7

H.—3l

Pollution of Streams by Sewage. —The Wairangi outbreak comes under this head, and it is the more interesting when we learn that this is the third epidemic which may be attributed to the conveyance of infection by the Wairangi Stream. The first occurred about nine years ago, when some cases occurring on the banks of this stream at the upper part of the valley were followed by others in families drawing their domestic supply from this source about half to one mile further down. In November and December, 1902, eight cases of enteric arose in the district, while a ninth person developed the disease immediately after he left the neighbourhood. The original source of infection probably was among some Maoris, whose settlement is situated on the banks of the upper part of the stream. In October there were five cases of fever in this settlement, and one woman died. A few weeks later a man (A), living on the banks of the stream, and drawing his water-supply thence about 300 yards below the Native village, developed enteric. Just at the time he took ill a ball was held in the district school, and water was obtained from a spot a few yards below his house. A few days after, an outbreak of severe diarrhoea occurred among those present at this ball, and later five of the guests developed typhoid. These cases live far apart, and as all took ill about the same time, and the water drunk at this ball seems to be the only thing they had in common, it seems pretty certain that the infection was in this water. This is the more likely since, privy and drainage accommodation being absent from the house in which A lived, everything went into the stream just above the point at which the water was obtained. Later three other cases occurred among other members of the infected families, the transmission being evidently by the agency of the various sanitary defects which obtained at these houses, a well polluted by slop-drainage, a leaking privy, and so forth. It seems probable, then, that the infection in case A was water-borne from the Maori settlement, where the usual primitive arrangements hold, the Natives bathing and washing their clothes in the stream. A repolluted the stream, and so infected the guests at the dance. The preliminary outbreak of diarrhoea is interesting—probably being an example of the infection by B. coli, recorded by Lorrain Smith at Belfast as preceding the invasion by the B. typhosis. It is remarkable that this creek should have been the means of spreading the infection in three distinct epidemics, since the conditions which conduced to the earlier ones no longer exist. It would seem to indicate that the nature of the water was favourable to the life of the B. typhosis. Local Conditions. In the majority of cases no very definite source can be traced, save that there is some unwholesome condition —a filthy open drain, a leaking privy, or a foul cesspit. The repeated outbreaks —single cases, perhaps —occurring in the same house one year after another go to prove that there are infected spots where the disease may lie dormant, awaiting some favourable condition to awaken it into activity. While dirt and evil smells are known to predispose to this disease, there must be some agency by which the specific germs are carried to the foods and drink—flies, very probably, play a part in this. I feel convinced that, so long as the present slipshod imperfect methods of removing nightsoil are permitted to continue in the city and suburbs, typhoid will remain a prominent feature in the diseases notified. At Hamilton an outbreak occurred, confined to six cases. I have failed to account satisfactorily for these. They seemed to coincide with the turning-up of the soil while the water-mains were being laid, but there is no evidence that this soil was polluted. On the whole the cases seemed to have some connection with a block of buildings in the main street, where lack of drainage produces a very foul condition of affairs in the back yards. I record the following cases as of interest, because the evidence is in favour of unexpected methods of conveyance. Water-cress. —Five cases, with apparently nothing else in common, living widely apart, arose after eating water-cress from a spring in the Penrose district. There is no visible evidence of pollution of the water, yet it seems strange that all five should have the same history. The spring is out of the way, and the cress not widely used. Oysters. —The third in a series of cases arose this year in a family at Waikumete. In each case is the same history—of eating oysters from a particular point on the upper reaches of the Waitemata Harbour. An interval of nearly a year occurred since the last case. There is no direct source of pollution of the oyster-bed, except that it is at the mouth of a tidal creek which receives the subsoil drainage from the Waikumete Cemetery. SCARLET FEVEK. Since March, 1902, there has been a fairly widespread epidemic of scarlet fever, though at no time or place attaining any alarming dimensions : 318 cases were notified, of which the city alone was responsible for 86, the suburbs 94, and the country districts 138. The type is evidently mild, since but three deaths occurred during this period from this disease. Grey Lynn and Arch-hill suffered most severely of the suburbs, and the district school, which probably was responsible for spreading this disease, was closed for three weeks and thoroughly disinfected, with good effect. Of the country districts, Bay of Islands County, with thirty-five cases comes highest. Most of the cases occurred in Kawakawa, where there was a somewhat severe outbreak in December. There was an utter neglect of all precaution, and most of the cases were not notified, the householders pleading ignorance when questioned. Several deaths resulted. The school, which was largely the means of distributing the disease, was closed, and at my suggestion the County Council appointed Dr. Menzies as Medical Officer under the amendment of " The Public Health Act, 1902." Inspector Winstanley was sent up with the necessary disinfecting appl : mces, and the school and houses were disinfected. This checked the outbreak, though there was a slight return in February.