[from the Medical Aid and Poor Relief Commission Report - 1879]

APPENDIX VII. - Minute of October 31, 1877, by the Lieutenant-Governor

The Lieutenant-Governor lays the following statement with respect to the number of known smallpox cases that have occurred within the town of Douglas and the number of deaths resulting therefrom, before the Tynwald Court, and invites the attentive consideration of the Legislature to the same.

Since the 8th July last to the date hereof there have been 102 reported cases. Of this number 27 had been vaccinated, 62 never vaccinated, one case of inoculation, and 12 vaccinated after incubation.

Among the unvaccinated there have been 25 deaths; while from among those attacked, and with whom the vaccination had taken, only 3 have died.

The number of deaths among the unvaccinated persons attacked has been at the rate of about one in two and a half, against a death rate of one in thirteen amongst those who had at some period of their life been vaccinated.

Dividing the vaccinated cases into two heads—viz., primary vaccination and re-vaccination—the following results are shown :—

Two out of the three vaccinated persons who have died were aged respectively 17 and 25, and had not been vaccinated since young; the third case was that of a baby, and death is reported to have ensued by convalsions in teething. Among re-vaccination cases no deaths have been reported.

The outbreak of the disease may be traced to a visitor who was removed to the Hospital, and it is supposed the contagion was conveyed by a woman connected with the Hospital, who herself caught the smallpox. The first attacked in Douglas were those who had never been vaccinated. This gave the disease a hold that it might not otherwise have obtained; but, once established in the most crowded part of the town, it has spread from family to family with considerable rapidity.

The conclusions that the Lieutenant-Governor draws from the figures now placed before the members of the Legislature, and from the spread of the disease, are —

1. That the statistics, supported as they are by similar experience gained in England, point to the necessity of compulsory vaccination.

2. That any epidemic disease once introduced into Douglas is very difficult to check, owing to the overcrowded state and absence of sanitary supervision over the poorer houses of the town. These houses are let out either in single rooms or in flats, and are to all intents and purposes "lodging-houses," yet, from the definition given in the Common Lodging-house Act to the term "common lodging-house," evade being brought under its provisions. In the licensed common lodging-houses, not a single case of smallpox has occurred. The Lieut.-Governor therefore submits that much of this evil of overcrowding could be remedied by an amendment of the definition given to common lodgings in the Insular Act, and by placing the law in this respect on a footing similar to that in England and Ireland.

3. The necessity for the appointment of a responsible sanitary officer for the whole Island.

4, The compulsory closing, where water can be obtained from the mains, of all wells within towns into which sewage and animal matter are likely to percolate.

There is another requirement, the importance of which has long been apparent, but which the smallpox has brought into unusual prominence, viz. the necessity for larger hospital accommodation - a building of sufficient size, with adequate arrangements for the reception of infectious cases, without danger to or interference with patients who may be under treatment for non-infectous diseases.

The Lieutenant-Governor considers the Tynwald Court may very materially promote and encourage the establishment of an efficient Hospital, and he is satisfied that the question will command the sympathy and careful consideration of both branches of the Legislature.

Considerable funds which may be applicable to the erection of a building already exist, and the The Lieut.-Governor believes it only requires a well-devised and well-considered scheme to ensure the further support of the public in the undertaking. The main difficulty doubtless exists in the selection of and the means of acquiring a suitable site of sufficient extent, for the nature of the buildings require their being detached from other houses, while the comfort of the inmates would be greatly enhanced,and their recovery expedited, if the surrounding enclosure included a garden, in which convalescents could sit and take exercise.

The Legislature is aware that the site purchased to 1871, in contemplation of the erection of public buildings thereon, returns no revenue lo Island. Its extent is 5,258 square yards of land.

Circumstances have rendered the erection of public buildings unlikely for the present of fulfilment, while even if they are to be provided at some future period, considerable doubt exists in the minds of many members if the site selected is the best for the purpose.

The Lieut.-Governor believes there is no public building the erection of which is more needed in the Island than a good Hospital; and, therefore, suggests for the consideration of the Legislature that the Tynwald Court should give upon certain conditions, for the erection of an Hospital, the site that was purchased for the legislative and other public buildings

The Lieut.-Governor will briefly refer to some of the conditions that he would consider essential, and others that he considers very desirable, if they could be carried out. The essential conditions are

1. That the Hospital shall be open to the whole Island.

2. That it can be shown that funds will be forthcoming for the erection of the requiste buildings

3. That an endowment be provided, sufficient for the maintenance of a resident surgeon and one nurse.

4. That a scheme be approved by the Tynwald Court for the management of the Hospital.

5. In the event of the Hospital being closed, that the land reverts to the Insular Government.

6. That neither the Hospital nor site can be sold except with the consent of the Tynwald Court.

The Lieut.-Governor would be glad if effect could be given to the following suggestions :-

1. That the medical gentlemen of the other towns be ex officio members of the Committee, and that they should be in communication, when necessary with the governing body of the Hospital

2. That dispensaries should be established in all the towns and villages, and be in connection with the parent Hospital, the dispensaries to be placed in the charge of medical men of the district. The times for attendance to be regulated according to the requirements of the place - in Castletown,Peel, and Ramsey, probably daily; while at Port St Mary, Ballaugh, Foxdale, Kirk Michael, Jurby, Laxey,&c once or twice a week. In the smaller places, a room in which medicines could be locked up, and patients seen, would be all that was necessary. The public vaccinators might be able to work the dispensaries in their several districts.

With the view of eliciting the opinion of the Tynwald Court upon the questions raised in this Minute, the Lieut.- Governor will shortly submit the following proposals, in the form of resolutions, for the determination of the Court :—

1. That, in the opinion of the Court, it is desirable that vaccination should be made compulsory.

2. That the definition given in "The Common Lodging-house Act to the term "common lodging-houses" be amended so as to include the class of house to which reference is made in the above Minute.

3. That it is also advisable, in the opinion of the Court, that a sanitary officer should be appointed for the whole Island.

4. Taking into consideration the urgent necessity that exists for more extended Hospital accomodation, the Court will, subject to conditions to be hereby approved of by the Court, sanction the coveyance of the land purchased for the legislative and other public works to certain authorities on which to build a General Hospital for the Island.

A report from the Sanitary Committee appointed under the authority vested in the Lieut.-Governor by "The Nuisances Removal and Diseases Prevention Act, 1851,\u201d will at an early date be laid before the Court.

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