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County Council of Dunbarton.
FIRST
ANNUAL REPORT
(YEAR 1891)
TO THE
COUNTY COUNCIL
AND
DISTRICT COMMITTEES,
BY
JOHN C. McVAIL, M.D., D.H.P.Camb., F.R.S.E.,
Medical Officer of Health.
GLASGOW:
WILLIAM HODGE & CO., 26 BOTHWELL STREET,
1892. |
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NOTE.
By regulations issued under the Local Government (Scotland) Act,
1889, the Board of Supervision requires all Medical Officers of
Districts of counties to prepare an annual Report and to transmit
copies thereof to the Board and to the County Council. Under
eight headings these Reports practically cover the whole field of
sanitary work as carried on the Districts. In addition, the Board
recommends that another Report, referring to each county as a
whole, be prepared and sent to the same authorities at a later
date, the County Report being based to some extent on the Dis-
trict Reports. This arrangement appears to have contemplated
the possibility of the County Medical Officer not being at the same
time Medical Officer for the Districts. But in the County of Dun-
barton, as usually elsewhere in Scotland, the same Officer acts in
both capacities. That being so, it seems convenient that County
and District Reports should appear together. Further, so much
of what I have to say refers alike to both Districts, that
instead of writing a separate Report for each, I have, under
such headings as House Accommodation, Water Supply, &c.,
&c, simply devoted separate paragraphs to the Western and
Eastern Districts. In preparing the Report I have transposed
the first two of the eight subdivisions laid down by the Board,
but in the table of contents the items are arranged in the proper
sequence.
24 GEORGE SQUARE,
GLASGOW, March 8th, 1892. |
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CONTENTS.
CLASSIFIED ACCORDING TO THE REGULATIONS OF THE BOARD OF SUPERVISION.
-- PAGE.
1. A General Account of the Sanitary State of the Districts,
and of the measures which should be adopted for its
improvement.
House Accommodation -
Rooms per house, -- 17
Persons per room, -- 18
Percentage of houses of certain sizes, -- 19
Character of accommodation, -- 22
Water Supply -
Western District, -- 24
Eastern District, -- 25
Drainage -
Western District, -- 28
Eastern District, -- 29
Mining Villages, -- 30
Refuse Disposal, -- 34
Scavenging of Villages, -- 35
Pollution of Rivers, -- 36
2. A Statement of the General Enquiries made during the
the year, and of any Special Enquiries as to Sanitary
Matters.
Area, Population, and Topography, -- 8
Climate, -- 8
Occupations, -- 12
Parishes and Districts, -- 12
Sex and Age Distribution, -- 15
3. A General Statement of any matters as to which the
Medical Officer has given advice or granted certificates,
including any action as to Offensive Trades and the
Sanitary Condition of Factories and Workshops.
Bye-laws -
Dairies, Cowsheds, and Milkshops, -- 39
Slaughter-houses, -- 40 |
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[Page] 6
-- PAGE.
Bye-laws (continued) -
Houses let in Lodgings, -- 40
Common Lodging-houses, -- 41
Piggeries, -- 41
Organisation of Public Health Department, -- 37
Hospital Accommodation, -- 42
4. An Account of the Inspections of Bakehouses and of
any Proceedings taken with regard to them, -- 41
5. An Account of the Supervision exercised over Hospitals
belonging to the Local Authority, or to which the
Local Authority are entitled to send patients.
Dunbarton Fever Hospital, -- 42
Helensburgh Fever Hospital, -- 43
6. A Summary of the action taken to prevent the Out-
break and Spread of Infectious Disease.
Western District -
Typhus Fever in Vale of Leven, -- 47
Scarlet Fever, -- 51
Diphtheria, -- 52
Eastern District -
Diphtheria, -- 54
Scarlet Fever, -- 54
Enteric Fever, -- 57
Erysipelas, -- 59
Puerperal Fever, -- 60
Measles, -- 60
7. A Statement of the Causes, Origin, and Distribution of
diseases within the Districts, and the extent to which
the same have depended on or been influenced by
conditions capable of removal or mitigation.
Vital Statistics -
Birth-rate of County, 1880-89, -- 61
Death-rate of County, 1880-89, -- 63
Death-rate of Registration Districts, 1880-89, -- 65
Deaths from certain causes in Small-town
Districts, and Rural Districts of County,
1885-89, -- 69
Infant Mortality, 1885-89, -- 79
8. A Tabular Statement of the Sickness and Mortality
within the Districts in 1891, -- 80
REPORT.
My work as medical officer to the counties of Stirling and Dun-
barton, and to the five Districts of which they are composed, began
on 16th March last. To a very great extent it has been both pre-
liminary and fragmentary, consisting of enquiries as to the general
sanitary condition and needs of the wide area of the two
counties, stretching across the centre of Scotland from the
Firth of Forth to the Firth of Clyde - these inquiries being car-
ried on in the intervals between the fulfilment of the various
administrative duties that have fallen to be attended to in one or
another part of the Districts. My first Report must of necessity
partake of the preliminary and fragmentary character of the work.
It treats of many matters that will not have to be dealt with at
any great length in future reports, and it passes over other
questions that I have not yet been able to take up. The great
bulk of my time has been occupied in the organisation of the
Public Health Department, in questions relating to hospital accom-
modation, in visiting houses and villages with reference to the
occurrence of infectious disease, in the preparation of bye-laws,
and in attending numerous meetings of District Committees and
Sub-Committees.
The services of the local Medical Officers and Sanitary Inspectors
were dispensed with as from 24th August last. But Mr. Sewell,
the former Inspector for the parish of West Kilpatrick, continued
for some time longer to report on infectious diseases notified in his
neighbourhood. And during outbreaks of typhus fever in Renton
and Alexandria, I called in the aid of Drs. Mitchell and McLelland.
With these exceptions my assistance in the County has been |
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[Page] 8
entirely that of the County Inspector, Mr. Dunbar, who has
been most active and unsparing in his work.
Among the thirty-three counties of Scotland Dunbarton stands
twenty-eighth as to area, there being only five smaller. Its total
area (including a part of East Kilpatrick recently added by the
Boundary Commissioners) is 157,289 acres. In population, how-
ever, it stood fourteenth at the census of 1881, and its increase
during the last decennium has been much more rapid than that of
any other county, so that it now occupies the tenth position. It
has grown at the rate of 25 per cent. as against a growth of 21 per
cent. by Linlithgow, 15 per cent. by Lanark, 14 by Midlothian, 11
by Stirling, and 10 by Clackmannan and Renfrew, all the other
counties showing a slower rate. The Dunbartonshire increase has
been greater in the burghs than in the landward part, but in both
it has been very considerable.
The county is of an irregular shape. On the east its
principal boundaries are Loch Lomond, the River Endrick and
its tributary burns, and the Allander Water. In some parts
the boundaries are artificial. On the west its main boundaries are
Loch Long, and to the north of Loch Long a part of Argyllshire.
Its southern boundaries are chiefly the Clyde and the Kelvin.
A detached portion, consisting of the parishes of Kirkintilloch and
Cumbernauld, lies between Stirlingshire and Lanarkshire, and has
for its principal natural boundaries the Kelvin on the north and
the Luggie Water on the south.
Climate. - In a county with a surface so varied as that of
Dunbarton it is obvious that, owing to local conditions of
elevation, exposure, relation to the sea, &c., there must be great
variety of climate. In the range of mountains along Loch Lomond
side, culminating in Ben Vorlich, it is necessarily severe, but in
the more populous parts along the shores of the Clyde and the
Gareloch, and in the Vale of Leven, it is much milder, and con-
tains such health resorts as Helensburgh and Shandon. There is
one station of the Scottish Meteorological Society within the
county. It is in Messrs. Denny's Leven Shipbuilding Yard at
Dunbarton. The station is only 27 feet above the sea level,
and is well sheltered. The following are the observations for
1891:-
[Page] 9
TABLE 1.
METEOROLOGICAL OBSERVATIONS at DUNBARTON, for the Year ending 31st December, 1891.
[Table inserted] |
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[Page] 10
A single year's data, referring to a single station, do not afford
a sufficient basis for generalisations as to the whole County, but,
in addition to the full meteorological records kept by Messrs.
Denny, I have, from the Journal of the Meteorological Society for
the year 1882, obtained the following statement of the mean
monthly and annual temperature at Cardross and Balloch Castle:-
[Table inserted]
These observations are valuable as giving the facts for a long
series of years - 13 years at Cardross and 20 years at Balloch
Castle - and they show a mean annual temperature of 47·1 and
a mean monthly temperature ranging from 37·8 and 37·9 in
January to 58·1 and 58·3 in July.
Regarding rainfall, observations have been made for a number of
years at five stations within the county, and have been published
in Symon's annual volumes. The following table gives the facts
for the seven years ending 1890, with, for comparison, the mean
of all the observations made in Scotland during the same period:-
[Page] 11
TABLE II. - RAINFALL.
[Table inserted] |
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From this table it will be seen that, as usual in the West of
Scotland, the rainfall is heavier than that of the country as a
whole.
Occupations. - In the northern part of the county, between
Loch Lomond and Loch Long, the population is almost entirely
rural, and is engaged in sheep and dairy farming and agriculture.
Along the shores of the lochs there is a growing residential
population, largely an overflow from Glasgow attracted by con-
siderations of scenery and health, and by the steamboat and
railway facilities. The Vale of Leven is a hive of busy industry,
the population being almost entirely engaged in the large dye-
works, printfields, bleachfields, forges, shipbuilding yards, &c.,
that line the banks of the river from Loch Lomond to the Clyde.
Of the string of towns - Jamestown, Bonhill, Alexandria, Renton,
and Dunbarton - on the banks of the Leven, only the last named
is a burgh, all the others being under the charge of the County
Council and District Committee. Eastward from Dunbarton
burgh, along the shores of the Clyde and on the higher lands rising
behind, the occupations are various - shipbuilding, sewing machine
making, canal working, iron working, cloth working, mining,
farming, &c. In the detached portion of the county, mining
prevails very largely, the rest of the population being employed
chiefly on the land.
Parishes and Districts. - The County consists of twelve
parishes, which, for Local Government purposes, have been
grouped into two Districts, the Western and the Eastern, the
former having the greater area and population, and the latter the
greater valuation.
The following table gives the area and population:-
[Page] 13
TABLE III.
[Table inserted]
* Including 949 Navvies on West Highland Railway.
Ϯ The total area of Dunbarton Burgh is 517 acres, but the division of this acreage between the two portions of Dunbarton and
Cardross is merely estimated. |
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[Table inserted]
TABLE IIIA.
Ϯ Including Woodilee Asylum.
‡ Including part transferred from Stirlingshire.
§ The Burgh of Clydebank was not formed in 1881, and the figures are only an approximate estimate of the present burghal area.
[Page] 15
In this table the "burghal" population has been distinguished
from the "landward," as only the latter is under the manage-
ment of the County Council. But the term "landward" does not
give a correct idea of its nature. Of the total so-called "land-
"ward" population of 49,037, no less than 21,788 live in towns*
of from 2000 to 9000 inhabitants, and 12,527 in villages of from
300 to 2000 inhabitants.
Table IV. contains the principal facts as to this town and village
population at the censuses of 1881 and 1891.
Exclusive of burghs the total population of the Western District
is 28,723, and of the Eastern District, 20,314. In the Western
District 19,634 live in towns (non-burghal) and about 1200 in vil-
lages, and in the Eastern District 2154 live in a town and 12,527
in villages. To a great extent, therefore, the Western District is
made up of town population and the Eastern District of village
population. Hence, in Table IV., the latter occupies more space
than the former, though the population is less. Taking the
county as a whole, inclusive of the burghs, the following were, in
1881, the percentages of town, village, and rural population as
compared with all Scotland:-
[Table inserted]
While the town population was thus slightly under the percentage
of all Scotland, the village population was very nearly double, so
that the proportion of strictly rural population was very much less
than the average.
Sex and Age Distribution. - It will be noticed from Table
IV. that in the Vale of Leven (including Jamestown, Bonhill,
Alexandria, and Renton), in the Western District, there is a
considerable excess of females over males. This, of course, is
due to the number pf public works employing female labour. In
Cardross, Row and Garelochhead, in the Western District, and
*In the Census report for 1881 "towns" have 2000 inhabitants or
upwards, and "villages" have from 300 to 2000. |
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[Page] 16
in Bearsden, in the Eastern District, a similar excess exists, the
cause here being the number of domestic servants. On the other
hand, in Bowling, Duntocher, Garscadden, Knightswood, Twechar,
Auchinstarry, Condorrat, and Smithston (all in the Eastern District),
the males are considerably in excess, and here again the character
of the work carried on explains the difference. In Scotland, in
1881, there were 107·59 females for every 100 males. I was sur-
prised to find that in Dunbartonshire (including the burghs), at
the same census, the ratio was only 101·90 females to 100 males.
This must be largely due to the burgh population, and perhaps
especially to the burgh of Dunbarton, where the occupations -
ironfounding and shipbuilding - involve little or no female labour.
It is necessary to note the influence which such ratios have on
death-rates. Taking all ages combined, females have a distinctly
lower death-rate than males. Among equal numbers of the two
sexes there are for every 100 male deaths only 90 female deaths.
On the other hand, between the ages of ten and twenty, females
have a rather higher death-rate than males. But the main influ-
ence which this class of inhabitants has on the death-rate depends
on the fact that it increases the percentage of population at the
healthiest ages of life. Everyone knows that children have a much
higher rate of mortality than adults. While the all-age or "crude"
death-rate is only 18 or 20 per 1000 living per annum, the rate
under five years of age is from 50 to 60 per 1000 living at that
period of life. And from ten to twenty-five years of age the annual
death-rate is only from 6 to 7 per 1000 living. Obviously, there-
fore, the addition to an average community of a large number of
persons belonging to these latter periods of life, will lower the
general death-rate quite independently of any sanitary improve-
ment in the condition of the place, and quite independently, too, of
any actual improvement at any one period of life. In comparing
the death-rates of the Vale of Leven, and of residential populations
like Row or Gareloch, with those of localities where ordinary age
averages prevail, this fact must be borne in mind. On the other
hand, in mining villages of the Eastern District, there is a
large population under five years old, and the total death-rate
is in consequence to some extent exaggerated. Better standards
of sanitary condition than those furnished by the total death-rate
will be dealt with further on.
[Table not complete - corrected on following page] |
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TABLE IV.
COUNTY OF DUNBARTON. - STATISTICS OF TOWNS AND VILLAGES.
CENSUS OF 1881. -- CENSUS OF 1891.
[Table inserted]
Ϯ Added in order to permit of comparison with 1891 Census. |
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[Page] 17
HOUSE ACCOMMODATION.
Rooms per House. - Table IV. also shows the number of in-
habited houses in each town and village, and the number of rooms.
For the census of 1881 the information is complete. For the facts
regarding 1891 I am indebted to the kindness of the local regis-
trars, who have been most obliging in replying to inquiries so far
as the data in their possession enabled them to do so. The whole
statistics will not, however, be obtainable until the publication of
the Registrar-General's detailed Census Report some time in the
course of 1892. Meanwhile it may be noted that during the
decade between the two censuses a distinct improvement has
taken place in the amount of accommodation. In the first place,
the newer houses have more rooms than the older ones, and in the
second place, it may be assumed that the rooms are as a rule
larger, though the chief improvement here is more in height of
ceiling than in area.
Western District. - In Jamestown there were 2·29 rooms per house
in 1881, and 2·56 in 1891. In Bonhill town the figures were
2·22 and 2·35, and in Alexandria 2·12 and 2·74. For the parish
of Bonhill, as a whole, the improvement is from 2·34 in 1881 to
2·60 in 1891. The figures for 1891 for the rest of the Western
District will not be available till the Census Report is issued. But
in 1881 they were - for Renton, 2·00; Cardross, 2·54; Row, 5·01;
and Garelochhead, 4·77.
Eastern District. - For Cumbernauld parish I have not been
able to get the data on which to base a comparison confined to the
villages alone, but in the parish as a whole no improvement has
taken place in the number of rooms per house in the decade 1881-
91. In Kirkintilloch parish, the village of Twechar, which had
2·06 rooms per house in 1881, had 2·46 in 1891. But in Water-
side village the ratio fell from 2·12 to 2·05. In East Kilpatrick
parish, Bearsden - which is practically a residential suburb of
Glasgow - had 6·44 rooms per house in 1881 and 7·39 in 1891.
The other villages in the parish made a very considerable improve-
ment - from 1·99 to 2·94 - or practically from two rooms to three
rooms. In the West Kilpatrick villages the corresponding figures
are 2·41 and 2·60.
-- B |
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Persons per Room. - Of even more importance than the
number of rooms per house is the number of persons per room.
Wherever the habit prevails of keeping lodgers, rooms are specially
apt to be overcrowded. In various parts of the county there is a
great deal of overcrowding, and when a sufficient staff of inspectors
is appointed a considerable part of their work, especially in the
Western District, will be the visiting of houses let in lodgings.
But even here some improvement is indicated.
Western District. - In the important parish of Bonhill there has
been a fair general improvement, which has not, however, been
shared in alike by all the populous places. In Jamestown the
persons per room have decreased from 2·77 to 1·94, in Bonhill from
2·37 to 2·20, and in Alexandria from 2·12 to 1·84. The greatest
improvement has thus been in Jamestown. In Cardross parish,
Renton, in 1881, had 2·65 persons per room, and in 1891 2·33
persons. It still, therefore, lags behind the rest of the Vale of
Leven, and when we come to examine its death-rate from all
causes, and especially from zymotic diseases, the facts will be
found to correspond. In Cardross village, in 1881, there were
1·16 persons per room; in Row, 1·01; and in Garelochhead, 0·92.
The figures for 1891 are not yet available.
Eastern District. - In the parish of Cumbernauld, though, as has
been seen, the number of rooms per house is less than in 1881, yet
the rooms are slightly less crowded, there being a reduction from
1·77 in 1881 to 1·68 persons per room in 1891. In Kirkintilloch
parish, Twechar has improved from 2·78 to 2·37. But Waterside
has gone slightly back - from 2·31 to 2·33. And no village in the
county can less afford overcrowding than Waterside. In East
Kilpatrick parish, in the mining villages of Garscadden, Knights-
wood, and Netherton, the average rate was 2·82 in 1881 and 1·71
in 1891. But in Drumchapel Row, and Cloberhill Locks, which
were not entered as constituting a village in the census of 1881,
the figures for 1891 are the highest in the county, being 2·80 and
2·71 respectively. In Bearsden the figures were 0·84 and 0·76 in
the two census years. In the West Kilpatrick villages the average
in 1881 was 1·94 persons per room, and in 1891 it was 1·89. The
fall here is very trifling. Indeed, in Faifley and Hardgate there
has been a rise - from 1·89 to 2·01 - while in Old Kilpatrick the
rate has been stationary at 1·60.
[Page] 19
Percentage of Houses of certain sizes. - Following the
same line of enquiry, we come to the question, How many families
live in houses of one room, two rooms, three rooms, &c? But here
the available information is very defective, as it refers only to the
census of 1881, and to Registration Districts* as a whole, towns
and villages not being differentiated. But for comparison with
the census of 1891, the Report of which will shortly be published,
I may place on record the percentages which I have calculated
from the Census Report of 1881. (See Tables V. and VA).
Western District. - In this district Dunbarton shows worst,
there having been 44 per cent. of the families in one-roomed
houses. This of course is due to the burgh being included within
the Registration District. Next on the list is Arrochar, with 31
per cent. of one-roomed houses. The table indicates a remarkable
difference between the two populous Registration Districts of
Bonhill and Cardross. In the latter, 29·6 per cent. of the
houses had one room, and in the former, only 19·9 per cent.
The difference in favour of Bonhill would have been even
greater if the comparison had been with Renton alone, but
in 1881 Renton had not been separated for registration purposes
from the rest of the parish of Cardross, in part of which the
average house accommodation is much better. The Bonhill
District is remarkable for the number of two-roomed and three-
roomed houses, the former being 53 per cent., and the latter 18
per cent. of the total. In Cardross the corresponding percentages
were 44 and 14. Row District includes Helensburgh, and the
nature of the population is shown by the small number of one
and two-roomed houses. The same remarks apply to Roseneath,
and Cove and Kilcreggan. The entirely rural parish of Kilmaronock
had the smallest percentage of one-roomed houses, and the largest
per centage of three-roomed houses. This is probably in great
part due to the number of farms in the parish.
*In the parishes of Bonhill, Kilmaronock, Row, Luss, Arrochar, Cum-
bernauld, Kirkintilloch, East Kilpatick, and West Kilpatrick, the
Registration District is now coterminous with the parish, and includes
the entire population. In Roseneath there are two Registration Districts
- (1) Roseneath parish, and (2) Cove and Kilcreggan. In Cardross parish,
since 1st January, 1883, there have been two Registration Districts - (1)
Renton, and (2) Cardross; and that part of the burgh of Dunbarton which
is within the parish of Cardross is in the Dunbarton Registration District. |
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[Page] 20
TABLE V. - WESTERN DISTRICT.
[Table inserted]
[Page] 21
TABLE VA. - EASTERN DISTRICT.
[Table inserted] |
| HH62/1/DUNBAR/23 |
[Page] 22
Eastern District. - Table IV. shows that Cumbernauld parish had
the largest percentage of two-roomed houses in the Eastern District,
they forming no less than 50·6 per cent. of the total, while of one-
roomed houses there were 24 per cent. In nearly all the miners'
rows the houses have two apartments, and the large number of
these rows in the parish accounts for the high percentage. In
Kirkintilloch (including the burgh) there were 32 per cent. of
one-roomed, and 44 per cent. of two-roomed houses. In East
Kilpatrick (including Milngavie and Bearsden) there were only 13
per cent. of one-roomed houses, while houses of two rooms
amounted to 40 per cent. It will be seen further on, that East
Kilpatrick has the lowest death rate in the Eastern District. In
West Kilpatrick one and two-roomed houses were in equal
numbers, and between them they formed 71 per cent. of the
total.
The next point is the character of the accommodation. Doubt-
less here, too, there is a gradual improvement. In the more
modern of the miners' rows, as at Barrhill and Auchinstarry, the
houses are of a very good class. In some other rows I found that
coal houses had not been provided, and that coals were stored
under the beds in the kitchen. But a house to house visitation
throughout the county would reveal a great deal of dampness in
walls and floors, and a great want of ventilation, owing mainly to
windows not made to open. In connection with an outbreak of
typhus fever at Renton, to be referred to later on, I inspected a
number of houses in the neighbourhood of some of the cases.
Here are some of the results as jotted down in my note-book:-
(a) House of two apartments. Walls damp. Ground at back
higher than floor level. Front window not made to open.
Upper sash of back window does not open.
(b) Damp house. Upper sash of back window does not open.
(c) Exactly like (b).
(f) Back wall damp. Upper sash of front and back windows
fixed.
(h) A one-roomed house. Dimensions, 14 ft. x 12 1/2 x 8 1/2 =
1488 cub. ft. Seven inmates, of whom five are over
ten years old. Cubic space per head (counting two
children as one adult), 248 ft.
[Page] 23
(i) Walls damp.
(j) A two-storey tenement. Back wall badly in need of
repair. Rain-water pipe broken. Plaster in stairway
broken.
(k) One room, 9 1/2 ft. x 9 1/2 x 8 = 722 cub. ft. Occupied by
two adults and three children. Cubic space per head
206 feet.
(l) Upper sash of windows fixed. Walls damp.
(m) One room. Back wall very damp. Not lathed. Dimen-
sions, 19 ft. x 13 x 7 1/2. Seven occupants, with 265
cubic feet of space each.
These are notes of the condition of some of the houses in one of
the worst parts of Renton, and I do not, of course, suggest that
they at all indicate the average condition in the Vale of Leven.
Time has not permitted a systematic examination of the condi-
tion of the dwelling-houses throughout the county, and I do not
propose to make a detailed report regarding individual nuisances
of this class that have come under my notice, or to which
Mr. Dunbar has called my attention. In some villages I found
that the occupants of damp or otherwise faulty houses were
also the owners, and where such owners are in poor circumstances,
and are themselves satisfied, there is naturally a difficulty in deal-
ing with them. But under the Housing of the Working Classes
Act of 1890 the duty is laid on the Medical Officer of reporting to
the Local Authority any dwelling-house unfit for habitation, and
then, if after a proper interval the houses be not made habitable,
it becomes the duty of the Local Authority to approach the
Sheriff for a closing order. This work will have to be gone
into in the course of the year, and is likely to occupy a good
deal of my attention and of that of the sanitary inspectors.
WATER SUPPLY.
In forming an opinion regarding the influence on the public
health of any particular water supply, a number of facts have to
be considered. But, speaking very generally, it may be taken
that the question which is likely to be of most consequence from
a sanitary point of view is, whether the source of supply is sur-
rounded by or is removed from human habitations; or, in other |
| HH62/1/DUNBAR/25 |
[Page] 24
words, whether it is liable to contamination from human beings
and their diseases. It is of use to know whether a water is hard
or soft, whether it has much or little solid matter, whether it
is filtered or not, and so on; but if one had to judge of the safety
or danger of any given supply from one single enquiry regarding
it, that enquiry would be, how does it stand as regards pro-
pinquity to or distance from inhabited dwelling-houses? In a
village supplied from local sources - from sunk wells on streets or
in back yards or gardens - a good deal will depend on whether
the wells are open dip wells or are properly covered and provided
with pumps; whether they are well puddled or otherwise rendered
impermeable to moisture near the surface of the ground; whether
there are any ashpits or drains close at hand; whether the wells
are in manured ground, &c. But in spite of all precautions to
the contrary, water from local sources will be liable to risks of con-
tamination, which may occasionally have very disastrous results
on the health of the consumers; and, with rare exceptions, an
open mountain stream, unprotected and unfiltered, will be found a
safer source of supply than the most carefully guarded water taken
from the soil of a populous village.
At the other end of the subject is the question of the facilities
provided for utilising the supply. Cleanliness should be made
easy to the population. Where village water has to be got say a
quarter of a mile away, the villagers are sure to be dirtier in their
houses and persons than if the water were piped into every individual
dwelling-house. There is even a difference between having to go
to a pillar well on the street, or to a water tap on a stair head,
and having the water led right into the kitchen sink. In so far,
therefore, as I have gone into the question of water supply in
the county, I have followed these lines of enquiry. Mr. Dunbar
will report in greater detail regarding both water supply and
drainage.
Western District. - Special Water Supply Districts are four in
number -
(1) Alexandria, Bonhill, and Jamestown (population about
14,000). Water is pumped from Loch Lomond into a reservoir,
and filtered. The storage accommodation is insufficient and is to
be greatly increased before the summer. Most of the houses have
the water conveyed in by pipes, and only in the poorer parts of
[Page] 25
the villages are there public taps or pillar wells. In the large
terraces of workmens' houses in Jamestown the water is piped into
the dwellings.
(2) Renton (population 5,255). Upland surface water is collected
in a reservoir and filtered. About one-half or nearly so, of all the
houses have the water led into them, and the remainder have it in
pillar wells in the back courts, often near the washing house.
Street wells have been mostly done away with, owing to the
obstruction they caused at the sides of the narrow footpaths. A
very few of the old wells are still in use.
(3) Row has a gravitation supply impounded from springs and
uncultivated moorland. It is stored in reservoirs at the head of
Aldownick Glen, 700 feet above the sea level. It is piped into all
the houses. Mr. Buchanan of Clarinish informs me that the
population within the Water District is about 862. In addition,
the Training Ship "Empress" is, by arrangement. provided with
the same supply, so that the total population using the water is
about 1300.
(4) The Burgh of Cove and Kilcreggan has charge of the
Special Water Supply District there. The District incudes about
80 houses in the parish of Roseneath outside the burgh, with a
population of probably 400 or thereby.
At Shandon Hydropathic (average inmates, including staff and
visitors, about 150), water for drinking and cooking purposes is
got from a spring on the hills behind. It is led by an iron pipe
into storage tanks, and is passed through filters constructed by the
late Mr. Robert Napier. It is plentiful at all seasons of the year.
Thus of the 28,723 inhabitants of the Western District, about
21,000 have a systematic water supply, led from a distance, and
not readily liable to serious pollution. I have not yet had
opportunity of making detailed investigation into the nature of
the various supplies that are in use in the remainder of the District.
Steps are being taken to form the village of Garelochhead into a
Special Water Supply District, and there can be no doubt about
the desirability of this being carried out.
Eastern District. - There are two Special Water Supply
Districts:-
(1) Duntocher and Dalmuir. This, in addition to the places
so named, includes Hardgate, Faifley, and Radnor Park, all in |
| HH62/1/DUNBAR/27 |
[Page] 26
West Kilpatrick parish. The population is about 4,900. The
supply is plentiful and is from Cochno Loch, on the Kilpatrick
Hills. It is not filtered. In Duntocher all the houses in
New Street and William Street have the water piped into the
tenements, though not always into individual houses. In the
rest of the village the supply is principally by pillar wells. In
Dalmuir the water is piped into the houses. Hardgate is served
chiefly by pillar wells, though the water is conveyed into some
of the new houses. In Faifley pillar wells prevail, excepting in
Dr. Gilmour's new buildings, which have the water taken into
each house.
(2) Bowling District (population 829), also in West Kilpatrick.
This district includes Littlemill. The water is abundant and is
taken by gravitation from Auchentorlie Hill. It is filtered. There
is one pillar well at Littlemill. Otherwise all the houses using the
special supply have it led into the dwellings. But one or two
houses still use private wells.
Thus less than 6,000 of the 20,000 people in the Eastern
District are within Special Water Districts. But in some other
populous places, there are privately formed districts, also provided
with a regular systematic supply from a source outside the
populous places, so that about 11,500 of the 20,000 have a
satisfactory supply, while fully 3000 more have supplies which
have at least the advantage of not being derived from a strictly
local source.
At Milton (population of Milton and Dumbuck, 640) in the same
parish, a new gravitation supply is being taken from Mattock Hill,
provided by Mr. Buchanan of Auchentorlie. It is filtered, and is
plentiful. The works are not yet quite finished. In addition there
is a spring on the roadside that is largely used. Some buildings
that have recently been erected have no proper supply, and
the occupants have to walk an inconvenient distance to get
water from a spout connected with a horse trough. This water
comes from Auchentorlie Hill. At Dumbuck the supply is from
a dip well.
At Old Kilpatrick (population 1313) Lord Blantyre has provided
water from the Kilpatrick hills. It is plentiful, is stored in a
reservoir, and filtered. It is piped into all but three or four of the
houses, and there is only one pillar well on the street. Two or
[Page] 27
three houses use private wells - one a pump well, and another a
dip well, said to be liable to occasional entrance of impure water
from the roadway.
In East Kilpatrick parish, Garscadden Rows (population, 499)
get their water by gravitation from the higher ground behind
the village, but I have not yet learned the exact source, whether
from surface and subsoil, or from old pit workings. It is led by
iron pipes to a tank in the centre of the Rows, capable of holding
about 53,000 gallons. The tank is of concrete, and was cleaned
out last summer. It is covered by heavy boards laid side by
side. Children appear to be in the habit of casting on these
boards all sorts of rubbish, and the water is thus liable to
pollution. As the population is about 500, the tank can hold
only from ten to eleven days' supply, even at the low rate of ten
gallons per head per day, and last summer there was great
temporary scarcity. The water looks dirty, and contains animal
life.
In Bearsden (population, 1561), the admirable Loch Katrine
supply of Glasgow is provided, and is led into most of the houses.
In the miners' rows at Knightswood, Netherton, Drumchapel,
and Cloberhill, (total population about 1900), the Loch Katrine
water is also used, and is obtained from pillar wells.
In Kirkintilloch parish, at Twechar (population, 882) there is a
gravitation supply provided by the owners. It is pumped from
the mines, and is collected in a tank on a "blaes bing", whence it
is piped into pillar wells convenient to the houses.
In Waterside (population, 446) the water at present is about
as bad as can be conceived. The Luggie was at one time a
chief source, but is now so polluted as to be unusable. Dip wells
form the present source. Several of these are private. In one
the water looked very dirty and contained numerous living
organisms. One of the chief resorts for water is to an open dip
well in private ground, but to which it is said there is a right of
way. Steps lead down to the well, and surface drainage enters it.
Analysis shows abundance of ammonia. On standing, a dark
vegetable sediment collected in the bottom of the vessel. Proceed-
ings are being taken to form Waterside into a Special Water
District, the supply to be, by permission of Mr. Whitelaw, from the
pipe conveying the Kirkintilloch burgh water to Gartshore House. |
| HH62/1/DUNBAR/29 |
[Page] 28
In Cumbernauld parish, at Auchinstarry (population, 698) there
is a supply by means of pillar wells at convenient distances. The
water ran short during last summer's exceptional drought. The
source is a spring a few hundred yards to the south of the houses.
At Croy Row (population, nearly 200) the supply is very
defective. The water has often to be carried from an open burn,
situated in private ground, about 500 yards distant. In winter a
pipe at the head of the row sometimes discharges surface and
subsoil water in sufficient quantity, but this source is very
intermittent and of varying quality.
At Smithston (population, 418) also the supply was very de-
ficient last summer. The water is led from a distance, and is there-
fore not so liable to pollution as are dip wells. But it is not
filtered, and the pipes get choked. The row is a very long one,
and should have several wells at convenient distances. Instead,
it has only one, at least for part of the year. At the head of the
row there is a spout discharging water from the fields, but the flow
is very irregular, and in dry weather ceases altogether.
At Condorrat, (population, 606) the chief supply is from a large
open well at the road-side, and exposed to pollution. It is from a
spring. There are besides several private wells, mostly dip wells,
some in garden ground, and liable to pollution from manure.
At Cumbernauld village (population, 956) there is a gravitation
water supply. It is led into a large tank at the side of the burn
running through the village. But the levels are such that it
cannot be distributed by pillar wells on the streets, so that the
distance from some places is inconvenient. In addition, there are
a few private wells, some provided with pumps, and some situated
in garden ground.
DRAINAGE.
Western District. - In the Vale of Leven the natural drainage is
into the Leven, which is used for this purpose by all the towns on
its banks. In no case does the sewage undergo treatment of any
kind before entering the stream. Fortunately the volume of water
is so great that the sewage is very much less of a nuisance
than it would be in any ordinary stream, and it is, of course,
quickly carried into the Firth of Clyde.
[Page] 29
Bonhill, Alexandria, and Renton have all been formed into
Special Drainage Districts, and they are the only such districts in
the western division of the county. In Alexandria the sewage
finds its way into the river by means of the burn of Bonhill, which
is simply an open sewer, and very offensive in hot weather. The
drains in the district are not ventilated excepting at the manholes,
which are not sufficiently near each other to provide proper venti-
lation.
The villages and residences along the shores of the Gareloch
drain into the loch. The sewage is not treated, unless by settling
in cesspools and overflowing into pipes leading to the shore. The
pipes terminate at various distances between high and low water
mark. The excrement from the population on board the
"Empress" training ship (over 400 boys) also enter the loch
without being previously treated. This is the case too with the
numerous steamers plying on the loch.
At Cardross station, a drain which conveys the sewage from a
number of the neighbouring houses, discharges at a point above
the ordinary high water mark, and only twelve or fifteen yards
distant from the window of a dwelling-house. The sewage spreads
irregularly over part of the foreshore and causes a very offensive
smell in warm weather. A Sub-Committee of the Local Authority
has charge of the extension of this drain to a point about fifty
yards further out. The plans have been prepared by Mr. Dunbar.
Eastern District. - Bowling drains into the Clyde by means of a
main sewer which passes under the railway. The sewer does not
appear to be ventilated unless at the gratings in the surface
channels. The houses are, as a rule, connected by drain pipes
with the main sewer. The West Kilpatrick villages drain into a
burn which enters the Clyde. The sewage is not treated in any
way. Radnor Park drains into a burn which passes through
Clydebank, and a question of alleged nuisance from this cause
has recently arisen.
Bearsden drains in two directions - westwards into a settling
tank, which overflows into an adjoining burn, and eastwards
into a ditch which empties into Garscadden burn. Well grounded
complaints were frequent during last summer, regarding the foul
smells arising from the drains in Bearsden, and the subject is at
present in the hands of a committee who have under consideration |
| HH62/1/DUNBAR/31 |
[Page] 30
plans for a new scheme for the whole locality. Part of Bearsden is
a Special Drainage District - the New Kirk District. The outfall is
at the tank just mentioned, but the arrangement is unsatisfactory
and inadequate.
Cumbernauld village from its high site is well adapted for a good
drainage system. The sewage at present pollutes the burn which
flows through the village, and last summer it caused an intolerable
nuisance, necessitating the cleaning out of the burn through its
whole length within the villiage. From some houses the slop-
water discharges into street channels, and others have private
drains, but all ultimately enter the burn.
In Condorrat the drainage is chiefly into road channels. A
number of houses drain into an abominably foul ditch which
communicates with and pollutes the Luggie.
Drainage of Mining Villages. - In the numerous mining
villages throughout the Eastern District one general plan of drain-
age prevails, with local variations. Slop-water is thrown into open
channels, which are carried along the front of the rows and usually
end in a covered drain connected with a neighbouring watercourse
It will be better to discuss the drainage of these villages jointly
rather than adhere to the grouping of parishes.
Open channels as opposed to covered drains are the salient
features of the system, and, in spite of certain obvious objections,
they appear to me to be on the whole the more suitable arrange-
ment. Even where the water supply is sufficient for the require-
ments of the inhabitants, it is sometimes so arranged as not to
permit of its being utilised for flushing purposes; and a covered
drain without a sufficient flow of water through it, gets quickly
choked and becomes a serious nuisance. To a great extent
scavenging of the open channels takes the place of flushing of
underground drains, and I am glad to be able to report that the
scavenging is as a rule being regularly attended to by the colliery
owners. The main points connected with the channels are their
structure, distance from the houses, scavenging, and flushing.
Twechar. - The village so named includes Twechar Row and Barr-
hill Rows. Twechar Row is situated on the south bank of the Forth
and Clyde Canal. The surface channel is of fireclay, and is about
14 feet distant from the front of the houses. It has a good slope,
[Page] 31
and is connected by a short covered drain with the Canal, which
receives the sewage. But between the end of the open channel
and the beginning of the drain there is a space of several feet
of irregular and unpaved ground, which appears to act as a kind
of catchpit, where much of the solid matter is deposited. Last
summer this was very foul, and the arrangement is very objec-
tionable. A neighbouring burn, apt to be dry in summer,
is said to have been at one time connected with the head of
the open channel, and to have kept a flow of water in it for
a great part of the year. There is no doubt that some flushing
arrangement would be of great advantage here. Meanwhile two
pillar wells have their waste water carried away by the channel,
the wells being placed just beside it. The channel is scavenged
regularly several times a week.
The ashpit and privy accommodation is bad. The distance is
only 15 feet from the front of the houses, the ashpits are too
large, badly built, not roofed over, and not often enough emptied.
The thoroughfare for the row consists of the 15-feet path between
the houses and the privies, and here milk carts, butchers' carts,
&c., do all their trade with the inhabitants.
Barrhill Rows are four in number, and contain the great bulk
of the population of Twechar village. The surface channels are
nearly 40 feet from the houses, and pillar wells are placed as in
Twechar Row. The scavenging is similar. Two of the channels
empty, by a rough trench, into a small quarry hole at the end of
the rows, and the sewage gets lost here, but doubtless ultimately
finds its way into the Canal, having meanwhile undergone an
irregular but perhaps effective filtration. The sewage from the
other two rows gets mixed with coal washings from a neighbouring
pit, and the mixture enters a ditch which ends also in the Canal.
The ashpits, privies, coal houses, and washing houses are all in well
built blocks 24 feet from the houses. The ashpits are roofed over.
Auchinstarry Rows. - There are four rows, with a population of
698. The channels here also are at a good distance - nearly 40
feet - from the houses, are of fireclay, and are scavenged daily.
Pillar wells are connected with them as in the other rows. At
the end of each channel there is a built cesspool for subsidence of
solids. Covered drains pass from the cesspools, and all empty into
a series of three small catchpits, in which there is further deposit |
| HH62/1/DUNBAR/33 |
[Page] 32
from the sewage, which afterwards enters the Canal. The ash-
pits, &c., are arranged as at Barrhill Rows.
Smithston Row. - Along the greater part of the Row there
is an open brick channel about 36 feet from the houses. Near
the lower end this empties into a burn which here passes
in front of the houses, and in a way replaces the channel.
The channel is swept out every day, but the sewage is not
treated in any way. The burn passes under the Forth and Clyde
Canal at Shirva, and enters the Kelvin. The ashpits, &c., are
faulty. They are only 15 feet from the houses, are uncovered,
and badly constructed. In summer they are much complained
of. The roadway, 14 feet wide, bordered on one side by the
houses and on the other by the ashpits, is, as at Twechar, the
scene of all the local traffic in milk and butcher meat. It is,
moreover, in bad repair, and very dirty in wet weather.
Croy Row. - The surface channel is about 36 feet from the
houses, excepting at one end where the distance is only 15 feet.
It discharges into a ditch in a neighbouring field, where the
sewage stagnates and soaks into the ground, any outflow finding its
way into the drain at the side of the railway. The ashpits are
about 18 feet from the front of the houses, are too large, not
covered, and not frequently emptied. It will be recollected that
the water supply here is very defective.
Knightswood Rows. - The channels are of brick and have a good
slope. They are 15 feet distant from the houses, and are swept
out by scavengers every morning. They are connected with the
burn which here forms the boundary between Dunbartonshire and
Renfrewshire, and which discharges into the Clyde. The ashpits
border on the surface channels. They are not roofed over, and
are emptied by a farmer. They were fairly clean at the time of
my inspection of the rows.
Netherton Rows. - There are two rows. In the higher one the
channels are 12 feet from the houses, and in the lower one 24 feet.
The solids are received into a small catchpit, and the effluent goes
into a covered drain which ultimately enters the Clyde. The
channels are of brick, are partly defective in structure, and are
understood to be cleaned out twice weekly. The ashpits here are
at a good distance from the houses, but have no roof and are very
large.
[Page] 33
Garscadden Rows. - Slop water is emptied into whinstone chan-
nels at the side of the footpath, and only about eight feet from the
houses. The channels are connected by a covered drain with
Garscadden burn, at the east end of the rows. They are
scavenged regularly. The ashpits here are not satisfactory.
They are not roofed over, and often contain a large quantity of
foul-smelling liquid, which at some points leaks through the walls
and pollutes the ground outside. They are about 23 feet from
the houses.
Drumchapel Row. - Here there is no surface channel, but instead
a covered drain empties into a cesspool at the lower end of the
row, the overflow entering a burn which, after joining Garscadden
burn, falls into the Clyde at Yoker. Between every two houses,
and at a distance of 8 feet from the front of them, there is a slop-
sink connected with the drain. The ashpits are at the back of
the row, at a distance of 20 feet from the dwellings. They are
large brick structures, with high walls but without a roof.
Throughout the whole county the drainage is principally of slop
and surface water. There are few water-closets, excepting in resi-
dential localities like Gareloch and Bearsden. Hence the drainage,
objectionable as it is in many cases, is yet not nearly so much of a
nuisance as if wet methods of excrement removal prevailed. As I
have said, the sewage does not undergo anywhere any systematic
treatment before finding its way into streams. In a great many
cases, either of single houses or small villages, a simple and inex-
pensive method of treatment, if properly attended to, would go far
to prevent pollution of streams. The treatment would consist of (1)
precipitation and (2) filtration. The precipitation would take place
in a small catchpit, and would depend either on mere subsidence of
the solids, or partly also on the presence of some such agent as
ferozone or sulphate of alumina. In either case the water would
pass from the catchpit into a small filter of sand and gravel, or
polarite, &c. There is, of course, nothing original in such a
proposal, and I mention the matter merely to indicate that the
difficulties of sewage purification on a small scale are not so great
as is apt to be supposed. Both the catchpit and the filter
would have manholes above to permit of regular emptying and
cleaning
-- C |
| HH62/1/DUNBAR/35 |
[Page] 34
REFUSE DISPOSAL.
As has just been stated, there are throughout the county
comparatively few water-closets. Privies and ashpits are the
general rule, and they vary in degree from almost the best to the
very worst.
They form the commonest of all nuisances existing in the Dis-
tricts, and the most frequent subject of official notices by the Sani-
tary Inspector. To strengthen the hands of Mr. Dunbar in the
issuing of such notices, it would be well if the District Committees
were to sanction the enclosure with each notice, of a sketch plan of
such a structure as would be held to meet the approval of the
Local Authority. At present, under the Public Health (Scotland)
Act, the Sanitary Authority is not required to suggest a remedy for
a nuisance, but only to see to its removal, and, where structural
works are concerned, to leave the owner to erect what may have
again to be condemned. Of course, in practice, an inspector is
always willing to give advice when asked, but often he is not
asked. The requisites of a proper ashpit are perfectly simple. It
should be of small capacity, to necessitate frequent emptying;
raised several inches above the ground level, to prevent entrance
of surface water; concreted in the bottom and sides, to prevent
filth impregnation of the walls or floor, or of the ground below;
provided with a slated shed roof, to prevent access of rain,
and to ward off the sun's rays, and so delay putrefaction of the
contents; thoroughly ventilated on at least three sides and by
the roof; and without any drain, so that the main drains of the
locality may not be choked and polluted by its contents. No
house water should be thrown into it, so that the contents may
be kept dry. Instead, all water should be emptied on a grating,
or into a slop sink, communicating by a trap with the drain.
In erecting such an ashpit the amount saved by having no drain
to provide is often sufficient to pay for the roofing and for the
concrete.
It is not my purpose in this Report to discuss the condition of
the structures in each separate town and village in the county.
Speaking generally, in the more populous places many of the
ashpits are of stone or brick. Some privies are of wood, saturated
with filth, and wood is the almost universal material in the
[Page] 35
smaller villages, excepting in the colliery rows. In some of
these rows, as at Barrhill and Auchinstarry the accommodation is
very fair. In others it is bad both in structure and posi-
tion. In many houses in the villages there are no built ash-
pits, but only accumulations of excrement and refuse in back
gardens, sometimes dangerously near the shallow wells which form
the source of water supply. In Jamestown the ashpits are of
concrete, well built, but not as a rule roofed over.
At Radnor Park an excellent system is in force. There are no
ashpits, but each dwelling has an ashbox which is put out on the
street for daily emptying into a dust-cart. There are no privies,
all the houses being provided with water-closets.
THE SCAVENGING OF VILLAGES.
In the Western District, five scavengers are employed by the
Local Authority, three being in Alexandria, and two in Renton.
In Alexandria their duties are confined to street sweeping; in
Renton they have charge also of emptying the ashpits. In the
Eastern District the Local Authority employs no scavengers.
The scavenging of villages is one of the most difficult questions
connected with the sanitation of the county. Supposing that
proper ashpits are erected, their contents soon become a nuisance
unless regularly and systematically removed.
In the colliery rows in the Eastern District this is done by
a scavenger employed by the owners. But in ordinary vil-
lages, with many different owners, a proper system can be
carried out only by the Local Authority taking charge of the
matter, for when it is left to individual owners to arrange with
farmers, the intervals that usually elapse between successive
removals are far too long to prevent nuisance. In many cases
refuse is allowed to accumulate for months. Unfortunately the
Local Authority has no power to confine assessment for cleansing
to the part of the District reaping the direct benefit, and till this
disability is abolished by legislation no quite satisfactory arrange-
ment is likely to be made. So soon, however, as a sufficient
sanitary staff is appointed, it might be advisable for the District
Committees, acting under section 51 of the Public Health Act to
issue public notice "for the periodical removal of manure or other |
| HH62/1/DUNBAR/37 |
[Page] 36
refuse matter." Failure to comply with such notice involves
liability to a penalty not exceeding twenty shillings per day.
The continual suing for penalties is most objectionable, but the
fact of the Local Authority having the power to enforce them
would probably have a good effect even if the power were not
often exercised. There is no doubt that the accumulations of
rotting filth that fester in sun and rain in the back yards of nearly
all the houses in an ordinary village have a most deleterious
influence on the public health, and especially on the health of
children. They are very apt to be a cause of the spread of such
diseases such as diarrhoea and enteric fever, and probably also of
diphtheria.
If the following resolution, which has been unanimously adopted
by the County Council, were given effect to by parliament, such
difficulties as those just discussed would be largely got rid of, as
would also those dependent on the want of building regulations,
and referred to at p. 38 of this Report:-
"That the Secretary of Scotland be petitioned to introduce a
Bill amending the Local Government (Scotland) Act to empower
County Councils (a) to define areas for lighting, cleansing, and
paving roads or streets (in populous places) and to assess therefor;
and (b) to exercise the functions of a Dean of Guild Court in
controlling the erection of new buildings as far as the site and
sanitary arrangements are concerned."
POLLUTION OF RIVERS.
Western District. - The question of the pollution of the Leven
has not been before the Committee. But at one of the largest
printfields on the Leven a series of experiments is being carried
out with regard to the efficacy of a new decolorizing and precipi-
tating agent, the property of the Strathclyde Chemical Company.
What the result will be is not yet certain, though one experiment,
of which I was a witness, gave such an effluent as to make the
enquiry a hopeful one.
Eastern District. - The Luggie at Waterside is affected by the
coal washing at Wester Gartshore pit, immediately above the
village. I called the attention of the owners to this, and they
have formed an additional settling tank. The water, however, is
[Page] 37
still polluted, and further action will have to be taken to provide
a remedy.
The Kelvin at Auchenvole is similarly polluted by washings
from Nether Croy pit. The proprietors have been repeatedly
written to by the Sanitary Inspector, and have agreed to take steps
to prevent the pollution, but as a matter of fact the Kelvin
remains pretty much as it was. Here also further action will be
necessary.
ORGANISATION OF PUBLIC HEALTH DEPARTMENT.
The question as to the amount and nature of the assistance
required to carry out the Public Health Acts in the county
has received much and careful attention during the year, and
it is only recently, as the result of growing experience, that
I have ventured to report to the District Committees on the
matter. As the subject had reference to both districts, the
Report treated of the requirements of the county as a whole.
It began by giving the following rough calculation of
probable routine sanitary work, which, to avoid exaggeration, was
kept well within the mark:-
-- Annual Visits or
Inspections.
Farms, 500, inspected quarterly, -- 2000
Houses let in lodgings, 400, visited quarterly -- 1600
Common lodging-houses, 20, visited fortnightly
(one-half of the visits being at night), -- 480
Retail bakehouses, 25, visited half-yearly, -- 50
Slaughter-houses, 15, visited quarterly, -- 60
Cases of infectious disease, 330, each visited,
say, thrice, -- 1000*
Total, -- 5190
The report continued, "The visits to infectious cases include
the carrying out of house fumigation in nearly all the cases, the
removal, where required, of patients to hospitals, and the removal
of infected clothing and bedding to a disinfecting chamber at an
hospital.
"In addition, there is all the work relating to ordinary nuisance
*This is probably considerably understated. |
| HH62/1/DUNBAR/39 |
[Page] 38
inspection, issuing of notices, taking of legal proceedings, and
seizure of unwholesome food. When the Food and Drugs Acts
have begun to be enforced samples of adulterated food will have
to be taken for analysis; and in the case of milk, this will often
involve the inspector's staying over night in the locality, so as to
catch the milk carts in the early morning."
In view of such facts, and of the amount of correspondence
necessitated by my own duties in the five Districts of Stirling and
Dunbarton, I recommended that in addition to the County
Inspector two assistant inspectors be appointed, and that I
should further have the assistance of a clerk. These recom-
mendations have been agreed to, and, since I began this Report,
the sub-inspectors have been selected.
I made a subsequent report regarding "Police and other
Assistance in the Health Department." Part of that report is as
follows:- "After full consideration, and after consultation with
Chief Constable McHardy, I am of opinion that it would be of
considerable assistance to the public health work of the county,
if (1) The Chief Constable would instruct his officers and men
throughout the county to inform the sanitary staff of all matters
coming under the notice of the police which might require the
attention of the Sanitary Department; and if (2) the inhabitants
of the various parts of the county were informed by advertisement
or handbills or otherwise, that any information or complaints
referring to sanitary questions, and left at the local police stations,
would at once be forwarded to the Sanitary Department.
"There is another matter in which outside assistance might be
of value. Through Mr. Wilson, County Road Surveyor, information
might be sent to the Health Office, of any new buildings about to
be erected within the Districts. The object here would be to allow
communication to be opened up with the owner, so that he might,
if he were willing, be advised as to the sanitary arrangements and
conveniences of the building. Frequently more money is spent in
making arrangements which have afterwards to be condemned as
nuisances than would be necessary for the erection of proper
structures or the laying of proper drains. In Scotland there is
not, as in England, any power to make bye-laws for the proper
construction of new buildings, and legal action can be taken only
when a nuisance has been created, but by a little advice before-
[Page] 39
hand the object of such bye-laws might to some extent be attained.
I have consulted Mr. Wilson in regard to this matter, and he is
quite willing to carry out my suggestions if the Districts so agree.
"Regarding the police, it is clearly out of the question that
they can be asked to visit infected houses, carry out disinfections,
give advice as to removal of nuisances, or undertake the ordinary
routine duties of sanitary inspectors. And it is also clear that
whatever aid they give must be given by the orders of the Chief
Constable, he retaining full control over the force. "
It appeared to me that if the suggestions contained in these two
Reports were carried out the scheme of administration would be
fairly complete. In addition to the staff entirely occupied in
public health work, there would be in every parish several officials
to whom messages regarding nuisances could be given in order to
be forwarded to the sub-inspectors or to the Public Health Office,
and there would also be timely information regarding the erection
of new buildings.
These proposals have been agreed to and will come into force
so soon as the details are arranged. In addition to the above
assistance, both District Committes have arranged that whenever
in regard to any matter local medical aid is required, I may obtain
and pay for it by fee.
In regard to legal proceedings, I recommended that under
section 7 of the Public Health Act of 1867, the Sanitary Inspector
should be empowered to make complaints and take proceedings
on behalf of the Local Authority, subject in all cases to receiving
a certificate from the Medical Officer and to consultation with the
District Clerk. This recommendation also has been adopted in both
Districts. In only one case has it been necessary to exercise these
powers.
Sale of Food and Drugs Act. - An analyst has not yet been
appointed, so that no action has been taken under this Act.
BYE-LAWS.
Rules and Regulations have been adopted regarding the follow-
ing matters by the Western District Committee:-
(1) Dairies, Cow-sheds, and Milk-shops, under the
Contagious Diseases (Animals) Acts and relative Orders. - Besides |
| HH62/1/DUNBAR/41 |
[Page] 40
providing for inspection and general cleanliness, the regulations
insist on byres being paved with concrete or with brick or stone
grouted with cement; on a cubic space of not less than 400
feet per cow; on lighting and ventilation; on a sufficient water
supply of good quality; on the keeping of one boiler entirely for the
purpose of washing milk vessels; on the sufficient separation of
the milk-house from all living or sleeping rooms; on the preven-
tion of any infected person having anything to do with the milking
of cows or the storage or disposal of milk; on the temporary
stoppage of the sale of milk where, owing to infectious disease
in the premises, this may be necessary in the public interest;
and on the owners of milk-shops furnishing, when required, a list
of the sources of their supply.
(2) Slaughter-House Regulations, under Section 30 of
the Public Health Acts. - These regulations are based on the
Model Bye-laws of the Local Government Board of England. The
first twelve have to do with structure, and the remainder with
maintenance. They provide for slaughter-houses being at least
100 feet from dwelling-houses, for water supply, for ventilation, for
paving floors with asphalte or concrete, and for covering walls to a
sufficient height with concrete or some other such material; for
keeping the ventilation, water supply, and drainage in good order,
and for general cleanliness.
(3) Regulations for Houses let in Lodgings, under
Section 44 of the Public Health Acts. - These are, almost with-
out alteration, the regulations suggested by the Board of Super-
vision. The most important relates to air space, which is fixed
at a minimum of 400 cubic feet per adult. The populous
places in which they will take effect - places, namely, having
over 1000 inhabitants at the last census - are, in the Western
District, Jamestown, Alexandria, and Renton. In the Eastern
District, if adopted, they will apply to Duntocher, Faifley and
Hardgate, Old Kilpatrick, Radnor Park, and Bearsden. None
of the villages in the detached portion of the county have the
necessary number of inhabitants. The nearest are Cumbernauld,
with 956, and Twechar, with 887 inhabitants.
These regulations will be of very special importance in the
crowded population of the Vale of Leven, and I am hopeful that
[Page] 41
their enforcement will go a long way to prevent such outbreaks of
typhus as have recently occurred there.
(4) Common Lodging-Houses under Section 62 of the
Public Health Acts. - Here also the amount of air space is fixed
at 400 cubic feet per adult. In addition to ordinary regulations
as to cleanliness and the separation of the sexes a separate
apartment is to be provided for lodgers working at night, and
the duty is laid on the keeper of ascertaining from a medical man
whether any illness among the lodgers is of an infectious nature.
The above sets of regulations have only recently come into
force, and no complete inspection of the places to which they refer
has yet been undertaken, or has indeed been possible by Mr.
Dunbar. And in regard to dairies and cow-sheds, proprietors
have not yet had reasonable time to bring their premises into
keeping with the bye-laws. But with two assistant inspectors, I
hope that it will be possible to overtake the visitations during 1892.
In the Eastern District the question of bye-laws is under the
consideration of a sub-committee.
Bakehouses. - The number of retail bakehouses in the district
is not large, as a good deal of bread is supplied by vans, &c.,
from neighbouring burghs. In the Western District there are
thirteen and in the Eastern District eight. On inspection - which
is almost completed - I have found them in very fair condition,
with the exception of certain defects which have been pointed out,
and especially two untrapped drain connections within bakehouses.
In no case were the provisions of the Factory Acts being infringed
with respect to the hours of employment of youths or boys.
Piggeries. - Here and there in the country villages, people
attempt to help their income, or at least to make a small family
savings bank, by keeping pigs. The piggeries are usually of wood,
both in walls and floor. The interstices of the wood are filled
with filth, and the smell is most offensive. But Local Authorities
can make no bye-laws nor regulations as to piggeries. When a
nuisance exists action can be taken, but no rule can be laid down
fixing a minimum distance from dwelling-houses or public roads.
In one or two cases, however, the circumstances have been such
as to justify an order to remove the piggeries, and this has accord-
ingly been done. |
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[Page] 42
HOSPITAL ACCOMMODATION.
This question has occupied much time during the year. It
may be accepted as one of the essentials of sanitary administration
that there should be within reach of every village within the
District of a Local Authority some place in which a person suffering
from infectious disease can be isolated and treated. Unfor-
tunately, county Districts are not always suitable as hospital
districts, and very often the rural population in a District is not
large enough to require a hospital of such size as can be wrought
with economy and efficiency.
Western District. - The Fever hospitals at present existing in
the District are two. (1) Dunbarton hospital was erected about
eighteen years ago, in presence of an epidemic of smallpox. It is
a wooden structure in the outskirts of the town of Dunbarton.
It was intended for the use of the burgh of Dunbarton and the
parishes of Bonhill and Cardross. It is well situated, being built
on a rising ground sloping towards the south, and sheltered from
the north wind. The soil is light and porous. An objection, largely
sentimental, but also perhaps to a certain extent real, is that it is
close to the cemetery. But the main defects are the slim character
of the building, and the insufficiency of accommodation. The walls
are decaying in parts, and in cold weather it is difficult or impos-
sible to maintain a proper temperature. On my first visit the
temperature in two of the wards, which were heated by stoves,
was 47º and 52º F. respectively.* There are two principal wards
and two smaller wards. Each of the former has a cubic space
of about 9000 feet, and is intended for eight patients. The
latter have each about 1250 cubic feet, and are intended for two
patients. In all the wards the cubic space per head is too small
to fulfil modern requirements. In one of the main wards there is
cross-ventilation by windows, but the other is divided into two
lengthwise by a partition reaching to the ceiling. The water-
closets are not of a good type, and the soil pipes are not ventilated.
The administrative accommodation - for the washing and disinfect-
ing of clothing, bedding, &c., and for other purposes - is quite
inadequate. But such as it is, the hospital has been simply
invaluable during the past year on account of the prevalence of
typhus fever.
*An additional stove is about to be put in.
[Page] 43
(2) Helensburgh Fever Hospital is intended for the use of the
town of Helensburgh and the parish of Row. It consists of the
upper flat of a two-storey stone building, of which the lower flat is
used as an hospital for non-infectious cases. It is well situated at
Craigendoran, and has two main wards, each of which has been
subdivided lengthwise into two, for the separation of the sexes.
One of these subdivisions, intended for 4 patients, has a cubic
space of about 3200 feet, so giving each case only 800 cubic feet.
There is no proper disinfecting apparatus.
The District requires, conjointly with the burgh of Dunbarton,
a large, well built, and properly equipped modern hospital in the
neighbourhood of Dunbarton. The parishes which might con-
veniently be served by it are Dunbarton, Cardross, Bonhill, Kil-
maronock, and at least the lower half of Luss. If it were so
arranged, cases from West Kilpatrick could also be received. The
total population which might be accommodated by this hospital
would be about as follows:-
Dunbarton, burgh, -- 16,908
Dunbarton, parish, -- 928
Bonhill, -- 14,372
Kilmaronock, -- 900
Luss, part of, say, -- 400
West Kilpatrick (in the Eastern District), -- 7,717
[Total] -- 41,225
For this population the hospital should have 40 beds, and
the cost would probably be not less than £6000. In addition the
hospital ground should contain, removed as far as possible from the
main building, a wooden pavilion which might be used as a recep-
tion house for quarantined persons, or for smallpox. The amount
of ground needed might be four or five acres. I have examined and
reported on two suitable sites, one on the Bonhill Road, and the
other between the Renton and Helensburgh Roads, and the matter
is at present in charge of a committee.
The parish of Rosneath presents a difficulty as to hospital
arrangements. To Helensburgh hospital the distance by the ferry
is not great, but the ferry could not be used for patients. By the
road the distance from the south end of the parish, going by
Garelochhead, is about 15 miles. Of course the road is very good |
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[Page] 44
and level, and many cases might be removable for that distance,
especially as their friends could get to the hospital to inquire
about them by crossing the ferry. But a better arrangement
would be to have a small cottage, or a double lined wooden hut,
of two or three apartments, erected on the rising ground between
Kilcreggan and Rosneath, and jointly available for the burgh of
Cove and Kilcreggan and the rural population. Alternatively, a
similar cottage or hut might be erected at Garelochhead, if it
were not that at pesent there is no resident medical man in that
village. Such a cottage or hut might be kept closed unless when in
use, or given rent free to a caretaker, especially if the caretaker could
be got who would be competent to act as nurse when required.
For the most northerly part of the District - the parish of
Arrochar and the upper part of Luss - it might perhaps be possible
to arrange with the Parochial Board of Arrochar. The board has
fitted up a small cottage of two apartments near Tarbet, principally
for the reception of tramps, and navvies engaged on the West
Highland Railway. With the addition of another room the needs
of the locality might be met.
Eastern District. - During the year, fever cases have been sent
mostly to Govan hospital, but for Cumbernauld parish Falkirk
hospital has been found more convenient, though also much more
expensive.
I recently made to the District Committee a special report on
the hospital accommodation required for the parishes of Kirkin-
tilloch and Cumbernauld. Briefly, my recommendations were
that a joint hospital of about thirty beds be erected to serve for
the burghs of Kirkintilloch and Kilsyth, and the parishes of
Kirkintilloch and Cumbernauld in Eastern Dunbartonshire,
Baldernock, Campsie, and Strathblane in Western Stirlingshire,
and Kilsyth in Central Stirlingshire. The burgh of Kilsyth has,
I am told, concluded not to have any share in such a hospital,
and since this report was begun Kirkintilloch has also assumed a
very doubtful attitude. On the other hand, informal enquiries
have been made in regard to the admission to the joint scheme of
a part of the Lower Ward of Lanarkshire, so that it may come to
replace the two burghs. The part of the Lower Ward is the
parish of Cadder, with a population of 8302 and a valuation of
£53,331. The cost of buildings might be allocated on the basis of
[Page] 45
a mean between population and valuation, and as the population,
though numbering 24,941, includes no towns, a hospital of twenty
beds might suffice. In that case the relationship of the several
local authorities to the scheme might be as follows, on the sup-
position that the hospital would cost £150 per bed:-
[Table inserted]
The site suggested is on a rising ground at Inchbelly Bridge
near the Kelvin, about one mile from Kirkintilloch. The soil,
elevation, distance from dwelling-houses, water supply, drain-
age, convenience for medical attendance, and nearness to the
greater part of the population in the district intended to be
served by the hospital, are all considerations which are fairly met
by the site suggested.
For East Kilpatrick undoubtedly the best arrangement, if it
could be equitably brought about, would be to utilise the existing
hospital at Knightswood, which belongs to the burghs of Partick
and Glasgow - the latter as representing the former burghs of
Hillhead and Maryhill. West Kilpatrick might be served by
a hospital near Dunbarton, as already suggested. Otherwise,
Knightswood hospital might be arranged with. The population
of East and West Kilpatrick, with that of the burghs of Clyde-
bank and Milngavie, is quite sufficient to make use of a joint
hospital of a fairly workable size; but it seems a pity to multiply
hospitals unnecessarily, and this alternative should only be thought
of if other feasible arrangements fail. |
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[Page] 46
Regarding hospital questions generally, under the Local Govern-
ment Act, much interest attaches to an Opinion of Counsel lately
obtained by the Lasswade District of Midlothian. The opinion is
briefly as follows:- (1) Parishes as such cannot be assessed for
hospitals; the assessment must be over the county District as a
whole, even if the hospital be in practice available only for a
part of the District. (2) Strictly speaking, Districts cannot com-
bine for a joint hospital open to only part of their population. In
theory, every joint hospital must be open to receive patients from
even the most distant parts of each of the Districts whose Local
Authorities have a share in the hospital.
There has been a tendency to take this Opinion as destructive
of all such joint proposals as are set forth above. For the fol-
lowing reasons it appears to me that this is not so, however;
and the Midlothian Council has evidently arrived at a similar
finding, as it is going on with arrangements for a joint hospital
for parts of two separate Districts and two police burghs.
(1) Clearly enough, under the Public Health and Local Govern-
ment Acts, a District must be assessed as a whole. But if hospital
accommodation is provided, as it ought to be, for all parts of a District,
the assessment will tend to equalise itself. Supposing that my sug-
gestions were carried out, it is true that East Kilpatrick, using the
Knightswood hospital, would be rated also for the Kirkintilloch
hospital. But, on the other hand, the rest of the parishes in the
District would be assessed for Knightswood hospital, on account of
its being used by the people living in East Kilpatrick.
(2) Though in theory every hospital in which any District has a
share must be open to all the infectious cases in the District, in
practice every case will go to the nearest hospital. There is no
likelihood of a man in Cumbernauld wanting to be taken to
Knightswood instead of to Kirkintilloch. And in arranging terms
of combination between two or more Local Authorities the practice
and not the theory would naturally be kept in view. If, as is
suggested in my Report, the main basis of payment per Local
Authority were the number of cases sent in annually by each, the
agreement as to cost of site and buildings should not be very
difficult to arrive at.
[Page] 47
INFECTIOUS DISEASES.
Western District. - In the Western District the Infectious
Disease (Notification) Act is not yet in operation, though its
adoption has been agreed on by the Committee. Several outbreaks
of disease have, however, come to my knowledge during the year.
Typhus. - The most important outbreaks have been of typhus
fever in the Vale of Leven. Unfortunately, owing partly to the
absence of compulsory notification, and partly to the difficulty
which was naturally experienced in recognising the nature of the
earlier attacks, in two of the outbreaks several cases occurred
before the Public Health Department became cognisant of the
matter.
On March 23rd, a case of typhus was discovered at 34A Napier-
ston Terrace, Jamestown, by Dr. McLelland. On the same evening
Mr. Lindsay, the Sanitary Inspector for the parish had the case
removed to Dunbarton fever hospital. The patient was a
woman who had come from Greenock, and Mr. Lindsay at once
communicated with the Sanitary Inspector there, where it turned
out that another case had occurred in the same house.
In the house in Jamestown, which in the meantime had been
placed under observation, a second case occurred and was sent to
Dunbarton hospital. I caused the remaining inmates to be removed
for quarantine to a separate ward in the same building. One of
these developed the disease eight days after admission, and a girl
who had stayed in the house for a night or two, and who had then
gone to Greenock, subsequently became ill and was isolated there.
From the house in Napierston Terrace all infected articles were
removed by Mr. Dunbar to Belvidere hospital for disinfection, with
the exception of some bedding which had to be burned. The disease
did not extend beyond these limits. The house is on the top flat
of a modern and well built three-storey tenement. There was
distinct want of cleanliness indoors, and the windows seemed to be
seldom opened. But there was no overcrowding, though the limit
of air space - 400 cubic feet per head - was very closely approached.
In Renton, in August, a more serious outbreak began.
The first cases to which I was called, on September 14th,
occurred under quite typical circumstances. In a house of two small
apartments, in a crowded locality, there were no less than twelve |
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[Page] 48
inmates, constituting two families. One of the inmates was a
woman with a baby two or three days old. In this house there were
four cases. Tracing backwards from these, other four were met with,
all of which had been sent to Dunbarton hopital, as suffering
from some kind of fever. No evidence whatever could be got as
to where the first case had contracted the infection. The illness
had begun in the second week of August. Contemporary with
the first four cases (in the families of Henderson and Fraser,
134 Back Street), seen by me, other four were discovered, one at
McCrae's, 18 Burn Street, another at Murray's, 18 Burn Street,
one at Bell's, 6 Lennox Street, and one at Haddow's, 68 Back
Street. These were at once sent to hospital. Subsequently, other
five cases occurred in the above-mentioned houses, there being thus
17 cases in all, constituting the outbreak.
The steps taken were briefly as follow:- All cases were re-
moved to hospital, and the bedding and clothing burned or dis-
infected. The houses were fumigated, lime-washed, and left with
windows open for a sufficient time before being used again. In the
same tenement to which I was first called it happened that there
was an empty house of two apartments. A little furniture was got
for it, and the people from the infected house were removed into it.
until the danger had passed. As the newly-confined mother was
one of the persons taken to the hospital, a nurse was got from
Glasgow to attend to the baby, which escaped the fever altogether.
In regard to each case of the disease, a list of all persons known to
have been exposed to infection was made out, and these were
visited to ascertain if any had developed symptoms of typhus.
An attempt was made to get, outside of the town, a reception house
large enough to accommodate in quarantine all these persons. A
suitable house was obtained in a sparsely populated locality, but so
much local feeling was aroused when the arrangement became
known that it had to be abandoned. The fear of harm from the
reception house was entirely groundless; but it is not rare to find
in purely rural districts a greater dread of infection than prevails
in a crowded locality. The next best plan had therefore to be
adopted. Dr. Mitchell agreed to take the list of persons who
ought to have been quarantined, and to visit each of them
daily for between two and three weeks. With one exception all
those on the list who were employed in workshops gave up work
[Page] 49
and stayed at home while under observation. It was in this way
that the last five cases were got hold of as soon as the first symp-
toms appeared, and were removed to hospital. I caused the
following notice to be posted through the town:-
"Typhus Fever. - An epidemic of typhus fever is at present
threatened in Renton, and may readily extend throughout the
Vale of Leven. Typhus is a most dangerous and infectious
disease, and the Public Health Department earnestly requests the
aid of the inhabitants to prevent its spread.
"The disease usually begins with headache, pains in the back
and limbs, great muscular debility, and a feeling of chilliness on
the part of the patient, though the skin is really hot to the touch.
Wherever any such symptoms are present, though in a slight
degree, the doctor should at once be sent for, in the interests alike
of the patient, the household, and the public. Concealment even
of the mildest case may be disastrous.
"The circumstances which above all others favour the develop-
ment of typhus are overcrowding, bad air, and dirt. People who
keep lodgers should see that their rooms have not too many in-
mates. Doors and windows should be kept as freely open during
the day as the weather will permit, and at night a chink should
be left open at the top of the windows of all sleeping apartments.
A bright fire makes an excellent ventilator.
"Floors, walls, and furniture should be kept thoroughly clean,
and all unnecessary curtains, hangings, and other means of inter-
fering with the circulation of air, especially around and underneath
beds, should be removed.
"Immediate intimation of slight or suspicious cases of illness
should be left at Dr. Mitchell's consulting rooms."
At the same time a house to house visitation was made in the
neighbourhood of all the known cases, partly to search for others,
and partly to impress on the inmates the need for ventilation and
cleanliness. I have already given some notes of this visitation. A
deal of extra scavenging was carried out, and extended not only to
the cleaning of streets, but to the emptying of ashpits.
The result of all these measures was that, excepting the
attacks which developed in those who had already the sickness
in their blood, no other person was affected. The disease was
for the time stamped out, and an epidemic which might have deci-
-- D |
| HH62/1/DUNBAR/51 |
[Page] 50
mated the Vale, and spread far beyond it, was prevented. But the
expense was not a trifle. The total cost to the District was about
£350. This included hospital charges, medical fees, disinfecting,
upkeep of quarantined persons, renewal of destroyed bedding and
clothing, and a variety of other payments. in addition there was
one life lost - that of a man about 50 years of age, with a wife and
family depending on him.
The lesson of the outbreak is the necessity for strict sanitary
supervision of such places as Renton. With nearly all the popu-
lation employed in the great dyeworks, with lodgers kept in very
many of the families, and with consequent overcrowding of houses
many of which are of an inferior class to begin with, it would not
be easy to find a more favourable field than Renton for the spread
of typhus.
Typhus is a disease that for the last score of years has been
almost extinct in Britain, and sanitarians have tended to the opinion
that it had died out for ever. But of recent date it has begun to
reassert itself here and there throughout the country. In the
West of Scotland it has shown itself, among other places, in
Glasgow, Greenock, Ayr and Mull. Three years ago it was at
Inverness, and lately it visited Dundee and Aberdeen. In such cir-
cumstances it behoves all communities like those situated on the
banks of the Leven to carry out the sanitary measures which
have been proved by experience to have the greatest control over
the malady. It is a disease of overcrowding and dirt, and its pre-
ventives are fresh air and cleanliness.
Almost at the close of the year, typhus reappeared in the Vale
of Leven. On Christmas morning Mr. Dunbar and I were sum-
moned to celebrate the day by tracing out the disease in the slums
of Alexandria. It had begun in a tramps' lodging-house, kept
by people named Kyle, and had killed both of the keepers,
so that no information could be got as to the part of the country
from which it had been carried. The poison had, however,
found a congenial home, and was beginning to thrive in it.
There had been four days between the deaths of the wife and
husband in the lodging-house, and a variety of people had been
exposed, either through neighbours' visits or through attending
the funerals. On the day of my visit there were three existing
cases of the fever. Each of these had been a lodger with the
[Page] 51
Kyles. From them the disease had branched out in the usual
way, and it ultimately attacked eleven persons in all. These were
at once removed to hospital, and steps were taken similar to those
already detailed. Though the cases were fewer than at Renton,
the outbreak caused no less than three deaths. I may be allowed
to call attention to one interesting fact connected with it. Among
the persons who had been exposed to infection was a relative of
the Kyles from Glasgow, who had stayed in the lodging-house, and
aided in the nursing, while the disease had not yet been recognised
as typhus. After the funeral she went home, probably unaware of
the character of the illness to which she had been attending. I suc-
ceeded in learning her address, and sent it on to Dr. Russell with
a note of the facts. In a few days I had a reply that the woman,
who had been put under observation, had developed typhus, and
had been removed to Belvidere. So that perhaps a Glasgow
epidemic was also strangled in the birth.
Scarlatina in "Empress" Training Ship. - In September
and October a slight outbreak of scarlatina occurred among the
boys on board the training ship "Empress" in the Gareloch.
Accompanied by Dr. Douglas Reid, the medical officer, I inspected
the ship, and learned that all necessary steps had been taken or
were in process of being taken, to check the spread of the disease.
The first case was that of a new boy who had come from Glasgow
on September 10th. Fever developed on the 16th, and he was
sent to Helensburgh hospital on the following day. Six more
cases were sent to the same hospital, but as these nearly filled it,
other measures had then to be resorted to. The brig belonging
to the ship, and used in summer for educating the boys in
seamanship, was turned into a temporary hospital, a nurse was
obtained, and it was arranged to remove cases as they occurred.
No better isolation could have been conceived, and the outbreak
was promptly brought to a conclusion. Only two cases had to be
removed to the brig. The necessary fumigation and other disin-
fection processes were energetically carried out under the super-
vision of Captain Deverill and Dr. Reid. In all, there were nine
cases, and the whole of them made a good recovery.
At Clynder in December a case of scarlatina occurred in a house
of three apartments, among whose inmates were several children
who had not had the disease. The case was the only one in the |
| HH62/1/DUNBAR/53 |
[Page] 52
district, and the parents agreed to allow the child to be removed.
It was taken to Helensburgh hospital, by way of Garelochhead,
a long journey, but the case was not a severe one, and did not
suffer from the removal. The date of the removal was December
25th.
In August three cases of diphtheria occurred at Row, and two
of them proved fatal. Mr. Dunbar visited and disinfected the
premises. The drains, on being smoke tested, were found
defective, and the owner had them rectified.
Eastern District. - The Infectious Disease (Notification) Act has
been in force here since 1st May. The following procedure has
been adopted in regard to it:- Under the Act notifications have
to be addressed to the Medical Officer, but residing in Glasgow as
I do, it was obvious that time would be lost if, in the first
place, the medical certificates were sent on to me, and then
re-posted to the parish sanitary inspectors, who were still on duty.
It therefore appeared better that the certificates should, as had
been also arranged in Renfrewshire, be addressed to the Medical
Officer under cover to the Inspector. Each Inspector was furnished
with a book of report forms, and was instructed to visit the cases
as they were notified, and fill up and send on to me the informa-
tion required on the forms. This includes notes regarding Date
of Commencement of Disease, School and Sunday School Attended,
Milk Supply, Water Supply, Ventilation, Refuse Disposal, Drainage,
Number of Apartments, Total Inmates, Number of Children under
fourteen, Sanitary Defects and Steps Taken. The information thus
obtained enables me to decide whether anything further need be
done in any case. These reports will in future be made by Mr.
Dunbar and the assistant Inspectors. Sheets of Instructions for
the Prevention of Scarlet Fever, and similar sheets for Enteric
Fever, have been drawn up and printed. In every house where
a case occurs one of these is left by the Inspector. Those
for scarlet fever serve also, in regard to some of the precautions,
fo diphtheria.
The following table (which corresponds to Table III. as issued
by the Board of Supervision) shows the total cases notified from
May 15th till December 31st:-
[Page] 53
TABLE VI.
Cases of Infectious Diseases coming to the knowledge of the Medical Officer during the year 1891.
[Table inserted] |
| HH62/1/DUNBAR/55 |
[Page] 54
It will be seen that in all 113 cases were notified. Of diphtheria
there were 9 cases; of erysipelas, 13; of scarlet fever, 60; of enteric
fever, 29; and of puerperal fever, 2. The total population being
20,314, the case-rate was thus 8·78 per 1000 per annum. Of
deaths amongst these cases there were 14. They occurred in the
following diseases:- Diphtheria, 3; erysipelas, 1; scarlet fever, 4;
and enteric fever, 6. One of the deaths from enteric fever and
two of those from scarlet fever occurred in Govan hospital. Five
of the deaths belonged to Cumbernauld parish, five to West
Kilpatrick, three to East Kilpatrick, and one to Kirkintilloch.
Diphtheria. - In Cumbernauld parish there were six cases. The
first was a child at Nethercroy, in a house which was only in
temporary occupation, and was not in a good sanitary condition.
The child died. The next occurred at a dairy farm at Castlecary.
The patient, a boy aged 12, was removed to Falkirk hospital,
and the milk supply stopped for a few days until the premises had
been thoroughly disinfected. Two cases occurred near the end of
July, in one family, at South Muirhead. The disease appeared to
have been brought from Edinburgh. The drainage of the house
was defective, and the owners were communicated with. Two
more occurred in a family in Cumbernauld village, both notified on
September 10th. The house was a new one, and the walls were
on that account rather damp.
In West Kilpatrick there were two cases of diphtheria - one,
intimated on 12th September, in a large house with ample means
of isolation, and the other on 10th October, at a dairy farm. This
latter case proved fatal on the day on which it was notified. The
body was interred on the 12th, and the premises were disinfected.
Scarlet Fever. - In the parish of Cumbernauld no less than
thirty-three cases of scarlatina occurred. The majority were in
the miners' rows, fourteen being in Auchinstarry, and four each
in Smithston and Croy. In the village of Cumbernauld there
were six cases, and in the rural parts of the parish five.
In a colliery village it is not easy to prevent the spread of
scarlet fever, unless by prompt removal to hospital. It is true
that the houses have a considerable advantage in being of
only one storey, each with its own door. This is very different
from tenements consisting of several flats, each with several
families, and a common stairway in the body of the building
[Page] 55
conveying the poison from one door to another. In a miners' row,
the poison gets into the open air whenever it gets out of the door
of the dwelling, and, looking to the effect of pure air in diluting
or destroying the germs of scarlet fever, this ought to be an
advantage. But the doors are often in pairs, close together, and
a good deal depends on the purity of the outside air. If within
a few feet of the houses there are rows of foul privy middens
and dirty slop-channels, then, especially in warm weather, the air
will foster rather than destroy the organisms of the disease. But
in a well planned and properly scavenged row it seems likely
that scarlet fever will less often be conveyed directly from the air
within an infected house to outsiders, than by infected children
allowed out too soon after their recovery, or by children not them-
selves ill, but living in an infected house, and conveying the
disease by means of their clothing, &c., to the juvenile population
with whom they mingle.
No case of scarlet fever in these rows was removed to hospital.
Owing to there being no hospital within the District one could not
insist on removal, while parents have not yet been educated up
to the point of ready compliance with a mere request, especially
as the available hospital is at Govan, which is about 16 miles
distant from some of the rows. In endeavouring to check the
spread of the disease it was therefore necessary to rely on the
printed instructions, on emphatic verbal appeals, on warning as
to the penalties incurred by exposure of infected children, and on
such supervision as was possible in the circumstances. On the
whole the result has been better than at one time appeared likely,
though it would be rash to attribute it entirely to our action.
At the census last year the population of Auchinstarry was 699.
And while fourteen cases of the disease occurred, only eight
houses were invaded, ten of the cases having been confined to
four families.
The first had been in progress nearly three weeks before
the Notification Act came into operation on May 1st. The next
two (in one family) began on May 13th, and subsequently the
dates were as follow - June 1st, July 18th, 23rd, 29th, August
5th, 13th, September 1st, 7th, 10th, 13th, and 14th. Most of
the attacks were in houses within a few doors of each other. In
Croy Row the four cases were in two families, and in Smithston |
| HH62/1/DUNBAR/57 |
[Page] 56
two were in one family. In Smithston the fever occurred in
May, and in Croy in October and November.
The seven cases in Cumbernauld village were all in separate
families. We succeeded in persuading the guardians of three of
these to have the patients sent to hospital - one being in the
school-house, another in the lodging-house, and the other in a single
small apartment with seven inmates.
The only legal proceedings that had to be resorted to under the
Public Health Acts were in connection witn Scarlet Fever in
Cumbernauld village. The complaint was the exposure of a child
recovering from the disease, but still in an infectious condition.
The case was a very glaring one, as the exposure was quite wilful,
and carried on in the face of repeated orders to the contrary.
Only a nominal fine was asked by the Local Authority and inflicted
by the Sheriff, the object being rather to prevent other similar
occurrences than to exact a heavy penalty.
Kirkintilloch. - Contemporaneously with the outbreak in Cum-
bernauld in May three cases of scarlatina were certified in the
miners' rows at Twechar, two of them being in one family. These
two were treated at home. The other was sent to hospital. In
August two children were attacked in Waterside village, and one
in Wester Gartshore Row, adjoining the village. The disease did
not extend further through the village.
West Kilpatrick. - In this parish there were ten cases of scarlatina,
four being in Duntocher, two in Faifley, two in Old Kilpatrick,
one in Bowling, and one in Dalmuir. The first was in a house
in Duntocher, where isolation could be maintained. It began on
May 11th. The next, also in Duntocher, on May 23rd, was in
a large tenement of houses, and was removed to Govan Hospital.
The next, on June 17, in Faifley, was also sent to hospital. The
fourth, also in Faifley, was notified on July 1st. It was a baby a
year old, and was treated at home. On July 23rd a case was
certified in Old Kilpatrick. There were no other children in the
house. On September 17th another attack occurred in the same
village. The parents refused to let the patient, a boy aged 5,
be sent to hospital. On 20th September a man in Bowling was
attacked. The next case (15th October) was in the family of a
ploughman connected with a dairy farm. Govan Hospital was
full at the time, but the house was not so connected with the
[Page] 57
farm as to make it necessary to stop the sale of milk. On 4th
November a case was intimated from another farm. Complete
isolation was arranged for. The last was that of a young man
living in Dalmuir, in a house where there were no children. It
was not possible to trace a connection between all these illnesses.
Very likely there may have been a link between some of them.
But until hospital arrangements are completed it will not be pos-
sible to deal in a satisfactory manner with many of the notifications
under the Act.
East Kilpatrick. - In this parish there were ten cases, two of
which were sent to hospital and the rest treated at home. Several
had existed not long before the Notification Act was intro-
duced, and one was in progress on May 1st. One occurred in
Bearsden in the house of a cattle-dealer, who was in the habit of
supplying milk, varying in amount, to a dairyman who disposed
of it in Maryhill. Evidently the first case certified from this
house had not been the first to occur in it, as a girl of eleven
years old had had, three weeks before, a slight illness, which had not
been attended by a doctor nor recognised as scarlet fever, but which
the medical attendant diagnosed as such on being called in to the
second case. About the same time as the first attack some
of the cattle had had on their teats an eruption, of which slight
traces remained - so slight, unfortuately, as to render hopeless any
investigation as to a causal relationship between the bovine and the
human disease. The milk sale was stopped, a note was taken of
the part of Maryhill in which the milk had been sold, and, through
the Medical Officer and Sanitary Inspector of that burgh, inquiry was
made as to any connection between this milk and scarlet fever which
had prevailed in Maryhill. But it turned out that scarlet fever
had been in Maryhill for some time before, and though several
cases existed in the streets in which the milk had been disposed of,
the people in the infected houses could not tell, among the various
dealers whose carts did business in the streets, whether or not
milk had been got from the source under suspicion. It should be
stated that the burn which receives the sewage of the "New Kirk"
Special Drainage District flows immediately behind the cattle-
dealer's house. At the time of the fever the burn was very foul
smelling.
Enteric Fever. - In the District there have been 29 cases of |
| HH62/1/DUNBAR/59 |
[Page] 58
enteric fever, 11 in the parish of Cumbernauld, 4 in Kirkintilloch,
and 7 each in East and West Kilpatrick.
They have not formed part of any one general outbreak, but
have rather been "sporadic" or individual cases. In many of
them local sanitary defects were found, and intimation made to
the owner. Some of these have been remedied, and others will
require further attention.
Cumbernauld. - The first case occurred in the village, and was
in progress when the Notification Act came into force. The ashpit
was very defective, being merely a hole in the yard, close to the
public street. The next was at Eastfield, in the end of May, in a
damp house, without proper ashpit or privy. The property belonged
to the occupant. In July a case was certified in Condorrat. There
was an untrapped jawbox for slop water at the footpath in front of
the house. This was connected with a drain communicating with
the ditch mentioned in my notes on the drainage of the village. On
August 27th a miner in Auchinstarry Rows became affected. The
house was of two rooms, with eight inmates. He was sent to
Govan hospital. The next case was that of a girl, eleven years
old, at Smithston Row, notified 5th September. There were seven
inmates in two apartments, but the guardians of the child would
not permit her removal. Another case at Eastfield was reported
on 15th September, and proved fatal on the following day. At
Condorrat a master baker became affected, and notification was
received on 16th September. The house was a roomy one, per-
mitting of sufficient isolation, and the children, of whom there
were six, were sent from home. A third case in Condorrat was
notified on 5th October. The drains were improperly trapped
and the ashpit defective. On October 11th a child at Smithston
Row became ill, and developed the disease. When reported the
the case was unfit for removal, and ultimately proved fatal. On
27th November a ploughman at Croy was notified as having
enteric fever. He was removed to Govan Hospital on the follow-
ing day. Another case at Auchinstarry Row was intimated on
1st December. The patient was a girl seven years old, and was
treated at home.
Kirkintilloch. - On May 13th notice was received of a lodger in
a house in Twechar having enteric fever. The house had two rooms,
with no less than thirteen inmates, of whom seven were children.
[Page] 59
The man was taken to Govan hospital. On October 15th two
cases, which should also have been removed, were reported. They
were in one house, but removal was not agreed to, and the circum-
stances had to be made the best of. There were eight dwellers in
two apartments. On 2nd November a case was certified from a
very dirty house in Twechar. The patient was the mother of the
family. She was unfit for removal.
East Kilpatrick. - A boy of twelve years old was removed to
hospital on August 15th from a one-roomed house at Netherton
Quarry. On August 24th information was received of a case in
Drumchapel Rows. It was treated at home, and a month later a
second member of the same family developed the disease. In
Knightswood Rows a mild case was reported on September 22nd.
Three were intimated from Netherton Rows between the end of
October and the end of November. All of these were sent to
Govan hospital. The houses were each of only one apartment,
and one of them was overcrowded. One is partly underground at
the back. The surface channel in front for conveying slop water
to the adjoining drain is defective.
West Kilpatrick. - Seven cases have been reported, the first three
being in the village of Duntocher, the fourth in Hardgate, the fifth
in Duntocher, and the last two in a neighbouring farm. In some
of these the nature of the disease was doubtful to begin with, the
early symptoms being rather those of the prevalent influenza.
Two of them were connected with a dairy farm; but, as dairy
regulations have not yet been adopted in the District, our powers
of interference were limited. Every precaution was taken con-
sistent with treatment at home. The cases were not the first to
occur in the locality, and no spread of the disease could be traced
to the milk supply. I analysed the drinking water and found it
satisfactory.
Erysipelas. - Thirteen cases have been notified in the district -
six in West Kilpatrick, four in Kirkintilloch, two in Cumbernauld,
and one in East Kilpatrick. One sufferer was a baby a fortnight
old, and died on the day on which the notification was received.
Most of the others were of little consequence. Some were
secondary to injury. Except as calling attention to the insanitary
condition of some of the houses, the notification of erysipelas has
been found of little benefit to the public health administration. |
| HH62/1/DUNBAR/61 |
[Page] 60
Puerperal Fever. - Only two cases were intimated - one at
Milton in West Kilpatrick, and the other at Knightswood Rows.
Removals to Hospital. - The total number removed to
hospital has been sixteen. Of scarlet fever there were eight cases;
of enteric fever, seven; and of diphtheria, one. From Cumbernauld
parish four were sent; from Kirkintilloch, two; from East
Kilpatrick, six; and from West Kilpatrick, three. Three died in
hospital - one from enteric fever and two from scarlet fever.
In looking back on the notifications received, and on the use
which has been made, in the public interest, of the information so
acquired, two considerations impress themselves on me. The first
obviously is the need of convenient hospital accommodation. The
second is that in future, with an increased staff of Inspectors, it
will be possible to follow up systematically the facts incidentally
brought to light regarding defects of structure, overcrowding,
and various nuisances existing in connection with the infected
houses. To a certain extent this has been done already, but the
multifarious questions requiring attention in the organisation of the
county public health work have prevented, in some instances, the
completion of proceedings that had been begun with reference to
the removal of ascertained nuisances.
Measles. - Measles is not in the list of diseases notifiable
under the Act, though Local Authorities have power to add
it if they so determine. On October 11th my attention was
called to an outbreak at Smithston. The disease had been
prevalent for some time previously in Kilsyth burgh and the
surrounding district, and a number of children from Smithston
attended the R.C. school in Kilsyth. Indeed the school
attendance was divided betweed this school and the Drumglass
school, the latter being under the Cumbernauld School Board. A
house to house visitation in Smithston disclosed eighteen cases of
measles. The disease also prevailed in Auchinstarry Rows, where
nearly all the children attend Drumglass school. I communi-
cated with the teachers of both schools, but had no reply from
Kilsyth. The Cumbernauld Board, however, at once agreed to
close their school, and it remained shut from 20th October till
7th December. On re-opening, measles again began to spread,
and the school had to be again closed on 21st December. It was
finally re-opened on 11th January. As I pointed out at the time,
[Page] 61
joint action between the several school boards is the only way to
stamp out such an epidemic, and I have little doubt that if the
same closure had been carried out in Kilsyth, as at Drumglass,
the disease would not have recurred.
VITAL STATISTICS.
In a first report it seems desirable to put on record, as standards
of comparison for future years, some facts going further back than
1891. And in regard to all the figures about to be submitted, it
will be needful to bear in mind what has already been said as to
the influence of age, sex, &c., on the rates of mortality. It is also
essential to bear in mind that in the various comparisons which
follow between Dunbartonshire and Scotland, the latter, especially
in its small towns and rural districts, does not yield a standard of
mortality which ought to satisfy Dunbartonshire. The Lord
Advocate, in introducing the Local Government Bill of 1889, said
that the Public Health Acts had been practically a dead letter in
the country districts. Clearly, therefore, while the death-rates
consequent on this sanitary inactivity may form a convenient
measure by which to gauge the health of the county, the con-
ditions which produce these rates are merely the starting point
and not the goal of the new administration.
Birth-rate. - The birth-rate, as has already been indicated, has
a certain bearing on the death-rate. Children under one year have
the highest mortality of all, and children from one to five have the
next highest. Of course, if a population is not migratory, the births
come to add to the healthiest as well as to the unhealthiest ages
of life, but in rural districts, where youths of both sexes tend city-
wards, a high birth-rate has as its immediate effect the raising of
the death-rate. Too much weight, however, is apt to be attached
to this factor.
The following are the rates for the decade 1880-89:- |
| HH62/1/DUNBAR/63 |
[Page] 62
TABLE VII.
Birth-rate per 1000 Living per Annum.
[Table inserted]
[Page] 63
It will be seen from this Table that the birth-rate in each of the
ten years, excepting the first, was above that of Scotland. In the
decade there were in the county about 860 births more than if
average rates had prevailed. Illegitimate children have as a rule
less parental care than those born in wedlock, and have a higher
mortality. In Scotland, in the ten years in question, the percent-
age of illegitimacy in the total births was 8·36. In the county it
was only 5·17 - a fact so far favourable to a low death-rate.
Death-rate. - Table VIII. (page 64) contains a statement
of the death-rates of the county as a whole for each of the
ten years, 1880-1889, with the corresponding rates for all
Scotland.
It will be seen that in every year of the decade, the Dunbarton-
shire mortality has been under the general mortality. On the
average, in every 10,000 of population, in Scotland, as a whole,
191 deaths occurred in a year, while in Dunbarton 180 deaths
occurred. Taking the population of the county at mean of 86,000
during the period in question, then in the ten years 946 fewer
deaths occurred than if ordinary rates had prevailed.
The next four tables give for the same ten years the death-rates
of the fourteen Registration Districts within the county. These
include both burghal and landward population.
(SEE TABLES IX, IXA, X, and XA.)
In the Western District the highest mortality was, naturally, in
Dunbarton, where the rate averaged 20·581 per 1000 living per
annum. The next highest rate was in Renton and Cardross
(18·735), and the next (18·080) in Bonhill. The lowest rate was
experienced in Arrochar, where nearly two-thirds of the popula-
tion have for some time consisted of navvies on the new railway,
among whom, barring accidents, there should be a very low
mortality. I say barring accidents because it happens that last
year, through deaths from exposure, drowning, &c., the navvies
raised the mortality to 20·82. The great variation from year to
year in some of the smaller Registration Districts shows how
needful it is to have a considerable basis of facts on which to |
| HH62/1/DUNBAR/65 |
[Page] 64
TABLE VIII.
Death-rate per 1000 Living per Annum.
[Table inserted]
[Page] 65
TABLE IX. - EASTERN DISTRICT.
[Table inserted]
-- E |
| HH62/1/DUNBAR/67 |
[Page] 66
TABLE IXA. - EASTERN DISTRICT.
[Table inserted]
[Page] 67
TABLE X. - WESTERN DISTRICT.
[Table inserted] |
| HH62/1/DUNBAR/69 |
[Page] 68
TABLE XA. - WESTERN DISTRICT.
[Table inserted]
[Page] 69
build statistical conclusions. In 1886 the mortality in Roseneath
was nearly 26 per 1000, and in 1889 it was less than 9, while the
mean rate for the ten years was about 15·5. And though in 1889
Roseneath had less than half the mortality of Luss, yet in the
decade Luss had a lower rate than Roseneath.
In the Eastern District as in the Western, the Registration
District which includes the largest burgh, had the highest death-
rate. Kirkintilloch had a mortality of nearly 22 per 1000, made
up of rates ranging from 18·9 in 1883, to 24·8 in 1889. The
lowest mortality was in East Kilpatrick parish, which includes
Milngavie and Bearsden. But on the whole, the rates in the
Eastern are higher than those in the Western District.
Deaths from Certain Causes. - From the Registrar-Gen-
eral's Detailed Annual Reports I have extracted for the five years,
1885-89, statistics bearing on the prevalence of zymotic and
tubercular disease in the county.
The Registrar-General in these Reports divides the Registra-
tion Districts of Scotland into five population groups - (1)
The principal towns, with a population of over 25,000;
(2) the large towns, with a population of from 10,000
to 25,000: (3) the small towns, with from 2000 to
10,000; and (4) and (5) the mainland-rural and insular-rural
districts, with populations under 2000.* Speaking generally, it
may be said that the Western and Eastern Districts of Dun-
bartonshire are made up of "small town" and "mainland-rural"
populations, and that the death-rates in these two groups
within the county will best represent the facts. It is not
possible here to separate out the police burghs like Kirkintilloch,
Milngavie, and Helensburgh from those towns - Alexandria, Bon-
hill, &c. - that have not become burghs, so that the figures in
Table XI. are not strictly confined to the population under the
District Committees. Nor is it possible to separate the Western
District from the Eastern. Not only so, but where a Registration
District includes a small town, no distinction is made between the
deaths in the town and those in the rural part around. Those
Registration Districts, therefore, which include small towns are
called "Small Town Districts," and the others are "Rural Dis-
*This grouping is not to be confused with that used in the Census
Reports already referred to. |
| HH62/1/DUNBAR/71 |
[Page] 70
tricts." The Small Town Districts of the county are Kirkin-
tilloch, East Kilpatrick, Bonhill, Cardross, Renton, and Row. The
Rural Districts are Cumbernauld, West Kilpatrick,* Roseneath,
Cove and Kilcreggan, Luss, Kilmaronock, and Arrochar. Dum-
barton is a "Large Town District," and is not included in the
following tables.
Table XI. contains a statement of the estimated population
and of the total deaths in the Small Town Districts and the Rural
Districts respectively in each of the five years, 1885-1889.
Table XII. is based on Table XI. It gives, not the actual
deaths, but the death-rates, and, to avoid decimals, these have
been calculated per 100,000 of the population, instead of per 1000.
The chief use of these tables will be to form a standard by
which to measure the health of future years; but it may be
interesting in the meantime to insert for comparison with Table
XII. the corresponding facts for the Small Town Districts and
Mainland-Rural Districts of all Scotland. Table XIII. contains
these facts.
* These groupings are only re-arranged at decennial periods by the
Registrar-General. From 1891 onwards West Kilpatrick will be a
"Small Town" district, owing to its containing Clydebank.
[Page] 71
TABLE XI. - COUNTY OF DUNBARTON.
Deaths from certain Causes, 1885-9.
[Table inserted] |
| HH62/1/DUNBAR/73 |
[Page] 72
TABLE XII. - COUNTY OF DUNBARTON.
Death Rates per 100,000 of Population.
[Table inserted]
[Page] 73
TABLE XII. - SCOTLAND.
Death Rates per 100,000 of Population.
[Table inserted] |
| HH62/1/DUNBAR/75 |
[Page] 74
Condensing these tables, by taking the mean of the five years,
we get the following result:-
TABLE XIV.
Mean of the Annual Death-rates per 100,000 of Population, 1885-89.
[Table inserted]
It will be seen from these figures that in the Small Town
Districts Dunbarton has a total mortality slightly lower than that
of Scotland. From phthisis, however, the rate is considerably
higher, the difference amounting to 12 per cent. The zymotic
rate is lower than the average by nearly 5 per cent., and among
individual zymotics, enteric fever, measles, diarrhoea, and whoop-
ing-cough contribute to this result. On the other hand, scarlatina
and diphtheria have a high mortality, especially the former, which
is nearly 90 per cent. above the average.
The Rural Districts do not show so well. The total mortality
is 5 per cent. above the average, the phthisis mortality is 15 per
cent. above the average, and, worst of all, the zymotic mortality is
no less than 56 per cent. above the average. Looking at the
[Page] 75
individual zymotics, we find that measles has a death-rate nearly
threefold the average, and that in diphtheria and whooping-cough
there is a twofold rate. Indeed, of the diseases that I have
selected for comparison, enteric fever is the only one in which
Rural Dunbarton compares favourably with Rural Scotland.
I stated at p. 16 that there were better standards than the total
death-rate by which to measure the health of a community.
One of these is the zymotic death-rate, and its application to
the county goes to show that in the Small Town Districts the
health conditions compare favourably with the rest of Scotland,
while in the rural districts they compare very unfavourably.
Doubtless the inclusion of Helensburgh, Row, and Garelochhead*
has much to do with the lowness of the small town death-rate. In
partial explanation of the high death-rate of the rural districts, it
is to be borne in mind that a great part of the so-called "rural"
population of the county lives in villages of from 300 to 2000
inhabitants, and that such villages are likely to have a higher
mortality than smaller hamlets or isolated farm-steadings. On
p. 15 I give figures showing that the village population of the
county is much greater than the purely rural population, while in
Scotland as a whole the reverse is the case. This, however, will
not account for the whole facts, nor will it explain, still less explain
away, the high death rate from phthisis in the rural population.
Bad sanitation in general, and, in regard to phthisis, bad house
accommodation in particular, must be set down as at the bottom
of the unsatisfactory condition disclosed by these figures. The small
mortality from enteric fever - the one redeeming feature in these
statistics - is probably partly due to the fact that so great a pro-
portion of the population has its water supply derived from non-
local sources.
There is too much tendency in the public mind, and perhaps
even in the professional mind, to talk of sanitation as if it had
exactly the same meaning with relation to all infectious diseases.
This is not so. It is true indeed that, in its measure, dirt fosters
all diseases, whether zymotic or tubercular, or belonging to any
other of the Registrar-General's genera and species. But special
* As I have explained, Registration Districts are taken as a whole in
the Registrar-General's Reports and the District of Row contains Helens-
burgh, Row, and nearly the whole of Garelochhead. |
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[Page] 76
diseases have special propagating and preventive agencies. For
enteric fever sanitation means pure water supply and strict dairy
inspection; for typhus it means the abolition of overcrowding and
the admission of fresh air; for measles it means the closure of
schools; for smallpox, vaccination; for hydrophobia, Pasteurism;
for phthisis, good house accommodation; for relapsing fever a
sufficient supply of good food; for scarlet fever, lengthened and
complete isolation of infected cases, and strict dairy and cattle
inspection - and so on. Of course, most of these preventive means
more or less overlap each other. Isolation is good against enteric
fever and smallpox, and sufficient food is good against typhus, but
all the same, the measures just noted have a special bearing on
the special diseases. And thus it comes that in the rural districts
of the county enteric fever shows a low mortality, and measles
and phthisis a high mortality.
The same facts, relating to the prevalence of phthisis and
zymotics, are set forth, on different basis, in tables XV. and XVI.
So far we have been dealing with the rate of mortality on the
population, the standard taken being the number of deaths per
100,000 persons living. Now I give tables showing the proportion
of total deaths due to the particular diseases already selected.
And again, to avoid decimals, I have followed the Registrar
General's plan of taking as a standard, 10,000 deaths from all
causes.
[Page] 77
COUNTY OF DUNBARTON.
TABLE XV. - Number of deaths from certain diseases to every 10,000 deaths from all specified causes.
[Table inserted] |
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[Page] 78
SCOTLAND.
TABLE XVI. - Number of deaths from certain diseases to every 10,000 deaths from all specified causes.
[Table inserted]
[Page] 79
Condensing these tables by taking the mean of the five years,
we get the following rates:-
TABLE XVII.
Mean of the Annual Deaths from Certain Diseases to every 10,000
Deaths from all specified Causes in the Years 1885-89.
[Table inserted]
Tables XV., XVI., and XVII., form a check on Tables XII.,
XIII., and XIV. In order to avoid certain statistical fallacies, it is
better to look at the mortality from both points of view. And
the lessons taught by the former set of tables are by the latter set
confirmed in every respect.
Infant Mortality. - There is just one other statistical test
which must be applied in forming an opinion as to the health
conditions of the county. I have stated that an abnormal age
distribution of population is almost certain to falsify a death-
rate, and that in the Vale of Leven and in Row parish, there is a
large excess of female population at the healthiest ages of life, so
that the all-age mortality, or "crude" death-rate, is considerably
lowered thereby. Moreover, insanitary conditions connected with
dwelling-houses have a greater effect on the infant population
than on adults. And where mothers are, to any appreciable
extent, employed at work which prevents them from nursing their
own babies, the infant mortality is augmented. It will be necessary,
therefore, to see whether the low general death-rate which prevails
in the small town districts extends to the infant population. For
this purpose a new statistical standard has to be set up - that, |
| HH62/1/DUNBAR/81 |
[Page] 80
namely, of the ratio of deaths under one year of age, to the total
births occurring during the year; and for convenience this is
usually stated as the "Deaths under one year, per 1000 births."
Table XVIII. gives the facts.
TABLE XVIII.
COUNTY OF DUNBARTON.
[Table inserted]
In all Scotland, during the same period, the average rate was
113 in the Small Town Districts and 90 in Mainland Rural
Districts. So that the low all-age rate which prevails in the
Small Town Districts of the county is hardly at all shared in by
infants, while in the Rural Districts infants have a mortality higher
by 20 per cent. than prevails in Scotland as a whole in the cor-
responding group of the population.
Death-rates in 1891. - We come finally to the mortality
during the past year, and here I am able to depart from the
"Small Town" and "Rural" subdivisions, and to revert to the
Districts as formed under the Local Government Act. In Scot-
land there is not as in England any law compelling local registrars
to furnish to the Sanitary Department statistics of the mortality
[Page] 81
of the various Districts. But in Dunbartonshire the registrars
have been good enough to agree to do so, on the payment of a
small fee by the District Committees, and it is from the returns so
received that I am able to calculate the death-rates for the year.
Tables XIX. and XXI. (which correspond to Table I., as issued
by the Board of Supervision) give a statement of the births and
deaths; and Tables XX. and XXII. (which correspond to the
Board's Table II.) give a statement of rates founded on the
statistics of Tables XIX. and XXI.
The figures in these tables do not, however, tally exactly with
those furnished to me by the local registrars. In the parish of
Kirkintilloch the population of Woodilee Asylum (amounting to
600) and all the deaths occurring therein have been excluded - the
reason being that the inmates of the Asylum belong to the Barony
Parish, and that the deaths ought to go to swell those of Lanark-
shire. On the other hand, I have obtained, through the courtesy
of those in charge, a statement of the deaths that occurred in the
Larbert Asylum and in the Dunbarton Combination Poorhouse,
and have distributed these throughout the Districts according to
the usual residences.
Western District. - The total death-rate here is 18·7; the zymotic
death-rate, 2·25; and the phthisis death-rate, 1·87. The lowest
total rate (13·01) occurred in the Cardross Registration District,
and the highest (21·36) in the Renton District, these two being
subdivisions of the parish of Cardross. Next to Renton comes
Arrochar, with a 20·82 rate. Of the 31 deaths that produce this
rate, 18 occurred among the railway labourers, and eight of these
were due to cold and exposure, drowning, &c. The highest
zymotic rate (3·47) was in Renton, and the next (3·34), strange
to say, in the rural parish of Kilmaronock. But in a small popu-
lation like that of Kilmaronock a single death more or less
makes a great difference in the zymotic rate. No deaths occurred
from phthisis in Cardross, while the highest rates were in Bonhill,
Roseneath, and Renton.
Eastern District. - The death-rate was 20.·8 per 1000 per annum,
this being made up of rates of 17·4 in East Kilpatrick, 21·2 in
West Kilpatrick, 22·7 in Kirkintilloch, and 23·1 in Cumbernauld
The zymotic death-rate was 3·38 - a high mortality. The lowest
-- F |
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[Page] 82
parish rate was 2·82, in West Kilpatrick; and the highest was
4·44, in East Kilpatrick. The death-rate from phthisis averaged
1·77 per 1000. Here Cumbernauld takes the lowest place, with
1·17, and East Kilpatrick the highest, with 2·68.
This concludes my Report for 1891. Many of the statistical
tables that have had to be introduced will not need to be repeated
in future years - and this, I take it, will be a boon as well to the
readers as to the writer. As I have indicated, the purpose of
these statistics is to show, by means of rates of mortality from
various causes, the health conditions that have prevailed previous
to the passing of the Local Government Act, so that in time to
come it may be possible to measure the results attained by the
new public health administration established under the Act.
JOHN C. McVAIL.
[Table not complete - corrected on following page] |
| HH62/1/DUNBAR/82A |
TABLE XIX.
BIRTHS AND DEATHS OCCURRING IN THE WESTERN DISTRICT OF DUNBARTONSHIRE DURING THE YEAR 1891.
[Table inserted]
NOTES. - "Diphtheria" includes "Membranous Croup," "Diphtheritic Croup," "Croupous Diphtheria."
All deaths from "Diarrhoea," "Dysentery," "Enteritis," "Gastro-Enteritis" - unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis-Diarrhoea,"
"Bright's Disease-Diarrhoea," are entered under the heading "Diarrhoea."
The designation "Other Tubercular Diseases" includes, inter alia, "Tabes Mesenterica," "Tubercular Meningitis," "Hydrocephalus," "Struma," "Scrofula."
The headings distinguished by asterisks cover all diseases placed under these headings in the classification of the Registrar-General. |
| HH62/1/DUNBAR/82B |
TABLE XX.
WESTERN DUNBARTONSHIRE - Density of Population, Birth-rate, Infantile and other Death-rates.
[Table inserted] |
| HH62/1/DUNBAR/82C |
TABLE XXI.
BIRTHS AND DEATHS OCCURRING IN THE EASTERN DISTRICT OF DUNBARTONSHIRE DURING THE YEAR 1891.
NOTES. - See Table XX.
[Table inserted] |
| HH62/1/DUNBAR/82D |
TABLE XXII.
EASTERN DUNBARTONSHIRE - Density of Population, Birth-rate, Infantile and other Death-rates, 1891.
[Table inserted]
* i.e., Smallpox, Diphtheria, Scarlet Fever, Typhus Fever, Enteric Fever, Continued Fever, Measles, Whoopng Cough, Diarrhoea. |
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