HH62/1/KIRKCU/33

Transcription

[Page] 32

III. - CERTIFICATES GRANTED.
Beyond the certificates necessary under Public Health (Scotland)
Act, 1867, sec. 40, I have been asked for no certificates.

IV. - BAKEHOUSES.
No proceedings have had to be taken in connection with bakehouses.

V. - HOSPITAL SUPERVISION.
(See report on Eastern District.) I advise the Committee to
appoint a sub-committee of inquiry.

VI. - PREVENTION OF INFECTIOUS DISEASE.
(a) In September, 1891, the District Committee adopted the
Infectious Diseases (Notification) Act, adding measles and whooping-
cough to the statutory list. The district has since afforded an
admirable example of the benefits to be derived from that Act. Thus,
in the Parish of Borgue, scarlet fever, as I afterwards discovered, had
been cropping up from time to time since March, or at least early
summer. Private notice called my attention to certain cases still
going on. A visit to the parish discovered nine cases. Most of them
had spread through the school, whither one case, if not more, had been
allowed to return without any attempt at disinfection. These nine
cases were isolated as well as private accommodation could allow. The
school at Borgue village was closed, but only for a fortnight, and this
without any knowledge of the Public Health or Sanitary Offices. The
result was one or two fresh cases. But the prompt intimation, due to
the Infectious Diseases (Notification) Act, has now put the officials in
full supervision, probably of all existing cases. As a consequence the
last case may soon be looked for. The type of fever, however, has
been so mild that in several instances no medical attendant has been
consulted. This will necessitate another thorough overhauling of the
parish at an early date.
The same Act has enabled the Public Health and Sanitary Offices
to isolate and stop a case of scarlet fever at one dairy farm; typhoid
fever, at two other farms.
(b) Over and above the administrative assistance due to this Act,
which enlists every medical practitioner and every householder in the
public service, the ordinary means of private isolation and disinfection
have been employed. The Sanitary Inspector has himself superin-
tended disinfection where such superintendence has been considered
necessary.

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(c) The want of a suitable hospital has been felt in the Borgue
outbreak. Private isolation cannot always be relied on. The super-
stition is still current that scarlet fever, like small-pox a century ago,
is a necessary incident of child life, and the indifference so generated
is certain sooner or later to result in prosecutions under the Public
Health (Scotland) Act, 1867, (sec. 59).
(d) I shall advise the District Committee to arrange with the
School Boards in terms of this section.
(e) The other infectious diseases notified have been efficiently dealt
with in the ordinary way.

VII. - CAUSES, ORIGIN, AND DISTRIBUTION
OF DISEASE.
Of these the only index yet available, except for infectious
diseases, is the death-rate, which in almost no disease bears any constant
relation either to the living population as a whole, or to the number
affected by the disease. So far, however, as the death-rate is an index,
I here direct attention to it, giving first the general and then certain
special death rates.

A. - GENERAL.
The total of deaths for the year was 206. This is equivalent to a
death-rate of 15·450 per 1000. There are, however, special variations
from this. In Kelton, the largest in population, 55 deaths occurred,
giving a rate of 14·850 per 1000 - slightly below the average. In
Kirkcudbright 70 deaths occurred, giving a rate of 20·090 per 1000 -
decidedly above the average.

B. - SPECIAL.
(a) Zymotic Diseases. - The death-rate from zymotic diseases is
very low, amounting only to 0·525 per 1000. Of two deaths from
enteric fever, one occurred in the burgh of Kirkcudbright, one in the
parish of Balmaghie. There have been no deaths from scarlet fever,
which, however, has had a record in the district of some 25 cases since
May. One death was due to diphtheria, which this year seems to be
exceptionally rare in the district; none to measles or whooping-cough,
neither of which has been recently in the district; 4 were due to
diarrhœa.
Of the enteric fever cases one was imported from Manchester; one
along with another, and several cases of doubtful nature were traced to
contaminated milk. There is no reason to look on the district as specially
favourable to the growth and propagation of infectious disease.