HH62/1/KIRKCU/5

Transcription

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Inspector, single-handed, has three kinds of work to do - he is Inspector
of Nuisances, etc., under the Public Health Acts; he is Inspector of
Dairies under the Dairy Regulations; and, under the Infectious Diseases
(Notification) Act, he is required to assist the Public Health Office in
the isolation of infectious cases and the disinfection of premises. In
these three kinds he acts for the County as a whole, for each of four
Districts, and for each of three Burghs. As County Inspector he must
advise proprietors and others on the sanitary reconstruction of premises;
as District Inspector he is provisional surveyor, draughtsman, and clerk
of works for all structural works under the Local Authority; and as
Burgh Inspector he must likewise work under the same Acts and Bye-
laws. As County, District, and Burgh Inspector of Nuisances, Dairies, and
Infected Premises he must traverse an area of some 900 square miles; he
must be available for infectious epidemics as the unforeseen incidence of
disease may determine; and he is required to inspect the dairies four
times a year. In a small county where dairies are few, the last item
might not be considerable; but in this county the dairies number about
200, and their inspection means 200 visits per quarter, or 800 visits a
year. The first year of this work is unquestionably the heaviest, for a
minute record has to be taken of cubic air space, drainage, and structure
generally; but always it must absorb a large part of the Inspector's time.
Add to this the time necessary to visit, isolate, and disinfect premises
when infectious cases number some 150 in the year, and it will be
obvious at once that the time left for special district work, for reports on
villages, systems of drainage, water supplies, and housing must be small.

Second. - I offer the following suggestions from the Public Health
standpoint, for nine months' experience of work in the county has
persuaded me that the efficient administration of the Public Health
Acts now operative in the county requires a certain minimum of
assistance to the Sanitary Inspector.
(a.) A large part of the Inspector's time is consumed in re-visiting
the site of notified nuisances in order to see that the nuisances have been
removed. If a definite arrangement could be made with the police
officials to supply information even on this one matter, a large per-
centage of time would be saved for other and more fruitful work. (See
Supplement to Skelton's Handbook of Public Health, p. 25.)
(b.) For the ultimate suppression and extinction of infectious
disease within the county it is essential that for some time every infected
house be disinfected by the Sanitary Inspector, or by an official directly
responsible to him. It is rare that private disinfection is really adequate.
In occasional instances it has been possible to secure a man in the
locality; but at least one such man should be available in every district,

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and one in every main aggregation of people. Two districts have
already given power to the Public Health Office to secure such
assistance. It is important that the assistance should be constantly
available at need in all districts. The result within a short time would
be fewer cases, and ultimate reduction of expense.
(c.) The dairies are a constant possible source of disease, and the
thoroughness of dairy regulations is an admirable feature of county
administration. But the regulations leave it unessential for very small
milk-sellers to register. This is an administrative mistake; the possible
dangers are admirably illustrated in the cases of fever at Bridgestone, in
Balmaghie (see appendix). Registration costs nothing, and ought to be
compulsory on every milk-seller whatsoever. If registration means
anything, it means a sharpening of responsibility for cleanliness and
avoidance of possible contamination, and it is precisely the minor byres
that most need a stricter supervision.

II. - VITAL STATISTICS.

A. - DEATH-INCIDENCE.
In the District Reports I have given the details of deaths and rates
for the year 1891. Those deaths and rates by themselves, however,
give little information.
In the County Report, therefore, my design is so to tabulate the
facts of past years as to provide a system for a critical estimation of
the present. This year neither the matter at my disposal nor the time
for its elaboration permitted more than the part realisation of such a
system, which, however, as a system must embody in its parts the main
principles of the whole. This is not the place to give a full exposition
of the plan that governs the details of a public service. I expound only
that part of it concerning the vital statistics of the year.
The tables that form the body of the report are designed to exhibit
in serial exposition the varying populations, the incidence of death, and,
through deaths, the incidence of disease within the county. The last
ten years have been chosen for a basis of averages, and for beginning
the construction of a system that shall gather in new facts to itself, and
give them their scientific meaning. Unrelated facts are meaningless
and worthless. A careful study even of these tables will show whether
things are going forward or backward, how the case stands with the
divisions of the county relatively to each other, and how the case for the
whole county stands in the general comparison with all Scotland.
In the arrangement of this table-series I have followed the great
generalities of Time and Space. In the time-incidence of deaths certain