HH62/1/KIRKCU/29

Transcription

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actual work of washing and disinfecting. But since the Ringbane out-
break there has been no scarlet fever or any other infectious disease
except whooping-cough in the district. And whooping-cough, which
has over-run the upper part of the district, exceeded at an early stage
any effort at prevention. The cases reported have been nearly 100,
but this does not more than indicate the prevalence of the epidemic.
Fortunately the type has been mild, and the deaths recorded are only
six. Of these three are returned as 'whooping-cough and over-crowd-
ing.' On investigation I found that the over-crowding was due, not to
defective house room, but to a mistaken anxiety to have all the sick
children in one room. This, with the addition of one or more adults,
undoubtedly amounted to over-crowding, and became an active cause of
death. It has been found hopelessly impossible to follow up all the
cases reported, much less those unreported. In the course of this year
I propose to use all the means available to forestall any such epidemic
in the district, in which such extensive epidemics are happily rare.
The treatment of whooping-cough, however, is so various, the chances
of its spread are so enormous, the fatalistic ideas regarding its necessity
are so deep-rooted, that only by a process of slow and gradual educa-
tion, guided by facts such as the present, is there any hope of its
ultimate extinction. I have already advised the District Committee to
arrange with the various School Boards against the return to school of
children that are uncertified.

VII. - CAUSES, ORIGIN, AND DISTRIBUTION
OF DISEASE.
The vital statistics of the past year are too imperfect and too
limited in range to justify a discussion here of cause, origin, or distri-
bution. The present year's facts will better fall in with the general
comparative view of the County Report, into which also I hope to gather
up in digest the important facts in the recent history of the district.
In general the district is healthy. The death rate is 17·2 per 1000;
but it is well understood that where numbers are small very slight
variations on the absolute numbers make large variations in the rates.
The death rate, though it is low, affords less indication of the healthy
nature of the district than the proportion of adult to post-mature
deaths - that is, the proportion of deaths between 25 and 60 and deaths
over age 60. Thus for 32 deaths over 60 there were only 15 between
25 and 60, adult deaths showing rather less than half in amount. This
means that the average age at death is high, which in turn means that
so far as quantity as distinct from quality of life is concerned, the
district stands well. Personally, however, I reckon quality higher than

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mere quantity; but on the quality of life in this district I have as yet
no organised data. There have been ten deaths from zymotic (that is,
infectious) diseases; that is, one-sixth of all the deaths. Six of these
zymotic deaths were due to whooping-cough, three occurring from
more or less preventable causes. Two were from scarlet fever; one to
my own knowledge was due to the merciless insalubrity of an excep-
tionally damp house. Five deaths were due to consumption, and none
to other forms of tuberculosis. This is a good record, and quite in
accord with the bracing hill-air of the district generally. Another
satisfactory feature is the small number of deaths from circulatory and
respiratory causes, and the large number of deaths over 60. Of the
latter many are over 70 and 80.
It is right to add that the population shows a fall from 4299 in
1881 to 3846 in 1891; that is a fall of 453 or about 10·5 per cent.
The fall for the whole county has been only 5·1 per cent. The parishes
of Carsphairn and Balmaclellan show a fall of 18·8 and 17·4 per cent.
respectively. The least fall has been in the parish of Kells, which fell
only 4·2 per cent. These facts must qualify any inferences from the
death-rates. The low death-rate between ages 25 and 60, instead of
being a subject for congratulation, may mean the swift emigration from
the district of adults between those ages - a fact that cannot be fully
understood till the complete census returns are published.

II. - SOUTHERN DISTRICT.
According to the requirements of the Board of Supervision, I now
present my annual report on the Southern District of the Stewartry of
Kirkcudbright.

I. - GENERAL SANITARY CONDITION.
A. - DISTRIBUTION OF POPULATION.
The Southern District, which includes the parishes of Balmaghie,
Borgue, Buittle, Crossmichael, Kelton, Kirkcudbright, Rerwick, Tong-
land, Twynholm, is one of the most populous districts. The total
acreage is 127,070 acres. The total population at the last census was
14,557; the number of persons per acre, therefore is 0·114, or other-
wise about one person to every ten acres. The population, too, is
distributed with fair equality over the various parishes; but here and
there tracts of hill land are little or not at all inhabited. The largest