HH62/2/RENFRE/19

Transcription

[Page] 18

industries are shipbuilding and engineering, I have no hesitation in
concluding that the bulk of the population is composed of adults in
the prime of life, amongst whom the deathrate is naturally low, with
but a small proportion of aged persons. I am unable, therefore, to
regard the low deathrate as a certificate of the healthiness of the
district - the high zymotic deathrate, 4·5, is sufficient of itself to dis-
countenance this idea, and I am satisfied that if I had the means of
calculating the 'infantile mortality rate' it would be found to be
very high.
Again, too much stress must not be placed upon the 'percentage of
deaths under five years of age.' A district which has a low gross
deathrate may have a high percentage of child-deaths, without that
circumstance signifying anything in particular, and vice versa. For
example: the Paisley landward district had a some what high per-
centage of deaths under five years - 38·4; but the gross death-rate of
that district was only 11·8 per thousand. Suppose this district to
have had a gross death-rate double what it actually was, i.e., 23·6,
(which was practically the death-rate of Elderslie over the same
period), the same number of deaths under five would only have
yielded a 'percentage of deaths under five' of 19·2, which would
have been a distinctly low percentage.
Above all, one must have in regard the fallacies attaching to the
working out of small numbers, where accidental circumstances and
coincidences may serve to yield misleading results. I have sought,
by taking the figures of the whole decennium, to obviate, as far as
possible, fallacies arising in this manner.
Generally speaking, one must treat the figures intelligently and
with due regard to the interplay of diverse factors. Thus, for ex-
ample, the tables I shall refer to bring out the extraordinary fact that
the village of Kilmalcolm has a somewhat high death-rate from
phthisical (consumption), namely, 3·1. Now, if there is a place in the
County which one would have expected, a priori, to have a low
phthisical death-rate it is Kilmalcolm. How then is one to explain
the high death-rate? I have no hesitation in accepting, as the real ex-
planation the circumstance, that persons with a phthisical tendency,
('with weak chests,' people say), or in the early stages of phthisis, are
recommended by their medical attendants, and very judiciously, to
take up their abode in Kilmalcolm, and that a certain proportion of
these die there. It is another illustration of the post hoc, propter hoc,
fallacy; in such a fashion, it has been remarked, one may prove that

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poultices cause whitlows, for statistics would certainly show that in
ninety-nine cases out of a hundred the development of the whitlow
has been preceded by the application of a poultice. This explanation
finds additional support in the circumstance that in Kilmalcolm land-
ward, the death-rate from phthisis is exceptionally low, being only 1·1
per thousand; so that the locality is not favourable to the develop-
ment of phthisis.
One other consideration I should like to refer to. In country dis-
tricts, it may happen that over a considerable series of years there
may have been no particular prevalence of infectious disease; in a
village or landward district there may, indeed, have been an entire
absence of particular diseases, and the guardians of the public health
may relax their vigilance, with a half unconscious sense of a special
providence watching over them. And yet, the moment may be im-
minent when a dire epidemic shall burst out in the district, extend-
ing with all the greater rapidity that there has accumulated, through
the absence of the particular disease for a long series of years, a large
bulk of susceptible material, in the shape of previously un-attacked
persons. Thus, for instance - there are many other examples - take
the cases of Inverkip at one end of the County, Eaglesham at the
other; there has been no death from measles in either of these vill-
ages over the whole decennium; it only requires, however, a case in-
troduced from without, especially if associated with school attend-
ance, to set these villages (so to speak) in a blaze, unless care be
taken. So, too, in the case of a polluted water supply; the life of
the village may flow on undisturbed, over a long series of years; but
let, by any chance, the infective matter of enteric (typhoid) fever
find entrance to the water course, and there shall follow, as the night
the day, a devastating outburst of enteric fever. Let us take, as an
illustration, the case of Neilston. There, notwithstanding the use of
water from contaminated wells, the ten years (1881-90) passed with-
out any excessive prevalence of enteric fever. But an inquiry into
the history of further-gone years reveals the fact that in 1861, the
necessary conditions being present, there occurred in the early months
of the year a wide-spread epidemic of enteric fever - then most com-
monly known as gastric or bilious fever - extending, probably, to
from one hundred to one hundred and twenty persons, and resulting
in sixteen deaths. Nor did the matter end there. The chronology
of the cases in the parish appears to show that the epidemic extended
from the village to the surrounding district, in which there occurred,