12

E.—3

No. 6. Dr Burns's Beport on Caversham Industrial School. Sir, — Dunedin, March, 1884. I have the honour to present my report on the Industrial School, Caversham, for the year 1883. The number of inmates was 253 —159 males and 94 females, ages from two to fifteen years. The general health of the institution has been good, only one death having occurred—a child admitted moribund, and dying the day of admission. The main cause of the diminished death-rate I attribute to the removal of the infant department to the custody of private families, and I venture to say that, with the continuance of the boarding-out system for the infants, and the maintenance of the same careful supervision over the sanitary arrangements, and the same attention to the feeding and cleanliness of the children, such ought to continue to be the tenor of my future reports —in the absence of any epidemic disease. I take the opportunity of referring to the outbreak of typhoid fever in the preceding year, because it terminated in the year now under report. Two outbreaks of typhoid fever have occurred in the history of the school, the latter the more serious. So convinced was I, from my experience of the former outbreak, that a succession of cases would follow, that immediate precautions were taken by isolating all who showed symptoms of indisposition in the schoolhouse, which stands fifty yards away from the other buildings. That we failed in stopping the progress of the fever was due to the impossibility of preventing all intercourse between the sick and the well. New cases occurred principally amongst the brothers and sisters of those shut up in the schoolroom. Nor was it till I was assured of the futility of all attempts at observing a rigid quarantine in our own grounds, and determined to admit no new cases in our provisional hospital, but to send them to the public hospital (kindly thrown open to us), that the fever ceased. From the 19th November, 1881, to the 20th February, 1882, we had fifty cases— five deaths. After that date we sent five cases to the public hospital, and on the 29th March we reopened the school. I know that my views as to the contagious (i.e., communicable) nature of typhoid fever are not generally entertained. I have been compelled to adopt them from the inadequacy of any other explanation. Our water-supply, if not the purest, is the town supply, got direct from the Silverstream reservoir Our milk was above suspicion. Our drains were excluded as a factor for originating or disseminating the disease, for drains we have none. The excreta, as has been the practice for years, were buried each morning in special pits at a distance from the school, and from which the fall is into another watershed. Above all, the general health of the children was never better No visitor ever suspected from the appearance of the children that we were fever-smitten. The fever was brought to the school by a child, and the second case occurred in the child brought most in contact with him. If, instead of typhoid fever, the outbreak had been one of scarlet fever, just such would have been its predicted behaviour. A few months sinee —January, 1883—we had a fresh case, also in a newly-admitted child. This boy had been under treatment for a month previous in the Dunedin Hospital for a skin complaint in the same ward was a case of typhoid fever We had him removed as soon as the disease was recognized; and no fresh case occurred. If its contagiousness is developed in the well-venti-lated, well-managed, and not overcrowded wards of a general hospital, how can we expect to escape it among our numerous population, whose tender years make them all the more susceptible to its ravages ? Prompt detection and immediate removal of any case that may occur in future may be confidently relied on as the simplest and most perfect means of preventing its extension ; but perfect immunity might have been obtained if the recommendation I gave after the first outbreak had been attended to, viz., that arrangements should be made for the reception of all new committals into temporary quarters, where they might be kept for a month before admission into the school. I have, &c, Bobert Burns, F.B.C S. Edin. The Secretary for Education, Wellington.