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County Council of Roxburgh.
FIRST
ANNUAL REPORT
TO THE
COUNTY COUNCIL
(YEAR 1891),
BY
M.J. OLIVER, M.B., D.P.H.,
Medical Officer of Health.
KELSO:
PRINTED BY RUTHERFuRD & CRAIG.
1892. |
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To the Right Hon. the Convener and Members of the
County Council of Roxburgh.
MY LORDS AND GENTLEMEN, -
In compliance with the regulations of the
Board of Supervision, I have prepared, and have the honour
to submit for your consideration, the following report on
the health and sanitation of the County and Districts of
Roxburgh during the year 1891. The report is necessarily
incomplete, owing to the short time I have been in office
and the absence of records of the work of former sanitary
officials; but I have endeavoured to give some information
about each of the subjects upon which it is my duty to
report.
The mortality tables and death-rates refer only to the last
five months of the year, and are therefore not so reliable as
if they were compiled from returns for the whole year.
Many important matters must be left over for consideration
in future reports; and if in many respects this report appears
to be meagre, it must be remembered that there is only one
sanitary inspector in the County, and every department of
public health cannot therefore be dealt with at one time.
I am,
My Lords and Gentlemen,
Your obedient Servant,
M. J. OLIVER.
NEWTOWN, ST. BOSWELLS,
30TH April, 1892. |
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REPORT
MY work as Medical Officer of the County, and of the five
Districts of which it is composed, began on the 13th July
last. It has consisted, to a large extent, of inquiries into the
general sanitary condition and needs of the County, whilst
much time has been spent in visiting villages and farms, in
preparing bye-laws, and in attending the numerous meetings
of committees.
The services of the former medical officers and sanitary
inspectors have been, or shortly will be, dispensed with in
all the Districts, with the exception of Liddesdale, where the
local sanitary inspector has been continued in office.
I am not aware of what work was performed in the earlier
part of the year, and all work referred to in this report has
been done by Mr. Morris, Sanitary Inspector to the County
and Districts. It may, perhaps, be useful to enumerate the
different classes of work he has to attend to in an area of
663 square miles, and for a population of 26,605 persons :-
1. The inspection of dwellings, made when complaints
have been received, or when District Committees
order reports to be made.
2. The inspection of villages, which should be visited
quarterly, if not more frequently, to secure the
regular removal of refuse. |
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[Page] 6
3. The inspection of dairies and byres, visits to be made
quarterly; owing to the large number of byres,
much time must be occupied in this work.
4. Inspection of common lodging-houses. There is only
one in the County, in Yetholm; but, as it has to be
visited monthly, twelve days a-year have to be spent
in that village or its immediate neighbourhood.
5. The inspection of bakehouses, about two visits a-year
to each.
6. The inspection of slaughter-houses, required at least
quarterly.
7. Supervision of new drainage works, one of the most
important of an inspector's duties, and occasionally
occupying much time.
8. Visits to houses in which are cases of infectious disease.
9. Fumigation of above houses, and the disinfection of
clothing - a proceeding which, with time spent in
travelling, usually occupies a day.
10. Seizure of unwholesome food.
11. Attendance during legal proceedings, getting up evi-
dence, finding witnesses.
12.Collection of samples of water and the inspection of
wells.
13. The keeping of registers and records of all work done.
The issuing of notices, correspondence, and the
preparation of special and periodical reports for the
five District Committees and the County Council.
The only assistance the Inspector has is that of the police,
but it is clearly out of the question that the constables be
asked to make inspections, or carry out disinfection, or
perform the ordinary duties of a sanitary inspector. The
members of the police force must receive all orders through
the Chief Constable, and I may here take the opportunity of
acknowledging the courtesy of this gentleman, and thanking
him for the trouble he has taken in arranging to render the
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assistance of the constables as effectual as the nature of the
force renders possible.
Police assistance is practically confined to giving infor-
mation, and the constables have orders to report to the
Sanitary Inspector any cases that come to their knowledge
in which his interference is necessary.
VITAL STATISTICS. - In addition to observation of those
things which are known to affect the health of the community
injuriously, it is necessary - to study the effect on the public
health of the general conditions of life, and, by means of rates,
to compare the mortality with that at other places or at other
times; for this purpose mortality tables are constructed
showing the number of deaths which have occurred within
the past year. It is also useful to record the mortality in
a convenient form for future reference, and for the use of
those who are studying the conditions which influence the
spread of disease - a study of which the public ultimately
receives the benefit.
An accurate statement of the population is required if
averages and rates are to be trustworthy, and it is, perhaps,
a medical officer's first duty to ascertain the population within
his district.
As the population is not constant, it is usual to make an
estimate of the changes which have occurred since the last
census, and this may be easily done in the case of large
populations; but in a purely agricultural community the
number of the people depends more on the methods of
farming than on the natural increase, and cannot be even
approximately estimated by means of a mathematical calcula-
ion. An estimate based on the excess of births over deaths
gives no better result, owing to the emigration of numbers of
young persons to the large manufacturing towns. Under the
circumstances, I shall take the number of the population as
found at the last census in March, 1891, believing that
figure to be as nearly correct as any estimate that can be
given. |
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The subjoined table gives the populations of the Districts
and the decrease since 1881 :-
[Table inserted]
The decrease in fairly uniform over the whole County, there
being only seven registration districts in which a slight
increase has occurred.
During the last ten years a similar decrease has been noted
in other agricultural districts in Scotland, and is doubtless
due to the effects of bad seasons and the conversion of arable
to grass land. One would naturally expect to find that the
poorer classes have at present more house accommodation than
they had ten years ago, and it will be interesting to notice,
on the publication of the complete Census Report for 1891,
if the number of inhabited houses in the County has fallen in
proportion to the population.
In addition to an accurate estimate of the population a
medical officer should have reliable information of the number
of births, deaths, and marriages in his district; and besides the
mere number of deaths, he should also know the age and sex
of the deceased, the occupation, and the cause of death. The
use to be made of the last particulars is sufficiently obvious,
and the birth-rate is required because it influences the death-
rate; whilst the number of marriages, again, affects the birth-
rate. The Public Health Committee authorised me to expend
about ten pounds in obtaining returns of deaths from the
local registrars - a sum which I found to be hardly sufficient
for the purpose, but after numerous interviews I am now -
thanks to the good nature of many registrars - supplied with
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the necessary information as regards deaths, but have no
returns of births made to me. The arrangement made is that
each registrar is paid 3d. for each death returned, with a
minimum fee of 5s. a-year.
As the information is required for public purposes, such a
method of obtaining it is unsatisfactory. Representations
have already been made to the Secretary for Scotland on the
subject, but without immediate effect; and apparently legis-
lation is the only remedy. There can be no doubt that it is
required in this instance, seeing how largely local authorities
and medical officers have to depend on vital statistics in
judging of the necessity for sanitary improvements.
BIRTHS. - In the County, including the towns, there were
1283 births in 1891, equal to 24·24 births per 1000 persons
living, on an estimated population of 52,963. The mean
rate for Scotland for the ten years 1880-89 was 32·3.
The above has been taken from the Registrar-General's
report, and I am unable to give the same information for the
County, excluding the burghs, not being authorised to obtain
the necessary data from the local registrars.
DEATHS. - In 1891 there were 1010 deaths in the County,
including the burghs, equal to an annual rate of 19·082 per
1000 persons living, on the estimated population, and, as with
the births, this may be compared with 19·000, the mean rate
for Scotland for the ten years 1880-89.
During the 22 weeks ending 2d January, 1892, there were
178 deaths in the County, excluding burghs, equal to an
annual death-rate per 1000 persons living of 15·867 on the
census population of 26,605, to 15·899 on an estimated
population.
In the four parishes, Hawick, Wilton, Jedburgh, and
Kelso - that is, the parishes containing the towns - the rate
for the same period was 19·385, calculated on an estimated
population of 30,540.
The mortality tables may be consulted for the detailed
information of the ages at which deaths have occurred and |
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the causes, and in one of the tables the death-rates for the
different districts are compared. In the first table the Local
Government districts are compared, and in the others the
Registration districts; but no rates are given for the latter,
the populations being too small to allow of such a method of
comparison being used with any approach to accuracy.
INFECTIOUS DISEASES. - The Act for the Notification of
Infectious Disease not coming into operation until March,
1892, there is no doubt that several single cases of disease
were unheard of, and it has since been found that in some
instances an extravagant notion of the duties and proceed-
ings of the Sanitary Inspector was the cause of things being
kept quiet which might otherwise have become known.
It is to be hoped, however, that the public will soon find
that the Sanitary Inspector is of real use in securing the
disinfection of clothing and houses, and that the intervention
of the Local Authority's officials, it at times troublesome, yet
is also of service to the patient's family, and to some extent
a safeguard to other people. Apart from isolated cases,
there were two small outbreaks which threatened to spread,
one of scarlet fever in the Melrose District and the other of
enteric fever in the Jedburgh District. Our fears, however,
proved groundless, and the fevers were confined to the
locality in which they originated. A full account will be
found in the District reports.
ACTION TAKEN. - There being no fever hospital at the
disposal of the local authorities (with the exception of one
bed in the burgh fever hospital at Hawick), isolation and
disinfection had to be carried out entirely at the patients'
homes, and the difficulties of carrying out thorough disinfec-
tion were materially increased by the absence of any apparatus
for the purpose.
On hearing of a case of infectious disease a visit is at once
made by either the Sanitary Inspector or by me, and to
ensure uniformity the same questions are asked in each case,
and the answers noted in a book provided with a printed
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fly-leaf, pasted in it in such a manner that it may be turned
out, when the printed lines correspond to the lines of the
pages, and the information required under each heading is
entered on the corresponding line of the page. Such a
note-book is more convenient that that in general use. The
fly-leaf is reproduced below:-
Parish. Day. Date.
Address.
Occupier. Owner. Agent.
Patient's Name, Age, Sex.
Workplace or School (Standard).
Sunday School.
Earliest Symptoms and Date.
Disease Notified. Date on Notice.
By whom? Name of Medical Attendant.
Date of his First Visit.
Rest of Family. Names and Ages.
Workplaces and Schools.
Milk Supply.
Sources of Infection.
After making any other inquiries thought necessary, an
examination of the house is made, and the results are noted
in a similar manner. An effort is then made to secure as
complete isolation of the patient as is possible. This is the
most unsatisfactory part of the proceeding, as it entails
trouble on the part of the patient's friends, and there is
difficulty in getting them to follow directions in every par-
ticular, and unless the details are attended to real isolation is
impossible.
Lastly, if it is required, a bottle of carbolic acid is supplied
gratis, with printed directions for its use. |
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If there are any children of school age in the infected
house a notice is sent to the master of the the school they attend.
On returning home the information obtained is entered in
a register, and as the advantages of a register are to a certain
extent lost by cutting up the country into small areas and
having a register for each, all the cases in the County are
entered in the same register. The columns in the register
are arranged with a view to easy reference. In the first
column are entered the number of the case, the date of
inspection, and the parish; in the second, the name and
address of the patient; in the third, the date of notification
by the householder, his name and address; in the fourth, the
date of notification by and name of the medical attendant;
in the fifth, the nature of the disease. In the succeeding
columns a number of facts are noted with reference to the
patient's circumstances or those of his family. Of these the
chief are the patient's occupation and the address of his work-
place; a change of residence; the date of the commencement
of the disease; the ages, occupations, and the situations of
workplace or school of the other members of the family;
the name and address of the milkman; the nature of the
water supply. Then follows information as to the state of
the house; the number and size of rooms; the number of
inmates; the condition of walls, floors, and roof; the number,
situation, and kind of sinks, drains, water-closets, ash pits, and
their condition.
Such a register is of the greatest use in practice.
By it one can, on the shortest notice, give information
as to the details of any infectious case; and the infor-
mation is tabulated for reference if it is required to report
to a District Committee. From the view of a medical officer,
its value is chiefly due to the facility with which the
details of a number of cases may be compared, and investi-
gation into the causes of an epidemic assisted. Thus, if the
name of the same dairy appear frequently in the column
devoted to milk supply, an inquiry should be made at that
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dairy; or if the infection is spread from a school or workshop,
attention can hardly fail to be directed to the original cause.
A complete system of investigation, to be carried out in
each case, takes up much time, and I should not advocate or
practise it if I were not convinced that it is only by attention
to details that any success is to be achieved in checking the
spread of fevers. At present, not being supplied with suit-
able means of isolation or disinfecting apparatus, it is impor-
tant to gain a knowledge of the course take by epidemics in
the country and the agencies by which infection is spread, so
that if in one direction much cannot be done, yet information
may be obtained that will ultimately prove useful.
HOSPITAL ACCOMMODATION. - The hospital accommodation
of the County consists of a single bed in the Hawick Fever
Hospital, which is at the service of the Hawick District
Committee by arrangement with the burgh authorities.
In considering the question of what hospital accommodation
is required, it is to be remembered that infectious diseases
vary in their characters, and that the measures to be taken
to prevent their spread also vary. For instance, pure water
and strict dairy inspection prevent enteric fever; for measles
and whooping cough the closure of the schools is perhaps the
most useful measure; scarlet fever is to be met by absolute
isolation of the patients, disinfection of houses, and strict dairy
inspection. Over-crowding and dirty rooms are the great
causes of typhus fever; thorough vaccination renders small-
pox practically harmless; and draining the subsoil has been
proved to lower the mortality from consumption or phthisis.
A defective drain is a common cause of either puerperal fever
or diphtheria.
Although in towns cases of enteric fever are generally
removed to hospital, we have in the country a fair prospect of
lessening the frequency of that disease by improving drainage
and water supplies, and when cases occur home measures
will usually be found sufficient. Phthisis, whooping-cough,
and measles we need not consider at present. If a case of |
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smallpox occur, absolute isolation is essential; but the disease
can only become epidemic if vaccination, the first line of
defence, is neglected. If the District Committees absolutely
prohibit the over-crowding of cottages, the possibility of
typhus is reduced to a minimum. Puerperal fever will always
be treated at home. It is usually best for persons attacked
with diphtheria to be removed to a healthy place in their own
interest; but the total number of cases ought to be much
lessened as the drainage of houses is improved. The above
diseases may, of course, be removed to hospital, and in many
large towns cases of enteric fever, typhus, measles, diphtheria,
etc., are as far as possible removed from their homes. In the
country the conditions of life are very different, and improved
sanitation will do more to lower the zymotic mortality than
the provision of hospital accommodation.
Scarlet fever is, however, very different from the other
zymotic diseases. At the beginning of the illness the patient
is not in a highly infectious state, but later the poison is
disseminated in dust and flakes of skin, and clothing and
furniture retain it for a long period; and the patient is
dangerous to others for eight or nine weeks. The disease
spreads from farm to farm and from village to village until
the supply of susceptible persons is exhausted, and it then
ceases, to return again a few years later.
The only method of successfully combating it is to take all
patients at the beginning, and strictly isolate them, and then
thoroughly disinfect the house, clothing, furniture, etc.
Although in many instances person suffering from in-
fectious diseases can be induced voluntarily to go to a fever
hospital for the sake of better accommodation than they have
at home, it is to be remembered that the Local Authority has
power, under section 42, Public Health Act, to remove a sick
person against his will on the order of the Sheriff or a
magistrate. If a Local Authority is to act with the support
of public opinion in exercising this power it is necessary to
provide such a means of transit and accommodation that a
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patient is not exposed by removal or retention in hospital to
any avoidable risk.
A suitable conveyance would therefore have to be provided,
so constructed that it may run easily, and after a journey
admit of being thoroughly disinfected. Then the hospital to
which the patient is taken must be so arranged that the
sufferers from one infectious disease are not exposed to the
infection of another.
In addition to the above, some form of disinfecting ap-
paratus is required, so that all the infected bedding and
clothing may be purified, both that brought from the hospital
and that brought from the patient's home.
There is no doubt that (apart from hospital accommodation)
such an apparatus should be at the service of each Local
Authority in the county, and as the expense would be con-
siderable an attempt might be made to enter into and arrange-
ment with the burghal authorities.
A similar arrangement may prove to be the most economical
by which to provide sufficient hospital accommodation, if an
agreement can be come to for the joint control of the
institution. The great distance some patients would have to
be brought would prove the chief obstacle to districts uniting,
and when a sufficiently large population to justify the exist-
ence of a hospital could be found by joining with a burgh in
the district, that arrangement would appear preferable.
At present it would be difficult to accurately estimate the
amount of accommodation required, as no records of the
number of cases in epidemics of past times are available, and
the usual estimate of one bed to 1000 persons might prove
misleading. A few years' experience of the Act for the
Notification of Disease would go far to remove the difficulty.
GENERAL SANITATION. - Under this heading two important
subjects fall to be considered - namely, the general water
supply and drainage of the district. Few countries have
naturally as plentiful a supply of water, and any difficulty
that is experienced in obtaining water is due to the pollution |
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of streams by farm and other refuse. Consequently springs
have to be found and wells sunk, and in a few instances
water has to be brought from a distance in pipes. Water is
very plentiful in the greywacke formation in the west and in
the porphyritic rocks in the east; but it is not quite so
abundant in the old red sandstone in the centre of the county,
especially where the strata lie at a considerable inclination.
North of the Tweed, also, water is scarce in some places.
There does not appear to be a deep well in the district, and
shallow wells and burns are the chief source of water. Many
of these shallow wells are in farm steadings or near to
dwellings, and analysis would show them to be polluted;
indeed, in some instances analysis is unnecessary, as sewage
can be seen passing into the well.
Until arrangements are made for the analysis of suspected
waters, it is impossible to deal satisfactorily with polluted
supplies, and little is to be gained by making inspections
which cannot lead to any further action.
Unfortunately, wells that have been condemned are not
closed, as it is alleged that the water is required for house-
hold purposes; and in villages the inhabitants frequently
prefer the water of a well which has been condemned more
than once to pure water brought by gravitation from a
distance.
Of the three classes of houses in the country - the large
mansion houses, the farm houses and smaller residences, and
the cottages - it is difficult to say which possess the most
defective drainage arrangements. Some of the largest houses
are drained by means of brick-built drains passing under the
whole length of the basement; while others have large un-
ventilated cesspools. It is not astonishing that the servants
who have to work on the ground floor suffer frequently from
anæmia, and that every few years there is a case of gastric
or typhoid fever.
In the farm houses faults in drainage are very common;
soil-pipes are placed inside the walls, and are unventilated,
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and directly connected to the drain. The drain itself is
brought under the foundations, and is unventilated, and very
frequently the apartment containing the water-closet is fixed
on as a suitable place to store the drinking water. Sinks,
also, are not faultless, and it is the rule rather that the
reverse to find sink waste-pipes directly connected to the
drain; the public seem to be satisfied that if a waste-pipe is
trapped everything is correct, whereas traps are only to be
relied on in conjunction with "disconnection."
Cottages are generally well built, and when they are pro-
vided with suitable drainage, and not over-crowded, they
are as salubrious dwellings as could be desired. One of the
commoner faults is that of building cottages on a damp,
undrained soil, and permitting them to be sheltered by trees,
so that they seldom get the sun. The general absence of
privies does not cause as much nuisance as sanitarians
accustomed to towns would imagine, but occasionally serious
nuisance results from this cause. The absence of ashpits
leads to the formation of middens unpleasantly close to
houses; and when ashpits exist they are nearly always un-
covered, and are consequently foul and wet, and the rain
water soaking though the refuge pollutes the soil around.
In describing what an ash pit ought to be I cannot do better
than quote from a report by Dr. M'Vail, Medical Officer of
Health for Dumbartonshire:- "The requisites of a proper
"ashpit are perfectly simple. It should be of small capacity,
"to necessitate frequent emptying; raised several inches
"above the ground level, to prevent entrance of surface
"water; concreted in the bottom and sides, to prevent filth
"impregnation of the walls or floor, or of the ground below;
"provided with a slated shed roof, to prevent access of rain,
"and to ward off the sun's rays, and so delay putrefaction of
"the contents; thoroughly ventilated on at least three sides
"and by the roof; and without any drain, so that the main
"drains of the locality may not be choked and polluted by
"its contents. No house water should be thrown into it, so |
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"that the contents may be kept dry. Instead, all water
"should be emptied on a grating, or into a slop sink, com-
"municating by a trap with the drain."
SCAVENGING OF VILLAGES.- The state of many villages
shows that in the past scavenging has practically been un-
attended to; scavengers, when employed, merely swept the
streets, and paid no attention to accumulations of refuse about
houses and in back yards. On the Local Government Act
coming into operation the District Committees found that
they were unable to confine the assessment for scavenging
to the places benefited, and there was naturally an objection
to assess the whole district for the benefit of a part only.
Where the village is the property of one owner, it is always
possible to arrange for the payment of a scavenger; but
where there are many owners, and it is left to them to arrange
with farmers for the removal of refuse, the intervals that
elapse between successive removals are too long to prevent
nuisance, and if not removed by the owners the poorer
tenants cannot, or will not, take the trouble to find suitable
places on which to deposit their refuse. The best solution
of the difficulty at present is to issue notices under section
51, Public Health Act, "for the periodical removal of manure
"or other refuse matter." Failure to comply with such
notices involves liability to a penalty of 20s. per day. The
objection to this course is that a large sanitary staff is neces-
sary to enforce the order, and the continual suing of the
poorer classes for penalties is most objectionable and un-
popular. The inhabitants of villages long accustomed to
dirty back yards are apt to forget that "cleanliness is next
"to godliness," and is of far more use in preventing the spread
of typhoid fever.
An amendment of the Local Government Act is urgently
required to empower County Councils, (1) to define areas for
lighting, cleaning, and paving roads or streets (in populous
places), and to asses therefor; and (2) to exercise the func-
tions of a Dean of Guild Court in controlling the erection of
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new buildings as far as site and sanitary arrangements are
concerned.
RIVERS POLLUTION. - No action taken.
FOOD AND DRUGS ACT. - The administration of this Act is
at present under consideration.
JEDBURGH DISTRICT.
POPULATION. - The population of the District, as ascertained
by the census of 1891, is 5923, and the density of the popu-
lation is 33 persons to a square mile.
BIRTHS. - I have not been furnished with information of the
number of births in the District.
DEATHS. - There were 39 deaths in the last five months of
the year, and of these 23 were of persons over 60 years of
age, 58·97 per cent. The death-rate was 17·522, being ·243
higher than the rate in the Melrose District, and 3·384 higher
than the rate in the Liddesdale District. In 1891 the death-
rate in the principal town districts of Scotland, as given in
the Registrar-General's Annual Report was 22·9, in the large
towns 21·8, and in the small town districts 20·3, in the insular
rural 17·8, and in the mainland rural districts 17·3. The rate
is therefore higher than it ought to be, and it is at first sight
not easy to account for this. Influenza caused four deaths,
giving a rate of 1·797; zymotic diseases caused three deaths,
or a rate of 1·347. I do not, however, put great trust in
rates taken for a short period in such a small population as
that of the Jedburgh District. This is well shown in the
per centage of deaths in children under five years of age,
in the different districts, usually considered the best index of
the state of a sanitary area. These per centages are -
Jedburgh District, 2·4; Kelso District, 2·6; Melrose District,
1·3; Hawick District, 0·0; Liddesdale District 3·5.
BAKEHOUSES. - There is one bakehouse in the District, in
Ancrum; it has not yet been inspected.
SLAUGHTER-HOUSES.- There are two slaughter-houses, one
in Ancrum, and the other the large slaughter-house belonging
B |
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to the Burgh of Jedburgh, and situated near the station. I
regret to have to report that neither of these is in a satisfactory
state. That in Ancrum is merely a dilapidated cottage, and
I directed the attention of the Sanitary Inspector to its
condition. No bye-laws being in force at that time, little
could be done, and action was delayed until the District
Committee had drawn up rules for the regulation of the
trade. The slaughter-house near Jedburgh is let for the use
of the butchers in the town by the Burghal authority, but
being situated in the County is under the control of the
District Committee. On several occasions I noticed that
the premises were in a most filthy condition, offal and blood
lying on the road outside the buildings. The structure is
good and substantial, although not well planned, proper
accommodation not being provided for animals previous to
slaughter, and there being no suitable receptacles for offal.
The nuisance is, however, chiefly caused by the unworkman-
like methods followed by the butchers, very different to the
practice of the trade in large towns. Here, again, proceed-
ings were delayed until bye-laws were passed to strengthen
the inspector's hands.
HOSPITAL ACCOMMODATION. - No hospital is available in this
District, and in this particular the District is no better off
than the Burgh of Jedburgh, which is also unprovided with
accommodation for the isolation of patients. Although the
want of a hospital has not been seriously felt, the only
infectious disease in the neighbourhood having been typhoid
fever, and being almost entirely confined to the places in
in which it originated, it would yet be advantageous
to discuss the subject at an early date. I understand
that it is contemplated to close the Poorhouse, in which
there is at present accommodation far in excess of the
needs of the District, and provide for the inmates elsewhere.
This being the case, it would be a favourable time to consider
the advisability of securing the building for the purposes of
a fever hospital - a plan highly recommended by Mr M'Neil
[Page] 21
when Inspector of the Board of Supervision, in a report to
that Board. If the matter were postponed on the plea that
there is little evidence to show that accommodation for
isolation is absolutely necessary, it is not unlikely that
in the future public opinion, which is now advancing so
rapidly in the direction of insisting on protection from in-
fectious disease, would force the Local Authority to provide
a hospital when possibly the present favourable opportunity
of obtaining a building on easy terms would be lost. The
burgh being in the same position, the question naturally
arises, Why should the two Local Authorities not unite and
share the expense? The building is well situated, and could
doubtless be so altered as to make a very suitable hospital
for two or three infectious diseases. In the County report I
made some remarks on the responsibilities incurred by Local
Authorities in establishing such an institution, and mention
the danger of "cross" infection; and I have no doubt that
when the matter comes up for discussion the whole subject
of provision of vans for the removal of patients, disinfecting
apparatus, and structural alterations will be considered fully,
so that no person removed to the hospital may feel that he is
being subjected to the danger of exposure to the infection
of another infectious disease.
ACTION TAKEN, AND CASES. - Near Crailing there was one
case of enteric fever, but as it had been imported, and gave
rise to no other cases, it may be dismissed without further
remark. At Hassendean Bank, in Minto parish, there were
two cases of the same fever, due probably to the use of the
sewage-polluted water of a burn near the cottages in which
the cases occurred. These were followed later by three
others, one of whom died. In addition to the water supply,
the cottages were in an insanitary state, owing partly to their
position close to the mill-pond, with rising ground behind on
which were the usual undrained pigstyes. The sink drains,
also were defective, and the houses damp. The pigstyes
were at once emptied, and shortly afterwards the drains were |
| HH62/2/ROXBUR/23 |
[Page] 22
relaid. The inhabitants were warned not to use the burn
water, but here a difficulty occurred. The only available
well was three hundred and eighty yards away, and the
housewives objected to carrying water from such a distance.
However, by making a new path across a field, another well
was brought within one hundred and fifty yards, and, the
pump being repaired, has since proved a satisfactory supply.
It is difficult to determine at what distance a well ceases to
be a proper supply for cottages, and it would much assist a
Medical Officer if a definite distance were fixed upon beyond
which a well must not be.
Another outbreak of enteric fever at Scraesburgh was of
an interesting character, owing to the difficulty of tracing its
origin, and I spent much time in investigating the circum-
stances. I was led to form the theory that the infection was
ultimately derived from Jedburgh, where enteric fever had
been prevalent in the summer. At the end of harvest the
inhabitants of Scraesburgh farm cottages began to use
the water from a spout near the houses; three weeks later
almost every house had a case of fever in it. Investigations
in every direction proving fruitless, I fixed on this water as
the probable cause. It comes from a drain passing through
two fields on the hill above the farm. In a wood beyond
the field there is a ditch, partly filled with surface water, and
communicating with the drain to the cottages. Noticing
that a number of trees had been recently felled, I made
enquiries and found that certain men from near Jedburgh
had worked in the wood at intervals during the summer, and
also that some of these men had suffered from attacks of
diarrhœa on more than one occasion. When not engaged in
the country, they worked at a saw-mill adjoining the Jedburgh
slaughter-houses, referred to above as being in a filthy con-
dition. My theory is that some of these men, exposed to
the infection of enteric fever in Jedburgh, suffered from a
slight attack of what medical men sometimes call "walking
typhoid," and contaminated the water of the ditch in the
[Page] 23
wood in which they worked. This idea is strengthened by
the fact that the only other case of fever in the neigh-
bourhood was the brother of one of these workmen, in whose
house at Ulston he lodged.
It is always difficult to understand how fever suddenly
arises in places in the country apparently removed from any
danger of infection, but a consideration of the above case
shows that germs of disease may be carried in ways and
by means little thought of and rarely brought to light. The
more circuitous the path taken the more difficult it is, as in
the above case, to bring forward scientific - that is incontro-
vertible - proof of its existence.
The two outbreaks of fever were both due to contaminated
water, and their occurrence shows the necessity of an inquiry
into the water supply of all farms in the District, both by
inspection and by analysis of samples.
GENERAL SANITATION. - The remarks made in the County
report apply generally to this District, and many years' work
will be required to remedy all the faults in sanitation gradually
being brought to light by the Sanitary Inspector.
A considerable time was spent in the inspection of the
villages of Ancum and Crailing. In the former village the
water supply is pure, as far as can be judged by inspection
of the source without analysis. The drainage system is not
in such a satisfactory condition, the main drains being only
ordinary rubble drains, and the branches to houses untrapped.
The village is not increasing, and is not likely to, and it is a
most ungrateful task to have to recommend that new drains
be laid. The houses are generally good, and if better pro-
vided with conveniences would leave little to be desired.
One house being damp, and placed next to a byre, was closed,
on the recommendation of the Sanitary Inspector. When the
inspection of the village is complete, a report will be presented
to the District Committee, and the same difficulty with regard
to scavenging must be disposed of that is giving Local
Authorities so much trouble in nearly every part of Scotland. |
| HH62/2/ROXBUR/25 |
[Page] 24
KELSO DISTRICT.
POPULATION. - The population of the District is 7329
(Census 1891), and the density is 49 persons to a square mile.
The most populous parishes are those of Morebattle (846),
Roxburgh (954), Sprouston (1006), and Yetholm (844).
BIRTHS. - No information furnished to me in this district.
DEATHS. - There were 48 deaths in the last five months of
the year 1891, 46 of which were deaths of persons over 60
years of age (54 per cent. of the deaths). The death-rate
calculated to an annual rate per 1000 persons living is 15·553,
placing the District third in the Districts of the County,
Jedburgh and Melrose Districts having higher rates. This
is partly accounted for by the deaths from diseases of the
respiratory system and influenza not being so numerous as in
those Districts. The rates from these two causes expressed
as a per centage on the total deaths are -
Jedburgh District, 34 per cent.; Kelso, 33 per cent.;
Melrose, 38 per cent.
INFECTIOUS DISEASES. - The only case of infectious disease
known to the sanitary authority was one of enteric fever in
Eckford parish. It was imported from a watering place, and
the house was found to be in a satisfactory condition as
regards drainage.
It is not surprising that under these circumstances the
question of the procedure to be followed when dealing with
infectious disease has not been discussed by the District
Committee. At the same time, in the event of an epidemic
visiting the neighbourhood, the only means of meeting it at
my command are those which have been used for long by
the medical practitioners in the country, and thorough dis-
infection of infected clothing by heat and isolation of patients
cannot be attempted.
BAKEHOUSES. - The greater part of the bread used in the
District is supplied from Kelso, and the only bakehouses are
those of Yetholm and Morebattle. The bakehouse in the
last-mentioned village appeared when inspected to be clean
[Page] 25
and well kept, and the only fault found with the premises
was an improperly-trapped drain near the door, which I
expect to see provided with a gully trap on my next visit.
The bakehouses in Yetholm are the best I have seen in the
County, well constructed and clean, with cement floors, and
I would be well satisfied if all the bakehouses were as well
managed.
SLAUGHTER-HOUSES. - Yetholm possesses three slaughter-
houses and Morebattle one; there are none in the other
villages of the District. One of the slaughter-houses in
Yetholm has hardly sufficient accommodation, and one end
of it is used as a byre or stable; but the business is well
conducted, and, with the exception of the byre, satisfactory.
Another is substantially and well constructed, the business
being conducted with care and cleanliness. The third
should not be used as a slaughter-house, being merely an
outhouse attached to a cottage, and undrained. The
slaughter-house in Morebattle is small and difficult of access,
cattle having to be driven through a passage in the dwelling-
house to enter it. It is, however, kept fairly clean. Hitherto
the butchers have had no bye-laws to guide them, and when
the proposed bye-laws are put in force there is no doubt that
the butchers will conform to them, and make what slight
alterations are required in their premises without experiencing
any difficulty.
GENERAL SANITATION. - More work, under this heading,
has been done in the Kelso District than in any other. The
remarks on general sanitation in the County report apply to
the District; but in addition to the general work of the
District, a detailed inquiry was made into the state of the
village of Yetholm, and a more general inspection made to
ascertain the sanitary condition of the other villages - viz.,
Morebattle, Heiton, Sprouston, and Smailholm. This work
was the first work the Inspector took in hand on his
appointment, and was done at the instance of the District
Committee. |
| HH62/2/ROXBUR/27 |
[Page] 26
YETHOLM. - A scavenger had formerly been paid by the
Parochial Board, and on the District Committee assuming the
functions of that Board, the payment was continued at the
expense of the whole District. This was naturally objected
to by members from parishes distant from Yetholm, and a
report was ordered to assist the Committee in considering
the matter. Any one acquainted with the unsatisfactory
state of the law under which sanitary authorities have to
endeavour to secure the cleanliness of villages will not be
surprised to learn that the report failed in its object. Much
useful information was, however, obtained, so that the Sanitary
Inspector and I were able to make ourselves familiar with
the conditions of village life. The following is a summary of
the report:-
The village consists of two parts - Kirk and Town Yetholm
(population 238 and 379 respectively) - and is situated on
either side of the river Bowmont. Every house was in-
spected, and information obtained in each instance as to the
size of the dwelling, ventilation, condition of walls, floors and
roofs, water and milk supply, state of drainage and number
and kind of sinks, privy accommodation, etc. Only four
houses were found to be too small for the number of persons
occupying them, each having less than 300 cubic feet air-
space per head.
The water supply in Town Yetholm is fairly satisfactory,
although some shallow wells are still used, owing to the
ignorance of the householders. In Kirk Yetholm good water
can be obtained at one spout, but the water of a burn is also
generally used; in spite of the fact that much house refuse,
ashes, etc., is thrown into it. It is however, under the
heading of privy accommodation, ashpits, and drainage that
the most serious nuisances are to be classed. In one village
there is only one ashpit, 88 houses of the other village are
unprovided with them. Eighty-nine houses have no privy
accommodation, and all the existing water-closets are defective
in some respects, many of them being in a most dangerous state.
[Page] 27
With the exception of one short length, the drains are only
rubble, and many houses have no drain near, so that slop
water has to be thrown on the surface of the ground.
In addition to the above insanitary conditions, there are
several large and offensive middens, and since the scavenger
was paid off there has been no street cleaning.
Under these circumstances, I recommended the District
Committee to instruct the Sanitary Inspector, to issue notices
to the authors of many private nuisances, to provide a better
water supply for Kirk Yetholm, to insist on the erection of a
privy for each house, to cause owners to construct ashpits or
to arrange for the daily removal of house refuse, to order
existing drains to be repaired, where necessary to be extended,
and to be provided with ventilating grates and surface gullies.
My recommendations were given effect to in so far that the
Inspector was directed to issue notices to the authors of a
few of the worst nuisances, and one of the members of the
District Committee undertook to induce the villagers to assess
themselves in order to provide a scavenger.* It appears to
be customary in this neighbourhood for the scavengers merely
to attend to street sweeping; and, tips or tooms not being
provided, the scavenger increases the size of the middens
already existing in the village. The Committee has not yet
taken action to secure an improved water supply for Kirk
Yetholm, to prevent pollution of the burn, to coerce owners
into providing privy accommodation or ashpits, or to improve
the drainage. Even if the committee went so far as to order
notices to be served on every person contributing to nuisances
of any kind, matters would not be much improved. Difficul-
ties would constantly arise; for instance, where tenants have
no land attached to their houses, the street is the only place
in which they can throw their house refuse. Notices would
also have to be served on the owners or occupiers of almost
every house, and much irritation caused. If the Committee
cannot by private arrangement with the proprietors secure
* The proposed arrangement is now almost completed. |
| HH62/2/ROXBUR/29 |
[Page] 28
efficient cleansing, not only of streets, but also of ashpits and
middens, the only resource under the law as it stands at
present is to issue notices under section 51, Public Health Act,
ordering the periodical removal of all refuse, or, if that fails,
to form the village into a special drainage district.
Other villages are in some respects in the same position as
Yetholm, but, owing to their small size, collections of refuse
are not so large, and the same difficulties do not occur in
securing their cleanliness.
MELROSE DISTRICT.
POPULATION. - The inhabitants of this District, the most
populous in the County, number 7549. The parish of Melrose
has 4321 persons, more than half the population of the district;
the other four parishes have under 1000 persons in each. Of
the 4321 in Melrose parish, 2000 live in the town of Melrose.
The density of the population is 101 persons to a square mile.
BIRTHS. - The birth-rate in this District for 1891 is 22·842
per 1000 persons living.
DEATHS.- In the last five months of 1891 there were 55
deaths, 29 of which were deaths of persons over 60 years of
age - a per centage on the deaths of nearly 53. The annual
death-rate, calculated on the deaths in five months, is 17·279,
and the rate for children under five years of age per 1000
persons living is 1·27. The general death-rate is higher than
in any district except Jedburgh. The excessive mortality
appears due to influenza; there were 12 deaths from influenza
and 9 from diseases of the respiratory system, giving a higher
rate from these two causes than in the other districts. Only
one death occurred from zymotic disease.
INFECTIOUS DISEASE. - A hospital or apparatus for the
disinfection of clothing not being available, there is no doubt
that shortly the whole subject of isolation of infectious cases
and disinfection of clothing must be considered by the
District Committee. The nearest burgh, Galashiels, not
being situated in the District, it is probable that more difficulty
[Page] 29
will be experienced in making suitable arrangements than in
Jedburgh, Hawick, or Kelso. A large part of the district is
within 8 miles of Galashiels, Hawick, or Selkirk, and if the
Local Authorities of these places provide for fever patients,
the relative advantage and cost of co-operation with the
Local Authorities of these places may be compared with the
erection of a cottage hospital in Melrose under the undivided
control of the District Committee. The District being the
most populous in the County, and having a considerable place
like Melrose in it, is in a better position to provide for itself
than any other.
DISTRIBUTION OF CASES. - An outbreak of scarlet fever near
Galashiels was of some interest, and caused some anxiety in
the burgh. Between the 6th and the 11th December, Dr.
Somerville, the Medical Officer of that town, received notice
of 41 cases of scarlet fever in families supplied with milk from
a dairy in the Melrose District, and no cases were notified by
families getting their milk from other sources. On the 11th
I received information and at once visited the place. The
dairyman had stopped the sale of milk on the 8th at Dr.
Somerville's request, and on the 12th promised not to recom-
mence until I certified that there was no further danger.
Altogether, 10 cases were found in the County, and every
precaution that suggested itself was taken to check the
spread of the epidemic, but there can be no doubt that its
cessation was chiefly due to the stoppage of the sale of milk.
Three children in the dairyman's family were infected, but
only took ill on the 6th, the same day that the first cases were
notified to the burgh. The original source of infection was
never satisfactorily accounted for, and the most probable
explanation is that a milk-can, left at a house in which there
was a case of scarlet fever, was returned to the dairy. In
bye-laws since brought into force, the practice of leaving cans
at houses has been prohibited. The question of compensation
has been raised, and in this case, as the milk was infected
through no fault of the dairyman, and as he immediately |
| HH62/2/ROXBUR/31 |
[Page] 30
stopped its sale without necessitating any legal process, it
would appear to be just to recompense him for his public-
spirited action, or at any rate to recoup him part of his
loss. Such compensation is not compulsory, but under
section 116, Public Health Act, a local authority has power
to compensate. In this case, although the dairy is in the
County, Galashiels chiefly benefited, the great majority of the
customers being in it, and only a few in the county district.
There will probably be difficulty in dealing with similar cases
in the the future if compensation be not granted, and it would be
for the benefit of the public if both Local Authorities consider
favourably any claim that may be made.
BAKEHOUSES. - The bakehouses in Melrose, St. Boswells,
and Newtown have been inspected, and were found in a
fairly satisfactory condition, with the exception of one at
Newtown. This bakehouse is a detached building behind a
shop, the end of an untrapped drain beside the door, a stable
at one side, and pigs kept in styes against two of its walls,
apparently for the sake the warmth of the oven.
SLAUGHTER-HOUSES. - The three slaughter-houses in Melrose
are not well situated, the butchers having difficulty in finding
suitable premises. As complaints have been received, the
District Committee must shortly consider the subject. In
St.Boswells there are two slaughter-houses, and although
they are not well constructed in every detail, yet if the new
bye-laws are carefully observed, no objection need be taken
to them. The slaughter-house in Newtown is a wooden
erection, partly occupied as a stable, and I am of the opinion that
some improvements are necessary.
GENERAL SANITATION. - The Sanitary Inspector has made
a very large number of inspections, chiefly in the villages,
and the District Committee is taking measures to materially
improve drainage and secure cleanliness. Melrose, Darnick,
Dingleton, Newtown, St. Boswells, Bowden, Midlem, and
Lilliesleaf have all been visited, and in some of them every
house has been inspected. After completing Yetholm, in the
[Page] 31
Kelso District, the Inspector made a similar systematic and
careful inspection of Newtown, with the result that the
District Committee have formed it into a special drainage
district. The Inspector's report on the state of this village
is an interesting document, in which he directs attention to
the following insanitary conditions: - Overcrowding of houses,
defective water closets, nearly half the houses without privy
accommodation, 80 out of 114 without ashpits, existence of
large middens, want of drainage, defective and untrapped
sinks. St. Boswells and Melrose are in better condition than
other places, houses being large and well-built, and sewers
having been laid. However, the only houses in the County
at all comparable to those of a city slum are to be seen in
Melrose. They are engaging the attention of the District
Committee.
HAWICK DISTRICT.
POPULATION.- In respect of population, Hawick comes
fourth amongst the districts of the County with a population
of 3791. Of the six parishes of which the District is com-
posed, those of Wilton, Cavers, and Kirkton have the largest
populations. The density is 24 persons to a mile. The only
village in the district, Denholm, has a population of between
500 and 600 persons.
BIRTHS.- The number of births in the District has not been
furnished to me.
DEATHS. - There were 24 deaths in the five months, 10 of
which were deaths of persons over 60 years of age. There
were no deaths of children under five years of age. The
general death-rate per 1000 persons living is 15·014, and the
zymotic rate 2·502, higher than in any district except Liddes-
dale. In proportion to the population, influenza caused
fewer deaths than in any other district.
HOSPITALS.- The District Committee has, by arrangement
with the Local Authority of Hawick, retained the use of one
bed in the burgh fever hospital. If this accommodation is
found to be insufficient in the future, there will be, I under- |
| HH62/2/ROXBUR/33 |
[Page] 32
stand, no difficulty in obtaining the use of more beds. As yet
arrangements have not been made for the transport of patients.
CASES OF INFECTIOUS DISEASE. - Two cases of enteric fever
in Denholm were derived from Minto parish, and although
isolation and disinfection could not be thoroughly carried out,
the disease did not spread.
BAKEHOUSES. - One in Denholm was visited and found in a
satisfactory state, except as regards cleanliness, and the baker
was warned that in future greater attention to this matter
would be expected of him.
SLAUGHTER-HOUSES. - Two in Denholm are small, and not
satisfactory in every detail; but, as in other districts, the
absence of bye-laws, and the fact that the trade was com-
menced in former times in premises unsanctioned by the local
authority, accounts for the insufficiency of the buildings.
GENERAL SANITATION - With the exception of the outlying
parts of Teviothead, every parish has been visited. As many
"house-to-house" visitations have not been made as in other
districts, owing to the Inspector's time being fully occupied.
After an examination of the places, I was of opinion that
Denholm was not quite so bad as other villages, and could
afford to wait while more insanitary villages were dealt with;
but as Wilton Dean, a small suburb of Hawick, appeared not
to be in so good a condition, the Inspector made a house-to-
house inspection, and will doubtless report when it is com-
pleted. The work he did, however, showed that many houses
were damp, and that there was the same absence of privy
accommodation, ashpits, drains, and house sinks that is so
characteristic of the other villages inspected. At the request
of the School Board, I visited Roberton and Hobkirk schools,
and reported on some matters connected with sanitation that
were then under discussion.
LIDDESDALE DISTRICT.
POPULATION. - Liddesdale is in many respects different from
the other districts, consisting of but one parish, and having
[Page] 33
only one village, Newcastleton. The chief occupation is
sheep farming, and there is but little arable land. Of the
2013 persons who form the population of the District, about
1000 live in Newcastleton, and are generally comparatively
poor. The density of the population is 19 person to a square mile.
BIRTHS. - The birth-rate for the year 1891 is 31·814.
MARRIAGES. - There were 11 marriages in 1891.
DEATHS. - In the year 1891 there were 31 deaths, equal to
a rate of 15·41 per 1000 persons living, and in the last five
months of the year there were 12 deaths, equal to an annual
death-rate of 14·138; of these 12 deaths, 8 were deaths of
persons over 60 years of age (66·6 per cent.) In the same
period there were three deaths of children under five years of
age, giving a rate per 1000 persons living of 3·50 - that is to
say, that a greater proportion of children died in this District
than in any other. Whooping-cough and influenza caused
5 deaths. The zymotic rate is 3·5, higher than in the other
districts, but only due to 3 deaths. Very little dependence
is to be placed on averages deduced from such small popula-
tions as this. It is yet well to record them, and after five or
ten years their value may be estimated with more accuracy.
INFECTIOUS DISEASE. - There were no cases of infectious
disease known to me in this District. Hospital accommoda-
tion is not available.
BAKEHOUSES AND SLAUGHTER-HOUSES. - The above were
visited, and were fairly satisfactory. The businesses appeared
to be cleanly conducted, and no objection was taken.
GENERAL SANITATION.- All the farms in the District have
not as yet been inspected; on several occasions I have made
inspections in Newcastleton. The District Committee employ
a scavenger, and the streets are clean; the scavenger,
however, deposited all the refuse in the river until I drew
attention to the circumstance, when the Committee ordered
it to be disposed of elsewhere. Many houses have byres or
pigstyes built against them, and have large collections of
manure near them. I reported this to the District Com- |
| HH62/2/ROXBUR/34 |
[Page] 34
mittee, and the scavenger was ordered to see that such heaps
were not again formed. The village is drained by rubble
drains, and as some houses are provided with water from
shallow wells, the matter is one requiring attention. In this
District the services of the local inspector were retained, but
it is difficult to see how they can be made use of. He is also
the scavenger, and it is perhaps better to have a scavenger,
called an inspector, and paid as such, than not to have one at
all as in Yetholm.
M. J. OLIVER.
22 WEEKS ENDING 2d JANUARY, 1892
[Table Inserted] |
| HH62/2/ROXBUR/35 |
TABLE I.
TOTAL BIRTHS AND DEATHS OCCURRING IN THE COUNTY AND DISTRICTS DURING THE 22 WEEKS ENDING 2d JANUARY, 1892.
[Table Inserted] |
| HH62/2/ROXBUR/37 |
TABLE II.
DENSITY OF POPULATION, BIRTH RATE, INFANTILE, AND OTHER DEATH RATES.
[Table Inserted]
TABLE III.
CASES OF INFECTIOUS DISEASE COMING TO THE KNOWLEDGE OF THE MEDICAL OFFICER DURING THE YEAR 1891.
[Table Inserted] |
| HH62/2/ROXBUR/39 |
TABLE IV.
BIRTHS AND DEATHS OCCURRING IN THE JEDBURGH DISTRICT DURING THE 22 WEEKS ENDING 2d JANUARY, 1892.
[Table Inserted] |
| HH62/2/ROXBUR/41 |
TABLE V.
DEATHS OCCURRING IN THE KELSO DISTRICT DURING THE 22 WEEKS ENDING 2d JANUARY, 1892.
[Table Inserted] |
| HH62/2/ROXBUR/43 |
TABLE VI.
DEATHS OCCURRING IN THE MELROSE DISTRICT DURING THE 22 WEEKS ENDING 2d JANUARY, 1892.
[Table Inserted] |
| HH62/2/ROXBUR/45 |
TABLE VII.
DEATHS OCCURRING IN THE HAWICK DISTRICT DURING THE 22 WEEKS ENDING 2d JANUARY, 1892.
[Table Inserted] |
|
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