| HH62/1/DUMFRI/1 |
REPORT.
The County of Dumfries covers an area of 1103 square miles,
or 705,945 acres, of which 20,427 are foreshore and 5301 water.
From west to east its extent varies between 21 and 46 miles, and
from north to south between 13 and 32. The western, northern,
and part of the eastern boundaries are mainly mountain watershed;
while the south-western, southern, and south-eastern consist re-
spectively of the rivers Cluden and Nith, the Solway Firth, and the
Sark, Esk, and Liddel waters. It contains the three great valleys
of Nithsdale, Annandale, and Eskdale, which are traversed by the
Nith, Annan and Esk as they flow southwards to lose their waters
in those of the Solway. The northern parts may be best described
as "prevailingly upland," with high hills and small glens and vales.
As one passes southwards these hills tend to become less lofty, and
the glens broaden out into the larger valleys, which in their turn
become almost level plains, varied by occasional low hills, most
prominent among which are those of the range in Tinwald, Torthor
wald, and Mouswald that forms one of the boundaries between the
plains of Nithsdale and Annandale.
The rocks are chiefly Silurian. Along the northern boundary
of Upper Nithsdale representatives of the Lower Old Red Sand-
stones are met with. Upper Old Red Sandstones form a fringe
underlying the Carboniferous rocks from the County boundary east
of the Ewes Water south-westwards by Langholm to Brunswark.
Carboniferous rocks are found in the district between Langholm and
Ruthwell, in Closeburn, Keir, and Morton, and in the neighbour-
hood of Sanquhar and Kirkconnel.The Sanquhar coalfield is stated
to be about nine miles in length and from two to four in breadth.
Permian strata occur at Moffat, Lochmaben, and Corncockle Moor,
between Annan and the mouth of the Esk, and in the Dumfries and |
| HH62/1/DUMFRI/3 |
[Page] 2
TABLE I.
Mean of Meteorological Observations at Drumlanrig and at Cargen (Kirkcudbrightshire).
[Table inserted]
[Page] 3
Thornhill basins. Igneous rock occur here and there, a large zone
existing in Middlebie, Hoddom, and Dalton to the north of the
Carboniferous.
The climate is variable, but on the whole mild. Of the 55
meteorological stations whose returns appear in the Quarterly
Reports of the Registrar-General, two are in Dumfriesshire, one at
Wanlockhead, the other at Drumlanrig. The Cargen station,
though outside the confines of the County, is so near that for all
practical purposes it may be regarded as within. Table I. is com-
piled from the Drumlanrig and Cargen returns, none having
apparently been made from Wanlockhead during 1891. It may
be considered to give a fairly accurate summary of the meteoro-
logy of Lower Nithsdale during last year.
NOTES.
BAROMETER - Mean Reading for the Year --- 29·889
Mean Highest of Month for the Year (February), --- 30·382
Mean Lowest of the Month for the Year (October), --- 29·633
THERMOMETER - Mean Temperature for the Year, --- 46·2·°F.
Mean Daily range for the Year, --- 15·4°F.
HYGROMETER - Mean of Dry Bulb for the Year, --- 46·8°
Mean of Wet Bulb for the Year, --- 44·7°
Mean Humidity, --- 85
Months of Greatest Humidity (January,
November, and December), --- 91
Month of least Humidity (June), --- 77
WINDS - Direction - N. 45 days. S. 68 days.
N.E. 34 days. S.W. 55 days.
E. 39 days. W. 53 days.
S.E. 24 days. N.W. 48 days.
Pressure - Mean Highest of Month (March), 2·25 on square foot.
Mean Lowest of Month (August), 0·56 on square foot.
RAIN - Aggregate Rainfall for the Year, --- 47·37 inches.
Number of Days it fell, 146.
Maximum Rainfall in Month (October), --- 9·51 inches.
Minimum Rainfall in Month (February), --- 0·19 inches.
Mean Rainfall for Scotland in 1891, Average
over 55 Stations, --- 39·27 inches.
For Local Government purposes the County is sub-divided
into six Districts - two in Nithsdale, three in Annandale, and one
in Eskdale. The general sanitary condition of these may be most
conveniently discussed under the heads of House Accommodation,
Water Supply, Disposal of Refuse, Pollution of Rivers, and
Industries, after which the Infectious Diseases and Vital Statistics
may be considered. |
| HH62/1/DUMFRI/5 |
[Page] 4
HOUSE ACCOMMODATION.
The total area of the six Districts, excluding burghs, fore-
shore and water, is 679,879 acres, or slightly more than 1062 square
miles. At the recent Census the inhabited houses were 9650 in
number and the population 47,115, giving an average of nearly
4·9 persons to a house. The numbers for each District were as
follows:-
--- Acreage --- Inhabited Houses. --- Rooms. --- Population.
Thornhill --- 214,348 --- 2,585 --- 10,032 --- 11,910
Dumfries --- 76,445 --- 2,106 --- 7,885 --- 11,137
Annan --- 83,203 --- 2,156 --- 8,185 --- 10,495
Lockerbie --- 79,035 --- 1,377 --- 5,498 --- 6,484
Moffat --- 91,622 --- 588 --- 2,703 --- 3,046
Langholm --- 135,226 --- 838 --- ? ---6,043
Many of the houses have been returned as having only one room,
but the majority have two or more. This, however, is a point on
which I hope to have further information for a future Report. The
number of complaints that have been made to me directly of insanitary
conditions actually existing in dwelling-houses has been small, but
an inspection, which since the appointment of assistants we have
been able to carry out in a more systematic manner than we could
formerly have attempted, reveals in not a few of them defects of
construction and arrangement that may more or less seriously affect
the health of the inhabitants. Chief among these may be men-
tioned the want of proper provision for the prevention of damp,
want of proper drainage, the too close proximity of byres, pig-
styes, and midden heaps, and generally the want of suitable privy
accommodation. Clay floors have not yet entirely disappeared
from houses tenanted by the working-classes. In new houses one
might look for damp-courses, but they are seldom visible, while a
less frequent and more easily remedied fault is the absence of rain-
gutters and pipes to roofs. These defects form a serious evil in
dwellings situated on wet and retentive soils in low-lying situations.
To many houses there is no drainage whatever, and slops are got
rid of by being thrown on the surface or along with solid refuse
into an ashpit, too often in close proximity to a well. Where
drains are provided they are frequently constructed of ordinary
field tiles, which are by no means suited for the removal of liquid
filth. In a few houses, but chiefly better class ones, are internal
sinks and water-closets. Where there is a good and reliable supply
[Page] 5
of water these are probably convenient, but where the supply is
not reliable (e.g., in cases where it is gathered from the roof) they
may constitute a dangerous nuisance. Trapping and disconnection
of closets and sinks are sometimes neglected. In older houses one
may expect to find occasional examples of this, but it was with
some surprise that I observed last summer in new houses, the
erection of which was just finished, the kitchen sinks directly con-
nected by untrapped pipes with drains constructed of field tiles,
which were carried within a few yards of a well, and into a stream
about forty yards above a point where houses lower down took
water for certain domestic purposes. The great want of privy
accommodation is at present receiving the attention of the Sanitary
Inspector and the assistants, and a very considerable improvement
is likely to be effected ere long.
As a result of our inspection, one house in the Thornhill
District was declared uninhabitable, and proceedings to have it
closed ordered to be taken by the District Committee. A new
building now occupies its site. There are certain other houses in
the County which are in such a state of disrepair that they may
require to be dealt with in the same way. One in the Lockerbie
District is so often visited by fever outbreaks, and is in such an
insanitary condition, that it may be considered a veritable plague-
spot, and it is doubtful whether mere patching will ever put it
right.
Three schools - Brownhall (Dumfries), Boreland (Hutton), and
Moniaive - were examined and reported on at the request of the
respective School Boards. At the Brownhall School some of our
recommendations have been carried out. One or two, particularly
the removal of a leaky cesspool from the play-ground, still remain
to be done. At Boreland, earth-closets acting automatically have
been substituted for the old privies, which had become abominable
nuisances. The earth-closets are giving every satisfaction, and we
were therefore encouraged to recommend them to the Glencairn
Board as a substitute for the water-closets at Moniaive School. In
country districts I am certainly of opinion that, if regularly
attended to, they are far more wholesome than any other form of
closet and less productive of nuisance. They get rid of the pollu-
tion of streams which water-closets are apt to cause, and it is not
by any means a difficult matter to keep them clean and free from
odour. They might with advantage be introduced by other Boards
in the County. |
| HH62/1/DUMFRI/7 |
[Page] 6
My experience so far leads me to the belief that it would be
well for the health of the County if the powers of District Com-
mittees over insanitary houses were extended. They certainly
ought to have at least equal powers with Burghs, and ought to be
able to prevent the erection of new buildings, whether they are
dwelling-houses or farm steadings, that are not planned and con-
structed on sound sanitary principles. Several factors and
builders have already begun to consult, in a somewhat desultory
fashion perhaps, the Sanitary Inspector and myself in regard to
these, and I do not think it would involve any hardship to have all
builders ordained to submit plans to a regularly appointed Sub-
Committee of the County Council or a District Committee (which
would be advised by the Sanitary Inspector) before erection of
such structures was sanctioned.
WATER SUPPLIES.
These have occupied much of our attention during the year.
The majority consist of springs and surface wells, but in not a few
instances streams and even land drains have to be utilised. A few
deep wells exist, and quite recently a very excellent Artesian well
has been sunk at the Crichton Asylum. Springs and deep wells
usually give a wholesome supply. Streams in upland districts
receiving no polluting material may also be considered as likely to
yield a wholesome, though perhaps not so palatable, water.
Streams in more populous parts, surface wells, and land drains
have to be regarded with suspicion. The River's Pollution Com-
missioners in fact class surface or shallow well water as
"dangerous." They are so situated as to attract all sorts of
impurities both in solution and suspension, and of very few of
those which we examined can it be said that they are safe or above
suspicion. Gravitation schemes have been laid down at Kirk-
connel, Crawick Bridge, Thornhill, Penpont, and Moniaive in the
Thornhill District, at Eaglesfield in the Annan District, and at
Bankshill and Boreland in the Lockerbie District, while a combined
pumping and gravitation supply is to be found at Blackshaw in
Caerlaverock. Of these, Penpont, Blackshaw, Eaglesfield, and
Bankshill are Special Districts under the 89th section of the Public
Health Act, 1867. There is in addition a number of small gravita-
tion supplies to isolated houses.
In the Thornhill District I have had opportunities of examin-
ing the Penpont and Moniaive supplies. The former is brought
[Page] 7
from a spring near the base of Tynron Doon, and appears to be of
a very excellent quality. The latter is really surface water, an
intake well being formed by the side of the Craigdarroch Water,
and a supply collected by lateral filtration. It is, I consider,
liable to contamination, both vegetable and animal, but more pro-
bably the former, as the intake is situated at the lower end of a
plantation. This opinion is to some extent borne out by an
analysis which was made recently at my instigation. I am, how-
ever, bound to admit that the chemical analysis was not so con-
demnatory as a biological examination made by myself. Four
drops of the water put with the usual precautions into a tube of
gelatine produced within a few days a large number of colonies of
putrefactive bacteria which liquefied the gelatine and gave rise to
very unpleasant odours. Four drops of water from the cistern on
the Craigdarroch road had the same effect. Filtration might get
rid of such contamination, but it would be preferable to take
spring water if it can be got, and I should imagine that in such a
district there ought not to be much difficulty in finding one suit-
able for the wants of Moniaive. In addition to the gravitation
supply, Moniaive has several pumps, one of which, situated at the
Cross, is a favourite with some of the villagers. An analysis of a
sample taken on December 22nd showed that there was some con-
tamination. Here again the biological examination was more
condemnatory than the chemical, numberless colonies of putrefactive
organisms having been found. There is a legend in the village
that at the building of the Police Station a well was sunk deep
enough to drain that at the Cross. The latter was sunk deeper,
with the effect of draining the former, which was then converted
into a cesspool. Investigating this point in December, I found that it
was undoubtedly true that the Station cesspool had once been a
well, but could find no confirmation of the statement that it had
been converted to its present use in consequence of going dry.
The result of an experiment I made to determine whether a com-
munication existed between the two, while tending to show that
such might be the case, was not sufficiently decisive, and I purpose
repeating it at a more favourable season. In another part of the
District, the well at a dairy farm was closed on account of its
polluted condition and a new supply ordered to be introduced. A
case of contamination by the discharge from a dipping-trough had
also to be dealt with. |
| HH62/1/DUMFRI/9 |
[Page] 8
In the Dumfries District, the Blackshaw supply in Caerla-
verock has occupied the attention of the Committee. There are
many places in this parish greatly in want of wholesome water.
It is now proposed to enlarge the area of supply so as to include
certain of these as well as two houses in the neighbouring parishes
of Mousald and Torthorwald. The water formerly supplied,
though of a good quality, cannot conveniently be utilised for the
enlarged district, but a suitable spring has been found on the farm
in South Kilblain. The analysis shows it to be of excellent quality,
and it is to be hoped that the Committee's scheme will be pro-
ceeded with as early as possible, as the want of water was a great
evil during last summer, and was particularly felt at a dairy farm
which sends milk into Dumfries. If the new supply is sufficient, it
would be well to consider the propriety of adding Glencaple to the
Special District. A considerable part of the parish of Dumfries
immediately outside the Police Burgh is supplied from the mains of
the Water Commissioners. If the water can be spared, I should
like to see it more extensively used in this district, most of the
surface wells being more or less polluted. As one gets further
out towards the Lochar Moss there seems to be difficulty in get-
ting reliable water. Several of the wells are unsatisfactory, and
it is doubtful whether in such a locality good and reliable wells
can be found. Locharbriggs is also sadly in need of a wholesome
and plentiful supply, and the question of obtaining water for it and
other outlying parts of the parish, as well, perhaps, as certain
adjacent places, such as Kirkton and Amisfield, is one which may
have to engage the attention of the Committee at no very distant
date.
The supplies to the Annan District have been the subject of
anxious consideration, not only by the officials, but also by
members of a Sub-Committee appointed earlier in the year. There
is one Special District, that of Eaglesfield, which was formed in
consequence of a fear that the serious outbreak of diphtheria in
1887, when sixteen cases proved fatal, was due to the extensive
pollution of the village wells which then existed. Whether this
view was correct or not I am unable to say, but since the present
supply was introduced there has been, so far as I can ascertain, no
recurrence of the disease. But if the supply to Eaglesfield is
satisfactory from a sanitary point of view the same cannot be said
of the rest of the District. The complaints of scarcity and con-
tamination have been very common. These have no doubt been
[Page] 9
more numerous because of the long drought which prevailed
during the early summer months, but in the course of our investi-
gations we found that not a few of the wells run dry every
summer. Acting on the instructions received from the Sub-
Committee, I made a systematic enquiry into the condition of the
supplies to the villages and to a large number of the farm-houses in
the District, particularly those on the west side of Annan. During
that enquiry we examined the surroundings of 157 wells, and
applied qualitative tests to samples taken from 139. Classifying
as "probably good" those which showed no reaction to these tests
and whose surroundings were above suspicion, as "doubtful"
those in which there was either a slight reaction or whose sur-
roundings rendered them liable to at least occasional contamination,
and as "bad" those in which such reaction was well marked and
whose surroundings were very unfavourable, we found that 7
were probably good, 68 doubtful, and 64 bad. The remaining 18
were dry, or contained so little water as to be practically of no use.
We also obtained presumptive evidence connecting some 7 or 8
with attacks of typhoid, diarrhoea, and derangements of stomach
and bowels. That a new and pure supply is urgently wanted
throughout certainly the greater part of the District was abun-
dantly manifested to us during these investigations. A first step
towards this has been taken in the adoption of the Crawford Act,
and I trust that in the interests of the public health the labours of
the Sub-Committee may soon be brought to a successful termina-
tion.
In Lockerbie District there are gravitation supplies at Banks-
hill and Boreland. Complaints of scarcity from this District have
not been numerous, but in one or two places there is some difficulty
in getting an adequate supply, and, as in other Districts, the surface
wells are too frequently placed where they are extremely liable to
receive all sorts of organic impurities. Indeed, one is almost
inclined to believe that to the minds of some people the nearer the
well to the dung-heap the better the water.
In Moffat District two cases of supplies from land drains have
been dealt with, and a well at a dairy farm which was found to be
contaminated by vegetable matter is being altered so as to prevent
the entrance of such impurity in the future.
There are a few places in the Langholm District, particularly
in Westerkirk, where difficulty has been experienced in finding
good and sufficient water. At Rowanburn, in Canonbie, there is |
| HH62/1/DUMFRI/11 |
[Page] 10
only one pump to well over 60 families and a population of 414.
Such a supply is totally inadequate, and I am informed that in
summer the pump has occasionally to be locked up and the water
doled out in measured quantity. I consider that for a place such
as this, which within its own limits is one of the most densely popu-
lated localities in the County, a better supply is absolutely necessary.
DISPOSAL OF REFUSE.
The Disposal of Refuse is attended with some difficulty in the
more populous parts of the County. There are two special Drain-
age Districts - Noblehill and Glencaple. Drains can only get rid of
liquid filth, and solids are too frequently left to accumulate in ash-
pits that are badly constructed, being too large, uncovered, some-
times excavated a few feet below the surface, and not lending
themselves readily to the cleansing process. Where drainage is
insufficient these ashpits receive liquids as well as solids, and in
one or two instances have drains running into them. They then
tend to become open cesspools of a most objectionable kind. In
addition to ashpits, there are in many of the villages manure heaps
in close proximity to the houses, some of them so situated that
liquid is allowed to drain from them by a gutter on to the public
road. In addition, the wells are usually placed where they are
liable to contamination from such heaps, and the longer they are
allowed to accumulate the more polluted does the ground from
which surface wells draw their water become. At many farms I
believe that a great sanitary improvement would be effected by
the use of liquid manure tanks, so placed and constructed as not to
form a nuisance, while in more densely populated parts (e.g., that
part of the parish of Dumfries immediately contiguous to the Police
Burgh) it would be well if District Committees had powers to form
Special Scavenging or Cleansing Districts. This is a matter which
has been brought under the notice of the Government by the Society
of Medical Officers of Health, and it is to be hoped that powers
may soon be granted to Local Authorities to form such districts
when and where they may find it necessary to do so. The only
other remedy is an unsatisfactory one, consisting as it does in whole-
sale prosecution of tenants who may find it a difficult matter to
clear away such accumulations.
POLLUTION OF STREAMS.
Closely akin to the question of Disposal of Refuse is that of
Pollution of Streams. I do not think I go beyond the mark when
[Page] 11
I say that there is probably no stream of any importance in the
County which does not at some part of its course receive both
liquids and solids of a kind that must not only more or less
seriously pollute its waters, but are directly prohibited by the Rivers'
Pollution Prevention Act. These are in particular farmyard drainage,
the discharge from water-closets, and solid rubbish shot in to
wait for the next flood to wash it away, while in one or two
instances the refuse of mills and dyeworks is also passed in un-
purified. It is true that we can hardly expect streams to escape
some pollution, and so long as a serious nuisance is not created, or
the water is not used either for domestic purposes or for cattle,
I am not inclined to make too much of it. But in too many cases
the quantity of polluting material is altogether out of proportion
to the volume of water, while some of the streams have to be utilised
lower down their course for the purposes I have indicated. Of the
larger waters, the Nith, Annan, and Esk suffer very serious pollu-
tion. The Nith and its tributaries are polluted both in the upper
district of Nithsdale and in the lower. The pollution in the latter
occurs most seriously within the precincts of the Burghs of Dum-
fries and Maxwelltown. During the summer I took advantage of
an enquiry instituted by the Fishery Board to investigate the pollu-
tion caused by the mills and by the sewage of the Burghs from a
sanitary point of view. Samples of the various mill effluents
showed that most of them consisted of water carrying soapy
matters, wool fibres, and dye stuffs. In one or two sulphuretted
hydrogen was found. The soap and wool wastes give rise to very
unsightly nuisances, particularly in sluggish parts of the stream.
Both they and the colouring matters take up a large quantity of
the oxygen in the river, which is thus deprived of a means of
cleansing itself from the ordinary pollution to which a stream may
be expect to be subject. I must, however, admit that a sample
taken from the centre of the river below the Burgh boundary
showed much less impurity than I expected to find. This I attri-
bute partly to the sedimentation which takes place just below the
Dock Park and partly to the fact that the river is tidal here. No
doubt, when the river is low, this sedimentation is the cause of an
evil smelling abomination, but it is one which does not come within
the jurisdiction of the County Council. Were it not for it the river
below would probably be much more foul than it is. I trust, however,
that the Burghs may at no distant date see their way to the adop-
tion of some purification scheme which would materially improve |
| HH62/1/DUMFRI/13 |
[Page] 12
the condition of the river not only within their own precincts but
also below them.
The Annan in its course receives the sewage of most of the
farms on its banks, as well as from the Burghs of Moffat, Locker-
bie, and Annan. The entrance of the sewage from Moffat and
Lockerbie is of importance. In the case of Moffat there are dairy
farms whose cattle are watered in the Annan below the point at
which the sewage enters, and I have myself come upon one placed
on the Register before our duties as District Officers began which
takes water for all dairy purposes from the river. It would be
well if the County Council or District Committee of Moffat were to
call upon the Police Commissioners of the Burgh to purify their
sewage before discharging it into the river, and there is no doubt
that, in the interests of the public health as well as of the farms
to which I refer, this is the proper thing to do. The Lockerbie
sewage does not enter the river direct. It passes through settling
tanks and filters into the Turnmuir Burn, a tributary of the Annan.
There is no precipitation attempted at the tanks, and the filters can-
not be said to be acting properly or even to be adequate to deal
with the sewage that comes to them. In consequence a very con-
siderable nuisance is caused in summer: the Turnmuir Burn is
seriously polluted, and from a complaint sent me by the late
tenant of Shillahill, it would appear to be the only water supply
he had during a certain part of the year for his cattle. In con-
sequence of this complaint I have recommended to the Lockerbie
Commissioners a purification scheme, which is at present under
consideration. The scheme is known as the International, and my
recommendation of it has been based on the fact that it appears to
be at once the most efficient and economical of those at present in
use for small centres of population. Some details regarding it
were given in the Report on Sewage Works visited by the Sani-
tary Inspector and myself last autumn. In my next Annual
Report I hope to be able to announce that the evil has been
remedied. It seems doubtful whether the sewage of Annan
Burgh can be said to be hurtful below the town, and I am
not at present prepared to express any definite opinion upon it. Of
the tributaries of the Annan, the one to which our attention has
been most frequently drawn is the Ecclefechan Burn. it is really
a secondary tributary, the Mein Water intervening between it
and the river. Into this burn, as it passes through the village,
the contents of several water-closets are discharged. Solid and
[Page] 13
liquid refuse are also thrown in to such an extent that in warm
weather, and particularly when the stream is low, a very serious
nuisance is created, an unsightly open sewer, abominably odori-
ferous, being formed, to which very naturally certain of the
inhabitants strongly object. It has been recommended that that
part of the burn which remains uncovered at the lower end of the
village should be covered over. I am not inclined to support this,
as it will simply put the sore out of sight without remov-
ing it. Two courses are open to the District Committee. The first
and cheapest would be to compel all who at present have water-
closets discharging into the stream to take them out, and to prevent
as far as possible the emptying of solids and liquid sewage into
it. The second would be more effectual but more costly - to form
Ecclefechan into a Special Drainage District and purify the sew-
age before it is discharged into the burn. If need be, the purifi-
cation could be done well below the village, but our experience
leads us to the conclusion that a very little attention indeed will
prevent properly constructed sewage works from becoming a
nuisance or even causing an occasional unpleasant odour.
The Esk receives the sewage of the Burgh of Langholm in an
unpurified state, and, I believe, also the mill wastes. I have not,
however, given as yet the same attention to the pollution of the
Esk as to that of the Nith, and cannot therefore go into details.
Of the smaller streams which do not fall into the Nith, Annan
or Esk, probably the Pow Water and the Water Beck suffer most
from contamination. The importance of the contamination of the
Pow is due to the fact that it is used by certain houses as a domestic
supply. One of its tributaries, the Hitchel Burn, from which a
part of the supply for Cummertrees is taken, is polluted by farm-
yard drainage. I am not prepared to say that there is any con-
nection, but it is an interesting point that in recent years there
have been cases of typhoid both in the village of Cummertrees and
in houses taking their supply from the Pow. The Water Beck, as
it passes through the village, receives the discharge of one or two
water-closets, but the principal pollution is caused by the amount
of solid refuse which is thrown in. These by no means exhaust
the list of polluted streams that might be brought under the notice
of the Council, but they are perhaps the worst of those to which
our attention has been drawn during the year. |
| HH62/1/DUMFRI/15 |
[Page] 14
INDUSTRIES.
Agriculture and allied pursuits form the principal industry of
the County. Of these dairy-farming constitutes a large part. It
is carried out in each District, under Bye-Laws which were first
carefully considered at a Conference of Representatives of the
Public Health and District Committees, afterwards by each District
Committee, and lastly by the Board of Supervision. On one point
only I have felt bound to disagree with these Bye-Laws. It is
that which leaves the cubic space for each cow in a byre undeter-
mined. The bye-law simply declares that it shall be "sufficient."
This leaves the matter too much to the judgement of the officials,
and will tend to cause friction in cases where there may be in the
official judgement overcrowding, though not perhaps in that of the
cow-keeper. A minimum cubic space ought, I think, to be insisted
upon and laid down in all bye-laws.
Of industries which come under the 30th section of the Public
Health Act, there are several examples in the shape of slaughter-
houses and one knackery. Some of the former are not kept quite
so cleanly as they ought to be, and in one at least the practice
exists of leaving the offal overnight in the same chamber in which
the meat is hung. The slaughter-house at Dornock, I have reason
to believe, is well conducted, but there are two objections to it
which must be stated. One of these is that a large dairy exists on
the same premises and under the same management, and another
that it is too close to the roadway and too near to dwelling-houses.
The first is probably the more important of the two, but both
objections would be removed if another site, preferably outside the
village, could be obtained for the slaughter-house.
The knackery to which I have referred is in the parish of
Dumfries. Complaints regarding it have reached us in an informal
manner, but it was difficult to get evidence that it was really a
nuisance, complainers refusing to come forward when asked, and
except in its immediate vicinity there was no effluvium nuisance
when we visited it. The owner is, however, about to remove to
what may prove to be a more suitable site. This I inspected along
with the Sanitary Inspector. It is beyond the prescribed distance
of a village or collection of houses, and therefore, unless the busi-
ness is conducted in such a way as to create a nuisance, not liable
to any regulation or special interference at the hands of the District
Committee.
[Page] 15
Bacon-curing is not a trade which comes under the Section
referred to, but it is one of those specially reported upon by Dr
Ballard, of the Local Government Board, as being, without due
care, likely to cause an effluvium nuisance. We have not received
complaints of any of the curing establishments in the County, nor
have we ourselves observed any nuisance when visiting the
localities in which they are situated. It may, therefore, be taken
for granted that hitherto they have been well conducted.
Other industries in the County do not affect the public health
except perhaps in the way of pollution of streams, of which I have
already spoken.
INFECTIOUS DISEASES.
Restricting the term "infectious" to those diseases which are
scheduled or to which the definition has been extended under the
Notification Act, the number of cases that have come to my
knowledge during the year in the six Districts has been 308. Of
these 297 were notified. The remainder were cases of deaths
appearing in the Registrars' returns, and had not been notified to
me during life. Some of them occurred either before the date of
my appointment or before the adoption of the Act in their respect-
tive Districts. The diseases scheduled in this Act are "small-pox,
cholera, diphtheria, membranous croup, erysipelas, the disease
known as scarlatina or scarlet fever, and the fevers known by any
of the following names: typhus, typhoid, enteric, relapsing, con-
tinued, or puerperal." Permission is given to extend the definition
to any other disease not specially named, and under this provision
measles has now been added to the above list in all the Districts.
The 11 unnotified cases which came to my knowledge included 4
scarlatina, 2 measles, 1 diphtheria, 1 typhoid, and 3 puerperal.
Table II, gives the respective notifications from each District:-
TABLE II.
Notifications Received during 1891.
[table inserted] |
| HH62/1/DUMFRI/17 |
[Page] 16
As these figures do not cover the same periods, the Act having
been adopted at different dates in the different Districts, it must be
understood that no fair comparison can be instituted between them,
nor do I think it proper to give any infectious sick rates. There
is one point to which I must, however, draw attention. Of the 297
cases, 275 were notified by medical men, 21 by heads of houses,
while one case was discovered, no doctor having been in attendance,
and the parents professing ignorance of the nature of their child's
illness, which was one of scarlet fever. Only 60 cases were notified
by both medical men and heads of houses. It should be widely
known that this omission to notify by heads of houses renders them
liable to a penalty. In the majority of instances I believe it is due
to ignorance of the law and to the fact that Notification Acts are
somewhat confusing in their provisions. There were several special
Acts providing for notification before the passing of that which has
been adopted in Dumfriesshire and other counties. Some of these
throw the burden of notification on the householder only, others on
the doctor, and a few, like that of 1889, on both doctor and house-
holder. I am aware that all medical officers do not agree with
me, but as my experience of notification increases I become more
than ever convinced of the necessity of insisting upon notification
by the householder as well as by the doctor in attendance. In the
first place, the law requires it; and in the second, its omission
enables certain cases to which a doctor is not called to escape our
observation. If the provisions of the Act were more universally
insisted upon, I believe that obscure outbreaks could be more
readily traced to their origin, and probably householders would be
more ready to call the doctor to cases which, while doubtful to
the untrained eye, may be quite clear to the skilled observer.
Scarlet Fever, as will be seen from the above figures, was
very prevalent, particularly in the Thornhill, Lockerbie, and
Annan Districts. The majority of cases occurred during the
summer and autumn months.
In Thornhill the northern part of the District was most
affected. There were 19 cases in Sanquhar parish, 14 in Kirk-
connel, 9 in Durrisdeer, 7 in Closeburn, 2 each in Dunscore and
Keir, and 1 each in Morton and Penpont. Of these cases two died.
The chief centre of the malady was Crawick Bridge and the
vicinity, where large families and small houses rendered it impos-
sible to secure the necessary isolation. No doubt also certain of
[Page] 17
the cases were due to infection caught at school. One case
occurred at a dairy farm, in consequence of which the milk trade
had to be stopped for a time.
In Dumfries District the greater number of the cases reported
were from the parishes of Dumfries and Caerlaverock. In the
former there were 8, in the latter 5. In Tinwald and Kirk-
mahoe there were three each, in Torthorwald 2, and in Kirk-
michael 1. One of the Caerlaverock cases was removed to the
Dumfries and Galloway Infirmary. One of those in Torthorwald
occurred at a dairy farm, and would also have been removed to
the Infirmary were it not that the farmer had an empty cottage at
his disposal, to which he preferred to send his child with an
attendant. Though one case only was reported from Kirkmichael,
there had been an epidemic in the upper part of the parish, in
consequence of which the School had to be closed. I heard
accidentally of the outbreak before entering on my duties, and
finding that the period agreed upon by the Board for closing was
too short, I recommended an extension so as to cover at least six
weeks from the date of attack of the last victim of the outbreak,
who happened to be one of the schoolmaster's children. This was
done, and, so far as I am aware, the spread of the malady ceased.
No further cases were reported. Three deaths occurred in the
district, one before, the others after, notifications had begun to be
made to me.
The parishes of Annan, Kirkpatrick-Fleming, and Middlebie
suffered most in the Annan District. The first furnished 11 of the
cases; the second 18; and the third, 9. From Cummertrees I
received 3 notifications, and from Ruthwell and Gretna 2 each.
The majority of the Annan cases occurred in the northern part of
the parish. Some of them were introduced from Hoddom, and the
Annan hiring fair appeared to be responsible for certain of the
cases which occurred both in Annan and Kirkpatrick-Fleming. In
the latter the school at Newton had to be closed. In Middlebie
there were 9 cases - 6 at the lower end of the parish (5 of them
being in one family) and 3 in Waterbeck. Two of the Cummer-
trees cases occurred close to Hoddom during the epidemic which
prevailed there. The third case was imported. Those in Ruthwell
and Gretna were probably imported also, and fortunately did not
spread. The type of fever appeared to be unusually mild, and
there were no fatalities. |
| HH62/1/DUMFRI/19 |
[Page] 18
In the Lockerbie District the affection was epidemic in the
Parishes of Hoddom and St. Mungo, and a sudden outbreak
occurred in Hutton in September. From the first came 22 notifi-
cations, from the second 13, and from the third 19. One case was
reported from each of Dryfesdale and Lochmaben parishes. The
disease appears to have been in existence both in St. Mungo and Hod-
dom at the time the Notification Act came into force. In both we
watched it spread from place to place, and felt ourselves practi-
cally powerless to prevent it. Isolation could not be properly
carried out. In many of the houses it was impossible to separate
the first affected from other members of the family, and during
convalescence the grossest carelessness was shown by those who
ought to have known better. Children were admitted to school or
allowed to play with their schoolmates when desquamating, and
in one instance a teacher went to her duties straight from an
infected house, and continued at them until a discovery was made
by me and the matter brought under the notice of the School
Board. The exposure of a convalescent from the same house was
so flagrant that a prosecution had to be ordered, with the result
that the accused pleaded guilty and was admonished. In addition
to the schools, the churches to some extent may have helped to
spread the infection, as far as people from infected houses were, until
stopped, fairly regular in their attendance. The fact that the
disease was of a mild type may account for the carelessness shown.
Out of the 56 cases there were only three deaths, one each in
Hoddom, St. Mungo, and Hutton. In the latter parish the disease
broke out in consequence of two boys being sent to school while
desquamating. Fifteen cases were notified within a few days.
The origin of the first cases could not be traced, and just at that
time we had no knowledge of scarlet fever nearer then Eccle-
fechan. It appears, however, from information we have since
received that there may have been intercourse between the two
places of a kind that would not be made known to us. I cannot, of
course, assert that the fever was so introduced, but a careful investi-
gation leaves it up to the present as the only likely source. In
consequence of the outbreak the school had to be closed for a
period of nearly seven weeks.
No cases were reported from Moffat District.
From Langholm I had ten notifications, but two referred to
the same case. They were all traceable to the outbreak in Hutton. The
[Page] 19
first case was that of a girl attending school there. She unfor-
tunately died, the only fatality of that outbreak. Other cases were
reported afterwards and traced to the same source. Eventually
the affection spread into Westerkirk and attacked two young
adults there. One of these was removed to his home in Canonbie,
and his case reported a second time. The removal gave rise to a
complaint on the part of the Canonbie School Board. With that
complaint I have every sympathy, but, on the other hand, the
patient appears to have been laid up at a farmhouse, where, in the
judgment of his medical attendant, he could not be treated with
safety either to himself or others. The manner of his removal
was, however, objectionable, and, as I am advised, illegal, inas-
much as the Public Health Act gives permission only to Local
Authorities or their servants to effect such removals. In this
instance no member of the Sanitary Staff was consulted. The
case is, to my mind, an example of the necessity of making some
provision in the shape of an hospital for infectious diseases as well
as a suitable carriage for the removal of such cases. Disinfection
in the form of sulphur fumigation was applied to the carriage in
which the patient had been taken to Canonbie, but as fumigation
has been known to fail, it is hardly safe to trust to it alone, and in my
view there ought to be a carriage specially reserved, or at any
rate so constructed that it can be well washed with a disinfectant
in addition to being fumigated.
Scarlet Fever is one of the zymotics which spread by direct
infection, and through articles of food and clothing as well as
from person to person. We have observed it more than once
recur in the same house after an interval of some months, a
circumstance that may be best explained on the supposition
that some part of the house, or some articles contained therein,
have escaped disinfection. The food by which it is most
liable to spread is milk, hence the necessity for stringent dairy
regulations, as well as complete and thorough isolation of
sufferers.
Measles is now notifiable in all the Districts except Langholm.*
It was included among the scheduled diseases when the Act was
adopted in the Annan, Lockerbie, and Moffat Districts. In Thorn-
hill and Dumfries it has been added by special resolution, and it
will probably be added in Langholm at an early meeting of the
*It becomes notifiable in this District on and after 15th May, 1892. |
| HH62/1/DUMFRI/21 |
[Page] 20
District Committee. The opposition to its inclusion has been very
slight, and the arguments against rather contradictory. In one
Committee it was urged that the disease was one which all children
were expected to take, and therefore not worthy of being brought
under the notice of a Sanitary Authority. In another, that it was
much too serious in most cases to admit of them being removed to
isolation hospitals. The latter argument is probably nearer the
truth than the former, but the inference that all cases notified must
at once be removed to isolation hospitals when these are provided
is erroneous. Notification will be beneficial not so much by enab-
ling us to remove cases of measles as by assisting us to give
prompt information to schoolmasters, and to have the schools
closed against children from infected houses. It will also give
the Sanitary Staff the opportunity of seeing whether disinfection is
properly carried out.
The Districts from which cases of the disease were reported
were Dumfries, Annan, and Lockerbie.
The two Dumfries cases occurred in the parish of Kirkmahoe,
one in October and the other in November.
In Annan District the majority of the cases occurred in Ruth-
well, 11 having been notified. The affection was introduced by a
child who had been brought from Carlisle to the Brow Cottages
when convalescent. There was one death. Four children in one
house in Middlebie suffered. They had caught the infection in
Tundergarth, where they attended school, and where measles were
prevalent during the months of June and July. Two notifications
were received from Dalton and one from Annan.
In the Lockerbie District the disease was epidemic in the
parish of Tundergarth during the greater part of June, July, and
August. There is little doubt that it spread from the Burgh of
Lockerbie, where it was prevalent a short time before. Certain of
the cases occurred before the Act came into force, but 28 were
afterwards reported. In addition, five were reported from St.
Mungo and two from Dryfesdale.
Though the mortality from measles in the rural districts
of Dumfriesshire is considerably less than it is in the mainland
rural districts generally, there is little doubt that the disease is
tending to become more fatal and widespread. It is one
of those maladies that are not directly amenable to im-
proved sanitary conditions, but spread by direct infection, and
particularly through the agency of day and Sunday schools. It
[Page] 21
must be dealt with by prompt isolation of early cases, and at
present the most efficient means of preventing it assuming an
epidemic form is the closing of schools.
Diphtheria occurred in two Districts only, Dumfries and
Annan.
In Dumfries two of the cases were reported from the parish
of Dumfries, one from Kirkmahoe, and one from Caerlaverock. One
of the Dumfries cases was imported. The other, as well as the
Caerlaverock case, was certainly connected with insanitary sur-
roundings. In one of them there was a tendency to attacks of
sore throat and probably a hereditary predisposition. In Kirk-
mahoe, where I did not see the case, it having occurred during
my absence in August, the surroundings were not quite satisfac-
tory.
In the Annan District diphtheria broke out at Bonshawside and
Breconbeds in November. There were eight cases, of which two
proved fatal. The house at Bonshawside was found in an unsatis-
factory state. It is built on a wet soil, and lies low. The walls
were damp, and we were informed that fungus growths sometimes
appeared on them. The drainage was most defective, there being
only some field tiles, which were frequently blocked up, while the
liquid filth from the piggeries was allowed to make its way over
the surface of the ground. These defects have begun to receive
some attention from those responsible for them. At Breconbeds
the water supply was exposed to some risk of contamination, but
I do not think there was evidence to show that it bore any relation
to the outbreak. It has, however, been put right. The school
was closed for some weeks in consequence of the outbreak. In
addition to these, two cases occurred early in the year in the
parish of Gretna and one in Kirkpatrick-Fleming.
Diphtheria caused six deaths - three in Thornhill, two in Annan,
and one in Lockerbie. Two of them occurred before the adoption of
the Notification Act. The rates are considerably less than the average.
While this is so, it has to be remarked that throughout Great
Britain it is the one zymotic whose death-rate has undergone an
increase. Though it is found chiefly in districts where the sur-
roundings are distinctly unhealthy, it has increased, particularly in
urban populations, in spite of improved sanitation. It is particu-
larly liable to spread through milk, and there is strong presumption
that in some of the epidemics which have been investigated in |
| HH62/1/DUMFRI/23 |
[Page] 22
recent years the milk has derived its infection from some condition
affecting the cow herself. The observations collected by Dr Thorne
and published recently in his Milroy lectures also tend to support
the view that some epidemics may have been in no small measure
due to the aggregation in schools of children suffering from mild
forms of sore throat, which frequently appear before an outbreak
of the disease.
Typhoid invaded all six Districts.
One case was notified from Dunscore, in Thornhill District. It
was, I believe, imported, and did not spread.
Of the Dumfries District cases, ten were in the parish of
Dumfries and one in Kirkmichael. Three of the Dumfries cases
were removed to the Infirmary, where one died and the other two
made good recoveries. The Kirkmichael case was too ill for
removal, though it was felt desirable. Even if he could have
been removed, I should have had grave misgivings about bringing
him into Dumfries in the fever cab, which at present is the only
conveyance available. All the typhoid cases were visited by the
Sanitary Inspector or myself, and in every instance the surround-
ings were more or less unhealthy. At one the ashpit was an open
cesspool. In another the closet accommodation was in an abomin-
able state of neglect, while in yet another the well was so situated
that it received surface washings, including manure, whenever
there were heavy rains.
The Annan cases were two in the parish of Cummertrees and
one in Gretna. One of the Cummertrees cases occurred in April,
the other in August. The water supply in both instances was
decidedly faulty. The Gretna case was that of a servant girl who
was reported to have shown symptoms of the disease a few days
after entering upon her duties in a new place. She was removed
to her home in Annan before the notification reached us.
In Lockerbie Districts three of the cases occurred in one
household in Hutton and Corrie. There did not seem to be any-
thing in the house itself, which is well isolated, to account for the
fever, but I understand that cases have occurred before, and the
water supply does not seem to me to be sufficiently guarded against
pollution. There were two cases in St. Mungo, one of them in a
house in which the germs of fever seem to have lurked for years,
it having become one of the plague-spots of the County. The
second case occurred in a neighbouring house, and as milk was
[Page] 23
obtained from that in which the first lay, I am inclined to take
the view that the one was referable directly to the other. The
sixth case was notified from Tundergarth and was imported.
The Notification Act came into force in the Moffat district on
November 15th. Immediately after, I received three notifications
of Typhoid. These have been the only cases of infectious disease
in the District which have come to our knowledge during the year.
They occurred in children in a house just outside the Burgh of
Moffat, and some time before the Act really came into force. I
had an opportunity of inspecting the house on November 9th, and
found it very defective, and the water supply polluted. Several
of the defects have since been remedied, but it is doubtful if the
house will ever be got into a satisfactory condition. Though
there have been no further cases of infectious disease within the
District, we received on December 27th a complaint from the
Sanitary Inspector of the Burgh that an outbreak of Typhoid had
occurred, and that it appeared to have been caused by the milk
from a dairy-farm in the District. This farm had been some time
before inspected and found to be in a satisfactory condition with
the exception of the water supply, the well being placed where it
might be liable to pollution. On investigation, we found that there
had been nine cases of typhoid in seven houses in the Burgh prior
to our visit, and that milk from this farm had been supplied to all
of these, that the first of the nine cases had occurred about the
middle of October, and the others at intervals up to the end of the
year. We visited five of the houses, and found in four of them
well-marked sanitary defects. In one these had apparently been
so bad that during the illness the internal fittings had been entirely
replaced, and a drain which passed underneath the house had been
taken out. In the fifth the smoke-test applied sometime after our
visit showed that sewer-gas was finding its way back by leaking
drain pipes. We interviewed the dairyman and took a sample of
water from the well for analysis. At the time when it began to
be said that the outbreak was probably due to milk from the dairy
he had over 110 customers within the Burgh. Occasionally he
found his supply short, and made it up by purchasing from indi-
viduals who, though not engaged in the trade, kept cows, and
found themselves able to spare some milk from their own use.
From the 13th to the 27th December he purchased daily a small
quantity from a house where two cows were kept. One of these
belonged to the people whose children were notified to me as |
| HH62/1/DUMFRI/25 |
[Page] 24
suffering from typhoid. Though the milk was not obtained from
this animal, it is admitted that some contamination may have
reached the milk which was supplied. The chemical analysis of
the sample taken from the well showed that it was contaminated
by vegetable matter, but there was no evidence of pollution of
animal origin. Though it was not expected that any organism
likely to cause typhoid would be found, a bacteriological examina-
tion was made, with the result that, while a considerable number
of micro-organismal colonies were developed, they were none of
them of such a kind as would be likely to produce disease. On
reviewing these facts it seems to me that there is not sufficient
evidence to show that this outbreak originated from the dairy in
question. The pollution of the water supply is not sufficient, as it
was vegetable in character, and there was, so far as we could
ascertain, no case of illness, such as diarrhœa or typhoid, in its
vicinity. The most damaging fact is the taking of milk, though in
very small quantity, which, it is admitted, may have been exposed
to the risk of typhoid contamination. But even if so much be
admitted, it will not account for the cases which occurred before
the 13th December, nor for a case which we are informed was
diagnosed on the 16th. Further, the proportion attacked is some-
what small for a milk epidemic. If there were 110 customers, it is
a low estimate to say that there must have been at least 400
consumers. Of these only nine were attacked and these at long
intervals during the last three months of the year, in two of which
typhoid is known to be prevalent. It has also been stated to
us by persons in Moffat, whose word we have no reason to doubt,
that there have been several cases in the Burgh during the last
three or four years. These may have been imported cases, but,
looking to the insanitary conditions in the houses which we visited,
it seems to me that the outbreak is as likely to have been caused
by these as by any contamination of the milk from the dairy in
question.
The solitary case reported from the Langholm District
occurred in Eskdalemuir. So far as our investigations went, there
did not appear to be anything in the locality to account for it, and
as the patient had been a short time before resident in another
place, it is highly probable that the disease was imported.
The deaths were three - one in Thornhill, two in Dumfries.
The rates are below the average.
[Page] 25
Erysipelas occurred in all some 14 times. There were three
cases in each of the Thornhill and Lockerbie Districts and four in
each of Dumfries and Annan. None of them call for any comment.
Whooping-cough is not a notifiable disease, and I am unable
to say how far it may have been prevalent in the County Districts.
Judging from the mortality returns, it would seem to have been
most active in Canonbie, where seven deaths have been registered
as due to it. In other Districts the sum total of the deaths is
twelve. The mortality rate is somewhat above the mean for
1881-90. It is a disease which can only be dealt with by prompt
isolation of sufferers.
Towards the end of the year Influenza became epidemic in
various parts of the County. My attention was drawn to it
officially on the 8th November, when I visited the parish of
Tundergarth in consequence of a communication from the School
Board to the effect that the school attendance had diminished 50
per cent. because of colds and bronchitis among the children. The
letter went on to say - "There are no cases of scarlet fever or other
epidemic, yet there is great sickness in the parish among young
and old." With the experience gained in the epidemic of 1889-90
one had little difficulty in concluding that the illness from which
so many suffered was Influenza. The question of closing the
school was raised, but as the epidemic appeared to have reached its
maximum I did not feel justified in recommending such a course.
It was too late to permit of any benefit being gained, and in a very
few days the attendance began to improve and the illness to
diminish, so far as Tundergarth was concerned. In other parts of
the Lockerbie District cases of the malady had occurred before
the epidemic in this parish. Dr Bell informs me that he saw a case
on the 12th September. Dr Maclachlan thinks it became prevalent
about the 20th October, but states that he has had occasional cases
under his care ever since January, 1890. This would seem to
have been the experience in some of the other Districts of the
County, deaths having been registered as due to it in the months
of March, May, June, July, and September, 1891. In the Annan
District the epidemic appears to have commenced in Dalton, where
Dr Scott saw the first case on Oct. 29th. It was supposed to have
been introduced from Lockerbie. It did not become prevalent in
Ruthwell till the 15th December, and in Cummertrees not till a
fortnight later. Dr Murdoch, Annan, saw cases about the end of |
| HH62/1/DUMFRI/27 |
[Page] 26
November, but found that the epidemic did not reach its height
till about four or six weeks after. He noted one interesting point,
that in the epidemic of 1889-90 the malady seemed to commence
in the town of Annan and radiate outward into the country in all
directions, whereas in this epidemic it seemed to be rife in the
country districts around before it was prevalent in the town itself.
Dr Carruthers saw cases in Rigg of Gretna in the third week of
November, but did not find the disease epidemic till about the
second week in December. In the Dumfries District cases were
seen in the vicinity of the Burgh towards the end of October, but
the malady does not appear to have become prevalent in Torthor-
wald, Mouswald, and Caerlaverock till the 15th November. In
Thornhill District the more northerly parishes appear to have
suffered most severely so far as my information goes. Dr Wilson
was called to the first cases in Leadhills about a month before.
Dr Macgregor, Sanquhar, believes that the first cases there
occurred at Crawick, and that they were the result of infection.
He made an observation of some importance in enabling one to fix
an incubation period. A man belonging to Crawick took ill in
Glasgow on Nov. 12th. He was brought home on the 15th, pre-
vious to which there had been no cases in the neighbourhood. On
the 20th two members of his family took influenza, and on the
following day two others. From the Langholm District Dr
Sturrock, Eskdalemuir, has favoured me with notes of a case in
which the incubation period would appear to have been prolonged
as much as eight days. In this instance workmen had gone from
Tundergarth to Aberlosk, Eskdalemuir, on Nov. 2. There were
no cases in the neighbourhood at that date nor until the 11th of
the month when it broke out at Aberlosk, and afterwards spread
rapidly over the parish. The majority of the practitioners who
have favoured me with this information agree in regarding the incuba-
tion period as shorter than these observations of Drs Macgregor
and Sturrock would seem to make it, 24 to 48 hours being the time
given by most of them; but Dr Carruthers not only gives five days
as the usual period, but states that he has seen in a considerable
number of cases in the same house a period of two weeks elapse
before the second case occurred. All, with one exception, agree in
regarding the malady as infectious. The evidence accumulated
elsewhere, particularly by Dr Parsons (Local Government Board
Report), has not only swept away a number of false conceptions
[Page] 27
regarding it, but show that this view of its infectiousness is the
only one that can now be held. The high death-rates that have
been recorded during its prevalence justify the resolution recently
passed by the English Medical Officers of Health Society, that "it
is a dangerous infectious disease." With all this it must be admitted
that our knowledge is as yet too limited to entitle Medical Officers
to advise their Authorities to take those repressive measures which
have been urged in some quarters. These measures are no doubt
successful when thoroughly carried out against diseases with
whose natural history and mode of propagation we are better
acquainted, but, as Dr Buchanan has pointed out in his introduction
to Dr Parsons' Report, they "cannot well be applied to persons
suspected of Influenza among the bread-winners of a community,
and the singular ability possessed by Influenza to disperse itself
over a population, owing to its brief incubation period, must add to
the difficulties of dealing with an infection that finds the bulk of
the population susceptible to its attack. Having, as would seem,
something like a third part of the incubation time proper to small-
pox, measles, or typhus, Influenza has correspondingly rapid ability
to reproduce itself, can, that is, give rise to some thousand attacks
in the time that small-pox and typhus had taken to produce ten,
each of the thousand cases being ready to infect other susceptible
people, and the difficulty of applying principles of isolation and
disinfection being in like manner enormously enhanced." The
discovery in the blood and purulent bronchial secretion of a micro-
organism which, it seems probable, is the exciting cause, raises our
hopes that our knowledge may be further extended; that we shall
know, for example, whether one attack affords protection against a
second, or, like malaria, renders the individual more susceptible,
whether the disease known as equine influenza, which has been
observed to occur in a somewhat epidemic form about the same
time as the human malady, is or is not the same, and whether any
or what measures are likely to be successful in preventing it
assuming the epidemic or pandemic form with which we have
become so familiar. Before leaving this matter it may be well to
note the severity of the recent epidemic as contrasted with that of
two years ago. In 1889 there were no deaths in the six Districts
registered as due to influenza, in 1890 there were 11, and in 1891
there were 41, seven of which occurred before the last quarter of
the year. |
| HH62/1/DUMFRI/29 |
[Page] 28
The means at present at our command for preventing the
spread of infectious disorders may be summed up in the words
Notification, Isolation, and Disinfection. The primary object of
Notification is, of course, to secure the other two, but I wish to
correct an impression which seems to exist in the minds of some
people that Notification must at once be followed by removal to an
Isolation Hospital. Notification is valuable inasmuch as it enables
us to give timely notice, among others, to Schoolmasters of the
occurrence of infection in the houses of their pupils. If this infor-
mation be promptly acted upon by excluding all the children of the
household, whether infected or not, much would be gained in
preventing such affections as Scarlet Fever, Diphtheria, and even
Measles, assuming epidemic proportions. These diseases in particu-
lar are apt to be spread by the congress of large numbers of
children in day and Sunday schools. To obviate such results as far
as possible, we now give notice to Headmasters and Clerks of
School Boards whenever we receive a notification from any house
in their respective districts in which there may be children of school
age. I regret to have observed that this information has not
always been acted on as it might, and that children who have been
infected have sometimes been received into school within the pre-
scribed time and without a medical certificate. It would be well
if Boards would instruct their teachers to exercise the utmost care
in this particular, and to lay it down as a hard-and-fast rule that
children from infected houses must not be admitted without a medi-
cal certificate showing that all danger of infection had ceased.
Isolation may in many cases be carried out efficiently at the
patient's home, provided that the house is large enough. It is but
seldom, however, that this is satisfactorily done, and it is question-
able whether it ought to be permitted at all in dairy farm-houses.
A recent correspondence which I have had with the Health Officer
of a large city that receives a considerable quantity of milk from
Dumfriesshire indicates that the Authorities there would not con-
sider such isolation satisfactory. For this and other reasons isola-
tion hospitals are necessary. In a letter* addressed to the Chair-
man of the Public Health Committee, I have advocated that
small hospitals should be placed in each District, providing
accommodation in the proportion of one bed to each 1000 of the
population. This scheme has been subjected to a good deal of
criticism, chiefly of the destructive order, but nothing practicable
*See Appendix
[Page] 29
has been suggested to take its place. It has been urged that the
Dumfries and Galloway Infirmary could amply supply the wants
of the County, and it has even been stated that it has done so in
the past. That it will supply the needs of the Dumfries District in
addition to those of the Dumfries Burgh and certain of the parishes
in the eastern part of the Stewartry of Kirkcudbright is all that
can be hoped for, and then only if certain arrangements which are
at present under consideration be carried out. For the other
County Districts the accommodation is too limited and the distance
too great, and should all the beds reserved for such cases be occu-
pied at any one time the amount of cubic space regarded as proper
for the treatment of fever patients will not be given, there being
only about 1300, instead of 2000, cubic feet to each bed. Any one
who chooses to examine the Detailed Reports of the Registrar-
General and the Infirmary Reports for the ten years 1881-90 will
not fail to observe that the deaths throughout the County from
infectious diseases have been very greatly in excess of the admis-
sions of such cases to the wards of the Infirmary, while the records
show further that the only Local Authorities who during that
period sent cases were those of Dumfries and Troqueer. Even if
it be granted that the accommodation is as ample as is asserted,
the question of distance has to be faced. It is a serious matter
to remove a patient suffering from an infectious fever a long dis-
tance. I do not think that even in a well-constructed ambulance
this distance should as a general rule be greater than six or seven
miles. In some instances it may be as much as ten, but these
should be made as exceptional as possible. It has recently been
urged that this objection might be got over by having an ambulance
waggon which could be trucked by railway. Apart from the
absurdity of this proposal, I have letters from Managers of the
Railway Systems running through Nithsdale and Annandale stating
that they cannot permit the transmission of infectious cases on
their lines in this or any other fashion. The separate provision by
each District remains, therefore, the only feasible plan, if any serious
attempt is to be made to grapple with the problem. I have else-
where urged the peculiar position of Dumfriesshire as a dairy
county as a reason why the utmost care should be taken against
the spread of infection. When one considers that there are at
present 204 dairies on the register, with an aggregate of over 6000
cows, which, taking the average annual yield of milk from each
at 500 gallons, and the average price per gallon at 6d, will bring a |
| HH62/1/DUMFRI/31 |
[Page] 30
revenue of at least £75,000 into the county each year, it will
hardly be urged that we should simply stop the trade and take no
further steps. The dairyman is not usually responsible for an out-
break of fever at his house, and it may very reasonably be asked
why should he be subjected to a loss if means of isolation can be
provided for his patient. It is not necessary that the patient
should be accommodated at the entire expense of the ratepayers,
but he ought to have the opportunity of availing himself of and
paying for such accommodation before steps are taken to stop his
trade for a period that in some cases may be ruinous. It is now
held that Local Authorities are the proper parties to provide this
accommodation. Permission to make such provision was given in
the Act of 1867, which also contains a clause that, if put in force
by the Board of Supervision, would render it compulsory during
epidemic periods. When the making of such provision has been
postponed to these times, it has almost invariably turned out
expensive and unsatisfactory, and I can hardly doubt that in the
onward march of sanitation Local Authorities will see that it is to
the interest of their Districts to make the provision before being
compelled to do it at the call of a higher authority or by the panic
caused by an epidemic.
After Isolation will come Disinfection. A partial disinfection
will probably be carried out in well-regulated households during
the illness and convalescence of the patient, but it is only when
he ceases to throw off the infecting material that the complete
process can be performed. This can be most effectually done by
thoroughly fumigating the room or rooms occupied during illness
with sulphurous acid, generated by burning sulphur in the proportion
of 1lb. to every 1000 cubic feet of air-space. To allow of thorough
disinfection, every aperture, chimney, window, door, &c., ought to
be closed, the room being made as nearly air-tight as possible and
the sulphur left to act for twenty-four hours. The addition of
moisture greatly facilitates the process. Koch found in his laboratory
experiments that sulphurous acid, acting in moist air in an air-tight
box, not only destroyed bacilli but also the pores of some of the
more resistant in the time I have specified. It has been said that
sulphurous acid fails in certain cases. There is no doubt this is
true, but I attribute the failure to the difficulties that arise in the
way of securing its prolonged action in an air-tight room. There
are but few of the houses tenanted by the working-classes in which
rooms can be vacated so long as twenty-four hours. We have then
[Page] 31
to be content with a shorter period, but this imposes on us the
necessity of seeing that the articles in the room which have also
been exposed to infection should be treated separately in some
other way. Indeed, this is necessary whether the fumigation can be
carried out for twenty-four hours or not. Washable articles are best
disinfected by being thoroughly boiled, and experience as well as
experiments show that it is quite sufficient. Koch found that
five minutes' boiling completely destroyed the spores of the
anthrax bacillus; and Dr Russell, Medical Officer of Health for
Glasgow, says in a letter, quoted in the 14th Annual Report of the
Local Government Board, that for many years he has used no other
disinfecting method for washable articles than boiling them for
one to three-quarters of an hour with soap and soda. He con-
cluded that this was sufficient, because, though they threw small-
pox, typhus, enteric, scarlet fever, &c., all into one witches'
cauldron, he never heard of any inter-communication or continuity
of infection. For articles that are not washable, disinfection by
hot air or steam is required. Disinfection by steam is more satis-
factory than by hot air. Bulky materials are more readily
penetrated, the diffusion of heat is more uniform, and there is
less risk of injuring articles by scorching. The germicidal effect
is also found to be greater with steam than it is with hot air at the
same temperature. Certain articles, such as leather and water-
proof materials, would be destroyed by steam, and probably they
would be better disinfected by hot air. Though there seems to be
a universal agreement among authorities as to the superior value
of steam, there is not the same unanimity on the question
of how it may be most efficiently and economically applied. Most
of the apparatus now in use are constructed to apply it under
pressure, the earlier experimenters having found that bulky
articles were more easily penetrated, while the increase of tem-
perature coincident with the increase of pressure was supposed to
be an advantage. These high pressure apparatus are, however, so
costly as to be almost prohibitive in rural districts, and while it
must be admitted that they are probably more efficacious, I am
inclined to think we may get all we want from circulating steam
introduced into a chamber at the top and passed out at the bottom.
Such chambers might be constructed at each of the isolation
hospitals, when these are provided, and so made that they could be
utilised for hot air as well as steam disinfection, and that at a very
much smaller cost than the high pressure chambers. When erected |
| HH62/1/DUMFRI/33 |
[Page] 32
they would form convenient disinfecting stations for the Districts.
Some experiments made recently would go to show that circulating
steam applied in this way for a space of twenty minutes will penetrate
articles of considerable bulk, and effectually destroy any infectious
germs that may be lurking in their interior. In addition to all this
personal disinfection of the patient, as ordered by the medical
attendant, will also be necessary.
VITAL STATISTICS.
Population. - The gross population of the entire Civil County
at the April Census was found to 74,308, while that of the Regis-
tration County was 74,332. The latter figure may, however, be
taken as the correct Census population, the boundaries of the Civil
and Registration County being now co-terminous. These figures
include the Burghal as well as the Landward population, which is
shown in Table III.:-
TABLE III.
Populations of the County Districts.
[Table inserted]
The population in the landward part of the County has thus
diminished to the extent of 2134 persons, while the total Burghal
population has increased by 302. The only District in which there
is an increase is Dumfries. An examination of the figures for the
eight parishes comprising that District shows that this increase has
taken place in Dumfries Landward, and particularly in the Crichton
Asylum:-
[Table inserted]
[Page] 33
Excluding the Asylum population altogether, where the in-
crease is in no small measure due to the reception of a larger
number of out-County patients, it is thus seen that, while there has
been an addition of 357 (males 200, females 157) persons to the
landward part of the parish of Dumfries, there has been a decrease
in the remainder of the District of 416, or a total decrease of 59 all
over. This decrease is chiefly in the female part of the population,
their numbers being less by 158 than in 1891, while males have
increased by 99. In this respect the Dumfries District approaches
more closely than any other the conditions that have obtained all
over the Mainland Rural Districts of Scotland, in which there has
been a slight increase of males with a very considerable decrease
among females:-
TABLE IV.
Percentages of Increase or Decrease in Rural Districts
of Dumfriesshire in 10 Years.
[Table inserted]
When the excess of Births over Deaths for the ten years
1881-90 is taken into account, it is evident that the migrations of
the rural population have been very extensive. The total Births
in the six Districts for these years have been 13,512 (males 6947,
females 6545), while the Deaths, excluding those which have
occurred in the Crichton Asylum, were 7885 (males 3843, females
4042). Had no migrations occurred the total rural population
should therefore have increased in 1891 by 5627 (males 3124,
females 2503). In the six parishes - Wamphray, Cummertrees,
Tinwald, Kirkconnel, Annan Landward, and Dumfries Landward - in
which there is an advance on the figures of 1881, there is only one,
Annan Landward, in which the actual increase is in excess of the
*Crichton population deducted. |
| HH62/1/DUMFRI/35 |
[Page] 34
natural increase. There the latter is 299, the Census figures
showing an actual increase of 309.
Births. - The total number of Births registered in the County
Districts was 1280 (males 663, females 617). The rate was 27·48,
which, while it is an increase on the rates for the two preceding
years, is less than the mean of the ten years 1881-90. It is also
less than the means of the same period for the whole of Scotland
and for the Mainland Rural Districts. (See Table V.)
The District showing the highest rate is Langholm; that with
the lowest is Moffat. Among the parishes showing high rates are
Glencairn, 42·50; Kirkconnel, 42·31; Westerkirk 41·85; Hutton,
38·57; and Eskdalemuir, 38·33. Relatively low rates are shown
by Half-Morton, 16·53; Mouswald, 16·00; and Dalton, 15·98.
The rates for the Districts as well as the illegitimacy rates are set
forth in Table VI.:-
[Page] 35
TABLE V.
BIRTH-RATES during the years 1881-90.
[Table inserted]
TABLE VI.
BIRTHS AND DEATH-RATES during the year 1891.
[Table inserted] |
| HH62/1/DUMFRI/37 |
[Page] 36
Mortality. - Before entering on my duties I had, through the
courtesy of the Registrar-General, an opportunity of examining
the Death Registers for the years 1881-89 of the forty-five
Registration Districts of the County. From these I compiled
certain tables too elaborate for publication in this Report, but some
of the figures may be usefully quoted and compared with those
for Scotland and its Mainland Rural Districts for the same periods.
The Rates for the Mainland Rural Districts form a fairer subject
for comparison with those of the County Districts of Dumfriesshire
than do the rates for the whole of Scotland, compiled as they are
from large urban as well as rural populations. The rates I select
for this purpose are in addition to the total death-rate, the infant
mortality, the zymotic (by which I mean the death-rates from - pox,
measles, diphtheria, whooping-cough, typhus, enteric and continued
fevers, and diarrhœa), and the phthisical. They will be found in
table VII. The total or crude death-rate is not one that can be
relied upon as a satisfactory test of the healthy or unhealthy state of
a district. It depends in part on conditions that may not be
amenable to sanitary influences, such, for example, as the age-
distribution, the social status, and the occupations of the people.
A population in which there is a large number of healthy young
adults will probably show a lower rate than a district where young
children or aged individuals predominate, while a manufacturing
centre may be expected to show higher rates than a residential.
On the other hand, young children are so extremely susceptible to
unhealthy surroundings that their mortality, expressed as "Deaths
under 1 year per 1000 Births," has been held by many sanitarians
to be a fair test of the health of a district. It must not, however,
be forgotten that this mortality may be influenced by other causes,
such as illegitimacy, hand-feeding, &c., so that in itself it is not
sufficient to warrant a definite conclusion. The Zymotic and
Tubercular or Phthisical deaths, depending, as they do, so largely
on preventable causes, afford more reliable evidence. The table
shows that while, as might have been expected, the curves of the
various rates show greater variations than do those for Scotland
and its Mainland Rural Districts, the mean annual mortalities, with
the exception of that of Infant deaths, come out lower than those
of Scotland but higher than those of the Mainland Rural Districts.
[Page] 37
TABLE VII.
DEATH-RATES per 1000 Persons Living.
[Table inserted] |
| HH62/1/DUMFRI/38 |
[Page] 38
But some of the Zymotics are more directly due to insanitary
conditions than others, and it is well to distinguish these. Thus,
enteric or typhoid fever mortality has been greatly reduced in
many districts by the introduction of a pure water supply, while
diarrhœa, particularly as it affects young children, and depending,
as it does, so largely on excremental pollutions of soil and atmos-
phere, may be said to have been similarly influenced. Others,
again, such as measles, scarlatina, and whooping-cough, while
undoubtedly aggravated by unhealthy conditions, do not so directly
depend on them as on direct infection, so that a prevalence of such
diseases will indicate a failure on the part of Authorities to enforce
efficient isolation and disinfection. Table VIII. shows that while
the County Districts as a whole contrast favourably with the
Mainland Rural Districts so far as Measles, Scarlet Fever, and
Typhus are concerned, the same cannot be said of Diphtheria,
Whooping-cough, Typhoid Fever, and Diarrhœa. Diphtheria in
particular shows a high mean rate, and this is no doubt due in
large measure to the epidemics which have occurred, particularly
in Eaglesfield, Hutton and Corrie, and in Wamphray.
TABLE VIII.
Mean Death-Rates per 1000 living from certain Zymotic
Diseases during the Years 1881-9.
[Table inserted]
Table IX. shows the mean annual rates for each District for
1881-90.
The mortality for the present year is set forth in the Tables of
the Board of Supervision appended to the Report. These are con-
structed from returns made to me by the Registrars. In some
points they will be found, so far as the total numbers are concerned,
not to correspond with those which appear in the Quarterly and
Annual Reports of the Registrar-General. The Landward and
Burghal returns for Annan, Sanquhar, Lochmaben, Dryfesdale,
[Table not complete - corrected on next page] |
| HH62/1/DUMFRI/38A |
TABLE IX.
MEAN ANNUAL RATES OF EACH COUNTY DISTRICT for 1881-90 inclusive
[Table inserted] |
| HH62/1/DUMFRI/39 |
[Page] 39
Moffat, and Langholm are separated, while only the Landward
returns for Dumfries parish are given. The returns for Wanlock-
head are added to those for Sanquhar Landward, while the Bryde-
kirk returns are separated and added to those for the three civil
parishes out of portions of which this Registration District is formed.
This is necessary, as two of these parishes lie within the Annan
District, while the third is in that of Lockerbie. Further, the
deaths of patients in the Crichton Asylum who do not belong to
the County have been altogether deducted, while those belonging
to the County have been added to the various parishes from which
they were admitted. In calculating the rates I have deducted 550
from the population, that figure representing as nearly as my infor-
mation goes the number of out-county patients in the Asylum last
year. A series of tables showing the rates for each parish were
constructed, but exigencies of space and other considerations pre-
vent their publication. The total number of deaths for the six
County Districts was 830, and the rate per 1000 living 17·823.
The Districts of Thornhill, Dumfries, and Annan show rates below
this figure - 16·960, 16·246, and 16·598 respectively. The rates
for Lockerbie, Moffat, and Langholm are considerably higher, being
20·203, 21·011, and 21·518 in each case. It may be further
observed that the total rate is slightly higher than the mean for
1881-89. The highest rates occurred in the parishes of Torthor-
wald, 26·058; Canonbie, 25·848; Tundergarth, 25·057; Hoddom,
24·787; and Kirkpatrick-Juxta, 24·590; the lowest in Dalton,
10·657; Westerkirk, 11·013; Hutton and Corrie, 11·019; and
Tynron, 11·142.
The Infant Mortality over the entire rural population is less
than the average, being 82 per 1000. This is exceeded in the
Moffat and Langholm Districts, where it is 118 and 139 per 1000.
The rate for Annan District is 95, for Dumfries 80, for Lockerbie
71, while Thornhill shows more favourably than any with 52.
Certain of the parishes show a very high mortality among infants.
In Tinwald it is 262 per 1000 births, in Torthorwald 230, in Canon-
bie 208, in Kirkpatrick-Juxta 178, and in Cummertrees 150. I
have already stated that this mortality, though perhaps largely, is
not entirely dependent on insanitary surroundings, and have
instanced illegitimacy as a cause. It is probable that it may not
exert the same influence in districts where it is common as in others
where it is less prevalent, but that such influence is undoubtedly
exerted is borne out by a comparison of the Illegitimacy rates with
the Infant Mortality rates for each District. |
| HH62/1/DUMFRI/41 |
[Page] 40
Zymotic Mortality. - The total zymotic mortality for the
year comes out somewhat better than in the ten preceding years,
with the exception of 1890, when it was 1·288. Moffat, Annan,
and Thornhill each show rates below, while Dumfries, Lockerbie,
and Langholm are above the total. In Langholm the rate is more
than double of what it is in any one of the other Districts. This
is explained by a high mortality from whooping-cough in the
parish of Canonbie.
There was no death registered nor case reported during the
year of either Small-pox or Typhus. The former has not, so far
as my information goes, appeared in any of the Districts since 1881,
when the death of a child in Brydekirk was registered as due to
it. Seventeen deaths from the same cause occurred in that year
in Scotland. Two deaths from Typhus have occurred during the
past ten years - one in 1887 and one in 1889. The Diarrhœa
mortality rate is below the average, but with the exception of
whooping-cough it is the highest of the zymotics. The disease is
most prevalent during the summer months, depends, as I have said,
largely on unhealthy surroundings, and affects more particularly
infants and young children. Of the other zymotics I have already
reported at some length.
The diseases included under the term Septic are those placed
in this classification by the Registrar-General. They are erysipelas,
puerperal fever, and pyaemia. Of these the two former are notifi-
able under the Infectious Diseases Notification Act. They depend
for their cause on the introduction into the system of micro-
organisms which thrive best in dirt and filth, and are therefore to
be considered as preventable diseases. They caused six deaths,
and the rate was 0·129, which is less than the average of the pre-
ceding ten years.
The discovery of the tubercle bacillus by Koch in 1883
confirmed the view that tubercular diseases are due to
preventable causes. Before this date, however, there was
ample evidence that both phthisis and the other tubercular diseases
might be prevented in several different ways. Thus, in the Report
of the Army Sanitary Commission, published in 1858, it was very
fully demonstrated that the excessive mortality from consumption
in the army was largely due to overcrowding and insufficient
ventilation. The recommendation of the Commissioners that in
[Page] 41
barracks where the disease had been found to be prevalent the
amount of cubic space given to each soldier should be increased
having been adopted, the phthisical mortality in the army began to
diminish. In addition to impure and vitiated air, dampness of soil
has a very important influence in the production of these diseases.
In towns where subsoil drainage has been carried out the phthisis
mortality has been reduced, and the very exhaustive investigations
made by Sir George Buchanan in 1865-6 conclusively prove
that wetness of soil is a cause of phthisis to those who live upon
it. Another cause, and one that probably affects young children
more than adults, is the ingestion of milk from tuberculous cows, as
well perhaps as the use of tuberculous flesh for food. It may be
that the latter danger has been exaggerated, but that tuberculous
milk may reproduce tubercle has been experimentally proved, and
the prevalence of tubercular diseases in young children along with
the use of milk as a large part of their diet is a point to be borne
in mind. These causes indicate the need for improved house
and byre accommodation and subsoil drainage in localities where
tuberculosis is prevalent, if any improvement is to be expected in
the mortality rates. Isolation of patients suffering from the disease
has been demanded by some, and within certain limits this might
be carried out. The difficulties in the way of complete isolation
are, however, too many and great, and more benefit would be
gained by attention to such hygienic precautions as I have
indicated. The number of deaths due to phthisis during the past
year was 61, and to other forms of tubercular disease 26. The
phthisical death-rate was 1·310, and therefore considerably below
the average. It was highest in Thornhill District and lowest in
Moffat.
In regard to other diseases, it may be noted that Cancerous
affections show a mortality slightly below the average for the past
ten years, but above that of Scotland for the same period, which is
0·58. It has shown a tendency to increase towards the end of the
decade. The highest rates are obtained in the Thornhill and
Lockerbie Districts, but the highest mean of the past ten years is
that for Dumfries, 0·874, and the lowest that for Lockerbie, 0·710.
The highest rate among the parishes occurred in Glencairn, and
was 3·035.
Deaths from Respiratory affections are above the average in
certain of the Districts, the increase being probably explained by |
| HH62/1/DUMFRI/42A |
BIRTHS AND DEATHS OCCURRING IN THE THORNHILL DISTRICT IN 1891. --- A
[Table inserted] |
| HH62/1/DUMFRI/42B |
BIRTHS AND DEATHS OCCURRING IN THE DUMFRIES DISTRICT DURING THE YEAR 1891. --- B
[Table inserted] |
| HH62/1/DUMFRI/42C |
BIRTHS AND DEATHS OCCURRING IN THE ANNAN DISTRICT DURING THE YEAR 1891. --- C
[Table inserted] |
| HH62/1/DUMFRI/42D |
BIRTHS AND DEATHS OCCURRING IN THE LOCKERBIE DISTRICT DURING THE YEAR 1891. --- D
[Table inserted] |
| HH62/1/DUMFRI/42E |
BIRTHS AND DEATHS OCCURRING IN THE MOFFAT DISTRICT DURING THE YEAR 1891. --- E
[Table inserted] |
| HH62/1/DUMFRI/42F |
BIRTHS AND DEATHS OCCURRING IN THE LANGHOLM DISTRICT DURING THE YEAR 1891. --- F
[Table inserted] |
| HH62/1/DUMFRI/42G |
TOTAL OF BIRTHS AND DEATHS OCCURRING IN THE SIX COUNTY DISTRICTS DURING THE YEAR 1891. --- G
[Table inserted] |
| HH62/1/DUMFRI/42H |
COUNTY DISTRICTS.
DENSITY OF POPULATION, BIRTH-RATE, INFANTILE AND OTHER DEATH-RATES. --- H
[Table inserted] |
| HH62/1/DUMFRI/42I |
BIRTHS AND DEATHS OCCURRING IN THE SIX COUNTY BURGHS DURING THE YEAR 1891. --- I
[Table inserted] |
| HH62/1/DUMFRI/42J |
DENSITY OF POPULATION, BIRTH-RATE, INFANTILE AND OTHER DEATH-RATES IN THE BURGHS. --- K
[Table inserted] |
| HH62/1/DUMFRI/43 |
[Page] 42
the prevalence of Influenza, of which I have already spoken at
some length. The mortality rate directly due to it was, for the six
Districts, 0·880. It was highest in Langholm, 1·236, and lowest in
Moffat, 0·328.
Age at Death. - Of the 830 deaths, 106, or 12·7 per cent.,
were under 1 year; 55, or 6·6 per cent., between the ages of 1 and
5; 50, or 6·02 per cent., between 5 and 15; 62, or 7·4 per cent., be-
tween 15 and 25; 174, or 20·9 per cent., between 25 and 60; and
383, or 46·1 per cent., above 60 years of age.
In addition to the Tables for the County Districts, I give two
for the Burghs. They will be useful for comparison with the
Districts, and, so far as the Police Burghs are concerned, the pre-
sentation of their statistics in tabulated form may partly, and with
least friction, fulfil the obligation under which, as County Medical
Officer, I am supposed to lie of exercising a general supervision
over their sanitary condition. I may, however, be permitted to
express my opinion that they, as well as the rural districts, would
be greatly benefited by a centralisation of their sanitary admini-
stration. County Councils and District Committees have given
evidence of a desire to take broader and more correct views than
obtained under the old parochial system of their responsibilities as
administrators of the various Public Health Acts. The change,
while it may have some attendant drawbacks, appears to be one
for the better, and I have every faith that in the years to come
"ancient landmarks of civic life" will see that it would have been
to their benefit to have participated more largely in the advantages
conferred upon rural districts by the Local Government Act.
J. MAXWELL ROSS,
County Medical Officer.
[Page] 43
IN THE FOLLOWING TABLES
Deaths of Persons belonging to a District occurring in Public
Institutions (as Lunatic Asylums, Poorhouses, Hospitals) out-
side of the District are included with the figures for that
District, and deaths of Persons not belonging to a District,
occurring in Public Institutions within the District, are
excluded.
"Diphtheria" includes "Membranous Croup," "Diphtheritic Croup,"
"Croupous Diphtheria."
All deaths from "Diarrhœa," "Dysentery," "Enteritis," "Gastro-
Enteritis," "Muco-Enteritis" - unless qualified by the designa-
tion "Chronic, or by an alleged primary cause, e.g., "Phthisis
Diarrhœa," "Bright's Disease - Diarrhœa," are entered under
the heading "Diarrhœa."
The designation "Other Tubercular Diseases" includes, inter alia,
"Tabes Mesenterica," "Tubercular Meningitis," "Hydro-
cephalus," "Struma," "Scrofula."
The diseases placed under the several headings "Septic,"
"Nervous," "Circulatory," and "Respiratory" are those so
classified by the Registrar-General. |
| HH62/1/DUMFRI/45 |
APPENDIX.
LETTER ON HOSPITAL ACCOMMODATION.
TO JOHN H. DICKSON, ESQ.,
Chairman of the Public Health Committee of the
County Council of Dumfriesshire.
SIR,
In accordance with your request, I
have the honour to submit for the information of the Conference
of Representatives of the Public Health Committee of the County
Council and of the District Committees of the County the following
statement, giving in general terms an outline of the provisions
that appear to me desirable in order to prevent the spread of
Infectious or Contagious Diseases in the County:
It has been said, and with much truth, that no Sanitary
Authority can be regarded as fulfilling its duty in the prevention
of such diseases unless it has provided for (1) Compulsory Notifi-
cation, (2) Isolation Hospitals, (3) Disinfection.
With the exception of Moffat, the District Committees have
adopted the Infectious Diseases (Notification) Act, and have
therby provided for the first requirement. Annan and Lockerbie
Districts have added Measles to the list of Diseases scheduled in
the Act for notification, and I wish to take the opportunity now
afforded me of suggesting to the other Districts that they might
do likewise. Apart from other considerations, it will promote
that uniformity in regard to the working of the Public Health
Acts which this Conference is seeking to secure, and would get rid
of much of the confusion that has already resulted from Measles
being notifiable in one district but not in another. Some of the
medical practitioners do not seem to have made themselves
acquainted with the geographical limits of the various Districts.
It thus not unfrequently happens that notifications of Measles come
from Districts where they are unauthorised, while it is not impro-
bable that omissions will occur in Districts where cases ought to be
duly notified. |
| HH62/1/DUMFRI/47 |
[Page] 46
The third requirement, Disinfection, to some extent depends
on the second, as a proper disinfection chamber to which articles
of clothing may be taken usually exists alongside every well-
equipped Hospital. Since the appointment of Mr Osselton and
myself we have to the best of our ability given assistance in any
case where we were asked to disinfect, and have provided dis-
infectants wherever we have seen the necessity of doing so.
Single-handed it has not been possible to do much in this way,
but in the event of sufficient assistance being provided by the
Public Health Committee or County Council, it will be part of the
duty of the assistants to carry out disinfection under our orders,
when we trust it will be more efficiently done.
The most important requirement for the prevention of the
spread of Infectious Disease is that we are now about to consider,
viz., Isolation Hospitals. There is no question of the power of
Authorities to provide such. Under Section 35 of the Public
Health Act, 1867, they may be required to do everything that may
be advisable for mitigating epidemic, endemic, or contagious
diseases. Section 39 gives power to provide hospital accommoda-
tion, which may be done by erecting buildings of a permanent or
temporary nature, or by arranging for the use of existing hospitals,
or by purchasing or renting a house or other building and adapting
it for the purpose. Such accommodation must, however, be within
the district of the Authority, or, in the event of a combination,
within the district of one of the Authorities so combining. Disin-
fection may either be done by an Authority at its own expense,
or an owner or occupier may be called upon to disinfect his
premises, under Section 40, which also declares it to be lawful for
an Authority to provide and maintain a carriage or carriages for
the conveyance to hospital of individuals suffering from infectious
disorders. Powers may be taken under Section 42 for the compul-
sory removal of individuals whose surroundings my not enable
their treatment to be carried out in their own homes or lodgings
without risk of spreading the disease. Further, under the 2nd
Section of the Public Health Amendment Act of 1871, Authorities
may borrow on the security of the assessments for the purpose of
building or otherwise providing permanent hospitals.
There is little doubt that if suitable provision is made during
what may be called a non-epidemic period it gives Sanitary
Authorities an opportunity for coping with disease that may be of
the utmost value. Where, however, Authorities have not taken
[Page] 47
advantage of such periods, but have run up hospitals under the
influence of panic caused by the rapid spread of an epidemic, these
have generally failed in their object. If evidence of this is desired
it can be had to repletion in a volume on the Use and Influence of
Hospitals for Infectious Diseases issued by the Local Government
Board in 1802. In it Dr Thorne Thorne, writing of hospitals
hastily erected while smallpox or fever was making head in the
district says - "It is often not ready for occupation until the im-
"mediate cause of its erection has passed by, it provides accommo-
"dation of a very indifferent sort, it fails almost without exception
"to meet the permanent requirements of the district, even
"when in amount it turns out to be more than the district
"needs, and thus the object of the hospital as a part of the
"sanitary defences of the district is often attained in a very
"imperfect manner and at a needlessly large cost." This opinion
was arrived at after an inspection by Dr Thorne of a large number
of hospitals in various parts of England.
If any argument from the local circumstances of our County
in favour of making such provision as early as possible is wanted,
it will be found, I think, in the dairy trade, one of the most
important industries in Dumfriesshire. Milk is sent from within
our area to many of the large towns in Scotland and the North of
England. It is the duty of our Authorities to see that the milk
leaves us pure and uncontaminated. The necessity of this is
apparent when we consider that milk is a fluid which has been
proved over and over again to have carried contagion and spread
disease. As matters are at present, should fever break out in any
of our dairy farms there is little chance of securing that isolation
which is necessary to prevent contamination of the milk, and it will
then be our duty to stop its sale, thus entailing upon the dairyman
a loss which at times cannot fail to be very heavy, and one which
in all fairness he should not be expected to bear entirely himself.
Indeed, it is a question whether he might not have a fair claim
against the Authority for compensation for damage sustained.
The existence of an isolation hospital would at anyrate relieve the
Authority of any moral responsibility, even if it be held that they
have no legal responsibility.
What is true of milk is true in a minor degree of other articles
of food. It was only the other day that Mr Ossleton and myself
were compelled to order a butcher to cease selling meat while his
children suffered from scarlet fever. The shop in this instance |
| HH62/1/DUMFRI/49 |
[Page] 48
communicated with a room in which the children were allowed to
play while in the peeling stage.
Further, there can be little doubt that a case quickly notified
and speedily isolated will tend to prevent the outbreak of what
might otherwise prove to be a widespread epidemic.
The question of how to provide such accommodation is one on
which I anticipate some diversity of opinion. It may be well to
consider some suggestions that have been made since it began to
be mooted. One of the most important emanated from the Gover-
nors of the Dumfries and Galloway Infirmary, and ought therefore
to receive some attention from us. The Governors offered to enter
into an arrangement with the various District Committees for the
reception of cases of Infectious Disease occurring within their re-
spective areas. Sixteen beds were to be set apart for the treatment
of infectious cases, but these beds were to be open to the Burgh
Authorities as well as to those in the Stewartry. Admission was
to be decided by priority of application. I have objected to this
proposal on two distinct grounds - 1st, the distance of Dumfries
from certain parts of the County for which provision must be made;
and 2nd, the inadequacy of the provision offered by the Governors.
A further objection which may be raised is the tendency of the pre-
sent day to keep hospitals for infectious diseases apart altogether
from general hospitals. The experience of Sanitary Authorities -
e,g., in Manchester and Southport - seems to be against the use of
general hospitals for sanitary purposes. Another proposal has been
to build one hospital for the whole County in some central part.
The objection of distance will apply here also, though not so
strongly as in the case of the Dumfries and Galloway Infirmary.
On this point I may be allowed to quote again from Dr Thorne
Thorne's report. "It is not," he says, "that removal for a distance
"of some 5, and even, in isolated instances, 8 and 10 miles in a well-
"constructed ambulance and over ordinary good roads, has ap-
"peared to do harm to the particular patient, provided the removal
"has been effected at an early stage of the disease. By far the
"greatest difficulty in the matter of distance has been found, as a
"rule, to lie with the relatives and friends of the patients, who
"assent much more readily to removal to hospital if it be within
"such distance as to enable them without much trouble and with-
"out material interference with their business and other vocations
"to make frequent enquiry as to the patient's welfare. In rural
"districts the question of distance is usually less thought of than
[Page] 49
"in urban districts, especially when the hospital to which removal
"is effected is in or near some centre to which the population often
"travel in connection with their daily or occasional pursuits." We
may then safely assume that the hospital should not, if at all pos-
sible, be placed further from the more populous parts of the area
it is intended to supply than 5 or 6 miles, and if this can be secured
there is not likely to be any great objection raised by patients or
relatives on the score of distance. I therefore think that each
District Committee should provide hospital accommodation within
its own area, and, with the exception of Thornhill, one building
situated in some central part will probably be found sufficient. A
suggestion has been made to me that in some of the Districts the
Combination Poorhouses might be utilised. There are two object-
tions to this proposal. The first is that it does not appear to be
legal to use these buildings for any other purpose than the recep-
tion of paupers, and the second is that, even if there were no
doubt as to the legality of doing so, it would be unwise, inasmuch
as the people who are not in a position to require parochial relief
naturally object to be removed to buildings that are specially
intended for paupers. I am of opinion that the best solution of the
problem will be found in a combination between each District and
the Burgh or Burghs within its area. Either a new hospital might
be built, which would be much the more satisfactory method, or
existing buildings might be purchased or rented and adapted.
The question of the amount of accommodation that will require
to be provided is one of some difficulty. If we accept the standard
recommended by Dr Buchanan of the Local Government Board,
which is one bed to every 1000 of the population, and assume that
the Burghs are willing to combine with the Districts, we shall find
that in Moffat 6 beds will be necessary, in Langholm 8, in Locker-
bie 10, in Annan 15, in Thornhill 14, and in Dumfries 30. In the
latter it may be that some difficulty will be experienced in effecting
a combination with the Burghs of Dumfries and Maxwelltown, and
and in that case for the District alone 12 beds will be required.
The arrangement of these will not depend merely on the separa-
tion of the sexes. The diseases demanding isolation must also be
taken into account. These are in particular Smallpox, Typhus,
Typhoid, Scarlatina, and Diphtheria. It may also happen that cases
of Measles and Erysipelas must sometimes be isolated. It is neither
necessary nor desirable that accommodation should be provided for
all of them. Some (e.g., Smallpox and Typhus) will occur with |
| HH62/1/DUMFRI/51 |
[Page] 50
such comparative rarity that temporary hospitals in the shape of
huts or tents will probably prove sufficient for their accommoda-
tion. But a permanent hospital, to be efficient, ought to be so con-
structed as to enable us to deal with at least two of the others
within its walls at the same time. To do so and to separate the
sexes four rooms or wards must be provided. Thus, in Moffat and
Langholm Hopitals there might be four wards with two beds each,
in Lockerbie four with two or three beds to each, and in Annan
four with three or four beds. Thornhill and Dumfries Districts call
for more careful consideration. For the former probably it will be
found that two hospitals may be required. If so, there ought to
be in each four wards, with two beds to a ward. In Dumfries, if
provision is to be made for the District alone, four wards, each con-
taining three beds, will probably suffice. If, however, the Burghs
combine with the District there ought to be accommodation for the
treatment of more than two fevers, which will necessitate probably
six or more wards, each of which might contain five beds. But in
addition to the wards there ought to be one or more smaller rooms
in which doubtful cases may be kept until their nature be ascer-
tained. If not required for patients they may be otherwise
utilised.
Such an hospital should be constructed of stone or brick.
The maintenance of a proper temperature has been found to be a
difficult matter in buildings of wood or iron, and in one instance a
somewhat substantially constructed hospital of wood had to be
closed during winter because it was believed that the deaths of
two patients had been brought about by the low temperature,
which it was found impossible to obviate. The internal walls
should be lime-washed and afterwards covered with a slightly
toned wash, or, if it be preferred, they may be constructed of
glazed bricks which can be easily kept clean. The ward space
should be such as to give each patient 144 square feet of floor and
2000 cubic feet of air. Ventilation should be carried out partly by
the windows and partly by air inlets and outlets. Tobin's tubes
and Boyle's ventilators have been found to give satisfaction in
small as well as in large hospitals. Heating may be done con-
veniently by open fires. The window surface must not be ex-
cessive, otherwise the air cannot be kept pure and equably warm.
One square foot to 70 or 80 cubic feet has been found to be a
suitable proportion. The furniture must be as simple as possible.
A table and one or two chairs to each ward of four beds may be
[Page] 51
sufficient. The bedsteads ought to be of iron. Carpets and cur-
tains are inadmissible. At least one moveable bath will be required,
and earth closets containing some disinfectant are preferable in the
country to water closets. Slops should be carried from a sink
outside the ward by a properly constructed drain to a well made
cesspool, disconnection and trapping being carefully attended to.
If the hospital is to be thoroughly equipped, it must have, in
addition to wards, an administrative building and certain out-
buildings. The administrative should contain kitchen, scullery,
pantry or larder, a dispensary, and bedrooms. In it the nurses or
caretaker should be housed, and it ought to be a building separate
from the wards but connected with them by a covered way. The
out-buildings will consist of a laundry, a mortuary, and a disin-
fecting chamber. A shed may also be required for the ambulance
or fever coach which must be provided for the removal of patients.
The site of the hospital should be at some distance from other
buildings; at least 40 feet ought to lie between its boundary fence
and the nearest. Its extent should be such as to admit of the
erection of huts or tents in the event of the permanent wards
being insufficient during an epidemic, or of Smallpox or Typhus
breaking out. It ought to be convenient of access, moderately
elevated, on a slope, and with a dry soil. There must be free cir-
culation of air and a good water supply. The most suitable aspect
in this county appears to be one facing the south-east. Lastly, a
close fence or wall about six feet in height ought to be placed
around it.
I have the honour to be,
SIR,
Your obedient servant,
J. MAXWELL ROSS.
DUMFRIES, July 30, 1891. |
|
|
