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34
Compared with last year the table shows 69 less notifications of scarlet fever,
but three fatal cases instead of one. There were 19 more notifications of
diphtheria, but the percentage of fatal cases was slightly lower ; the notifications
of enteric fever were 9 more, but the fatality was less than last year.
THE GUARDIHNS AND INFECTIOUS DISEASE.
The agreement with my Council accepted on December nth, 1912, only
lasted until December 25th, 1913—barely 12 months—when it was terminated
by notice from the Guardians given in a letter of their Clerk (Mr. Shelton) on
July 23rd, 1913. During 1914 my Council received no payment whatever
for dealing with outdoor paupers suffering from infectious diseases, but the
Enfield and Edmonton Joint Hospital Board have continued receiving paupers
resident in the Guardians institutions in Enfield and Edmonton at 7s. instead of
4s. 6d. a day, when there is room for them. In July the Joint Hospital Board
informed the Guardians that the latter charge would be reverted to, if and when
the Guardians renewed payment to the District Councils of Enfield and Edmonton
for outdoor pauper cases.
In January I submitted a report as to the past history and present position
of the subject and advised the Council as to the best course to pursue, and our
Clerk presented a statement as to the legal aspect; he gave his opinion that
" Any agreement should be between the Joint Board and the Guardians
for casep of disease for which the Joint Board has provided,
including conveyance to and from the hospital."
I received the Sanitary Committee's instructions as to dealing with infectious
outdoor paupers whilst the agreement was in abeyance. The Clerk was
instructed to confer with the Clerk of the Guardians, which he did on January
29th.
In January there were four cases of scarlet fever in a poor family and in
February a case of diphtheria in another. The latter case was ultimately
removed to our hospital, but the former four remained at home under the care
of the pauper medical officer. I drew the attention of the relieving officer and
the clerk of the Guardians to them, as owing to the expiration of an agreement
with the Guardians in December 1913, the responsibility for the care of these
five persons rested with the Guardians.
In February the Clerk reported that Mr. bhelton maintained that his Board
were not liable for the isolation of any cases outside the workhouse premises
and that his Board would not enter into an agreement with the Council, unless
it provided for the isolation of all cases of infectious disease within and without
the workhouse premises. The Clerk and I were then instructed to interview