Medical Officer of Health reports, 1891 - Argyll

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HH62/1/ARGYLL/3 ARGYLL COUNTY COUNCIL. MEDICAL OFFICER'S ANNUAL REPORT. MY LORDS AND GENTLEMEN, I beg respectfully to submit my annual report as Medical Officer of Health for the County of Argyll for the year ending December 31st, 1891. 1. The Returns of the Registrars in the seven Districts of the County give a total of 1028 births, and 911 deaths. This is equal to a birth rate of 19·65, and a death rate of 17·41 per 1000 of the population. The cause of death was not certified in 247 cases out of the 911 deaths. No reliable con- clusion can therefore be drawn from the Registrar's Returns as to the prevalence of any particular disease in the County as a cause of death. During the year I sent schedules to medical practitioners in the County in order to get the num- ber of cases of preventible diseases met with in their practice. I received information on this subject from every medical officer in the County except two. I also received valuable assistance and information in this matter from private medical practitioners in all parts of the County. The appended tables pp. 18-22 give the number of cases of preventible diseases re- ported to me in the County as a whole, and in each District separately, to the end of the year. It will be seen that influ- enza was the most prevalent disease in the County during the past year, bronchitis being the next; dyspepsia, diarrhoea, quinsy and sore throat, rheumatism, heart disease, consump- tion, pneumonia, follow in order. Of the ordinary infectious diseases the following was the order of prevalence:- measles, whooping cough, scarlet fever, chickenpox, typhus fever, typhoid fever, diphtheria.
HH62/1/ARGYLL/5 [Page] 4 I have recommended to the District Committees: 1st- That influenza be dealt with in future like other infectious diseases. It spreads by infection. Precaution should be taken to prevent it from spreading. Persons suffering from [Note in margin] --- RMN influenza should not attend schools, churches, or public meetings. They should keep to their houses for some time after recovering from this disease. This is not only desirable for their own safety, as by exposure they are liable to suffer from inflammation of the lungs, bronchitis, and other ailments, but it is also necessary for the protection of the public. 2nd- That precautions should also be taken in cases of consumption, as persons in continuous contact with a [Note in margin] --- RMN patient suffering from this disease are liable to become affect- ed by it. 3rd- That a uniform method be adopted for the guidance of Sanitary Officials, with regard to the action to be taken by them to prevent the spread of infectious diseases. I beg to suggest that the Council frame Bye-laws under Section 57, Local Government Act, defining more clearly the duties of Local Sanitary Officials for adoption by the District Committees. 4th- That Hospital provision should be made in the Districts for the insolation and treatment of cases of infectious disease. It will be seen from the appended Tables of Sickness, that infectious diseases were prevalent in every District in the County during the past year. I recommended that the Poorhouses in Tobermory, Lochgilphead, and Islay be acquired by the respective District Committees, and con- verted into isolation hospitals; that small corrugated iron buildings be erected at Bunessan, Coll, and Tiree; that pro- vision be made at Oban and Ballachullish for Lorn; at Tarbert for part of Mid-Argyll and Kintyre; at Campbeltown for the South end of Kintyre; and at Dunoon for the adjacent part of the District of Cowal. Without hospital provision, ambulances for the conveyance of patients, and nurses to attend on them, it will be impossible to prevent infectious diseases from spreading. 5th- I also suggested to the District Commit- tees that the provisions of the Public Health Act, and the Housing of the Working Classes Act, should be more [Note in margin] --- RMN thoroughly enforced. Table p.3 gives the number of houses specially reported, or certified by me to the District Committees as injurious to health. The majority of these were old, thatched houses, dilapidated and out of repair, with leaky roofs, unplastered damp walls, damp mud floors, and in want of proper drainage and ventilation. In many cases cattle and fowls were kept in the dwelling-houses; in a few cases pigs. I have much pleasure in stating that the District Committee of Kintyre took decided action in regard to this matter. II. During the past year, I made 263 ordinary or special visits to places or parishes, in order to make enquiry into the [Page] 5 conditions affecting health. I travelled over 5,484 miles in the discharge of my duty. I wrote, including my annual reports, 327 pages of foolscap, and 98 pages of quarto. I wrote 324 letters, and addressed and circulated 858 separate official communications. In addition to this, I collected and tabulated the statistics given in the appended Tables. I visited the various districts systematically, and made special enquiries as circumstances demanded, and the time at my disposal allowed. I reported to the District Committees at various times on such questions as the prevalence of infectious diseases, and the measures required to prevent the spread of infection; defective water supply; condition of bakehouses; prevalence of nuisances injurious to health; condition of dairies; insanitary candition of many of the houses of the labouring classes, and paupers. A detailed statement of my enquiries and special reports is given in my annual reports to the District Committees, sent herewith. I reported to the County Council in May last, in regard to the sanitary condition of the whole County, and the measures which in my opinion should be adopted for its improvement and I made certain recommendations for the approval of the Council. These recommendations have been brought under the notice of the District Committees. I beg to state that in accordance with these suggestions, (1) A Public Analyst has been appointed for the County. (2) Local assistants have now been provided in every parish in the County, with the exception of Kilmodan in the District of Cowal, and Kilmallie in the District of Ardnamurchan. I have brought this matter under the notice of these District Committees. From the liability of infectious diseases being introduced into all parts of the County, it is necessary that local Medical Officers be appointed to take immediate action for the isolation of such diseases, and otherwise render some assistance to me in the discharge of my duties. (3) The In- fectious Diseases Notification Act has been adopted by every District Committee with the exception of Ardnamurchan. I also brought this matter under the notice of that Committee. (4) Disinfectants have been supplied free of cost by the Mull, Lorn, and Cowal District Committees. (5) Leaflets have been printed by all the Committees, giving precautions that should be taken by householders and Sanitary Inspectors for preventing the spread of infectious diseases, and giving de- tailed directions for isolation and disinfection. So far as is known to me, no decided action has been taken by any District Committee for providing suitable hos- pital accommodation for the isolation of infectious diseases. I beg to append a copy of the suggestions referred to, with a view that the Council may again consider them. I would draw special attention to the necessity for adopting sugges-
HH62/1/ARGYLL/5 [Note in margin] Alterations signed off by RMN (Roger McNeill)
HH62/1/ARGYLL/7 [Page] 6 tions 3 and 7, to 18. I would also draw special at- tention to the frequency (as l shall endeavour to show further on) with which infectious disease is introduced into the County through carelessness or neglect. Notices should be printed according to suggestion 17 to warn the public in such matters. III. In regard to the causes, origin, and distribution of disease, I beg to append a map shewing the distribution of influenza, and the principal infectious diseases, so far as as- certained by me during the past year. The number of cases of other preventible diseases that came to my knowledge in each District is detailed in Tables, pages 18-22. It may be seen from Chart, page [---] that influenza was most prevalent in the County from February to June, and again during the months of November and December. From July to October this disease seems to have almost disappeared. This chart also shews the manner in which bronchitis and pneumonia followed more or less the same course as influenza. A larger number of persons appears to have suffered from these diseases during the excessive prevalence of influenza. If the curves of these diseases be compared with the curve of the mean temperature of the County, Chart page [---] it will be noticed that whenever the temperature rose, influenza, bron- chitis, and pneumonia got less prevalent, only to return again as the temperature fell. In some parts of the County local outbreaks of influenza occurred during the heat of summer. At the same time pneumonia and bronchitis shewed a tend- ency to get more prevalent. I am therefore inclined to believe that persons affected by influenza are for some time after the attack peculiarly liable to suffer from bronchitis and pneumonia, and in all probability other lung diseases. Persons should therefore be cautioned against exposing themselves to sudden changes of temperature after an attack of influenza. I have no doubt, however, that various elements or climate have independently of the co-existence of influenza a large share in the causation of bronchitis and pneumonia. On Chart page [---] I also give curves representing the course followed by diarrhoea, sore throat, and rheumatism It will be noticed that diarrhoea followed closely the same curve as the temperature rising and falling with it. Sore throat also tended to follow the course of the temperature, whereas rheumatism does not appear to have been affected by this agent. Diarrhoea and sore throat prevailed in several districts more or less in an epidemic form during the heat of summer. This was probably due to the fermentation of food [Note in margin] --- RMN or of organic matter in soil or water; the summer heat bring- ing into life deleterious organisms which at other times [Page] 7 remain dormant. The proximity of middens to dwelling houses, and the saturation of the soil with liquid sewage bring about a state of matters favourable to the growth and pro- pagation of such organisms. Dyspepsia is excessively prevalent in many parts of the County. This disease may be attributed to errors of diet, such as bad cooking, want of proper proportion of animal and vegetable foods, and excessive consumption of tea too long infused. There is a great tendancy, especially among the poorer classes, to substitute strong tea with bread and butter, for the more wholesome diet of porridge and milk. Eggs and butter are often sold to buy tea and sugar, a valuable article of nourishment being exchanged for that which only acts as a refreshing drink, and when prepared as it generally is, it tends to retard digestion without giving any nourish- ment whatsoever. In the majority of cases, outbreaks of infectious disease were traced to persons from the South either ill or convales- cing from the disease, or after coming from an infected house. Wherever there is a large population crowded in villages, townships, or burghs, outbreaks of infectious diseases are more common. This is owing in the first place to the fre- quent communication between such places and centres of dis- ease, and in second, to the danger of the diseases getting some headway before action can be taken to prevent it from spread- ing. Such localities, again, infect persons from the more thinly populated surrounding districts. Whooping cough and measles probably spread in this way during the past year from the Burgh of Campbeltown to the landward part of the parish and to Southend. Measles spread from Oban to the neigh- bouring parts of the District of Lorn. Measles was probably introduced into Ballachulish from the South, and spread be- fore the disease was discovered. This also was probably the case in the Quarry villages of Kilbrandon and Kilchattan. Scarlet fever appears to have been carried by visitors from the South to the Parishes of Campbeltown, Kilberry, Kilfinan, Lismore and Appin; measles to the Parishes of North and South Knapdale, and Muckairn; whooping cough to Ardnamurchan, Kilmeny and Tyree. In some places such as Kilfinan and Ballachulish, scarlet fever was introduced more than once, but was prevented from spreading. This reflects much credit on the local Sanitary Officials. The infection of Typhoid fever in Jura was traced to a young man who came home after suffering from this disease in Glasgow. This man lived in a small ill-ventilated dwelling,
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HH62/1/ARGYLL/9 [Page] 8 and ultimately died of consumption. In succession, three of the same family suffered from the typhoid fever, and after recovering from that disease, also died of consumption. In Innellan, Tighnabruaich, and Innishail, typhoid fever broke out in houses, the drainage of which was found defective. No other cause of infection was known. Diphtheria broke out twice in a house in Kilberry. The drainage was found defective, Unless in this case, I am not aware that diphtheria was traced in any part of the County during the year to infection from a previous case of the disease. Some cases occurred in houses which were in an insanitary condition. In others nothing was found to account for the disease. An outbreak of typhus fever occurred in Kilfinichen in the early part of the year. The disease was evidently in the locality since the autumn of the previous year. The source of infection could not with certainty be traced. It spread from the township in which it was first detected to other parts of the parish. This is a disease which generally affects the over-crowded poor. It is difficult to eradicate when the infection gets a footing in such a place as Mull where many of the people are poor and living in small badly ventilated and otherwise insanitary houses. Want of proper disinfection was probably the cause of some outbreaks. A case of scarlet fever occurred in one parish in a house where the disease occurred in the previous year. No other source was discovered. In another parish a case of typhoid fever occurred during the demolition of an old insanitary dwelling. The Medical Officer is of opinion that the infection was traced to this source. In my report in May last, I drew attention to another house where typhoid fever broke out repeatedly for years. This was probably owing to want of proper disinfection. In many parts of the County there appears to be a morbid dread of infectious disease. When a fever breaks out liable to attack adults, the fear sometimes develops into a panic. This increases the hardship to infected householders, as they may be shunned for weeks or months by their neighbours. On the other hand, the spread of infection is sometimes en- couraged in the belief that if the disease is willingly taken or caught from an otherwise healthy subject, it is not so likely to be severe. This was the case with an epidemic of whoop- ing cough in one part of the County during last spring. The local Sanitary Inspector wrote me that he considered it use- less to try to check the spread of the disease, as parents carried their children to catch the infection.The epidemic, however, contrary to their expectation was severe, and several cases proved fatal. [Page] 9 I regret that through want of proper information being supplied to me in a systematic manner, want of clerical assistance, and owing to my numerous engagements in all parts of the County, I have not been able to give such a full statement of the causes, origin and distribution of disease as I would wish, nor to compile statistics in such a way as to shew the death rate, and particulars of diseases in sub- divisions of the Districts. At the same time, from the information I have been able to collect as to the prevalence of infectious diseases, as well as diseases indicative of insanit- ary conditions such as diarrhœa, consumption, erysipelas, typhoid fever, diphtheria, and sore throat, in various parts of the County, from the high rate of mortality in Western Ardnamurchan, and other localities; from the appearance of typhus fever, (a disease of poverty and dirt) in the parish of Kilfinichen; and lastly from what I know from personal knowledge of the conditions of life in the County, I am convinced that the want of provision for the isolation of infectious diseases, and the insanitary condition of the houses of the labouring classes, lie at the root of the ill-health of a large portion of the population. Defects in dwelling- houses, such as want of proper ventilation and drainage, accumulations of filth in close proximity polluting air, water, and soil; the housing of cattle, pigs, and fowls along with human beings, come under various statutes, and can be re- moved by enforcing the law. Other conditions, however, such as want of cleanliness, unhealthy habits, thriftlessness, ignorance of good cooking, and of the most rudimentary laws of health and disease do not come under any statute, and can only be removed by the gradual diffusion of knowledge, and by the example and co-operation of all persons able to give advice in such matters. Co-operation and encouragement on the part of the educated classes might do a great deal in raising the sanitary standard of the poorer classes in the County. This would enhance their well-being, improve their health, stimulate their energy, diminish pauperism, and en- large their mental and moral capabilities. Such knowledge might be imparted by the establishment of popular sanitary societies in parishes and villages; by the dissemination of leaflets, tracts, and booklets giving information on the sub- ject in plain language, by district visitors who would point out defects in house-keeping, and by giving lectures on sub- jects relating to health in different centres. If I myself were relieved from some clerical work which could be done cheaply and quite as well otherwise, I might be able to give more time to the visitation of the various Districts, give an occasional lecture on these subjects in central localities, and thus give a stimulus and direction to such organisation as I have in view. As matters, are however, my time is more than fully occupied otherwise
HH62/1/ARGYLL/11 [Page] 10 In many districts it might be difficult, if not impossible, to enforce strictly the statutes bearing on insanitary dwellings. It has occurred to me that a good deal might be done in a variety of ways. Proprietors, I am told, in many cases are ready to provide wood and lime on condition that the occupiers do the necessary labour for the improvement of such crofters' or cottars' houses as may be found in an in- sanitary condition on their estates. It might be desirable to devote part of the Local Taxation grant towards the improve- ment of the dwellings of paupers, or towards the relief of local rates, in so far as such rates might be affected by the improvement of pauper's houses. In some cases it might be necessary to apply to Government for further help for the im- provement of the dwellings of the poor. Such a petition coming from the County Council would have great weight. The present insanitary condition of the houses of the labour- ing classes in the County is a most important question, and deserves the serious consideration of the Council, as well as the District Committees. IV. With regard to the Hospital provision at present in the County, and to the action taken to prevent the outbreak and spread of infectious disease, I beg to state that there is a hospital for the isolation of infectious disease within the burgh of Oban. It is situated within the Poorhouse grounds, and consists of a kitchen, three nurses' rooms, and four wards. There is accommodation for from twelve to fourteen patients according to ages. The kitchen is too small. Hitherto the food was cooked in the Poorhouse. The laundry is defective; there is no disinfecting chamber attached to the hospital; there is no ambulance for the conveyance of patients to it; the baths are not provided with hot water. It is not in my opinion sufficiently isolated from the Poorhouse. A small cottage in Tarbert, consisting of a kitchen and two rooms has been used for isolating infectious diseases in the neighbouring parts of the Districts of Mid-Argyll and Kintyre. One room is 18 1/2 ft. by 14 1/2 ft. by 9 ft., and one room is 12 ft. by 10 ft. by 9 ft. This cottage would accom- modate two or three cases. Two infectious diseases could not with safety be isolated in this cottage at the same time. There is no ambulance nor disinfecting chamber in connection with this cottage. It is in my opinion too small, not suffici- ently equipped, and not well situated for the requirements of the district. Near Bowmore, in Islay, there is another cottage, con- sisting of a kitchen, nurses' room, and two rooms for patients. One room is 12 ft. 9 in., by 14 ft. 8 in., by 10 ft.; and the other is 11 ft. 3 in., by 14 ft. 8 in., by 10 ft. The wards [Page] 11 here also are not sufficiently far apart for the isolation of two infectious diseases at the same time. It is not well situated, being close to the public road; it has no water supply; there is no disinfecting chamber; nor an ambulance for the con- veyance of patients to it. As far as I know, only three cases of scarlet fever were treated during the year in the Tarbert cottage; and two cases of erysipelas, and one of influenza were treated in the hospital at Oban. In the absence of hospital provision, ambulances to con- vey patients to the hospitals, and nurses to attend on them, it was impossible in some places to prevent disease from spreading during the past year. Owing to the small ill-constructed houses in which a large proportion of the population dwell, it was impossible in many cases to isolate the infected person from the rest of the inmates, with the result that in many cases all susceptible persons suffered from the disease. Every care was taken to isolate the infected household from the rest of the community. Whenever a case of infectious disease was reported to me I made the necessary enquiries, or asked the local Medical Officer to act for me, and directed the chief Sanitary Inspector to take immediate action in order to prevent the spread of the disease. Leaflets with printed instructions were sent by him to the local Sanitary Inspector to be de livered and explained to the house-holder. These leaflets- give directions as to the measures which should be taken to prevent the disease from spreading among other members of the family. Other printed instructions were sent to the local Sanitary Inspector giving particulars of the action that should be taken by him in each case. When the disease terminated, and the case was declared recovered by the local Medical Officer, or the medical practitioner in attendance, the house was disinfected according to the instructions by the local Inspector, and a report to that effect sent by him to the chief Sanitary Inspector. I beg to point out the want of medical attendance in many parts of the County. There is no medical man resident in Craignish, Kilninver, or Kilmelfort. The nearest doctor to these places lives on the one side at Ballymeanoch, near Lochgilphead; on the other in Oban or in Easdale. The parochial Medical Officer for Kilmodan, I understand lives in Rothesay; for Gigha, in Tarbert; and for Colonsay, in the Island of Jura. There is no Medical practitioner within twenty miles of a large population in Western Ardnamurchan. Many in these places die without medical attendance, and the
HH62/1/ARGYLL/13 [Page] 12 cause of death is often not certified. I would point out that this was the case during the past year in the whole of Western Ardnamurchan, in Gigha, and in Colonsay. V. I beg to append tabular statements of the area, and of the population at the last census of the County as a whole, as well as of the Burghs, and of the seven Local Government Districts. I also give Tables of the sickness, births and deaths during the past year in each District separately, and in the whole County; a Chart giving the course followed by influenza, bronchitis, pneumonia, diarrhœa, sore throat, and rheumatism, from month to month during the year, and another chart giving the mean monthly temperature, the mean daily range, and the rainfall at four meteorological stations in the County. My thanks are specially due to private medical practitioners in the County, for their courtesy and co-opera- tion, and for supplying me with monthly schedules of preventible diseases, although not in receipt of remuneration from any of the District Committees or the Council. Also to Dr Campbell of Craigrannoch for supplying me monthly with meteorological data for Ballachullish. My thanks are also due to the local Medical Officers and to the County and local Sanitary Inspectors for their co-operation and assistance in the discharge of my duties. I am, My Lords and Gentlemen, Your obedient Servant, Roger McNeill MD. DPH Camb County Medical Officer, Argyll. OBAN, MARCH 31st, 1892. APPENDIX TO THE REPORT OF THE COUNTY MEDICAL OFFICER ON THE STATE OF THE PUBLIC HEALTH AND THE SANITARY CONDITION OF THE COUNTY OF [note in margin] --- RMN ARGYLL. [Note] --- of May 1891. previously referred to. MAY 6th, 1891. I regret that owing to the short time at my disposal the foregoing Report is not so complete or so carefully put together as I should wish it to be, but even from the imperfect account that I have been able to give of the state of the Public Health and the Sanitary condition of the County of Argyll, it will be seen that there is much need for enforcing the provisions of the Public Health Acts and other Acts bearing on the Public Health. [Page] 13 The unsatisfactory state of the Water Supply in many localities has been repeatedly referred to. During my visit to each district I inspected the Bakehouses. Several of those visited by me are satisfac- tory while others can hardly be said to be so. I regret that I have not been able to examine many of the Dairies. Butcher Meat, Meal, Milk, Butter, and indeed provisions of all kinds I have been unable from want of time to examine. From all that I have seen and heard I have come to the firm conclusion that it would be well if the Council would, without delay, appoint a Public Analyst for the County. I beg also to suggest that the Sanitary Committee frame rules and bye- laws for the guidance of the District Committees, under Section 57 of the Local Government Act, and with this view would respectfully submit the following suggestions for consideration. (1). The formation of a Sanitary or Public Health Committee of each Local Authority under Section 7, Public Health Act, to receive notices and take proceedings in matters requiring attention in the intervals between the meetings of the District Committees. (2). The necessity for each District Committee to appoint some person to take proceedings on their behalf. This is necessary for the removal of nuisances. Under Section 7, Public Health Act, the Local Authority or their Committee may by minute or other writing signed by the Chairman of such body or Committee empower any officer to make complaints and take proceedings on their behalf. (In general the Sanitary Inspector would be the proper person to appoint). (3). The absolute necessity of providing Hospital Accommodation for infectious diseases in each district, and ambulances for the con- veyance of patients to such hospitals. In some places like Tarbert, two District Committees might with advantage join in building an efficient Hospital. Hitherto a few inefficient cottages have been set apart by Parochial Boards as Hospitals, but they were seldom if ever used. This was mainly owing to the fact that there was no ambulance attached to any of them and no conveyance could be got on hire for the purpose. (4). The necessity of adopting the Notification of Infectious Diseases Act by each District Committee, and at the same time of adopting the Bye-laws of the Board of Supervision for the purpose. When this Act is adopted in any district notice should be sent to all Medical Practitioners in the district. It should be stated that the Notifications should be sent to me as Medical Officer to each District Committee. Forms of certificate required by the Board for the purpose should be sent by the Clerk of the District Committee to each Medical practitioner. The form for certificate is a statutory form and cannot be altered. A foot note however may be added. It would be desirable if in a foot note the age of the patient, the date of the attack, the milk supply, the school attended, the probable source of infection and the occupation of parent (if child) should be given. (5). The compulsory removal of persons suffering from infectious disease, and being without proper lodgings and accommodation, to an infectious diseases hospital. This power is given to Local Authorities under Section 42, Public Health Act. The Local authority should in all cases authorize the Sanitary Inspector or Medical Officer, in terms of Section 7, to exercise the power of the Local Authority under Section 41, otherwise a meeting of the Local Authority would have to
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HH62/1/ARGYLL/15 [Page] 14 be called to authorise application in each case, and the object of the provision would be defeated by the delay which would take place before the removal could be effected. (6). The necessity of retaining the services of local Medical Officers of Health, and of appointing Medical Officers for those parishes having no such officials at present. Without local assistance it will be utterly impossible to carry out the provisions of the Public Health Act in such a wide county as Argyllshire. Local assistance is most necessary for the purpose of taking immediate measures for the isolation and disinfection of infectious diseases. Without such assistance many days might elapse before measures could be taken from the central office and the disease might get beyond control. (7). The necessity of engaging nurses to attend on cases of in- fectious disease. If a few nurses were engaged by the whole County they might be transferred from one district to another as they would be required. (8). The necessity of each Medical Officer of Health in the parishes, of sending me the schedule of new cases of sickness monthly as resolved at the meeting of the County Council in December. The Clerk of each Local Authority should notify this to each Local Medical Officer in the district. (9). The desirability of allowing a small fee to Medical practitioners who are not Medical Officers of Health for filling up similar returns. (10). The necessity of insisting on the Registration of Dairies and common Lodging-Houses, and of providing Registers for the purpose. (11). The necessity of insisting on the providing of properly con- structed privies and ashpits in villages and all populous places, and of these being emptied at regular short intervals by men engaged by the Local Authorities for the purpose. (12). The necessity of insisting on the storage of ashes, house refuse and maunre in conutry places where no ashpits or privies exist, not nearer than 30 yards to any dwelling-house, and in such localities as not to pollute a well or stream of water used for dietetic purposes, or to drain toward the house. (13). The absolute necessity of prohibiting the keeping of fowls, pigs, or cattle in dwelling-houses or in houses or sheds built against the wall of dwelling-houses; or in separate houses or sheds in close proximity to dwelling houses, unless proper provision is made for drainage, and for keeping them in a cleanly and sanitary state. In villages, pigstyes should not be allowed within 50 yards of any dwell- ing-houses. (14). The necessity of prohibiting the throwing of ashes and house refuse on the beach or fore-shore, and the discharging of sewers along the foreshore above high water mark. (15). The desirability of prohibiting persons from giving accom- modation to vagrants, except in registered common lodging-houses. (16). The advisability of printing placards in large type such as, "This house is infected with typhus fever," to be posted on the doors of [Page] 15 infected houses as a warning to the public. These placards should not be removed until such houses are thoroughly disinfected and a certifi- cate given to the householder to that effect. It might be disirable to authorize the Medical Officer in cases where further publicity is neces- sary and not likely to unduly alarm visitors and others to notify in local newspapers the prevalence of a dangerous infectious desease in any house or locality, and also to write local constables as well as sanitary inspectors to warn the public. (17). The desirability of printing placards in large type to be posted in prominent places on piers and steamers to the effect that persons suffering from infectious disease or who are convalescing from such diseases, or resided in houses where any infectious disease recently occurred, found visiting any part of the County will be prosecuted, unless in the case of convalescents or persons from infected houses, they are provided with a certificate signed by a Medical Officer of Health, that they are free from infection. (18). The lime washing of small cottages or part thereof as well a dairies and common lodging houses twice a year would be beneficial if made compulsory. The local Sanitary Inspectors could see that this is carried out. (19). The printing of leaflets with precautions against the spread of infectious disease to be sent to householders when necessary. It might be desirable to print such leaflets in Gaelic and English. (20). The printing of leaflets giving minute directions to Sanitary Inspectors as to the process of disinfection necessary for preventing the spread of infectious or contagious disease. I beg to draw the special attention of the Council to the large number of deaths registered in various districts without the cause of death being specified. In my Annual Report I shall endeavour to deal with this subject more minutely. It may however be desirable to bring the attention of the proper authorities to bear on the subject with the view of improving the present state of matters. I would also draw special attention to the custom which I believe is common of supplying raw whiskey in large quantities to labourers in distilleries. Pressure might be brought to bear on the proprietors of such works with the view to this custom being stopped, as it lowers the moral, mental, and physical condition of those employed in them. I am, Gentlemen, Your obedient Servant, ROGER McNEILL, M.D., D.P.H. CAMB. Medical Officer of Health, Argyll.
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HH62/1/ARGYLL/17 [Page] 16 POPULATION at the last Census, 1891, and Estimated Area of the COUNTY OF ARGYLL. --- Population. --- Area in Acres. ARGYLL, --- 74,106 --- 2,006,173 or thereby. Burghs, --- 21,797 --- 4,946 or thereby. DISTRICTS UNDER THE LOCAL GOVERNMENT ACT. Kintyre, --- 7,564 --- 195,831 or thereby. Cowal, --- 7,702 --- 238,461 or thereby. Lorn, --- 9,981 --- 502,980 or thereby. Mid-Argyll, --- 8,121 --- 240,558 or thereby. [note in margin] --- RMN Ardnamurchan, --- 3,553 --- 307,302 or thereby. Mull, --- 6,874 --- 260,865 or thereby. Islay, --- 8,514 --- 255,230 or thereby. TOTAL, --- 52,309 --- 2,001,227 or thereby. NOTE.- The Registrar General reckons the Population of Argyll at 79,317, being 5,211 more than the above. That number however, reside in the County of Inverness, 929 being in Arisaig, 672 in part of Aharacle, 3,125 in part of Kilmallie, and 485 in the Inverness part of the Registra- tion District of North Ballachulish. I have copied the area from the Census of 1881. The Ordnance Survey gives the acreage of land in Argyll as 2,056,402. This however, includes 32,039 acres in Small Isles, and 19,750 acres of Kilmallie now added to Inverness. I got the area of Lochgilphead and Tobermory from the Burgh Clerk; of Inverary from the Clerk of Works; of Dunoon from the Burgh Surveyor; of Campbeltown from Dr Gibson; and of Oban, from the County Sanitary Inspector. [Page] 17 TABLE 1. Births and Deaths occurring in the County of Argyll during the year 1891.* [Table inserted] * Deaths in Institutions have been allocated to the Districts to which the persons belong. + No Returns from Salen. Ages and causes of death in District as a whole cannot be given. ‡ In Islay age of one person not stated.
HH62/1/ARGYLL/19 [Page] 18 Density of Population, Birth Rate, Death Rate, Number of Deaths in which Cause is not certified, and Total Number of Deaths. [Table inserted] [2 Notes in margin] ---RMN NOTE.- As the cause is not certified in a large per centage of the deaths, the rate of mortality from various diseases cannot be ascertained. COUNTY OF ARGYLL Cases of Sickness reported during 1891.* [Table inserted] [Note in margin] --- RMN * Including cases reported by Dr Harvey Thomson in the Burgh of Cam beltown and Drs Bailey and McCalman in the Burgh of Oban. [Page] 19 COUNTY OF ARGYLL. Influenza Cases Reported During 1891. [Table inserted] BRONCHITIS. Total, 145 -- 82 -- 81 -- 71 -- 49 -- 32 -- 36 -- 47 -- 57 -- 67 -- 204 PNEUMONIA. Total, 22 -- 25 -- 18 -- 17 -- 16 -- 7 -- 7 -- 4 -- 11 -- 18 -- 19 DIARRHOEA. Total, 56 -- 49 -- 36 -- 48 -- 77 -- 99 -- 66 -- 44 -- 35 -- 39 --27 QUINSY OR SORE THROAT. Total, 57 -- 40 -- 48 -- 39 -- 61 -- 59 -- 46 -- 46 -- 48 -- 48 -- 44 RHEUMATISM. Total, 53 -- 45 -- 30 -- 33 -- 31 -- 20 -- 28 -- 36 -- 31 -- 26 -- 29 DISTRICT OF LORN. Cases of Sickness reported during the year 1891* [Table inserted] * Including cases reported by Drs McCalman and Bailey in the Burgh of Oban.
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HH62/1/ARGYLL/21 [Page] 20 DISTRICT OF MULL. Cases of Sickness reported during the Year 1891. [Table inserted] [Note in margin] ---RMN DISTRICT OF KINTYRE. Cases of Sickness reported during the year 1891.* [Table inserted] * Including cases reported by Dr Harvey Thomson in the Burgh of Campbeltown. [Page] 21 DISTRICT OF MID-ARGYLL. Cases of Sickness Reported. [Table inserted] DISTRICT OF COWAL. Cases of Sickness reported during the year 1891. [Table inserted]
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HH62/1/ARGYLL/23 [Page] 22 DISTRICT OF ISLAY. Cases of Sickness reported during the Year, 1891. [Table inserted] DISTRICT OF ARDNAMURCHAN. Cases of Sickness reported during the Year, 1891. [Table inserted] [Page] 23 COUNTY OF ARGYLL. Cases of Infectious Disease reported during 1891. [Table inserted] [Note in margin] --- RMN NUMBER of HOUSES specially Reported or Certified as Injurious to Health, under the Housing of the Working Classes Act. --- DISTRICT. --- NUMBER. Lorn --- 6 Mull --- 9 Kintyre --- 12 Mid Argyll --- 11 Cowal --- 12 islay --- 9 Ardnamurchan --- 9
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