HH62/1/AYR/19

Transcription

[Page] 18

diseases in Ayrshire for ten years may be noted, as given in the
Registrar General's detailed reports:-

1880 - 810. 1885 - 647.
1881 - 816. 1886 - 648.
1882 - 792. 1887 - 687.
1883 - 700. 1888 - 561.
1884 - 672. 1889 - 539.

An average of 687 deaths annually, or a total of 6872 in ten years.
Although there is doubtless a reduction in the death-rate from
tuberculosis in common with many other diseases, it is highly
probable that a part at least of this reduction is more apparent than
real, owing to the diagnosis which now obtains being more exact.
Formerly it was the practice amongst a great many practitioners to
certify deaths from chronic bronchitis, &c., as "consumption."
This view is also strengthened by the fact that the death-rate from
respiratory diseases, other than phthisis, has not been falling, but
has even been increasing slightly in Ayrshire during the last ten
years.
At anyrate, it is clear that the amount of tuberculosis in our
midst is appalling. When we also consider that the average age of
consumptive patients is not at the extremes of life, but at the most
useful periods of human existence, it renders the disease still more
serious. In the present report I shall not discuss this subject as
fully as it deserves, but will briefly note certain facts in connection
with its prevention:-
1. That tuberculosis (including phthisis) is a disease due to a
well-known micro-organism, which may exist outside
the body wherever it can find favourable conditions as
regards temperature, moisture, and pabulum, such as
are found in the vitiated air of human dwellings and
cowsheds, damp houses, decomposing organic matter,
in milk and other food, and especially in the sputum
of consumptive patients.
2. That the temperature, tissues, and fluids, especially of the
lungs, of the human body and of other animals become,
under certain circumstances and conditions, most
favourable for the development and propagation of
this microbe, resulting in very many cases in the
death of its hosts.
3. That this microbe can be almost banished from our midst, at
least so far as its danger to health is concerned, by
good ventilation of dwellings, factories, schools,
churches, &c., as well as of cow sheds and other places
where animals are confined; by the isolation of cases
of consumption, and the thorough disinfection of their
clothing, rooms and especially their sputa; and by
carefully guarding against milk from tuberculous cows
- the safe plan being to boil the milk in every case
before use - and of partially cooked meat of tubercul-
ous animals.

[Page] 19

We do not expect that all this is practicable, but it is not too
much to urge that every precaution possible under ordinary circum-
stances should be observed, in order to lessen the ravages of this for-
midable disease.
Influenza. - Some reference must be made to this alarming
epidemic which visited our shores in the end of 1889 and beginning
of 1891, and appears to have been present since in a more or less
smouldering form, and again exploding into a wide-spreading
epidemic during the latter part of this year, attended with a high
general mortality all over the country. The deaths due to influenza
pure and simple were, however comparatively few. In the Report
of the Registrar-General of England and Wales, recently published,
which shows 4523 deaths directly due to influenza in England and
Wales in 1890, he says:- "If we assume - as we may, though not
with certainty, yet with much probability - that the increased
mortality from pneumonia, bronchitis, and diseases of the organ of
circulation, as compared with the nine preceding years of the
decennium, were due to the same cause as were the deaths directly
ascribed to influenza, the total number of deaths due directly or
indirectly to the epidemic influenza (in England and Wales) was
not merely 4523, but 27,074, or 91 per million living." On this
estimation the increase in the death-rate due to influenza was nearly
1 per 1000 of the population. This represents merely the actual
mortality, but the amount of suffering endured by patients who
lived through the disease, although it cannot be represented numeri-
cally, must be considerable. The death-rate from influenza
as a primary cause in this county (landward) during the year
1891 was .389 per 1000. But probably, as has already been stated,
this by no means estimates the death-rate due to the agency of
this disease; and using the same basis of computation as the
English Registrar-General, the death-rate in Ayrshire has been in-
creased - directly or indirectly - by influenza over 2 per 1000 during
the year 1891. In regard to influenza, the following remarks in con-
nection with its prevention, may be considered to have been estab-
lished:- That influenza is an infectious disease of microbic origin;
that it attacks all classes irrespective of sanitary environments; that
it is much more fatal in the case of aged people, being so frequently
complicated with pneumonia and other chest diseases; that anything
which lowers the vital powers, such as impure air, &c., predisposes
persons to its attack; that persons attacked should immediately ex-
ercise great care not to expose themselves to cold, or anything which
might aggravate the disease; and that by thorough isolation and
disinfection in every case, the disease would be stamped out, or, at all
events, kept within comparatively insignificant bounds.
The other groups of diseases do not call for any special notice.
It may be noticed, however, from Table II., that cancer prevailed
more in the Ayr and Carrick Districts. This is probably almost
entirely due to a preponderence of aged people in these districts -
especially of aged females, who are more liable to this disease than
males.

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