HH62/1/KIRKCU/39

Transcription

[Page] 38

probably come before the Board. I mean to use every means, such as
leaflet instruction, public lectures, and practical demonstration, to over-
come the utterly irrational and disproportionate terror inspired by
certain zymotic disorders. With a little judicious expenditure in the
formation of a sound public opinion, the difficulties of disinfection will
be considerably reduced.

VI. - PREVENTION OF INFECTIOUS DISEASE.
The prevention of infectious disease may be divided into two:-
(a) Administrative Mechanism. - In June, 1891, the District Com-
mittee adopted the Infectious Diseases (Notification) Act. This has
worked admirably in the district. It has enabled me to catch in the
beginning what threatened to become a serious outbreak of typhus
fever; to have three groups of enteric fever cases dealt with by isolation
and disinfection, two cases being sent to hospital; to follow up a pretty
extended outbreak of scarlet fever in the parish of Newabbey. No
fresh cases have been reported from this parish since early in December.
At the earliest possible opportunity I propose to visit the site of every
case, to make certain that, so far as our means permit, we may prevent
a fresh outbreak. The cases have been mild.
(b) Executive. - In all cases where it was considered necessary the
Sanitary Office superintended the actual work of disinfection. Every
effort has been made to isolate the cases in their private houses. Success
has not been universal, but not discouraging. No schools have had to
be closed in the district.

VII. - CAUSES, ORIGIN AND DISTRIBUTION OF
DISEASE.
The methods as yet available for ascertaining the cause and
distribution of disease in the district are two:- First, the Infectious
Diseases (Notification) Act, which applies only to one class of diseases;
second, the death-rates, which, however, bear no constant relation to the
number of cases of any one disease. I deal with the death-rate first.
(a) Death-rate for District. - In all the calculations here given the
Burgh of Maxwelltown (population, 4961) is excluded. The Burgh of
Dalbeattie offers certain contrasts that are instructive; the Dalbeattie
figures are therefore given - first, as part of the district; second, as a
separate calculation.
The total of deaths for the year has been 218, giving a death-rate
for the year of 18·748 per 1000 of population. If the burgh of
Dalbeattie is also excluded the death-rate becomes 17·890 per 1000.
This rate represents on the whole, fairly the rates for the lesser

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localities. All the parishes except Colvend, Dalbeattie (district), and
Urr have populations less than 1000. It would be misleading to give
rates for these separately, because the separation is nothing more in
most cases than a mere administrative convenience; there is no great
change in situation or climate, or social condition, or mode of life. The
parishes with considerable villages, however, show a higher figure.
Thus Kirkpatrick-Durham has a record of 21 deaths, and the parish has
one village of its own name and part of Crocketford, which has more
than its fair proportion of disease and death. But in all of these
parishes calculations are of little value for comparison, because the
variations in the absolute numbers make too large a variation in the
rates per 1000.
For a mainland-rural rate 17·690 per 1000 constitutes a satisfactory
average. Thus, for instance, in the quarter ending June 20, 1891, the
mainland-rural rate for Scotland was 16·7 per 1000; in the preceding
quarter it was 19 per 1000. The rate for the Eastern district is, there-
fore, neither exceptionally high nor exceptionally low.
(b) Age Incidence. - One of the least satisfactory features is the
high death-rate of children under one year. For every 100 births 13
die under one year. This, compared with many other localities, is not
a high rate, but the large number of deaths under five from diseases of
the respiratory organs leads one to conjecture that the district, from
whatever cause is not favourable to early childhood. A less unsatis-
factory feature, though not strikingly good, is the proportion of deaths
between ages 25 and 60 to ages over 60. Other things equal, and given
a fairly stationary population, this ratio indicates a high average age at
death. But this is only when we choose ages over one year. Such an
average is satisfactory for quantity of life (quality is not in any wise
indicated thereby) and I hope to make quality of life in rural districts
the subject of special research in future reports.
(c) Disease Incidence. - No one locality shows a striking preponder-
ance of any one disease.
(a) Zymotic Deaths. - The zymotic death is strikingly low. In this
I do not include deaths from influenza, which, as a cause of death, is
more properly regarded as a complication of other diseased conditions.
Deaths registered from influenza are 13. These have been in greatest
proportion in the villages of Kirkpatrick-Durham, Crocketford, and
Springholm, and all except one occurred within the months of November
and December.
(b) Tubercular Diseases. - These show a death rate of 232 per 100,000
of population This - which is rather less than the average for Scotland -
does not indicate the existence of any exceptionally unhealthy conditions.