Medical Officer of Health reports, 1891 - Banffshire

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HH62/1/BANFF/1 [Note] 4 COUNTY OF BANFF REPORT BY THE COUNTY MEDICAL OFFICER FOR 1891 [Date Stamp] SCOTLAND 11 Apr. 92 [April 1892]
HH62/1/BANFF/3 Elgin, March 29, 1892 To the County Council of Banffshire, Gentlemen, In accordance with the Bye-laws recommended by the Board of Supervision for regulating the duties of Medical Officers of Counties, I beg herewith to present to you my Report for 1891, being my first Annual Report as County Medical Officer for Banffshire. I entered on my duties on the 16th March 1891, and, since doing so, have endeavoured to make myself acquainted with the County generally, and its sanitary requirements, by personal observation and inquiry. The result of the information thus obtained has, to a great extent, been embodied in the District Reports, which are already before you. The following Report is a summary of these, with some additional remarks on special points. I have the honour to be, Gentlemen, Your obedient Servant, James A. Cameron.
HH62/1/BANFF/5 COUNTY OF BANFF Report by the County Medical Officer For 1891 Population according to the Census of 1891, -- 36,862 Population estimated to middle of 1891, -- 36,868 Approximate Area in Acres, -- 399,000 Approximate Density of Population, .092 persons per Acre. Extent. - The County of Banff, inclusive of the areas em- braced within the Municipal Boundaries of Royal and Police Burghs, extends to 403,484 Acres. It is divided into 29 Parishes or Registration Districts, of which one is purely burghal and seven are partly burghal and rural. The Boundary Commissioners have recently dealt with the boundaries and áreas of several of these Parishes. As their decisions did not come into force til the 15th day of May last, not only have these Parishes been altered in extent, but, in two or three cases, the number if the inhabitants, as shown by the Census taken in April 1891, has been altered. Population. - During the last decade the Population of the County, exclusive of Burghs, has remained about stationary. In the purely agricultural and rural districts, the Population has in most cases decreased since 1881 ; but this decrease has been counter-balanced by an increase in the coast villages. Within the last few years four of the larger villages have been formed into Police Burghs. There are now two Royal Burghs and six Police Burghs situated within the County, with a population of nearly 25,000 persons. The Population embraced within the jurisdiction of the County Council I have estimated at 36,868, as at 30th June last. Of these, about 10,500 reside in villages. Exact information on one point required by the Board of Supervision, viz., the density of the population in the different districts, I have failed to obtain, owing to the recent alterations
HH62/1/BANFF/7 [Page] 6 in the Parish boundaries and the difficulty in obtaining the exact extent embraced within the Royal and Police Burghs. In Table I., p. 15, I have endeavoured to set forth, according to information received (but subject to future revision), the acre- age, population, and density of population (inclusive of Burghs) of the different Parishes within the County. The Returns issued by the Registrar-General give the popu- lation of the Parishes and Registration Districts. The acreage supplied for the census of 1881 by the Directors of the Ordnance Survey (see Blue Book) gives the extent of the Parishes. The Registration Districts and the Parishes, however, are in many cases not co-terminous, consequently a difficulty arises - for example, the Registration District of Seafield, which includes portions of the Parishes of Rathven and Fordyce, and all the extra burghal part of the Parish of Cullen, the Population is given in the Registrar-General's Returns, but the acreage is not stated anywhere that I have been able to find. Vital Statistics. - From the Registrar-General's Returns for the last ten years, I have compiled a Table (Table II., p. 16) of the Birth and Death Rates of Banffshire, in order to compare them with those for the whole of Scotland. The figures there given for the small towns and the main- land rural districts form perhaps the best bases of comparison, because, in my calculations, I have been obliged to include both burghal and rural populations. (a) General Sanitary State. In the District Reports reference has been already made in general terms to this point, the time that has elapsed since I entered on my duties, and the amount of information I have been able to acquire, rendering anything more special out of the question. In these Reports reference was made to those conditions which influence the health and sanitary state of a district. These were roughly divided into natural and artificial. Of the former, the most important are the meteorological (including temperature, rainfall, and prevailing winds), the geo- logical, and the physical. The two latter are mainly of import- ance when taken in connection with the first. The artificial conditions, however, embracing, as they do, those belonging more particularly to the inhabitants, their occu- pations, their dwellings and the surroundings thereof (including site, water supply, drainage, and removal of refuse), the diseases most commonly met with amongst them, and how far these dis- eases are dependent on causes capable of removal by hygienic measures, are the most important. Judging generally from the vital statistics of Banffshire, as [Page] 7 compared with those for the rest of the country (see Table II., p. 16), the sanitary state of the county would seem to be equal to, if not above, the average. The death rate, however, is no guide, or at most an uncertain one, as to the health of a community, or the existence of insani- tary conditions. We may have a low death rate, and still a large amount of sickness, or we may have the opposite, depending on the age constitution of the population, and other causes. In many of the rural parishes, there is reason to believe that the decrease of population is due to the migration from those dis- tricts into the town and villages of young adults, leaving a resi- dent population, belonging principally to the two extremes of life amongst whom, naturally, the death rate is higher, and the birth rate lower, than would be the case were all ages properly repre- sented. Judging, on the other hand, from personal observation and investigation, there are many things have struck me as cap- able of improvement, and where the provisions of the Public Health (Scotland) Act 1867 might be enforced with advantage to the sanitary state of the district and the health of the inhabitants. Notably is this the case with regard to many of the cottages, their site, construction, and surroundings, both in rural districts and villages, and it is to this point that I would beg especially to refer at this time. The Public Health (Scotland) Act, 1867, has been in force nearly 25 years, but I fear that its provisions are not at all well known. For example, Sect. 16 (a) provides that the word "nuisance" shall include "any insufficiency of size, defect of struc- ture, defect of ventilation, want of repair, or proper drainage, or suitable water closet or privy accommodation, or cesspool, and any other matter or circumstance rendering any inhabited house, building, or premises or part therof injurious to the health of the inmates, or unfit for human habitation or use." Again, Sect. 89 (2) provides that "if any house within the district be without a proper supply of water at or near the same, the Local Authority shall compel the owner to obtain such supply, and to do all such works as may be necessary for that purpose." I have little doubt that during the last twenty-four years cottages have been built in the county which through ignorance of the Act do not comply with the foregoing requirements in many particulars. One most important point, not directly but indirectly included in the foregoing, that I have noticed is frequently ignored, is the site and exposure of the cottage. In many cases, both in villages and rural districts, the existing cottages are built on a slope - the back wall or one gable being built into the slope of the ground, causing damp, which is one of the most fruitful sources of dishealth, being, as it is, intimately connected with the causation of Catarrh, Rheumatism, Neuralgia, Phthisis, Diphtheria, and, according to some, Typhoid Fever.
HH62/1/BANFF/9 [Page] 8 According to Dr Buchannan (Medical Officer to the Local Government Board), there has been a marked diminution in the number of deaths from Phthisis in towns which have been drained, and in which the ground has been rendered drier. "Where the drying of the subsoil was considerable, the deaths from Phthisis were reduced by a third, or even by half of what they had previously been." In a recent work by Dr Thorne- Thorne (Assistant Medical Officer to the Local Government Board), on Diphtheria, he states "That dampness of site, and aspect involving exposure to cold wet winds, and a surface soil favourable to the retention of wetness and of organic refuse, tend apparently to the fostering and fatality of Diphtheria." This statement is based on the extensive evidence obtained in the investigation of numerous outbreaks of Diphtheria by the officials of the Local Government Board during the last 20 or 30 years. During 1891, 47 deaths were registered in Banffshire as due to Phthisis, 17 to other tubercular affections, 4 to Diphtheria, and 5 to Typhoid Fever. Since the adoption of the Infectious Disease (Notification) Act in July last, 35 cases of Diphtheria and 40 cases of Typhoid Fever have been notified. Dampness of the dwelling may be due not only to a bad site, but to faulty construction. The older cottages, in many instances, in addition to being badly situated, have their walls constructed of stones and clay - the roof being made of thatch, with no provision for gathering and getting rid of the rain water, which is allowed to soak into the walls or foundations. The floors of such cottages are generally on a level with, sometimes below, that of the surrounding ground, and formed of clay or unevenly paved with stones. The only means of ventilation are the door and the chimney, the Windows being small and often fixtures. In rural districts the above state of matters is bad; still any evil effects may not be apparent owing to the inhabitants spend- ing so much of their time in the open air, but in villages such sites and modes of construction become positively hurtful and dangerous. Especially is this the case where the houses are crowded together and the site has been long occupied. Here we have the surrounding ground usually saturated with filth, and possibly con- taining germs of disease. At night, with the house door shut, and a fire burning, a certain amount of fresh air may gain access through the crevices of the building, but another amount of vitiated air, very deleterious in quality, bearing not improbably germs of disease, is extracted from the soil below the dwelling. I would strongly advise that in future dry sites with proper exposure be chosen for cottages - that the ground surface around dwellings be sloped so as to allow of ready surface drainage - that, if necessary, subsoil drains be introduced - that the floors [Page] 9 be raised above the level of the ground and properly constructed, and that all windows be made to open, their size being regulated by the size of the rooms. I need hardly say how important for health is the breathing of pure unvitiated air at all times. That Phthisis, to which 47 deaths were attributed during the past year, depends, to a great extent, not only on dampness of site, as mentioned above, but on deficient cubic space and ventilation, has been proved. The same remark applies to Respiratory diseases in general. In 1891, 72 deaths were registered in Banffshire as due to diseases of the Respiratory System. In other words, including the deaths from Phthisis, out of 511 deaths registered, 119 were due to diseases of the lungs. But not only may the air of the dwelling-house become vitiated through a faulty site, want of ventilation, and deficient cubic space, but the surrounding air is apt to become so, owing to faulty disposal of refuse - its accumulation - the want of drainage for slop water, and the near vicinity to the dwelling of ill-kept pigstyes, byres, &c. This is, perhaps, most noticeable in some of the inland villages. In conclusion, I would beg to quote the following remarks by the late Dr Parkes :- "The diseases arising from faulty habitations are in a great measure, perhaps entirely, the diseases of impure air. The site may be at fault; and from a moist and malarious soil excess of water and organic emanations may pass into the house. Or ventilation may be imperfect, and the exhalations of a crowded population may accumulate and putrefy; or the excretions may be allowed to remain in or near the house; or a general unclean- liness, from want of water, may cause a persistent contamination of the air. And, on the contrary, these five conditions ensure healthy habitations :- "1. A site dry and not malarious, and an aspect which gives light and cheerfulness. "2. A pure supply, and proper removal of water, by means of which perfect cleanliness of all parts of the house can be insured. "3. A system of immediate and perfect sewage removal, which shall render it impossible that the air shall be contaminated from excreta. "4. A System of ventilation, which carries off all respiratory impurities. "5. A condition of house construction which shall insure perfect dryness of the foundation, walls, and roof. "In other words, perfect purity and cleanliness of the air are the objects to be obtained. This is the fundamental and
HH62/1/BANFF/11 [Page] 10 paramount condition of healthy habitations; and it must over- ride all other conditions." (b) Inquiries and Proceedings. As stated in the District Reports I have devoted the time since my appointment principally to making a general survey of the county, especially of the villages, because there the insanitary conditions most commonly exist and are most apt to prove hurtful. In the Report for the Keith District, reference is made to a complaint as to pollution of the river Isla. Under the Local Government (Scotland) Act, 1889, section 55, the power of enforcing the provisions of the Rivers Pollution Prevention Act of 1876, is conferred on County Councils. The compaint was received by the County Sanitary Inspector, through the Chief Constable of the County, in the end of last June. The complaint stated that the fish in the river were dying, and that some of the complainant's cattle were suffering through drinking the river water. We took an early opportunity of calling on the complainant, who repeated verbally the complaint already made in writing, adding that dead fish were not unfrequently seen in the river. I asked him to be good enough to let the Sanitary Inspector know at once should he see any more dead fish in the river. We have received no communication from him since. Further inquiries on the subject brought out very conflicting statements. That the Isla is polluted to a greater or less extent there seems to be little doubt. The sources of pollution are:- 1. The sewage from the Burgh of Keith. 2. The waste liquids from a Woollen Manufactory, from a Distillery situated within the Burgh, and from a Manure Manufactory situated further up the stream in the landward part of the Parish of Keith. (To this latter source of pollution reference is made in the District Report, p. 7.) The pollution of rivers in Scotland, especially in the North, has not hitherto attracted the same amount of attention that it has done in England, and I think it best to here quote the law on the point. Section 83 of the Public Health (Scotland) Act, 1867, is as follows:- "The owners or occupiers of distilleries, manufactories, and other works shall be compelled, where possible, to dig, make, and construct pools and reservoirs within their own ground, or as near their works as possible, for receiving and depositing the [Page] 11 refuse of such works, so far as offensive or injurious to the health of those living in the vicinity thereof, or to use the best practical means for rendering the same inoffensive or innoxious before dis- charging it into any river, stream, ditch, sewer, or other channel." In this Section "offensiveness" is to be construed as distinct from "injury to health" (see Dr Skelton's Handbook of Public Health, p. 77). Section 3 of the Rivers Pollution Prevention Act, 1876, states - "Every person who causes to fall or flow, or knowingly permits to fall or flow or to be carried into any stream any solid or liquid sewage matter shall (subject as in this Act mentioned) be deemed to have committed an offence against this Act" "When any sewage matter falls or flows or is carried into any stream along a channel used, constructed, or in process of con- struction at the date of the passing of this Act for the purpose of conveying such sewage matter, the person causing or knowingly permitting the sewage matter so to fall or flow or to be carried shall not be deemed to have committed an offence against this Act if he shows to the satisfaction of the Court having cognisance of the case that he is using the best practicable and available means to render harmless the sewage matter so falling or flowing or carried into the stream." Then follows a clause granting time to any sanitary authority to enable it "to adopt the best practicable and available means." Section 4 of the same Act repeats Section 3, substituting for the words "solid or liquid sewage matter," "any poisonous, noxious, or polluting liquid proceeding from any factory or manufacturing process." The enactments quoted above have, I fear, been frequently offended against. Under the Rivers Pollution Prevention Act, there is no reference whatever to injury to health, The mere fact of turning "sewage" or "polluting liquid" into a stream without using the "best practicable" and "reasonably available" means for render- ing it harmless seems to be a breach of the law. The Isla is a small stream, and the fact that Keith is steadily increasing in size and population means that, in the near future, if no steps are taken to prevent it, the river must become seriously polluted. I am glad to hear, however, that a new scheme for the sewerage of the Burgh has been recently under consideration, and is now in process of being carried out in one district within the Burgh. I trust that this scheme will, when carried out in its entirety, include proper sewage disposal works, and thus do away with any cause for complaint in the future. In no part of its course below Keith is the water of the Isla used for dietetic purposes, so far as I have ascertained. Cattle grazing along the banks drink it, but we failed to get evidence of illness amongst them in consequence. At the same time, the
HH62/1/BANFF/13 [Page] 12 drinking of polluted water must affect injuriously the lower animals as well as human beings, more especially if such water be specifically infected. Of recent years it has been affirmed, and is quite possible, that cattle suffer from Scarlet Fever, Typhoid Fever, and perhaps Diphtheria, and that cows so affected may communicate these diseases to human beings through the milk. That the milk of tuberculous cows containing tubercli bacilli is capable of transmitting the disease to other aminals has been well established. (c) Causes, Origin, and Distribution of Disease. I do not feel myself in a position to speak with any certainty on those points. The only means of information at my disposal are the Registers of Deaths in the various districts. The Registrars have kindly furnished me with particulars (age, cause, &c.) of those deaths which have occurred within the county during the past year. These are set forth in detail in the tables appended to the District Reports, but such data for one year are insufficient to draw any conclusion from. It would be necessary before doing so to have specific information extend- ing over a series of years - and this unfortunately we cannot get, so far as the existence of sickness is concerned. I trust in the course of the present year to be able to make some inquiry into the incidence and fatality of different diseases in certain districts during the past few years, and their persistence there. In Table III., p. 17, I have set forth the number of cases of those diseases now classed as infectious and communicable (i.e., preventible) which have proved fatal during 1891. (d) Prevention of the Spread of Infectious Disease - Hospital Accommodation, &c. In the district reports, mention has been already made of the measures taken to prevent the spread of infectious disease, and these need not here be repeated in detail. The adoption of the Infectious Disease (Notification) Act by the District Councils has been of great service, though the carry- ing of it out has thrown a good deal of extra work upon the Sanitary Inspector. Through it we have been informed of the existence of infectious disease in certain localities, and by inquiry, in some cases of its existence there in previous years. In the Report for the Banff District (p. 6), I mention that I had been struck by the condition of two or three of the coast villages, and that the opinion I then formed had been borne out, partly by the operation of the Infectious Disease (Notification) Act, and partly by the returns received by the Registrars. Reference was made to the village of Whitehills, where Typhoid [Page] 13 Fever, Erysipelas, and Diphtheria seem, I might say, to be endemic. The mortality, however, from these diseases has been almost nil, a proof of a previous statement that the death rate is no sure criterion of the existence of disease or of the health of a com- munity. Most of the Typhoid Fever and Diphtheria patients have been children, amongst whom the mortality from the former disease is usually small. I suspect the absence of adult patients is due to most of the native inhabitants of Whitehills having an attack of Typhoid Fever in their youth, because, from what I can learn, the disease has been more or less prevalent there for many years. Another village to which my attention was directed is Gardenstown, in Gamrie parish. The Registrar's Returns for Gamrie show that during last year in that village, Typhoid Fever, Puerperal Fever, Whooping Cough, and Diarrhoea, caused each two deaths. Since the Notification Act came into force only one case of Erysipelas has been notified from the village. Of recent years, the connection between contaminated milk supply and the spread of infectious disease has been so often brought to public notice that I need here only mention the fact, as my reason for advising the enforcing of the Dairies, Cowsheds, and Milkshops Order of 1885-6. As yet, no Inspector of Dairies has been appointed in the County of Banff; but I hope such an appointment may be made at an early date in order that this most important matter - the milk supply - may be carefully looked after, and every possible precaution taken against its becoming a source of disease. In Table IV., p. 17, the information acquired through the Notification Act with the number and nature of the cases notified from each district is given. In the District Reports an account of the Hospitals avail- able in each District for the reception of cases of infectious diseases, along with a detailed account of the accommodation of each, has been given, and need not be repeated here. In the report for the Banff District, attention has been drawn to the fact that the Western part of that District, includ- ing the populous Parish of Rathven and the Registration Dis- tricts of Enzie and Seafield, and comprising the Burghs of Buckie and Cullen, with the Villages of Portgordon, Portessie, Findochty, Portknockie, &c., is entirely without Hospital accommodation for the isolation and treatment of infectious disease. This is the most densely populated part of the County, and during the herring fishing season the population must be largely increased by immigration. Besides, the intercommunication with other ports, both home and foreign, is very extensive. Under these circumstances, I trust that action may be taken by the District Council in conjunction with the Local Authorities of Buckie and Cullen to provide adequate Hospital accommodation for the Dis- trict.
HH62/1/BANFF/15 [Page] 14 In the Upper or Keith District of the County, the lower part, except the Parish of Rothiemay, is provided for by the Keith Hospital. An arrangement might be made for accom- modating any cases from Rothiemay at Keith or Aberchirder. The latter would be the most suitable. The central portion of this District, including the Parishes of Mortlach and Aberlour, with the Police Burgh of Dufftown, is without Hospital accom- modation for infectious diseases. I am of opinion that a com- bination between these Parishes for providing such accommoda- tion would be advisable, or even a larger scheme to embrace the Parish of Knockando, and perhaps the Parish and Burgh of Rothes in Elginshire might be still better. In the remaining and upper part of this District, embracing Cabrach, Inveraven, Glenlivet, Kirkmichael, and Tomintoul, the population (except in the Village of Tomintoul) is sparse and scattered - distances are great and means of transit not readily available. Since the Notification Act was adopted only three cases have been reported from this part of the District, viz., one of Erysipelas and two of Typhoid Fever, one of the latter being an imported case. In conclusion, I would beg to quote the following from the Memorandum issued by the Local Government Board "On the provision of Isolation Hospital Accommodation" - "Large villages and groups of adjacent villages will commonly require the same sort of provisions as towns. Where good roads and proper arrangements for the conveyance of the sick have been provided the best arrangement for village populations is by a small building accessible from several villages; otherwise the requisite accommodation for (say) four cases of infectious disease in a village may be got in a suitable four-room or six-room Cottage at the disposal of the Sanitary Authority; or by arrangement made beforehand with some trustworthy Cottage- holders, not having children, that they should receive and nurse, on occasion, patients requiring such accommodation." I have endeavoured in Table V., p. 18, to tabulate the existing, and proposed, Hospital Accommodation in Banffshire. (c) Tabular Statements of Mortality. In Tables VI. and VII, pp. 19-20, I have embodied the information derived from the Returns the Registrars have kindly furnished me with for 1891. During that year 1107 Births and 511 Deaths were registered within the County of Banff, exclusive of Burghs. Of the 511 Deaths 90 occurred during the first year of life, and 215 were those of persons aged 60 years and upwards. In 54 cases the cause of death was not certified, and of these more than one-fourth were children under five years of age. [Page] 15 TABLE I. - Population and Acreage of Banffshire. [Table inserted]
HH62/1/BANFF/17 [Page] 16 TABLE II. - COMPARATIVE TABLE, for the purpose of showing the Annual Birth and Death Rates per 1000 of Population in Banffshire for 1891 and the previous ten years, as compared with the rest of Scotland for the same period. [Table inserted] [Page] 17 TABLE III. - Showing the Number of Cases of Infectious and Communicable Diseases (i.e., Preventible Diseases) which have proved fatal in the County of Banff during 1891. [Table inserted] TABLE IV. - Notification of Infectious Diseases in the County of Banff, July-December 1981. [Table inserted]
HH62/1/BANFF/19 [Page] 18 TABLE V. - Existing and Proposed Hospital Accommodation in Banffshire for Infectious Diseases. [Table inserted] [Page] 19 TABLE VI. - Births and Deaths occurring in the County of Banff during 1891. [Table inserted]
HH62/1/BANFF/21 [Page] 20 COUNTY OF BANFF, 1891. TABLE VII. - Density of Population, Birth Rate, Infantile and other Death Rates. [Table inserted] [Note] 5 County of Banff. FIRST OR BANFF DISTRICT. REPORT BY THE DISTRICT MEDICAL OFFICER OF HEALTH FOR 1891.
HH62/1/BANFF/23 COUNTY OF BANFF. FIRST OR BANFF DISTRICT. Report by the District Medical Officer, For 1891. Population at Census of 1891, -- 22,146 Population estimated to the middle of 1891, -- 22,154 Approximate Area in Acres, -- 122,000 Approximate density of Population, 0.18 persons to an Acre. Extent. - The district comprises 15 Parishes or Registration Districts. Two Royal Burghs and four Police Burghs are situ- ated within the District. Of the latter, three have been formed during the past ten years. I regret that, owing, first to having failed to get the exact extent of the areas embraced within the Burghs, and second, to the recent decisions of the Boundary Commissioners, which have altered more or less the boundaries and area of several of the Parishes, I am unable to give the exact Acreage of each Parish. Approximately the extent of the District is 122,000 Acres. Population. - In seven of the Parishes the population has increased, in eight it has decreased, during the last decade. On the whole the population has increased. Owing to want of information as to acreage, I am unable to give the density of population in the different districts, but hope to do so on a future occasion. 1. - General Sanitary State. Many different factors tend to influence directly or indirectly the sanitary state of a district. Its position, the nature of the soil and its conformation, the rainfall and meteorological con- ditions generally all affect it; but what we have principally to deal with are the conditions more immediately connected with the inhabitants - their occupation, their accommodation and im- mediate surroundings, the diseases most commonly met with
HH62/1/BANFF/25 [Page] 6 amongst them, and their vital statistics - Birth and Death Rates. Information on several of these points can be derived from books, annual returns and reports, but the information thus obtained we must look upon more as a hint or a guide to personal ob- servation and investigation In this District we have two very different sets of conditions to deal with, both as regards the density of the population, their occupation, and their surroundings. This is due to the geo- graphical position of the district. Its northern boundary is a coast line of about 30 miles in a straight line. Along this are situated a series of towns and villages varying in population from 300 to 6000. In all, 5 burghs and 8 villages are so situated, with a population of over 25,000. The villages, with which we are only concerned, contain a population of 7457, engaged principally in fishing. The rest of the district is purely agricultural, and contains only 3 or 4 small villages or hamlets, the majority of the inhabitants occupying isolated dwellings. As insanitary conditions and disease generally exist in direct ratio to the density of the population, my attention has been prin- cipally directed to the coast villages. Twenty years ago the sani- tary condition of such villages was, I believe, generally speaking, deplorable. Much remains to be done, but from what I have seen and heard, I think the condition of the fishing villages on the Banffshire coast will bear favourable comparison with those in many other parts of the country. Thanks to the action of the late Local Authorities, all those villages have been supplied with water. The old objectionable middens and ash-pits have been almost entirely done away with, public receptacles for refuse have been provided, and a system of removal instituted. Thanks to the recent action of the District Council, efficient scavengers have been appointed under the control of the Sanitary Inspector. But though much has been done, there still remains a great deal to do, especially in two or three of the villages. When first built, no regular plan seems to have been adopted, and the houses have been set down anyhow, many of them being built into the bank, badly constructed, damp, and too closely crowded together. Though water has been introduced, sufficient provision in most cases has not been made for getting rid of the waste water and for drainage. Drains of sorts have been constructed - stone- built as a rule, untrapped, and on no regular plan. I was more particularly struck by this state of matters in the villages above referred to. The operation of the Notification Act during the last six months, and the returns received from the Registrars for the past year, bear me out in the opinion I then formed, especially with regard to the village of Whitehills, in Boyndie Parish, where cases of infectious disease have been numerous. These data, however, for such a short period, might be considered insufficient. [Page] 7 Judged from its vital statistics alone for the past year, the sanitary state of the District should be good. The Birth Rate = 31.506 per 1000 of Population. The Death Rate = 14.17 per 1000 of Population. The Infantile Death Rate = 85.9 per 1000 Births. The Infectious Disease (Notification) Act was adopted by the Local Authority, and came into force on the 10th of July last. Between that date and the 31st December, 91 cases of Infectious Disease were notified, equal to 8.215 cases per 1000 of population for the year. The foregoing data, however, for one year only, are insuffi- cient to enable one to form a definite opinion, though, taken in conjunction with personal observation and investigation, they may help one to a tolerably accurate conclusion as to the sanitary state of a particular locality. We require similar data for a series of years to enable us to judge decidedly. The time at my disposal has not permitted me to enquire particularly into the history of disease in certain localities, but I hope to do something in this direction this year. The following table, which includes the urban as well as the rural population of the District, I have compiled from the annual reports of the Registrar-General for the past five years:- [Table inserted] 2. - General and Specific Inquiries. Since my appointment I have inquired into the sanitary state of the District generally, and more especially into that of the coast villages. 3. Advice Certificates and Offensive Trades. I have granted no advice certificates, and no action has been taken regarding offensive trades, or the sanitary condition of factories and workshops. 4. - Bakehouses. I have inspected eight Bakehouses situated within the Dis- trict. Lime washing is, as a rule, being regularly attended to. In the majority of cases, the water supply and sink are outside
HH62/1/BANFF/27 [Page] 8 the Bakehouse. In two cases the sink was within the Bakehouse - trapped, but not disconnected; but this has now been done in both cases. 5. - Hospitals. The Local Authority possess no Hospital of their own, if we except the two cottages - one at Buckie, and the other at Gar- denstown - which were provided by the previous Local Authori- ties in view of cholera being brought into the District some years ago. The cottage at Buckie is presently occupied as a dwelling-house. In Chalmers' Hospital, Banff, the benefits of which are free to inhabitants of the County, provision has been made for the reception of infectious disease. This institution possesses a de- tached Fever House, with two wards, four beds in each. Also, a detached Smallpox Hospital, with accommodation for four patients. Two wards in the upper storey of the wings of the main building have been used for the treatment of cases of typhoid fever. Each ward will accommodate four cases, and can be shut off from the rest of the building. The Hospital is pro- vided with a hand ambulance. The southern portion of the District will shortly be well provided with Hospital accommodation. The parish of inver- keithny is presently accommodated by the Forgue Hospital; and the Cottage Hospital now in course of erection at Aberchirder is to contain six beds for cases of infectious disease, from the parishes of Marnoch and Forglen. The western part of the Distict, including the populous parish of Rathven and the burghs of Buckie and Cullen, is entirely without Hospital accommodation for the reception of infectious diseases. 6. - Prevention of Infectious Disease. The Local Authority adopted the Infectious Disease (Notifi- cation) Act last June, and it came into operation on the 10th of July. Prior to that, though a few cases of infectious disease were discovered and attended to, we were without definite information as to its existence. The origin of all the cases that have been notified to me since the 10th of July have been inquired into by the Sanitary Inspector or myself. Instructions for preventing the spread of those diseases, and for disinfection, were drawn up, and a copy given to the householder at the time of our visit, with additional verbal instructions when required. Any sanitary defects were looked into by the Inspector, and steps taken to have them rectified. [Page] 9 When the patient was a scholar, or if any child of school age was an inmate of the infected house, notice was sent to the school, so that no child from the dwelling was allowed to attend school till declared free from infection. In all 91 cases have been notified, as shown in the annexed table. Four of those cases proved fatal. BANFF DISTRICT. NOTIFICATION OF INFECTIOUS DISEASE. 10th July to 31st December 1891. [Table inserted] 7. - Causes, Origin, and Distribution of Disease. Naturally my attention has been almost entirely directed to inquiring into the origin and causes of the diseases included under the Notification Act. Cases of Diphtheria have been the most numerous. In all 33 cases have been notified. Eighteen of these occurred in the parish of Marnoch. As I reported at the time, the disease first appeared in a family at Upper Culvie. A daughter suffered from sore throat, probably a mild attack of diphtheria, and infected a younger sister. The disease was unrecognised, no medical man being called in. The child returned to Culvie School, having been absent only two or three days, and infected another sister, a pupil teacher in the school, and her schoolfellows. In all ten families were affected; but, thanks to the hearty co-operation of the medical attendants, isolation and disinfection were strictly
HH62/1/BANFF/29 [Page] 10 carried out, as far as circumstances admitted, and, excepting the first family, in only one other did the disease spread. Three of the cases proved fatal. Eight cases of the same disease have been notified from Boyndie parish. Two of these were traceable to a third. The others were isolated cases. Three cases, affecting two families, occurred in the village of Cornhill. The first case appeared at the same time as the outbreak in Marnoch, but we failed to trace any connection. Twenty-five cases of Typhoid Fever have been notified. Eleven of these were from Boyndie parish, the majority being in the village of Whitehills. The four cases notified from Enzie occurred in Portgordon, and were imported from Fraserburgh. They were all members of the same family, and were ill when brought home. The two cases in Gamrie were also members of one family. The other cases notified were isolated ones. The Forglen case came from Aberdeen. Seventeen cases of Scarlet Fever were notified. Of the eight cases from the parish of Rathven, seven occurred in one family, one case proving fatal. Of the Portsoy cases, three occurred in one family. The Enzie case (Portgordon) was traceable to Aber- deen. Of Erysipelas, 12 cases were notified, and, in four instances, contagion from a previous case was proved. Four cases of Puerperal Fever were notified from the village of Whitehills Through the kindness of the Registrars, whom I take this opportunity of thanking, I have been furnished with returns of the Births and Deaths in the different Registration Districts for the past year. The information thus received I have embodied in Table I., which shows the distribution, according to Registra- tion Districts, of those diseases which have proved fatal during the year. 8.- Tabular Statements of Sickness and Mortality. On a preceding page (9), I have given a table of the Sickness within the District, so far as it has come to my knowledge through the operation of the Infectious Disease (Notification) Act, but this only includes some of the infectious diseases. The tables which follow are drawn up on the lines of those issued by the Board of Supervision. TABLE I. - Births and Deaths occurring in the Banff or Lower District of the County of Banff during the Year 1891. [Table inserted] * The District Asylum is situated in this Parish. Deaths occurring in that Institution belonging to other Parishes have been included in those Parishes, and an allowance made for the average number of inmates.
HH62/1/BANFF/31 TABLE II. - Density of Population, Birth Rate, Infantile and other Death Rates, in the Banff District. [Table inserted] [Note] 6 County of Banff. SECOND OR KEITH DISTRICT. REPORT BY THE DISTRICT MEDICAL OFFICER OF HEALTH FOR 1891.
HH62/1/BANFF/33 Elgin, February 6, 1892. To the District Council Of the Second or Keith District of the County of Banff. Gentlemen, In conformity with the Regulations of the Board of Supervision, dated May 1, 1890, issued in virtue of the authority conferred by Sect. 53 (1) of the Local Govern- ment (Scotland) Act, 1889, I herewith beg to present to you my Report for 1891, drawn up on the lines laid down in Sect. 1. of these Regulations. I have the honour to be, Gentlemen, Your obedient Servant, James A. Cameron, Medical Officer of Health.
HH62/1/BANFF/35 COUNTY OF BANFF. SECOND OR KEITH DISTRICT. Report by the District Medical Officer, For 1891. Population at the Census of 1891, -- 14,716 Population estimated to middle of 1891, -- 14,714 Approximate Area in Acres, -- 277,000 Approximate Density of Population, .053 Persons per Acre. Extent. - The District is divided into thirteen Parishes or Registration Districts. Two Police Burghs are situated within the District, with populations at last Census of 4622 and 1469 respectively. The exact areas embraced by these Burghs I have failed to ascertain. The recent decisions of the Boundary Com- missioners have added to the extent of several of the Parishes. The total area of the District, including the Burghs, is now 278,049 acres. Population. - The Census of last spring shows that in six of the Parishes the population has increased, and that in seven it has decreased, during the last ten years. On the whole, the population may be considered as about stationary - the decrease in the highland and out-lying parts being compensated for by the increase in the lower portion. 1. - General Sanitary State. In forming an opinion regarding the Sanitary State of any District many different points have to be taken into consideration.
HH62/1/BANFF/37 [Page] 6 These may roughly be divided into natural and artificial. The former include the physical conformation, the situation, the geology, and the meteorology of the District. The latter, and with them we are more immediately concerned, include the population, its density, the occupation of the inhabitants, the nature of their house accommodation and surroundings, the diseases most commonly met with amongst them, and how far the incidence of such diseases may be modified or obviated by hygienic measures. As a guide to these last-mentioned conditions, we have to make ourselves acquainted with the vital statistics of the District - the Birth and Death Rates, with the cause of, and age at Death. Knowledge regarding the foregoing points must be combined with personal observation and research. The District is an inland one. Generally speaking the population is sparse and a purely agricultural one, occupying detached houses. Only four large villages exist, with two or three smaller hamlets. The total village population may be set down at under 3000, leaving about 12,000 in the purely rural Districts. The villages are all fairly well supplied with water, and in one a system of sewerage has been introduced. Of late, much seems to have been done in the way of improving the cottage accommodation in some parts of the District, but a great deal still remains to be done, more particularly with regard to the surroundings of the dwellings. Judged from its natural conditions, the health of the District should be good, and in spite of the artificial conditions being, in many cases, not what they ought to be - thanks to fresh air and pure water - the vital statistics are satisfactory. During 1891, 409 Births and 197 Deaths were Registered in the District, giving a Birth-Rate 0f 27.8 per 1000 living, and a Death-Rate of 13.38. Thirty of the Deaths were those of infants under one year of age; so that the Infantile Mortality was equal to 73.3 per 1000 Births. Eighty-seven of the Deaths registered were those of persons aged 60 years and upwards. The Death- Rate, however, is no criterion of the amount of dishealth in a community; but from what I have been able to learn, this District has not suffered so severely as some others have of late. The Infectious Disease (Notification) Act was adopted by the Local Authority last May, and came into force on the 1st of July. Forty-six cases of the diseases scheduled under the Act were notified between July 1st and December 31st, equal to 6.25 per 1000 living. The various data given above, being for one year only, are not sufficient to enable us to arrive at a decided conclusion. For such a purpose, we must have similar data, extending over a series of years. The data as to the incidence of infectious disease in the District during past years is unfortunately unob- tainable; but the annual reports of the Registrar-General [Page] 7 enable us to calculate the Birth and Death Rates for previous years. The following table compiled from these reports shows what these rates have been for the District (including Burghs) for five years 1886-90:- [Table inserted] 2. - General and Specific Inquiries. Since my appointment, I have inquired generally into the sanitary state of the district, especially into that of the villages. Owing to a complaint as to pollution of the river Isla, the Sanitary Inspector and I inquired into the matter. Reference will be made to this in a future report. 3. - Advice, Certificates, Offensive Trades, &c. I have granted no Certificates. On account of complaints, partly as to an effluvium nuisance and partly as to pollution of the river Isla, the Sanitary Inspector and I inquired into the condition of a Slaughter-house and Manure Manufactory situated in Keith Parish. We found that the drainage was run directly into the Isla, with only a species of intercepting grease trap. The killing-house was built of wood. The water supply was deficient, and the killing and boiling sheds were not sufficiently ventilated. At a subsequent meeting with the Manager, he kindly agreed to carry our our suggestions as to treatment of the sewage, improved water supply, and ventilation. 4. - Bake-Houses. Five Bake-houses have been inspected within the district. Generally speaking, their condition is fair, but I found that lime- washing was not being attended to so frequently as it should, through ignorance of the provisions of the Act of 1883. 5. - Hospitals. The Local Authority possess no Hospital of their own for the treatment of cases of Infectious Disease.
HH62/1/BANFF/39 [Page] 8 The Infectious Wards of the Turner Memorial Hospital at Keith are open to Patients from the Parish and Burgh of Keith, the Parishes of Grange, Boharm, and Botriphnie. The Wards are two in number, with four beds in each. Adjoining the Hospital, a temporary one of Wood, containing similar accommodation, was erected some years ago by the Local Authority of Keith for the reception of Small-pox cases, and is still available. The rest of the district is unprovided with Hospital accommo- dation for the reception, isolation, and treatment of cases of Infectious Disease. 6. - Infectious Diseases. The Local Authority adopted the Infectious Disease (Notifi- cation) Act last May, and it came into force over the district on the 1st of July. Forty-six cases were notified between that date and the 31st of December. Their nature and distribution may be seen from the subjoined table:- KEITH DISTRICT. NOTIFICATION OF INFECTIOUS DISEASE, 1st July to 31st December 1891. [Table inserted] On the notification of each case, its origin was immediately inquired into by the Sanitary Inspector or myself, and measures [Page] 9 taken to prevent its spread. Printed instructions as to the pre- cautions to be observed and the means of disinfection were handed to the householder, and, if the patient, or any occupant of the dwelling was attending school, intimation was sent to the school, and the children kept from school till the termination of the illness and final disinfection of the premises. Of the cases notified, none proved fatal. In only two or three instances did any new cases occur in the same household. 7. - Causes, Origin, and Distribution of Disease. The time has been too short to enable me to report as to the Causes and Origin of Diseases within the District, except in the case of such as came to my knowledge through the operation of the Notification Act. Twenty cases of Scarlatina were notified. Of these, thirteen occurred in Aberlour Parish. In the majority of the cases, the source of infection could not be traced. Two of the cases were brought from Elgin. In one case, the infection was probably brought from Edinburgh; and in another, from Aberdeen. Next to Scarlatina, cases of Typhoid Fever were most numerous. Of the six cases in Keith Parish, two occurred in one family. The others were isolated cases - one probably im- ported. Three cases were reported from Aberlour Parish; but of these, two were imported - the one from Mortlach, the other from Archiestown, in Knockando; and from the latter, another inmate of the house was infected. From Mortlach Parish, three cases were notified. Three cases occurred in the same house; but one was removed to Aberlour. The origin of this outbreak was not traced. The other case, in Mortlach, occurred in a cottage with an unhealthy reputation, but the defects have been remedied. The case notified from Cabrach Parish came from Aberdeen; and the Boharm case was supposed to have got infection from Buckie. Nine cases of Erysipelas were notified; and in two of these, contagion was traceable to a previous case. Two isolated cases of Diphtheria were notified from Rothie- may Parish, and in both we failed to trace any connection with a previous case. Through the kindness of the Registrars, whom I take this opportunity of thanking, I have received information as to the number of Births and Deaths (with particulars of the latter) that have occurred in the different Registration Districts during 1891. This information I have tabulated (see Table I.) according to the form issued by the Board of Supervision, showing the distribu- tion of the various diseases that have proved fatal according to Districts.
HH62/1/BANFF/41 [Page] 10 8. - Tabular Statements of Sickness and Mortality. On a previous page, I have given a table to show the number and distribution of cases of Infectious Disease notified during the last six months of 1891. On the following pages, Tables of Mortality, &c., are given, showing ages at and causes of death in the District for the past year. Of the 197 deaths registered, 35, or 17 per cent, were due to diseases which may be classed amongst the communicable or preventible diseases. Twenty-five, or 12 per cent., of the deaths were uncertified. COUNTY OF BANFF. TABLE I. - Births and Deaths occurring in the Upper or Keith District during the Year 1891. [Table inserted]
HH62/1/BANFF/43 COUNTY OF BANFF - KEITH OR UPPER DISTRICT. TABLE II. - Density of Population, Birth Rate, Infantile and other Death Rates. [Table inserted] [Note] 7 [Stamped] BOARD OF SUPERVISION SCOTLAND RECEIVED 30 MAY. 92 [1892] County Council of Berwickshire. ANNUAL REPORT BY DR. ROBERT C. MACWATT, County Medical Officer. Year 1891. Ordered by the Council to be printed, 3rd May 1892.