HH62/45/47

Transcription

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The removal of insanitary conditions is the first proceeding required in taking
measures to prevent the outbreak and spread of infectious diseases. During the past
year much has been done in regard to such matters; in some instances where faulty
drainage was found to be associated with disease the drainage systems have been
completely remodelled. Where infectious disease occurred disinfectants have been
freely supplied for use in connection with those attacked, and the disinfection of
premises at the termination of the illness has been carefully observed.
During the year seven cases of Enteric Fever, seven Scarlet Fever, and five
Diphtheria have been reported; in all cases the above measures were
sufficient to prevent the disease from spreading.
As yet nothing approaching to complete Returns regarding the distribution of
disease in the Highland District have been obtainable. Only in one instance has a
Return (and that a very complete one) been sent.
From the Mortality Returns diseases of the Respiratory System are seen to
form a large proportion of the cause of death:- 18.4% of the total. With such a
changeable climate as ours, this is quite what may be expected.
Tubercular disease, including Consumption, has caused 9.6% of the total deaths.
With improved sanitation and the exercise of proper precautions in the treatment of
such disease there ought to be a marked decrease of this in future Returns. It has
now been definitely settled that tubercle is a disease which is due to infection, just as
are the more familiar fevers, and that in almost all cases in which it affects the lungs,
the infection has been carried by the air from a former case. The method by which
this is brought about is that the expectoration (which contains the infective germs
of the disease in a consumptive case) becomes dried, and is then, in the form of
minute particles of dust, carried by currents of air; when breathed by a person
having a consumptive tendency, these particles set up a new process which only
ceases, in the majority cases, with the death of the individual. If the guardians of
persons suffering from consumption will only remember that the whole of this danger
can be obviated by the exercise of a little care in the disposal of the expectoration,
how much might be done to stop the ravages of this disease? A few general directions
may not be out of place here:- The patient should be placed in a well-lighted room,
where efficient ventilation should be constantly maintained. All over-crowding of
the apartment by visitors should be avoided, and the patient should always occupy a
single bed. The expectoration from the lungs should be carefully collected into a
porcelain spittoon, which should contain a disinfectant, and the spittoon should be
regularly cleaned by immersing it in boiling water.
There is a common idea that tubercular disease is inherited, but this is erroneous.
True, the tendency to afford a suitable soil for the growth of the tubercle germ is
inherited, but nothing in the shape of heredity or bad hygiene surroundings will
cause tubercle unless the specific poison is introduced. In the case of young children
being brought up on the feeding-bottle there is a risk that they may be affected by
the disease germs passing from a tuberculous cow. As the milk given is often that
of one cow, it will be seem how great is the danger should that cow be one affected
by tubercle. All milk which is to be used for bottle-feeding should be boiled before
use, as, besides making the milk less likely to upset the child's digestion, boiling
will effectually kill the tubercle poison.
Diseases of the Digestive System bulk largely as a cause of illness, and form 33.8
per cent. of the total in the Sickness Return above referred to, and 7 per cent.
of the total certified causes of death. As these diseases, along with anaemia, are

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largely due to constipation, it is to be expected, that with modern sanitation and the
education of the rising generation to habits of regularity, a considerable diminution
on this class of disease will be effected.
Rheumatic Diseases, and to these may be added Diseases of the Circulatory
System (which in many cases owe their origin to rheumatism in early life), form 11.7
per cent. of the total sickness, and 6.7 per cent. of the total deaths. Damp houses
are a fertile source of this class of diseases, and many houses have been observed in
the District which are rendered so, either from being built on a bad site, (viz., on the
slope of a hill with the earth banked against the back wall), or from the absence of
eaves-gutters to carry off the rain water which must otherwise soak into the foundations
of the houses, or from both causes combined, and no subsoil drainage. Such matters
will be remedied gradually as opportunity offers.
Influenza has been prevalent throughout the District during the latter part of
the year. The deaths directly attributed to this disease form 1.6 per cent. of the total.
Influenza is not in itself a fatal disease, but in a constitution weakened by some other
diseases condition, an attack of this now dreaded foe often means death. It is hardly
to be expected that we have yet heard of all the cases in which death must be traced
back to an attack of influenza, as, in many cases, although the disease has not proved
immediately fatal, the constitution has been so shattered as to leave little ground to
anticipate a permanent recovery. So far as Perthshire is concerned, it is to be hoped
that the disease has now passed its maximum, and that we shall have a respite from
its ravages for a considerable time. One essential principle to be observed in all
cases of influenza is, that the disease must not be looked upon as trivial, or as an
ailment which can be worked off. In nearly every instance where it has proved fatal,
there has been some carelessness on the part of the patient to account for the compli-
cations which caused such a termination. When a person is seized with influenza,
every precaution should be taken to avoid chills, the patient should be confined to
bed, and placed under medical advice. Should the epidemic again recur, some
prompt and energetic means will require to be adopted for checking its spread.
There seems to be no doubt that its spreads by direct infection from person to person,
and that with a rapidity which outstrips any other disease with which we are
acquainted. Whether, as in other infectious diseases, one attack of influenza protects
another, has not yet been definitely decided; but if it does, it is satisfactory to know
that the population of this country ought to be proof against it for a considerable
number of years.
Appended will be found a Statement of the Sickness and Mortality within the
District for the year 1891, in tabular form, as required by the Board of Supervision,
and also, in Table IV., a detailed statement shewing the Returns of each of the
Registration Districts into which the Registrar-General has Sub-divided the
District.
The thanks of the whole community are due to the District Registrars who have
supplied Monthly Returns of Births and Deaths, without which these statistics
could not have been made.

JOHN T. GRAHAM, M.D.,
Chief District Medical Officer.
February 29th, 1892.

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