Medical Officer of Health reports, 1891 - Clackmannanshire

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HH62/1/CLACKM/1 SEAL OF THE COUNTY COUNCIL OF CLACKMANNAN CLACKMANNANSHIRE COUNTY COUNCIL AND BURGH COMMISSIONS. ANNUAL REPORT OF THE Medical Officer of Health, (T. G. NASMYTH, M.D., D.Sc., D.P.H.,) FOR 1891.
HH62/1/CLACKM/3 COUNTY COUNCILLORS AND BURGH COMMISSIONERS. MY LORDS AND GENTLEMEN, I have the honour to present for your consideration my Annual Report as Medical Officer for the County and Burghs for the year 1891. The County by the alterations of the Boundaries Commissions has been considerably changed, and in consequence it is difficult to ascertain the exact acreage within the new boundary, but as far as I can make out there are 33,832 acres. There is the same difficulty in ascertaining the exact population, from the transference of portions from Stirling into Clackmannan, and from Clackmannan into Stirling, but as near as I can make out, the population within the County is 33,011, distributed as follows:- [table inserted] From the Census Returns (made on former area) we find that there were 6,220 families, living in 5,767 houses, with 17,212 rooms in all. In Clackmannanshire there is a mean of 1.6 persons to room with one window, in Fifeshire 1.4, and in Kinross-shire, 1.0. The complete details of the Census are not yet issued, but the following abstracts from the Census of 1881, will be interesting to compare with those of 1891 when they are issued.
HH62/1/CLACKM/5 [Page] 4 TABLE SHEWING NUMBER OF HOUSES IN EACH PARISH, POPULA- TION, AND NUMBER OF PERSONS PER HOUSE 1881. [table inserted] TABLE SHEWING PARISHES AND PARTS OF PARISHES IN COUNTY, ACREAGE, ROOMS, AND PERSONS TO ROOM WITH ONE OR MORE WINDOWS. 1881. [table inserted] These figures will doubtless be found not to agree with those which will be ascertained from the Census Returns of 1891, but at the same time they enable us to judge of the relative degrees of persons to room in the different parishes. In the remainder of this Report, the arrangement followed will be that prescribed by the Board of Supervision for District Medical Officers' Reports. GENERAL SANITARY STATE OF THE COUNTY, AND MEASURES WHICH SHOULD BE ADOPTED FOR ITS IMPROVEMENT. In this report it will be necessary to separate references to Burghal areas, which come under the jurisdiction of Police Commissioners, from District areas, which come under the County Council as Local Authority. It will be understood that the Sanitary condition of Burghs is generally better than that of rural districts, chiefly on account of the greater powers that Burgh Local Authorities have under the General Police Act. In the County of Clackmannan there are now four Police Burghs - Alva having been transferred by the Boundaries Commission into Clack- [Page] 5 mannanshire, and the town of Dollar having adopted the Police Act in 1891. BURGH OF ALLOA. The Burgh of Alloa, being the largest of the four, entitles it to first consideration. The general Sanitary condition of the town, as far as I have been able to ascertain in my short tenure of office, is very good. The water supply, formerly abundant for all purposes, having, by the increasing population and extension of trades, become insufficient, it was necessary to apply to Parliament for further powers to enable the Com- missioners to provide an additional supply, and to make and maintain new and additional water works. By the Alloa Water Act of 1891 these powers have been given. The sewerage system has been con- structed on good principles, and the outfall sewers discharge into the Forth. In many cases there is not proper disconnection between house drains and the main sewers, and waste pipes, soil and drain water con- ductors lead into the sewer without any break in their continuity. These defects are serious ones, and should be removed wherever they occur. In some parts of the Burgh, old defective privies are still in use, but arrangements are being made to have these substituted by some form of water carriage system. SPECIAL ENQUIRIES MADE. Complaints having been made that the Glass Works now and again emitted such noxious effuvia as to interfere with the comfort, if not the health of the inhabitants, it was remitted to me to enquire into the matter and report to the Commissioners. I accordingly made frequent visits to the Glass Works, and also visited similar works in Glasgow, in order to ascertain how the offence was produced, and how it might be obviated. The whole matter was fully reported to the Burgh Commis- sioners, and my suggestions were submitted to the Manager, who was most anxious that all ground for complaint might be removed. I also had the benefit of discussing the subject with Mr Falconer King, Edin- burgh, who was engaged by the Glass Works Company to advise them in the matter. I am sorry, however, to have to report that all cause for complaint has not yet been removed, although the smells complained of do not appear to continue so long or to be so offensive as formerly. ENQUIRIES INTO SMOKE NUISANCE. The subject of smoke nuisance was also remitted to me for con- sideration and report, and accordingly I visited all the works and trades in the Burgh and enquired into the manners of stoking, working of furnaces, &c. The whole subject of smoke consumption and abatement is an exceedingly difficult one to deal with, and meantime I have not sent in any special report. A great deal can be done to abate smoke by steady stoking in those cases where flue accommodation is sufficient. A great many different methods of dealing with the emission of black
HH62/1/CLACKM/7 [Page] 6 smoke have been tried, but without much success, but there are several forms of apparatus in the market which are said to be very satisfactory, and it may be useful to refer shortly to these. The most successful type of apparatus seems to be mechanical stokers, and of these the coking stokers of Vicar, Cass and Sinclair, seem to be the best, and the following is a short description of these three:- CASS'S FURNACE. - In this furnace the fuel gravitates from a hopper on to a large dead plate, where it is coked by the heat from a fire brick arch at front of flue. The combustible gases are ignited by the air which passes through the white hot clinker at the back of the bars. The bars come out one at a time for four inches and all go home together dragging the fuel with them. The rate of move ment is regulated so that nothing but clinker flows over the back of the grate. This system has been in use at Mr Herbert Fletcher's colliery, at Boston, for thirteen years, and is absolutely smokeless VICAR'S FURNACE, SINCLAIR'S FURNACE - Are similar in principle to Cass's, but have shorter fire bars and pushers to force fuel over the dead plate to the travelling bars Vicar's furnace is amongst other places on at the London Hydraulic Power Company's, the Liverpool Hydraulic Power Company's, Messrs Coates' Thread Mills, of Paisley, Messrs Musgrave's Cotton Mills, Bolton, all of which are practically smokeless. Sinclair's stokers at Penicuik Paper Works, Edinburgh, on a range of sixteen boilers, besides being smokeless, are estimated to have saved £1,500 in fuel in nine years. The results from these forms of mechanical stokers seem to be so good that it might be useful to make a practical trial of one of them in Alloa, as there certainly is need of some such remedy being adopted. INSPECTION OF BAKE-HOUSES. I have personally visited all the Bake-houses in the Burgh at least once, and several two or three times. The most were found to be in a satisfactory condition, and in accordance with Bake-house Regulations, under the Factory and Workshop's Act. There was one in a most un- satisfactory state, from the near proximity of a privy closet to the door of the Bake-house. The Bake-house itself was not so clean and tidy as it ought to, but after some pressure was brought to bear on the occupier the necessary alterations were carried out. COMMON LODGING-HOUSES. I have inspected these frequently, and cannot report that they are all satisfactory. There is one, at least, which is hardly fit to be used as a Common Lodging-House, from structural defects of the premises; and others are scarcely so well kept as they might be. These houses often becomes centres of infection, and hence the reason why they require careful supervision. DAIRIES AND BYRES AND MILKSHOPS. I have, along with Mr. Keith, made a point of visiting all the Dairies and Byres within the Burgh. This is a duty remitted usually to the Sanitary Inspector, but its importance demands the most careful attention of all those connected with sanitary administration. In the Sanitary Inspector's report full reference will doubtless be made to the condition of the Dairies and Milkshops within the Burgh, but speaking generally much [Page] 7 more attention is needed to cleanliness of Byres, Milkshops, and Milk vessels than is now given. In some cases no fault could be found to the various details of the business of a dairy-keeper, but this was by no means so universal as could have been desired. The Regulations for Dairies and Milkshops in force in the Burgh are sufficiently stringent for all purposes, although the cubic space allowed for each cow is small, viz., 500 cubic feet, but if the Regulations were acted up to there would not be much to complain of. REPORT ON BURGH HOSPITAL. I have made frequent visits to the Isolation Hospital, and made a report to the Commissioners regarding its present state, and its capability of being extended. At the present time there are only two wards, each capable of receiving six patients. As long as there were only one form of infectious disease prevalent in the Burgh this would be ample, but if there were, for instance, cases of scarlet and typhoid fevers, in different sexes, they could not be treated in only two wards. The internal ar- rangement of the wards and rooms is not good, nor are the general sanitary arrangements in conformity with present-day ideas. One very great defect is the want of a disinfecting apparatus, so that clothing of patients cannot be disinfected before they return home, or bedding dis- infected before the bed is occupied by another case. The whole question of improved Hospital accommodation for the Burgh of Alloa and for the whole County was considered at a joint-meeting of representatives from the Burghs and County Council, and at present there are indications that a satisfactory arrangement will be come to. The advantages of a Com- bination Hospital have been pointed out already by me, and it is not necessary therefore to refer further to this matter. INSPECTION OF MEAT. I have made frequent visits to the Slaughter-house with the object of inspecting any carcases there, whether there was reason to suspect their quality or not, as the mere fact of such a supervision being exercised has a good effect. On one visit the whole carcase of a cow was con- demned, as the animal had suffered from advanced tuberculosis. There could be no doubt this animal should never have been sent to the Public Slaughter-house as intended for human food. On a recent inspection, as reported to the Burgh Commissioners, I had to order the destruction of some of the internal organs and a con- siderable portion of the carcase, as I found evidences of disease in these. After I had made a microscopic examination of a piece of the diseased tissue, I found that the disease was what is called, popularly, "Wooden Tongue," from the pecular hardness it causes when the tongue is affected. The carcase otherwise was in excellent condition, and certainly had been purchased as a sound animal. EPIDEMIC OF SCARLET FEVER. An epidemic of scarlet fever of a mild type prevailed during the months of September and October, and gave rise to a considerable
HH62/1/CLACKM/9 [Page] 8 amount of alarm in this town, but the fatality was very low indeed, as will be found in the death statistics in the appendix of this report. The Notification of Infectious Diseases Act has not been adopted in the Burgh yet, and this was a great disadvantage, as it was difficult to hear of cases as they occurred, and I had no exact idea how many cases actually occurred. I sent notices to the medical men in town asking them to kindly intimate any cases of scarlet fever in their practices, and notices to schoolmasters not to allow children to attend school from in- fected houses, until they produced medical certificates certifying that they were free from infection. One school, where a number of children had been infected, was fumigated with sulphur, and the wood-work washed with strong carbolic soap. Printed directions for the isolation and dis- infecting of cases affected were sent to all houses where scarlet fever was known to be. I had a meeting with members of the School Board regarding the propriety of closing the schools, but after deliberation we considered not to do so, as there were indications that the outbreak was disappearing, which proved to be correct, and in a short time no fresh cases were reported. I would again advise the Burgh Commissioners of the desirability of adopting the Notification of Infectious Diseases Act, as by early intimation of cases it is alone possible to stamp out an epidemic such as this at the commencement. TYPHOID FEVER. Only two cases of this disease have come to my knowledge, and they exemplify the dangers which I have referred to from soil pipes and rain water conductors discharging into the main sewers without any dis- connection, as into the room where the cases were, sewage emanations must have found entrance, the rain water pipe opening just below a window, and not being trapped off from the sewer. The total deaths from Zymotic diseases for the whole parish of Alloa were 10, and for a population of 13,734 estimated to the middle of 1891, gives a zymotic death rate per 1000 per year of 1.4. At the end of this report will be found the statistics of the Parish of Alloa, separate from those of the whole County, as the population is sufficiently large to give a basis for calculating free from the statistical errors which occur when rates are calculated on too small a population. BURGH OF ALVA. The general sanitary state of the Burgh is very good indeed. The water supply is by gravitation, and is supplied from a covered-in reser voir and filtering tank at the base of the hill from where the water is collected. The sewerage system is apparently well constructed, but owing to the soil being mossy subsidence occurs occasionally. The ventilation of the sewers is effected by manholes from the crown of the sewer, opening on to the surface of the streets. These ventilators were at one time supplied by charcoal trays, but have now been removed. [Page] 9 Owing to the flatness of some of the gradients blockages occur in the sewers, and some extra means of flushing should be adopted, such as by Field's automatic flushing tanks. As the sewage must pass into the Devon, there should be some means adopted to purify the sewage, such as by irrigation or by some other practicable method. The streets are wide and very well kept. There is a considerable number of large uncovered ashpits, which should be entirely done away with in a Burgh otherwise so well attended to as Alva, and the pail system adopted, with the daily removal of the contents by the scavengers of the Burgh Commissioners There is a considerable number of pig- styes in the Burgh not kept so as to be free from offence, and as under the General Police Act there is no difficulty in dealing with these, the Commissioners should only sanction the continuance of those that are scrupulously well attended to and free from offence. The Bake-houses in the Burgh are very well kept indeed, and one is really a model of its kind. The question of a common Slaughter-house has been the subject of several meetings with representatives of the Commissioners and myself, as those at present in use are private ones, and at any time I have in- spected were not in a very sanitary state. The most satisfactory ar- rangement would be for the Commissioners to take advantage of their powers, and provide a Slaughter-house which would enable much better supervision to be made over the meat supply than in private Slaughter- houses. If a common Slaughter-house is not provided, the Commis- sioners would secure much better management in others by the adoption of bye-laws such as are in force in the County. HOSPITAL FOR INFECTIOUS DISEASES. The question of Hospital accommodation at present is under con- sideration by representatives of the various Burghs and the County Council, and I trust that this matter will be so arranged that the Burgh will be able to secure means of isolation for any infectious cases which may occur, proportionate to its population. I would suggest that notwithstanding that there is no means yet for isolating infectious cases, the Notification of Infectious Diseases Act should be adopted in the Burgh, as by that means alone is it possible to hear of infectious cases as they occur, and to adopt precautions in time to prevent their spread. MORTALITY STATISTICS. The population of the Burgh is too small to calculate death rates on free from grave sources of error, as what might be termed accidental causes turn the results one way or another. During the past six months there have only been 56 deaths in the Burgh, and eleven of these were under 5 years of age, or 19 per cent. of the total. Two of these were due to influenza, one to a nervous disease, six to respiratory diseases, and two to other causes.
HH62/1/CLACKM/11 [Page] 10 Of the 46 above 5, twenty-six were upwards of 60 years of age, six died from tubercular disease, and three from cancer or other malignant disease. There were no deaths from zymotic diseases. Judging by the mortality, the Burgh of Alva is in a very satisfactory state, and the deaths have been swelled by influenza and respiratory diseases consequent to the epidemic. These latter are examples of accidental causes, which introduce disturbing influences on death rates calculated on too small a population. BURGH OF DOLLAR. I have made only two visits to the Burgh of Dollar, and as far as I can judge from these a good deal has to be effected in Dollar by the Commissioners to put the Burgh in a sanitary state. The Water Supply and Drainage systems are apparently satisfactory, but the method of Sewage disposal requires improvement, as the irriga- tion field has been too long in use, and has got into a state in consequence by which sufficient purification is not secured. The pail system is being introduced, and through time the ashpits and privies at present used will doubtless be removed. Several Common Lodging-houses are not fit to be used as such, and as far as I can ascertain they have not been registered, and hence their owners are acting illegally in using them for these purposes. The Slaughter-houses on my visit were in very unsanitary condi- tion, and the Commissioners should adopt bye-laws to regulate these and any others that may be erected. A considerable number of houses in the Burgh are not in a sanitary condition, but I have not yet reported on these, but intend doing so. The population of the Burgh is too small to calculate death rates on, but the following table will show what deaths occurred at different ages in the parish of Dollar from 1st July to 31st December, 1891:- [table inserted] [Page] 11 BURGH OF TILLICOULTRY. At the request of the Burgh Commissioners I reported fully on the Sanitary state of the Burgh. This report dealt specially with the want of a proper Sewerage system, and the evils of the present system of Drainage. At the present time Drainage is provided for by surface channels, and for a town of the size and importance of Tillicoultry this is a very unsatisfactory method. In addition to the evils of such a system, the want of proper sewers perpetuates the use of old-fashioned privies, and the retention for too long periods of dangerous putrescent matters. However well constructed and well attended to, privies are at all times most objectionable, but until sewers are constructed no other system can be carried out, unless the use of earth closets were intro- duced, but this system is more difficult to manage and more easily put out of order than the "water carriage" method of sewage removal. On the principle of the water carriage system excretal matters and liquid refuse are removed from the vicinity of houses as quickly as possible; while under the system at present in operation such matters are stored up, so that they necessarily give off deleterious gases, which pollute the air, while the liquids soak into the soil and pollute both it and the ground air. The evils of this system are well known, and epidemics of typhoid fever and diarrhoea are frequently traceable to the pollutions of air, water, and soil, which it produces. WATER SUPPLY. The Water Supply for Tillicoultry was most severely taxed during the unusual drought of last summer. This test was probably a more severe one that may occur for years again, and it may not be a fair one to judge the sufficiency of the water supply by; but for the exigency produced by a long drought there is not sufficient storage capacity for a water supply for trade and domestic purposes, and the former requires an unusually large quantity. The Ochils form a very fine collecting ground, and the water derived from them must be of very fine qualify, as there are no sources of pollution on their slopes, but owing to drain- age of the fields the ground does not store up the water so long as it formerly did, but allows it to run away quickly and come down in greater abundance at times when it is least needed. There would not be much engineering difficulty in constructing a reservoir in one of the ravines on the hills, which would provide the storage for which the Burgh now stands in need. The want of water power for the machinery in the various manu- factories was much felt during last summer, and this is a matter which intimately concerns the welfare of the inhabitants, many of whom are connected with the staple industry of the town. INSPECTIONS OF BAKE-HOUSES AND SLAUGHTER-HOUSES. The Bake-houses and Slaughter-houses have been visited by me, and I have nothing to report about the former, as they were in con- formity with the Act. The Slaughter-houses are not in a very satis-
HH62/1/CLACKM/13 [Page] 12 factory state, and probably the best arrangement, if it could be carried out, would be to have a Public Slaughter-house for the Burghs of Tilli- coultry and Alva. HOSPITAL ACCOMMODATION. This question is at present under consideration, and my advice has been already given, that on the grounds of economy and good manage- ment a Combination Hospital for the Burghs and County would best meet these considerations. VITAL STATISTICS OF THE PARISH. Since 1st July to 31st December there were intimated 37 deaths, and at the following ages:- [table inserted] Four deaths were due to zymotic diseases, four to influenza, three to tubercular diseases, two to cancer, and five to respiratory diseases. Other causes bringing up the total to 37. LANDWARD DISTRICT. The report so far as only referred to Burghs, which of course are not under the administration of the County Council, and the remainder will deal with that part of the County administered by the Council. At the last Census the population within the new boundaries was 33,011, distributed between Burghs and Landward districts as follows:- Burghal Population, ... ... ... ... 21,682 Landward Population, ... ... ... 11,329 Total, ... ... ... ... 33,011 [Page] 13 GENERAL SANITARY CONDITION OF DISTRICT. I have already reported to the Council, at the request of the Chairman of the Public Health Committee, on the Sanitary condition of all the populous places in the district, and as these reports were printed and circulated it is not necessary to enter into details regarding the various places reported on. It would be evident from these reports that in nearly all these places there were defective water supplies. Tullibody, Menstrie, and Sauchie fairly well represent the general conditions prevailing as to water supply, and there it is derived from shallow wells in close and dangerous proximity to sources of pollution. It is no unusual thing to find in these villages a well used for supplying water, and within a few feet of it an ashpit, a pigstye, or a byre. At Menstrie there should not be difficulty experienced in getting a good gravitation water supply, and at Tullibody, after Gartmorn reservoir is extended, a branch from Alloa main might possibly be obtained. In these reports already referred to, the condition of the villages as to drains and sewers was referred to, and in few is there sufficient pro- visions for these. Clackmannan village may be specially mentioned, and Duke Street, where the surface channels run into a cesspool at the foot of the row of houses. The question of cleansing and scavenging of these villages is a very important and difficult one, and as the power of a Local Authority under the present Public Health Act is limited, the burden of providing for these must be thrown on the owners and occupiers of property, and ex- perience shows that then this is not carried out as efficiently as it ought to be, and accumulations of foul and offensive matters result in consequence. Wherever people are congregated together, it is only by scrupulous attention to cleanliness in the very general meaning of the term, that their health can be preserved. The powers of a Local Authority, how- ever, do not permit them to undertake uniformly the cleansing and scavenging of villages, unless under the General Police Act, and under these circumstances it will necessitate the constant and vigilant attention of the Sanitary Inspector to see that owners and occupiers of houses each perform their part in adopting the necessary means to prevent undue accumulations of house refuse and other dangerous matters near to dwelling houses. The general condition of the houses of the working classes is fairly good, although in some of the villages there are houses which will require considerable alterations or additions before they will come up to the standard of efficiency necessitated by the Act of 1891 dealing with the housing of the working classes. Under this Act it is imperative that the Medical Officer of Health report on all houses in the district which are not in a sanitary condition, and unless they are made so, the Local Authority may apply for a closing order, so that they cannot be occupied until the necessary improvements have been effected.
HH62/1/CLACKM/15 [Page] 14 A STATEMENT OF THE GENERAL INQUIRIES MADE DURING THE YEAR, AND OF ANY SPECIAL INQUIRIES AS TO SANITARY MATTERS. Since my appointment I have visited all the populous places in the County several times, in order to become acquainted with their general sanitary condition, and reports have been submitted to the County Council, giving accounts of the provision of water supply and drainage for these places. A special report dealt with the insanitary conditions produced by the extensive keeping of pigs in the County, under conditions which were highly injurious to the public health. Pig keeping is carried on most extensively in the County, due no doubt to the facilities for obtaining spent grain for food from the various breweries and dis- tilleries. As long as the animals are kept clean and free from offence, no fault can be found, but when, as commonly is to be found, no care is taken to keep the animals clean, and that the places in which they are kept are in close proximity not only to dwelling houses, but to the sources of the domestic water supply of these, are most urgent reasons why they should be found fault with, and attempts made to remove the evils. The report contained the following suggestions to pig-owners, and these were printed and circulated throughout the County:- 1. The pig-stye to be as far removed from a dwelling house as is possible, and in no case to abut upon, or communicate with, any part of a dwelling house. 2. Where several pigs are kept, the house should be built of brick or stone, and ventilated from the roof. 3. The flooring should be made of concrete, and lead into a proper drain or cesspool. 4. The pig should be washed at least once a week, and supplied with clean litter frequently. 5. Manure should not be allowed to accumulate, but removed daily to a place well removed from any dwelling house. 6. On no account will pigs be allowed to be kept in a byre where a cow is kept. There have been some alterations made since these recommenda- tions were published, but in many cases no attempts have been made to act up to them, and seeing that conciliatory methods have failed to secure the object in view, recourse will have to be made to legal means. A GENERAL STATEMENT OF ANY MATTERS AS TO ADVICE OR CERTIFICATES, INCLUDING ANY ACTION AS TO OFFENSIVE TRADES AND THE SANITARY CONDITION OF FACTORIES AND WORKSHOPS. Since my appointment in May, Regulations for Byres, Dairies, and Milkshops, have been drafted and printed, and also Regulations for Slaughter-houses, and it is to be hoped that by attention to these the general conditions of cleanliness and better structural arrangements of these premises will be secured. [Page] 15 The question of a Knackery, which was proposed to be erected at Tullibody, was before the Council, and as I had visited the spot where it was proposed to be erected, and found that it was nearly 500 yards from Tullibody, and the applicant was quite prepared to construct it entirely to my satisfaction, I advised that permission should be granted. As opposition to the proposal was made by some of the inhabitants of Tullibody, and an appeal sent in to the Board of Supervision, Mr Malcolm McNeil visited the place, and afterwards discussed the matter with me, and we, taking all the circumstances into consideration - some of which I did not know before - agreed that the applicant must seek some place for the Knackery beyond the 500 yards limit. A Knackery has now been established in a place where permission was not necessary for its erection. I have not any action to report regarding the sanitary condition of factories and workshops. AN ACCOUNT OF INSPECTIONS OF BAKEHOUSES IN THE DISTRICT, AND OF ANY PROCEEDINGS TAKEN WITH REGARD TO THEM. There are not many bakehouses in the district outside the Burghs, and those that I have inspected were all in a pretty fair condition - structurally. Some were in need of the periodical lime-washing, and one had an untrapped drain opening into it. Under the Bakehouses Regulations in force, the Medical Officer has very little power to insist on the thorough sanitary condition of premises in which such an im- portant article of food as bread is prepared, unless the Bakehouse has been let or occupied since 1st June, 1883. Why Bakehouses in use before this date should be allowed to be in worse insanitary condition than those sub- sequently, is difficult to understand. SUPERVISION OVER HOSPITAL. There is no Hospital in the County under the supervision of the County Council, but negotiations are in progress for a Combination Hospital for the County and Burghs, and it is to be hoped that these will come to a satisfactory result, and a Hospital situated at some con- venient place will be provided. The various arguments for such a Hospital were dealt with in a report on Hospital accommodation which I submitted to the County Council, and it is therefore unnecessary to again refer to them. INFECTIOUS DISEASES IN DISTRICT. The Notification of Infectious Diseases Act has not yet been adopted in the County, and hence it is not possible to give an account of all the cases that may have occurred during the past six months. There were several cases of scarlet fever in the village of Menstrie, one occurring at a dairy, and before we got intimation of this the sale of milk had been going on as usual, but after this all communication between the infected
HH62/1/CLACKM/17 [Page] 16 person and the milk supply was cut off by a milkhouse being secured away from the house, and a person to carry on the dairy operations being engaged from outside. The usual precautions to isolate this and the other cases were adopted, and printed directions for isolation and dis- infection were left at all houses where cases occurred. There have been several other cases of scarlet fever over the dis- trict, and some of these proved fatal. I am not aware that any other type of infectious disease has occurred since May. STATEMENTS OP MORTALITY AND DEATH RATES IN THE COUNTY. In the following table are given the death rates of the various Parishes in the County from 1881 to 1890. It will be seen that these vary very widely, according to whether the population is sparse as in Dollar, or dense as in Alloa. The death rates on the whole are high, 50 per cent. being at or above 17 per thousand, which might be considered a favourable death rate. CLACKMANNAN PARISHES DEATH RATE from 1881 to 1890. [table inserted] [Page] 17 In the following tables, the mortality and death rates for the Parish of Alloa are given, as the population is sufficiently large to calculate death rates on, free from the errors which otherwise occur. 1891. PARISH OF ALLOA. Mortality according to ages. [table inserted] Mortality according to Diseases, under or above 5 years:- [table inserted] Birth Rate, Infantile, and other Death Rates. [table inserted]
HH62/1/CLACKM/19 CLACKMANNAN. Births and Deaths occurring in the District since 1st July, 1891. [table inserted] Density of Population, Birth Rate, Infantile, and other Death Rates. [table inserted] [Page] 19 VITAL AND MORTALITY STATISTICS. In the charts appended to this Report are shewn the total death- rates and the zymotic death-rates of the whole county for 10 years. For comparison with the conterminous counties of Kinross and Clack- mannan, the corresponding death-rates for these counties are also given. The dotted line representing the death-rate for Clackmannanshire begins at the year 1878, with a death-rate of 20.7 per thousand of estimated population, and reaches 20.9 in 1879; from this it falls to 17.0 in 1881, and rises to 19.5 in 1883. Next year it has fallen to 16.5, and for the last three years it remains about 19. This chart upon the whole indicates that the death-rate in the county from 1878 to 1887 has not been very high. In the chart representing the zymotic death-rate shows great fluctuations. In 1878 there was a high zymotic death-rate, but it fell till 1881, after which there was a rise. In 1885, 1886 and 1887 the zymotic death-rates were too high. In separate tables are shewn the total death-rates, the infantile death-rates, and other special death-rates during the last six months of 1891, calculated for the year, The total death-rate is not high, nor is the infantile death-rate, and the other death-rates are not unusual. In the table of Mortality it will be seen that a large proportion of people 60 years old and upwards succumbed during the last half of 1891. The death-rates for the Parish of Alloa are, as might be expected, higher than the death-rates for the whole county, as the effects of a dense population as in the Burgh of Alloa come into operation. The total death rate is high, 20.3, and the zymotic death-rate is higher than for the whole county. The epidemic of Scarlet Fever accounts for 4 deaths. In going over the death returns for the Parish of Clackmannan I was struck with the large number of deaths of children under 1 year, and with this fact, that many of them were illegitimate. It would be of interest to know if these infantile lives had been insured or not.
HH62/1/CLACKM/21 TABLE SHEWING DEATH RATE PER 1000 OF POPULATION IN FIFE, KINCROSS, & CLACKMANNAN FROM ZYMOTICS. [table inserted]
HH62/1/CLACKM/23 TABLE SHEWING DEATH RATE PER 1000 OF ESTIMATED POPULATION IN FIFE, KINROSS, & CLACKMANNAN FROM 1878 TO 1887. [table inserted]