PUBLIC HEALTH

Nelson Evening Mail, Volume LXIV, 4 February 1930, Page 9

PUBLIC HEALTH

LECTURES TO INSPECTORS

SANITARY OFFICERS' REFRESHER

COURSI

At the refresher course for sanitary inspectors in Christchiircli hist week an oxtremely interesting and valuable lecture on intestinal diseases was given by Colonel K. W. W. Dawson, Assistant Medical Oflicer ol' Health in Christchurch.

EASIEST DISEASE TO CONTROL

"The study of acute intestinal disease should be of the greatest interest to sanitary inspectors, because they are probably "the easiest to control," said Colonel'Dawson. "They give rise to outbreaks which are dramatic in the suddenness of their onslaught, the .severity of their symptoms, and, in some cases, 'the fatal nature of the illness. ICqually dramatic is Ihe result of the methods of control. We have. the. satisfaction of knowing that some of these diseases, which in countries that have not our sanitary organisation decimate the population, are, thanks to our efforts and lo the efforts of our predecessors, unknown in this country. '1 here still remains work to be done in regard to some of these diseases before ,we can say that they are eradicated. Those to which 1 am referring this morning are preventable. In the words of his Majesty the King: -Then, why not prevent them.' "

CAUSES OF DIARRHOEA

Outbreaks of diarrhoea could occur in certain districts from the use of drinking water, said Colonel Dawson. These could be divided into two classes, soluble and insoluble. In certain districts the water contained salts in sufficiently strong solution to cause energetic action of the bowels, if used as drinking water. Muddy water contained particles in suspension" If these particles consisted of fragments of silica, talc, or similar material they were liable to set up diarrhoea in persons partaking of the water The South African and Mesopotamia!! rivers were muddy, and they caused this form of illness. Early in 'the South African War, during the advance on Kimberley, this disease made its appearance among the troops. As in Canterbury most of the river water ran underground, this disability was not likely to appear in this district. Alum had'been found to be the most useful substance in removing this mud from water. An outbreak of diarrhoea due to muddy water would resemble one from drinking soluble salines. It would attack newcomers and would be more prevalent among campers.

EOOD POISONING

"Acute intestinal disease may be causby the ingestion of food," said the Colonel. "It must be remembered that good food in excessive quantity may give rise to symptoms resembling food poisoning. As well as the historic instance of the death of Henry 1. from eating lampreys, we can each of us bring to mind some instance, particularly among the young, of acute intestinal disturbance i\ui'. to over-eating. The consumption of food may be a source Ot ill-health in a number of ways, the following being the most important: — _ (1) "The food may be inherently poisonous. Certain plants, including fungi and the flesh of certain animals, are either always, or at special times, poisonous. (2) "The food may bo the cause ot disease because it acts as a vehicle foi the transmission of disease-producing bodies of plant, animal, or bacterial origin. . . (3) "The food may have originated from healthy sources but subsequently because contaminated by bacteria pathogenic to man. The food may or may not he visibly decomposed. (4) "The food may be mixed with poisonous substances. These may have been added as food preservatives or have been absorbed from food containers. These may have been added deliberately or accidentally. (5) "The food may have been so treated as'to be deprived of valuable and essential substances, thereby giving rise to one or other of the so-called deficiency diseases.

POISONOUS FISH

"Many fish, especially those nativo io tropical waters, develop poisonous bodies very rapidly after death so that their consumption even a few hours after death gives rise to symptoms of poisoning, although such fish are quite harmless it consumed perfectly fresh. Apart from these, certain fish, even when alive, possess toxic substances of 'Treat potency. These mainly consist of flic, 'puffers balloon' fish and have been tlie cause of :i number of cases in Japan. Where fish is plentiful, as in New Zealand, and where there are few poisonous fish, cases of this type are unusual.

MUSSELS CAUSE SOME

OUTBREAKS

"In addition lo the outbreaks ol typhoid fever these shellfish have given rise to outbreaks of acute poisoning. In addition to the ordinary symptoms of diarrhoea and vomiting there are prickly sensations in the hands and feet, constriction in the mouth and throat, difficulty in swallowing, numbness and muscular weakness of the limbs. _ It has been found that the mussels causing the illness have been Liken from positions where they are liable to sewage pollution such as dock walls. ' It has been shown thai healthy mussels placed in polluted water became poisonous while harmful mussels kept in clear running sea water losi their virulence." Outbreaks of sudden illness from the consumption of chees-3 were not uncommon, said Colonel Dawson. The chief

sympl ,; Wl'l'i' dial I Imcii, vniiiili ig, ;i'i,l abdominal pain Tin re. was usually some degree of fever, shivering, and collapse, bul as a nil; the were not fatal.,

NATURE OF FOOD CAUSING:

OUTBREAKS

Dr. \V. G. Sfivago, in lii.s book on food poisoning and food infection, gave details of Jl2 outbreaks wliicli lie bad personally investigated, In 101 eases (hens were l-ho following causes: —

Made up meal foods 37 Tinned foods 18 Fresh foods 20 Milk, cream and ice-cream 16 Viscera 5 Other foods 5 Total 101 In a number of cast's I lie fond which caused Ihe outbreak was nou-infcclious al first and only caused illness after the lapse, of a dclinite period of time.

HOMICIDAL ATTACKS

"Jt must he remembered," said Colonel Dawson, "that poisons are sometimes in (rod need into food for criminal purposes, Poisoning by food and drink is as old as history. Kings had thuir fcod taslors and cup-bearers as precautions. We read ill Genesis of a case of foodpoisoning in the household of Pharaoh. We know how Joseph assisted in the. enquiry and in this case the hod and not the wine was to blame. Powdcr-d glass was considered the bisuvjuab " poison in West Africa. Bamboo haiiS were similarly used in the East. Arsenic is easy to obtain, easier to use, unci more certain in its action. H has large,y .supplemented the others.

MUCH WORK TO IJE DONE

'There is still much work to he- done by the. medical officers in the examination of material and in the correlation of cases. The education of the public in cleanliness in the preparation of food is necessary. Meat inspection at the time of slaughter is carefully carried out, in -New Zealand. Our regulations aim at the separation oi the slaughter house from food-preparing places and we must see that they are carried out to the letter. It is our duty and that of the others in charge of slaughter-houses to instruct persons dealing in the preparation of meal- in the danger there of these attacks and the necessity of taking steps to avoid it.- The enforcement of a high standard of cleanliness in premises where made-up meats are prepared is also desirable. Our by-laws are good and the standard they set up must he maintained."

HOUSE-FLIES SPREAD DYSENTERY

Epidemics of dysentery had occurred in tropical and temperate countries. At the present time they were of greater intensity and frequency in those countries where the insanitary habits of natives and primitive conditions of life tended to encourage the spread of disease. In the. tropical country the panics of evil from a sanitary point of view were gathered together in force. The climate was suitable for the growth of the insect life which carried so many of these diseases. Water was difficult to obtain, more in demand and difficult to protect. Direct contagion could only occur when there was gross disregard of ordinary sanitary precautions. There was little doubt that the house-flies acted as carriers of infection. The seasonal prevalence of dysentery corresponded both in temperate and tropical countries with the maximum prevalence of these pests. "The outbreaks of dysentery during the last year arc a warning to us," said the speaker. "You will realise the grave dangers of this disease, particularly to ow Maori brethren. The surroundings of many of our Maori pahs are favourable to the spread of dysentery. The lack of protection of the water supply. the absence of proper methods of disposal of excreta and other refuse, the overcrowding that takes place at tangis and other functions, and the presence of debilitary diseases such as tuberculosis and their indifference and ignorance of disease, and its prevention, make this race particularly liable to epidemics of this type. 'lt was a bad day for the Maori when he left his raupo whare on the top of the hill and imitated the European in his housing and clothing. Measures of prevention became anti-fly measures. Protection of the food and water from pollution, and the satisfactory disposal of refuse should be carried out in an energetic manner. The inspector who can win the confidence of the chief or other head of the pah. and can impress on him the importance of the measures required for the defence against the, scourge has won more than half the battle. As they already possess that confidence we now lock on the Maori nurse and medical man in charge of the Maoris as our greatest ally.

'lnnoculation has not proved as successful as was hoped. Reaction is severe, and the immunity is not a long one."

CARRIERS OF ENTERIC

Enteric fever was a group of diseases associated with drowsiness, headache, diarrhoea and severe prostration. Among (he common causes were direct contact with a patient. It was essential that all attendants on the sick should lie very careful. A carrier patient of unclean habits would soon cause an cutbreak. Persons who had had the disease could still harbour the organisms and pass them though apparently in good health. These persons could readily infect foods. Milk was a 'good culture medium for these bacilli. Many outbreaks had been traced to a carrier who had access to a milk supply. Dust, was certainly one of the causes of typhoid in South Africa. The dust increased as the Hies disappeared, hut the incidence of the disease did not fall off with the decrease of the (lies.

The organism could live for a considerable time in heavily infected clothing. Several epidemics had been started in institutions which bought surplus army blankets from South Africa. "Flies are common carriers of the disease," said Colonel Dawson. "The organisms have been recovered from the intestines of the fly, and from the feet and wings. In the Boer War we were able to trace at least one outbreak to Hies and most observers have had the same experience.