49

H. 31

Scarlet Fever.

This disease has almost exhausted itself in the northern half of the district; but it appears to be slower in dying away in the southern half. Thus, while we had notification of only 22 cases in Dunedin and its suburbs, and 2 in Port Chalmers, we had only 2 in Clutha County, and none in the Peninsula, Taieri, and Bruce Counties ; but we had 59 cases in Invercargill and its suburbs, 30 in Southland, 2 in Wallace, 1 in Lake, and 4 in Tuapeka Counties, all of which are in connection with Invercargill. It would thus appear that the disease was being spread from that as a centre. Even here, however, the incidence of the disease is less in the later than in the earlier months of the year. A few cases occurred in one of the most northerly of the counties of my district—namely, Waikouaiti. but none in the other three —Waihemo, Maniototo, and Vincent Counties. Enteric Fever. This disease has not bulked very largely in my district, although we have had cases cropping up occasionally, in widely scattered localities, without any link to connect them, and, so far as could be ascertained, dirty surroundings as the only discoverable cause. We had 15 cases in and about Dunedin, some of them imported into the Hospital from various localities, while there was only lin and about Invercargill, and 4in Tuapeka County. But, unfortunately, we had a renewed outbreak at Mount Pisa Station, where it raged last year, during the early months. Two of the station hands were attacked about the middle of May, both recovering, but a week later a wool-classer who had gone meantime to a neighbouring station was taken ill, and died. 1 had information, too, that his friend who had also been wool-classing at Mount Pisa Station had been treated for enteric fever in Wellington. Some three weeks later a man who had been for a time at Mount Pisa Station with a threshing-mill was taken ill with the disease at a place in the Cromwell Gorge where he was encamped, but recovered. This seemed to end the trouble, but we looked forward with some anxiety to the next shearing season ; and, unfortunately, our fears were realised, for early in February a case occurred, a week later 4 more, of whom 1 died ; and a few days later still there were 2 more. In March again, on the 9th, two men became ill at the same place, and a servant (not a nurse) who had needlessly exposed herself to infection took ill, and died in the Cromwell Hospital. Most of these cases came from the men's quarters, but the station-manager and a household servant were also attacked. We had then 15 cases connected with the station this year, of whom 3 patients died, the others recovering. About the time these cases were occurring at Mount Pisa I received notice that a man was ill with the disease at Rocky Point, near Bendigo, and as this appeared to be a new centre, I made a special visit to the place to investigate. I found that the farm at which the sick man was, distant from Cromwell about eight miles, lay at a point nearly opposite Mount Pisa Station, but with a rapid unfordable river separating the two places, and therefore no connection between them. There was, however, a remote possibility of infection from that source, as a man who had been ill with the fever the preceding year was then living at Bendigo, a mile or so distant from the farm, and the farmer's children were in the way of going to the post-office at Bendigo for their letters. Two of these children had been suffering from diarrhoea (not improbably a mild attack of enteric fever), and they may possibly have received infection during a visit to Bendigo. It is not likely, however. The farm surroundings were very dirty, with a shallow well liable to pollution from a swamp into which refuse of all kinds was being thrown. Immediately I received information of the outbreak of the disease at Mount Pisa I went out to make a renewed examination of the whole place, looking carefully not only at the buildings, several of which had been burnt down and rebuilt, as I had required last year, but at the whole surroundings, including the complete course of the water-race. In this I had the advantage of the assistance of Dr. Coughtrey, who had been sent out for the purpose by the agents for the estate. There was some evidence of pollution of the top of the water-race from a very dirtily kept rabbiter's house and the foul pig-sty which was close to it; but the liquids, &c, from these percolated over and through loose gravel in a valley in which ran the creek from which the water was taken, and the race from the point of intake was about a mile long, running in a clean, open, gravel-bottomed bed, so that this pollution would have been abated most probably thoroughly before the water reached the homestead. Besides, the fact was undoubtedly brought out, by the statements of three of the sick men, and by those of the station-manager and others conversant with the habits of shearers and station hands, that they never drank, by any chance, water in its natural state, but always tea made with well-boiled water. It is thus evident that the water-pollution had nothing to do with the occurrence of the fever, but that it had still been hanging about the station, in spite of what had been done, and that the flies had carried it to the food in some way, as I indicated in my last year's report on the epidemic at the same place. I shall have a look at the station early next season, before the shearing begins, to make sure that it is well cleaned up. If the fever breaks out again, lam inclined to think that the whole of the station buildings should be shifted to another location, and the present place dismantled and not used at all. Meantime the rabbiter's place has had a thorough cleaning-up, and the water-race has been taken into the station by a different line, from a point some distance above the present intake. In this connection it may be mentioned that not only in the district contiguous to Mount Pisa, but also in other parts of my district, there was a rather unusual amount of diarrhoea, due probably to the fact that after a wetter than ordinary spring and early summer, we had a sharp change into hot weather. Thus a well-recognised factor in the production of diarrhoea and suchlike diseases was in operation. Diphtheria. Only three cases of this disease were notified in Dunedin and its suburbs, with one death. These, it is worthy of note, perhaps, all occurred in the low-lying portions of the town ; the more highly situated parts being exempt from the disease. 7—H. 31.