119