HH62/45/7

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cause is the absence of necessary conveniences in many houses; but with improved
sanitation, and the education of the younger generation to habits of regularity, we
may expect a marked diminution of such diseases.
Rheumatic Diseases, along with affections of the Circulatory System (which
often owe their origin to an attack of rheumatism in early life), caused 11.2 per cent.
of the total deaths. In such a moisture-laden climate, as Perthshire, rheumatism is
always liable to occur, and, as a safeguard, the body should warmly clothed, houses
should be provided with eaves-gutters, and their subsoil should be throughly drained.
Influenza has been very prevalent during the past year, and the deaths attributed
to it were 52, or 4.1 per cent. of the total. Of the 52 deaths 40 were in persons over
60 years of age, and this mortality has usually been caused not by the influenza itself,
but by respiratory complications. The rapidity with which influenza spreads, and
which has been the cause of a large amount of speculation, is chiefly due to its being
infectious during its short incubation period when the person is going about.
Zymotic Diseases have caused deaths in all the Districts. The highest death-rate
1.58 was in the Central District, and the lowest, .51, in the Blairgowrie District.
Diphteria has been certified as the cause of 19 deaths, or 1.5 per cent. of the total.
Where this disease occurred sanitary defects were found in the majority of the houses
to account for it, and these defects were everywhere remedied. Scarlet Fever during
the year has occurred in various parts of the county; the infection in most of the
cases was traced to sources beyond the control of the rural local authorities, and by
strict isolation the disease was prevented from spreading. Measles and Whooping-
Cough have been widely prevalent in a mild form, and did not call for any interference.
Diarrhoea caused 24 deaths, or 1.9 per cent. of the total.
Cancer caused 42 deaths, or 3.3 per cent. of the total, as against the average
4.7 per cent. in mainland rural Scotland
Violence caused 65 deaths, or 5.1 of a total.
4. No Hospital has been erected in the County for the accommodation of persons
suffering from infectious diseases, but, during the year, the Directors of the Perth
Royal Infirmary have opened their doors to receive cases requiring such accom-
modation. They have, moreover, made an offer to the various District Committees
which, for a small outlay, would ensure provision for the treatment of infectious
diseases (except smallpox), during the next five years, at the end of which period
it would be seen whether or not it will be necessary to burden the Districts
with the erection and maintenance of separate Infectious Diseases Hospitals. This
proposal has already been accepted by four of the five Districts, and has the full
approval of the County Council and their officials. The accommodation in the
Perth Royal Infirmary for infectious cases consists of one detached block
containing two wards, each capable of holding nine beds, and allowing 106 square
feet of floor and 1,590 cubic feet of air space to each patient. Each ward
is heated by a Galton's fireplace, which, while warming the room, also aids
the ventilation. There are fresh air inlets by Sheringham's valves near the ceiling,
and free exit for foul air by shafts in the roof, besides six large windows in each ward,
extending nearly to the ceiling and opening at the top, so that ample additional
ventilation can be obtained by perflation. The baths, &c., are in perfect order, and
there is also in this block a kitchen, and accommodation for nurses. In another
detached building are four wards, each capable of accommodating ten patients, giving
to each patient a floor space of over 100 square feet and 1,500 cubic feet of air space.
The upper wards in this block have been so arranged that they can, when required,
be completely shut off from the rest of the building, in which case the only access is

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by a door opening to the outer air. These wards are heated and ventilated in the
same manner as the first-mentioned, and there is kitchen and nurses' accommodation,
while the sanitary appliances are all of recent introduction. In the lower wards of
this block there is ample room for treating 20 cases of enteric fever; the heating and
ventilating are after the same fashion, excepting that the foul air is carried in flues
to the roof of the house. Besides the large wards there is an isolated room which is
used for observation of doubtful cases; in it there are two beds. Thus it will be seen
that there are, in all, 60 beds available for the reception of fever cases, of these 40
are completely isolated, and 20 are partially so, and could be used for enteric fever
cases. To make this accommodation fully available, a Steam Laundry and Disinfector
require to be erected, without which no Infectious Diseases Hospital is now considered
perfect. It is intended to erect at the Infirmary the largest size of Goddard, Massey,
& Warner's Combined Hot Air and Steam Disinfectors, so that beds and such
unwieldy articles can be easily dealt with. Those Disinfectors do their work so
thoroughly that the largest articles can be completely dealt with in half-an-hour, and
the goods come out of the apparatus dry and fit for immediate use. This is achieved
by alternate currents of hot air and steam, by means of which the temperature of the
infected article may be raised to the point necessary for the destruction of infective
germs (230° Fahr.), and at the same time condensation of the steam and consequent
dampness is effectually prevented.
No ambulance waggon has yet been provided for removing cases of infectious
disease, but during the past year an old carriage has been in use as a make-shift.
It has fulfilled its purpose exceeding well, but is not adapted for long journeys.
Enquiries have been made regarding the best kind of waggon for such cases; and it
has been found that a specially-constructed waggon would be required for Perthshire.
The District Committees who have accepted the offer of the Perth Royal
Infirmary Directors have agreed to obtain such a waggon, which will be kept in
Perth, and a nurse will be sent to take charge of any case during removal to the
hospital.
During the year 296 cases of infectious diseases have been reported to the Public
Health Department. In 9 cases removal was necessary, and these were accommodated
in the Perth Royal Infirmary, free of charge. The remainder were treated at home,
and strict isolation was maintained during the infective period, under the supervision
of the local medical and sanitary staff. In some of the cases it was necessary, in order
to prevent infection from spreading, to provide a nurse, whose expenses were paid by
the respective District Committees.
The Infectious Diseases (Notification) Act has not been adopted in any of the
Districts of Perthshire, and from the experience of the past year there does not seem
to be any necessity for doing so.
5. Appended is a Tubular Statement of the Sickness and Mortality within the
County in the form required by the Board of Supervision, as well as detailed state-
ments of deaths due to the various diseases occurring in the Registration Districts
into which the County of Perth is sub-divided by the Registrar-General.
In so far as they could render assistance to sanitary science the District
Registrars have done their best, and deserve the thanks of the community for so
doing.

JOHN T. GRAHAM, M.D.,
County Medical Officer.
March 31st, 1892.

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