HH62/1/AYR/15

Transcription

[Page] 14

In the Carrick Distrist, which I consider quite exceptional in
regard to sparseness of its population and other circumstances,
the local Medical and Sanitary officials have been retained. This
seems to be the best arrangement for the District.
Beside the ordinary sanitary staff, it may be stated, that arrange-
ments have been made with the police in the county, through Captain
McHardy, Chief-Constable, by which the constabulary are to report
to the Sanitary Inspector any nuisance which comes under their notice
in the discharge of their ordinary duties in their respective districts.

DISTRIBUTION OF DISEASES, STATISTICS, &c.

Although we have no reliable data as to the amount of non-
fatal illness in the county during the year, the Infectious Disease
(Notification) Act will in future supply this want as regards the
diseases included under it. From the returns of the local Registrars,
however, we have trustworthy information as to the cases of sick-
ness which proved fatal.
Birth-rate. - The birth-rate (33.5 per 1000) for the non-burghal
part of the county during the year under notice is a little above the
mean annual birth-rate of Scotland for the preceding ten years,
which was 31.9 per 1000 of the population. It is lowest in the
Carrick District and highest in the Ayr District. As a rule birth-
rates are high in towns and low in rural districts. The chief cause
of this is the age-distribution of the population, there being generally
a preponderance of young adults in towns as compared with country
districts - a circumstance which, moreover, tends to lower the total
death-rate in the former, while raising it in the latter.
Total Death-rate. - The death rate from all causes in the non-
burghal part of the county during the year 19.25. This is
higher than the mean annual death-rate for the county (including
burghs) for the previous ten years, which was 18.7. The mean an-
nual death-rate of Scotland for the same period was 18.9. It is
therefore highly probable that influenza was the chief disturbing ele-
ment during the year 1891. It may be here noted that the total
death-rate is not always a reliable criterion for comparing the health
and sanitary condition of different districts. The death-rate from
all causes will be naturally influenced by the age distribution of the
population. Thus, in a district where there is a large proportion of
persons between the ages of five and fifty years - a period at which a
low death-rate prevails - there will necessarily, with ordinary sani-
tary conditions, be a low total death-rate; whereas in districts with
a preponderance of persons under five years of age and at the
other extreme of life - periods at which there is always a high death-
rate - the total death-rate will be comparatively high, irrespective of
sanitary conditions. Although we have not yet the last detailed
census of the population of the districts of the county, there are good
grounds for believing that the Carrick District contains a much
larger proportion of aged people than either of the other three dis-
tricts, so that the total death-rate of the former appears much

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higher than it would be were the age distribution in the same propor-
tion as the other districts. With this reservation as to the Carrick
District, we may state that the annual total death-rate of the county
should not exceed 17 per 1000.
Infantile Death-rate. - As young children are most susceptible to
unhygienic surroundings the proportion of infants dying within a
year after their birth is one of the best tests of the healthiness of a
district, and it has the advantage of being unaffected by the increase
or decline of the population, or by the respective number of persons
at different ages. For healthy rural districts 100 deaths
of infants under one year of age per 1000 births may be considered a
fair average. Over the four districts of the county the infant death-
rate was 166 per 1000. The highest was in the Kilmarnock Dis-
trict, and, as might be expected, the lowest in the Carrick District.
Zymotic Death-rate. - The death-rate from the familiar zymotic
diseases - smallpox, diphtheria, scarlet fever, typhus, typhoid, measles,
whooping cough, and diarrhoea - is 2.37 per 1000, which may be con-
sidered about the average for the whole of Scotland. The district
with the highest zymotic rate is that of Kilmarnock, and the lowest
the Carrick District. The zymotic death-rate is a good test of the
health of the community. A reduction in the number of cases of
typhus, typhoid, diphtheria, and diarrhoea always indicating
sanitary improvements in connection with dwellings, drainage, water
supply, &c., while a low death-rate from smallpox, scarlatina,
measles and whooping cough is not so directly due to these improve-
ments, but greatly depends on isolation and disinfection, as well as on
efficient vaccination in the case of smallpox.
Smallpox. - Fortunately there has been no death and no case of
this virulent disease notified within any of the districts of the county
during the year. It is proper, however, that the Local Authorities
should have means for the immediate isolation of cases of this disease
should it unhappily appear in our midst. Although I have
thorough confidence in the protection afforded by vaccination, I have
reason to believe that in a considerable number of the population such
protection does not exist, and this chiefly for two reasons - (1) While
a certain number of children, owing to the migration of their parents
from place to place, escape vaccination entirely, a large number, I
believe, are more or less imperfectly vaccinated - anything in the
shape of a vesicle appearing on the arm after vaccination being
sufficient for filling up the vaccination certificate; and, (2) although
it is a well established fact that the protection of vaccination in
infancy is to a considerable extent lost after ten or twenty years,
how few people avail themselves of the benefits of re-vaccination, which
has been almost conclusively proven to be practically an absolute
protection against smallpox. Evidence as to the latter can be easily
found, for example, by observing the immunity from smallpox, year
after year, secured to nurses in the London and other smallpox hos-
pitals by re-vaccinating them before entering on their service, and
also from the case of the permanent officials of the postal service in
London, who are all re-vaccinated, and who, in times of smallpox
epidemics in that city, invariably escape.