| HH62/2/LANARK/1 |
[Note] 19 HH 62/2
COUNTY OF LANARK.
[Coat of arms inserted]
FIRST
ANNUAL REPORT
ON THE
HEALTH AND SANITARY CONDITION
OF THE COUNTY
FOR
1891,
BY
JAMES McLINTOCK, M.D., B.Sc.,
COUNTY MEDICAL OFFICER
GLASGOW:
PRINTED BY ROBERT ANDERSON, 22 ANN STREET. |
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| HH62/2/LANARK/3 |
INDEX.
--- PAGES
AGES AT DEATH - County, --- 32
AGES AT DEATH - Upper Ward, --- 43, 44
AGES AT DEATH - Middle Ward, --- 68
AGES AT DEATH - Lower Ward, --- 110
ALMOND RIVER, --- 24
AREA - County, --- 9
AREA - Upper Ward, --- 41
AREA - Middle Ward, --- 66
AREA - Lower Ward, --- 82
ASHPITS AND PRIVIES, --- 15
BIRTHS AND DEATHS - County, --- 29, 30
BIRTHS AND DEATHS - Upper Ward, --- 41
BIRTHS AND DEATHS - Middle Ward, --- 67, 68
BIRTHS AND DEATHS - Lower Ward, --- 100, 101
BYE-LAWS REGULATING DUTIES OF MEDICAL OFFICER AND
SANITARY INSPECTORS, --- 21
CAUSES OF DEATH - County, --- 32
CAUSES OF DEATH - Upper Ward, --- 42, 43
CAUSES OF DEATH - Middle Ward, --- 68-75
CAUSES OF DEATH - Lower Ward, --- 101-107
CLYDE RIVER, --- 11
CLYDE RIVER, POLLUTION OF, --- 23, 39
COUNTY, SANITARY CONDITION OF, --- 9-28
COUNTY, PHYSICAL CHARACTERISTICS OF, --- 10
DAIRIES, COWSHEDS, AND MILK-SHOPS - County, --- 22
DAIRIES, COWSHEDS, AND MILK-SHOPS - Upper Ward, --- 37
DAIRIES, COWSHEDS, AND MILK-SHOPS - Middle Ward --- 62, 63
DAIRIES, COWSHEDS, AND MILK-SHOPS - Lower Ward, --- 95, 96
DEATH-RATES OF CONTIGUOUS COUNTIES, --- 30
DISINFECTION, --- 57, 87-95
DRAINAGE AND SEWAGE DISPOSAL, --- 17
DRAINAGE - Upper Ward, --- 37, 38
DRAINAGE - Middle Ward, --- 61, 62
DRAINAGE - Lower Ward, --- 85, 86
GEOLOGY OF COUNTY, --- 12
HOSPITAL ACCOMMODATION - County, --- 18
HOSPITAL ACCOMMODATION - Upper Ward, --- 35-37
HOSPITAL ACCOMMODATION - Middle Ward, --- 48-57
HOSPITAL ACCOMMODATION - Lower Ward, --- 87 |
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[Page] 4
--- PAGES
HOUSE ACCOMMODATION - County, --- 13
HOUSE ACCOMMODATION - Middle Ward, --- 57-59
HOUSE ACCOMMODATION - Lower Ward, --- 83, 84
INDUSTRIES OF COUNTY, --- 13
INFANTILE MORTALITY, --- 32, 43, 68
INSPECTIONS MADE, --- 26
MEETINGS ATTENDED, -- 26
NOTIFICATION OF INFECTIOUS DISEASE - County, --- 19
NOTIFICATION OF INFECTIOUS DISEASE - Upper Ward, --- 35, 36
NOTIFICATION OF INFECTIOUS DISEASE - Middle Ward, --- 63-65
NOTIFICATION OF INFECTIOUS DISEASE - Lower Ward, --- 106-107
NUISANCES - County, --- 25
NUISANCES - Middle Ward, --- 65
NUISANCES - Lower Ward, --- 98
OFFENSIVE TRADES, --- 97-98
PAROCHIAL MEDICAL OFFICERS AND SANITARY INSPECTORS, --- 21
PIGSTYES, --- 17
POPULATION - County, --- 9
POPULATION - Upper Ward, --- 41
POPULATION - Middle Ward, --- 66, 67
POPULATION - Lower Ward, --- 82
RECOMMENDATIONS - GENERAL, --- 26-27
RETURNS OF BIRTHS AND DEATHS, --- 20, 40, 66, 96
RIVERS, POLLUTION OF, --- 23, 39, 65
SALE OF FOOD AND DRUGS ACTS, --- 23, 37
SCAVENGING, --- 38
SPECIAL VISITS AND REPORTS - Upper Ward, --- 39
SPECIAL VISITS AND REPORTS - Lower Ward, --- 99, 100
STAFF OF HEALTH DEPARTMENT, --- 5, 22
VITAL STATISTICS - County, --- 28
VITAL STATISTICS - Upper Ward, --- 40-47
VITAL STATISTICS - Middle Ward, --- 66-81
VITAL STATISTICS - Lower Ward, --- 100-111
WATER SUPPLY - County, --- 15
WATER SUPPLY - Upper Ward, --- 37, 38
WATER SUPPLY - Middle Ward, --- 59-61
WATER SUPPLY - Lower Ward, --- 84, 85
STAFF OF HEALTH DEPARTMENT.
JAMES McLINTOCK, M.D., B.Sc.,
COUNTY AND DISTRICT MEDICAL OFFICER.
UPPER WARD.
DUNCAN GLEN, COUNTY SANITARY INSPECTOR.
MIDDLE WARD.
JAMES DOBSON, COUNTY SANITARY INSPECTOR.
GEORGE MILLER, Sanitary Inspector, Parishes of Avondale, East Kilbride, Glasford, and Stonehouse.
DAVID ROBERTSON, Sanitary Inspector, Parishes of Blantyre & Cambuslang.
JOHN S. McNEILL, Sanitary Inspector, Parish of Bothwell.
C.D. BOOTH, Sanitary Inspector, Parishes of Cambusnethan & Dalziel.
WILLIAM STEWART, Sanitary Inspector, Parishes of Dalserf and Hamilton.
CHARLES BROWN, Sanitary Inspector, Parish of New Monkland.
THOMAS J. ALLAN, Sanitary Inspector, Parish of Old Monkland.
JAMES WATSON, Sanitary Inspector, Parish of Shotts.
LOWER WARD.
ALEXANDER HAY, COUNTY SANITARY INSPECTOR.
EDWARD BURNS, Sanitary Inspector.
DUNCAN M'MILLAN, Sanitary Inspector.
DAVID MALCOLM, Clerk to County Medical Officer, County Offices, Hamilton.
WM. DICK, Clerk to Middle Ward County Sanitary Inspector, Uddingston.
T. HAIN, Clerk to Lower Ward County Sanitary Inspector, Glasgow. |
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To the Members of the County Council and District
Committees of the County of Lanark.
MY LORDS AND GENTLEMEN,
The following Report which I have the honour to
submit to you, on the health and sanitary condition of the
County of Lanark during 1891, has been prepared in accor-
dance with the duties prescribed for County and District
Medical Officers in the Local Government Act and by the
Board of Supervision.
It was originally my intention to go fully into the vital
statistics of the whole county, for a period of, at least, ten
years back, in order to furnish a basis for future comparison,
and to show how the county, as regards hygienic conditions
- in so far as these could be deduced from mortality statis-
tics - compared with the rest of the country.
As, however, my appointment only dated from May of
the year under consideration, and as, in addition to routine
work, my time has been so fully occupied with the organising
and arranging incident to the establishment of what is
practically a new office, I was obliged to limit this report,
so far as regards birth and death returns, to the year ending
31st December, 1891.
Considering also that the full report on the last census
has not yet been published, and a complete statistical
account at present therefore impossible, it seems to me
preferable to prepare, at some future period, a supple-
mentary report dealing entirely with the statistics of the |
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[Page] 8
county, and embodying the information obtained at the
census. For this purpose a considerable number of figures
have been already collected.
I avail myself of this opportunity to thank the members
of the Council for the consideration and courtesy they have
shown to me during the past year, and also to express my
gratitude to the Clerks of the County and of the three
Districts for the assistance and advice they have been ever
ready to give me.
I have only to add that the three County Sanitary
Inspectors have loyally carried out the duties imposed
upon them, and have united with me in endeavouring to
combat the spread of disease, and to improve the sanitary
condition of the county.
I am,
MY LORDS AND GENTLEMEN,
Your obedient Servant,
JAS. McLINTOCK.
COUNTY OFFICES, HAMILTON.
March, 1892.
THE COUNTY.
GENERAL SANITARY CONDITION.
LANARK is an inland county, occupying a large part of the
centre of southern Scotland, and bounded on the north
by Dumbarton and Stirling; on the east by Stirling,
Linlithgow, Midlothian, and Peebles; on the south by
Dumfries; and on the west by Ayr, Renfrew, and Dum-
barton. Its greatest length is from north-west to south-
east, a distance of 52 miles, and its greatest breadth
34 miles.
It has a total area of 882 square miles, and ranks tenth
among the counties of Scotland in point of size.
As regards population, however, it stands far above any
other Scottish county. At the last census the population
numbered 1,091,703, while that for the whole of Scotland
was 4,025,647; so that Lanarkshire contains over one-fourth
of the whole population of Scotland.
Glasgow and the burghs, however, have the largest share
of this population, the city since its extension containing
within its boundaries a population of 658,073, the whole
of which, with the exception of 46,282 in Renfrewshire,
was in the County of Lanark at November, 1891.
By the Local Government Act of 1889 the county
councils in Scotland have no jurisdiction as regards health
matters over the burghs, although these are in not a few
instances merely large villages. In this respect Scotland
differs considerably from England, where the county
councils have the sanitary supervision of the whole county,
except in towns having a population of 50,000 or more.
On the other hand, it may be remarked in passing that
the Scottish county councils do not merely exercise a
supervision, but have in their own hands, through the
district committees, the direct administration of the sani-
tary affairs, in this way securing a more direct and efficient |
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[Page] 10
control than that possessed by English county councils.
In fact the Local Government Act of Scotland has secured
the formation of large combined districts for purposes of
sanitary administration, which in England are only found
here and there throughout the country, and which when
formed are often liable to be broken up by the withdrawal
of one or other of the communities entering into the
combination.
It thus comes about that the population over which the
Lanark County Council has sanitary jurisdiction does not
represent the whole or nearly the whole population of the
county, but is merely what is known as the landward
population, that is, the people living in the county outside
the City of Glasgow and the burghs. This numbers
209,308, distributed as follows among the three wards or
districts into which the county is divided, viz.:- Upper,
37,005; Middle, 143,009; and Lower, 29,294. The area
inhabited by the people these figures represent is 542,340
acres, divided as follows:- Upper Ward, 326,980 acres;
Middle Ward, 186,780 acres; and Lower Ward, 28,580
acres.
[Table inserted]
Physical Characteristics. - The physical features of the
county are extremely diversified. The Upper Ward is
very largely high moorland, almost destitute of trees or
* Calculated on the total population, including that of Govan Poorhouse
and Shieldhall Hospital.
[Page] 11
shrubs, and forming in many cases conical peaks, rising, like
Coulter Fell, to a height of 2,456 feet, and Tinto, to a height
nearly 1,700 feet above the Clyde, which washes its base,
or 2,350 feet above the sea. What is said to be the highest
inhabited land in Scotland is the village of Leadhills in
the Parish of Crawford, about 1,300 feet above sea level.
As we approach the neighbourhood of the Burgh of
Lanark the character of the county changes, becoming
more fertile and better wooded, until we reach the Vale of
Clyde with its well-wooded slopes, its fruitful orchards, and
fertile haughs or meadows. An extensive portion of the
Middle Ward, chiefly in the Parishes of Shotts, New
Monkland, and Avondale, is of considerable elevation, and
contains large tracts of moorland.
River Clyde. - With the exception of outlying portions,
such as at Harthill and Longriggend, of very limited area,
the whole county is drained by the River Clyde and its
tributaries, and hence often spoken of as Clydesdale.
The river rises in the southern uplands, as the hills are
called which separate Lanarkshire from Dumfriesshire
and neighbouring counties, and is formed by the union
of a number of small streams, the chief of which are the
Powtrail and Daer Waters. Its course is at first almost
directly north until it reaches Crawford, where it receives
the Midlock and Camp Waters. Flowing westwards for a
short distance it is then joined by the Glengonner Burn,
after which it again runs almost north until near Roberton,
receiving on the way the Duneaton Water from the Parish
of Crawfordjohn. Thence in a north-easterly direction it
makes towards Biggar Park, where it again changes its
course flowing in a north-west direction until it receives the
Medwin, near Carstairs. From this point its course is south-
west until it is joined by the Douglas Water, where it
abruptly assumes a north-westerly course, which, generally
speaking, it retains until it reaches Glasgow. Shortly after
skirting the town of Lanark it receives the Mouse Water, |
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and near Crossford the River Nethan. Hitherto its course
has been entirely through the Upper Ward, but a little
below its junction with the Nethan it forms the division
between the Parish of Dalserf in the Middle Ward, and the
Parish of Carluke in the Upper. From the village of
Dalserf it is entirely within the Middle Ward, through
which it flows until arriving nearly at Rutherglen.
In its passage through the Middle Ward it receives the
Avon, and the South Calder near Hamilton, the North
Calder and the Rotten Calder near Daldowie. In the
Lower Ward the only tributary of any importance is the
River Kelvin.
The length of the river from its source to its termination
in the Firth of Clyde is a little under 100 miles, about 90
miles of which are within the County of Lanark.
Geology. - The geology of the county has an important
bearing on its industries, and, consequently, on many of its
sanitary conditions. No apology, therefore, is needed for
a brief reference to it here.
A considerable part of the Upper Ward, and practically
the whole of the Middle and Lower Wards, are occupied by
the carboniferous strata, forming the coalfield of the Clyde
basin. "The formation rests on traps and ashes associated
with the Lower Calciferous Sandstones, which towards the
east separate the coalfield from that of the Lothians, and
in the west from that of Ayr. The middle portion of
the formation, which contains the best coal seams, with
blackband and other ironstones, is without limestone
and apparently of fresh-water origin, although a bed
of marine fossils has been detected in the series near
Glasgow. It also contains many valuable coal seams
and veins of ironstone. The line of junction between
this lower series and the Old Red Sandstone occurs in
the vicinity of the Falls of Clyde, Lanark, and Carstairs.
Besides the older trap rocks, which bound the field to the
east and west, others, probably of the same age as the
[Page] 13
Upper Carboniferous series, rise through and disturb the
strata of the interior in many places; and numerous basaltic
dykes, which, however, are generally unconnected with
faults in the strata, extend through the area of the coal-
field in an easterly direction. These, like the other erupted
masses, usually alter the strata with which they come into
contact, converting coal into coke, and clay into jasper, and
highly indurating the shales and sandstones. The isolated
coalfield of Lesmahagow, about 7 miles square, is nearly
surrounded by Old Red Sandstones, upon which also the
coal rests." *
Industries. - From what has been said it may be inferred
that over nearly the whole of the Upper Ward the in-
habitants are mainly engaged in occupations connected
with the soil - dairy farming, sheep farming, cultivation of
cereals, and fruit growing. The exception is to be found in
the Parishes of Carnwath, Carluke, and Lesmahagow,
where valuable seams of minerals are worked, principally
house coal, gas coal, and limestone, and where, consequently,
we find a large section of the population engaged in mining.
In the village of Leadhills the lead mines provide employ-
ment for a number of people.
In the Middle Ward the great bulk of the population is
dependent upon coal mining, and on the manufacture of
iron and steel, except in the Parishes of Avondale, Glasford,
Stonehouse, and East Kilbride, which are devoted almost
entirely to agriculture and weaving. In the Lower Ward,
also, the chief occupations are connected with coal, iron,
and fireclay.
Housing of the Working Classes. - This is a subject the
consideration of which I approach with a sense of no little
responsibility. In many things Scotland, and especially the
County of Lanark, can challenge comparison with the rest of
* Encyclopædia Britannica. |
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[Page] 14
the kingdom, but most assuredly the condition of the dwel-
lings of the working classes, and particularly of the miners, is
not one of them. I am bound to state that, with a consider-
able experience of the dwellings of the labouring classes, I
have never seen anything so uniformly bad as the condition
of the miner's cottage and its surroundings in the Midland
Counties of Scotland. I hope I appreciate the difficulties
which colliery proprietors have to contend with, such as in
many instances the temporary character of the works, the
short time often in which the houses have to be got ready
for their occupants, and, perhaps most important of all, the
disinclination on the part of the workmen to furnish a large
house and pay a proportionate rent for better accommoda-
tion. Still the fact remains that the owners of the houses
are responsible for their property, and these considerations
may palliate, but do not excuse their neglect of providing
something more worthy of the name of homes for those in
their employment.
It is altogether anomalous to have a whole series of
regulations for the housing of cows, while for human beings
the dwellings are allowed to be "the chance product of
an unscrupulous and unregulated downward competition
for cheapness." Clearly in this matter the same powers
of formulating building regulations ought to be possessed
by districts in Scotland as are possessed by every village in
England.
Under this heading, in the reports for each ward, I have
entered more into detail, and it is therefore unnecessary to
do more than indicate generally the condition of the
county in this respect. With the exception of the "colliers'
rows" nearly all the houses are substantially built of stone,
and contain at least two apartments. The proportion of
one storeyed houses is large, particularly in the Upper and
Middle Wards. In the Lower Ward, especially in the
neighbourhood of Glasgow, there is a growing tendency to
erect tenement houses, which are let in flats.
One objectionable feature even in houses of three
[Page] 15
apartments is that of having a bed in the kitchen. Apart
from considerations of cleanliness in cooking and eating, it
is clear that proper ventilation and airing of the bed-
clothes cannot be carried out. Even in farmhouses it is not
uncommon to find one or, as I have sometimes seen, two
beds in the kitchen. In case of sickness the objections are
still more evident.
Water Supply. - This important subject is pretty fully
discussed in the separate reports for each ward, and it is
therefore unnecessary to enter here into detail. Speaking
generally, about three-fourths of the Middle Ward, one-
third of the Lower, and a smaller proportion of the Upper
have no water supply worthy of the name; but in all three
wards, and particularly in the Middle, efforts are being
made to wipe away this reproach. The Glengavel scheme
of the Middle Ward District is the most comprehensive
with which I am acquainted for dealing with a population
scattered over an area like that of the Middle Ward, and
will, when carried out, as there seems every probability
of its being within the next three or four years, be a
splendid testimony to the large hearted manner in which
the District Committee has met its responsibilities.
Ashpits and Privies. - I have elsewhere in this report
alluded to the insanitary structures, if they can be dignified
by such a name, which do duty in many cases throughout
the county for privies and ashpits.
These blots upon the face of the county are in direct
opposition to all that is involved in modern hygiene.
Indeed, in the majority of instances, they are admirably
contrived for polluting the air, and water, and soil
in their vicinity. It is not difficult to understand
why the ashpits were made so large - clearly because
they were not intended to be emptied except twice
or thrice a year, nor why they were uncovered - |
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evidently for convenience of throwing rubbish into them,
and to save expense, but I must confess that I have
been puzzled to explain why they should so often be
dug below the level of the surrounding surface. The
condition of some of these "conveniences" is not infre-
quently loathsome, and must lead to nuisance being
committed in the fields and lanes, and even to the retention,
for some time, of offensive matters in the houses. When
the accumulations of weeks and months are being removed,
after being exposed to the action of rain and sun, the air of
the neighbourhood must be literally poisoned.
Destructive criticism is generally easy, but to suggest a
remedy often difficult. In this case improvement can only
be carried out on certain well defined lines. In the first
place the comparatively huge structures must give place to
small well-built closets and ashpits, all roofed over, and
with watertight floors in both closet and ashpit. They
ought to be so arranged that the ashes and excreta will
readily mix. Above all, and here we are face to face with
the greatest difficulty, they ought to be emptied before
putrefaction sets in, at least once in every fortnight, pre-
ferably once a week. Plainly, this can only be accomplished
by a properly organised system of scavenging, involving
the disposal of the refuse after its removal, either by
"destructors" - a wasteful process in country districts - or
by utilising as manure, or by a combination of both, as is
carried out with more or less success in many towns in the
North of England.
In view of the improvement likely to take place in the
water supply of the county, the question of providing what
are called waste water-closets might be worth the con-
sideration of many proprietors. Several forms are in the
market, and those I have seen in operation compared most
favourably with even the best forms of the ordinary privy.
This applies more particularly to the "tumbler" closet
which possesses an arrangement by which it can be auto-
matically flushed.
[Page] 17
I believe that the time will come when what is called
the "conservancy" system - that is, practically, the privy
system - will be abolished in all but the smallest rural
communities, and that the immediate removal of all refuse
matters will be made compulsory.
Pigstyes. - Pigstyes are not infrequently found at no great
distance from dwelling-houses, and as they are often
roughly constructed of wood, and not, as a rule, well
kept, their presence does not add anything to the charm
of the neighbourhood, except in the eyes of the owner of
the pig. It is scarcely fair, however, that while one individual
gets the benefit of the bacon his neighbours should have
only the nuisance. Certain bye-laws such as are common
in every little township in England, regulating the distance
at which these erections should be placed from dwelling-
houses, are extremely desirable.
Drainage and Sewage Disposal. - With the exception
of the Special Drainage Districts, the county generally is
very imperfectly provided with suitable drains, and stagnant
ditches and filthy pools are too frequently met with, although
their number is being steadily reduced by the efforts of the
sanitary staff. The introduction of a proper water supply
must of necessity make the question of drainage in various
localities an even more pressing one than it is at present,
and already populous places like Larkhall and Strathaven
are setting their house in order in this respect.
The purification of sewage is a problem, in some localities
at any rate, extremely difficult of solution, and yet one
which, in view of the agitation regarding the pollution of
rivers, must be faced.
As a rule, where suitable land can be obtained, the best
and least wasteful method is by irrigation farming. Where
this cannot be done, then what is known as intermittent
downward filtration through soil gives the best effluent. |
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Under certain conditions neither of these methods can
be employed, and then it is necessary to fall back upon
one of the numerous precipitation processes. Of these,
that in which lime is the principal agent has not been in
my experience altogether successful, even with the improved
methods of mixing the lime with the sewage. A lime
effluent discharged into a river is apt to cause further
fermentation and decomposition.
One of the best effluents I have seen is that from the
Acton Sewage Works, where "ferrozone" and "polarite"
are employed under the system of the International Sewage
Purification Company. It is right to point out, however,
that the sewage at Acton is not difficult to treat compared
with that of a manufacturing community, and whether
it would be as effective in dealing with trade refuse is
another question. The same system has been adopted
lately, I believe, at Larbert Asylum. One drawback
appears to me a somewhat serious one, viz., that the sale
of the materials used is, so far as I am aware, in the hands
of the one company, who, I presume, are at liberty to fix
their own prices. A great many other agents have been
recommended, and even electricity has been pressed into
the service, but except the experimental works at Cross-
ness, Salford, and Bradford, I am not aware of the system
having been adopted.
In no single instance, so far as I know, has the sewage
from any district been subjected to treatment before
entering the streams. In the two localities named, how-
ever - Larkhall and Strathaven - for which drainage
plans have been prepared, the necessity for a pure effluent
has been recognised, and the plans so arranged that irriga-
tion or intermittent downward filtration can be carried out.
Hospital Accommodation. - On this subject also I have
entered at length in my accompanying reports on each of
the wards. There are at present nine hospitals in the
county to which the District Committees are entitled to
[Page] 19
send patients, but of these seven are combination hospitals
with different burghs, and two only (both within the Middle
Ward) are under the control of the Council. Of the nine,
one is in the Upper Ward, seven in the Middle, and one in
the Lower.
The inadequacy of the present hospital accommodation
has been recognised by each District Committee. In the
Middle Ward the Committee has adopted a comprehensive
scheme, which I have fully described at page 49; in the
Lower Ward the Committee has practically agreed to
provide at least 30 beds; while in the Upper Ward no
definite scheme has as yet been agreed upon.
Notification of Infectious Disease. - Throughout the
whole of the landward portion of the county the Infectious
Disease (Notification) Act, 1889, is now in operation.
It was first adopted in the Middle Ward, coming into
force on 1st January, 1891; then in the Upper Ward,
on 13th July; and, finally, in the Lower Ward, on 1st
September, 1891.
The necessary forms for the use of the medical men in
attendance on cases of infectious disease were drawn up
and printed in accordance with the statutory form. They
have been bound in books of 50 and distributed among the
medical men of the county, accompanied, in the case of the
Upper and Lower Wards, by a circular letter drawing
attention to the main provisions of the Act. The distri-
bution of the blank forms in the Middle Ward was under
the superintendence of the Sanitary Inspector, the Act,
as already stated, having been adopted prior to my
appointment.
The Act provides that the Certificate of Notification is
to be forwarded to the Medical Officer. It would obviously,
however, cause considerable delay in dealing with such
cases were the notifications to be forwarded to Hamilton,
and then sent to the various Inspectors in the county; it
was, therefore, arranged that the notification in each of |
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[Page] 20
the wards should be forwarded direct to the offices at
Lanark, Uddingston, and Glasgow respectively, and there
opened by the County Sanitary Inspectors, and action
taken.
In order to keep the Medical Officer thoroughly acquainted
with the work done, daily returns are forwarded from each
ward to the office in Hamilton.
The total number of notifications received during the
year was 2,704, viz.:-
Scarlet Fever, -- 1,737 cases.
Enteric Fever, -- 520 cases.
Diphtheria, -- 177 cases.
Erysipelas, -- 230 cases.
Puerperal Fever, -- 23 cases.
Continued Fever, -- 17 cases.
Since the Act came into force throughout the whole
county on 1st September, the weekly average of cases
notified has been 78.
Returns of Births and Deaths. - My experience of
public health having hitherto been confined to England,
where, under the Registration Act of 1875, provision is
made for the periodical receipt of returns of the births and
deaths from the local Registrars, I was greatly astonished
to find that apparently the furnishing of these returns to
Medical Officers in Scotland had never been contemplated.
I must confess that to me it almost seems ludicrous to
attempt to carry on the health work of a great county
without knowing from time to time the number of deaths,
where they occur, from what disease, and at what ages, and
it is most vexatious to find that this public information
can be given or withheld at the caprice of any of the
numerous Registrars in the county. I am pleased to say
that the great majority of the Registrars have most cordially
responded to the request for monthly returns on the same
terms as fixed by statute in England. In a few instances,
however, great difficulty has been experienced in coming to
[Page] 21
an agreement, and the whole work of arranging about these
returns has been accompanied by an amount of worry and
a waste of time, which has been almost disheartening. It is
to be hoped that a short Act of Parliament will be introduced
at the earliest possible moment, settling this question on a
definite and equable basis. Seeing that the whole work of
the Sanitary Authority in the county must be judged by its
results "in practical relation to the Public Health," and that
"each Sanitary Authority has for its purpose under the law
to lessen to the utmost it can the incidence of disease
within its district," it needs no argument to prove the
necessity of full and exact information being given to the
officers of the Sanitary Authority regarding the whole of
the deaths within their district.
Parochial Medical Officers and Sanitary Inspectors. -
Another question of importance which had to be decided
was whether the services of the local Medical Officers and
Sanitary Inspectors were to be retained or dispensed with.
After full consideration of the whole subject it was agreed
to dispense with their services in time to enable them to
claim compensation for loss of office. I would have pre-
ferred to have had their assistance and advice for a longer
period, but the time prescribed by the Act for dealing with
the question compelled the Council to take the necessary
steps before the end of August.
At the present time, therefore, I am discharging, without
medical assistance, the whole of the duties pertaining to
the Medical Officer of Health throughout the landward
portion of the county.
Bye-laws regulating the Duties of the County
Medical Officer and of the County Sanitary Inspectors. -
The next question, and one of special importance, was
the framing of bye-laws regulating the duties of the County
Medical Officer and of the County Sanitary Inspectors, and
their relative position towards each other. Being entirely |
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[Page] 22
without staff, and having charge of the whole county, it
was to me a matter of the utmost importance that I should
be able to keep myself thoroughly in touch with everything
likely to affect the public health. In order to do this
thoroughly and effectively, the Committee specially ap-
pointed for the purpose recognised that the Medical Officer
must be the head of the health departments, and the bye-
laws were accordingly framed with that end in view, at the
same time giving to each of the three County Inspectors
full supervision over their subordinates, and a wide discretion
in carrying out such work as the removal of nuisances,
construction and reconstruction of ashpits, privies, drains,
and sanitary work of a like nature.
The regulations referred to were presented to the County
Council at their meeting on the 19th of May, 1891, and
unanimously agreed to. At the instance of the Board of
Supervision, they were also brought before each of the
District Committees and agreed to, and at the date of
writing have now been fully approved by the Board of
Supervision.
Staff. - The sanitary staff of the county, under the control
of the Council, at the present time, consists of the County
Medical Officer, with offices at Hamilton; a County Sanitary
Inspector for each of the three wards into which the
county is divided - Upper, Middle, and Lower - with offices
at Lanark, Uddingston, and Glasgow respectively; eight
assistant inspectors in the Middle Ward, devoting the
whole of their time to the work; and two assistant inspectors
in the Lower Ward who also devote their whole time to
their sanitary work. There is, in addition to these officers,
a clerk under the Medical Officer; one under the Chief
Inspector for the Middle Ward; and one under the Chief
Inspector for the Lower Ward.
Dairies, Cowsheds, and Milkshops. - Regulations for
these have been considered and approved by committees
[Page] 23
appointed for the purpose in each ward of the county.
They are uniform throughout the county, except that in
the Upper Ward, 380 cubic feet have been allotted for each
cow, and 400 in the Middle and Lower Wards. I was
extremely anxious to have no difference in this respect, but
in the case of the Upper Ward it was urged that the
conditions were very different from those in the more
populous districts of the Middle and Lower Wards.
The regulations are very much the same as those generally
adopted by other counties, and I anticipate a gradual but
important reform from their adoption and enforcement.
Sale of Food and Drugs Acts. - These Acts, so far as
the landward portion of the county are concerned, have
hitherto been practically inoperative. The best means of
putting them into operation have been under the considera-
tion of the Council, and arrangements have been made by
which Dr. Clark of Glasgow, the County Analyst, reports
on samples submitted to him by the sanitary officials of the
various districts. It is expected that during the year 1892
the working of the Acts will be in full operation.
Pollution of Rivers. - The question of river pollution is
one which is engaging the anxious consideration of nearly
every County Council in Great Britain. The Rivers Pollu-
tion Prevention Act has not accomplished the good that
some sanguine sanitarians anticipated it would, and in fact
until about a couple of years ago it was practically a dead
letter. However, since the formation of County Councils,
renewed attention has been given to the need for action,
and a determination shown on the part of many counties
and of large cities and burghs to fairly grapple with the
difficulties with which the whole subject bristles. That it
is feasible, or even advisable, to attempt to restore to its
natural state a river flowing through a district dependent
upon large industries is, I feel sure, what few would admit.
It is, however, beyond dispute that an unnecessary and |
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[Page] 24
unjustifiable pollution of rivers is going on. The first
stream to which my attention was directed - the River
Almond - is one which flows for a very short distance
through an outlying part of the Middle Ward, and then
enters the County of Linlithgow. It rises in the Parish of
Shotts, and its course through the county is not more than
3 miles. The stream, almost at its source, is polluted with
the refuse from coal-washing, the so-called precipitating
tanks being totally inadequate for purification purposes.
A little lower down the stream receives the water pumped
from ironstone mines - water which is charged with a large
proportion of iron, and imparts to the river, for, I believe,
the whole of its course, an ochrey colour. From one of
these mines 528,000 gallons of water, with iron in solution
and suspension, are discharged daily. In addition to this
mine water, soakage into the stream from a number of
refuse heaps along its banks is continually taking place,
the water from which is heavily charged with iron.
The sewage from the miners' houses at Benhar ultimately
finds its way into the river; while into the How Burn, which
joins the Almond outside the Middle Ward District, there
flows the sewage of Harthill.
In a special report, with map, which I submitted to the
District Committee, the question of remedies is discussed,
and details given of the various sources of pollution.
The pollution of the River Almond, however, so far as
Lanarkshire is concerned, is insignificant when compared
with that of the Clyde. The first of the important tributaries
showing signs of contamination is the Nethan, which carries
down into the main stream a large amount of discoloration,
due almost entirely to coal-washing. Then follows the
Avon, charged with the sewage of Strathaven, Stonehouse,
&c., in addition to coal-washing refuse, followed by the
South Calder Water, to which an additional pollution has
been added by the sulphate of ammonia works at Shotts,
in the shape of spent ammoniacal liquors and tarry matters.
The North Calder joins the river about a mile further on,
[Page] 25
and brings with it the contributions to pollution from print
works, paper mills, ammonia works, collieries, and human
habitations; and it is here I am inclined to think the
maximum of contamination is reached, the Calder, as it
joins the Clyde, being altogether unlovely and unsavoury.
Still lower down the main stream receives the third of the
Calders, known by the name of the Rotten Calder - a desig-
nation which might perhaps be more appropriately applied
to the one just mentioned. From here until it reaches Glas-
gow the river receives numerous minor polluting tributaries.
A detailed account of the pollutions of the Clyde is in
course of preparation at the request of the District Com-
mittee of the Middle Ward, and in it will be discussed the
various remedies which have been suggested.
I have thought it advisable, however, to give in this
annual report a general idea of the present condition of
the great stream which flows through the whole length
of Lanarkshire, and without which a description of the
hygienic condition of the county would be incomplete.
Nuisances. - These have been considered more fully
under the proper headings in the reports for each ward. I
only wish to draw attention to one unsatisfactory feature
connected with the law as it appears to stand at present.
Of the various prosecutions that have been undertaken in
the Lower Ward, one of the most important was that in
connection with the Stanley Chemical Works.
These were, and are, simply most offensive storerooms
for blood, yet, although the sanitary officials were pre-
pared to bring forward indisputable evidence as to their
offensiveness, the case was delayed until a report from a
third party was sent in. Of course the premises were
carefully prepared for the visit of the gentleman to whom
the matter had been referred. He reported that the
premises were a nuisance, but added that he was unable to
find evidence of injury to health. On this ground the
Sheriff dismissed the case, but I venture to assert that a |
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[Page] 26
decision on these grounds acts most prejudicially to the
cause of sanitation, and in England, I believe, it would not
be necessary to require positive proof of injury to health
before condemning any premises as a nuisance. Such
proof is notoriously difficult to give, although every one con-
cerned may be satisfied that a dangerous nuisance exists.
Various matters of no little importance I have been
unable yet to undertake, but regarding which I hope in my
next report to give you full information. Chief among
these are the inspection of slaughter-houses, with regula-
tions for their management, the inspection of meat, the
condition of the bakehouses - these, singularly enough, by
the law of Scotland, being under the direct and sole inspec-
tion of the Medical Officer - and the condition of the schools.
Although each of these subjects has engaged my atten-
tion, yet my observations have been of too fragmentary
a character to be worth recording here.
In addition to what may be termed the routine work of
the Medical Officer, details of which will be more fully
given when I deal with each ward in turn, I have attended
a considerable number of meetings during the eight months
in which I have held office, the total number being 88. As
was to be expected, the greatest number of those meetings
have been connected with the Middle Ward of the county.
The total number of special inspections made during
the eight months is 33, and these are particularised in the
reports which follow on the respective wards.
The number of certificates granted for nuisances has been
20, mostly in the Lower Ward.
General Recommendations. - From what has preceded
it is scarcely necessary to state on what lines the improve-
ments in the sanitary condition of the county must proceed.
They may, however, be summarised in a few words -
1. The improvement of the houses of the working-classes,
especially of the miners, and the establishment of a
code of building regulations.
[Page] 27
2. The abolition of the present barbarous privy and
ashpit, so common in villages and miners' rows.
3. The proper drainage of the districts generally, and of
the smaller villages in particular.
4. Scavenging of the populous places, including the
periodical cleansing of ashpits.
5. Disposal of refuse either by burning in "destructors"
or utilising as manure.
6. The enforcement of the provisions of the Rivers Pol-
lution Prevention Act.
It is to be noted that, as already stated, water supply,
hospital accommodation, adulteration of foods, regulations
for dairies and cowsheds have been already practically dealt
with throughout the county generally. Therefore, I have
not included them in the above list.
In concluding my report on the general sanitary condi-
tion of the county, I am bound to express the hope that
very soon a new Public Health Act for Scotland will be
passed. So far back as 1876, Sheriff Spens, in his book on
the "Sanitary System of Scotland," wrote that, "since our
Public Health Act of 1867, there has been no large Public
Health measure passed with reference to Scotland. In
England, on the other hand, there has been great legislative
activity in sanitary matters. There must, I believe, be,
at no distant date, a Public Health Amendment Act."
Although the Local Government Act has dealt with
many of the objections raised by Sheriff Spens, yet there
is more than ever a need for a well conceived Public Health
measure for Scotland.
It is, to say the least of it, anomalous that the new
sanitary officers of Scotland should have to use as their
main instrument an Act passed a quarter of a century ago,
and that, too, when our ideas of sanitation have undergone,
in that long interval, quite a transformation. |
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[Page] 28
With a new Public Health Act, embodying and consoli-
dating the best features of the Scottish and English
Sanitary Acts, administered by a trained body of medical
officers and sanitary inspectors devoting the whole of their
time to the work, such as Scotland now possesses (in this
respect far in advance of England), under the control of
enlightened county councils, and guided by the central
authority, Scotland would speedily take a foremost place in
the march of sanitary progress among the nations of the
world.
VITAL STATISTICS.
In regard to that part of the report dealing with returns
of births and deaths a few explanatory remarks may be
serviceable.
In the first place, I would emphasize the fact that the
figures are only for the year 1891, and that too much
importance, especially in the case of small populations,
must not be attached to them as indicating the sanitary
condition of the various districts.They are important as
the beginning of a series of statistics which will undoubtedly
by-and-bye throw great light on the different circumstances
influencing the health of the people in the county.
It must also be borne in mind that, not being in posses-
sion of the full census report, I have been unable to make
the usual corrections for age and sex. In comparing one
population with another as regards mortality, and in
drawing inferences as to comparative healthiness from the
figures, it is essential to know in what respects the popula-
tions differ, and more especially as regards the number of
people living at various ages and of each sex. It is quite
obvious that a community with a relatively large propor-
tion of persons between 10 and 25 years of age would
have, even under the same sanitary conditions, a lower
death-rate than a community with a small proportion of
persons between these ages, and with a higher proportion
of infants and old people.
[Page] 29
So, too, with sex. Women on the average live longer
than men, and therefore a population with a large number
of females has - all other things being equal - a lower death-
rate than one with a smaller proportion.
In all reports on vital statistics the word "rate" is con-
tinually occurring, and in this first annual report it may
not be out of place to briefly describe what is meant by it.
The total number of deaths for the year 1891 in the Upper
Ward was 702; in the Middle, 2,908; and in the Lower,
539; but these figures, as they stand, give no indication
as to whether the mortality was highest in the Upper,
Middle, or Lower Wards. It is customary, therefore, for
purposes of comparison, to state the number of deaths that
occur in each thousand of the population: thus, in the
Upper Ward, with its population of 37,005, a total of 702
deaths is equal to 18·9 for every 1,000 people living in the
various parishes comprised in the Upper Ward District, or,
if decimals are to be avoided, 189 deaths for every 10,000
inhabitants. In dealing with small figures, as in the case
of the rates for scarlet fever and other zymotic diseases, it
is not unusual to give the rates per million instead of per
1,000, so as to avoid carrying the figures to three or four
decimal places; but I have preferred, for the sake of
uniformity, to give the rates per 1,000 in every instance.
One fallacy is so common that I think I may venture to
call attention to it, viz., that of expecting the rate for the
district as a whole to be the average of the rates for the
different parishes in the district. As an example, in Table
XVIII., p. 111, we find that the actual total death-rate in the
Lower Ward is 18·39, while the average of the rates of the
different parishes is only 17·29 - a considerable difference.
Were the populations of the parishes equal, then the
average rate would be that for the district as a whole, but
not otherwise, unless as a mere coincidence.
Births and Deaths in the County (Landward). - In the
portion of the county over which the County Council |
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[Page] 30
exercises sanitary administration there occurred, during the
year 1891, eight thousand and seventy-eight (8,078) births,
and four thousand one hundred and forty-nine (4,149) *
deaths, the number of births thus exceeding the number of
deaths by 3,929.
These figures, in a population of 209,308, are equivalent
to a birth-rate of 38·59 per 1,000, and a death-rate of 19·82.
During the same period the rates for the whole of Scot-
land were 31·29 and 20·75 per 1,000 respectively, so that
the County of Lanark compares favourably in both respects
with the country generally.
While this is so far satisfactory it is but right to point
out that the rates for Scotland include the large towns, in
which we do not expect to find the same favourable hygienic
conditions as ought to prevail in the country. Not that we
have by any means throughout "landward" Lanarkshire a
country or rural population in the strict acceptation of the
term. On the contrary, of a large part of the Middle and
Lower Wards it is no exaggeration to say that it forms
almost one large town.
By the kindness of the medical officers for the following
counties I am able to state the rates in 1891:-
--- Total Death-rate.
Renfrewshire - Upper District, --- 19·68
Renfrewshire - Lower District, --- 17·10
Dumbartonshire - Western District, --- 18·72
Dumbartonshire - Eastern District, --- 20·81
Stirlingshire - Central District, --- 22·92
Stirlingshire - Eastern District, --- 17·92
Stirlingshire - Western District, --- 19·96
Ayrshire, --- 19·25
Dumfriesshire, --- 17·82
* These figures are taken from the returns supplied by the local registrars.
They differ slightly from those given in Registrar-General's Quarterly Reports
- the explanation being, that I have stated the actual number of deaths; the
Registrar-General the number of deaths registered.
[Page] 31
TABLE I. - Showing Population, Acreage, and Total Number of Births and
Deaths in the County of Lanark (Landward), in comparison with
Scotland, for the Year 1891.
[Table inserted] |
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[Page] 32
Ages at Death. - Of the total number of deaths in the
landward districts of the county 25 per cent. were in infants
under 1 year, or, as usually stated, 125 per 1,000 births.
Between the ages of 1 and 5, 620 deaths took place,
making for children under 5 years of age a total mortality
of 1,631, or a death-rate of 7·8 per 1,000 of the whole
population. This rate, although often exceeded, suggests
what is not infrequently too manifest in the course of our
inspections, a great waste of child life, due to ignorance,
carelessness, and deficient house accommodation.
The deaths in persons over 60 years of age numbered
941, or 70 less than the number of children who died under
1 year.
Causes of Death. - Throughout the landward portion of
the county 623 deaths were registered as due to preventable
diseases, yielding a zymotic rate of 2·976 per 1,000. Of
these diseases, as is seen from the accompanying table,
diarrhœa was the most fatal, and to this is due very largely
the high mortality in children, 153 of the total of 175 being
in children under 5 years of age Diphtheria also was
responsible for a large share of the zymotic mortality, there
being 90 deaths recorded, while from enteric or typhoid
there were 92 deaths.
These three diseases, diarrhœa, diphtheria, and enteric or
typhoid, all of which are pre-eminently filth diseases -
diseases, that is to say, dependent for their propagation and
development on impure air or impure water - thus con-
tribute 357 deaths during the year.
From tubercular diseases there died during the year
the large number of 505 persons, and of these deaths 318
were due to pulmonary consumption.
The only other cause of death to which I will specially
refer is "violence," to which 190 deaths (or 4·6 per cent. of
the total mortality) were attributed. As might be expected
from the nature of their industries, the Middle and Lower
Wards had the highest proportion of violent deaths.
[Page] 33
[Table inserted - not complete - corrected on next page] |
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[Page] 33
TABLE II. - Births and Deaths occurring in each Ward of the County of Lanark (Landward) during the year 1891.
[Table inserted]
* Number of Deaths from these causes not ascertained for Upper Ward. |
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[Page] 34
TABLE III. - Density of Population, Birth-rate, Infantile and other Death-rates in each Ward of the County
of Lanark for the year 1891.
[Table inserted]
* Number of Deaths from these causes not ascertained for Upper Ward.
† Calculated on combined populations of Middle and Lower Wards. |
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[Page] 35
UPPER WARD.
PART I.
The chief matters of sanitary importance which have
occurred in the Upper Ward during the year 1891 have
been the appointment of the County Inspector, Mr. Duncan
Glen, who began his duties on 15th May; the adoption of
the "Infectious Disease (Notification) Act, 1889;" the
consideration of Dairies and Cowsheds Regulations; the
appointment of officers under the Sale of Food and Drugs
Act; and the adoption of a scheme for supplying Law
District with water.
Compulsory Notification of Infectious Disease. -
The Notification Act came into force on the 13th of
July, since which period a total of 226 cases have been
reported, equal to an average of 9 per week, and at a cost
to the ratepayers of £27.*
The provisions of a measure like this on its first intro-
duction appear to many to involve considerable interference
with the liberty of the individual; but I entertain no doubt
that its advantages among a population so dependent upon
their freedom from anything likely to interfere with their
trade of dairy farming will become evident.
Hospital Accommodation. - Closely connected with com-
pulsory notification of infectious disease is the question of
hospital accommodation, and already considerable difficulty
is being experienced in such parishes as Carluke, Carstairs,
Carnwath, and others in isolating patients suffering from
infectious disease.
* Ten of the total number of cases were not notified by private medical
practitioners, some coming under the direct notice of the County Medical
Officer and of the Sanitary Inspector. |
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[Page] 36
TABLE IV. - Weekly Return of "Notifications"
in the Upper Ward from 13th July to 31st
December, 1891.
[Table inserted]
Those marked with an asterisk (*) are cases not notified by medical
practitioners. Two were certified by County Medical Officer, the others by
householders.
[Page] 37
The only hospital in which the District Committee have
an interest is that at Lanark, which is a joint-hospital
intended originally for the Parish of Lanark and the Burgh
of Lanark, and contains a total of 8 beds, of which none
are reserved exclusively for either the burgh or the land-
ward portion of the parish. As the hospital accommodation
for a population of 40,000 ought to be something like 40
beds, it is obvious that the Upper Ward is deficient in the
means of isolating its infected sick. To this the District
Committee are alive, and I have been instructed to prepare
a report on the whole subject, which will shortly be presented.
Allied to the subject of hospital accommodation is that
of disinfection of clothing, and this also will be considered
in the hospital report. At present there are no special
means for the proper disinfection of clothing and other
articles from infected houses in the Upper Ward.
Dairies, Cowsheds, and Milk-shops. - A considerable
number of the inhabitants of this portion of the county are
interested in dairy farming, and for them the subject of
Dairies and Cowsheds Regulations possesses a special
interest. I submitted to the District Committee draft
regulations, which were remitted to a sub-committee to
consider and report upon.*
Food and Drugs. - The Sale of Food and Drugs Acts,
1875 and 1879, have also been brought before the Com-
mittee, and the sanitary officials, with the inspectors of
Weights and Measures, have been appointed officers under
the Acts, with the view of having them put into immediate
force. Instructions to the various officers are being printed.
Water Supply and Drainage. - The question of water
supply in the Upper Ward does not assume the same acute
form that it does in the Middle and Lower Wards of the
county. A large part of the district consists of hilly land
* Since confirmed by District Committee of Upper Ward. |
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[Page] 38
but sparsely populated, and devoted mainly to grazing. The
water from the hill sides is not, therefore, liable to specific
contamination, and is more than ample, as a rule, for the
needs of the people. There are, however, one or two
localities - such as the mining villages of Law, Haywood,
and Wilsontown, and also the village of Carstairs - where
the water supply has been from time to time defective.
The Committee have taken steps, at an estimated cost of
£3,200, to provide Law with a suitable water supply - that
part of Carluke Parish having been constituted a Special
Drainage and Water Supply District.
The Caledonian Railway Company have also been called
upon to improve the water supply to their workmen's
houses at Carstairs.
Carluke and Douglas have been constituted Special
Drainage and Water Supply Districts; Lesmahagow, a
Special Drainage District; and Crawford, a Special Water
District.
Scavenging. - There are comparatively few populous
places in the Upper Ward; still there are villages, like Hay-
wood, Tarbrax, Lesmahagow, Carluke, and others, where a
proper system of cleansing and scavenging might with ad-
vantage be instituted. It ought to be in the power of these
localities to constitute special cleansing districts, where the
inhabitants of such a district would be assessed for the
expenses incident to the cleansing and scavenging of their
streets, yards, and ashpits. While, in the other wards of the
county, it might not appear so much of an injustice to rate
every one for scavenging purposes, it would be manifestly
unfair to make a general rate in the Upper Ward, as there
are many who would derive no benefit from the money
expended in scavenging. In Crawford Parish, for example,
with its area of 65,400 acres, the inhabitants outside the
village of Crawford might reasonably complain if they were
called upon to pay for the cleansing of the village, with its
very limited area.
[Page] 39
Pollution of Rivers. - As regards river pollution, it is
scarcely worth while touching upon the subject, seeing that
a general report on the pollution of the Clyde and its tribu-
taries is being prepared. It is sufficient here to say that, for
nearly the whole of its course through the Upper Ward, the
Clyde and the streams flowing into it are comparatively
pure, and afford good fishing. Near to where it enters the
Middle Ward, coal working becomes, as elsewhere, one of
the chief, if not the chief, cause of pollution. The sewage
discharged bears, as a rule, a small proportion to the
volume of water flowing in the stream.
Special Visits and Reports, either in writing or verbally,
have been made with reference to the following, viz.:-
(1) Nuisance in a field near Railway Station at Lesma-
hagow, caused by the sewage from adjoining cottages, and
which has now been satisfactorily remedied by the con-
struction of a proper drain, and irrigation before sending
into river; (2) outbreak of enteric fever at Haywood, more
particularly with reference to milk supply; (3) outbreak of
scarlet fever at Braehead, with closing of school; (4) occur-
rence of scarlet fever at Kype Water Head Farm traced to
a case which had escaped observation on a neighbouring
farm; (5) Inspection of Douglas Village, with special
reference to deficient privy accommodation and drainage;
(6) outbreak of enteric fever at Carluke, and inspection of
piggeries there.
With regard to the privy accommodation at Douglas,
the chief difficulty in many cases appears to be that the
owners have practically no land on which to build proper
closets, and recourse is had, therefore, to public privies which
are in process of being greatly improved and extended.
The outbreak of enteric fever at Carluke occurred
towards the end of the year chiefly in Heather Row,
Engine Row, Castlehill, and Stewart Street. Some of the
cases, especially those in Stewart Street, were of a virulent
character. The conditions affecting the spread of the |
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[Page] 40
disease appeared to be chiefly filthy surroundings, and
direct infection due to overcrowding, want of means of
isolation and of proper disinfection. The milk and water
supplies were carefully investigated, but with an entirely
negative result. The Sanitary Inspector has been, and still
is, devoting his attention to the removal, so far as can be
done at present, of the conditions which, in our opinion,
contributed to the spread of the disease.
From the summary of the Sanitary Inspector's report I
extract the following figures, which show that, since his
appointment, Mr Glen has energetically devoted himself to
his work:-
Total Inspections, --- 3048
Nuisances dealt with, --- 630
Visits of Inquiry under Infectious Disease Notification Act --- 1,020
The directions in which sanitary reform in the Upper
Ward may be reasonably expected are - improvements in
the dwellings of the mining classes; in farm buildings,
which will to a large extent result from the Dairies and
Cowsheds Regulations; in ashpit and privy accommoda-
tion, and in drainage.
PART II.
For the greater part of the information on which my
calculations are based, I am indebted to the courtesy of
the various Registrars throughout the Upper Ward. No
arrangement has yet been made for the remuneration of
these gentlemen, as the conditions in a sparsely populated
district, such as are now under consideration, differ widely
from those in the Middle and Lower Wards of the County,
and it was considered unlikely that the same amount of
detail in the returns would be required.
As, however, the forms issued by the Board of Super-
vision towards the end of the year for the purposes of
this annual report are the same for the whole county,
[Page] 41
and are of an exhaustive character, the question of pay-
ment of Registrars for the necessary returns will have to
come under the consideration of the committee.
Population and Acreage. - The Report on the Census
taken in 1891 has not yet been published, but the
following figures, obtained from the Registrar's Returns,
may be taken as fairly accurate.
According to these, the total population of the Upper
Ward is 42,940. Deducting the population of the Burghs
of Biggar (1,356) and Lanark (4,579) there remains a
total landward population of 37,005, and it is on this
figure that the calculations for the Upper Ward are
based in this report.
The area of the district, exclusive of burghs, is 326,980
acres, giving an average of 8·8 acres to each person, or,
as it is usually stated, ·11 persons per acre. The highest
proportion of persons to the acre, as is seen in Table VI.,
is ·52 in the Parish of Carluke.
It is, of course, sufficiently obvious that the population
is not thus evenly distributed, and that in the more
populous villages the density must be very much greater
than these figures indicate. It is recognised by students
of vital statistics, and was clearly brought out by the
late Dr. Farr, that there is a definite relation between
density of population and mortality. That being so,
the death-rate of the Upper Ward ought to be among
the lowest in the kingdom.
Births and Deaths. - During the year 1891 there were
registered in the Upper Ward, excluding the Burghs of
Biggar and Lanark, 1,231 births and 702 deaths, or an
excess in births as compared with deaths of 529.
The birth-rate for the whole landward district is
33·26 per 1,000 of the population, while in the various
parishes (Table VI.) it ranged from 44·5 in Carnwath to 9·5
in Culter. |
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[Page] 42
Zymotic Diseases. - From zymotic diseases a total of
94 deaths was registered, of which Carluke and Lesmahagow
contributed 55 - a number considerably in excess of their
proportion according to population. In Dolphinton,
Dunsyre, Lamington, Libberton, Walston, and Wiston and
Roberton no deaths from zymotic diseases were registered.
The total zymotic death-rate for the whole district is
2·540 per 1,000 of the population, while in the various
parishes it ranges from 5·05 in Covington and Thankerton
to nil in the parishes already named.
The zymotic rate is thus made up -
Smallpox, --- 0·000 per 1,000.
Diphtheria, --- 0·243 per 1,000.
Scarlet Fever, --- 0·162 per 1,000.
Typhus, --- 0·000 per 1,000.
Enteric or Typhoid, --- 0·513 per 1,000.
Measles, --- 0·568 per 1,000.
Whooping Cough, --- 0·568 per 1,000.
Diarrhœa, --- 0·486 per 1,000.
[Total] 2·540 per 1,000.
The points of interest in connection with the figures for
zymotic diseases are (a) the total zymotic rate for the whole
district is below the average - which may be put at 3·3 per
1,000 for the whole country - but not more so than we have
a right to expect from the conditions which ought to prevail
in the Upper Ward; (b) the rate of 0·51 for enteric or
typhoid fever is above the average rate, which is 0·32 per
1,000, and is much above the rate for a healthy district.
As the cases of fatal typhoid are confined to Carluke and
Lesmahagow, with the exception of one in Symington, it
follows that the sanitary condition of portions of these
parishes is of an unfavourable character - the occurrence of
typhoid fever being the test par excellence of hygienic condi-
tions. It is on the other hand, extremely satisfactory to
note that no death from typhoid occurred in 17 out of the
20 parishes.
[Table inserted] |
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[Page] 43
Phthisis or Consumption. - The number of deaths from
this malady has been 52 in the whole district, or over 7 per
cent. of the total mortality, and equal to a rate per 1,000 of
1·405 - a rate which may be regarded with satisfaction as
being below the average.
Cancer. - To this and other malignant diseases 23 deaths
were attributed, viz., 6 in Carluke, 1 in Carmichael, 4 in
Carnwath, 4 in Carstairs, 1 in Crawfordjohn, 1 in Dolphinton,
3 in Lanark (landward), 2 in Lesmahagow, and 1 in
Symington.
Violence. - From the different forms of violence the
comparatively large number of 28 deaths was registered,
viz., 1 in Biggar, 7 in Carluke, 6 in Carnwath, 4 in Carstairs,
1 in Crawford, 1 in Culter, 1 in Lanark, and 7 in Lesma-
hagow.
The death-rate from all causes is 18·97 per 1,000, and
is considerably higher than might be expected in a popu-
lation living under the conditions of the great majority of
the people in the Upper Ward.
As regards parishes, the highest rate is found in the
Parish of Symington, where 11 deaths were registered in a
population of 432, equal to a mortality rate per 1,000 of
25·4, while in the Parish of Dunsyre, with a population of
191, no death was registered during the year. I must here,
however, point out the fallacy of judging from the death-
rate of one year of the comparative healthiness of two or
more parishes with populations so small as those possessed
by the majority of the parishes of the Upper Ward. In
order to be of much value, the average rate for a series of
years not less than 10 should be adopted.
Mortality at different ages. - Of the total of 702 deaths
134 were in children under 1 year. Calculated in relation
to the number of births during the year, this number
gives a rate of 108 per 1,000 births, and indicates a very |
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[Page] 44
favourable rate of mortality among infants. Throughout
Scotland generally the infant mortality rate is about 120
per 1,000 births, while in England it is much higher.
The low infantile mortality in the Upper Ward is, no
doubt, due in great measure to the greater care exercised
by the mothers in feeding and nursing - their occupations,
as a rule, permitting them to devote much more care
and attention to their children than mothers living in
large manufacturing towns where female labour is so
largely employed are able to do.
In Carmichael, Dolphinton, Dunsyre, Lamington, Sym-
ington, and Walston parishes no deaths of infants under
1 year were registered.
Among children between 1 and 5 years of age 78 deaths
took place, which, with 134 deaths under 1 year, give a
total of 212 deaths in children under 5 years, or 30 per
cent. of the total mortality.
Forty-seven (47) deaths were in persons between 5 and
15 years; 40 between 15 and 25; 134 between 25 and 60;
and 269, a large proportion of the total, in persons over 60
years of age. |
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Unable to see table on second page - looks as if it might be folded |
| HH62/2/LANARK/45 |
TABLE V. - Births and Deaths occurring in the UPPER WARD District during the year 1891.
[Table inserted]
* A portion of Culter Parish has been transferred to the County of Peebles. |
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TABLE VI. - Density of Population, Birth-rate, Infantile, Zymotic, and other Death-rates in the Upper
Ward District for the year 1891.
[Table inserted] |
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| HH62/2/LANARK/47 |
[Page] 47
TABLE VII. - Cases of Infectious Disease coming to the knowledge of the Medical Officer during part of the year 1891
from 13th July to December 31st in the District of the Upper Ward.
[Table inserted]
* Of these, 10 were not notified by medical practitioners, but came directly under the notice of County Medical Officer and Sanitary Inspector. |
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[Page] 48
MIDDLE WARD.
PART I.
THE matters which have chiefly engaged my attention
in the Middle Ward since my appointment in May,1891,
until the end of the year are -
(a) Hospital Accommodation.
(b) Disinfection.
(c) House Accommodation.
(d) Water Supply.
(e) Drainage.
(f) Regulations for Dairies, Cowsheds, and Milkshops.
(g) Infectious Disease Notification Act.
(h) Pollution of Rivers.
(i) Organisation of Returns of Births and Deaths.
Hospital Accommodation. - To the Committee ap-
pointed to consider this question I presented two reports
- the first dealing with the existing hospital accommodation
in the district of the Middle Ward, with map showing
position of the various hospitals and the localities for which
they are available; and the second dealing mainly with
various schemes for providing hospitals on a more complete
scale.
In the first it was shown that in the Middle Ward there
are seven hospitals available for cases of infectious disease,
of which two - viz., those at Blantyre and Bellshill - are
under the sole control of the District Committee; while in
the other five the Local Authorities, prior to the formation
of the County Council, had formed joint-hospitals with the
Burghs of Airdrie, Coatbridge, Hamilton, Motherwell, and
Wishaw. The condition generally of the hospitals was
described, and the number of beds available for the land- |
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[Page] 49
ward part of the district given as 91. After a full discussion,
the Committee requested me to lay before them alternative
schemes of small and large hospitals, and to leave out all
consideration of the present hospitals so as to have the
way clear for a scheme which would, untrammelled, best
suit the wants of the Middle Ward as a whole. Accord-
ingly, in my second report, while dealing more definitely
with the number of beds required, and showing that, as
suggested by Mr. Dobson, the basis of one bed per thousand
of population was too low an estimate for a population
where a large proportion lived in one and two roomed
houses, two schemes were considered, viz., (1) that of erecting
seven small hospitals throughout the district; and (2) that
of providing two or, at most, three large central hospitals.
The advantages and disadvantages of these schemes were
discussed in the report; and a third scheme was recom-
mended which embodied the best features of the other two.
This scheme was unanimously adopted by the Committee,
and accepted at their next meeting by the District Com-
mittee. By it, when carried out, practically the whole of
the inhabitants of the Middle Ward will be within four
miles of a fever hospital.
The following is the report which, in view of the import-
ance of the decision arrived at, I give in full:-
TO THE CHAIRMAN AND MEMBERS OF THE DISTRICT
COMMITTEE OF THE MIDDLE WARD.
GENTLEMEN,
In my previous report on this subject I described the
hospital accommodation at present available in the Middle
Ward, and indicated in what respects it fell short of our
requirements for the proper isolation of infectious cases.
After careful consideration and discussion, the Hospitals
Committee were of opinion that, in preparing a scheme
or schemes for the provision of hospitals on an adequate
and comprehensive scale, the present joint-hospitals for
several reasons might be left out of the question.
The population of the Middle Ward, exclusive of the
Burghs, was, according to the available returns of last
[Page] 50
census, 143,000 in round numbers, and for this number, on
the usual basis of one bed per 1,000 of the population,
practically 140 beds are necessary.
In a report placed in my hands by Mr. Dobson, whom,
at an early stage of this inquiry, I asked to assist me with
his complete local knowledge and experience of existing
difficulties, he points out that an unusually large pro-
portion of the inhabitants of the Middle Ward live in one
and two-roomed houses, where attempts at isolation are
consequently futile. He also takes into account the
number of cases notified for some months back, and
argues that no fewer than 263 beds are necessary to fully
meet the requirements of the Middle Ward.
There is, however, what appears to me a fallacy in
estimating the number of beds required from the average
of cases lately notified.
Our present hospital accommodation is obviously de-
ficient, and we have not therefore had a fair opportunity
of combating the spread of the various infectious diseases.
With better accommodation and a more thorough system
of disinfection, we ought to be able to diminish the number
of cases, otherwise the building of hospitals and consequent
isolation of patients fail in their main object.
The first argument is one, however, which must not be
lost sight of, viz., the large proportionate number of small
houses; and, after due consideration, I am of opinion that
it would be safer to provide a total of 180 beds for present
necessities.
The question then arises of how these are to be dis-
tributed.
Two schemes at least suggest themselves - (A) one by
which small hospitals are placed in situations so chosen
as to be within easy distance of the population they are
intended to serve; the other (B), by which larger hospitals
are more centrally situated so as to command a larger area.
A. - By the first scheme I am of opinion that seven
hospitals would be necessary, viz.:- One near Glasford
Station, with 14 beds, for a population of 10,000; a second
at Larkhall, with 26 beds, for 20,000; a third at Blantyre
or Cambuslang, with 36 beds, for 30,000; a fourth at
Bellshill, with 38 beds, for 32,000; a fifth at Airdrie,
with 36 beds, for 28,000; a sixth at Shotts, with 16 beds,
for 12,000; and the last near Cambusnethan, with 14 beds,
for 11,000. |
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[Page] 51
It will be observed that this gives exactly the same
number of hospitals as are at present available, with the
important differences that under this scheme they would be
more centrally situated, give more accommodation, and
be under the sole control of the Committee.
--- No.of Beds. --- Population.
Glasford, --- 14 --- 10,000
Larkhall, --- 26 --- 20,000
Blantyre, --- 36 --- 30,000
Bellshill, --- 38 --- 32,000
Airdrie, --- 36 --- 28,000
Shotts, --- 16 --- 12,000
Cambusnethan, --- 14 --- 11,000
[Total] --- 180 --- 143,000
Of the two hospitals belonging exclusively to the Middle
Ward District Committee, that at Bellshill can be utilised
for one of the seven. At present it contains two wards,
having eight beds in each, with an administrative portion.
There would fall to be added to it, in order to make it a
thoroughly good hospital, a new administrative block, and
at least other two wards containing each ten beds.
The other - that at Blantyre - is a substantially-built
hospital, but contains only two wards, capable of accom-
modating twelve beds, although at present sixteen are
placed in these wards. Considering that the hospital in
this part of the district ought to serve for a population of
30,000, it is obvious that extensive alterations and additions
would be necessary; and it is a question whether, owing to
the limited size of the site (about half an acre), and the
more central position of Cambuslang, it would not be
better to build a new hospital nearer the latter place.
In connection with this scheme of seven smaller hospitals
several points have to be specially considered. One is that
they must be so situated as to be able to command the
services of a medical man by day and by night; another
that they ought, for various reasons, to be at no great
distance from a railway station; and a third, that they
must be easy of access by road.
B. - By the second scheme, viz., that of providing larger
hospitals, three would, in my opinion, be absolutely
necessary. Thus, one containing 72 beds might be
built in the immediate neighbourhood of Hamilton for a
[Page] 52
population of 58,000; the second near Wishaw, with 40 beds,
for a population of 32,000; and the third between Airdrie
and Coatbridge, with 68 beds, for a population of 53,000.
--- No. of Beds. --- Population.
Hamilton, --- 72 --- 58,000
Wishaw, --- 40 --- 32,000
Airdrie, --- 68 --- 53,000
[Total] --- 180 --- 143,000
I. - HAMILTON, 72 beds, 58,000 population.
A hospital of this size, and so situated, would provide
accommodation for a population of 58,000, made up as
follows:-
Avondale, --- 5,069
East Kilbride, --- 3,781
Glasford, --- 1,317
Blantyre, --- 11,352
Cambuslang, --- 15,364
Hamilton (landward), --- 6,712
Dalserf, --- 11,325
Stonehouse, --- 3,400
[Total] --- 58,320
So far as I can ascertain, seventy per cent. of the popula-
tion would be within six miles of the hospital; twenty per
cent. within eight miles; while the remainder would be
beyond that radius. The farmhouses situated in Avondale
beyond Strathaven would be the farthest dwellings, two of
them being about fourteen miles distant from Hamilton.
2. - WISHAW, 40 beds, 32,000 population.
The parishes served by this hospital would be as under:-
Cambusnethan, --- 10,626
Shotts, --- 11,957
Dalziel, --- 1,343
Bothwell (part of), --- 8,000
[Total] --- 31,926
With the exception of a large part of Shotts parish the
whole of the population would be within easy distance of
the hospital. Some parts of Shotts parish, comprising the |
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[Page] 53
villages of Harthill, Benhar, Northrigg, and Eastfield,
would, however, be considerably beyond six miles, in some
instances as much as ten miles by road.
3. - AIRDRIE, 68 beds, 53,000 population.
Such a hospital would provide accommodation for the
parishes of New Monkland, Old Monkland, and part of
Bothwell.
New Monkland, --- 14,608
Old Monkland, --- 14,736
Bothwell (portion), --- 23,419
[Total] --- 52,763
Over 80 per cent. of this population would be within
five miles of the hospital, but there would remain some-
thing like 8,000, chiefly at Longrigg, Longriggend, Rough-
rigg, and other mining villages separated from the hospital
by a distance of seven or eight miles.
The advantages of large hospitals over small ones are
so obvious as to scarcely require enumeration. They are -
(a) Less cost per bed.
(b) Less cost for accessories, as laundry, disinfecting
stove, &c.
(c) Proportionately smaller expense for management
and nursing, and maintenance of patients.
(d) Greater efficiency, as allowing of a more per-
manent and thoroughly equipped staff.
The one great disadvantage is the greater distance from
parts of the district in urgent need of hospital accom-
modation. With well-constructed ambulances it is, perhaps,
possible to convey the majority of patients a distance of
eight, or even ten miles, although in even a moderately
severe case of typhoid fever, I would not take the respon-
sibility of removing a patient as far as eight miles.
With human nature as it is, the removal of a patient
to a hospital situated a considerable distance from home,
and to a locality comparatively unknown to them, is always
a severe trial to the relatives. This sentiment, if we may
call it so, appeals to every one, and certainly not least to
those who, like myself, have had frequent occasion to
prevail upon parents to allow young children to be
taken from under their own care. When the hospital is
situated in the neighbourhood, and at a place where it
[Page] 54
can be conveniently visited, then it becomes much easier
to accomplish the removal of patients.
This, of course, tells very strongly in favour of establish-
ing a number of small hospitals.
The whole subject is one of so much importance,
involving as it does an expenditure of a large sum
of money, and what is of greater importance, the
safety of the public health and the comfort and care of
the sick, that I am extremely anxious to have the subject
fully and carefully thought out before committing our-
selves to any scheme; and, for this reason, I do not
regret the apparent delay which has taken place in
coming to a definite decision.
It is for this reason also that I venture to go beyond
the terms of the remit, and to offer for your consideration
a third scheme which may commend itself to you, as
embodying the best features of the other two. This is
the establishment of one large central hospital and three
small hospitals.
It is, I think, apparent that such places as Strathaven
and adjoining villages, Longriggend and Roughrigg, and
practically the whole of Shotts, are too far removed to
allow of patients being conveyed to central hospitals.
For them I would therefore suggest an arrangement as
follows:-
1. A hospital near Glasford Station, containing 14 beds
for a population of 10,000, made up as follows -
Avondale, --- 5,069 population.
Glasford, --- 1,317 population.
Stonehouse, --- 3,400 population.
[Total] --- 9,786 population.
2. A hospital between Shotts Station and Harthill,
containing 16 beds for a population of 13,000, viz.,
nearly the whole of Shotts parish and a portion of
the parish of Cambusnethan.
3. A hospital near Greengairs, or other convenient
place for the mining villages in that part of New
Monkland parish, containing 16 beds for a popu-
lation of about 12,000.
4. A large central hospital, situated near Hamilton or
Motherwell, containing from 100 to 140 beds for
the rest of the Middle Ward. |
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[Page] 55
Over 80 per cent. of the inhabitants of the Middle Ward
would in this way be within seven miles of one or other
hospital.
A modification of this scheme might be adopted were
the Lower Ward District Committee, who are also now
considering this subject of hospital accommodation, to
combine with the Middle Ward Committee in erecting a
joint-hospital between Cambuslang and Blantyre. Such a
hospital might contain about 40 beds, of which the Lower
Ward would require 15 for the Shettleston and Tollcross
portion of their district.
This would necessitate a central hospital of not more
than 100 beds, and would enable a site to be chosen
still more convenient for the remainder of the population,
as, for instance, in the neighbourhood of Motherwell.
As to comparative cost of small and large hospitals, I am
of opinion that the cost per bed in the former need not
exceed £120 per bed, exclusive of site, and in the latter
£100 per bed.
I am, Gentlemen,
Your obedient Servant,
JAS. McLINTOCK.
COUNTY OFFICES,
HAMILTON, Jan., 1892.
On the same day on which I received the proof of the
foregoing report from the printer, Mr. Dobson's report on
the same subject was placed in my hands. It was at once
forwarded to the printer, and is now appended. Mr. Dob-
son's estimate per bed for large hospitals is under, and for
small hospitals above, the figures given by me.
J. McL.
GENTLEMEN,
From further enquiries I learn that hospitals upon the
pavilion style can be erected at the rate of from 3 1/2d. to
4 1/4d. per cubic foot, according to the character of the
arrangements and artistic work displayed upon them.
For instance, a pavilion capable of accommodating 30
patients, such as is provided at Belvidere, with the most
approved appliances for heating and ventilation, oak
polished floors, white brick string courses, and arches to all
[Page] 56
the walls, can be erected at the rate of 4 1/4d. per cubic foot,
or £80 per bed; but I presume a less elaborate structure
will suffice for the Middle Ward, such as delineated upon
the plans herewith submitted.
The material with which they are to be constructed is
brick, 16 inches thick, with a hollow space between the
outer 9-inch and inner 4 1/2-inch facing of brickwork, with a
damp course of third-class Caithness paving, and white
string brick courses, and arches to the walls forming the
front elevation, and one of the side walls of each pavilion.
The interior of the walls to be plastered with Keen's
cement, the ceilings with the ordinary plaster. The floors
laid with Quebec red pine flooring, 3 inches broad.
The wards could be heated by an ordinary fire at one
end, and a slow combustion stove at the other, and
ventilated by openings in the side walls for the admis-
sion of fresh air, and the extraction of the foul by the
aid of ventilators placed upon the ridge of the roofs, and
by flues heated by the fires and stoves.
Pavilions constructed upon these lines can be erected at
a rate of 3 3/4d. per cubic foot, and as these shown on plan 2
contain 61,375, the cost to erect the two will be £960.
The walls of the administrative department will be of
the same construction as the wards, and the internal fittings
of the plainest character, so that the rate per foot will not
exceed 6d. for one part of it, and 5d. for the kitchen and
offices - the two costing £419.
In selecting a site I presume that one with its boundaries
40 feet distant in all directions from the extreme points of
the hospital will meet the requirements of the institution,
and assuming that it will be necessary to enclose it upon
three of its sides, with a wall 6 feet high, and the fourth
with a dwarf wall, railing, and gate, the cost in doing so
will be £230.
For van shed, washing-house, mortuary, and disinfecting
room, £140.
The total cost being as follows:-
HOSPITAL WITH 20 BEDS.
Pavilions, --- £960.0.0
Administrative Department, --- £419.0.0
Enclosing of site, --- £230.0.0
Van sheds, &c., --- £140.0.0
Total, £1,749, or at the rate of £87 9s. per bed. |
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[Page] 57
HOSPITAL FOR 10 BEDS.
Pavilions, --- £535.0.0
Administrative Department, --- £419.0.0
Boundary walls, --- £200.0.0
Van sheds, &c., --- £100.0.0
Total, £1,254, or at the rate of £125 8s. per bed.
I am,
Your obedient Servant,
JAMES DOBSON.
PUBLIC HEALTH DEPARTMENT,
UDDINGSTON, 11th January, 1892.
The question of sites for the various hospitals is now
under the consideration of the Committee.
Disinfection. - The means for disinfection of clothing,
bedding, &c., at the disposal of the sanitary officers are
totally ineffective in the Middle Ward, as well as in the
rest of the county. Recognising that much haziness existed
in the minds of the public generally as to the real signifi-
cance of disinfection, I issued a report in pamphlet form,
part of which I have reproduced at page 87 of this report.
The establishment of one or two public disinfecting stations
for the use of the Middle Ward is an absolute necessity,
and I have no doubt that such will be supplied, probably
in connection with the larger hospitals.
House Accommodation. - While dealing with the
county as a whole, I made reference to this subject, and
can add little as regards the Middle Ward, beyond saying
that it is in this part of the county that one meets with
the greatest number of badly constructed and overcrowded
houses.
In Mr. Dobson's report he gives certain statistics - the
accuracy of which I have no reason to doubt - pointing to
[Page] 58
a lamentable deficiency in good house accommodation.
He says that of 3,606 houses visited 2,063 were of one
apartment, and the remainder 1,543 of two apartments. In
the former there were living 9,830 people, or an average of
4·76 persons to each room, and in the latter 11,094, an
average of 7·19 persons per house, or 3·59 persons per
room! In 261 houses of one apartment actually lodgers
were kept, as if in a one-roomed house there were room
enough and to spare beyond what was required for a family.
I do not know that comment upon such a state of affairs is
needed. Still I cannot refrain from pointing out that
under these conditions the moral and physical well-being
of the inmates must suffer deterioration.
But not only were these houses deficient in the amount of
room; many of them were and are damp, undrained, and
out of repair. In short, there are those in the Middle Ward
who consider they have provided a house fit for habitation
when they have erected four brick walls of sufficient thick-
ness to support a roof, into one of which they have placed
a door and window - the latter so that it cannot open - into
another a brick fireplace, with a few iron bars, and against
a third wall, two partially enclosed spaces for beds so
contrived as to give the minimum of ventilation, especially
when the mistress of the house, in her desire to make
things look as comfortable as possible, places a curtain
across these bed spaces. The majority have wooden floors,
especially those built within recent years, and a small press
or cupboard.
Happily all are not alike, and I am glad to find that it is
beginning to be recognised that houses of one apartment
should not be tolerated; and I would like to add that some
colliery proprietors have displayed a laudable desire to
improve the dwellings of their workpeople, both as re-
gards internal arrangements and their surroundings. There
can be no doubt, however, that building regulations are
urgently required to put a check on less scrupulous
individuals. |
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Water Supply. - This is undoubtedly the most im-
portant question which has engaged the attention of the
Committee. During practically the whole of the year the
greater portion of the Middle Ward has suffered severely
from want of water fit for domestic use.
With the exception of the parts supplied by the Bothwell
Water Supply, the Blantyre Water Supply, the Cambuslang
Water Supply, and the Newmains Water Supply Districts,
and the Airdrie and Coatbridge Water Company, the
supply generally for the Middle Ward is from wells, pits,
and streams. Almost without exception the wells are
shallow, situated in gardens, at roadsides, or in fields, and
are liable to pollution.
Analysis of water from these wells frequently showed
contamination from sewage, and, in the case of three of
them, to such an extent as to necessitate closing. These
were at New Stevenston, Stonehouse, and John Street,
Larkhall. The Stonehouse Well, although far from satis-
factory, was reopened after cleaning out and repairing, as
it was found that the people in the neighbourhood were
having recourse to supplies equally objectionable, or even
more so. Many of the mining villages, particularly in the
Parishes of New Monkland, Old Monkland, and Shotts,
depend for their supplies on water pumped up from pits.
It is a well-known fact that such water, in the great
majority of instances, is not free from danger on account of
its almost necessary pollution by the men and horses
employed in the pits. In the case of New Stevenston,
the District Committee have been obliged to arrange for a
temporary supply from a disused working. The water,
however, flows naturally from a bore, and is more of the
nature of spring water than ordinary pit water, and it seems
reasonable to suppose that the contaminating matter has
long ago disappeared. Those unfortunately depending for
their water supply upon streams are, if possible, in an even
worse plight than the others. Any one acquainted with
the district of the Middle Ward knows that the streams,
[Page] 60
with the exception of the upper reaches of the Avon, are
contaminated with sewage or trade refuse, and not in-
frequently both.
Under these circumstances the District Committee re-
solved to boldly grapple with the problem, and introduce a
general supply for the whole of the Middle Ward. To get
rid of an initial difficulty in the way of rating for such a
scheme, a short Bill was promoted at the instance of
the District Committee, and passed successfully through
both Houses of Parliament, becoming law on 5th August,
1891, and known as "The Public Health (Scotland)
Amendment Act, 1891." In accordance with one of its
provisions, the Act was adopted by the District Com-
mittee on 11th September, 1891. Messrs. Leslie & Reid, of
Edinburgh, who had been previously instructed to report
on the best means of relieving the pressing necessities of
the Middle Ward as regards water, then submitted a report
recommending Glengavel, in the Parish of Avondale, and
within the Middle Ward, as the best available source of
supply - this scheme being ultimately adopted by the
Committee. In the course of the consideration of the
scheme, I was instructed to visit and report upon the pro-
posed gathering ground. I inspected it on two occasions,
taking samples - two of which I submitted for analysis to
Dr. Stevenson Macadam, two to Mr. Tatlock, and two I
retained. In September I reported that "the special
feature of this gathering ground is the entire absence of
dwellings or other sources of pollution of a dangerous
character. It is moorland, with a small proportion of peat,
and is, in my opinion, well adapted as a source of water
supply for domestic purposes."
Dr. Macadam reported, as the result of his analysis, that
"the water is free from contamination and noxious matters,
and is pure and unobjectionable in quality. Besides being
suitable for daily household wants, such as drinking, cook-
ing, and washing purposes, the water from its softness will
be found serviceable for steam boilers, and for general |
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manufacturing operations." Mr. Tatlock reported in
similar terms.
Drainage. - In the Middle Ward there are special
drainage districts, in some of which, however, no action
has yet been taken to carry out the purpose for which
they were so constituted.
In Avondale there is practically no proper system of
drainage, although Strathaven, the only populous locality,
was formed into a special drainage district in 1887. A
well-devised scheme, however, has been approved of, and
will, it is expected, be shortly carried out, if not in its
entirety, at least in part. As the situation of the village
lends itself to good drainage, and as an essential part
of the scheme is a large sewage farm, I anticipate for
Strathaven a very great benefit from the proposed
undertaking.
Blantyre was constituted a special drainage district in
1875, and, at considerable expenditure, a fairly comprehen-
sive scheme was carried out. As in many other parts of
the Middle Ward, subsidence of the surface has taken place
from time to time, causing considerable damage to the
drains, and necessitating additional expense. As the
village increased the drains have been extended to meet
the requirements of the new buildings.
Bothwell Parish is a very large one, and a great part of it
is drained by means of open gutters running parallel to
the miners' cottages.
The villages of Bothwell and Uddingston, both of which
are almost entirely residential suburbs of Glasgow, have
been constituted special drainage districts, and possess
fairly good drainage systems, although, in the latter
especially, there are many defective traps, and a want of
flushing appliances.
Bellshill, also in Bothwell Parish, is a special drainage
district, although the extension of the drains has not kept
pace with the growth of the village.
[Page] 62
Cambuslang. - The village of Cambuslang, containing a
large proportion of the inhabitants of the parish, forms a
special drainage district, and possesses a well arranged
drainage system, on which some improvements have been
made during the year. The villages outside, however,
possess no proper drainage system.
Old Monkland. - The only special drainage districts in
this parish are those of Baillieston and Mount Vernon. The
former has experienced considerable difficulty from inter-
ference with the drains by the working of the minerals
underneath, and in some parts it is still unsatisfactory.
The latter includes the villages of Mount Vernon, Carmyle,
Broomhouse, and Barrachnie.
With these exceptions, and that of Stonehouse, which,
although not a drainage district, has a good drainage
system, the rest of the Middle Ward is drained, where it
is drained at all, by the open gutters already described.
These, when well constructed and having sufficient fall,
answer their purpose fairly well. In many instances,
however, the material used has been unsuitable, and the
workmanship careless, so that stagnant pools and polluted
soil are not by any means infrequent, and give rise to the
conditions referred to in the part of the report dealing with
diarrhœa, enteric fever, and diphtheria. No attempt is
made at purifying the sewage before it enters the
streams.
Dairies, Cowsheds, and Milk-shops. - Towards the
end of the year the necessity for having well-defined
regulations for dairies, milkshops, and cow-sheds was
brought before the District Committee, and a Sub-
Committee was appointed to consider and report upon
the draft regulations which I had submitted. These, with
some few alterations of an unimportant character, were
ultimately adopted by the District Committee. Even with
the provision of 400 cubic feet of space for each cow, I
anticipate a great improvement in the condition of the |
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animals themselves, and, as a necessary result, in the quality
of that most important article of diet - milk.
I have not been able to make anything like a complete
inspection of the 238 registered dairies and milkshops.
What I have seen, however, shows me the necessity of
having such regulations as have been submitted for your
consideration. While a fair proportion of the cowsheds
and dairies are well constructed and well kept, many are
badly adapted for the purpose, and carelessly looked after.
In particular, the milk-house is often situated in a position
liable to contamination from the effluvia of the dungstead,
the byre, or the dwelling-house, and as milk, more than any
other article of diet, is liable to be affected by foul
surroundings, it is obvious that the most scrupulous care
must be directed to the milk-house. In one well-marked
instance, Mr. Dobson demonstrated in my presence how the
foul air from the dungstead was unmistakably rushing
through the wall gratings directly into the milk-house of
a large farm. Another milk-house in use I found utilised
as a kind of lumber room, prominent amongst other articles
being a few pairs of old boots.
As this question is likely to engage a considerable
amount of attention, a fuller report will, it is expected, be
submitted at a future date.
Infectious Disease (Notification) Act. - This Act
was adopted in the Middle Ward prior to my appointment
as Medical Officer, the notifications being received by the
County Sanitary Inspector.
Since the adoption of the Act by the other wards of the
county the arrangements have been made uniform, so that
while notifications for the Middle Ward are still forwarded
to Uddingston and addressed to me, the Chief Inspector is
empowered to open them and thus enable his inspectors to
take immediate action. A return is daily sent to the office
in Hamilton, with an account of the case, its surroundings,
and the action taken. The same measures are adopted as
[Chart inserted - not complete - corrected on next page] |
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CHART shewing Number of Cases of Infectious Disease notified in the District of the Middle
Ward during each week of 1891. Red line - represents Scarlet Fever; Blue line - Diphtheria;
Black line - Enteric Fever
[Chart inserted] |
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[Page] 64
in the other parts of the county - the patient is removed to
hospital, where it can be conveniently effected, and the house
disinfected. If the patient be not removed, the Inspector
for the district occasionally visits the house after his first
visit, and advises as to precautions to be taken. After death
or recovery the house is disinfected. Should an examina-
tion of the house and surroundings reveal any sanitary defect,
steps are taken to provide a remedy.
In Table XIV., p. 81, the notifications from each disease
are given for each parish. Two thousand two hundred and
eighty-two cases in all were notified at a total cost of £284 13s.
The weekly average was 44. The number of cases notified
for each thousand inhabitants in the Middle Ward was 15,
and ranged from 8 in Stonehouse to 27 in Dalziel. The
rates for the other parishes are given in Table XIV., p. 81.
The various diseases under the Act were notified in the
following numbers:-
Diphtheria, --- 111
Membranous Croup, --- 38 [bracketed total] 149
Erysipelas, --- 192
Scarlet Fever, --- 1,490
Enteric or Typhoid Fever, --- 417
Relapsing Fever, --- 2
Continued Fever, --- 10
Puerperal Fever --- 21
Diarrhœa, notified as "Cholera," --- 1
Total, --- 2,282
Of these cases only a small proportion were treated in
the different hospitals, viz.:- 1 diphtheria, 3 erysipelas, 39
scarlet fever, and 90 typhoid, a total of 133, or barely
6 per cent. This is in marked contrast to what occurs in
such towns as Birmingham and Bradford, where from 70 to |
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[Page] 65
74 per cent. of the notified cases are removed to the
hospital. When the hospitals already sanctioned by the
Committee are built and ready for use, advantage must be
taken of them to a much greater extent than at present is
the case. My experience, and that of other medical officers,
shows that not only are the cases better isolated in the
hospital, but that the mortality is very much less than
among cases treated at home.
In the accompanying chart the number of cases of scarlet
fever, diphtheria, and enteric fever is shown for each week.
Scarlet fever was most prevalent at the beginning of the
year, while, as is almost invariably the case, typhoid was
most prevalent in the autumn months.
Pollution of Rivers. - At page 23 I have referred to
the pollutions of the Almond and of the Clyde, so that
further reference is unnecessary beyond emphasising the
fact that it is in the Middle Ward the greatest pollution
takes place from coal-washing, ammoniacal liquors, and
sewage. Full details will be given in the report which
the District Committee have specially requested me to
make on the pollution of the Clyde and its tributaries.
Nuisances. - The chief inspector in his report states that
no fewer than 2,838 were brought under his notice and that
of the sanitary inspectors, mostly foul ashpits and privies.
In another part of this report (page 15), I have dealt at
some length with the class of ashpits and closets most
common in the district, and I have no hesitation in saying
that many of them, if not the majority, are simply abomina-
tions, and ought to be swept away.
That the District Committee are anxious to cope with
this depressing state of matters I am well aware, and I am
hopeful that the scavenging arrangements, which they are
considering, will, when put in operation, greatly tend to
diminish the evil.
[Page] 66
Returns of Births and Deaths. - I have already,
when dealing with the county generally, referred to the
great value of periodical returns of births and deaths
(page 20). It is unnecessary to say more here on that
subject. I am very glad to state that the registrars
in the Middle Ward are supplying me monthly with full
particulars of the mortality in the different parishes - par-
ticulars which enable me to furnish the District Committee
with monthly reports on vital statistics.
PART II.
Population and Area. - The Report on the Census of
1891 has not yet been published, and the following figures
are only approximately correct, although sufficiently so for
practical purposes.
The following Table shows the number of people living
at last Census in the Middle Ward, in the burghs, and in
the landward portion:-
Total Population of Middle Ward, --- 250,599
Population of Burgh of Airdrie, --- 19,135
Population of Burgh of Coatbridge, --- 29,996
Population of Burgh of Hamilton, --- 24,863
Population of Burgh of Motherwell, --- 18,727
Population of Burgh of Wishaw, --- 14,869
[Total] --- 107,590
Total Landward Population of Middle Ward, --- 143,009
It is on this number of 143,009 that the calculations in this
report for the Middle Ward District are based.
The area of the district, exclusive of burghs, is 186,780
acres, or an average of 0·76 persons to each acre, or, con-
versely, nearly 1 1/3 acres to each person.
A glance at Table IX., p. 77, shows that, of the fourteen
parishes into which the Middle Ward is divided, the
greatest density of population is in Cambuslang, viz., 2·97 |
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[Page] 67
persons per acre; while in Avondale it is least, with 0·13
persons per acre.
The parishes are grouped for administrative purposes
into three divisions, named respectively - First, Second,
and Third.
The First Division includes the Parishes of Avondale,
East Kilbride, Glasford, and Stonehouse, having a popula-
tion of 13,567, and an area of 72,976, or an average density
of 0·18 persons per acre; the Second includes the Parishes
of Blantyre, Bothwell, Cambuslang, Cambusnethan, Dalserf,
Dalziel, and Hamilton, having a population of 88,141, and
an area of 61,087 acres, or an average density of 1·44
persons per acre; while the Third includes the Parishes of
New Monkland, Old Monkland, and Shotts, having a popula-
tion of 41,301, and an area of 52,717 acres, or an average
density of 0·78 persons per acre. (See Tables X. and XI.)
As was pointed out in the case of the Upper Ward, but
which, indeed, scarcely requires referring to, this average
density is, to some extent, a hypothetical one, as in every
parish there are more populous villages or towns where the
density is as great almost as in a large town.
Births. - In the landward portion of the Middle Ward
District there were registered during the year 1891 five
thousand eight hundred and fifty-three births (5,853), or a
birth-rate of 40·9 per 1,000 of the population. That this is
an exceptionally high rate may be judged from a compari-
son with the birth-rate for Scotland for 1891, which was 31·3.
Of these 5,853 births, 3,032 were males and 2,821
females, contrary to the usual rule, by which the majority
of children born are females. Three hundred and nine
(309) were illegitimate, or a proportion of 1 in every 19
births - a proportion which compares very favourably with
other parts of the kingdom.
The birth-rates in the various parishes ranged from 24,
in the Parish of Avondale, to 47 per 1,000, in the Parish of
New Monkland.
[Page] 68
Calculated according to divisions, the rates were 27·5 in
the First, 41·8 in the Second, and 43·3 in the Third.
Deaths. - The deaths from all causes during the twelve
months under consideration numbered 2,908 - rather less
than half the number of births, and equal to a rate per
1,000 of 20·33. This is not by any means a favourable
death-rate, and greatly exceeds the 17 per 1,000 which Dr.
Farr estimated as a normal death-rate for a population
partly urban and partly rural.
Among the parishes, Blantyre has the highest death-
rate, viz., 23·25; Bothwell coming next with 22·80; while
Glasford has the lowest, 12·14 per 1,000.
According to divisions, the rates are 16·28, 19·51, and
21·34 per 1,000, in the First, Third, and Second respectively.
Ages at Death. - As the details of the Census are not
yet published, it is impossible to give the rate of persons
dying at various age-periods in terms of the number of
persons living at these ages. This it is proposed to give in
future reports, as such information is absolutely necessary
in order to judge correctly of the relative mortality of
different districts.
Infantile Mortality. - In the landward portion of the
Middle Ward District, 752 deaths, out of the total of 2,908,
were in infants under 1 year. Stated in terms of the
infantile population - that is, practically, the number of
births during the year - the infantile mortality rate is 128
per 1,000 births. In the First Division it was 77; in the
Second, 136; and in the Third, 122. Considerable im-
portance attaches to the infantile death-rate as affording
evidence of the sanitary condition of a community, and,
judged by this standard alone, the Middle Ward, as a
whole, occupies a very fair position.
Among the parishes, Blantyre is in the unenviable
position of having the highest infantile mortality, viz., 159
per 1,000 births, and at the same time the highest total |
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death-rate; while Bothwell ranks second in both, having
an infantile death-rate of 144 per 1,000 births. It is
significant that in Glasford, which has the lowest total
death-rate, no death was registered of an infant under 1
year; while in Dalziel, with the next lowest total death-
rate, the infantile mortality was only at the rate of 41 per
1,000 births.
Zymotic Diseases. - The chief infectious diseases caused
449 deaths - the most fatal being diarrhœa, which was
credited with 145 deaths. The total zymotic rate for the
year is 3·13 per 1,000, and is made up as follows:-
Diphtheria, --- 0·426 per 1,000
Scarlet Fever, --- 0·370 per 1,000
Enteric or Typhoid Fever, --- 0·398 per 1,000
Measles, --- 0·566 per 1,000
Whooping Cough, --- 0·335 per 1,000
Diarrhœa, --- 1·013 per 1,000
Other, or doubtful, --- ·028 per 1,000
[Total] --- 3·136 per 1,000
Diphtheria. - The death-rate from diphtheria (0·426 per
1,000) is a comparatively high one, and varies considerably
in the different divisions, from ·221 per 1,000 in the First, to
·508 in the Third. There can be little doubt but that
diphtheria is pre-eminently a preventable disease, and de-
pends largely for its propagation on bad drainage, foul
air, and insanitary conditions generally.
Scarlet Fever. - The deaths registered as due to scarlet
fever numbered 53, a rate per 1,000 of 0·370, which must
be regarded as, on the whole, fairly satisfactory, considering
the highly infectious nature of the disease, and the favour-
able opportunities for spreading among children living in
the long rows of cottages so common in the district. Of
the divisions, the First suffered most heavily, with a rate of
0·442 per 1,000; the Second next, with 0·408; while the
Third Division was more fortunate, with a rate of 0·266 per
[Page] 70
1,000. These figures, as will afterwards be more clearly
seen when dealing with the operations of the Infectious
Diseases Act, fairly represent the comparative prevalence
of this troublesome malady in the different parts of the
Middle Ward.
Enteric or Typhoid Fever. - In order to prevent mis-
apprehension, it may be well to state here that the term
"typhoid fever" is being generally discarded in this
country as giving rise to some misconception, and that the
term "enteric fever" is gradually being substituted. The
latter is the one generally used in this report.
Fifty-seven (57) deaths were attributed to enteric fever
during the year 1891 in the landward portion of the Middle
Ward, and of these 38 took place in the Second Division,
and 19 in the Third. The rate per 1,000 of the population
is 0·398 for the whole Ward, 0·431 for the Second Division,
and 0·460 for the Third - no death, as already indicated,
having been registered from this cause in the First Division.
This is a high death-rate when it is considered that for the
last eight or ten years the mortality from enteric fever has
been declining throughout the country generally - the
average in England and Wales for the eight years 1881-8
being as low as 0·2 per 1,000, or half that of the Middle
Ward for 1891. In the eight principal towns of Scotland
the rate for the year 1890 was ·19 per 1,000, and still less,
probably, for the whole of Scotland. In Table VIII., p. 76,
will be found the number of deaths in each parish, ranging
from 1 in Shotts to 16 in Bothwell.
Fuller reference is made to the incidence of enteric fever
and its probable significance under the heading of the
Infectious Diseases Notification Act, p. 63.
Measles. - Owing to an epidemic in Bothwell Parish,
and particularly at Hamilton Palace Colliery and neigh-
bourhood, a large number of deaths was reported as due to
measles, viz., 81, equal to a rate per 1,000 of 0·566 for the
whole ward. In this disease the fatal result is usually |
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directly due to some affection of the lungs or air passages,
consequently the mortality is highest when the epidemic,
as in this instance, occurs in the colder months of the year.
Of the 81 deaths (see Table VIII., p.76), 68 took place in
the Parish of Bothwell, only 3 of these being in children over
5 years of age. It was extremely fortunate that this, one of
the most infectious of diseases, was practically limited to
one part of this parish.
Taken according to divisions, the rate for measles was
nil in the First, 0·839 in the Second, and 0·169 in the Third.
These figures show, what has long been known to
medical men, that, contrary to the general belief, measles
is a dangerous and fatal malady unless the greatest
precautions are taken - precautions which, partly from
ignorance and partly from want of the necessary means
and accommodation, are rarely carried out among a large
section of the community.
Some health officers have urged that measles should be
included among notifiable diseases, but I am not yet con-
vinced that the advantages which might accrue would
repay the great expense and trouble that would be incurred.
The mere notification of a disease is of little or no value
unless the knowledge so gained can be made the basis of
preventive action. In the case of measles, the contagion is
given off from the patient at the earliest stage of the
disease, even before, in many circumstances, the nature of the
illness can be determined, and it is mainly for this reason
that we have so little control over epidemics of measles.
Again, many cases are so slight that no medical attendance
is deemed necessary, and many centres of infection would
escape observation.
Whooping Cough. - The deaths registered from this
disease number 48 (43 of which were in children under 5
years of age), giving a rate of 0·335 per 1,000. In the
divisions the rates were ·147 for the First, ·317 for the
Second, and ·435 for the Third.
[Page] 72
This also is a malady almost entirely affecting children,
and one over which sanitary authorities can exercise little
or no control, as, from its long period of infectiveness,
hospital isolation is practically out of the question. It
may surprise many to know that whooping cough is now
admitted to be over the country generally one of the most
deadly of all the infectious diseases in children under the
age of 5 years.
Diarrhœa. - This disease, especially among children and
during the summer and autumn months, has for some years
back attracted the special attention of sanitarians; but our
knowledge regarding its etiology is still far from being
complete.
Dr. Ballard, in his well-known report on the subject, *
gives the following "working hypothesis a provisional
explanation":-
"That the essential cause of diarrhœa resides ordinarily
in the superficial layers of the earth, where it is intimately
associated with the life processes of some micro-organism
not yet detected, captured, or isolated.
"That the vital manifestations of such organism are
dependent among other things, perhaps principally, upon
conditions of season; and on the presence of dead organic
matter, which is its pabulum.
"That, on occasion, such micro-organism is capable of
getting abroad from its primary habitat - the earth; and,
having become air-borne, obtains opportunity for fastening
on non-living organic material, and of using such organic
material, both as nidus and as pabulum, in undergoing
various phases of its life history.
"That in food inside of as well as outside of the human
body such micro-organism finds, especially at certain
seasons, nidus and pabulum convenient for its develop-
ment, multiplication, or evolution.
"That from food, as also from the contained organic
matter of particular soil, such micro-organism can manu-
facture by the chemical changes wrought therein through
* Supplement in continuation of the Report of the Medical Officer for 1887. |
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[Page] 73
certain of its life processes a substance which is a virulent
chemical poison; and
"That this chemical substance is in the human body the
material cause of epidemic diarrhœa."
I have quoted thus fully from Dr. Ballard's report, as the
opinions therein expressed unmistakably point to diarrhœa
as being emphatically a filth disease. Its occurrence,
therefore, to any marked degree in a community indicates
the necessity for greater cleanliness both inside and outside
the homes of the people. That this necessity exists in the
Middle Ward is, to my mind, evident from the fact that no
fewer than 145 deaths were recorded from diarrhœa (of
which 131 were in children under 5 years of age), equal to
a mortality rate from this disease alone of 1·013 per 1,000,
or more than double the rate for the eight large towns of
Scotland in 1890.
The rates in the three divisions were 0·515 in the First,
1·179 in the Second, and 0·823 in the Third.
Tubercular Diseases. - In recent years it is becoming
more and more clearly recognised that tubercular diseases
generally, and pulmonary phthisis or consumption specially,
are to a great extent influenced by sanitary measures.
Dampness of soil, impure air, insufficient food and clothing,
all predispose to tubercular affections. That tuberculosis
is a specific disease - a disease, that is to say, always
associated with a particular micro-organism - was proved
by Koch in 1882 by the discovery of the bacillus tuber-
culosis. There can be little doubt that this organism
enters the body, as a rule, by the air passages, but there are
many writers who believe that it may obtain ingress by
milk, or in the flesh of animals which have suffered from
tuberculosis, as admittedly so many do - hence the import-
ance of cleanly, well-ventilated cowsheds.
The deaths from phthisis or consumption registered
during 1891 numbered no fewer then 223. When we con-
sider that in the majority the disease is of a lingering |
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[Map inserted]
MIDDLE WARD.
The depth of colour indicates the
relative Mortality from Zymotic Diseases
in the different Parishes (Landward)
during 1891.
[Page] 74
nature, and attacks, as a rule, young men and women, this
figure represents an almost appalling amount of sickness
and loss of valuable life. Of these deaths, 19 occurred in
the First Division, 157 in the Second, and 47 in the Third
- rates respectively of 1·400, 1·781, and 1·137 per 1,000,
while the rate for the whole district was 1·559.
From other tubercular diseases the deaths numbered
163, mostly in children, from tabes mesenterica and tuber-
cular meningitis.
The total number of deaths therefore from diseases of a
tubercular nature reached a total of 386, or over 13 per
cent. of the total mortality, and equal to a rate per 1,000 of
2·698.
Cancer. - Malignant diseases caused 76 deaths, all in
persons over 40 years of age, of which 9 were registered in
the First Division, 53 in the Second, and 14 in the Third -
rates respectively of 0·663, 0·601, and 0·338. The rate for
the district as a whole is 0·531 per 1,000.
Diseases of the Nervous System caused a large number
of deaths, viz., 311, of which 127 were in children under 5
years of age. The rates per 1,000 did not vary greatly in
the different divisions - the lowest being 2·053 in the
Second, and the highest, 2·874, in the First.
From Diseases of the Circulatory System the mortality
was 195, all, with the exception of 3, being adults. The rates
per 1,000 ranged from 0·992 in the Third Division to 2·358
in the First. The rate for the Second Division was 1·384,
and for the district as a whole 1·363 per 1,000.
Diseases of the Respiratory System. - Five hundred
and sixty (560) deaths resulted from diseases affecting the
lungs and air passages (exclusive of consumption), and of
these, 235 were in children under 5 years of age, and 325 in
persons over. The respiratory death-rate for the whole
district was 3·915 per 1,000 living, which is very slightly |
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[Page] 75
above the average rate. Taken according to divisions, the
rate per 1,000 was lowest in the First, 1·842; the Second
coming next with 3·846; while in the Third it was as high
as 4·745.
In Table IX., p. 77, where the rates are given for each
parish, it will be seen that they varied from 1·764 in
Stonehouse to 5·681 in New Monkland, where an unusually
large proportion of cases was in young children.
Influenza. - Owing to the great interest attaching to
this disease, it has been thought advisable to make it a
separate heading. Sixty-seven (67) deaths were attributed
to this cause during 1891, nearly the whole of which
occurred in the last four months of the year. Of these, 6
were registered in the Parish of Avondale, 6 in Blantyre,
8 in Bothwell, 11 in Cambuslang, 4 in Cambusnethan, 7 in
Dalserf, 3 in Glasford, 6 in New Monkland, 7 in Old
Monkland, 8 in Shotts, and 1 in Stonehouse. From this it
is evident that the Third Division suffered most heavily,
just as it did from respiratory diseases. Calculated in
terms of the population, the rates ranged per 1,000 from
0·256 to 2·277, that for the whole district being 0·468. In
East Kilbride, Hamilton, and Dalziel no deaths were
registered.
Violence. - Although in a large industrial district, like
that of Middle Ward, accidents are almost unavoidable,
I was scarcely prepared to find that so many as 138 people
lost their lives in one year from one or other form of
violence. Of that number, 14 were children under 5 years
of age, the most frequent cause of death among them being
drowning and burns. By far the highest rate per 1,000 is
found in Dalziel Parish, viz., 5·956, Hamilton coming next
with 2·085. The lowest was in Stonehouse, 0·294 per
1,000. |
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[Chart inserted]
TABLE VIII. - Births and Deaths occurring in the MIDDLE WARD District during the year 1891.
[Table inserted]
See foot-note, p. 30. |
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[Page] 76
TABLE VIII. - Births and Deaths occurring in the MIDDLE WARD District during the year 1891.
[Table inserted]
See foot-note, p. 30. |
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[Page] 77
Table IX. - Number of Persons per Acre, the Birth-rate and Principal Death-rates
in each MIDDLE WARD Parish during the year 1891.
[Table inserted]
* Death-rate excluding Deaths (20) which occurred in Kirklands Asylum. |
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[Page] 78
Tabular Statement of Sickness and Mortality referred to in the Regulations issued by the Board of Supervision for Medical Officers of Districts of Counties.
TABLE X. - Births and Deaths occurring in each division of the MIDDLE WARD District during the Year 1891.
[Table inserted]
NOTES. - The Medical Officer may, if he thinks fit, give separately the figures for any Sub-Divisions of the District: in all cases the Total for the District is to be given.
Deaths of Persons belonging to a District occurring in Public Institutions (as Lunatic Asylums, Poorhouses, Hospitals) outside of the District, are to be included with the figures for that District, and deaths of persons not belonging to a District, occurring in Public Institutions within the District, are to be excluded.
"Diphtheria" shall include "Membranous Croup," "Diphtheritic Croup," Croupous Diphtheria."
All deaths from "Diarrhœa," "Dysentery," "Enteritis," "Gastro-Enteritis," "Muco-Enteritis" - unless qualified by the designation "Chronic," or by an alleged primary cause, e.g., "Phthisis - Diarrhœa," "Bright's Disease - Diarrhœa," are to be entered under the heading "Diarrhœa."
The designation "Other Tubercular Diseases" shall include, inter alia, "Tabes Mesenterica," "Tubercular Meningitis," "Hydrocephalus," "Struma,"
"Scrofula."
The headings distinguished by asterisks shall cover all diseases placed under these headings in the classification of the Registrar-General. |
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[Page] 79
TABLE XI. - Density of Population, Birth-rate, Infantile, and other Death-rates, in each Division of the MIDDLE WARD
District for the Year 1891.
[Table inserted]
TABLE XII. - Cases of Infectious Disease coming to the knowledge of the Medical Officer, in the MIDDLE WARD District,
during the Year 1891.
[Table inserted] |
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[Page] 80
TABLE XIII. - Number of Births and Birth-rate in each of the fourteen Parishes in the MIDDLE WARD
during 1891.
[Table inserted] |
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[Page] 81
TABLE XIV. - Number of cases of INFECTIOUS DISEASES notified in each Parish of the MIDDLE WARD during each month of the year 1891.
[Table inserted] |
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[Page] 82
LOWER WARD.
PART 1.
In considering the best method of reporting upon the
sanitary condition and needs of the Lower Ward, I have
experienced some difficulty in deciding whether to take
the district as it stands at present, after the annexation by
Glasgow of a part of the district, or to include the whole
district as it was prior to annexation.
For the purposes of future comparison, it seems advis-
able to adopt the former course, and deal with the Lower
Ward District in its present condition.
The Lower Ward (landward) comprises part of the
Parish of Barony, and the Parishes of Cadder, Carmun-
nock, Govan, and Rutherglen, and forms the north-western
portion of the county. The whole district is influenced
and overshadowed by Glasgow, which is situated almost in
the centre of the Lower Ward, so that the landward por-
tion almost forms a fringe round the city for two-thirds of
its extent.
Leaving the various burghs out of account, the area of
the Lower Ward under the jurisdiction of the District
Committee is 28,580 acres, with a population at the last
Census (April, 1891) of 29,294.
Partly on account of annexation from time to time by
Glasgow, the district of the Lower Ward is now of most
irregular shape, a circumstance which adds not a little to
the difficulties of administration.
On the north side, the district is bounded by Stirlingshire
and Dumbartonshire; on the east, by the Middle Ward;
on the south, by the Middle Ward and by Renfrewshire;
and on the west, by Renfrewshire and Dumbartonshire. |
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[Page] 83
The River Clyde enters the Lower Ward at a point near
Battleburn, previously forming part of the boundary
between the Parishes of Rutherglen in the Lower Ward
and Cambuslang in the Middle Ward, flows in a westerly
direction, marking the boundary between Rutherglen Parish
and the Shettleston portion of the Barony Parish, and
between Rutherglen Parish and the City of Glasgow, until,
at a point a little beyond Dalmarnock Bridge, it enters
within the city limits, emerging at Linthouse to form, for
about one mile and a half, the northern boundary of the
Parish of South Govan, landward.
As in the Middle Ward, the predominating Industries
are associated with coal and iron, especially in the Parishes
of Barony and Rutherglen. In addition, there are valu-
able seams of fireclay in the neighbourhood of Garnkirk
(Cadder Parish), the working and manufacture of which
have led to the establishment of several populous vil-
lages.
The Parishes of Cadder, Carmunnock, and South Govan
are largely agricultural and pastoral, some of the land being
under a high state of cultivation.
Housing of the Working Classes. - A considerable
section of the population live in one and two-roomed houses;
but until the publication of the Census report I am unable
to give the figures.
In the Barony Parish, including mainly the villages of
Shettleston and Tollcross, the majority of the houses are
of the tenement class, and fairly well built. There are,
however, some conspicuous exceptions both in Shettleston
and Tollcross, where the houses are so bad as to be almost
uninhabitable - six of which, indeed, I reported as unfit for
habitation. These were one-roomed houses with low
ceilngs, damp walls, and floors considerably below the
level of the surrounding ground. The windows were of
one sash, and fixed so as to be useless for purposes of
ventilation. There were no rain-water pipes, so that the
[Page] 84
foundations were constantly in a damp state. The privy
and ashpit accommodation was simply disgraceful, and
utterly subversive of either decency or cleanliness.
In the case of the mining villages, the houses, as in the
Middle Ward, are, as a rule, of a very inferior description,
consisting of one or, at most, two apartments, with the
objectionable fixed beds on one side, a cheap fire-place on
the other, a window, and a door.
Even in the more rural districts, such as Carmunnock,
and the greater part of Cadder and South Govan, many of
the houses, though better and more substantially built,
still afford far too limited accommodation.
Water Supply. - The County Sanitary Inspector, in his
annual report, has fully described the water supply of the
Lower Ward, and I will not, therefore, enter into the same
detail.
From the proximity of the district to Glasgow, on the
one hand, and to the Airdrie and Coatbridge Water
District, on the other, there has not been the same general
scarcity of water as was the case in the Middle Ward.
With the exception of Easter and Wester Cardowan,
with a comparatively small population, the whole of the
Barony Parish is supplied by Glasgow.
In Cadder Parish the two Water Districts of Bishopbriggs
and Auchinairn are now under the control of the Glasgow
Water Commissioners; while the South Lenzie Water
District, which is largely residential, is supplied by the
Burgh of Kirkintilloch.
In certain parts of this parish, however, notably Gart-
cosh, Stepps Road, and Garnkirk, the water supply has
been most unsatisfactory, with the result, as will afterwards
be more fully shown, that enteric fever and other diseases
have been prevalent.
These places, as well as others in the parish, are de-
pendent for their supplies on streams, shallow wells, and
pits, all of which are liable to contamination. Analysis has |
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[Page] 85
been repeatedly made, showing, in some instances, un-
doubted indications of sewage contamination.
Rutherglen and South Govan are wholly supplied by the
Glasgow Water Commissioners.
In the sparsely populated and comparatively isolated
Parish of Carmunnock, the water supply, which is almost
entirely from wells, appears to be fairly good as regards
quality, and for the present, at all events, sufficient to meet
the necessities of the inhabitants.
On the whole, therefore, the necessity of a further supply
of water fit for domestic use in the Lower Ward is
practically limited to that part of Cadder Parish embracing
the villages of Garnkirk, Gartcosh, Muirhead, Chryston,
Stepps Road, Old Auchinairn, and adjoining dwellings, and
in these the question is of the most pressing character.
The very large asylum at present in course of erection at
Gartloch, in the same neighbourhood, will be forced to find
a good water supply from one or other of the water com-
panies, and it is hoped that an attempt will be made
to arrange for a supply to the destitute places in the same
neighbourhood.
Drainage. - There are three drainage districts within the
area of the Lower Ward, viz.:- Barony, embracing the
greater part of Shettleston and Tollcross; South Lenzie;
and Carmunnock.
Barony Parish. - This, as already indicated, is practically
all included in the Barony Special Drainage District -
important additions having been made during the year,
while others are in course of being carried out. The Chief
Inspector, in his report, estimates the length of sewers at
6 miles 240 yards.
There are still portions of the parish where drainage is
required, and I have no doubt but that the Committee will
give these their early consideration.
The South Lenzie District, in Cadder Parish, has been
handed over, under certain conditions, to the Commissioners
[Page] 86
of the Burgh of Kirkintilloch. The primary reason for
making such an arrangement was the fact that towards the
Burgh of Kirkintilloch was the only way by which Lenzie
could be drained except at very great cost. However, the
working out of the arrangement has been productive of
much dissatisfaction on the part of the inhabitants of
Lenzie, as they allege that the sewers are not properly
flushed, that the ventilating openings are too few and
placed in improper situations, and that, therefore, serious
nuisance is caused. The dispute has been brought under
the notice of the Board of Supervision, and by it been
referred to an engineer.
At Chryston, Muirhead, Garnkirk, Bishopbriggs, Auch-
inairn, Stepps, and other small villages, the drainage is of
the ordinary primitive character met with in Scottish
villages, viz.:- an open channel running alongside the foot-
path, and more or less out of repair, permitting of formation
of small pools of stagnant water.
I am not prepared to say that such channels, if reserved
exclusively for slop water, and kept thoroughly clean, are
not perhaps the best adapted means for the purpose they
are intended to serve, inasmuch as, when foul, the nuisance
becomes soon apparent, and can be easily removed. In
nearly all the parts of the parish, as indeed throughout the
Lower Ward, it is part of the duty of the roadmen to
periodically clean out these channels, at any rate in the
more populous parts of the district.
In the other parts of the Lower Ward District the
question of drainage is not one of much urgency, unless it
be at Eastfield, Burnside, and Gallowflat, in the Parish of
Rutherglen.
it is necessary to mention that in no instance is the
sewage treated before admission into the streams, but it is
allowed to enter in its crude state. In view of the putting
in force the Rivers Pollution Prevention Act, this aspect of
the question is one which the Committee will be bound to
seriously consider at no very distant date. |
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[Page] 87
Hospital Accommodation. - Until the month of Novem-
ber the District Committee did not deem it necessary to
consider any new scheme for providing hospital accom-
modation, believing that, under an agreement with the City
of Glasgow, the greater part of the district would have the
right of sending patients to Belvidere Hospital. However,
immediately after the extension of the city became an
accomplished fact, formal intimation was given that the
whole of Belvidere would be required for the wants of the
extended city. The District Committee at once took the
question in hand, and a sub-committee was appointed to
consider and report.
Although not of very large area in the aggregate, yet
from its irregular and straggling shape, due largely to the
encroachment of Glasgow and neighbouring burghs, the
distance between the extreme points of the district is con-
siderable, and makes it a matter of some difficulty to
provide for the whole by one hospital. In my report on
the subject to the Committee I was at first, therefore,
inclined to advise that combination with the Stirlingshire
County Council on the one side, and with the Middle
Ward on the other, might be the better plan, securing, if
possible, additional beds in the Shieldhall Hospital for
South Govan and the district adjoining. Further con-
sideration and negotiation showed, however, that the
disadvantages were likely to more than outweigh the
advantages, and the Committee have now practically
decided that one hospital of between 30 and 40 beds,
situated somewhere near Shettleston, will best meet the
necessities of the Lower Ward, at the same time retaining
their original rights in the Shieldhall Hospital.
The question is still under the consideration of the Com-
mittee, and they are now awaiting a further report from me
as to probable cost and expense of management and
maintenance.
[Note in margin] [....]
Disinfection. - The question of disinfection is much in
the same position, this being formerly carried out by the
[Page] 88
Glasgow Authorities. I have already reported upon the
requirements of a well-equipped public disinfecting station,
and give an extract from it:-
At one time it was believed that all disease was a visita-
tion from the Almighty, and that it was futile to attempt
to prevent it. Indeed, there are still some who, if they do
not openly express this opinion, act as if they believed in it,
utterly ignoring the fact that many diseases, such as leprosy,
ague, typhus, and even smallpox, have been practically
driven from this country by purely sanitary measures.
Indeed, there is no reason why many others, such as typhoid
fever, scarlet fever, and diphtheria, should not utterly be
eradicated.
I do not intend to add to the length of this paper by
discussing the question of vaccination in regard to its
prevention of smallpox, but will confine myself to stating
briefly the general measures to be adopted for the prevention
of infectious disease.
Dr. Fagge lays down the following general rules:-
"(a) During an illness the utmost care should be
exerted to hinder the contagion from being carried
away from the sick-room by means of attendants,
or in the patient's excreta, or upon the linen of
his bed or body, or in any other way. In all
probability its escape into the open air through
windows or chimneys is of no consequence.
"(b) That at this time it is impracticable effectually
to disinfect the patient himself or his surroundings,
and, therefore, that the attempt should not be
made.
"(c) That the patient, after recovery, and the nurses
also, should be most carefully disinfected; that
minute pains should be taken to prevent clothes,
books, and other articles from conveying
contagion; and that the sick room, with all its
contents, should be thoroughly purified before
healthy persons are allowed access to it."
It is quite clear that in the great majority of cases -
probably not less than 90 per cent. - that come under the
notice of the Sanitary Authorities of the Middle and Lower
Wards of Lanarkshire, these conditions cannot be complied |
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Note in margin? |
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[Page] 89
with if the patient be allowed to remain at home. It is
utterly unreasonable to expect that infection can be
confined to a house consisting of one or two rooms with
the inmates constantly passing in and out, eating their food
and sleeping in near proximity to the sick person. It is
well, also, that people should understand that a little
Condy's fluid placed in a saucer on the floor or sprinkled
about is of little more value than so much water in
arresting the spread of infection.
Obviously, therefore, the only safe course is the
immediate isolation of the patient in a properly equipped
hospital reserved solely for cases of infectious disease.
Upon the sanitary authority rests the responsibility of
providing such an hospital.
After removal to the hospital, or (where for any reason
this unfortunately is not effected) at the close of a case of
infectious disease, it then becomes necessary to carry out
the process of disinfection.
All articles of little value used by the patient, or which
are likely to have become infected, should be at once burnt.
Then all washable articles, bedding, mattresses, pillows,
blankets, carpets, clothing, curtains, anything, in fact, liable
to be contaminated and which cannot be injured by heat,
should be removed in a van kept exclusively for the
purpose to the disinfecting station, there to be dealt with
under the direction of the sanitary staff.
Meanwhile the room occupied by the patient and, if
deemed necessary, any adjoining room should be entirely
closed and made as air-tight as possible. Some difference of
opinion exists as to the efficacy of either sulphur of chlorine
as disinfecting agents, but they, no doubt, possess consider-
able value, and their use has this advantage, that before the
room can be inhabited it must be thoroughly ventilated for
some hours.
Sulphur is employed in the form of sulphurous acid gas,
and is produced by burning sulphur on a shovel, flat stone,
or in a specially constructed iron vessel. The quantity to
be employed should not be less than 1 lb. to every 1,000
cubic feet of space.
Chlorine is credited with better results than sulphurous
acid, especially when the air is saturated with moisture. It
is generated by "gently heating a mixture of 4 parts of
common salt and 1 part of binoxide of manganese with
dilute sulphuric acid (half acid and half water)."
[Page] 90
After the use of one or other of these fumigating agents,
the apartment must be kept closed for from two to four
hours, and then the windows are to be kept open for at
least another four hours, so as to allow a free current of fresh
air to be kept up during that time.
The next step in the thorough disinfection of a house is
the removal of wall-papers and the limewashing of ceiling
and walls. In removing wall-papers great care should be
taken not to allow patches of paper to remain about the
floors, or blown about the streets, but the whole should be
carefully removed and burnt.
The wood work, floors, furniture, &c., should then be
cleansed with a strong solution of disinfectant. Carbolic
acid, in the proportion of 1 part to 20 of water, is the one
generally used; but, so far as recent researches go, it has
been found that mercuric chloride (corrosive sublimate),
dissolved in water, 1 part per 1,000, is by far the most
powerful. In order to avoid accidents, for it is a powerful
poison, it has been recommended to have the solution
coloured in such a way as to readily distinguish it.
Certain conditions may make it inadvisable to remove a
patient from his or her home, and in that case it becomes
the duty of the sanitary staff to see that all possible pre-
cautions are adopted to limit the spread of the disease
during the illness.
If the house be a large one, the patient must be isolated
in a separate apartment, as far as possible from the principal
rooms - preferably at the top of the house. Outside the
door of the sick-room there should be hung a sheet, kept
constantly moist with the solution of carbolic acid or
perchloride of mercury.
All articles not required in nursing the patient, including
carpets, curtains, clothing, books, &c., should be removed
before the patient is placed in the room.
No one should, under ordinary circumstances, be allowed
to enter the room except those actually engaged in nursing,
and the nurse or nurses ought not to visit other parts of the
house.
All discharges from the patient should be rendered harm-
less by the addition of the solution of mercuric chloride
already referred to. This is especially necessary in the case
of a patient suffering from typhoid fever, as the poison is
conveyed in the discharges from the bowels.
The soiled sheets, handkerchiefs, and other washable |
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[Page] 91
articles, if not dealt with at the public disinfecting station,
should be placed in a solution of mercuric chloride for a
few hours, then soaked in water for some hours before
being sent to wash. These should not be washed with the
clothes of the rest of family.
With the ordinary erections in use in this part of the
country - the majority of which, in our district, are simply
abominations - it is a most dangerous practice to throw
infected materials into the ashpit. They should, if possible,
be burnt or buried.
The poisons of many infectious diseases are undoubtedly
capable of lying dormant for a long time, and then
developing under favourable circumstances. If carried
into the ashpit it is easy to understand how it becomes a
very "magazine of disease," dangerous not only to those in
the immediate vicinity, but to others at a distance. I have
not the slightest doubt but that many epidemics, of which
it was difficult or impossible to trace the origin, have arisen
in this way. Incidentally, I may point out that this is a
most powerful argument why ashpit refuse should not be
deposited in bulk near habitations, and used for levelling
up of old quarries and other surface inequalities. As for
building on such material, the idea is contrary to all
common sense.
I next take up the question of how properly to disinfect
the articles removed to the disinfecting station.
Disinfection by Heat and Chemicals. - Koch and
Parsons, who are among the best authorities on the subject
of disinfection, accept as the true test of a "disinfectant"
that it shall have the power of destroying the most resistant
micro-organisms and their spores. The measure of this
successful destruction consists in the failure or otherwise of
subsequent attempts at cultivation.
The main disinfecting agents are -
1. Heat
2. Chemicals -
(a) In Solution.
(b) In the Form of Vapour.
Heat. - This form of disinfection is the only one of real
value for all articles of clothing, bedding, and carpets which
it is inadvisable to wash in boiling water. It may be applied
in two forms - (a) as Dry Heat, and (b) as Steam.
[Page] 92
(a) Dry Heat. - This is the form in which heat was
generally applied until a few years ago, and there is no
doubt that much good work was done by such disinfecting
stoves, as Ransome's, Scott's, and others. And even
now, for such articles as leather goods, and others which
are injured by steam, dry heat is to be preferred.
As, however, our knowledge regarding the organisms
concerned in the production of infectious disease increased,
and especially after the methods of cultivation enabled
us to determine when these organisms, or germs, were
deprived of their vitality, it became apparent that in
many respects dry heat was an unsatisfactory agent. The
main objection to it is that woollen articles of any thickness
are not penetrated by heat, and that consequently all the
infective particles are not destroyed. This can be simply
illustrated by placing a thermometer in several folds of
blanket, and subjecting to the heat of a disinfecting
machine of this class. A temperature of 200° F. may be
registered on the surface, while that of the thermometer,
even after two hours, may be under 120° F. - a heat in-
sufficient to affect many of the disease germs.
The second objection, and one associated with that
already mentioned, is that it takes a much longer time
to disinfect with dry heat, and that consequently expense
and inconvenience are unnecessarily great.
A third objection is that, if the necessary heat be long
enough maintained, scorching of the articles is apt to occur.
(b) Disinfection by Steam. - Micro-organisms, like all
other living things, die when subjected for a long enough
period to a temperature equal to that of boiling water,
viz., 212° F. The spores, however, show themselves more
refractory. For their destruction a higher temperature
is necessary, or else a much longer exposure to a heat
of 212° F.
Steam disinfectors, therefore, have come now to be
generally used by those sanitary authorities desirous of
carrying out disinfection in a satisfactory manner. Until
a year or two ago Washington Lyon's apparatus, made
by Manlove, Alliott, & Co., of Nottingham, was considered
the most satisfactory, and it still forms the model on which
improvements have been effected by other makers. It
practically consists in its best form of an elliptical
steam jacket surrounding a large central chamber, with a
door at each end. In this chamber the articles to be |
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[Page] 93
disinfected are placed, the doors closed, and steam intro-
duced into both jacket and central chamber. Two gauges
mark the pressure within jacket and chamber respectively,
and at the same time indicate the temperature - the pres-
sure and temperature in the jacket being kept higher than
in the chamber in order to super-heat and dry the contained
steam. The steam from the chamber, after a period of
twenty minutes or half-an-hour, is then allowed to escape,
and the articles should remain until dried by the heat
caused by the steam in the jacket. Disinfectors of
this pattern are at work in nearly all the large towns in
England and Scotland, and my own experience of them
has been satisfactory. There are, however, one or two
drawbacks. The doors not being jacketted are colder than
the rest of the machine, and consequently condensation
occurs, which for various reasons is a disadvantage. Again,
there was no arrangement for displacing the air in the
chamber before beginning to disinfect; and this air inter-
feres to some extent with the penetrative power of the
steam. A third objection was that the drying of the
clothes was not quite satisfactory. In actual practice I
found that by careful manipulation these difficulties might
be almost entirely overcome. Still, they suggested that
improvements were required.
Accordingly, Messrs. Goddard, Massey, & Warner, of
Nottingham, the makers of one of the best of the old hot
air ovens, brought out a disinfecting apparatus which has
had considerable success. It is of rectangular shape,
with rounded corners, and gives considerably more room in
the chamber for mattresses, &c., while the makers assert
that by proper stays in the jacket the flat sides are strong
enough to stand all necessary pressure. The doors are
jacketted, and supplied with steam by means of a double-
jointed copper pipe, which allows the doors to open. By
this contrivance condensation on the doors is avoided. By
means of a coil, hot air can be introduced into the chamber,
and thus displace the cold air prior to the introduction of
the steam, and after disinfection, hot air can again be
introduced to dry the clothing and other articles.
In addition to these advantages the apparatus has been
so arranged that it can be heated by a fire forming part of
the machine - using the jacket as a boiler and thus saving
the necessity of a separate boiler.
Quite recently, Manlove, Alliott, & Co., have introduced
[Page] 94
further improvements into the Washington Lyon Dis-
infector, and they are now supplying it with coil, jacketted
doors, and so arranged that the same machine can be worked
either by steam generated in the jacket, or by steam intro-
duced from a detached boiler. Both of these machines
were adopted by the Bradford Corporation by my advice
(that made by Manlove, Alliott, & Co., being the first of
the kind), and are now working admirably.
The relative disinfecting power of Steam and Dry Heat
is as follows:-
(a) Dry Heat, at 220° F., ---4 hours.
Dry Heat, at 245° F., --- 1 hour.
(b) Steam, at 212° F., --- 5 minutes.
Steam is therefore the most expeditious and reliable, and
is free from the danger of scorching, but, as already stated,
leather is immediately spoilt by it.
One of the disadvantages of steam is that stains in
fabrics are fixed by it so that they cannot be removed by
washing. This is an additional reason for the erection of
a wash-house in connection with a disinfecting station, as
stained articles, and all washable articles, can be dealt with,
and then, if necessary, submitted to the heat of the dis-
infectors.
Chemicals. - (a) In Solution. - To these I have already
referred. They are only of use where heat is inapplicable
as in dealing with excretions or discharges from patients
suffering from infectious diseases, and notably in the case
of typhoid patients where the poison is contained in the
discharges from the bowels.
They are used also for scrubbing floors, woodwork, &c.
The best of all is mercuric chloride in a solution of
1 in 1000. Sanitas, creolin, and carbolic acid are also useful.
(b) As Vapour. - Disinfectants in the form of vapour or
gas are used in infected rooms in order to, if possible,
destroy those germs which cannot otherwise be reached.
Perhaps the best, as already indicated, is chlorine in the
presence of moisture, although sulphurous acid is supposed
to act powerfully upon organic matters.
In considering the whole question of disinfection it is
absolutely necessary to bear in mind that the mere removal
of offensive smells does not therefore mean the destruction
of infective power. |
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[Page] 95
Requirements of a Disinfecting Station. - I wish to
state clearly what is involved in the establishment of a
public disinfecting station.
There are required -
1. Steam boiler.
2. Disinfecting apparatus.
3. Wash-house appliances.
4. Two vans - 1 for infected goods, and 1 for disinfected
goods.
5. Horse.
6. Buildings for these, including a chimney, stable, and
van-house.
An officer devoting his whole time to the work of disin-
fection would be required, and an additional man to act as
driver and assistant.
And I would add that I look upon the carrying out of
the work of disinfection as one of the most important
duties devolving upon a sanitary authority, one which can
only be done by a properly trained staff and with proper
appliances; and that the cost of it ought to be borne by
the whole body of ratepayers, as it is in their interest and
for their protection that the expense is incurred.
Dairies, Cowsheds, and Milkshops. - I have not been
in a position so far to personally inspect the whole of the
dairies and cowsheds in the Lower Ward, but, from what I
have seen, I am convinced that the regulations which the
Committee have now sanctioned will result in great improve-
ment in many of them. One, to my mind, striking instance
of the importance of proper ventilation in a cowshed came
under my notice in the Parish of Cadder, where practically
the whole stock of a farmer was attacked, one after another,
by tuberculosis. The veterinary surgeon in attendance was
of opinion that a bad water supply was the original cause;
but, while this doubtless had its effect in deteriorating the
health of the cattle, no doubt exists in my mind that the
faulty construction of the cowshed or byre, its proximity
to a huge dungheap, its situation in a confined courtyard,
accompanied probably by overcrowding, all contributed to
vitiate the air breathed by the animals to such an extent
[Page] 96
as to favour the development of tuberculosis once the
disease had gained a footing among the stock. The
mortality was so great that the farmer determined very
wisely to discontinue for some time the keeping of dairy
cattle.
Under the new regulations, power is given to remedy
such a state of things, and their due enforcement must
result in benefit, not only to the milk consumer, which
is their primary object, but also to the farmer and landlord.
According to the Chief Inspector's report, there are 228
premises in the Lower Ward registered as cowsheds,
dairies, or milkshops.
Returns of Births and Deaths. - The necessity of having
periodical returns regarding births and deaths was brought
before the Committee, and at once recognised. After great
delay and negotiations with the various registrars, arrange-
ments were finally made for the supply of these returns.
The present system of having so many different registrars
for the Lower Ward District is unnecessarily complicated,
and it is to be hoped that a complete rearrangement of
registration districts in and around Glasgow will soon be
made, and that the "shreds and patches," regarding which
Dr. Russell so justly complains, will give place to some
uniform and readily understood system.
Another matter of some importance was the Organisation
of the sanitary department, particularly with reference
to the carrying out of the provisions of the Infectious
Diseases (Notification) Act. Forms were drawn up in
accordance with the provisions of the Act, bound up in
books of 50, and, with the necessary addressed envelopes,
sent out to each medical man likely to use them.
As County Medical Officer my office is in the County
Offices, Hamilton; but it is obvious that, if notifications of
infectious disease were forwarded to me there, and then |
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[Page] 97
sent on to the Sanitary Inspector, much valuable time
would be lost. It was, therefore, arranged that the en-
velopes for notification purposes should be addressed to me
at the office, 56 George Square, Glasgow, where, in my
absence, Mr. Hay would open them, and at once instruct
his inspectors to take the necessary steps. As in the case
of the other wards, a return is forwarded to me daily giving
details of the results of inspection.
Offensive Trades. - Very soon after my appointment my
attention was directed to various offensive businesses
carried on principally in the neighbourhood of Carntyne
Station. Three of these were engaged in tallow-rendering,
and one in the storing of blood, without other treatment
than exposure to the air, if treatment it can be called.
For the works engaged in tallow-rendering, it soon became
evident that special regulations were necessary, and the
Committee, at my suggestion, adopted the following:-
(a) Fresh fat only shall be melted. No stale or tainted
fat shall be allowed on the premises at any time.
(b) The melting shall be by steam only, and in closed
vats, from which flues, properly jointed with cement or
other material approved of by the Chief Sanitary Inspector,
shall conduct the whole vapour into the furnace, passing
thence into the chimney.
(c) Each vat shall be thoroughly cleansed out every 24
hours.
(d) All floors in those portions of the works in which fat
is dealt with shall be of good concrete, free from cracks,
and shall be thoroughly cleansed at least once daily.
(e) The drains in and from the premises shall be formed
and properly trapped to the satisfaction of the Chief
Sanitary Inspector, and shall be thoroughly flushed once
daily.
(f) The inside walls of the building shall be whitewashed
on the first Monday of each alternate month.
(g) All refuse matters shall be removed from the
premises once every second day (i.e., no refuse matter shall
be allowed to remain on the premises longer than 48 hours).
[Page] 98
In addition to these regulations, which have been rigidly
enforced, causing considerable alterations in the oldest of
the tallow works, as well as in the other two, a special
stipulation was made before granting a license to a new
tenant that the chimney should not be less than 50 feet in
height.
In the case of the other, and, in my opinion, more object-
tionable trade, greater difficulties have been experienced.
As the storing of blood for an indefinite period, without
any attempt at deodorisation, is essentially an obnoxious
trade, an effort was made on the part of the District
Committee to close the premises. The proprietor objected,
and the case ultimately came into Court before one of the
Sheriffs, who referred the matter to Dr. Hay, of Maryhill,
for a report. Some time, however, elapsed before Dr.
Hay's visit, and advantage was taken of this to have the
premises in as cleanly and orderly a condition as possible.
Dr. Hay reported that there was a distinct nuisance within
the building, but that he was unable to say that there was
or had been danger to the health of the people outside the
premises. Acting on this, the Sheriff dismissed the case.
Although the decision was an unsatisfactory one from the
point of view of the Sanitary Authority, the prosecution
has had the effect so far of making the proprietor alive to
the necessity of keeping his premises as free from nuisance
as the nature of the trade will allow.
Nuisances. - The principal nuisances brought under my
notice by the Chief Inspector were two, and both the result
of deposits of ashpit and other refuse by the authorities of
the Burgh of Govan. One was at Merrylands, and the
other at Merryflats, and from both an undoubted nuisance
arose.
Although the "tips" or "coups" were distant in each case
about a hundred yards from a main road, and about a couple
of hundred yards from dwelling-houses, no attempt was
made to minimise the nuisance until the case was taken
before the Sheriff, and remitted to Dr. Russell, of Glasgow. |
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[Page] 99
The result was that at Merrylands the material to be
deposited was limited to certain kinds, and that a covering
of earth to a specified depth was to be spread over each
deposit as it took place. On these conditions the case was
adjourned for six months to allow time for the Govan
Authorities to complete the "destructor" for which they are
at present arranging.
At Merryflats, where the conditions were complicated by
the existence of a large pond of water, disinfectants were
freely used to abate the smell, and the deposit of refuse
stopped entirely.
Although a great improvement resulted as the action of
the District Committee, yet the inspector reports lately
that some degree of carelessness in carrying out the condi-
tions is being shown, and, as a consequence, indications of
heating are manifested.
Inspections. - Special visits and reports have been made
upon the following:-
(a) South Lenzie Drainage.
(b) New Tallow Works belonging to Messrs. Elliott &
Co.
(c) New Tallow Works belonging to Mr. Muir.
(d) The Stanley Chemical Works, Carntyne.
(e) Pigstyes belonging to Mr. Wm. Watson, Carntyne.
(f) Nuisance arising from unloading manure at Lenzie
Railway Station.
(g) New property at 89-91 Main Street, Tollcross, as to
fitness for occupancy.
(h) Nuisance at Garnkirk Railway Station.
(i) Nuisances at Merrylands & Gribben's farm, Govan.
(j) Nuisances at Merryflatts.
(k) Tallow Works of Martin Brothers, and Mr. Muir.
(l) Organisation of Sanitary Staff.
(m) Nuisances at Bishopbriggs.
(n) Complaints as to smells arising from Hyndland
Sewer.
[Page] 100
(o) Unhealthy Dwellings in Gray Street, Shettleston.
(p) Nuisances at Main Street, Tollcross.
(q) Monthly Report on Vital Statistics for December,
1891.
Seventeen (17) certificates of nuisance were granted in
terms of Section 18, Public Health (Scotland) Act.
PART II.
Population and Area. - According to the last Census
in April, 1891, there were in the Landward District of the
Lower Ward, not including the part annexed to Glasgow,
30,254 inhabitants. This figure includes the inmates of
the Govan Combination Poorhouse and of the Shieldhall
Fever Hospital, amounting to 960, both of which insti-
tutions draw so few people from the parishes of the Lower
Ward that the number living in them may, so far as
the vital statistics of the Lower Ward are concerned, be
altogether disregarded. The number therefore upon which
the following rates are calculated is 29,294.
The area of the district, after extension of the city
boundaries and exclusive of burghs, is 28,580 acres, or an
average of 1·05 persons per acre, estimated, of course, on
the larger figure of 30,254. The figures for the different
parishes are given in Table XVIII., page 111.
Births. - The number of births registered during the
year numbered 994, more than half of which were registered
in the Barony Parish. This figure gives a birth-rate per
1,000 of 33·93, which is somewhat below the average for
the county, but higher than the rate for Scotland, 31·29.
Among the parishes Carmunnock has the lowest birth-
rate, viz., 21·33, and Govan the highest, 38·97 per 1,000.
The excess of births over deaths in the whole district
was 455. |
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[Page] 101
Deaths. - From all causes 539 deaths were registered
during the year under consideration or a rate per 1,000
of 18·39 - a rate which compares favourably with the rest
of the county, although higher than what one might expect
in a semi-rural population like that of the Lower Ward.
Of the parishes, Carmunnock, as is natural, considering
the number of the people per acre and their occupations,
had the lowest death-rate, viz., 14·22 per 1,000, which, if
maintained, is a very favourable rate indeed; Rutherglen
occupies the next position with 16·37; while the highest
rate is in the Barony Parish, viz., 18·98, which is only a
little above the average rate for the whole district.
Of the 539 deaths 125 were in infants under 1 year,
or, reckoned in proportion to the number of births, 126
per 1,000. This is an infantile mortality below the average,
but still too high to be satisfactory. Carmunnock, again,
is lowest with 67; while Barony has the high proportion
of 152 per 1,000; Rutherglen is second with 74; the
infantile mortality rate in the different parts thus bearing
out the fact shown by the total death-rate that, during
the year 1891, Carmunnock is the healthiest of the parishes
in the Lower Ward, and Rutherglen (landward) the next.
Zymotic Diseases. - Coming now to a consideration of
the deaths from zymotic diseases we find that the total
number of deaths from the principal infectious diseases
in the Lower Ward during 1891 numbered 80. This is
equal to a rate per 1,000 of the population of 2·73, made
up as follows:-
Smallpox, --- 0·000
Diphtheria, --- 0·682
Scarlet Fever, --- 0·204
Typhus Fever, --- 0·000
Enteric Fever, --- 0·546
Measles, --- 0·204
Whooping-cough, --- 0·682
Diarrhœa, --- 0·409
Total, --- 2·727 per 1,000.
[Page] 102
Carmunnock, which has the lowest total death-rate and
the lowest infantile mortality rate, yet stands highest in
the list as regards rate of mortality from zymotic diseases.
That too much importance must not attach to this is
evident from the fact that only 3 deaths took place from
zymotic diseases in this parish, viz., 1 from scarlet fever
and 2 from whooping-cough. The lowest zymotic rate
was in Barony Parish, where 32 deaths took place from
zymotic diseases, viz., 7 from diphtheria, 3 from scarlet
fever, 6 from enteric fever, 1 from measles, 10 from
whooping-cough, and 5 from diarrhœa.
Smallpox. - Fortunately no case of this troublesome
malady came under notice during the year.
Diphtheria. - It is not quite satisfactory to note from
Table XVII. that 25 per cent. of the total mortality from
zymotic diseases was due to diphtheria. Of the 20 deaths
registered 13 were in children under 5 years of age, and
7 in persons over. The rates per 1,000 in the various
parishes were 0·483 in the Barony, 0·728 in Cadder, 1·163
in Govan, and 1·204 in Rutherglen - no death from this
disease being registered in Carmunnock. As I have said
elsewhere in this report our knowledge of the causation
of diphtheria is not very clear, but, to my mind, the disease
is always associated with impurity of air and water, unless,
of course, in those cases where it can be traced to direct
infection.
Scarlet Fever. - The deaths from this very infectious
disease numbered 6 for the year, or a rate for the whole
district of 0·204 per 1,000. This is eminently satisfactory,
although, as scarlet fever comes in waves, we must not
expect always to maintain this low mortality. In the
majority of communities the interval between epidemics
of scarlet fever is five to six years. With complete hospital
accommodation, early notification, and prompt action on |
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[Page] 103
the part of the officers, it is hoped, and I think may
reasonably be expected, that epidemics will not assume
in the future the same dimensions that they have done
in the past.
Typhus Fever. - This disease, at one time so prevalent,
appears to have become almost extinct in many parts of
England and Scotland. In Glasgow, however, and other
localities of the West of Scotland, it reappears from time
to time, and in the Lower Ward, from our proximity to
Glasgow, we are not free from danger from this cause.
As it is a disease dependent upon filth and overcrowding,
our hope of escape depends upon the success of our efforts
to eradicate these evils from our midst. Happily, during
1891, we were exempt from any visitation of this plague.
Enteric or Typhoid Fever. - Such, however, was not
the case with the disease which at one time was confounded
with typhus, viz., typhoid, or, as it is better named, enteric
fever. Sixteen (16) deaths were ascribed to this cause,
10 of which took place in the Parish of Cadder, and the
other 6 in the Barony Parish. While, therefore, the enteric
death-rate is 0·414 per 1,000 in Barony Parish, Cadder
Parish has the bad pre-eminence of a rate of 1·214 per
1,000, that for the Lower Ward as a whole being 0·546.
The deaths in Cadder were the result of a special out-
break, which is treated under another heading.
From Measles there were 6 deaths, giving the same
rate as for scarlet fever, viz., 0·204 per 1,000.This is
often a fatal disease among children, and the low death-
rate is therefore exceedingly satisfactory.
Whooping-cough, on the other hand, has proved a fatal
disorder during the year, and shares equally with diphtheria
the highest death-rate among zymotic diseases. Twenty
(20) deaths were registered, of which 18 were in children
under 5 years of age.
[Page] 104
Parents, as a rule, are not sufficiently alive to the im-
portance of isolating children suffering either from measles
or whooping-cough - these diseases being foolishly enough
accepted as a matter of course.
The efforts of the sanitary staff will be directed towards
preventing children suffering from either of these disorders,
or who have been in immediate contact with those suffering
from them from attending school.
Diarrhœa is one of the most fatal of diseases among
children, especially during the months of August, September,
and October. It is therefore gratifying to find that the
death-rate from this cause, in the Lower Ward, is con-
siderably below the average. Twelve (12) deaths occurred,
all in children under 5 years of age, equal to a rate of
0·409 per 1,000. It is somewhat significant that one half
of these deaths were registered in Cadder Parish, where
enteric fever has been most prevalent, and where the water
supply has been most deficient.
Phthisis. - In all health reports this scourge of large
populations occupies a prominent place, but it is only of
late years that we are beginning to recognise that much
of it is preventable by drainage, ventilation, and other
sanitary measures. Forty-three (43) deaths, all in adults,
were registered as due to pulmonary consumption in 1891,
22 of which were in Barony, 12 in Cadder, 1 in Govan,
and 8 in Rutherglen. Given in rates per 1,000 we have
0·581 in Govan, 1·457 in Cadder, 1·518 in Barony, and
1·926 in Rutherglen, while for the Lower Ward as a
whole the rate is 1·467.
From other Tubercular Diseases 24 deaths were regis-
tered, the majority of which were in children under 10
years from tabes mesenterica. The rate per 1,000 was
0·819, making, with the death-rate from phthisis or con-
sumption, a total rate from tubercular diseases of 2·286. |
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[Page] 105
Cancer caused 10 deaths, all, as might be expected,
in persons over 30 years of age, equal to a rate per 1,000
of 0·341. The rates ranged from nil in Govan to 2·844 in
Carmunnock. As in other instances, however, no generalisa-
tion can be drawn from this limited number of facts.
Diseases of the Nervous System were credited with
56 deaths, 23 of which were in children under 5, mainly
from convulsions. The rate per 1,000 was 1·911 for the
district. Among the parishes Rutherglen had the lowest,
1·204, and Barony the highest, 2·208.
Diseases of the Circulatory System. - From diseases of
the heart and other organs of circulation 44 deaths, only
2 of which were in children under 5 years of age, were
registered during the year, equal to a rate per 1,000 of 1·502.
Diseases of the Respiratory Organs. - This is always
one of the most important classes of disease in a com-
munity, and generally responsible in a climate like ours
for a large proportion of the mortality. In this respect
the Lower Ward, during 1891, was no exception to the
rule, for out of the total of 539 deaths 123 were due to
respiratory diseases, yielding a mortality rate of 4·198 per
1,000. With the exception of Carmunnock, in which,
singularly enough, no death from respiratory disease was
egistered during the year, the rate in the various parishes
was wonderfully constant, ranging from 3·371 in Rutherglen
to 4·831 in Barony.
Violence. - Twenty-four (24) deaths were registered in
the Lower Ward as due to one or other form of violence
during the twelve months, 3 of which were in children
under 5 years of age. Ten (10) of these, a large proportion
according to population, were registered in Cadder Parish,
8 in Barony, 5 in Rutherglen, and 1 in Carmunnock. The
death-rate was 0·819 per 1,000.
[Page] 106
Inflenza. - This form of disease has, in some localities,
caused great mortality and sickness, and it may be worth
while noting its effects in the Lower Ward during 1891.
In 17 instances influenza was registered as the cause of
death, all of which, with one exception, were in persons
over 5 years of age. Seven (7) of these deaths were in
Barony Parish, 6 in Cadder, 1 in Govan, and 3 in Ruther-
glen. The rate per 1,000 of the population for the district
was 0·580.
Notification of Infectious Disease. - The Infectious
Disease (Notification) Act, 1889, was adopted by the
District Committee, and came into force on 1st September.
From that date until 31st December 196 cases were notified
by medical practitioners at a cost to the ratepayers of
£24 10s.
Generalisations from such a limited experience would
obviously be of little value, but all experience tends to
show that, with adequate hospital accommodation and
means of disinfection, the greatest benefit may be expected
to accrue from early intimation of cases of infectious disease.
Table XV. shows the number of cases notified weekly of
each disease, from which it is seen that the greatest incidence
of scarlet fever was in the month of September, of typhoid
fever also in the same month and particularly in the second
week, and of diphtheria in the early part of November. In
all, 105 cases of scarlet fever were notified, 59 of enteric,
14 of diphtheria, 2 of puerperal fever, and 16 of erysipelas.
Of the scarlet fever cases 32 were removed to hospital,
the remainder being treated at their own homes.
Into the cases of typhoid or enteric fever it is necessary
to enter at greater length. Of the 59 cases reported 19
occurred at Gartcosh and neighbourhood, in the Parish of
Cadder. The history of this outbreak is instructive, although
the lesson it teaches has often been taught before.
Gartcosh is a village of about 500 inhabitants, dependent
almost entirely on the ironworks of Messrs. Smith & |
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[Page] 107
McLean, round which the houses are built. These works
and adjoining houses are dependent for their water supply
on an open stream which skirts the works, and which
receives the sewage of several houses higher up. This
water, so liable to contamination, is pumped up and passed
through a series of small filters, and then distributed to
the works and the dwelling-houses. Of the whole series
of cases the only thing in common was that they used
this water. In more than one instance boys, who were
temporarily employed at the works and had drunk of the
water, were attacked with typhoid, even although they
lived at some distance from what might be called the
infected area. In every instance, without exception, the
persons attacked used the water from the stream referred
to, and this fact is of the greatest significance as pointing
to the source of infection. Of these cases 10 were removed
to hospital, and 9 allowed to remain at home.
Sixteen (16) cases of erysipelas were reported, but the
information so derived is of little sanitary value, as the
mortality from erysipelas is so low as to be comparatively
trifling. I have never been able to understand why
erysipelas should have been included in the Notification
Act, as a large proportion of cases seem to arise indepen-
dently of the sanitary surroundings.
[Page] 108
Table XV. - Cases of Infectious Diseases notified
in the LOWER WARD from 1st September
to 31st December, 1891.
[Table inserted]
In addition to above, 5 cases of Whooping Cough and 1 of Measles
were reported. |
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[Page] 109
TABLE XVI. - Births and Deaths occurring in the LOWER WARD District during the year 1891.
[Table inserted] |
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[Page] 110
TABLE XVII. - Births and Deaths occurring in each Parish of the LOWER WARD District during the year 1891.
[Table inserted]
See foot-note, p. 30. Deaths in institutions are included. |
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[Page] 111
TABLE XVIII. - Density of Population, Birth-Rate, Infantile and other Death-Rates in each Parish of the
LOWER WARD for the year 1891.
[Table inserted]
* Number of persons to the acre for Govan (landward) is calculated on the total population, including that of institutions.
TABLE XIX. - Cases of Infectious Disease coming to the knowledge of the Medical Officer during the part of the year
1891 from 1st September to 31st December in the District of the LOWER WARD.
[Table inserted] |
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