Medical Officer of Health reports, 1891 - Aberdeenshire

Page Transcription
HH62/1/ABERD/1 [Page] viii. human habitation, so that it may be possible to present to the Council, from time to time, a partial, and ultimately a complete, record of the County. Such a survey can be carried out by merely systematising the work of the Inspec- tors, and it would be of great value. It does not imply that everything is to be made perfect at once, but merey renders us cognisant of the conditions throughout the County. I have the honour to be, MY LORDS AND GENTLEMEN, Your obedient Servant, JAMES P. WATT, Medical Officer of Health for Aberdeenshire. ABERDEEN, 8th April, 1892. [Page 1] Aberdeen County Council. REPORT ON THE Aberdeen District of the County of Aberdeen. Prepared in accordance with the Regulations of the Board of Supervision, under the Local Government (Scot- land) Act, 1889. To The District Committee, ABERDEEN DISTRICT, COUNTY OF ABERDEEN. GENTLEMEN, I beg to submit the following Report on the district, prepared in accordance with the Regulations issued by the Board of Supervision. The Aberdeen District is a district which, from a health point of view, derives special importance from its vicinity to the City of Aberdeen. The district itself is an extensive and populous one. Like the rest of the County it is almost entirely agricultural; but along the Don valley there are several very large works for the manufacture of paper and one for manufacture of cloth. Accordingly, in the parish of Newhills we have a considerable factory population. In the Dee valley there are many suburban villas, while the villages of Cults and Culter are rapidly increasing in size. At Culter there is a large paper factory. The total population, which is larger than that of any other district in the County, with the exception of Deer,
HH62/1/ABERD/3 [Page] 2 was, in 1891, 20,274. The acreage is 94,330 acres, giving an average of .214 persons to the acre, or one person for every five acres. The total number of children born in the district in 1891 was 544. The total number of persons who died was 292, the difference of births in excess of deaths thus being 252. The total death-rate was, in 1891, 14.402 per 1000 of the population. The following table shows the position of the district in this respect in comparison with the other districts in the County, and with the Mainland Rural Districts of Scotland, and Scotland as a whole:- [Table inserted] The total number of deaths from zymotic (i.e., epidemic and contagious) diseases was, in 1891, 34, giving a total zymotic death-rate of 1.672. This is very much higher than that of any other district in the County (see Table I. in Appendix), and the explanation of this is undoubtedly to be found in the immediate vicinity to the district of a large City, where zymotic disease is always more or less prevalent. This is a matter that requires all the more attention when we consider that there are in the district no fewer than 191 dairies, from which a large part of the milk supply of the City is drawn. The District Committee, therefore, deserve great praise for the energetic measures which they at once took for dealing with zymotic disease. The adoption of the Notification Act, the arrangement made for the reception of patients into the City Hospital and the Woodside Burgh Hospital, and the appointment of a well-trained Inspector, were steps of the greatest importance for the district no less than for the City. [Page] 3 The total tubercular death-rate was 1.330, that from phthisis or consumption alone being .887. Table B shows the population of the parishes in the district in 1881 and 1891, the average parochial death-rate in 1891, and also during the ten years from 1861 to 1870, inclusive. [Table inserted] Table C shows the average death-rate in the district, as a whole, during the last ten years. [Table inserted]
HH62/1/ABERD/5 [Page] 4 GENERAL ACCOUNT OF THE SANITARY STATE OF THE DISTRICT. Following the order adopted in my other District Reports, I shall deal first with the villages. AUCHMILL. - The village with the largest population in the district is Auchmill, the Waterton District as it is now called, since its formation into a Special Water and Drainage District. At two or three points in the village the main sewer will require to be extended to secure connections with some of the houses. The water supply has been exceedingly deficient in the past, but works are in process for increasing it considerably. Few villages in the district stand in greater need of systematic scavenging. The urgent necessity for this was shown by a Report, prepared by a Sub-Committee, on the condition of the village. The District Committee determined to petition Parliament for scavenging powers, being of opinion that the power under the Act was insufficient for the purpose. Cases of typhoid fever and diphtheria have occurred in consequence of the insanitary surroundings of some of the tenement houses. The attention of the Sanitary Inspector has been constantly directed to these places, and considerable improv- ments have been effected, though nothing but systematic scavenging will be effectual. SUMMERHILL. - The drainage of this village is at present occupy- ing the attention of the District Committee, who have under consideration its formation into a Special Drainage District. Attention was specially called to the need for this by cases of disease which were clearly traceable to the want of proper drainage. The water supply, which is from deep pump wells, is plentiful and of good quality, except where, as in one or two of them, it has been contaminated by sewage, due to defects of drainage. CULTS. - This important village, the population of which is in- creasing rapidy every year, claims attention both as regards drainage and water supply. There is no drainage system whatever. Cesspools are the only means of disposal of the sewage. As the water supply to most of the houses is from pumps, and as the soil is sandy and porous, the danger of such a condition of matters is at once apparent. The water supply is also exceedingly deficient towards the end of the summer, as many of the pumps become dry. The only remedy for this condition of matters is the formation of a Special Water and Drainage District. CULTER. - The drainage of this place will require attention. The only sewer existing in the meantime is that belonging to [Page] 5 the Culter Paper Mills Company, who decline to allow any connection to be made from the houses not occupied by their own employés, on the ground that the sewer is already in- sufficient in size to carry away the sewage from the houses of their own work people. Several of the houses in the village have accordingly no means of disposing of slop and waste water, and a nuisance has been created by the discharge of it on the roadside. A good sewerage system is necessary, and the village should be formed into a Special District for Water and Drainage. PARK. - I may just state shortly that the drainage of this hamlet is being put into a thoroughly satisfactory condition, and improvements are being carried out in regard to ashpits and privy middens. HATTON OF FINTRAY. - Defects exist in regard to the drainage and ashpits of several of the dwelling-houses in this small village. Legal steps are being taken to have these remedied. BLACKBURN. - Improvements in regard to drainage and water supply are under consideration. An increased water supply is to be introduced. These are all the villages in the district. FARM STEADINGS. In connection with the farm steadings the most impor- tant matter for consideration is the sleeping accommodation provided for unmarried men. This is a matter not peculiar to the Aberdeen District, and the following remarks are applicable to many of these places in every district in the County. The chief sanitary defects found in connection with these are:- (1) Bad position, and (2) bad ventilation. They are generally placed above the stable or byre, connected therewith by a trap-door. As this stands always open, the foul air rises from the stable into the room. In fact, this is the only source of air supply, when, as in winter the invariable skylight is closed to keep out cold and rain. The foul hot vapours from the stable find their way also into the sleeping room through crevices or holes in the floor. (3) Insufficient size. Not only are these sleeping apartments in a bad position and badly ventilated, but they are often insufficient in size. I have measured many of them and found the cubic space allowed for each man totally inadequate. In many cases they do not have one- half, occasionally even not one-third, of what is enforced by law for a tramp in a common lodging-house. (4) Dampness.
HH62/1/ABERD/7 [Page 6] There is rarely a fireplace, and moisture rising from the stable, or coming, as it often does, through the roof, renders the place damp and unhealthy. There is another very important view from which to regard these sleeping apartments, and that is their general moral effect on the men. Comfort in such places is, of course, a thing unknown. Dr. Lawson, Medical Officer for Midmar, well describes this view of the question. After giving a vivid description of some such places, he continues - "The men-servants are, as a rule, healthy, hardy young fellows, and are quite capable of roughing it somewhat, and I do not think it is their health so much that suffers by living in such dens as their morals, the feelings of decency and self-respect, which are at the foundation of good conduct and character, cannot be kept alive in such places." It will be necessary to insist on these places being dis- used and replaced by others more fit for human habitation. In the newer steadings more attention is being paid to pro- viding suitable accommodation, and it is certain that the comfort of such sleeping apartments is fully appreciated by the men. The District Committee have dealt very sharply with one case which it was found necessary to bring before them. COTTAR HOUSES. The cottar houses on farms are too often in a very unsatisfactory condition. The point most important to secure in connection with them is - that they shall be dry as far as they can be made so. I think it is unquestionable that the percentage of deaths from respiratory diseases, in- cluding consumption, would be less were these conditions better attended to. Too often, also, the houses are draughty, and the effect of this on the same class of disease is well described by Dr. Paterson, Inverurie. "In bad weather," he says, "many cases of bronchial trouble have scarcely a chance of recovery on account of the impossibility of keep- ing out draughtss from defective roofs, doors and windows." Inspection of the houses of the labouring classes is one of the most important parts of Public Health work. The whole work of a Public Health Department is directed towards the prevention of disease. Recent medical research has thrown great light upon the cause of many diseases and the conditions that favour their development. Inspec- tion of the dwellings of the labouring classes is directed towards the removal of such conditions, either in the [Page] 7 building itself or around it - a wiser plan than to wait till our attention is forced to their existence, and the necessity for their removal by the actual outbreak of disease. The better classes are perfectly alive to the necessity of securing healthy homes, and are in a position to do so. The poorer classes are too often not in the same fortunate position, and cannot obtain unaided the advantages of healthy homes, however much they may desire them. WATER SUPPLY. The water supplies to individual houses in the district are here, as in all the other districts, open, in many cases, to pollution, from thier proximity to drains, ashpits, and middens. This is undoubtedly the cause of most cases of enteric fever and diarrhœa that are prevalent in country districts, and the practice that I have for some time adopted, of analysing a sample of the drinking water in every case of typhoid reported, has led to some interesting results. THE NOTIFICATION ACT. This Act has been in force for fourteen months, and has proved of invaluable assistance in checking the spread of infectious disease. The close connection with Aberdeen, through scholars attending school there, and people living in the district going into town to business or work, renders it impossible to prevent the dissemination in the district of every form of infectious disease prevalent in town. During the latter half of 1891, while an epidemic of unusual severity was raging in the city, many cases, clearly traceable to in- fection brought from the town, occurred here and there, and but for the advantage gained by immediate notification and hospital or house isolation, a widespread epidemic would, in all probability, have occurred. In his report on North Newhills, Dr. Maver, Medical Officer, says:- "An epidemic of scarlet fever has been nipped in the bud, and this entirely owing to notification and the enforcement of isolation. Had fever made its appearance at so many points before the adoption of the Notification Act we would have had a wide- spread epidemic." HOSPITAL ACCOMMODATION. The hospitals to which the Local Authority have been entitled to send patients were the Aberdeen City Hospital for Infectious Disease and the Woodside Hospital. The
HH62/1/ABERD/9 [Page] 8 latter, though far from being in accordance with the re- quirements of a modern hospital, was exceedingly convenient for patients in the Buxburn District, more especially as the City Hospital was overcrowded during the latter months of the year, and could only take the most pressing cases. I was able, by using it, to carry out hospital isolation in all cases where it appeared necessary. I visited it repeatedly and found, under Dr. Fowler's charge, everything as satis- factory as could be with the means at his command. It has been disused as a hospital since the absorption of the burgh into the town. I have paid very frequent visits to the City Hospital, which is well equipped and under excellent management. ZYMOTIC DISEASE IN THE DISTRICT DURING 1891. From information obtained from the Sanitary Inspector, I learn that during the earlier part of the year a number of cases of scarlet fever connected with Craigton School occurred in the parish of Peterculter. The breaking up of the school for holidays had the effect of checking the disease, for no fresh cases occurred thereafter. The school was thoroughly disinfected. This is an accidental illustration of the benefit of closing schools in arresting the spread of disease. The latter portion of the year was marked by an out- break of scarlet fever which especially affected Newhills, a few cases occurring in other parts of the district. Many of these cases were traced to infection spreading from the town, where, from August to December, a very severe epidemic was raging. Prompt measures were taken in all cases for the removal of patients, clothing, bedding &c., to hospital, wherever isolation could not be carried out in the house of the patient. In the cases where isolation was carried out in the house every precaution was taken, and in no case is there evidence of infection having spread from any of the houses so isolated. Out of twelve cases where patients were isolated at home, in only three did infection spread to any of the other members of the family. Every assistance was rendered by the Medical Officers of the various districts where the outbreaks occurred. I msut also express my appreciation of the services of the District Sanitary Inspector, Mr. Reid, who carried out my instructions with zeal, promptitude, and ready tact. With regard to typhoid fever, of which eleven cases were reported to me since the beginning of August, the [Page] 9 usual steps were taken in regard to them. Four were isolated at home, the others removed to hopsital. DIPHTHERIA. - Six cases were reported. Two of these were traced to the drinking of dirty water taken from a ditch, two others to defective drainage, another to eman- ations form a foul ashpit, and the sixth to defective trapping of the house drains. In all cases efficient measures were taken to prevent the spread of the disease. WHOOPING COUGH. - A severe epidemic occurred in the district during the year. Nearly all the cases reported were visited by the Sanitary Inspector. The children were not allowed to go to school, and the parents warned of the danger of infection. MEASLES. - Only two cases of measles were reported during 1891. GENERAL AND SPECIAL INQUIRIES. The results of the general inquiries made are summed up in the previous remarks. A special inquiry was made into an outbreak of fever on a dairy farm at Northfield, from which milk was supplied to Aberdeen. The results of that investigation I submitted at the time to the Public Health Committee. The infection was traced to the milk boy, whose work took him to houses where scarlet fever was. In consequence of this inquiry, the Committee issued a warning to dairy farmers against leaving milk-cans in houses during the prevalence of the epidemic of scarlet fever, and to take other precautions, which were specified. Many other investigations were carried out in connection with outbreaks of enteric fever, diphtheria, and scarlet fever. A special inquiry was also made, at the request of the Public Health Committee, into the drainage of Culter. OFFENSIVE TRADES. The only offensive trade is the slaughtering of cattle. There are four slaughter-houses, three of which I have already visited. Two of these, viz., at Broomhill and Westhills, Skene, I found defective as regards drainage, and instructions have been given to carry out improve- ments. BAKEHOUSES. I have inspected many of the bakehouses, but have found none unfit for use as bakehouses. In one case a con-
HH62/1/ABERD/11 [Page] 10 travention of Section 15 of the Act of 1883 was found in the opening, within the bakehouse, of an open drain. This was immediately remedied by the owner. DAIRIES. There are in the District, as mentioned above, 191 dairies. Bye-laws have been drawn up by the District Committee for regulating the cubic space, the ventilation, the keeping clean of the cowsheds, and for securing clean- liness of the dairies and milkshops, the Sanitary Inspector being commissioned to see that these regulations are attended to. Supervision of dairies is a duty imposed on a Local Authority by an Order, which is equivalent to an Act of Parliament, and from the view of Public Health it is a matter of the very utmost consequence. The systematic inspection was unfortunately delayed, but will be taken up and carried through, as far as possible this year. CAUSES, ORIGIN, AND DISTRIBUTION OF DISEASE. This is a very wide subject and would require more time to enter upon with any satisfactory or sufficient results. The cases of enteric fever and diphtheria which I inves- tigated I found invariably associated with insanitary con- ditions. Polluted drinking water was found to be the cause in a number of the enteric cases; in a few others at Auchmill the condition of ashpits in connection with the tenement houses was clearly the cause of the disease. The foul condition of these ashpits was apparently also the cause of one case of diphtheria at Auchmill. In the other cases of diphtheria drainage was always present. One may reasonably hope that, with improved sanitary conditions, these cases will become fewer, if they do not altogether disappear. Whooping Cough and scarlet fever will, I am afraid, always persist in the district, owing to the vicinity of the town. The means of notification and isolation now at the command of the Sanitary Authority will, however, enable scarlet fever outbreaks to be immediately controlled and minimised. Whooping cough is a disease which, from various causes, we are hardly in a position to deal with satisfactorily. It would be impossible to resort to hospital isolation, both from the heavy expense such a proceeding [Page] 11 would entail and the opposition that would be met with from parents. The disease often lasts for a long period or breaks out afresh, and thus renders any attempt at home isolation extremely difficult. It is my intention, when time allows, to examine into the statistics of places where notification of this disease has been in operation for some years, and to ascertain what the results have been. Phthisis is not so prevalent in this as in other districts in the County. Many of the cases are undoubtedly im- ported from the town, those affected coming back to their homes, or into the country to recruit, in too many cases to die. In this way the tubercular death-rate of a town will be lessened, that of the country district increased. The death-rate from respiratory diseases is higher in the Aber- deen District than in any of the other districts of the County. It would be interesting to inquire to what extent the deaths from diseases of the respiratory tract are depen- dent upon the condition of the houses of the people. I hope to enter more fully into this subject in subsequent reports. STATISTICAL TABLES. Appended are the Tables prepared in accordance with the Regulations of the Board of Supervision. I have the honour to be, GENTLEMEN, Your obedient servant, JAMES P. WATT. COUNTY HEALTH DEPARTMENT, MUNICIPAL BUILDINGS, ABERDEEN, 1892.
HH62/1/ABERD/13 Aberdeen County Council. REPORT ON THE Ellon District of the County of Aberdeen. Prepared in accordance with the Regulations of the Board of Supervision, under the Local Government (Scot- land) Act, 1889. To The District Committee, ELLON DISTRICT, COUNTY OF ABERDEEN. I beg to submit the following Report on the sanitary condition of the district, as prepared for the Board of Supervision and the County Council. The Ellon District of the County of Aberdeen comprises the parishes of Ellon, Logie-Buchan, Cruden, Slains, Foveran, Udny, Tarves and Methlic. The parishes of Cruden, Slains, and Foveran lie on the coast, giving to the district an exten- sive seaboard. The fishing villages are Port Erroll, Bullers of Buchan, North-haven, and Whinnyfold, in Cruden; Old Castle and Collieston in Slains; and Newburgh in Foveran. The other villages in the district are Ellon, Methlic, Tarves, Hatton, Pitmedden, and Green of Udny. The district comprises an area of 106,907 acres, with a population, according to the census of 1891, of 16,767. The population of the district in 1881 was 16,755, showing an
HH62/1/ABERD/15 [Page] 14 increase in the ten years of 12. While the population of the district, as a whole, has thus remained almost stationary, it will be seen from Table D that there has been considerable fluctuation in the several parishes. The density of population is .157 persons to the acre, or one person for every 6.36 acres. The total number of births in the district in 1891 was 568. The total number of deaths from all causes was 228. The total death-rate for the district is thus 13.597 per 1000 of the population. From the following Table it will be seen that the Ellon District has the third lowest death-rate of the eight districts into which the County is divided and the highest birth-rate:- Table A. [Table inserted] The average death-rate in the Mainland Rural Districts of Scotland, according to the Returns of the Registrar- General was, in 1891, 17.3 per 1000, while the average death-rate for the whole of Scotland was 20.7. It will thus be seen that the Ellon District compares favourably, not only with the Mainland Rural Districts of Scotland as a whole, but also with the other districts in the County. The total number of deaths in 1891 registered as due to zymotic (i.e., epidemic and contagious) diseases was 23. This gives a total zymotic death-rate of 1.371 per 1000 of the population. The zymotic death-rate in the eight principal towns of Scotland was, in the same year, 3.34 per 1000. Of the 23 deaths due to zymotic diseases, 9 were caused by diphtheria, one by typhoid fever, three by whooping-cough, and three by measles; while seven are put down as due to diarrhœa, which is now included among zymotic diseases. With regard to diphtheria, I may here mention that attention was directed by the Registrar- General, in 1874, to the fact that Aberdeenshire had the highest death-rate from this disease of any county in Scotland during the decennium 1860-1870. The following [Page] 15 Table shows the number of deaths per million in Scotland and several of the counties (from diphtheria) during that period:- Table B. [Table inserted] Table C shows the death-rate in 1891 from diphtheria in the eight districts of the County (exclusive of Burghs) and in the town of Aberdeen, and it may be interesting to com- pare with it here the death-rates from the other infectious diseases:- Table C. [Table inserted] It will be noticed from the above Table that the death- rate from diphtheria is greater in the Country districts than in the City. The greater prevalence of diphtheria in Country districts is an old and well-known fact - though, for some cause not yet sufficiently understood, diphtheria has of late years been increasing at an almost alarming rate in some of the larger cities, as, e.g., in London.
HH62/1/ABERD/17 [Page] 16 The dampness of so many of the houses, and want of subsoil drainage, along with the insanitary conditions round many of the cottages in the country, may go far to explain the above facts. Moisture, dampness, and filth are favourable to the development of the micro-organism which is the cause of the disease. Seventeen deaths in the district were registered in 1891 as due to phthisis. The total of deaths from tubercular diseases (including phthisis) was 21 - giving a tubercular death-rate of 1.251. This is nearly equal to the zymotic rate of 1.371. TABLE D shows the death-rates in the various parishes in 1891, and the average death-rate during the decennium 1861-70, also the population of each parish in 1881 and 1891, with the increment or decrease. TABLE D. [Table inserted] TABLE E shows the death-rates during the last ten years in the Ellon District. Table E. [Table inserted] [Page] 17 SANITARY STATE OF THE DISTRICT. In describing the sanitary state of a district, I shall follow in my Reports the same order for facility of refer- ence. I shall consider, first, the general condition of the villages; next, the condition of the houses of the labouring classes and their surroundings, and the accommodation pro- vided for farm labourers. Lastly, I shall describe the hospital provision and the means at command of the Local Authority for dealing with infectious disease. VILLAGES. In the autumn of last year I made an inspection of the villages in the district to determine what measures were advisable for improving their sanitary condition. The fol- lowing notes are taken from the Report presented to the District Committee. There is no question that, in the case of all the villages, the first and foremost need is scavenging. The scheme the Sanitary Inspector suggests, of grouping the villages for purposes of scavenging, is excellent, and, probably, with the better prices commanded for the manure when stored in depôts and sold only as required by the farmers, the cost of the working expenses would be comparatively small, But the Public Health Act of Scotland gives no power to carry out scavenging, and, until the enactments on this head in the English Public Health Act are extended to Scotland, we will have to be content with prosecuting for nuisance those who keep their ash-pits and privies foul. As regards drainage, Newburgh, Ellon, Hatton, Port Erroll, Whinnyfold, Old Castle, and Collieston, will, to a more or less extent, require the attention of the Committee. In regard to water supply, the lower or fishing village at Port Erroll stands most in need of increased supply, which is, fortunately, a very simple matter - for as at Pitmedden, a larger storage tank will be sufficient to meet the require- ments of the case. An increased supply of water at New- burgh, a supply to the upper part of Collieston, a new supply to Tarves, and attention to the supplies at Hatton and North-haven are all desirable, and should be dealt with by the Committee. NEWBURGH. - I found some of the small houses in the village in rather a dilapidated condition. The ashpits in many places were very faulty in construction and badly kept. Privies in the same condition. The effluents from the sewers are poured out along the side of the burn, and as the sewage is strewn along the bank by the tide, the whole strand is
HH62/1/ABERD/19 [Page] 18 converted into a sort of huge cesspit. Some scheme of sewerage for the place ought certainly to be entered upon without delay. There is here very clamant need for scavenging, as soon as powers for that can be obtained. COLLIESTON. - A water supply for the higher part of the village is a desideratum. A sewer laid down along the line of the road from the higher part of the village to the lower part, and emptying into the sea, would certainly be an advantage. The village was wonderfully clean when I visited it, but I have no doubt that at the height of the fishing season it would not be in such a sanitary condition. There is a scavenger in the village, an old man, who was engaged by the old Local Authority at a salary of £6 a year. OLD CASTLE. - Behind the village is a kind of natural amphi- theatre formed by some low hills. The rainwater gathering here pours down in a torrent, and floods the houses. Fifty yards of drainage pipes would carry away the storm water and entirely remedy the evil. There is a manure stance here that forms an abominable nuisance. It will require to be emptied regularly. WHINNYFOLD. - This village consists of two rows of houses, situated on ground sloping to the sea. The houses face the sea. All the slop water from the upper row of cottages is thrown out on the piece of waste ground behind the lower row of cottages. As there is no drainage to carry away the slop and rain water, the ground under the lower row of houses is excessively damp, as I ascertained by examining the earth under the flooring of one of the houses. In this same house one of the sons had died of consumption, a disease which is now acknowledged to be closely associated in its causation with dampness of sub-soil. The condition of matters here is one which ought to receive the immediate attention of the Local Authority. I found the ashpits in front of the houses and at the back of the village in an abominable condition. These ought to be done away with entirely. Stances should be provided at either end of the village for the fish offal, which should be removed every second day. OLD WHINNYFOLD consists of a congeries of old houses, which will fall to pieces by a process of natural decay. The place is not worth the expense of drainage. It might, however, be cleaned occasionally by a scavenger. The houses are very poor - some of them hardly fit for human habitation - but as several of the tenants pay no rent, it is rather a difficult matter to deal with these cases. [Page] 19 PORT ERROLL. - Several points demand immediate attention. (1st) The ashpits were in the worst condition of any I have as yet seen. This was due mainly to the fact that the drains for carrying off slop water were entirely blocked with the drifting sand, and that all the slop water was, accordingly, thrown into the ashpits, with which the privies were also directly connected. A condition of things more detrimental to health, especially for children, or more calculated to origi- nate or intensify disease, can scarcely be imagined. Dr. Duguid, of Hatton, informed me that he had repeatedly called the attention of the old Local Authority to the condi- tion of matters here, but nothing had ever been done. (2nd). The water supply for the lower village is very deficient, especially when the fishermen are all at home. This de- ficiency has led to water riots. On one occasion the fishermen cut off the supply to the upper village, being determined that their neighbours should not enjoy a supply which left them in scarcity. The supply for the lower village is ap- parently about 2160 galls. per day, giving to the population, which is over 300, a supply of about 7 galls. per head. Probably, at times, the amount is very considerably less than this. I think the Sanitary Inspector's scheme for increasing the supply should be considered by the Committee. BULLERS OF BUCHAN AND NORTH-HAVEN. - These small clusters of houses will need the occasional services of a scavenger. The water supply is not very good, but might easily be improved. The sewage runs in open drains or gutters, and in summer time must constitute a nuisance. HATTON. - Something will require to be done towards improv- ing the drainage of this village. It is very defective. Some of the ashpits shown me by the Inspector were in a very foul condition. The owners of these should, in the mean- time, be compelled to prevent them from becoming a nuisance. METHLIC. - Little requires to be said of this place. An in- creased supply of water may be brought in by-and-bye. A few nuisances existed requiring to be remedied, and these will, I have no doubt, ere this time have been removed. TARVES. - It is greatly to be regretted that the proposal to procure a fresh and abundant water supply to this village had to be abandoned through the opposition of the inhabi- tants. The present supply is of a very unsatisfactory char- acter. It is certainly open to suspicion of contamination. One of the pumps is so situated close to a midden, which is on slightly higher ground, that it could scarcely escape pollu- tion. A rough analysis, which was all I could make with the materials at my command, of a sample taken from this
HH62/1/ABERD/21 [Page] 20 pump, strengthened my suspicions. I hope to be able, at a later time, to present to the Committee a full report on the water supply of this village. A plan for the drainage of the village has been proposed, and is, I understand, to be executed at the expense of the Earl of Aberdeen. I cannot help remarking that, in my opinion, a wholesome supply of water would have been a more import- ant gift from a public health point of view, taking into consideration the danger of a system of drainage without sufficient water for flushing purposes. The services of a scavenger could be usefully employed occasion- ally in parts of the village. ELLON. - Ellon requires improved drainage and scavenging. Scavenging is strongly demanded here, and I fear it will be utterly impossible otherwise to kee the place in a condition compatible with health. The drainage of the old town should be dealt with at once. WIth regard to the present outfall of the sewers, I would suggest that, if permission were ob- tained to do so, they should be carried well into the stream so as to avoid the nuisance that their outfall on the bank produces. The Public Health Sub-Committee, at a Meeting held on the 5th of December, unaminously agreed to recommend that Newburgh, Hatton, and Port Erroll be formed into special water and drainage districts; that Ellon should be formed into a special drainage district; and that the pro- prietors of the several other villages be asked to carry out improvements as regards drainage and water supply. With regard to scavenging of the villages, the Sub-Committee agreed to recommend "that the District Committee should join in any petition to Government by other districts or County Councils, with a view of having the law providing for the cost of scavenging by District Committees defined, and uncertainty on the point removed." Next year's Report will show how far these measures have been carried to completion. HOUSING OF THE LABOURING CLASSES. Many of the cottages of the labouring class are not in a condition that can be described as sanitary. Damp roofs, damp walls, damp earthen floors, imperfect ventilation, the old unhealthy box-bed, badly constructed ashpits and privies, dung heaps close to windows or doors, pumps or shallow wells in close proximity to ashpit, midden, or [Page] 21 midden drain - these are some of the common faults met with in connection with these cottages. Much will require to be done in improving their condition The dampness of the floors and walls that is met with so often is a matter that deserves careful attention. The close connection of phthisis with dampness of subsoil, and the effect of damp dwellings generally on health, render it of the greatest importance to take measures to secure for the work- ing classes that their houses shall be thoroughly dry. The following extract from a sheet on Diphtheria, issued by me for the information of Sanitary Inspectors, will help to show the necessity fot this:- "Another condition that has been shown to be associated as a factor in the production of Diphtheria is dampness in houses. Consumption and Diphtheria are both caused by micro-organisms, the development of which is favoured by dampness of subsoil. "With regard to dampness, everyone is familiar with the in- fluence of a damp house in causing Rheumatism. Dampness has also to answer largely for glandular affections in children, especially enlargement of the tonsils, a condition often causing a serious interference with general health. It may further be the direct cause of, or render more dangerous, such lung diseases as Bronchitis (Acute and Chronic), Pneumonia, and Pleurisy. It may intensify, and cause dangerous complications of, many other diseases not directly due to it, as, e.g., Whooping Cough and Measles in children. We cannot, then, lay too much stress upon the necessity of having this defect of dampness remedied as far as possible in every house in which it is found." Improvements in many points will doubtless be effected through the education of the people in sanitary matters. They are often greatly at fault themselves by creating insanitary conditions in or around their dwellings. Attention will also have to be directed to securing in all cases to the single houses equally with the villages an ample supply of pure water. In some parts of this District, as, e.g., in the Parish of Slains, the water supply at some of the farms is very defective. In connection with this, I would like to direct attention to the sixth column in Table C - the death-rates in the several districts from diarrhœa. The following extract, taken from a volume issued from the Registrar-General's office in 1874, will help to throw light on this subject:- "It would be a subject as well worthy of investigation whether the purity of the water from vegetable or animal matter in a state of decomposition has anything to do with the
HH62/1/ABERD/23 [Page] 22 comparative death-rate in different counties and towns. The single circumstance that the rural parts of the counties have a higher death-rate from these bowel complaints than the large, over-crowded towns in the same county seems to favour the idea that the greater impurity of the water in the rural parts is the cause of the higher death-rates in them. Thus, contrast the death rates from these bowel complaints in the town of Edinburgh - 693 (per million) - with that in the rural parts of the county - 976; or that of Glasgow - 590 - with that of the rural parts of the county of Lanark - 766. In both of these cases, notwithstanding the greatly higher general death-rate which prevailed in the towns, the relative death-rates from bowel complaints was much higher in the rural parts than in the towns. These towns are both well supplied with wholesome water; but the water which supplies the rural parts of the counties of Lanark and Edin- burgh is chiefly derived from small open streams, which receive the drainage of the highly manured parks which are under cultivation, or from wells within the influence of deterioration from surface drainage. All these bowel com- plaints are know to be aggravated and increased by the use of water full of decaying animal or vegetable matter; and till further researches are made in the subject, the above facts seem to lead to the conclusiosn that such is one of the leading causes for the difference in the mortality from bowel complaints in the counties and towns of Scotland." It is very interesting, accordingly, to note that in the upland districts of Huntly, Alford, Turriff, and Deeside, where the water supplies are probably the most pure, the death-rates from diarrhœa are lowest, and that in the city of Aberdeen itself this rate is only half of what it is in the district around it. SLEEPING APARTMENTS. The accommodation of the unmarried male servants on farm steadings is a matter that must receive careful atten- tion. In many cases it is quite insufficient in size, and is situated above the stables, or sometimes above a byre. The entrance is from the stable by a rickety ladder and trap door. This standing generally open, allows the foul air from the stable to rise into the sleeping chamber. The only other opening consists usually of a skylight. As this in winter must be shut the only means of ventilation is from the stable. This is a condition of matters that unfortunately prevails too much throughout the whole county, and will require to be slowly but steadily changed. In some of the newly-built farm steadings the sleeping apartments are greatly improved, and are provided with fireplaces - a very essential requirement in cases of sickness. [Page] 23 The work of inspecting the houses of the labouring classes - one of the most important duties of a Health Department - is being carried out very thoroughly in this district. I hope to be able to enter more fully into this subject in my next year's Report, and show what advance has been made. HOSPITAL PROVISION. With regard to means of isolating infectious cases, the District is provided with a Cottage Hospital at Ellon. It had been erected by the Parish and was taken over by the Local Authority and made a District Hospital. It has proved of the greatest service, but it will be found necessary by-and-bye to add to it two more wards. The District Committee have at present under consideration the provid- ing of a good ambulance. Hitherto a cab has been employed, but it is hardly sufficient for the requirements of the district. SANITARY ORGANISATION OF THE DISTRICT. The sanitary organisation is excellent. The parochial medical officers have been retained meanwhile, and many of them have rendered excellent service. I think no error has been committed in making the change from the old system to the new a gradual one. It has proved, in my opinion, an advantage to gather the experience gained in the past to help to direct and strengthen our present action. A Sanitary Inspector was appointed for the district, to act as chief district inspector. I cannot express too strongly my approval of this system. Each district of a large county like Aberdeenshire should have a well-trained and efficient Inspector, who should make himself thoroughly acquainted with every part of his district, and give his whole time to the discharge of his duties. SPECIAL INQUIRIES. An inquiry into an outbreak of scarlet fever which had begun in July in the Savoch portion of the district, before my appointment, elicited one or two points of interest. The primary case had been, or is said to have been, mistaken for an attack of nettle rash. No doctor was called in attendance until a second child was attacked. Meanwhile the infection had spread to several houses through milk supplied from this farm. This shows the importance of diagnosing and dealing with first cases of infectious disease, and illustrates the danger of milk as a carrier of infection.
HH62/1/ABERD/25 [Page] 24 The school of Savoch was closed by the School Board on 18th July, and during the vacation it was thoroughly cleaned, the walls disinfected, and the woodwork painted. A few weeks ago a boy at Quilquox, attending the Savoch School, took scarlet fever. Blame was laid upon the school as the source of the infection, but, on investiga- tion of the case, I could establish no connection with the previous outbreak. The infected houses and everything in them had been disinfected in a most thorough manner by the Sanitary Inspector himself, all the school books used by the children in the infected houses being burnt - a most im- portant precaution. I was inclined to trace the source of the disease in the Quilquox case to the boy's father, whose work took him constantly to Aberdeen, where scarlet fever was very prevalent. This seemed to receive confirmation from the fact that, though the boy was immediately isolated, and his father went to reside in another house, the latter was, a few weeks after, himself attacked. No other case occurred amongst the scholars attending the Savoch school. OFFENSIVE TRADES. The only offensive trade in the Ellon District is the slaughtering of cattle. Some of the slaughter-houses in the different villages are not in accordance with strict sanitary requirements. They are being dealt with. BAKEHOUSES. As bakehouses are placed under the direct supervision of the Medical Officer of Health, I have made a personal in- spection of a number of those in the district. In several of them in which I found the conditions not quite satisfac- tory, I gave instructions for having improvements carried out. DAIRIES. The Sub-Committee have under their consideration a series of bye-laws for regulating the condition of the dairies in the district. A strict supervision of dairies is a matter of the utmost importance from the point of view of the public health. Milk forms one of the best means of multiplying and conveying disease germs. Any contamination, therefore, of the milk by polluted water, drain effluvia, or contact with anyone suffering from an infectious disease, may be the source of a dangerous epidemic. The transmission, now proved, of [Page] 25 disease from animals, and we need mention only tuberculosis, has rendered it further necessary to regulate more carefully the conditions under which the cows themselves are kept. HOSPITAL SUPERVISION. As I mentioned before, the Local Authority have an excellent hospital, so far as its accommodation goes. It con- sists of an administrative block and one pavilion connected with it by a covered way, the pavilion being divided into two wards, with a nurse's room between. Each ward is capable of accommodating four beds. There is in the ad- ministrative block a room with one bed which may be used for a single case. The original plan evidently took into consideration an extension, for which there is ample room. A pavilion behind, like the one in front, would give ample accommodation for the needs of the whole district. A steam disinfector, or a disinfecting oven, at the hospital would be of no little service. Bedding and clothes could be taken there and disinfected, and this even in cases where a patient is isolated at home. A small sum might be charged for the use of it to cover the cost of up-keep. The hospital is fortunate in possessing an excellent matron, whose kind treatment of the patients and excellent manner with children have been of the utmost service in overcoming the dislike on the part of the public to hospital isolation. The wards are also bright and clean, and every- thing about the hospital reflects great credit on all who have been connected with the charge of it. One shilling a day is charged to patients, but a wise discretion is allowed in relaxing the rule in special cases. MEASURES FOR THE PREVENTION OF OUTBREAK AND SPREAD OF INFECTIOUS DISEASE. Removal to hospital, where isolation at home was im- possible, thorough disinfection of house, bedding, and clothes under the personal supervision of the Sanitary Inspector in every case - these are the measures that have been employed with marked success in checking the spread of infectious disease. CAUSES, ORIGIN, AND DISTRIBUTION OF DISEASES. This is a question that the short time at my command will hardly allow of my giving any sufficient account of, and I shall, therefore, reserve it for a future Report.
HH62/1/ABERD/27 [Page] 26 TABLES I. and II. in the Appendix are prepared from the Returns courteously supplied by the Registrars in the District and County. They are drawn up in accordance with the forms adopted by the Board of Supervision. JAMES P. WATT. COUNTY HEALTH DEPARTMENT, MUNICIPAL BUILDINGS, ABERDEEN, 1892. Aberdeen County Council. REPORT ON THE Alford District of the County of Aberdeen. Prepared in accordance with the Regulations of the Board of Supervision, under the Local Government (Scot- land) Act, 1889. To The District Committee, ALFORD DISTRICT, COUNTY OF ABERDEEN. GENTLEMEN, I beg to submit the following Report on the district, prepared in accordance with the regulations issued by the Board of Supervision. The District of Alford is the third largest of the eight districts into which Aberdeenshire has been divided. Its total acreage is 165,894 acres, that of Deer being 166,817, and that of Deeside, 416,882. While standing thus third in extent, its population is next to Huntly, the lowest. The census of 1891 gves it as 10,813. In 1881 it was 11,555, thus showing a decrease in the ten years of 742. A large part of the district lying along the upper reaches of the Don is purely Highland, and is very sparsely
HH62/1/ABERD/29 [Page] 28 populated. Over the whole district the total density of population in only .065 persons to the acre, or 15.3 acres for every person. The Vale of Alford, a fine tract of country lying in an amphitheatre of hills, is the most fertile part of the district. Alford is in the fortunate position of having the lowest zymotic death-rate of any district in the County. This position is due to several causes, which will be commented upon in a subsequent part of this Report. As in the other districts of Aberdeenshire, diphtheria adds a considerable quota to the death-rate. The death-rate from diphtheria is .277 per 1000, as against .184 each from enteric fever, scarlet fever, and diarrhœa respectively. The death-rate from phthisis alone is also a low one, .832 per 1000, coming next to Huntly, which stands with .727. The total tubercular death-rate is 1.294, which is thus .369 in excess of the total zymotic rate. The following Table shows the position of the rural part of the County as a whole, and the various districts separately, in relation to the death and birth rates - (1) of the whole of Scotland, and (2) of the Mainland Rural Districts of Scotland, as given by the Registrar-General in his returns for 1891:- [Table inserted] On the whole, to judge from these statistics, the District of Alford occupies a good position, and, in some respects, is fortunately situated, as regards the incidence of disease. The following Table shows the parishes embraced in the district, with their acreage, their population in 1881 and 1891, with increase or decrease, and the death-rate in each parish [Page] 29 in 1891. As an interesting comparison, I have added in the last column the average death-rate in each parish during the ten years from 1861-1870 (inclusive):- TABLE A. [Table inserted] Table B shows the death-rate (i.e., the number of deaths per 1000 of the population) in the whole district during the years from 1881 to 1891 (inclusive):- TABLE B [Table inserted]
HH62/1/ABERD/31 [Page] 30 GENERAL ACCOUNT OF THE SANITARY STATE OF THE DISTRICT. This district has an advantage, from a sanitary point of view, in having few villages. There are only two - Alford and Lumsden. The drainage of Alford is in an exceedingly unsatis- factory condition, while the water supply is also defective. I need not enter into a detailed account as this has been very well given by Mr. Hogg, the Sanitary Inspector, in his Report. I will content myself with corroborating from my own personal observation all that he says with regard to drainage and water supply. I would strongly advise the formation of the village of Alford into a Special Water and Drainage District. The health of the village would un- doubtedly be much improved by the introduction of an ample supply of pure water, and by thorough drainage. Cases of diphtheria and typhoid fever occur from time to time in the village, and it may be hoped that these diseases will occur less frequently under improved sanitary con- ditions. The village of Lumsden shows some peculiar features regarding its drainage, but the place is exceedingly healthy. Were it not for the gravelly nature of the soil, the existing conditions would be very dangerous to health, more es- pecially were the water supply not introduced, as it is, by gravi- tation from a distance. The sewage is removed, one may say, by a natural process of downward intermittent filtration. Something, certainly, may be done to carry away the slop water, but it is questionable how far a regular system of drainage is necessary under the circumstances, unless it were shown to be requisite for the benefit of the inhabitants. It would be well, however, to institute a careful inquiry into the health of the village during a number of years, to find out if disease has resulted from the present method of sewage disposal. Of this, as yet, I have found no evidence. SANITARY CONDITION OF THE FARM STEADINGS AND THE HOUSES OF THE LABOURING CLASSES. In connection with farm steadings, the most important matters for consideration are the sleeping accommodation for the unmarried men and the condition of the cottar houses. With regard to the sleeping apartments and cottar houses, I would beg to refer to my remarks in my Report on the Aberdeen District. In the newer steadings more attention is being paid to providing suitable accommoda- tion for farm servants. One such apartment I inspected at [Page] 31 a new farm steading in this district might well be taken as a model for all the others. I was assured by the foreman on the farm that the comfort of such an apartment was fully appreciated by the men. Before passing from farm steadings, I cannot help emphasising strongly that the Sanitary Inspector's suggesstions regarding the method of dealing with the liquid manure, and pointing out that such a plan would more than repay the primary outlay through the non-deterioration of the solid part, and the preservation and utilisation of what is really the most valuable part of stable or byre manure, viz., the liquid part. It would also prevent the too frequent pollution of small streams by farmyard sewage, which is a very important matter. Such streams are used for cattle, and sometimes for human beings, and polluted water may produce disease in cattle, as it certainly does in man. SCHOOLS. I have looked into the health conditions of some of the schools in the district. The school at Corgarff was specially unsatisfactory with regard to cubic space and ventilation, but improvements are to be effected. THE NOTIFICATION ACT. With regard to infectious disease, the adoption of the Notification Act, as contemplated by the Public Health Committee, will facilitate the more prompt dealing with such cases. The only object aimed at by the Notification Act is to secure the earliest intimation to the Sanitary Authority of cases of infectious disease, so that more immediate steps may be taken than would otherwise be possible, and the spread of disease perhaps averted. It gives no extra power of dealing with such diseases. Some form of hospital provision, or means of isolating the cases that cannot be readily isolated at home, will be of undoubted service to the district. This latter question will require the careful consideration of the Committee. GENERAL AND SPECIAL ENQUIRIES. During the latter part of the year, I made a general inspection of a large part of the district, directing my atten- tion to the villages, farm houses, cottar houses, and schools. Several special inquiries were made into the cause of outbreaks of enteric fever, as at Auchline, Castlenewe, and Deuchary. I will no enter at length into details. Some
HH62/1/ABERD/33 [Page] 32 of these investigations showed the necessity of adopting careful precautionary measures in dealing with first cases of typhoid fever. OFFENSIVE TRADES. The district is purely an agricultural one. There is only one slaughter-house, and it is in fairly good condition. BAKEHOUSES. I have inspected a number of these, but found none in such a condition as to require interference. MEASURES ADOPTED FOR PREVENTION OF SPREAD OF DISEASE. In all cases of infectious disease that came to my know- ledge, the case was visited by the Sanitary Inspector, and in most of the cases by myself; and every precaution was taken to secure the isolation of the patient and of the house. Disinfection was carefully attended to in all cases by the Inspector. CAUSES, ORIGIN, AND DISTRIBUTION OF DISEASE. Diseases of the respiratory system bulk very largely in the death-rate, being 2.774; including phthisis, they amount to 3.606, out of a total of 13.780. That these may be diminished by improvement in the houses of the working classes is extremely probable. In this district typhoid fever is the most prevalent of the zymotic diseases. Typhoid or gastric or enteric fever is due generally to the drinking of water contaminated by sewage, or to the emanations of foul drains. Milk is an admirable carrier of the germs of this disease, and many epidemics have been caused in this way. These germs are always contained in the stools of a typhoid fever patient, and these stools are most virulently infectious. The number of cases in the district ought undoubtedly to be diminished by:- (1) prompt isolation; and (2) improvement of the water supplies. (1) Prompt isolation. It has been my experience in this and other districts of the County that cases of typhoid fever, unless isolated, are apt to give rise to others in the same house. The great authority of Murchison engendered a false security in regard to typhoid fever, and the necessary precautions in regard to it have been too much neglected. (2) By removal of the sources of water pollution. The removal of the dangers of water supply pollution will tend to prevent outbreaks of typhoid fever, as well as diarrhœa. [Page] 33 In my Report on the Ellon District, I have called attention to the remarks of the Registrar-General regarding the incidence of these diseases in towns and country districts, and have pointed out that in Alford and the other upland districts of the County, where the water supply is naturally purer, the death-rate from this cause is less than in the more low-lying parts of the County. Prompt attention to the water supply, in the first case of enteric fever or diarr- hœa in a house may often be the means of preventing others. One of the cases of enteric fever that I investigated appeared to have originated from the patient - a mechanic - sleeping above a byre in which some calves were kept, and from which a most nauseous and sickening smell emanated. Typhoid fever is undoubtedly common among farm servants; but it is probable that most of these cases are due to the drinking of polluted water from about the farm steading. Diphtheria is a common form of disease in this district. Several cases occurred at the village of Alford. Improved drainage of the village may prevent the recurrence of such cases. A number of cases of scarlet fever occurred during 1891. Most of these were traced to infection from Aber- deen. The immediate notification and prompt isolation of such cases is, therefore, all the more important to prevent the disease from spreading through the district. In future Reports I hope to enter upon a more full discussion of this question. TABLES. The Tables in the Appendix are prepared from Returns kindly furnished me by the various Registrars in the County, to whom I must express my obligation for fur- nishing me gratuitously with the information I required, information involving very considerable labour, in many cases, on their part. I have the honour to be, GENTLEMEN, Your obedient Servant, JAMES P. WATT. COUNTY HEALTH DEPARTMENT, MUNICIPAL BUILDINGS, ABERDEEN, 1892.
HH62/1/ABERD/35 Aberdeen County Council. DEER DISTRICT. REPORT BY MEDICAL OFFICER OF HEALTH For Year 1891. The Deer District is the second district in extent, and by far the largest in population of the districts into which the County is divided. Its total acreage is 166,817, while the population at last census amounted to 34,020 (i.e., 13,746 more than the Aberdeen District, which comes second in point of population.) It is a wide district, and contains numerous villages both inland and on the coast. The total death-rate in the whole district for 1891 was 15.079, which is above the average of the rural death-rate in Aberdeenshire for the same year - the average being 14.484. The number of villages and the density of the population would lead us to expect a higher death-rate than we would find in a district with few villages and a more scattered population. When we look into the elements that make up this death-rate, we find that the rates from the general groups of diseases, tubercular, respiratory, nervous, and circulatory, are high. (See Table in Appendix.) The zymotic rate, on the other hand, is a very low one, being only .970. The following Table gives the parishes comprised in the district, with their population in 1881 and in 1891, with the
HH62/1/ABERD/37 [Page] 36 increment or decrease of population in each, the death-rate in each parish last year, and the average death-rate in the same parish during the ten years from 1861 to 1870 (inclusive):- Table A. [Table inserted] [Page] 37 The following Table shows the average death-rate in the district during the past ten years:- Table B. DEATH-RATES DURING EACH OF THE TEN YEARS PREVIOUS TO 1891. [Table inserted] Table C shows the position of the Deer District as compared with the other districts in the County, and with the Mainland Rural Districts of Scotland, and Scotland as a whole:- Table C. [Table inserted] GENERAL ACCOUNT OF THE SANITARY STATE OF THE DISTRICT. - The sanitary state of the Deer District is capable of improvements in many points, and more especially in regard to many of the villages. In addition to improvement in the drainage and water supply of a number of them, there is no part of the County in which increased powers of scavenging are more urgently required. To this the Local Authority are fully alive, and the members of the District Committee have joined most heartily in the petition framed by the Public Health Committee of the County, and adopted by the County Council, to ask Parliament for increased powers in regard to scavenging of villages. Such powers, if obtained, will undoubtedly be the means of vastly im-
HH62/1/ABERD/39 [Page] 38 proving the sanitary condition of all, but but more especially the fishing, villages. With regard to drainage, the villages of New Pitsligo, New Leeds, Boddam, Mintlaw, Longside, St. Combs, New Stirling, Cairnbulg, and Inverallochy, are all more or less defective. The inhabitants of New Pitsligo have undertaken, at their own expense, to improve what is most defective in the drainage of that village. The other places will be gradually dealt with. Improved water supply is required at Stuartfield, New Stirling, New Deer, and Cairnbulg. Old Deer has now been formed into a Special Water District, and the works are in process. Attention is being directed to the improvement of the water supply at Strichen and Cairnbulg. HOUSING OF THE WORKING CLASSES. - With regard to this subject, the same sanitary defects exhibit themselves in these as prevail in other parts of the County. Damp walls, damp earthen floors, sometimes dilapidated roofs, the pump or well often in suspicious proximity to midden drain or ash- pit, middens too near the house, badly constructed ashpits, privy accommodation defective or absent, these are the common defects met with, and give ample scope for im- provement. SLEEPING APARTMENTS OF UNMARRIED SERVANTS. - The sleeping apartments on farm steadings are here, as elsewhere, in great need of improvement, though in some parts of the district, in more recently erected steadings, this has been effected. INFECTIOUS DISEASES NOTIFICATION ACT. - Passing to the consideration of infectious disease, I have first to remark that the Notification Act has been in force for fourteen months, and has proved of great service. In many cases it has enabled prompt measures to be taken in regard to out- breaks that might have led to dangerous consequences. I need not say more in regard to an Act, the utility of which is so self-evident. HOSPITAL PROVISION. - During 1891 the Local Authority possessed only one small hospital, which in fact was not open except during the latter two months of the year. Previously to that it was closed, and, I understand, the summer before was let for summer lodgings. Though very small, consisting only of two rooms avaiable, besides the matron's room, it has been of some service since it was reopened. It may, however, be found expedient to close it altogether [Page] 39 if we have a new hospital built at Maud, as the most convenient centre. A Sub-Committee of the Public Health Committee, drawn from representatives of the various parts of the district, has been appointed to examine into the whole question of hospital provision. The District Committee have now taken over, as a district hospital, the small cottage hospital at Crimond, which, built by Lady Carnegie, was supported by the voluntary contributions of the inhabitants of St. Fergus, Lonmay, and Crimond. With a few improvements it will, I think, answer well for the requirements of that part of the district which lies too far from Maud, where a central hospital will probably have to be erected. During the earlier part of 1891 the Local Authority contributed a certain proportionate sum to the upkeep of the Fraserburgh Hospital for the parishes which had a right to send patients there, but that contribution ceased in October, as it was considered out of all proportion to the benefits accruing. It may, however, be worth considering how far the hospital should be utilized by the Committee for patients from the surrounding parts of the district. The district of Deer is a very large one, and one hospital is in- sufficient for its requirements. Some such scheme as the fol- lowing might be found most workable:- 1. A well-equipped hospital at Maud, which being a railroad junction, might enable the railway service to be brought into requisition for conveyance of patients, as has been done in Ayrshire. Maud also would be convenient for friends visiting patients at the hospital. 2. The small hospital just taken over by the Local Authority at Crimond. 3. The use of the Fraserburgh hospital for patients from the north part of the district at a fixed rate per patient. A good ambulance service will be necessary. GENERAL INQUIRIES AS TO SANITARY MATTERS. - I have made investigations into the conditions of the villages in the district during the latter portion of the year, and also as far as possible into the state of the surrounding districts. The result of my inquiries I have summarised in the pre- vious part of my report. SPECIAL INQUIRIES. - An investigation was made in con- nection with an outbreak of typhoid fever that occurred at the farm of Buckie, in the neighbourhood of Boddam. Two cases of typhoid were removed at the same time from this
HH62/1/ABERD/41 [Page] 40 farm, and on inquiry it was found that other cases of fever had occurred at the place in previous years. It was also thought that typhoid fever had been conveyed from here to Boddam, through the milk sent there. On making a com- plete inspection of the premises, the only cause that pre- sented itself to me as likely to cause the fever was the drinking water. This was taken from a well situated at a distance of about 40 yards from a midden and at a lower level. The urine had been drawn away from the midden by a superficially cut drain, but the nature of the soil, which was of clay lying close to the surface, suggested the possibility that the urine had found its way along the sur- face of the clay bed into the well. I took away with me a sample of the water, and on analysis found it to be greatly polluted. Two years ago the water from other two wells at this farm had been analysed by Professor Brazier, in connec- tion with an outbreak of typhoid fever at the time, and pronounced by him to resemble rather sewage mixed with water than water mixed with sewage. Directions were given to disuse the well, and steps to be taken to procure a fresh supply. I made a careful investigation, in conjunction with Dr. McLeod, Medical Officer for New Deer, into a case of typhoid at the Free Church Manse there. The water supply was suspected by him, and I accordingly made two analyses of it. The first analysis pointed to recent contamination. The pump was then thoroughly cleaned. A second analysis was then made. It showed that all traces of recent pollution had disappeared, but traces of more remote pollution remained. An inspection of the ground gave reason for suspecting that the pollution came from an old cesspool at some distance from the pump. This was all the more likely as the soil was exceedingly sandy and porous. The taste of the water at the different times corresponded exactly with the results of the analysis. After the emptying and cleaning of the pump, when the sample for the second analysis was taken, the water was quite good to the taste, but it gradually changed and became unpleasant. The question of a new supply to the Manse by gravitation is now under the consideration of the Deacons' Court. Other investigations were made into outbreaks of scarlet fever, diphtheria, and typhoid. Any insanitary conditions in connection with typhoid fever and diphtheria were dealt with. OFFENSIVE TRADES. - The slaughter-houses in the district are not all that could be desired. It has been, [Page] 41 however, determined by the District Committee, as only one man had received licence for the old Local Authority, to intimate to them that they must now apply to the District Committee for permission to slaughter cattle. The Com- mittee will take care that all grounds of nuisance are removed before such permission is granted. This is the only offensive trade in the district. BAKEHOUSES. - I have inspected a number of these, and with one or two exceptions, found their condition satisfactory. HOSPITAL SUPERVISION. - The hospitals available for the use of the Local Authority in 1891 were, the Old Deer Cottage Hospital and the Thomas Walker Hospital at Fraserburgh. I visited the latter, and found it satisfactorily equipped. I made several visits to the Old Deer Hospital, and always found, under Dr. Wilson's charge, everything in ex- cellent order. MEASURES TAKEN FOR PREVENTION OF SPREAD OF DISEASE. - Cases of infectious disease were visited by the Sanitary Inspector, or, where there seemed any circumstance requiring personal supervision, by myself. Outbreaks of scarlet fever were dealt with personally at Fetterangus, Strichen, New Pitsligo, Rathen Schoolhouse, Kininmonth Schoolhouse, Longside, New Aberdour, and Boddam. Every assistance was rendered by the various Medical Officers of the district. CAUSES, ORIGIN, AND DISTRIBUTION OF DISEASES. - The principal zymotic diseases in 1891 were diphtheria, enteric fever, and diarrhœa. The two latter undoubtedly depend on the polluted condition of many of the water supplies. (See report on the Ellon District, page 22.) As the investigation of a number of them has clearly shown, improvement in this respect will, in all probability, lead to a diminution of these diseases. The outbreaks fo diphtheria were, in nearly all the cases, traced to defective drainage of the houses in which they occurred. One of the commonest diseases reported under the Notification Act is erysipelas. It often appears to be connected with, if not dependent upon, insanitary conditions, and its prevalence in Boddam is very instructive in view of the insanitary condition of the village. Phthisis and other forms of tubercular disease are ex- ceedingly common. The total tubercular death-rate is 1.445.
HH62/1/ABERD/43 [Page] 42 Diseases of the respiratory system show also a high rate, due, probably, to the proximity of the district to the sea and its exposure to east winds, as also to the damp charac- ter of a large part of the district. In future reports I shall deal more fully with this subject. The Tables in the Appendix have been prepared from information given me by the various registrars in the County. ABERDEEN COUNTY COUNCIL. GARIOCH DISTRICT. REPORT BY MEDICAL OFFICER OF HEALTH FOR YEAR 1891. The Garioch District has an acreage of 104,397 acres with a population of 15,713. The density of population is thus .150 persons to the acre, or 6.6 acres to each person. The number of births during the year 1891 was 457; the number of deaths for the same period being 223. The total death rate in the district 14.318 is almost exactly the average of the rural part of Aberdeenshire, viz., 14.484. The zymotic death rate is only .954. Next to Alford, this is the lowest zymotic death rate in the various districts in 1891. Tubercular diseases are in this district rather above the average of the whole county, being 1.399 per 1000; to which phthisis alone contributes 1.018. The following Table shows the population of the parishes in 1881 and 1891, with the death rate for each parish, and
HH62/1/ABERD/45 [Page] 44 also the average death rate in the same parish during the ten years from 1861 to 1870 (inclusive):- [Table inserted] GENERAL ACCOUNT OF THE SANITARY CONDITION OF THE DISTRICT. - The Garioch District is purely agricultural. In regard to sanitation, the same defects are found as in the other districts of the County. Many of the houses of the working classes present conditions that are not always in accordance with the maintenance of good health by the inmates, and this is especially true as regards the children. Moreover, when sickness comes upon them it is apt to be aggravated by these conditions. I would beg to refer to my remarks on this subject in some of my other district reports. Many of the sleeping apartments provided for the farm servants are also very insanitary in regard to position, cubic space, ventilation, and other matters. Improvements in all these directions will require some time to accomplish, but is [Page] 45 a matter of the utmost importance. The general education of the working classes themselves in sanitary matters is of not less consequence, and will effect no less an improvement as regards health. VILLAGES. PORT ELPHINSTONE. - The water supply here will require im- provement. It is got by pumps which, in the lower part of the village, lie at a lower level than the ashpits and privies. The water is in danger of pollution, and a systematic analysis will have to be made, and the water dealt with according to the results. The drainage of the place is bad. There is no regular sewerage system, the drains being simply of stone. In the upper part of the village the water is supplied by dug wells which, from the different nature of the ground, are not so exposed to danger of contamination. DAVIOT. - The water supply is here exceptionally unsatisfactory. The well from which almost all the drinking water is taken is at too great a distance from the village; while the pumps beside the houses are open to the gravest suspicion, from their proximity to the churchyard, to which they lie at a lower level. I took a sample from one of these pumps, and, on analysis, found it to be greatly polluted. INCH. - The water supply here is good, but the drainage will require attention, as some of the drains are laid at too high a level to admit of being connected to the houses on one side of the street. KEMNAY. - The water supply is somewhat deficient in summer. With regard to the village, Dr. Henry, Medical Officer for Kemnay, reports:- "The houses are mostly new and have been built at as little expense as possible, and with no atten- tion to sanitary requirements. The village is supplied with good water by a system of properly jointed iron pipes, but the supply is apt to run dry in a protracted drought. There are also a considerable number of pump wells in which the water is easily reached at a depth of from 20 to 30 feet, and these are frequently liable to contamination from middens and cesspools, of which there is a considerable number, although the peculiarly receptive nature of the sub-soil - a dry gravel - has hitherto prevented serious trouble from this source. There is no proper sewerage system possible with the present water supply, which is quite insufficient for proper flushing, though in the lower part of the village there is a drain flushed periodically by water pumped into a cistern for that purpose. "Beside Mr. Fyfe's quarry there are several blocks of tenement houses supplied with pure water, but the ashpits, &c., attached to these are often in bad condition and require
HH62/1/ABERD/47 [Page] 46 more frequent cleaning out. In one block several cases of enteric fever have occurred." The enteric fever at this tenement may have arisen from emanations from a most foul undrained ashpit of huge size, which was little better than an open cesspool, and into which everything from the tenement block was thrown. Instruc- tions were given for improving the condition of the place, and a promise received from the manager that it would be attended to. I have met with cases of typhoid fever origi- nating under similar circumstances, as at Auchmill in the Aberdeen District. MONYMUSK. - With regard to Monymusk, Dr. Henry reports as follows:- "With few exceptions the houses in Monymusk contain no water pipes, sinks, or closets. The village is efficiently drained by a sewer running through the main street, and there is an abundant supply of water in the street wells, brought from springs about a mile distant. In the bakehouse the sink pail and water tap are not what they should be, and the office and dunghill, in the rear, are too close to the house." OLDMELDRUM. - Dr. Wilson, Medical Officer of Health for Meldrum, reports as follows:- "The water supply of the village is deficient in summer, and no extra supply can be obtained in the vicinity of the reservoir. From the nature of the soil, contamination of the wells has never to my knowledge taken place, and I would suggest the erection of pump wells, in properly situated stations, to augment the limited supply. "Drainage. - The drains of the village are well arranged; most of the houses, as well as the ashpits, have connection with the main drains. The Local Authority has for years bestowed much attention to the drainage of the village. "Slaughter-House. - The slaughter-house is erected on a bad site, it being next to impossible to obtain proper drainage, and there is not a sufficient supply of water. Recent steps have been taken to improve matters." (Dr. Wilson had sent several reports to the old Local Authority, but apparently without much effect.) "Infectious Disease. - There was one death during the year from infectious disease, viz., a child that came from Glasgow ill with whooping cough, and died a few days after its arrival. The disease spread to two children in an adjoining house, but no further. "There has been no case of typhoid fever for very many years. I have observed for a long time back that, in the summer months, we have annually imported into the village, scarlet fever, measles and whooping cough. During the past [Page] 47 year we had a case or two of this, otherwise I should have said that the parish was entirely free, as it now is, from this disease. "Dwelling-Houses. - The state of the dwelling-houses in the village is on the whole fairly good, with the exception of a block of buildings in Back Wynd. These are in a most filthy condition, overcrowded, and unfit for human habitation." (Note. - These have since been closed). Dwelling-Houses of the Labouring Classes. - In connection with this subject, I desire to draw attention to the remarks of Dr. Paterson, Medical Officer for Inverurie, Landward, which are deserving of careful consideration. "In regard to the dwelling-houses of the labouring classes, great improvement is required. In such weather as at present we are having, many cases of bronchial troubles have scarcely a chance of recovery, on account of the impossibility of keeping out draughts from defective roofs, doors and windows." Improvement is also necessary in the case of sleeping places on farm steadings. On the newer farms these are somewhat more satisfactory. On this subject, Dr. Wilson, Oldmeldrum, reports:- "The sanitary condition of the farm steading might with great benefit and profit be greatly improved, and better accommodation for farm servants is, in many cases, much to be desired." Hospital Provision. - Some hospital provision will be required for the district. The following passages from the reports of Medical Officers of the district are of interest in this connection. Dr. Paterson, Inverurie, says:- "In cases of infectious disease occurring among servants at farm towns, we are very much in want of hospital accommodation. It will be difficult to say what accommodation would be required, but the removal of all cases at the outbreak might be the means of curtailing an epidemic which might assume large propor tions." Dr. Wilson, Oldmeldrum, writes:- "There is much need for an hospital for infectious disease for this and adjacent parishes, and I am of opinion that the present Parochial Board room and the two adjacent wings of the Poorhouse could be altered, at a nominal cost, to meet the requirements." Dr. Davidson, Medical Officer for Rayne, Daviot, and Chapel of Garioch, writes:- "Hosptial accommodation is needed for fevers and critical cases, where the home is poor and the nursing inadequate, as is too often the case. Should an hospital not be forthcoming, one or two efficient nurses in the district, available at a cheap rate, would be of service." Dr. Currie, Insch, has expressed to me the great need
HH62/1/ABERD/49 [Page] 48 that has been felt for years for a cottage hospital in that district, and I have myself had experience in my work of the benefit that would have resulted from such a hospital. THE NOTIFICATION ACT. - The adoption of the Notifica- tion Act will be of undoubted benefit in dealing with in- fectious disease in the district, and will, I hope, enable us to reduce still further the low zymotic death-rate of last year. It is always necessary as a measure of prevention. The question of hospital provision, and with it the adop- tion of the Notification Act, will, I trust, receive the at- tention of the Committee, so that the district may be ready to meet an epidemic when it comes, and not be taken un- prepared. SPECIAL INQUIRIES. - A special inquiry was made into the cause of an outbreak of typhoid fever at the farm of Pitscurrie, near Pitcaple. It was supposed to have been brought by infection from Auchline, in the Alford district. The drinking water was analysed, and found to be polluted. The pump, which from its position could not escape con- tamination, was disused, and drinking water taken from a spring at a little distance. A supply is to be taken from this to the farm. Another investigation was made into an outbreak of typhoid fever at Colpy, near Insch. This forms an excellent illustration of the danger of not isolating first cases of in- fectious disease. The first case was not isolated. Infection spread to several of the inmates, resulting in one death, and was also carried to a woman and her daughter who were supplied with milk from this house. Another inquiry was made into an outbreak of diph- theria at Duncanstone. The cottage was in a wretched con- dition, with a midden close behind it, from which the urine must have soaked under the foundations of the house and polluted the subsoil. OFFENSIVE TRADES. - The only offensive trade in the district is the slaughtering of cattle. The District Commit- tee has intimated to owners of slaughter-houses, none of whom held a licence to slaughter from the old Local Authority, to apply now for licence. The Committee will secure that the places are put into good condition, or re- moved from any objectionable position, before such licence is granted. BAKEHOUSES - Those I have examined are satisfactory. ZYMOTIC DISEASE. - In all cases of which information was [Page] 49 obtained (the Notification Act not being in force), the house was immedicately visited by the Sanitary Inspector, who re- ported to me full particulars. If any case seemed to require special attention, I visited it personally, and gave the neces- sary directions. In all the cases disinfection was carried out under the instructions, and with the assistance of, the Sanitary Inspector. Means of hospital isolation will, however, be of great assistance in the district. CAUSES, ORIGIN, AND DISTRIBUTION OF DISEASE. - There is very little of interest that I can say as yet on this head. Much of what I have mentioned in other reports as to the origin of such diseases as diphtheria, enteric fever, diarrhœa, respiratory diseases, &c., is applicable to this district as well. It is, however, a subject that will require more time to enter fully upon than the short part of last year at my disposal allowed.
HH62/1/ABERD/51 Aberdeen County Council. DEESIDE DISTRICT. REPORT BY MEDICAL OFFICER OF HEALTH For Year 1891. The Deeside District has by far the largest area of any district in the County, its total acreage being 416,882, while the Deer District, which is second in extent, has 166,817 acres. But a great part of the district consists of mountain and moorland, and the total population is only 13,070. It is far the most thinly populated of the districts, the density of population being only .031 persons to the acre, which gives about 32 acres for every person. Alford, which comes next in sparseness of population, gives .065 persons to the acre, or 15.3 acres for each person. The births in the district in 1891 amounted to 370; the total deaths to 224. The total birth-rate, 28.3, is very slightly under the average of the rural districts of the County, which is 28.8, but slightly above that of the Mainland Rural Districts of Scotland, which is 27.9. The average birth-rate for the whole of Scotland is 31.2. The death-rate from all causes, for 1891, is 17.138. This is very high as compared with the average of the rural districts in the County, which is only 14.484. The disease groups that contribute most towards it (see Tables in Appendix) are the tubercular (especially in the form of phthisis) nervous, circulatory, and respiratory. The death- rate from zymotic diseases, on the other hand, is rather under the average. The tubercular death-rate is very high, being .6 per 1000 more than that of any other district. The explanation of this may, perhaps, be found in the fact that people resort to the district for cure from this disease. It is a point worthy of careful investigation. It will be seen, however, from Table B that the death- rate for last year is unusually high, and may have been
HH62/1/ABERD/53 [Page] 52 due to the severity of the epidemic of influenza in this district during that year. The following Table shows the population of the parishes in the district in 1881 and 1891, with the increase or decrease, the death-rate of each parish in 1891, and for comparison the average death-rate of the parish during the ten years from 1861 to 1870 (inclusive) as given by the Registrar General:- TABLE A [Table inserted] The following Table shows the death-rates in the whole district during the last ten years:- TABLE B. DEATH-RATES DURING THE TEN YEARS PREVIOUS TO 1891. [Table inserted] [Page] 53 GENERAL ACCOUNT OF THE SANITARY STATE OF THE DISTRICT. - We have in Deeside very much the same conditions as obtain in other districts. A report on one district will present in the main the sanitary picture of another. In better housing for the working classes, especially the agricultural labourer, there is a wide field for sanitary improvement. With regard to the villages, the drainage of these into the river Dee, and the purification of the sewage, has been a subject of no inconsiderable difficulty and contention between the Town Council of Aberdeen and the District Committee. The question of hospital provision is one which, from the character and configuration of the district, will require careful consideration. Aboyne would undoubtedly be the best centre for the erection of a cottage hospital. It is the natural centre for the most populous part of the district, and a small hospital here would probably meet most of the requirements. The Notification Act is not yet adopted, but it is the intention of the Local Authority to do so at an early date. I subjoin a few extracts from the reports of the Local Medical Officers on their special districts:- BRAEMAR. - Dr. Noble reports that no cases of infectious disease have occurred for two years. Before that time they had outbreaks of scarlet fever and measles, spreading apparently from Aberdeen. "It was interesting," he says, "to notice how the greater communication between Ballater and Braemar first affected Braemar, and from here contagion spread to the Crathie and Balmoral districts." The general sanitary state of the district he considers good, and quotes in proof of this the fact that no case of typhoid fever has originated in the district within his recollection. (Compare remarks on purity of water supply in relation to typhoid fever, in the Ellon District Report).- "The new system of sewerage and water supply," he say, "has been a great boon to Braemar. The more efficient trapping of the sewers in the Castleton district has been attended to by the sanitary inspector. The bakehouse is in good repair. while the condition of the slaughter-house is being improved." GLENMUICK, TULLICH, AND GLENGAIRN. - Dr. Mitchell reports: - " As regards the occurrence of infectious disease, the condition of this district is satisfactory, there having been no case during the last year, so far as I know. When I came here four years ago, scarlet fever was the most common infectious disease. Since then it has decreased, and during the last two years, I believe, there has not been a single case.
HH62/1/ABERD/55 [Page] 54 In the outlying districts, many of the old uncomfortable, draughty farm-houses have been replaced by new and more comfortable buildings. The want of a cottage hospital," he says, "is sometimes felt." ABOYNE, BIRSE, AND LUMPHANAN. - Dr. Keith describes an outbreak of diphtheria that occurred in the parish of Aboyne, and which was due, in his opinion, to pollution of the well from which the drinking water was obtained. He directed the well to be disused, and the "house to be pulled down, as it was at best a mere hovel." An outbreak of typhoid fever in the village gave rise to uneasiness regarding the water supply, and several analyses were made without any result. Dr. Keith regrets the entire absence of hospital accommodation in the district. KINCARDINE O'NEIL. - Dr. Cran reports:- "The sanitary condition of the houses of the working classes is fairly good, but in many cases they sleep in rooms small, badly ventilated, and damp, and with no fireplace. I may say this is quite common. In case of sickness I always insist on the patient being removed to a larger room with a fireplace. This is not entirely confined to the working classes. In farm houses, where one might expect better things, this state of matters also exists. In many houses the floor of the kitchen is composed of earth, which is often damp. "A fortnight ago my attention was called by the Inspector to two cases. The houses were much in the same condition - filth, bad smells, dirty beds, and damp, rotten floors. The utmost confusion existed, and sickness reigned. One of the cases I removed to the poor's cottages; in the other case, a room in the house was put in order, fires put in, and a nurse took charge of the case. I may mention that during the last fifteen years many of the thatched houses have fallen, or are not used. "As far as infectious diseases are concerned, we are remarkably free from them. Last year at Maldron several of the family died of enteric fever, all due, in my opinion, to the damp, dirty condition of the old farm-house. The drinking water was analysed without results. "A case of scarlet fever that occurred at Craig was im- ported from Strichen." MIDMAR. - Dr. Lawson sends an exhaustive report on this parish. He describes the sanitary condition of the large farms as on the whole satisfactory, with the exception of the sleeping apartments for the unmarried labourers, which he strongly condemns. His description of these may be quoted: - "A part of a loft, above a stable, to get to which you [Page] 55 have to pass along the stable, behind the heels of half-a-dozen horses, and then up by a rickety stair or ladder. Inside the room are two or more beds, according to the size of the farm, and if any space is left, it is nearly all taken up with trunks, which also serve as seats. Soiled clothes, bits of harness, &c., are lying about. The floor is often not very clean. There is no fireplace of any description. The place is lighted by a sky-light, with one or two panes broken, perhaps, and filled up with straw or a pair of trousers, which is, perhaps, of excellent use for ventilation. Such, with varia- tions, are the sleeping apartments I have visited in the course of my practice during the last three years. The sleeping apartments at the farm of Shiels which was on the ground floor had a large fireplace, but, evidently, never a fire, and seemed very cold and damp. I am afraid that by far the greater number of sleeping apartments are of this latter sort." The cottar houses, he says, are in some cases good, while others present insanitary conditions, which have sometimes led to disease. The crofts and small farms, Dr. Lawson continues, are, from a sanitary point of view, not nearly so satisfactory as the larger farms. The buildings are generally of older date and not in such good repair. "These small holdings, so important socially, and perhaps soon politically, are at present a difficulty to the landlord. I understand it costs much more in proportion to the rent received to rebuild these than larger farms. The result is when these buildings get worn down, a small place is either added to a large one, or two old houses are merely patched up to serve another period of years; so that to-day we find them standing pretty much as originally built, and seldom quite satisfactory in arrangements or condition." There is no doubt that this fact, taken in conjunction with the employment of unmarried farm labourers by farmers in prefer- ence to married men, accounts largely for the diminution of the country population, and the growing scarcity of labour in country districts. Some very old houses exist in Midmar, of the style common two generations ago. When the thatch is well kept, these, Dr. Lawson says, are comfortable enough. The general water supply and drainage in this district are satis- factory, and, on the whole, the parish is a very healthy one. "The landlords are, as a rule, liberal and anxious to maintain good feeling. On the Corsindae estate, the most backward, a great deal has been done in recent years to improve the houses of the tenantry. "Zymotic Disease. - During the last three years no cases of diphtheria, membranous croup, relapsing or puerperal fever,
HH62/1/ABERD/57 [Page] 56 has occurred. There has been only one case of erysipelas, following an attack of influenza, in an old man over eighty. Three cases of scarlet fever occurred at Cairndye, but they were at once isolated and the diseaase did not spread. How they originated was a puzzle, as there were no cases within six or seven miles. Only two cases of typhoid have occurred to my knowledge within three years, and one of these was imported from Echt, and the other may have been con- tracted by the patients in Aberdeen. "Measles. - There was an epidemic of measles in this parish in the autumn of 1889. In June of that year two cases occurred at Meikle Midmar, which were isolated, and the disease did not then get a hold of the parish; but, two months thereafter, it spread from Cluny, and attacked all the liable persons, causing one death from concurrent pneumonia. "Whooping Cough. - During the spring and summer of 1891 there was an epidemic of whooping cough, causing four deaths. "Influenza. - Midmar has been visited each time that in- fluenza has been epidemic. Three deaths occurred during the last outbreak. "Phthisis. - I have had only one death from phthisis. I have at present only one other case. He came into the parish about a year ago, for his health." Tubercle in other forms is very rare. "The pure air," Dr. Lawson considers, "the good water, the out-door agricultural life, the absence of the press and stress of city life, the elevation of the district, make the inhabitants more resistant to the attacks of epi- demic disease, and more able to cope with it when it gains a hold of their systems." TARLAND, MIGVIE, COULL, AND LOGIE-COLDSTONE. - Dr. Alex- ander reports:- "We have through the district some houses in very bad condition. I have drawn the Inspector's atten- tion to several. On the whole the working class is not well housed." Dr. Alexander draws attention to the condition of the water supply and drainage of Tarland village, and the condition of many of the houses, as also of the ashpits and privies. He also comments on the want of a hospital for the isolation and treatment of cases of infectious disease, the want of which he has felt greatly. Aboyne, he considers, would be the best centre. During the past four years Dr. Alexander says he has had in his practice about twenty cases of typhoid fever, and six outbreaks of diphtheria, with a total of sixty cases. [Page] 57 Scarlet fever broke out in two families during 1891. Phthisis, according to Dr. Alexander, is very prevalent in this district. The epidemic of influenza was very severe in this, as in many other parts of Deeside, during last year. The Tables in the Appendix, prepared from the returns furnished by the Registrars, show the mortality statistics in this and other districts of the County.
HH62/1/ABERD/59 Aberdeen County Council. TURRIFF DISTRICT. REPORT BY MEDICAL OFFICER OF HEALTH For Year 1891. The District of Turriff comprises the parishes of Auch- terless, Fyvie, King-Edward, Monquhitter, and Turriff land- ward with the two quoad sacra parishes of Millbrex and New Byth. The acreage of the district is 100,419 with a population of 12,982. The density of population is thus .129 persons to the acre, or rather over seven acres to each person. The total births in 1891 was 355, the total deaths 176. The birth-rate (i.e. the number of births per 1000 of population) is thus 27.3, while the death-rate is 13.5. This is a comparatively low death-rate, and for the year is stands second lowest of the death-rates of the various districts, as will be seen from Table II. in the Appendix. The zymotic death-rate was rather a high one, caused mainly by diphtheria and whooping cough. Fifteen deaths in all were due to infectious disease, and if we take the rough estimate of ten cases for each death, there would have been 150 cases of zymotic disease in the district last year. The total tubercular death-rate is above the average, being 1.617, the district in this respect standing third; Deeside having the highest death-rate with 2.356, and Deer the next, 1.640. The death-rates from the diseases grouped under the names nervous, circulatory, and respiratory, are very low. The following Table shows the parochial acreage,
HH62/1/ABERD/61 [Page] 60 population, and death-rate, with the average death-rate in each parish, during the ten years from 1861 to 1870:- TABLE A. [Table inserted] *Quoad sacra parishes. The following Table is the death-rates during the last ten years:- TABLE B. DEATH RATES DURING EACH OF THE TEN YEARS PREVIOUS TO 1891. [Table inserted] GENERAL ACCOUNT OF THE SANITARY STATE OF THE DISTRICT. -The general sanitary condition of the Turriff District resembles closely that of Alford and Huntly. The same defects from a sanitary standpoint exhibit themselves as in these districts. I would beg to refer to my remarks in the Aberdeen and Ellon Districts Reports on the condi- tion of the cottar houses and farm-servants' sleeping apart- ments, which may be taken as more or less applicable to all the districts in the county. There are four villages in the district - Fyvie, Cumines- town, Garmond, and New Byth. Garmond stands in need [Page] 61 of a new water supply. Samples from four of the wells were analysed by Mr. Jamieson, the city analyst, and found suspicious. Cuminestown was formed some years ago into a special water district. An increased supply is now being got for the village. The drainage is not good, and will require early attention. With regard to Fyvie, neither the drainage nor the water supply can be said to call for attention meanwhile. In New Byth the water supply is defective, and an in- creased supply is under consideration. NOTIFICATION ACT. - The Notification Act is not in force for the district, and there is no hospital provision as yet made by the Local Authority for the treatment of in- fectious disease. There is at Fyvie an excellent cottage hospital, built and endowed by the late Mrs. Gordon of Fyvie, part of which, when required, is used for the treatment of infectious cases from this parish. The consent of the managers might be secured by the Local Authority for the use of the hospital. A small cottage hospital erected at Turriff itself would com- plete the equipment of the district. The necessity for hospital accommodation is very greatly felt in connection with the unmarried male servants at farm steadings. If one of them is seized with infectious disease, a great deal of trouble is often experienced if there is no hospital to which the patient may be sent. Again, if an in- fectious disease breaks out in a two-roomed cottar house, one room of which is sometimes uninhabitable, isolation is impossible, and without hospital provision the disease must be spread through the family, causing, occasionally, the death of one of the members, and involving often much expense and trouble. In many of these cases, too, the nursing is not very efficient; nor are the conditions of the house itself such as to give the patients the best chance of life. There is further the general consideration which forms the strongest reason for the existence of fever hospitals, viz., the power of dealing promptly with first cases, and so being able to check what might otherwise spread and lead to an epidemic. For an illustration of this I would refer to the effect of hospital isolation in the outbreak of scarlet fever at Newhills. (See report on the Aberdeen District.) In the Ellon District, also, the prompt removal of patients to Hospital has undoubtedly been the means, in a number of cases, of checking the spread of disease. People soon learn to
HH62/1/ABERD/63 [Page] 62 appreciate the advantages afforded by Isolation Hospitals. This was shown in a very striking manner by the experience at the Kilmarnock Fever Hospital. From 1880, when it was erected, to 1885, only 80 patients were treated in it. During the next five years the numbers rose to 500. A simple illustration, from a recent experience of my own, will make clear the conditions too frequently met with in country districts. Ten days ago I was called to visit a cottar house in Tarves, where a child had just been attacked with scarlet fever. I found the father, mother, and five young children occupying the same room with the patient, two beds being all that I could see available. There was another room in the house, but that was uninhabitable through damp. They could get no one to act as nurse to the child. As isolation was impossible, I removed the boy at once to hospital, and had the house disinfected. No other case occurred in the house. Had the child not been removed the fever would in all probability have attacked the other children, and might have spread far beyond. SPECIAL INQUIRIES. - In the end of the year I investigated a very interesting history of typhoid fever. Cases had occurred at a farm called North Wells, at Gordonstown, annually since 1887. This is one of several farms in the County on which typhoid fever seems to be endemic. In some of these cases it is extremely difficult to discover a sufficient cause for the continued presence of the fever. The drinking water, generally the source of the disease, may be found, as it was in this case, to be, chemically at least, free from all traces of pollution. This, however, has been shown to be consistent with the presence of typhoid bacilli in the water, and this part of the examination cannot be completed without a biological examination. Again, the drainage of these farms may be perfectly satisfactory. Sometimes the germs seem to adhere to clothes or bedding, and retain their vitality for an indefinite period of time. A very striking instance of this occurred at one of these farms in the County, the farm of South Camaloun in Fyvie. During a period of thirty years enteric fever was never long absent from this place. The tenants who had occupied it during this time carried the disease with them to their new home. Strange to say, no case occurred at the farm after their departure, and this though the succeeding tenant had a young family, and children are specially [Page] 63 susceptible to the disease. It was suspected, with much probability, that the germs of the disease had been retained in bedding. As showing how clothes may keep the virus of typhoid fever, I cannot omit the following very interesting case told me by one of the medical men in this county, in whose practice it occurred. A patient of his, a seamstress, had received for alteration a sealskin jacket, which had hung beside a bed in which a patient had died of enteric fever four years before. The bed and all its surroundings had been left undis- turbed during all that time. A fortnight after receiving the jacket, on which meanwhile she had been engaged, the seamstress was attacked by enteric fever, which proved of a particularly malignant type. Three others in the house were subsequently attacked, and in every case the type of disease presented the same characteristics. No other cause whatever could be discovered on the closest investigation. I need not enter into the details of the investigation at North Wells. Only one curious fact may be mentioned, that every primary case seemed to be associated with the emptying of a midden near the house, from which a peculi- arly offensive odour - compared by one of the patients to a "rotten egg broken" - seemed always to emanate on these occasions. The typhoid stools had always been buried in what was really part of this midden. The outbreaks occurred in all seasons of the year, and did not in any way correspond to the period of typhoid prevalence. OFFENSIVE TRADES. - There are no offensive trades in the district except slaughtering of cattle. I have not yet had time to inspect the slaughter-houses in this district, and the same remark applies to the bakehouses. I shall deal with them in a future report. ZYMOTIC DISEASE. - Scarlet and enteric fevers have occurred in this district. In all cases that came to my knowledge measures were taken to isolate the patient and the house, and disinfection was carried out under the direc- tions of the Sanitary Inspector.
HH62/1/ABERD/65 Aberdeen County Council. HUNTLY DISTRICT. REPORT BY MEDICAL OFFICER OF HEALTH For Year 1891. The Huntly District is the smallest of the eight Dis- tricts into which the County is divided. It embraces seven parishes, viz., Cairnie, Drumblade, Gartly, Glass, Forgue, Huntly, and Ythan Wells. The total acreage is 71,263, and the population of the district, exclusive of the Burgh of Huntly, is 7,538. In 1891 this district had the lowest death-rate of the districts in the County, the death-rate being 12.337. This was due to low death-rates in the following disease groups: - Tubercular, nervous, respiratory, and circulatory and malignant. The district shows the lowest death-rate in the first three groups of any district in the County. On the other hand, the zymotic death-rate (i.e., deaths due to infec- tious or contagious diseases), stands third highest of the districts. The scarlet fever death-rate is more than the total of the scarlet fever death-rates in all the other districts. Diphtheria and typhoid fever are the other infectious dis- eases which contribute to the zymotic death-rate. The Tables in the Appendix give the general mortality statistics for this and other districts. In the following Table is given the acreage of each parish, with its population in 1881 and in 1891, with the increase or decrease, the death-rate in each parish in 1891, and the average death-rate in each parish during the ten years from 1861 to 1870 (inclusive):-
HH62/1/ABERD/67 [Page] 66 TABLE A. [Table inserted] The following Table shows the average death-rate in the district during the ten years from 1881 to 1891:- TABLE B. DEATH-RATES DURING EACH OF THE TEN YEARS PREVIOUS TO 1891. [Table inserted] GENERAL ACCOUNT OF THE SANITARY STATE OF THE DISTRICT, AND MEASURES WHICH SHOULD BE ADOPTED FOR ITS IMPROVEMENT. - The district is entirely an agricultural one, and presents the usual sanitary features of such a district. There is only one village in the district, viz., Rhynie. With regard to it, improved drainage and a better water supply are undoubtedly necessary. This applies especially to the upper part of the village, where in summer the inhabitants are very badly provided with water on account of the too low level at which the supply is introduced. The drainage of the whole village is capable of improvement, and the only satisfactory plan will be its formation into a Special Water and Drainage District. Many of the ashpits here are badly constructed, and badly kept, and will have to be dealt with. [Page] 67 HOUSING OF THE WORKING CLASSES. - As regards the rest of the district, the same observations apply as I have made at some length in my Report on the Alford District, to which in its general character it bears a close resemblance. Improvements are required in regard to the houses of the labouring classes, and the sleeping apartments of the ser- vants on farm steadings. INFECTIOUS DISEASES NOTIFICATION ACT. - The Notifica- tion Act is not yet in force. Its adoption will be of un- doubted service. Early intimation of the cases and proper isolation may help to lower the high zymotic death-rate shown by last year's returns. In order to complete the means for effectively dealing with infectious disease, the District Committee, as Sanitary Authority, should make provision for the isolation of such cases of infectious disease as cannot be otherwise isolated. There are at present two cottage hospitals in the district, the Victoria Jubilee Cottage Hospital in Huntly, and a small cottage hospital in the Parish of Forgue. Both these hos- pitals have fever wards, and together they would have, I think, sufficient accommodation to meet the requirements of the district. It would be well for the Committee to secure the right to send cases to these hospitals. It is of the greatest importance for a Sanitary Authority to have means of isolating cases of infectious disease, and it is essential for efficient sanitary administration. ZYMOTIC DISEASE. - The cases of infectious disease in the district that have come to my knowledge since August have been exclusively cases of diphtheria. Intimation was received of seven cases in all. Two cases occurred in the house adjoining the slaughter-house at Gartly Station. The drainage was found, on inspection, to be in a condition that could hardly have failed to cause disease. The slaughter-house itself was not kept as it ought to have been - the blood being frequently allowed to remain in casks in the yard until it became exceedingly offensive - a source of peculiar danger. In most of the other cases the cause was clearly traceable to insanitary conditions in connection with the dwellings. Care was taken to have these insanitary conditions re- moved, so as to prevent the recurrence of the disease. This illustrates one of the advantages of notification. In all the cases the isolation of the patients was seen to, and the subsequent thorough disinfection of the houses and of any articles likely to retain infection - a matter of especial con- sequence in diphtheria, the germs of this disease being very apt to adhere to articles of clothing and furniture, and retain their vitality for an indefinite time.
HH62/1/ABERD/69 APPENDIX.
HH62/1/ABERD/71 TABLE I. SHOWING POPULATION, ACREAGE, BIRTHS, AND DEATHS; ALSO THE AGES AND CAUSES OF DEATH. [Table inserted]
HH62/1/ABERD/73 TABLE II. SHOWING DEATH-RATES IN THE DIFFERENT DISTRICTS. [Table inserted]