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The transhipping of dust is carried on within a short distance of houses in
Melbourne Grove, the platform of East Dulwich Station, which is used by a great
number of people travelling to the City, and a much-used 'bus and tram route.
While, on the other side (i.e., the north) of the line and station is Constance Road
Workhouse.
Taking a measurement from the map of the nearest point of any of the Infirmary
Wards to the siding on which the dust trucks are, I find it to be 70 yards;
and the furthest distance that I have ever detected the slightest smell of dust to
the leeward of the discharging carts is eighty-five paces, i.e, roughly about 60 to
70 yards, and that only when a very strong wind was blowing towards me and dust
disposal was in active progress. But between the truck line and the Infirmary and
in the grounds of that Institution there is a belt of trees in one part and a large
building in another which must certainly break the current of air.
The original complaint was, I understand, of dust and smell, but this has
recently been enlarged to include the disposal of manure as being the causes of
enteritis in the Infirmary. For the information of the Committee I set out below
in tabular form for the three years 1911, 1912, and 1913, the combined deaths from
enteritis and those from epidemic diarrhoea, gastro-enteritis and zymotic enteritis in
children under one year, and all over that age since May of this year and for the
corresponding weeks of 1911 and 1912. (See table facing p. 26.)
The curve of mortality from infantile diarrhœa is said by Osler to usually rise
in May, increase in June, reaching the maximum in July, and gradually sinking
through August and Septemper.
I have sub-divided the incidence up to the end of August for the three years
1911, 1912, and 1913, and have classified these deaths under the heading of
Southwark Infirmary; our own Infirmary in Camberwell; of Constance Road
Workhouse (the female sick ward of which is not very far from the trucks); the
Borough generally, and of institutions outside the Borough where deaths have
occurred. I have als taken a radius round Glengall Road Depot corresponding to
the distance of the trucks from East Dulwich Infirmary. The neighbourhood of
Glengall Road Depôt being partly occupied by factories, the figures relating to this
must be judged accordingly. But in the three years there has only been one death
from diarrhoea, so that there appears to be no reason to even hint at the dust
transhipping at this Depot to be a cause of enteritis. These figures must, of course,
be considered with the fact that we have no knowledge of how long each of these
fatal cases has been in the Infirmaries, nor of the actual number of children in them
at the time. Too much reliance must not therefore be placed upon them.
I think it may fairly be said that two points stand out: firstly, when there is
much enteritis in the St. Saviour's Infirmary, there is always considerable prevalence
elsewhere in other parts of the Borough; secondly, the great freedom of
Constance Road Workhouse from illness and complaint.
The smell from the trucks I have mentioned above. I would also point out
that on the grass and young shoots of the bushes and small trees that are growing
close to the Infirmary wall there was 110 evidence of dust, although I visited after
several days' dry weather and northerly winds. Further, when I have been there I
have seen members of the staff sitting outside in the open air between the trucks
and the Infirmary itself, apparently suffering no inconvenience. I have also been
in the grounds of Constance Road Infirmary when the wind was blowing direct from
the dust carts and trucks to me, and although I was as close to the wall as possible,
I could detect no smell.
There remains to consider the smell of the manure. This is usually fairly
strong in the immediate neighbourhood of the trucks where it is actually being taken
from the carts, weak round the full trucks, while in both cases it is practically nonexistent
at a further distance.
In conclusion, I would especially ask the members of the Committee to very
carefully weigh the facts set out. and to bear in mind that because the handling of
dust takes place near an institution where children have been attacked by enteritis
that it is by no means necessarily a case of cause and effect. There are many other
factors to be weighed and excluded before we can accept what is, on the evidence
supplied, nothing but theory.
I am, Gentlemen, your obedient Servant,
FRANCIS STEVENS,
Medical Officer of Health.