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COUNTY OF PERTH.
FIRST ANNUAL REPORT BY THE COUNTY MEDICAL OFFICER
1891.
1. The County of Perth has an area (exclusive of the City of Perth) of 1,586,115
acres, and the Census Returns for 1891 shew a population (exclusive of Burghs) of
69,912. The County of Perth consists of 74 Parishes, which, for purposes of Public
Health administration, have been grouped into five Districts, viz.:-
PERTH DISTRICT, - - - - - 27 Parishes.
CENTRAL DISTRICT, - - - - 14 Parishes.
WESTERN DISTRICT, - - - - 9 Parishes.
HIGHLAND DISTRICT, - - - - 10 Parishes.
BLAIRGOWRIE OR EASTERN DISTRICT, - - 14 Parishes.
Although the general sanitary condition of the County of Perth may be
considered fair, the fact that the death-rate is 18 per 1000 of population, or more
than 2 per 1000 above the average (15.7) for mainland rural Scotland, shews that
there is still ample room for improvement.
Throughout the County there are numerous large villages, and it is improving
the sanitary condition of these that the largest reduction of the death-rate will be
attained. As a result of bad hygienic surroundings the mortality in many of these
villages is exceptionally high. There is, in the majority of the villages, no provision
made by the Local Authority for the regular removal of house refuse, hence the soil
in the immediate vicinity of the dwelling-houses becomes saturated with all manner
of offensive matter, and, from the construction of the houses, the gases from this
polluted soil has free ingress to the homes of the people; in some instances the liquid
manure may even be seen soaking through the walls. Such a condition has a very
depressing effect upon the general health of the household, and should scarlet fever,
or a similar disease occur, it very often proves fatal, and the cases invariably assume
a more or less malignant type, a result largely due to the unhealthy state of the
systems into which the fever has been introduced. Strong recommendations have
been laid before the various District Committees by the Chief Medical Officer, and
Sanitary Inspector, urging these Committees to take advantage of the ample powers
conferred upon them under the Public Health (Scotland) Act, and to appoint in each
of the large villages a scavenger, whose duty it would be to remove all domestic refuse
regularly to a safe place; and it would be well if the County Council would strongly
urge the District Committee to adopt the views of their Chief Officers.
The general house accommodation throughout the County is good, and it is the
exception to find a familly living in a single room. As a rule, there is ample provision
made for efficient ventilation by means of windows. In very many cases, however, a
bad selection has been made as to the site of houses. Earth banked against the wall,
eaves-drippings, and the absences of any sub-soil drainage, must cause damp. The
want of ventilation underneath the floors is also a serious defect.
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One special danger to which Perthshire is liable arises from the presence, in the
County, of many large houses which are only fully occupied for about two months
during the year. In most cases the drainage of these houses is carried into a
cesspool, and unless such a drainage system be properly supervised, there is a great
risk in suddenly utilizing it for the requirements of a large establishment. A proper
certificate ought to be obtained annually, in his own interest, by the occupier, as to
the efficiency of the drainage system of the house. In many of the older houses the
drainage systems are antiquated, but still doing good service; these must be made the
best of. It would be well, however, that Bye-laws should be made (Section 57,
Local Government Act), with regard to new houses, and their plans submitted for
the approval of the Sanitary Inspector. Thus faults might be easily remedied, which,
if allowed to go on, would eventually lead to sickness, and a larger subsequent
expenditure.
In many parts of the County there is a great deficiency of conveniences in
connection with houses, or a primitive and dangerous arrangement for the same. This
is gradually being remedied by the introduction of the pail system, which is the least
expensive in construction and maintenance.
The question of retaining the services of Sub-District Medical Officer has been
before the various District Committees of Perthshire during the past year. In only
two Districts, the Central and Western, have the services of these officials been
retained; but, where retained, they have been of great benefit. The determination
of the other Committees to dismiss the Sub-District Medical Officers is much to
be regretted, as, without their valuable local knowledge and co-operation, Preventive
Medicine is deprived of one of its most important aids. The Local Government
(Scotland) Act, in deciding that the Chief District Medical Officer should be debarred
from private practice, did not anticipate that the Medical Officers under the Public
Health Act should be abolished; it was rather intended to supplement the efficiency
of the latter by giving them a superior independent of local influences, who
might consequently enforce reforms which they saw to be necessary, but were unable,
from their position, to execute. The Sub-District Medical Officers were also of great
service to the County in furnishing data for statistics regarding the Distribution of
Disease, and should these District Committees adhere to their decision of dismissing
their officers, some arrangement will require to be made whereby Sickness Returns
from all the medical men throughout the County may be obtained.
There has been, in recent years, a general adoption of the water carriage system
for the removal of excreta throughout the County, and at the same time no means
have been adopted to render harmless the discharged sewage matter before its
reception into the nearest water-course. In the case of large towns and villages the
pollution caused by such a proceeding is very great, and even from isolated country-
houses where, to be fashionable, in these days the water carriage system is adopted, the
pollution is likely to assume such grave dimensions as to necessitate active interference.
Such a total disregard for law and common decency is in direct violation of one
of the Sections of "The Rivers' Pollution Act, 1876." which states that "Every
person who causes to fall, or flow, or knowingly permits to fall, or flow, or to be
carried into any stream, any solid or liquid sewage matter, shall (subject as in this
Act mentioned) be deemed to have committed an offence against this Act." That
there is ample provision made by the Act for the enforcement of this clause may be
gathered from another section which is as follows:- "The County Court (in Scotland
Sheriff Court) having jurisdiction in the place when any offence against the Act is
committed, may by summary order require any person to abstain from the commission
[Note] 2
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of such offence;" and farther, "Any person making default in complying with any
requirement of an order of a County Court (Sheriff Court) made in pursuance of this
section, shall pay to the person complaining, or such other person as the Court may
direct, such sum not exceeding £50 a day for every day during which he is in default,
as the Court may order." Within the past year two large burghs have taken steps
to adopt measures which, when completed, will do much to obviate the pollution of the
neighbouring rivers; but similar improvements will have to be made in connection with
all defaulting drainage systems ere the "Rivers' Pollution Act" can be said to be
carried out satisfactorily in Perthshire. One instance will prove the necessity of
such measures being adopted. The City of Perth, with a population of 29,902, is
entirely dependent on the River Tay for its drinking-water; and as the Tay, before it
reached the Perth Bridge, may receive the sewage of a population roughly
estimated at 45,000, it will be perceived that he inhabitants of the city are placed
in a most perilous position. That want of thought which is frequently the origin of
river pollution amounts in this case to almost criminal selfishness, and it is time that
corporations and private individuals should know that they must adopt one or other
of the simple means employed for the purification of sewage, and that the conversion
of some of the finest rivers in the country into common sewers will no longer be
tolerated.
During the past year much has been done by the Sanitary Inspector and his
Assistants to improve the condition of the County. Their efforts, however, have
been impeded by lack of organisation, and by the fact that the Assistant Inspectors
in many places were new to their work. Now that Bye-laws have been adopted for
the various Districts, and that the workers have grasped the extent of their duties, it is
hoped that during 1892 the administration of the Public Healths Acts will be much
facilitated. It is gratifying to state that in no instance have legal proceedings been
required to induce improvements. Although alterations have often entailed a some-
what large outlay, there has been a general willingness on the part of proprietors and
their agents to undertake whatever was deemed necessary, and where these take the
initiative, there is little difficulty in persuading tenants to carry out their part of the
necessary changes. Such a state of matters augurs well for the progress of sanitation in
Perthshire, for where the people can be made their own sanitary reformers, the Public
Health Act will not be felt as a coercive measure, and its most perfect fulfillment will be
attained. With a view to making the District Committees more intimately acquainted
with the work of their officials, the Finance Committee asked the latter to send Quarterly
Excerpts from their County Journals to the respective Districts. If the Finance
Committee would further recommend that the Chief District Officials should be
present at Committee Meetings when it is intended to discuss matters relative to
Public Health, the efficiency of this department would be greatly increased.
2. During the past year systematic general enquiries have been made into the
Sanitary Condition, &c., of the more populous parts of the County. On many
occasions special investigations have been necessitated in consequence of the occurr-
ence of infectious disease, but in no case has any action been necessary as County
Medical Officer. This is owing to the fact that as Chief District Medical Officer I
have executed the work which, in the terms of my original appointment, would have
been referred to me as County Officer by the Subordinate District Officials.
Upon the recommendation of the County Medical Officer, the County Council
issued a strong recommendation to the various District Committees, urging them to
accept of a very generous offer made by the Directors of the Perth Royal Infirmary
whereby accommodation for infectious cases would be secured during a period of five
years.
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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-
[Note] 4
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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
[Note] 5 |
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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
[Note] 6
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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.
[Note] 7 |
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[Note] 8
TABULAR STATEMENTS
OF
Sickness and Mortality
IN THE
COUNTY OF PERTH.
1891.
[Note] 9 |
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[Note] 10
TABULAR STATEMENT of SICKNESS and MORTALITY referred to in the Regulations issued by the Board
of Supervision for Medical Officers of Counties.
COUNTY OF PERTH.
TABLE I. - Births and Deaths occurring in the County during the Year 1891.
[Table inserted]
NOTES. - The Medical Officer may, if he thinks fit, give separately the figures for any Sub-Divisions of the County: in all cases the Total for the County is to be given.
Deaths of Persons belonging to a County occurring in Public Institutions (as Lunatic Asylums, Poorhouses, Hospitals) outside of the County, are to be included with the figures for that County,
and Deaths of Persons not belonging to a County, occurring in Public Institutions within the County, are to be excluded.
"Diphtheria" shall include "Membranous Croup," "Diphtheritic Croup," "Croupous Diphtheria."
All Deaths from "Diarrhoea," "Dysentery," "Enteritis," "Gastro-Enteritis," "Muco-Enteritis," - unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis-
Diarrhoea," "Bright's Disease-Diarrhoea," are to be entered under the heading "Diarrhoea."
The designation "Other Tubercular Diseases" shall include, inter alia, "Tabes Mesenterica," "Tubercular Meningitis," "Hydrocephalus," "Struma," "Scrofula."
The headings distinguished by asterisks cover all diseases placed under these headings in the classification of the Registrar-General.
[Note] 11
TABLE II. - Density of Population, Birth Rate, Infantile and other Death Rates.
[Table inserted]
*To be calculated to three places in decimals.
TABLE III. - Cases of Infectious Disease coming to the knowledge of the Medical Officer during the Year 1891
[Table inserted]
(Signed) JOHN T. GRAHAM, M.D.,
Medical Officer. |
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[Note] 12
COUNTY OF PERTH - PERTH DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
[Note] 13
COUNTY OF PERTH - PERTH DISTRICT. - Continued.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
*Acreage included under Auchtergaven, Kinclaven, and Redgorton
+After deducting (4336) Acreage of Perth City, formed by parts of Kinnoull, Perth, Scone, and Tibbermore. |
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[Note] 14
COUNTY OF PERTH - CENTRAL DISTRICT.
TABLE IV. - Table of BIRTHS and DEATHS occurring in the District during the Year, 1891, according to the Registration Districts.
[Table inserted]
[Note] 15
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
*1 Acreage included under Dull, Fortingal, Logierait, Kenmore, and Weem.
*2 Acreage combined with Dowally.
*3 Acreage included under Dull.
*4 Acreage included under Fortingal.
*5 Acreage included under Moulin.
*6 Acreage included under Blair-Athole, Dull, and Moulin.
+ Unclaimed Land adjoining Kenmore.
‡ Land common to Blair Athole, Fortingal, and Logierait. |
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[Note] 16
COUNTY OF PERTH - WESTERN DISTRICT.
TABLE IV.-Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
[Note] 17
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
* Acreage included under Kirkmichael.
+ Acreage included under Alyth, Bendochy, Blairgowrie, Caputh, Kirkmichael, Lethendy and Kincloch, and Rattray |
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COUNTY OF PERTH.
FIRST ANNUAL REPORT
BY THE
COUNTY MEDICAL OFFICER,
1891.
[Note] 18
COUNTY OF PERTH.
FIRST ANNUAL REPORT BY THE CHIEF MEDICAL OFFICER
OF THE
BLAIRGOWRIE or EASTERN DISTRICT.
1891.
1. The Blairgowrie District has an area of 175,664 acres,* and a population of
9,778 (exclusive of the Burghs of Alyth, Blairgowrie, Coupar-Angus, and Rattray),
as ascertained by the Census of 1891. The number of acres to each person is
about 17. The Census Returns for 1891 show a decrease of population in the
District of 1,038 during the preceding 10 years.
In the rural part of the District the total Births were 222, or 22.7 per 1000,
and the Deaths were 162, or at the rate of 16.5 per 1000 inhabitants. The Infant
Mortality was at the rate of 40.5 per 1000 births; and the Mortality over 60 years,
54.3 per cent. of the total. The natural increase of the population of the District is
60.
From the above figures it will be seen that the health of the District is very
good. Indeed, in this respect, it stands second in the list of the Districts of
Perthshire.
As the population of the Blairgowrie District is nearly equally divided into urban
and rural, a comparison of the vital statistics of the two classes would form an
interesting study, but the time at disposal during the past year has been too limited
to permit the details being worked out.
The appointment of Chief Medical Officer to the District dates from 9th July,
1891, hence this Report only deals with the latter half of the year, and is of necessity
not so full as it might otherwise have been.
There are a number of villages in the District, and these are, as a rule, in good
condition as regards sanitation. In all of them the water supply is obtained from
wells or streams, and is in most cases of good quality. In the village of Meigle,
where the Dundee Water Supply pipe runs close by the village, it would be of decided
advantage to the inhabitants if a supply could be obtained from this.
The house accommodation of the working-classes throughout the District is good.
No overcrowding has been found, and there is ample provision for ventilation by
means of windows which open, - the chief trouble being to convince the occupiers of
*i.e., as nearly as possible approximating its boundary to that as altered by the Boundary Commissioners.
[Note] 19 |
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the necessity for using the same. A frequent argument against opening windows is
to point to the fact, that where a room is completely shut up, curtains, &c., may be
seen affected by draughts. This is taken as indication that abundance of fresh air
is entering the room, forgetting that a local draught of foul air may cause movement,
but it requires the oxygen of the outer air to give health.
Many of the houses has been erected on bad sites (with earth banks against the
back wall), and these have a great tendency to become damp. In many cases this is
increased by the absence of eaves-gutters to carry away the rain water, which other-
wise must soak into the earth at the back of the houses. Where proper drainage
does not exist this is likely to cause injury to health, hence, wherever such a state of
matters has been discovered, the proper remedies in the shape of eaves-gutters and
drainage have been recommended. In many cases, also, where the floors of dwelling-
houses are made of stone, no precaution has been taken, by excavation and filling up
of the substructure, to prevent damp from rising. This is certainly not a proper state
of matters, but as the object aimed at in the administration of the Public Health Act
in Perthshire is to make the inhabitants their own sanitary reformers, improvements
will proceed, we trust, gradually but surely. Acting on the above principle, a large
amount of permanent work has been accomplished throughout the District, and it is
very much to the credit of the Sanitary Inspector that this has been done without
resorting to legal proceedings.
During the year 1892 the Dairy Regulation will come into force, and will be
the means of greatly improving the condition of cowsheds and milk-houses, as well as
ensuring a plentiful supply of pure water to farms, which are at present badly off
for such an essential element of health.
With regard to the villages, the District Committee should call for a Report on
the condition of the larger ones, especially in regard to the disposal of house refuse,
in order that, when judging of sanitary measures, they may be in possession of the
facts, and also the remedies suggested by their Officials. As the Public Health Sub-
Committee should have all the information possible when dealing with matters relating
to Public Health, it would be well that the District Officials were invited to attend
its meetings.
It is to be regretted that the District Committee have dispensed with the
services of the Local Medical Officers, for, by so doing, much valuable knowledge has
been lost irretrievably to the Public Health administration. It is quite impossible
for an outsider to acquire that intimate and personal acquaintances with the homes of
the District which a local Medical man has as a natural result of his every-day work.
The removal from office of these skilled observers will, in the future, prove a serious
impediment to the progress of Preventive Medicine in the District, and it would be
well for the Committee to reconsider their decision.
2. During the past year a systematic inspection of the more populous parts of the
Blairgowrie District has been made, including, in the first place, the topographical
and geographical features, the water supplies and drainage; and, in the second place,
the condition of houses as regards dampness and ventilation. Attention has been
directed to what was amiss, and instructions for improvement were given.
Special enquiries were made regarding an outbreak of enteric fever in the District,
and, along with the Sanitary Inspector, into some nuisances of which complaints were
lodged.
3. No Certificate under the Public Health Act has been required, as the removal
of insanitary conditions was at once undertaken willingly, so soon as the necessity
was understood.
[Note] 20
[Page] 3
No action has been demanded regarding the sanitary condition of Factories and
Workshops; nor has any offensive trade been brought under notice, excepting two
slaughter-houses, which will in due course be dealt with by the Sanitary Inspector.
4. There has been, during the latter half of the year, a systematic inspection of the
Six Retail Bakehouses in the District. One of them is in very bad repair, but is
not in use as a bakehouse at present; the others have been put in good order,
both internally and externally, and are now in a thoroughly sanitary condition. One
young person was found employed, and reported to H.M. Inspector of Factories.
5. No proper arrangement has been made regarding the provision of accommo-
dation for persons suffering from infectious diseases in the District, and requiring, for
purposes of isolation, removal to Hospital. By the courtesy of the Directors of the
Perth Royal Infirmary, the Wards of that Institution set apart for the treatment of
infectious cases, have been, during the past year, placed at the disposal of the District
Committee. This accommodation has not as yet been required, but, with the view of
making a definite arrangement for the future, a Joint Meeting of Representatives from
the Directors, and from the District Committee, was held. At this Meeting the
Directors made a proposal to take the entire charge of any cases of infectious disease
(smallpox excepted) which might be sent to the Infirmary, during a period of five
years, the sole conditions being, that the Local Authorities, who are to have the use
of the Fever Wards, should pay one-half of the expenses which will be incurred in
the necessary alterations connected with the Laundry and Disinfecting Apparatus.
The Directors contemplate erecting a Steam Laundry and Disinfector of the
most modern design. These negotiations are in progress, and it is to be hoped that
all will soon be satisfactorily arranged.
The distance from the extreme parts of the District may be deemed by some an
objection to this scheme, but with a good Ambulance Waggon, such as it is proposed
to secure, there will be no difficulty in removing cases, even from the most outflying
places. At the termination of the five years' arrangement, the Committee can more
easily judge whether, or not, it is necessary to erect a special Epidemic Hospital for
the District. Should the Perth Royal Infirmary be decided upon as the centre to
which infectious cases are to be sent, as Senior Visiting Surgeon to that Institution,
under the Directors, the Chief District Medical Officer has every opportunity of
supervising the accommodation and treatment of patients admitted to it.
6. Little has required to be done in the way of taking action to prevent the spread
of infectious disease in the District, during the past year. One case of diphtheria,
which was imported from outside the District, and six cases of enteric fever are all
which have come under the notice of the District Officials. In the diphtheria case
the disease did not spread. How the first three enteric fever cases were infected has
not been definitely settled, but the other cases were undoubtedly infected from one of
these. Special precautions were taken regarding the disposal of the excreta of the
latter cases, and no fresh outbreak has occurred. Enteric, or, as it is commonly called,
typhoid or gastric fever, is one of the most infectious diseases known; but, fortunately,
its infective powers are chiefly contained in the excreta, and if these be carefully
dealt with, there is very little danger of the disease spreading. The nurse of an
enteric case should attend to the following rules:- 1st. The excreta should always be
received into some powerful disinfectant, and all clothing soiled by discharge should
at once be soaked in strong disinfecting solution, and thereafter washed. 2nd. The
nurse's hands ought to be carefully washed after assisting, or touching the patient in
any way. 3rd. In the disposal of excreta great care should be exercised that a
[Note] 21 |
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sufficient quantity of disinfectant is used to ensure thorough extinction of the infective
germs, and then removal should take place, as speedily as possible, to some safe
quarter. The local Sanitary Inspectors have now a supply of disinfectants ready for
use when required.
7. No Returns have been received from the local Medical Officers regarding the
distribution of sickness in the District during the year. The following facts are
obtained from an analysis of the Mortality Returns for the year:-
Circulatory Diseases caused 23 deaths, or 14 per cent. of the total. As, in many
cases these, diseases owe their origin to attacks of rheumatism in early life, much may
be done towards their prevention by making the dwellings less liable to damp, which
is one of the commonest causes of rheumatic affections. Another essential in the
prevention of these ailments is to protect the body from sudden chills by wearing
woollen underclothing, which, from its non-conducting properties, protects the surface
of the body. Still, in a part of the country so exposed to moisture-laden and chilling
east winds, as is the Blairgowrie District, illness of this sort must always be prevalent.
Two deaths have been certified as having been caused by rheumatic fever.
Respiratory Diseases come next on the list as a cause of death, viz. - 16 deaths,
or 9.8 per cent. of the total. These, like the Circulatory diseases, are largely due to
climatic conditions, and as a preventive warm non-conducting underclothing should
undoubtedly be adopted, especially for those who are exposed to the inclemency of
the weather.
Diseases of the Digestive System account for 15 deaths, or 9.2 per cent. of the
total mortality. As these in many instances owe their origin to constipation, often
acquired in consequence of the want of the necessary conveniences in connection with
dwelling-houses, it is only reasonable to expect a marked diminution of disease of this
class, as sanitary measures remove the initial cause, and as the rising generation
become educated to regular habits.
Tubercular Disease has accounted for 12 deaths, or 7.4 per cent. of the total.
Nine of these deaths have been caused by tubercular disease, other than phthisis.
As it has now been proved that tubercular disease is transmitted from man to man,
or from cattle to man, as the case may be, it will not be out of place here to give
some general directions for the prevention of such transmission. In the first place, it
ought to be known that the old idea that this disease is hereditary has now been
exploded. A tendency to it is certainly strongly marked in some families, but the
tendency, without the actual reception of the special infective germ, cannot now be
held as a cause of the disease. The germ of infection is received into the human
body, either in the form of minute particles which are carried by the air into
the lungs in the ordinary process of respiration, or it enters by the alimentary
canal. In the former case, when such a particle enters a lung which is in a weak con-
dition, and not in possession of its normal resisting powers against such poison, it soon
obtains a firm hold, and its work of destruction ceases only with the death of the
sufferer. In the latter, the poison may be received from the milk of a cow affected by
tubercle; to this infants brought up on the feeding-bottle will be specially susceptible,
and therefore all milk used for such a purpose ought to be boiled. It has also been
proved that eating the flesh of animals affected by this disease can cause the same in the
bodies of other animals previously healthy. Reasoning by analogy, we conclude that
such meat is quite as likely to produce a like result in the human race. Doubtless
such meat, if subjected to a sufficiently high temperature, is quite safe for use; but
[Note] 22
[Page] 5
it has been proved that it is practically impossible to raise the temperature of a large
piece of meat sufficiently by roasting without entirely carbonizing the outer
portions. Although boiling is, perhaps, the most effectual method of ensuring that the
temperature has been raised to the full 212°, still such a treatment would effectually
destroy the nutritive quality of the meat, and hence its adoption cannot be recom-
mended.
As to precautions against infection from consumption, the room occupied by a
consumptive patient should be well ventilated, and as much exposed to sunshine as
possible; all overcrowding of the apartment by visitors should be avoided, and the
patient should occupy a single bed. In fact, consumption should be treated with as
much caution as enteric fever.
Influenza has been widely prevalent throughout the District; the deaths
directly attributed to this cause were 8, or 4.9 per cent. of the total. The disease
seems now to have ceased, so far as Perthshire is concerned, and we trust it has now
left us for this generation. Spreading so rapidly as it does, influenza is a disease
which it seems almost impossible to combat in the way of prevention; but as the Local
Government Board has taken up the matter, we may soon expect to have laid before
us the best means to be adopted, should the disease again attack our shores.
8. Appended are Tubular Statements of the Sickness and Mortality in the District
during the year 1891. The first three Tables are in the forms required by the
Board of Supervision, and in the fourth is a detailed statement showing the Births
and Deaths (with causes of the latter) in the various Registration Districts, into
which the Registrar-General has sub-divided the Perth District.
The local Registrars cannot be too highly commended for the unanimous manner
in which they have come forward to supply the data for these Tables.
JOHN T. GRAHAM, M.D.,
Chief District Medical Officer.
February 29th, 1892.
[Note] 23 |
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[Note] 24
TABULAR STATEMENTS
OF
Sickness and Mortality
IN THE
BLAIRGOWRIE DISTRICT.
1891.
[Note] 25 |
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[Note] 26
TABULAR STATEMENT of SICKNESS and MORTALITY referred to in the Regulations issued by the Board
of Supervision for Medical Officers of Districts of Counties.
County of PERTH. BLAIRGOWRIE District.
TABLE I. - Births and Deaths occurring in the District during the Year 1891.
[Table inserted]
NOTES. - The Medical Officer may, if he thinks fit, give separately the figures for any Sub-divisions of the District: in all cases the Total for the District is to be given.
Deaths of Persons belonging to a District occurring in Public Institutions (as Lunatic Asylums, Poorhouses, Hospitals) outside of the District, are to be included with the figures for the District,
and Deaths of Persons not belonging to a District, occurring in Public Institutions within the District, are to be excluded.
"Diphtheria" shall include "Membranous Croup," "Diphtheritic Croup," "Croupous Diphtheria."
All Deaths from "Diarrhoea," "Dysentery," "Enteritis," "Gastro-Enteritis," "Muco-Enteritis," - unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis-
Diarrhoea," "Bright's Disease-Diarrhoea," are to be entered under the heading "Diarrhoea."
The designation "Other Tubercular Diseases" shall include, inter alia, "Tabes Mesenterica," "Tubercular Meningitis," "Hydrocephalus," "Struma," "Scrofula,"
[Note] 27
TABLE II. - Density of Population, Birth Rate, Infantile and other Death Rates.
[Table inserted]
*To be calculated to three places in decimals.
TABLE III. - Cases of Infectious Disease coming to the knowledge of the Medical Officer during the Year 1891.
[Table inserted]
February 29th, 1892.
(Signed) JOHN T. GRAHAM, M.D.,
Medical Officer. |
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[Note] 28
COUNTY OF PERTH - BLAIRGOWRIE DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
[Note] 29 |
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[Note] 30
COUNTY OF PERTH.
FIRST ANNUAL REPORT
BY THE
CHIEF MEDICAL OFFICER
OF THE
BLAIRGOWRIE DISTRICT.
1891.
COUNTY OF PERTH.
FIRST ANNUAL REPORT BY THE CHIEF MEDICAL OFFICER
OF THE
CENTRAL DISTRICT.
1891.
1. The Central District has an area of 267,504 acres, and a population of 14,554,
according to the Census taken 5th April, 1891. The number of acres to each person
is about 19. Included in the District are five large villages, the populations of which
range from 2,500 to 650, otherwise the inhabitants are widely scattered.
The Births, during the year 1891, were 322, or at the rate of 22.1 per 1000; and
the Deaths were exactly the same in number. Infantile Mortality was at the rate of
77.6 per 1000 births. The Census returns for 1891 show a decrease of population
in the District of 1,704 during the preceding ten years.
It would be well for the Committee to call for a detailed Report on the sanitary
condition of all the large villages in the District (with regard to the disposal of house
refuse, &c.), as it will be from improved sanitation in these, that the most marked results
of the application of the Public Health Act will be obtained. This is fully borne
out by statistics, which show that if the parishes containing large villages are
eliminated from the totals of the District. the mortality falls from 22.1 to 18.8 per
1000, and the infant mortality from 25 to 6.
There is an abundant supply of pure water, by gravitation, to all the large villages;
but in some of them the drainage is not in keeping with modern ideas of sanitation,
the gutters at the side of the public streets being utilized for this purpose. When
the overflow of cesspools and sinks (which are often not much better than cesspools
in respect to the matter they discharge) falls into these gutters, it affords a good
opportunity for the spread of such diseases as typhoid fever.
In some of the country districts the water supply is not at all in a satisfactory
condition; in the Parish of Madderty, for example, along a ridge extending from
Crieff to St. David's, it is difficult, owing to the geological formation, to obtain water
by means of wells. In this case, however, the proprietors are doing all in their power
to provide a sufficient supply. Taken as a whole, the Central District may be said
to be well supplied with water.
In a few of the cases where detailed examinations of farm steadings have been
made, it was found that considerable improvements in the way of sanitation were
required; however, when the new Dairy Regulations come into force, matters of this
kind, along with the individual water supplies, will be remedied.
[Note] 31 |
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The condition of the houses of the working classes in the District is good.
There is generally ample provision for ventilation, the difficulty being to get the
occupants to make use of it; but there is a great want of conveniences in connection
with the houses.
During the year the Chief Sanitary Inspector furnished the Committee with a
full Report on the Drainage of Auchterarder. It would be well that effect were
speedily given to his suggestions, in the matter of laying down a proper system of
sewers, and providing for discharge of the effluent, so as to prevent the pollution
of the neighbouring stream. At the same time it would be desirable to make an
extensive alteration of the houses and their surroundings, in various parts of the
village.
The Central District Committee has shown a good example to the rest of the
County by providing scavengers for all the large villages from the general rates, and
if, besides keeping the streets clean, these men were employed in emptying ashpits,
&c., the system would be most beneficial. At present the heaps of house refuse,
found in immediate proximity to dwelling-houses, are a constant source of weak
health and a high death rate. Nothing will make such a speedy improvement upon
the general health of the villages as the regular removal of the above, and the
consequent purification of the soil, which is now, in many instances, soaking with
poisonous organic matter. In fact, until such a measure is adopted, these villages
will be only superficially clean, and therefore the more dangerous.
In the Central District the Sub-District Medical Officers have been retained,
and during the past year these officials have proved of immense service by their
energetic action in stamping out infectious disease at its very beginning, and thus
preventing a panic in a part of the County much frequented by summer visitors, at a
time when such a panic would have meant serious pecuniary loss to the inhabitants
of the District.
2. During the year general systematic inspections have been made into the sanitary
condition of the more populous parts of the District, when the soil, geological
formation, water supplies, general house accommodation, and sanitary condition of the
houses were noted. Special enquiries have also been necessitated in consequence of
complaints of defective water supplies, or the outbreak of infectious disease on
various occasions.
The accommodation provided by the Contractors for the workmen employed in
the construction of the new Crieff and Comrie Railway has been supervised, and
many suggestions have been carried out. The accommodation is now in a very fair
sanitary condition, though there is a deficiency int he cubic air space of the huts. It
has not been considered advisable to interfere on this ground, so long as the huts are
kept clean, and well ventilated. The reasons for this decision are found in the
airy situation of the huts, and the fact that the men are continually in the open air
when at work, together with the circumstance that the while erection is of a
temporary character. So far there has been no cause to regret the course taken, as
every endeavor has been made by the Contractors to carry out suggestions given;
and had the huts been placed on the register as common lodging-houses strained
relations would probably have ensued.
As Quarterly Excerpts have been sent to the Committee from the Medical
Officer's Journal, relative to work done in the District, it is unnecessary to say more
than that in every instance in which suggestions were made, they were carried out, and
in the majority of cases this was done most willingly.
[Note] 32
[Page] 3
3. No prosecutions have taken place in the District under the Public Health Act.
No advice has been required regarding the sanitary condition of Factories, and no
offensive trade has been notified during the year.
The Public Health Sub-Committee consulted the Medical Officer once, viz. -
regarding the proposed Dairy Regulations, and it is hoped that, in future, the Sub-
Committee will consult their Officers when discussing matters relating to Public
Health, as, until such a course is adopted, sanitation can proceed only in a very
unsatisfactory manner.
4. During the year many visits have been made to the 18 retail Bakehouses in the
District. They have all been put into good order, although in some cases the
alterations required were very extensive. Nuisances in the shape of ashpits, &c.,
which were too near the windows or doors of Bakehouses, have all now been abated.
In four Bakehouses young persons were found to be employed, and these were
reported to H.M. Inspector of Factories.
5. No definite arrangement has yet been made for providing accommodation for
infectious diseases occurring in the District. Cases requiring to be removed to
Hospital for better isolation have, during the past year, been received by the Perth
Royal Infirmary. As Senior Visiting Surgeon to that Institution, the Chief District
Medical Officer has, under the Directors, the full supervision of all the arrange-
ments in connection with the treatment of fever cases there, and it is on his
suggestion that negotiations have been begun for the treatment of infectious cases
from the Central District in the Perth Infirmary. Should the agreement
be completed with the Directors of the Perth Infirmary, there would be,
for the period of five years, sixty beds at the command of the District Committee
for the treatment of any infectious disease, except smallpox. The Steam
Disinfector (Goddard, Massey, & Warner's), which it is proposed to erect, would also
be available for the disinfecting of bedding and other articles, and the Infirmary
Directors intend, in the event of the Local Authorities agreeing to use their Wards,
to equip the Infirmary with the latest and best machinery for dealing with infected
clothing in every shape.
Should Perth be chosen as the centre to which infectious cases from the various
Districts are to be removed, it would be possible to have an Ambulance Waggon,
replete with every known contrivance for ease and expedition of removal, kept there
for the removal of cases from any required point.
6. With a view to prevent the outbreak and spread of infectious disease in the
District, many improvements have been carried out in connection with the removal
of dangerous nuisances, and providing wholesome drinking water, under the
directions of the Chief District Sanitary Inspector, and his assistants. No steps
have been taken to introduce the Infectious Diseases (Notification) Act in the Central
District, and, as yet, notification by the local Medical and Sanitary staff has proved
efficient, 42 cases having been notified during the past year.
In dealing with one group of diphtheria cases, in which nearly all the members of
a family were affected, and where it was impossible to remove the patients to Hospital,
it was deemed advisable to employ a nurse at the expense of the District, with a
view to prevent the disease from spreading. In a case of measles which occurred in a
common lodging-house (the child of a tramp), it was found best to isolate the patient
in a room of the same house, until the danger of infection was over. The necessary
expenses were, in this case also, borne by the District. Two cases of enteric fever
were removed to the Perth Royal Infirmary, and treated there free of charge. Other
[Note] 33 |
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infectious cases were treated in their own homes, under the supervision of the local
Medical and Sanitary Officials. In many of the scarlet fever cases the infection
was discovered to have been brought into the District by visitors, coming thither
too soon after convalescence. In none of these instances did infection spread -
thanks to the energetic measures adopted. In two groups of diphtheria cases, the
action of the local Officials was successful in confining the disease to its original
limits.
7. With regard to the Distribution of Diseases, from partial Returns received from
the local Medical Officers, it is found, as might be expected in our changeable
climate, that diseases of the Respiratory System form a large proportion of the total -
26 per cent. of the above Sickness Returns, and 20 per cent. of the total deaths.
Tubercular Diseases also form a large proportion of the deaths, viz., 10.8 per
cent. Of these. more than two-thirds were caused by consumption. As it has now
been proved that, in this form of tubercular disease, the infection passes from one to
another just as in fever, the public generally cannot be too soon warned to treat such
cases as they would an infectious fever. In consumption the chief danger from
infection lies in the expectoration, which should be carefully collected in proper
spittoons containing some disinfectant, and thereafter disposed of by washing the
spittoon with boiling water. The chief danger lies in the allowing the expectoration to
become dried, when, in the form of dust, it may be breathed by lungs which have not
the normal power of resisting infection. The habit of expectorating into handker-
chiefs, and on the floor, should be forbidden in all cases. The room of a patient
suffering from consumption should be well ventilated, and there should be no over-
crowding by visitors; the patient should also occupy a separate bed.
With regard to other forms of tubercular disease, it has been found that milk
from a cow suffering from tuberculosis can be made to cause tubercule in the lower
animals, and, reasoning by analogy, it is as likely to cause this disease in the human
species. Now, in the case of bottle-fed children, it is customary to use the milk of
one cow, and should this cow be tuberculous, the danger of infection will be great.
It is recommended, therefore, that in all cases in which bottle-feeding is used, the
milk should be boiled, as that process will effectually destroy disease and other germs,
and consequently the milk will be not only safer, but will keep better.
Diseases of the Digestive System, caused 26% of sickness in the above Returns,
and 3.4 per cent. of the total deaths. As this class of diseases is largely due
to constipation, it is fully expected, that with improved sanitation, and the training
of the rising generation to regular habits, such sickness will be much reduced.
Diseases of the Circulatory System account for, in the above-mentioned Returns,
5.4 per cent. of the sickness, and for 9 per cent. of the total deaths in the District.
These diseases are in many cases due to attacks of Rheumatism in early life, which,
in turn, are caused by dampness of the soil around houses, and this can only be
removed by proper drainage.
Influenza has in this District, as in all other parts of the country, caused a great
amount of illness. It had two culminating periods in its progress, - one in May, and
the other in December, - and at times it seemed as if there was not a house free from
the scourge. The death rate, however, only indicates 6 per cent. of the total, or 19
deaths to have been caused by influenza, and of these, 14 were deaths of persons
above 60 years of age. It is probable that the disastrous effects of the epidemic are
not yet fully known, as, in many cases, although the disease has not proved
immediately fatal, the constitution has been so shattered as to leave little ground
[Note] 34
[Page] 5
to anticipate a permanent recovery. There seems to be now no doubt that influenza is
an acute infectious disease, communicable from person to person, that it has a very short
period of incubation, and that during that period it is also infectious. In future
occurrences of influenza it would be well to isolate cases at the outset, and that will
now be the more easily done, as the public has conceived a due respect for the
unwelcome visitor.
8. Appended is a Tabular Statement of the Sickness and Mortality in the District,
in the form required by the Board of Supervision, as well as a detailed Statement
of the various Diseases occurring in the Registration Districts into which the Central
District is divided by the Registrar-General.
The Registrars of the District have, with one exception, furnished me with
particulars of deaths, but unfortunately, in 6.8 per cent. of the total deaths, the cause
was uncertified. It is to be hoped that in future years this deficiency will be
remedied.
In so far as they could render assistance to Sanitary Science, the Registrars have
done their best, and deserve the thanks of the community for so doing.
JOHN T. GRAHAM, M.D.,
Chief District Medical Officer.
February 29th, 1892.
[Note] 35 |
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| HH62/45/37 |
[Note] 36
TABULAR STATEMENTS
OF
Sickness and Mortality
IN THE
CENTRAL DISTRICT.
1891.
[Note] 37 |
|
| HH62/45/39 |
[Page] 38
TABULAR STATEMENT of SICKNESS and MORTALITY referred to in the Regulations issued by the Board
of Supervision for Medical Officers of Districts of Counties..
County of PERTH. CENTRAL District.
TABLE I. - Births and Deaths occurring in the District during the Year 1891.
[Table inserted]
NOTES. - The Medical Officer may, if he thinks fit, give separately the figures for any Sub-Divisions of the District: in all cases the Total for the Districts is to be given.
Deaths of Persons belonging to a District occurring in Public Institutions (as Lunatic Asylums, Poorhouses, Hospitals) outside of the District, are to be included with the figures for that District,
and Deaths of Persons not belonging to a District, occurring in Public Institutions within the District, are to be excluded.
"Diphtheria" shall include "Membranous Croup," "Diphtheritic Croup," "Croupous Diphtheria."
All Deaths from "Diarrhoea," "Dysentery," "Enteritis," "Gastro-Enteritis," Muco-Enteritis,"-unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis-
Diarrhoea," "Bright's Disease-Diarrhoea," are to be entered under the heading "Diarrhoea."
The designation "Other Tubercular Diseases" shall include, inter alia, "Tabes Mesenterica," "Tubercular Meningitis," "Hydrocephalus," "Struma," "Scrofula."
[Note] 39
TABLE II. - Density of Population, Birth Rate, Infantile and other Death Rates.
[Table inserted]
*To be calculated to three places in decimals.
TABLE III. - Cases of Infectious Disease coming to the knowledge of the Medical Officer during the Year 1891.
[Table inserted]
February 29th, 1892.
(Signed) JOHN T. GRAHAM, M.D.,
Medical Officer. |
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[Note] 40
COUNTY OF PERTH - CENTRAL DISTRICT.
TABLE IV. - Table of BIRTHS and DEATHS occurring in the District during the Year, 1891, according to the Registration Districts.
[Table inserted]
[Note] 41 |
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[Note] 42
COUNTY OF PERTH.
FIRST ANNUAL REPORT
BY THE
CHIEF MEDICAL OFFICER
OF THE
CENTRAL DISTRICT.
1891.
COUNTY OF PERTH.
FIRST ANNUAL REPORT BY THE CHIEF MEDICAL OFFICER
OF THE
HIGHLAND DISTRICT.
1891.
The Highland District has an area of 686,419 acres, and a population (exclusive
of the Burgh of Aberfeldy) of 13,171 persons, as ascertained by the Census, taken
5th April, 1891. Except along the eastern side of the District, the population is
very scattered. Over the whole, the proportion of persons to the acre is .019, or 52
acres to each person.
*During the year 1891, the Births in the District were 248, or at the rate of
18.8 per 1000; the Deaths being 238, or at the rate of 18.0 per 1000. The Infantile
Mortality was 48.3 per 1000 births, and 57.9 per cent. of the total deaths occurred in
persons over 60 years of age.
The Census returns of 1891 show a decrease in the population of this District of
1,324 during the preceding 10 years.
The District is well supplied with water, either by gravitation or from wells
and streams, and in most cases, the supply is as pure as can be desired, although in a
few places gross pollution was discovered in the form of the discharge of liquid manure,
or the contents of washing-tubs into streams which, lower down in their course,
would be the sole source of drinking water. In these instances the pollution has
been stopped, although it was sometimes hard to convince the authors of it that there
could be any permanent harm in such proceedings.
The houses of the working-classes in the District are in good condition, but were
often found to be deficient in sanitary conveniences. There is ample provision for
ventilation, in the shape of windows which can be fully opened; but, as in other
parts of the county, the difficulty is to induce the occupiers to make use of what is
provided.
The drainage in the large villages is good. In Dunkeld there is a scavenger
who not only keeps the streets clean, but also empties ashpits, &c., and whose wages
are paid by the inhabitants. In Pitlochry there is also a scavenger, recently
appointed. His duties do not include the emptying of ashpits, &c., so that a very
essential means of making the village what it should be is neglected there, and the
progress of sanitation in this popular health resort will be much retarded until such
measures are adopted.
*Fuller details will be found at the end of the Report.
[Note] 43 |
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During the year 1892, the Regulations in connection with Dairies, Cowsheds,
&c., will be enforced. These much needed sanitary bye-laws will tend to decided
improvement in the matter of water supplies and separate milk-houses. Besides the
carrying out of these Regulations, the Committee should call for a full report of the
sanitary condition of all the villages in the District, especially as regards the disposal
of house refuse. This would put them in possession of the main facts regarding each
village and the views of the officials in respect to the remedies proposed.
The Public Health Act would, in my opinion, be much more efficiently
administered were the District Officials invited to attend Public Health Sub-
Committee Meetings.
The question of allowing local Medical assistance for the proper administration
of the above Act in the Highland District was discussed by the Committee,
and the District Clerk requested a Report on the subject from the Chief
District Medical Officer. In this Report it was stated that the services of the
Medical men ought to be retained. The reasons for this were the following:- (1)
By dismissing these Medical Officers an amount of valuable local knowledge is lost,
which it will be impossible to replace; (2) For Returns of sickness, it is essential to
have the co-operation of Medical men; (3) The Highland District is peculiarly liable
to receive an infectious case within its bounds, because of the large number of visitors
who go thither from all parts of the country, and a panic, which would result in
serious pecuniary loss to the District, may very easily be created by a visit from head-
quarters to such a case, whereas a local Medical man can superintend isolation more
quietly and efficiently, from the fact that he is on the spot day by day in the ordinary
pursuit of his profession. Much valuable help has been given by the Sub-District
Medical Officers during the past year, and the loss of their services would be much
felt in the administration of Sanitation in the District should the Committee adhere
to their resolution of dismissal.
During the year a general inspection has been made of the condition of the more
populous parts of the District. On these visits, the nature of the soil, geological
formation, and general topographical features of the localities were noted, together
with the water supplies, and general sanitary condition of the houses.
Special investigations have been necessitated by the occurrence of infectious
disease, and alleged contamination of water supplies. It was observed that many
sanitary improvements had been made, or were in process of being carried out, under
the direction of the Chief Sanitary Inspector and his assistant.
No certificates have been required during the year. On several occasions advice
was given regarding the purity of water supplies, or the condition of premises, with
a view to a certificate being required for prosecution if the matter were not remedied.
This was, however, always done without having recourse to the unpleasant necessity
of prosecution. Advice was also given with regard to the isolation, &c., of infectious
cases.
Some very insanitary and dilapidated Slaughter-houses in one part of the
District are to be replaced by new erections, which will in every way be in keeping
with the requirements of modern sanitary ideas.
No action has been called for in regard to the sanitary condition of Factories
and Workshops.
Retail Bakehouses. - These are 10 in number, and have, in some cases, required
a great deal of attention to get them put into a sanitary condition. In one instance
[Note] 44
[Page] 3
the building, although fitted up as a bakehouse, was not used as such, and in another
the premises were only used during the busy season. Of the remainder, which were
in constant use, some were found to be in a very dilapidated state within, and
rendered insanitary by nuisances without. In all cases the premises have been put
into proper repair, and the necessary lime-washing, &c., has been carried out. The
Bakehouses may now be said to be in a good sanitary state. In one instance only
was a young person found employed. This was notified to H.M. Inspector of
Factories.
As yet no arrangement has been made for providing accommodation for persons
suffering from infectious diseases. The Committee were advised to make a
temporary arrangement with the Directors of the Perth Royal Infirmary, in order
that cases from the District might be received in that Institution. At the present
time, however, no indication has been given of the adoption of this suggestion or of
any alternative proposal.
In the Perth Royal Infirmary there are 60 beds which the Directors are willing
to place at the disposal of the various District Committees in the County, for a
period of five years, on condition that the District Committees and the Local Authority
of Perth conjointly pay one half of the expenses of erecting a Steam Laundry and
Disinfector. This generous offer should certainly be accepted for the present, as, by
the end of five years, the Committee would be in a better position to judge of the
number of patients likely to require accommodation, and whether or not a Cottage
Hospital would be necessary. Doubtless the distance from Hospital is an objection
to the Perth scheme, but with a good ambulance waggon, such as it is proposed to
provide, and early notification of the disease, there would be no difficulty in removal.
In a District like the Highland, where so much of the prosperity of the inhabitants
depends upon summer visitors, it is imperative that provision should be made to
remove, at an early stage, if necessary for purposes of isolation, cases of infectious
disease. Otherwise a scare may be caused which would prove highly prejudicial to
the reputation of the most popular health resorts, at a time when everything depends
upon a clean bill of health being produced. The erection of a properly equipped
Infectious Diseases Hospital would be the true solution of this difficulty, but that
would mean the expenditure of a large sum of money in the erection, and a constant
epue se [expense] to maintain in an efficient state. It would be wise to pause until certain
that such an expenditure is necessary, especially as the offer of the Perth Infirmary
Directors gives an opportunity of doing so without danger to the public. The
Steam Disinfector to be erected at the Perth Infirmary is to be of the largest size,
and it will be available to disinfect bedding, &c.
During the past year the Fever Wards of the Perth Royal Infirmary have been
open to receive infectious cases from the Highland District, on the recommendation
of the Chief District Medical Officer, and on one occasion this was taken advantage
of. In his position as Senior Visiting Surgeon to the Perth Royal Infirmary, the
District Medical Officer has, under the Directors, full supervision of the accommodation
and treatment of cases admitted into the institution. It is intended to maintain at the
Perth Royal Infirmary a permanent staff of fever nurses, so that such cases may be
completely isolated from the general part of the building. The proper cleansing of
infected clothing, &c., has been a serious difficulty hitherto in the way of treating
fever in the Perth Infirmary, and the expense of chemicals and washing has been
very great. It is only fair that, if the Directors are to treat the cases for the next
five years, they should be put in possession of the most modern appliances for the
effectual, and, at the same time, least expensive carrying-out of their work.
[Note] 45 |
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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
[Note] 46
[Page] 5
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.
[Note] 47 |
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[Note] 48
TABULAR STATEMENTS
OF
Sickness and Mortality
IN THE
HIGHLAND DISTRICT.
1891.
[Note] 49 |
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[Note] 50
TABULAR STATEMENT of SICKNESS and MORTALITY referred to in the Regulations issued by the Board
of Supervision for Medical Officers of Districts of Counties.
County of PERTH. HIGHLAND District.
TABLE I. - Births and Deaths occurring in the District during the Year 1891.
[Table inserted]
NOTES. - The Medical Officer may, if he thinks fit, give separately the figures for any Sub-Divisions of the District: in all cases the Total for the District is to be given.
Deaths of Persons belonging to a District occurring in Public Institutions (as Lunatic Asylums, Poorhouses, Hospitals) outside of the District, are to be included with the figures for that District,
and Deaths of Persons not belonging to a District, occurring in Public Institutions within the District, are to be excluded.
"Diphtheria" shall include "Membranous Croup," "Diphtheritic Croup," "Croupous Diphtheria."
All Deaths from "Diarrhoea," "Dysentery," "Enteritis," "Gastro-Enteritis," "Muco-Enteritis," - unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis-
"Diarrhoea," "Bright's Disease-Diarrhoea," are to entered under the heading "Diarrhoea."
The designation "Other Tubercular Diseases" includes, inter alia, "Tabes Mesenterica," "Tubercular Meningitis," "Hydrocephalus," "Struma," "Scrofula." The headings distinguished by asterisks cover all diseases placed under these headings in the classification of the Registrar-General.
[Note] 51
TABLE II. - Density of Population, Birth Rate, Infantile and other Death Rates.
[Table inserted]
*To be calculated to three places in decimals.
TABLE III. - Cases of Infectious Disease coming to the knowledge of the Medical Officer during the Year 1891.
[Table inserted]
February 29th, 1892.
(Signed) JOHN T. GRAHAM, M.D.,
Medical Officer. |
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[Note] 52
COUNTY OF PERTH - HIGHLAND DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
[Note] 53 |
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[Note] 54
COUNTY OF PERTH.
FIRST ANNUAL REPORT
BY THE
CHIEF MEDICAL OFFICER
OF THE
HIGHLAND DISTRICT.
1891.
COUNTY OF PERTH.
FIRST ANNUAL REPORT BY THE CHIEF MEDICAL OFFICER
OF THE
PERTH DISTRICT.
1891.
The Perth District has an area (exclusive of the Burgh of Perth) of 148,849
acres and a population (exclusive of the Burghs of Perth and Abernethy) of 21,661,
according to the Census of 1891. The number of acres to each person is 6.8.
The appointment of Chief District Medical Officer dates from July 13, 1891,
consequently this Report deals only with the latter months of the year, and it is
impossible at this time to give more than a general sketch of the sanitary condition
of the District, as there has been no time for minute inspection, except in the places
where infectious disease occurred.
*The Vital Statistics for the year are the following:- Births 501, at the
rate of 23.1 per 1000. Deaths from all causes 384, or at the rate of 17.7 per 1000,
showing a natural increase of population of 117 for the year. The Infant Mortality
was at the rate of 65.8 per 1000 births. The Mortality over 60 years of age was
55% of the total. The Census returns for 1891 show a decrease of population,
amounting to 1,039 during the preceding ten years.
Almost the whole District has a plentiful supply of water, by gravitation in
many cases, and from wells and streams in the remainder. Judging from the sources
of the gravitation water-supplies, their quality may be considered in most instances
to be beyond suspicion, but in one suspected instance analysis proved the water
to be unfit for use. Where wells yield the supply it is usually plentiful, but in many
instances it is not protected against surface pollution. In these cases it will be
necessary without delay to make certain that the water is not contaminated, and the
Sanitary Inspector should be empowered accordingly.
Drainage is mostly in a rudimentary condition, and will require elaboration ere
it can be considered satisfactory.
With the exception of the Village of Errol, there is no system of scavengering
in the seven large villages of the District. One of the most prolific sources of a low
condition of health is to be found in the heaps of house refuse, &c., stored up in
back gardens waiting the convenience of a neighbouring farmer to remove them.
Now, a man devoting two, or, at the most, three days a week to each village could not
only keep the streets clean, but also effectually prevent the above state of matters,
*Fuller details will be found at the end of the Report.
[Note] 55 |
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and the employment of such a man would also allow the Sanitary Officers to
insist upon a much greater degree of tidiness and cleanliness than at present exists.
The District Committee have resolved to discharge the Errol scavenger at
Whitsunday, as they consider it unfair to pay him from the District Rate, he being
the only scavenger in the District. Instead of allowing Errol to retrograde thirty
years, in those days of sanitary progress, the obvious solution of the difficulty
would have been to place the other large villages on the same footing by employing
scavengers for them. The former Local Authority, who have hitherto paid for the
Errol scavenger, found the employment of such a man to be a success in every way.
Certainly the need of these village scavenger is urgent, and the Committee will
do well to see to some provision for such speedily, otherwise the consequences, as in
other Counties, may be disastrous. The Committee should ask for a Report upon
the sanitary condition of the villages with regard to the mode of disposal of house
refuse.
Farm houses have not been systematically inspected, but those examined were
found, with few exceptions, to be well supplied with water. Those exceptions
occur chiefly in the lower parts of the Carse of Gowrie, where the only drinking
water is obtained from the sluggish streams called Pows.
The house accommodation is on the whole good; a number of the houses are
old, but they are not in a condition to come under the clauses of the Public Health
or the Housing of the Working Classes Acts. There is abundant provision for
ventilation, the difficulty being to get the tenants to make use of it; but one great
fault in cottages is the laying of wooden floors near to the earth without proper
arrangement for ventilation underneath. The result is that abundant fungoid
growths occur, and when the house is shut up at night the exhalations from these
cannot but be prejudicial to health. Where such a state of matters has been found
to exist it has immediately been remedied.
There is either an absence of sanitary conveniences in connection with many
dwellings in the District, or primitive and dangerous arrangement for the same.
This matter is being rapidly remedied by your energetic Chief Sanitary Inspector,
under whose supervision much valuable work has already been done, - and this
without a single prosecution, - which fact augurs well for the progress of sanitation
in the District. When proprietors show a willingness to comply with the require-
ments of modern sanitation occupiers will soon do the same. There may be a certain
feeling that the Public Health Act is an unwarrantable interference with the liberty
of the subject, but a little reasoning enables the individuals affected to take the
common-sense view of the matter. The Act would, in my opinion, be much more
efficiently administered were the District Officials invited to attend the Public
Health Sub-Committee Meetings. This is a point to which serious consideration
should be given.
During the part of the year to which this Report applies, a general systematic
inspection has been made of the more populous parts of the District. In these the
topographical and geological features were examined, the water supplies noted, and
the general condition of the houses observed.
Special enquiries have been made, from time to time, into polluted water supplies,
with the result that, in three instances, new supplies have been provided; in one
case this was an extensive undertaking, but, with its completion will be settled
finally the now famous question of the Sanitary Condition of the Fishing Lodges.
There will soon be an abundant supply of pure water within easy reach of each
Lodge, and otherwise the Lodges are in fair condition.
[Note] 56
[Page] 3
The question of Sub-District Medical Officers has been before the District
Committee, and they have decided to appoint none at this time The Medical
Officer, in a Report upon this subject, gave his opinion as strongly in favour of their
services being retained. Without a mutual interest the Medical Officer and the
local practitioners will soon drift apart, much to the loss of the public weal. The
Local Government Act was not intended to supersede the Public Health Act, but to
supplement it; and the reason for appointing a District Medical Officer, without
practice, was not that the Parochial Medical Officers were unfit for their work, but
that from their small salaries and personal relations with those who were the authors
of nuisances, their hands were somewhat tied in the execution of the same. By the
dismissal of such men the County is losing valuable local knowledge,
which cannot be replaced. Again, with regard to granting certificates
of infectious diseases, either for removal to Hospital or for disinfection, these local
medical men, on their daily rounds, could make visits which cost nothing for
travelling expenses, but which, if made from headquarters, would cost the County far
more in the course of a year than the total salaries allowed.
This opportunity of publicly thanking Dr. Howison, Errol, for the very valuable
help given by him to the County Officials, in connection with an outbreak of Scarlet
Fever at Kilspindie, cannot be allowed to pass. It was indeed chiefly owing to the
energy displayed by Dr. Howison, and by Mr. Nish, the local Sanitary Inspector,
that the outbreak did not assume very grave dimensions.
No certification of nuisances under the Public Health Act has been required
during the past year in the District. Along with the Sanitary Inspector many
inspections have been made, and improvements have been carried out voluntarily,
in accordance with our wishes.
Several suspected waters have been analysed, and the analyses have been
submitted to me by the Sanitary Inspector. The results in general shewed that the
suspicions were justly founded, and the water has in such cases been pronounced
unfit for use.
In one case advice was required regarding a house alleged to be unfit for
habitation; but, on examination, it was decided that the source of unfitness lay, not
with the house, but with its inhabitants.
No action has been demanded with regard to offensive trades in the District,
neither has the sanitary condition of factories been brought under notice.
There are 17 retail bakehouses, and these have required considerable attention
during the past six months. Apparently no systematic inspection had been
previously made into their condition, and, with one or two exceptions, they were
found to be kept in bad order; some were in a very insanitary state, both externally
and internally. In every instance, however, all that has been required has been done
in cleaning, repairing, ventilating, and removing nuisances, &c. Four young
persons were found to be employed, and these were accordingly reported to H. M.
Inspector of Factories.
In connection with infectious cases, eighteen, special enquiries have been made:-
Enteric Fever, 5; Scarlet Fever, 12; and Diphtheria, 1. Three of the Enteric
outbreaks were single and isolated cases, in which it was impossible to trace the
source of infection; in another outbreak there were four cases, and enquiry proved
that they were the result of careless disposal of the excreta of former cases, - in
fact, the gross carelessness discovered could scarcely be believed unless seen. In
the Scarlet Fever cases on group of twenty-four was traced to one child, whose
[Note] 57 |
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case had been overlooked by the parents, and it was only when infection spread
that she was discovered to be desquamating. In this instance, fifteen cases in
seven separate houses had been infected before anyone was aware of the presence
of the disease, and it very much owing to the energy displayed by the former
Medical Officer and Sanitary Inspector, whose services have since been dispensed
with by the District Committee, that the outbreak never spread beyond these
houses, and this with only one case removed to Hospital. All the other cases
have been more or less isolated, and their source of infection traced to contact with
a town where Scarlet Fever was prevailing at the time. In ten at least of the
outbreaks the source of the infection was clear. All of these were treated at home,
disinfectants were supplied, and strict isolation of the families insisted upon. In
every instance success crowned the labours of the local staff, and there was not a
single case reported as having spread from those isolated. Where Diphtheria
occurred it was found, as usual, to be associated with faulty drainage.
As yet no definite arrangement has been made for accommodation of infectious
cases in the District, but as a tentative measure, during the year, it was suggested
that they should be removed to the Perth Royal Infirmary. In this institution
there are 40 beds isolated for the treatment of infectious cases, and 20 additional beds
partially so in which Enteric fever cases can be treated. To make the accommoda-
tion complete all that is required is the erection of a proper Steam Laundry and
Steam Disinfector. The matter has been discussed by representatives of the
Infirmary Directors and of the District Committees of Perthshire; and on condition
that the District Committees and the Local Authority of Perth pay one-half of the
cost of erecting the Laundry and Disinfector, the Infirmary Directors are willing to
receive and treat without further charge all the cases (except small pox) which
require removal to Hospital during a period of five years. This is a most generous
offer, and there is every prospect that it will be accepted at an early date by the
Perth District Committee. With a good ambulance waggon, and a nurse to attend
to the patient during the journey, there will be no difficulty in removal from any part
of the District to the Perth Infirmary. Should this arrangement be carried out,
the Committee will have an opportunity of judging during the next five years
whether the accommodation at Perth is sufficient, or if the erection of an Infectious
Diseases Hospital is an absolute necessity. 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.
During the past months six persons suffering from infectious diseases have been
removed from the Perth District to the Royal Infirmary, viz.:— 3 Enteric and 3
Scarlet Fever cases. These were admitted by the courtesy of the Directors on the
recommendation of your Medical Officer. As it is found, from experience, that the
average cost of treating a case of infectious disease in Hospital, is about £10, the
Perth District Committee will easily perceive that they are considerably indebted to
the Perth Royal Infirmary. As Senior Visiting Surgeon to the Infirmary, I have,
under the Directors, full powers of supervision in the institution, and it is only right
to state that I have always found the Board most anxious to give effect to any
suggestion likely to be of benefit to the patients.
[Note] 58
[Page] 5
No ambulance has yet been provided for the District, but during the latter part
of the year a make-shift in the shape of an old carriage has been in use. It has
fulfilled its purpose exceedingly well, but it is not the sort of vehicle suitable for
removing serious cases. By request of the Committee, your officials visited various
places to see the kind of waggon used for removing fever cases. The result of these
investigations went to shew that, for such work as we have in Perthshire, a special
waggon would require to be made - Mr. Holmes, Carriage-Builder, Irvine, has
undertaken to build, and deliver such ambulance in Perth within six weeks of
receiving the order. The waggon proposed at present would carry six patients,
besides the attendant, and would in all respects be the best of its kind to be found
in Scotland.
Much has been done by the Sanitary Inspector, in removing dangerous
nuisances, and infectious cases have either removed to Hospital, or have been
strictly isolated in their own homes. Children of infected families have been
prevented from attending school, and persons in charge have been carefully warned
regarding the special infectious features of the fever. At the expense of the Local
Authority disinfectants have been freely supplied to be systematically used during
the course of the illness, and, at the end of the same, disinfection of the premises has
been carried out under supervision of the local Sanitary Inspector. The Infectious
Diseases (Notification) Act has not, as yet, been adopted in the District, but when
hospital accommodation has been provided, it will be for the District Committee to
seriously consider the matter. So far as the Perth District is concerned, the
experience of last year goes to prove that it is not required.
During the year 86 infectious cases have been reported. The majority have
been of a mild type, and there has been nothing of the nature of a dangerous
outbreak. It is a subject for congratulation that, in all the infectious cases dealt
with by the Local Authority, isolation has been so well carried out that in no case
has the disease spread after precautions had been taken.
Nothing like complete Sickness Returns have been procurable, but from two
very full sets of Returns giving nearly 1000 cases the following is the proportion in
which the various diseases occur. Influenza heads the list with 21% of the total
sickness and 4% of the total deaths. There was a considerable number of cases in
April and May, then the epidemic assumed a less acute form, till September, when
it again became general, and for three months one might say there was no other
disease in the District, judging from the frequency with which it was assigned as the
cause of illness. The deaths ascribed to Influenza have been all caused, not by the
Influenza itself, but by some respiratory complication, and, with only one exception,
these deaths occurred in persons over 60 years of age. It is to be hoped that the
epidemic is now at an end, so far as Perthshire is concerned. Whether it will ever
be possible to isolate Influenza is yet doubtful, spreading as it does with such
rapidity as completely to evade ordinary modes of isolation. Still it ought to be
prominently brought before the mind of the public that Influenza, in itself, is not a
fatal disease, but, that when it is so, this result is due to some complication; and as
a safe-guard against this, the person attacked should be confined to the house at once,
a placed under medical supervision, which alone can ensure the certainty of no
latent pulmonary mischief being overlooked, and the consequent disastrous results
of too early an exposure to chills.
Respiratory diseases form, as might be expected, in our climate, a large
proportion of the sickness and death lists. In the 1000 cases before mentioned, this
group accounts for 14% of the total sickness, and, over the whole District, for 14.6% of
the total deaths.
[Note] 59 |
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Diseases of the Digestive system, (and to those may be added anæmia, which
often proceeds from constipation), cause a large amount of illness, in some parts
amounting to 27% of the total sickness, and 4.4% of the total deaths. In this class
of diseases it is expected that sanitation will bring a marked improvements to Public
Health, and by the education of the rising generation to habits of regularity a large
factor in causation of these diseases will be eliminated.
Consumption and other tubercular diseases caused 6.6% of the total sickness
amongst the cases reported, and 9% of the total mortality of the District. Now
that it has been proved that tubercular disease is infectious, it behoves parents or
guardians to exercise a very careful watch over cases where the disease attacks the
lungs that the expectoration be carefully removed. There is no doubt that it
is from breathing the dried expectoration from a previous case that the disease has its
most frequent origin in the lungs. Spitting into handkerchiefs should be forbidden.
Porcelain spittoons should be used; these should contain a disinfectant, and should be
regularly cleansed by having boiling water poured into them. Where there is a case
of consumption, a fire should be constantly kept in the room and free ventilation
maintained; the patient should be in a single bed, and all overcrowding of the apart-
ment by visitors should be avoided. The old, and now nearly obsolete box-bed,
insanitary under all conditions, cannot be too severely condemned as the cause of a
great deal of consumption.
Rheumatic diseases account for 3% of the sickness, and cancer for 2% of the
same in the above returns, and for 5% of the total deaths.
Appended are Tabular Statements of the Sickness and Mortality in the District
during the year 1891. The first three Tables are in the forms required by the
Board of Supervision, and in the fourth is a detailed statement showing the Births
and Deaths (with causes of the latter) in the various Registration Districts into
which the Registrar-General has sub-divided the Perth District.
The local Registrars cannot be too highly commended for the unanimous manner
in which they have come forward to supply the data for these Tables.
JOHN T. GRAHAM, M.D.,
Chief District Medical Officer
February 29th, 1892.
[Note] 60
TABULAR STATEMENTS
OF
Sickness and Mortality
IN THE
PERTH DISTRICT.
1891.
[Note] 61 |
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[Note] 62
TABULAR STATEMENT of SICKNESS and MORTALITY referred to in the Regulations issued by the Board
of Supervision for Medical Officers of Districts of Counties.
County of PERTH. PERTH District.
TABLE I. - Births and Deaths occurring in the District during the Year 1891.
[Table inserted]
NOTES. - The Medical Officer may, if he thinks fit, give separately the figures for any Sub-Divisions of the District: in all cases the Total for the District is to be given.
Deaths of Persons belonging to a District occurring in Public Institutions (as Lunatic Asylums, Poorhouses, Hospitals) outside of the District, are to be included with the figures for that District,
and Deaths of Persons not belonging to a District, occurring in Public Institutions within the Districts, are to be excluded.
"Diphtheria" shall include "Membranous Croup," "Diphtheritic Croup," "Croupous Diphtheria."
All Deaths from "Diarrhoea," "Dysentery," "Enteritis," "Gastro-Enteritis," 'Muco-Enteritis,"—unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis-
Diarrhoea," "Bright's Disease-Diarrhoea," are to be entered under the heading "Diarrhoea."
The designation "Other Tubercular Diseases" includes, inter alia, "Tabes Mesenterica," "Tubercular Meningitis," "Hydrocephalus," "Struma," "Scrofula." The headings distinguished by asterisks cover all diseases placed under these headings in the classification of the Registrar-General.
[Note] 63
TABLE II. - Density of Population, Birth Rate, Infantile and other Death Rates.
[Table inserted]
*To be calculated to three places in decimals.
TABLE III. - Cases of Infectious Disease coming to the knowledge of the Medical Officer during the Year 1891.
[Table inserted]
February 29th, 1892.
(Signed) JOHN T. GRAHAM, M.D.,
Medical Officer. |
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[Note] 64
COUNTY OF PERTH - PERTH DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
[Note] 65
COUNTY OF PERTH - PERTH DISTRICT. - Continued.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
* Acreage included under Auchtergaven, Kinclaven, and Redgorton
+ After deducting (4336) Acreage of Perth City, formed by parts of Kinnoull, Perth, Scone, and Tibbermore. |
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[Note] 66
COUNTY OF PERTH.
FIRST ANNUAL REPORT
BY THE
CHIEF MEDICAL OFFICER
OF THE
PERTH DISTRICT.
1891.
COUNTY OF PERTH
FIRST ANNUAL REPORT BY THE CHIEF MEDICAL OFFICER
OF THE
WESTERN DISTRICT.
1891.
1. The Western District has an area of 307,679 acres, and a population (exclusive
of the Burghs of Dunbale, Callander, and Doune) of 10,748, as ascertained at
the Census of 1891. The proportion of persons to the acre is ·034, or 29 acres
to each person. The Births during the year were 214, or 19·9 per 1000; and
the Deaths were 156, or 14·5 per 1000, showing a natural increase of 58 for the
year. Deaths under one year were 10, or 46·7 per 1000 births. Death over
60 years of age were 43.9% of the total. The death rate is the lowest of any
District in Perthshire. The Census of 1891 shows an increase of population in
this District during the preceding 10 years of 1,196, principally accounted for by
the presence of workmen employed on large contracts.
In this District it was found that sanitation had not been neglected under the
former Local Authorities, that the Sanitary Inspectors were intelligent and active
men, and altogether it compared favourably with the other Districts of Perthshire.
Throughout the District the supply of water is good, but in some cases rather
scanty in dry seasons.
There are several large villages in the District, but in none of these is a public
scavenger employed. In the villages of Deanston and Ashfield, however, the
respective proprietors provide for this work being done in a highly efficient manner.
It would be well for the Committee to follow this example, as, if employers find it to
be for their own advantage to provide means of cleanliness for their employees, it is
equally important that the general public should be protected by the District
Committee from the evil effects of insanitary surroundings.
The house accommodation is good, and there is ample provision for ventila-
tion; but in many instances ash-heaps, &c., were found in too close proximity to
dwelling-houses, and there is a regrettable want of sanitary conveniences. In many
houses there is also no provision for preventing rain-water running from the roof into
the earth outside the walls. This, with the absence of a damp-proof course in the
wall, causes an unhealthy dampness. Eeves-gutters should be supplied, and where
there is no sub-soil drainage this also should be carried out without delay.
The farm steadings when examined were not found to be in such good order as
might have been expected; the Diary Regulations, however, when they come into
force, will cause a vast improvement in this respect.
[Note] 67 |
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Two large contracts are in process in the District, viz., that portion of the
West Highland Railway which passes from Inverarnon to Tyndrum, and the
Glasgow Water Works Extension in the Parish of Aberfoyle. Considerable attention
has been given to the sanitary condition of the huts erected by the several Contractors
for the accommodation of their navvies. Many improvements have been suggested
and carried out, and it has not been found necessary to place the huts on the
Common Lodging-House Register. The worst feature about them now is that
the cubic air space is much below that required by the law; but when the airy
situation, and abundant provision for ventilation of the huts is taken into consideration,
along with the out-door employment of the men, and the temporary nature of the
structures, there seem to be no reasonable grounds for interference.
If in addition to the enforcement of the Regulations for Dairies, Cowsheds, &c.,
the District Committee would devote special attention to the sanitary condition of
the various villages in the District, with regard to scavengering and the disposal of
house refuse, by the end of another year it would be plainly felt that a distinct
advance had been made in sanitary matters
2. During the year general inspections of the District have been made, in the
course of which the soil, geological formation, water supplies, and general house
accommodation were noted; also the sanitary condition of the houses. Special
enquiries have been necessitated on several occasions in consequence of complaints
regarding water pollution, and occurrences of infectious disease. On two of these
occasions serious results amongst the navvies on the West Highland Railway were
prevented by the energetic action of the Contractors' Medical Officer, Dr. Kay, and
the kindness of the Contractors, Messrs. Lucas & Aird, who provided nursing and
accommodation for the patients.
3. No certificates have been required under the Public Health Act. On several
occasions advice was given regarding water supplies and insanitary dwellings, but
further proceedings were never required. No offensive trades have been brought
under notice, nor has the sanitary condition of workshops and factories demanded
attention.
The opinion of the Chief District Medical Officer was asked as to whether the
retention of the services of the local Medical Staff was necessary, and the Public
Health Sub-Committee appointed accordingly six Sub-District Medical Officers,
who have in some instances given valuable assistance in combating with, and
stamping out infectious disease. In the matter of the distribution and cause of
disease in their own localities these local officials have also given much useful
information.
Advice has also been given regarding provision for accommodation of persons
suffering from infectious disease, but as yet nothing definite has been adopted by the
Committee.
4. Retail Bakehouses. - These are four in number, and have been put into good
order. In one case extensive repairs were executed, and in another case an ashpit
was removed which was too near the bakehouse. Thereafter regular lime washing
was ordered, and the bakehouses may now be considered to be in a satisfactory state
of cleanliness and repair. One young person was found to be employed, and was
reported to H.M. Inspector of Factories. The majority of bakehouses in this
District are situated within the bounds of the Burghs, and are therefore beyond the
jurisdiction of the rural Local Authority.
[Note] 68
[Page] 3
5. No Hospital has as yet been erected in the District for the reception of persons
suffering from infectious disease, neither has any arrangement been made whereby
such cases can be admitted into Hospitals outside of the District. As the provision
of such accommodation is an urgent necessity, it behoves the Committee to come to
a decision regarding this matter without delay. During the year a suggestion was
made that the use of the Perth Royal Infirmary, where there are 60 available beds,
should be obtained; but this arrangement has not yet been carried out, as Perth was
considered too distant for practical purposes. The distance is certainly great in some
instances, but the necessity for removal from these outlying districts would occur but
rarely; and even from them - if the cases were reported at an early stage of the
disease - there would be no difficulty in removal by means of a proper ambulance
waggon, especially if it could be placed on a carriage truck and conveyed by rail.
The Perth Infirmary Directors have opened their doors to receive any cases of
infectious disease sent from the Directors of Perthshire, but in so far as the Western
District has been concerned it has not been required to make use of that Institution.
The Directors have further made a very generous offer which, for a small outlay,
would make provision for the treatment of infectious diseases (except smallpox) for a
period of five years, at the end of which period it would be seen whether or not it
would be necessary to burden the District with the erection and maintenance of a
separate Infectious Diseases Hospital. 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 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.
The erection of these will cost a considerable sum, but the Infirmary Directors
are willing to pay one half of this, and to treat all cases sent to them by the various
District Committees during a period of five years, on condition that the Local
Authorities share the other half of the expense of erection. It is the intention of
the Directors to put in one of the largest size of Goddard, Massey, & Warner's Hot
Air and Steam Disinfectors, which will be available for the purpose of disinfecting
heavy articles such as bedding, &c.
[Note] 69 |
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It is true that in such a District as the Western the majority of fever cases
must be treated on the spot by strict isolation, but there will be occasional cases
which cannot be so dealt with, and for which Hospital accommodation must be
provided. Should the Perth Royal Infirmary be decided upon as the centre to which
infectious cases from the Western District are to be sent, as Senior Visiting
Surgeon, the Chief District Medical Officer has, under the Directors, the full
supervision of the treatment and accommodation of fever cases in that Institution.
6. The first steps necessary to prevent the outbreak and spread of infectious disease
are the removal of such accumulations near houses as are likely to lower the general
health, and the prevention of the use of impure water for domestic purposes. In
many instances these have been seen to during the past year by the Sanitary staff.
In treating infectious cases strict isolation has been insisted upon, and disin-
fectants have been freely supplied. Cases of enteric fever have occurred in houses
using water drawn unfiltered from the Forth, and consequently filters have been placed
in these by the proprietors. This is, however, only a temporary measure, as the
Forth can hardly be considered a satisfactory source for a pure water supply,
owing to its sluggish current and the amount of sewage it receives.
When measles broke out amongst the navvies working on the West Highland
Railway, the source of infection was clearly traced to the Island of Harris, where the
disease was prevalent at the time. As the patients were too ill to be removed, the
Contractors, Messers. Lucas & Aird, very kindly put the use of a hut at our disposal,
and the whole treatment, except the final disinfecting of the hut, was taken over by
Dr. Kay, the local medical man.
Scarlet fever occurred at Killin during the year. The cases were treated at
home, and the local Medical Officer and Sanitary Inspector were happily able to
prevent the disease from spreading. This was the more fortunate, as the fever,
judging from the death rate (viz., 2 deaths in 18 cases), must have been of a malignant
type.
Measles and whooping-cough have been prevalent in the District, but, as a rule,
the cases have been very mild, only one death from each disease being reported.
7. The voluntary notification of infectious diseases has been so complete throughout
the District (134 cases having been so notified during the year) that there seems to
be no necessity for adopting the Infectious Diseases (Notification) Act.
From Returns received from local Medical men, giving data of 2000 cases of
sickness, the various diseases occur in the following proportion:- Diseases of the
Digestive System, 27 per cent. of the sickness, and 3.8 per cent. of the total
deaths in the District. Habitual constipation is a chief factor in the causation of
this disease, and with improved sanitation, and an education to regular habits, a
distinct diminution of the same may be expected. Another cause of the prevalence
of digestive troubles is to be found in the large consumption of tea which, in most
cases, is not infused as it to be ought to be, but rather boiled, and so impregnated with
tannis as to pervert the action of the stomach by its constant use. Tea should never
be infused for more than five minutes. If it be necessary to keep it, the liquid should
be poured off the leaves and kept hot. If this rule be attended to, tea is found to be
not only harmless, but a healthful beverage.
Diseases of the Respiratory System caused 24 per cent. of the sickness, and
15.3 per cent. of the total deaths. This is what might have been anticipated during
such a changeable season as we experienced last year, along with the all-prevailing
epidemic of influenza, which was so frequently complicated by chest affections.
[Note] 70
[Page] 5
Consumption and other Tubercular Diseases formed 3 per cent. of the total
sickness, and 11.5 per cent. of the total causes of death. This disease is most
prevalent, and has been said by one authority to affect about one-half of the human
race. It has now been proved that every case is infected by another from which the
specific poison is derived, and that, not consumption, but the tendency to take con-
sumption, is inherited. In cases where it affects the lungs, the usual mode of infection
is by the poison being conveyed into the air passages in the form of suspended dust
which contains the germs of the disease. In a healthy being the processes of nature
are able to successfully combat the intruders; but where any weakness exists, or even
where the general health of the recipient is below normal, the germs find a suitable soil,
and rapidly establishing a footing, they seldom cease their baneful mission while life
lasts. Those germs are derived from the dried expectoration of a previous
case of tubercular consumption, and it behoves guardians of patients suffering from
such complaints, in their own interest, and that of the public at large, to exercise a
constant vigilance in dealing with the discharge from the lungs. The expectoration
should be received into a porcelain spittoon, containing some disinfectant, and the
spittoons should be regularly cleansed by immersion in boiling water. If this simple
measure were regularly carried out a very fertile source of consumption would be
eliminated from the field. A patient suffering from consumption should be kept
in a well lighted and efficiently ventilated room, all over-crowding of which by
visitors should be avoided, and the patient should always occupy a single bed.
Another mode by which the germs of tubercular disease reach the human race
is to be found in milk. Infants are specially liable to suffer from this, as it is the
usual custom where bottle-feeding is resorted to, that the milk from one cow should
be obtained for this purpose. If that cow should be the subject of tubercular disease
the danger of infection is necessarily great. To prevent this, milk used for feeding
children should always be boiled.
Rheumatic Affections form 15 per cent. of the sickness Returns. This large
proportion must also be ascribed to the wet season, especially in a district whose
rainfall is nearly double that of any other in Perthshire (during the past ten years the
rainfall at a station in the Western District averaged 74.64 inches annually).
Diseases of the Circulatory System, which may be classed alongside of the above,
caused 14 per cent. of the total deaths during the year.
Of persons over 60 years of age there were 69 deaths, or 44 per cent. of the
total, and in 16 cases old age was the reported cause of death.
Infectious Diseases formed 6 per cent. of the sickness Returns, and there
were 8 deaths reported from these diseases, or 5 per cent. of the total.
Influenza has been very prevalent, and has caused, as a sequence, a large
amount of respiratory disease. The epidemic seems now to have spent itself, in so
far as Perthshire is concerned, and it is hoped, that for this generation, it will now
be quiescent. It would, however, be well to be prepared should the disease again
appear in our midst, to grapple with it at the very onset by enforcing strict isolation.
There seems to be no doubt that influenza is a disease which spreads by
contagion, and that the poison lies dormant in the system for a short period before
declaring itself by violent constitutional disturbances. During this period of incu-
bation, the disease seems like some others of the same class, to have the power of
infection, so that it is easily understood how many cases may be traced to one in a
very short time. It is this rapidity of infection which has caused so much speculation
to arise, as to whether influenza had not some peculiar method of spreading itself
[Note] 71 |
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through the community. Influenza is not in itself a very fatal disease; as a rule it is
only where complicated by acute inflammation of some of the internal organs of the
body that danger and death ensue. The proper treatment of a case of influenza is
that, as soon as the patient is affected, no attempt should be made to fight against
the disease, the invalid's couch is the only safe place under the circumstances, and
without delay medical aid should be summoned, as it is only under the skilled
surveillance of a physician that the danger of exposing the body to chills at too
early a date, and the consequent dangerous sequalæ of influenza may be avoided.
8. Appended are Tabular Statements of the Sickness and Mortality in the
District, during the year 1891. The first three tables are in the form required by
the Board of Supervision. The fourth is a detailed Statement shewing the Births
and Deaths in the various Registration Districts into which the Registrar-General
has Sub-divided the District.
The local Registrars cannot be too highly commended for the unanimous way in
which they have come forward to supply the data for those tables.
JOHN T. GRAHAM, M.D.,
Chief District Medical Officer
February 29th, 1892.
[Note] 72
TABULAR STATEMENTS
OF
Sickness and Mortality
IN THE
WESTERN DISTRICT.
1891.
[Note] 73 |
|
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[Note] 74
TABULAR STATEMENT of SICKNESS and MORTALITY referred to in the Regulations issued by the Board
of Supervision for Medical Officers of Districts of Counties.
County of PERTH. WESTERN District.
TABLE I. - Births and Deaths occurring in the District during the Year 1891.
[Table inserted]
NOTES.—The Medical Officer may, if he thinks fit, give separately the figures for any Sub-Divisions of the District: in all cases the Total for the District is to be given.
Deaths of Persons belonging to a District occurring in Public Institutions (as Lunatic Asylums, Poorhouses, Hospitals) outside of the District, are to be included with the figures for that District,
and Deaths of Persons not belonging to a District, occurring in Public Institutions within the District, are to be excluded.
"Diphtheria" shall include "Membranous Croup," "Diphtheritic Croup," "Croupous Diphtheria."
All Deaths from "Diarrhoea," "Dysentery," "Enteritis," "Gastro-Enteritis," "Muco-Enteritis," - unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis-
Diarrhoea," "Bright's Disease-Diarrhoea," are to be entered under the heading "Diarrhoea."
The designation "Other Tubercular Diseases" includes, inter alia, "Tabes Mesenterica," "Tubercular Meningitis," "Hydrocephalus," "Struma," "Scrofula." The headings distinguished by asterisks cover all diseases placed under these headings in the classification of the Registrar-General.
[Note] 75
TABLE II. - Density of Population, Birth Rate, Infantile and other Death Rates.
[Table inserted]
*To be calculated to three places in decimals.
TABLE III. - Cases of Infectious Disease coming to the knowledge of the Medical Officer during the Year 1891.
[Table inserted]
February 29th, 1892.
(Signed) JOHN T. GRAHAM, M.D.,
Medical Officer. |
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| HH62/45/77 |
[Note] 76
COUNTY OF PERTH - WESTERN DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
[Note] 77 |
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[Note] 78
COUNTY OF PERTH.
FIRST ANNUAL REPORT
BY THE
CHIEF MEDICAL OFFICER
OF THE
WESTERN DISTRICT.
1891.
TABULAR STATEMENTS
OF
Sickness and Mortality
IN THE
COUNTY OF PERTH.
1891.
[Note] 79 |
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[Note] 80
TABULAR STATEMENT of SICKNESS and MORTALITY referred to in the Regulations issued by the Board
of Supervision for Medical Officers of Counties.
COUNTY OF PERTH.
TABLE I. - Births and Deaths occurring in the County during the Year 1891.
[Table inserted]
NOTES. - The Medical Officer may, if he thinks fit, give separately the figures for and Sub-Divisions of the County: in all cases the Total for the County is to be given.
Deaths of Persons belonging to a County occurring in Public Institutions (as Lunatic Asylums, Poorhouses, Hospitals) outside of the County, are to be included with the figures for that County,
and Deaths of Persons not belonging to a County, occurring in Public Institutions within the County, are to be excluded.
"Diphtheria" shall include "Membranous Croup," "Diphtheritic Croup," "Croupous Diphtheria."
All Deaths from "Diarrhoea," "Dysentery," " Enteritis," "Gastro-Enteritis," "Muco-Enteritis," - unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis-
Diarrhoea," "Bright's Disease-Diarrhoea," are to be entered under the heading "Diarrhoea."
The designation "Other Tubercular Diseases" includes, inter alia, "Tabes Mesenterica," "Tubercular Meningitis," "Hydrocephalus," "Struma," "Scrofula." The headings distinguished by asterisks cover all diseases placed under these headings in the classification of the Registrar-General.
[Note] 81
TABLE II. - Density of population, Birth Rate, Infantile and other Death Rates.
[Table inserted]
* To be calculated to three places in decimals.
TABLE III. - Cases of Infectious Disease coming to the knowledge of the Medical Officer during the Year 1891
[Table inserted]
(Signed) JOHN T. GRAHAM, M.D.,
Medical Officer. |
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[Note] 82
COUNTY OF PERTH - PERTH DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
[Note] 83
COUNTY OF PERTH - PERTH DISTRICT. - Continued.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
*Average included under Auchtergaven, Kinclaven, and Redgorton
+After deducting (43360) Acreage of Perth City, formed by parts of Kinnoull, Perth, Scone, and Tibbermore. |
|
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[Note] 84
COUNTY OF PERTH - CENTRAL DISTRICT.
TABLE IV. - Table of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
[Note] 85
COUNTY OF PERTH - CENTRAL DISTRICT. - Continued.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
*1 Acreage included under Dull, Fortingal, Logierait, Kenmore, and Weem.
*2 Acreage combining with Dowally.
*3 Acreage included under Dull.
*4 Acreage included under Fortingal.
*5 Acreage included under Moulin.
*6 Acreage included under Blair-Athole, Dull, and Moulin.
+Unclaimed Land adjoining Kenmore.
‡Land common to Blair Athole, Fortingal, and Logierait. |
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[Note] 86
COUNTY OF PERTH - WESTERN DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
[Note] 87
COUNTY OF PERTH - WESTERN DISTRICT. - (Continued)
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1891, according to the Registration Districts.
[Table inserted]
*Acreage included under Kirkmichael |
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| HH62/45/87 |
|
The last sentence on the second table is hidden. |
| HH62/45/89 |
[Note] 88
COUNTY OF PERTH.
FIRST ANNUAL REPORT
BY THE
COUNTY MEDICAL OFFICER,
1891.
PERTH COUNTY COUNCIL.
MEDICAL OFFICER'S REPORT,
1892.
[Note] 89 |
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INDEX.
-- PAGE.
COUNTY OF PERTH, -- 1
PERTH DISTRICT, -- 9
CENTRAL DISTRICT, -- 13
HIGHLAND DISTRICT, -- 16
WESTERN DISTRICT, -- 19
EASTERN DISTRICT, -- 23
TABULAR STATEMENTS, -- 25
[Note] 90
County of Perth.
SECOND ANNUAL REPORT BY THE COUNTY MEDICAL OFFICER,
1892.
The general Sanitary Condition of the Landward part of the County of Perth
has undergone a marked change for the better during the past year. There is also
distinct evidence that the inhabitants appreciate the benefits conferred on them by
sanitary reform, as, in many instances, improvements have been carried out with-
out any interference on the part of the Local Authorities, and, in all cases when the
aid of the latter has been called in, their behests have been willingly obeyed. Con-
siderable progress has been made in the removal of ashpits, piggeries, and hen-coops
from the immediate proximity of dwelling-houses to safer quarters, and, although the
oft-repeated argument "that the condition of affairs is the same as it has been for
forty years" has been advanced, in the majority of cases the required changes have
been carried into effect, or soon will be.
A wholesome dread of drinking polluted water is spreading amongst all classes
of the community. This is as it should be: pure water is a prime necessity from a
hygienic point of view. In several instances Water-supplies by gravitation have
been taken to dwellings formerly dependent on very questionable sources, and there
are various schemes under the consideration of the Local Authorities, having for
their object the provision of a plentiful and pure Water-supply.
To the Water-supply of part of the Carse of Gowrie much attention has been
given, and ere long measures will be taken to enforce the provisions of Section 89
of the Public Health Act. The Water-supply to the Fishing Lodges at Kinfauns
and Inchyra has been completed, and there is now an ample supply of pure water at
each Lodge. Pitlochry has commenced operations with a view to bring into the
village a new supply of water to replace the present one. The new supply will be of
great benefit to this favourite health resort. At Killin operations are also in progress
which, when completed, will greatly enlarge the available supply of water. Through-
out the County generally much attention has been directed to Water-supplies, and
important alterations in this respect have been carried out.
No large Drainage Systems have been taken up during the year, but there are
several which, in the interests of Public Health, must be considered by the District
Committees concerned; and there are improvements required in some of the already
existing systems.
House Accommodation. - The Registrar-General, in his Census Report for 1891,
gives figures which shew the Landward County of Perth to contain 15,435 houses,
with 16,504 families living in them. The houses contain 69,150 rooms with windows,
giving, on an average, 4.4 rooms to each house, and 4.2 persons to each family.
[Note] 91 |
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[Page] 2
From this it will be seen that there is little danger of overcrowding in Landward
Perthshire. Even in the villages, where such a source of disease might be
supposed to predominate, the average number of rooms to a house is 3.9, and the
average number of persons to a family 3.7. Only one house appeared distinguished
by the fact that it had no windows. On enquiry this was found to be a shelter-hut
erected on the Moor of Rannoch in connection with the West Highland Railway
works, and it is now replaced by a very comfortable structure.
STATISTICS OF VILLAGES IN COUNTY OF PERTH.
[Table inserted]
[Note] 92
[Page] 3
Houses occupied by single men at farms have been the subject of considerable
controversy. On one side the condition of the houses and the treatment of the men by
their employers is held up as the cause, whilst on the other the men and their habits
are blamed for the existing condition of affairs, which is certainly not satisfactory.
There is truth on both sides, but experience proves that, in many instances, the men
do not take advantage of the means already at their disposal to keep their living-
room clean and tidy. The occasional wholesale destruction of the fittings of a good
room for the purpose of procuring firewood does not give very great encouragement
to proprietors and employers to exert themselves. The reform in the housing of
this class of agricultural labourers, if it is to be a success, must be accomplished by
the mutual exertions of both parties concerned.
Rivers Pollution. - In last Annual Report attention was directed to the existing
pollution of the River Tay by the wholesale discharge into it of unpurified sewage.
This important matter has been taken up by the County Council, to whom a
Special Report on the whole question was presented, the result being that the
attention of the various Local Authorities concerned has been called to the existing
state of matters. Except in the Burgh of Blairgowrie, where an extensive alteration
of the drainage outlet is in process, nothing has really been undertaken as yet.
Dunblane is also re-modelling its drainage system, and means are provided to purify
the effluent before its discharge into the River Allan. The whole subject is one of
considerable magnitude, and can only be dealt with gradually, although a good
beginning has been made in this important branch of sanitation.
Sale of Food and Drugs Act. - This has been very effectually carried out under
the County Police for many years, and its effects, as a deterrent force, are highly
satisfactory.
Slaughter-Houses have received a considerable share of attention. The con-
dition of many of them was found to be so bad that the necessity for the adoption of
Bye-Laws with reference to construction and conduct of operations was very
evident. These Bye-Laws are at present under the consideration of the District
Committees, and it is to be hoped that a uniform set will soon be adopted for
the whole County.
The corrected population of Perthshire for 1891 was 69,715, and estimated to
the middle of 1892 it was 69,283. Births were 1491, giving a Birth-rate of 21.52
per 1000. Deaths were 1091, giving a Death-rate of 15.76 per 1000, against 18.05
for 1891. Natural Increase during the year, 400. There were 544 deaths of persons
over sixty years of age, or 49.8 per cent. of the total. Of these 169 were due to Old
Age. Deaths under one year were 131, of which 56 were due to Birth-debility,
giving an Infant Mortality of 87.8 per 1000 Births.
Distribution of Diseases. - In three of the five Districts of Perthshire the Dis-
tribution of Diseases can only be gathered from the Death Returns. In the Central
and Western Districts the local Medical Officers have been retained, and Sickness
Returns give a better idea of the prevalence of the various diseases.
Respiratory Diseases caused 169 deaths, or 15.4 per cent. of the total in 1892,
against 184 in 1891. In persons over sixty years of age 88 deaths occurred, and 44
were of those under five years. The months in which deaths from Respiratory
Diseases were most prevalent were:-
January, -- 34.
March, -- 22.
April, -- 20.
[Note] 93 |
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[Page] 4
The following table shews the per centage of deaths and sickness due to
Respiratory Diseases throughout the County during the year:-
Percentage of Death.
PERTH DISTRICT, -- 17.9
CENTRAL DISTRICT, -- 16.4
HIGHLAND DISTRICT, -- 13.3
WESTERN DISTRICT, -- 10.8
EASTERN DISTRICT, -- 16.3
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 26.6
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 27.7
EASTERN DISTRICT, -- No Returns.
These diseases were most prevalent during the first six months of the year, 116
of the deaths occurring during that period. Along with the cold weather which
prevailed, doubtless the remains of the Influenza Epidemic was an important
predisposing cause.
Tubercular Diseases caused 137 deaths, or 12.5 per cent. of the total (of which 85
were due to Phthisis), against 125 in 1891. These diseases belong to a class which is
distinctly preventable, and it is to be expected that a large diminution of the deaths
ascribed to them will be effected when the supervision of the sanitary conditions of
dwelling-houses, milk supplies, and of meat intended for human use is carried out.
With regard to Phthisis, it cannot be too prominently brought under the notice
of the public that this is a disease transmitted from one person to another, and that
precautions should be taken to prevent, as far as possible, such transmission, which is
almost entirely due to the careless disposal of the expectoration from consumptive
patients.
The following table shews the per centage of deaths due to Tubercular Diseases
during the year:-
Percentage of Deaths.
PERTH DISTRICT, -- 10.7
CENTRAL DISTRICT, -- 16.4
HIGHLAND DISTRICT, -- 8.0
WESTERN DISTRICT, -- 17.3
EASTERN DISTRICT, -- 11.3
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 5.3
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 3.6
EASTERN DISTRICT, -- No Returns.
Diseases of the Circulatory System, with which may be grouped Rheumatic
Diseases, caused 137 deaths, against 148 in 1891 - 94 of those occurred in persons over
sixty years of age. They were distriibuted over the country as shewn by the following
table:-
Percentage of Deaths.
PERTH DISTRICT, -- 13.2
CENTRAL DISTRICT, -- 13.2
HIGHLAND DISTRICT, -- 10.0
WESTERN DISTRICT, -- 9.6
EASTERN DISTRICT, -- 12.5
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 16.4
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 17.1
EASTERN DISTRICT, -- No Returns.
Diseases of the Nervous System caused 82 deaths, of which 62 were in persons
over sixty years of age, against 127 in 1891. The distribution over the county was as
follows:-
Percentage of Deaths.
PERTH DISTRICT, -- 7.5
CENTRAL DISTRICT, -- 10.0
HIGHLAND DISTRICT, -- 5.0
WESTERN DISTRICT, -- 4.4
EASTERN DISTRICT, -- 9.4
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 11.0
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 10.5
EASTERN DISTRICT, -- No Returns.
[Note] 94
[Page] 5
Diseases of the Digestive System caused 50 deaths, or 4.5 per cent. of the total - the
same as 1891. From the Sickness Returns of the Central and Western Districts, it will
be oberved that this class of disease accounts for about a quarter of the total sickness,
and is mostly attributable to errors of diet and climatic influences. These latter are beyond
the power of man to control; he can only protect himself against them by suitable
clothing and strict attention to diet, remembering that a digestive system loaded with
indigestible matter is more likely to be affected by a chill than one which is in a
perfectly normal condition.
The mortality and sickness from Digestive Diseases were distributed over the
County, as shewn in the following Table:-
Percentage of Deaths.
PERTH DISTRICT, -- 5.6
CENTRAL DISTRICT, -- 2.8
HIGHLAND DISTRICT, -- 4.2
WESTERN DISTRICT, -- 7.0
EASTERN DISTRICT, -- 3.1
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 29.3
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 31.7
EASTERN DISTRICT, -- No Returns.
Developmental Diseases caused 59 deaths, against 30 in 1891.
Cancer and Malignant Diseases caused 42 deaths, or 3.8 per ent. of the total.
The distribution was as follows - Perth District, 13; Central District, 12; Highland
District, 6; Western District, 2; Eastern District, 9. Of these 17 were males and
25 females.
Influenza caused 24 deaths in 1892, against 52 in 1891. It was prevalent in the
early months of the year, as is shewn by the Sickness Returns for the Central and
Western Districts, in which 210 cases of the disease were reported.
Zymotic Diseases. - Fifty-three deaths were caused by these during 1892,
against 76 in 1891.
Small-pox caused 1 death. The disease was carried by a tramp from the North
of England to Balquhidder, where he took ill and died about the twelfth day of his
illness. The man was 55 years of age, and had never been vaccinated. He had been
nearly a week ill before a medical man was called, and during that period seven
people had been constantly exposed to infection. Even at that stage, however, re-
vaccination was successful in preventing the disease in five out of the seven, and in the
two cases attacked the illness was of the mildest type. All the above seven had
also good marks of previous vaccination. Small-pox is evidently on the increase, and
may perhaps serve to teach a lesson much needed by the anti-vaccinators. These
individuals, while sheltered so far by their dwelling amongst a community who, as a
rule, have submitted to vaccination, recklessly do their utmost to withdraw themselves
and others from the protection afforded by one of the greatest discoveries of medical
science. They industriously circulate reports regarding the horrors of vaccination
from impure vaccine. At the present day no one requires to submit to vaccination
from any other than from calf vaccine, so their calumnies are behind the age. In my
opinion, the laws regarding vaccination, instead of being relaxed, should be made more
stringent, and re-vaccination should be made compulsory.
Of Typhus Fever 2 cases were reported, and are referred to in the Western
District Report.
Scarlet Fever caused 5 deaths, against 4 in 1891. This disease has been exceed-
ingly prevalent during the year. Its type has, however, been very mild, and where
it was severe there was generally some complication in the shape of insanitary con-
dition of premises, or constitutional weakness, of the patient to account for this.
Again and again the disease was almost directly traced to convalescents who had
[Note] 95 |
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[Page] 6
come for change of air, or to cases which were so slight as to be completely overlooked
by the parents until, on the occurrence of some more severe case, enquiries were
instituted. One of the chief difficulties in dealing with Scarlet Fever is that,
though assuming in the main a mild type, in these days of improved sanitation, it
has lost none of its power of infection. The Scarlet Fever cases reported were
distributed over the County as follows:-
PERTH DISTRICT, -- 32 cases.
CENTRAL DISTRICT, -- 16 cases.
HIGHLAND DISTRICT, -- 37 cases.
WESTERN DISTRICT, -- 23 cases.
EASTERN DISTRICT, -- 29 cases.
Diphtheria caused 12 deaths. The cases reported during the year amounted to
forty-one, and were distributed as follows:-
PERTH DISTRICT, -- 9
CENTRAL DISTRICT, -- 14
HIGHLAND DISTRICT, -- 1
WESTERN DISTRICT, -- 15
EASTERN DISTRICT, -- 2
The primary source of the disease was, in all cases, traced to insanitary condi-
tions. A number of the secondary cases were due to infection at school. With
improved sanitation it is to be hoped that this, the most deadly of our Infectious
Diseases, will be banished from our midst, but meanwhile parents and guardians
cannot too soon ask for medical advice when children are suffering from throat
trouble, as the disease is of a most insidious and extremely infectious character.
Enteric Fever caused 7 deaths; 26 cases of the disease were reported during the
year. These were distributed as follows:-
PERTH DISTRICT, -- 10
CENTRAL DISTRICT, -- 4
HIGHLAND DISTRICT, -- 1
WESTERN DISTRICT, -- 5
EASTERN DISTRICT, -- 6
In 7 cases the source of infection has been outside of the Districts; in
the remaining 29, insanitary conditions or infection from patients accounted for the
disease. Frequently enquiry has elicited the fact that, in previous years, quite a
series of cases of this fever has occurred in the same houses; doubtless these were
propagated by careless deposit of the infected excreta in the soil of the garden.
Precautions have been taken that such a cause will not account for future cases.
Measles caused 2 deaths. There have been, during the year, three outbreaks of
this disease, of a mild type. Wherever it has occurred, almost the whole susceptible
population has been attacked. One school was closed on account of Measles.
Whooping Cough caused 15 deaths, all of children under five years. The disease
has been very general, but has, on the whole, been of a mild type.
Diarrhoea caused 6 deaths. The low temperature of last year was not favourable
for the development of the factors chiefly concerned in the causation of this disease.
In 92 cases, or 8.4 per cent. of the total deaths, the cause of death was either
uncertified or insufficiently stated. This is an improvement on last year, when 121
deaths had to be included in this list.
[Note] 96
[Page] 7
Appended is a Table of Deaths occurring in the Landward County of Perth
during the ten years previous to my receiving office, with corresponding Death-
Rates:-
[Table inserted]
*Calculations based on the population estimated to the middle of each year.
The Perth, Central, Highland, and Eastern Districts have now arranged with
the Directors of the Perth Royal Infirmary for the reception and treatment of cases
of Infectious Disease, excepting small-pox. This arrangement has been taken advan-
tage of to a considerable extent during the past year, in all 42 cases have been
admitted on the behalf of the District Committees. These cases, without exception,
have made good recoveries, and thus much has been done to break the prejudice
against removal to hospital. Great credit is due to the nursing staff of the Perth
Infirmary for these highly successful results. With the facilities offered by the
Railway Companies for the conveyance of the freighted Ambulance Wagon, it is to
be anticipated that the percentage of removals will be much increased. The Directors
of the Perth Royal Infirmary, after agreeing to take in the cases of Infectious Disease
sent to them by the Local Authorities, immediately took steps to make the equip-
ment of the institution adequate. A new laundry and disinfecting apparatus have
been erected at a large cost, and will soon be in full working-order, and the services
of a fever staff have been secured.
As the accommodation of the Royal Infirmary does not cover the isolation of
Small-pox cases, during the year the necessity of providing for these was brought
under the notice of the Finance Committee, when it was suggested that, in view of
the difficulty of securing a suitable site for the erection of a permanent building for
the purpose, portable hospitals should be procured which could be stored when not
required, and erected on short notice in an infected locality. Matters were under
consideration when a crisis was produced by the occurrence of an outbreak of Small-
pox in the Western District. A small iron hospital was secured. This served its
purpose so well that now the Perth, Central, Western, and Eastern Disticts have
each provided themselves with a portable hospital capable of accommodating four
patients and a nurse. These hospitals have been specially designed to meet the re-
quirements of portability in country districts. None of their parts measures more
than 8 feet, by 4 feet 3 inches, or weighs more than one man can handle. They are
built in sections, each of which is complete, so that the hospital can be made larger
or smaller as required, on very short notice. It is found that the heating and ven-
tilation of these hospitals is very easily managed, whilst the varnished wood with
which they are lined makes disinfection easy. In these buildings the object aimed
at, and very successfully attained, is the utmost stability combined with ease of
[Note] 97 |
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transport. In the Western District, which has not united with the other Districts in
obtaining the use of the Perth Royal Infirmary for infectious cases, it is intended to
accomplish the whole isolation of these in such hospitals. As so much opposition
has been offered to the erection of permanent hospital buildings in the vicinity of
Burghs, matters will be much simplified by such a course.
Cholera. - In July, 1892, on account of the prevalence of Cholera on the
Continent of Europe, special instructions were issued that preparations should be
made for dealing with the disease in such a manner as to prevent its spreading
further should a case occur. In a Rural District the impossibility of removal of
Cholera patients to hospital will necessitate the treatment of the majority of patients
in their own homes, and one of the most important factors in such treatment will be
the nursing. In the case of Cholera this will frequently fall to the lot of a relative,
who must be prepared to lay aside all selfish fear and nervous panic, and to attend
simply to the orders of the doctor. A nurse who does this will not run any great risk
of infection from the patient. Cholera is not a disease carried by air: its infection
is transmitted by contaminated food or water. Consequently, there should be the
free use of disinfectants in the disposal of excreta, and the washing of soiled clothing,
and strict attenton to cleanliness and order in personal habits. In Diarrhoea also,
the disinfecting of discharges should take place, as, again and again, a mild case of
Enteric Fever has been passed over as an attack of Diarrhoea, and only discovered to
be the former when a more severe attack of fever occurred, infected by it.
If, during 1893, the country is again threatened with Cholera, I hope to be able
to give a short course of lectures and practical instruction on the special nursing
required for Cholera cases to those who are willing to undertake the duties.
Notification of Infectious Diseases by medical practitioners has, during 1892,
been performed very satisfactorily. In the Central and Western Districts, where the
recommendation of the County Council to appoint local Medical Officers has been
carried out, these are, in terms of their Bye-Laws, bound to notify to the Chief
Medical Officer all cases of Infectious Disease which come to their knowledge. In
the other Districts the Medical Men have almost uniformly notified infectious cases.
This was, however, only taken advantage of till it was seen whether or not Medical
Officers would be appointed in these Districts. As no such appointments have been
made, the District Committees have been recommended to adopt the Infectious
Diseases (Notification) Act without delay.
In conclusion, I would thank the Sanitary Inspector and his assistants for the
valuable work done during the year.
On the following pages will be found District Reports and Tabular Statements
of Sickness and Mortality.
JOHN T. GRAHAM, M.D.
March, 1893.
[Note] 98
Perth District.
1. The Sanitary Condition of the Perth District is fairly good. Much has
been done towards removing nuisances, remedying faults in the construction of
dwelling-houses, and examining the surroundings and sources of water used for
domestic purposes, with a view to securing it against pollution, or providing a safe
supply. Although no scavengers have as yet been appointed to see to the removal
of refuse in the more populous villages, a great improvement has been effected in the
surroundings of many of these. But, as the removal of refuse could only be insisted
on when it had accumulated to such an extent as to become a nuisance, the benefits
of this system cannot be compared to those which would result were a man specially
engaged to do this work regularly. The question of providing scavengers for each
of the larger villages has been before the Committee more than once during the year,
but the only result, so far, has been that, pending a final decision, the Errol scavenger
has been retained. It is to be hoped that the District Committee will soon arrive at
a decision which will be of the greatest value to the practical sanitation of the
District. So long as the removal of domestic and other refuse is not regularly
attended to, those unfailing indices of bad sanitation, enteric fever and diphtheria,
will form a blot on the records of the District.
Water-supplies have, in anticipation of an invasion of cholera, received
an extra share of attention. The Water-supply of the lower part of the Carse
of Gowrie has proved to be the largest scheme. As it was found on
analyzing samples taken from wells in this District that, almost without
exception, the water is unfit for human use, the matter is before the District Com-
mittee, and it is to be hoped that definite measures will be taken to ensure the
substitution of good, wholesome water for the liquid at present in use. The simplest
and cheapest way of meeting the difficulty would be to form a large part of the
parish of Errol into a Water District, and to have a supply for the same brought from
the Sidlaw Hills. This is, of course, rather a matter for the inhabitants than for the
Local Authority, who should, however, insist upon the houses now destitute of
pure water being immediately supplied with it. The Water-supply of Almondbank
is derived from two sources, one by gravitation, and the other from surface wells.
The former in its present condition is unfit for use; the wells yield a
fair supply of water, but, from their situations, they are liable to pollution,
and it would be advisable to have this village, along with Bridgeton, formed
into a special Water District, to which a new supply of water, readily available
by gravitation, could be brought. In many cases wells liable to surface pollution
have been ordered to be cleaned and protected from the same.
Public Schools have received a considerable amount of attention during the past
year, and it is gratifying to be able to report that, as a whole, they were found in a
very good condition; and, whilst many of them have the latest appliances in the shape
of ventilating shafts, all were found to have, what is apt to be forgotten in these
advanced days, viz., provision for ventilation by means of open windows. In some
few cases the latrines required re-modelling, and this was willingly carried out.
[Note] 99 |
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The Bye-Laws relating to Milk-sellers have come into force during the year,
and their provisions have been prominently brought before those interested, the
result being that the larger number of milk-sellers have at once taken steps to do
what was necessary. The greatest trouble has been to have the milk stores removed
from the centres of dwelling-houses to safer situations. This has in all cases been
insisted upon, and the placing upon the Register of every seller of milk is also found
to be advantageous.
The Scone Special Drainage District is beginning to show that it will not
do to lay down such a scheme and leave it afterwards to take care of itself, as the
results are frequent chokages and other evils, such as diphtheria. A man should
be appointed to take charge of this Special Drainage District, after it has been
thoroughly overhauled, and his appointment might well include the scavenging of
the village. In my opinion a village as large as Scone, having a drainage system,
should also have a gravitation water supply, which would ensure regular flushing of
the drains.
Recently an informal petition was lodged with the District Committee by some
of the inhabitants of Bankfoot, asking for advice in reference to the drainage of the
village. This should be followed up, and an opportunity offered to form a Special
Drainage District, as, from a careful examination of the place, I am certain that it
will never be right until a proper system of drainage is introduced. Depending as it
does for its water-supply on surface wells, most of which are sunk in a gravel bank,
the want of proper slop-sinks in the village is likely to lead to trouble, as was proved
by the occurrence of five cases of enteric fever during the year.
The Slaughter-Houses in the District have received a considerable amount of
attention. There is urgent need for the adoption of the Bye-Laws at present before
the Committee.
The local Sanitary Staff have done much to improve the general sanitary
condition of the District, and, when infectious diseases occurred, have been helpful in
preventing their further spread.
2. During the year General Inspections of localities in the District have
been made with a view to observing the sanitary condition, and the progess of
improvements previously recommended. Special Inspections have been called for
in connection with water-supplies or insanitary premises; and many visits have been
made in connection with infectious diseases.
3. Advice has been given regarding Dwelling-houses, and, where insanitary con-
ditions existed, these have been remedied by the proprietors without the necessity of
calling in the aid of the law. In many instances advice given regarding water-
supplies has also been accepted, and what was amiss has been remedied, although
in the Carse of Gowrie - where matters are most serious - no remedy has yet been
adopted.
No action has been called for regarding Factories and Workshops during the
year. It is intended that the latter should receive special attention during 1893.
Retail Bakehouses are sixteen in number, and eighteen visits have been paid
to them during the past year. The Bakehouses are much improved; indeed many
of them are now in very good order. One has ceased to be used as a Bakehouse.
Five young persons were reported to H. M. Inspector of Factories.
5. The arrangement by which the Perth District Committee is enabled to send
patients suffering from Infectious Disease to the Perth Royal Infirmary has been
completed. Full advantage has been taken of the facilities offered, twenty-two cases
having been removed, although it was the middle of October before the new
[Note] 100
[Page] 11
Ambulance Wagon was available for the removal of cases. The Medical Officer
has ample opportunity for supervising the management of the infectious cases admitted
to the Royal Infirmary, and has every reason to be satisfied with the treatment and
isolation afforded them.
6. To prevent the Outbreak of Infectious Disease much has been done in the way
of removing insanitary conditions, and the dread of cholera in autumn enabled many
matters to be dealt with in a more summary manner than might otherwise have been
permitted. Where infectious disease has occurred, the patient has, in all cases where
it was expedient, been removed to hospital, and where such removal could not be
carried out, absolute isolation has been maintained during the infectious period.
The childen from infected houses have been prevented attending school, and, where
there was any evidence of the disease spreading by means of this channel, the school
has been closed. Disinfection or removal of infectious clothing has been carefully
carried out.
As no local Medical Officers have been appointed for the Perth District, I must
recommend that the Committee should, without delay, adopt the Infectious Diseases
(Notification) Act.
Thanks are due to the medical men in the District for the valuable service they
have rendered during the year in gratuitously notifying and assisting in the isolation
of infectious cases.
The corrected population of the Perth District for 1891 was 21,557, and estimated
to the middle of 1892 it is 21,400. During the year there were 495 Births, giving a
Birth-rate of 23.13, and there were 317 Deaths, giving a Death-rate of 14.81, and
showing a Natural Increase of the population of 178 during the year. The Mortality in
persons over 60 years of age was 159, or 50 per cent. of the total. Deaths under
one year 47, of which 25 were due to Birth-debility, giving an Infant Mortality
of 94.9 per 1000 Births. The Zymotic Deaths were 9, giving a rate of .420 per 1000,
against .923 in 1891.
7. Respiratory Diseases. - Diseases of this class have caused 57 deaths, as compared
with 56 in 1891. Of children under one year there were 13 deaths, as against 5 in
1891; of these, children under six months constituted 12. Of the deaths from
respiratory disease 42 occurred in the first six months of the year, against 26 in the
same period of 1891.
Tubercular Diseases. - Diseases of this class caused 34 deaths (of which 18 were
due to Phthisis), compared with 37 in 1891. There is thus a slight reduction of
the number of deaths caused by this scourge, although 10 per cent. of all the deaths
during the year are due to it.
Diseases of Circulatory System caused 42 deaths, of which 34 were in persons
over 60 years of age, against 46 in 1891, shewing also a slight improvement.
Diseases of Nervous System caused 24 deaths, against 40 in 1891, proving
clearly the baneful effects of the influenza epidemic last year.
Developmental Diseases caused 25 deaths, of which 18 were due to Birth-debility,
against 13 in 1891.
Diseases of the Digestive System caused 18 deaths, against 17 in 1891.
Cancer and Malignant Diseases caused 13 deaths, against 20 in 1891.
Zymotic Diseases. - Diphtheria caused 4 deaths. The same number occurred in
1891. Two were isolated cases, the other two were victims of an outbreak
in a school to which the infection was carried, and in which 5 children suffered
from it. In all there were 9 cases (the same number as last year) reported. Three
were removed to hospital.
[Note] 101 |
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Scarlet Fever caused 1 death (last year the same). This case was the first of a
rather serious outbreak of the disease in a village. The infection had been
brought to the place by a convalescent visitor, 21 children were attacked, and it was
only by wholesale removal to hospital that the disease was eventually stamped out.
With the exception of 2, all the cases were of a mild type. In all, 14 of the
patients were taken to hospital. Besides these, 11 other cases of the disease were
reported during the year, of whom 3 were removed to hospital. All were traced to
infection brought from outside, they were scattered over the District, but the disease
did not spread from them.
Enteric Fever caused 3 deaths, the same number as last year. Two of those
deaths were in a village, in which 5 cases occurred about the same time. Two of
the cases were removed to hospital and did well. During the year 10 cases of
the disease were reported, but with the exception of the above they were isolated
cases, and their origin was traced to local insanitary conditions, or infection caught
elsewhere.
Measles caused 1 death, an infant's. The disease was very prevalent in Findo-
Gask and Abernethy Parishes, but was of a very mild type.
Whooping Cough caused no deaths during the year.
No deaths occurred from Diarrhoea, the low temperature being unfavourable to
the germination of the poison producing it.
During 1892, regular Monthly Returns have been received from the 27 District
Registrars, whom I would take this opportunity of thanking for their valuable
assistance.
[Note] 102
Central District.
1. The Sanitary Condition of the Central District compares very favourably with
last year. In the villages especially this is to be observed, the various scavengers
appointed having had a very good effect on the surroundings of houses. These men
were not appointed to do private scavenging in the way of cleaning ash-pits, &c., but in
practice it has been found that any offence of this nature pointed out by the local
Sanitary Inspector has at once been removed by the scavenger. The good effect
of the cleaning of the villages is seen by noting the total Death-rate for the year
1892, which is 16.6 against 23.3 in 1891, and the Infant Mortality of 68.2 in 1892
against 92.6 in 1891. Over the whole District the Death-rate has fallen from 22.12
in 1891 to 17.5 in 1892.
Auchterarder still evaded being formed into a Special Water and Drainage
District by the petition of a portion of the inhabitants to the Sheriff to have the
village formed into a Burgh. This has not, however, been accomplished, and the
District Committee should lose no further time in giving effect to the other petition
desiring the formation of Auchterarder into a Special Water and Drainage District,
as, until this has been done, no permanent improvement is probable. It would be
better for the place that the management of its sanitary affairs should remain in the
hands of the District Committee than that another independent unit, in the shape
of a small burgh, should be created to hamper the progress of sanitation.
Special attention has been directed to the many Water-supplies throughout the
District, especially where these were derived from wells, and the recommendations
given for the improvement of them have been, or are in process of being, carried
out.
Public Schools have received considerable attention. In one case the ventilation
and heating were found to be defective, and the matter was brought before the
School Board, with a view to rectification.
The Bye-Laws relating to the Sale of Milk have come into force in the District,
and have already effected a marked improvement upon the condition of the premises
where dairy operations are carried on.
Several Slaughter-Houses used for trade purposes have been examined during
the year, and found to be in a most deplorable condition as regards sanitation.
Measures to ensure cleansing and keeping in a better condition were taken. When
the Bye-Laws for Slaughter-Houses, at present before the District Committee, are
adopted, a total reconstruction of not a few such premises will be required.
The local Medical and Sanitary Staff have given much time to the improve-
ment of the sanitary condition of the District, and a gradual but very considerable
change for the better has been the result.
2. During the year General Inspections have been made in the District,
defects have been pointed out, and improvements noted. In connection
with insanitary conditions, many Special Inspections have been made and advice
given, which has in all cases been taken, and improvements carried out as the result.
Several Visits were made in connection with Infectious Diseases, when, along with
the local Medical Officers, such precautions were taken as to prevent the further
spread or recurrence of the disease.
[Note] 103 |
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3. Advice has been given regarding insanitary Houses, and defective Water-
supplies. No certificates under the Public Health Act have been required, as pro-
prietors have invariably done what what was necessary. No Factories have been reported
to the Local Authority as in an insanitary condition.
4. Retail Bakehouses have received eighteen visits during the year. All were
found to be clean and well kept. Some are very old, and might with advantage be
replaced by new buildings. Six young persons found to be employed were reported
to H.M. Inspector of Factories.
5. The Central District Committee entered upon a five years' agreement with
the Directors of the Perth Royal Infirmary, in accordance with which cases of
Infectious Disease are admitted to that Institution for treatment. An Ambulance
Wagon has also been procured, by which the removal of patients is accomplished
with safety and ease. The Railway Companies have courteously agreed to carry the
Wagon loaded, and thus the time occupied by the journey is reduced to a minimum.
Four cases were removed to hospital during the year. The Chief Medical Officer has
ample opportunities of supervising the accommodation and treatment of patients
admitted to the Perth Royal Infirmary, and has every reason to be satisfied there-
with.
During the summer the District was threatened with an outbreak of Small-pox,
as an infectious convalescent had been visiting some of its busiest parts. At that time,
no provision having been made for the isolation of Small-pox cases, application was made
to Perth City Local Authority, who very generously agreed to receive any case of
the disease from the Central District sent for treatment to their Small-pox Hospital.
As this accommodation was only granted for a limited period, arrangements have been
made whereby a portable Iron Hospital will now be kept for the use of the District
at some central spot, from which it can be taken and erected near the infected house
in a day's time.
6. The energies of the Medical and Sanitary Staff have been directed towards
the prevention of any Outbreak of Infectious Disease. Cases of Fever have been
imported again and again, but prompt action in the way of isolation has been the
means of preventing the disease from spreading. Schools have been notified of the
occurrence of Infectious Disease, and it has been recommended that members of
infected families should not be permitted to attend. This precaution has been carried
out. Two schools had to be closed on account of the occurrence of Diphtheria
amongst the scholars. Happily, the disease spread no further.
The retention of the services of the local Medical Officers has enabled the
notification of cases of Infectious Disease to be made at once, and measures for
removal or isolation to be adopted without delay. The department has worked
exceedingly well during the year.
7. The corrected population of the Central District for 1891 was 14,441, and
estimated to the middle of 1892 it was 14,246.
Births - 323 were registered, giving a Birth-rate of 22.6 per 1000. Deaths -
249 were registered, giving a Death-rate of 17.4 against 22.12 in 1891, and shewing
a Natural Increase in the population of 74 during the year. Deaths in persons over
sixty years of age were 126, or 50.4 per cent. of the total. Deaths under one year
were 23, of which 10 were due to Birth-debility, giving an Infant Mortality at the rate
of 71.2 per 1000 births, against 77.6 in 1891.
Zymotic Diseases caused 9 deaths, giving a Zymotic Death-rate of .631 per 1000,
against 1.58 in 1891.
[Note] 104
[Page] 15
To the Local Medical Officers thanks are specially due for supplying, besides
immediate notification, regular monthly returns of sickness in their districts. From
the latter, it has been possible to give some idea of the distribution of disease through-
out the District.
Respiratory Diseases caused 41 deaths, as compared with 44 in 1891. In 25
cases the age at death was over sixty years, and in 8 it was under one year. From
sickness returns extending over 2000 cases, it is found that this class of disease formed
26 per cent. of the whole.
Tubercular Diseases caused 41 deaths, of which 32 were certified as due to
Phthisis. The respective figures for 1891 were - Phthisis, 29, and other Tubercular
Disease 8, shewing an increase in the deaths caused by Phthisis in 1892. This
class of disease formed 5.3 per cent. of the total sickness in the District.
Diseases of the Circulatory System caused 33 deaths, of which 23 were in persons
over sixty years of age. This class of disease caused 30 deaths in 1891. The
percentage for 1892 is 13.2 per cent. of the total, and 16.4 per cent. of the sickness.
Diseases of the Nervous System caused 25 deaths, against 32 in 1891, and 11 per
cent. of the total sickness.
Diseases of the Digestive System caused 7 deaths, against 13 in 1891, and 29.3 per
cent. of the total sickness.
Cancer and Malignant Diseases caused 12 deaths, against 11 in 1891.
Rheumatic Diseases caused 7.4 per cent. of the total sickness.
Influenza caused 6.6 per cent. of the total sickness, and 8 deaths were due to
this cause.
Developmental Diseases caused 10 deaths, against 7 in 1891.
Old Age was certified as causing 26 deaths, against 42 in 1891.
Zymotic Disease caused 9 deaths, against 23 in 1891.
Scarlet Fever caused 1 death. Sixteen cases of the disease were reported during
the year. They were all scattered over the rural part of the District with one
exception, which occurred in a village, where isolation was maintained very strictly.
Two of the cases were removed to hospital. Two of the cases occurred in connection
with dairies. Absolute isolation of the dairy, and of those handling the milk, was
willingly carried out.
There were no deaths from Enteric Fever during the year. Four cases of the
disease were reported. These were infected the one from the other in spite of
exceptional precautions in the way of professional nurses, &c., being employed.
Measles caused 1 death, but there has been no epidemic of the disease. Cases
have been infected on several occasions, but no outbreak has ever occurred.
Whooping-Cough has caused 3 deaths, and was prevalent in the early part of the
year in certain portions of the District. It was of a mild type.
Diarrhoea caused 1 death. With the exception of Dunning, no part of the
District reported an unusual number of cases during the year.
The District Registrars have regularly supplied Monthly Returns of Births and
Deaths, and deserve public thanks for their willing help in this important matter.
[Note] 105 |
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[Note] 106
Highland District.
In so far as the more populous parts are concerned, the Sanitary Condition of the
Highland District is very good; but in the more sparsely-populated tracts of country,
where the crofter houses form an element, years will have to be spent in gradual im-
provement before the condition of things will meet the requirements of modern times.
Happily, in the Districts where those houses most abound, everything, so far as
nature is concerned, is in favour of a healthy condition. Much trouble has been ex-
perienced in getting manure-heaps removed from the close proximity of dwelling-
houses - a common argument against such a proceeding being that the heaps have
been in the same position ever since the offender can remember. The removals,
nevetheless, have all been eventually effected.
Water-supplies have received a great deal of attention. In all cases, where the
quality of the water was suspected, samples were analysed, and, in the event of an
unfavourable report, the well was ordered to be put right or closed.
In Pitlochry the scavenger's duties are still restricted to keeping the streets
clean. It seems a pity when so much benefit might be conferred upon the community,
by adding to the scavenger's present work that of cleaning the ash-pits, that this should
not be arranged for. The necessity of compelling proprietors and tenants to keep
their own premises clean is the cause of constant friction as matters at present
stand. The scavenger in Dunkeld is doing very well, and is a good example of
what can be done at small cost in keeping large villages in a sanitary condition.
Public Schools have been examined, and found to be thoroughly satisfactory
from a hygienic point of view.
The new Dairy Regulations have come into force during the year, and their
powers have, in several instances, been met with a good deal of opposition. The
entire separation between living-room and milk-store is a sine quâ non in the pro-
tection of milk from infection; but it is very hard to convince people of this.
Prosecutions will have to take place in the event of further resistance.
The Bye-Laws relating to Slaughter-Houses have been brought under the
notice of the District Committee, and it is to be hoped that they will soon come into
force. However, all the worst Slaughter-Houses in this District have been replaced
by new buildings, which are quite in keeping with modern requirements.
2. During the year many General Inspections have been made of various
parts of the District, with a view to ascertaining the sanitary condition and marking
the progress of improvements. Numerous visits have also been made in connection
with Infectious Diseases.
3. Advice has been frequently required regarding Nuisances, with a view to
granting certificates in the event of legal proceedings being necessary; but in all
cases defects have been remedied without such a course of action being required.
Advice has been given regarding water-supplies, and one, found impure, was ordered
to be closed.
No action has been called for in connection with the Factories or Workshops in
the District.
[Note] 107 |
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4. Eleven visits were paid to the Retail Bakehouses. Eight of these are in
operation; two are not used as Bakehouses. There is a great improvement in most
of the Bakehouses. In one instance a new building has replaced an old and scarcely
creditable one, and in another instance it is to be hoped that the proprietor will be
induced to follow the same course. Considerable trouble was caused by the occupier
of one Bakehouse, whose premises were in anything but a satisfactory condition; in
fact, it was only when a certificate of unfitness was threatened that the matter was
put right. Three young persons were found employed, and were reported to H.M.
Inspector of Factories.
5. An arrangement has been made with the Directors of the Perth Royal
Infirmary whereby, for five years, cases of Infectious Disease will be treated in that
Institution. This has been found to work very satisfactorily, and it will be even
more readily available now that the Railway Companies have agreed to carry the
loaded Ambulance Wagon, hence a large saving of time will be effected. Eight
cases were removed to hospital during the past year. The Medical Officer has ample
opportunities for supervising the accommodation provided, and the treatment of
patients in the Royal Infirmary, and has every reason to be satisfied with the same.
6. To prevent the Outbreak of Infectious Disease, the local Sanitary Inspector
has devoted his time throughout the year to ascertaining and insisting upon the
removal of insanitary conditions. He has proved that the method adopted by the
Highland District Committee, of employing one man who could devote his whole
time to the work, is most satisfactory. Cases of Infectious Disease, when they
occurred, were promptly isolated by removal to hospital or otherwise. The result
has been highly satisfactory. When Infectious Disease has occurred in a family,
from which children attend school, notification of the existence of the disease has
been sent to the teacher, who has been at the same time advised to debar the
members of the family from coming to school. In two instances schools have been
closed, Whooping Cough being the cause in one case, and Scarlet Fever in the
other.
As no local Medical Officers have been appointed by the Highland District
Committee, I must recommend that the Infectious Diseases (Notification) Act be
adopted without delay.
7. The corrected population of the Highland District for 1891 was 13,175, and
estimated to the middle of 1892 it was 13,019.
Births registered were 226, giving a Birth-rate of 17.3 per 1000.
Deaths registered were 210, giving a Death-rate of 16.2, against 18.0 in 1891.
The Natural Increase of the population during the year was 16. Deaths in
persons over sixty years of age were 123, or 58.5 per cent. of the total, and Deaths
under one year were 21, of which 9 were due to Developmental Diseases, giving an
Infant Mortality of 92.9 per 1000 Births.
Zymotic Diseases caused 6 deaths, of which 4 were due to Whooping-Cough,
giving a Zymotic Death-rate of .460, against .759 in 1891.
Respiratory Diseases caused 28 deaths. In 20 cases the age of death was over
sixty years, and in 2 it was under one year. This class of disease caused 13.3 per
cent. of the total, against 18.4 per cent. in 1891.
Tubercular Disease caused 17 deaths (in 10 Phthisis was the cause of death).
This class of disease caused 8.0 per cent. of the total deaths, against 9.6 per cent.
in 1891.
Diseases of the Circulatory System caused 21 deaths; of these 15 occurred in
persons over sixty years of age. The per centage was 10.0, against 8.8 in 1891.
[Note] 108
[Page] 18
Diseases of the Nervous System caused 11 deaths, or 5.2 per cent. of the total,
against 9.6 per cent. in 1891.
Diseases of the Digestive System caused 9 deaths, or 4.2 per cent. of the total,
against 7 per cent. in 1891.
Influenza caused 6 deaths in the early part of the year.
Cancer and Malignant Diseases caused 6 deaths, or 2.0 per cent.
Developmental Diseases caused 9 deaths, of which 6 were due to immaturity,
against 3 in 1891.
Old Age caused 45 deaths, or 21 per cent. of the total, against 17.2 per cent.
in 1891.
Scarlet Fever caused 1 death. There were reported 37 cases of the disease.
These occurred in small groups, and the cases being isolated or removed, infection
did not spread.
Only one case of Enteric Fever was reported. The patient could not be removed,
so the family were located in another house, and a nurse and doctor employed to look
after the patient, who, after a serious illness, recovered. The infection was traced to
excreta of former cases of the disease which had been buried in the garden of the
house. A flood occurred, the soil with its infection was washed into the house, and
in cleaning up after the flood, the infection had been received.
Whooping Cough caused 4 deaths, and was prevalent in a mild form in the early
part of the year.
No deaths was caused by Diarrhoea during the year; but, with a view to prevent
the occurrence of such disease, extra precautions were taken by insisting upon the
removal of insanitary conditions. In this the Authorities were much assisted by the
dread of an invasion of Cholera, which prevailed during the autumn.
Monthly Returns of Registered Births and Deaths have been received from the
District Registrars, to whom thanks are due for the valuable information they have
voluntarily given.
[Note] 109 |
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[Note] 110
Western District.
The Sanitary Condition of this District has gone on steadily improving during
the year. The local Medical Officers and Sanitary Inspectors have more than kept
up the reputation of the past by their energetic attention to Public Health matters.
The sanitary condition of the huts occupied by the navvies engaged on the new West
Highland Railway and Glasgow Water-Works Extension Contracts has demanded a
good deal of attention, but as the contractors and their managers have taken the wise
plan of adopting precautions to prevent the outbreak of filth-diseases amongst the
employees, the duties of supervision have been considerably lightened. The accom-
modation provided for the men is much above what might have been expected.
No scavengers have as yet been appointed by the Committee to see to the
cleaning of the villages. Killin specially requires the appointment of a scavenger.
The private scavengers of Deanston and Ashfield are doing good work, and these
villages are a proof of what can be done by the systematic removal of domestic refuse.
Water-supplies, on the whole excellent throughout the District, have, in a few
instances, been found to be polluted. In one instance the pollution was transitory,
being caused by the washings of the new Railway gaining access to the water.
The resultant flavour of creosote was not agreeable, but it soon disappeared. In
another instance the pollution was found to be of a more dangerous nature; the well
was consequently closed, and is to be replaced by a gravitation supply derived from
a pure source, which will be a great improvement. The village of Killin is
increasing its water-supply, and will be abundantly supplied when the new works are
completed.
The Bye-laws relating to Milk-sellers have come into operation, and a number
of dairy-farms have been inspected. In many cases an inhabited bedroom, almost
in direct communication with the milk-store, was found, and this most objectionable
combination was ordered to be discontinued. It is pleasant to be able to add that
occupiers and proprietors alike have willingly carried out the recommendations given,
on the reasons for these being explained to them.
The Drainage in some of the modern houses has caused trouble during the
year, as the occurrence of Diphtheria has again and again been traced to neglected
soil-pipes, &c. These have been rectified, and the expenses connected therewith will
convince proprietors that it is very unwise to neglect such matters until disease
manifests itself, and a large expenditure is necessary to remedy faults which a little
regular supervision would entirely have prevented.
In the village of Aberfoyle, where the water-carriage system of soil is almost
universally carried out, a large pollution of the neighbouring river is caused. Steps
should be taken to prevent the discharge of the sewage from the village into the
river without purification. In summer, when the river is small and a large number
of visitors are resident, there is grave danger to the households further down the
river, who depend on its water for domestic supply.
Slaughter-Houses have, on several occasions, been inspected, and found to be
in very good order. The proprietors have also voluntarily carried out suggested
improvements.
[Note] 111 |
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The local Inspectors were troubled a good deal during part of the year by house-
holders buying sheep when the price was exceedingly low, then slaughtering privately,
and disposing of the offal in the nearest ash-pit, where, in due time, it created a most
offensive nuisance.
2. During the year many General Inspections of localities in the District
have been made, and the sanitary condition noted. In connection with complaints of
insanitary conditions and polluted water-supplies, various Special Inspections were
made. On account of Infectious Diseases, a great deal of time had to be spent in
this District. The Committee having made no provision for the isolation of persons
suffering from the above, the work was thus rendered exceptionally difficult. How-
ever, it is only fair to add that, when the necessity arose, the Committee did all in
their power to help forward the work.
3. Advice has been given on several occasions regarding nuisances polluting, or
alleged to be polluting, water-supplies; as well as in connection with insanitary
dwelling-houses. In the latter the chief fault was caused by earth banked against
the back walls of the houses, and the entire absence of ventilation of the sleeper joists
of the floor. In the cases reported. excavations of the earth at the back of the houses
and free ventilation under the floors have been insisted upon.
No action has been called for in connection with Factories and Workshops during
the year.
One Cemetery was examined, and, at the request of the Committee, certified as
overcrowded and dangerous. Steps have been taken to have it closed.
4. Eight visits have been paid to the five Retail Bakehouses in the rural part of
the District. In all cases the premises have been put into good order, in one
especially, improvements on an extensive scale have been effected. Three young
persons found employed were reported to H.M. Inspector of Factories.
5. As before stated, the carrying out of the provisions of the Public Health
Act in regard to Infectious Disease, was rendered exceedingly difficult when a case
occurred. The first instance in which removal was required was a case of Scarlet
Fever, and the patient was taken to the Perth Royal Infirmary as the only available
place where the fever could be treated. The second case was in one of the huts on
the Glasgow Water-works Extension at Loch Dhu. To prevent the disease spreading
in these crowded huts, removal of the patient was absolutely necessary. Through the
kindness of the Medical Officer, and of those connected with its management, a small
hospital connected with the works was placed at our service. Thus, by the kindness
of outsiders, isolation was provided, and the disease stayed. The next case was one
of Enteric Fever which occurred at the Aberfoyle Slate Quarries, where a visitor to
one of the men was laid down in his lodgings. To secure isolation here, the
other members of the family were removed to another hut, the use of which
was kindly granted by the Managers of the Slate Quarries. The patient was
treated in the original house, a nurse and doctor being employed on behalf of
the District Committee. Here again there was no extension of the disease.
The next call upon the Committee for isolation was in connection with a tramp
who fell ill of Small-pox in a byre in Balquhidder Parish. No accommodation could
be got for him anywhere, except in a disused smithy. It was now that the District
Committee saw the necessity of making some provision, and a temporary iron
hospital was ordered to be erected without delay. This was found to answer its
purpose admirably, in spite of the exposed situation and the inclement weather of
November, it was easily warmed and very comfortable; it will now be stored
and reserved for the treatment of Small-pox. Since this, the Committee have not
[Note] 112
[Page] 21
only been willing to provide accommodation, but have shown a degree of anxiety
to which their former apathy forms a strange contrast. They have endeavoured to
carry the Burghs in the District along with them, but in this they have not been
successful. Besides the above the Committee have procured a portable hospital,
capable of accommodating four patients and a nurse. If this proves a success,
and is not large enough for the wants of the District, it is proposed to secure
another similar building. Thus the question of providing for infectious cases
occurring in the Western District has been settled, and in a most satisfactory
manner.
6. To prevent the Outbreak of Infectious Disease, a good deal has been done in
having defective drainage remedied, and this has been most willingly carried out by
the proprietors interested. In those cases where no drainage existed the defect was
put right, on its necessity being pointed out. The chief danger to which the Western
District is exposed is from tramps. They have on three distinct occasions during the
year brought Infectious Disease into it, and that more cases did not occur is a matter
of surprise. Where cases of Infectious Disease occurred, they have been immediately
notified by the local Medical Officers, who, along with the local Sanitary Inspectors,
have done much good work during the year in superintending isolation.
The local Medical Officers have also sent Monthly Returns of Sickness, accom-
panied by remarks on the sanitary condition of their various Districts. Much valuable
help in the prevention of the outbreak and spread of Infectious Disease has been
rendered by the Medical Men employed by the contractors engaged on the West
Highland Railway and the Glasgow Water-Works extension. Although not upon
the local Medical Staff, they have done quite as much good work, and are much to be
commended for their courtesy and help.
7. The corrected population of the Western District for 1891 was 10,759, and
estimated to the middle of 1892 it was 10,954. Births registered were 243, giving a
Birth-rate of 22.18 per 1000. Deaths registered were 156, givng a Death-rate of 14.24
per 1000. The Natural Increase of the population during the year was 87. Deaths
in persons over sixty years of age were 54, or 33.9 per cent. of the total, and Deaths
under one year were 14, of which 3 were due to Developmental Disease, giving an
Infant Mortality of 57.6 per 1000 Births.
Zymotic Disease caused 17 deaths, or 10.9 per cent. of the total, against 15.3
per cent. in 1891. This class of disease caused 28.8 per cent. of the total sickness in
the District during the year.
Tubercular Disease caused 27 deaths, of which 15 were due to Phthisis, giving
a Death-rate of 17.3 of the total, and 3.6 per cent. of the sickness. In 1891 the
Death-rate was 11.5 per cent.
Diseases of the Circulatory System caused 15 deaths, or 9 per cent. of the
total, and a Sickness-rate of 8.2 per cent.
Diseases of the Nervous System caused 7 deaths, or 4.4 per cent. of the total,
and a Sickness-rate of 10.5 per cent.
Influenza caused 3 deaths, and accounted for 2.9 per cent. of the Sickness.
Diseases of the Digestive System caused 11 deaths, or 7 per cent. of the total,
and 31.7 per cent. of the Sickness.
Rheumatic Diseases caused 3 deaths, and 8.8 per cent. of the total sickness.
Cancer and Malignant Diseases caused 2 deaths during the year.
Old Age caused 22 deaths, or 14.1 per cent. of the total.
Zymotic Diseases caused 17 deaths, and gave a Zymotic Death-rate of 1.55 per
1000 of the population.
[Note] 113 |
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| HH62/45/115 |
[Page] 22
Small-pox caused 1 death. Three cases of the disease occurred. The infection
was carried from the North of England by a tramp. He had never been vaccinated,
and, as is usual in such cases, the disease proved to be of a most malignant type,
death occurring on the twelfth day. Re-vaccination of all the members of the house-
hold with whom he had been in contact was carried out so soon as the case was
recognised, and its efficacy, even after exposure to infection for a week, was proved
by only two out of seven being affected by the disease, which, in their case, was
of the very mildest type.
Typhus Fever. - Two isolated cases were reported. In neither could the source
of infection be traced; neither was there any extension of the disease, although the
conditions were favourable for this.
Scarlet Fever caused no deaths, but 23 cases of the disease were reported, all of
them in scattered groups; and the means of isolation adopted (in one instance, the
closing of the Public School) were effective in stamping it out.
Enteric Fever. - Two deaths were caused by this disease, and five cases were
reported. All the cases were solitary, except one in January, which was the last of
a small outbreak in a house referred to last year as deriving its water-supply from the
Forth. The water-supply has now been much improved. Two of the remaining
cases were traced to insanitary condition of premises, and the other two were
imported from without.
Diphtheria caused 6 deaths, or 3.8 of the total. Fifteen cases were reported,
and all were traced to insanitary conditions of the houses in which they occurred.
The conditions have been remedied.
Two cases of Measles were reported, but there was no extension of the outbreak.
Whooping Cough caused 5 deaths, and 40 cases were reported. The disease
prevailed chiefly in the early months of the year.
Monthly Returns of registered Births and Deaths have been regularly forwarded
by the Registrars, who have thus rendered valuable help during the year.
[Note] 114
Eastern District.
1. The Sanitary Condition of the Eastern District has, during the past year,
steadily improved, although not to the same extent as that of the other four Districts.
The local Sanitary Inspectors, considering themselves to be under-paid, have not been
animated by the spirit required for an effectual aggressive Sanitary reform, although,
when called upon to take action in connection with Infectious Diseases, they have given
most loyal assistance.
A great deal of satisfactory work has been done in connection with the removal
of sanitary defects in the more populous parts of the District, and there are other
improvement schemes which are still in progress. In view of the threatened invasion
of Cholera in the autumn, Water-Supplies received special attention. Some suspected
sources were found, on analysis, to be quite pure; in one case, a supply of good quality,
but deficient quantity, was replaced by an ample one, whilst many wells, liable to
surface pollution, were ordered to be cleaned and made safe.
Public Schools have been examined, and found to be in a very satisfactory
condition.
The Dairy Bye-Laws have been found to work well, and the special provision,
which insists on the stoppage of the sale of milk when Infectious Disease occurs at a
dairy-farm until the Sanitary Authorities are satisfied that isolation is complete, has
been of good service.
Slaughter-houses have demanded a considerable share of attention during the
year. One has been closed in favour of new premises, and another has been put into
good order.
2. General Inspections in the District have been made frequently with a view to
ascertain the sanitary conditions and the habits of the people. On several occasions
Special Inspections were required in consequence of complaints of insanitary
conditions. Cases of Infectious Disease have also involved frequent visits.
3. Advice has been given in connection with Nuisances and Dwelling-houses,
and on all occasions the recommendations given have been carried out.
No action has been called for on the part of the Local Authority of the District
in connection with the Factory and Workshops Act.
4. Retail Bakehouses have been frequently examined and found to be in good
order; one, in particular, has been much improved by the carrying out of suggested
alterations. One young person was found employed, and reported to H.M. Inspector
of Factories.
5. The arrangement by which the Eastern District obtained a right to send, for
five years, cases of Infectious Disease to the Perth Royal Infirmary has been com-
pleted and fully taken advantage of. Six patients were admitted during the year.
The Medical Officer has ample opportunities of supervising, and is completely
satisfied with the treatment and isolation provided. For Small-pox cases a portable
Hospital has been provided, which will accommodate four patients along with a nurse.
6. To prevent the Outbreak of Infectious Disease, every effort has been made to
improve the sanitary condition of the Dwellings, as well as to ensure pure Water-
[Note] 115 |
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| HH62/45/117 |
[Page] 24
supplies. One source of danger over which, at present, the Committee has no power
is that, within the bounds of the District, there exist several populous places from
which, again and again, infection has been transmitted into the surrounding country.
When Infectious Disease has broken out, precautions have been taken by isola-
tion or removal of the patient to prevent the spread of infection. These efforts have,
in all cases, been successful.
As no local Medical Officers have been appointed, I must recommend the Com-
mittee to adopt, without delay, the Infectious Diseases (Notification) Act. To the
Medical Practitioners of the District, thanks are due for the hearty co-operation given
during the year in notifying and assisting in the isolation of cases of Infectious Disease.
7. The corrected population of the Eastern District for 1891 was 9783, and
estimated to the middle of 1892 it was 9664. Births in 1892 were 204, giving a
Birth-rate of 21.1 per 1000 for the year. Deaths 159, giving a Death rate of 16.45
per 1000 living, and a Natural Increase of 45 for the year. On persons over sixty
years of age there were 82 deaths, or 51.5 per cent. of the total. Deaths under one
year were 26, of which 12 were due to Developmental Disease, giving an Infant
Mortality of 127.4 per 1000 births, against 40.5 in 1891. This is chiefly accounted
for by Birth Debility and Respiratory Diseases.
Respiratory Diseases caused 26 deaths, or 16.3 per cent. of the total, against 9.8
in 1891.
Tubercular Diseases caused 18 deaths, of which 10 were due to Phthisis, forming
11.3 per cent. of the total, compared with 7 per cent. in 1891 - a considerable increase.
Diseases of the Circulatory System caused 20 deaths, of which 15 were in persons
over sixty years of age, forming 12.5 per cent. of the total, against 14 per cent.
in 1891.
Diseases of the Nervous System caused 15 deaths, or 9.4 per cent. of the total,
against 9.8 per cent. in 1891.
Developmental Diseases caused 12 deaths, against 5 in 1891.
Diseases of the Digestive System caused 5 deaths, against 15 in 1891.
Cancer and Malignant Diseases caused 9 deaths, against 6 in 1891.
Zymotic Diseases - Diphtheria caused 1 death, against 2 in 1891. Only 2 cases
of the disease were reported during the year, 1 of which was removed to hospital.
Scarlet Fever caused 2 deaths. These occurred in one house in which the disease
assumed a very malignant type; but, fortunately, it spread no further. During the
year 29 cases of the disease were reported, all, with the exception of the above, of a
very mild type. They occurred in small groups in various parts of the District. In
one instance the Public School was closed as a precautionary measure.
Enteric Fever caused 2 deaths. Six cases were reported, in 4 of which the cause
of infection was traced to causes outside of the District, and in 2 to impure water.
Whooping Cough caused 3 deaths, all in children under one year.
Diarrhoea caused 3 deaths, and was at no time prevalent during the year.
The District Registrars deserve public thanks for their valuable assistance.
[Note] 116
TABULAR STATEMENTS
OF
Sickness and Mortality
IN THE
COUNTY OF PERTH.
1892.
[Note] 117 |
|
| HH62/45/119 |
[Note] 118
TABULAR STATEMENT of SICKNESS and MORTALITY referred to in the Regulations issued by the Board
of Supervision for Medical Officers of Counties.
County of PERTH AND DISTRICTS.
TABLE I. - Births and Deaths occurring in the County during the Year 1892.
[Table inserted]
NOTES. - The Medical Officer may, if he thinks fit, give separately the figures for any Sub-Divisions of the County: in all cases the Total for the County is to be given.
Deaths of Persons belonging to a County occurring in Public Institutions (as Lunatic Asylums, Poorhouses, Hospitals) outside of the County, are to be included with the figures for that County,
and Deaths of Persons not belonging to a County, occurring in Public Institutions within the County, are to be excluded.
"Diphtheria" shall include "Membranous Croup," "Diphtheritic Croup," "Croupous Diphtheria."
All Deaths from "Diarrhoea," "Dysentery," "Enteritis," "Gastro-Enteritis," "Muco-Enteritis," - unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis-
"Diarrhoea," "Bright's Disease-Diarrhoea," are to entered under the heading "Diarrhoea."
The designation "Other Tubercular Diseases" includes, inter alia, "Tabes Mesenterica," "Tubercular Meningitis," "Hydrocephalus," "Struma," "Scrofula." The headings distinguished by asterisks cover all diseases placed under these headings in the classification of the Registrar-General.
[Note] 119
TABLE 11. - Density of Population, Birth Rate, Infantile and other Death Rates.
[Table inserted]
(Signed) JOHN T. GRAHAM, M.D., Medical Officer.
31st March, 1893. |
|
| HH62/45/121 |
[Note] 120
COUNTY OF PERTH - PERTH DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1892, according to the Registration Districts.
[Table inserted]
[Note] 121
PERTH DISTRICT - Continued.
[Table inserted]
*Acreage included under Auchtergaven, Kinclaven, and Redgorton
+After deducting (4336) Acreage of Perth City, formed by parts of Kinnoull, Perth, Scone, and Tibbermore. |
|
| HH62/45/123 |
[Note] 122
COUNTY OF PERTH - CENTRAL DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1892, according to the Registration Districts.
[Table inserted]
[Note] 123
COUNTY OF PERTH - HIGHLAND DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1892, according to the Registration Districts.
[Table inserted]
*1 Acreage included under Dull, Fortingal, Logierait, Kenmore, and Weem.
*2 Acreage combined with Dowally.
*3 Acreage included under Dull.
*4 Acreage included under Fortingal.
*5 Acreage included under Moulin.
*6 Acreage included under Blair-Athole, Dull, and Moulin.
+ Unclaimed Land adjoining Kenmore.
‡ Land common to Blair-Athole, Fortingal, and Logierait. |
|
| HH62/45/125 |
[Note] 124
COUNTY OF PERTH - WESTERN DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1892, according to the Registration Districts.
[Table inserted]
[Note] 125
COUNTY OF PERTH - EASTERN DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1892, according to the Registration Districts.
[Table inserted]
* Acreage included under Kirkmichael.
+ Acreage included under Alyth, Bendochy, Blairgowrie, Caputh, Kirkmichael, Lethendy, and Kinloch and Rattray. |
|
| HH62/45/127 |
[Note] 126
County of Perth.
REPORT BY MEDICAL OFFICER
FOR
1893.
[Note] 127 |
|
| HH62/45/129 |
INDEX.
-- PAGE
METEOROLOGICAL OBSERVATIONS, -- 3
COUNTY OF PERTH, -- 5
PERTH DISTRICT, -- 14
CENTRAL DISTRICT, -- 20
HIGHLAND DISTRICT, -- 26
WESTERN DISTRICT, -- 32
EASTERN DISTRICT, -- 40
TABULAR STATEMENTS, -- 44
[Note] 128
[Page] 3
METEOROLOGICAL OBSERVATIONS.
FROM DATA SUPPLIED BY MR. CROUCHER, GARDENER, OCHTERTYRE, PER DR. GAIRDNER, CRIEFF.
The comparisons are with the averages for Scotland for the Month, since 1855.
HEIGHT OF STATION ABOVE THE SEA, 333 FEET.
JANUARY. - Barometer (Mean), 29.636", higher by 0.225". Range, 1.200".
Thermometer (Mean), 35.80°, lower by 1.4°.
Mean Humidity, 80, less by 8.
Rain fell on 19 days; depth in inches, 2.23, less by 1.78.
Hours of Sunshine during Month, 55, less by 7.
Wind, [Table inserted]
FEBRUARY. - Barometer (Mean), 29.185", lower by 0.301". Range, 1.496".
Thermometer (Mean), 38.0°, lower by 0.3°,
Mean Humidity, 84, less by 4.
Rain fell on 24 days; depth in inches, 4.73, greater by 1.70.
Hours of Sunshine, 53, less by 32.
Wind, [Table inserted]
MARCH. - Barometer (Mean), 29.653", higher by 0.193". Range, 1.180".
Thermometer (Mean), 43.4°, higher by 3.8°.
Mean Humidity, 77, less by 9.
Rain fell on 11 days; depth in inches, .95, less by 1.90.
Hours of Sunshine, 139, greater by 17.
Wind, [Table inserted]
APRIL. - Barometer (Mean), 29.868", higher by 0.348". Range, 0.898".
Thermometer (Mean), 48.1°, higher by 4.0°.
Humidity, 78, less by 6.
Rain fell on 6 days; depth in inches, 0.96, less by 1.30.
Hours of Sunshine, 160 (average).
Wind, [Table inserted]
MAY. - Barometer (Mean), 29.717", higher by 0.149". Range, 1.156".
Thermometer (Mean), 53.8°, higher by 4.7°.
Humidity, 76, (average).
Rain fell on 11 days; depth in inches, 1.23, less by 1.
Hours of Sunshine, 147, less by 52.
Wind, [Table inserted]
JUNE. - Barometer (Mean), 29.770", higher by 0.135". Range, 1.106".
Thermometer (Mean), 59.0°, higher by 4.3°.
Humidity, 73, (greater by 6).
Rain fell on 7 days; depth in inches, 3.15, more by 0.80.
Hours of Sunshine, 205 (average).
Wind, [Table inserted]
[Note] 129 |
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| HH62/45/131 |
[Page] 4
METEOROLOGICAL OBSERVATIONS - (Continued).
JULY. - Barometer (Mean), 29.571", higher by 0.062". Range, 0.958".
Thermometer (Mean), 58.66°, higher by 1.4°.
Humidity, 77 (average).
Rain fell on 13 days; depth in inches, 2.90, less by 0.26.
Hours of Sunshine, 104, less by 100.
Wind, [Table inserted]
AUGUST. - Barometer (Mean), 29.637", higher by 0.133". Range, 1.192".
Thermometer (Mean), 60.4°, higher by 3.7°.
Humidity, 79, greater by 5.
Rain fell on 18 days; depth in inches, 4.17, greater by 0.72.
Hours of Sunshine, 125, less by 53.
Wind, [Table inserted]
SEPTEMBER. - Barometer (Mean), 29.420", lower by 0.107". Range, 1.450".
Thermometer (Mean), 53.3°, higher by 0.5°
Humidity, 79, less by 8
Rain fell on 11 days; depth in inches, 1.15, less by 2.47.
Hours of Sunshine, 102, less by 41.
Wind, [Table inserted]
OCTOBER. - Barometer (Mean), 29.389", lower by 0.071". Range, 1.376".
Thermometer (Mean), 48.0°, higher by 1.3°.
Humidity, 81, less by 6.
Rain fell on 14 days; depth in inches, 2.52, less by 1.49.
Hours of Sunshine, 85, less by 22.
Wind, [Table inserted]
NOVEMBER. - Barometer (Mean), 29.632", higher by 0.183". Range, 2.016".
Thermometer (Mean), 38.9°, lower by 1.6°.
Humidity, 78, less by 11.
Rain fell on 11 days; depth in inches, 2.88, less by 1.00
Hours of Sunshine, 64, less by 10.
Wind, [Table inserted]
DECEMBER. - Barometer (Mean), 29.369" (average). Range, 2.112".
Thermometer (Mean), 40.0°, higher by 2.2°.
Humidity, 81, less by 7.
Rain fell on 23 days; depth in inches, 4.06 (average).
Hours of Sunshine, 34, less by 24.
Wind, [Table inserted]
[Note] 130
County of Perth.
THIRD ANNUAL REPORT BY COUNTY MEDICAL OFFICER,
1893.
During 1893 the improvement in the general sanitation condition of the County
of Perth, noted in previous Annual Reports, has been well maintained. The
Death-rate for the year was greater than in 1892 by .67 per thousand; but, as
the cause of death in more than half of the excess was accounted for by old age,
the increased mortality can scarcely be attributed to preventable causes.
Much valuable work has been accomplished, or well begun, under the District
Committees of the County, including the provision of water supplies and drainage for
villages, the supervision of burying-grounds, the registration of slaughter-houses, and
the constant struggle with infectious disease. Under the various Districts these
matters have been fully gone into, so that it is needless to do more than refer to their
Reports for information regarding the proceedings of the year.
Rivers Pollution Prevention Act. - During 1893, in consequence of the
action of the County Finance Committee in directing the attention of the Perth,
Highland, and Eastern District Committees to pollution caused by certain Burghs
and Villages, vigorous measures have been taken by these Committees to apply a
remedy where the power to do so lay with them, or to see that it was applied when
the cause of pollution lay within the jurisdiction of an independent authority. In the
Perth District the pollution caused by Stanley and by Scone was specially considered.
In so far as Scone is concerned, the purification of its sewage before discharge
into the stream has been satisfactorily settled, and the works necessary have been
authorised. Stanley, owing to peculiar circumstances, has not yet been dealt
with. The question is still under the consideration of the District Committee,
and a Report by a Civil Engineer is to be laid before the next Quarterly Meeting.
In the Highland District the pollution of the Tay caused by Aberfeldy and Dunkeld
has been under consideration. The Aberfeldy Local Authority have, at the instance
of the District Committee, agreed to carry out works which will greatly reduce the
pollution at present caused by the discharge of the sewage of the Burgh into the
river. At Dunkeld it was anticipated that there would be greater difficulty in
introducing the necessary purification works, owing to the situation of the Town in
a hollow. This difficulty has been overcome, and the Report of Mr. James Ritchie,
C.E., shows how not only the purification of the sewage can be successfully accom-
plished but that, in so doing, the drainage of the Town will also be much
improved. In the Eastern District the attention of the Committee was directed to
the pollution of the Ericht caused by the sewage of Blairgowrie and Rattray.
During the past year Blairgowrie has carried out extensive works designed for
sewage purification. It is too early yet to speak of the result in so far as the
effluent is concerned, but, judging from the difficulty experienced in keeping the
[Note] 131 |
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[Page] 6
settling-tanks and screens clean, there must be a great improvement on the state
of matters which existed in the river before such treatment was adopted. Were the
effluent treated by broad irrigation after leaving the works, its purification would be
complete. In so far as Rattray is concerned, the attention of the Local Authority
of the Burgh was called to the pollution caused by its sewage, and various proposals
have been made as to the best available means for preventing the pollution. As yet
no works have been erected, but it is probable that progress will be made during
1894. In the Western District the pollution of the Forth by the sewage of
Aberfoyle has been the subject of much consideration, but nothing in the way of
erecting purification works has yet been done; but that these will be insisted upon by
the District Committee is certain. There are many cases of infringement of the
Rivers Pollution Act still to be dealt with in the County; but the above are the
most flagrant, and were they remedied a great improvement would be the result:
the water of our rivers would be made far safer as a beverage than has been the case in
the past, and future action would be simplified by its being possible to show purifica-
tion effectually executed at a small cost.
Sale of Food and Drugs Act. - Much good has been done by the administration
of the Act under the Chief Constable of the County.
Slaughter-Houses. - Since the Registration of these under the Bye-Laws in
connection with them, a considerable improvement has been effected, as many of the
occupiers saw that the only way to escape total demolition of the buildings was to
keep them so as to prevent complaints being lodged. Visits have been made from
time to time with a view to ascertain whether meat of diseased animals was sold, but
no evidence of this has been discovered.
Dairies have undergone a very great improvement, and it is now the exception
to find one which does not fairly well fulfil the conditions set forth in the Regulations.
The population of the County of Perth, according to the Census of 1891, was
122,109. Of these, only 69,700 (34,216 Males, and 35,484 Females) are within the
landward part of the County, to which this Report particularly refers. The landward
population, estimated to the middle of 1893, was 68,950. During 1893, there were 1,655
Births, and 1,333 Deaths (564 Males, and 269 Females), giving a Birth-Rate of 24.14,
and a Death-Rate of 16.43, per 1000, against a Birth-Rate of 21.52, and a Death-Rate
of 15.76 in 1892. The natural increase of the population during 1893 was 532, against
400 in 1892. There were 569 Deaths in persons over 60 years of age, or 52.2 per cent.
of the total, against 544 in 1892. Deaths under 1 year were 140, of which 56 were due
to Developmental causes, giving an Infant Mortality of 84.08 per 1000 Births, against
87.8 in 1892.
The distribution of diseases can still only be gathered from Death returns in three
out of the five Districts, so that it is only in the Central and Western Districts that
anything like complete information regarding the distribution of sickness can be given.
Respiratory Diseases caused 167 Deaths, or 14.7 per cent. of the total, against 169
in 1892. Of the 167 Deaths, 73 were in persons over 60 years of age, and 51 in those
under 5 years. The following table shows percentage of Death and Sickness due to
Respiratory Diseases throughout the County during the year:-
Percentage of Death.
PERTH DISTRICT, -- 15.1
CENTRAL DISTRICT, -- 15.1
HIGHLAND DISTRICT, -- 9.1
WESTERN DISTRICT, -- 18.0
EASTERN DISTRICT, -- 15.8
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 26.4
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 22.2
EASTERN DISTRICT, -- No Returns.
[Note] 132
[Page] 7
Circulatory Diseases caused 122 Deaths or 10.7 per cent of the total, against 137
in 1892. Of the 122 Deaths, 92 were in persons over 60 years of age. The distribution
of Circulatory Diseases throughout the County is shewn in the following table:-
Percentage of Deaths.
PERTH DISTRICT, -- 9.9
CENTRAL DISTRICT, -- 16.3
HIGHLAND DISTRICT, -- 6.0
WESTERN DISTRICT, -- 19.0
EASTERN DISTRICT, -- 10.7
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 6.4
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 6.6
EASTERN DISTRICT, -- No Returns.
Tubercular Diseases caused 127 Deaths or 11.2 per cent. of the total, against 137
in 1892. Although there is a reduction in the number of Deaths caused by these
Diseases as a whole as compared with last year, still for a preventable class of Disease
like this the Sickness and Deaths attributed to it are excessive, and 84 of these Deaths
were due to Phthisis, against 85 in 1892. The following table shows the distribution
of Tubercular Diseases throughout the County during the year:-
Percentage of Deaths.
PERTH DISTRICT, -- 19.9
CENTRAL DISTRICT, -- 11.9
HIGHLAND DISTRICT, -- 8.1
WESTERN DISTRICT, -- 15.7
EASTERN DISTRICT, -- 11.8
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 3.0
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 2.8
EASTERN DISTRICT, -- No Returns.
Nervous Diseases caused 100 Deaths or 8.8 per cent. of the total, against 82 in
1892. In 63 of these Deaths the age at death was over 60 years, the following table
shews the distribution of these Diseases throughout the County during the year:-
Percentage of Deaths.
PERTH DISTRICT, -- 9.3
CENTRAL DISTRICT, -- 11.9
HIGHLAND DISTRICT, -- 8.6
WESTERN DISTRICT, -- 4.8
EASTERN DISTRICT, -- 7.3
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 8.3
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 9.3
EASTERN DISTRICT, -- No Returns.
Digestive Diseases caused 70 deaths, or 6.1 per cent. of the total, against 50 in
1892. The sickness returns from the Central and Western Districts show that a
very large proportion of the total sickness is attributable to this class of diseases.
The distribution of Digestive Diseases throughout the County is shown in the
following table:-
Percentage of Deaths.
PERTH DISTRICT, -- 5.5
CENTRAL DISTRICT, -- 7.1
HIGHLAND DISTRICT, -- 5.5
WESTERN DISTRICT, -- 5.4
EASTERN DISTRICT, -- 7.3
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 22.7
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 30.5
EASTERN DISTRICT, -- No Returns.
Cancer and Malignant Diseases caused 49 deaths, or 4.3 per cent. of the total,
against 42 in 1892. The distribution of these diseases throughout the County was
as follows:- Perth District 16, Central District 13, Highland District 9, Western
District 4, Eastern District 7.
[Note] 133 |
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[Page] 8
Violence caused 43 deaths, against 33 in 1892, these were distributed throughout
the County as follows:- Perth District 14, Central District 5, Highland District 6,
Western District 14, and Eastern District 4.
Developmental Diseases caused 56 Deaths, of which 33 were due to Premature
Birth, against 59 in 1892.
Old Age caused 197 death or 17.3 per cent. of the total, against 169 in 1892.
Zymotic Diseases caused 65 deaths, against 53 in 1892. In all, 593 cases of
Infectious Disease were reported during the year, against 303 in 1892. Of these 95 or
16.0 per cent. were removed to hospital, the mortality amongst those removed being
5 or 5.4 per cent., and 498 were treated at home, amongst whom the mortality was
60, or 12 per cent. of the total cases treated at home.
Smallpox occurred on four separate occasions in the Western District, three
centres of infection occurring in Glenfalloch, and one at Frenich; in all of these the
disease was successfully stamped out before it had got any very great hold, and was
entirely confined to the localities in which it first showed itself. This was chiefly
owing to the free hand allowed to the Medical Officer by the District Committee,
and the ready assistance rendered by the Contractors, Messrs. Lucas & Aird, and
Messrs. John Waddell & Sons. By the prompt action which was thus made possible,
not only the inhabitants in the vicinity of the outbreak, but, indeed, the whole country
was protected. Such action was imperative amongst the class of men attacked
by the disease, or the country would have been overrun by those who had
been exposed to infection, and who might have wandered far before the
disease developed itself. The expense fell very heavily on the particular District
involved, but it nobly met the call, and it has now the satisfaction of knowing
that its prompt action not only saved Perthshire, but probably a large part of
Scotland from the most dreaded disease (popularly) of modern times. A full account
of the Smallpox outbreak will be found under the Western District Report.
Typhus Fever occurred in the Central and Highland Districts during the past
year - there were in all 9 cases. The disease commenced amongst the tinkers, and,
unfortunately, two nurses were infected, and one lost her life. The 7 tinkers,
however, as usual, all pulled through. Full particulars of these outbreaks will be
found in the Reports for the Central and Highland Districts.
Scarlet Fever has been exceedingly prevalent during the year in all of the five
Districts, but especially in the Central. In all, there were 230 cases reported, against
137 in 1892. There were 7 deaths due to Scarlet Fever, against 5 in 1892. The type
of the disease was, as a general rule, exceedingly mild - in fact, so mild that in
many of the outbreaks it was not recognised till it had been spreading amongst the
children for some time, and even when the disease was known to be in a particular
locality, it was impossible to certainly diagnose some of the cases as no rash appeared,
and there was no desquamation - in fact, nothing to be observed but a slight sore
throat; still there was the occasional cropping up of cases of undoubted Scarlet
Fever, which could have no other source than the doubtful ones, and were thereby
proved to be of a scarlatinal nature, and not ordinary sore throats. Full
details of some of the more serious outbreaks of the disease will be found under the
District Reports.
Diphtheria caused 18 deaths, against 15 in 1892. There were 54 cases of the
disease reported during the year. The places in which the most serious outbreaks
occurred were Scone and Bridgeton in the Perth District, and Killin in the Western.
Fuller details of these outbreaks (which are an infallible sign that the sanitary
condition of the localities in which they occur is defective) will be found in the
Reports for the Districts in which they occurred.
[Note] 134
[Note] 135 |
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| HH62/45/137 |
DIAGRAM
showing the prevalence of
SMALLPOX, DIPHTHERIA, SCARLET FEVER, TYPHUS FEVER and ENTERIC FEVER
DURING 1893.
[Graph inserted]
[Note] 136
[Page] 10
Enteric Fever caused 4 deaths, against 7 in 1892. There were 54 cases of
the disease reported, against 26 in 1892. The chief groups of these cases occurred in
the Perth and Eastern Districts, and are full referred to in the District Reports.
It is unnecessary to say more in this place than, that in so far as the cases at
Bankfoot, in the Perth District, are concerned, the cause of the disease is,
undoubtedly, the want of a proper system of drainage, which leads to the
accumulation of slop-water around the dwelling houses, as well as the pollution of
the water supply, which is entirely derived from surface wells.
TABLE showing the prevalence of certain Zymotic Diseases in the several Districts
during the different Months of 1893.
[Table inserted]
[Note] 137 |
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[Page] 11
Measles caused 7 deaths, against 2 in 1892. Oubreaks of the disease occurred in
various parts of the County during the year. The type of the disease was mild in
most instances, but one outbreak in the Comrie District assumed a very severe and
almost malignant type. In all, 214 cases of the disease were reported, the most
extensive outbreak being in the Muthill neighbourhood. An attempt was made in
one instance to endeavour to prevent the spread of the disease by the prompt
removal of the first case, but it proved unavailing, as the infection had spread widely,
even before the disease was recognised and the patient removed - in fact, infection is
most intense during the first day or two, when the patient seems only to be suffering
from a cold in the head.
Diarrhœa caused 20 deaths, against 6 in 1892. In no instance did the disease
assume a choleraic type.
In 85 cases the cause of death was either uncertified of insufficiently stated.
This list is steadily becoming smaller, as it included 92 cases in 1892.
The arrangement made by the Committees of the Perth, Central, Highland,
and Eastern Districts with the Directors of the Perth Royal Infirmary to provide
accommodation for fever cases, requiring removal, has been found to work very well,
and the facilities afforded by the various Railway Companies to carry the ambulance
waggon, with patients and nurse inside, has been fully taken advantage of, and has
been found to minimise the shaking, and shorten the journey very materially, as well
as to cost less than removal by road. In all, from the four Districts, 78 patients
have been admitted to the Perth Hospital during the year. The Directors of the
Royal Infirmary have spared neither trouble nor expense on fully equipping the Institu-
tion for the work. The laundry and disinfector have been found to give the most
complete satisfaction, and, in addition to the beds already put at the disposal of the
Districts for infectious cases, it has been found possible to add three more for
observation, a very necessary adjunct to the equipment of an institution which admits
all diseases except Smallpox, and even the latter has to be taken in and kept till the
diagnosis is certain.
With the exception of the Highland District Committee, all the Districts have
now made provision for the isolation and treatment of Smallpox cases by means of
iron hospitals, which are kept ready for erection in the event of being required. In
the Western District two of these hospitals (each capable of treating four patients)
has been obtained with a view to treat not only Smallpox, but other infectious
diseases. These have been in use during the year, with most satisfactory results.
The removal of patients, even from a considerable distance, has been accomplished
without any difficulty, and the patients have never suffered from the journey. As an
attendant accompanies the waggon as well as the nurse, there is no need for the
latter to come out of the ambulance to give directions, and thus the risk of infection
to the public is prevented. Two incidents will show the light in which the portable
hospital and the ambulance are now looked upon in the parts where they have been
used. In one District an application was made to obtain the use of a hospital in
which Smallpox had actually been treated, as summer quarters for a family; in
another District, as the ambulance waggon was starting on its journey, a much-
esteemed clergyman stopped it for a few minutes while he offered prayer and
gave thanks that such assistance had been provided. The Infectious Disease
(Notification) Act will be in force throughout the whole landward part of the County
on the 1st of March, and the Medical Officer should then know of all the recognised
cases of infectious disease throughout the County. However, the difficulty in the
past has not been so much with the recognised as with the unrecognised cases, and
[Note] 138
[Page] 12
unless those District Committees who have at present no assistant Medical Officers
make some provision by which country people can obtain medical advice for the
purpose of deciding whether a malady is notifiable or not, there will be difficulty in
obtaining a conviction for failure to notify on the part of a householder. In so
far as medical men are concerned, they have no excuse for failure to notify,
as, in my capacity of District Medical Officer, I am always willing to meet
them in consultation over doubtful cases, and share the responsibility with them.
There can be no blame attached to a man who has not seen much infectious disease
for some years who does not recognise such a disease as Typhus Fever, but he
ought to recognise that he has got a malady out of the ordinary run to deal with,
and ought not to classify it in that limbo of all doubtful cases - Influenza. There
seems, moreover, to be some strange dread of notifying a case which is doubtful.
This is a mistake. It is surely better to notify several doubtful cases, and have the
necessary provision made against infection, than to allow one infectious case to pass,
and so endanger the public. So long as notifications are bona fide, if a medical man
certifies a disease as any of those scheduled under the Act, and proper precautions
are adopted, no question as to the correctness of his diagnosis will be raised. Schools
have been found again and again to be centres of infectious disease. A child is ill
for a day or two, and returns to school saying it has had a cold; in two or three
weeks there is an outbreak of Scarlet Fever, and this child is found to be
desquamating. Again, how quickly what is regarded only as a slight sore throat
may spread the fatal infection of Diphtheria. It ought to be a matter of serious
consideration with School Booards whether they should not pass a law forbidding
children to return to school after any illness, however slight, without a medical
certificate that there is no infection - the cost of such certificate to be borne by the
Local Authority. It would be well-spent money, as many epidemics of infectious
disease would be prevented, and school attendance would be very slightly interfered
with. It would also ensure a medical man seeing every case of illness amongst those
who are most liable to be attacked by infectious disease.
The Registrars of the 82 Registration Districts in the County, have again
during the past year supplied monthly Returns of Births and Deaths, and deserve the
thanks of the community for so courteously supplying data, without which it would
be impossible to produce the Vital Statistics required by the Board of Supervision,
and which are invaluable for guaging the health of the community.
JOHN T. GRAHAM M.D.
March, 1894.
[Note] 139 |
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[Note] 140
Perth District.
1. During the year 1893 there has been a great advance made in sanitary
matters in the Perth District. Not only has a large amount of work been satisfactorily
accomplished, such as the appointment of scavengers in all the large villages, the
formation of the Carse of Gowrie and Almondbank Special Water Supply Districts,
and the works for purifying the sewage of Scone, but the beginnings of several
matters, of the utmost importance to the sanitary well-being of the District, have
been under the consideration of the Local Authority. It is to be hoped that it will
be our pleasant duty to report, in 1891, that these have been satisfactorily carried out;
amongst them may be mentioned the proposed Drainage of Stanley and Bankfoot.
The Sanitary Condition of the entire District has undergone a very marked
improvement, but this is specially observable in the larger villages, in which, during
the latter part of the year, scavengers have been appointed by the District Committee.
These appointments were made in spite of considerable opposition, not only from
the ratepayers of the rural districts, who considered that they would derive no benefit
from the proposed expenditure, but also from the villagers themselves, who did not
approve of the old convenient excuse (that the farmer had not come, as he promised,
to empty the contents of the midden) being taken from them, and a man permanently
appointed, who would, on receiving a hint from the local Inspector, make very short
work of the removal of offensive heaps. Already very satisfactory progress has
been made, and most of the middens considered dangerous to health have been cleared
out, and either entirely abolished or new places substituted for them at a safe distance
from the houses. Where this was found impossible the daily removal of domestic
refuse has been undertaken. The appointment of scavengers was hastened by an
outbreak of diphtheria in Scone, of rather a serious nature, which showed the inhabitants
that the sanitary condition of the village was not in the high perfection they imagined;
and, as the disease spread to the surrounding district, nothing more was said
against the [s]cheme, the country people being convinced that it would be for
their own interest rather to pay the small sum necessary to defray the expense of a
scavenger than to incur the presence of such a deadly malady.
The much-vexed question of the Water Supply for a part of the Carse of
Gowrie has been frequently discussed by the District Committee, who have
now resolved to form a large portion of the Parish of Errol into a Special
Water Supply District which will embrace all the farms destitute of a
supply of pure water. This will prove a great benefit to those included in
the District. The proposed source of the above Water Supply is a stream
flowing down the south side of the Sidlaws, nearly opposite the Special District,
which has a gathering ground almost entirely free from cultivation. The supply of
water is ample, and the quality excellent, while the formation of the glen through which
the stream flows is particularly adapted for constructing a large storage reservoir at small
cost. During the interval which elapsed between the first mention of the proposed
Water Supply for the Carse and the formation of the Special Water District, two
attempts were made, by proprietors concerned, to obtain sufficient water. In one case
the result was a failure, but in the other, an ample supply of water was obtained by
[Note] 141 |
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[Page] 15
boring down into the Old Red Sandstone; this water will, however, require to
be pumped to make it available, and, although of excellent quality, it is a very hard
water, and not well suited for washing purposes.
The village of Bankfoot has, during the past year, suffered from occasional
outbreaks of Enteric Fever. The cases have shown a remarkable malignancy, and as
nothing has been done towards forming the village into a Special Drainage
District, as requisitioned for last year, it is to be hoped that the inhabitants may now
see that the small increased rates, which would be the result of such a scheme, would
be a mere trifle when compared with sickness and death. The proper drainage of
Bankfoot would, from an engineering point of view, be a comparatively easy matter,
and ample provision could be made for its systematic flushing. As regards Water
Supply, Bankfoot is at present amply provided from wells, the majority of which are
liable to pollution; this risk would be minimised were a proper system of Drainage intro-
duced. Moreover, a Water Supply by gravitation might easily be obtained, if thought
desirable. The Water Supply may be a matter of choice, but the introduction of a
proper system of drainage is an absolute necessity, if the village is to cease to produce
its annual crop of fever cases.
Stanley has had a considerable share of the attention of the District Committee
bestowed on it, in consequence of the County Finance Committee calling upon the
former to enquire and report as to what could be done to prevent the pollution of the
River Tay by the sewage of the village. The first difficulty encountered was, that
although there was an extensive pollution of the river going on, Stanley was found to
possess no proper system of drainage, two small ditches which flow through the
village having been gradually converted into little else than common sewers. These
ditches are partly open and partly covered, and constitute an element of considerable
danger to the health of the village, especially since the introduction of the gravitation
water supply, and the consequent temptation to erect water-closets. A report was
sent in by the Medical Officer recommending that settling-tanks should be erected
near the point at which the sewage of Stanley enters the river, and that, after
settling, the partially purified effluent should be used for irrigating some ground well
suited for the purpose. The District Committee decided, on consideration, not
to proceed with the purification works, as it was assumed that Stanley would soon
require a proper system of drainage, and, as this would not discharge at the same
point as the present ditches did, any works erected here would be practically useless
for the new drainage. This is partly true, but there is a small portion of the village
which cannot be otherwise drained than to the present outfall, and the works would
not have been completely useless even in the event of the village having its main
sewage outfall carried to a different point. As the matter at present stands there is
no purification of the sewage before its discharge into the river, nor has anything been
done by the inhabitants to form the place into a Special Drainage District. Both
measures are very necessary.
In connection with the sewage of New Scone, a report was sent in by the
Medical Officer recommending that a duplicate system of settling-tanks and filters
should be constructed, as the best means of purifying the effluent sewage before its
discharge into the stream. This was reported on by Mr. Ritchie, C.E., and the
necessary works have been authorised by the District Committee. As was
remarked in the Annual Report for 1892, the Scone Drainage System requires
to be extensively remodelled. There are many houses in the village not connected
with the main drain at all, whilst others have been in the past connected with
this drain by branch drains not laid down by the Special Drainage Committee,
[Note] 142
[Page] 16
and the workmanship of these has been proved to be of a very inferior kind, by the
frequent chokages which have taken place. The Special Drainage Committee
should lay down main drains in all the thoroughfares of the village, and the Local
Authority could then insist upon the house drains being connected with these, instead
of discharging, as occurred last year in at least one instance, on to the surface of the
public road. The wells on which Scone entirely depends for its water supply have
been found to be in a condition far from safe, and the sooner the inhabitants send a
requisition to the District Committee to have their village formed into a Special
Water Supply District the better. There are several available sources from which
good supplies of water could be obtained without any extraordinary expense, so that
there should be no hesitation in discontinuing the old surface wells, seeing that Scone
is likely to become quite a favourite residence on account of its very healthy situation,
and the increased facilities of communication which will be afforded by the electric
tramway now being projected.
2. During the year general enquiries have been made as to the sanitary condition
of the District, and much special work has been necessitated in consequence of out-
breaks of infectious disease, in connection with which valuable assistance has
been received from the local Sanitary Inspectors, some of whom have shown a zeal
and tact which cannot be too highly spoken of. Special enquiries were made in
connection with the necessity for the formation of Special Water Districts, sewage
purification under the Rivers Pollution Prevention Act, &c.
3. Reports were sent in to the District Committee dealing with the purification
of the sewage discharged by the villages of of Scone and Stanley. On the outbreak of
Smallpox at Crianlarich in the early part of the year, a small portable hospital was
secured, which was stored at the Royal Infirmary, ready for immediate use should
a case of the disease occur. From four to six patients can be treated in the hospital
at one time.
No certificates have been required in the Perth District, as it has invariably
been found that proprietors have been only too glad to remedy defects in
connection with their houses, on those being pointed out.
No action has been required in connection with offensive trades, or the sanitary
condition of Factories and Workshops, during the year.
4. Of Retail Bakehouses, fifteen are in operation in the district. These have been
inspected and found to be in a very satisfactory condition; the owners of some of
them deserve praise for the good order in which they keep buildings which are old
and consequently require more labour bestowed on them to ensure cleanliness.
5. The Perth Royal Infirmary being still the Hospital used by the Perth
District for the treatment of persons suffering from Infectious Diseases, the Medical
Officer is still enabled by his position on the Staff of that Institution, to supervise the
treatment and isolation of patients admitted. In both respects he is satisfied, and,
what is of more importance, so are all the patients who have been under treatment
during the year. The Directors of Perth Royal Infirmary have, in accordance with
their agreement with the Local Authorities, expended a large sum in fully equipping
the Institution for the increased work; the Laundry and Disinfector have now been
in full operation for some months, and are giving entire satisfaction. In the event
of Smallpox breaking out, the portable Hospital, which is stored in Perth, would be
immediately erected in the vicinity of the outbreak, and the supervision of the treat-
ment of any cases admitted to it would be entirely under the Medical Officer, a local
Medical man being engaged to attend upon the patient. Twenty-eight cases of
Infectious Disease have been admitted from the District to the Perth Royal
[Note] 143 |
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[Page] 17
Infirmary during the year, and all have been discharged cured. The prejudice
against removal which at first very much hampered the proper administration of the
Public Health Act is rapidly breaking down.
6. During the year two very important measures have been adopted by the
District Committee, viz:- the appointment of village scavengers and the adoption
of the Infectious Diseases (Notification) Act. The former, by removing the offensive
collections around houses in the more populous localities, will greatly improve the
health of the District, and the latter will enable such precautions to be taken in
connection with the first case of Infectious Disease as, it is to be hoped, will effectually
prevent the spread of the malady. Reference to the Table of the Sanitary Inspector
will show how much has been done to remove those conditions of dwellings which are
likely to foster disease. When a case of Infectious Disease has occurred all the
usual precautions have been taken, and the patient either removed to Hospital, or so
isolated at home as to ensure the safety of the public. For this reason a nurse, in
one instance, was provided where, in one house, there were several cases of Diphtheria
too ill to be removed.
The population of the Perth District, estimated to the middle of 1893, was
21,274. During the year there were 574 Births and 343 Deaths, giving a Birth-
Rate of 26.98, and a Death-Rate of 16.12, against a Birth-Rate of 23.13, and a Death-
Rate of 14.81, in 1892. The natural increase of the population of the District during
the year was 231, against 178 in 1892. The Registrar General's Report on the
Census of 1891 shows that the population of the Perth district at that time was
21,557, of whom 10,420 were males and 11,137 females. The Mortality Returns for
1893 show that 174 deaths occurred amongst males, and 169 amongst females.
Deaths in persons over 60 years of age were 160, or 46.6 per cent. of the total,
and under one year there were 45 Deaths, of which 17 were caused by Developmental
Diseases, giving an Infant Mortality of 78.39, against 94.94 in 1892. The Zymotic
Deaths were 26 during 1893, giving a Zymotic Death-Rate of 1.22, against .420 in
1892.
Respiratory Diseases caused 52 Deaths, compared with 57 in 1892. Of the
52, eleven occurred in children under one year, whilst 21 were in persons over 60 years
of age; the percentage of Deaths from these diseases was15.1 of the total.
Tubercular Diseases caused 34 Deaths (of which 24 were due to Phthisis),
forming 9.9 per cent. of the total. The number of deaths was the same in 1892, still
showing that many Deaths are due to these diseases.
Nervous Diseases caused 32 Deaths in 1893, against 24 in 1892. Of the 32
Deaths 19 were in persons over 60 years of age.
Circulatory Diseases caused 34 Deaths in 1893, against 42 in 1892. Of these 34
Deaths, 24 were in persons over 60 years of age.
Digestive Diseases caused 19 Deaths in 1893, against 18 in 1892.
Cancer and Malignant Diseases caused 16 Deaths in 1893, against 13 in 1892.
Old Age was given as the cause of 64 Deaths, or 18.6 per cent. of the total.
Violence caused 14 Deaths in 1893, against 10 in 1892.
Zymotic Diseases. -
Diphtheria caused 12 Deaths in 1893, against 4 in 1892. In all, 28 cases of the
disease were reported during the year, thus giving a case mortality of 42.8 per cent.
Only one patient was removed to Hospital. Of these cases one group of 15 occurred
in New Scone, or amongst the children attending the Public School there. As a
consequence the School had to be closed and thoroughly cleaned, and the surroundings
thereof improved, and finally the whole drainage was remodelled. There seemed to
[Note] 144
[Page] 18
be no doubt that, here, the School was the centre of infection, and the resulting six
Deaths went to prove that in Diphtheria we have a most infectious and deadly
disease. The people of Scone should be warned from the events of the past year
and take measures to put their pretty village into a better sanitary condition, or they
will certainly be brought to their senses by some other such dire visitation.
Another group of six cases occurred in Redgorton Park, and was due to the
fact that a boy suffering from the disease was not suspected of having anything so
deadly the matter with him, until five other persons were infected, with the result
that two of the patients died. In another case the cause of the disease was
attributed to the child playing in a field on which town manure was being spread at
the time; another child here was infected and died. The other five cases occurred
singly in various parts of the District, and were mostly accounted for by insanitary
conditions of the houses, although in one case there was a strong suspicion that the
disease had been carried from a distance.
Scarlet Fever caused one death, the same as in 1892. In all, 43 cases of this
disease were reported, and of these 14 were removed to hospital, and all made good
recoveries; the only death which occurred was in New Scone, in a child treated at
home. In many of the cases the source of infection was traced to Perth, where the
patients were either attending school or employed in business. By taking strict
precautions as to isolation, it was found easy to prevent any serious spread of the
disease, although, in one instance, a fresh centre of infection was started just as it
was considered that the disease had been stamped out, by the carelessness of an
inexperienced medical man, who allowed a convalescent to return to school too early.
Most of the cases were of a very mild type, in fact the mildness of the disease
rendered the work of checking it more difficult, as in some of the cases it was almost
impossible to recognize the nature of the disease.
Enteric Fever caused two deaths. In one of these the nature of the disease was
very doubtful, but the sanitary condition of the premises was such as to make it very
probable that the disease was Enteric Fever. One case was imported from Broughty
Ferry, to which health resort the family had removed when the sanitary arrangements
of their house were being put right. In all, 17 cases of the disease were reported
during the year, 10 of these were credited to Bankfoot. Nearly all of the latter ran
a very protracted course, and showed a malignancy which clearly pointed to the
patients having been in a lowered state of health, caused by faulty hygienic
surroundings, previous to their receiving the specific poison. Everything possible
has been done in Bankfoot, as it is at present situated, to prevent a recurrence of the
disease, but it is hopeless to expect any marked diminution of such diseases until
a proper system of drainage is introduced. Six patients suffering from Enteric
Fever were removed to hospital, and all recovered.
Measles was prevalent in various parts of the District, and caused three deaths,
one at Errol, and two at Tibbermore. Two patients with Measles were taken to
Hospital, the first as an attempt to stamp out the disease by prompt removal, but, as
was anticipated, it had not the slightest effect, and every susceptible child who had been
in contact with the patient took the disease. The second case occurred in a common
lodging-house, and was removed in consequence. In nearly all of the cases the disease
assumed a mild type.
Whooping Cough was also prevalent, but only caused one death; the disease was
of a mild type.
Diarrhœa caused seven deaths. In five, the age at death was under one year.
Three of these infant deaths occurred in Errol, again pointing to the more densely
populated centres as the weak parts of the District's sanitary armour.
[Note] 145 |
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[Note] 146
Central District.
There has been a steady improvement in the sanitary condition of the Central
District during the year 1893. The villages continue to derive much benefit from the
labours of the scavengers, although it will require some years for the soil formerly polluted
by the organic filth of years to return to its natural condition, and for the improvement
to make itself evident in a permanently lowered Death-Rate. The Death-Rate for 1893
was 17.81, against 17.47 in 1892, but the mortality under one year was 42, giving a
rate of 125.748 to the 1000 Births, against 71.20 in 1892. During the past year the
excessive drought caused great want of water in several parts of the District, but, in
one instance at least, there was evidence that the water was largely used for watering
gardens instead of being properly utilised. Several Slaughter-Houses were inspected,
a consequence of complaints being received that they were annoying the people in their
vicinity by the condition in which they were kept. In most instances the complaints
were not without reason; the Slaughter-Houses were badly kept, and the inevitable
piggery attached, in which the animals fed on offal, made the nuisance worse than it
otherwise would have been. Considerable improvement has been effected in connection
with them, but it will require the strict application of the Bye-Laws recently passed
to effectually remedy the matter.
Auchterarder still halts between the alternatives of being made eother a Burgh
or a Special Water and Drainage District, and even yet there is evidence that it will
only be under compulsion that anything will be done. As the matter at present stands,
one section of the inhabitants have requisitioned the Sheriff to have the place declared a
Burgh, whilst another section have requisitioned the Central District Committee to have
it made into a Special Water and Drainage District, and, finally, an appeal has been
lodged with the County Council against the resolution of the District Committee. As
the latter party have, however, omitted to lodge an appeal with the Sheriff within the
statutory 10 days, it is questionable if it is now competent.
Nothing has been done as yet in connection with the prevention of the pollution of
Loch Earn, by the direct discharge of the sewage of St. Fillans into it. This matter
should have early attention.
The village of Comrie shows a high Death-Rate for such a healthily-situated village,
possessing an abundant and pure water supply. In 1891 the Rate was 31.1, in 1892
18.4, in 1893 23.3 per thousand. The inhabitants should, without delay, requisition
the District Committee to form Comrie into a Special Drainage District, as, at present,
the drainage is certainly unsatisfactory, both as regards the village itself, and the
pollution of the River Earn. With increased facilities of access by rail it is to be
presumed that Comrie will become a popular resort, and it would be well that it could
show a better sanitary record.
In Braco there is a covered drain which extends about two-thirds of the length of
the main street, and, beyond this, a surface gutter, regarding the unhealthy condition of
which there have been frequent complaints, as it is used for the reception of slop water by
the people residing near, and certainly in warm weather there is good cause for com-
plaint. It would not be a serious matter to extend the drain to the top of the village,
and it is a matter which should not be allowed to stand over.
[Note] 147 |
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2. During the year many general inspections have been made of various parts of
the District, and a number of special visits have been necessitated in consequence of
complaints as to matters alleged to be injurious to health. Enquiries into the
causes and means of isolating cases of Infectious Disease have entailed a great amount
of anxiety and supervision. In one instance it was the unpleasant duty of the Medical
Officer to express dissatisfaction with the action of those in power in Crieff, as they
deposited a tramp from the police cells, suspected of having Smallpox, in a disused
hut in Monzievaird. This hut was close beside a much-frequented thoroughfare,
and the only person left in charge of the case was a woman of the same class
as himself. Considering the situation of the hut, and the supervision of the case,
it was no wonder that the residents of the neighbourhood felt a good deal of
alarm. On examining the man, it was found he was not suffering from Smallpox;
and the Burgh Authorities were informed that, whilst willing to assist them in every
way in a difficulty of the kind, the removal of cases of infectious disease to this hut
would be opposed in future, on account of its dangerous situation. Measles and Scarlet
Fever have been unusually prevalent, and have demanded much attention from the
Medical and Sanitary Staff during the year.
3. Advice was given and examination made of various houses considered to be in
an insanitary condition; most of the defects found were remedied through the good
sense of the proprietors, but in one instance a certificate under Section 16 of the Public
Health Act was required, and the premises were only made right by order of the
Sheriff. In a case of Scarlet Fever, in Auchterarder, it was found necessary in order to
effect proper isolation to apply to the Sheriff for a warrant to remove from the room
occupied by the patient all the rest of the family except the mother, who was nursing
him. The warrant had the desired effect, and no further difficulty was encountered
in connection with this case, or any others, in securing the isolation considered essential
either by removal to Hospital or at home. No action was demanded in connection with
the sanitary condition of Factories and Workshops, as no complaints were received
during the year.
4. Retail Bakehouses. - There are seventeen of these in operation in the land-
ward portion of the Central District; these were visited and examined during the year,
and were found to be kept in good order. One in Comrie has been transferred to new
premises, which, having been specially built for the purpose, are excellent.
5. During the past year the arrangement made with the Perth Royal Infirmary to
receive cases of Infectious Disease requiring removal has been taken full advantage of;
in all, 25 patients were removed, and all, with one exception, recovered. The fatal case
was that of a young man who, whilst suffering from chronic disease of the kidneys, was
unfortunate enough to contract enteric fever. The agreement of the Railway Companies
to carry the Ambulance loaded has been taken advantage of, and found in practice to
be very satisfactory, as not only are the removals more quickly effected, but the motion
is so easy that the patients are more comfortable in the Waggon, with a Nurse in
attendance, than they were at home. The Smallpox Hospital has happily not been
required to be taken from the store shed in the engine yard at Crieff, where, through
the courtesy of the Road Board, it is kept ready for use at any moment. Should
this hospital be required, the supervision of its management would be entirely in the
hands of the Medical Officer, one of the assistant Medical Officers being specially
appointed to take charge of the patients.
6. The whole energies of the assistant Medical and Sanitary Staff have been
directed to discover cases of Infectious Disease, and in a very satisfactory manner have
they done their work in preventing anything like a serious epidemic. The work was
[Note] 148
[Page] 22
rendered exceptionally difficult in one part of the District from the parents discovering
some weak points in the Public Health Act, and being thus enabled to evade removal of
patients until the Sheriff granted a Warrant, which showed that, removed or not removed,
patients must be isolated. In addition to the assistant Staff, in 1894 the Infectious
Disease (Notification) Act is to come into operation in the Central District, which will
make the means of ascertaining the existence of cases even more complete.
7. The population of the Central District was 14,441 according to the Census of
1891, consisting of 6868 males and 7573 females, and, estimated to the middle of 1893,
it was 14,092. In 1893 there were 334 Births and 251 Deaths, giving a Birth-Rate of
23.70 and a Death-Rate of 17.81, as compared with a Birth-Rate of 22.6, and a Death-
Rate of 17.47 in 1892. The natural increase of the population in 1893 was 83, against
74 in 1892. Of those who died in 1893, 128 were males and 123 females. Deaths in
persons over 60 years of age were 122, or 48.6 of the total. Deaths in children under
one year were 42, of which 14 were due to Developmental causes, giving an Infantile
Mortality of 125.7 per 1000 Births, against 71.2 in 1892. This is an excessive mortality
for such a District as the Central, and, as six of these Deaths were caused by diarrhœa,
it shows that there is yet great room for improvement.
Respiratory Diseases caused 38 Deaths, or 15.1 of the total in 1893, against 41 in
1892. In 19 of these 38 Deaths the age was above 60, and in 7 it was under 1 year.
From sickness returns supplied by the assistant Medical Officers, it was found that
26.4 per cent. of the total sickness during the year was caused by these diseases.
Circulatory Diseases caused 41 Deaths (of which 32 were in persons over 60 years
of age) in 1893, against 33 in 1892. This gives a percentage of 16.3 of the total as
due to this class of diseases, and the sickness returns show 6.4 per cent. of the total
sickness to be due to them.
Tubercular Diseases caused 39 Deaths (of which 17 were due to Phthisis) in 1893,
against 41 in 1892. This gives a per centage of 11.9 of the total Deaths, and it was
found that 3 per cent. of the total sickness of the District was due to this class of
diseases. Of the 30 Deaths, 12 are credited to Auchterarder, and 10 of these were
certified as due to Phthisis, abundantly proving that with all its boasted healthiness
that place is not what it should be.
Nervous Diseases caused 39 Deaths, in 21 of which the age at Death was over 60
years, giving a mortality of 11.9 per cent. of the total Deaths as due to this class of
diseases. The sickness returns show 8.3 per cent. of the total due to them.
Digestive Diseases caused 18 Deaths in 1893, as against 7 in 1892. This gives a
mortality of 7.1 per cent. of the total as due to this class of diseases, and the sickness
returns show 22.7 of the total sickness caused by them.
Rheumatic Diseases caused 1 Death and 5 per cent. of the total sickness during
1893.
Cancer and Malignant Diseases caused 13 Deaths in 1893, against 12 in 1892.
This gives a percentage of 5.1 of the total as due to this class of diseases, and
sickness returns show that .87 per cent. of the total was also due to them.
In the sickness returns 1.2 per cent. of the total was ascribed to Alcohol as a cause.
Developmental Diseases (of which 10 were due to Premature Birth) caused 14
Deaths, against 10 in 1892.
Old Age caused 19 Deaths in 1893, or 7.5 per cent. of the total, against 26 in 1892.
Zymotic Diseases -
Zymotic Diseases caused 16 Deaths in 1893, against 9 in 1892. The Zymotic
Death-Rate was 1.135, against .631 in 1892; but, considering the large number of cases
reported (277, exclusive of 7 of Diarrhœa), the case mortality of 3.2 was not excessive.
[Note] 149 |
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Typhus Fever. - A group of cases of this disease occurred amongst a tinker family
who were peeling bark in the neighbourhood of Crieff. Thanks to the prompt
recognition of the nature of the disease by the assistant Medical Officer, and the removal
of five of those affected to the Hospital, as well as thorough disinfection of the place, there
was no spread of the disease in the neighbourhood. The mother and an infant were the
only members of the family who were not ill at the time of the removal, and, on interrogat-
ing the former, she asserted that she certainly suffered from what a doctor who had
seen her called influenza, some time before the rest of the family took ill. She also was
positive that the baby had the same disease as she had, and declared that there had
been no other tinkers about their camp for some time previous to the illness. As events
turned out, it was discovered later that a girl had left the Crieff camp for the Highlands,
(at what date is uncertain), who had been admitted to Logierait Poorhouse, and was
being treated for Measles, on the 22nd of June - four days before the five cases were
admitted to the Perth Hospital. It was well for the Strathearn Poorhouse that they
had for their Medical Officer one who recognised the nature of the disease, as it was only
when application was made for parochial relief that he saw the cases. Eleven days later,
the baby who was stated to have already had the disease was found to be ill, and
was admitted to Hospital. All of these patients did well, although, in two of the cases,
it required all the tinker's tenacity of life to enable the crisis to be safely passed.
Scarlet Fever caused 2 Deaths, against 1 in 1892. In all, 94 cases were notified
during the year. The majority of the cases occurred in the Auchterarder district - 48
were from it. Cases also occurred at Muthill, Braco, Comrie, Gilmerton, and
Fowlis-Wester. In nearly all of these outbreaks, the origin of the infection was traced
to some slight unrecognised case, which had been overlooked; or to infection caught by
visiting large towns in the neighbourhood; or, in a few, from convalescent visitors.
The type of the disease being, on the whole, exceedingly mild, it was very difficult
to maintain isolation. However, when the heads of families became convinced that the
officials meant what they said, this difficulty was considerably lessened. In the country,
Scarlet Fever is rapidly becoming so mild that it is no easy matter, even for a medical
man, to diagnose it; and, if this be the case, heads of families can scarcely be blamed
for not "becoming aware of the nature of the disease." However, in the Central
District, where there is a full staff of assistant Medical Officers, who are ready to visit
any case for the purpose of diagnosis, and thus enlighten the ignorance of the parents, it
will not be held as an excuse for failing to report cases under the Infectious Disease
(Notification) Act, for the head of the house to plead ignorance of the existence of the
disease, seeing that the District Committee has provided means for removing that
ignorance free of expense.
Enteric Fever caused 1 Death - a young man who was previously suffering from
chronic kidney disease. In all, 9 cases were reported during the year, 2 of which were
removed to Hospital. The majority of these were more or less closely connected with
the cases which occurred in Auchterarder Parish in the end of last year, and received
the infection either directly, or through the agency of milk; for, although none was sold,
it was discovered that one person had taken milk, which was to be given to the pigs -
the result being that two members of her family were soon laid down with fever. The
continuance of severe frost delayed somewhat the remedy of the defects about the
premises which were the cause of the outbreak; but, as soon as suitable weather came;
everything was put into a satisfactory state. One of the other cases, a very severe one,
was removed into the District from Dundee during the second week of the disease.
However, by the precautions taken by the Medical Assistant and the care
of the mother, who acted as nurse, the patient recovered, and there was no spread of
the disease.
[Note] 150
[Page] 24
Diphtheria caused 2 Deaths in 1893, against 3 in 1892. In all, 6 cases were
reported, against 14 in 1892. Three of these occurred in the neighbourhood of
Dunning, and were doubtless connected with others which occurred there in the latter
part of 1892. The remainder were single cases in various parts of the District, and were
due to insanitary surroundings, although one was imported from Perth.
Measles caused 1 Death. There were 162 cases of the disease reported during the
year. A large number of these occurred in Muthill, where the assistant Medical Officer
had again and again successfully isolated cases of the disease imported, but at last the
infection spread, and almost every susceptible child took the malady. On the whole,
the disease was of a mild type, but at St. Fillans it was very severe, and it was in
connection with the outbreak there that the only fatal case occurred.
Whooping Cough caused 3 Deaths, the same number as in 1892.
Diarrhoea caused 7 Deaths. In 6 of these the age at death was under one year.
In the latter part of the year this disease was prevalent in the Muthill and Comrie
Districts. At St. Fillans the Water Supply was blamed for the disease, but enquiry
proved that this was not the case.
Influenza caused 6 Deaths or 2.3 per cent. of the total; and Sickness returns show
4.8 per cent. of the total Sickness due to this disease.
[Note] 151 |
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[Note] 152
Highland District.
The Highland District has steadily maintained its course of improvement in
sanitary matters during 1893. This is testified by a reduced Death-Rate, and a low
Infantile and Zymotic Mortality. Until close to the end of the year there was
a remarkable freedom from infectious disease in the District.
The Sanitary Condition of the District has been carefully attended to by the
assistant Sanitary Inspector, who has abundantly proved that it is the best plan to
employ one man for this work, and it is a great relief to the minds of those at
headquarters to know that orders will be carried out at once, and in a business-like
manner.
During the year the Pitlochry scavenger has been authorised to do private
scavenging when requested, and thus a felt want has been met.
A complaint was lodged regarding the alleged pollution of the Moulin Burn by
the discharge of sewage into it, but it was found on enquiry that the means adopted
to purify the sewage before its discharge were working most efficiently, and that any
pollution which existed was due to the emptying of all manner of refuse into the Burn
by those living in the vicinity. The remedy for this would be to have the Pitlochry
Drainage District extended to as to embrace the village of Moulin, when sewerage
and scavenging would be provided.
The question of preventing the pollution of the River Tay by the discharge into it
of crude sewage, was brought under the consideration of the District Committee
by a communication from the County Finance Committee, requesting a report on
what could be done to remedy the infringement of the Act, as noticed in the Medical
Officer's Annual Report for 1891, and specially directing attention to the pollution caused
by Aberfeldy and Dunkeld. With regard to Aberfeldy, as it is a Burgh, the District
committee could only call upon the Local Authority to take measures to purify the
sewage before discharging it into the River. At first a plea of prescription was
advanced, on the allegation that the drainage of the town was run into the Tay before
the Rivers Pollution Prevention Act was passed, and when it was found that this
plea would not save the erection of the best available method of purifying the effluent
before its discharge, a new plea was tendered, viz., that there was no pollution caused
by the discharge of the sewage, and that the River water was not used for domestic
purposes for a long distance below Aberfeldy. Both of these statements having
been disproved, the Burgh Authority finally agreed to take such steps as would
effectually remove the complaint, and is is fully expected that the necessary purifi-
cation works will be erected, and in operation, during 1894.
The pollution of the Tay by the sewage of Dunkeld was a matter within the
jurisdiction of the District Committee, and a Sub-Committee was appointed along
with the Sanitary Officers to examine and report on the best means of preventing it.
At first a plea was brought forward that there could be no pollution caused by the
drainage of Dunkeld, as there was nothing offensive put into the drains; however, this
was found not to be the case, and on examination it was seen that the works necessary for
purification could be easily carried out. A Report, and Specification for the same,
being lodged by Mr. Ritchie, C.E., Perth, objection was raised to the proposed works
[Note] 153 |
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on the ground that they would cause a nuisance and frighten visitors from the town;
consequently the matter has been delayed until it can be seen whether similar works
can be conducted without causing a nuisance. Of the possibility of this being
accomplished there is no doubt, and it is confidently anticipated that the works will
be completed during 1894.
One cemetery, about the condition of which a complaint was received, has been,
by orders of the District Committee, put into good order, and Bye-Laws have been
made to prevent a recurrence of the cause of complaint.
2. General inspections have been made to ascertain the Sanitary Condition of
various parts of the District, and a large number of special visits have been
necessitated in connection with insanitary premises, and the diagnosis or isolation of
infectious diseases.
3. Advice was frequently given in connection with nuisances or insanitary
conditions of dwelling-houses; these were all remedied, but in one instance the remedy
was only provided after a certificate had been granted with a view to prosecution.
In connection with the introduction of the Infectious Disease (Notification) Act,
a considerable amount of trouble was entailed, as it was found difficult to break the
old habit of keeping any disease of an infectious nature as secret as possible.
In several instances violation of section 49 of the Public Health Act occurred
by convalescent scarlet fever patients coming out too soon. It was, however, deemed
not advisable to prosecute any of them, as the offence was committed in ignorance,
but occasion was taken to inform the people generally of the penalties incurred, and
there is a distinct understanding that a prosecution will follow the next failure to
conform to instructions.
In one instance a serious difficulty threatened the administration of the Public
Health Act (in so far as the supervision of the isolation of notified cases of infectious
disease was concerned), the Medical attendant having taken upon himself
to order that no Sanitary Official was to be admitted to the house; the
assistant Inspector was in consequence refused admission when he called to see that
the case was properly isolated. On this state of matters being reported at head-
quarters, a Sheriff's Warrant to enter the premises was obtained, which had the
effect of immediately securing admission, and enabling the Department to be satisfied
that such precautions were taken as to secure the other members of the family, and
the public, from risk of infection.
No action has required to be taken in connection with Factories or Workshops
within the District, during the year.
4. Retail Bakehouses. - There are eight of these in operation in the Landward
Highland District. Visits have been made to these during the year, and they have
all, with one exception, been found in good order. One Bakehouse has been removed
to new premises, which are all that can be desired. The Rannoch Bakehouse is still
in a condition far from creditable either to the proprietor or occupier, and it would
be well to have it replaced by premises better suited for the purpose, as has
been done in Pitlochry and Dunkeld. Were this done the Highland District
Bakehouses would compare favourably with the same class of workshops in other
parts of the County.
5. During 1893 there were 11 cases of Infectious Disease admitted from the
Highland District to the Perth Hospital. In all of them, with the exception of one
of Typhus Fever, the result was most satisfactory, and the patients sent home well
and happy. The facilities for removal have been much increased by the Highland
Railway Company consenting to carry the ambulance, containing patients and nurse,
[Note] 154
[Page] 28
by ordinary trains, and still further by the courtesy of the officials in carrying the
waggon by trains which, as a rule, do not take on carriage trucks at wayside stations.
Whilst the patients are in Perth Hospital, the Medical Officer has ample
opportunities for supervising the treatment and isolation received, with both of which
he is fully satisfied.
6. To removing conditions injurious to the health of those resident within the
Highland District, the assistant Sanitary Inspector has devoted his whole time;
and from the tables appended to the Chief Sanitary Inspector's Report it will be seen
that, conjointly, they have accomplished a large amount of work, which is the chief
means at the disposal for the Local Authority for preventing the outbreak and spread
of Infectious Disease. In such a favourite health resort as the Highland District,
there is a constant risk of such disease being imported from the large towns by
convalescents, who are sent for change of air at too early a date; and there is another
class of visitors - viz., the tinkers - who have, on two occasions at least, during the past
year, been the medium by which disease has been carried into the District. In
no instance has there been any serious spread of infectious disease in the District.
In the early part of the year, in consequence of the occurrence of a number of
Smallpox cases on the Crianlarich section of the new West Highland Railway works,
it was feared that the malady might spread to that section of the works which passes
through the Highland District, and, in consequence, the propriety of securing a portable
Hospital was brought under the consideration of the District Committee. A Sub-
Committee was appointed to act along with the Medical Officer in securing a Hospital
should a case occur, but happily there has been no occasion to call a meeting; thanks
to the effectual barrier interposed between the affected section and the Moor of
Rannoch by the prompt re-vaccination of the men employed under Mr. Macrae, one
of Lucas & Aird's managers. Messrs. Lucas and Aird, through their chief engineer,
Mr. Tarry, also largely contributed to the effectual stamping out of the disease by
refusing to take on any new men unless they had been successfully re-vaccinated,
whilst Mr. Grainger, the manager of the northern section of the works, by kindly
agreeing to grant the use of a hut for hospital purposes on the same terms as were
paid at Crianlarich, did much to lessen the anxiety of the Department. As many of
the navvies working on a small contract between Loch Rannoch and New
Station as would submit to the operation, were re-vaccinated by Dr. Caird, Rannoch,
at the suggestion of the Medical Officer.
One suspicious case was reported, which happily proved not to be Smallpox.
As matters at present stand, the Highland is the only Rural District of Perthshire
which has no provision made for the isolation and treatment of Smallpox, but it is
ready when a case actually occurs to make the necessary provision.
7. The population of the Highland District was 13,175 according to the census
of 1891, consisting of 6346 males and 6829 females, and, estimated to the middle of
1893, the population was 12,895. In 1893 there were 276 Births and 197 Deaths,
giving a Birth Rate of 21.40 and a Death Rate of 15.27, as compared with a Birth Rate
of 17.3 and a Death Rate of 16.2 in 1892. Of those who died in 1893, 92 were males
and 105 were females.
The natural increase of the population during the year was 79, against 16 in
1892. Deaths in persons of 60 years and upwards were 121 or 61.4, of the total.
Deaths in children under one year were 14, of which 9 were due to Developmental
causes, giving an Infant Mortality of 50.72 per 1000 births, as against 92.9 in 1892.
Respiratory Diseases caused 18 Deaths or 9.1 per cent. of the total. In 10
of these the age at death was above sixty years, and in 2 it was under one year.
Circulatory Diseases caused 13 Deaths or 6.0 per cent. of the total; 11 of these
were in persons over sixty years of age.
[Note] 156 |
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Tubercular Diseases caused 16 Deaths (of which 13 were due to Phthisis) in
1893, as against 17 in 1892. This shows that 8.1 per cent. of the total deaths were
due to this class of diseases.
Nervous Diseases caused 17 Deaths, in which 8 were persons of sixty years and
upwards.
Digestive Diseases caused 11 Deaths, in which 6 were persons of sixty years
and upwards, or 5.5 per cent. of the total.
Cancer and Malignant Diseases caused 9 Deaths, or 4.5 per cent. of the total,
against 6 in 1892.
Devolopmental Diseases caused 9 Deaths, of which 5 were due to premature birth,
against 9 in 1892.
Old Age caused 48 Deaths or 24.3 per cent. of the total. In 1892 the deaths due
to Old Age were 45, or 21 per cent. of the total.
Zymotic Diseases -
Zymotic Diseases caused 6 Deaths in 1893, against 6 in 1892, giving a Zymotic
Death-Rate of .465. In all, 73 cases were reported during 1893, against 48 in 1892.
Typhus Fever was unfortunately brought to the District by a girl who had
been in contact with a family of Tinkers, six of whom were removed to Hospital from
the neighbourhood of Crieff suffering from the disease. The girl had left the Crieff
camp some time before the disease there was recognised, and when it was discovered
no information could be elicited which pointed to anyone having left the infected camp
immediately previous to the illness there. The patient in the Highland District was ill
in a wood, and when seen by a medical man he certified her to be suffering from inflam-
mation of the lungs, and ordered her removal to the Logierait Poorhouse, where,
fortunately, the Governor placed her in an isolated part of the building as being more
comfortable. Here she remained during the whole of her illness, as she was suspected of
having something more than simple pneumonia wrong with her. She was nursed by the
Matron, who, unfortunately, became infected, and had a severe struggle for her life. The
Matron was treated in a room on the top flat of the Poorhouse, where she and the
Nurse attending on her were well isolated from the rest of the inmates. The
Matron ultimately recovered, but the Nurse took the disease a month later, and was,
in consequence, removed to Perth Hospital, where she died on the twelfth day of the
fever. By her death the County lost the services of one of the most kind-hearted
and best of Nurses, one who had on many former occasions risked her life at a
moment's notice to nurse those suffering from infectious disease. In the Nurse's case
the disease had attacked her for the second time in her life. It speaks well for the
isolation maintained by those in charge of the Poorhouse that, with the exception of
those in actual attendance on the patients, there was no spread of the disease.
As soon as it was discovered that the girl had been removed from the camp in
the Highlands suffering fromTyphus, enquiry was made and it was reported that
two other children there had been suffering from a disease, called measles by a doctor
who had seen them. However, somehow they had been informed that we were
searching for them, and it was only after a continuous hunt for two days that the
assistant Inspector caught up with them near Aberfeldy. He found that two of the
children had been ill, and procured a medical man, who pronounced them to be not
suffering from an infectious disease.
In connection with these cases a requisition was sent by the Committee of
Management of the Poorhouse, asking the District Committee to join with other
Local Authorities throughout the country in obtaining powers to prevent vagrants,
suffering from infectious disease, from wandering about the country to the danger of
the lieges. In so far as those vagrants are concerned who are actually suffering from
[Note] 156
[Page] 30
infectious disease, if medical men could only be relied on to diagnose accurately the
diseases from which they are suffering, there exists at present ample powers under
the Public Health Act to effectually protect the public. For those, however, who
have been only in contact with the patients there is no power to do more than remove
them from the room occupied by the patient, and, although accommodation is provided
for them at the expense of the Local Authority, no powers are given to confine the
suspects. By all means let us have a good reception house, and all the powers
necessary to enable the Local Authority to compulsorily detain suspects there; but
in so far as the vagrants are concerned it would be sufficient to put into force the
Bye-Laws for the Prevention of Vagrancy made by the County Council at Perth on
the 13th of October, 1890, and approved of and confirmed by the Secretary for Scotland
on the 16th December of the same year. Amongst those Bye-Laws may be cited,
"That all persons conducting themselves as vagrants, having no fixed place
of residence, and no lawful means of gaining their livelihood within the
County, shall be guilty of an offence punishable by a fine of £5, or in
default of payment thereof with expenses, to imprisonment." The strict
enforcement of the above would effectually rid the County of dangerous disseminators
of infectious disease, and would leave the money of the ratepayers to be devoted to the
protection of the inhabitants of the County, by the provision of Reception Houses,
in which the suspected members of respectable infected families of the poorer classes
might be quarantined, till the expiration of the incubation periods of the diseases to
which they may have been exposed. The Highland District Committee referred this
important matter to the County Council, who, as a remedy, advised those Districts
who had not already adopted the Infectious Disease (Notification) Act to do so.
This was good so far as it went; although as the trouble arose not from the want of
Notification, but from the inaccuracy of medical men, no Notification Act can be
relied on as a remedy.
Enteric Fever. - The Highland District is the only one in Perthshire which can
say that, during 1893, there was neither a death nor a reported case.
Scarlet Fever caused 3 deaths during 1893, against 1 in 1892. In all, there were
37 cases of the disease reported, and of these 3 were removed to Hospital, and were
discharged cured. One of the fatal cases occurred in a poor woman who had had a
child only three days previously. As is usual in such cases, the disease proved rapidly
fatal. With the exception of the nurse who was in attendance on this patient, there
was no extension of the disease.
A group of cases with one death was traced to a girl who had come from Perth
to reside in the local Post Office. On the occurrence of several cases in the
neighbourhood, an enquiry pointed to the Post Office as the probable centre of
infection, and the girl was found with her hands desquamating.
Another group of cases occurred in one of the huts at the new West Highland
Railway Works. Here the infection was brought from Fort William. Thanks to the
precautions taken by Dr. Kay, Messrs. Lucas & Aird's Medical Officer, there was no
spread of the disease.
Diphtheria caused 1 Death. In all, 6 cases of the disease were reported during
the year; 3 were removed to Hospital and all recovered. In one group of cases the
disease was evidently imported from a town.
Measles was prevalent during the year, but there were no fatal cases of the
disease. Three children (tinkers) were removed from the neighbourhood of Moulin to
Hospital.
Diarrhœa caused 2 Deaths, one in a person over 60 years of age, the other in a
child under 1 year. No epidemic of the disease was reported during the year.
Influenza caused 4 Deaths during 1893, against 6 in 1892.
[Note] 157 |
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Western District.
The Western District has well maintained its reputation as the most healthy
in the County, during the past year. For the last three years its Death-Rate has
been under 15 per 1000, which is generally held to be a normal rate for rural districts.
Several matters of great importance, from a Public Health point of view, have
engaged the attention of the Committee during the year. One of the most beneficial of
these was the appointment of scavengers in all the larger villages in which a man
was not already privately employed for this purpose. The scavengers have already
begun work, and the improvements made by them are giving satisfaction generally.
Water supplies have demanded a good deal of attention during the year, and
in two instances gravitation supplies have replaced those formerly in use.
The pollution of the Forth by the sewage of Aberfoyle, has been under the
consideration of the District Committee, and steps have been taken which, it is
hoped, will eventually lead to the stoppage of the offence. This question
received a fresh impetus from the fact that Enteric Fever occurred in a number
of farms and houses which depend entirely on the Forth for their water supply.
Many of these houses are widely separated, and have nothing in common except
their water supply, so that it has undoubtedly been by this means that the specific
poison of the fever has been carried. The disease in this instance cannot
be traced to Aberfoyle, but as there were previously cases in the neighbour-
hood of Kippen, and the drainage of this village and others ultimately flows
into the Forth above the infected houses, it shows that the River Forth
requires for its proper purification, not only the energetic action of the Western
District of Perthshire, but also the like action on the part of the Central District
Committee of Stirlingshire. It is very questionable, however, how far the Forth
water can be relied on as a safe source for the supply of domestic water even although
all possible means are taken to protect the river from pollution from the villages,
and the question of providing a safe and sufficient supply may soon have
to be faced by the proprietors in the Carse. The floor of the Carse is composed of
Old Red Sandstone, but this has been worn away by the forces of nature until a
deep hollow has been made, which in process of time has been filled up with alluvial
deposits, probably laid down whilst the Carse was an arm of the sea; shells found
embedded in the deposit have pointed to this. As is usually the case, when wells have
been sunk into such soil, the water obtained is unfit for use, but were a proper Artesian
bore made through the alluvial deposits down to, and into, the rock, and were the
upper portion of the well protected by tubing against the entrance of surface
water, a plentiful and wholesome supply of water could be obtained. However,
it will be for the proprietors to choose between this form of supply and a gravitation
one from some of the neighbouring hill streams, should the efforts at present
being made to purify the Forth not prove a success.
The Cemetery referred to in the Report for 1892 has been closed to all except near
relatives of those already interred there, and a piece of new ground has been set
apart for the purposes of future interment.
[Note] 159 |
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The New West Highland Railway Works and the Glasgow Water Works
Extension contracts, employing as they do a large number of navvies, have caused
the exercise of a considerable amount of supervision of the huts used for their accom-
modation. In securing the necessary sanitation much help was offered to the
Department by the Contractors, Messrs. Lucas & Aird, and Messrs. John Waddell
& Sons, along with their Officials; and during the prevalence of smallpox it was
chiefly owing to the help received from them that it was possible to prevent men
who had been exposed to the infection from wandering all over the country.
2. General enquiries have been made during the year to ascertain the
sanitary condition of the District, and a large amount of work has been necessitated
in connection with complaints regarding impure or deficient water supplies, the
insanitary condition of dwelling-houses, attempts to secure suitable sites for the
erection of Infectious Diseases isolation Hospitals, as well as the diagnosis and
isolation of cases of infectious disease, especially smallpox.
3. Advice was given in connection with the Hospital accommodation, purification
of sewage before its discharge into the Forth, and several other matters,
but no certificates were necessary, as the insanitary conditions were removed
voluntarily.
No action required to be taken in connection with Factories and Workshops
in the District.
4. The five Retail Bakehouses in the Landward part of the Western District
have been visited during the year, and found to be in good order; some minor
improvements in the structure of some of them have been carried out as soon as the
defects were pointed out to the occupiers.
5. While Smallpox prevailed at Crianlarich, the Hospital accommodation
of the Western District consisted of two large Huts, which were hired by
the District Committee at so much per week. Each of these huts was divided
into four rooms, one of which was reserved for the accommodation of the Nursing
Staff, the others being used either as sick rooms, or day and bed rooms for
convalescents. Another small hut was purchased, and erected at a point between
three and four miles down Glenfalloch, for the reception of a poor woman who was
too ill to be safely removed to the Crianlarich Huts. The treatment of the cases
admitted to these Hospitals was undertaken by Dr. Kay, Crianlarich, who devoted
himself to working amongst the infected section of the works, engaging an assistant
to attend to all the rest of his practice.
When the Smallpox case occurred at Frenich, one of the new Portable
Hospitals was available, and was at once taken to the place and erected at the
head of Loch Chon (a site having been kindly granted by the farmer, Mr.
Cowbrough), the assistant of Dr. MacGregor, Aberfoyle, being appointed to look
after the patient.
At Killin, on the occurrence of five cases of Scarlet Fever in the Public Reading
Room there, another of the Portable Hospitals was erected in a field just outside
the village, a site having been kindly granted by Mr. McLean of Finlarig
Farm; the cases were taken charge of by Dr. Bryce, Killin. All arrangements in
connection with the removal and treatment of patients removed to Hospital were
under the supervision of the Medical Officer.
Shortly after the termination of the Smallpox outbreak at Crianlarich, the two
large Huts, which had been used for the treatment of patients, were disinfected and
cleaned, and the District Committee's property contained in them was transferred to
the small Hut down Glenfalloch, which it was decided to keep ready for any
[Note] 160
[Page] 34
emergency. A short time afterwards, this Hut took fire one night, and was totally
destroyed, with everything it contained.
The Hospital accommodation now available for those requiring it in the Western
District, consists of the two Portable Hospitals purchased last year. Each of these is
capable of dealing with, at least, four patients, and there is besides a room
for the nurse, in each. These Hospitals are intended to be erected at central points
of the District, when not in use, and as the foundations for one of them
will be made of concrete, it will be ready to be taken to pieces, removed, and re-erected
near the patient's house, or if considered best the patient may be removed to where
the Hospital is; the other is intended to be stored in sections ready for immediate
removal. On both of the occasions on which these Hospitals have been in use they
have given the most complete satisfaction, and the expense of treatment in them has
not been found to be unusally heavy. As an instance of how the prejudice against
these Hospitals is breaking down, it may be mentioned that the District Committee
received an application to rent the Hospital at Frenich (in which Smallpox had been
treated) as summer-lodgings for a family.
6. To prevent the outbreak of Infectious Disease, the whole energies of the
Department have been directed, and on many occasions attention has been directed to
faults, either in the surrounding or internal arrangements of dwelling-houses, with a view
to their being remedied. Water supplies have been examined, and on several occasions
analysed, and, when found to be defective, they have been made good or replaced by
better. One very important means for preventing the outbreak of Infectious Disease
has been adopted by the Western District Committee during the year, viz:- the ap-
pointment of scavengers in all the principle villages. These men by clearing away from
the vicinity of houses collections of domestic refuse, will do much to prevent the
occurrence of Diphtheria and Enteric Fever.
To prevent the spread of Infectious Disease, much valuable work has been done
by the assistant Medical Officers, and they have been loyally assisted in this work by
Drs. Kay, Crianlarich, and Macgregor, Aberfoyle. By the early recognition
of the nature of the disease, and by the prompt isolation of the patients
(in which the assistant Sanitary Inspectors did most excellent work), they
have shown that with an efficient local staff it is comparatively easy to check
the spread of Infectious Disease even when it occurs in very unpromising places.
In all cases of Infectious Disease strict isolation has been insisted upon, either
by removal to Hospital or at home, and in connection with Smallpox cases, not
only the patient but those in contact immediately previous to the illness, have been
isolated, thanks to the kind assistance of the contractors in whose employ the
majority of the suspects were. These, after re-vaccination, were kept working
in separate gangs, and no fresh hands were allowed to enter the quarantine hut during
what is known as the "incubation period" of the disease, or the time which usually
elapses between the reception of the infection and development of the first symptoms
of the disease. In one or two instances the men under quarantine made their escape,
but, as it was generally known in which direction they had gone, they were kept in
sight by the officials of the various Local Authorities through whose districts they
passed in their wanderings, warning being previously sent by telegraph, as soon as
the escape was discovered. Free re-vaccination was offered by the District Com-
mittee to all applying to the assistant Medical Officers; 545 operations were performed
at the Committee's expense, besides at least 150 private re-vaccinations in the
Parish of Killin.
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7. The population of the Western District was 10,745, according to the Census
of 1891, of these 5,721 were Males and 5,024 Females. Estimated to the middle of
1893 the population of the Western District was 11,120. During 1893 there were
243 births and 165 deaths, giving a Birth-rate of 21.8, and a Death-rate of 14.8 per
1000 of the population, against a Birth-rate of 22.1, and a Death-rate of 14.2 in
1892. The Natural Increase of the population was 78 in 1893, against 87 in 1892.
Of the 165 Deaths, 86 were Males and 79 Females. The Infant Mortality was 22, or
at the rate of 90.5 per 1000 Births against 57.6 in 1892. The Zymotic Death-rate
was .719 in 1893 against 1.55 in 1892, 8 Deaths were caused by these diseases in 1893.
Respiratory Diseases caused 31 deaths, or 18 per cent. of the total in 1893,
against 17 in 1892. The sickness returns supplied by the Assistant Medical Officers,
show that 22.2 per cent. of the total was due to this class of diseases, against 26.4
per cent. in 1892.
Circulatory Diseases caused 15 deaths, or 9 per cent. of the total in 1893,
against the same number in 1892. Sickness returns show that 6.6 per cent. of the
total was due to this class of diseases, against 8.2 per cent. in 1892.
Tubercular Diseases caused 26 deaths, or 15.7 per cent. of the total in 1893,
against 27 in 1892. Of these 26 deaths 11 were due to Phthisis. Sickness returns
show that 2.8 per cent. of the total was due to diseases of this class, against 3.6 per
cent. in 1892.
Nervous Diseases caused 8 deaths, or 4.8 per cent. of the total in 1893, against
7 in 1892. Sickness returns show that 9.3 per cent. of the total was due to this class
of diseases in 1893, against 10.5 in 1892.
Digestive Diseases caused 9 deaths, or 5.4 per cent. of the total in 1893, against
11 in 1892. Sickness returns show that 30.5 per cent. of the total was due to this
class of diseases, against 31.7 in 1892. In many instances these diseases are
attributed to "errors in diet," showing that with care in respect to food there might
be a large diminution of sickness of this class.
Rheumatic Diseases. - No deaths were certified as having been caused by this
class of diseases in 1893. Sickness returns, however, show that 10.5 per cent. of the
total was due to diseases of this class. The majority of the cases reported occurred
in connection with the West Highland Railway Contract, and were mostly due to
exposure.
Cancer and Malignant Diseases caused 4 deaths, or 2.4 per cent. of the total in
1893, against 2 in 1892. Sickness returns show that 6 per cent. of the total was due
to this class of diseases in 1893, against 8.8 in 1892.
Developmental Diseases caused 8 deaths (of which 4 were due to premature
birth), against 14 in 1892.
Old Age caused 33 deaths, or 20 per cent. of the total in 1893, against 22
in 1892.
Zymotic Diseases caused 8 Deaths, or 4.8 per cent. of the total in 1893,
against 17 in 1892.
Smallpox caused 3 deaths; two of the victims never had been vaccinated, and
in the third there was only one very slight mark of primary vaccination, the patient
was 48 years of age. Ten cases of the disease occurred in the Western District -
9 in Glenfalloch - amongst the employees of the contractors for the New West
Highland Railway, - and 1 at Frenich, about 9 miles from Aberfoyle, in connection
with the Glasgow Water-Works Extension.
The year began with rumours of Smallpox. On the 2nd of January a com-
munication was received from Dr. McVail, intimating that two men had left a
[Note] 162
[Page] 36
Smallpox infected hut at Tarbert, and it was thought that they might find their
way to one of the Perthshire contracts. The assistant Medical Officers, as well as
the medical men in charge of the contract works, were immediately apprised of the
danger, and a vigilant watch was kept lest the men might get into any of the huts
occupied by navvies. In this work the County Police gave valuable assistance.
Nothing was heard of these men till January 12th, when Dr. Lindsay, Buchlyvie,
reported that he had seen one of the men, who had turned up at the Aberfoyle Slate
Quarries, that he had found the man in good health, and that he had suffered from
an attack of Smallpox some years previously; the other man was not discovered in
Perthshire. On the 11th January, in response to a telegram from Dr. Kay,
Crianlarich, a visit was made to a large hut in the neighbourhood of that place, and
it was found that one of the navvies was suffering from virulent Smallpox. The
man had never been vaccinated, he had come to the hut from Helensburgh, where he
had caught infection, as was afterwards discovered, from a mate with whom he had
been wandering about the country between Helensburgh and Crianlarich, about a
fortnight before the New Year. This mate had been feeling ill about the beginning of
his wanderings, but was never laid up, so that in his case the disease had not been
recognised, but the occurrence of a number of cases amongst people widely separated,
and with nothing in common save contact with this man, who suffered from an
illness a fortnight subsequent to a visit to Glasgow, where the disease was prevalent
amongst the Common Lodging-Houses, at which such a person would stay during
his visit, seems to point conclusively to the disease from which he had suffered being
Smallpox. The man disappeared immediately after the occurrence of the first cases
of the disease at Helensburgh and Crianlarich, and it was impossible to ascertain the
facts of the case, but the mere fact of his disappearance shows that he himself was
conscious of his being the origin. The patient at Crianlarich had been watched by
Dr. Kay for two days before my visit, and as he was suspicious of the nature of the
illness, he had been removed to an unoccupied part of the hut on the previous day.
It was decided that it would be the wisest course to leave the patient where he was,
and with the ready help of Messrs. Lucas and Aird's officials, all the remaining navvies
in the hut, except one, were transferred next day to the only other hut available,
which was near the side of the public road. During the night the whole of the navvies
in the hut were re-vaccinated, with the exception of four, who refused, as they had
either been re-vaccinated or had Smallpox. The operation was delayed some hours in
consequence of having to wait till the arrival of the late train from Edinburgh, with
sufficient lymph to vaccinate all the inmates - 35 in number - at once. About 3
a.m., however, after a good deal of argument, all, with the above exceptions, were
re-vaccinated. The hutkeeper's wife had a child only the day previous to the
discovery of the case, and, as she was not in a very good state, and objected
to removal, she was not removed to the other hut for a week after the other
inmates. The communication between the room occupied by her and the
rest of the hut was securely closed, and there were besides two empty rooms
between her room and the one in which the patient was. A Nurse was
kindly sent by the Lady Superintendent of the Edinburgh City Hospital
to take charge of the patient, and during the intervening eight hours one of the
navvies, who was off work in consequence of a slight accident, volunteered to see that
the patient was attended to. As soon as the Nurse arrived this navvy was placed in
an unoccupied room of a neighbouring hut, and helped the Nurse by carrying water,
coals, &c. It was found that, in a very considerable number of instances, the
re-vaccinations of the inmates of this hut were very unsatisfactory. It was afterwards
[Note] 163 |
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discovered that they had sucked the wounds as soon as the doctors left, and, in con-
sequence, three of them, along with the man who voluntered to attend to the patient,
developed the disease. Their cases were, however, exceedingly slight, and some of
them were never off work until removed to Hospital. Each of the four was protected
to a considerable extent by having two good marks of primary vaccination; in fact it
was only by a very close examination that the symptoms of the disease were discovered
in any of them. One other case was due to infection caught from this hut. It
occurred in a woman, the wife of a blacksmith, who lived in a turf hut in the neighbour-
hood of the infected hut. She and her family had not been re-vaccinated, and it was
discovered after her seizure that she had been in the habit of going about the hut in
which the men were quarantined, and had done some washing for them. This woman,
who was immediately removed to a second hospital hut which had been hired, had
only one very indistinct mark of primary vaccination, and, as she suffered from a
diseased heart, her case was a very unsatisfactory one. However, she pulled through
the worst part of the disease, and died of syncope, caused by suddenly sitting up in
bed during convalescence. Although this woman had been sleeping in a small bed
occupied by her husband and three children in the small turf-hut, none of these showed
a single symptom of smallpox during the rigid quarantine to which they were
subjected. They were all re-vaccinated, and besides had very good marks of primary
vaccination. On the 27th January Dr. Kay was called to see a man in a hut four
miles down Glenfalloch; he found him to be suffering from confluent smallpox. He
had come from Glasgow shortly before his illness, and had caught infection in Burns'
Lodging House there. In this case there was no evidence of primary vaccination,
and the man was certain that he had never been vaccinated. He was removed to the
hospital hut at Crianlarich, but died during the second week of the disease. As soon
as the disease was recognised every inmate (45 in number) of the hut in which he was
was re-vaccinated; the hut was thoroughly disinfected, and there was no other case
amongst them. On the 30th January Dr. Kay discovered, on being asked to visit
the wife of a hut-keeper 3½ miles down Glenfalloch, that she was suffering from a very
severe attack of confluent smallpox. She had never been vaccinated, and was so ill
as to make her removal to the Crianlarich hut unsafe; and, as it was impossible
to get accommodation for the navvies in this hut elsewhere, it was deemed prudent,
with a view to secure isolation, to purchase a small hut from the Contractors, which
was erected in a field near, and to this the poor woman was removed. She, how-
ever, succumbed to the disease the second week. It was difficult to trace how this
case was infected; but it seems that the woman was of a kindly nature and in the
habit of giving tramps a cup of tea when passing, so that it is quite likely that, in
their wanderings, the navvy first attacked and his mate may have been her guests,
and so have left the infection. Everything which had been in contact with this woman
was removed to the small hut along with her. The inmates were re-vaccinated, and
the hut disinfected; but a week later, on examining the men on their return from
work, one of them was found to be suffering from very modified smallpox. He had
good marks of primary vaccination, and his re-vaccination had also taken. This man
was removed to the Crianlarich hut, and a further period of quarantine fixed for the
rest of the inmates. There was a general outcry against this, and affairs became so
threatening of a general defiance of authority, that it was considered wise to warn the
authorities at Oban, that there might be an escape after the pay for the week.
This warning led to rather a serious mistake, as the authorities at Oban seized and
quarantined some innocent men, but the same mistake put an effectual stop to the
threatened departure of the men under quarantine, as they saw that it would be
[Note] 164
[Page] 38
better to remain in quarantine where they were than be put under restraint in
another place.
Soon after smallpox had really got a hold in Glenfalloch, the majority of the
men employed on this section by the Contractors were re-vaccinated, as the manager,
who had not been in favour of previously giving the order for every man who would
not submit to the process being dismissed, saw that it was his only safe course, and,
within a week, all were protected. The men in the infected huts were re-vaccinated
immediately on the discovery of a case, on the understanding that, in the event of
their being incapacitated from work in consequence, they would be paid for the time
lost; but, although nearly a hundred men were thus guaranteed, the total sum paid for
compensation did not exceed £6.
The mode adopted in dealing with infected clothing and bedding was that, when
a case of smallpox was discovered, the patient - with his clothing, bedding and every
thing which had been in contact with him - was removed to the Hospital, the
hutkeeper being allowed value for all his property taken. The bedding was
used for the patient during the stay in hospital, and, before discharge, everything
belonging to each patient was burnt, and all clothing replaced by new.
Through the kindness of Messrs. Lucas & Aird it was arranged that the men whilst
under quarantine, should be employed working in separate gangs, and no new hands
were allowed into the quarantine huts. At the termination of the quarantine the
huts were thoroughly disinfected and cleaned, before the restrictions were removed.
The man who was first ill in Glenfalloch had such a severe attack of the disease that
it was the 19th April before he was considered fit to be dismissed. Immediately
thereafter the huts, which had been rented for hospital purposes, were thoroughly dis-
infected, and all the property belonging to the District Committee was removed to the
small hut in Glenfalloch, which, it was decided, should be kept in readiness, lest another
case should occur. However, this hut with all its contents was destroyed by fire on
the night of the 8th May, much to the satisfaction of those resident in the district,
which was in some instances so freely expressesd as to make it almost appear that the
burning had been wilful. The two huts formerly used as hospitals have been, for
several months, again full of navvies, none of whom have shown any signs of infection,
which proves how effectual must have been the disinfection carried out by the local
Sanitary Inspector, as they looked the worst possible subjects for satisfactory disin-
fection.
Another case of smallpox was introduced into the District by a youth employed
on the Glasgow Water Works Extension Works at Frenich; he only arrived from
Glasgow the day before his illness commenced, and it was discovered that he had been
staying for three weeks in a Lodging House, in that City, which had been infected
with smallpox. The lad had two good marks of primary vaccination, and his case was a
very mild one. One of the portable Hospitals was transported to a field near Frenich
and erected there, the patient being removed to it and placed under the care of Dr.
McGregor, Aberfoyle. It so happened that in this case there were only six men
occupying the hut in which the patient was, and one who had been sleeping in the
same bed with him had been thoroughly re-vaccinated in Glenfalloch. The others
were re-vaccinated, and, through the kindness of Messrs. Waddell, put to work on an
outside job (they were previously working in the tunnel) during their period of
quarantine. There was at first a good deal of indifference exhibited by the men here
in regard to re-vaccination, but with a little coaxing Dr. Macgregor, Aberfoyle,
succeeded in getting nearly the whole protected. There was no extension of the disease,
except that the nurse who temporarily had charge of the patient (until the one from
[Note] 165 |
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Crianlarich was free), took the disease after her return to Perth. As she had had
smallpox in her youth and had previously nursed cases of the disease with impunity,
she would not submit to re-vaccination.
The total cost of treating the smallpox cases in the Western District was £403.
Diphtheria caused 2 deaths in 1893, against 6 in 1892. Sickness returns show
that 10 cases of the disease were reported during the year, against 15 in 1892. Of
these 10 cases 8 were credited to Killin, where the school had to be closed in
consequence of the outbreak. Both of the fatal cases occurred at that place, and
there seemed to be good grounds for believing that the disease was caused by the
excavation of the soil from under the floor of a house in which diphtheria had
formerly occurred; it was in consequence of this that the alteration was being made,
so that free ventilation might be provided under the floor.
Typhus Fever. - One death appears in the Registration returns for 1893, but as
the reason for this was delay in consequence of a Fiscal's inquiry into the circumstances
of the death, (no medical man having seen the person before death), and the death
occurred in 1892, and was referred to in the Annual Report for that year, there is no
necessity for further reference to it. A little anxiety was caused by a communication
received from the Health Department of Glasgow, in October, stating that four
young women had been admitted to Hospital there suffering from Typhus Fever, and,
further, that they had previously been engaged with a contractor in the neighbour-
hood of Doune lifting potatoes. On enquiry being made it was found that the gang had
come to the place, from another County, shortly before the girls now sick had left; all
the rest of the workers were found to be in perfect health, and continued so till their
departure from Perthshire, which took place within a week.
Scarlet Fever. - No Deaths are recorded as due to Scarlet Fever during 1893;
there were 20 cases of the disease reported, and no epidemic occurred. Five of these
cases occurred in the house of the keeper of the Public Reading Room at Killin, and
as they were in a very dangerous place in so far as the public were concerned, one of
the portable Hospitals was erected in a field near the village and the patients removed
to it. The Hospital gave complete satisfaction to all concerned.
Enteric Fever - No death was caused by this disease during 1893, seven cases
were reported, two were isolated cases, - one traceable to the patient having been in
attendance on another case of the disease, the other to polluted water. The other
five cases occurred in one family, and were due to one member coming home from
another County with a diseases thought to be Influenza until the rest of the family
took the disease; it was then too late to prevent the mischief.
Measles caused two deaths in 1893, against none in 1892. Sickness returns
show that this disease was the cause of 1 per cent. of the total; this, however, is very
much under the actual percentage, as the character of the disease was so mild
that no doctor was called in to see many of the cases.
Diarrhœa - There were no death caused in the District during 1893; in
1892 there were 2 deaths caused by it.
[Note] 166
Eastern District.
There has been a steady improvement in the Sanitary condition of the Eastern
District during 1893. Many dwelling-houses have been much improved either in
their surroundings, or structure, and the water supplies have received a large share of
the attention of the Department. Although a large expenditure has been entailed
by these improvements, it is satisfactory to know that everything was accomplished
without the necessity of an appeal to the Sheriff.
The Village of Kirkmichael for the major part of the year, has been rejoicing in
a new Water Supply, laid on by the proprietors from the adjoining hill. This will
much improve the amenity of the place, and is thoroughly appreciated by the
inhabitants, some of whom had nothing but the river water to drink before; the next
move will doubtless be the formation of a Drainage System.
Wells have been found polluted in several instances, and these have either been
made "chemist proof," or have been replaced by others in more suitable situations.
The whole question of assistant Sanitary Inspectors has been under the consideration
of the District Committee, and a proposal has been made to appoint one man to do
the whole work, as is done in the Highland District, to the advantage of the
work. At present there is a feeling amongst the local Inspectors that they are
underpaid, and this is not likely to inspire them to work.
The pollution of rivers by the discharge of sewage into them, was brought under
the notice of the District Committee, by a communication from the County Finance
Committee, in reference to the pollution caused by the sewages of Blairgowrie and
Rattray, which were discharged into the Ericht without filtration. It was reported
that Blairgowrie was at present constructing works which, when completed,
would prevent the pollution in so far as that Burgh was concerned, and Rattray was
called upon to take measures to do likewise, but hitherto no actual progress has been
made with the prevention of the pollution of the river by its sewage. The Blairgowrie
Purification Works have been carried out during the year, and, so far as they go, they
do the intended work well; but, were the effluent treated by intermittent downward
filtration, or broad irrigation after coming from the tanks, any danger to the river
water from the discharge of the effluent would be completely prevented. When it
is remembered that the chief value of sewage from a manurial point of view is
contained in the liquid which is so frequently discharged into the rivers without any
attempt being made to utilize it, it seems strange in these days of agricultural
depression that such a state of matters is allowed, altogether apart from a Public
Health point of view.
In so far as the Burghs of Alyth and Coupar-Angus are concerned, the purifi-
cation and utilization works in operation are giving continued satisfaction.
2. On many occasions general inspections have been made with a view to ascertain
the sanitary condition of the District, and in connection with complaints regarding
offensive trades, polluted water supplies, and infectious disease, a considerable amount
of work has been necessitated.
3. Advice was given in regard to insanitary dwelling-houses, and polluted water
supplies, but happily in no case was there any need for a certificate under the Public
Health Act, as the Chief Sanitary Inspector managed to accomplish all that was
[Note] 167 |
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[Page] 41
required. No action has required to be taken on connection with Factories or Work-
shops in the District during the year.
4. The Five Retail Bakehouses in operation within the District, have been
inspected during the year, and found to be in good order. One has been transferred
to new premises, and in another a new floor has been laid down.
5. The arrangement by which the District Committee have a right to send patients
suffering from Infectious Disease to Perth Royal Infirmary, has been found
advantageous, as during the year 15 cases were removed. While in Perth Hospital
the Medical Officer has from his position on the Staff of the institution full supervision
of the treatment and isolation maintained, and is satisfied with both. All of the cases
removed to the Hospital did well.
In consequence of the occurrence of Smallpox in another part of the County, in
the early part of the year, a portable Hospital was purchased, and stored in the Road
Surveyor's Yard in Blairgowrie, in a shed specially erected for the purpose; happily
there has been no occasion for the use of this Hospital by the District Committee,
but undoubtedly their being in a position to sell the Hospital to the Burgh of Rattray,
when a case of Smallpox occurred there, was the means of preventing a serious spread
of the disease, which would in all probability have extended into the landward part of
the parish, had it not been for the prompt isolation which was thus rendered possible.
The Hospital sold was immediately replaced. Should this Hospital be required in
the Eastern District, the supervision of its management would be in the hands of the
Medical Officer, a local doctor being engaged to attend on the patient.
6. As a means to prevent the spread of Infectious Diseases, the District Committee
adopted the Notification Act, which has now been in operation since the beginning
of October. It has not, however, realized the high expectations as the means of
securing notice of the first cases of Scarlet Fever, as the first notifications received
are often received only when the whole of a family have been ill for some time,
and a doctor has been called perhaps to see the last child seized. In the country
the parents cannot be entirely blamed for not calling in a doctor, as the charge for a
visit is often high, and for what is apparently nothing but a sore throat it seems
needless to incur such expense, so that until the District Committee can see its way
to provide a medical man in each parish, or group of parishes, who can be called in
free of expense in order to pronounce whether the disease is infectious or not, it will
be impossible to obtain convictions under the Infectious Disease (Notification) Act, as
there is always the convenient excuse of "not having been aware of the nature of
the disease."
7. The population of the Eastern District was 9782, according to the Census of
1891, consisting of 4861 Males and 4921 Females. Estimated to the middle of 1893,
the population was 9569. In 1893 there were 238 Births, and 177 Deaths, giving a
Birth-Rate of 24.87 and a Death-Rate of 18.49, against a Birth-Rate of 21.1, and a
Death-Rate of 16.45 in 1892. The increased Death-Rate is chiefly accounted for by
the excess of deaths from Old Age. The natural increase of the population during the
year was 61, as against 45 in 1892. Of those who died in 1893, 84 were Males and 93
Females. Deaths in persons over 60 years of age were 95 or 53.8. per cent. of the total,
against 82 in 1892. Deaths in children under 1 year were 17, of which 8 were due
to developmental causes, giving an Infant Mortality of 71.42, against 127.4 per 1000
in 1892.
Respiratory Diseases caused 28 Deaths or 15.8 of the total, against 26 in 1892.
Of the 28, 13 were in persons over 60 years of age, and 2 in children under 1 year of
age.
[Note] 168
[Page] 42
Circulatory Diseases caused 19 Deaths or 10.7 per cent. of the total, against 20
in 1892. Of the 19 deaths 16 were in persons over 60 years of age.
Tubercular Diseases caused 21 Deaths or 11.8 per cent. of the total, against 18
in 1892. There were 17 Deaths attributed to Phthisis in 1893, against 10 in 1892,
these were largely originated by the influenza epidemic in the previous year.
Nervous Diseases caused 13 Deaths or 7.3 per cent. of the total, against 15 in
1892. Of the 13 deaths 11 were in persons over 60 years of age.
Digestive Diseases caused 13 Deaths or 7.3 per cent. of the total, against 5
in 1892.
Cancer and Malignant Diseases caused 7 Deaths or 3.9 per cent. of the total,
against 9 in 1892.
Developmental Diseases caused 8 Deaths in 1893, against 12 in 1892. Of the 8,
3 were due to premature birth.
Old Age caused 33 Deaths or 18.6 per cent. of the total. against 23 in 1892,
showing an increase of 10 deaths due to this cause.
ZYMOTIC DISEASES.
Zymotic Diseases caused 9 Deaths in 1893, against 5 in 1892, giving a Zymotic
Death-Rate of .940. There were 65 cases of Infectious Disease reported during 1893,
of which 15 were removed to Hospital.
Scarlet Fever caused 1 Death in 1893, against 2 in 1892, with the exception of
the fatal case which occurred in a person who was not strong before the fever, the
rest of the cases were of a very mild type, in fact some of them were only regarded
as cases of the disease from having been in contact with other cases shortly before a
slight malaise. There were 31 cases reported during the year; 24 of these cases
occurred in the neighbourhood of Collace, and seemed to be traceable to a visitor from
Glasgow who had suffered from Measles (?) before coming. The disease had been
spreading in the place for some weeks before a doctor was called and its nature
recognized; the people said they had thought it was a rash due to the children eating
berries. In spite of the long start the infection had, yet, by prompt isolation and removal
of 10 of the cases to Hospital, the disease never spread to any of the hamlets in close
proximity to Collace, and was soon stamped out. The remaining cases were
of an isolated character, and their source traced to contact with visitors or infection
carried from a town. By strict isolation there was no spread of the disease from any
of them.
Enteric Fever caused one death in a young man, who had been long ailing before
his final illness, and no cause was discovered about the premises for the disease.
There were 21 cases of the disease reported during the year, against 6 in 1892. In
one case, the disease was contracted in Blairgowrie; and in 11 more the cause was
traceable to the drinking water being contaminated by the sewage of Blairgowrie and
Rattray, in both of which places the disease was prevalent at the time. There was
no great extension of the disease, and a better supply of water was provided. The
rest of the cases were of an isolated character, in various parts of the District, and
there was no spread of the disease from them.
Diphtheria caused one Death in 1893, the same as in 1892. There were 4 cases
of the disease reported during the year, 2 of these were brought ill into the District
from Forfarshire, and another took ill immediately after returning from a visit to
Perth. In the fatal case the origin of the disease was obscure.
Measles caused 1 Death; the disease was prevalent in some parts of the District
during the later months of the year; the type was mild.
Diarrhœa caused 4 Deaths during 1893, against 3 in 1892, but no epidemic of
the disease was reported.
[Note] 169 |
|
| HH62/45/171 |
[Note] 170
TABULAR STATEMENTS
OF
SICKNESS AND MORTALITY
IN THE
COUNTY OF PERTH.
1893.
[Note] 171 |
|
| HH62/45/173 |
[Note] 172
TABULAR STATEMENT of SICKNESS and MORTALITY referred to in the Regulations issued by the Board
of Supervision for Medical Officers of Counties.
COUNTY OF PERTH AND DISTRICTS.
TABLE I. - Births and Deaths occurring in the County during the Year 1893.
[Table inserted]
NOTES. - The Medical Officer may, if he thinks fit, give separately the figures for any Sub-Divisions of the County: in all cases the Total for the County is to be given.
Deaths of Persons belonging to a County occurring in Public Institutions (as Lunatic Asylums, Poorhouses, Hospitals) outside of the County, are to be included with the figures for that County,
and Deaths of Persons not belonging to a County, occurring in Public Institutions within the County, are to be excluded.
"Diphtheria" shall include "Membranous Croup," "Diphtheritic Croup," "Croupous Diphtheria."
All Deaths from "Diarrhoea," "Dysentery," "Enteritis," "Gastro-Enteritis," "Muco-Enteritis," - unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis-
"Diarrhoea," "Bright's Disease-Diarrhoea," are to entered under the heading "Diarrhoea."
The designation "Other Tubercular Diseases" includes, inter alia, "Tabes Mesenterica," "Tubercular Meningitis," "Hydrocephalus," "Struma," "Scrofula." The headings distinguished by asterisks cover all diseases placed under these headings in the classification of the Registrar-General.
[Note] 173
TABLE II. - Density of Population, Birth Rate, Infantile and other Death Rates.
[Table inserted]
*To be calculated to three places in decimals.
TABLE III. - Cases of Infectious Disease coming to the knowledge of the Medical Officer during the Year 1893.
(Signed) JOHN T. GRAHAM, M.D., Medical Officer.
31st March, 1894. |
|
| HH62/45/175 |
[Note] 174
COUNTY OF PERTH - PERTH DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1893, according to the Registration Districts.
[Table inserted]
[Note] 175
PERTH DISTRICT - Continued.
[Table inserted]
* Acreage included under Auchtergaven, Kinclaven, and Redgorton.
+ After deducting (4336) Acreage of Perth City, formed by parts of Kinnoull, Perth, Scone, and Tibbermore. |
|
| HH62/45/177 |
[Note] 176
COUNTY OF PERTH - CENTRAL DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1893, according to the Registration Districts.
[Table inserted]
* Acreage included under Fowlis-Wester, Little Dunkeld, Methven. Monzie, and Redgorton.
[Note] 177
COUNTY OF PERTH - HIGHLAND DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1893, according to the Registration Districts
[Table inserted]
*1 Acreage included under Dull, Logierait, and Kenmore.
*2 Acreage combined with Dowally.
*3 Acreage included under Dull and Blair-Atholl.
*4 Acreage included under Fortingal.
*5 Acreage included under Moulin.
*6 Acreage included under Blair-Atholl and Moulin.
+ Unclaimed Land adjoining Kenmore.
‡ Land common to Blair-Atholl, Fortingal, and Logierait. |
|
| HH62/45/179 |
[Note] 178
COUNTY OF PERTH - WESTERN DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1893, according to the Registration Districts.
[Table inserted]
[Note] 179
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1893, according to the Registration Districts.
[Table inserted]
* Acreage included under Kirkmichael.
+Acreage included under Alyth, Blairgowrie, and Kirkmichael. |
|
| HH62/45/181 |
[Note] 180
County of Perth.
REPORT BY MEDICAL OFFICER
FOR
1894.
[Note] 181 |
|
| HH62/45/183 |
[Note] 182
INDEX.
-- PAGE.
METEOROLOGICAL OBSERVATIONS, -- 4
COUNTY OF PERTH, -- 7
PERTH DISTRICT, -- 15
CENTRAL DISTRICT, -- 19
HIGHLAND DISTRICT, -- 23
WESTERN DISTRICT, -- 27
EASTERN DISTRICT, -- 31
TABULAR STATEMENTS, -- 35
[Note] 183 |
|
| HH62/45/185 |
[Note] 184
METEOROLOGICAL OBSERVATIONS.
From Data supplied by Mr. CROUCHER, Ochtertyre Gardens, Crieff. Height of Station above the Sea, 333 Feet.
[Table inserted]
*First Reading of New Instruments.
[Note] 185
WIND.
[Table inserted] |
|
| HH62/45/187 |
[Note] 186
County of Perth.
FOURTH ANNUAL REPORT BY COUNTY MEDICAL OFFICER,
1894.
The population of the Landward County of Perth, as estimated to the middle
of 1894, was 67,218. As the Registrar General has, during 1894, given effect to
many more of the alterations made on the populations of the component Registration
Districts of the County, by the orders of the Boundary Commissioners, considerable
changes have in several instances been made on the populations of these Districts,
although they have had little or no effect on the County as a whole, the altered
Registration Districts being already entirely included within the County. Moreover,
the navvies employed on large contracts in the Western District having now taken
their departure, the population of that District has returned to its normal, and in
estimating the same for 1894 this has been taken into consideration. Although
considerably reduced, the population of the Western District is still the only one of
the five in Perthshire which shows any signs of increase. During 1894 there were 1493
Births registered in the Landward County, of these 741 were males and 752 females,
and there were 1027 Deaths registered, of which 498 were males and 529 females,
giving a Birth-Rate of 22.21 and a Death-Rate of 15.27, as compared with a Birth-
Rate of 24.14 and a Death-Rate of 16.43 in 1893. The Natural Increase of the
population during 1894 was 466, as compared with 532 in 1893. In persons over 60
years of age there was 485 deaths, or 47.2 per cent. of the total, as compared with
569 in 1893; and in children under one year there were 105 deaths, of which 43 were
ascribed to developmental causes, giving an Infant Mortality of 70.32 as compared
with a Rate of 84.08 in 1893.
During the past year the sanitary condition of the County has been steadily
improving, and the health of its population has been very good. This is attested by
the Death-Rate of 15.27, a figure well below the average of the preceding five years,
and one which has not been equalled since 1886. Moreover, although Infectious
Disease has been very prevalent, the Zymotic Death-Rate was only .966, and the
Infant Mortality (one of the surest guages of the health of a community) was 70.32,
as compared with 84.08, and 87.86, in the two preceding years.
In the report for 1893 reference was made to several large works as likely to be
completed during 1894, but unforeseen difficulties have arisen by which the com-
pletion of the schemes has been delayed. There is, however, every prospect of good
work being accomplished during 1895, as the negotiations of the Sub-Committees
entrusted with the carrying out of these schemes have been nearly completed.
Pollution of Rivers.- The proceedings under the Rivers Pollution Prevention
Act, commenced during 1893, have been maintained during the past year; and, although
little seems to have been actually accomplished, on looking back on the year's work,
at least indifference to the increased pollution of Rivers has been overcome, and the
various District Committees concerned have done everything within their power to
[Note] 187 |
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[Page] 8
forward the work of purification. In the Perth District the purification works in con-
nection with the sewage of Scone were interdicted through a want of attention to the
preliminary steps, previous to commencing operations; but it is anticipated that the
works will ere long be in operation. The works considered necessary for the preven-
tion of the pollution of the Tay by the sewage of Stanley have been authorized to be
carried out at the expense of the District, and there is little doubt that, even if the
necessary land required for the works has to be taken by compulsion, the scheme will
be proceeded with.
In the Central District the pollution of drinking water by the sewage of Crieff was
most successfully dealt with, and the Burgh has given a guarantee that such pollution
will not be permitted for the future. A sample of water taken from one stream be-
fore its pollution was stopped, although under chemical analysis not showing signs
of contamination by sewage, was found on bacteriological examination to contain 17,000
colonies of micro-organisms in each cubic-centimetre, that is a number enormously
in excess of that considered allowable in a safe drinking water, and at the time the
sample was taken this water was undoubtedly causing Enteric Fever amongst those
who used it unboiled. In the Highland District, the purification works in connection
with the sewage of Dunkeld are only waiting till it can be shown that it is
practicable to maintain sewage purification works without causing a nuisance
in their vicinity, the reason for this being that the only available site for these works
at Dunkeld is close to the Village and a public road. In so far as the prevention of
the pollution of the Tay by the sewage of the Burgh of Aberfeldy is concerned,
little except talking has been done by the Police Commission, and the District Com-
mittee will not allow this important matter to rest in its present unsatisfactory con-
dition. In the Western District the pollution of the Forth has been energetically
taken up by the District Committee, as well as the pollution of the Rivers Teith,
Dochart, and Lochay. In connection with the purification of the two last-mentioned
rivers, everything seems to favour an early and satisfactory issue.
In the Eastern District the sewage of the Burgh of Rattray is still discharged
into the Ericht in its crude state; but, although the adoption of purification works is
delayed, there is no intention on the part of the District Committee to allow the
Burgh Commissioners to evade their responsibilities.
In the Perth and Eastern Districts important and very satisfactory changes
have been effected in the appointment, in the former, of five Assistant Sanitary
Inspectors to undertake the whole work of the District, and, in the latter, of a single
Assistant. These changes have not much increased the expenditure and have very
much improved the administration of the Public Health Acts in the respective
Districts.
The Sale of Food and Drugs Act. - This Act has been administered during the
past year by the County Police, and the Report of the Chief Constable of the County
shows that good work has been done.
The Bye-Laws in connection wth Slaughter-houses have proved helpful in pre-
venting the erection of unsuitable premises, and as a result new premises are
far in advance of the majority of the older structures erected for this purpose
Meteorological Tables. - Through the kindness of Sir Patrick Keith Murray
of Ochtertyre, it has been possible to add to these during the latter half of the year
a new series of readings, namely, those of the underground temperatures, at depths from
3 to 48 inches. Sir Patrick Keith Murray, understanding that the Medical Officer
was anxious to obtain regular records of those temperatures, very generously ordered a
complete set of new instruments for the Ochtertyre Station. It is anticipated
[Note] 188
[Page] 9
that the readings obtained from these instruments will prove to be of great
value. During the year, selected readings of the various instruments at the
Ochtertyre Meteorological Station have been kindly supplied by Mr. Croucher,
who, besides being a careful observer, takes a keen interest in the influence of
Meteorological conditions on the health of the community.
During 1895 the Parish Councils will come into existence, and the discharge of
many important duties will fall upon them.
In so far as their power to form scavenging districts - which is one feature of the
new Local Government Act - is concerned, Perthshire has, under the power given in
the Public Health Act, already provided a scavenger in every large centre where it
was considered necessary. The wages of these scavengers are paid out of the District
Rates, and the scavengers are entirely under the control of the Chief Sanitary
Inspector. Their position is thus very different from that of the scavengers who
will be appointed under the Parish Councils. The latter will be responsible to the
Committees of the various small Districts appointing them, and will, in all probability,
assume the same attitude as the officials appointed by the Special Drainage District
Committees under the Public Health Act, which is one of the absolute independence in so
far as the Officials of the Local Authority are concerned. This is a position of affairs
which is not at all in accordance with the principle of the Local Government Act of
1889, and it will be a step backwards if the Act of 1894 leads to a decentralization of
the control of sanitary matters.
The administration of the Prevention of Cruelty to Children Act, 1894, will also
fall upon the Parish Council, as proceedings under this Act can be instituted by
that body; and when it is stated that the exposure of a young child, so as to
cause such child unnecessary suffering or to injure its health, constitutes an offence
under the Act, it will be seen that it is within the powers of the Parish Council to
deal effectually with the much vexed question of reclaiming the tinkers, and that in
the most effectual manner, by removing the children from their parents at an early
age; for when a conviction under this Act is obtained the Court has not only power
to imprison the person who caused the exposure, but may also take from
the person so convicted the custody of the child, and commit it to a relative
of the child, or other fit person named by the Court, until it attains the age of 16
years.
DISTRIBUTION OF DISEASES.
Respiratory Diseases caused 122 deaths, or 11.8 per cent. of the total during
1894, as compared with 167 in 1893. Of these 122 deaths, 55 occurred in persons over
60 years of age, and 34 in children under one year. Deaths from these diseases show
a considerable diminution, which is probably accounted for by the mild season and the
absence of any great amount of influenza. The following table shows the percentage
of Deaths throughout the County from Respiratory Diseases, and also the percentage
of Sickness in the Central and Western Districts, these being the only Districts in
which the services of the local Medical Officers have been retained, and thus sickness
returns have been available:-
Percentage of Deaths.
PERTH DISTRICT, -- 9.7
CENTRAL DISTRICT, -- 10.9
HIGHLAND DISTRICT, -- 11.4
WESTERN DISTRICT, -- 11.2
EASTERN DISTRICT, -- 18.9
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 32.1
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 28.6
EASTERN DISTRICT, -- No Returns.
[Note] 189 |
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[Page] 10
Circulatory Diseases caused 128 deaths, or 12.4 per cent. of the total during
1894, as compared with 122 in 1893. Of these 128 deaths, the age at death was
over 60 in 93 instances. The distribution of these diseases throughout the County is
shown in the following table:-
Percentage of Deaths.
PERTH DISTRICT, -- 15.3
CENTRAL, -- 13.0
HIGHLAND, -- 8.1
WESTERN, -- 12.5
EASTERN, -- 10.8
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL, -- 8.0
HIGHLAND, -- No Returns.
WESTERN, -- 7.4
EASTERN, -- No Returns.
Tubercular Diseases caused 135 deaths, or 13.1 per cent. of the total during
1894, as compared with 127 in 1893. Of the 135 deaths, 104 were attributed to
Pulmonary Consumption. Doubtless many of these were indirectly caused by the
Influenza epidemics of previous years, but without the specific germ of tubercle,
Influenza would be powerless; and it seems strange that in these days of active
legislation for the benefit of the people such a widespread cause of death and misery
should be allowed an almost unrestrained course, and it may be safely affirmed that
were the same loss to occur amongst cattle, means would be speedily found to combat
the disease. The distribution of Tubercular Diseases throughout the County is
shown in the following table:-
Percentage of Death.
PERTH DISTRICT, -- 14.6
CENTRAL, -- 15.1
HIGHLAND, -- 10.8
WESTERN, -- 13.9
EASTERN, -- 8.7
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL, -- 4.2
HIGHLAND, -- No Returns.
WESTERN, -- 2.4
EASTERN, -- No Returns.
Diseases of the Nervous System caused 109 deaths, or 10.6 per cent. of the
total during 1894, as compared with 100 in 1893. Of the 109 deaths, 77 occurred in
persons over 60 years of age. The following table shows the distribution of these
diseases throughout the County:-
Percentage of Deaths.
PERTH DISTRICT, -- 6.8
CENTRAL, -- 14.3
HIGHLAND, -- 9.2
WESTERN, -- 11.9
EASTERN, -- 12.8
Percentage of Sick.
PERTH DISTRICT, -- No Returns.
CENTRAL, -- 11.4
HIGHLAND, -- No Returns.
WESTERN, -- 13.4
EASTERN, -- No Returns.
Diseases of the Digestive System caused 59 deaths, or 5.7 per cent. of the
total during 1894, as compared with 70 in 1893. Sickness returns, where obtainable,
show that a large proportion of the total is due to these diseases. The following
table shows the distribution of these diseases throughout the County:-
Percentage of Deaths.
PERTH DISTRICT, -- 7.8
CENTRAL, -- 5.4
HIGHLAND, -- 4.3
WESTERN, -- 3.9
EASTERN, -- 5.4
Percentage of Sick.
PERTH DISTRICT, -- No Returns.
CENTRAL, -- 30.3
HIGHLAND, -- No Returns.
WESTERN, -- 39.5
EASTERN, -- No Returns.
[Note] 190
[Page] 11
Cancer and Malignant Diseases caused 56 deaths, or 5.4 per cent. of the
total during 1894, as compared with 49 in 1893. The distribution of these diseases
throughout the County was as follows:- Perth District, 16; Central District, 14;
Highland District, 13; Western District, 6; Eastern District, 7.
Violence caused 40 deaths during 1894, as compared with 43 in 1893. The
distribution of these throughout the County was as follows:- Perth District, 8;
Central District, 7; Highland District, 5; Western District, 12; Eastern District, 8.
Developmental Diseases caused 43 deaths during 1894. Of these 32 were
attributed to premature birth. The number of deaths due to these diseases in 1893
was 56.
Old Age caused 137 deaths, or 13.3.per cent. of the total, as compared with
197 in 1893.
Zymotic Diseases. - 63 deaths were attributed to these during 1894, as
compared with the same number in 1893. In all 612 cases were reported during
1894, against 593 in 1893. The number of these cases removed to Hospital was
80, or 13.0 per cent., and of these only 2 died; the other 532 cases were treated at
home.
Smallpox. - No deaths occurred from Smallpox during 1894, and there were
only two cases of the disease reported. One of these cases occurred in Muthill, the
patient being a visitor from Glasgow; the other was at Inver, near Dunkeld. For
details of these cases reference may be made to the reports of the Central and
Highland Districts. Of the three suspected cases reported, two proved to be
false alarms, but in the third the Perth District had a narrow escape from having
to deal with a case of the disease, as a girl, who had been an inmate of a Smallpox
Hospital in Edinburgh for 10 days, came immediately after her discharge to reside
in the District. The surveillance under which she was kept in Perthshire did not
meet with her approval, and she soon returned to Edinburgh, where she was
re-admitted to the Smallpox Hospital within a few days.
Scarlet Fever was exceedingly prevalent throughout the County, and caused
12 deaths during 1894. In all there were 393 cases of the disease reported, as
compared with 230 in 1893. In many of the outbreaks of this disease the source
of infection was traced to contact with large Towns and Burghs, or to visitors
from these; but in several it was impossible to trace the disease further than to
some unrecognised case, which, being overlooked by the parents, was allowed to
become a centre of infection.
Diphtheria caused 25 deaths during 1894, as compared with 18 in 1893.
During 1894 there were 71 cases of the disease reported - this shows an increase of
17 cases, as compared with 1893. As this disease always owes it origin to insanitary
conditions, the presence of so many cases shows that much work yet requires to be
accomplished ere the sanitary condition of the County reaches the perfection to be
desired. When cases of the disease have occurred an endeavour has been made to
ascertain the source of the disease, and the remedial measures considered necessary
to remove the same have been taken.
Enteric Fever caused 5 deaths during 1894, as compared with 4 in
1893. There were 65 cases of the disease reported during the year. The
majority of these occurred in the Perth, Central and Western Districts. In the
Perth District no steps have as yet been taken to form the Village of Bankfoot into a
Special Water and Drainage District, which is, in my opinion, the only means of
securing that place from the almost continuous presence of Enteric Fever. In the
Central District the occurrence of an outbreak of Enteric Fever has always been
[Note] 191 |
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followed by the removal of the causes of the disease, and the experience of the past
year has been no exception to this. In the Western District the cause of a large
number of the cases of Enteric Fever was the pollution of the River Forth by
sewage. The remedy of this opens up a very large question affecting, not only
Perthshire, but also the Central District of Stirlingshire. The Western District
Committee have, however, energetically faced the difficult problem.
TABLE showing the prevalence of certain Zymotic Diseases in the several Districts
during the different Months of 1894.
[Table inserted]
Measles caused 1 death during 1894, as compared with 7 in 1893. The disease
was prevalent in many parts of the County, and, although the type of the epidemic
[Note] 192
DIAGRAM
showing the prevalence of
SMALLPOX, DIPHTHERIA, SCARLET FEVER & ENTERIC FEVER
DURING 1894
[Graph inserted]
[Note] 193 |
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[Note] 194
[Page] 13
was severe, the absence of complications accounts for the small number of
deaths.
Diarrhoea caused 8 deaths during 1894, as compared with 20 in 1893. There
was no epidemic of the disease, a fact probably accounted for by the temperature
of the ground never reaching the height which is most favourable for the production
of the poisons producing these outbreaks.
Whooping-Cough caused 14 deaths during 1894, as compared with 5 in 1893.
Deaths Uncertified, or from causes insufficiently stated, were 68. The number
in 1893 was 85.
To the Registrars of the various Registration Districts, within the County,
thanks are due for supplying returns of Births and Deaths during the year, as well
as to many of them who took much trouble to secure certificates of the cause of
death, thus making the returns more valuable.
The arrangement made by the Perth, Central, Highland, and Eastern District
Committees with the Perth Royal Infirmary to provide accommodation for infectious
cases requiring Hospital treatment has again been found to suit exceedingly well.
It is now two and a half years since this arrangement has been made use of, and as it
was only made for a term of five years, it will fall to these District Committees by the
end of 1895 to consider what steps shall be taken to provide accommodation for their
fever cases when the present arrangement terminates. It has been abundantly
proved that, with the means of transporting patients as the disposal of the
Local Authorities of Perthshire, a central Hospital is quite available for all parts
of the County, so that should it be deemed advisable to build, one large central
Hospital would meet all requirements, and thus the expense of maintainence and the
difficulties of administration would be reduced to a minimum. In the past the
County Medical Officer has, from his position on the Medical Staff of the Infirmary,
been in a position to supervise the arrangements for the admission and treatment of
patients admitted from the County, but by the time this Report is in the hands of
the public, he will cease to have any official connection with the Institution, and
as a consequence, his power of supervision will also be at an end. In the Western
District two Portable Hospitals, capable of accommodating from eight to ten patients,
have been in use during the year, and have proved eminently satisfactory in so far
as the treatment of patients is concerned; with one of them, however, considerable
annoyance was caused by those on whose ground it was erected. To obviate this
for the future the District Committee have now secured permanent sites to
which these Hospitals are to be removed when not in use in other parts of
the District. The Ambulance Waggon has done good service during the past
year, and thanks are due to the officials of the various Railway Companies
concerned, who have often, at great inconvenience, made arrangements which
materially shortened the time usually occupied in transit. In each of the five
Districts provision has now been made for the isolation and treatment of cases of
Smallpox.
The Infectious Disease Notification Act has, for the greater part of the past year,
been in operation throughout the Lowland County. In the Central and Western
Districts the operation of this Act has been very successful, but in the Perth,
Highland, and Eastern Districts, although the working of the Act has been fairly
satisfactory, there is still room for improvement, which will be enforced, if necessary,
during 1895. The difficulty referred to has not been due to wilful failure to notify,
for which the Act provides an effectual remedy, but from a failure on the part of
the householders to acquaint themselves of the nature of the disease in their houses
by calling in a Medical man.
[Note] 195 |
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The County Council and District Committees have, by their courtesy and
support, done their utmost to lessen the labours of the Public Health Department,
and, personally, I would take the opportunity of returning thanks to them for the
kindness and consideration shown.
JOHN T. GRAHAM,
County Medical Officer.
31st March, 1895.
[Note] 196
Perth District.
The population of the Perth District, estimated to the middle of 1894, was
20,886. During the year there were 468 Births (227 Males and 241 Females), giving
a Birth-rate of 22.40, and 307 Deaths (166 Males and 141 Females), giving a Death-
rate of 14.69. In 1893 the Birth-rate was 26.98, and the Death-rate 16.12. The
Natural Increase of the population during 1894 was 161, against 231 in 1893.
Deaths in persons over 60 years of age were 137, or 44.6 per cent. of the total,
and of infants under one year there were 44 Deaths, of which 17 were due to
developmental causes, giving an Infant Mortality of 94.0, against 78.3 in 1893.
Zymotic Diseases caused 29 Deaths in 1894, against 26 in 1893, giving a Zymotic
Death-rate of 1.38, against 1.22 in 1893.
The advance made in the sanitary condition of the Perth District, referred to in
the previous Reports, has been steadily maintained during 1894. The improvements
of the past year have been rather the result of action taken in former years and of the
ordinary routine work, coupled with a steady enforcement of the provisions of the
Public Health Acts, than of the execution of any large works. Of the large works
referred to in the Report for 1893, as likely to be completed during 1894, none were
completed. The delay in carrying out these works was not due to any want of will
on the part of the District Committee, or those directly concerned in the schemes,
but to the difficulty, in the case of water supplies, of obtaining water on reasonable
terms, and, in the case of sewage purification works, of obtaining land on which to
erect the necessary works. As an instance of how greatly the obtaining of a water
supply is obstructed by so-called scientists, it may be mentioned that in one agree-
ment drawn up under their guidance, the following clause occurs:- "The
Proprietor reserves to himself the full right to cultivate and manure the whole or
any portion of the gathering ground . . . . . . . which is at present in
pasture, free from any claim or charge, at the instance of the County Council,
in respect of pollution or otherwise." Again, in the carrying out of sewage
purification works, the usual difficulties met with are that when attention is first
drawn to the necessity for such works being undertaken, those pecuniarily interested
discover that nothing but clean water passes through the drains, and that no offence
can possibly be caused. When a statement is produced showing how many sinks,
&c., communicate with the drains, it is then alleged that the purification works will
cause an "intolerable nuisance." That some so-called sewage purification works have
proved a nuisance is true enough. Both settling ponds and irrigation fields con-
nected with Burghs in the County have, from neglect, come to such a condition, but
were these same works attended to as they should be, nothing in the shape of a
nuisance would result. It is confidently hoped that the proposed purification works
at Scone will soon be in operation, and it will then be possible to show that sewage
purification can be carried out without any offence.
The sanitary condition of the villages in the District has undergone a most
marked change for the better; the results of the operations of the village scavengers
having exceeded even the most sanguine expectations. In some of the villages,
however, there exists a crying need for the introduction of a water supply, or
[Note 197] |
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drainage, or both, and as yet no steps have been taken by the inhabitants to secure
these. In Scone the necessity for a proper water supply has been proved by the
results of analyses of the water taken from wells in various parts of the village, as in
every instance the samples have been found to be more or less polluted. No steps
have been taken to complete the system of drainage which at present only exists in
a very imperfect form in Scone, but it is hoped that the District Committee will
find means for hastening on both of these important improvements during 1895.
In the village of Errol a proper system of drainage is a necessity, as the present
method of utilising the gutters at the sides of the streets for the purpose of sewers
causes a state of matters offensive to sight and smell, and dangerous to health,
especially in hot weather. The question of securing a pure water supply for this
village must also be faced, as analysis has shown that the few wells are bad on
which the inhabitants depended for water for domestic purposes, and on which the
Parochial Board (then the Local Authority) expended much money in the past with
a view to render them pure. In Stanley the necessity for a proper system of
drainage is urgent, as the present system in which roadside drains and open ditches
are made use of is both dangerous and offensive. In Bankfoot both a water supply
and drainage system are urgently needed, and the District Committee should lose no
time in seeing that these are provided.
The Carse of Gowrie Water Supply District has now, after much trouble,
secured a sufficient supply of water, and it is expected that the water will be available
before summer. The Almondbank and Bridgeton Water Supply District has also
secured a supply of water, and, it is hoped, will soon have the benefit of it.
2. General enquiries have been made into the Sanitary condition of the District,
and many special enquiries have been necessitated in connection with tracing the
source of Infectious Disease, and securing the safe isolation of sufferers from these
diseases. Much extra labour, which was ungrudgingly given, was entailed in getting
the Infectious Disease Notification Act fairly put into operation in the District, and
many special visits were made at the request of local medical men to meet them in
consultation over doubtful cases.
3. No certificates have been granted during the year under the Public Health
Acts, neither has any action been required to be taken in connection with the
sanitary condition of Factories and Workshops.
4. Retail Bakehouses. - There are sixteen of these in operation in the Perth
District; they have been inspected during the year, and found to be kept as required
by the Act. Young persons found employed in the Bakehouses have been reported
to the Inspector of Factories.
5. The arrangement made with the Perth Royal Infirmary, to receive cases of
Infectious Disease from the Perth District, has been fully taken advantage of during
the year, and has been found in practice to work very well. During the year, 38
cases were removed by the Local Authority to Hospital. From his position on the
Acting Staff of the Infirmary, the District Medical Officer has had ample opportunities
for supervising the management of the infectious cases while under treatment. The
accommodation for Infectious Diseases in the Infirmary has proved sufficient, although
the number of Scarlet Fever patients at one time threatened to overfill the wards set
apart for these.
6. During 1894 the Infectious Disease Notification Act has been in operation
in the Perth District, and has, to a certain extent, assisted the Department in dealing
successfully with Infectious Disease; but in many instances, from the fact that no
doctor was in attendance on the patients, the nature of the disease was unrecognised
[Note] 198
[Page] 17
until they were hunted up after the notification of later cases infected from them.
In all known cases of Infectious Disease removal of the sick to Hospital has been
recommended, when this was considered necessary for the protection of the public;
and, when removal was refused, isolation of the sick from the healthy has been insisted
upon. Houses in which cases of Infectious Disease occurred have been examined,
and defects ordered to be remedied as soon as possible after the recovery of the
patients.
7. Respiratory Diseases caused 30 deaths during 1894, as compared with 52 in
1893. Of the 30, six occurred in children under one year, and fourteen were in
persons over sixty years of age.
Tubercular Diseases caused 45 deaths during 1894, as compared with 34 in
1893. Of the 45 deaths, 35, or 77.7 per cent. were due to Pulmonary Phthisis.
This shows an increase of 11 from Phthisis during 1894, and is accounted for by the
prevalence of Influenza during the previous year. Deaths from Tubercular Diseases
formed 14.6 per cent. of the total, and show a very large mortality still due to them,
a mortality which might be largely reduced were full powers given to Local
Authorities.
Nervous Diseases caused 21 deaths during 1894, as compared with 32 in 1893.
Of the 21 deaths, 15 were in persons over 60 years of age.
Circulatory Diseases caused 47 deaths during 1894, as compared with 34 in
1893. Of the 47 deaths, 33 were in persons over 60 years of age.
Diseases of the Digestive System caused 24 deaths during 1894, as compared
with 19 in 1893.
Cancer and Malignant Diseases caused 16 deaths during 1894, as compared
with 16 in 1893. Of the 16 deaths, 7 occurred in males and 9 in females.
Old Age. - This was given as the cause of death for 35, or 11.4 per cent. of the
total. In 1893 the deaths from Old Age were 64.
Violence. - Eight deaths were attributed to Violence in 1894, as compared with
14 in 1893.
Zymotic Diseases caused 29 deaths during 1894, as compared with 26 in 1893.
The Zymotic Death-Rate was 1.38 per 1000 of the population.
Diphtheria caused 11 deaths, as compared with 12 in 1893. In all 25 cases of
Diphtheria were reported during 1894, thus giving a case mortality of 44.0 per
cent. Many of the cases occurred singly throughout the District, but groups of
cases occurred in Invergowrie and Stanley. Six patients suffering from Diphtheria
were removed to Hospital, and all recovered; the fatal cases occurred amongst
patients treated at home.
Scarlet Fever caused 6 deaths, as compared with 1 in 1893. in all 124 cases of
Scarlet Fever were reported during the year. Removal to Hospital was carried out
in 26 of these 124 cases, and all of the patients removed made good recoveries. The
type of the Disease during 1894, although mild in the main, showed a greater
malignancy than in 1893. A large proportion (38) of the cases reported occurred in
Bankfoot and its immediate neighbourhood, and were doubtless due to failure to
notify on the part of some of the guardians of the patients.
Enteric Fever caused 1 death during 1894, as compared with 2 in 1893. In all
21 cases were reported during 1894. The fatal case occurred in a young man who
was removed to Hospital from Errol at an advanced stage of the disease. As usual,
a large proportion (8) were in Bankfoot, and it behoves the inhabitants to bestir
themselves to have the sanitary condition of the village remedied by its formation
into a Special Water and Drainage District.
[Note] 199 |
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Whooping-Cough caused 8 deaths during 1894, as compared with 1 in 1893.
The Disease was prevalent in the District, and although on the whole its type was
mild, in several localities it was the reverse.
Diarrhœa caused only 2 deaths during 1894.
Deaths in which the cause of death was uncertified or insufficiently stated were
16, against 17 in 1893.
[Note] 200
Central District.
The population of the Central District, estimated to the middle of 1894, was
14,000. During the year there were 326 Births (171 Males and 155 Females), and
237 Deaths (108 Males and 129 Females), giving a Birth-rate of 23.28, and a Death-
rate of 16.92, as compared with a Birth-rate of 23.7, and a Death-rate of 17.8, in
1893. The Natural Increase of the population during the year was 89, as compared
with 83 in 1893. Deaths in persons over 60 years of age were 115, or 48.5 per cent.
of the total, and 18 Deaths occurring in children under 1 year (5 of these were due
to developmental causes), give an Infant Mortality of 55.21 per 1000 Births, as
compared with 125.7 in 1893.
During 1894 satisfactory progress was made in advancing the sanitary condition
of the Central District. Beyond combating infectious diseases the work has been
chiefly routine, a lowered Death-rate, - both under the headings of All Causes and
Under One Year, - is the best proof that it has been of use. In the Report for 1893
several matters were pointed out as requiring attention, but, so far, nothing has been
done.
In the latter part of the year Auchterarder finally decided to throw off the yoke
of the Central District Committee, and went boldly in for Home Rule by having the
Village declared a Police Burgh. With a limited exchequer the ratepayers of the
new Burgh may have reason to regret that, when large expenditure in connection
with Public Health administration is demanded, the funds of the Central District
Committee are not available, but , if one may judge from the salary of the Burgh
Medical Officer, there seems to be no intention on the part of the Local
Authority to depart from the practice of other small Burghs in spending as little
under the Public Health Department as possible. In so far as the Burghs them-
selves are concerned, the fact that their Local Authorities, by want of Hospitals and
non-administration of the Public Health Acts, allow infectious disease to pursue a
practically unchecked course, is no business of the Local Authorities in the Landward
Districts. But as the Burghs are the centres on which the Landward Districts
depend for supplies, and often also for education, it will be easily understood that,
indirectly, the Landward Local Authorities, who are spending a large sum in properly
administering the Public Health Acts, are interested that Burghs should advance in
line with them.
In Comrie the inhabitants have at last shown a disposition to move in the
direction of securing for that Village a proper drainage; this is a matter of great
importance for the health of the place, and one to which the District Committee
should give every encouragement. One difficulty in the way of draining Comrie
efficiently arises from the levels of the ground surrounding the Village being
exceedingly flat, but this difficulty could be easily overcome, as there is an abundant
supply of water power, which could be utilised to raise the sewage to such a level as
would allow it to be used for irrigation purposes.
After considerable difficulty the Crieff Local Authority have been convinced
that it is their duty to see that the sewage from the Burgh should not be allowed
to pollute the water supplies of the neighbouring Landward District, but it was only
[Note] 201 |
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on the occurrence of cases of Enteric Fever, both within and without the Burgh, that
practical steps were taken to put the sewage irrigation works on a sound footing.
The necessity for providing a proper water supply for a large tract of country to the
east of Crieff was under the consideration of the District Committee during the
year, though from the failure of the inhabitants to agree as to the exact area, and the
absence of a properly drawn up requisition to the District Committee to form the
area into a Special Water Supply District, nothing definite was accomplished. Two
essential points have, however, been prominently brought out; first, that there is an
urgent need for a water supply; and second, that an abundant supply of pure water
is obtainable at a reasonable cost. In these circumstances there is little reason to
doubt that a plentiful supply of pure water will soon be provided.
2. During the year general enquiries have been made with a view to ascertain
the sanitary condition of the District, and special visits were frequently required to
investigate the source and secure the isolation of cases of infectious disease.
In spring a case of Smallpox was discovered in Muthill (the patient had come
from Glasgow for a change), and it was only by the exercise of constant vigilance that
the disease was prevented from spreading at a time when, had it done so, the
reputation of the District as a health resort would have been seriously injured. It
was well for the Central District that, having a Portable Hospital stored and ready
to accommodate such cases, it was possible to thoroughly isolate the first case on
short notice.
In Dunning, cases of Diphtheria have occurred from time to time, and have
caused considerable anxiety. The origin of these cases seems to be the antiquated
drainage system, which is entirely unfit to cope with the necessities of such a large
village possessing a gravitation water supply. The only remedy will be to form the
place into a Special Drainage District, under which the drainage might be re-
modelled and brought up to modern requirements.
3. Advice was required in connection with the occurrence of cases of infectious
disease within the District. No certificates have been required to be granted under
the Public Health Acts, nor has action been necessary in connection with the
sanitary condition of Factories and Workshops.
4. The Retail Bakehouses under the jurisdiction of the District Committee have
been inspected during the year; they were all found to be kept in good order, and
where young persons were found employed, the fact was reported to the Inspector of
Factories. By the formation of Auchterarder into a Burgh, the Bakehouses situated
within the Village now cease to be under the jurisdiction of the Central District
Committee. This reduces the number of Retail Bakehouses to 14. Two of the
Bakehouses are in new premises, which are admirably suited for the purpose.
5. During the past year, the arrangement by which the Perth Royal Infirmary
has been made the Infectious Hospital for the Central District, was found to
work satisfactorily. Seventeen patients were removed, and all made good recoveries.
The District Medical Officer has had ample opportunities of supervising the treatment
and isolation of patients in the Infirmary. When the Smallpox case occurred at
Muthill, the Portable Hospital was erected in a field near the Village, and the
patient removed thither without delay. The District Medical Officer had full
supervision of all arrangements in connection with the Hospital, the local medical
man being employed to attend on the patient.
6. Since March the Infectious Disease Notification Act has been in operation in
the Central District, and has been of much service in securing the prompt isolation
and, where necessary, removal of those suffering from infectious disease. As the
[Note] 202
[Page] 21
medical men in the District have all along been in the habit of working hand in hand
with the District Medical Officer, no difficulty was experienced in securing full
notifications of the cases. By the removal of insanitary conditions, and the provision
of pure water supplies in place of those regarded with suspicion, much has been done
to prevent the occurrence of infectious disease, and, when such disease has occurred,
measures have been promptly taken to protect the public from danger.
Respiratory Diseases caused 26 deaths, or 10.9 per cent. of the total in 1894,
as compared with 38 in 1893. Of the 26 deaths, 11 occurred in persons over 60
years of age, and in 3 the age was under 1 year. Sickness returns show that 32.1
per cent. of the total was due to this class of diseases.
Circulatory Diseases caused 31 deaths, or 13.0 per cent. of the total during
1894, as compared with 41 in 1893. Of these 31 deaths, 25 were in persons over 60
years of age. Sickness returns show that 8.0 per cent. of the total was due to this
class of diseases.
Tubercular Diseases caused 36 deaths, or 15.1 per cent. of the total, as com-
pared with 30 in 1893. Of these 36 deaths, 29 were certified as due to Phthisis.
Sickness returns show that 4.2 per cent. of the total was due to this class of diseases.
During 1894, as in 1893, Auchterarder stands prominent by the large number of
deaths returned from it as due to Tubercle; the Local Authority of the new
Burgh will require to do their utmost if they wish to present a health report such
as a village in the situation of Auchterarder ought to show, for 1895. In so far as
the Central District is concerned, we may fairly anticipate, from the removal of the
Auchterarder contingent, a considerable improvement in the Tubercular Death-Rate
during 1895.
Diseases of the Nervous System caused 34 deaths, or 14.3 per cent. of the
total, during 1894, as compared with 30 in 1893. Of these 34 deaths, 24 occurred in
persons over 60 years of age. Sickness returns show that 11.4 per cent. of the total
was due to this class of diseases.
Diseases of the Digestive System caused 13 deaths, or 5.4 per cent. of the
total, during 1894, as compared with 18 in 1893. Sickness returns show that 30.3
per cent. of the total was due to this class of diseases.
Rheumatic Diseases caused 1 death during 1894. Sickness returns show that
8.1 per cent. of the total was due to this class of diseases.
Cancer and Malignant Diseases caused 14 deaths, or 5.9 per cent. of the
total, as compared with 13 in 1893. Of those who died from this class of diseases in
1894, 4 were males and 10 females.
Developmental Diseases caused 6 deaths during 1894; 4 of these were due
to premature birth.
Old Age was the cause of death in 27 instances, or 11.3 per cent. of the total.
In 1893 the number was 19.
Violence caused 7 deaths during 1894, as compared with 5 in 1893.
Zymotic Diseases caused 15 deaths in 1894, as compared with 16 in 1893.
The Zymotic Death-Rate was 1.07 in 1894, against 1.135 in 1893.
Smallpox .- In April the Central District Committee was unfortunately put
to considerable expense by the discovery of a case of Smallpox in a house in Muthill.
The patient was a visitor who had come from Glasgow for change of air. Fortunately
the nature of the illness was discovered in time to prevent the disease from spreading
amongst the inhabitants. Immediately the disease was recognised a nurse was put
in charge of the case, and as soon as the Portable Hospital was ready for occupation
the patient was removed to it. To prevent the disease from spreading, everyone who
[Note] 203 |
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had been in contact with the patient was re-vaccinated and kept under observation
during the period of incubation. The room from which the patient had been removed
was thoroughly disinfected, and all clothing therein contained was destroyed. The
measures adopted were thoroughly effectual, as there was no spread of the disease;
but the expense of the outbreak amounted to over £70. So soon as the patient was
discharged the Hospital was disinfected, taken down, and returned to its shed in
Crieff without any harm resulting to any of those engaged in the work, thus proving
that these buildings can be effectually disinfected.
Scarlet Fever caused 1 death during 1894. In all 59 cases were reported;
14 of these patients were removed to Perth Hospital, and made good recoveries.
The cases of Scarlet Fever were widely scattered throughout the District; but the
only localities in which difficulties were experienced in stamping out the disease were
Auchterarder and Blackford. The type of the disease was mild, which, in many
instances, made its recognition difficult.
Enteric Fever caused 2 deaths during 1894, as compared with 1 in 1893. In
all 15 cases of the disease were reported during the year, and of these only two were
removed to Hospital, where they made good recoveries. The majority of the cases
of this disease occurred in the vicinity of Crieff, and were more or less directly caused
by drinking water polluted by Crieff sewage. Considerable trouble and expense were
incurred by the proprietors, whose water supplies were contaminated, in protecting
them temporarily against pollution; and, finally, the District Committee, by
threatening to take action under the Rivers Pollution Prevention Act against the
Town Council of Crieff, secured the diversion of the sewage from the vicinity of the
stream. The water of this stream is, at its best, only of secondary quality, and it is
to be discarded as soon as the Madderty Water Supply District has been formed.
Diphtheria caused 5 deaths, as compared with 2 in 1893. In all 21 cases of
the disease were reported during the year (only 1 was removed to Hospital); 10 of
these were from Dunning and its neighbourhood, the others were scattered through-
out the District. In connection with most of the cases, insanitary conditions were
discovered which accounted for the disease. These have been mostly remedied; but
in Dunning the continuous occurrence of Diphtheria cases points to the faulty
condition of the drains, and the inhabitants cannot too early requisition the District
Committee to form the Village into a Special Drainage District, so that a new system
of drainage may be laid down to replace the present one, which is completely out of
date.
Whooping-Cough caused 2 deaths during 1894, as compared with 3 in 1893.
Diarrhœa caused 4 deaths during 1894, as compared with 7 in 1893.
Influenza caused 1 death during 1894, as compared with 6 in 1893. Sickness
returns show that 4.2 per cent. of the total was caused by Influenza.
Deaths in which the cause was uncertified, or insufficiently stated, were 14 in
1894, as compared with 15 in 1893.
[Note] 204
Highland District.
The population of the Highland District, estimated to the middle of 1894, was
12,772. During the year 1894 there were 250 Births (132 Males and 118 Females),
and 184 Deaths (82 Males and 102 Females), giving a Birth-rate of 19.57, and a Death-
rate of 14.40, as compared with a Birth-rate of 21.4, and a Death-rate of 15.27 in
1893. The Natural Increase of the population during 1894 was 66, as compared with
79 in 1893.
Of the 184 Deaths 103, or 55.9 per cent. of the total, were in persons over 60
years of age, and 11 were in children under 1 year, giving an Infant Mortality of
44.0, against 50.7 in 1893.
The improvement in the sanitary condition of the Highland District, referred to
in former Reports, has been steadily maintained during 1894. This is evidenced by
reduced Death-rates under the headings of All Causes, Infant Mortality, and Zymotic.
Much good work has been accomplished during the year, but this has been chiefly of
a routine character. Pitlochry has now the advantage of a new water supply of
excellent quality, and steps have been taken to secure the extension of the irrigation
fields in connection with the drainage system of that Village, the former fields having
proved too small for the proper purification of the sewage. An attempt has also
been made to remedy the flooding which formerly occurred in certain parts of the
Village during heavy rainfalls, when the sewers overflowed, and much damage was
caused to properties. The overcrowded condition of the Burying-Ground at
Moulin has been under the consideration of those concerned, and it has been decided
to open a new Burying-Ground nearer to Pitlochry.
The disposal of the drainage of Dunkeld has also been under consideration.
The scheme for purifying the sewage, before its discharge into the Tay, has
practically been decided upon, but the carrying out of the works has been delayed
until it is seen whether one of similar works, to be established in another part of the
County, causes any nuisance in its neighbourhood. The reason for more than
ordinary caution is that the only available ground at Dunkeld is situated close to the
Village. In so far as the Burgh of Aberfeldy is concerned, nothing has as yet
been done to prevent the pollution of the Tay, and the District Committee should
lose no time in putting the Rivers' Pollution Prevention Act in force against the
Police Commissioners. At the Perth District Lunatic Asylum, Murthly, a sewage
irrigation scheme is under consideration, and when this is complete it will remove a
large pollution from the Tay.
Considerable anxiety was awakened in June by the notification of a case of
Smallpox in the vicinity of Dunkeld. There were several difficulties in the way of
this case being successfully dealt with. In the first place no accommodation had
been provided by the Highland District Committee for the isolation of Smallpox
cases; and second, through the action of the doctor and the person in charge of the
case, no supervision of the isolation of the patient, or of those who had been in con-
tact with him, was possible. In the circumstances the only mode of protecting the
neighbours was to isolate the infected house and those living in it. This was
accomplished by removing the family who lived next door, with all their furniture,
to a Portable Hospital erected in a field close at hand. The reason for so doing was
[Note] 205 |
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that the separation between the infected house and this family was only a very
imperfect partition, and as the head of the removed household was the Rural
Postman, it was important that his surroundings should be kept free from infection.
At first everything seemed to be in favour of a wide spread of the disease, but
fortunately no more cases occurred.
During the early part of the year a large number of navvies were employed on
the Moor of Rannoch in making the West Highland Railway, and after the
experience at Crianlarich during the previous year, considerable anxiety was felt lest
a repetition of that Smallpox outbreak should take place. However, the fears
proved groundless, and the men enjoyed perfect freedom from infectious disease
during their stay on the Moor. The only difficulty experienced was in preventing
the hutkeepers from overcrowding the huts.
2. General Inspections have been made with a view to ascertain the sanitary
condition of the District, and much extra work has been entailed by special
enquiries necessitated in connection with the outbreak of Infectious DIsease, or cases of
suspected Infectious Disease.
3. Advice was given in connection with the prevention of the Pollution of Rivers,
with regard to the improving of water supplies, and in connection with nuisances
reported. No action has been required in connection with the sanitary condition of
Factories and Workshops.
4. Retail Bakehouses. - These have been inspected during the year and found
to be kept in good order, with the exception of the Rannoch Bakehouse. Where
young persons have been found employed in Bakehouses, the fact has been reported
to the Inspector of Factories.
5. The arrangement by which the Perth Infirmary was made the Infectious
Hospital for the Highland District, has been found to work well during the past year.
Eight patients were removed to Hospital, and wth the exception of one poor tinker
woman, who was removed in the last stages of Puerperal Fever, all made good
recoveries. The District Medical Officer has had ample opportunities of supervising
the isolation and treatment of patients removed to Hospital from the Highland
District. A Portable Hospital for the isolation of Smallpox cases has now been
provided for the District, but has only been used for the purpose of isolating the family
whose house was in dangerous proximity to one infected with Smallpox. From
remarks made by the family, who spent a considerable time in the building, there
seemed to be no want of comfort in the Hospital. The building is to be stored, and
will be ready for use should a case of Smallpox occur anywhere in the District.
6. The Infectious Disease Notification Act has been in operation during the
entire year in the Highland District, and has been of considerable service. During
1894 Scarlet Fever has again and again been imported into the Highland District,
but, by careful supervision of the patients, and thorough disinfection of the houses on
the recovery of the patients, the disease has been prevented from obtaining any great
hold. By the removal of insanitary conditions in the surroundings of dwelling-
houses, and the prevention of the pollution of drinking water, much has been done to
prevent the occurrence and spread of such diseases as Diphtheria and Enteric Fever.
On two occasions cases, which in some respects resembled Smallpox, caused consider-
able anxiety; but, as their true nature was early recognised, no panic resulted. As
already stated, one of the Portable Hospitals, similar to those secured by the other
Districts, has been procured, and is now ready for use on very short notice.
Respiratory Diseases caused 21 deaths, or 11.4 per cent. of the total, as com-
pared with 18 in 1893. In 13 of these the age at death was over 60 years.
[Note] 206
[Page] 25
Circulatory Diseases caused 15 deaths, or 8.1 per cent. of the total, as com-
pared with 13 in 1893. In 13 of these the age at death was over 60 years.
Tubercular Diseases caused 20 deaths, or 10.8 per cent. of the total, as compared
with 16 in 1893. In 15 of these the cause of death was Pulmonary Phthisis.
Nervous Diseases caused 17 deaths, or 9.2 per cent. of the total; in 1893 the
number of deaths was the same. In 11 of these the age at death was over 60 years.
Digestive Diseases caused 8 deaths during 1894, or 4.3 per cent. of the total,
as compared with 11 in 1893. In 7 of these the age at death was over 60 years.
Cancer and Malignant Diseases caused 13 deaths during 1894, or 7.0 per
cent. of the total, as compared with 9 in 1893. Of these 13 deaths, 4 were in males
and 9 females.
Developmental DIseases caused 8 deaths during 1894, as compared with 9 in
1893. In 6 of these the cause of death was premature birth.
Old Age caused 37 deaths, or 20.1 per cent. of the total during 1894, as com-
pared with 48 in 1893.
Violence caused 5 deaths during 1894, as compared with 6 in 1893.
Zymotic Diseases caused 4 deaths during 1894, as compared with 6 in 1893.
The Zymotic Death-Rate was .313 in 1894, as compared with .465 in 1893. In all,
119 cases were reported during the year, against 73 in 1893.
Smallpox. - In June a case of Smallpox was reported from Inver, near Dunkeld.
The patient was alleged to have caught infection from Leith, by handling bags of
grain which had come from there. On enquiries, however, it was found that the
grain had been brought in bulk by sea to Perth, and had there been loaded in bags,
and, as no ill results happened in Perth, it is rather unlikely that this was the channel
of infection. The circumstances surrounding this case were very unfortunate, as, by
the action of the doctor in attendance and those in charge of the patient, it was
impossible to verify the diagnosis or to properly secure the safety of the public. It
was only by careful enquiry amongst outsiders that is was possible to find out who
had been exposed to infection, and a goodly number of visitors who had been in the
sick-room shortly before the case was notified, were traced up and re-vaccinated, where
this was thought necessary. One of the most disquieting elements in connection with
the case was the fact that the people kept a cow and sold part of the milk to neigh-
bours, and up to the time of the first visit of the District Officials, the wife who was
nursing her husband ill of Smallpox, was at the same time milking the cow and selling
the milk. This was at once stopped, and all who had partaken of the contaminated
milk were re-vaccinated. As it was impossible to obtain any control over the isolation
of the patient, the family who occupied the adjoining house were removed as has been
already stated. Although the work of protecting the public from danger was much
handicapped by the action of those in charge of the patient, it is satisfactory to be
able to state that there was no spread of the disease.
On two other occasions the Medical Officer was called to advise as to the nature
of cases which were suspected of being Smallpox. In one the disease proved to be
severe Chicken-pox, and in the other Cowpox.
Diphtheria caused 2 deaths in 1894, as compared with 1 in 1893; in all,
8 cases were reported. The cause of the disease was almost invariably found to be
insanitary conditions in the houses or their surroundings. These defects were
remedied.
Scarlet Fever caused 2 deaths during 1894, as compared with 3 in 1893. The
disease was very prevalent in the District at two periods, and in all 89 cases were
reported during the year. The type of the disease was slight, and diagnosis was
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somewhat difficult. In some of the outlying Districts much difficulty was experienced
from the fact that no doctor had been called, and in many instances it was only by
house to house visits that the cases were discovered. Much valuable assistance was
obtained from teachers in some of the Public Schools, who placed the school registers
at the disposal of the Medical Officer, so that the reason of any absences could be
ascertained. In Pitlochry and Moulin this was exceptionally helpful, and it was
by the co-operation of the teachers that it was possible to keep the schools open
and well attended during two outbreaks of the disease.
Enteric Fever. - No deaths were due to Enteric Fever during 1894. Four
cases of the disease were reported; these were in different parts of the District,
and had no connection with each other. During the past two years the Highland
District has been remarkably free from cases of Enteric Fever.
Influenza caused 1 death during 1894, as compared with 4 in 1893.
Deaths in which the cause was uncertified, or insufficiently stated, were 24 during
1894, as against 35 in 1893, and it is hoped that, as time goes on, the numbers coming
under this heading will be still further reduced.
[Note] 208
Western District.
The population of the Western District, estimated to the middle of 1894, was
9884. During the year there were 241 Births (118 Males and 123 Females), and 151
Deaths (70 Males and 81 Females), giving a Birth-Rate of 24.38, and a
Death-Rate of 15.27, as compared with a Birth-Rate of 21.8, and a death-Rate of
14.8 in 1893. The Natural Increase of the population during the year was 90 as
compared with 78 in 1893. Deaths in persons over 60 years of age were 64, or 42.3
per cent. of the total, and there were 15 deaths in children under one year (8 of which
were due to premature birth), giving an Infant Mortality of 62.2, as compared with
90.5 in 1893. The Zymotic Death-Rate was .809, as compared with .719 in 1893.
Sanitary progress has been well maintained in the Western District during 1894,
and the general condition of the District is exceedingly satisfactory. The excep-
tionally heavy work which was necessitated in the District by the presence of the
large number of navvies who were employed in the contracts for constructing the
West Highland Railway and the Glasgow Water Works Extension has been lessened
by the completion of the contracts and the dispersion of the navvies, thus allowing
the population of the District to return to its normal.
The Western District Committee have been, during the past year, energetically
facing the difficult problem of preventing the pollution of the River Forth by sewage,
and, in so far as Perthshire is concerned, good progress has been made. At Aber-
foyle sub-irrigation has been adopted wherever possible, and the discharge of sewage
into the River has been stopped. There are, however, a number of houses in Aber-
foyle the disposal of whose sewage cannot be so easily accomplished, as the levels and
the impervious nature of the soil render sub-irrigation impossible. There is one way
by which the difficulty might be overcome, that is by raising the sewage by
mechanical power to a sufficient level to allow of its being suitably treated; this
operation need not be an expensive one, as there is ample water power available close
at hand to supply motive power. The Western District of Perthshire have drawn
the attention of the Central District Committee of Stirlingshire to the fact that
sewage from the latter District is allowed to enter the Forth without purification, and
have invited them to join action in the purification of the River, so this work is well
begun.
The Western District Committee having called the attention of the inhabitants
of Killin to the pollution of the Rivers Dochart and Lochay by the sewage from that
Village, the inhabitants petitioned the District Committee to form the Village into a
Special Drainage District; thus it is probable that not only will the pollution of the
river be stopped, but also that the drainage of the Village will be much improved.
The water supply of the Carse Lands, bordering along the River Forth, has been
delayed pending the results of the action which was to be taken by the District
Committee to stop the pollution of the river by sewage; however, matters here seemed
to have reached a crisis at an early period of the year, when a number of cases of
Enteric Fever occurred in several houses which depended on the river water for drink-
ing purposes. The danger was temporarily averted by ordering all water drawn from
the river to be boiled before drinking. With the boiling of the water the disease
ceased, and, as the specific pollution of the river higher up was stopped, there has
[Note] 209 |
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been no return of the disease; but, until permanent measures are adopted to prevent
the risk of such a pollution again occurring, the use of the river water for domestic
purposes cannot be looked upon as safe.
2. General enquiries have been made from time to time to ascertain the sanitary
condition of the District, and many special enquiries have been necessitated in con-
nection with the isolation and accommodation of cases of Infectious Disease, as well as
in endeavouring to secure suitable sites for the Portable Hospital (no easy matter in
some parts of the District), and the examination of alleged nuisances with a view to
granting certificates.
3. Advice was given in connection with the Prevention of the Pollution of
Rivers and Nuisances, together with the selection of suitable sites for Hospitals. No
certificate was given under the Public Health Acts during the year, neither was any
action necessary in connection with the sanitary condition of Factories and Work-
shops within the District.
4. Retail Bakehouses within the Landward portion of the Western District have
been inspected and found to be kept in good order. Where young persons were
found to be employed, the fact was reported to the Inspector of Factories.
5. The Portable Hospitals belonging to the Western District Committee are
entirely under the supervision of the Medical Officer. When in use the services of a
local medical man are retained for the treatment of the patients who may be removed
to the Hospital. These Hospitals have been found to answer their purpose exceed-
ingly well, and those who have lived in them pronounce them very comfortable. It
has been decided to store the second Hospital on a site which has been secured near
Dunblane, but, instead of placing the dismembered building in a store-shed, to erect
it on concrete foundations in the same way as the other Hospital in the Killin
District. This was found to be advisable on account of the annoyance caused by threats
of legal action on the part of those interested in the ground on which the Hospital
has been erected when taken to the neighbourhood of infected houses. On the site
at Dunblane the Hospital will be ready to admit patients who can bear removal, or,
should that not be possible, it can be removed temporarily to where the patient is.
It is a strange fact that, in the localities where most of the infectious cases have
occurred, and where consequently the Hospital was most required, the greatest
difficulties have been met in securing a suitable site or even freedom from annoyance
when the Hospital has been in use.
6. The Infectious Disease Notification Act has been in operation in the Western
District since March, 1894, and has been of much use in assisting the Local Authority
to stamp out outbreaks of disease. In the Western District, as in the Central, no
difficulty was experienced in securing full notifications of the cases. The energies of
the Sanitary Department have been directed to the removal of causes likely to
engender disease, and when it has unfortunately broken out, every precaution has
been taken to prevent its spread. As it was considered advisable that the Western
District should have a share in the use of the County Ambulance Waggon, a
successful application was made for the same during the year on the advice of the
Medical Officer, and the Western District now enjoys the same facilities for
removal of cases of Infectious Diseases as the other Districts of Perthshire.
In connection with some of the cases of Enteric Fever, where it was impossible
to remove the patients, the District Committee took entire charge of the cases,
providing both for the medical attendance and nursing of the patients. The Western
DIstrict Committee have at all times shown a desire to carry out every suggestion
likely to prevent the origin and spread of Infectious Disease.
[Note] 210
[Page] 29
By the removal of Dr. Bryce, one of the assistant Medical Officers, from the
District, a vacancy occurred on the staff, and to this Dr. J. M. Kay, who had in the
previous year done such good work in connection with the stamping out of the
Smallpox amongst the navvies at Crianlarich, was appointed. It is sad to state that
a chill, caught soon after his appointment, terminated fatally, and by his death the
community lost a skilful and most self-sacrificing medical practitioner, and the Local
Authority a most capable and trustworthy coadjutor.
7. Respiratory Diseases caused 17, or 11.2 per cent. of the total deaths during
1894, as compared with 31 in 1893. In 6 of these the age at death was over 60
years, and in 2 the age was under 1 year. Sickness returns show that 28.6 per cent.
of the total was due to this class of diseases.
Circulatory Diseases caused 19 deaths, or 12.5 per cent. of the total during
1894, as compared with 15 in 1893. Of these 19 deaths, 12 occurred in persons over
60 years of age. Sickness returns show that 7.4 per cent. of the total was due to
these diseases.
Tubercular Diseases caused 21 deaths, or 13.9 per cent. of the total during
1894, as compared with 26 in 1893. Of these 21 deaths, 15 were attributed to
Pulmonary Phthisis. Sickness returns show that 2.4 per cent. of the total was due
to Tubercle.
Diseases of the Nervous System caused 18 deaths, or 11.9 per cent. of the
total, as compared with 8 in 1893. The age at death was over 60 years in 14 of
these 18 deaths. Sickness returns show that 13.4 per cent. of the total was due to
these diseases.
Diseases of the Digestive System caused 6 deaths, or 3.9 per cent. of the
total, as compared with 9 in 1893. Sickness returns show that 39.5 per cent. of the
total was due to these diseases.
Rheumatic Diseases caused no deaths during 1894. Sickness returns,
however, show that 7.5 per cent. of the total was due to these diseases.
Cancer and Malignant Diseases caused 6 deaths, or 3.9 per cent. of the total,
during 1894, as compared with 4 in 1893. Two of those who died were males, and
four were females.
Developmental Diseases caused 8 deaths during 1894. All of these were
attributed to premature birth. In 1893 the deaths from these diseases were also 8.
Old Age was returned as the causes of death in 20 cases, or 13.2 per cent. of the
total, as compared with 33 in 1893.
Violence caused 12 deaths in 1894, as compared with 14 in 1893.
Zymotic Diseases caused 8 deaths, or 5.2 per cent. of the total during 1894, as
compared with 8 in 1893. The Zymotic Death-rate was .809 during 1894.
Smallpox. - Happily there was not even a suspected case during 1894.
Scarlet Fever caused 2 deaths during 1894. In all 73 cases of the disease
were reported during the year, the majority occurring in the Aberfoyle and Gartmore
Districts. How the disease was introduced was not absolutely certain, but there
seemed to be a distinct connection between first cases and the arrivals of visitors from
large centres. Of the 73 cases, 9 were removed to the Hospital, 8 being
treated in the Portable Hospitals, and 1 in Perth Infirmary. All of the cases
removed did well. In connection with the Gartmore cases, proper isolation was
rendered impossible from the fact that the proprietor, on whose ground the building
had been erected (with the consent of the tenant), began to demand the removal of
the Hospital from his ground, just at the time when, by removing patients from
houses where proper isolation was impossible, the disease was almost checked. As
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in these circumstances it was not thought advisable to remove any more cases to
Hospital, and it was also impossible at the time to remove the Hospital to another
site as there were 6 patients in it, the only alternative was to offer removal to Perth.
The parents would not agree to this, and the result was that cases of Scarlet Fever
which, for the safety of the public, ought to have been removed to Hospital, had to
be left at home. The type of the disease was in general mild - both of the fatal cases
occurred in Gartmore - in fact in many of the cases the diagnosis was only possible
when the patients began to desquamate. Two other groups of cases of Scarlet
Fever were distinctly traceable to the wanderings of a convalescent child from a
neighbouring County. It is only fair to state, however, that the disease from which
the child suffered had not been recognised in time to prevent harm being done. The
disease was spread in this instance to points, in one case 6, and in the other 11 miles
from the original centre.
Enteric Fever caused 2 deaths during 1894. As 1 of these deaths was not
registered until January, 1895, it does not appear in the Mortality Tables for 1894.
In all 15 cases of the disease were reported during the year. One group occurred
at Killin where a whole family became infected from a case of supposed Influenza.
There was, however, no spread of the disease beyond the house. The cause of
infection was the return home of the supposed Influenza case. Another group of
cases occurred in the vicinity of the Forth, in the Parish of Kincardine. Here there
were almost simultaneously 10 cases. The only connection in this instance between
the infected houses was that they shared the same drinking water, which was drawn
from the Forth, and so soon as the water was ordered to be boiled before being used for
drinking, the disease ceased. Analysis and bacteriological examination of the water
in the Forth at this point showed it to be greatly polluted.
Diphtheria caused 4 deaths during 1894, as compared with 2 in 1893. As one
of these deaths was not registered until January, 1895, it does not appear in the
Mortality Tables for 1894. In all 11 cases of this disease were reported during the
year, as compared with 10 in 1893. The larger number of the cases occurred in the
Aberfoyle District; there was little spread of the disease beyond the houses in which
it first appeared, and this was as well, as the disease was of a very malignant type.
Diarrhœa caused only 1 death during 1894.
Deaths in which the cause of death was uncertified, or insufficiently stated, were
10, as compared with 6 in 1893.
[Note] 212
Eastern District.
The population of the Eastern District, as estimated to the middle of 1894, was
9676. During 1894 there were 208 Births (93 Males and 115 Females), and 148
Deaths (72 Males and 76 Females), giving a Birth-Rate of 21.4, and a Death-Rate of
15.2, as compared with a Birth-Rate of 24.8, and a Death-Rate of 18.4, in 1893.
The Natural Increase of the population during 1894 was 50, as compared with 61 in
1893. Deaths in persons over 60 years of age were 66, or 44.5 per cent. of the total, as
compared with 95 in 1893; and there were 17 deaths in children whose age was under
1 year. Five of these were due to premature birth, giving an Infant Mortality of 81.7,
as compared with 71.4 in 1893. During 1894 the sanitary condition of the Eastern
District has undergone a decided improvement. This is largely owing to the
District Committee having appointed a single Assistant Sanitary Inspector for the
District, who devotes the whole of his time to the work. The former poorly-paid
Parochial Inspectors have been dispensed with. Since his appointment the Assistant
Inspector has done much good work in the removal of nuisances, and in seeing that
milksellers were registered, as well as that their premises were put and kept in such
condition as the Regulations require.
The Death-Rate of the Eastern District shows a marked decline during 1894
when compared with the Rates of the two preceding years, and part of this
reduction may be fairly claimed to be due to the better sanitary conditions in which the
people now live. No large works have been executed in the District during the
year, but steps have been taken to secure for the Villages of Woodside and Burreltown
a better water supply than is at present available, for even those wells in the
place, which from their situation seemed most likely to be good, have been found to
be unfit for use for domestic purposes.
The Burgh of Rattray has as yet done nothing practical towards preventing the
pollution of the River Ericht by sewage, and the District Committee should not
allow this important matter to be unduly postponed.
A requisition was received from the inhabitants of Rosemount, a district lying
to the south of Blairgowrie, and which at present is badly supplied with water, to
have a Special Water District formed; this was done by the District Committee
Negotiations have been for some time going on between the District Committee and
those in charge of the Blairgowrie Special Water District, with a view to the Rosemount
District obtaining its water supply from Blairgowrie, but as the Blairgowrie
Water District could not guarantee a minimum supply, it was doubtful if it would
be wise to accept water on such terms, as, in the event of any scarcity of water in
Blairgowrie, the Rosemount District might be deprived of gravitation water just at
the time when it was most required. From all accounts there seems to be an
abundance of water in Blairgowrie to meet all requirements and give a large overflow,
and it is to be hoped that some arrangement may be come to by which the Rosemount
District may receive a supply of water at reasonable cost.
2. General enquiries have been made from time to time with a view of
ascertaining the sanitary condition of the District, and special enquiries have been
necessitated in connection with water supplies and outbreaks of Infectious Disease.
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3. Advice has been given in connection with water supplies and the prevention
of the pollution of rivers. No certificates have been required to be granted under the
Public Health Acts, neither has any action been required in connection with the
sanitary condition of Factories and Workshops in the District.
4. Retail Bakehouses - There are now six in operation in the Eastern
District; these were inspected and found to be kept in good order. One new
Bakehouse was opened during the year in Kirkmichael, and the premises, though
rather small, are very suitable for the purposes intended. It would be a decided
benefit to those erecting new Bakehouses if the plans were submitted to the Medical
Officer before building operations are commenced, as, at that time, any little alteration
could be effected without expense, whereas, after the building is finished, changes
sometimes mean considerable outlay.
5. The arrangement by which the Perth Royal Infirmary is used as the
Infectious Hospital for the Eastern District has been found to work well during the
past year. Six patients were removed, and all made good recoveries. The Medical
Officer, from his position on the Staff of the Infirmary, has had full opportunities of
supervising the isolation and treatment of patients removed from the Eastern
District. The Hospital reserved for the treatment of Smallpox cases has not been
required during the year, but, should it be required, it is ready for use on very short
notice.
6. The Infectious Disease Notification Act has now been in operation in the
Eastern District for a little over a year, and, whilst in many instances the notifications
received have been of much service in checking the spread of the disease, yet over
and over again from the ignorance of the householder, and the absence of a Medical
attendant, notifications have failed to give the timely warning expected. When
Infectious Disease has broken out, those in charge have, with one exception, been
found willing to carry out any directions given to ensure the protection of the public.
That these precautions were really attended to is proved by the fact that, although
the outbreaks frequently occurred in circumstances where the least carelessness would
have certainly resulted in a wide-spread dissemination of the disease, it was invariably
confined to the houses in which it first broke out. In all cases of Infectious Disease,
disinfectants have been freely supplied during the illness, and, at its termina-
tion a special supply has been given for the disinfection of the rooms and
clothing.
7. Respiratory Diseases caused 28 deaths, or 18.9 per cent. of the total
during 1894, as compared with the same number in 1893. Of the 28, 11 occurred in
persons over 60 years of age, and 6 in children under 1 year.
Circulatory Diseases caused 16 deaths, or 10.8 per cent. of the total during
1894, as compared with 19 in 1893. Of these 16 deaths, 10 were in persons over 60
years of age.
Tubercular Diseases caused 13 deaths or 8.7 per cent. of the total during
1894, as compared with 21 in 1893. Of these 13 deaths, 10 were attributed to
Pulmonary Phthisis. Deaths due to Tubercular Diseases show a marked decrease
during 1894, and especially so under the heading, "Other than Phthisis."
This is a satisfactory condition of matters.
Diseases of the Nervous System caused 19 deaths, or 12.8 per cent. of the
total during 1984, as compared with 13 in 1893. Of these 19, the age at death was
over 60 in 13.
Diseases of the Digestive System caused 8 deaths, or 5.4 per cent. of the
total during 1894, as compared with 13 in 1893.
[Note] 214
[Page] 33
Cancer and Malignant Diseases caused 7 deaths, or 4.7 per cent. of the total
during 1894, as compared with the same number in 1893. Of the 7 deaths from
these diseases, 4 occurred in males and 3 in females.
Developmental Diseases caused 5 deaths, of which 3 were attributed to
premature birth during 1894, as compared with 8 in 1893.
Old Age was given as the cause of death in 18 instances, or 12.1 per cent. of
the total during 1894. As compared with deaths from the same cause, in 1893 this
shows a decrease of 15 in 1894.
Zymotic Diseases caused 9 deaths during 1894, the same number as in 1893.
The Zymotic Death-rate was .930 for 1894. In all, 78 cases were reported during
the year.
Scarlet Fever caused 1 death during 1894. In all 48 cases of the disease were
reported during the year, as compared with 31 in 1893. The cases of this disease
were widely scattered through the District, but there was never any alarming spread
of the disease, although in many instances whole families were down with it
before its nature was recognised. That there was no wide-spread epidemic in the
District seems wonderful, when the masterly inactivity shown in dealing with
Infectious Diseases in some of the Burghs is taken into account. In one case of the
disease imported into the District from Glasgow, the guardian of the patient defied
the Local Authority, and, in disobedience to the orders of the Medical Officer,
removed the patient by the railway to Glasgow whilst in an infectious condition.
The case was reported fro prosecution, but was spoiled by failure to present it
properly before the Sheriff. Although no conviction was obtained, the proceedings
had a salutary effect.
Enteric Fever. - Seven cases of this diseases were reported during 1894, as
compared with 21 in1893. The type of the diseases was mild, and the cases were
scattered throughout the District. The infection was accounted for either by
contact with infected centres outside the District, or by insanitary conditions of the
premises and surroundings.
Diphtheria caused 4 deaths during 1894, as compared with 1 in 1893. In all
6 cases of the disease were reported during the year, as compared with 4 in1893.
These figures show a case mortality of 66.6, which is exceptionally high, even for such
a fatal disease as Diphtheria. In one case the disease was attributed to the child
having fallen into a cesspool a few days previous to his sickening, and in another
the cause seemed to be a faulty condition of the drainage, but in the other cases the
cause of the disease was uncertain. In many country houses there exists no
provision for ventilating under the floors, and this, when combined with a damp soil
is found to be one of the most certain means of generating the environments which
favour the development of Diphtheria.
Measles caused 1 death during 1894.
Whooping-Cough caused 2 deaths, both in children under 3 years of age.
Deaths in which the cause was uncertified, or insufficiently stated, were 6 during
1894, as compared with 12 in 1893.
[Note] 215 |
|
| HH62/45/217 |
[Note] 216
TABULAR STATEMENTS
OF
SICKNESS AND MORTALITY
IN THE
COUNTY OF PERTH.
1894.
[Note] 217 |
|
| HH62/45/219 |
[Note] 218
TABULAR STATEMENT of SICKNESS and MORTALITY referred to in the Regulations issued by the Local
Government Board for Medical Officers of Counties.
COUNTY OF PERTH.
TABLE I. - Births and Deaths occurring in the District during the Year 1894.
[Table inserted]
NOTES. - The Medical Officer may, if he thinks fit, give separately the figures for any Sub-Divisions of the County : in all cases the Total for the County is to be given.
Deaths of Persons belonging to a County occurring in Public Institutions (as Lunatic Asylums, Poorhouses, Hospitals) outside of the County, are to be included with the figures for that County,
and Deaths of Persons not belonging to a County, occurring in Public Institutions within the County are to be excluded.
"Diphtheria" shall include "Membranous Croup," "Diphtheritic Croup," "Croupous Diphtheria."
All Deaths from "Diarrhoea," "Dysentery," "Enteritis," "Gastro-Enteritis," "Muco-Enteritis," - unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis-
"Diarrhoea," "Bright's Disease-Diarrhoea," are to entered under the heading "Diarrhoea."
The designation "Other Tubercular Diseases" includes, inter alia, "Tabes Mesenterica," "Tubercular Meningitis," "Hydrocephalus," "Struma," "Scrofula." The headings distinguished by asterisks cover all diseases placed under these headings in the classification of the Registrar-General.
[Note] 219
TABLE II. - Density of Population, Birth Rate, Infantile and other Death Rates.
[Table inserted]
*To be calculated to three places in decimals.
TABLE III. - Cases of Infectious Disease coming to the knowledge of the Medical Officer during the Year 1894.
[Table inserted]
(Signed) JOHN T. GRAHAM, M.D., Medical Officer.
31st March, 1895. |
|
| HH62/45/221 |
[Note] 220
COUNTY OF PERTH - PERTH DISTRICT.
Table IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1894, according to the Registration Districts.
[Table inserted]
[Note] 221
PERTH DISTRICT - Continued.
[Table inserted]
*Acreage included under Auchtergaven, Kinclaven, and Redgorton.
+ After deducting (4336) Acreage of Perth City, formed by parts of Kinnoull, Perth, Scone, and Tibbermore. |
|
| HH62/45/223 |
[Note] 222
COUNTY OF PERTH - CENTRAL DISTRICT.
Table IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1893, according to the Registration Districts.
[Table inserted]
+Acreage included under Monzie, Methven, and Little Dunkeld.
*Merged in Methven, Crieff, and Monzievaird and Strowan.
[Note] 223
COUNTY OF PERTH - HIGHLAND DISTRICT.
Table IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1894, according to the Registration Districts.
[Table inserted]
*1 Acreage included under Dull, Logierait, and Kenmore.
*2 Acreage combined with Dowally.
*3 Acreage included under Dull and Blair-Atholl.
*4 Acreage included under Fortingal.
*5 Acreage included under Moulin.
*6 Acreage included under Blair-Atholl and Moulin. |
|
| HH62/45/225 |
[Note] 224
COUNTY OF PERTH - WESTERN DISTRICT.
Table IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1894, according to the Registration Districts.
[Table inserted]
*Acreage included under Killin.
[Note] 225
COUNTY OF PERTH - EASTERN DISTRICT.
Table IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1894, according to the Registration Districts.
[Table inserted]
*Acreage included under Kirkmichael.
+Acreage included under Alyth, Blairgowrie, and Kirkmichael. |
|
| HH62/45/227 |
[Note] 226
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENTS,
For YEAR ending 31st December, 1894.
[Note] 227 |
|
| HH62/45/229 |
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1894.
LOCAL AUTHORITY of the PERTH DISTRICT of the COUNTY of PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 2
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 10
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 228
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1894.
LOCAL AUTHORITY of the CENTRAL DISTRICT of the COUNTY of PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 0
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 229 |
|
| HH62/45/231 |
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1894.
LOCAL AUTHORITY of the HIGHLAND DISTRICT of the COUNTY OF PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 3
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 11
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 230
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1894.
LOCAL AUTHORITY of the WESTERN DISTRICT of the COUNTY of PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 1
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 231 |
|
| HH62/45/233 |
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1894.
LOCAL AUTHORITY of the EASTERN DISTRICT of the COUNTY OF PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 1
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 14
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 232
[Note] 233 |
|
| HH62/45/235 |
[Note] 234
County of Perth.
REPORT BY MEDICAL OFFICER
FOR
1895.
[Note] 235 |
|
| HH62/45/237 |
PERTH : PRINTED BY T. M. McGREGOR.
[Note] 236
INDEX.
-- PAGE.
METEOROLOGICAL OBSERVATIONS, -- 4
COUNTY OF PERTH, -- 7
PERTH DISTRICT, -- 17
CENTRAL DISTRICT, -- 21
HIGHLAND DISTRICT, -- 25
WESTERN DISTRICT, -- 29
EASTERN DISTRICT, -- 33
TABULAR STATEMENTS, -- 37
[Note] 237 |
|
| HH62/45/239 |
[Note] 238
METEOROLOGICAL OBSERVATIONS.
From Data supplied by Mr. CROUCHER, Ochtertyre Gardens, Crieff. Height of Station above the Sea, 333 Feet.
[Table inserted]
[Note] 239
WIND.
[Table inserted] |
|
| HH62/45/241 |
[Note] 240
County of Perth.
FIFTH ANNUAL REPORT BY COUNTY MEDICAL OFFICER,
1895.
The population of the Landward County of Perth, as estimated to the middle
of 1895, was 66,758, but from this the new Burgh of Auchterarder (2554)
has to be subtracted, leaving a population of 64,204 under the District Com-
mittees. During 1895 there were 1481 Births registered in the Landward County,
and 1054 Deaths, giving a Birth-rate of 23.067 and a Death-rate of 16.416, as
compared with a Birth-rate of 22.21 and a Death-rate of 15.27 in 1894. The Natural
Increase of the population during 1895 was 427, as compared with 466 in 1894. In
persons over 60 years of age there were 524 deaths, or 49.6 of the total, as compared
with 485 in 1894; and in children under 1 year there were 118 deaths (of which
42 were due to Developmental causes), giving an Infant Mortality of 79.6. To
Old Age 139 Deaths were ascribed during 1895, as compared with 137 in 1894.
During the past year the improved sanitary condition of the County has been
not only well maintained but considerably advanced, and the health of the population
was very good after the effects of the very severe weather in the early months of the
year passed off. The effects of the extreme weather were most severely felt in the High-
land District, in which the number of deaths was raised 38 per cent. as compared
with 1894. The Death-rate for 1895 was 16.4, which is higher than in 1894, but still
very favourable. The Zymotic Death-rate was 1.1, and the Infant Mortality 79.6.
For comparison, the following Tables have been prepared, which at a glance show the
Death-rates from various diseases both in the Landward Districts and in the Burghs
in the County of Perth during the past five years:-
LANDWARD DEATH RATES.
[Table inserted]
[Note] 241 |
|
| HH62/45/243 |
[Page] 8
BURGH DEATH-RATES.
[Table inserted]
In the Table for the County it will be seen that, with slight fluctuations, the
Death-rate has been steadily improving, and, if the rate for 1895 be compared with
that for 1891, an improvement of 8.9 per cent. is found to have taken place. In the
Death-rates for the Burghs, not only has no improvement taken place, but there has
been a slight increase, and, taking into consideration the very similar circumstances
of the populations resident in the Landward Districts and the Burghs, expecially
when it is remembered that the former include many large villages, the excess in the
Death-rate in the Burghs seems to be abnormally high. As the Burgh of Auchter-
arder is only of recent origin, the rates for it have not been included in the above
Tables.
During 1895 the long-looked-for water supply to the east Carse of Gowrie was
completed, and is giving satisfaction to those dependent on it. The Perth District
Committee have at present a requisition under consideration for a water supply to
the Village of Errol and the remaining portion of the Parish of Errol which is
not properly supplied with water. The water supply to Almondbank has also been
carried out, and is giving complete satisfaction. Water supplies for Scone and
Bankfoot have been subjects of consideration by the Perth District Committee, and
there is a prospect of works for the same being completed at an early date.
In the Central District the scheme for supplying Madderty and the adjacent
districts with water has received much attention, but so far nothing has been settled.
It is to be hoped, however, that the Special Water District will soon be formed, as
the need for a proper water supply for the district is urgent.
In the Eastern District the supply of good water for the Villages of Woodside
and Burrelton has engaged the attention both of the Local Authority and the
residents; an attempt was made to rectify two of the wells in the latter place, but
the results have not been encouraging, as the water proved no better for all the
money spent in attempting to prevent it from contamination. The Rosemount
[Note] 242
[Page] 9
Special Water District still exists without the water supply for which it was formed,
and the Eastern District Committee should endeavour to secure a supply from some
other source if it cannot be had from the Blairgowrie supply.
Drainage schemes for the Villages of Stanley, Bankfoot, and Methven in the
Perth District have been considered by the District Committee, and, as in all
drainage is urgently necessary, it is to be hoped some definite steps will be taken at
an early date.
In the Central District the upkeep of the drainage in the Village of Dunning
has been undertaken by the District Committee, so that for the present the dangers
alluded to from its being neglected, have been averted. The drainage of the Village
of Comrie is still in an unsatisfactory condition, and it is to be hoped that the
inhabitants will, during 1896, take the necessary steps for having it made into a
Special Drainage District.
In the Highland District the drainage of Pitlochry has been under consideration
both as regards the liability of flooding in the lower portion of the village during
heavy rains, and the want of sufficient land for the proper treatment of the sewage of
the village. Improvements in both these points will commence at an early date.
In the Western District the drainage of the Village of Killin has received much
attention, and it is expected that at the next meeting of the Committee the plans
will be approved, and the works authorised to be commenced forthwith.
Under the Local Government (Scotland) Act, 1894, two cleansing areas have
been formed in the Highland District - one for Pitlochry, and the other for Dunkeld.
In connection with the forming of the latter much feeling was manifested, and finally
the Highland District Committee took the management of the area out of the hands
of the members of the Parish Council (who were at first entrusted with the manage-
ment), and appointed members of the District Committee to carry out the provisions
of the Act. In connection with the scavenging of villages under the Local
Authorities of the Perth, Central, and Western Districts, nothing but praise can be
given. The work is well done, the cost is moderate, and the resulting improvement
on the condition of the villages is manifest to the most casual observer. This
improvement is best seen in some of the villages in the Perth District, and is amply
proved to be real by the decreased Death-rate.
Pollution of Rivers. - During the past year, although no actual works were
completed in connection with the prevention of the discharge of sewage into rivers,
the various District Committees interested have by no means neglected the responsi-
bilities imposed on them by the Rivers Pollution Prevention Act. Preliminaries
have occupied much time, but there is every prospect of satisfactory works being
erected at the outfalls of the sewers of Methven, Scone and Stanley in the Perth
District, Aberfeldy and Dunkeld in the Highland District, Aberfoyle and Killin in
the Western District, and Rattray in the Eastern District, during 1896.
In the Central District, through resignations and death of local Sanitary
Inspectors, the work of the Department has been much impeded. As the local
Inspectors were insufficiently paid, the Committee have under consideration the
advisability of appointing one Inspector for the whole District, on the same
lines as in the Highland and Eastern Districts. Of the fact that this is the
most efficient and cheapest method of accomplishing the work of the Department
there can be no doubt, and it is to be hoped that the Committee will decide
accordingly.
Sale of Food and Drugs Act. - This Act continues to be administered by
the County Police.
[Note] 243 |
|
| HH62/45/245 |
[Page] 10
Meteorological Tables. - Again thanks are due to Mr. Croucher for kindly
supplying data from observations at the Ochtertyre Station, from which these have
been compiled. The temperature records are of exceptional interest as showing the
protracted cold spell at the commencement of 1895, and the readings of the under-
ground thermometers show the penetration of the cold. The severe weather caused
a large increase of deaths to be recorded during the months of February, March, and
April.
During 1896 there is a prospect of Scotland receiving what is only her due of
legislation in connection with Public Health, and it is to be hoped that we shall soon
be in possession of a Public Health Act which, whilst retaining the good parts of the
1867 Act, and amending those portions which have been found, by practical
experience, to be defective, will at the same time embody all the Public
Health provisions which are at present dealt with under separate statutes. The
passing of such an Act would greatly facilitate the administration of Public Health,
and would be warmly welcomed by all engaged in this important work.
DISTRIBUTION OF DISEASES.
Respiratory Diseases caused 124 Deaths, or 11.7 per cent. of the total during
1895, as compared with 122 in 1894. Of these 124 Deaths, 62 occurred in persons
over 60 years of age, and 22 in childen under one year. While there is a very
slight increase in these Deaths over those recorded in 1894, the Infant Death-rate
from the same shows an improvement of over 35 per cent. The following Table
shows the percentage of Deaths throughout the County from Respiratory Diseases,
and also the percentage of Sickness from them in the Central and Western Districts,
which latter are compiled from returns furnished by the Local Medical Officers in
the Districts.
Percentage of Deaths.
PERTH DISTRICT, -- 10.8
CENTRAL DISTRICT, -- 12.6
HIGHLAND DISTRICT, -- 13.0
WESTERN DISTRICT, -- 11.1
EASTERN DISTRICT, -- 10.8
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 29.7
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 19.1
EASTERN DISTRICT, -- No Returns.
Circulatory Diseases caused 132 Deaths, or 12.5 per cent. of the total during
1895, as compared with 128 in 1894. Of these 132 Deaths, the age was over 60 in
98 instances. The distrbution of these diseases throughout the County was as
follows:-
Percentage of Deaths.
PERTH DISTRICT, -- 12.2
CENTRAL DISTRICT, -- 12.6
HIGHLAND DISTRICT, -- 9.0
WESTERN DISTRICT, -- 11.1
EASTERN DISTRICT, -- 21.6
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 5.4
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 4.1
EASTERN DISTRICT, -- No Returns.
Tubercular Diseases caused 119 Deaths, or 10.3 per cent. of the total during
1895, as compared with 135 in 1894. Of these 119 Deaths, 79 were attributed to
Pulmonary Consumption, the remaining 40 being due to other forms of Tubercular
Disease, thus showing a decrease in the number of Deaths from Phthisis of 25, but
an increase in the number of Deaths from other Tubercular Disease of 9 as compared
with 1894. The large mortality from this class of diseases, which are now believed
[Note] 244
[Page] 11
to be preventible, is alarming, and it is to be hoped that the public will demand that
some effectual measures be taken to check their ravages. In so far as infection derived
from diseased milk-cows is concerned, there is no doubt that in tuberculin a most
valuable diagnostic agent exists, and that by its use it would be an easy matter to
separate the sick from the healthy cows in dairies. The distribution of Tubercular
Disease throughout the County was as follows:-
Percentage of Deaths.
PERTH DISTRICT, -- 14.1
CENTRAL DISTRICT, -- 12.6
HIGHLAND DISTRICT, -- 9.3
WESTERN DISTRICT, -- 10.4
EASTERN DISTRICT, -- 7.6
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 2.1
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 1.6
EASTERN DISTRICT, -- No Returns.
Diseases of the Nervous System caused 97 Deaths, or 9.2 per cent. of the
total during 1895, as compared with 109 in 1894. Of these 97 Deaths, 66 occurred
in persons over 60 years of age. The distribution of Nervous Diseases throughout
the County was as follows:-
Percentage of Deaths.
PERTH DISTRICT, -- 7.5
CENTRAL DISTRICT, -- 12.1
HIGHLAND DISTRICT, -- 8.1
WESTERN DISTRICT, -- 9.7
EASTERN DISTRICT, -- 9.5
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 1.6
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 9.2
EASTERN DISTRICT, -- No Returns.
Diseases of the Digestive System caused 63 Deaths, or 5.9 per cent. of the
total during 1895, as compared with 59 in 1894. From the Sickness Returns in the
Central and Western Districts it will be observed that a large amount of the total is
attributed to this class of diseases. The distribution of these diseases throughout
the County was as follows:-
Percentage of Deaths.
PERTH DISTRICT, -- 5.9
CENTRAL DISTRICT, -- 6.3
HIGHLAND DISTRICT, -- 4.0
WESTERN DISTRICT, -- 7.6
EASTERN DISTRICT, -- 7.0
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 22.9
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 21.5
EASTERN DISTRICT, -- No Returns.
Cancer and Malignant Diseases caused 52 Deaths, or 4.9 per cent. of the
total during 1895, as compared with 56 in 1894. The distribution of these Deaths
throughout the County was as follows:- Perth District, 17; Central District, 7;
Highland District, 14; Western District, 4; Eastern District, 10.
Violence caused 36 Deaths during 1895, as compared with 40 in 1894. These
Deaths were distributed throughout the County as follows:- Perth District, 4;
Central District, 9; Highland District, 12; Western District, 5; Eastern District, 7.
Developmental Diseases caused 42 Deaths during 1895. Of these 27 were
attributed to Premature Birth.
Old Age caused 139 Deaths or 13.1 per cent. of the total during 1895, as com-
pared with 137 in 1894.
Zymotic Diseases. - 77 Deaths were attributed to these during 1895, as com-
pared with 65 during 1894. The increase in number was due to Diarrhoea. The
total number of cases of Infectious Disease reported during 1895 was 565, as com-
[Note] 245 |
|
| HH62/45/247 |
[Page] 12
pared with 612 in 1894. The number of these cases removed to Hospital during
1895 was 85, or 15 per cent., as compared with 80 in 1895.
Smallpox. - Only one slight case of the disease occurred within the bounds of
the Landward Local Authorities of Perthshire during 1895. The case was that of
a young man resident in Killin. As soon as his disease was recognised, he was
removed to the Glenoglehead Hospital, where he made a good recovery. There was
no spread of the disease.
Scarlet Fever caused 8 Deaths in 1895, as compared with 12 in 1894.
The number of cases reported was 277, as compared with 393 in 1894.
The disease was a source of continual anxiety to the Department, but all
the outbreaks were successfully stamped out, except at Acharn in the High-
land District, and Dunning in the Central District. In both of these places
negligence on the part of some of the householders to make themselves aware of the
nature of the disease, hindered efficient action. In many of the outbreaks the primary
source of infection was clearly traced to travelling in an infected public conveyance.
The manner in which infection reaches these public conveyances was very clearly
shown in three instances during last year. The child of a medical man took
ill in the country, it was immediately removed by rail to its home in one of the large
towns, and on its arrival was notified to the Local Authority there as suffering from
Scarlet Fever; the excuse pleaded here was that the disease was not recognised earlier.
A servant girl with a family in lodgings in the country was ill for two or three days; she
was then sent home, and on her arrival certified as having Scarlet Fever; here again
"ignorance was bliss." Again, a medical man sees a patient suffering from a puffy
face, he suspects that it is the result of a recent attack of Scarlet Fever, and wisely
recommends that the patient be removed from the midst of a large family to hospital
for isolation, but, unwisely, neither communicates with the Local Authority nor gives
proper instructions as to the mode of removal, and the patient is removed, - in a
crowded omnibus! Until the Law is amended to such an extent as to make such
actions as those above-mentioned subject to heavy penalty, and the too-commonly-
used back-door of ignorance, as an excuse, is closed for good, we need scarcely hope
to be able to stamp out Scarlet Fever.
Diphtheria caused 21 deaths during 1895, as compared with 25 in 1894. The
total number of cases reported during 1895 was 130, as compared with 71 in 1894.
The case mortality was only 15.1 per cent., which is a large improvement on 1894,
when it was 35.2. Doubtless, to a large extent, the improved Death-rate is due to
the notification of a number of doubtful cases, which, without the Notification Act,
would never have been reported; still, when in some of the outbreaks as many as 27
consecutive cases occur with only one death, one cannot help thinking that in this
dreaded disease, like Scarlet Fever, we may look for a milder type in the future.
The chief outbreaks of the disease occurred at Longforgan and Stanley in the Perth
District, and at Killin and Balquhidder in the Western District. There can be no
doubt that school attendance was the main factor in the spreading of some of these
outbreaks.
Enteric Fever caused 10 deaths during 1895, as compared with 5 in 1894.
There were 56 cases of the disease reported during 1895, as compared with 65 in 1894.
Although the number of deaths is double that of the previous year, the total number
of cases shows a substantial reduction, and when to this it is added that most of the
cases were either sporadic or clearly traceable to infection contracted without the
bounds of the Landward Local Authority, there can be no doubt that the en-
forcement of the provisions of the Public Health Acts, and especially the regular
[Note] 246
[Note] 247 |
|
| HH62/45/249 |
DIAGRAM
showing the prevalence of
SMALLPOX, DIPHTHERIA, SCARLET FEVER & ENTERIC FEVER
DURING 1895.
[Graph inserted]
[Note] 248
[Page] 13
scavenging of villages, is now having a beneficial influence on the condition of the
people.
TABLE showing the prevalence of certain Zymotic Diseases in the several
Districts during the different Months of 1895.
[Table inserted]
Diarrhoea caused 31 deaths during 1895, as compared with 8 in 1894. The large
increase in the number of deaths from this disease was probably accounted for by the
rapid rise of temperature as indicated by the 48-inch underground thermometer
during June, July, and August. The relation of deaths from Diarrhoea to the
readings of the underground thermometer is shown as follows:-
[Note] 249 |
|
| HH62/45/251 |
[Page] 14
TABLE showing relation between Deaths from Diarrhoea and
Underground 48-inch Thermometer Readings.
[Table inserted]
Whooping Cough caused 4 deaths during 1895, as compared with 14 in 1894.
Measles caused 3 deaths during 1895, as compared with 1 in 1894. The disease
was prevalent during the year, but the type was mild.
Deaths Uncertified, or in which the cause was insufficiently stated, were 99
during 1895, as compared with 68 in 1894. It is to be regretted that so much
valuable information is lost through the laxity allowed in connection with the Medical
Certificate of Cause of Death. In the Highland District there were 46 deaths, or 4
per cent. of the total uncertified.
To the Registrars of the various Registration Districts within the County
thanks are due for supplying returns of Births and Deaths during the year, without
which the compilation of Vital Statistics would be impossible.
Hospital Accommodation. - The arrangement by which the Perth, Central,
Highland, and Eastern District Committees are entitled to send patients to the Perth
Royal Infirmary has again been found to prove most useful. As this arrangement
is drawing to a close, it is now necessary to reconsider its terms. Until February,
1895, the County Medical Officer, by his positiion on the Acting Staff of the Infirmary,
was able to supervise the treatment of the County cases, and to give information to
the relatives when required. Since the above date the County Medical Officer has
ceased to be connected with the Infirmary, and, although the treatment of the patients
has been so far satisfactory, yet, difficulties have occurred which might have been
obviated had the terms of the agreement with the Perth Royal Infirmary secured
to the County Medical Officer a right of admission to the County cases.
In the Western District the portable Hospitals are now stationed one at
Glenoglehead, near Killin, and the other at Wellpark, near Dunblane. The latter
had no occasion to be opened during 1895, but in the former no less than 14 cases
were treated. The portable Hospital for Small-pox belonging to the Highland
District has now been moved to a central position, and stored in a shed erected for
the purpose close to the main line, so that when required it can be easily trucked and
taken to the infected locality. Removals of patients suffering from infectious disease
have been carried out during the past year without mishap, and the operations have
been much facilitated by the hearty co-operation of the various Railway Companies
and their officials.
[Note] 250
[Page] 15
The Infectious Disease (Notification) Act has during the past year very
materially assisted in the stamping out of infectious disease, and where all of the cases
were notified there never was any difficulty in at once circumscribing the disease, but
again and again cases were unreported either through the real or pretended ignorance
of those in charge, and much trouble and annoyance resulted.
I desire again to offer to the County Council and District Committees my sincere
thanks for the kindness they have shewn, and for their willingness at all times to give
their thoughtful consideration to the sanitary interests of the County.
JOHN T. GRAHAM,
County Medical Officer.
31st March, 1896.
[Note] 251 |
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[Note] 252
Perth District.
The population of the Perth District, estimated to the middle of 1895, was
20,746. During the year there were 523 Births registered, giving a Birth-rate of
25.20, and 303 Deaths, giving a Death-rate of 14.60. In 1894 the Birth-rate was
22.4, and the Death-rate 14.69. The Natural Increase of the population during
1895 was 220, as compared with 161 in 1894. Deaths in persons over 60 years of
age were 130, or 42.9 per cent. of the total, and of Infants under one year there
were 44 Deaths, of which 19 were attributed to developmental causes, giving an
Infant Mortality of 84.13, as compared with 94.0 in 1894. Zymotic Diseases caused
25 Deaths in 1865, as compared with 29 in 1894, giving a Zymotic Death-rate of
1.34 during 1895, as compared with 1.38 in 1894.
The sanitary condition of the Perth District has steadily advanced during the
past year, and the fact is testified by a steadily-decreasing Death-rate.
During the year two important Water-Supply Schemes have been completed,
one for the eastern portion of the Carse of Gowrie, and the other for the Villages of
Almondbank and Bridgeton. Both are giving satisfaction to those immediately
interested. Water Supplies for the Villages of New Scone and Bankfoot have
received much attention from the District Committee; and as it has been demonstrated
by the Reports of the Engineer to whom the matter was remitted, that water might
be brought to both of these important places at a moderate expense, it is hoped that
before the expiry of 1896 the works will be accomplished facts. No Drainage
schemes were carried out during the past year, but the District Committee have had
under consideration the necessity of proper Drainage being provided for the Villages
of Bankfoot, Stanley, and Methven; and there is little doubt that the Committee will
not rest satisfied until the present insanitary condition of these villages, due to the
want of proper drainage systems, is remedied.
2. General enquiries have been made to ascertain the Sanitary condition of the
District during the year, and much work has had to be undertaken in connection
with the ordinary routine of the Department, in dealing with cases of Infectious
Disease and nuisances. In carrying out the latter, great assistance has been rendered
by the local Sanitary Inspectors. No certificates have been necessary under the
Public Health Acts during the past year, not has any action been required in connec-
tion with the sanitary condition of Factories and Workshops.
4. Retail Bakehouses. - There are now seventeen of these in operation in the
Perth District, a new Bakehouse having been opened during the year at Glenfarg.
Another of the older Bakehouses has been extensively remodelled by the proprietor,
and thereby brought into keeping with the terms of the Acts. The Bakehouses
have been inspected during the year, and in the majority of instances the premises
were found in good order. In one or two, however, the tenants had to be remonstrated
with in consequence of the untidy condition in which the Bakehouses were found.
5. During 1895 full advantage has been taken of the arrangement made with the
Directors of the Perth Royal Infirmary, whereby the District Committee are entitled
to send for treatment any patient suffering from Infectious Disease. During the
year 32 cases received Hospital treatment. As the agreement with the Infirmary
[Note] 253 |
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[Page] 18
wil shortly expire, it will be necessary, during 1896, to make some fresh arrangement.
The term of the Chief Medical Officer's official connection with the Infirmary Staff
having expired in 1895, he has no longer any supervision over the patients sent by
the District Committee.
The Portable Hospital for treating Smallpox patients has not been called into
requisition during the past year; it is ready for use, however, on a few hours' notice,
should the necessity arise.
During the past year the energies of the Public Health Officials have been on
several occasions rather severely taxed in endeavouring to stamp out Infectious
Disease, and, on the whole, the results have been satisfactory. The usual routine of
urging removal to Hospital of such patients as were fit, has been followed, and, when
this could not be carried out, isolation at home was insisted on, and at the termination
of the illness thorough disinfection of the premises carried out. The source of the
disease has invariably been a subject for investigation, and, when due to insanitary
conditions, these were rectified as far as possible. During 1895, 209 cases of Infectious
Disease were reported to the Chief Medical Officer.
Respiratory Diseases caused 33 deaths during 1895, as compared with 30 in
1894. Of these 33, 8 occurred in children under 1 year, and 16 in persons over 60
years of age.
Tubercular Diseases caused 43 deaths during 1895, as compared with 45 in
1894. Of these 43 deaths, 25 or 58.1 per cent., were attributed to Pulmonary
Consumption. Deaths from this class of disease formed 14.1 per cent. of the total,
and show a large proportion still due to them.
Nervous Diseases caused 23 deaths during 1895, as compared wth 21 in 1894.
Of these 23 deaths, 11 were in persons over 60 years of age.
Circulatory Diseases caused 37 deaths during 1895, as compared with 47 in
1894. Of these 37 deaths, 24 were in persons over 60 years of age. Diseases of this
class caused 12.2 of the total mortality.
Diseases of the Digestive System caused 18 deaths during 1895, as compared
with 24 in 1894. This class of disease caused 5.7 per cent. of the total.
Cancer and Malignant Diseases caused 17 deaths, as compared with 16 in 1894.
Old Age. - To this cause were ascribed 40 deaths during 1895, or 13.2 per cent.
of the total mortality. In 1894 the deaths due to Old Age were 35.
Violence. - Four deaths were caused by Violence during 1895, as compared with
8 in 1894.
Zymotic Diseases caused 25 deaths during 1895, as compared with 29 in 1894.
The Zymotic Death-rate was 1.34 during 1895, as compared with 1.38 in 1894.
Diphtheria caused 10 deaths during 1895, as compared with 11 in 1894. The
number of cases of the disease reported was 64, as compared with 25 in 1894, thus
giving a case mortality during 1895 of 15.6, as compared with 44.0 in 1894. There
were two large groups of cases - one at Longforgan, and the other at Stanley. In
the former the disease was evidently caused by children attending school whilst
suffering from slight unrecognised Diphtheria, and that it spread in the school was
not to be wondered at, seeing that the only drinking water available at the time was
from what is known as the 'factory pan," to obtain a drink of water from which it is
necessary to apply the lips to the top of a tube, fixed in the top of the pan, and to suck
up the water. In Stanley the drainage of the village is in such a bad state that it is
remarkable that there were not more cases of Diphtheria than actually occurred.
The remainder of the cases occurred in scattered groups throughout the District, and
were mostly discovered to have been due to faulty drainage, which was immediately
[Note] 254
[Page] 19
rectified. Eleven patients suffering from Diphtheria were removed to Hospital and
made good recoveries, with the exception of one who died.
Scarlet Fever caused 2 deaths during 1895, as compared with 6 in 1894.
During the past year 90 cases of the disease were reported to the Chief District
Medical Officer, as compared with 124 in 1894. Seventeen of these patients were
removed to Hospital and made good recoveries. The type of the disease was mild in
the large majority of the cases.
Enteric Fever caused 4 deaths during 1895, as compared with 1 in 1894.
During the past year 23 cases of the disease were reported, and, of these, four were
removed to Hospital; one proved fatal, the case being in an advanced stage of the
disease before his removal. Most of the cases were of a sporadic character; but one
group was traced to the use of water from a polluted well, perversely used in spite of
warnings, and although there was a good supply of water by gravitation available;
the reason alleged for the preference being that the water was much cooler and better
than that from the pipes.
Whooping-Cough caused 2 deaths during 1895, as compared with 9 in 1894.
Measles caused 2 deaths during 1895.
Diarrhoea caused 8 deaths during 1895, as compared with 2 in 1894.
Deaths in which the cause was uncertified, or insufficiently stated, were 20, as
compared with 16 in 1894.
[Note] 255 |
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[Note] 256
Central District.
The population of the Central District, estimated to the middle of 1895, was
13,858, but from this must be subtracted the population of the Burgh of Auchter-
arder (2554), thus leaving only a population of 11,304 under the jurisdiction of the
Central District Committee. During the year 1895 there were 265 Births and 206
Deaths registered, as compared with 326 Births and 237 Deaths in 1894. The
Birth-rate for 1895 was 23.44 and the Death-rate 18.22. The Natural Increase of
the population during the past year was 59, as compared with 89 in 1894. Deaths
in persons over 60 years of age were 103, or 50.0 per cent. of the total; and 27
Deaths occurred in children under 1 year, of which 6 were due to developmental
causes, giving an Infant Mortality of 101.8, as compared with 55.2 in 1894.
During the past year the ordinary routine work of the Public Health Depart-
ment has been kept well up to the standard of former years, and much extra labour
has been necessitated to effectually combat outbreaks of Infectious Disease.
None of the larger works recommended as needful in former Reports have as yet
been carried out. In so far as the drainage of Dunning is concerned, the District
Committee has taken charge of keeping the existing drainage in working order, so
that for the present the grave danger in that quarter has been averted, and it is hoped
that before long the inhabitants may see their way to sending a requisition to have
a Special Drainage District formed. The drainage of Comrie stands practically where
it did, the idea of forming the place into a Special Drainage District having ended, as
it began, in talk. The Madderty Special Water District has not yet been formed,
although the requisition has for some time been under the consideration of the District
Committee; there is, however, every prospect of a resolution being passed at the next
meeting of the District Committee, which will be the means of providing for a large
extent of the District a plentiful supply of pure water from the hills. The pollution
of the water supplies to the east of the town of Crieff, complained of bitterly during
former years, has now entirely ceased, but, as these supplies are in some instances not
above suspicion altogether apart from the Crieff pollution, it is anticipated that they
will be replaced by water drawn from the main supply to the Madderty District when
that is completed.
2. General enquiries have been made during the past year to ascertain the
sanitary condition of the District, and many special enquiries have been necessary to
ascertain the cause and secure the isolation of cases of Infectious Disease.
3. Advice was required in connection with the Madderty Water Supply, and in
connection with the drainage of Dunning, also in connection with some houses found
to be in an insanitary condition, as well as in many other matters incidental to the
administration of the Public Health Acts within the Central District; but no certi-
ficates were required, nor was any action necessary under the Factroy and Workshops
Acts.
4. Retail Bakehouses. - These were visited during the year, and found to be
kept in good order. One was destroyed by fire, and has now been rebuilt. There
have been no new Bakehouses erected during the past year, and the number in opera-
tion still remains at fourteen.
[Note] 257 |
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[Page] 22
5. The arrangement by which the Central District has been entitled to send persons
suffering from Infectious Diseases to the Perth Royal Infirmary has again been found
to work well. During the year 27 patients were removed to Hospital, all of whom
recovered, excepting one woman, who suffered from Erysipelas. Since February, 1895,
the Chief District Medical Officer, having ceased to be on the staff of the Perth
Royal Infirmary, has not been in a position to supervise the treatment of patients
when removed to that Hospital. The Smallpox Hospital belonging to the Central
District has not been required for the treatment of any cases within the
jurisdiction of the Local Authority, but, on the occurrence of a case of the disease
in the newly-formed Burgh of Auchterarder, an application was made for the use of
the Central District Hospital. This was most readily granted, the only conditions
being that the Burgh was to bear the whole expense of removing, erecting, and
returning the Hospital to its shed, after it had been disinfected to the satisfaction of
the District Medical Officer. By the energetic action of the Burgh Authorities the
spread of the disease was effectually checked; the expense was, however, heavy, and
was a severe lesson to the Local Authority as to the responsibilities it had incurred
by the separation of the town from the Central District.
6. The Infectious Disease (Notification) Act has on the whole been found to
work efficiently during the past year. Some difficulty was, however, experienced in
the Village of Dunning in securing full notifications, and, owing to this, an outbreak
of Scarlet Fever there threatened to assume serious proportions. Much valuable
assistance was received in dealing with Infectious Diseases from the Local Medical
Officers. To prevent the outbreak and spread of Infectious Disease much was done
in removing insanitary conditions; and when cases of Infectious Disease were reported,
removal or the proper isolation of the patients was insisted upon. Infected houses
were supplied with disinfectants during the course of the illness, and at its close
thorough disinfection was carried out.
Respiratory Diseases caused 26 Deaths, or 12.6 per cent. of the total, during
1895, as compared with the same number in 1894. Of these 26 Deaths, 17 were in
persons over 60 years of age, and 2 in children under one year. Sickness returns
show that 29.7 per cent. of the total was due to this class of diseases.
Circulatory Diseases caused 22 deaths, or 10.6 per cent. of the total, during
1895, as compared with 31 in 1894. Of these 22 deaths, 22 occurred in persons over
sixty years of age. Sickness returns show that this class of diseases caused 5.4 per
cent. of the total.
Tubercular Diseases caused 26 deaths, or 12.6 per cent. of the total, during
1895, as compared with 36 in 1894. Of these 26 deaths, 16 were certified as due to
Pulmonary Consumption. Sickness returns show that 2.1 per cent. of the total was
due to this class of diseases.
Diseases of the Nervous System caused 25 deaths, or 12.1 per cent. of the
total, during 1895, as compared with 34 in 1894. Of these 25 deaths, 20 occurred in
persons over 60 years of age. Sickness returns show that 6.3 per cent. of the total
was due to this class of diseases.
Diseases of the Digestive System caused 13 deaths, or 6.3 per cent. of the
total, during 1895, as compared with the same number in 1894. Sickness returns
show that 22.9 per cent. of the total was due to this class of diseases.
Rheumatic Diseases caused 7 deaths, or 3.3 per cent. of the total,
during 1895, as compared with 14 in 1894.
Cancer and Malignant Diseases caused 7 deaths, or 3.3 per cent. of the total,
during 1895, as compared with 14 in 1894.
Developmental Diseases caused 6 deaths during 1895, of which 4 were ascribed
to Premature Birth.
[Note] 258
[Page] 23
Old Age caused 21, or 10.1 per cent. of the total, during 1895, as compared
with 27 in 1894.
Violence caused 9 deaths during 1895, as compared with 7 in 1894.
Zymotic Diseases caused 17 deaths in 1895, as compared with 15 in 1894,
thus giving a Zymotic Death-rate of 1.50, as compared with 1.07 in 1894.
Scarlet Fever caused 2 deaths during 1895, as compared with the same number
in 1894. During the year 69 cases of the disease were reported to the Chief Medical
Officer, and 24 were removed to Hospital. The only serious outbreak of the disease
was at Dunning, where an unrecognized case was allowed to go about for almost three
weeks before he was isolated. The disease was thus widely distributed, and it taxed
the energies of the Department to stamp out the infection. The type of the disease
was very mild, indeed, it was owing to this very fact that so many cases were overlooked
by the parents.
Enteric Fever caused 2 deaths during 1895, as compared with the same number
in 1894. There were 5 cases reported during the year, and of these two were
removed to Hospital. In 1894 there were 15 cases of this disease reported, so that
in comparison the record for the past year comes out well.
Diphtheria caused 2 deaths during 1895, as compared with 5 in 1894. There
were 22 cases of the disease reported during 1895, as compared with 21 in 1894. In
the majority of the outbreaks the cases were of an isolated character, and were due
to local causes, but in one group of cases the infection had evidently been carried by
one member of a large family to the country from a large town in which she had been
visiting; the true nature of the illness was not recognized until this patient had
infected several members of her family.
Measles caused one death. The disease was prevalent, but its type was mild.
Whooping-Cough caused one death during 1895, as compared with two in 1894.
Diarrhoea caused 9 deaths during 1895, as compared with 4 in 1894. The
disease was most prevalent during August and September.
Influenza caused 5 deaths during 1895, as compared with one in 1894.
Deaths in which the cause of death was uncertified, or insufficiently stated, were
15, as compared with 14 in 1894.
[Note] 259 |
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[Note] 260
Highland District.
The population of the Highland District estimated to the middle of 1895 was 12,651.
During the year there were registered 266 Births and 245 Deaths, giving a Birth-rate
of 21.02 and a Death-rate of 19.36, as compared with a Birth-rate of 19.57 and a
Death-rate of 14.40 in 1894. The Natural Increase of the population in 1895 was
21, as compared with 66 in 1894.
Of the 245 Deaths, 139, or 56.7 per cent., occurred in persons over 60 years of
age, and 17 in children under 1 year, giving an Infant Mortality of 63.9 against 44.0
in 1894.
The improvement in the sanitary condition of the Highland District has been
steady during the past year, and although the Death-rate under All Causes is larger,
that can be accounted for by the increased number of Deaths from Respiratory,
Circulatory, and Nervous Diseases in persons over 60 years of age, and when the
Zymotic Death-rate and the Infant Mortality, as well as the absence of any excess in
the number of cases of Diphtheria and Enteric Fever, are taken into account, the
District must be considered to be in a healthy condition. The work done during the
year by the Public Health Department has been chiefly of a routine character.
Special attention has also been directed to the improvement of the sanitary condition
of some of the outlying Schools, the prevention of pollution of the River Tay by
the sewage of Aberfeldy and of Murthly Asylum, as well as the selection of a good
site for the new Burying-Ground at Moulin. At Murthly Asylum a very complete
system of treating the sewage by irrigation has been decided on, and the necessary
works commenced. The scavenging of the villages of Pitlochry and Dunkeld was
under the consideration of the District Committee, and both places have now been
declared Special Cleansing Areas, but it is too early to speak of how the work will
be carried out under the new arrangement. One thing is certain, that it is now a much
more serious matter to start one of those Districts than under the old Public Health
Act, when the whole arrangements were in the hands of the Sanitary Inspector, and
the work cannot be done more efficiently under the new regime. The drainage of
Pitlochry received considerable attention, as it was found that the alterations carried
out last year had not the desired effect of preventing the houses in the lower portion
of the village from being flooded with sewer water during the heavy rains; it has now
been decided to duplicate the lower portion of the sewer, and when this has been done
there is little doubt of the cause of the complaint being removed. It has been found
that the sewage irrigation fields in connection with the outfall of the Pitlochry
Drainage were inadequate to properly purify the effluent before its discharge into the
Tummel, and it has been decided to obtain more land for irrigation purposes.
The completion of the West Highland Railway, and, as a consequence, the
removal from the District of the large body of navvies engaged in its construction,
has much lessened the anxiety experienced during former years lest Smallpox should
occur in such an inaccessible part of the country as the Moor of Rannoch.
2. General enquiries have been made to ascertain the sanitary condition of the
District, and many special investigations have been necessary in dealing with outbreaks
[Note] 261 |
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[Page] 26
of Infectious Disease. No certificates have been required under the Public Health
Acts during the past year, nor has any action been necessary in connection with
Factories or Workshops.
3. Retail Bakehouses. - These have been inspected during the year, and found
to be in good order. The old premises at Rannoch have been closed and the Bake-
house transferred to a new and more suitable building, much to the satisfaction of all
concerned.
4. Advice has been given in connection with the proposed sewage purification
works at Murthly Asylum, the securing of a suitable site for a store-shed for the
Smallpox Hospital, and the selection of a site for the Burying-Ground at Moulin.
5. The arrangement by which the Highland District Committee were entitled to
send infectious cases to the Perth Royal Infirmary for treatment will soon terminate,
and it will be necessary to reconsider the agreement at an early date. During the
past the Hospital at Perth has been found to be very suitable for the District, and
the arrangement has been a very good one in so far as expense was concerned for the
Committee. The Chief Medical Officer has now ceased to have any official connection
with the Infirmary Staff, and has consequently no supervision of the treatment of
patients admitted to the Hospital from the District. All of the five patients who
received Hospital treatment during the past year made good recoveries. The Portable
Smallpox Hospital, which was procured at the time of the scare in Dunkeld in 1893,
has now been removed and stored in a shed erected for the purpose on ground kindly
granted by the Highland Railway Company; the shed has been so placed as to allow
of the sections of the Hospital being easily loaded in trucks when required for
transport. It is hoped that it will not soon be necessary to use the Hospital, but in
view of the proposed doubling of the main line through Perthshire, it is well to be
prepared for any contingency.
6. When Infectious Disease has broken out the energies of the Public Health
Officials have been directed to protecting the public by removal of patients, and where
that was refused, in endeavouring to maintain isolation at home; however, this, even
with the greatest care, is often quite insufficient, and it is to be hoped that a clause
may be inserted in the new Public Health Act which will make removal compulsory
where reasonable isolation is not obtainable. Much valuable assistance has been
given in combating Infectious Disease by the Assistant Sanitary Inspector who has
been unremitting in his endeavours to remove insanitary conditions and most
particular in carrying out the disinfection of infected premises. Thanks are due to
many of the Teachers in the Public Schools in various parts of the District for the
valuable information given in connection with absentees when epidemics threatened
the districts in which their schools were situated.
Respiratory Diseases caused 32 deaths, or 13.0 per cent. of the total, during
1895, as compared with 21 in 1894. In 13 of these the age at death was over 60
years.
Nervous Diseases caused 20 deaths, or 8.1 per cent. of the total, during 1895, as
compared with 17 in 1894. In 15 of these 20 deaths the age was over 60 years of age.
Circulatory Diseases caused 23 deaths, or 9.3 per cent. of the total, during 1895,
as compared with 15 in 1894. In 17 of these the age at death was over 60 years.
Tubercular Diseases caused 23 deaths, or 9.3 per cent. of the total, during 1895,
as compared with 20 in 1894. Of these 23 deaths, 16 were attributed to Pulmonary
Consumption.
Digestive Diseases caused 10 deaths, or 4.0 per cent. of the total, during 1895,
as compared with 8 in 1894.
[Note] 262
[Page] 27
Cancer and Malignant Diseases caused 14 deaths, or 5.7 per cent. of the total,
during 1895, as compared with 13 in 1894.
Developmental Diseases caused 6 deaths, of which 4 were ascribed to Premature
Birth, as compared with 8 in 1894.
Old Age was the cause of death in 35 cases, or 14.2 per cent. of the total, during
1895. In 1894 the number of deaths due to Old Age was 37.
Violence caused 12 deaths during 1895, as against 5 in 1894.
Zymotic Diseases caused 8 deaths during 1895, as compared with 4 in 1894.
The increase in number was due to Diarrhoea. The Zymotic Death-Rate was .632
during 1895, as compared with .313 in 1894. In all there were 90 cases of Infectious
Disease reported to the Chief Medical Officer in 1895, as compared with 119 in 1894.
Scarlet Fever caused one death during 1895, as compared with two in 1894.
Fifty-six cases of the disease were reported during the year 1895, as compared with
89 in 1894. The type of disease was again exceedingly mild, and in most of the out-
breaks little difficulty was experienced in stamping it out. One outbreak at Acharn
on Loch Tay side gave much anxiety to begin with. Before the disease was reported
it had been prevalent amongst the children attending school for a considerable time,
the nature of the complaint being considered to be Influenza, and no precaution had
been taken. When the true nature of the disease was discovered, there was a
tendency on the part of the parents to consider it hard that they should be compelled
to isolate their sick when the neighbours from whom their children had caught the
disease had been allowed to escape; and it finally became impossible to receive
intimation of all of the cases, as no doctor was called, owing to the mildness of the
disease. One of what may be called return cases of Scarlet Fever occurred in the
family of a visitor to the district. A case of Scarlet Fever was notified, and on enquiring
as to its probable cause, it was discovered that shortly before the patient sickened,
another of the family who had been ill of the disease had returned to the house. The
remarkable feature in this case was that the first patient had been confined to Hospital
for seven weeeks, and thereafter had been sent to a Convalescent Home, moreover,
that all the infected clothes had been destroyed, the patient being furnished
with a new wardrobe. It was found that the only evidence of anything being amiss
with this patient was that the nails were being shed at the time of his return to the
family circle.
Enteric Fever. - No deaths occurred from this disease during 1895. Six
cases of the disease were reported during the year, as compared with four in 1894.
One of these cases came sick into the district. The others were in small groups of
two and three, and were due to insanitary conditions, which were remedied. Two of
these patients were removed to Hospital, and made good recoveries.
Diphtheria caused one death during 1895, as compared with 2 in 1894. Only
two cases of the disease were reported, as compared with 8 in the previous year. The
cause of the disease was dampness of the walls and floor of the house.
Influenza. - To this cause 5 deaths were attributed during 1895. These Deaths
occurred during the earlier months of the year.
Diarrhoea caused 6 deaths during 1895, as compared with none in 1894. The
majority of the deaths from this disease occcurred during September and the following
months.
Deaths in which the cause of death was uncertified, or insufficiently stated, were
46, as compared with 24 in 1894. This state of matters is most disappointing, as it
was anticipated that, as time went on, diseases relegated to this class would be reduced
to a minimum. Much valuable information has thus been lost through neglect
on the part of the medical men in some parts of the country to furnish the necessary
certificates.
[Note] 263 |
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[Note] 264
Western District.
The population of the Western District, estimated to the middle of 1895, was
9928. During the year there were registered 197 Births and 143 Deaths, giving a
Birth-rate of 19.84, and a Death rate of 14.40, as compared with a Birth-rate of
24.38 and and a Death-rate of 15.27 in 1894. The Natural Increase of the population
during the past year was 54, as compared with 90 in 1894. Deaths in persons over
60 years of age were 68, or 47.5 per cent of the total, as compared with 64 in 1894;
and there were 13 deaths in childen under one year (of which 3 were due to Pre-
mature Birth), giving an Infant Mortality of 65.9, as compared with 62.2 in 1894.
The Zymotic Death-rate was 1.91 during 1895, as compared with .80 in 1894.
During the past year considerable improvements were effected on the sanitary
condition of the District. The outbreak of Diphtheria at Balquhidder and Killin
having necessitated that one house should be closed as uninhabitable, and that others
should be extensivley remodelled at the former place, and the expediting of the pro-
posed drainage scheme at the latter. The absence of any large contracts within the
District has relieved the Department during the past year of any undue strain of
work. The purification of the River Forth has occupied much attention during the
year, and in so far as the pollution of the river by the sewage of Aberfoyle is con-
cerned, it may be practically considered as settled, as it has been decided to erect
purification works at the outfalls of the drains. The attention of the Central District
of Stirlingshire having been called to the pollution of the Forth by sewage from
villages situated in that locality, a reply was elicited which in effect said that the
Forth was already so polluted that the sewage from the Stirlingshire villages tended
rather to dilute it than to make it worse. In connection with the village of Gartmore
a complaint was received that a ditch running near the village was rendered a nuisance
in consequence of sewage matter being allowed to find its way into it; that the ditch
might be offensive could well be believed, but as it was at a considerable distance from
any house, it could scarcely be certified as a nuisance. It was in consequence decided to
deal with the offensive ditch under Section 24 of the Public Health Act, but finally
those interested made up their minds that, as they would have the cost to pay, it
would be better to do the work of improvement themselves rather than to allow the District
Committee to carry it out at their expense.
2. General enquiries have been made from time to time to ascertain the sanitary
condition of the District, and special enquiries have been made in connection with the
detection and isolation of cases of Infectious Disease, as well as nuisances alleged or real.
3. Advice was given in connection with the best method of preventing the
pollution of rivers and the proposed Killin Special Drainage District. No certificates
were required under the Public Health Acts, nor was any action required in connec-
tion with the sanitary condition of Factories and Workshops during the past year.
4. Retail Bakehouses. - These have been inspected during the year, and were
found to be kept in good order. One of the five has been closed, thus only leaving
four now in operation in the Landward District.
5. The Hospitals belonging to the Western District are entirely under the
supervision of the Chief District Medical Officer. The Glenoglehead Hospital has
[Note] 265 |
|
| HH62/45/267 |
[Page] 30
been frequently in use for the treatment of Small-pox, Scarlet Fever, Enteric Fever,
and Diphtheria during the year, and has given complete satisfaction in every respect,
except that it has been placed too far from the Village of Killin for conveniently
obtaining supplies and medical attendance; there is, however, a desire amongst the
residenters that the Hospital should be moved to a site nearer the village, and this
would much facilitate the administration. A very suitable site having been secured
for the other Hospital at Wellpark, near Dunblane, an acre of ground was fenced in and
the building erected there; as plenty of good water is available and the site in every
way suitable, it would be a good place on which to erect a permanent building if this
were decided upon. The Wellpark Hospital has never been required since it was
erected there.
6. To check the spread of Infectious Disease it has been a matter of routine to
urge the removal of the sick to Hospital whenever possible, and when this was not
consented to the cases were insolated at home. In connection with some of the cases
of Enteric Fever, the want of compulsory power to remove was the cause of several
members of the family being infected. In connection with one case of Diphtheria
which could not be removed, a nurse was provided in order to ensure isolation. In
all cases disinfectants were supplied to infected families, and at the termination of the
illness the houses were thoroughly disinfected. The use of the County Ambulance
has been frequently taken advantage of during the year, and has proved a great
comfort in the removal of patients. As the arrangement by which the other four
Districts are entitled to send their infectious cases to the Perth Royal Infirmary will
shortly expire, and a new agreement will have to be made, it would be well if the
Western District Committee would join with the other Districts in combining for
hospital accommodation, as it has been found that the small Portable Hospitals,
although exceedingly convenient, are more costly than could be wished, and that
patients could be treated in a larger Hospital for about half the cost.
There were two vacancies in the local Medical Staff, one at Killin and the other
at Dunblane. The former was filled by the appointment of Dr. Wilson, who has
given much valuable assistance since his appointment, and the other by Dr. Howatson,
of Dunblane.
Respiratory Diseases caused 16 deaths, or 11.1 per cent. of the total, during
1895, as compared with 17 in 1894. In nine of these the age at death was over 60
years, and in two the age was under one year. Sickness returns show that 19.1 per
cent. of the total was due to this class of diseases.
Circulatory Diseases caused 16 deaths, or 11.1 per cent. of the total, during 1895,
as compared with 19 in 1894. Of these, 16 deaths 13 occurred in persons over 60
years of age. Sickness returns show that 4.1 per cent. of the total was due to this
class of disease.
Tubercular Diseases caused 15 deaths, or 10.4 per cent. of the total, during
1895, as compared with 21 in 1894. Of these 15 deaths, 13 were attributed to
Pulmonary Consumption. Sickness returns show that 1.6 per cent. of the total was
due to this class of diseases. The percentage both of sickness and mortality from
Tubercular Disease show a marked improvement during the past year.
Diseases of the Nervous System caused 14 deaths, or 9.7 per cent. of the total,
during 1895, as compared with 18 in 1894. Of these 14 deaths, 12 occurred in persons
over 60 years of age. Sickness returns show that 7.2 per cent. of the total was due
to this class of disease.
Diseases of the Digestive System caused 11 deaths, or 7.6 per cent. of the
total during 1895, as compared with 6 in 1894. Sickness returns show that 21.5 per
cent. of the total was due to this class of disease.
[Note] 266
[Page] 31
Cancer and Malignant Diseases caused 4 deaths during 1895, as compared
with 6 in 1894.
Developmental Diseases caused 5 deaths during 1895, as compared with 8 in
1894. Of these 5, 3 were due to Premature Birth.
Old Age. - This was the cause of death in 21 instances during 1895, as compared
with 20 in 1894.
Violence was the cause of 5 deaths during 1895, as compared with 12 in 1894.
Zymotic Diseases caused 19 deaths during 1895, as compared with 8 in 1894.
The Zymotic Death-rate was 1.91, as compared with .80 in 1894. The increased
number of deaths due to this class of diseases come under the headings of Diphtheria
and Diarrhoea.
Smallpox. - There was only one case of this disease during 1895. The patient
was a young man who had an exceedingly slight attack; he had been travelling some
time previous to his sickening, so that it was probable he caught infection during his
travels. As soon as the disease was recognised, the patient was removed to the
Glenoglehead Hospital, where he made a good recovery. There was no spread of
the disease.
Scarlet Fever caused 2 deaths during 1895, the same number as in 1894.
There was no epidemic of the disease, the cases occurring in small groups and never
spreading to any extent. Forty cases of the disease were reported during the year,
of whom 8 were removed to the Hospital. In 1894 the number of cases reported
was 73.
Enteric Fever caused 2 deaths during 1895, as compared with the same number
in 1894. During 1895, 7 cases of the disease were reported, as compared with 15 in
1894. With the exception of a small group of cases which occurred in a family in
Tyndrum, the cases were of a sporadic type, and were due to some insanitary
conditions, which were remedied.
Diphtheria caused 8 deaths. During 1895 there were 39 cases of the disease
reported, as compared with 11 in 1894. The majority of the cases occurred in
Balquhidder and Killin districts. In the former place, disease was due to damp houses
and bad drainage, which causes were remedied, one house being condemned as unfit
for human habitation. In the latter a remedy will be found when the Killin Special
Drainage District is completed, the work being expedited in consequence of the out-
break of the disease.
Diarrhoea caused 6 deaths during 1895, as compared with 1 in 1894.
Whooping Cough caused only one death during 1895.
Deaths in which the cause of death was uncertified, or insufficiently stated, were
9, as compared with 10 in 1894.
[Note] 267 |
|
| HH62/45/269 |
[Note] 268
The population of the Eastern District, estimated to the middle of 1895, was
9575. During the year 1895 there were registered 230 Births and 157 Deaths, giving
a Birth-rate of 24.02, and a Death-rate of 16.39, as compared with a Birth-rate of 21.4,
and a Death-rate of 15.2 in 1894. The Natural Increase of the population during
1895 was 73, as compared with 50 in 1894. Deaths in persons over 60 years of age
were 84, or 53.5 per cent. of the total; in 1894 the number was 66. In children
under 1 year there were 17 deaths, of which 6 were due to developmental causes,
giving an Infant Mortality of 73.9, as compared with 81.7 in 1894.
During the past year a decided improvement in the sanitary condition of the
District has taken place. Public and private water supplies and drainage have received
much attention, and, by the removal of insanitary conditions of dwelling-houses, much
has been done to prevent the outbreak of infectious disease. The Death-rate of the
Eastern District shows a slight increase during 1895 as compared with that of 1894,
but this is accounted for by the large number of deaths from Diseases of the
Circulatory System in persons over 60 years of age, which were due to the strain on
the vital energies caused by the severe storm at the beginning of the year. In
connection with water supplies, much attention was given to that derived from the
wells in Burrelton and Woodside, which were almost without exception found to be
polluted and dangerous. As a remedy, it was proposed that the villages should be
formed into a Special Water District, and a requisition to this effect was considered
by the District Committee. At the meeting, as no one proposed that the District should
be formed, and so much opposition was shown, the matter was allowed to drop,
and it was determined to insist on each proprietor procuring a pure and sufficient water
supply for his tenants. To those who opposed the gravitation supply this seemed to be
an easy matter, but when it was found that to protect the wells a considerable
expenditure would be necessary, a request was made that an experimental improvements
should be carried out on a few of the wells in order to see whether any good would
result. To this consent was given, and two wells were made, as far as possible, secure
against pollution. After a time, samples of the water from these wells were examined,
and showed that no good had been derived from the alterations. It is now hoped
that the formerly discarded supply by gravitation, which can be brought in at small
cost, will be taken up heartily by those interested.
The supply of water to the Rosemount Special District has not yet been
secured. Negotiations for securing this from Blairgowrie have been carried on during
the year. Should some agreement not be arrived at soon, the District Committee
ought to turn their attention to bringing in a supply from some other source.
The pollution of the Ericht by the sewage of Rattray has been a matter of con-
sideration to the Local Authority of that Burgh, and if consulting experts would
purify sewage, the result would have been perfect; however, as none of the proposed
schemes have been adopted, the infringement of the River Pollution Prevention Act
still goes on.
2. General enquiries have been made to ascertain the sanitary condition of the
[Note] 269 |
|
| HH62/45/271 |
[Page] 34
District, and a good deal of extra work has been caused by outbreaks of Infectious
Disease in some of the more inaccessible parts of the District, as well as in examination
of dwellings reported to be in an insanitary condition.
3. No Certificates have been required under the Public Health Acts during the
past year, nor has any action been necessary in connection with the sanitary condition
of Factories and Workshops.
4. Retail Bakehouses. - These have been inspected, and, with the exception of
one, found to be kept in very good order; the exception is a bakehouse in a very old
and dilapidated building, and it is only by close supervision that it can be kept as
required by the Act.
5. The arrangement by which the Eastern District Committee is entitled to use
the Perth Royal Infirmary as a Hospital for cases of Infectious Disease has been
found to meet all requirements during the past year. As the agreement made with
the Infirmary was only for five years, it will be necessary to reconsider the matter.
Since February, 1895, the Chief District Medical Officer, having ceased to be on the
Staff of the Infirmary, has not been in a position as formerly to supervise the
treatment of patients removed to Hospital from the District. The portable Small-
pox Hospital has not been required, but is ready for immediate erection should it be
required.
During the snow-storm in the early part of the year, for the first time it was
impossible to carry out a removal to Hospital when requested; the roads were
blocked with snow to a great depth for many miles, and a track having been cut
only wide enough to allow of the passage of vehicles having wheels of the ordinary
width, it was impossible to reach the place with the wide Ambulance Waggon.
6. The routine of urging removal of all cases of Infectious Disease to Hospital has
been followed, and, when that could not be carried out, isolation at home has been
insisted on. In one instance a nurse was provided for the proper isolation of a girl
so ill of Typhoid Fever as not to be considered fit for removal, who, from poverty,
was unable to pay for attendance. This patient was a pauper in the strict inter-
pretation of the word, but the Local Authority took upon it the entire cost of
providing for medical attendance, nursing and maintenance during her illness.
Respiratory Diseases caused 17 deaths, or 10.8 per cent. of the total, during
1895, as compared with 28 in 1894. Of these 7 occurred in persons over 60 years of
age, and 5 in children under 1 year.
Circulatory Diseases caused 34 deaths, or 21.6 per cent. of the total, during 1895,
as compared with 16 in 1894. Of these 34 deaths, 27 were of persons over 60 years of
age. The mortality from this class of diseases was more than double what it was during
1894, the excessive deaths being amongst the aged.
Tubercular Diseases caused 12 deaths, or 7.6 per cent. of the total, during 1895,
as compared with 13 in 1894. Of these 12 deaths, 9 were attributed to Pulmonary
Consumption. The record of the past two years for this Disease shows favourably
for the District.
Diseases of the Nervous System caused 15 deaths, or 9.5 per cent. of the
total during 1895, as compared with 19 in 1894. Of the 15, the age at death was
above 60 in 8 cases.
Diseases of the Digestive System caused 11 deaths, or 7 per cent. of the total,
during 1895, as compared with 8 in 1894.
Cancer and Malignant Diseases caused 10 deaths, or 6.3 per cent. of the total,
during 1895, as compared with 7 in 1894.
Developmental Diseases caused 6 deaths, of which 5 were attributed to
Premature Birth during 1895, as compared with 5 in 1894.
[Note] 270
[Page] 35
Old Age was returned as the caused of death in 22 instances, or 14.0 per cent. of
the total, during 1895. In 1894 the number was 18.
Zymotic Diseases caused 5 deaths during 1895, as compared with 9 in 1894.
The total number of cases of Infectious Disease reported to the District Medical
Officer during the year was 49, as compared with 78 in 1894. The Zymotic Death-
rate was .522 in 1895, as compared with .930 in 1894.
Scarlet Fever caused 1 death during 1895. The number of cases of the disease
reported during the year was 22, as compared with 48 in 1894. The type of disease
was very mild, and as the cases were promptly reported, there was little difficulty
experienced in securing isolation.
Enteric Fever. - Two deaths were registered from this disease during 1895.
There were 15 cases of the disease reported during 1895, as compared with 7 in 1894.
Seven cases occurred at Ashgrove (a place which has before been visited by the
disease), 6 of whom were removed to Hospital, and as the remaining one was too ill
to permit of removal, her house was made into a temporary hospital, and everything
required provided at the expense of the Local Authority. Investigations made
in connection with the outbreaks of fever at Ashgrove revealed some interesting
facts in relation to well pollution, and clearly showed that chemical analysis alone is
not sufficient to prove a water safe for use. In 1893, when the first occurrence of
disease took place at Ashgrove, the water from the wells was analysed; in one,
only used by a small portion of the people, the water was found to be very bad, and
as it was so situated as to preclude any hope of improvement, the well was closed.
The two other wells yielded on chemical analysis a very fair result, but a bacterio-
logical examination revealed that the one used by the greater portion of the inhabitants
and the majority of the sick contained 1100 colonies of micro-organisms per cubic
centimetre, while the other well which was not so much used only contained 286.
The people were told to use the water from the latter well, and were practically
interdicted from using the former, while means were taken to protect it from
surface pollution. No more trouble was experienced until the outbreak of Fever
in 1895, when the water was again analysed. It was found that the well which had
formerly been so bad was now in a satisfactory condition, only containing 22 colonies,
but the other had become dangerously polluted, yielding 44,000 colonies; the chemical
analysis of both of these waters gave no evidence of dangerous contamination. The
pollution in both instances was due to waste water being thrown down in the vicinity.
The well formerly closed was now allowed to be used, and the other was closed, but
nothing was done in the way of protecting it from further pollution. Some months
later, as the proprietor wished to use the bad well again, a sample of the water was
examined bacteriologically, and found to give only 76 colonies, entirely proving that the
former contamination was due to the careless throwing down of waste water when
the well was in use.
Diphtheria. - Only 3 cases of this disease were reported during 1895. The
cause of the disease was the close proximity of a midden to the house. This was
removed.
Diarrhoea caused 2 deaths during 1895.
Deaths in which the cause of death is uncertified, or insufficiently stated, were 9,
as compared with 6 in 1894.
[Note] 271 |
|
| HH62/45/273 |
[Note] 272
TABULAR STATEMENTS
OF
SICKNESS AND MORTALITY
IN THE
COUNTY OF PERTH,
1895.
[Note] 273 |
|
| HH62/45/275 |
[Note] 274
TABULAR STATEMENT of SICKNESS and MORTALITY referred to in the Regulations issued by the Local
Government Board for Medical Officers of Counties.
COUNTY OF PERTH.
TABLE I. - Births and Deaths occurring in the County during the Year 1895.
[Table inserted]
NOTES. - The Medical Officer may, if he thinks fit, give separately the figures for any Sub-Divisions of the County: in all cases the Total for the County is to be given.
Deaths of Persons belonging to a County occurring in Public Institutions (as Lunatic Asylums, Poorhouses, Hospitals) outside of theCounty, are to be included with the figures for that County,
and Deaths of Persons not belonging to a County, occurring in Public Institutions within the County, are to be excluded.
"Diphtheria" shall include "Membranous Croup," "Diphtheritic Croup," "Croupous Diphtheria."
All Deaths from "Diarrhoea," "Dysentery," "Enteritis," "Gastro-Enteritis," "Muco-Enteritis," - unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis-
"Diarrhoea," "Bright's Disease-Diarrhoea," are to entered under the heading "Diarrhoea."
The designation "Other Tubercular Diseases"shall include, inter alia, "Tabes Mesenterica," "Tubercular Meningitis," "Hydrocephalus," "Struma," "Scrofula."
The headings distinguished by asterisks cover all diseases placed under these headings in the classification of the Registrar-General.
[Note] 275
TABLE II. - Density of Population, Birth Rate, Infantile and other Death Rates.
[Table inserted]
*To be calculated to three places in decimals.
TABLE III. - Cases of Infectious Disease coming to the knowledge of the Medical Officer during the Year 1895.
[Table inserted]
(Signed) JOHN T. GRAHAM, M.D., Medical Officer.
31st March, 1896. |
|
| HH62/45/277 |
[Note] 276
COUNTY OF PERTH - PERTH DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1895, according to the Registration Districts.
[Table inserted]
[Note] 277
PERTH DISTRICT - Continued.
[Table inserted]
*Acreage included under Auchtergaven, Kinclaven, and Redgorton.
+After deducting (4336) Acreage of Perth City, formed by parts of Kinnoull, Perth, Scone, and Tibbermore. |
|
| HH62/45/279 |
[Note] 278
COUNTY OF PERTH - CENTRAL DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1895, according to the Registration Districts.
[Table inserted]
+Acreage included under Monzie, Methven, and Little Dunkeld.
[Note] 279
COUNTY OF PERTH - HIGHLAND DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1895, according to the Registration Districts.
[Table inserted] |
|
| HH62/45/281 |
[Note] 280
COUNTY OF PERTH - WESTERN DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1895, according to the Registration Districts.
[Table inserted]
[Note] 281
COUNTY OF PERTH - EASTERN DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1895, according to the Registration Districts.
[Table inserted]
*Acreage included under Kirkmichael.
+Acreage included under Alyth, Blairgowrie, and Kirkmichael. |
|
| HH62/45/283 |
[Note] 282
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENTS,
For YEAR ending 31st December, 1895.
[Note] 283 |
|
| HH62/45/285 |
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1895.
LOCAL AUTHORITY of the PERTH DISTRICT of the COUNTY of PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 0
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 284
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1895.
LOCAL AUTHORITY of the CENTRAL DISTRICT of the COUNTY of PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 0
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 285 |
|
| HH62/45/287 |
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1895.
LOCAL AUTHORITY of the HIGHLAND DISTRICT of the COUNTY of PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 0
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 286
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1895.
LOCAL AUTHORITY of the WESTERN DISTRICT of the COUNTY of PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 0
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 287 |
|
| HH62/45/289 |
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1895.
LOCAL AUTHORITY of the EASTERN DISTRICT of the COUNTY of PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 0
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 288
[Note] 289 |
|
| HH62/45/291 |
[Note] 290
County of Perth.
REPORT BY MEDICAL OFFICER
FOR
1896.
[Note] 291 |
|
| HH62/45/293 |
PERTH : PRINTED BY T. M. McGREGOR.
[Note] 292
INDEX.
-- PAGE.
METEOROLOGICAL OBSERVATIONS, -- 3
COUNTY OF PERTH, -- 7
PERTH DISTRICT, -- 17
CENTRAL DISTRICT, -- 21
HIGHLAND DISTRICT, -- 25
WESTERN DISTRICT, -- 29
EASTERN DISTRICT, -- 33
TABULAR STATEMENTS, -- 37
[Note] 293 |
|
| HH62/45/295 |
[Note] 294
METEOROLOGICAL OBSERVATIONS.
From Data supplied by Mr. CROUCHER, Ochtertyre Gardens, Crieff. Height of Station above the Sea, 333 Feet.
[Table inserted]
[Note] 295
WIND.
[Table inserted] |
|
| HH62/45/297 |
[Note] 296
County of Perth.
SIXTH ANNUAL REPORT BY COUNTY MEDICAL OFFICER,
1896.
The population of the Landward County of Perth, estimated to the middle of
1896, was 63,752. During the year there were 1545 Births, of which 772 were
males and 773 females, and 906 Deaths registered in the Landward County, giving a
Birth-Rate of 24.23 and a Death-Rate of 14.21, as compared with a Birth-Rate of 23.06
and a Death-Rate of 16.41 in 1895. Of the births, 9.5 per cent. of the total were
illegitimate, and were thus distributed through§ the various Districts - Perth District,
8.7 per cent.; Central District, 8.3 per cent.; Highland District, 11.2 per cent.;
Western District, 6.4 per cent.; Eastern District, 13.5 per cent. The Natural
Increase of the population during the year was 639, as compared with 427 in 1895.
There were 483 Deaths in persons over sixty years of age in 1896, as compared with
524 in 1895, and there were 118 Deaths in children under one year (the same number
as in 1895), of which 50 were attributed to Developmental Causes, giving an Infantile
Mortality of 76.3, as compared with 79.6 in 1895.
To Old Age were ascribed 146 Deaths during 1896; the number in 1895 was
139. The Zymotic Death-Rate was .674 in 1896 compared with 1.1 in 1895, and
the total number of cases of infectious disease reported during the year was 449, as
compared with 565 in 1895.
From the above figures it will be observed that the year 1896 has been one in
which the health of the County has been in a very satisfactory condition. The
number of Births was 64 in excess of that of the previous year, and what is of more
importance, the number of deaths was 148 less; also, when the cause of death is
looked to, it will be seen that a considerable part of the reduction is due
to fewer deaths from Zymotic, or what are commonly called Preventable Diseases,
i.e, those diseases which the Sanitary Department is specially called upon to stamp
out, or mitigate, under he Public Health Acts. Whilst it must be admitted that during
the past year climatic conditions have been favourable for living, as evidenced by a
general low death-rate, still, on looking back and comparing the death and sickness
records of the five Rural Districts of Perthshire, undoubted evidence is to be found
of a steady reduction of the gross death-rate, and especially so in that due to
Zymotic Disease. This is well exemplified in the case of the Perth District
where the population is most dense, but where, by the wise foresight of the Local
Authority, village scavenging is carried out in every village. Here, even with such
black spots as Stanley and Bankfoot to retard the general progress, the journey
healthwards has been, and continues to be, very satisfactory.
[Note] 297 |
|
| HH62/45/299 |
[Page] 8
The following tables shew at a glance the various death-rates in the County
Districts and Burghs during the past five years:-
LANDWARD DEATH-RATES.
[Table inserted]
BURGH DEATH-RATES.
[Table inserted]
It will be seen that the Burghs have actually begun to make some progress
healthwards during 1896, and there is no reason why the Death-Rates of these
should not compare favourably with those of the surrounding county, as, with ample
powers to enforce sanitary measures, the Burgh Local Authorities are much more
favourably situated than their rural brethren.
[Note] 298
[Page] 9
Most of the large Water-Supply Schemes in the County of Perth have now
been grappled with. After a stiff fight the Wester Errol Special Water District
has been formed, and it is now only a matter of carrying out the work; when
this has been done the Carse of Gowrie will be one of the best watered parts of the
County.
Scone has at last decided to forsake its polluted wells, and the inhabitants are
now crying out for gravitation water; had it not been that appeals were lodged
against some of the boundaries of the District, doubtless considerable progress would
have ere this been made with the work. However, as there is now a prospect of
opposition being withdrawn, steps will soon be taken to bring in a plentiful supply of
good water for the village, which already shows signs of becoming a thriving place.
Bankfoot still hesitates about sending a requisition for forming the village into
a Special Water District, and meanwhile its grim record of malignant typhoid fever
and consequent death continues. Both water and drainage are urgently required in
order to put the village into a sanitary condition, and it is high time that from such
places, heedless of their own safety as well as that of the surrounding country, the
power of initiating proceedings for the introduction of water and drainage
should be taken and given to the District Committee, so that when the
necessity arises the body responsible for the administration of Public Health
Acts could take the measures best calculated to ensure the safety of those under
their care.
The Madderty Water District had to be abandoned by the Central District
Committee owing to the opposition with which its formation was met, first by one
portion of the inhabitants and then by another; but as instructions were given to the
Sanitary Inspector to see that all parts of the intended District were provided with
a supply of pure water, much valuable work has been already done, and many estates
have procured, or are in course of procuring, supplies of water, and so far as the
health aspects of the District are concerned, the results will be the same as if the
Special Water District had been proceeded with.
In the Eastern District the villages of Burreltown and Woodside have been
formed into a Special Water District, and as there is a plentiful supply of good
water available near the villages, it is anticipated that the necessary works may be
completed at an early date.
The Rosemount Water District is still without a supply of water, and its cir-
cumstances have received considerable attention during the past year, the conclusion
arrived at being, that although several other sources of water for the District are
available, the most reasonable plan is that the Blairgowrie Special Water District
should be extended so as to embrace Rosemount. Were this done the difficulty
would soon be solved, as it has been shown by the Engineers' Reports that there
is ample water for all purposes going into Blairgowrie.
In Methven, the drainage of which is in an unsatisfactory condition, the inhabit-
ants devoted some consideration to what should be done to improve matters, but after
mature deliberation, they reported to the District Committee that a proper drainage
scheme for the village could not be worked without a gravitation water supply, and thus
the matter rests for the present. How, in the face of such a statement, the present
stone-built drains in the village can work properly, and be as perfect as represented
by some of the inhabitants, passes understanding. If the want of gravitation water
be the only objection to the introduction of what is essential to the sanitary improve-
ment of the village, why not form it into a Special Water District? There is an
abundant supply of good water within a reasonable distance at a sufficient height for
[Note] 299 |
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the supply of the entire village, and the cost of the combined schemes for both
drainage and water would not be prohibitive.
At Stanley the progress of sanitation has been much retarded by the decision of
the Sheriff that the village should not be formed into a Drainage District. It has been
through no fault of the District Committee that Stanley has not been provided with
the only means of rendering it other than the most insanitary of the villages in the
District; but, in view of the Sheriff's decision, the Local Authority are powerless,
excepting to order the removal of nuisances as they arise. This partial remedy will
not suffice for Stanley, as such a village, with practically an unlimited gravitation water-
supply taken into or close to every house, can never be in a healthy condition without
a properly-constructed drainage system. It is all very well to speak of rural hygiene
and perfect scavenging, but this is not applicable to a village with a water supply of
something like 100 gallons per head of the population, in the 24 hours. No scavenger
could be expected to remove some 400 tons of slop water daily to a safe distance from
the houses, and the dirty water from sinks, &c., must, even with the most careful
scavenging, still find its way over or through the soil in the immediate neighbourhood
of crowded dwelling-houses into the nearest open ditch, or equally offensive brick-
built drain, which is little better than an elongated cesspool. The continuance of
such a state of matters is a constant danger to the health of the inhabitants.
In Killin, the Special Drainage District referred to in last Report has been
proceeded with during the year, and the works are now approaching completion, and
give every evidence of being perfect. The purification system adopted is the most
recent application of the International.
The system of Scavenging throughout the County of Perth has been fully main-
tained during the year, and has, to a large extent, been the cause of the improved
sanitary condition. It has proved itself at the same time efficient and economical.
In Dunkeld, one of the only two Special Scavenging Districts in the County, the
scavenger has been placed under the direction of the Sanitary Inspector, so that for
the future the work will be supervised as it should.
Pollution of Rivers. - At Aberfoyle works have been completed for the
purification of the sewage from many of the houses which previously discharged it into
the Forth. The system adopted by order of the Sheriff was a modified form of the
International, and, if properly managed, should give a very good effluent.
At Killin the International System of Sewage Purification is to be adopted in its
entirety, and as the whole sewage of the village is to be purified thereby, a very com-
plete installation will be the result.
Aberfeldy, after many vain promises to cease polluting the Tay by its sewage,
suddenly decided to do nothing, holding it to be the privilege of the Burgh to dis-
charge its sewage into the noble river, and further asserting that by doing so the
water was purified and made more fit for domestic purposes for those who might
require to use it further down. The patience of the Highland District Committee
was at last exhausted, and a prosecution was ordered, and as the case now stands, the
Sheriff has appointed an expert to report on the best available means for purifying
the Burgh sewage before it enters the Tay.
In connection with the Sewage Irrigation fields at Crieff, complaints were again
and again received that they were managed in such a manner as to cause a nuisance
to those living in the neighbourhood. An investigation showed that the fault lay in
failing to attend to the proper distribution of the sewage, and, after a conference, the
Burgh Authorities agreed to employ a man who should attend to this most importamt
[Note] 300
[Page] 11
matter. There is no doubt that this was all that was required to stop complaints, as
otherwise the system is very satisfactory.
It has now been decided to carry Rattray sewage into the Blairgowrie main
sewer, so that the pollution of the Ericht, so far as Rattray is concerned, will be
obviated.
Meteorological Tables. - Extracts from the records at the Ochertyre Station
have again, through the kindness of Mr. Croucher, been regularly supplied during
the year, and from these the Tables have been compiled, which are well worthy of
perusal. To the following facts particular attention may be directed:- The high
barometer, high mean temperature, and small rainfall of May. The mean temperature
of October was the lowest since 1859. The rainfall of November was the smallest
since 1867.
Diseases of the Respiratory System caused 109 deaths, or 10.9 per cent. of
the total during 1896, as compared with 124 in 1895. Of these 109 deaths, 56
occurred in persons over 60 years of age, and 23 in children under 1 year. The
following table shows the percentage of deaths throughout the County, as well as the
percentage of sickness in the Central and Western Districts, from Respiratory
Diseases.
Percentage of Deaths.
PERTH DISTRICT, -- 15.5
CENTRAL DISTRICT, -- 13.5
HIGHLAND DISTRICT, -- 9.3
WESTERN DISTRICT, -- 10.1
EASTERN DISTRICT, -- 7.6
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 30.0
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 28.5
EASTERN DISTRICT, -- No Returns.
Diseases of the Circulatory System caused 129 deaths, or 14.2 per cent. of
the total during 1896, as compared with 132 in 1895. Of these 129 deaths, 92
occurred in persons over 60 years of age. The distribution of these diseases
throughout the County was as follows:-
Percentage of Deaths.
PERTH DISTRICT, -- 16.2
CENTRAL DISTRICT, -- 17.0
HIGHLAND DISTRICT, -- 11.0
WESTERN DISTRICT, -- 18.1
EASTERN DISTRICT, -- 13.8
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 8.8
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 9.6
EASTERN DISTRICT, -- No Returns.
Tubercular Diseases caused 118 deaths, or 13.0 per cent. of the total during
1896, as compared with 119 in 1895. Of these 118 deaths, the cause of death in 77
was attributed to Pulmonary Consumption. This shows a decrease of 2 in the
number of deaths due to Consumption, as compared with the previous year, but an
increase of 1 from other Tubercular Diseases. The ravages of Tubercule seem from
the records of the past few years to be kept within certain limits. This is probably
due to better housing of the people, but to effect any marked reduction, the disease
will require to be boldly faced, as are other infectious disorders. The distribution of
Tubercular Diseases throughout the County was as follows:-
Percentage of Deaths.
PERTH DISTRICT, -- 12.1
CENTRAL DISTRICT, -- 15.2
HIGHLAND DISTRICT, -- 9.3
WESTERN DISTRICT, -- 12.3
EASTERN DISTRICT, -- 17.6
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 3.6
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 4.8
EASTERN DISTRICT, -- No Returns.
[Note] 301 |
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Diseases of the Nervous System caused 82 deaths, or 9.0 per cent. of the
total during 1896, as compared with 97 in 1895. Of these 82 deaths, 60 occurred in
persons over 60 years of age, and 2 in children under 1 year. The distribution of
Nervous Diseases throughout the County was as follows:-
Percentage of Deaths.
PERTH DISTRICT, -- 8.4
CENTRAL DISTRICT, -- 7.6
HIGHLAND DISTRICT, -- 9.3
WESTERN DISTRICT, -- 11.5
EASTERN DISTRICT, -- 9.2
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 10.3
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 13.0
EASTERN DISTRICT, -- No Returns.
Diseases of the Digestive System caused 61 deaths, or 6.7 per cent. of the
total during 1896, as compared with 63 in 1895. The distribution of Digestive
Diseases throughout the County was as follows:-
Percentage of Deaths.
PERTH DISTRICT, -- 8.4
CENTRAL DISTRICT, -- 5.2
HIGHLAND DISTRICT, -- 5.8
WESTERN DISTRICT, -- 4.3
EASTERN DISTRICT, -- 8.4
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 36.7
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 34.8
EASTERN DISTRICT, -- No Returns.
Cancer and Malignant Diseases caused 51 deaths, or 5.6 per cent. of the
total during 1896, as compared with 52 in 1895. These deaths were distributed
throughout the County as follows:- Perth District, 17; Central District, 11;
Highland District, 11; Western District, 8; Eastern District, 4.
Old Age was given as the cause of death in 146 instances, or 16.1 per cent. of
the total, as compared with 139 in 1895.
Developmental Diseases caused 50 deaths, of which 30 were attributed to
premature birth, during 1896, as compared with 42 in 1895.
Violence was the cause of death in 26 instances during 1896, as compared with
36 in 1895. These deaths were thus distributed:- Perth District, 11; Central
District, 5; Highland District, 1; Western District, 5; Eastern District, 4.
Zymotic Diseases caused 43 deaths during 1896, as compared with 77 in 1895.
The total number of cases of illness due to these diseases was 449 during 1896, as
compared with 565 in 1895. This condition of matters is very satisfactory, as it is
against these diseases that the most strenuous efforts of the Sanitary Department are
directed. The number of patients suffering from infectious diseases removed to
Hospital during 1896 was 100, or 22.2 per cent., as compared with 85 in 1895.
Scarlet Fever caused 5 deaths during 1896, as compared with 8 in 1895. The
total number of cases reported during the year was 263, as compared with 277 in
1895. Much anxiety was caused in connection with several of the outbreaks
of this disease from the fact that slight cases, which had not been reported,
had been allowed to wander about amongst the inhabitants, without any
precautions, for weeks. Consequently, the extent of the epidemic was an unknown
quantity for some time; but, happily, in none of the outbreaks was the spread
alarming. In former years the happy ignorance of parents was enjoyed under the
assumption that the patient was suffering from Influenza, or the result of eating
unripe fruit; but during the past year the disease has been put down as German
Measles, and no precautions taken in consequence. Now, though Rötheln is a well-
recognised malady, this so-called German Measles is simply a cloak under which to hide
[Note] 302
[Page] 13
slight cases of Scarlet Fever. This was proved by the fact that over and over again
the return of patients, who were said to have suffered from German Measles, to
school was followed by a well-marked epidemic of genuine Scarlet Fever. Until the
Infectious Disease (Notification) Act has been altered so as to make it an offence to
remain in ignorance as to the nature of an illness from which a child is suffering, and
this is further supplemented by the Local Authorities providing medical advice to
supply the information at the expense of the rates, little more can be done in the
direction of stamping out Scarlet Fever in rural districts. Removal to Hospital
was carried out in 23.5 per cent. of the cases of this disease. The type of Scarlet
Fever was, in most cases, exceedingly mild, and it was only when it attacked
constitutions weakened by insanitary conditions that untoward results were ex-
perienced.
Diphtheria caused 4 deaths during 1896, as compared with 21 in 1895. The
total number of cases of this disease reported during the year was 67, as compared
with 130 in 1895, and, without doubt, this number would have been still further
reduced had it not been that in two of the outbreaks - one on Loch Tayside and the
other in Glenshee - the disease was unrecognised by the relatives until several mem-
bers of the families had become infected. It is satisfactory, however, to be able to
report such a marked reduction in this the most deadly of diseases with which
we have to combat. Not only were there fewer cases of Diphtheria during the past
year, but the case mortality was much lower than in 1895. In 1896 it was only 5.9
per cent., whereas in 1895 it was 16.1 per cent. The benefits of Hospital treatment
were afforded to 17 per cent. of the cases of Diphtheria. As in former years this
disease was usually found to be connected with insanitary conditions, which are now
rapidly disappearing.
Enteric Fever caused 9 deaths during 1896, as compared with 10 in 1895. At
Dunning and Blackford the disease was introduced from without by members of
infected families being removed to these places. In both of these series of cases the
epidemic was clearly traceable to milk infection. Bankfoot and Stanley still continue
to be fertile sources of Enteric Fever, the cases from the former place being always
of a most maligant type.
[Note] 303 |
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TABLE showing the prevalence of certain Zymotic Diseases in the several
Districts during the different Months of 1896.
[Table inserted]
[Note] 304
DIAGRAM
showing the prevalence of
DIPHTHERIA, SCARLET FEVER & ENTERIC FEVER.
DURING 1896.
[Graph inserted]
[Note] 305 |
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[Note] 306
[Page] 15
Diarrhoea caused 20 deaths during 1896, as compared with 31 in 1895. Again,
as in 1895, the maximum deaths from this disease correspond closely with the
maximum readings of the 48-inch underground thermometer. The following table
shows the monthly relation of deaths from Diarrhoea to the mean readings of the
48-inch underground thermometer:-
TABLE showing relation between Deaths from Diarrhoea and
Underground 48-inch Thermometer Readings.
[Table inserted]
Measles caused no deaths durng 1896.
Whooping-Cough caused 5 deaths during 1896, as compared with 4 in 1895.
The deaths recorded occurred in the Western and Eastern Districts, and were all
childen under five years of age.
Uncertified Deaths, or those in which the cause of death was insufficiently
stated, amounted to 53, or 5.8 per cent. of the total, as compared with 99 in 1895,
thus showing a marked improvement.
During 1896, as in former years, the Registrars of the 82 Registration Districts
have supplied regular monthly returns of Births and Deaths, and I would take this
opportunity of publicly thanking them for their valuable assistance.
Hospital Accommodation. - As noticed in last Annual Report, the arrange-
ment by which the Perth, Central, Highland, and Eastern Districts received
accommodation for their infectious cases in the Perth Royal Infirmary Wards,
terminates in May, 1897, and, in consequence, a new arrangement was necessitated,
in which it was considered advisable that the Western District should, to some extent,
participate. A conference was held between representatives of the City of
Perth and of the five County Districts, and it was agreed to accept a very
favourable offer made by the Infirmary Directors to receive the patients from the
Local Authorities, as in the past, on the payment of an annual sum of £700. This sum
was to be divided between the City of Perth and the Perth, Central, Highland, and
Eastern Districts in the proportions of £300 from the City and £400 from the
Districts, the payment from the latter to be less whatever sum was received from the
Western District, which agreed to pay at the rate of £5 per patient treated. Both
the Infirmary Directors and the Local Authorities are to be congratulated on this
agreement, as it will prove mutually advantageous. The County Medical Officer has
no supervision over the management of any patients in the Perth Infirmary, but, by
[Note] 307 |
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the courtesy of the Directors, he has the right of entry, when necessary, to the
Fever Wards.
The Portable Hospitals belonging to the various District Committees have not
been in use during the past year, but they are ready to be erected at a few hours'
notice, should they be required. The Hospital of the Western District, formerly
situated at Glenoglehead, has been removed at the request of the inhabitants of
Killin to a site nearer the village, and in its present position the management will be
much easier.
Removals of fever patients have been carried out without accident or bad
results of any kind during the past year, and, as formerly, much valuable assistance
has been received from the various Railway Companies, who have, by the courtesy
of their officials, much facilitated removals.
Little has to be added to the remarks of former years regarding the working of
the Infectious Disease (Notification) Act, which has been in many instances of
material help in preventing the spread of infectious disease during the past year,
though in several cases the disease was only notified after its discovery by the
sanitary officials, which is not exactly a help to them. It is to be hoped that during
the present year Scotland may become possessed of a new Public Health Act
thoroughly up to the times, which will place rural Local Authorities in a position to
do their duty more expeditiously than at present.
The courtesy and consideration at all times extended to me by the County
Council and District Committees must again be acknowledged gratefully.
JOHN T. GRAHAM,
County Medical Officer.
31st March, 1897.
[Note] 308
Perth District.
The population of the Perth District, estimated to the middle of 1896, was
20,612. During the year there were 525 Births (273 males and 252 females)
registered, giving a Birth-rate of 25.47, as compared with 25.2 in 1895, and 296
Deaths, giving a Death-rate of 14.36, as compared with 14.60 in 1895. The Natural
Increase of the population during the year was 229, as compared with 220 in 1895.
Deaths in persons over 60 years of age were 153, or 51.6 per cent. of the total (in
1895 the number was 130), and in childen under 1 year there were 44 deaths, of
which 21 were attributed to Developmental Causes, giving an Infantile Mortality of
83.8, as compared with 84.1 in 1895. Zymotic Diseases caused 15 deaths during
1896, as compared with 25 in 1895, giving a Zymotic Death-rate of .630, as compared
with 1.34 in 1895.
The continuous improvement in the sanitary condition of the Perth District,
noted in former years, has been well maintained during 1896; and, in the Villages,
the changes for the better are especially marked. During 1896 the water supply for
the Village of Errol and western portion of the Parish, received much consideration,
and the formation of a Special Water District to include them was met by appeals to
the Sheriff against this. After mature deliberation, however, the appeals were
dismissed, and now all that is required to complete the District is the bringing in of
the water. The source of water supply for the District is from a little hill stream,
which yields an ample and pure supply. The formation of the Wester Errol Water
District completes the water supply, to a large extent, of the Carse of Gowrie.
The water supply of New Scone has also been under consideration, and a
requisition to form the village into a Special Water Supply District was met
by appeals against the inclusion of certain lands within the District; but,
whilst under the consideration of the Sheriff, the appeals were withdrawn,
so that the introduction of the water to the village will not be delayed much
longer. The water supply to the inhabitants of Bankfoot still continues to be
derived from shallow wells, and with the same dire results as in the past to the health
of the inhabitants. Malignant Typhoid Fever seems to have come to stay in the
place. Much has been done to render the present wells safe, but without success; and,
in my opinion, the only course is to have the wells closed by order of the Sheriff, and the
proprietors compelled to bring in asafe supply of water. The inhabitants of Methven,
about the drainage of which village considerable discussion took place, resolved to do
nothing to improve the condition of the village, as they say that without a gravitation
water supply no drainage system can give satisfaction. Perhaps they may be right
in so saying, but certainly, if properly laid fire-clay pipes cannot be worked satis-
factorily without plenty of water to flush them, the present system of old-fashioned
stone-built drains cannot be in any other condition than one of grave danger to the
inhabitants. Some portions of the Village of Methven are fairly supplied with water
which, however, from the situations of the wells yielding it, is liable to contamination
from the above-mentioned drains, so that for the benefit of the whole village, as well as
the neighbouring district, it would be well that those interested should introduce a supply
of water by gravitation, rather than shut their eyes to the present dangerous condition
[Note] 309 |
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of affairs. Besides all this, there is the question of nuisance caused by the discharge
of the present drainage into a stream which passes close to several houses; this
has been completely overlooked by the inhabitants in their consideration of the
question. To this latter the District Committee should direct earnest attention. In
so far as the completion of the drainage system of New Scone is concerned, nothing
has been done during the past year, but it will be imperative that the District
Committee urge the Sub-Committee, entrusted with the management of the Scone
Drainage District, to do their duty so soon as the new water supply is introduced,
otherwise the present condition of the drainage of the village will not be tolerable.
As for the drainage of Stanley, the District Committee decided to form the village
into a Special Drainage District, but appeals were lodged against this, and the
Sheriff upheld these. This is most unfortunate, as without a safe drainage system
Stanley will be a continual source of Infectious Disease.
2. General enquiries have been made during the year in order to ascertain
the sanitary condition of the District, and many special visits have been necessitated
in connection with water supplies, drainage, and nuisances, as well as for ascertaining the
origin and spread of Infectious Disease. No certificates have been granted under the
Public Health Acts, nor has any action been taken under the Factory and Workshops
Acts during the year.
3. Advice was given in connection with various water supplies and drainage
schemes, as well as in connection with the arrangements for securing accommodation
for fever patients.
4. Retail Bakehouses. - These have been visited during the year and found to
be in a satisfactory condition; lime-washing has been regularly attended to.
5. During the past year 37 patients suffering from infections disease were
removed to the Perth Royal Infirmary. The former arrangement whereby the
District Committee was entitled to send its infectious cases to Perth Infirmary
expires in May, 1897, but a new agreement has been entered into by which, on pay-
ment of an annual sum, patients may still be sent. The Chief District Medical
Officer has no supervision over the treatment of patients removed to the Perth
Infirmary. No use has been made of the portable iron Hospital retained for the
treatment of Smallpox cases should they occur.
6. When infectious disease has been notified, either under the Act, or privately,
the energies of the Sanitary Staff have been at once directed to prevent its spread as well
as to ascertain its cause, and, if due to any insanitary condition, insist on its removal.
Much valuable assistance has been received from the Local Inspectors, who were ever
ready to do their utmost to help. During 1896 133 cases of infectious disease were
reported to the Medical Officer, as compared with 209 in 1895, thus showing a con-
siderable reduction, the most marked being in the number of cases of Diphtheria,
which were less than a fourth of those reported in 1895.
Respiratory Disease caused 46 deaths during 1896, as compared with 33 in
1895. Of the 46 deaths, 26 occurred in persons over 60 years of age, and 7 in
children under 1 year.
Circulatory Diseases caused 38 deaths during 1896, as compared with 37 in
1895. Of these 38 deaths, 30 occurred in persons over 60 years of age. This class
of disease caused 16.2 per cent. of the total mortality.
Tubercular Disease caused 36 deaths during 1896, as compared with 43 in 1895.
Of these 36 deaths, 24 were attributed to Pulmonary Consumption. These diseases
caused 12.1 per cent. of the total mortality.
[Note] 310
[Page] 19
Diseases of the Nervous System caused 25 deaths during 1896, as compared with
23 in 1895. In 21 of these deaths, the age at death was over 60 years.
Diseases of the Digestive System caused 25 deaths during 1896, as compared
with 18 in 1895. This class of diseases caused 8.4 per cent. of the total mortality.
Cancer and Malignant Diseases caused 17 deaths during 1896, the same
number as in 1895.
Old Age was the cause of 35 deaths during 1896, as compared with 40 in 1895.
Violence was the cause of 11 deaths during 1896, as compared with 4 in 1895.
Developmental Diseases caused 21 deaths during 1896, of these 15 were
attributed to premature birth; the number of deaths due to Developmental Diseases
in 1895 was 19.
Zymotic Diseases caused 13 deaths during 1896, as compared with 25 in 1895.
The Zymotic death rate was .630, as compared with 1.34 in 1895.
Diphtheria. - There were no deaths from diphtheria in the Perth District during
1896, and only 15 cases of the disease were reported, as compared with 10 deaths
and 64 cases in 1895. The cases were scattered widely throughout the District,
and there was no spread of the disease, excepting in one instance where the first
patient, a servant, was sent home, and two sisters were infected there in consequence.
Six patients suffering from diphtheria were removed to Hospital, and made good
recoveries.
Scarlet Fever caused 3 deaths during 1896, as compared with 2 in 1895. There
were 78 cases of the disease reported to the Medical officer during the year, as com-
pared with 90 in 1895. Twenty-three of these patients were removed to Hospital,
and all, with one exception, made good recoveries.
Groups of cases of Scarlet Fever occurred at Methven, Stanley, Aberdalgie, and
Glencarse, but the type of disease was exceedingly mild, excepting in the Stanley
cases, which were very malignant. Nowhere did the disease assume alarmig pro-
portions, although it was surprising that this did not happen, as in several instances
the patients had been thought to be suffering from Measles, and no precautions taken.
Enteric Fever caused 4 deaths during 1896; in 1895 the number was the
same. During the year 17 cases of this disease were reported to the Department,
of these 7 were removed to Hospital. Six cases were credited to Bankfoot, and of
these, two were fatal; another of the fatal cases occcurred in Stanley.
Measles. - One case of this disease was removed to Hospital at the request of a
householder. The patient was a servant, and had recently come to the District.
Diarrhoea caused 6 deaths during 1896, as compared with 8 in 1895.
Deaths in which the cause of death was uncertified, or insufficiently stated, were
16 in 1896; in 1895 the number included under this heading was 20.
[Note] 311 |
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[Note] 312
Central District.
The population of the Central District, estimated to the middle of 1896, was
11,163. During the year 301 Births (157 males and 144 females) and 170 deaths were
registered, giving a Birth-rate of 26.06, and a Death-rate of 15.22. In 1895 the
Births were 265, and the Deaths 206. The Natural Increase of the population of
the District during the year was 131, as compared with 59 in 1895. There were 99
deaths in persons over 60 years of age, making 58.2 per cent. of the total, and there
were 22 deaths in children under one year of age, of which 5 were due to develop-
mental causes, giving an Infantile Mortality of 73.08, as compared with 101.8 in 1895.
The Zymotic Death-rate in 1896 was .985, as compared with 1.50 in 1895.
The general health of the Central District was very satisfactory during the past
year; there were, however, several sharp outbreaks of Infectious Disease, which were
confined to the localities in which they originated. No works of magnitude have
been carried out during the year, although much has been done in providing water
supplies to places previously deficient in this respect within the proposed Madderty
District. The Requisition to form Madderty into a Special Water Supply District
was abandoned by the District Committee in consequence of the opposition with
which it was met. That the locality will be as completely supplied with water as if
the District had been formed is undoubted, but whether those interested have taken
the wisest and most economical course remains to be seen. When the larger scheme
was abandoned, the District Committee authorised the Sanitary Inspector to proceed
against those proprietors in the area who had not provided water supplies, and
already many small independent schemes have been introduced, and others are in
progress. The drainage of Dunning has given no trouble during the past year, and
under the charge of the District Committee it may serve for years to come. The
Village of Comrie has not yet been formed into a Special Drainage District, but the
desirability of this being speedily accomplished must again be pointed out, as the
present drains are a constant source of danger to the inhabitants, and a pollution of
the River Earn. Some trouble was experienced by complaints about the want of
management of the Crieff sewage irrigation fields, and it was arranged at a conference
between the County Officials and representatives of the Burgh Authority, that a
man should be employed to attend to the proper distribution of the sewage. The
Crieff irrigation fields are well suited for their purpose, and with good supervision
should cause no nuisance. Two vacancies occurred amongst the Local Medical
Officers, one at Blackford the other at Logiealmond; these were both due to resigna-
tions. Dr. Hislop, Blackford, was appointed to the former, and Dr. Simpson, Trinity
College, to the latter. The reorganization of the Local Sanitary Staff was under
consideration, and it was at first decided to dismiss the whole of the Parochial
Inspectors, and to appoint one man to do the whole work of the District, but finally
vacancies in the existing staff were filled up, and the Local Inspectors were retained,
their salaries being made somewhat adequate to their duties, and an allowance given
for travelling expenses when extra work was necessitated, so the matter is now on a
more satisfactory footing.
2. General enquiries were made throughout the year to ascertain the sanitary
[Note] 313 |
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condition of the District, and many special enquiries have been rendered necessary in
connection with complaints of alleged nuisances, water supplies, the discovery of
the origin of outbreaks of Infectious Disease, and the proper isolation of the patients.
3. Advice was given in connection with the introduction of water supplies in the
District, the rearrangement of the Local Sanitary Staff, and the new agreement with
the Perth Infirmary Directors for the continued reception of infectious cases from the
Central District. Under the Factory and Workshops Acts several matters were
attended to at the request of the Factory Inspector. The proper administration of
the Factory Acts is at present under the consideration of the District Committee, as
a large amount of work required under them is thrown on the Local Authority.
4. Retail Bakehouses were inspected during the year, both by the Medical
Officer and Factory Inspector, who has now this added to his duties. On the whole,
the Bakehouses were found in a satisfactory condition, and any defects were due to
neglect to lime-wash or paint the ceilings and walls.
5. The arrangement by which the Central District Committee were entitled to
send infectious cases for treatment to the wards of the Perth Infirmary was fully
taken advantage of during the past year, 31 patients having been removed. The
former arrangement terminates in May, 1897, but a new agreement has been entered
into, by which, on payment of an annual sum, patients will be admitted as formerly.
The portable Hospital belonging to the Central District, which is reserved for treating
cases of Smallpox, should they occur, has not been in use during the year.
6. During the past year the energies of the Department have been much taxed
in tracing up the cause and confining the spread of Infectious Disease, and when the
Infectious Disease (Notification) Act failed to give notice through ignorance of the
nature of the illness on the part of householders, this was remedied by house to house
visitation. As a result, none of the outbreaks were allowed to spread to any extent.
When Infectious Disease was ascertained to exist in a house, all of the usual
precautions were taken to protect the public, and disinfectants were supplied. In
dealing with Scarlet Fever, in one or two instances the closure of public schools was
recommended.
Diseases of the Respiratory System caused 23 deaths, or 13.5 per cent. of the
total during 1896, as compared with 26 in 1895. Of these 23 deaths, 13 were in
persons over 60 years of age, and 7 in children under 1 year. Sickness returns show
that 30.0 per cent. of the total was due to this class of diseases.
Diseases of the Circulatory System caused 29 deaths, or 17.0 per cent. of the
total during 1896, as compared with 22 in 1895. Of these 29 deaths, 22 occurred in
persons over 60 years of age. Sickness returns show that 8.8 per cent. of the total
was due to Circulatory Diseases. A close relation is seen between these Diseases and
Rheumatic Diseases, as, during the year, the latter caused 8.7 per cent. of the total
sickness.
Tubercular Diseases caused 26 deaths, or 15.2 per cent. of the total, during
1896, as compared with 26 in 1895. Of the 26 deaths, 18 were ascribed to Pulmonary
Consumption. Sickness returns show that 3.6 per cent. of the total was due to
Tubercular Diseases.
Diseases of the Nervous System caused 13 deaths, or 7.6 per cent. of the
total, during 1896, as compared with 25 in 1895. Of these 13 deaths, 12 occurred in
persons over 60 years of age. Sickness returns show that 10.3 per cent. of the total
was due to Nervous Diseases.
Diseases of the Digestive System caused 9 deaths, or 5.2 per cent. of the total,
[Note] 314
[Page] 23
during 1896, as compared with 13 in 1895. Sickness returns show that 36.7 per
cent. of the total was due to Digestive Diseases.
Cancer and Malignant Disease caused 11 deaths during 1896; in 1895 the
number was 7.
Old Age was given as the cause of death in 24 instances, as compared with 21
in 1895.
Developmental Diseases caused 5 deaths during 1896, as compared with 6 in
1896.
Violence caused 5 deaths during 1896, as compared with 9 in 1895.
Zymotic Diseases caused 11 deaths during 1896, as compared with 17 in 1895.
The Zymotic Death-rate was .985, as against 1.5 in 1895, thus showing a marked
improvement. During 1896, 117 cases of Infectious Disease were reported to the
Department. In 1895 the number was the same.
Scarlet Fever caused no deaths during 1896, but 75 cases of the Disease were
reported. Scarlet Fever was very prevalent in some parts of the District, at Trinity-
Gask and Madderty, and especially at Dunning, where the Disease was existing at
the beginning of the year. The type of the Disease was so mild, that in several
instances it had been in existence in the localities for some time before its nature was
recognized. A considerable number of the cases were supposed to be German Measles
by the parents, and thus the infection was spread through lack of proper precautions.
Of the 75 cases reported, 16 were removed to Hospital.
Enteric Fever caused 3 deaths, as against 2 in 1895. There were 26 cases of
the Disease reported to the Department during the year, as compared with 5 in 1895.
Most of these cases were included in two outbreaks which occurred, one at Dunning
and the other at Blackford, and there seemed to be little doubt that the infection in
both was introduced from without. Unfortunately, the early cases were very mild,
and before a medical man was called in, and their true nature recognised, they had
contaminated milk supplies, and thus the infection was spread. One fatal case was
removed to a house in the District only a few days previous to death. The necessity
for securing early diagnosis of Enteric Fever was very clearly shown in connection
with these outbreaks, as irreparable mischief is often caused by slight cases unrecog-
nized through heedlessness on the part of relatives. Half of the 26 cases were
removed to Hospital, and made good recoveries.
Diphtheria caused 1 death during 1896, as compared with 2 in 1895. Only 4
cases of the Disease were reported during 1896, as against 22 in 1895, thus showing
a marked improvement.
Diarrhoea caused 7 deaths during 1896, as compared with 9 in 1895. The
Disease was most prevalent during the months of June, July, and August.
Deaths in which the cause of death was uncertified, or insufficiently stated, were
12 in 1896, as compared with 15 in 1895.
[Note] 315 |
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[Note] 316
Highland District.
The population of the Highland Distict, estimated to the middle of 1896, was
12,531. During the year 226 Births (152 males and 114 females) and 172 Deaths
were registered, giving a Birth-rate of 21.22, and a Death-rate of 13.72, as compared
with a Birth-rate of 21.02, and a Death-rate of 19.36 in 1895. The Natural Increase
of the population during the year was 94, as against 21 in 1895. There were 92
deaths, or 53.4 per cent. of the total, in persons over 60 years of age; and 18 (of
which 10 were ascribed to Developmental Causes) in children under 1 year, giving an
Infantile Mortality of 67.6, as compared with 63.9 in 1895. The Zymotic Death-rate
was .558, as compared with .632 in 1895. In common with the other Districts of
the County, the Highland District has, during the past year, enjoyed a very good
record in so far as health, indicated by Death-rates, is concerned, the total number of
deaths being 73 below that recorded in 1895; but, during the year, Scarlet Fever has
been very prevalent in several localities, and thereby much anxiety has been caused
to the Public Health Department. No large undertakings have been in progress
within the District during the year, and the work of the Department has been chiefly
of a routine nature, but in such a wide District this means a good deal. The sewage
from Murthly Asylum has been treated by broad irrigation on a very suitable field,
and gives promise of becoming a profitable investment for the Institution. The
ground has as yet not been laid down in permanent grass, but, during the short time
it has been irrigated, gratifying results have been achieved in the form of a splendid crop
of turnips. Pitlochry has taken measures to make the sewage irrigation fields
connected with its drainage system more efficient. The Burgh of Aberfeldy has at
last been forced to acknowledge that its sewage, as at present discharged into the Tay, is
contrary to the Rivers Pollution Prevention Acts, and the Sheriff has appointed Mr.
Copland, C.E., Glasgow, to report to him regarding the best available means of
purifying the sewage before its discharge into the Tay. Dunkeld still waits to see a
system of sewage purification which can be carried out without causing a nuisance,
but the time rapidly approaches when the District Committee will have to insist that
some system shall be adopted, as there is danger of this matter becoming lost sight of
amidst the many excitements in the ancient City. The Killin Drainage Works are
expected to be in full working order early in the present year, and a visit to these
might enlighten the inhabitants of Dunkeld as to the possibility of not only perfectly
purifying sewage, but of doing so without causing any nuisance.
2. General enquiries have been made throughout the past year to ascertain the
sanitary condition of the Highland District, and many special visits, some of them
to the most inaccessible parts of the District, have been necessitated in endeavours to
secure information of the existence of Infectious Disease, and to ensure the adoption
of measures to check the spread of the same.
3. Advice was given in connection with the proposed proceedings against the
Burgh of Aberfeldy for polluting the Tay; also in connection with the new agreement
with the Directors of the Perth Infirmary, whereby cases of Infectious Disease from
the District might be received, and on many occasions consultations have been held
[Note] 317 |
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with local medical men regarding suspected cases of Infectious Disease. No certifi-
cates were necessary under the Public Health Acts during the past year, nor was any
action taken under the Factory and Workshops Act.
4. Retail Bakehouses were inspected during the year, and the requirements of
the Factory and Workshops Acts were enforced regarding their condition. The
premises were, however, found in very fair condition.
5. The arrangement by which the Highland District infectious cases were
admitted into the Perth Infirmary was fully taken advantage of during the past
year, 23 patients having been removed during its course, but in May, 1897, the former
agreement terminates, so that a fresh agreement had to be completed. The District
patients are to be admitted as formerly on the payment of an annual sum. Year by
year proves that a Central Hospital is quite sufficient for the requirements
of the Highland District. During the year many patients were removed long
distances without in any way suffering thereby, - one case of Diphtheria having been
removed 47 miles to Hospital. The Portable Hospital belonging to the District
Committee, reserved for the treatment of Smallpox cases, has not been in use during
the year, but is ready for erection when and where required.
6. When Infectious Disease has been reported to exist, or suspected to exist,
immediate steps have been taken to ascertain the exact nature of the outbreak, and
prompt measures have been adopted to secure isolation. Much difficulty was
experienced through one outbreak of Scarlet Fever having been looked upon as some
other disease, until the whole locality had become infected, but careful tracing up of
suspects, and rigid isolation of these when suspicious evidence was detected, sufficed to
check the epidemic, although the infection had made considerable progress before the
Department was made aware of its existence. In one instance where a whole family
had become infected, it was thought best to provide a Nurse in order to secure
isolation. In the trying work of tracing up supposed clues regarding infectious cases,
much valuable assistance was received from the Assistant Sanitary Inspector, who
most willingly took many long journeys in order to ascertain the truth or falsity of
rumours. Wherever insanitary conditions were found to be causing or aggravating
disease, prompt measures were taken to effect a remedy. Two School Boards within
the District showed much anxiety to put their property into good sanitary condition,
the Kenmore Board having done a great deal to the premises at Acharn, where there
was an out outbreak of Scarlet Fever in 1895, and also at Ardeonaig, where there
were a number of Diphtheria cases in the Teacher's house during 1896, and where
insanitary conditions abounded. The Logierait School Board, owing to an outbreak
of Scarlet Fever amongst the children attending Grandtully Public School, and com-
plaints as to the condition of the premises, decided to erect a new School at a more
central point.
Respiratory Diseases caused 16 deaths, or 9.3 per cent. of the total,
during 1896, as compared with 32 in 1895. In 6 of these deaths, the age at death
was over 60 years, and 3 occurred in children under 1 year.
Diseases of the Circulatory System caused 19, or 11.0 per cent. of the total,
during 1896, as compared with 23 in 1895. Of these 19 deaths, 11 occurred in
persons over 60 years of age.
Tubercular Diseases caused 16 deaths, or 9.3 per cent. of the total, as com-
pared with 23 in 1895. Of these 16 deaths, 11 were attributed to Pulmonary
Consumption. Deaths due to this class of disease show, during the year, a
satisfactory diminution.
Disease of the Nervous System caused 16 deaths, or 9.3 per cent. of the total,
[Note] 318
[Page] 27
during 1896, as compared with 20 in 1895. Of these 16 deaths, 10 occurred in
persons over 60 years of age.
Diseases of the Digestive System caused 10 deaths, or 5.8 per cent. of the
total, during 1896, as compared with the same number in 1895.
Cancer and Malignant Diseases caused 11 deaths, or 6.3 per cent. of the total,
during 1896, as compared with 14 in 1895.
Old Age was certified as the cause of death in 40 cases, or 23.2 per cent. of the
total, during 1896, as compared with 35 in 1895.
Developmental Diseases caused 10 deaths, of which 7 were attributed to
premature birth, during 1896, as compared with 6 in 1895.
Violence caused only 1 death during 1896, as compared with 12 in 1895.
Zymotic Diseases caused 7 deaths during 1896, as compared with 8 in 1895.
The total number of cases of these deseases reported to the Department during the
year was 116, as compared with 90 in 1895, the increase being due to an excessive
number of Scarlet Fever notifications. The Zymotic Death-rate during 1896 was
.558, as compared with .632 in 1895.
Scarlet Fever caused 2 deaths during 1896, as compared with 1 in 1895. There
were 85 notifications of the disease received by the Department, as compared with 56
in 1895. The chief outbreaks of the disease occurred at Moor of Rannoch, Dunkeld,
Grandtully, Ballinluig, and a few cases in Pitlochry. In the outbreak at the latter
place, what can be done by prompt measures was well seen; the cases were early
seen by medical men, the nature of the disease recognised, removal was carried out,
and the village was clear of infection in less than a week. The disease was of a very
mild type, and the only two deaths which occurred happened in the same family.
The epidemic in Dunkeld threatened at one time to assume alarming proportions,
but fortunately, the precautions adopted soon checked its spread. Several Schools
had to be recommended to be closed for a time, as it was found that convalescents
had been attending whilst in an infectious condition, and a scare amongst the parents
was the result of this being discovered. There were 19 cases removed to Hospital;
all made good recoveries.
Enteric Fever. - As in 1895, no death was cause by Enteric Fever during 1896,
and only 4 cases of the disease were reported to the Department during the year. One
of the cases undoubtedly received infection before coming to the District, another
was a tinker, and it was thus difficult to ascertain whence the infection in this case
had been derived. In another case the disease was probably derived from the turning
up of some old drains during alterations. One patient was removed to Hospital, and
made a good recovery.
Diphtheria caused 1 death during 1896; in 1895 the number of deaths was the
same. During the year, 12 cases of the disease were reported to the Department, as
compared with 2 in 1895. The majority of the cases of the disease occured at
Ardeonaig and in one house, the infection having spread over the family previous to
the nature of the disease becoming known; here, doubtless, insanitary conditions were
a large factor in the causation and spread of Diphtheria. Of these 12 cases of
Diphtheria, 3 were removed to Hospital, and made good recoveries.
Diarrhoea caused 4 deaths during 1896, as compared with 6 in 1895.
Deaths in which the cause of death was uncertified, or insufficiently stated, were
14, as compared with 45 in 1895. This is satisfactory, and as it should be.
[Note] 319 |
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[Note] 320
Western District.
The population of the Western District, estimated to the middle of 1896, was
9972. During the year there were 225 Births (103 males and 122 females) and 138
Deaths registered in the District, giving a Birth-rate of 22.56, and a Death-rate of
13.83, as compared with a Birth-rate of 19.84, and a Death-rate of 14.40 in 1895.
The Natural Increase of the population during the year was 87, as compared with 54
in 1895. Deaths in persons over 60 years of age were 69, or 50.0 per cent. of the total,
as against 68 in 1895. There were 16 deaths of children under 1 year, of which 6
were attributed to premature birth, giving an Infantile Mortality of 71.11, as com-
pared with 65.9 in 1895. The Zymotic Death-rate during 1896 was .601, as compared
with 1.91 in 1895. The total number of infectious cases notified during the year
was 35, as against 100 in 1895.
During the past year the health of the Western District has been very
satisfactory, and the work of the Health Department has been little beyond the
ordinary routine of administration. The absence of large contracts, or at least the
absence of the many men employed on these, has been felt as a relief from the con-
stant anxiety of former years. The only contract still in progress in the District is
in connection with the Glasgow Water Works, but, as the work is at present confined
to tunnelling through a hill, only a few men can be employed. It is soon expected,
however, that the final part of the contract will be attacked, that is, the raising the
level of Loch Katrine by constructing a heavy embankment, which will necessitate
the employment of a large number of men. The purification of the Forth by the
removal of the sewage of Aberfoyle from entering the river in its crude state has now
been accomplished, and the Western District Committee, having put its own house
in order, will be in a favourable position to insist on the elimination from the river of
the sewage from the Stirlingshire villages also. At Killin the works in connection
with the Special Drainage District, although much retarded by unfavourable weather,
have made good progress, and it is anticipated that they will be in full operation in
May, 1897, this event is looked forward to with much interest, as with a complete
purification system, under the management of the District Committee, it ought to be
possible to develope its highest efficiency.
2. General enquiries have been made throughout the year in order to ascertain
the condition of the District, and special enquiries have been made, in connection with
outbreaks of infectious disease, to discover their origin, and secure isolation for the
protection of the public, as well as to determine whether action was necessary to be
taken as to alleged nuisances, of which complaints were from time to time received.
Enquiries were also made as to the best site for the Killin Hospital, formerly located
at Glenoglehead, but which it was considered advisable to remove to a more easily
accessible place.
3. Advice was given in connection with the purification of the sewage from some
of the houses in Aberfoyle and Killin Drainage Scheme, as well as in connection
with the proposal of the inhabitants of Killin, to have the District Hospital removed
to another site nearer to the village. No certificates were necessary under the Public
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Health Acts, nor was any action taken in connection with the sanitary condition of
Factories or Workshops.
4. Retail Bakehouses. - These were inspected during the year, and the pro-
vision of the Acts enforced. The Deanston Bakehouse is still vacant, and there are
only four others in the landward District.
The Hospitals belonging to the Western District have been closed during the
past year. As, in such circumstances, they are simply shut up, no expense is incurred
for management. Only two patients required Hospital treatment during the year;
both of these were removed to Perth Infirmary, as the District Committee decided that
where that course was possible it would be best to follow it. The Hospital for the
Killin District was, at the request of the inhabitants, removed from its former site at
Glenoglehead to one much lower down, and more suitable in every way. A water
supply by gravitation was brought within the Hospital enclosure, and a system for
dealing with slop water constructed. When the new arrangement between the
Directors of the Perth Royal Infirmary, and the other four District Committees, for
the reception of their infectious cases was made, it was thought advantageous that the
Western District should join with them in so far as to secure the admission of any
patients which were considered able to bear the removal, at the same time having con-
sideration of the expense of providing Hospitals at Dunblane and Killin, in which
some of the patients would still be treated, it was thought that, instead of paying an
annual sum, like the other districts, the Western District should only pay so much
per head for patients sent to Perth. This proposal was favourably received by the
Infirmary Directors and the other Districts, and it was agreed that a sum of £5 per
patient should be paid by the District, any sums so received to be deducted from
that payable to the Infirmary by the other four Districts.
6. To check the spread of Infectious Diseases, and to prevent their occurrence,
the usual precautions have been taken in securing the removal of conditions likely to
cause or aggravate them. That these measures have been fairly successful is
evidenced by the small number of cases and consequent deaths from such diseases as
Enteric Fever, Diphtheria, and Diarrhoea. One house reported as unfit for human
habitation in 1895, has been replaced by a very superior building. When infectious
disease has been reported, its origin has been the subject of enquiry, strict isolation
has been enforced, and disinfectants freely supplied.
Diseases of the Respiratory System caused 14 deaths, or 10.1 per cent. of the
total, during 1896, as compared with 16 in 1895. In 5 of these deaths, the age at
death was over 60 years, and in 4, the age was under 1 year. Sickness returns show
that 28.5 per cent. of the total was due to Respiratory Diseases.
Diseases of Circulatory System caused 25 deaths, or 18.1 per cent. of the
total, during 1896, as compared with 16 in 1895. Of these 25 deaths, the age at
death was over 60 years in 14 instances. Sickness returns show that 9.6 per cent. of
the total during 1896 was due to these diseases.
Tubercular Disease caused 17 deaths, or 12.3 per cent. of the total, during
1896, as compared with 15 in 1895. Of these 17 deaths, 9 were attributed to Pul-
monary Consumption. Sickness returns show that 4.8 per cent. of the total was due
to Tubercular Diseases.
Diseases of the Nervous System caused 16 deaths, or 11.5 per cent. of the
total, during 1896, as compared with 14 in 1895. Of these 16 deaths, 11 occurred in
persons over 60 years of age. Sickness returns show that 13.0 per cent. of the total
was due to Nervous Diseases.
Diseases of the Digestive System caused 6 deaths, or 4.3 per cent. of the total,
[Note] 322
[Page] 31
during 1896, as compared with 11 in 1895. Sickness returns show that 34.8 per
cent. of the total was due to Digestive Diseases.
Cancer and Malignant Diseases caused 8 deaths during 1896, as compared
with 4 in 1895.
Old Age. - To this cause were attributed 21 deaths during 1896, as compared
with the same number in 1895.
Developmental Disease caused 6 deaths during 1896. Three of these were
attributed to Premature Birth, in 1895 the number was 5.
Violence caused 5 deaths during 1896, the same number as in 1895.
Zymotic Diseases caused 6 deaths during 1896, as compared with 19 in 1895.
The number of Infectious cases reported to the Department during the year was 35,
as compared with 100 in 1895. The Zymotic Death-rate was .601, as compared
with 1.91 in 1895.
Scarlet Fever caused no deaths during 1896, and only 15 cases of the disease
were reported to the Department. In 1895 the number reported was 40. Most of
the cases occurred in the Port of Monteith district, and were of such a mild character
as to make their recognition difficult, some of the patients had only sore throats,
others only had a slight rash, and no throat affection, but the occasional occurrence
of a well-marked case of Scarlet Fever showed the true nature of the disease. In
very many of the patients no desquamation followed the attack. Only one case from
near Dunblane was removed to Hospital, as he was an inmate of a bothy in which
several others were living, no more cases followed his removal.
Enteric Fever. - Of this disease, there were only two cases reported during the
year. Both patients made good recoveries. The cases were well isolated, and no
spread of the disease resulted. These cases occurred in widely separated parts of the
District, and had no connection with each other.
Diphtheria caused 2 deaths during 1896, as compared with 8 in 1895. Sixteen
cases of the disease were reported during the year, as compared with 39 in 1895, thus
showing a very marked improvement. One of the fatal cases occurred in a child who
had only recently come to the District, and had doubtless brought the disease in its
system. In another family where several were affected, the cause of the disease
was evidently faulty drainage and damp sub-soil. Killin has been quite free from
the disease during the past year.
Whooping Cough caused 3 deaths during 1896, as compared with 1 in 1895.
These deaths occurred in the Dunblane and Aberfoyle districts, in which the disease
was very prevalent.
Diarrhoea caused only 1 death during 1896, as compared with 6 in 1895.
This also is satisfactory.
Erysipelas. - Two cases were notified, and one, a domestic servant, was removed
to Hospital.
Deaths in which the cause of death was uncertified, or insufficiently stated, were
8, as compared with 9 in 1895.
[Note] 323 |
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[Note] 324
Eastern District.
The population of the Eastern District, estimated to the middle of 1896, was
9474. During the year 1896 there were 228 Births (107 males and 121 females)
and 130 Deaths registered in the District, giving a Birth-rate of 24.06, and a Death-
rate of 13.72, as compared with a Birth-rate of 24.02, and a Death-rate of 16.39 in
1896. The Natural Increase of the population during the year was 98, as compared
with 73 in 1895. There were 72 deaths, or 53.8 per cent. of the total, during the year,
in persons over 60 years of age, and in childen under 1 year there were 18 deaths, of
which 8 were due to Developmental Causes, giving an Infantile Mortality of 78.9, as
compared with 73.9 in 1895. The Zymotic Death-rate was .633, as compared with
.522 in 1895, and during the year 48 cases of Infectious Disease were reported, as
compared with 49 in 1895.
The general health of the District has been very satisfactory during the past year,
the number of deaths being less by 27 than in 1895. The excess in the Zymotic
death-rate was caused by two deaths from Whooping-Cough, a disease which sanit-
arians have not as yet sufficient powers to successfully control. Several water supplies
have been dealt with by the District Committee during the past year, the chief
was that for the supply of the combined villages of Woodside and Burrelton,
where the inhabitants, having given up hopes of permanently improving the present
wells, requisitioned the District Committee to form a Special Water Supply District.
This was done when it was satisfactorily shown that a sufficient supply of pure water
could be obtained at a reasonable cost, and a Sub-Committee has been appointed to
carry out the necessary works. The partially abandoned Rosemount Water District
was again brought to the front by the Local Government Board ordering an enquiry
and report as to the requirements of the District, and the possibility of securing a
supply of water for it, should that be found necessary. A very exhaustive enquiry
was made, which resulted in the discovery that there was a grievous want of water
in many parts of the District, also that there were three possible sources from which
water might be obtained; first, from the water supply to Blairgowrie, if that could
be guaranteed constant, and obtained at a reasonable cost; second, by pumping the
water from Loch Marlee to a sufficient elevation to allow it to gravitate to the
highest parts of the District; and third, by sinking a well in the District itself, and
pumping the water from that to a sufficient height. This latter alternative was,
however, laid aside for two very sufficient reasons, first, that it was very doubtful
whether the quality of the water likely to be obtained from such a well would be
pure, and second, that there was no place within the District on which a sufficiently
elevated reservoir could be erected to supply houses in the higher parts of the
District. The pollution of the River Ericht by the discharge of the sewage of
Rattray into it was several times under consideration, and it was finally decided by
the Rattray Commissioners to join their sewer to that of Blairgowrie, at the
outfall of which purification works have been erected. There is no doubt that this
scheme will be the best in the long run as it will remove the present pollution of the
river, and a conjoint purification scheme will be at the same time most economical
and efficient.
[Note] 325 |
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2. General enquiries have been made throughout the year in order to ascertain the
sanitary condition of the District, and several special enquiries were made in connection
with water supplies, drainage, and the investigation of outbreaks of Infectious
Disease.
3. Advice was given in connection with the Rosemount, and Woodside and
Burrelton Water Districts, the purification of the sewage of Rattray, and also the
new arrangement with the Perth Infirmary for the reception of infectious cases from
the District.
Retail Bakehouses. - These have been inspected during the year, and were found
in good order with the exception of one, the condition of which was not as required by
the Factory Acts; it was, however, improved after remonstrance.
5. The arrangement with the Directors of the Perth Infirmary by which cases
of Infectious Disease were admitted there for treatment during the past five years
terminates in May, 1897, but a new agreement has been entered into by which
patients will be received as formerly on payment of an annual sum. During the past
year 7 cases were removed to Hospital, and all made good recoveries. The Portable
Hospital belonging to the District Committee which is retained for treatment of cases
of Smallpox, should they occur, has not been in use during the year, but is ready
when wanted.
6. By the removal of insanitary conditions, the likely causes of filth diseases
have been eliminated in so far as possible, and when cases of Infectious Disease were
reported, prompt measures were taken to secure the isolation necessary for the protect-
ion of the public, disinfectants were freely supplied to infected houses, and directions
given as to the best means of minimizing the danger. Much valuable assistance was
received in dealing with Infectious Diseases from the Assistant Sanitary Inspector,
who, year by year, proves the wisdom of the District Committee in appointing one
man to attend to the entire District.
Diseases of the Respiratory System caused 10 deaths, or 7.6 per cent. of the
total during 1896, as compared with 17 in 1895. In 6 of these 10 deaths, the age at
death was over 60 years, and there were 2 deaths in children under 1 year.
Diseases of the Circulatory System caused 18 deaths, or 13.8 per cent. of the
total, during 1896, as compared with 34 in 1895. Of these 18 deaths, the age at
death was over 60 years in 15 instances. Under both Circulatory and Respiratory
Diseases there is shown a marked decrease in the number of deaths as compared with
the previous year; this was probably accounted for to some extent by the mild winter
and the absence of influenza.
Tubercular Diseases caused 23 deaths, or 17.6 per cent. of the total, during
1896, as compared with 12 in 1895. Of these 23 deaths, 15 were attributed to Pul-
monary Consumption. The number of deaths caused by Tubercular Diseases during
1896 is almost double that of either of the two previous years.
Diseases of the Nervous System caused 12 deaths, or 9.2 per cent. of the total,
during 1896, as compared with 15 in 1895. Of these 12 deaths, the age at death was
over 60 years in 6 instances.
Diseases of the Digestive System caused 11 deaths, or 8.4 per cent. of the
total, during 1896, as compared with the same number in 1895.
Cancer and Malignant Disease caused 4 deaths during 1896, as compared
with 10 in 1895.
Old Age was given as the cause of death in 26 instances, as compared with 22
in 1895.
[Note] 326
[Page] 35
Developmental Diseases caused 8 deaths during 1896, of these 5 were attributed
to premature birth; in 1895 the number of deaths due to Developmental Diseases
was 6.
Violence caused 4 deaths during 1896, as compared with 7 in 1895.
Zymotic Diseases caused 6 deaths during 1896, as compared with 5 in 1895.
The Zymotic Death-rate was .633, as compared with .522 in 1895. The total number
of infectious cases reported during 1896 was 48, as compared with 49 in 1895.
Scarlet Fever. - There were no fatal cases of this disease during 1896; the
number of cases reported was only 12, as compared with 22 in 1895. The type of
Scarlet Fever was mild, and, the cases having been promptly reported, little difficulty
was experienced in preventing infection from spreading in the District. Three cases
were removed to Hospital, and made good recoveries.
Enteric Fever caused 2 deaths during 1896, as compared with the same number
in 1895. There were 9 cases of the disease reported during the year, as compared
with 15 in 1895. Most of the cases were sporadic, but in some there was a strong
presumption that the infection had been contracted beyond the bounds of the District.
Two of these cases were removed to Hospital. The record of Ashgrove has somewhat
improved during the past year, but the occasional occurrence of cases of Enteric
Fever still points to the water supply as not being above suspicion.
Diphtheria. - There was no death from Diphtheria during the past year, but 20
cases of the disease were reported. The chief outbreaks of the disease were in
Glenshee and near Balbeggie; the cause of the former was probably insanitary
conditions, and infection was due to the non-recognition of one slight case; in the latter,
the disease seemed to have been brought by visitors, and infection was conveyed by
the Nurse to other members of the family, although the patient was well isolated
from them. One case which occurred in a Bothy was removed to Hospital. The
type of the disease was exceedingly mild.
Whooping Cough caused 2 deaths, both of which occurred in the Coupar-Angus
District.
Diarrhoea was the cause of 2 deaths during 1896, as compared with the same
number in 1895,
Erysipelas. - Seven cases of this disease were reported during the past year; one
of these was removed to Hospital. This patient was a Nurse who had been provided
by the District Committee to assist in nursing a severe case of Typhoid Fever, and
the over-fatigue of attending to the case seemed to have been the cause of the attack.
Deaths in which the cause of death was uncertified, or insufficiently stated, were
3, as compared with 9 in 1895.
[Note] 327 |
|
| HH62/45/329 |
[Note] 328
TABULAR STATEMENTS
OF
SICKNESS AND MORTALITY
IN THE
COUNTY OF PERTH,
1896.
[Note] 329 |
|
| HH62/45/331 |
[Note] 330
TABULAR STATEMENT of SICKNESS and MORTALITY referred to in the Regulations issued by the Local
Government Board for Medical Officers of Counties.
COUNTY OF PERTH.
TABLE I. - Births and Deaths occurring in the County during the Year 1896.
[Table inserted]
NOTES. - The Medical Officer may, if he thinks fit, give separately the figures for any Sub-Divisions of the County: in all cases the Total for the County is to be given.
Deaths of Persons belonging to a County occurring in Public Institutions (as Lunatic Asylums, Poorhouses, Hospitals) outside of the County are to be included with the figures for that County,
and Deaths of Persons not belonging to a County, occurring in Public Institutions within the County, are to be excluded.
"Diphtheria" shall include "Membranous Croup," "Diphtheritic Croup," "Croupous Diphtheria."
All Deaths from "Diarrhoea," "Dysentery," "Enteritis," "Gastro-Enteritis," "Muco-Enteritis," - unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis-
"Diarrhoea," "Bright's Disease-Diarrhoea," are to entered under the heading "Diarrhoea."
The designation "Other Tubercular Diseases" includes, inter alia, "Tabes Mesenterica," "Tubercular Meningitis," "Hydrocephalus," "Struma," "Scrofula." The headings distinguished by asterisks cover all diseases placed under these headings in the classification of the Registrar-General
[Note] 331
TABLE II. - Density of Population, Birth Rate, Infantile and other Death Rates.
[Table inserted]
*To be calculated to three places in decimals.
TABLE III. - Cases of Infectious Disease coming to the knowledge of the Medical Officer during the Year 1896.
[Table inserted]
(Signed) JOHN T. GRAHAM M.D., Medical Officer.
31st March, 1897. |
|
| HH62/45/333 |
[Note] 332
COUNTY OF PERTH - PERTH DISTRICT.
Table IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1896, according to the Registration Districts.
[Table inserted]
[Note] 333
PERTH DISTRICT - Continued.
[Table inserted]
*Acreage included under Auchtergaven, Kinclaven, and Redgorton.
+After deducting (4336) Acreage of Perth City, formed by parts of Kinnoull, Perth, Scone, and Tibbermore. |
|
| HH62/45/335 |
[Note] 334
COUNTY OF PERTH - CENTRAL DISTRICT.
Table IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1896, according to the Registration Districts.
[Table inserted]
*Acreage included under Monzie, Methven, and Little Dunkeld.
[Note] 335
COUNTY OF PERTH - HIGHLAND DISTRICT.
Table IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1896, according to the Registration Districts.
[Table inserted]
*1. Acreage included under Dull, Logierait and Kenmore.
*2. Acreage combined with Dowally.
*3. Acreage included under Dull and Blair-Atholl.
*4. Acreage included under Fortingal.
*5. Acreage included under Moulin.
*6. Acreage included Blair-Atholl and Moulin. |
|
| HH62/45/337 |
[Note] 336
COUNTY OF PERTH - WESTERN DISTRICT.
Table IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1896, according to the Registration Districts.
[Table inserted]
* Acreage included under Killin.
[Note] 337
COUNTY OF PERTH - EASTERN DISTRICT.
[Table inserted]
*Acreage included under Kirkmichael.
+Acreage included under Alyth, Blairgowrie, and Kirkmichael. |
|
| HH62/45/339 |
[Note] 338
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENTS,
FOR YEAR ending 31st December, 1896.
[Note] 339 |
|
| HH62/45/341 |
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1896.
LOCAL AUTHORITY of the PERTH DISTRICT of the COUNTY of PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 0
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 340
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1896.
LOCAL AUTHORITY of the CENTRAL DISTRICT of the COUNTY of PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 0
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 341 |
|
| HH62/45/343 |
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1896.
LOCAL AUTHORITY of the HIGHLAND DISTRICT of the COUNTY of PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 0
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 342
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1896.
LOCAL AUTHORITY of the WESTERN DISTRICT of the COUNTY of PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 0
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 343 |
|
| HH62/45/345 |
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1896.
LOCAL AUTHORITY of the EASTERN DISTRICT of the COUNTY of PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 0
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 344
[Note] 345 |
|
| HH62/45/347 |
[Note] 346
County of Perth.
REPORT BY MEDICAL OFFICER
FOR
1897.
[Note] 347 |
|
| HH62/45/349 |
PERTH : PRINTED BY T. M. McGREGOR.
[Note] 348
INDEX.
-- PAGE.
METEOROLOGICAL OBSERVATIONS, -- 4
COUNTY OF PERTH, -- 7
PERTH DISTRICT, -- 17
CENTRAL DISTRICT, -- 21
HIGHLAND DISTRICT, -- 25
WESTERN DISTRICT, -- 29
EASTERN DISTRICT, -- 33
TABULAR STATEMENTS, -- 37
[Note] 349 |
|
| HH62/45/351 |
[Note] 350
METEOROLOGICAL OBSERVATIONS.
From Data supplied by Mr. CROUCHER, Ochtertyre Gardens, Crieff. Height of Station above the Sea, 333 Feet.
[Table inserted]
[Note] 351
WIND.
[Table inserted] |
|
| HH62/45/353 |
[Note] 352
County of Perth.
SEVENTH ANNUAL REPORT BY COUNTY MEDICAL OFFICER,
1897.
Estimated to the middle of 1897, the population of the Landward County of
Perth was 63,302. During the year 1897 there were 1539 Births registered in the
Landward County, and 992 Deaths, giving a Birth-Rate of 24.3 and a Death-Rate
of 15.6, as compared with a Birth-Rate of 24.2 and a Death-Rate of 14.2 in 1896.
Of the 1539 Births, 7 per cent. of the total were illegitimate, and were thus dis-
tributed amongst the five Districts - Perth, 6 per cent.; Central, 8 per cent,;
Highland, 7 per cent.; Western, 4 per cent; Eastern, 8 per cent. The Natural
Increase of the population during 1897 was 547, as compared with 639 in 1896.
Of the 992 Deaths, 507 occurred in persons over 60 years of age, whilst 101
were children under 1 year, of which 40 were attributed to Developmental
Causes, giving an Infant Mortality of 65.6, as compared with 76.3 in 1896. Old
Age was given as the cause of death in 174 cases during 1897, as compared with
146 in 1896.
The Zymotic Death-Rate during 1897 was .963, as compared with .674 in 1896.
The total number of cases of Infectious Disease notified during 1897 was 377, as
compared with 449 in 1896. Measles and Whooping-Cough were very prevalent
during the year, and 24 deaths were due to them.
The general health of the County has been good during 1897, and although
the Death-Rate was a little higher than during 1896, it is still within the limits
of what may be expected in a population such as that of Perthshire. The Notifi-
cations under the Infectious Disease Notification Act were 72 fewer than in 1896,
proving that these diseases, which are generally known as preventable, have been
well kept in hand; the type of these diseases was more severe than in former years
as the case mortality shows. Of the five Districts, the Perth is the only one which
shows fewer deaths during 1897 than in 1896, thus keeping up its reputation of
former years. In the Highland District the most remarkable feature is the almost
entire absence of deaths from Zymotic disease - 3 deaths from Whooping-Cough and
1 from Diarrhoea making up the total, while perfect immunity from Diphtheria
is a fact to be noted.
[Note] 353 |
|
| HH62/45/355 |
[Page] 8
The following Tables are given to show the Death-Rates from various causes in
the different Districts, as well as the Burghs of the County, during the past five
years:-
LANDWARD DEATH-RATES.
[Table inserted]
BURGH DEATH-RATES.
[Table inserted]
In connection with the Water Supplies which were referred to in last year's
Report as likely to be completed during 1897, none have attained completion, ex-
cepting that for the Burghmuir of Perth.
[Note] 354
[Page] 9
The Wester Errol Water District has now a fair prospect of soon enjoying its
much-needed supply of water, as the preliminary negotiations for securing rights
to the water (which were exceedingly complicated) have now been completed, and
the contracts fixed for executing the work, which is very considerable. The cost
of the works far exceeds the original estimate, but thanks to the generosity of one
proprietor in the District, the extra expense will not be borne by the ratepayers,
but by him.
The proposed water supply for Scone, after being favourably reported on by two
Engineers and remitted to a Special Sub-Committee to carry out the work, has
mysteriously been allowed to become dormant; it will be necessary to have it restored
to life, and that speedily, as the inhabitants of the village are urgently in need of a
pure water supply.
Bankfoot still clings to its wells, although these are becoming fewer, owing
to the action of the Sanitary Inspector in ordering the closing of those found
unsafe, so that it is hoped that the inhabitants may soon see the wisdom of requisi-
tioning the District Committee to form the place into a Special Water District.
The Madderty District has now been fairly well provided with water, through
the efforts of individual proprietors, and the inhabitants are now realising the benefits
of one of Nature's greatest blessings - pure water.
The water-supply of Dunkeld has received much attention. It was thought at
one time that it would be necessary to bring an increased supply from a distance,
but before doing so it was arranged that the present supply should be carefully
tested as to its capacity, and also that efficient filters should be erected, as the water
receives a considerable amount of vegetable debris which renders it unsightly as well
as somewhat dangerous to use for domestic purposes without filtration.
At Kinbuck frequent complaints have been made as to the inconvenience of the
present water-supply, which is derived from a single well. The water of this well
is of fair quality, but the situation of the well renders it liable to pollution. This,
coupled with the fact that the well, although "at or near" all of the houses in the
village, is still a long way from some of them, makes it desirable that a gravitation
supply should be introduced if possible. It is understood that water has been offered
from the Dunblane supply on very reasonable terms.
Burrelton and Woodside now enjoy the advantages of a very good and efficient
water supply, and although some perverse persons still prefer their old sink wells,
the great body of inhabitants are thankful for the water. The Rosemount
Water District, the procuring of a supply of water for which has been the cause of
much anxious thought, has now secured water from the Blairgowrie Burgh supply
on very reasonable terms. As the cost of laying pipes in the District has been
found to be reasonable, it is expected that the much-needed water will be available
during the coming summer.
In connection with Drainage, a very excellent system was proposed for Scone
by Mr. Copland, C.E. It was agreed that this should be acted upon, and the
Drainage Committee was empowered to carry out the works, but as yet there has
been no visible result. That the present water-supply and drainage of Scone are
notoriously bad has been often pointed out, and as the peeople who are to be
taxed for the introduction of a better condition of sanitary matters are demanding
the completion of the works, it seems somewhat mysterious that nothing has been
done in the matter, and the District Committee should call for an explanation at an
early date.
[Note] 355 |
|
| HH62/45/357 |
[Page] 10
The inhabitants of Methven have, during the past year, been endeavouring to
improve the drainage of the village, but to make satisfactory work the old stone
built drains should be replaced by properly laid water-tight pipes. This has been
done in the vicinity of some of the wells, and will undoubtedly have a beneficial
influence on the condition of the water drawn from the same.
The drainage of Comrie has during the past year received much consideration.
A very satisfactory system has been proposed by Mr. Copland, which it is hoped
the inhabitants will have the good sense to adopt, and that without delay, as the
existing drainage of the village is anything but in keeping with modern requirements.
Pollution of Rivers. - The scheme of drainage for Scone proposed by Mr.
Copland includes a very effective system of land filtration, and nothing better could
be desired.
The sewage of Comrie still pollutes the Earn, but Mr. Copland's scheme for
draining the village includes a very complete land filter which would satisfy the most
exacting, if adopted.
At Blackford the pollution of the Allan from the village and breweries begins
to assume a serious aspect, and it is high time that the Drainage Committee should
look about for some efficient method of purification.
The pollution of the Tay by the sewage of Aberfeldy will soon be a thing
of the past, as the purification works ordered by the Sheriff have been nearly
completed.
At Pitlochry considerable expense has been incurred in endeavours to perfect the
irrigation fields. This work is rendered exceedingly difficult by the fact that in
carrying out the drainage of the village all of the spring water passed en route has
been carried into the drains. As a result an excessive quantity of diluted sewage
reaches the irrigation fields, which are consequently apt to become water-logged.
The pollution of the Tay by the sewage of Dunkeld has been left in statu quo for
some time, but now that the purification works at Killin are working so admirably
and without the slightest nuisance, the pledge given by the District Committee
that Dunkeld would not be pressed in this matter, until some purification works could
be shown suitable for its peculiar situation, is fulfilled, and Dunkeld should be forth-
with called on to follow the example of other towns and cease from polluting
the Tay.
At Killin the sewage purification works have been in operation for some time,
and are giving great satisfaction to all concerned; in fact, a more complete, compact,
and efficient system could not be wished for.
Rattray sewage, in so far as being effectively purified before entering the Ericht,
is not one whit advanced. Sheme after scheme is brought before the Police Com-
missioners, only to be thrown aside by them. It is now high time that the whole
facts of the case be laid before the Sheriff, who would doubtless solve the difficulty
in some such manner as he did when Aberfeldy was in doubt on a similar point.
Meteorological Tables. - Materials for these have again been kindly provided
from the records of the Ochtertyre Station by Mr. Croucher. Comparison of these
Tables, with those of 1896, show that there was a Rainfall of 10 inches more during
1897 than in 1896, the amount of rain being 2.96 inches in excess of the average;
that there were 117 hours less sunshine than in 1896, and the amount was 576
hours short of the average.
Diseases of the Respiratory System caused 114 deaths, or 11.4 per cent. of
the total during 1897, as compared with 109 in 1896. Of these 114 deaths, 52
[Note] 356
[Page] 11
occurred in persons over 60 years of age, and 24 in childen under 1 year. The
following table shows the distribution of deaths and sickness due to Respiratory
Diseases throughout the County:-
Percentage of Deaths.
PERTH DISTRICT, -- 12.2
CENTRAL DISTRICT, -- 9.4
HIGHLAND DISTRICT, -- 9.0
WESTERN DISTRICT, -- 14.8
EASTERN DISTRICT, -- 12.4
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 37.3
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 30.5
EASTERN DISTRICT, -- No Returns.
Diseases of the Circulatory System caused 105 deaths, or 10.5 per cent. of
the total, as compared with 129 in 1896. Of these 105 deaths, 71 occurred in
persons over 60 years of age. The distribution of these diseases throughout the
County is shown as follows:-
Percentage of Deaths.
PERTH DISTRICT, -- 10.5
CENTRAL DISTRICT, -- 7.1
HIGHLAND DISTRICT, -- 10.1
WESTERN DISTRICT, -- 14.1
EASTERN DISTRICT, -- 12.4
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 10.1
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 10.4
EASTERN DISTRICT, -- No Returns.
Tubercular Diseases caused 137 deaths, or 13.8 per cent. of the total, as
compared with 118 in 1896. Of these 137 deaths, 97 were due to Pulmonary
Consumption, showing an increase of 20 as compared with 1896. It is passing strange
that in these days when such precautions are demanded by the public in respect of
the ordinary infectious fevers, this preventable scourge is allowed to cut off valuable
lives without hindrance. The distribution of these diseases throughout the County
was as follows:-
Percentage of Deaths.
PERTH DISTRICT, -- 16.3
CENTRAL DISTRICT, -- 14.6
HIGHLAND DISTRICT, -- 6.4
WESTERN DISTRICT, -- 16.7
EASTERN DISTRICT, -- 13.7
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 5.2
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 4.3
EASTERN DISTRICT, -- No Returns.
Diseases of the Nervous System caused 114 deaths, or 11.4 per cent. of the
total during 1897, as compared with 82 in 1896. Of these 114 deaths, 83 occurred
in persons over 60 years of age, and one death was that of a child under 1 year.
These diseases were distributed throughout the County as follows:-
Percentage of Deaths.
PERTH DISTRICT, -- 12.2
CENTRAL DISTRICT, -- 11.8
HIGHLAND DISTRICT, -- 9.0
WESTERN DISTRICT, -- 13.5
EASTERN DISTRICT, -- 10.3
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 9.7
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 11.8
EASTERN DISTRICT, -- No Returns.
Diseases of the Digestive System caused 54 deaths, or 5.4 per cent. of the
total during 1897, as compared with 61 in 1896. These diseases were distributed
throughout the County as follows:-
Percentage of Deaths.
PERTH DISTRICT, -- 5.1
CENTRAL DISTRICT, -- 7.5
HIGHLAND DISTRICT, -- 4.2
WESTERN DISTRICT, -- 5.1
EASTERN DISTRICT, -- 4.8
Percentage of Sickness.
PERTH DISTRICT, -- No Returns.
CENTRAL DISTRICT, -- 37.5
HIGHLAND DISTRICT, --No Returns.
WESTERN DISTRICT, -- 42.8
EASTERN DISTRICT, -- No Returns.
[Note] 357 |
|
| HH62/45/359 |
[Page] 12
Cancer and Malignant Diseases caused 62 deaths, or 6.2 per cent. of the total, as
compared with 51 in 1896. These deaths were distributed amongst the five Districts
as follows:- Perth, 18; Central, 15; Highland, 14; Western, 4; Eastern, 11.
Old Age was the cause of death in 174 instances, or 17.4 per cent. of the total,
as compared with 146 in 1896.
Developmental Diseases caused 40 deaths during 1897 as compared with 50 in
1896. Of these 40 deaths, 24 were ascribed to premature birth.
Violence caused 44 deaths during 1897, as compared with 26 in 1896. These
deaths were thus distributed:- Perth District, 11; Central District, 11; Highland
District, 5; Western District, 8; Eastern District, 9.
Zymotic Diseases caused 61 deaths during 1897, as compared with 43 in 1896.
The notified number of illnesses due to these diseases during 1897 was 377, as
compared with 449 in 1896, thus showing a reduction in their number of 72. The
number of patients suffering from infectious disease who received Hospital treatment
during 1897 was 118, as compared with 100 in 1896.
Scarlet Fever caused 11 deaths during 1897, as compared with 5 in 1896, and
as there were fewer cases during the former year, the case mortality was much
higher, being 4.7 per cent. There were many outbreaks during the past year,
but the efforts of the Department were happily able to prevent any great spread of
the disease. One of the most severe outbreaks occurred at Aberfoyle, where the
disease had existed for some considerable time in two large families ere its nature was
recognized. In some of the outbreaks there was almost conclusive evidence that the
infection had been carried to outlying districts by tramps. That the type of Scarlet
Fever has become more severe is not altogether to be regretted, as country people were
beginning to think the disease so trifling that the efforts of the Department to check
it did not meet with the support expected. During the past year 232 cases of Scarlet
Fever were notified, of whom 39.6 per cent. were removed to Hospital, as compared
with 263 and 23.5 per cent. in 1896.
Diphtheria caused 4 deaths during 1897, as compared with the same number in
1896. There were 36 cases of the disease notified during 1897, as compared with 67
in 1896. As this is one of the diseases which, by their absence or presence, indicate
whether the sanitary condition of the surroundings of the people are satisfactory or
otherwise, it is gratifying to see such a marked reduction in the number of cases. Of
the 36 cases, 36.1 per cent. were removed to Hospital.
Enteric Fever caused 9 deaths during 1897, as compared with the same numerb [number]
in 1896. During 1897, 43 cases of the disease were notified, as compared with 58 in
1896. The majority of the cases were sporadic, and were probably attributable to
insanitary conditions which were rectified as soon as possible. Of the Enteric Fever
patients, 30.2 per cent. were removed to Hospital.
The following table and diagram show at a glance the incidence of sickness from
Diphtheria, Scarlet Fever, and Enteric Fever during the year in the five Districts:-
[Note] 358
[Note] 359 |
|
| HH62/45/361 |
DIAGRAM
showing the prevalence of
DIPHTHERIA, SCARLET FEVER, & ENTERIC FEVER.
DURING 1897.
[Graph inserted]
[Note] 360
[Page] 13
TABLE showing the prevalence of certain Zymotic Diseases in the several
Districts during the different Months of 1897.
[Table inserted]
[Note] 361 |
|
| HH62/45/363 |
[Page] 14
Diarrhoea caused 13 deaths during 1897, as compared with 20 in 1896. As in
1896 there was a close relation between the prevalence of Diarrhoea and the maximum
readings of the 48" underground thermometer. The following table shows the
relation between deaths from Diarrhoea and the monthly mean readings of the
thermometer:-
TABLE showing relation between Deaths from Diarrhoea and
Underground 48-inch Thermometer Readings.
[Table inserted]
Measles was exceedingly prevalent in various parts of the County during 1897.
Three deaths were caused by the disease, these occurred in the Perth and Western
Districts.
Whooping-Cough caused 21 deaths during 1897, as compared with 5 in 1896.
The disease was very prevalent, and the deaths all occurred in children under five
years of age.
Uncertified Deaths, or those in which the cause of death was insufficiently
stated, were 38 during 1897, as compared with 53 in 1896. As these only amounted
to 3.8 per cent. of the total, the fact speaks volumes for the care of the Registrars in
securing certificates, a very difficult matter in some of the scattered districts.
Returns of Births and Deaths have during the past year been regularly furnished
by the Registrars of the 82 Registration Districts. The passing of the new Public
Health Act puts an end to the old voluntary arrangement which has worked so well
in Perthshire during the past seven years. Changes have occurred during that period
amongst the Registrars, but the newcomers were always found ready to carry on the
good work of their predecessors. I would take this opportunity of thanking the
Registrars for the services they have rendered so efficiently, and the trouble many of
them have taken to secure accurate returns, thus showing that they took a lively
interest in the work. Under the new Act the furnishing of Returns of Births and
Deaths is compulsory.
Hospital Accommodation. - The arrangement by which the five District
Committees of Perthshire have a right to send infectious cases to Perth Royal
Infirmary for treatment was fully used during the past year, 117 patients having
been admitted; and as the annual sum paid for the accommodation is £400, it shows
that the cost of providing hospital treatment only amounted to about £3 8s. 4d.
per patient. Unfortunately the number of scarlet fever cases under treatment at the
same time from the City and County seriously taxed the capacity of the Infirmary,
[Note] 362
[Page] 15
but the temporary difficulty was surmounted by placing at the service of the Infirmary
Directors two of the Portable Hospitals belonging to the District Committees. These
were erected on a suitable site some distance from the town, and were temporarliy
used for convalescents. It is understood that the Directors have under consideration
a proposal to erect some cottages on the site formerly occupied by the Portable
Hospitals, to be a permanent Convalescent Home for scarlet fever patients. Such a
measure is of most essential importance, as the practice of sending out recovered
patients from wards in which acute cases of scarlet fever are being treated is fraught
with danger to the families to which they return. The County Medical Officer has
no supervision over the management or treatment of infectious cases whilst in the
Perth Royal Infirmary.
As in former years, removals of patients suffering from infectious diseases have
been carried out from all parts of the county, and much assistance has been rendered
in so doing by the Railway Companies and their officials.
The Portable Hospitals belonging to the various District Committees have
happily not been required for the treatment of small-pox cases during the past year,
but they are ready for use when required.
A new disinfectant, known as Formic Aldehyde, has been introduced during the
past year. It is a gas formed by the incomplete combustion of wood spirit. Formic
Aldehyde is one of the most powerful disinfectants yet discovered, it is safe and
convenient to use, and also non-poisonous to human beings. For general use the
Formic Aldehyde Gas is dissolved in water to the extent of 40 per cent., and the
solution is known by the trade name Formalin. As water containing 1 per cent. of
the gas in solution has been found by experiment to be fatal to all germs, whilst it
does not injure the texture or colour of articles steeped in it, nothing better could
be desired for the disinfection of clothing.
For the disinfection of the walls, &c., of rooms, Formalin solution can be used by
means of a spraying machine made by Defries & Co., but this machine is too heavy
for use in country districts, although much used in Paris. It has been found that air
containing a certain amount of Formic Aldehyde Gas is a powerful disinfectant; the
gas being of the same density as the air makes the diffusion of it in the air of a room
easy. There are two methods whereby the air of an infected room can be charged
with a definite quantity of Formic Aldehyde Gas. In that known as Trillat's method
a watery solution of the gas, to which some chloride of calcium has been added, is
heated in a strong boiler, and when under considerable pressure almost pure gas is
given off, which is introduced into the room through a small tube. This system
requires an expensive apparatus, which is too heavy for use in country districts,
besides demanding skilled attention whilst in use. The other method is to use
Paraform, which is a polymeric form of Formic Aldehyde, and is a solid substance,
easily handled. This Paraform, when heated in a specially-constructed lamp, becomes
decomposed, and, combining with the products of combustion, a definite quantity of
Formic Aldehyde Gas is given off, and the air of a room is easily charged with it.
The lamps and Paraform are light and easily portable, and thus the method is
admirably adapted for country work. It has been also found that by an adaptation
which I have received permission to use in Perthshire an ordinary paraffin lamp can
be utilised for vapourising the Paraform, which still further simplifies its use.
Experiments are at present being carried out with a view to fully test the merits
of Formic Aldehyde as an aerial disinfectant in actual practice, and so far every
evidence goes to show that it is efficacious, and a vast improvement on the practically
exploded sulphur fumigation of the past.
[Note] 363 |
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[Page] 16
The Infectious Disease Notification Act has during the past, as in former years,
been only partially successful in its objects, as in outlying districts cases of scarlet
fever have again and again been discovered which had not been recognised. The new
Public Health Act will to a certain extent remove this tendency to overlook slight
cases of infectious illness, as under Section 57 it is rendered illegal, under a heavy
penalty, for the teacher of a school or the guardian of a child who has suffered from
any infectious disease, or has been an inmate of a house in which such disease has
existed, to allow the child to return to school within three months unless a medical
certificate is produced certifying that the child is free from infection, and that the
house, &c., have been satisfactorily disinfected. When teachers insist, for their own
protection, on these certificates it will necessarily lead to suspicious cases
being medically examined who otherwise would escape. When it is stated
that this section not only applies to notifiable diseases, but to all infectious
diseases, its far-reaching beneficial effects can be well imagined. To give
full efficacy to the working of the above section, the Local Authorities should have
the services of a medical man retained in every parish or group of parishes, who could
grant certificates to those unable or unwilling to pay for them. In the Central and
Western Districts the machinery for working the section is complete, as the Assistant
Medical Officers are available.
The new Act gives great power to Local Authorities in dealing with infectious
disease. The Medical Officer is, under Section 45, empowered to enter any premises
where he has reason to suppose that infectious disease exists, and further, to examine
any person in the premises in order to ascertain whether they are suffering or have
recently suffered from infectious disease. Under Section 47, the disinfection of
infected houses and clothing is put on a very satisfactory footing. Under Section
54, removal to Hospital of those suffering from infectious disease, where satisfactory
isolation cannot be provided at home, is made compulsory. Under Section 59, it is
made illegal for any owner or person in charge of a public conveyance knowingly to
carry any person suffering from any infectious disease, as well as for the person who
knowingly enters any such carriage whilst so suffering. The penalty for infringing
the provisions of this section is £10. If this section be properly enforced, it will have
a marked effect for good in preventing the dissemination of scarlet fever.
The protection of the public from infected milk supplies is very fully provided for
under the new Act. Should a source of milk supply be suspected of causing or
spreading infectious disease, it is imperative that the premises and everyone connected
with them be examined, and the result reported forthwith to the Local Authority.
Under Section 181 Rural Local Authorities are empowered to make Bye-laws
for the regulation of the building and rebuilding of houses; this is a new power, and
supplies what was felt to be a grave defect in the past. These Bye-laws are to be
drawn up under seven heads, all of which deal with matters essential for the securing
of healthy houses. The drawing up of these Bye-laws will require careful consideration
for such a county as Perthshire, as whilst they must secure what is absolutely
necessary, they must not be in any way prohibitive in their requirements. After
plans have been submitted and approved by the Local Authorities, it will be necessary
to ensure that they are faithfully carried out; this can only be done by the appointment
of an Inspector, who will devote his whole time to this work throughout the county.
I must again gratefully acknowledge the courtesy and consideration extended to
me by the County Council, and District Committees, during the past year.
JOHN T. GRAHAM,
County Medical Officer.
31st March, 1898.
[Note] 364
Perth District.
The population of the Perth District, estimated to the middle of 1897, was
20,474. During the year there were 544 Births (271 males and 273 females), and
294 Deaths registered, giving a Birth-Rate of 26.57, and a Death-Rate of 14.35, as
compared with a Birth-Rate of 25.47 and a Death-Rate of 14.36 in 1896. The
Natural Increase of the population during 1897 was 250 as compared with 229 in
1896. There were 134 Deaths in persons over 60 years of age in 1897, as compared
with 153 in 1896; and in children under 1 year there were 42 deaths, of which 17
were attributed to Developmental Causes, giving an Infant Mortality of 77.2, as
compared with 83.8 in 1896. Zymotic Diseases caused 26 deaths during 1897, as
compared with 15 in 1896, thus giving a Zymotic Death-Rate of 1.26, as compared
with .630 in 1896.
The general health of the inhabitants of the Perth District during the past
year has been good, the Death-Rate and Infant Mortality have been low. The
number of infectious cases reported duirng the year shows a considerable reduc-
tion, especially in Diphtheria, and the higher number of deaths from Zymotic
Diseases is mainly due to prevailing epidemics of Measles and Whooping-Cough.
The contract for the water supply of the Wester Errol Special District has,
after many difficulties, been placed in the contractors' hands, and all that is required
to complete the large undertaking is the construction of the storage reservoirs and
the laying of the pipes.
As regards the Scone Special Water District, after everything seemed to be in
train for a speedy completion of this important work, the Committee appointed to
carry out the work have delayed doing so, for some unaccountable reason best known
to themselves. It will be the duty of the District Committee to call on their Sub-
Committee to give an account of their proceedings, and to urge on the completion
of the scheme with as little delay as possible. The village is growing rapidly, and a
pure water supply is much required.
The Burghmuir Special Water District has been completed, a supply of water
being obtained from the Perth City supply, the Sub-Committee entrusted with the
carrying out of this work having faced it with commendable expedition.
The complete drainage of Scone, which was remitted to the Special Drainage
Sub-Committee to carry out, has evidently followed the fate of the water supply,
the reason assigned for delay being that some difficulty was experienced in obtaining
land for the proposed purification works; but, even were this not to be got, there is
no reaon why the other portion of the proposed works should not be proceeded
with, the latter being what is essential for the health of the villagers.
At Methven some works have been carried out with a view to improve the
drainage of the village.
At Stanley private enterprise has aided in the improvement of the village
drainage, and it seems as if this were the only way open, seeing that the decision of
the Sheriff has tied the hands of the Local Authority.
[Note] 365 |
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[Page] 18
2. General enquiries have been made throughout the year in most parts of the
District to ascertain its condition, and very many special inspections were made in
connection with proposed water-supplies, drainage, and the supervision of infectious
diseases. No certificates under the Public Health Acts were granted during the
year. The District Committee recognising its responsibilities under the Factory
and Workshops' Acts, appointed the Chief Medical Officer and Sanitary Inspector
Inspectors under these Acts, and in consequence most of the Workshops in the
District have been visited and particulars of the premises, and those employed in
them, registered. Factories have been visited with a view to ascertain the provision
made for escape in the event of a fire occurring.
3. Advice was given in connection with Water and Drainage schemes, also in
the arrangement for the accommodation of Infectious cases in the Perth Royal
Infirmary.
Retail Bakehouses. - These have been visited during the year and found
in a satisfactory condition, the cleanliness of the premises receiving careful attention.
One bakehouse was closed during the year, and one new one opened.
5. During the past year 41 patients suffering from Infectious Diseases were
removed to the Perth Royal Infirmary from the Perth District. The Medical
Officer has no supervision over the management of the Infirmary, or treatment of
cases in the Institution. The Portable Hospital has not yet been required for
Smallpox. At one time when the Infirmary Scarlet Fever Wards were overfull, the
Directors received permission to erect the Portable Hospital as a convalescent house,
and it suited its purpose very well.
6. The usual precautions were taken during the year to prevent the spread of
Infectious Diseases, and the results prove these to have been effectual, as the total
number of cases reported during 1897 was 23 under that of the previous year. This is
especially noticeable in connection with Diphtheria, the cases during 1897
being less than half of those of the previous year, and only one-sixth of those of
1895.
Respiratory Diseases caused 36 deaths during 1897, as compared with 46 in
1896. Of the 36 deaths 19 occurred in persons over 60 years of age, and 9 in
children under 1 year.
Circulatory Diseases caused 31 deaths during 1897, as compared with 38 in
1896. Of these 31 deaths 20 occurred in persons over 60 years of age.
Tubercular Diseases caused 48 deaths during 1897, as compared with 36 in
1896. Of the 48 deaths 36 were due to Pulmonary Consumption whilst the deaths
from other Tubercular Diseases remained the same as in 1896, 12.
Nervous Diseases caused 36 deaths during 1897, as compared with 25 in 1896.
Of these 36 deaths 23 occurred in persons over 60 years of age.
Diseases of the Digestive System caused 15 deaths during 1897, as compared
with 25 in 1896.
Cancer and Malignant Diseases caused 18 deaths during 1897, as compared
with 17 in 1896.
Old Age was the cause of death in 39 instances, as compared with 35 in
1896.
Violence caused 11 deaths during 1897, as compared with the same number
in 1896.
Developmental Diseases caused 17 deaths during 1897. Of these 10 were
attributed to premature birth. In 1896 the number was 21.
[Note] 366
[Page] 19
Zymotic Diseases caused 26 deaths during 1897, as compared with 13 in 1896.
The number of cases notified during the year was 110, as compared with 133 in
1896, showing a satisfactory reduction.
Diphtheria. - There was only one death from this disease during the year.
The number of cases notified was 7, as compared with 15 in 1896. Three of the
seven cases were removed to Hospital.
Scarlet Fever caused 4 deaths during 1897, as compared with 3 in 1896. The
number of cases of the disease notified was 71, as compared with 78 in 1896. Forty-
one patients suffering from Scarlet Fever were removed to Hospital, as compared
with 23 in 1896. The disease at no time assumed alarming proportions, and the
type of the disease was mild, with the exception of that which occurred at Scone.
Enteric Fever caused 4 deaths during 1897, as compared with the same number
in 1896. The number of cases reported during the year was 15, as compared with
17 in 1896. Of these 17, 4 received Hospital treatment. Bankfoot and Stanley, as
in former years, contributed to the Enteric Fever death-roll, and Scone has begun
to follow their example.
Measles caused 2 deaths in 1897. The disease was prevalent, but on the
whole its type was mild.
Whooping-Cough caused 8 deaths during 1897. The disease was very pre-
valent, and, as usual, the mortality was confined to those of tender years - the
majority of the fatal cases occurring in the Methven and Scone Districts.
Diarrhoea caused 7 deaths during 1897, as compared with 6 in 1896. The fatal
cases were distributed over the District.
Deaths in which the cause of death was uncertified, or insufficiently stated, were
8 in 1897, as compared with 16 in 1896.
[Note] 367 |
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[Note] 368
Central District.
The population of the Central District, estimated to the middle of 1897, was
11,024. During the year there were 279 Births (139 males and 140 females), and
211 Deaths registered, giving a Birth-Rate of 25.30 and a Death-Rate of 19.14, as
compared with a Birth-Rate of 26.06 and a Death-Rate of 15.22 in 1896. The
Natural Increase of the population during the year was 68, as compared with 131
in 1896. During the year there were 102 deaths in persons over 60 years of age,
and there were 16 deaths of children under 1 year, of which 7 were due to Develop-
mental Causes, giving an Infant Mortality of 57.3, as compared with 73.0 in 1896.
There were 16 deaths from Zymotic Diseases during the year, as compared with 11
in 1896.
Judged by the gross death-rate, the health of the Central District has not been
so good during the past year as in 1896, as there were 41 more deaths, raising the
rate from 15.2 to 19.1 - the latter figure being somewhat higher than the average
during the past five years. There was a considerable reduction in the number of
deaths under one year, which is always a good sign of the health of a community;
and the number of cases of Infectious Disease notified was 45 fewer than in 1896.
Measles and Whooping-Cough were very prevalent, and there were 6 deaths
recorded as due to the latter, as compared with none in 1896, thus swelling the
deaths attributed to the Zymotic group of diseases.
Although no large water schemes were under consideration during the past
year, much good work has been done quietly. In the Madderty District water has
been provided for all of the localities requiring a new supply, excepting the Village
of St. David's, and there is a small part including Tomacknock, Kincardine, and
Pittentian Farms, which are still without a proper supply of water. In many places
outside of the Madderty District polluted wells have been replaced by gravitation
water supplies, or safe wells.
The most important drainage scheme under the consideration of the District
Committee during the past year was that proposed for Comrie. In former years, when
a drainage scheme was proposed for this place it was met by a statement on the part
of objectors that, from its peculiar situation, the proper drainage of Comrie would be
a very expensive matter. To settle this point once and for all, Mr. Copland, C.E.,
was requested by the District Committee to make a survey, and give a plan and
estimated cost of what, in his opinion, would meet the requirements of the village.
The first plan given showed a complete scheme for draining the entire village, but
this being objected to by some of the inhabitants as too expensive, a second
plan was lodged providing for the drainage of the most important parts of the village,
as well as for that of places likely to be built on in the immediate future. This latter
scheme was amply sufficient for the village, and as it seems to have met with the
approval of the inhabitants, and its estimated cost is low and well within the means
of the village, it is hoped that it may be adopted without delay. As there seems to
be some unnecessary delay in sending in the requisition to the District Committee
for the formation of the Village of Comrie into a Special Drainage District, it will
[Note] 369 |
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[Page] 22
soon be a matter for the consideration of the Committee whether a requisition should
not be got from Ratepayers who, although resident in the Central District, are not
resident in Comrie. Certainly the present condition of the drainage of Comrie
canot be long left as it is, if for no other reason than the pollution of the Earn
caused by its sewage. Mr. Copland's scheme for drainage included a very effective
purification system which would meet all the requirements of the Rivers Pollution
Prevention Act.
At Blackford complaints are received of the pollution of the neighbouring
streams by the discharges from the drains and breweries of the village. The Com-
mittee in charge of the Special Drainage District should have their attention directed
to finding out the best available means of purifying the drainage effluent before its
discharge, and works for this purpose should be constructed without delay.
2. General enquiries have been made throughout the District to ascertain its
condition, and special investigations have also been made in connection with water
supplies, drainage, and the supervision of Infectious Disease.
3. Advice was given in connection with the proposed drainage scheme for
Comrie, also in concluding the arrangement with the Perth Royal Infirmary for the
treatment of Infectious Cases. No certificates were given under the Public Health
Acts during the past year. The Central District Committee recognising its re-
sponsibilities under the Factory and Workshops' Acts appointed as Inspectors
under the Acts the Chief Medical Officer and Sanitary Inspector; as a result, all of
the Workshops in the District have been visited, and particulars of the various
premises, and persons employed therein, registered. When premises were found not
in harmony with the provisions of the Acts, attention was directed to the defects in
order that these might be rectified.
4. Retail Bakehouses. - These have been visited during the year, and the
provisions of the Factory and Workshops' Acts relating to them enforced. As a
rule the premises were found in a satisfactory condition.
5. The new arrangement by which the Central District Committee is entitled
to send Infectious cases to Perth Royal Infirmary for treatment has been fully
taken advantage of during the year, as 22 patients were admitted from the District.
The Portable Hospital reserved for Smallpox cases has happily not been required.
6. The usual endeavours have been made by the various Officials of the Depart-
ment to prevent or limit the outbreak of Infectious Disease, and the substantial
reduction of the number of cases reported, as compared with 1896, shows what
success has attended these efforts.
Respiratory Diseases caused 20 deaths during 1897, as compared with 23 in
1896. Of these, 7 occurred in persons over 60 years of age, and 7 in children under
5 years. Sickness returns show that 37.3 per cent. of the total was due to this class
of diseases.
Circulatory Diseases caused 15 deaths during 1897, as compared with 29 in
1896, thus showing a considerable reduction. Of these, 11 deaths occurred in persons
over 60 years of age. Sickness returns show that 10.1 per cent. of the total was
due to this class of diseases.
Tubercular Diseases caused 31 deaths, as compared with 26 in 1896. Of the
31 deaths 22 were attributed to Pulmonary Consumption. Sickness returns show
that 5.2 per cent. of the total was due to Tubercular Diseases.
Nervous Diseases caused 25 deaths during 1897, as compared with 13 in 1896,
these diseases also showing a large increase over 1896. Of the 25 deaths 20 occurred
in persons over 60 years of age.
[Note] 370
[Page] 23
Digestive Diseases caused 16 deaths during 1897, as compared with 9 in 1896.
Sickness returns show that 37.5 per cent. of the total was due to this class of diseases.
Cancer and Malignant Diseases caused 15 deaths during 1897, as compared
with 11 in 1896.
Old Age was the cause of death in 33 instances, as compared with 24 in 1896.
Developmental Diseases caused 7 deaths, of which 3 were attributed to pre-
mature birth, as compared with 5 in 1896.
Violence caused 11 deaths during 1897, as compared with 5 in 1896.
Zymotic Diseases caused 16 deaths during 1897, as compared with 11 in 1896.
The Zymotic Death-rate was 1.4, as compared with .98 in 1896. During the year
72 cases of Infectious Disease were notified, as compared with 117 in 1896.
Scarlet Fever caused 3 deaths during the past year. In all 37 cases of the
disease were notified, as compared with 75 in 1896, showing a considerable reduction.
The type of the disease was more severe, however, as is shown by a case mortality of
of 8.1 per cent.
Enteric Fever caused 4 deaths during 1897, as compared with 3 in 1896. In all
10 cases were notified, as compared with 26 in 1896. Although the number
of cases was smaller, the type of the disease was much more malignant than
in 1896. The cases were mostly isolated, and three of them were doubtless due to
bad water or insanitary conditions, which were at once remedied. In none of the
cases was there any spread of the Disease.
Diphtheria caused 2 deaths during 1897, as compared with 1 in 1896. The
majority of the cases occurred in a large family, in which the disease had
existed for some time before it was recognised; the other cases were distributed
over the District, and were chiefly due to damp houses or faulty drainage. Seven of
the 14 cases were removed to Hospital.
Measles was exceedingly prevalent during the past year, especially in the
Dunning, Auchterarder, Muthill, Blackford, Madderty, and Monzievaird Districts.
The type of the disease was mild, and no fatal cases resulted.
Whooping Cough caused 6 deaths during 1897. The Disease was very prevalent
in the Logiealmond, Dunning, Auchterarder, Blackford, and Monzievaird Districts.
As usual, the deaths occurred amongst children under five years of age.
Diarrhoea caused 1 death during 1897, as compared with 7 in 1896.
Deaths in which the cause of death was uncertified, or insufficiently stated, were
6 in 1897, as compared with 12 in 1896.
[Note] 371 |
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[Note] 372
Highland District.
The population of the Highland District, estimated to the middle of 1897, was
13,175. During 1897 there were 271 Births (148 males and 123 females) and 187
Deaths registered, giving a Birth-Rate of 21.8 and a Death-Rate of 15.2,
as compared with a Birth-Rate of 21.2 and a Death-Rate of 13.7 in 1896.
The Natural Increase of the population during 1897 was 84, as against 94 in 1896.
There were 129 deaths in persons over 60 years of age, as against 92 in 1896, and 8
in children under 1 year, of which 3 were attributed to Developmental Causes, giving
an Infant Mortality of 29.5, as compared with 67.6 in 1896. Deaths from Zymotic
Diseases only amounted to 4 in 1897, as against 7 in 1896, and the Zymotic
Death-Rate was .322.
The general health of the Highland District has been very good during the
past year, and there has been a marked reduction in the number of notified cases of
Infectious Diseases. This is especially noticeable in regard to Diphtheria and
Enteric Fever - no cases of the former, and only two of the latter having occurred.
The work of the Health Department during the past year was chiefly of a
routine character, excepting the consideration of the water supply for Dunkeld, and
the purification of the Aberfeldy sewage. There seems to be every indication that
during 1898 a large influx of workmen will take place, in connection with the work of
doubling the Highland Railway as it passes through the District, and the supervision
of the arrangements for housing them will entail much attention to protect the
inhabitants from Infectious Disease.
The purification of the sewage of Dunkeld, previous to its entering the Tay, is a
question now ripe for consideration, as the works formerly proposed were only delayed
until works suitable for the town could be shown in operation. One method of
solving the difficulty can be seen in successful operation at Killin, and so far from any
nuisance being caused by the works, these amply prove that nothing of the kind is
to be feared, and that the same system might be adopted at Dunkeld without danger
of the amenities of the place being injured. The Killin system is known as the
International. There is another system known as the Septic, which is rapidly coming
into favour. In it the sewage is conveyed into a large air-tight tank, which is also
devoid of light, and in this tank the processes of nature rapidly change the character
of the sewage. The effluent from the tank, which is non-offensive, after filtration
through coke is pure enough to be discharged into such a river as the Tay. The
District Committee will now be in a position to point out the efficiency of these
systems, and to insist that one or other, or some equally efficient purification works,
be adopted for Dunkeld, as after forcing Aberfeldy to purify its sewage it behoves
the District Committee to put its own house in order.
2. General enquiries have been made throughout the District to ascertain its
sanitary condition, and many special enquiries have been necessary in connection with
outbreaks of Infectious Disease.
3. Advice was given in connection with the water supply for Dunkeld, as well
as the arrangements for the reception of cases of Infectious Disease by the Perth
[Note] 373 |
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[Page] 25
Royal Infirmary. No certificates were required under the Public Health Acts.
Under the Factory and Workshops' Acts the District Committee appointed as
Inspectors the Chief Medical Officer and Sanitary Inspector. All of the Workshops
and most of the Factories have been visited, and the various points concerning them
registered.
Retail Bakehouses. - Those in operation in the District have been visited, and
found to be in a satisfactory condition, the statutory provisions as to lime-washing
having been attended to.
5. The new arrangement whereby accommodation is secured in the Perth Royal
Infirmary for patients suffering from infectious disease in the District has been fully
taken advantage of during the past year, 13 patients having been sent to Hospital.
The Medical Officer has no supervision of the management of the Perth Infirmary.
The portable Hospital belonging to the Highland District has not yet been required
to be used for Smallpox. For a short time it was lent to the Perth Infirmary
Directors for the accommodation of convalescent Scarlet Fever patients, but it was
shortly returned to its store-shed at Ballinluig, and is in readiness should it be
required in connection with the railway extension works.
6. As in previous years, energetic measures were adopted to prevent the out-
break or limit the spread of infectious diseases. The Assistant Sanitary Inspector
has been most assiduous in doing all that was possible to check these outbreaks, and
the results as shown by the large reduction in the number of reported cases of
infectious disease as compared with the previous year, as well as the entire absence of
Diphtheria, amply prove the nature of the work done.
Respiratory Diseases caused 17 deaths during 1897, as compared with 16 in
1896. Of these, 11 were in persons over 60 years of age and 1 in a child under 1 year.
Circulatory Diseases caused 19 deaths during 1897, as compared with the same
number in 1896. Of these, 15 occurred in persons over 60 years of age.
Tubercular Diseases caused 12 deaths during 1897, as compared with 16 in
1896. Of these, 12 deaths 8 were attributed to pulmonary consumption.
Nervous Diseases caused 17 deaths during 1897, as compared with 16 in 1896.
Of these 17 deaths 13 occurred in persons over 60 years of age.
Digestive Diseases caused 8 deaths during 1897, as compared with 10 in 1896.
Cancer and Malignant Diseases caused 14 deaths during 1897, as compared
with 11 in 1896.
Old Age was the cause of death in 59 instances, as against 40 in 1896.
Developmental Diseases caused 3 deaths during 1897, as compared with 10 in
1896.
Violence caused 5 deaths during 1897, as compared with 1 in 1896.
Zymotic Diseases caused 4 deaths during 1897, as compared with 7 in 1896.
Of these deaths 3 were caused by Whooping-Cough and 1 by Diarrhoea. The Zymotic
Death-rate was .322, as compared with .558 in 1896. The number of cases of infectious
disease notified during the past year was 72, as against 116 in 1896, showing a
satisfactory reduction.
Scarlet Fever. - No deaths were due to this disease in 1897, and the number
of cases reported was less than half of that in 1896. The disease broke out frequently
in various parts of the District, but prompt isolation was effectual in preventing its
spread to any extent. In one or two of the outbreaks there was almost conclusive
proof that the infection had been carried by tramps. There were 13 cases of Scarlet
Fever removed to Hospital from the District during the year.
[Note] 374
[Page] 26
Enteric Fever. - No deaths were caused by this disease during 1897. Only two
mild cases of the disease were reported.
Diphtheria. - No death was caused by this disease in 1897, neither was any
case of the disease notified. This, taken along with the small number of cases of
Enteric Fever, is one of the best proofs that the sanitary condition of the District is
satisfactory.
Whooping-Cough caused 3 deaths during 1897. The disease was prevalent in
various parts of the District, the fatal cases occurring in the parishes of Blair-Atholl
and Dunkeld.
Diarrhoea caused 1 death during 1897, the same as in 1896.
Deaths in which the cause of death was uncertified, or insufficiently stated, were
20 in 1897, as compared with 14 in 1896. This number, though somewhat in excess
of that in 1896, is still very satisfactory when the difficulties in procuring certificates
in such a scattered District are taken into account.
[Note] 375 |
|
| HH62/45/377 |
[Note] 376
Western District.
The population of the Western District, estimated to the middle of 1897, was
10,017. During the year 1897 there were 223 Births (104 males and 119 females),
and 155 Deaths registered, giving a Birth-Rate of 22.2 and a Death-Rate of 15.4, as
compaired with a Birth-Rate of 22.5, and a Death-Rate of 14.4 in
1896. The Natural Increase of the population during the year was 68, as against
87 in 1896. There were 67 deaths in persons over 60 years of age during 1897, as
compared with 69 in 1896, and 14 deaths occurred in children under 1 year, of which
5 were attributed to Developmental Causes, giving an Infant Mortality of 62.7 as
against 71.1 in 1896.
The number of deaths from Zymotic Diseases was 9 as compared with 6 in
1896, and the Zymotic Death-Rate .898 as against .601 in 1896.
During the past year the health of the Western District has been very good,
and although at times considerable anxiety was caused by outbreaks of Scarlet
Fever, in some of which the nature of the disease had not been recognised until a
number of childen had been infected, still there were few cases of Enteric Fever
and Diphtheria.
No large number of men have been employed during the past year on
contracts, but as the raising of the level of the water in Loch Katrine by the
Glasgow Corporation is to be proceeded with during 1898, the huts necessary for the
accommodation of the large number of navvies likely to be employed will entail a
good deal of supervising.
The water-supply for the Village of Kinbuck received some attention during the
year. Complaints had been received as to the inconvenient situation of the only well
in the place, but as the quality of the water is good and the well is quite within the
statutory "at or near" all of the houses, it is more a matter to be settled between
landlord and tenant than by the Local Authority, unless a requisition be lodged for
the formation of the place into a Special Water Supply District. A good supply of
water for the place is understood to be available on reasonable terms.
The Killin sewage system was completed during the year, and the works are
giving great satisfaction to all concerned. The International sewage purification
process is yielding excellent results, and the purified effluent from the filters comes
out as clear as rain water. During the progress of laying the new drains many
defects in the old system were discovered, which fully accounted for the former pre-
valence of Diphtheria in the village. The absence of this disease is an ample reward
for the expenditure involved in making the drainage one of the most perfect in the
country, as well as one of the best certificates that could be held out to attract
summer visitors.
As it is understood that the Burgh of Doune is about to proceed with Drainage
Works, it will be necessary that the District Committee be assured of the proper
purification of the effluent before it enters the Teith.
2. General enquiries have been made to ascertain the sanitary condition of the
District, and special enquiries have been made in connection with complaints as to
alleged nuisances, insanitary conditions of houses, and investigation of outbreaks of
Infectious Disease.
[Note] 377 |
|
| HH62/45/379 |
[Page] 30
3. Advice was given in connection with complaints as to insanitary con-
ditions also in connection with alleged overcrowding of some houses in
Aberfoyle, whilst the arrangements whereby cases of Infectious Disease might be
admitted to Perth Royal Infirmary were completed. No certificates were necessary
under the Public Health Acts during the past year. The Western District Com-
mittee appointed the Chief Medical Officer and Sanitary Inspector Inspectors under
the Factory and Workshops' Acts, and as a result all of the Workshops and Factories
in the District have been visited, and particulars obtained for making a complete
register of them. At the request of H. M. Inspector of Factories one Factory was
specially visited, and the latrines inspected with a view to a better system being
introduced.
4. Retail Bakehouses. - These have been visited during the year and found in
good order. The Deanston Bakehouse is again in operation.
5. The Western District Committee have now joined with the other four Dis-
tricts in securing a right to send patients suffering from Infectious illness to Perth
Royal Infirmary; most of the cases removed were sent there during the past year,
14 patients having been admitted. One patient was treated in the Committee's
Hospital near Killin, and as the mother was able to act as nurse, the arrangement
was satisfactory. The Hospital near Dunblane has not been used since its erection.
The Medical Officer has no supervision over the management of the Perth Royal
Infirmary, but the Hospitals belonging to the District Committee are entirely under
his supervision.
6. The usual precautions were taken during the past year to prevent the outbreak
or to check the spread of infectious disease. From the large reduction in the number
of Diphtheria cases during the past two years it is evident that satisfactory work has
been accomplished in improving the condition of the dwellings of the people. Infectious
cases, so soon as reported, have been carefully isolated at home, or removed to
Hospital, disinfectants being supplied, and directions given as to their use.
Respiratory Diseases caused 23 deaths during 1897, as compared with 14 in
1896. Of these, 11 occurred in persons over 60 years of age, and 4 in children under
1 year. Sickness returns show that 30.5 per cent of the total was due to these
diseases.
Circulatory Diseases caused 22 deaths during 1897, as compared with 25 in
1896. Of these, 11 deaths occurred in persons over 60 years of age. Sickness returns
show that 10.4 per cent. of the total was due to Circulatory Diseases.
Tubercular Diseases caused 26 deaths, as compared with 17 in 1896. Of these
26 deaths 15 were due to Pulmonary Consumption. Sickness returns show that 4.3
per cent. of the total was due to Tubercular Disease.
Nervous Diseases caused 21 deaths during 1897, as against 16 in 1896. Of these,
15 deaths occurred in persons over 60 years of age. Sickness returns show that 11.8
per cent. of the total was due to Nervous Diseases.
Digestive Diseases caused 8 deaths during 1897, as compared with 6 in 1896.
Sickness returns show that 42.8 per cent. of the total was due to Digestive Diseases.
Cancer and Malignant Diseases caused 4 deaths during 1897, as against 8 in
1896.
Old Age was the cause of death in 20 instances. The number attributed to this
cause in 1896 was 21.
Violence caused 8 deaths during 1897, as compared with 5 in 1896.
[Note] 378
[Page] 31
Zymotic Diseases caused 9 deaths during 1897, as compared with 6 in 1896.
The Zymotic Death-rate was .898, as against .601 in 1896. The number of cases
notified to the Department was 68, as against 35 in 1896.
Scarlet Fever caused 4 deaths during 1897. The number of cases of the disease
reported was 52, as compared with 15 in 1896. There were 14 patients suffering from
Scarlet Fever removed to Hospital - 13 to Perth, and 1 to the Killin Hospital. The
disease was again and again introduced, but, excepting in the Aberfoyle District, it
was easily checked. In the latter place the disease had existed in two adjoining
houses for some considerable time, and a fatal case made it necessary to call in a
medical man, who at once recognised how matters stood. What aggravated the
matter considerably was the fact that the two families were each living in single rooms, as
they had let their proper houses and had gone, as is frequently the case, into summer
quarters; although there was really air space for all, the danger to the community
of this objectionable practice was clearly proved
Enteric Fever caused no deaths during 1897. There were 7 cases of the disease
notified, as compared with 2 in 1896. The cases were mostly isolated, and in several
instances infection was contracted outside of the district. At Ashfield it was found
that an unsatisfactory condition of the drainage existed, and this was rectified as soon
as the defects were pointed out to those responsible.
Diphtheria caused no deaths during 1897, and there were only 3 cases of the
disease notified, as compared with 16 in 1896. This is a highly satisfactory record,
as, a few years since, the reputation of the Western District for Diphtheria was
anything but enviable.
Measles caused 1 death during 1897. The disease was very prevalent, especially
in the Aberfoyle, Dunblane, and Killin districts.
Whooping-Cough caused 3 deaths during 1897. The disease was very prevalent
in the Port of Monteith district, all of the fatal cases occurring there.
Diarrhoea caused one death. In 1896 the number was the same.
Deaths in which the cause of death was uncertified, or insufficiently stated, were
only 4 during 1897, as compared with 8 in 1896.
[Note] 379 |
|
| HH62/45/381 |
[Note] 380
Eastern District.
The population of the Eastern District, estimated to the middle of 1897, was
9375. During the year there were 222 Births (112 males and 110 females) and 145
Deaths registered, giving a Birth-rate of 23.68, and a Death-rate of 15.46, as
compared with a Birth-rate of 24.06 and a Death-rate of 13.72 in 1896. The Natural
Increase of the population during 1897 was 77, as compared with 98 in 1896. There
were 75 deaths in persons over 60 years of age, and 21 children under 1 year died
during 1897, 8 of the latter deaths being attributed to Developmental Causes
giving an Infantile Mortality of 94.5, as against 78.9 in 1896.
The Zymotic Death-rate was .640 during 1897, as compared with .633 in 1896,
the number of deaths from these diseases in both years being the same.
The general health of the Eastern District has been satisfactory during the past
year.
During the year an excellent water supply was introduced into the combined
villages of Burrelton and Woodside. The water is of good quality, and the quantity
is largely in excess of the requirements of the inhabitants.
Rosemount Special Water District seems now to be in a fair way to obtain its
long-deferred water supply during the coming summer. Many sources for supplying
water to this District were considered, but it has been finally settled that as there
was plenty of water to spare from the supply to Blairgowrie Burgh, the Rosemount
District should avail itself of that on payment of a small assessment. As the estimated
cost of distributing the water through the District has been shown by Mr. Baxter,
Dundee, to be reasonable, it looks as if, after its many ups and downs, the Rosemount
Water District were to come out very well.
In the Report for last year it was mentioned that the Commissioners of the
Burgh of Rattray had decided to carry the sewage of the burgh into the Blairgowrie
main sewer. This very sensible idea had been departed from, and several schemes for
the draining of the burgh considered, but so far no plans have been laid before the
Eastern District Committee for approval, nor have any works been commenced The
laying of the plans before the District Committee is not a necessary part of the
burgh's proceedings, but as the efficacy of the measures adopted to purify the sewage
before its discharge into the River Ericht will certainly be made a subject of careful
enquiry by the Committee, this course would be advisable. The prevention of the
pollution of the Ericht by the Rattray sewage has been too long under consideration.
It is high time that the Eastern District took steps to have the matter finally settled
by the Sheriff.
2. General enquiries have been made during the year to ascertain the condition
of the District, and many special enquiries have been necessitated in connection with
complaints as to alleged nuisances, and the outbreak of infectious diseases.
3. Advice was given in regard to proposed water supplies, drainage schemes, and
the arrangements for securing accommodation for cases of infectious disease in the
Perth Royal Infirmary. No certificates have been necessary under the Public Health
Acts. The Eastern District Committee during the past year appointed the Chief
Medical Officer and Sanitary Inspector Inspectors under the Factory and Workshops
[Note] 381 |
|
| HH62/45/383 |
[Page] 34
Acts, and as a result all of the workshops in the District have been visited and
registered, as well as a number of factories. Some factories were visited in conjunction
with H.M. Inspector of Factories, with a view to having improvements carried out.
4. Retail Bakehouses. - These have been visited during the year, and found to
be in good order. Lime-washing has been attended to, though at Burrelton some
difficulty was experienced in connection with this.
5. The new arrangement whereby the Eastern District Committee are entitled
to send infectious cases to the Perth Royal Infirmary was freely used
during the past year; 27 patients were removed. The Medical Officer has no
supervision of the management of Perth Infirmary. The portable Hospital belonging
to the District Committee has not been required during the year; it is ready for use
when wanted, and costs nothing for upkeep when not in use.
6. Much anxious work was entailed during the past year in connection with
endeavouring to check the spread of infectious disease in some parts of the District.
The main difficulties arose from scarlet fever cases which had not been recognized,
and which by the time they were discovered had done much mischief. It was only
by house-to-house visitation that effectual steps could be taken to stamp out the
infection. Disinfectants were freely supplied, with directions as to use. Insanitary
conditions have been steadily removed when found, and the decreasing number of
diphtheria cases shows that considerable improvements have been effected.
Respiratory Diseases caused 18 deaths during 1897, as compared with 10 in
1896. Of these, 4 occurred in persons over 60 years of age, and 7 in children under 1
year.
Circulatory Diseases caused 18 deaths during 1897, as compared with the
same number in 1896. Of these, 14 occurred in persons over 60 years of age.
Tubercular Diseases caused 20 deaths during 1897, as against 23 in 1896. Of
these 20 deaths, 16 were due to Pulmonary Consumption.
Nervous Diseases caused 15 deaths during 1897, as compared with 12 in 1896.
Of these, the age at death was over 60 years in twelve instances.
Digestive Diseases caused 7 deaths during 1897, as compared with 11 in 1896.
Cancer and Malignant Diseases caused 11 deaths during 1897, as against 4
in 1896.
Old Age. - To this cause were attributed 23 deaths during 1897, as compared
with 26 in 1896.
Developmental Diseases caused 8 deaths, of which 6 were attributed to pre-
mature birth during 1897; in 1896 the number was the same.
Violence caused 9 deaths during 1897, as compared with 4 in 1896.
Zymotic Diseases caused 6 deaths during 1897, the same number as in 1896.
The Zymotic Death-rate was .640, as compared with .633 in 1896. During the past
year 71 cases of Infectious Diseases were notified, as compared with 35 in 1896, the
increase being chiefly due to Scarlet Fever cases, which were 23 in excess of the
number in 1896.
Scarlet Fever. - No deaths were due to Scarlet Fever during 1897, the number
of cases reported during the year being 35, as against 12 in 1896. Of these cases,
23 were removed to Hospital. Most of the cases of this disease occurred in the
Parish of Cargill, or were connected therewith. The type of the disease was for a
time exceedingly mild, and no medical man having been called in, convalescent
patients soon mixed with the healthy, and the disease rapidly spread in every direc-
[Note] 382
[Page] 35
tion, especially as the School Board became very exacting as to school attendance
about this time, and nothing could be better calculated to spread Scarlet Fever than
the presence, in a classroom, of convalescents from the disease. So soon as the nature
of the disease became recognised, the people gave every assistance in helping to
stamp it out.
Enteric Fever caused 1 death during 1897, as compared with 2 in 1896.
There were 9 cases of the disease notified during the year, the number being the
same as in 1896. In connection with 2 of the cases there was presumptive evidence
that the infection had been contracted without the District, and in relation to some
of the others, insanitary conditions were discovered, which were rectified as soon as
possible, as a matter of routine.
Diphtheria caused 1 death during 1897. There were only 12 cases of the
disease notifed during the year, as against 20 in 1896. With the exception of one
family in which 5 cases occurred, the cases were isolated, and in different parts of the
District. There was distinct evidence that in one of the cases the disease was im-
ported. Insanitary conditions were associated with the majority of the outbreaks of
Diphtheria; these were removed as soon as possible. Three cases of Diphtheria
were removed to Hospital, and made good recoveries.
Whooping-Cough caused 1 death, which occurred in St. Martins. The disease
was prevalent, but its type was mild.
Diarrhoea caused 3 deaths during 1897, as compared with 2 in 1896.
There were no deaths during 1897 in which the cause of death was insufficiently
stated, or uncertified.
[Note] 383 |
|
| HH62/45/385 |
[Note] 384
TABULAR STATEMENTS
OF
SICKNESS AND MORTALITY
IN THE
COUNTY OF PERTH,
1897.
[Note] 385 |
|
| HH62/45/387 |
TABLE II. - Density of Population, Birth Rate, Infantile and other Death Rates.
[Table Inserted]
* To be calculated to three places in decimals.
TABLE III. - Cases of Infectious Disease coming to the knowledge of the Medical Officer during the Year 1897
[Table Inserted]
(Signed) JOHN T. GRAHAM, M.D., Medical Offcier.
31st March, 1898.
[Note] 386
TABULAR STATEMENT of SICKNESS and MORTALITY referred to the Regulations issued by the Local
Government Board for Medical Officers of Counties.
COUNTY OF PERTH.
TABLE I. - Births and Deaths occurring in the County during the Year 1897.
[Table inserted]
NOTES.
The Medical Officer may, if he thinks fit, give separately the figures for any Sub-Divisions of the County: in all cases the Total for the County is to be given.
Deaths of Persons belonging to a County occurring in Public Institutions (as Lunatic Asylums, Poorhouses, Hospitals) outside of the County, are to be included with the figures for that County,
and Deaths of Persons not belonging to a County, occurring in Public Institutions within the County, are to be excluded.
"Diphtheria" shall include "Membranous Croup," "Diphtheritic Croup," "Croupous Diphtheria."
All Deaths from "Diarrhoea," "Dysentery," "Enteritis," "Gastro-Enteritis," "Muco- Enteritis," - unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis-
Diarrhoea," "Bright's Disease - Diarrhoea," are to be entered under the heading "Diarrhoea."
The designation, "Other Tubercular Diseases" shall include, inter alia, " Tabes Mesenterica," "Tubercular Meningitis," Hydrocephalus," "Struma," "Scrofula."
The headings distinguished by asterisks shall cover all diseases placed under these headings in the classification of the Registrar-General.
[Note] 387 |
|
| HH62/45/389 |
[Note] 388
COUNTY OF PERTH - PERTH DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1897, according to the Registration Districts.
[Table Inserted]
* To be calculated to three places in decimals.
[Note] 389
PERTH DISTRICT - Continued.
[Table inserted]
* Acreage included under Auchtergaven, Kinclaven, and Redgorton.
+ After deducting (4336) Acreage of Perth City, formed by parts of Kinnoull, Perth, Scone, and Tibbermore. |
|
| HH62/45/391 |
[Note] 390
COUNTY OF PERTH - CENTRAL DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1897, according to the Registration Districts.
[Table inserted]
[Note] 391
COUNTY OF PERTH - HIGHLAND DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1897, according to the Registration Districts.
[Table inserted]
*1 Acreage included under Dull, Logierait, and Kenmore.
*2 Acreage combined with Dowally.
*3 Acreage included under Dull and Blair-Atholl.
*4 Acreage included under Fortingal.
*5 Acreage included under Moulin.
*6 Acreage included under Blair-Atholl and Moulin. |
|
| HH62/45/393 |
[Note] 392
COUNTY OF PERTH - WESTERN DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1897, according to the Registration Districts.
[Table inserted]
[Note] 393
COUNTY OF PERTH - EASTERN DISTRICT.
TABLE IV. - Details of BIRTHS and DEATHS occurring in the District during the Year 1897, according to the Registration Districts.
[Table inserted]
* Acreage included under Kirkmichael.
+ Acreage included under Alyth, Blairgowrie, and Kirkmichael. |
|
| HH62/45/395 |
[Note] 394
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENTS,
For YEAR ending 31st December, 1897.
[Note] 395 |
|
| HH62/45/397 |
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1897.
LOCAL AUTHORITY of the PERTH DISTRICT of the COUNTY OF PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 1
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 396
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1897.
LOCAL AUTHORITY of the CENTRAL DISTRICT of the COUNTY OF PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 1
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 397 |
|
| HH62/45/399 |
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1897.
LOCAL AUTHORITY of the HIGHLAND DISTRICT of the COUNTY OF PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 0
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 398
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1897.
LOCAL AUTHORITY of the WESTERN DISTRICT of the COUNTY OF PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 1
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- 0
[Note] 399 |
|
| HH62/45/401 |
INFECTIOUS DISEASE (NOTIFICATION) ACT, 1889.
TABULAR STATEMENT
For the YEAR ending 31st December, 1897.
LOCAL AUTHORITY of the EASTERN DISTRICT of the COUNTY OF PERTH.
TABLE I.
[Table inserted]
TABLE II.
[Table inserted]
3. Number of Notifications by Head of Family, Occupier, &c., -- 0
4. Number of Cases omitted either by Medical Practitioners or Heads of Families, &c., -- 0
5. Number of Prosecutions, in terms of Section 3 (2), consequent on such omissions, -- 0
6. Number of Convictions consequent on such Prosecutions, -- [note] 4 -- 0
[Note] 400
[Note] 401 |
|
|
|
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