Medical Officer of Health reports, 1891 - East Lothian (Haddingtonshire)

Page Transcription
HH62/1/HADDIN/1 REPORT BY DR CAVERHILL, COUNTY MEDICAL OFFICER, TO THE COUNTY COUNCIL OF HADDINGTONSHIRE. MY LORDS AND GENTLEMEN, I beg leave to lay before you my first Report for the year ending 1891. Size. The County is of small extent, 279 square miles (an acreage of 179,142 acres), and measures not more than 24 miles in length. Its greatest breadth is sixteen miles. Boundaries. The Firth of Forth bounds it on the East and North, while Edinburghshire and the range of the Lammermuir Hills, separating it from Berwickshire, complete its boundaries on the West and South respec- tively. Some Geological Considerations. Travelling eastwards from the Edinburghshire Bound- ary along the coast, one meets with a continuation of the carboniferous limestone formation and coal measures in the neighbourhood of Tranent and Prestonpans. Further East the fine coast section of carboniferous igneous rocks continues until we reach a narrow belt of calci- ferous sandstones extending along the valley of the Tyne westwards, towards West Linton in Peeblesshire. Car- boniferous limestone is well seen on the shore to the east of Dunbar, where lime-kilns are in active operation. The lower calciferous sandstones are met with until Cock- burnspath is reached, where the old red sandstones are seen resting on highly inclined Silurian Shales. The remainder of the County is occupied by grey- wacke slates and limestone, characteristic of the South of Scotland uplands. Here and there the felstones have been "intruded," of which North Berwick Law and Traprain are the most notable examples. "Their conical form is entirely due to 'denudation,' though not unlike volcanic in origin."
HH62/1/HADDIN/3 [Page] 2 These facts will explain the remarkable results of the analysis of the water supply which I shall refer to later on. Population - Results of 1891 Census. The population of the whole County, including Burghs, according to the last census in 1891, is 37,306. In 1881 the population was 37,700. In that decennial period, the parishes of Aberlady, North Berwick, Ormiston, Pencaitland, Prestonpans, and Tranent alone show an increase. In all probability the increase is entirely in the number of the inhabitants in the burghs or villages of these parishes. As North Berwick parish has increased by 350, Tranent by 272, and the other four parishes are responsible for 319, some idea may be inferred of the depopulation in the more rural parishes in the County. It will be well to keep these facts in mind in consider- ing the formation of special Drainage Districts or of any expensive scheme of sewerage which may seem most desirable in the interests of public health. Under the Local Government Act for administrative purposes, the County is divided into two Districts - the Eastern and Western. Division of County into Districts. The EASTERN DISTRICT is formed by nine parishes - Dunbar, Innerwick, North Berwick, Oldham- stocks, Prestonkirk, Spott, Stenton, Whitekirk and Tynninghame, and Whittinghame. The WESTERN DISTRICT comprises the parishes of Aberlady, Athelstaneford, Bolton, Dirleton, Garvald, Gladsmuir, Haddington, Humbie, Morham, Ormiston, Pencaitland, Prestonpans, Salton, Tranent, and Yester. Royal and Police Burghs not controlled by County Council. The Royal Burghs of Dunbar and North Berwick and the Police Burgh of East Linton are situated in the Eastern District, while the Royal Burgh of Haddington and the Police Burghs of Tranent, Cockenzie, and Prestonpans belong to the Western. These various Burghs each possess independent and separate Sanitary Departments, and are not controlled in any way by the County Council or District Committees. The Districts are unequally divided both in regard to population and acreage. [Page] 3 Density of Population. In the Eastern District (Burghs included) we have a population of 13,699, and an acreage of 79,325 acres, which gives 5.7 acres to each person and .17 person to each acre. Excluding the Burghs the population is 7,291. Population under Control of County Council, 21,564. In the Western District (Burghs included) the popula- lation is 23,607, with an acreage of 99,817 acres. This gives 4.2 acres to each person and .23 person to each acre. Excluding the Burghs, the population is 14,273. District Committees now the Local Authority. The District is the unit for the administration of the Public Health Acts, and the two District Committees of the County Council are the Local Authorities for carry- ing out these Acts. Their Medical and Sanitary Officers can only be dismissed with the sanction of the Board of Supervision for Scotland. DISTRICT MEDICAL OFFICERS. District Medical Officers. In 1890, 4 Medical Officers were appointed as Dis- trict Medical Officers to various parishes in the Eastern District, while 9 were similarly appointed in the Western District. One of the latter has since resigned. SANITARY INSPECTORS. Sanitary Inspectors. Shortly after the District Committees were appointed, some of the former Sanitary Inspectors were continued in their appointments, also some Sergeants and Inspec- tors of Police who acted as Sanitary Inspectors. At the instance of the Board of Supervision, however, who would not sanction the employment of the Police, the latter staff resigned; and the other Sanitary Inspectors, with a few exceptions, having resigned, ex-Sergeant Reid from North Berwick was appointed County and District Sanitary Inspector on 9th January 1892. SPECIAL DRAINAGE AND WATER SUPPLY DISTRICTS. Special Drainage and Water Supply Districts. There are Special Drainage Districts in Aberlady, Gullane, and Haddington parishes, and Special Water Districts in the parishes of North Berwick, Aberlady, and Garvald.
HH62/1/HADDIN/5 [Page] 4 GENERAL SANITARY STATE OF THE COUNTY. Sanitary State of County. The County of Haddington is almost purely agricul- tural, and its sanitary condition, on the whole, is in a very satisfactory condition. With the exception of the Beltonford Paper Mills and the Glenkinchie Distillery, there are no factories under the jurisdiction of the County Council. The Tyne - the only river - flows in a state of con- siderable purity throughout the whole length of the County. There are no Common Lodging-Houses. Dairies. The Registered Dairies - 3 in the Eastern, and 43 in the Western - are all reported to be in a satisfactory condition. I shall treat of the sanitary state of the County under the headings of:- I. WATER SUPPLY. II. VILLAGES. III. LABOURERS' HOUSES. IV. INFECTIOUS DISEASES. V. MORTALITY AND MORBIDITY STATISTICS. VI. GENERAL RECOMMENDATIONS. WATER SUPPLY. Water Supply. The most important of all the duties to be overtaken by the District Committees is the improvement of the water supply. An impure water supply means a lower standard of health of the people drinking it, who readily become victims to infectious and other diseases. A water-contaminated area is thus a veritable plague spot, from which every man, woman, and child may eventually suffer during general epidemics. Though I know no County where the water supply generally is of such purity, I have to point out the need that exists for still greater precautions being taken to maintain that excellence. Water Analysis. The water supply is plentiful, principally by gravi- tation, and with one exception no new water schemes are likely to be required. A very char- acteristic quality in the water is the great amount [Page] 5 of hardness which is found on analysis by Dr Aitken, the County analyst. Effects of Hardness. Water of such great hardness is extremely unsuitable for cooking and washing, and may be a frequent cause of dyspepsia. Waters, over 20 grains to the gallon of total solids, are termed "hard." The following tables of analysis of 5 waters will show the general characteristics of the water extensively used in the County, wherever, in fact, the lower ("calciferous") sandstones are found:- [Table inserted] The presence of so much lime - 18 grains per gallon in No. 4, and 19.6 grains per gallon in No. 5 - especi- ally renders these waters most unsuitable for boilers where incrustations must be quickly formed. No. 1 and No. 2 both suitable for drinking and dietetic purposes; both hard, especially No. 1. No. 3 is a suspicious water, and is very hard. No. 4, extremely hard; no evidence of pollution. Its use cannot be forbidden on sanitary grounds, unless it is found that the large amount of mineral matter is injurious to health. No. 5 contains a very large amount of organic matter of vege- table origin, therefore not suitable for drinking. They cannot be absolutely condemned on sanitary grounds for drinking purposes. Large Amount of Solid Residue. Another marked feature in the above analysis is the large amount of solid residue. For purposes of com- parison, I shall show in tabular form the total solid residue in 5 other samples expressed in grains per gallon:- [Table inserted]
HH62/1/HADDIN/7 [Page] 6 Peat in Water. A notable characteristic also is the high per centage of organic matter of vegetable origin which is found in the water along the eastern slopes of the Lammermuirs. Peat, in all probability, accounts for the presence of this vegetable contamination. Heavy and continuous rains must make such water undrinkable, but owing to the complete drainage of these uplands, that can only exist for a few hours, when it rapidly regains the normal condition. The presence of peat in larger amount, I know by observation, is likely to cause con- siderable irritation of the stomach to some, but the inhabitants drink it evidently with impunity. Filtering through sand is the most reliable method for lessening the amount in solution. Methods of Water Supply. In the Western District, generally, the water supply to the villages and hamlets is by gravitation. Ormiston and Pencaitland, in addition, have wells and pumps. Dirleton, Elphingston, Gladsmuir, Gullane, East and West Salton, and Samuelston have exclusively wells or pumps. In the Eastern District, Stenton, Westbarns, Inner- wick (partially), Oldhamstocks, and Whitekirk (par- tially) have gravitation, while Spott and Tynninghame have pumps or wells. Procedure in regard to suspected Water Supply. A systematic examination of all pumps and wells, especially those supplying bakehouses and dairies, is now being carried out, and where a rough test shows some form of pollution, or where the chances of contamination seem great, a complete analysis is made by the County Analyst. I have made observations and inquiries in all parts of the County, and have too often seen surface drainage in dangerous proximity to the water supply. Wells are able to drain the sur- rounding areas from great distances. Pollution of Wells. At first the soil checks any pollution from reaching the well, but in time, like all filters, the earth becomes saturated with organic impurities, and the cleansing of such becomes almost an impossibility. In the case of a pump, which supplied a bakehouse, the water was examined lately by the County Analyst, and was found to be "dilute sewage." The most probable cause was nearly 40 yards away. [Page] 7 It must be remembered that every house must have a proper water supply, and it can even be condemned as insanitary if the supply is too great a distance. With the possible exception of Gullane, no new special Water Supply Districts seem necessary. The village of Spott could be easily provided with a new supply, by gravitation, at small expense. LABOURERS' COTTAGES. (Housing of Working Classes Act, 1890.) Labourers' Cottages. The cottages of the labouring classes are of a very superior class throughout the County, and on most of the large estates they reach a high standard of comfort compared with those of other counties. The only noticeable features likely to cause insanitary conditions are the too frequent want of proper privies, the irregular removal of the contents of ashpits, and the dangerous contamination of shallow wells. Where the water is generally so hard, the want of barrels for rain water is specially noticeable. Gutters and rhones are too often absent and badly kept, thus allowing the founda- tions and the earth surrounding the house to get damp. This condition is specially to be condemned where there is a want of through ventilation beneath the floor, owing to flags or bricks being simply laid on the ground with or without a bed of lime. Evil Effects of Damp Floors. In houses that are already built, this cannot be altered; but where new houses are being built, or where old ones are being rebuilt, I would strongly urge that a ventilated space of from 16 to 12 inches be pro- vided beneath the flooring. Rheumatism must often be induced in this way, and the tendency to tuberculosis (consumption) enormously increased. There are not a few instances of over-crowding, and the decencies of life must be maintained with great difficulty in a still larger number of cases. New Dwellings. In this connection I would impress upon owners the advisability of having the opinion of the District Medical Officer or Sanitary Inspector before under- taking the building or the renewal of Dwellings. Section 16 of the Public Health (Scotland) Act, 1867, will show what constitutes a "Nuisance," and it will be
HH62/1/HADDIN/9 [Page] 8 found the most economical way in the end to bear its provisions in mind. By the Act houses can only be condemned after erection and occupation. VILLAGES. Villages. There are 26 villages and several small hamlets within the County. I have visited them all, with a few exceptions, inquiring into their Drainage and Water Supply. While many are almost models of cleanliness, others will require immediate attention before they can become sanitarily passable. The movement now on foot to acquire the power to form special cleansing and scavenging districts will, it is hoped, be successful. At present there is no fixed rule, sometimes neighbouring proprietors, or the ratepayers, voluntarily undertake these duties with markedly good effect. Defect of Privy Accommodation. In all the villages there is a great want of privy accommodation. The ashpits and dustbins also require attention, being badly kept, and often too near shallow wells and pumps. Various sections of the Housing of the Working Classes Act, 1890, will require the immediate attention of the Local Authority in hamlets and small villages. The clauses are most stringent, and a systematic inspection must be carried out when other more pressing general insanitary conditions have been cor- rected. In some few cases sewers will have to be constructed by the Local Authority under Section 73 of the Public Health Act. In this connection the villages of Gifford and Westbarns both require the early attention of the Local Authority. INFECTIOUS DISEASES. Infectious Diseases. The adoption of the Notification of Infectious Dis- eases Act is a matter of urgency, and I trust this ques- tion will be satisfactorily settled at the next meetings of the District Committees, when the subject comes up for consideration. By this Act, both the attending physician and the head of the family or house must notify to the District [Page] 9 Medical Officer of Health the existence of any disease to which the Act applies. Procedure under Notification Act. By isolating the patient as far as possible at an early stage of the disease; by correcting any glaring sanitary defects; by communicat- ing with Board and Sunday School Teachers, and by dis- infecting, or giving directions for the use of disinfectants, the Sanitary Inspector acting under the Health Medical Officer can do much to prevent the spread of infectious disease. As valuable time is often lost by the delay of a few hours, the following case which I specially investigated shows the necessity of the early recognition of the disease, and of prompt measures being taken. The County Inspector reports:- " R. T. occupies a house in "the village of - with his wife and five of a family, "viz., A. (17), M. (14), R. (10), B. (7), and J. (5). On "Saturday, 16th January, the boy B. became ill, and was "confined to bed. The following day, the youngest girl, "J., also became ill, and on Thursday, 21st January, the "Doctor was called in, who pronounced them suffering "from scarlet fever. The house consists of one apart- "ment, and there are two beds in it. The man and his "wife, and the girl J., sleep in one bed, and A., M., "and R. (all girls), sleep in the other, along with the sick "boy B. Owing to the small accommodation it is im- "possible to isolate the sick persons. The house is very "low in the roof, and seems to be damp. There are no "drains in connection with the house, and all refuse, etc., "has to be carried to the garden at the back. The house "is one of a row on the face of a hill, and the ground at the "back of them is higher than the back wall; it is faced "with a stone wall, and a gully about 3 feet wide is "formed between it and the back wall of the houses. "The bottom of this gully is laid with flat, hewn stones, "and a gutter is formed in the centre along which there "is a constant flow of clean water from field drains which "must cause dampness by the water soaking through "between the seams of the stones. No precautions were "being taken to prevent the disease from spreading. I "could find no trace of how the disease originated. "There are no other cases of scarlet fever in the village. "The two sick children had been attending the public
HH62/1/HADDIN/11 [Page] 10 "school. The girl M. was employed as a telegraph "messenger at the village Post Office, but I warned the "mother not to allow her to carry any more telegrams "until the house was clear of infection. I saw the doctor "who was attending, and he said he would cause pre- "cautions to be taken against the spread of the disease, "and have the house thoroughly disinfected." No other cases have occurred, either in the family or in the village, and the family are removing from such an insanitary house. The boy first attacked was in a position to infect others for four days before the visit of the Sanitary Inspector, and the sister who delivered the telegraphic messages in the village and neighbourhood still slept in the same bed with him, along with two other sisters. Enteric Fever. On communicating with many doctors who have practised in the Eastern District during the past twenty years and under, I find that Enteric - one of the drain fevers - has been almost unknown; and that the Burghs of Dunbar and North Berwick seem never to have any epidemic disease of any kind. Imported cases have had no tendency to spread, even when little was done in the way of prevention. In the Western Dis- trict, occasional cases of Enteric (Typhoid) Fever occur from time to time, and the question of hospital accommodation is more urgent there. Tuberculosis. Tuberculosis must now be included under the head- ing of Infectious Diseases. Towards its mitigation and expulsion from the County, all the energies of the Sanitary Department must be directed at no distant date. A disease that is on the increase, attacking men and cattle alike, and one that causes nearly one-third of the infant mortality, and the death of every fifth person in the Country, cannot be allowed to remain unchecked. It is a preventable disease, and will prove as amenable to the influence of Sanitation and Hygiene as the highly infectious and formerly dreaded Typhus, which has become almost unknown in Edinburgh during the last 25 years. For the present, an increase of cubic space to each [Page] 11 person in living and sleeping rooms where that is in- sufficient, lowering the height of the sub-soil water by proper sewerage, dry foundations, free ventilation, care- ful meat inspection, and a pure water and milk supply, embraces all that can be done for its prevention. It was found that co-incident with the increase of cubic space in army barracks, consumption (Tuberculosis of the lung) became markedly less. The town of Leicester, previous to the carrying out of sewerage works for the lowering of the sub-soil water, had a mortality from consumption amounting to 43 1/3 per 10,000 living; during the six subsequent years the rate fell to 25 1/6. Nothing is more certain than that Tuberculosis is curable, but that is only possible under good hygienic conditions. It has been found that from 23 to 38 per cent. of people dying in advanced life have been found by post-mortem examination to have suffered from Tuberculosis, usually of the lungs (consumption). "They had recovered so completely that they had lived "in many cases to advanced life, and had died of some "other disease. The vigour of their tissues had been "sufficient to prevent the infection getting a hold of their "system, and the microbe had died out (Coats)." That vigour of the tissues may be diminished by unhealthy surroundings and still more by the tendency to Tuber- culosis inherited from parents. Inherent tendency alone appears incapable of originating the disease, but external deteriorating agencies can. The combination of these factors is very deleterious, but any debilitated state of body, no matter how induced, is as equally influential - probably more so - as inherited tendency. As probably every second person becomes infected by some form of the disease, the necessity for vigorously carrying out sanitary reform must be recognised by everyone. If stringent measures are carried out for some time, there is no reason why Tuberculosis should not be as rare as in Algeria, where M. Bouzom, who inspected the Abattoirs of Algeria-Mustapha for the purpose, found that, out of a total of over 165,000 cattle of all ages, only a few cases of pulmonary Tuberculosis were
HH62/1/HADDIN/13 [Page] 12 found. M. Dauzon also found seven cases out of 72,623; four of the seven were of French breed. It is questionable if animals in a state of nature ever suffer from Tuberculosis. Only when they become domesti- cated do they exhibit it to any extent; the greater the confinement the greater will the increase be apparent. An earlier and more easily recognisable symptom than we already possess must be discovered, and systematically sought for amongst the increasing number of stall-fed animals, if their flesh and milk is to be kept free from tubercular poison. Sources of Infection. As the great sources of infection are from the expectoration and discharges of people suffering from consumption, and from the milk and flesh of cattle, it can only be a question of time before Tuberculosis will be included under the Notification of Infectious Diseases Act. Already in Germany, strict regulations are en- forced in regard to patients so affected, and the medical profession in America and in this country are moving in the same direction, on account of its great increase among the bovine race. HOSPITALS. The Hospital accommodation for infectious diseases is at present engaging the attention of the District Committees. Beyond a share in the Burgh Hospital possessed by the Parish of Dunbar, no isolation is possible in the Eastern District. In the Western District, small houses have been rented in Tranent and Prestonpans. The erection of a suitable Hospital in that neighbourhood is to be recommended, and com- bination Hospitals at Haddington, Dunbar, and North Berwick might possibly be arranged with these Burghs. Combination is more likely to result in advantage being taken of such institutions, as they will un- doubtedly be more efficiently managed and made more comfortable and attractive by being oftener used. The prevailing sentiment against them will, as in other places, disappear when it is seen that owing to superior nursing the mortality is less and the risk to other members of the family is entirely prevented. [Page] 13 Where Hospitals are erected, I would recommend that the nursing should be done by nurses in constant employment, and that the services of nurses in Edin- burgh or Glasgow should be retained at a small annual fee, who would be obliged to come or provide efficient substitutes whenever required. Disinfecting Chambers. What perhaps is still more urgently required, is the erection of suitable disinfecting chambers at Dunbar, Haddington, North Berwick, and Tranent or Preston- pans. Here, again, combination is to be recommended, provided that the site chosen is outside the Burgh Boundaries, and close to the Hospitals, if possible. Articles of clothing and bedding can be brought in special iron boxes from the Burgh or surrounding County. The official in charge would be likely to manage this most important duty more efficiently by having frequent practice in the working of the disin- fecting apparatus. A suitable vehicle will also be required at each centre. Several outbreaks of infectious diseases have been noted during the year, but, with the exception of influenza, none have become epidemic. Influenza. First in importance is Influenza, which unduly raised the mortality over previous years. It, however, never became so general as in some other counties. In May and June, and again in November and December, it was somewhat prevalent, especially in the latter months. In view of its dangerous and insidious mode of attack, it is essentially a disease requiring, on its re-appearance, the immediate attention of the Local Authority. Disin- fection and isolation should be carried out, and leaflets distributed showing the necessity for its careful treat- ment and the danger of neglecting even mild attacks. Dr Ronaldson informs me, as an interesting fact, that the Asylum Officials suffered in a larger proportion than the patients. It is amongst these latter, with broken- down or weakened nervous systems, that it seems to exert its most hurtful influences. Pneumonia (Lung Inflammation) was the most frequent complication in fatal cases.
HH62/1/HADDIN/15 [Page] 14 Scarlet Fever. There has been distinct evidence of a masked epi- demic of Scarlet Fever, but only at Elphingston were there more than a few cases. Here, as in some other infectious diseases, it is by the slight cases who require and get no medical attention that the disease is most commonly spread. Where it has occurred, the sanitary condition has been inquired into, the origin and causes ascertained if possible, isolation recommended, and directions for disinfection given or carried out if re- quired. As the exposure of those suffering from infec- tious disease is illegal, convalescents have been reminded of the penalties they are liable to, and the risk others run by coming in contact with them. A few cases of Enteric Fever on the Western Boundary, some isolated cases of Hooping Cough and Measles, complete the infinitesimal amount of infectious disease during the past year. SICKNESS AND MORTALITY RETURNS. It is impossible to give any statement of the distribu- tion of ordinary disease throughout the County - such information is most important as showing where sani- tary defects are likely to be found, and measures taken for their improvement. Next year, it is hoped, such data may be available for Medical Officers of Health. Meanwhile, the Registrars are not obliged to supply the necessary particulars. TABLES OF MORTALITY. Through the kindness of the local Registrars of Parishes, where Burghs exist, I am able, after much trouble, to give a Table of Mortality for the last three years, which will enable us in the future to measure the amount of success attending the administra- tion of the Public Health Acts. Owing to the great depopulation in most of the Parishes in recent years, which has even prevented the number of inhabitants increasing with the natural growth of the population, I have used the data furnished by the 1891 census of population through- out. [Page] 15 ANNUAL MORTALITY OF WHOLE COUNTY [Table inserted] EASTERN DISTRICT [Table inserted] WESTERN DISTRICT [Table inserted] It will be seen that, contrary to what is usually found, the mortality in 1890-1 in the Western District is considerably less than that of the Eastern District in the same years, even though the density of the population per acre is greater. The annual mortality should not exceed 17 per 1000 without some definite cause. GENERAL RECOMMENDATIONS. Defect in present arrangements. Undoubtedly, the main defect in the present arrange- ments for raising the standard of health in the County is the number of independent local authorities. In this comparatively small County there are nine independent local authorities. Co-operation and uniformity is necessary, if rapid, effective, and economical action is to be taken on such subjects as Notification of Infectious Disease, Main Drainage, Water Supply, Regulation of Dairies and Bakehouses, Meat Inspection, Food and Drugs Adulteration Act, River Pollution, Disinfection and Fever Hospital Accommodation. It is to be hoped that either the Legislature or the common interests of the Burgh and Landward Local Authorities will replace this cumbrous Sanitary Machine by a representative Combined Public Health Committee, or in some other way. In the meantime, the formation of a Health Com- mittee in each district would be likely to deal with urgent defects more rapidly than is possible under the present system. Mr Reid only entered on his duties as County Sanitary Inspector on the 9th January 1892, so no
HH62/1/HADDIN/17 [Page] 16 report will be found from him. I would recommend that an Assistant Sanitary Inspector be appointed at Dunbar, to act only on emergencies, and to assist him when required. For more detailed information as to the work of the year, I have to refer you to the Medical and Sanitary Reports of the various District Officers. As the improvement in the standard of Public Health of a community largely depends on the individual efforts of its members, so it is to be hoped that the exertions of the Sanitary Department will be aided in every possible way. The publicity which the printing of the various Medical and Sanitary reports must give the whole subject, will awaken general interest, and as the importance of the work becomes more recognised, every assistance will, it is hoped, be given in carrying out such needful and judicious improvements as the advance of the Science of Public Health may demand. I have the honour to be, MY LORDS AND GENTLEMEN, Your most obedient Servant, THOS. F. S. CAVERHILL. EDINBURGH, 30th March 1892. REPORTS BY MEDICAL OFFICERS TO THE COUNTY COUNCIL OF HADDINGTONSHIRE FOR YEAR 1891. WESTERN DISTRICT. PARISH OF YESTER. I beg to report for the information of the County Council that, so far as personally known to me, only one case of Scarlatina has occurred in the Parish during the year ending 31st December 1891. Isolation and disinfection were strictly carried out, and subsequent disinfection of the apartments was duly attended to. No other cases have occurred in the house nor in any part of the Parish. There was one case of Hooping Cough. In the Spring of last year, complaints were made about bad smells coming from the gratings into the street and road drains in the Village of Gifford, and on 13th March I reported to your Committee on the subject, condemning the use of such drains for conveying sewage - such being a Nuisance and injurious to health. Nothing has as yet been done towards remedying or removing this Nuisance, but I believe the subject is under the consideration of the Proprietors of Property in the Village and others, with the view of adopting a complete system of Sewerage. I have visited and examined the Bakehouses in the Village of Gifford occupied by Mr William Ogilvie, Mr Robert Macadam, and Mr George Guy, all of which I found cleanly and in good order, and that they had been limewashed during the year.
HH62/1/HADDIN/19 [Page] 18 PARISH OF ATHELSTANEFORD. I beg to report for the information of the County Council that, during the year ending 31st December 1891, no cases of Infectious or Contagious Disease have been reported to me, nor have any cases of such come under my own personal observation; neither has there been any complaint of, nor am I aware of, any insanitary condition affecting any part of the Parish. I have visited several times the Bakehouse in the Village of Athelstaneford occupied by Mr W. Garlick. This has been almost wholly rebuilt and enlarged, is admirably suited for the purpose, and is kept in thorough good order. PARISH OF MORHAM. I beg to report for the information of the County Council that, during the year ending 31st December 1891, no cases of Infectious or Contagious Disease have been reported to me, nor have any cases of such come under my own personal observation; neither has there been any complaint of, nor am I aware of, any insanitary condition affecting any part of the Parish. WILLIAM MARTINE, M.D. WESTON, HADDINGTON, 30th January 1892. PARISH OF SALTON. The Sanitary condition of this district continues in many particulars highly unsatisfactory - e.g., nothing, or next to nothing, has been done to improve the condition of the Dwelling-Houses of the Villages of East and West Salton, many of which are scarcely fit for piggeries much less for human habitation. In East Salton, all the Sewage from a Byre at the top of the Village flows right down the Street, and in warm weather is extremely offensive. The Butcher's premises are in a condition meriting the strongest condemnation. The Slaughter-House is simply an old cart shed, which communicates directly with the Stable on one side, and with the shop on another; while the shop in its turn is in direct com- munication with the Dwelling-House. There is no drain from the Stable, and the midden into which all the offal, [Page] 19 etc., is put is within about ten yards of the Dwelling- Houses. The Bakehouse referred to in my last Report has been put into a satisfactory state of repair. There have been six deaths during the year, aged respectively - 73, 70 years, 11 weeks, 65, 12, and 54 years; the assigned causes being - 1, Burns; 2, Heart Disease; 3, Gastro-Enteritis; 4, Found Dead (cause not certified); 5, Bright's Disease; and 6, Broncho-Pneumonia. J. BRUCE RONALDSON, F.R.C.S.E., D.P.H., &c. PARISH OF BOLTON. I certify that during the last year I have not been called upon to take any action in respect of any Nuis- ance or case of Infectious Disease in this Parish. No Bakeries, Dairies, or Workshops exist calling for inspection. PARISH OF ABERLADY. I have to report that the Sanitary condition of the Parish, as a whole, is satisfactory. Since the beginning of the year 1891, I have only once had occasion to make a Report to the County Council. This was with refer- ence to the house in Cockle Square, Aberlady, reported on 22nd April 1891. There have not been any other cases of Nuisance calling for report, though two inspections for such were made, and in one case, where a Nuisance did exist, it was rectified. The Nuisance complained of in this case was with respect to the insanitary condition of the house occupied by Mr McDonald, baker. Here a Nuisance was found. The floors of two rooms were lifted, and a through-drain which was choked was diverted, and a cesspool cut off from communication with it. Through- ventilation of the house was provided, and all made right by the Proprietor. On 15th July, I inspected the three Bakehouses, and found all in a Sanitary condition. No further cases of Nuisance, nor any cases of Infec- tious Disease in the Parish, have been reported to me during the past year.
HH62/1/HADDIN/21 [Page] 20 PARISH OF GARVALD. I certify that, as Medical Officer of Health to this Parish, I have not been consulted not had to report upon any alleged Nuisance, nor have any cases of Infectious Disease been reported to me as requiring any action on my part. On 17th Feb. 1891, I examined the two Bakeries, and found these in a Sanitary condition. PARISH OF HADDINGTON (Landward). I have to report that in the Landward Part of the Parish I have not had to take any action or report upon any alleged Nuisance, or in respect of any case of Infectious Disease. ROBERT HOWDEN, M.B. HADDINGTON, 25th January 1892. PARISH OF DIRLETON. In submitting my Annual Report, as Medical Officer of Health for the Parish of Dirleton, I have to state that, with the exception of "The Gullane Drainage Case," decided by Lord Low in favour of the Local Authorities, very little has taken place in the Parish calling for remark. Influenza was very prevalent in the Parish during the months of November and December, and induced death from Apoplexy in one case. The number of Births during the year was 33, and the Deaths 19 - being 31.1 per 1000. Of these seven were over 60 years of age, three over 70, and one over 80. JOHN L. CROMBIE, M.D. NORTH BERWICK, 19th January 1892. PARISH OF TRANENT (Landward). The following is a short Report on work done by me as Sanitary Medical Officer during the year 1891:- During the summer, numerous cases of Scarlatina occurred in the Village of Elphinstone, and in June a [Page] 21 Report upon the epidemic was sent in. After the middle of July, there were no fresh cases, and to the end the disease was of an exceedingly mild type. At the time of sending in the Report, I thought it right to recommend the introduction of a New Water Supply, and also that more attention should be paid to the Ashpits and Drains. Some of the latter con- nected with Sinks inside the Houses were choked. At the request of the Board of Supervision, I accom- panied Mr Falconer-Stewart and Dr Littlejohn over the course of the drain by which it was proposed to carry the Tranent Sewage direct to the sea, and in September I met a Committee of the County Council at St Joseph's Hospital to inspect the Tranent Sewage where it joins the "Day Level." No more cases of Typhoid Fever have occurred at Seton Farm during the year, but I am sorry to say none of the changes recommended by me in my Report of last January have been carried out. The Seton Pond, however, has been cleaned out, and some alterations made in the foundations of the adjacent Cottages, whereby the latter have been rendered drier. PARISH OF GLADSMUIR. At the Farms of Greendykes and Chesterhall, several cases of Scarlatina occurred in January. One case at Chesterhall proved fatal, but others were mild, and made good recoveries. The origin of the outbreak could not be discovered. In November, a case of Scarlatina was reported in the house of R. Hogg, Macmerry, but on visiting I found the patient from home, and Mrs R. Hogg disinclined to give any information regarding the illness. In March, I made an inspection of and sent in a Report upon the Sanitary condition of Macmerry, Penston, and Gladsmuir. At that time, I stated that the Sanitary arrangements at Macmerry and Penston were very unsatisfactory, and so far as I am aware nothing has been done by way of improvement.
HH62/1/HADDIN/23 [Page] 22 PARISH OF PENCAITLAND. One case of Typhoid Fever occurred at Red Row, Pencaitland, and this was supposed to have been caused by a bad Water Supply. At that time, the Water for all purposes was obtained from the Tyne below the inflow of the Ormiston Sewage, but now a pump has been sunk near Red Row, which has improved matters. D. RITCHIE, M.D. TRANENT, 23rd January 1892. PARISH OF PRESTONPANS (Landward). The Sanitary state of the Parish is in general satisfactory, as is evidenced by a death-rate of 13 per 1000. The main requirement is a properly-equipped Hospital for infectious cases. In connection with this, there should be an ambulance waggon, and appliances for the disinfection of clothes and bedding. Special inquiries were made as to the Sanitary condition of the Cuthill - the principal village in the Parish (Landward). This has decidedly improved. Dust-bin Refuse is now removed daily, instead of bi-weekly as formerly. Special inquiry was made into an outbreak of Scarlet Fever at Preston in September. A certificate was granted in the case of the Preston Nuisance, where a drain has been used as a Sewer. The Prestonpans Hospital has been occasionally visited. Both building and furnishings are unsuited for their purpose. Twelve cases of Scarlet Fever occurred during the year. The parents of the children were directed to isolate them as much as possible, and to keep them and any other children in the house from School for six weeks. Fourteen Deaths were registered during the year. Deducting one case, where a drowned body was washed ashore, the death-rate has been under 13 per 1000 (12.753). In 1890, it was 18 per 1000. There were 32 births registered - the birth-rate being 31.465 per 1000. In April 1891, the population of the Parish (Landward) was 1017. [Page] 23 Influenza prevailed to some extent in the Spring, and again, much more extensively, in the months of November and December. It caused one death, through Pneumonia. One case of Typhoid Fever occurred, and ended fatally. In all probability, the disease was contracted beyond the bounds of East Lothian. WILLIAM C. McEWAN, M.B., C.M. PARISH OF HUMBIE. In the Spring months of 1891, the Parish was visited by an epidemic of Hooping-Cough. There were two deaths from the epidemic - one an infant, and the other a child about four years old. The Hooping-Cough appears to have been imported from the County Town by a family affected visiting their friends in the Parish. During the summer, a complaint was made about the dirty condition of a Well at Harestanes. I made an inspection of, and instructed the complainer how to clean, the well, and he cleaned it. There was a fatal case of Erysipelas at Bught- knowe Cottages in November. There was no apparent cause, but I may remark that this case occurred while an epidemic of Influenza was prevalent in the Parish. The Cottages nearest the Farm Steading at Upper- keith have been reconstructed, and the Pigsty, formerly at the gable, is now removed to a suitable distance. At Pogbie House, in the last month of the year, there was a fatal case of Typhoid Fever. Two cases that occurred at the Cottages there a year ago con- valesced favourably. These cases, as I reported last year, were in my opinion due to the Water Supply used. On this occasion perhaps the cause is not so apparent, but from the Sanitary Inspector's Report, and from my own observations, I have to note that the metal pipe conducting the Water Supply of the House from the spring to the cistern has been broken in more than one place, and repaired only with field drain pipes - the result being that Surface Water can
HH62/1/HADDIN/25 [Page] 24 get into the House Supply. This condition may be a source of danger where it is possible that Surface Water from sheep excrement might get into the pipes. While attending the Typhoid Fever case, the water, as seen in a tumbler after rainfall, was quite turbid. I have no doubt that after the water settled, and the rainfall ceased, an analysis of the water may be favour- able, but the above condition is in my opinion a pos- sible source of danger, and I would strongly recom- mend that the pipe conducting the water from the spring to the cistern should be properly repaired with metal pipe, and the joints well secured. From the Sanitary Inspector's Report it would seem that the Drains of the House had been recently improved. On examination, I find the cesspool is closely covered with a stone slab. In this case, I would advise that the cesspool be covered with a strong perforated iron plate, or to have a ventilated trap nearer the house, in addition to the present ventilation of the Drain. The Ashpit at the west end of then Ploughmen's Cottages is too near the gable, being about three yards distant. The population of the Parish is 828. During the year, there have been thirteen deaths. Two occurred from Hooping-Cough, one from Erysipelas, and one from Typhoid Fever. The other deaths were princi- pally due to Cardiac and Bronchial affections (in the aged). ARCHIBALD CRAIG, M.D. PATHHEAD, FORD, 20th January 1892. PARISH OF ORMISTON. I have to report that, during the year ending 31st December 1891, there have been registered in the Parish of Ormiston 8 Deaths, against 22, 20, and 13 in the three previous years. These 8 Deaths repre- sent an annual mortality of 6.7 per 1000 of the popu- lation. Cardiac Disease was the cause of one of these Deaths; Diseases of the Chest, other than Phthisis, three; Hemiplegia, one; Cuihosis, one; and Premature Birth, one. Ages at Death were:- [Page] 25 Under 1 year, one; over 40 and under 60, two; over 60 years, five. There were registered 49 Births - 21 Males and 28 Females - two of these being illegitimate. The District has been very healthy during the year, and clear of Infectious Disease. A. LINDSAY, M.B. EASTERN DISTRICT. PARISHES OF PRESTONKIRK, WHITEKIRK, WHITTINGHAME, AND STENTON. I beg to submit my Report for the area comprising the Parishes of Prestonkirk, Whitekirk, Whittinghame, and Stenton, of which I am Medical Officer. The Sanitary condition of this area is, on the whole, satisfactory, and no special measures are required for its improvement. It may, however, be stated generally that the condition of the Drains and the accumulation of Filth in the neighbourhood of Dwellings do require constant attention and supervision. The necessary constant care and attention ought to be enjoined and enforced upon those who use them. The best con- structed Drains, if not properly used, will inevitably choke, and breed mischief. General inquiries during the year led to the dis- covery of no unsanitary condition calling for any special inquiry. There existed no matters as to which advice was required to be given or certificates granted. The Bakehouses in the Districts are all in a satis- factory condition, and no proceedings required to be taken in regard to them. No Hospital now exists in the District - the only one which formerly existed (a Combination Hospital situated in Prestonkirk) having been discontinued. The only outbreak of Infectious Disease requiring any action to be taken to prevent the spread of it was that of Scarlet Fever in the Parish of Whitting-
HH62/1/HADDIN/27 [Page] 26 hame. Here it broke out in the Teacher's House. The School was accordingly closed for a month; and, when it was re-opened, the Schoolmaster completely isolated himself by taking up his residence in a separate house. No conditions existed within the District bearing on the causes, origin, and distribution of Diseases calling for removal or mitigation. During the months of May and June, Influenza prevailed over the whole District. Again, during November and December, it abounded on every hand. During this visitation, it was characterised to a remarkable extent by pulmonary complications. In the Parishes of Prestonkirk and Whittinghame, Scarlet Fever appeared in a few families. The suspicion is that those few cases were only the out- crop of a more general mild epidemic, which, on account of its mildness, was either not detected or not heeded. In the Parish of Prestonkirk, Measles was imported into one family; and in the same Parish there was one imported case of Enteric Fever. JAMES GORDON, M.D., C.M. SCOTSCRAIG, PRESTONKIRK, 31st January 1892. PARISH OF NORTH BERWICK (Landward). During the past year, the Landward part of the Parish of North Berwick has been in a very Sanitary condition, and my services as Medical Officer of Health have not once been called for. JOHN L. CROMBIE, M.D., M.O.H. MELBOURNE VILLA, NORTH BERWICK, 10th March 1892. PARISHES OF DUNBAR (Landward), SPOTT, AND INNERWICK. During the year 1891, no cases of Infectious Dis- ease have been brought under my notice in the Parishes of Dunbar, Spott, and Innerwick, nor have there been any cases of illness attributed to Insanitary conditions. The Dairies, Cowsheds, &c., have been visited, and, although the standard of Sanitary con- [Page] 27 dition is not high, I have not found it necessary for the Local Authority to take any action. A Special Report was sent in by me with refer- ence to the Sanitary condition of the new Slaughter- House at Dunbar. The objectionable conditions described still continue, and ought to be dealt with forthwith. All cases of Nuisance reported to me by the Sanitary Inspector have been visited, and any action that was necessary taken. With reference to any out- break of Infectious Disease, it seems to me very desirable that there should be a Local Sanitary Inspector ready to deal with it, as valuable time might be lost before the County Inspector could visit and deal with the cases. I have not the data to enable me to fill up the tabular statement of Sickness and Mortality required by the Board of Supervision. I am willing to do so as soon as these are provided. W. B. MACDONALD, Medical Officer. PORT LODGE, DUNBAR. PARISH OF OLDHAMSTOCKS. The Sanitary condition of this Parish has been most satisfactory during the year. The Village is kept very clean, and altogether free from Nuisances. The Water Supply is plentiful and good. There has been no case of Infectious Disease during the year, excepting Influenza, which was very prevalent during December. Two Deaths occurred from this Disease, both in people about 70 years old. Many cases of illness are due to the damp cond- dition of the Cottages, and, if this could be remedied, I am confident there would be a great diminution of Sickness among Farm-Servants. The introduction of Earthen Closets on all the Farms would be of great benefit to the people, and of the highest importance from a Sanitary view. DUNCAN R. MACDONALD, Medical Officer. COCKBURNSPATH, 31st January 1892.
HH62/1/HADDIN/29 REPORTS BY SANITARY INSPECTORS TO THE COUNTY COUNCIL OF HADDINGTONSHIRE FOR YEAR 1891. WESTERN DISTRICT. The health of the District for the last twelve months has been generally good. One young woman died of Scarlet Fever in a "Bothy" at Greendykes, in the Parish of Gladsmuir, in the early part of the year, and a few mild cases of Scarlet Fever occurred in the same Parish. Two persons were attacked with Typhoid Fever at a Farm in the Parish of Humbie in the month of January last, and both recovered; but in the month of Decem- ber last, the Farmer at the same place contracted the disease, and died after about a fortnight's illness. It was suspected that the water used for domestic purposes was bad, and two samples were sent to Dr Aitken, analyst, Edinburgh, for analysis, and he reported that the samples were very good, wholesome water. Another man died of Typhoid Fever in the Parish of Prestonpans, but it is supposed that he contracted the disease when visiting a relative who was affected in an adjoining County. A few cases of Scarlet Fever occurred in the same Parish, but all were of a mild type. The Sanitary condition of the eleven Parishes inspected by me is generally good. JAMES McKENZIE, Sanitary Inspector. COUNTY POLICE OFFICE, HADDINGTON, 18th January 1892. [Page] 29 PARISH OF MORHAM. In submitting this, my last Report, I am pleased to state that the health of the Parish has during the past year been, as compared with other districts, remarkably good. New Piggeries and Privies have been erected at Morham Mains at my suggestion. The Dairy at Morham Muir, which, during my frequent visits, I always found scrupulously clean, has ceased as in September last, so that there is now no Dairy in the Parish. DAVID LOUDEN, Late Sanitary Inspector. MORHAM, HADDINGTON, 19th January 1892. PARISH OF PENCAITLAND. During the past year (1891), I have made regular monthly visits of inspection throughout the Parish, under the Public Health Acts. That, regarding the Mining Village of New Winton, I had to complain to Messrs Deans & Moore, coal- masters, regarding the laying down of Ashes and other Refuse on the edge of the Public Road; also of choked Drains in the Village, and, further, of the deficiency of the Water Supply there - all of which have since been attended to. The house accommodation of the labouring classes in the Parish is fairly good. In one case, in June last, an outbreak of Typhoid Fever occurred. This being a second outbreak within a few months in the same house, although with different occupants, led me to make a more that usually close inspection of the house and its surroundings. I at length discovered that the former occupants had kept pigeons which had lodged in the loft above them, and here I found a very considerable quantity of pigeon dung, which had lain probably for years, emitting dangerous and poisonous gases which I at once saw was cleared out. As soon as the patients could admit of it, the house was wholly and thoroughly washed out and fumigated, with the best results.
HH62/1/HADDIN/31 [Page] 30 There are no Common Lodging-Houses in the Parish. Saving the prevailing epidemic of Influenza and other bronchial complaints, there are at present no serious and certainly no Infectious Disease in the Parish. Burial-ground quite satisfactory. Twenty-three people keep 54 Cows in the Parish. These are in good health. The Milkhouses and Byres clean, and all well cared for. The two Bakehouses in the Parish are kept scrupul- ously clean, and nothing has been known or heard here of unwholesome food. Drainage generally satisfactory. No legal proceedings have been at all necessary. P. COSSAR, Sanitary Inspector. PENCAITLAND, 13th January 1892. PARISH OF BOLTON. In submitting my Annual Report of the Sanitary condition of this Parish, I have nothing of very special importance to bring before you for consideration. In my frequent casual visits to the several parts of the Parish, I have found everything in a fairly satisfactory Sanitary condition. The Ashpits, without exception, were in good condition; and Privies, as a rule, were clean and well kept, as also back and front premises. It is satisfactory to note that the order and cleanliness are largely due to the readiness with which Farmers will assist to remove accumulations of Refuse, Ashes, &c. At Little Plimore, in front of the house occupied by James Blair, is a Ditch on the roadside, which is sup- posed to empty itself, by crossing under the road, into the Blance Burn. The slope, however, is not sufficient, and the consequence is that the Ditch is very often full of stagnant liquid, from which at times proceed deleterious effluvia. I have not yet been able to ascertain whether or not this is a matter which the Road Trustees ought to remedy. [Page] 31 My general inspections of the Parish were made on March 21st and September 16th; while various casual visits to every part of the Parish have been made at irregular intervals throughout the year. The house accommodation of the Parish remains as in last Report. There is no such thing as over- crowding - in fact the population might be, with beneficial effect, considerably augmented. By last Census Returns, the population has decreased from 337 in 1881 to 271 in 1891, a total of 66; while by the last Census there were 62 inhabited and 15 uninhabited houses. There are no Common Lodging-houses. There are no Registered Dairies, Cowsheds, or Milkshops, although at least three Farmers ought to be registered inder Sec. 34 of the Contagious Diseases (Animals) Act, 1878. The Burial-ground in connection with the Parish Church remains as in Report of last year. The disposal of Household Refuse, contents of Ash- pits, Privies, Cesspools, &c., is undertaken by the various Landlords or their Tenants. No means exist in the Parish for the isolation of persons suffering from Infectious Diseases. EDWARD J. WILSON, Sanitary Inspector. 18th January 1892. EASTERN DISTRICT. I have to report that during the year 1891 the inspections made in the eight Parishes mentioned in this Report was 40, and 114 Nuisances dealt with, all of which were abated. The Water Supply has been carefully examined at the Villages of Oldhamstocks, Innerwick, Spott, Stenton, Whittinghame, Whitekirk, and Tynning- hame, and at each Village the Water was found to be good, and the Supply ample for the requirements of the people.
HH62/1/HADDIN/33 [Page] 32 The Churchyards in the Parishes are in a good Sanitary condition, except Innerwick, which requires to be levelled. The Sanitary state of Parishes has been good. No Common Lodging-houses are in the Parishes. The Dairies are in a good condition. The Household Refuse is taken away in carts or used in the gardens for manure. There is no means for isolation of persons affected with Infectious Disease in working-men's houses, except in such as have spare rooms. No cases of Infectious Disease have occurred during the year in any of the Parishes named, except one mild case of Scarlet Fever at Whittinghame. The Infectious Diseases Notification Act, 1889, has not been adopted in any of the Parishes. JOHN AMOS, Sanitary Inspector. DUNBAR, 5th February 1892. PARISH OF DUNBAR (Landward). The Parish consists mainly of Farms with the neces- sary buildings and Cottar Houses, and one Village Community, viz., Westbarns. The Farms are wide and scattered, and are generally drained to Cesspools, &c. Westbarns is partly drained into the Biel Burn. A Drainage System for Westbarns might be beneficial, but that would imply a Water System, and on a limited rental the Taxation necessary for such purposes would be out of all proportion to the benefits to be gained. Moreover, I am not aware of a single instance of Infectious Disease having been caused by the absence of these systems. There is an ample supply of Water generally at the Farms, and the Thristly Spring consti- tutes the Main Supply of Westbarns. The usual Quarterly Inspections of the Parish generally have been made, and also two Special Inspections in reference to Nuisances in connection with which complaints had been made. Generally, the whole Parish has been found in a fairly satisfactory condition. Proprietors and Tenants alike are ever [Page] 33 ready to attend to any defects to which their attention may be drawn. The House accommodation of the Labouring Class is of a modern character, with hardly an exception; indeed, superior to what is found under similar circum- stances in most parts of Scotland. There are no Common Lodging-houses within the Parish. The Dairies, Cowsheds, and Milkshops within the Parish have, during the year, been kept by their Owners in a clean and tidy condition, and no case of Disease has been traced to them. The only Burial-grounds within the Parish - viz., Dunbar Churchyard and New Cemetery - have been kept in an orderly and satisfactory manner, free from any offence under the Public Health Acts. At the Cottar Houses connected with the Farms, the Household Refuse, &c., is collected in Ashpits, and removed by the Farmers from time to time for Agricul- tural purposes, and in Westbarns and the Parish generally the same system holds good. The District Committee hold, for the use of this Parish, one-fourth share of a small Hospital situated within Dunbar Burgh. ROBT. MASTERTON, Sanitary Inspector. 30th January 1892.
HH62/1/HADDIN/35 Statement by Sanitary Inspectors of Proceedings under the Public Health Acts during the year ending 31st December 1891. WESTERN DISTRICT [Table inserted] EASTERN DISTRICT [Table inserted]