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INVERNESS-SHIRE COUNTY COUNCIL.
ANNUAL REPORT OF THE
MEDICAL OFFICER
FOR YEAR 1891
BY OGILVIE GRANT, M.B., D.P.H.,
MEDICAL OFFICER OF HEALTH.
Inverness:
R. CARRUTHERS & SONS, PRINTERS COURIER OFFICE.
1892 |
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[Front Elevation /Ground Plan/Scale inserted]
PLAN OF A SMALL COUNTRY HOSPITAL
W.L. Carruthers.
F.R.I.B.A.
Architect. |
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[drawing/picture inserted]
STONE BUILT COTTAGE WITH SEVEN ROOMS. |
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Inverness-shire County Council.
Annual Report of Medical Officer
FOR YEAR 1891.
INTRODUCTORY.
The largest county in Scotland, Inverness, possesses
also one other equally marked characteristic of its
own. Stretching right across the island from sea
to sea, embracing every variety of scenery, almost
every variety of climate to be found in the British
Isles, containing alike the highest mountain of Britain and its
most remarkable valley - the Great Glen of Albyn - through
which the ocean at one time rolled, cutting Scotland in two - it
is a unique combination of contrasts. Here is land of rare
fertility, there bleak moors whose wildness is unsurpassed. The
pine forests of Strathspey, the placid waters of many lakes, "the
spectral peaks of Skye," the busy streets of the Highland Capital,
the solitudes of Affaric, the crags of far St Kilda, all have their
place in the picture - all go to the making of the geographical
unit known as Inverness. And as with the land, so too with
the people. Norsemen of varied blood, Picts to whose fathers
Columba preached under the protection of Brude, Scots from the
west and south, and many a Saxon from the low country - all
these have their place in the population, sometimes still capable
of distinction, sometimes crossed and blended beyond all possi-
bility of recognition; and their dispositions, their circumstances,
and their callings are as diverse as their stock. What holds
of the fisher folk and farmers of the East Coast may be
utterly untrue of the crofters of the West. What is urgently
true of the mainland may have no bearing on the fifty
inhabited islands. Of all this your Medical Officer has
become only too well aware in the discharge of his official
duties during the past twelve months, and he adverts to it now
not so much with the object of drawing attention to the difficulties
he has had to face as with the view of emphasising the need for
caution in dealing with such a County. Each district has its own
special needs - if, indeed, each separate township might not profit-
ably be treated apart. There is no place for generalities or for a |
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[page] 6
priori reasoning. Each separate set of facts requires separate
investigation, and the results of one enquiry may not be assumed
in the presecution of another. In the present report few con-
clusions have been drawn; it is essentially a collection of statistics
which may be of use in the future.
GEOLOGICAL FEATURES OF THE COUNTY OF INVERNESS.
The relationship between geological formation and disease is
well known. The broad geological features of the County are
as follow:-
OUTER HEBRIDES.
Beginning with the Outer Hebrides, extending from Harris
to Barra Head, they are composed of crystalline gneiss and schist,
traversed by occasional dykes of basalt. In the valleys and low-
lying ground adjoining the sea, there is a thin covering of boulder
clay.
THE ISLAND OF SKYE.
This island is mainly composed of teriary volcanic rocks.
That portion of the island lying to the north of the Coolin Hills
and Loch-Sligachan is almost wholly covered by a great succession
of lava floors, in nearly horizontal sheets, resting on different
members of the secondary stratified rocks. Here and there round
the coast the latter sedimentary strata are exposed where the
overlying volcanic rocks have been worn away. These sedimentary
strata, including the lias, lower oolite, and Oxford clay, are exposed
in Loch-Bay, Uig Bay, at Duntulm, and along a large part of the
east coast, from Loch-Staffin to Loch Sligachan. Similar sedi-
mentary strata are met with between Broadford Bay and Loch-
Slapin. The Coolin Hills are composed of basic eruptive rocks,
while to the east of the Coolin Hills, between Loch-Sligachan and
Broadford, the mountains consist of granitoid rocks of acid
composition.
In the peninsula of Sleat there is a limited development of
the Torridon sandstone, and the overlying quartzites and lime-
stones which are the southern continuations of the ancient
sedimentary formations in the west of Sutherland and Ross.
Along the eastern portion of the peninsula the crystalline schists
are met with.
RAASAY AND RONA.
The Island of Rona and the northern part of Raasay south
to a point near Brochal Castle is composed of crystalline gneiss,
while the central portion of Raasay is occupied by stratified beds
(sandstone and flags) of the age of the Torridon sandstone. The
southern portion of the island presents a fine development of the
secondary stratified rocks ranging from the lias clay to the oolite
formation. There are small patches of the volcanic rocks of Skye
in the southern portion of the island.
[page] 7
EIGG.
This island is mainly composed of inter-bedded volcanic rocks
similar to those in the northern part of Skye, but round the
northern part of the coast the Oxford clay is met with.
RUM.
In the northern part of this island there is a fine development
of the Torridon sandstone, while the remainder is occupied by acid
and basic igneous rocks, similar to the rocks in the Coolin Hills
and south of Sligachan.
THE MAINLAND.
The mainland portion of the County is composed of different
types of crystalline gneiss and schist, on which rest unconformably
the respresentatives of the Old Red Sandstone. The latter are
sparingly developed: they form a continuous belt from Culloden
Moor to the Falls of Foyers, while to the west of Fort-Augustus
they occupy a narrow strip of ground along the east shore of
Loch-Oich. On the north-west side of the Great Glen they ex-
tend from Clachnaharry to near the mouth of Loch-Ness. They
reappear at the mouth of Glen-Urquhart and cap Mealfourvonie,
There is also an important development of the old Red con-
glomerates and sandstones in Beauly basin.
Excepting these areas, the remainder of the County is occu-
pied by crystalline gneiss and schist pierced by large masses of
intrustive igneous rocks. Of the latter, the most important areas
lie along the north-west shore of Loch Ness at Abriachan, and
again to the south of the Old Red Sandstone area between Farraline
and Foyers. In the valleys there is a considerable development
of glacial deposits, boulder clay, and moraines; while round the
shores of the Beauly Firth there are remains of the raised
beaches, consisting of stratified gravels, sand, and clay.
I have been enabled to give these geological notes through
the courtesy of Mr Horne, of the Geological Survey of Scotland.
AREA AND POPULATION.
AREA.
[table inserted]
These figures are according to Ordnance Survey. Alterations
have recently been made by the Boundary Commission, which
have increased the acreage of the County. |
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[page] 8
Inverness-shire is divided into 33 Parishes, some of which
are partly situated in other counties. It includes 92 Islands
above 50 acres in extent - from Skye with 411,703 acres, to Soay
Beg with 52 acres.
POPULATION - CENSUS 1891.
[table inserted]
In the last decade there was a decrease of 2089. This
decrease was most marked in the purely agricultural parishes.
DENSITY OF POPULATION.
[table inserted]
In Table I. number of acres to each person in the different
parishes is given. Average in each district is as follows:-
[table inserted]
BIRTHS AND BIRTH RATES.
In Table II. births and birthrates are given. It will be
seen from this table that the districts having the highest birth-
rates are Harris and South Uist, while those having the lowest
are the 1st or Inverness District and the 2nd or Aird District.
The birthrate has been high in the poor and insanitary districts,
and low in more prosperous districts of the mainland.
INFANT MORTALITY.
A high infant mortality is almost always associated with
insanitary surroundings. Before accurate conclusions can be
drawn it will be necessary to have statistics of several years, as
mortality may be raised any one year from accidental causes. In
[page] 9
Table IV. number of deaths under one year. per 1000 births, is
given. In 28 of the large manufacturing towns of England the
average deaths of infants under one year, per 1000 births, was
161 in year 1889, and 171 in year 1890. In the insanitary
districts of Harris and Kilmuir, in Skye, the average deaths of
infants under one year, per 1000 births, were -
[table inserted]
The prevalence of zymotic disease in these districts largely
contributed to this high infantile mortality.
UNCERTIFIED DEATHS.
Before referring to the deaths from zymotic and other diseases
which are give in Tables VI. and VII., I must refer to a
circumstance that makes the inferences drawn from these tables
misleading, namely, the number of deaths registered that are not
certified by medical men. The cause of death given in many
such cases can only be a mere supposition. 47.1 per cent. of
deaths registered in the County generally were uncertified. In
Skye 65 per cent., and in South Uist and Barra 73 per cent.,
were uncertified. Table V. gives further details on this subject.
ZYMOTIC DEATH RATE.
TABLES VI. and VII.
The zymotic death rate of the mainland districts was low, and
may be considered satisfactory. In 2st, 2nd, and 3rd Districts it
was almost the same. In the island districts it was considerably
higher. In Skye it was 2.45 per 1000, and in Harris 3.11 per
1000, exceeding the zymotic death rate of England and Wales for
1890, which was 2.05
Diphtheria caused five deaths in Skye, and three in rest of
County.
Scarlet Fever - The mortality from this disease was very low;
only three deaths were due to it.
Typhus Fever was present in a severe form in Skye, where
it caused one death.
Enteric Fever caused two deaths in Skye and one in Harris.
Measles - Of the 36 fatal cases of measles, Skye contributed
20, Harris 14, and North Uist 2.
Whooping Cough caused 42 deaths; of these only one
occurred in the mainland.
Diarrhoea - Very few deaths appear to have been produced
by this disease. Epidemic diarrhoea, which is so fatal among
young children in England, does not seem to have existed. Dr
Ballard, who writes with authority, states "that the essential
causes of diarrhoea resides ordinarily in the superficial layers of the |
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[page] 10
earth, where it is intimately associated with the life process of
some micro-organism not yet captured or isolated;" evidently this
micro-organism does not thrive in the Highlands. Perhaps also
the nature of the food of the people, and the fact that little or no
fruit is grown in the greater part of the County, may account for
the absence of summer diarrhoea.
Cancer is generally distributed throughout the County.
The highest death rate from this disease, .57, is found in Skye.
The average death rate in England from cancer is .54.
Phthisis - 61 deaths were registered from phthisis or con-
sumption. Of these, 27 occured in the Mainland and 34 in the
Islands. The highest death rates from this disease were in the
South Uist and Barra and Skye Districts. 1.708 in the former
and 1.175 in the latter. The lowest death rate was in the 2nd
or Aird District, .433 per 1000. As one of the causes of phthisis
is foul air, caused by overcrowding and other insanitary condi-
tions, the greater prevalence of this disease in the West Coast is
easily accounted for. I consider that the climatic conditions of
the Western Islands are infavourable to the production of this
disease, and that the deaths are due to insanitary conditions.
COMPULSORY NOTIFICATION OF INFECTIOUS DISEASES ACT.
The Infectious Disease (Notification) Act has been adopted
in all the Districts of the County, with the single exception of
the Lochaber District. I have repeatedly urged the District
Committee of Lochaber to adopt this Act, so that the whole
County might be under its operations, and the danger of the
spread of infectious diseases lessened. They have not, however,
done so, nor have they appointed a District Medical Officer,
differing in this respect also from the rest of the County. I
append maps showing approximately the situation of various
outbreaks of fever.
Typhus Fever was notified from Skye and Benbecula. Dr
Dewar states that the disease, which was present in the Parishes
of Duirinish, Strath, and Kilmuir, originated from overcrowding
and insanitary condition of the houses. In Benbecula it broke
out in an insanitary house in a swamp. I visited the house
during the presence of the fever. It was confined to the one
house, and did not cause any deaths.
Diphtheria - Cases were notified from 1st, 2nd, and Skye
Districts. In Strath, Skye, it was supposed to have originated
from the insanitary surroundings and polluted water. A serious
outbreak, resulting in two deaths, took place in a dairy farm in
the neighbourhood of Inverness. The dairy was closed, the
premises were disinfected, and the disease stamped out.
Scarlet fever - The great majority of cases of scarlet fever
occurred in the immediate neighbourhood of Inverness, where is
has been epidemic for some time.
TYOHOID X
DIPTHERIA #
ERYSIPELAS Ø |
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[map inserted]
NOTIFICATIONS
UNDER
COMPULSORY NOTIFICATION ACT
ACT NOT IN OPERATION O |
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[map inserted] |
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[page] 11
Typhoid Fever - Cases have been notified from 1st, 2nd, 3rd,
and Skye Districts. I had to investigate two serious outbreaks
of this disease in the 3rd or Badenoch District. The epedemic at
Moor of Feshie was associated with insanitary houses, one of
which was unfit for human habitation. In this case I understand
a new house is to be erected by the proprietor. The other out-
break was at Moy Post office. Strathdearn. This epidemic was
associated with a polluted water supply. Measures have been
taken to remedy this state of matters.
The Badenoch District Committee have added mealsles and
whooping cough to the diseases to be notified under the Act.
MEASLES EPIDEMIC.
An epidemic of a very severe and malignant type of measles
took place in the districts of Harris, North Uist, and Skye.
In the district of North Harris, measles broke out in the month of June
(first death on 19th June). It rapidly spread over the whole
district, and caused many deaths. Dr Stewart, Tarbert, gives the
approximate number of persons affected for eight weeks ending
20th July at 236 cases. Dr Mackenzie, North Uist, writing on
24th July, states that measles was present in eight townships.
Infection was traced by Dr Mackenzie to two sources -
I. The disbanding of Inverness-shire Militia.
II. Direct infection from the adjoining parish of Harris
Dr Dewar, Portree, states that measles cases were imported into
Parishes of Kilmuir and Portree by young men who had con-
tracted the disease at Tyndrum, Argyllshire. He also states -
"One of the crew of s.s. 'Lochiel' was infected from another
source, namely, from a Militiaman returning home from Muir of
Ord Camp, and who was travelling in the eruptive stage of the
disease." From above quoted report it is observed that the Camp
Muir of Ord, is stated to have been a cause of the spread of the
disease. This camp is situated in Ross-shire. I therefore com-
municated with the Medical Officer of that County, and learned
from him how energetic he and the other authorities had been. I
also wrote the General Manager of the Highland Railway, and
pointed out the penalties attached to any contravention of sections
48 and 49 of Public Health Act, which refer to persons suffering
from infectious disease. I also communicated with Colonel Mac-
donell, who informed me that no one would leave the camp who
had not been medically discharged and was perfectly safe. The
first five cases were admitted to hospital on 15th June, the first
day after entering camp. Surgeon-Major Macfadyen is satisfied
that the infection came from Harris. He treated 135 cases of
measles in camp.
Whooping Cough - An epidemic of whooping cough spread
over Skye and the Long Island. This disease appears to have
been absent from the mainland. |
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[page] 12
INFECTIOUS DISEASE IN LOCHABER DISTRICT.
Owing to the non-adoption of the Infectious Disease Notifica-
tion Act in this district, it is impossible to speak with accuracy
in respect of Lochaber. From information received from parish
medical men, I find that scarlet fever was present in Parish of
Kilmallie, that there was a fatal outbreak of typhoid fever at
Arisaig, that measles was present in Parish of Kilmonivaig, and
that there was an outbreak of gastric fever at Spean Bridge.
INFLUENZA EPIDEMIC.
The influenza epidemic was severely felt in nearly every part
of the County, and materially increased the death-rate for the
year. The number of deaths certified as having occurred from
this disease by no means gives a correct indication of the extent
of the epidemic. Chest and other complications carried off many
aged and weakly people. In the early part of the year this
disease was present in Harris and Uist, where it was followed by
epidemics of measles and whooping cough. In the month
of November it appeared in a very virulent form almost
simultaneously in all parts of the mainland of the County.
At that time it was raging in the East Coast, in the neighbourhood
of Inverness, and in the West Coast, in Glenelg, where very few
persons escaped it. In Kingussie District it appeared about the
5th December. Dr de Watteville states it caused a considerable
increase in the death-rate (7 deaths in 7 days for a population of
2000), chiefly among the aged, being, in the fatal cases, accom-
panied or followed by pneumonia. Dr Winchester, Fort-Augustus,
writes - "I would say that, roughly speaking, at least one-third
of the population suffered from the disease more or less severely."
The symptoms varied much; the attack usually began with
shivering, general constitutional disturbance, and high temperature.
There was seldom much cough. Headache was usually present;
sometimes it was agonizing. Pain in the back was often com-
plained of. This epidemic appears to have differed in many
respects from former epidemics. There appears to have been a
greater tendency to gastro-intestinal catarrh. Diarrhoea and
vomiting were very troublesome in some cases. Some observers
noted that children were more affected than in former epidemics.
One careful observer states that he considers influenza closely
allied to rheumatism and malaria. I am still engaged in investi-
gating this important subject, and hope to return to it in my next
annual report.
HOSPITALS.
In a former report I pointed out the necessity for the pro-
vision of hospital accommodation for the treatment of infectious
diseases. Several of the District Committees have now moved in
this matter. The 1st and 2nd District Committees have appointed
sub-committees to confer with the Local Authority of Burgh of In-
[page] 13
verness, as to the advisability of erecting a joint fever hospital. The
South Uist and Barra District Committee have had the question
under their notice, and have made temporary arrangements. The
Badenoch District Committee have not as yet made any arrange-
ments. The Lochaber District Committee have no hospital, but
they have the right to send fever patients to the Belford Hospital,
Fort-William. There is no fever hospital in Skye District. The
Medical Officer of this district draws attention to the necessity
of providing small cottage hospitals for the treatment of infectious
disease, and ambulance waggons for conveying patients to such
hospitals. This, he states, is urgently required on account of the
limited accommodation of the dwelling-houses. Dr Mackenzie,
North Uist, recommends that the district should provide itself
with a moveable hospital, to which infectious cases might be re-
moved. In Harris there is no hospital of any description. I
would suggest that several small hospitals be erected in the
Long Island, and that each hospital be under the charge of a
trained nurse, whose services would be available for any case of
sickness in the district when not required at the hospital. I con-
sider that a trained nurse constantly going among the people
could do very much towards teaching the advantage that would
accrue by attending to the ordinary rules of sanitation. Attached to
each hospital there should be a covered wheeled litter, with stretcher,
for the removal of patients. I consider such a vehicle more suitable
for the circumstances of the district than a horse ambulance. It
could be taken to those townships which have no roads leading to
them, and could be placed in a boat when it was necessary to re-
move a patient by sea. Dr Mackenzie's suggestion as to a moveable
hospital deserves consideration. There are, however, difficulties
in giving effect to it. I fear such an hospital would not be very
comfortable; there would be difficulties in the way of transport,
difficulties in the way of getting skilled labour to erect it, and on
each occasion when it was moved I fear there would be disputes
about the new site. Through the kindness of Mr Carruthers, I have
been enabled to exhibit the accompanying sketch plan of a small
hospital, which gives a good indication of the class of building
which I should like to see adopted for the treatment of infectious
diseases in districts where there is no hospital accommodation.
From a glance at the plan it will be seen that the building con-
sists of two wards, separated by the nurse's apartment and the
kitchen. In connection with each ward, but separated by a
passage ventilated from end to end, is a bathroom, w.c., and a
chamber for disinfecting clothing. Separate entrances at each
end of building give access for patients to the wards. A very
thorough cross ventilation is secured by having the windows
placed opposite each other. The beds are placed round the room,
heads to the wall, and separated from each other by a considerable
space, so that the attendant may have free access to both sides
and end. Two attic bedrooms are provided over kitchen and
nurse's room. In the nurse's room there is provided a closet for |
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[page] 14
medicines. The heading is by small steam pipes from kitchen
range fire. It is estimated that the average cost of a building of
this description would be about £500, but of course this would
depend a good deal on the locality in which it is built.
INSANITARY HOUSES.
In a former report I drew attention to the wretched state of
many of the houses in the Western Islands, especially referring to
those dwellings where human beings and animals of all descrip-
tions are huddled together under the same roof. Dr Dewar,
Portree, describes a typical insanitary house in Skye as follows:-
"The house is divided into three apartments, with one entrance.
The first apartment is used for housing the cattle, the manure and
house refuse being allowed to accumulate here for months, and in
some cases until required for agricultural purposes. The second
apartment, used as kitchen, is divided from the first by a rudely
constructed partition a few feet high. The fire is on the middle
of the floor, and a small hole in the roof serves to let out the
smoke. As a rule there is no window, but a small pane of glass
is fixed in one corner, where the roof joins the wall. Beyond the
kitchen is the third apartment, used as a bedroom, with two or
more beds, according to the number of inmates. This apartment
is also used as the storeroom." Dr Stewart, Tarbert, thus
describes a similar house in Harris:- "The house is divided into
three compartments, with only one door of entrance. The first
compartment is used for housing the cattle, and the manure and
liquid filth are allowed to accumulate for twelve months before
the place is cleaned out. Immediately adjoining is the second
compartment or kitchen, usually divided by a rudely constructed
wooden partition from the cattle - in some instances there is no
partition at all; the third or innermost compartment is the bed-
room, containing two, four, or five beds. In this bedroom every
member of the family sleeps, irrespective of age or sex, and it is
often used for storing potatoes, straw, corn, and all sorts of
rubbish. The houses are seldom or never cleaned." As the great
majority of the people of the Long Island live in houses similar to
those above described, a remedy is urgently needed. If this stat
of matters existed in some remote colony, probably attention
would have been given to it long ago, but as it exists almost at
our very doors, nothing whatever has been done to assist these
poor islanders, and from a variety of causes they themselves have
been able to do little. The geological formation of the islands
does not include limestone, so to build stone and lime houses
means the importation of lime. The islands being destitute
of trees, the only wood to be obtained is from stray logs cast
up by the sea; and above all, we have to deal with an
essentially poor people, who yet, owing to their remoteness
from markets, have had to pay high prices for the most
ordinary necessaries of life. It is proposed to spend a considerable
[page 15]
[drawing/picture inserted]
STONE BUILT THREE-ROOMED COTTAGE.
[drawing/picture inserted]
IN NORTH UIST. |
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[page] 16
sum of money (on the mainland) for the development of the
islands. Railway companies and steamboat proprietors are to be
sibsidized, and the result, no doubt, will be beneficial to the
islands; but surely something also might be done for their internal
development. Money spent in making roads, which are greatly
needed, in building piers, which would be of immense advantage,
and in improving the dwellings of the people, would certainly
improve the health of the people, and make them more prosperous
and more likely to take advantage of the proposed new railways.
The great majority of the men belong to one or other branches
of the Reserve, being either Naval Reserve men or Militia men,
thus showing their willingness to assist in the defence of the
country, and on this account they have a claim on the Govern-
ment to take some interest in their welfare, and to help
to enable them to live in houses fit for human habitation.
Although, owing to heavy rates and other charges, the islanders
do not reap so much benefit from the fisheries as they might be
expected to do, still, as large exporters of food supply, they are
important factors in the economy of the country. The list of
deaths from drowning in the Appendix speaks eloquently on the
danger of their calling. Since the benefits of the Crofter Act have
been obtained, and fixity of tenure secured, much has been done
by the people themselves to improve their dwellings. In the
Island of Barra a skilled mason, I understand, is now constantly
employed in erecting houses of an improved type. I would
suggest that the crofters be assisted by the Government in their
laudable endeavours to improve their dwellings; that on certain
conditions grants be given to them for this purpose; and that they
be supplied with wood and lime on easy terms. If this were done,
I am sure that in a few years very few of the wretched huts,
which are a blot to our boasted civilization, would remain. I give
some sketches showing the class of houses found in the Western
Islands. They are from photographs which I took during my
inspection of the district. I show, also, sketches of houses recently
erected by a member of County Council for his labourers; the
contrast is striking and speaks for itself.
DISTRICT REPORTS.
1ST DISTRICT.
The sanitary condition of this district is, generally speaking,
satisfactory. The District Committee have given much attention
to sanitary matters. They have appointed sub-committees, who
have visited all parts of the district along with the sanitary staff.
Regulations have been issued for the treatment of infectious dis-
eases and for the supervision of common lodging-houses. A sub-com-
mittee has visited all the dairies in the district, and regulations
are to be drawn up on this subject. The state of the villages of
Campbelltown and Culcabock has been investigated, and remedial
[drawing/picture inserted]
FIVE ROOMED STONE BUILT COTTAGE
[drawing/picture inserted]
IN NORTH UIST |
| HH62/1/INVERN/19 |
[page] 18
measures are under consideration. The question of hospital
accommodation for the treatment of infectious disease is engaging
the attention of a special sub-committee. Supplies of disinfectants
for the use of the district have been placed under the charge of
the District Sanitary Inspector, to be used by him and his assistants
as occasion requires. The state of the houses of farm servants
and labourers in this district is being investigated by the sanitary
staff. The death rate is extremely low.
2nd DISTRICT.
Sanitary condition satisfactory. Very few cases of infectious
disease have occurred in this district. Death rate is much below
average death rate of country. The question of hospital accom-
modation is also engaging the attention of this committee, a sub-
committee having the matter under consideration. Disinfectants
have been provided for the use of the district. Sub-committees
have been appointed, and along with sanitary staff have in-
vestigated questions relating to water supply and drainage. The
Beauly Committee have given much attention to the sanitation of
that neighbourhood. They have endeavoured to improve the
supply of water, and to keep the village in a sanitary condition.
A proposal was made to bring, at village of Milton, Glen-Urquhart,
a new supply of water, but the inhabitants of the village being
consulted, they expressed a wish that matters in the meantime be
left as at present.
3RD DISTRICT.
Sanitary condition satisfactory. Several special enquiries
were made and reports furnished to District Committee by District
Medical Officer - as reports on outbreak of typhoid fever at Muir
of Feshie, on alleged pollution of River Nethy, on alleged pollution
of well at Abernethy Public School, on alleged pollution of
water supply of school at Laggan, and on outbreak of typhoid
fever at Moy. The District Committee have taken no steps to
provide accommodation for the treatment of infectious diseases,
but they have obtained supply of disinfectants for use of district.
They have approved of rules for the regulation of dairies and of
common lodging houses.
4TH DISTRICT.
This district differs from all the other districts in the County
of Inverness. The District Committee have not appointed a District
Medical Officer, and they have not adopted the Infectious Disease
Notification Act. I have, therefore, been able to obtain
accurate information as to the state of the district I have visited
some of the most insanitary portions of it, and have observed
more insanitary surroundings than I have seen in any other part
of the mainland. I have endeavoured to obtain as much informa-
tion as possible from the parish medical officers and the registrars,
[page 19]
[drawing/picture inserted]
IN LOCHABER.
[drawing/picture inserted]
INDUSTRIOUS HARRIS. |
| HH62/1/INVERN/21 |
[page] 20
but as my information is far from complete I cannot report with
any certainty on the condition of this district. Dr Millar, Fort-
William, writing on the state of the Parish of Kilmallie, says that
in the spring of the year there was an epidemic of enteritis, due,
he thinks, to some atmospheric influence. Towards the end of
November he states, "an outbreak of influenza occurred at Kin-
lochiel. This affected practically the whole of the inhabitants in
the township, and it was found necessary to close the school for a
period of several weeks. One death, in a delicate subject, resulted
from influenza. There seemed good reason for supposing that the
disease was directly imported from Fifeshire. The infection did
not appear to spread from the centre of Kinlocheil, notwithstand-
ing the mail and trading connection with Corpach and Fort-
William." Measles and scarlet fever were also present in this
parish. Dr Nicoll, Arisaig, writes that "during the months of
February, March, and April influenza was very prevalent through
the district;" he also reports on a fatal outbreak of typhoid fever
at Meoble. Dr Winchester, writing on the state of Glengarry,
says - "The sanitary condition of the district is very good, and
the spirit of emulation kept up among the cottagers by the inspec-
tion and awarding of prizes to tenants of the most tidy and best
kept houses and gardens, has, in my opinion, a great deal to do
with this happy state of affairs."
SKYE DISTRICT.
Dr Dewar, Chief Medical Officer for Skye District, reports as
follows:- "Having visited the different localities in the district,
I beg to report that the sanitary state of these is very unsatisfac-
tory. The ordinary laws of sanitation have hitherto been totally
neglected, as shown by the wretched state of the dwelling-houses
occupied by the crofting population. There is no attempt at
drainage. The manure and house refuse, when removed, are
heaped within a few yards of the dwelling-house.... The
state of the water supply is very unsatisfactory, the water being
taken from shallow wells in close proximity to the dwelling-house,
where it is liable to be polluted with sewerage from the dunghill
and liquid filth percolating from manured fields." The result of
these insanitary conditions described by Dr Dewar is seen both
in the number of deaths from infectious diseases and from the
variety of these diseases. In this district there were fatal cases
of diphtheria, typhus fever, typhoid fever, scarlet fever, measles,
whooping cough, and also from other undefined fevers.
NORTH UIST DISTRICT.
The sanitary condition of this district compares favourably
with the adjoining districts of Harris and South Uist. Dr
Mackenzie writes - "The sanitary state of the district is fairly
satisfactory within the last year. Many houses have been built,
rebuilt, or otherwise repaired and made more comfortable, and
[page] 21
the advice and instruction given as to the keeping of cattle in the
dwelling-houses and allowing manure heaps to accumulate about
the doors are bearing good fruit." Referring to the water supply
he states - "The water supply generally has always been and is
very inferior. The sources of supply are shallow wells, surface
water, and lake water, which are all more or less contaminated
with organic and other objectionable matter, and in summer some
of these resources run dry. Much might be done to remedy this
state of things by filtration, and, in the case of some of the town-
ships, by the introduction of a water supply from the adjacent
lakes." I, in a former report, described the dreadfully insanitary
condition of the township of Hougharry, where the water supply
is frightfully contaminated. Dr Mackenzie says - "This water is
the common supply of cattle and human beings, and is frightfully
contaminated with organic matter, a fruitful source of the enteric
fever from which the township is scarcely ever free."
SOUTH UIST AND BARRA.
Within the last year there has been a distinct improvement
on many of the crofters' houses. This is especially observable in
the Island of Barra, where now better houses are to be seen than
in any part of the Long Island. In South Uist there are still many
insanitary houses, but there is a tendency on the part of the
crofters to build separate byres for their cattle. The township of
Howmore is in a most insanitary condition; there the houses are
all huddled together, and are not placed on the crofts. If arrange-
ments could be made whereby each crofter would build on his
own croft, this state of matters would be remedied. The district
has at present no hospital, but I understand arrangements are
being made, the result of which will be that there will soon be a
fully equipped hospital in this district. This will be an immense
boon to the inhabitants of the district. It is interesting to note
that in Barra there were no deaths from infectious diseases, and
that although measles were so fatal in the northern part of the
Long Island there were no fatal cases in the districts of South
Uist and Barra.
HARRIS DISTRICT.
In a report, dated 30th April 1891, I drew attention to the
disgraceful condition of the graveyard at Luskintyre. I described
the shocking state of matters I saw on my visit to it on the 13th
April. My report has been of no avail, nothing has been done.
Dr Stewart, Tarbert, Harris, Medical Officer of North Harris,
writing on date of 11th of this month, says - "From recent
information, which is thoroughly reliable, I believe that the con-
dition of this burial place is, if possible, much worse than it was
on the 26th of January 1889, the date on which I made a careful
inspection, and gave a detailed report to the then sanitary
authority. The result of this report was a sworn enquiry, held
by Sheriff Webster at Tarbert, on the 7th of May 1889, for the |
| HH62/1/INVERN/23 |
[page] 22
purpose of having the graveyard closed. The decision to close was
advertised for three months by public notices, to give parties
interested an opportunity of lodging objections. Every step in
the procedure was taken, up to selecting ground for a new
graveyard by the sanitary authority. Beyond this I am not
aware any further steps were ever taken. You will excuse
me if I quote a few sentences from my report of 26th January
1889, but the present state of the burial ground must be
much worse than it was then, on account of the exception-
ally heavy mortality of 1891, and consequently of a larger
number of interments. 'The general aspect of the grave-
yard shows that it is actually teeming with bodies - the graves
not only being packed closely together over the whole area, but
the surface of the graveyard being greatly elevated over the level
of the outside ground. This elevation is progressive, and appears
to be caused, first, by interments taking place so frequently in
unripe graves that one coffin is placed above another without a
sufficient interval elapsing between interments to allow of decay;
and second, by the fact that not a single burial at present takes
place without sods being cut and carried from the ground outside
the grave-yard to cover the mound, to which Mr Brydone, factor
for South Harris, informed me he was frequently an eye-witness.
On the date of my inspection, twelve graves were gauged in the
presence of Mr Brydone, the Sanitary Inspector, and myself, and
the graves were so chosen in different parts of the grave-yard as
to give a fair idea of how burials are generally conducted there.
" 'I subjoin the following table, which was embodied in my
report:-
[table inserted]
" 'The superficiality of the graves as shown by the foregoing table,
as well as the manner in which coffins are so closely packed
together, are contrary to all civilised and modern ideas of decency.
It is not only offensive, but absolutely and without doubt injurious
to and dangerous to Public Health.' As I mentioned above,
[drawing/picture inserted]
IN NORTH UIST.
[drawing/picture inserted]
IN SKYE. |
| HH62/1/INVERN/25 |
[page] 24
matters are even worse now, I believe, than in 1889 - besides
being a nuisance under Section 16 of Public Health Act. For the
sake of decency this scandal ought to be dealt with, and a new
burial ground opened with as little delay as possible. Other
burial grounds in the parish are also overcrowded, particularly
the church-yard at Scarrista, and the Cathedral burial ground at
Rodel. I would suggest that two new burial grounds should be
provided when Luskentyre is closed - one, say, at Shillibost or
Nisibost, on the Borve side of the Luskentyre Sands, and another
in the neighbourhood of Tarbert for North Harris."
I was much struck with the very great hardships that the
people who live in the townships along the east coast of Harris
are subjected to owing to the want of roads, and I asked Dr
Stewart, who is only too well aware of the difficulties and dangers,
to state his views. He writes of the townships on the east coast
of the South Harris estate from Tarbert to Rodel. "Some of these
townships are five and six miles distant from the main road,
and the people undergo great hardships and injury to health,
particularly in winter, in having to walk that distance over
wet and boggy moors. I am confident that this is a chief
cause of the many chest affections from which the people suffer,
and especially colds and more serious diseases from which school
children suffer. Apart from the injustice of assessing the crofters
of these townships for road rates, they suffer far more through
sickness. As an instance of the beneficial effect of roads on
public health, I would draw attention to the Island of Scalpay.
I know from personal experience that some years ago this town-
ship was the most unhealthy in the whole parish, whereas from
the date of which roads were opened through the Island there
has not been one-third the amount of sickness (though this town-
ship is the most congested one in Harris), for now they can walk
to their homes from one end of the Island to another dry-shod."
The mortality in the registration district of North Harris has
been three times heavier that the average of the last fourteen
years. Dr Stewart states that the District Committee have
taken no steps to improve the sanitation of the townships.
He says this is a matter that must be faced at an early date.
"Many of the townships use water for culinary purposes which,
without doubt, is greatly contaminated. The houses and their
surroundings are in a most insanitary condition, but the first and
the foremost step for the District Committee to take is to compel
the people to provide byres for their cattle, instead of having them
sheltered as at present in their dwelling-houses." I consider that
from a public health point of view the Harris District is the
most important in the county. The state of matters found
in the Bays of South Harris must be remedied. I have on
several occasions during last year visited the district and
made careful enquiries, and as a result of information received
I am satisfied that the District Committee cannot solve the
difficulties unless they receive external aid. The people are
[page] 25
extremely industrious; they try to eke out a scanty subsistence
by weaving Harris tweeds; but now, as many so called Harris
tweeds are made outside Harris, prices have fallen, and this
industry is languishing. I would desire most strongly to draw the
attention of the County Council to the very serious state of matters
existing in South Harris.
The remote island of St Kilda is an interesting portion
of this district. Population according to 1891 census was
71 - 32 males and 39 females. This is exactly the same as
it was in year 1871. The most striking feature of the death
returns of this island is the great mortality among infants.
From year 1882 to 1891 inclusive there were 28 deaths; of these
15 were of infants under 15 days of age, and of these 15, 12 were
due to lockjaw.
TECHNCAL EDUCATION.
I may be permitted to refer to this subject, although, per-
haps, it will be thought to be outside my province. Still, when
it is considered how intimately health and prosperity are associ-
ated one with the other, it may not be considered out of place for
your Officer of Health to refer to a matter which, if judiciously
carried out, will greatly increase the prosperity of the County. I
observe that it is proposed to distribute the money set apart for
this purpose among school teachers and school children. While
there are undoubtedly within the county many teachers capable
of giving able lectures on the most difficult technical subjects, I
question much if the benefit to be derived by children from such
courses of instruction will be either great or lasting. I venture
to suggest that much greater benefit would accrue to this
County if the County Council, instead of handing the money
over to School Boards, would appoint special teachers who would
devote their whole time to these special subjects, and give,
say, six weeks' courses of instruction in the various centres of the
County, not only to school children, but also to all members of the
community who might desire to benefit by this instruction.
Dyspepsia is one of the most common ailments in the Highlands.
The cause of its prevalence is well known. Bad cooking and
errors of diet are the great factors in the production of this
disease. It causes much misery and unhappiness, making
the unfortunate victims a terror to themselves and to all
about them. If a teacher of cookery was appointed by the
County Council to give practical instruction on this subject,
I consider that the result would be most beneficial to the com-
munity. If funds permitted, another teacher might be ap-
pointed to teach dairy and laundry work. I find that it is
stated in census returns for 1881 that there were at that time
in the County of Inverness 2470 female domestic servants, and
1605 female farm servants. To such the instruction I suggest
would be of much benefit, and through them to the rest of com- |
| HH62/1/INVERN/26 |
[page] 26
munity. Still another teacher might be appointed with advantage
to give instruction in weaving, dyeing, and carving.
Hygiene can best be taught by example, and School Boards
can greatly assist in this method of instruction by keeping the
schools under their charge in a cleanly and sanitary condition. I
have visited schools in all parts of the County: some were
extremely well kept, others were not so. Other public bodies can
assist in this method of instruction. Parochial Boards, by taking
care to see that their aged paupers live in houses fit for human
habitation, can show a good example to the crofters. Railway
and steamboat companies might, with much advantage to the
travelling public, supply better conveniences for their use, and
keep the same in better order.
During my inspection of the County I have received much
information and most valuable assistance from all classes of the
community, and more especially from my professional brethren,
who have most willingly assisted me in many ways. To these
and to all others I take this opportunity of expressing my sincere
thanks.
OGILVIE GRANT, M.B., D.P.H.,
Medical Officer of Health, County of Inverness.
31st March 1892. |
| HH62/1/INVERN/26A |
NOTIFICATIONS
UNDER
COMPULSORY NOTIFICATION ACT.
[map inserted] |
| HH62/1/INVERN/27 |
[page] 27
TABLE I.
DENSITY OF POPULATION.
[table inserted]
These figures are only approximately correct, as in some of the parishes
the boundaries have recently been changed, and I have been unable to obtain
the new acreage. |
| HH62/1/INVERN/29 |
[page] 28
TABLE II.
BIRTHS AND BIRTH RATES.
[table inserted]
TABLE V,
UNCERTIFIED DEATHS.
[table inserted]
[page] 29
TABLE III.
DEATH AND DEATH RATES.
[table inserted] |
| HH62/1/INVERN/31 |
[page] 30
TABLE IV.
INFANTILE MORTALITY.
[table inserted]
[page] 31
TABLE VI.
BIRTHS AND DEATHS.
[table inserted] |
| HH62/1/INVERN/33 |
[page] 32
TABLE VII.
DENSITY OF POPULATION, BIRTH RATE, INFANTILE AND OTHER DEATH RATES.
[table inserted]
[page] 40
TABLE XIII.
MONTHLY AMOUNTS OF THE RAINFALL IN INVERNESS-SHIRE IN INCHES IN 1891.
[table inserted]
(Signed) ALEXANDER BUCHAN, Scottish Meteorological Society. |
| HH62/1/INVERN/35 |
[page] 38
TABLE XI.
LONGEVITY. - Showing Average Age of those who died during year.
[table inserted]
[page] 39
TABLE XII.
MEAN TEMPERATURES IN INVERNESS-SHIRE IN 1891.
[table inserted]
NOTE - From information received from Dr. Buchan, Secretary, Scottish Meteorological Society. |
| HH62/1/INVERN/37 |
[page] 36
TABLE IX. - Continued.
DEATHS REGISTERED FROM ALL CAUSES DURING THE YEAR 1891.
[table inserted]
[page] 37
TABLE X.
DEATHS DURING EACH MONTH OF YEAR.
[table inserted] |
| HH62/1/INVERN/39 |
[page] 34
TABLE IX.
DEATHS REGISTERED FROM ALL CAUSES DURING THE YEAR 1891.
[table inserted]
[page] 35
TABLE IX. - Continued.
DEATHS REGISTERED FROM ALL CAUSES DURING THE YEAR 1891.
[table inserted] |
| HH62/1/INVERN/40 |
[page] 33
TABLE VIII.
NOTIFICATIONS UNDER COMPULSORY NOTIFICATION ACT.
[table inserted]
TYPHUS FEVER •
TYPHOID FEVER X
ERYSIPELAS Ø
PUERPERAL FEVER * |
| HH62/1/INVERN/41 |
NOTIFICATIONS
UNDER
COMPULSORY NOTIFICATION ACT
[map inserted] |
|
|
