LOCAL BOARD OF HEALTH.

Thames Advertiser, Volume IX, Issue 2312, 27 March 1876, Page 3

LOCAL BOARD OF HEALTH.

A meeting of the Local Board of Health was held on Saturday afternoon. There were present Mr James Eonshaw (in the chair), and Messrs Wilson, Davies, Gibbons, and Macnab. The minutes of the previous meeting were read over. A letter was read from Dr Lethbridge, accepting the position of medical officer to the Local Board of Health.

• Mr Davies said he thought it would he better if in future the medical officer attended the meetings of the Board of Health, as a great deal of time and discussion might be saved. He proposed a resolution to the effect that the medical officershouldattend the future meetings of the Board. The motion was agreed to.

A report from J. B. Mason, officer under tbe Board of Health, dated 9th instant, was read relative to cases of scarlet fever in Tararru.—The Secretary, Mr Dean, also stated that on the 15th; instant Dr Payne reported that a child' ofMrMaginn had scarlet fever, and on the same day a note from Mr Power, Kegiatrar, was received,, stating that a case of death had occurred from the same cause, and calling the attention of the Board to the necessity there was for having such cases duly reported by the medical men. After a brief discussion' the subject was dropped, the Chairman suggesting that they, had better now proceed with the special business on which they were called together, . . The Secretary then read the following letter: — " Gfrahamstown, March ''22, 1876. Sir,—l am directed by the Chairman of the Waiotahi School Committee to ask for information bb to the time considered necessary by the Board of Health, for children having had the scarlet fever, to be excluded from the schools or children in whoso families the fever has been raging, as there appears to be a difference of opinion even amongst the medical faculty, and the committee are anxious for some rule to guide them.—l have, &c, Thos. Wayth Gudgeon, Hon. Secretary. To the Chairman of the 'Board of Health."

Mr Macnabsaid the only thing which it was competent for them to do was to get the opinion of the medical officer. Mr Davies said ho had seen the Mayor on the subject several days ago, and he promised to obtain information from the members of the medical profession. This he had been informed by Mr Dean had been done. The School Committeo felt it their duty to do something, but were rather doubtful as to what they ought to do, but thought they would obtain the advice of the Board of Health as the constituted authority. It seemed, an important matter that something should bo done. Some-parents, in whoso families the disease had been, were anxious to send their children to school; and others Would withdraw their children if these were admitted, and, under the circumstances, he. thought the School Committee could not do better than apply to the Board of Health for advice."

Mr Gibbons said he thought if the medical officer gave a certificate, countersigned by the Chairman of the Board'of Health, that there was no danger of infection in admitting these children to school, it would be sufficient./ It would be more satisfactory to leave the power in the hands of the .Chairman to veto the opinion of the doctor in case any unpleasantness arose. , The Chairman said there was no use that ho could see in having the certificates countersigned by the Chairman, There was'no use in their employinga professional man at all if they did not show confidence in him.

Mr Gibbons said ho thought that other questions might arise, and a precaution of. that sort would prevent alarm. Mr i)ean then read the replies from the medical gentlemen of the Thames, as follows:- ' Pollen-street, March 23,1876. Dr Kilgour having been requested by his Worship the Mayor to give information for the use of the Foard of Health on the following points, viz,:—l. The lapse of time which ought .to' ensue before a child who has been affected by scarlatina may safely be permitted to associate with other children ? 2, In like manner, how soon may a child who has been living/with, persons affected by the disease be permitted to associate with healthy children ? 3. What circumstances would be likely to lengthen or shorten the period of danger, or to increase or decrease the .danger during such period? Has much pleasure in acceding -to his Worship's request; and, in reply to question No. 1, Dr Kilgour considers fourteen days to be the minimum time which ought to elapse after complete recovery from scarlatina before the patient ought to' be permitted to mingle with healthy children, In reply to question No. 2, Dr Kilgour is of opinion that, in the case then supposed, twenty-one days ought to elapse before permitting the child to : mingle, with others, the reason for the addition of seven days being that the incubation of the disease, although umally completed within fourteen days,, may possibly exceed that period. 3. The circumstances likely to affect the third question are:—(a) The state of the child's clothing; (b) the condition of the house in which he lives j (c) the epidemic tendency to the disease.

As regards the Thames, it must be borne in mind that a very severe and general epidemic of measles lately visited the district, that few children escaped- that visitation, which probably still exercises a protecting, power oyer the individuals who was affected by it. , Mary-street, Shortland, -.. -Dr. Letiibiidga has much, pleasure in replying to the Mayor's questions with reference : to scarlatina as follows:—Question 1: The answer to this depends entirely upon when the date of recovery is taken. The period of desquamation which is , considered the most infectious, sets in usually about the ninth day of the fever, and continues on an average from eight to fifteen days after that. Now, this latter period isoue during which the majority of cases will be pronounced by the friends " recovered J" when, in point of fact,. they aro by no means so., This latter stage may be prolonged up to forty days, so that I .would say that it would bo only safe to. let children associate with others at a date of at.least fifty' days from the first invasion of the'feverish symptoms. Question 2: With respect to children who have been with scarlet fever patients without taking the disorder, I consider a period of sixty days would he practically ample time to

nl'ow before sending them to school again, Qurstion 3: The circumstances likely to lengthen the periods would be (a) the virulence of the attack; (4; with respect to question 2, whether the children first attacked and lived with by the other children, recovered or died early in the course of the malady; (c) whether proper disinfection of clothes, bedding, and rooms in the houses where patients resided had been well carried out j [d) if children wore woollen or stuff clothes which they had worn with the patient. Such materia's are much more likely to retain the contagious matter. The whole family, both recovered and unattacked, should wear linen or cotton garments, and clothes of any material should be properly washed and disinfected. March 22,1876,

To his Worship the Mayor of Thames. Sir,—ln answer to a communication received this day from the Board of Health, I beg to offer the following statements:—l. A child convalescent from scarlet fever ought not to associate with others who have not had' the disease for a period of one month from the time of the red rash, 2. In answer to your second question I would refer you to what I shall say further on. I consider that- the risk of association with healthy children froin the infected house will depend entirely upon whether the parents are able and willing to take proper precautions, Unless full confidence is f«lt in them the month's quarantine should be enforced. 3. Attention to greasing or oiling the skin daily greatly diminishes the danger of contagion, and mollifies the virulence of the disease. The oil not only acts mechanically,, keeping the little particles of cuticle from Beattaring and carrying infection with them, but besides this it really disinfects them. Again, if the healthy children are carefully separated from the sick—if no unnecessary carpets, curtains, and the like are allowed in'the bedroom —if ventilation is properly attended to—if the excreta are carefully disinfected and buried—if. all clothes and bedding that have touched the sick are carefully disinfected by boiling or otherwise, then the period of danger will be: much shortened, and the danger itself will be; greatly decreased. If those points are' carefully; . attended to the risk to others who are obliged to communicate with the infected family will bo reduced to a minhnum.~l have, &c, Alexander Fox, M.D., M.R.O.P. ■March 22,1876. Dr Payne will be>happy to give tho Mayor the information requested in answer to the following questions :-l. How.soon after a child has recovered from an attack of scarlet fever may it associate with other children without risk to the latter? Answer—Not less than three, weeks. 2. The like as to a child who was : living with a scarlet fever pHient during the. attack? Answer—The period of incubation varies from a few hours to 14 days, but the poison might be retained in and be communicable by the clothes for a much longer period.; 3, What circumstances would be likely to lengthen or shorten the period of danger or increase or decrease the danger' during such period ? Answer—The absence or otherwise of proper hygienic measures, such as boiling or hot ironing all clothes, and moreespecially all woollen articles, proper fumigation of .rooms, free use of carbolic acid, poison may otherwise hang about an indefinite time, and any accident might convey it to another house. Thames, March,22,1876;

Shortland, 32nd March, 1876. To his Worship the Major. Sir,-In reply to your circular of this date, I have to reply that "scarlatina" continues infectious eo long as the desquamation of the cuticle is going on, and that the disease is considered to be propagated through portions of this cuticle being borne about either on the persons or clothing of those who have suffered from the disease, or of those who have come in contact with them. Infection may therefore hang about both classes of persons, above-men-tioned for an indefinite period, unlessboth persons and clothing have been most efficiently disinfected.' Considering the high.rate of mortality during the late epidemics of measles and whooping-cough, I consider that both the local authority and School Committees would very much fail in their duty were they to allow children from an infected district to associate with those in a healthy one., I do not consider it possible to err in over-caution in this respect, and individual cases of inconvenience and hardship should not be allowed any weight against the public good. As in cases of quarantine, I consider it a bad precedent to deal with individual cases, " Children from an infected district Bhould' be, absolutely excluded from schools in a healthy district till the' district as a whole can be pronounced healthy."—l am, &c, Wm. A. PbrStok, M.D.

A lengthened ..discussion then ensued as to the varied character of the medical opinions, and as to how the schoolmaster or the committee could ascertain the time when a patient was convalescent. Mr Davics said that in his opinion the only feasible, plan was to get the medical officer.of the Board of Health to visit.tho premises and report. In the case of,Mr Steedman's family,' the school committee were prepared to pay the fee out of _ their own pocket, for being the first case it was k sort of- precodent, and they thought extreme caution was necessary. But he thought it would b* best if the medical officer of the Board of Health reported and let the school committee know. By that means no injustice would be done, and the responsibility would rest on the medical man who was supposed to know all about it. If it was loft altogether in the bands of the sohool committee some parents would think it hard to have their children, excluded from school; and others would think it a. hardship if they were admitted, and it was impossible that they could please everybody. In cases like these, where skill was required, it was better to leave these questions in the hands of those who were considered competent to judge. The Chairman asked who was to pay the medical officer for reporting on those cases?-

Mr Davis said he considered it came within the duty of the Board of Health, being a matter which affected the health of the district. ,

Mr Gibbons thought these inspections would lead to professional jealousies, and asked whether it would not be better for the parents or guardians of children who had been infected, or who lived in a house where the disease existed, to obtain a certificate from the doctor who attended the cases as to the time of recovery. ' The parents would get those certificates, and thero would be data upon which to go. The school committee would then only have to fix the number of days which must elapse from the date of recovery until the children could be admitted to school.

The Chairman said that the objeot of the meeting was to agree what they were to recommend to the school committee— to answer their letter in fact.

, After some further disoussion, Mr Macnab proposed—'.' That copies of the letters received from the medical gen tiemen be forwarded, to Mr Gudgeon, the hon. secretary of,the Waiotahi. School Committee." Mr Wilson seconded this motion.-' Mr. Gibbons proposed, aa an amend? mend—" That the Board recommend the school committee that thirty days be allowed to elapse from date of recovery before children who had been infected, or in whose family infection had existed, be admitted to school." . •

This motion was not seconded, and was withdrawn. • • Mr Gibbons then proposed-" That the letters of Mr Gudgeon and the medical gentlemen bo referred- to the central Board of Health, asking their advice, and if necessary, to have a regulation framed

and brought into force beating on the question." Both motions were agreed to, and the meeting then terminated.