HH62/45/5

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The Finance Committee, also, on the suggestion of the Medical Officer,
sanctioned the obtaining, for statistical purposes, Returns of Births and Deaths
throughout the County. The Registrar-General kindly gave his permission to
obtain the above, and thereafter the District Registrars (82 in number) were asked
to send in Returns to the County Medical Officer. In every cases, but one, the
Registrars have agreed to do so, and although at first there was some difficulty in
getting the papers regularly, they now arrive most punctually.
3. Nothing like complete Returns of Sickness in the County during the year 1891
have been received, although a number of very full reports have been sent by various
Medical men throughout the County, who deserve the highest praise for the valuable
help thus afforded. From the two sources referred to, the following data have been
obtained. There were 1,507 Births and 1,262 Deaths registered as having occurred
in rural Perthshire during 1891. This shows a natural increase during the year of
245. The Census Returns for 1891 shew a decrease of the population during the
preceding ten years of 3,909, the only District which shows an increase being the
Western. The total Death-rate for the County is 18.05, which is higher than it
ought to be, taking 15.7, the death-rate of mainland rural Scotland as a standard.
The only District whose death-rate is below this average is the Western. The
Infant Mortality was, however, only 59.05 per 1,000 births, as against 90.8, the
average for mainland rural Scotland. The only District whose Infant Mortality at
all approached this average was the Central (77.6); with this exception rural Perth-
shire stands well. Deaths occurring in persons over 60 years of age were 687
or 54.4 per cent of the total, the average in this case for mainland rural
Scotland being 45.5, and of these deaths 175 were certified as due to old age. The
same average for the principal zymotic diseases stands at 1.18, and in Pethshire there
were from these diseases .986 deaths per 1000 living.
Respiratory Diseases. - From an analysis of the Sickness Returns received,
this class of disease is found to form 21 per cent. of the total, and from the Mortality
Returns the deaths directly attributed to the same class (consumption excepted)
are 184, or 14.5 of the total, against 16.6 for mainland rural Scotland. In a climate
such as Perthshire with its sudden changes of temperature and prevailing east winds,
diseases of the respiratory system are always certain to cause a large number of the
deaths. Besides the climate there are many other causes which tend to produce
respiratory disease, such as damp houses and insufficient non-conducting clothing, to
protect the body from the sudden chills. The latter factors may be removed by
attention to the sub-soil drainage of houses, and prevention of the eaves-dripping
penetrating under the foundations and rendering the walls damp, and by the use of
woollen underclothing.
Tubercular Diseases were distributed pretty equally over the County; 125
deaths, or 9.9 per cent. of the total are directly attributed to this group of diseases.
The old idea of heredity has now been given up and the causation of tubercular
disease has now been settled beyond dispute to be always the result of infection from
a previous case, from which the living poison has been derived. There is certainly,
a hereditary tendency in some cases to afford a suitable soil for the development
of the tubercular bacillus, but without the presence of the latter no hereditary
predisposition will cause tubercle. Tubercular diseases, especially consumption,
ought to be treated in the same way as a case of typhoid fever, as there is no doubt
that, in the majority of cases in which the disease affects the lungs, the infection is
directly received from the expectoration of a former one. That bad hygienic
surroundings predispose to consumption cannot for a moment be doubted, but with-

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out the specific germ there would be no more phthisis than enteric fever. The now
nearly obsolete box-bed, insanitary in every way, had much to answer for in the spreading
of consumption. To give an idea of the frequency of the occurrence of tubercular
diseases, it may be mentioned that the deaths directly attributed to the same,
amount to 22 per cent., or more than a fifth of the total; and, beyond this,
it is found that in nearly two cases out of three, affected by tubercle, death
does not follow as a direct result. Hence, to the actual deaths recorded,
there must be added this large class of sufferers, bringing up the total of
those so affected to nearly one-half of the human race. At first sight, this
statement may seem to the non-professional mind to be a gross exaggeration,
but a little reflection will enable anyone to judge that it is not very far wide of the
truth. It must be borne in mind that tubercular consumption is only one manifesta-
tion of tubercular disease, and that all the diseases popularly known as scrofulous, or
strumous, which affect the internal organs, the joints, bones, brain-membranes,
lymphatic glands, and skin, are also due to the same infective germ. When all of
these, together with many more which are not recognized during life, are taken
into consideration, the all-prevailing character of tubercular disease becomes evident.
For the prevention of tubercular disease, the first thing necessary is to get the
people into a healthy state, and to keep them so. This is attained by giving them
healthy homes and preventing over-crowding, and it is here that the true function of
Preventive Medicine comes to the rescue, as it is a well-known fact that, in a person
in perfect health, the processes of nature are sufficient to successfully combat the
poison even when introduced, and the disease would in such a case become extinct from
lack of suitable soil for its growth. As before stated, the tubercular bacillus must
be introduced into a system before tubercular disease developes, and in every instance
the germ is derived from a former case, either in man or the lower animals. Therefore,
the next step is to prevent the germ from being so transmitted. In consumption,
most of the infection passes from the body in the expectoration, and it is from careless
disposal of this that so much consumption abounds. Were the expectoration care-
fully collected in a porcelain or enamelled spittoon, containing strong Condy's Fluid,
or some other disinfectant, there would be an end of this mode of transmission, as it
is by the inhalation of the dry particles into which the expectoration is resolved that
infection is received. Another channel by which the tubercle germs enter the human
body is by the alimentary canal, either in the flesh of animals which have suffered
from tubercle, or in the milk of cows affected by the same. Hence, meat from a
tuberculous ox should be condemned as unfit for human food, as no ordinary cooking
will ensure the complete destruction of the germ which pervades all parts of the
animal. Milk is more easily dealt with, as, by thorough boiling, it can be completely
sterilized. This process should be regularly carried out, especially in regard to milk
intended for bottle-feeding. The milk for this is very often obtained from one cow,
and if this cow happens to be suffering from tubercular disease, the danger of infection
must be exceptionally great. The new Dairy Regulations, which will come into
force during 1892, will have a decidedly beneficial effect upon the health of dairy
cattle, as it has been found that tubercle is a disease of domestication amongst cattle,
and the improved ventilation and ample air-space guaranteed in these Bye-laws will
tend to remove the evils consequent upon the necessary confinement of cows.
Diseases of the Digestive System caused 28 per cent. of the sickness, and 5.5
per cent. of the total death-rate. Constipation accounts for a large number of these
diseases, and this is frequently due to using boiled tea, tinned meat, and bakers' bread,
as a make-shift for cooking the old-fashioned meals of porridge and milk, &c. Another

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