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APPENDIX TO PART I.
Table I. - Analysis of census returns, First District.
Table II. - Analysis of census returns, Second District.
Table III. - Death-rates, First District, 1881-90.
Table IV. - Death-rates, Second District, 1881-90.
Table V. - Mean Villatic and Landward Death-rates, 1881-90.
Table VI. - Mean Death-rates of Villages and Landward Sections, 1881-90,
First District.
Table VII. - Mean Death-rates of Villages and Landward Sections,
1881-90, Second District.
Table VIII. - Abstract of Meteorological Observations, Paisley Obser-
vatory, 1891.
PART II.
THE DISTRICTS.
-- PAGE
Vital statistics of the First or Upper District, 1891, -- 82
Vital statistics of the Second or Lower District, 1891, -- 84
Tabular statement of Sickness and Mortality, in the First and Second
Districts, in the year 1891, as required by the regulations of the
Board of Supervision.
TO THE MEMBERS OF THE COUNTY COUNCIL AND
DISTRICT COMMITTEES.
GENTLEMEN, - In accordance with the requirements of the Local
Government Act and the Regulations of the Board of Supervision, I
have the honour to place in your hands the First Annual Report
upon the Health and Sanitary Condition of the County.
I have considered it advisable, in this first Report, to enter with
considerable fulness into the general circumstances of the County in
so far as they have any relation to the public health, and to describe,
perhaps with some tediousness of detail, the working of the County
Health Department, - this with a view to placing the Members of the
County Council and the District Committees in a position to exercise
an intelligent control over the public health administration of the
County. In order the better to attain this end, and with a view to
avoiding wearisome iteration, I have endeavoured, while treating of the
sanitary circumstances of the districts under the headings prescribed
by the Board of Supervision, to group the circumstances of the two
districts under common headings. This method has the advantage
of obviating the necessity for repeating over again observations which
apply with equal force to both districts, and of bringing the experi-
ence of the whole county, in each department of sanitary work, to a
common point of vision.
The position of a County Medical Officer in Scotland is widely dif-
ferent from that of a County Medical Officer in England. In the lat-
ter case the Medical Officer is a purely advisatory official, exercising,
for the purposes of the County Council, a general supervision over
the sanitary administration of all the towns in the county with popu-
lations under 50,000, as well as of the rural districts, and reporting
thereon to the County Council. In Scotland only the Police (practi-
cally, the smaller) Burghs come in any degree within the purview of
the County Council, and even in their case their relation to the
County Council has been left entirely undefined. The County Medi- |
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MAP
OF THE
COUNTY OF RENFREW
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[Map inserted]
PREVALENCE ...
IN THE COUNTY
Scarlet Fev..
Enteric ...
Diphtheria...
Measles...
County Health Department
County Buildings
Paisley |
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[Map inserted]
PREVALENCE OF INFECTIOUS DISEASE
IN THE COUNTY DURING THE YEAR
Scarlet Fever Cases
Enteric Fever Cases
Diphtheria Cases
Measles Cases
County Health Department
County Buildings
Paisley |
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[Page] 2
cal Officer in Scotland, as the result of circumstance rather than of
deliberate intention, has become the administrative health officer of
the rural districts, with but a slender relation to the County Council.
In some counties, where the districts are difficult of access and tra-
verse, the services of the Parochial Medical Officers have been re-
tained; in other cases, deputy or assistant medical officers have been
appointed, to act under the County Medical Officer in particular di-
visions of the county.
It seems to me, although it may appear presumptuous to say
so, that the Scottish Local Government Act was not a thoroughly
thought-out measure, more especially in its public health rela-
tions. In particular, it is defective in that it leaves the relations
of the County Councils to the Police Burghs altogether undefined.
I am, of course, speaking generally, and without any reference
to the circumstances of Renfrewshire. The smaller burghs are
now the weak point in the sanitary organization of Scotland. In the
body of my report I have remarked that it is axiomatic that 'the
smaller the unit of sanitary administration, the less efficient.' The
Police Burghs are too small to be efficient as units of sanitary admin-
istration. Again, in a good many counties the landward (sanitary)
districts which have been created under the Local Government Act,
while admirably adapted for the local administration of the Roads
and Bridges Acts, are too small to be efficient in the administration
of the Public Health Acts. All this would be remedied if in the
amending Act, which is already admitedly required, means were
adopted for drawing closer the relations between the County Councils
and the Police Burghs and District Committees. In this way would
be rendered impossible a condition of affairs, whereby, in the centre
of a county in which the larger towns and the other landward dis-
tricts have adopted the Infectious Disease (Notification) Act, the In-
fectious Disease (Prevention) Act, the Public Health Acts Amend-
ment Act, or other Acts the adoption of which is optional, there re-
mains a small burgh or district in which none of these measures have
been adopted, and which serves as a distributing centre of disease;
whereby in one district of a county one code of Dairy Regulations is
in operation, in the next another; whereby burghs and landward
districts are left to squabble amongst themselves as to the construc-
tion and upkeep, or ownership, of hospitals. In this connection I
may be permitted to congratulate the District Committees of the
County upon the harmony which has prevailed in Renfrewshire -
[Page] 3
which has secured one uniform system of sanitary administration
over the county; while the Notification system, the Dairy Regulations,
and the Lodging-house Regulations, have been brought into opera-
tion simultaneously, and on identical lines, all over the County land-
ward.
I should like to refer to one other point which will require atten-
tion, when the question of a new Local Government Act comes up
for consideration. I have already remarked that small burghs are,
generally speaking, inefficient in respect of sanitary administration,
not to speak of other points; petty burghal administration is also
relatively extravagant, in respect of the maintenance of a separate set
of officials. Still, if a considerable village is to be made reasonably
habitable, it has no other course open to it than to constitute itself
a burgh. A system of public lighting (which is necessarily by vol-
untary assessment) has a constant struggle for existence, and is never
sufficient; there can be no public system of scavenging; the foot-
paths, in wet weather, are puddles, unless the proprietor ex-adverso
chances to be more public-spirited than usual; new houses are run
up by jerry-builders, over the building of which no one has any con-
trol - it is only after they have been sold, when complaints of damp-
ness or bad smells have been made, or some one has died of diphtheria,
that the Local Authority, too late, comes upon the scene. Already
several County Councils have had these matters under consideration.
The following are the terms of a resolution on the subject adopted
by the Stirlingshire County Council:-
'That the Secretary for Scotland be petitioned to introduce a Bill
amending the Local Government (Scotland) Act, to enpower County
Councils: (a) to define areas for lighting, cleansing, and paving roads
or streets (in populous places) and to assess therefor; and (b) to ex-
ercise the functions of a Dean of Guild Court in controlling the
erection of buildings as far as the site and sanitary arrangements are
concerned.'
I respectfully commend the matter to the consideration of the
County Council.
In presenting this report I may be permitted to express my sense
of the extreme kindness which has been extended to me by the mem-
bers of the County Council and the District Committees, individually
and collectively. The work of the year was anxious and arduous, as
will sufficiently appear in the body of the report, but it was rendered
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I received, and in consequence of the very harmonious relations which
exist between the county officials of Renfrewshire. I am personally
indebted, in particular, to Mr. Caldwell, the County Clerk, and to
Dr. Hill and Mr. Macdougall, the District Clerks, for much wise
counsel, and their patient indulgence of my thirst for information. The
Chief Constable has shown himself most kind and willing to assist in
anything which seemed to be for the advantage of the county, whether
it lay within the four corners of his duties or not. As respects the
staff under my control, I can only say that no county in Scotland has
a more loyal or zealous body of servants, nor one more desirous of
doing their duty faithfully, intelligently, and 'not as eye-servants.'
In view of the criticism to which the constitution of the Health
Department was, at the outset, exposed, I am pleased to say that the
relations existing between the members of the sanitary staff could not
possibly have been more harmonious than they have been.
I am, Gentlemen,
Your obedient Servant,
A. CAMPBELL MUNRO.
COUNTY BUILDINGS, PAISLEY,
March, 1892.
PART I.
THE COUNTY GENERALLY.
The County of Renfrew is inconsiderable in size, measuring in its
extreme length only 31 1/2 miles, in its widest extent only 13 miles:
its area comprising, according to the Ordnance Survey, only 156,785
acres.* Although thus limited in extent, the County has always, in
the present century, at least, held a position of importance amongst
the counties of Scotland, having been, prior to its curtailment, fifth
in respect of population and rateable value. Its population at the
census of 1891, including the Burghs, was 290,798; and in respect of
density of population it stood second amongst the counties of Scot-
land, having 1186 persons to the square mile; the County of Edin-
burgh being first with 1226 persons to the square mile. The popu-
lousness of the County is due in part to the considerable towns it
includes within its borders; in great part to the position it occupies
* Of this area, 133 acres were within the limits of the City of Glasgow prior
to the passing of the Glasgow Extension Act, 1866 acres were added to the city
by that Act; this area, with the Burgh of Kinning Park (109 acres), has been
transferred to the County of Lanark by the Boundaries Commission; by a pre-
vious Order of the Boundaries Commission, which came into operation in May,
1891, the detached portions of the Parishes of Beith and Dunlop, comprising
1645 acres, were transferred to Ayrshire. The area of the County has thus
been reduced by 3753 acres. Of the remaining 153,032, 7761 are embraced
within burghal boundaries, as follows:- Paisley, 3,538 acres; Renfrew, 1,614;
Greenock, 1440; Port Glasgow, 473; Johnstone (approximately), 300; Gourock,
246; Pollokshaws, 150. I have been careful to note these figures here, as they
are not otherwise to be obtained, in a complete form, without considerable diffi-
culty. The area of the County landward, that is, under the direct control of
the District Committees for sanitary purposes, is now 145,271 acres, of which
63,396 are within the jurisdiction of the First or Upper District Committee,
and 83,983 in the Second or Lower District. It may be noted in passing that
there are 348 persons per square mile in the First or Upper District landward,
as compared with 148 in the Second or Lower District. |
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as a manufacturing county; in some degree to its suburban position
in relation to Glasgow. Its industries are varied, the principal being
the various processes connected with the manufacture of cotton;
while it is in considerable repute as a dairy county. There are also
certain shale pits and oil works in the centre of the County.
The physical characteristics of the County are easily summarised.
Its general declination, on the large scale, is from the south north-
wards to the valley of the Clyde. It has been customary to describe
the County as consisting, topographically, of three districts. An
upper one, with a medium elevation of from 500 to 600 feet above
the sea level, attaining its highest elevation in the south-east, in the
Parish of Eaglesham, and in the west, where the highest elevation in
the County is reached by the peak of Misty Law, 1663 feet above
the sea level. To this high district, lying mostly on gravel or whin-
stone (trap), or 'rotten' (fissured) whinstone, is assigned an area of
101,600 acres, and this, while partly heath and moss, yields a large
proportion of excellent pasture-land. This is the southern zone of
the County, and includes most of the Parishes of Eaglesham,
Mearns, Neilston, part of the Abbey Parish, and part of Loch-
winnoch, Kilbarchan, Kilmalcolm, and Inverkip. The middle
district, of moderate elevation, extends to about 40,600 acres,
generally of gently rising ground, and includes the Parishes of
Cathcart, Eastwood, parts of Abbey Parish, Inchinnan, Erskine,
Houston, Kilbarchan, and Renfrew. The soil here is, generally
speaking, a thin earth, sometimes on a gravelly, often on a 'till'
bottom (composed of rocky detritus), with loamy hollows; here there
is little land which is not arable. The characteristics of this district
are 'little hills gently swelling in endless variety, interspersed with
various coloured copses, often watered at the bottom by winding
rivulets.' * The low country consists chiefly of the level tract
situated to the north of Paisley, comprehending a considerable por-
tion of the parishes of Abbey, Renfrew, Inchinnan, Erskine, Houston
and Kilbarchan, and extends to about 12,000 acres. Ϯ In this district
the rock is deeply overlaid with moss, sand, gravel or clay, the soil,
or upper layer, consisting generally of a rich, deep loam, 'apparently
a deposition of vegetable mould from the higher parts of the
country.' ‡ The geological features of the county are thus summar-
* Chalmers' Caledonia; published by Alex. Gardner, Paisley.
Ϯ These are the measurements of a period antecedent to the Ordnance Survey.
‡ New Statistical Account.
[Page] 7
ised:- 'Renfrewshire is the north-west corner of the great coalfield
of Scotland. The coal measures are all in the N. E. division of the
County; the old red sandstone girdles it on the seashore from Kelly
to Port Glasgow; all the rest are traps or igneous rocks of various
descriptions. If a line be drawn from the Cloch Lighthouse to the
extremity of Eaglesham, a distance of about 31 miles, the whole is of
the whin formation. Generally speaking, the highest lands in the
most hilly districts are composed of igneous rock.'
Renfrewshire is a well watered country. The airs rising off the
Gulf Stream and striking the line of hills to the southward, discharge
their moisture as rain, thus giving birth among the hills to a thousand
'burns' or rivulets. To this circumstance it is no doubt due that the
cotton industry took root in the country, a plentiful supply of water
being necessary to the open-air system of calico-bleaching formerly in
vogue. Curiously enough, for a sea-board county, all the consider-
able streams, the White Cart, Black Cart, and Gryffe, with their
various tributaries, converge to one common point of outfall into the
Clyde, below Inchinnan Bridge.
A reverend chronicler, in the 'Statistical Account,' describes his
Parish as having three separate and distinct climates! It may, there-
fore, be permissible for me to allege that while the climate of the
County, generally, may be described as equable, with a rainfall above
the average, it may be distinguished, according to locality, as of three
varieties. Some observers might be inclined to associate a particular
quality of climate with each of the three districts above defined;
but it appears to me that the climate of the middle district is simply
intermediate between that of the higher and lower, and has no
particular characteristic of its own. Unfortunately there are no
scientific records to which I can refer in support of the system of
climatology I suggest. Very careful and precise meteorological
records are kept by Mr. McLean, of the Paisley Observatory (107
ft. above ordnance datum), and Mr. Wilson, at the Greenock Water-
works (233 ft.), but these elevations and localities are not sufficiently
distinct to serve as a basis for a system of comparative meteorology
for the county. For such a purpose, and to demonstrate scientifically
the three differently characterized climates, which I believe to exist in
the county, one would require to have a meteorological station at,
say, Eaglesham, or above Newton-Mearns; another at Inkerman or
Blackstoun; and a third at Wemyss Bay. I believe that the first
would indicate a greater rainfall, a less degree of humidity of the |
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atmosphere, a lower mean temperature, and probably a greater daily,
monthly, and annual range of temperature, a greater and more rapid
air-movement, greater earth-radiation (as shown by the minimum
black-bulb thermometer); and generally speaking, a 'bracing,'
although somewhat rainy, climate. These characteristics would be
shared in a slightly less degree by such places as Kilmalcolm and
Bridge of Weir (Ranfurly). The second, or low level, station would
show, I believe, a less rainfall, a much greater degree of humidity (as
witness the winter fogs), a higher mean temperature and a less range,
less air-movement; or, summarily, a more equable but damper
climate. The third, or western, station would speak for a much
smaller area, but would tell of a milder, and from its sea environ-
ment, a still more equable climate.
THE CENSUS OF 1891.
IT happened, not inopportunely, that the first year of the operations
of the Sanitary Authorities constituted under the Local Government
Act, should be a censal year. Vital statistics are based largely upon
returns of populations, and unless founded upon an accurate
knowledge of the populations involved, are apt to prove
will-o'-the-wisps rather than guiding lights. The census, further,
in addition to its main object of numbering the people,
affords an opportunity of investigating various matters affecting their
social life, which throw an effective side-light upon various
sanitary conditions. Under these circumstances I was much
gratified when the County Council, by authorising a fee in each case,
afforded me an opportunity of obtaining abstracts of the census
returns for the County before they left the hands of the local
registrars. This was the more important in view of the partition of
the County likely to arise under the operation of the Glasgow Exten-
sion Bill, and having in regard the probable course of action of the
Boundaries Commission. I addressed myself, therefore, to secure
returns not only of the population of the County as it stood at the
date of the census, but also as it might come to be altered in the
course of the year. I am thus in a position to state with precision
the figures for the different districts of the County, landward, with
which, as the Sanitary Authorities, the County Council and the Dis-
trict Committees are chiefly concerned.
Considering that it might be convenient to have on record here an
abstract of the populations of the burghs within the County, as
[Page] 9
ascertained at the censuses of 1881 and 1891, I have prepared the
subjoined tables:-
Burghal Populations in 1881 and 1891.
[Table inserted]
It will be observed that the highest rate of increase has been in the
Glasgow Suburban Burghs, of which Crosshill, Pollokshields-East,
and Pollokshields-west, have been absorbed by Glasgow since the
date of the census. The following table, showing the populations
and rates of increase in the various villages * and landward districts
now comprised within the jurisdiction of the First and Second Dis-
trict Committees, are of greater practical interest to us:-
* Having over 300 inhabitants: hamlets with under 300 of a population are in
this and all other tables included in the "landward" sections. |
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FIRST OR UPPER DISTRICT.
Populations of Villages and Landward Districts, 1881 and 1891.
[Table inserted]
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SECOND OR LOWER DISTRICT.
Populations of Villages and Landward Districts, 1881 and 1891.
[Table inserted] |
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In one or two instances I have been unable to obtain the popula-
tions of landward sections of Registration Districts from the census
returns of 1881.
It will be observed that the mean increases of 5·8 per cent. in the
First District, and 3·2 in the Second, cover considerable fluctuations
in particular localities. In the First District the highest rate of in-
crease in the intercensal period was in the suburban district of Cath-
cart (under which designation the exigencies of the census returns
compel me to group Old and New Cathcart and Netherlee), with an
increase at the rate of 114 per cent.; Scotstoun, on the north side of
the Clyde, and the purely landward portion of Renfrew Parish,
which includes Scotstounhill, come next. The most marked rate of
decrease is shown in the case of the village of Inkerman, where the
population has declined, with some fluctuations, by 30 per cent.;
next comes the village of Newton Mearns, with a decrease of 25 per
cent., and the landward section of Neilston Parish, with a decrease
of 22 per cent. All the landward sections show a decrease, with the
exception of Renfrew (which, on the north side, is suburban), and
Abbey landward (which is also, in another sense, suburban). In the
Second District the highest rate of increase is shown in the case of
Bridge of Weir (Ranfurly) with 52 per cent., and Kilmalcolm village
with 41 per cent. The highest rate of decrease is found in the
mining village of Clippens, 36 per cent., next coming the Parish of
Houston landward, with 25 per cent.
On reference to old records I find that the population of the
Parish of Eastwood in 1801 was set down at 3375, as compared with
16,042 in 1891; while during the same period the population of the
Parish of Cathcart has risen from 1050 to 16,510 - surely a marvel-
lous rate of increase.
In Tables I. and II. of the Appendix, there is given a careful
analysis of the census abstracts of 1891, in so far as the sections of
the County are concerned which are under the sanitary jurisdiction
of the First and Second District Committees. Of much the most
importance here, from the sanitary point of view, are the figures
showing the average number of rooms per house; the same results
being obtained, however, in a general way, but upon an enlarged
scale, when the number of persons per thousand rooms is taken.
From the average size of house, the average social grade of the
population, so important an element in the sanitary problem,
may be deduced with considerable precision. The smallest houses
[Page] 13
are found to be those at Scotstoun, where the average number
of rooms per household is as low as 1·5, implying the existence of a
considerable number of one-roomed houses. Next come Linwood and
Gateside, each with an average of 1·9 rooms per household, and
Elderslie, Inkerman and Newton-Mearns with an average of 2·0;
thereafter Nitshill and Neilston with 2·1; Busby (Renfrewshire) and
Blackstoun with 2·2; Barrhead with 2·3. At the other end of the
scale we find Wemyss Bay (+ Inverkip landward) with an average of
6·8 rooms per house; Langbank, 6·2; Erskine landward, 5·8;
Kilmalcolm landward, and Eastwood landward (including Giffnock),
5·5; Eaglesham landward, 5·4; Kilbarchan landward (including
Milliken Park), 5·3; and Renfrew landward (including Scotstoun-
hill), 5·2. In order to place in greater relief the influence
of social position and the crowding together the population
upon sanitary conditions I have drawn up the following tables,
in the first of which I have placed the ten sections of the County in
which there are the greatest number of persons, in the second the
ten sections having the smallest number of persons, per thousand in-
habited rooms. In each I have set down the mean percentage of
deaths under 5 years * - that is, amongst young children, who are
most susceptible to insanitary influences, over the ten years 1881-90;
the mean death rate from zymotic, i.e., preventible, diseases, per ten
thousand; Ϯ and the mean death rate per thousand, from all causes.
It will be seen that the mean or average percentage of deaths under
five years is 44·6 amongst the closely aggregated populations as com-
pared with 26·2 amongst their better-off neighbours. The zymotic
death rate is in the first case 37, as compared with 13 in the second,
or almost three times as high; and the mean death rate 18·9, as com-
pared with 13·1. Were the figures selected from the data of a large
town, the results would be even more striking, as the circumstance
of living in a one-roomed house, in a large town, implies many sani-
tary disabilities which are not associated with the tenancy of a one-
roomed house in the country, where the beneficent powers of
Nature are active to mitigate the results of man's heedlessness and
neglect.
* I shall subsequently refer to the relative value of this as a test of sanitary
conditions.
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Most Closely Aggregated Populations, with Death Rates.
[Table inserted]
Least Closely Aggregated Populations, with Death Rates.
[Table inserted]
Of less importance, although not without a certain interest of its
own, is the analysis of the number of persons per household. The
* The mean death rate is not relatively very high, but that is explained by the
fact that it is these most closely aggregated populations which have an 'age-
distribution' most favourable to a low death rate - the bulk of the population
being in the prime of life, with a very small admixture of aged persons.
[Page] 15
five localities at the head of this list are all landward, with one ex-
ception. Stated in order, they are - Eaglesham landward, with 6·7
persons per household; Kilbarchan landward, with 6·1; Houston
landward and Blackstoun, 6·0; Abbey Parish landward, 5·9. A high
rate of persons per household implies one of two things, either a
social class amongst whom many servants are kept, or a high propor-
tion of large families. The first is the probable explanation of all
the above instances, except Blackstoun, where it is evident that the
proportion of large families is greater than elsewhere. At the other
end of the scale we have Houston (Village), with an average of 3·6
persons per household; Newton Mearns, with 4·0; Bridge of Weir
(Houston) and Lochwinnoch (Village), with 4·1; and Bishopton with
4·2. These figures probably imply that there is in these sections of
the County a considerable proportion of aged couples, whose families
have gone out into the world.
The proportion of uninhabited houses may be taken to represent,
broadly, the relative prosperity of the different localities at the time
of the Census. In Thornliebank there were reported to be no unin-
habited houses; at Anniesland, in the north part of the Parish of
Renfrew, the uninhabited houses were only one per cent. of the in-
habited houses; at Yoker, Ferry Road Head, Bridge of Weir (Ran-
furly), Bishopton, and Busby, 2 per cent.; at Scotstoun and Linwood,
3 per cent.; at Blackstoun, 4 per cent. At the other end of the
scale we have Eaglesham, with 87 per cent.; Inkerman, with 64 per
cent.; Clippens, with 57 per cent.; Houston (village) and Crosslee,
with 28 per cent.; Inverkip, with 26 per cent.; Gateside, with 24
per cent.; Newton Mearns, with 22 per cent. In two of the in-
stances in the latter list an exception, or partial exception, must be
made to the general deduction as to comparative prosperity. The
census is taken in the beginning of April; Eaglesham and Inverkip
are places of summer resort; if the census were taken at midsummer,
a much smaller proportion of unoccupied houses would fall to be
recorded in these villages.
There appears to be a general preponderance of females over males
in the County landward. This is most accentuated at Neilston, where,
probably in consequence of the number of female operatives employed
in the Cotton Mills, there are 124 females to every 100 males. In
Langbank the proportion is 118; here the excess is doubtless due to
the number of female domestic servants; in Eaglesham the proportion
is 116 - why I cannot say, unless it be that a large proportion of male
adults is drawn away to seek employment in the large towns; in |
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[Page] 16
Mearns landward, 114, possibly in connection with the bleach-fields;
at Kilmalcolm, 112, the excess beiug attributable to the same cause
as at Langbank. The only sections of the County in which there are
fewer females than males are - Anniesland, Scotstoun, Neilston
landward, Barrhead landward, Inchinnan, Clippens, and Busby land-
ward.
THE GENERAL SANITARY CONDITION OF THE COUNTY AS DEDUCIBLE
FROM THE VITAL STATISTICS OF THE PAST TEN YEARS.
When a physician is called upon to deal with a case of illness, his
first duty is, at whatever cost, to make a careful diagnosis of the
case - to ascertain the nature of the disease and its seat. Until
this is done, any attempt at treatment is mere empiricism. In
coming to deal with the sanitary ills of the body corporate of a
County, it appeared to me that I should have to act more or less
empirically, and consequently inefficiently, in the absence of any
attempt to diagnose, more especially in the sense of localizing, the
evils from which the district suffered. Furthermore, I was met at
the outset with statements as to the healthfulness of certain localities,
which it was difficult to reconcile with the marked sanitary disabilities
under which these localities lay. Under these circumstances it
appeared to me indispensable to the intelligent discharge of my duty
to the County Council and the District Committees, that I should
endeavour to collect and collate the vital statistics of the County, so
far as within my jurisdiction, over a considerable period, in order to
ascertain which sections had suffered most in the past, as the result
of insanitary conditions, to which sections the attention of the Health
Department ought in the first instance, to be principally directed,
and to obtain, if possible, from the nature of the prevalent diseases,
in the various localities, some indications of the sanitary conditions
which were in default. With this object in view I determined to
extract from the death-registers of the County, all the deaths which
had occurred over the ten years 1881-90, with localities, causes, ages,
etc., and to tabulate and analyse them so as to obtain, as far as
possible, the information desired. I hoped to have been able to
extract the births, over the same period, in order to place myself in
a position to calculate the 'infantile mortality rate' * for each
* the 'infantile mortality rate' is the proportion of babies (infants under
one year) who die within the first year of life: this is infinitely the most
sensitive and reliable individual test of the sanitary condition of a district.
[Page] 17
section, over the ten years; but I found that this would have
absorbed the time and energies of a person familiar with the district,
for a period of about five weeks. I had, therefore, to relinquish the
idea as impracticable. As it was, the labour involved in the
collection, collation, localization, tabulation, and analysis of the
figures has been very great.
There is nothing so deceptive as facts, except figures, says a cynical
critic. The phrase is more than an epigram. Figures must be care-
fully and intelligently handled, in a judicial spirit, and too large
deductions must not be drawn from them, if they are to be of any
practical service. I desire, therefore, to guard myself and my readers
from too hasty or too literal an interpretation of the figures which
follow, and which are set forth in detail in the tables of death-rates in
the Appendix.
In the first place, I remark that the death-rate alone, is a very
insufficient guide to the sanitary condition of a district - one ought
also to know what is called the 'age distribution' of the population.
One place, for instance, may have an excessive proportion of old men
and women, and only a small proportion of persons in the prime of
life; a high death-rate in this case does not necessarily imply an
insanitary condition of affairs. We have an excellent illustration of
this fallacy in the case of the village of Eaglesham, whose mean death-
rate over the ten years is given, in the tables which follow, as 22·7,
an abnormal death-rate for a village remote from towns; and one
which I could not accept nntil I had gone over the figures again and
again. I am unable to apply the necessary correction for the age-
and-sex-distribution of the population of the village, the material for
which will not be forthcoming until the further publication of census
results. But I find that, over the ten years, 47·9, or roughly,
50 per cent. of the deaths in the village were of persons over
sixty years of age; and I am led to understand that there
is in the village an abnormal proportion of aged persons.
As an illustration of the same fallacy acting in the reverse
way, I take the case of Scotstoun; there, as we have seen, the
population is more closely crowded together than anywhere else
in the County, yet the death-rate is only 16·0 per thousand. Here,
however, I observe that the percentage of deaths over sixty years of
age is only 8·4, the lowest, save one, in the County, while the per-
centage of deaths under five years of age is 69·4 - the highest in the
County. With these figures before me, and knowing that the local |
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[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
[Page] 19
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, |
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in the course of the year, no fewer than thirteen deaths. Towards
the end of 1891 the disease once more broke out in epidemic form in
the village, as will be seen in the further course of this report.
With these preliminary observations, I pass on to a consideration of
the general results of the analysis of the vital statistics of the last
decennium.
Vital Statistics of the Two Districts, 1881-90. - Taking
first the First or Upper District, it is gratifying to observe that not-
withstanding the non-existence of a County Health Department (!)
there emerged a distinct improvement in the condition of the public
health as the decennium advanced. This improvement is masked if
the figures of only one year are compared with those of another; but
when the decennium is divided into quinquennial periods, progress
stands revealed. Thus, we find the mean death-rate fell from 18·6
per thousand of the population in the first five years of the decennium
to 17·0 in the second five years; the zymotic death-rate, from 3·1 to
2·2. The mean death-rate of the decennium was 17·8, the mean
zymotic death-rate 2·7. The scarlet fever death-rate fell from ·9 in
the first period to ·2 in the second - but, as a matter of fact, this dis-
ease appears to have simply burnt itself out in the more populous
districts in the first period, and only now is there becoming aggre-
gated a sufficient bulk of unattacked, susceptible, material to furnish
forth a new conflagration. A slight decline in the mortality from
whooping-cough is counterbalanced by a slight increase in the
diphtheria death-rate. There is a slight decrease in the death-rates
from septic diseases ('blood poisoning'), phthisis, other tubercular
diseases, and diseases of the lungs.
In the Second or Lower District, the death-rate fell from 17·9 per
thousand in the first quinquennium to 16·2 in the second, the zymotic
death-rate from 2·2 to 1·7: the mean rates for the decennium being
17·1 and 2·0 respectively. The scarlet fever death-rate fell from ·4
to ·1, as in the First District, there was as light increase in the death-
rate from diphtheria; the measles death-rate, however, fell from ·3
to ·1. It may be that to some of my readers a fall 'from ·3 to ·1'
does not appear to have much significance; translated into simpler
elements, it means a saving of 24 lives, and of, approximately, 600
cases of illness, with the impairment of constitution which so often
follows upon non-fatal attacks of measles. There was also a slight
decrease in the death rates from septic diseases, phthisis, other tuber-
cular diseases, heart disease, and diseases of the lungs.
[Page] 21
The Condition of the Public Health in the Villatic as
compared with the Landward Sections of the County,
1881-90. - Table V. of the Appendix shows very clearly that the
conditions of life in a purely landward (rural) district, outwith the
villages, as compared with the average conditions in the villages, are
infinitely more favourable to the public health than are the condi-
tions of village life as compared with those of towns. Thus, it will
be seen that the mean death-rate in the villatic section of the county,
over the ten years, has been 19·063 per thousand of the population,
while in the purely landward section it has been as low as 11·032, or
8·031 per thousand less: the difference is much greater than one
would have been inclined to anticipate, even taking into considera-
tion the insanitary conditions prevalent in so many of our villages.
The mean zymotic death-rate in the villages was 2·929, as compared
with 1·204 in the landward districts; considering that proximity of
susceptible persons is an important factor in the spread of infectious
diseases, one is not surprised at this result. The death-rate from
scarlet fever was 560 * per million in the villages, as compared with
140 in the landward portion; measles, 300, as compared with 108;
whooping cough, 577, as compared with 215. But it is of importance
to note, in view of the current discussions to the causation of
diphtheria, that the diphtheria death-rate in villages was 280, as
compared with 190 out in the country. It is of even more impor-
tance to observe that the mean diarrheal death-rate for the villages
was as high as 862, as compared with 380 in the purely landward
district; diarrheal diseases are just what we would expect to follow
in the train of the foul ashpits, wretched scavenging, and general
pollution of the soil which characterise so many of our villages. In
only one important particular does the standard of public health in
the landward districts fail to rise appreciably above that in the vill-
ages, that is in respect of septic diseases - the class of diseases gener-
ally spoken of as arising from 'blood poisoning'; here the villatic
death-rate is 212, as compared with 209 landward; it is painful to
observe the number of women in the country who die of puerperal
fever, in the pure country air this class of diseases should be almost
unknown. I have little difficulty in attributing such a prevalence of
diseases of this class in the country to what is generally regarded
as the healthful muckiness of farm-steadings; it has not yet come to
* Abolishing the decimals.
2 |
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[Page] 22
be 'understanded of the people' that the proximity of considerable
areas of putrefying filth of any sort - even if it be the excreta of
animals other than human - is inimical to health, and that but for
the great mitigating influence of the free sweep of the oxoniferous
country air, and the out-door life led by the people, the results of
living amidst such surroundings would be disastrous. - Phthisis in
the villages shows a mean death-rate of 2467, as compared with only
1534 in the country; and, still more striking, the death-rate in the
country districts from other tubercular (sometimes called 'scrofu-
lous') diseases was only 608, as compared with 1341 in the villages.
There is a diminution in the landward death-rates under each of the
headings cancer, diseases of the nervous system, heart diseases,
and respiratory (or lung) diseases; but, curiously enough, the death-
rate from 'violence' - generally speaking, accidents - in the country
is as high as 513, as compared with 459 in the villages; and, indeed,
the liability to fatal accidents in the country, so far as these figures
go, appears to be about as great as in the average busy industrial
town, with its thousand evident chances of misadventure. It may be
useful to give here, mainly for purposes of comparison with the vill-
atic death-rates, a summary of the mean death-rates, over the same
period, of a town with which I was formerly officially connected.*
The mean death-rate was 20·528, or, practically, 1·5 higher than the
mean of the Renfrewshire villages. The mean zymotic death-rate,
however, was only 2·345, as compared with 2·929 in the villages - a
very striking circumstance, considering the crowding together of the
population which exists in a town. The death-rate from diphtheria
in the town was - again abolishing decimals - 106 per million, as com-
pared with 280 in the villages. The death-rate from so very com-
municable a disease as scarlet fever was only 455 in the town, as
compared with 560 in the villages; from 'fever' (i.e., typhus and
enteric fevers) 198, as compared with 347; from measles, however,
it was 346, as compared with 300 in our villages; from whooping
cough, 440, as compared with 577. The mean death-rate in the
town from diarrhœa was 785, as compared with 862 in the country
villages. This last is a most pregnant fact - it speaks volumes in
favour of the establishment of a proper system of scavenging in our
rural communities. The death-rate from phthisis was 1·846 per
thousand, as compared with 2·467 in the villages. The death-rate
* South Shields.
[Page] 23
from septic diseases was at the rate of 120, as compared with 212 in
the villages. The death-rate from respiratory diseases, however,
was considerably higher in the town, being at the rate of 3·551 per
thousand, as compared with 2·940; and so, also, the death-rate from
heart disease, nervous diseases, and other diseases not generally re-
garded as susceptible to preventive treatment. - These figures alone
suffice to show how much remains to be done in order to place our
village populations in the position of healthfulness they ought to
occupy in virtue of their great natural advantages - of pure air,
more cloudless skies, comparative isolation from sources of infection,
less sedentary occupations, lessened wear and tear, and opportunities
of out-door exercise.
The relative healthfulness of the various villatic and land-
ward sections of the County, so far as deducible from the
vital statistics of the County over the decennium, 1881-90.* -
As I have already said, in the absence of a calculated 'infantile
mortality rate' too much stress may not be laid upon the percentage
of deaths under five, 'the gross death-rate,' nor, indeed, upon any
individual rate. Probably the most reliable individual test remaining
to us is the death-rate from zymotic, that is, infectious and filth-produced,
diseases. In this black list the village of Elderslie claims the worst
place with a deathrate of 6·3 per thousand of the population; coming
first, also, at the head of the list under the heading Diphtheria, with
·7; third in respect of Scarlet fever, with 1·5; Enteric fever, second,
with others. 1·5. This is a woful history, the more discouraging that
on comparing the second quinquennium of the decade with the first,
the mean zymotic death-rate shows no sign of decrease. Ϯ Blackstoun
and Clippens come next, with a zymotic death-rate of 5·5, and 5·3
respectively; these villages head the list under the heading Enteric
fever, and Blackstoun comes out highest under the heading Measles;
Blackstoun and Clippens share the discredit of second place in re-
spect of Diarrheal mortality, with Elderslie and Anniesland. To
summarize the results of the analysis of the zymotic death-rates: the
localities, all villages, having a death-rate of over 2·5 per thousand,
that is, having an excessively high zymotic death-rate, are in the
* See tables VI. and VII. of the Appendix.
Ϯ It is of good omen that of 12 cases of scarlet fever, occurring in the village
since the inauguration of the County Health Department, we have been able to
secure the removal to hospital of every one. |
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[Page] 24
order named - Elderslie, Blackstoun, Clippens, Scotstoun, Thornlie-
bank, * Crosslee, Busby, and Anniesland, Linwood - Ϯ Howwood,
Barrhead, Nitshill - Yoker, Kilbarchan - Newton Mearns - and the
Sheddens-Clarkston district. - Under the heading Diphtheria, the
following sections stand highest, in the order named - Elderslie,
Blackstoun, Scotstoun - Anniesland - Cathcart, Clippens - Howwood
- Barrhead - Barrhead landward - Mearns landward - Renfrew land-
* One of the most interesting circumstances brought out in the course of this
analysis has been the improvement in the condition of the public health in
Thornliebank, which, while twelve years ago it was very unsatisfactory, is
now as good as in any other part of the country. When, as in the other
cases, I divided the decennium into two quinquennial periods, this improvement
was placed in relief. Over the first five years the mean death-rate was 24·1 per
thousand of the population, as compared with 16·1 over the second five years -
a decrease of 8 per thousand! The zymotic death-rate fell from the abnormal rate
of 6·4 to 2·2; the principal decrease being under the heading 'scarlet fever' -
which appears to have raged as a plague in 1881-82; but the most interesting,
in view of what I am about to say, is the decline in the death-rate from enteric
fever, which fell from 1·1 to ·3. The death-rate from 'tubercular diseases other
than phthisis' fell from 2·6 to ·9, and that from 'septic diseases,' from ·3 to ·1;
the death-rate from phthisis fell from 3·8 to 3·3. For the purpose of closer
examination I divided the decennium into a series of biennial periods, the most
characteristic features of which are summarised in the following table. I regret
I have not in my possession the figures for preceding years.
[Table inserted]
I felt bound to inquire whether any collateral circumstance could account for
this very striking improvement in the health of the village. I found that in the
course of 1882-83, a new main-sewerage system for the village had been provided
by Mr. Crum, at an expense of over £2000, and that simultaneously the house-
drains over the village had been reconstructed, and 'jawboxes' which had stood
in the kitchens had been replaced generally outside. Words can add nothing to
the force and suggestiveness of this sequence of events. - The rise in the zymotic
death-rate in the biennial period, 1885-86, was due to an epidemic of whooping-
cough.
Ϯ Places separated by a dash have an equal death-rate.
[Page] 25
ward. Scarlet fever, Nitshill, Clippens, Elderslie, Thornliebank, Barr-
head, Gateside, Yoker, Houston (village), Scotstoun and Kilbarchan
(village). Enteric fever, Blackstoun and Clippens, Elderslie - John-
stone landward, Inkerman - Crosslee - Gateside - Renfrew landward,
Bridge-of-Weir (Houston) - Linwood - Linwood landward - Erskine
landward - Newton-Mearns - and Eaglesham village. Measles, Black-
stoun, Elderslie, Scotstoun, Sheddens-Clarkston, Howwood, Newton-
Mearns, Linwood - Busby - Neilston - Anniesland. Whooping-cough,
Busby, Clippens, Scotstoun - Yoker, Linwood - Thornliebank, Barr-
head - Bridge-of-Weir (Houston) - Houston landward, Blackstoun -
Bishopton - Kilbarchan - Neilston - Newton Mearns. Diarrhea,
Crosslee, Elderslie - Blackstoun - Clippens - Anniesland, Howwood,
Scotstoun - Inverkip, Linwood - Yoker - Lochwinnoch (village).
The following districts have had no deaths from diphtheria in the
course of the decennium, - Inchinnan, Bishopton, Bridge-of-Weir
(Ranfurly), Lochwinnoch landward, Inverkip, Kilmalcolm landward,
Kilbarchan landward, Mearns landward, and Renfrew landward.
The following have had no deaths from enteric fever, - Inchinnan,
Bridge-of-Weir (Ranfurly), Kilbarchan landward, Mearns landwaad,
Houston landward, Anniesland, Clarkston, Barrhead landward. No
deaths from measles were registered during the decennium in
Kilmalcolm, Langbank, Erskine landward, Inchinnan, Inverkip,
Clippens (?), Linwood landward, Houston landward, Eaglesham,
Eaglesham landward, Mearns landward, Paisley landward, Yoker.
There were no deaths from whooping-cough in Kilbarchan landward,
Lochwinnoch landward, Neilston landward.
The death-rate from Phthisis fluctuates extraordinarily over the
County. It is difficult to discover any working hypothesis upon
which to account for these fluctuations. They are apparently
independent of climate, soil, or elevation of site. Thus Newton
Mearns heads the list with a death-rate of 4·7, while the death-rate in
Mearns landward, the surrounding district, is only 1·2; Thornliebank
has a mean phthisical death-rate of 3·6, while the death-rate of the
landward part of the parish is only 1·3; the Linwood death-rate is
3·4, in Linwood landward it is as low as ·8. Linwood landward
(death-rate ·8) Yoker (·6), Scotstoun (·9), Clippens (·9), part of
Inchinnan (1·0), most of Paisley landward (1·0), lie at a low level, on
a flat plain but little elevated above the sluggish rivers which wind
slowly through their midst, and have an undoubtedly damp subsoil;
on a considerable number of winter days fog hangs heavily over them. |
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[Page] 26
On the other hand Newton Mearns (4·7), Neilston landward (3·5),
Neilston village (3·1), Eaglesham Village (2·9), stand at a high
elevation, 500 to 700 feet above sea-level (as compared with,
probably, an average elevation of 50 to 60 feet for the first mentioned
districts), and have a naturally well-drained subsoil. Nor is it that
the population of the first series of localities has an age-distribution
which renders it less susceptible to the inroads of the disease;
consumption finds the bulk of its victims amongst the persons in the early
prime of life, and if any distinction can be made, it appears likely
that there is a larger proportion of persons at ages from 15 to 35 in
the first, or low-lying series of districts, than in those of the higher
elevation. While accepting it that too much must not be made of
the results of the analysis of comparatively small figures, it may safely
be stated that the experience of Renfrewshire over the ten years
1881-90 lends strength to the idea that the inception of phthisis is
not so much a question of soils and climate as is generally supposed,
and that occupation, habits of life, and, probably, dampness of dwell-
ings, are more efficient factors in the predisposition to phthisis. In
most of the districts in which the phthisical death-rate runs high, a
considerable number of the population are mill-hands. One fact, in
this relation, it is important to note, - that the sixteen sections which
have the highest mortality-rate from phthisis are all villages, with the
exception of Neilston landward, while most of the districts in which
the phthisis mortality-rate is low are landward districts. It appears
highly probable that the excessive death-rate from consumption in
some of the villages, may be explicable upon the hypothesis that a
large proportion of the young people, who have left their native
villages to seek occupation in some of the large towns, and who have
there contracted the disease, have returned home to die.
Of the 'Other tubercular diseases' it may be sufficient to say that
the experience of the ten years shows that they predominate where
insanitary conditions abound, and that the excess is practically
confined to villages. Erskine landward and Renfrew landward have
actually had no deaths from any of these diseases during the decenium.
With respect to the mortality from Respiratory diseases (diseases of
the lungs other than phthisis), the maleficent influence of low eleva-
tion and dampness of soil are tolerably apparent, the villages of the
plain, Blackstoun, Clippens, Inkermann, and Linwood, all standing
high on the list. All the sixteen sections at the head of the list are
villatic, while of the sixteen districts having the lowest death-rate
[Page] 27
from respiratory diseases, all are purely landward, with the exceptions
of Langbank, Bishopton, and Yoker, each of which, strangely enough,
lies near the Clyde. These figures show pretty conclusively that the
repeated wettings and constant exposure to the weather, to which
our agricultural population are subject, do not lead to a fatal
prevalence of respiratory diseases amongst them. The death-rate at
Blackstoun is so abnormally high, 6·4, that I am inclined to believe
that it is partly made up of cases of respiratory disease following
upon measles, which would have been certified as due to measles had
there been a doctor in attendance.
THE METEOROLOGICAL CONDITIONS OF 1891.
For the purposes of a general review of the average climatology of
the County, the observations taken at the Paisley Observatory fur-
nish a moderately good basis, Paisley being centrally situated, and
the Observatory being at a fair elevation. An ideal County Observa-
tory would find its site in the neighbourhood of the Stanley Reser-
voirs, which, being away from the local influences of the town, and
at a greater altitude, would furnish observations more nearly ap-
proaching a mean for the County than those taken at the Coats
Observatory. Of course, according to the view formerly expressed,
no fewer than three meteorological stations would be required
adequately to elucidate the climatology of the County. I have ab-
stracted and abridged the meteorological observations taken at the
Paisley Observatory, and the Greenock Water Works station, over
the year 1891, and have given the results of the first-mentioned
series in Table VIII. of the Appendix. The principal characteristic
of the meteorology of the year was, probably, the diminished rain-
fall over the first seven months of the year; of the total rainfall at
Paisley, 38 inches (which appears to be, approximately, an average
rainfall there), only 11·4 inches fell in the course of the first seven
months, while there was a yield of 26·6 inches in the succeeding five
months - altogether a most unsatisfactory distribution of moisture
from the agricultural point of view. The rainfall at the supra-
Greenock Station was similarly distributed over the year, but
amounted to no less than 60·8 inches, Greenock being thus true to its
past reputation. I have no doubt, however, that observations taken
at a greater altitude would show a still higher rainfall. 'Rain fell'
upon 189 days at Paisley, and 213 at Greenock; but as every day |
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[Page] 28
upon which as small a quantity as one-hundredth of an inch fell is
reckoned on the list, the really 'rainy days' were doubtless less by
about one-half than might be supposed from the tabular abstract.
The months of greatest 'wind pressure' at Paisley were September
and December; west and south-westerly winds were the most pre-
valent - especially in the autumn months; while the dryness of the
early summer months was doubtless associated with the exceptional
prevalence of easterly winds which characterised these months. It is
important to observe, as illustrating the distinction between excessive
rainfall and moistness of the atmosphere, that while the Greenock
rainfall amounted to 60 inches, as compared with 30 at Paisley,
the mean humidity (degree of moistness of the atmosphere)
was 4 per cent. less at Greenock. In Paisley, the black-bulb
thermometer, exposed to the sun, registered 95·1° in the month
of June, the temperature in the shade at the same time being
82·5°. The black-bulb minimum thermometers on the grass
(indicating the earth radiation and temperature on the surface
of the ground, at night) fell as low as 11·8° - the equivalent,
in popular phrase, of 20 degrees of frost - in March, at the same time
the minimum thermometer in the shade registered 21·0°. While,
however, the lowest temperatures were registered in that month, the
mean temperature of the month was a degree higher than that of the
month of January. At Paisley, the mean monthly range of tempera-
ture (i.e., difference between the highest and lowest temperatures of
the month) was 33·4°, as compared with 29·1° at Greenock; the mean
'daily range' being 13° at Paisley, as compared with 12·1° at
Greenock; whereby the greater equability of climate of Greenock,
due, doubtless, to its relative proximity to the sea, is demonstrated.
THE FORMER SANITARY ORGANIZATION OF THE COUNTY.
As is well known, the former sanitary organization in Scotland
was parochial. The Parochial Board was the Local Authority for
the administration of the Public Health Act in each parish. It
would be invidious for me to enter into a discussion of the reasons
which led to the transference of the duties of the Parochial Boards,
as guardians of the public health, to the County Council and District
Committees; they are all comprehended in the axiom that 'the
smaller the unit of sanitary administration, the less efficient.' Ac-
cepting that as axiomatic, it may be remarked, in passing, that in
[Page] 29
future the least efficient sanitary authorities in Scotland will be the
smaller burghs, which have been left in an anomalous and undefined
position, in respect of sanitary administration, under the Local
Government Act. Most people who have devoted any attention to
the subject regret that the smaller burghs, burghs under, say, 20,000
inhabitants, were not placed in the same relation to the County
Council as the Districts of the County, in respect of sanitary adminis-
tration.
At the passing of the Local Government Act, there were, in the
First or Upper District of the County, seven parishes, with the larger
half of an eighth, Govan (part of which was in Lanarkshire), and
smaller portions of a ninth and tenth, Beith and Dunlop (the major
portions of which were in Ayrshire). In the Second or Lower Dis-
trict were seven parishes, with the smaller portions of the parishes of
Greenock and Port-Glasgow which are landward. In the service of
the Parochial Boards, acting as Local Authorities for these parishes,
there were 21 Medical Officers, whose gross salaries amounted to
£149 5s. (exclusive of one officer paid by fees), and 16 Sanitary In-
spectors, with salaries amounting in the aggregate to £418 10s. - or
a total of £567 15s. Parochial Renfrewshire had therefore been, in
this matter, more liberal and enlightened than most counties. Still,
it will be understood that, in the case of the Medical Officer, the
average salary of £7 was intended rather as a retaining fee, in order
that the Local Authority might have the benefit of his advice when
they desired it, than as remuneration for the duties he was hypo-
thetically understood to discharge, under the regulations of the Board
of Supervision and the requirements of the Public Health Act.
THE EVOLUTION OF THE COUNTY HEALTH DEPARTMENT.
The County of Renfrew, acting under the provisions of the Local
Government Act, 1889 (which superseded the parochial system of
sanitary administration in Scotland), alone, I believe, among the
counties of Scotland, determined first of all to appoint a Medical
Officer of Health for the County, and to require him to produce for
the consideration of the County Council, and of a Special Committee
appointed for the purpose, a draft scheme for the constitution of a
County Health Department. The County Council decided from the
first that the Medical Officer of Health should be head of the County
Health Department - a matter which would have been a work of |
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[Page] 30
supererogation in England, where, as the result of ampler experience,
cela va sans dire.
I entered upon office in the middle of January, 1891, and from
that time, under the controlling hand of the County Council, the
Special Committee, and the District Committees, the county sanitary
organization evolved itself, slowly, step by step, so cautiously that it
was not until the end of the year that the County Health Depart-
ment would be considered fully organized. The first step was the
authorisation of the engagement of a clerk by the medical officer of
health. The next was the appointment, under the requirements of
the Local Government Act, of a 'county sanitary inspector or sani-
tary inspectors.' The County Council and the special Committee, in
consideration of the considerable size of each of the two Districts
into which the county was divided, decided to appoint two county
sanitary inspectors, each of whom should also be Chief Sanitary In-
spector for one of the Districts. There were about two hundred ap-
plications for these appointments, and the special Committee, after
the most careful consideration, from a select list prepared by myself,
appointed the two gentlemen who appeared most suitable. The next
question which arose was that of the retention, or otherwise, of the
parochial sanitary officers - to act under the control of the county
medical officer of health and sanitary inspectors. After full considera-
tion of all the circumstances of the case, I felt bound to advise that
the local officers should be relieved - most of them were most anxious
to be relieved - of their somewhat invidious duties, and that assistant
inspectors should be appointed, who should not be hampered by any
private engagements. The County Council and District Committees,
in consideration of the relatively small size and compactness of the
county, its advantages in respect of railway accommodation, and in
view of certain suggestions, subsequently to be developed, for the
further annihilation of distance, and having in regard the broad prin-
ciple that it is undesirable that public officials, and especially sanitary
officials, should be engaged in private work, determined to dispense
with the services of the local officers (who should be duly compen-
sated in accordance with the Civil Service system), and to appoint
two assistant sanitary inspectors for the First District, and one for
the Second, debarred from private work. The services of the local
officers were retained until the county officers should have obtained
a sufficient acquaintance with the sanitary history and the topography
of the county. To meet possible emergencies, which are likely very
[Page] 31
seldom to arise, I was authorised to have recourse, when required, to
the services of local medical men, to be paid by fee. Offices were
secured in an accessible position in the County Buildings for the
medical officer of health and the chief sanitary inspectors (who
meet here daily, from nine to ten A.M.), and arrangements were made
for connecting them with the trunk telephonic system of the district.
Office accommodation was obtained for the assistant inspectors at
Barrhead, Pollokshaws and Greenock, all in close association with the
connty police centres in these towns, so that morning (9 to 9.30 A.M.)
and afternoon (4.30 to 5 P.M.) daily telephonic communication should
be established between the head office and the assistant inspectors, so
that the sanitary circumstances of the whole county could be focussed
in the medical officer of health and chief sanitary inspectors without
any loss of time.
On the fifteenth of May the Infectious Disease (Notification)
Act was brought into operation all over the County. I venture
to believe that it will be regarded as a standing memorial to
the sagacity of the District Committees that this was done in each
case by a unanimous vote, and without requiring the least prompting
from me. Matters were in train at the end of the year for the inclu-
sion of Measles in the list of notifiable diseases.* I was in doubt, at
first, as to whether all notifications of cases of infectious disease should
be addressed directly to me, or whether the more remote ones should
be sent to me, care of the assistant sanitary inspectors. The essence
of the matter, in such cases, is promptitude of action. By the adop-
tion of the telephonic connection, however, the problem was simpli-
fied, and I was able to arrange that all notifications should be ad-
dressed to me, at the County Buildings, enclosed in blue envelopes
(with which all the medical men practising in the county were pro-
vided, along with their books of notification-forms), bearing a printed
address, so that a notification would be at once recognisable on re-
ceipt, and opened, in my absence, by the clerk or one of the chief in-
spectors, and dealt with as speedily as possible. In practice, most of
the notifications arrive by the morning's post, the particulars are at
once telephoned to the assistant inspectors, unless the cases are situ-
ated within home-districts of the chief sanitary inspectors; and the
first business of the day, for the inspectors, is to attend to such noti-
fications. Notifications coming in in the course of the day are tele-
phoned to the branch offices between 4.30 and 5 P.M., and if practi-
* Subsequently carried into effect in each District by a unanimous vote. |
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cable are still attended to that day. Having in recollection difficulties
which had arisen in connection with the working of the Notification
Act, in my past experience, I endeavoured to anticipate such by ac-
companying the issue of the formal intimations of the adoption of
the Act to medical men, by a friendly circular letter, in the course of
which I said:- 'I particularly desire that if at any time you should
think you have reason to complain of anything I have done or left
undone, you will let me know frankly and at once, in order that I
may have an opportunity of explaining or apologising.' I am glad to
say that on one or two occasions when difficulties, which might have
developed into unfriendliness, arose, matters were amicably settled by
mutual explanation. To meet cases of emergency which might arise
on Sundays or out of office hours, all the medical men in the county
have been furnished, in their notification-books, with my private ad-
dress and that of the Chief Sanitary Inspectors.
One difficulty arose in connection with the retirement of the
parochial sanitary inspectors, in that the less-informed section of the
community lost the media through whom they had been wont to
lodge complaints, or address communications to the sanitary authori-
ties. With the sanction of the Standing Joint Committee, and the
cordial co-operation of the Chief Constable for the County, arrange-
ments have been made by which every county constable has been in-
structed to receive complaints and communications for the County
Health Department, and to forward them forthwith to headquarters.
For that purpose constables have been provided with special memor-
andum forms and envelopes, and bills have been posted all over the
county making these facilities known to the public, which bills will
be renewed every year - on the village notice-boards which I hope to
be able to arrange for. The Chief Constable in the 'General Order'
issued to the force, giving instructions as above, was good enough to
add - 'They [all officers and constables] must also report anything of
an insanitary nature which comes under their observation, or any sus-
pected case of infectious disease which has not been reported to the
Public Health Department.' Members of the general public, instead
of having as formerly, only one official in a parish with whom to
lodge complaints, have now one in every village, and the Public
Health Department has received a large accession of strength through
the co-operation of the police force. I am not aware that in any
other county has an arrangement so conducive to efficiency been en-
tered into, and I feel personally indebted to the Chief Constable for
taking the matter up so readily and heartily.
[Page] 33
It is a great advantage to start with a clean slate. In formulating
a scheme of Office Registers and Forms, I have endeavoured to make
due use of this advantage, and for that purpose have drawn upon my
own experience of the past, and upon the forms used in other well-
conducted offices of the like character, in particular, upon the forms
in use in the City Health Department of New York, one of the best
organised Health Departments in the world, the working of which I
took occasion to study on the spot, a year or two ago. In order to
avoid confusion, the work of the two Districts having to be directed
from one office, I have arranged that, for the most part, the forms for
the First District shall be on white paper, those for the Second on
blue, and that the registers and books for each District shall have
distinctive bindings. For each District there is a Register of Cases
of Infectious Disease, having headings corresponding to those in the
inquiry-forms of the visiting inspectors; these are posted up daily,
and are found - as their well-thumbed condition indicates - of great
service. They are so arranged as to form a record of the amounts
due to medical men for notifications; and each medical man's account
is made up in the office half-yearly, initialled, and sent on to the
District Clerk, who, after the audit of the Finance Committee, for-
wards the accounts, with P.O., to the medical men. This arrange-
ment saves the medical men trouble, and materially simplifies the
work of the clerk as treasurer. The inspectors proceed to the inspec-
tion of a dairy-farm armed with a special 'inspection form,' with
headings based upon the Dairy Regulations, and dealing with every
detail in connection with a farm steading and its precincts. In the
office is kept a Register of Dairies for each District, the left-hand
pages of which are duplicates of the inspection-forms, and will con-
stitute, when filled in, a complete statement of the condition of every
farm-steading in the County as when taken over by the County
Council; the vis-à-vis pages are plain-ruled, and will constitute a
record of future inspections and of any alterations in the condition of
the dairies. Each inspector is furnished, in addition to his diary,
with a Monthly Abstract-sheet of work done, ruled vertically for the
days of the month, and having at the side a printed detail of every
possible incident of work. It is thus possible to see at a glance the
amount and variety of work done by each inspector during the
month, and on any given day. The printed minutes of the County
Council and District Committees are preserved in copiously-indexed
files, for purposes of reference: it would otherwise be impossible to |
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keep in hand the diverse work over so large an area. The office
stamp-book, which is so arranged as almost automatically to indicate
whether particular letters or other communications have been sent
by me or one or other of the chief sanitary inspectors, exhibits an
expenditure of £11. 13s. 9d. for the year, and gives some indication
of the amount of clerical work involved in the administration of the
Department.
ISOLATION HOSPITAL ACCOMMODATION IN THE COUNTY.
Probably no County in Scotland, at the passing of the Local
Government Act, was so well provided with hospital accommodation
for the isolation of cases of infectious disease, as the County of Ren-
frew. There was access for patients from the County (landward) to
Belvedere Hospital (Glasgow), one of the most famed institutions of
the kind in the world, to Knightswood Hospital (for patients from
Renfrew Parish), to the Govan Combination Hospital (for patients
from Govan Parish), to Cowglen Hospital (for patients from the south-
eastern parishes), to the Paisley Infirmary and Fever Hospital (for
patients from the widespread Abbey Parish), to the Johnstone Com-
bination Hospital (for patients from the Parishes of Houston,
Kilbarchan, Erskine, and Inchinnan), to Greenock Infirmary and
Fever Hospital (for patients from Kilmalcolm and Inverkip Parishes).
The only parish in the County without access to an isolation hospital
was Lochwinnoch. The misfortune was that these facilities were not
sufficiently utilized.
Since then the situation has altered in certain particulars, more
especially in the First or Upper District. Access to the Govan
Hospital has been abrogated by the inclusion of Govan Parish land-
ward, so far as in Renfrewshire, within the limits of extended Glas-
gow, and the extension of Glasgow has necessitated the withdrawal of
the access to Belvedere, which had previously been accorded to the
eastern section of the County. The arrangement subsisting between
the Abbey Parochial Board (acting as Local Authority under the
Public Health Act), and the Paisley Infirmary Authorities, was that
in consideration of the payment of a yearly sum of one hundred
guineas to the Paisley Local Authority, who built the Fever Hospital,
and four guineas per patient to the Infirmary Directors, at whose
cost the patients are nursed and fed, four beds in the hospital would
be placed at the disposal of the parish for isolation purposes. The
[Page] 35
First District Committee, of course, fell heir to this arrangement,
an arrangement which, financially, bore somewhat hardly, I think,
upon the landward Local Authority. The Paisley Corporation, how-
ever, has, as the result of negotiation, and in a neighbourly spirit
deserving of all honour, agreed, so far as the accommodation at their
disposal may permit, to receive patients from outwith the Abbey
Parish, over and above the four referred to in the agreement with the
Abbey Parish, upon payment of £2 2s per capita, (in addition to four
guineas per patient to the Infirmary Directors) - this in consideration
of the £105 paid to them as a standing charge, and having in regard
that they did not hold themselves bound to receive at any time more
than the four patients conceded by the original agreement. - The
Knightswood Hospital continues available for patients from the
Parish of Renfrew - practically that part of the parish north of the
Clyde. The District Committee here again fell heir to an agreement
of a somewhat extravagant character - there being a standing charge
of £45 per annum, in addition to a rate for board, etc., of £1 5s. per
week, one bed only being reserved for the use of the parish. Un-
fortunately, in a part of the County so detached, we have no alterna-
tive. The only satisfaction remaining to us is, that with a rapidly
increasing population, and more energetic action on the part of the
new Local Authority, the £45 charge will be spread over a larger
number of patients - for we shall not really be restricted to
one bed so long as there is vacant accommodation in the hospital
- and will be relatively less expensive than it has been in the
past. - The Cowglen Hospital, a wooden erection, was built origin-
ally at the expense of the Local Authority of the Parish of
Eastwood, for the isolation of cases of small-pox. Subsequently
it developed into a general Fever Hospital, managed and main-
tained by the Eastwood Local Authority, with the aid of con-
tributions from the various parishes sending in patients. To
this hospital, it is understood, the First District Committee has
fallen heir under the Local Government Act. The hospital has
apparently never been very much resorted to, and when the County
Health Department began, in the early winter of 1891, to utilize
it more actively, it was found to be but partly furnished and
plenished, and other defects became apparent. The truth is, and it
is of importance that it should be clearly recognised, that the hospital,
while sufficient for its original purpose, is entirely unsuited for use
as a general fever hospital; it is structurally impossible properly to |
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[Page] 36
isolate patients suffering from one disease from those suffering from
another. This objection, alone, is sufficient to condemn the present
building; any attempt to ignore it would inevitably lead to trouble
in the future. There are other material objections; the wards are
absolutely without means of ventilation in winter weather, there
being no fire-places in them, and the heat from the hot-water pipes is
so irregularly distributed that it is as entering an oven when one
opens the doors of one of the scarlet fever wards, while at the other
end of the hospital the temperature is, in winter, too low to be toler-
able. The bathing arrangements are most primitive and unsuitable,
so also the arrangements of the water-closets. There is no proper or
sufficient accommodation for the staff - the way from one end of the
hospital to the other leads through the matron's bedroom. The case
is clear: a new hospital is required. The ambulance, also, is no
longer sufficient for the longer journeys and more delicate work
required of it. I hope presently to be instructed to report more fully
upon the whole subject. In the later months of the year the Hos-
pital Committee had under consideration the circumstances of the
management of the Cowglen Hospital, and with a view to the intro-
duction of a more business-like system, I prepared a code of rules,
which, briefly, provided specifically that the medical officer shall be
styled medical superintendent, and have full control of, and be re-
sponsible for, everything in connection with the hospital; that the
matron shall have charge of the hospital, subject to the control of
the medical superintendent; that all provisions and goods for the
hospital shall be ordered only upon printed counter-foiled forms,
signed by the matron, and initialled by the medical superintendent;
that an inventory of the hospital furnishings be made up by the
matron every six months, initialled by the medical superintendent,
and presented to the committee; and that the matron keep an invoice
book. All the members of the staff received an increase of salary
during the year.
In the Second District the Greenock Infirmary Directors, in the
course of 1891, decided that patients should no longer be received
from Kilmalcolm or Inverkip Parishes, unless a certain fixed annual
charge, based upon population, were paid by or for these parishes,
towards the maintenance and staffing of the hospital, whether or no
any patients were sent in during the year - an equitable enough
arrangement, considering, for instance, that while the hospital had
been maintained, ready equipped, for the reception of patients from
[Page] 37
Kilmalcolm Parish, no patient had been admitted from that parish in
the course of the last five years. Under the circumstances I advised
the District Committee that the proposal of the Infirmary Directors
(of a standing charge of £15) must be accepted in so far as Inverkip
Parish was concerned, - from the isolated position of the parish there
was, indeed, no alternative. I further advised that negotiations should
be entered into with the Committee of the Johnstone Combination
Hospital with a view to arranging for the admission of patients into
that hospital from the parishes of Kilmalcolm and Lochwinnoch.
These negotiations at first promised to be fruitless, but towards the
end of the year the Hospital Committee agreed to receive patients
from these parishes, in the meantime, at a fixed rate of £8 8s. per
patient. I trust that in the ensuing year a more satisfactory and
permanent arrangement may be entered into. In the meantime,
however, we have access to hospital accommodation for patients from
every part of the Second District, which is so far satisfactory.
A matter which will have to receive the consideration of the Dis-
trict Committees during the ensuing year, is the question of the
provision of disinfecting stations, or of some other system perhaps
better adapted to the wants of a widespread rural district. The
question is involved in difficulty, and I have not yet been able to
think out a scheme which would satisfy myself.
THE POSITION OF THE COUNTY AS REGARDS WATER SUPPLY.
In respect of water-supply the county is better off, generally
speaking, than the average rural district, and it would be strange if
it were otherwise, for this is, indeed, a well-watered country. The
water-supply system of the county, however, still leaves much to be
desired.
In the First or Upper District the question of water-supply has,
for the most part, settled itself naturally, without the intervention
of the Local Authorities. The Gorbals (Glasgow) Water Commission,
by arrangement, supplies a large part of the area contiguous with
its compulsory area, including Barrhead and Thornliebank. And the
Busby Water Company supplies the villages of Busby, Clarkston,
and Sheddens, and most of Giffnock. Thus it has happened that the
lower area, remote from the hills where the rain falls most copiously,
is well supplied with water, while the higher levels are badly off in
this respect. |
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Most pressing was the case of Neilston. Standing at a level too
high to be supplied with water from the Gorbals Water-works, it
was dependant for its water-supply upon public or private wells, all
of them more or less polluted. Efforts had been made in vain to
secure a public water-supply, and when the County Council came into
office the practical assets (?) of the Water District Committee were
an area so straggling, yet circumscribed, as to render it impossible to
supply it at an economical rate, and a debt of over £200 incurred in
preliminary legal and engineering expenses; while the village was no
nearer a water-supply than ever. Largely through the intervention
of Mr. Renshaw, the water from the 'Lady Well,' or 'Aboon the
Brae Spring,' has become available, and in the course of the year
1891 a scheme was adopted for conveying the water of this copious
spring, alleged to run equably in wet seasons and dry, to a distribut-
ing tank of 200,000 gallons capacity, estimated to contain five days'
supply for the village, and situated at an elevation of 550 feet. The
daily consumpt of the village is estimated by the engineer at 37,500
gallons, while the estimated supply from this source is estimated at
only 38,000 gallons per diem. It is thus evident that there is but a
narrow margin between supply and demand, and difficulties arising
from this circumstance are to be anticipated. But the matter of
water-supply was, as will appear from what I shall have to record
under the heading 'Prevalence of Infectious Diseases in 1891,' so
urgent, that no other course was open to the Committee than to
accept this scheme. The water is so pure that it does not require
filtration. The contract has been let at £3,147, and it is anticipated
that the water will be available for the supply of the village by mid-
summer, 1892.
The village of Newton-Mearns, too, is very badly off in respect of
water-supply, and any extension of the feuing area at Giffnock is
rendered impossible by the lack of water. Under these circum-
stances a requisition has been presented to the District Committee
with a view to the formation of Newton-Mearns and part of Giffnock
into a Water Supply District. The requisition has been under con-
sideration, and Mr. Stodart, C.E., has, at the request of the District
Committee, prepared a Scheme for a water-supply to be derived from
the Black Loch. While it was apparent to me that, with a growing
population at the lower level, and in consideration of the limited
number of unappropriated sources of supply, it was almost inevitable
that the Black Loch should sooner or later come into requisition, I
[Page] 39
felt that the quality of the water, from the quantity of dissolved
organic matter in it, and its high degree of peatiness, and in
view of their being no bye pass for flood-water, was such as to render
it likely to prove distinctly unsatisfactory for the purpose of domestic
supply, especially in the later summer months. On going over the
ground with the County Sanitary Inspector, Mr. Little, I found that
while a good deal of the gathering-ground was peaty, an appreciable
part of the supply to the loch was derived from a sodden peat-hag,
situated at pretty nearly the level of the water-shed, which an
engineer might contrive means to divert. Having advised the Com-
mittee on these points, it was remitted to the Engineer and myself to
go over the ground together, to make experiments with different
filtering materials, and to report with reference to the effect of settle-
ment and special filteration upon the quality of the water, Mr.
Stodart to report with respect to the possible diversion of the water
from the peat-hag. Thus the matter stands at present. The scheme
undoubtedly involves considerable expense for the water-supply of a
straggling, and at present non-populous, district, but this is a case in
which the Committee is bound to have in regard the possibilities, or
rather the probabilities, of a near or more distant future.
Should the last referred-to scheme be proceeded with, the only
tolerable sized village remaining without a proper water supply will
be the village of Eaglesham. The village is at present dependant
upon a series of shallow wells, and so called 'springs,' which I have
little doubt are simply the out-crop of subsoil drainage. It will be
my duty to investigate this matter more fully in the course of the
ensuing year, especially in consideration of the outbreak of enteric
fever, to which I shall have occasion to refer later on, as having
occurred in the village in the autumn of 1891.
It is deeply to be regretted in respect of the question of water-supply,
that the Local Government Act had not come into operation in the
Second or Lower District ten or fifteen years before it did. The people
of the District have been fully alive to the advantages of a suitable pub-
lic water-supply, and after most strenuous efforts, the wants of almost
every village have been supplied. But at what a cost! Every parish,
as the want became pressing, set about securing a water-supply of its
own, the reductio ad absurdum being reached at Bridge-of-Weir, where
one half of the village being in Kilbarchan Parish has a water-supply
system all to itself, and the other half, situated in Houston Parish,
another. Thus we have, at this moment, no fewer than seven different |
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Water-Supply Districts in the Second District, - Bridge-of-Weir
(Houston), Bridge-of-Weir (Ranfurly), Inverkip, Kilbarchan, Kil
malcolm, Linwood, and Lochwinnoch; with six different sets of
lawyers' fees, six different sets of engineers' fees, six different water-
supplies to look after, six different committees, six different sets of
minutes; and the larger half of the schemes at present are in an
unsatisfactory condition. Now it appears to me, that with the
exception of Inverkip, which is remote from other villages, and which
has an efficient, though limited, water-supply system of its own,
these villages - with the addition of Houston and Crosslee, which are
badly off for water - might all have been supplied from one common
source, by means of a couple of large reservoirs placed at or near the
water-shed between Kilmalcolm and Lochwinnoch. Under such a
large scheme, the different villages could have been supplied more
securely than at present, and very much more economically. Under
a parochial system of sanitary administration one could hardly expect
things to have fallen out otherwise. It is no good crying over spilt
milk. My object in referring to the matter is to point the moral
that in future any movement should be in the way of coalescence
and unity of action.
The oldest scheme in the District is that for the supply of
Kilmalcolm Village. As early as 1875 the Kilmalcolm people appear
to have had the matter seriously under consideration, the original
scheme having been that of taking water from the Gowkhouse burn;
that proposal was not very ardently pursued, and was, luckily - for
neither in quality nor quantity was the water likely to meet the
requirements of the district - knocked on the head by the declinature
of the Board of Supervision to sanction it. In 1878 the scheme now
in operation, known as the Blacketty Scheme, was projected: there
were, indeed, two schemes, - the 'high level' reservoir scheme, and
the 'low level' scheme, the first estimated to cost £5,500, the second
£3,300; the latter was ultimately adopted. As the matter originally
stood, the water was taken from a reservoir constructed on the course
of the Blacketty stream, but the constant complaints of the villagers
as to the discolouration of the water, which is naturally peaty,
impelled the Local Authority to construct, at considerable expense, a
bye-pass channel, through which to pass flood-water without disturb-
ing the reservoir. The filters, also, have been reconstructed, and no
complaint appears now to be made as to the discolouration of the
water. The total amount of money borrowed in connection with this
[Page] 41
scheme has been £5,300, and the water-assessment for the year
1891-92 was 7 1/3d per £ on Owners, and 7 1/3d on Tenants.
Next in order of seniority comes the Bridge-of-Weir (Ranfurly)
Scheme, which had its inception in the year 1880; the works in their
original form were completed early in 1882. The water here is taken
from the Powburn. In 1884 the community was threatened with a
shortness of supply; and in the summer of 1885 the Committee was
compelled to resort to an intermittent supply in order to meet the
requirements of the case. In 1886 the reconstruction of the existing
reservoir, filters, and distributing tank, appears to have been pro-
ceeded with. The total amount of money borrowed in connection
with this scheme has been £4250. The water-rate for the year
1891-92 was 9 3/4d on Owners, 3 3/10d on Tenants of agricultural subjects,
and 11d. on Tenants of other subjects.
The Local Authority for the parish of Lochwinnoch appears to
have been for years, if such a phrase may be permitted, between the
devil and the deep sea, with respect to this matter of water-supply.
The village wells were found to be extensively polluted, the death-
rate of the village was high, and the Board of Supervision was pres-
sing the Local Authority to provide a proper supply of water for the
village. On the other hand, there appears to have been the greatest
difficulty in arranging for such a supply. One after another pass in
review in the minutes of the Local Authority, the Gillsyard Burn
scheme, the Garpel scheme, the Kaim Dam scheme, the Linthills
scheme. The minutes of the old parochial Local Authority close in
1890 with the adoption of the Maich Burn scheme, and the resolution
to borrow £3650, for the execution of the necessary works. The
scheme included the construction of a reservoir, with bye-pass channel,
on the course of the Maich Burn, at an elevation of about 480 feet,
with filters and clean water tank at a lower level. Various difficulties
have been encountered in the course of the prosecution of the work,
and it is understood that the original estimate has been exceeded. A
statement of the water-assessment for 1891-92 would, I find, be mis-
leading. The water-supply became available for the wants of the
village in the early summer of 1891.
In the Parish of Houston the water question has long been to the
front. In 1876 there appears to have been an extensive prevalence
of enteric fever in the Village of Houston, and what was known as
'The Cross Well' was found to be much contaminated. £30 was
spent upon the improvement of this well and its surroundings, but, |
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[Page] 42
notwithstanding, the quality of the water is reported to have been
but little improved, and in 1877 the 'North Brae Well' was sunk.
The supply from this well appears to have been insufficient, and the
Cross Well appears to have been intermittently resorted to until
1883, when the water was again analysed, and the well closed. In
1884, and again in 1888, requisitions from Crosslee, and Houston and
Crosslee, for the formation of a Water-supply District, appear to have
been presented to the Local Authority, but on account of opposition
were nipped in the bud. In 1887 a requisition was presented from
the inhabitants of Bridge-of-Weir (Houston) to have that village
formed into a Water-supply District, and such a district was accord-
ingly formed. Not before the time! The water of the village wells
was found, on examination, to be extremely polluted, the analyst de-
claring the water of one well ('Lang's Well') to be the worst he had
ever examined, and to have been the equivalent of undiluted sewage,
filtered. The Local Authority, being unable to arrange for a water-
supply from Barlogan, resorted to the Carruth Burn. There is no
reservoir in connection with this scheme; the 'works' consist simply
of an intake from the burn, a filter, a 'clean-water tank,' and the
necessary piping. The money borrowed upon this scheme has been
£2294. The water-rate for the year 1891-92 was 1s. 2 5/6d. per £. on
Owners, 4 2/9d, on Tenants of agricultural subjects, and 1s. 2 2/3d. on
Tenants of other subjects.
The Inverkip Water-supply is derived from a bounteous spring
issuing just above the village; its waters are conducted into a large
white-enamelled brick tank, from which the supply descends by
gravitation, through a comparatively short range of distributing
pipes, to the village. Even in so dry a season as last it was not found
necessary to curtail the villagers' supply of water; if, however, any
additional demand were made upon the tank, it would have to be
considerably enlarged. The sum borrowed in connection with this
Water-supply Scheme was only £500, and the water-rate for the
year 1891-92 was only 2 1/2d. per £. on Owners, and 2 1/2d. on Tenants.
The Village of Linwood constitutes a Water-supply District, which
in consequence of the circumstances of the case, manages itself auto-
matically. In its inception, an agreement was entered into with the
Paisley Water Commission, whereby the latter undertook to supply
the District with water, upon a guarantee that the water rate to be
levied would yield the Commission interest at the rate of ten per
cent. upon the outlay involved in the extension of their water-mains,
[Page] 43
provision of distributing pipes etc. This guarantee was furnished
by the contribution of the sum necessary to yield the requisite
security, by public-spirited gentlemen connected with the District.
The assessment for 1891-92, - under exceptionally favourable circum-
stances, it is true - was only at the rate of 2 1/2d. per £. on Owners,
33/40d. on Tenants of agricultural subjects, and 2 3/4d. on Tenants of other
subjects.
The Village of Langbank is supplied by agreement with the Port-
Glasgow Commission, and the Villages of Blackstoun and Clippens
obtain their water-supply, by agreement entered into between the
proprietors and the Paisley Water Commission, from the Paisley
mains.
One of the most gratifying circumstances in the sanitary history of
the year was the formation of the Village of Kilbarchan into a Special
Water-Supply District. The Village has up till this time been de-
pendent upon wells for its water-supply. These wells were known
to be extensively contaminated. The drought of the early summer,
a wave of sickness which passed over the village at the same time,
and (I venture to hope) a special report upon the water-supply of the
village prepared by myself, brought matters to a climax, and the vil-
lage was formed into a Water-supply District without opposition.
Negotiations were entered into with the Paisley Water Commission,
a deputation waited upon that body, and it was finally arranged that
the Commission should grant a supply of water to the District and
carry out the necessary work, recouping themselves by charging a
water-rate of 11d. per £. It may be hoped that ere long the Com-
mission may see its way to accede to the original proposition of a
water-rate yielding ten per cent. on their outlay, always provided
that the rate to be levied shall not in any year be less than the Pais-
ley rate, plus 1d. in the £ of public water-rate.
In winding up this statement of the condition of the Public Water-
supply of the Second District, I have to remark that the Villages of
Howwood, Crosslee, Houston, and Bishopton remain still without a
proper supply of water, and that the condition of affairs in this re-
spect, especially in Crosslee and Houston, demands the most serious
consideration of the Local Authority.
THE CONDITION OF THE DRAINAGE OF VILLAGES IN THE COUNTY.
Under this heading I have to treat of the most difficult problem
which the new county sanitary authorities will have to encounter. |
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[Page] 44
Having in regard to the length to which this report has already run,
I can only deal with the matter here very summarily.
According to the provisions of the Rivers Pollution Prevention
Act, 'every person who causes to fall or flow, or knowingly permits
to fall or flow, or to be carried, into any stream, any solid, liquid or
sewage matter, shall (subject as in this Act mentioned) be deemed to
have committed an offence against this Act'! Now it happens that
in the county the Local Authorities are as much in default as any
one or any class. It may be said that in this matter we are 'no
worse than our neighbours'; but this, it will be admitted, is but a
poor excuse; and in so populous a district, in which there are so
many manufacturing processes carried on which contribute to the
pollution of our streams, the question of 'Rivers Pollution' is rapidly
approaching a crisis. During the warmer months of last year the
condition of the Cart and of the Clyde can hardly be described in
moderate language. The purification of the Clyde is a problem which
must be seriously faced in the near future. One point I wish to make
clear, in this connection, is, that it must be the policy of the county,
having no very direct interest in the purification of the Clyde per se,
to decline, when the time comes, to allow itself to be rated - as was
formerly proposed, I believe, - for the purification of the Clyde, but
to organize, with the Burghs in the County contributing to the pollu-
tion, a general scheme by which all artificial (manufacturing) pollu-
tion and all putrescent matter of the nature of sewage, shall be so
dealt with as to cease to contribute to the pollution of the Clyde. In
that way we shall secure for ourselves, within the county, a fluvial
system such as has not been known since the beginning of the cen-
tury. It would be premature, at this time, to enter into a discussion
of the means by which this may be attained.
At this present time, it may be remarked, nowhere over the
county, except it be in the case of Kilmalcolm, where the crudest
possible attempt at sewage irrigation has been made, has anything been
done to purify the sewage of either town or village. This has been of
the less consequence in the past, so far as the Districts under the con-
trol of the District Committees are concerned, in that in most of the
villages no proper system of sewerage has been introduced; the sewage
matter has either been tossed into the ashpits, converting them into
foul and fœtid cesspits, or has been simply thrown upon the ground
in front or in the rear of the houses, whereby the soil has been
polluted, as well as, frequently, the water-supply; to these causes,
[Page] 45
in a considerable degree, is to be attributed the relatively high death-
rates of the villages, and in particular, the high death-rate from
enteric fever and diarrheal diseases.
I do not propose to discuss in detail the condition of the different
villages in respect of sewerage; that will be matter for report to the
District Committees in the course of the ensuing year. I shall here
only refer to cases in which something has been done or inaugurated
in the course of 1891.
At the beginning of the year there was no Special Drainage Dis-
tricts in existence in the county, within the limits now defined.
In the autumn a requisition was presented to the First Dis-
trict Committee for the formation of a part of Clarkston into a
Special Drainage District. The sewage of the area in question
discharged itself in such a way as to cause a nuisance, and it is under-
stood that legal proceedings had been threatened. An immense
amount of time and trouble was expended over this matter by the
Special Committee appointed to deal with it, and by myself and Mr.
Little, the area suggested by the requisitionists being considered too
limited. A report on the subject was obtained from Mr. Stodart,
C.E.; several meetings with parties were held upon the ground, and
a great effort was made, having regard to the probable requirements
of the future, to secure the assent of adjoining proprietors to the pre-
scription of a more comprehensive district. These negociations
failed, and the Committee was compelled, towards the end of the
year, to adopt, with some slight modifications, the original scheme.
In association with the representatives of the village of Eaglesham
upon the District Committee, I found it necessary to direct the atten-
tion of the Committee to certain defects in connection with the
drainage of the village. A special Committee was appointed to con-
sider the subject, and it was finally decided that the most efficient
method of dealing with the question would be the constitution of the
village into a Special Drainage District; at the end of the year
matters were in train for the completion of this project. The
necessary requisition had been lodged, and Mr. Little had prepared a
plan defining the area which might properly be included within the
district, and had been instructed to prepare a plan and specifications
for the extension and improvement of the existing sewers. The
works to be executed, in the meantime, consist mainly of the prolon-
gation of the sewer on the south side of the village, upwards and
downwards; and the assessment required will be little more than
nominal. |
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[Page] 46
At the end of the year a requisition was in course of preparation
for the constitution of the village of Newton-Mearns, into which it is
proposed to introduce a public water-supply, into a Special Drainage
District, and in consideration of the high death-rate of the village, as
revealed in my analysis of the vital statistics of the ten years, 1881-
90, it will generally be considered that it is full time something
substantial were done to improve the sanitary condition of the village.
In the course of the summer I was required to report upon the condi-
tion of the drainage of the Village of Lochwinnoch, the recent introduc-
tion of a public water-supply having brought matters in that respect
to a crisis. After going fully into the question, I had no alternative
but to report that a drainage scheme was urgently required. A re-
quisition from the inhabitants was presented to the District Com-
mittee, and a resolution was adopted constituting the area already
defined as a Water-supply District, a Special Drainage District, sub-
ject to the approval of the Standing Joint Committee to the neces-
sary works being proceeded with. The Standing Joint Committee,
however, in consideration that all the available rating power within
the area had been hypothecated for the purposes of a water-supply,
declined to sanction the prosecution of any works for sewerage pur-
poses, the money for which would have had to be provided from the
general rate of the District. Matters are, therefore, at a deadlock in
the meantime.
Fortune was more propitious in the case of Inverkip. As the
result of a careful and minute inspection of the condition of affairs in
the village in company with Mr. Murray, the County Sanitary
Inspector, I felt bound to advise the District Committee that the
drainage was extremely defective, and that the only efficient remedy
lay through the formation of a Special Drainage District, and Mr.
Murray prepared an approximate estimate of the cost. Mainly on
the initiative of Sir Michael Shaw-Stewart, who kindly interested
himself personally in the matter, the village was formed into a
Special Drainage District, and Mr. Wilson, C.E., Greenock, was in-
structed to prepare a scheme for the sewerage of the village.
The existing (feuars') main-sewer in the village of Nitshill being in
a very unsatisfactory condition, towards the close of the year I ap-
proached the representatives of Sir John Stirling-Maxwell with a
view to ascertaining upon what terms the sewer laid down by them,
along the main street of the village, might be transferred to the Local
Authority. The sewer is well laid, and of sufficient size to meet the
[Page] 47
requirements of the village, and I venture to hope that further
negotiations, if taken up by the District Committee, may lead to an
agreement satisfactory to both parties.
The village of Kilbarchan was, on the requisition of the inhabi-
tants, constituted a Special Drainage District by the same resolution
which constituted it a Special Water Supply District. That being
the case, it is unnecessary for me to say anything with respect to the
existing condition of affairs. No definite scheme has yet been evolved,
but the natural outlet for the sewage of the village is into the Black
Cart. It is proposed to acquire a piece of land upon the steep
declivity towards the river, upon which to establish now, or subse-
quently, precipitation and filtration works for the treatment of the
sewage. It will ultimately have to be considered whether it will be
more economical to establish precipitation-works at this point, or
whether the sewage should be carried in a pipe, along the course of
the river, to a junction with the intercepting sewer - which it will
sooner or later be necessary for the authorities of the Burgh of John-
stone to construct - and dealt with in common with the sewage of
Johnstone.
I may, at this point, interject the observation that in all the
Drainage Schemes under consideration, I have kept steadily in view
the necessity of arranging things so that when a general scheme for
the purification of the rivers of the county shall come to the front,
the drainage schemes now projected shall fit in with it, and that if
possible no money shall be thrown away in constructing sewers which
it will subsequently be found necessary to disuse. The circumstances
of the case at Kilbarchan I have just described. At Clarkston I was
desirous that an old quarry should be acquired with a view to meet-
ing the contingencies of the future, but it was considered probable
that the most economical arrangement there, when the time came,
would be to carry the sewage of Busby, at a sufficiently high level,
in a pipe along the course of the Cart, to join the sewage from Clark-
ston, and from houses likely to be built further down the course of
the stream, to a common precipitating station. At Eaglesham and
Mearns the sewage of the villages could be disposed of by irrigation.
At Inverkip the sewage will fall into the sea, and will not require
treatment. At Lochwinnoch the problem, when it arises, will be
most difficult of solution. From the general position and low level
of the village, irrigation is out of the question, and it is a narrow
question of levels whether a system of precipitation and filtration
could be carried out without pumping. |
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[Page] 48
At Kilbarchan, in the course of the summer, an old built branch-
sewer was found to be silted up, and considerable nuisance resulted.
By arrangement with the proprietors of the properties draining into
it, we were able to envolve an agreement for the construction of a
new sewer. Mr. Murray provided the necessary plans and speci-
fications for the substitution of a pipe-sewer, with an automatic flush-
tank at its head, and subsequently superintended the execution of
the work. This is probably the most efficient sewer in the county
landward.
Our attention was early directed to the condition of Blackstoun,
the unhealthiness of which has been proverbial in the District. There
I found the worst feature in the case to be the system of drainage,
which consisted of open gutters running along the side of the road,
in front of each row of houses. The roads had never been properly
made and were uneven and porous; liquid and solid filth alike was
tossed into the gutters, which, with but little fall, were scarce other
than elongated cesspools. After I had had an interview with the
proprietor on the ground, he agreed to provide a system of pipe-
sewerage for the village, with slop-gullies conveniently placed, accord-
ing to plans and specifications to be prepared by Mr. Murray, which
scheme has since been carried into effect under Mr. Murray's super-
vision. At the same time the proprietor agreed to limewash, for the
first time, the grimy exteriors of the brick 'rows,' and to repair the
roadway. The result of the whole has been materially to improve the
appearance and sanitary condition of the village. I may mention, in
passing, that after some pressure, about the same time I secured the
lime-washing of the exteriors of the houses of the whole village of
Inkermann - which, also, had never been touched before - the general
effect being most gratifying. People are much affected by their sur
roundings, and I am satisfied that I see an improvement in the clean-
liness of the interiors in these villages, since the exteriors have been
cleansed. It is my intention, therefore, to insist upon the free use of
the lime-washing brush in such villages all over the county.
At Howwood, complaints have been made for years of the condi-
tion of the road-side channel on the Lochwinnoch Road, into which
the sewage of a series of houses discharged; and also of the discharge
of sewage into a ditch running from the side of the highway near the
Station. I advised the Committee to proceed, under the 24th section
of the Public Health Act, for the substitution, at the expense of the
proprietors, of a pipe-sewer in lieu of the road-side channel; and to
[Page] 49
lead the sewage from the point at the road-side which is the point of
outfall for the most of the sewage of the village, in a pipe-sewer laid
along the ditch in which the sewage stagnated, to a point at which it
might discharge without nuisance, for the irrigation of the field. The
Committee agreed to this procedure; Mr. Murray drew out plans
and specifications for the work; and at the end of the year, after full
illustration of 'the law's delays,' a tender had been accepted for the
execution of the work.
A preliminary inspection has indicated that the drainage of Lin-
wood village, carried out, in part at least, by means of built drains,
with little fall, is in a very unsatisfactory condition. The matter
will, however, come before the District Committee more specifically
presently.
The minutes of the former Local Authority for the Parish of Kil-
malcolm show that, for a long series of years, intermittent complaint
has been made with reference to the marshy (meadow?) land beside
the railway station, into which the major part of the sewage of the
village is discharged, at a common point of outfall with the Mill
Burn. There would be little to complain of here were the commingling
water and sewage permitted to follow its original course unhindered,
and were the cut in which it runs periodically cleansed. But instead
of this, a system of sluices, and even a small precipitating tank, has
been established, for purposes of so-called irrigation, - the actual re-
sult being that the diluted sewage of the village is dammed up so as
to saturate and water-log the soil, and to convert the area in question
into a miasma-emitting swamp. I was instructed to report upon the
subject, and a special committee was appointed to take charge of the
matter. The question is complicated by the fact that there are several
different proprietors, and several different tenants to be dealt with.
After the most careful consideration, I have come to the conclusion
that the only effective solution of the matter is for the Local Autho-
rity, or Special Drainage-district Committee, to obtain a long lease of
the whole marshy area - the land is of little value, - although, I sup-
pose, if the question came to be matter for arbitration it might appear
otherwise. Properly drained, the area in question would cease to be
a nuisance, the land would rise in agricultural value, and, farmed by
a suitable sub-tenant upon conditions which would prevent a recur-
rence of the nuisance, the committee would be little out of pocket by
the arrangement, unless handicapped by an excessive rent. Thus put,
the matter appears simple enough - upon paper. But, in considera- |
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[Page] 50
tion of the numerous interests involved, and the unexpired leases
which will have to be dealt with - although only in respect of mere
patches of ground, it must be accepted that it will require diplomatic
talent of the highest order to negotiate a working agreement.
As the result of complaints made to me, I, in company with the
chief sanitary inspector, made a careful inspection of the drainage
system of the Village of Langbank. The result surprised me. I found
that no fewer than 23 house-drains or branch-sewers discharged
separately, simply at the side of the highway, which is the main pro-
menade of the village, the sewage finding its way as best it might
down to the River Clyde. The sewage of the greater part of the village
discharges simply at the side of the road. I reported the circumstances
of the case to the District Committee, and the representatives of the
parish were constituted a sub-committee to deal with the matter.
The sub-committee went over the ground with myself and the sani-
tary inspector, and agreed that the existing condition of things was
a standing menace to health. It was further agreed that the proper
solution of the difficulty was to construct an intercepting pipe-sewer,
with which all the independent drains of the eastern, and greater,
portion of the village should be connected, and to lead the sewage to a
point of outfall in the river, about a hundred yards from the side of
the highway. The sewage of the west end of the village, which has
a declination in a westward direction, is already collected by a large
pipe-sewer, and led to a considerable distance; but the sewer, impro-
perly laid, for a part of its course, on the surface of the shore, had be-
come dislocated and broken. It was proposed to relay the defective
part of this sewer, and protect its point of outfall. Mr. Murray was
instructed to prepare a plan and approximate estimate of the cost of
carrying out such a scheme - the cost would have been insignificant
- and a meeting of the inhabitants was convened to consider the
matter. I regret to say that the proposal was rejected by what, for
the size of the meeting, must be considered an overwhelming majority.
It was urged that there had been no death from the zymotic (or filth-
produced) diseases within recollection, and, in effect, that the time to
lock the stable-door was when the steed had been stolen. The repre-
sentatives of the parish felt that it would be undesirable to proceed
further, and the matter was allowed to drop, in the meantime. I
was unable to make any reply at the time to the allegation that there
had never been a death from zymotic disease in the village; it seemed
to me that it was a very surprising circumstance, apart from all ques-
[Page] 51
tions of drainage. A subsequent reference to the death-registers of
the parish enables me to state that during the ten years 1881-90,
there had been one death from enteric fever, one from scepticemia,
(blood poisoning), three from diarrhea, one from scarlet fever, and one
from whooping-cough; I refer to this, not as indicating an unhealthy
condition of the village, but as an illustration of the loose way in
which the case against the proposed scheme was argued.
As the result of complaint by the proprietor of the Dargavel Estate
as to the pollution of the Dargavel Burn, whose tributary streamlets
in part arise in the vicinity of Bishopton, I was required to inquire
into the matter and report to the District Committee. My report,
summarily, was to the effect that while the Village of Bishopton con-
tributed to the pollution of the stream, there was no nuisance at the
point with reference to which complaint had been made, viz., Her-
schaw Farm, that there were other material contributions to the pol-
lution of the stream arising upon the Dargavel Estate; that the water
of the burn at Hershaw was not, and never had been, within the
memory of living man, fit for use for domestic or dairy purposes; and
that, in brief, the time was not ripe for dealing with the pollution of
the stream in an effectual manner.
CIRCUMSTANCES OF INTEREST AND IMPORTANCE IN CONNECTION WITH
THE PREVALENCE OF INFECTIOUS DISEASE IN THE COUNTY DUR-
ING 1891.
The system of compulsory notification of cases of infectious disease
came into operation over the whole county landward upon the 15th
of May, at which date the County Health Department took over the
control and management of this department of work. The Notifica-
tion Act had already been adopted in the parishes of Cathcart and
Eastwood, in the first of which no fewer than 259 cases were notified
prior to the 15th of May, in the second 4; 10 cases were notified,
voluntarily, in the Abbey Parish, 9 in the parish of Govan, and 1 in
Neilston parish. Of the total, 283, nine, or 3·2 per cent., were removed
to hospital. I have no record of the cases which occurred in the
Second District prior to May 15.
From the 15th May to the 31st December 502 cases were notified
to me. Of these, in the First District 25·2 per cent. were removed
to hospital; in the Second District 25·7 per cent. I cannot help
regarding it as a very satisfactory circumstance that in the first year |
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[Page] 52
of our existence, in a country district, we should have been able to
secure the removal to hospital of so large a proportion of cases. I
am indebted to the medical men in the county for their kind assist-
ance in this matter. But so favourable a result is mainly due to the
enthusiasm, tact, and perseverance of the chief and subordinate
sanitary inspectors, who wrought early and late - disregardful of
'office-hours,' in fair weather and foul, to attain a solution of the case
so satisfactory alike to the patients and the public, as removal to
hospital. Few people have any idea of the amount of diplomacy, of
the patient waiting, of the persuasive arguing-out of the matter,
which is required in connection with the removal to hospital of a
large proportion of the cases. The inspectors were careful never to
push the matter to extremes, having regard to my standing instruc-
tion that until we had obtained the confidence and goodwill of the
people, stringent measures were never to be resorted to, even in the
most clamant cases, except under my direct supervision. Under
these circumstances, upon grounds of general policy, a considerable
number of cases were left at home when their removal to hospital was
urgently called for in the interests of the public health.
Before leaving this part of the subject, I may be permitted to
explain what occurs upon the receipt of the notification of a case.
The inspector within whose district it occurs visits the premises
immediately, obtains the particulars required for his enquiry-form -
occupation of patient or parents, school attended, water-supply, milk-
supply, sanitary condition of premises, etc. - with as little of an in-
quisitorial air as possible; if it is a suitable case for removal
to hospital he does all he can to persuade the friends to consent to
removal. If the case is to remain at home, he gives minute instruc-
tions and hints as to isolation and disinfection, and if necessary
supplies disinfecting fluid and soap. I have prepared a simple-
written statement of the dangers and the precautions to be taken in
the case of scarlet fever and enteric fever, respectively, a printed copy
of which is left with the friends. I have in course of preparation
similar sheets for measles and diphtheria. If there is anything
exceptional or urgent in connection with the case I am wired for,
or if not so urgent I hear of it next morning. If any of the family
are attending school, the head of the school is communicated with by
means of a printed form, and a period defined during which no mem-
ber of the family is to be allowed to school. If the case is to be
removed to hospital, the inspector's first duty is to fill in a form
[Page] 53
directed to the medical man in attendance, informing him that the
necessary steps are being taken, so that he may be saved an unavailing
visit. If the patient remains at home the house is kept under such
supervision as is possible, so long as it remains in an infectious con-
dition.
The circumstance of greatest importance in connection with the
prevalence of infectious diseases during the year was the epidemic
prevalence of Measles in various parts of the county - at Kil-
barchan, Bridge-of-Weir, and Inkermann, the disease spread with
alarming rapidity, and its prevalence was attended by great
fatality. At Cathcart, also, there was a sharp outbreak of the dis-
ease, but owing probably to the early closure of the school, the
disease never assumed the proportions of an epidemic, and the
mortality was small. - Measles is now becoming the most fatal and
wide-spread disease of the zymotic class. I desire to take this oppor-
tunity of explaining clearly my view of the methods by which we
may hope to control the extension of the disease. The first point to
note is that measles, unlike most of the other infectious diseases, is
most infectious in its early stages - is, indeed, highly infectious in the
premonitory stage of the disease, before the characteristic rash has
appeared. This suggests a fundamental difference in respect of pre-
ventive treatment. With other infectious diseases the essence of the
efforts to prevent their spread is hospital isolation. By the prompt
removal of the first case occurring in a family, one has every reason
to anticipate that the disease will be stamped out in as far as that
family is concerned. Not so here. The chances are that before the
disease in any case has assumed a characteristic form, all or several
of the other juvenile members of the family have become infected.
Further, it is the case, in poorer-class localities at least, that in cases
of measles, frequently no medical man is called in, the nature of the
disease may not, indeed, be recognised; in spite of compulsory noti-
fication there will always be a proportion of undiscovered cases.
Again, in any outbreak of measles there will always be a consider-
able proportion of infants attacked; these cannot be removed to
hospital unless their mothers accompany them, and with the present
average condition of public opinion that is not to be hoped for.
Further, generally speaking, under existing circumstances the dis-
ease spreads so rapidly that no practicable amount of hospital accommo-
dation would serve to meet the requirements of the case. So that in
this case hospital accommodation must be regarded as only an
4 |
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[Page] 54
auxiliary agency. The first step towards any efficient attempt at the
extirpation of measles is the compulsory notification of the disease;
without this, any attempt at its control is foredoomed to failure.
The next step, especially when the disease 'breaks out' in a poorer
class community, is to post bills plentifully over the district reminding
householders that they, too, as well as the medical men, are responsi-
ble, under the Notification Act, for the notification of cases occurring
in their households - this for the purpose of including cases with
respect to which no medical man had been called in. I have found
a most valuable auxiliary, here, in the village schoolmaster, to whom I
have forwarded posters, which I have asked him to display in the
school-room, and to the contents of which I have asked him to direct
the attention of the children, who shall be invited to bear the intima-
tion to their parents. Simultaneously, every effort must be made
to obtain the removal of the first cases to hospital, and especially the
first cases occurring in houses where there are no other children.
Under ordinary circumstances it will be found that these measures
do not suffice to prevent the spread of the disease. The main danger
in the case of measles arises in consequence of the fact that children
in the premonitory and undiagnosable, but highly infective, stage of
the disease are apt to be allowed to attend school, and thus it comes
that schools so often become the means of spreading the disease. In
view of this circumstance it becomes the duty of the medical officer
of health carefully to observe the progress of events - and it is here
that compulsory notification becomes indispensable - and if the dis-
ease is found to be spreading in a village beyond the two or three
families first attacked, to take immediate steps for closing the school.
There is no more delicate or difficult duty appertaining to his office
than that of deciding the point at which the school should be closed -
the medical officer of health has to resist the influence of the panic
which is apt to arise in connection with the slightest outbreak of
measles in a village community, he has to be careful not to interfere
rashly or unnecessarily with the educational machinery of the place,
and he must, above all, endeavour to avoid the 'too late' policy which
has generally characterised the resort to school-closure in the past.
He is somewhat hampered in Scotland, as compared with England,
by the circumstance that neither he, nor the Local Authority as a
body, have power to compel the closure of schools; he can only
advise, and throw the responsibility of inaction upon the educational
authorities. I believe, however, that no difficulty will arise in Ren-
[Page] 55
frewshire in respect of this matter. I have no difficulty in declaring
that, except under extraordinary circumstances, school-closure is not
justifiable in dealing with any other disease than measles, but I am
bound, as the result of a somewhat large experience, to say that
school-closure is the most efficacious means of dealing with an out-
break of measles, especially in the case of village schools, which are
attended by a considerable proportion of children who are not liable
to come into intimate contact elsewhere. One of the most interesting
characteristics of a measles outbreak is the occurrence of cases in
crops; often the school-register, too late, reveals the fact that twelve
or thirteen days before, a child has been at chool on the day before
the rash in his case was recognised, or even on the morning of the
day on which it appeared. Sunday-schools should, of course, be
closed simultaneously with the day-schools. For the rest, as close a
surveillance as possible must be maintained over the infected area, in
order to check the carelessness of the people, who consider measles
but a light thing, and who are apt to indulge in sympathetic gossip
in infected houses. All the time, of course, the necessary measures
of disinfection must be attended to.
Scarlet Fever, while never attaining the proportion of an epide-
mic during the year, was exceptionally prevalent in the eastern
central portion of the county in the early winter months. In dealing
with this excessive prevalence I was a good deal hampered in respect
of hospital accommodation, although I was fortunately able to
arrange matters so that only in three or four cases were we unable to
secure hospital accommodation where necessary. When it became
evident that there was likely to be considerable pressure upon our
accommodation, the Cowglen Hospital Committee authorised the
complete furnishing of the hospital, and the devotion of all the wards
to scarlet fever purposes; and the District Committee gave me a
free hand to dispose of any fever cases which might arise as I might
be able. Such enteric fever cases as we were bound to deal with I
proposed to send into Paisley Hospital. Soon, however, our legiti-
mate accommodation there was exhausted, but I continued to send
cases in, with the kind consent of the Paisley Local Authority, leav-
ing terms to be subsequently arranged. There came a time, however,
when the accommodation at the Paisley Hospital was no more than
sufficient for the requirements of the burgh, plus our four cases, and
I had to make arrangements with the Committee of the Johnstone
Hospital for the reception of three scarlet fever patients there. The |
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[Page] 56
position of affairs in the First District at this point was exceedingly
complicated; we had patients distributed over no fewer than six
hospitals - Belvedere, Knightswood, Shieldhall, Cowglen, Paisley, and
Johnstone - besides which I had to engage a nurse to take charge of
a case of enteric fever in Eaglesham village for which we had no
available accommodation. These exertions were not, we have reason
to believe, without effect; the excessive prevalence of scarlet fever
never assumed what may be termed an epidemic form, and terminated
at an earlier date in the winter than usual. In the Second District
we had, practically, only to deal with sporadic cases of scarlet fever,
the isolation of which received the most careful attention of the
Department, and the year passed without any death from the disease
having to be recorded.
Under the heading of Enteric Fever, I shall only refer to two
outbreaks which were of special interest and importance. - The first
may be termed 'the Eaglesham outbreak.' On the 28th of August I
received notifications of two cases of enteric fever occurring in one
family at Shawland (now in Extended Glasgow); the cases were
visited by the sanitary inspector, and among the other particulars
entered in the office Register of Infectious Diseases, as the result of
his inquiry, it was noted that the persons affected had been resident
in the remote village of Eaglesham up to the 15th of August, and had
derived their milk supply from -- 's dairy there. On the afternoon
of the 31st I received notifications of two cases in the village, and in
view of what had already occurred, I decided to go down to the
village with the sanitary inspector next morning. On inquiry there,
I ascertained that both the cases in the village had obtained their
milk from the dairy already referred. I visited the dairy in question,
and made careful inquiry as to whether there was or had been
any case of illness in the house, but I found there was no one ill
in the house, and it was maintained, in the face of what I regarded
at the time as a skilful and searching cross-examination, that there
had been no illness. In the face of the facts already elicited, how-
ever, I felt it to be my duty to order the dairyman to cease supplying
milk. Before leaving I ascertained the existence of two other cases
in the village, through the resident medical man, Dr. Pollock, who
afforded me great assistance in the course of my subsequent investiga-
tions; here the ordinary milk-supply was from a different source, but
I found that at least on one occasion milk had been obtained at -- 's
dairy. Knowing that Eaglesham was much resorted to by Glasgow
[Page] 57
people in the course of the summer, I communicated with Dr. Russell,
Glasgow, and ascertained that already in respect of one or two cases
in Glasgow, Dr. Russell had had his suspicions directed towards
Eaglesham. At that time, however, I had no idea of the wide-spread
character of the mischief which had been wrought by this unfortun-
ate dairy. It was only as the result of further experience, of infor-
mation received from Dr. Russell, and of a laborious course of inquiry
pursued by the sanitary inspector for the sub-district, that the extent
of the injury to the public health was revealed. The facts of the case
as afterwards ascertained, were these. From first to last no fewer
than 42 persons were prostrated by the disease, of these, all except
the five last cases of the series had partaken of --'s morbific milk; the
five exceptions were persons who had evidently contracted the disease
from previous cases of the series. Of the 42 cases constituting the
series, only twelve sickened in the village; the others had left, bear-
ing the seeds of the disease in their systems, and were prostated,
some in Glasgow, some in Govan, some in Partick, some in Govanhill,
and one, even, in a remote English town. 4 deaths occurred amongst
the cases we were able to follow up; assuming the mortality to have
been at the same rate amongst cases which we were unable to watch,
the fever-tainted milk was the cause of the death of six persons.
The sickening of the first cases, so far as I can speak from researches
carried on a month later, dates from the 10th of August. I find no
fewer than 28 cases must have been laid down by the disease, in or
near Glasgow, prior to the date of my receiving the first notification.
In the fortnight following my appearance on the scene - and I must
here direct attention to the fact that the incubation period, the period
during which the seeds of the disease lie dormant in the system, is
about fourteen days - nine persons were prostrated by the disease.
From the termination of that fortnight, no case occurred having any
association with Eaglesham, with the exception of the five already
referred to, whose infection was clearly traceable to pre-existing cases.
The first of these, who sickened upon the 20th September, had not
been in Eaglesham after the 13th of August, but was brother to, and
lived with, a patient who sickened after returning home from Eagle-
sham. The next two cases, whose illness dates from September 27th,
and October 11th, occurred in a family in which there had already
been two cases. The last two cases were of women who had nursed
prior cases. It will have been remarked that I was unable, at first,
to get behind the milk as a source of infection. I learnt subsequently, |
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[Page] 58
however, from outside sources that a daughter of the dairyman's,
employed in an adjoining parish, had been staying with her father
for a time, and it was alleged that she had been suffering from illness.
Cross-examined on this story, the dairy people admitted to me that
the daughter had been staying with them, but denied that there had
been anything the matter with her. I obtained, with considerable
difficulty, a rather vague address as the present residence of this
daughter. Mr. Little undertook to find this woman before there
could be any communication between her parents and her; he
succeeded, and obtained from her own lips a statement that she had
felt ill and given up work on the 13th June, and had returned home;
that she had suffered from headache, sickness, and diarrhea, that she
had been entirely confined to bed for a week, and that she had not
felt able to return to work until the 10th of August. No medical
man will fail to recognise in this case, probably a mild case, of
enteric fever. The most remarkable circumstance in connection with
this outbreak is that the facts show that the milk had not obtained
its infective quality during the illness of the girl. The largest pro-
portion of the cases did not sicken until more than a clear fortnight
had elapsed since the departure of the girl, and her resumption of
work in perfect health; while the earliest cases of all, which sickened
on the 10th of August, the date upon which the girl returned to
work, must, according to all we know of the disease, have become in-
fected one or two weeks after the girl herself had ceased to be infec-
tive. How are we to explain this circumstance? Only upon the
hypothesis that the infection lingered about the premises, and for
some reason only obtained access to the milk at a later period. Was
there anything in the circumstances of the premises to furnish a
material basis for this hypothesis? The dairy was in a bad sanitary
condition, the structure of the byre was defective, and there was a
dung-pit sunk in the ground beside it, which was the natural recep-
tacle for the excreta of the patient. Typhoid excreta thrown into
such a receptacle, in the warm month of July, would find there the
most favourable conditions for the development and multiplication of
the infectious germs. The water-supply was derived from a boiler
sunk in the ground, fed by two pipes, believed to be the overflow
from springs higher up. The overflow from this boiler was into a
built drain. Into this drain, a foot or two lower down in its course,
the drain from the dung-pit discharged. Under ordinary circum-
stances the liquid from the dung-pit would enter the main drain lower
[Page] 59
down in its course than the overflow from the boiler; but should the
outfall of the dung-pit drain become in any degree clogged up, the
sewage matter would be dammed back, and overflow through the un-
joined pipes into the boiler, from which the water-supply of the dairy
was drawn. I have, therefore, no difficulty in accepting it that the
water was, in all probability, the medium through which the milk
obtained its infectivity. - It seemed contrary to all the canons of
morality that the persons in charge of the dairy should escape punish-
ment for the part they had played in the matter. I considered the
question whether they should not be proceeded against for having
failed to notify a case of infectious disease occurring in the house-
hold; but I was advised that in all probability a prosecution would
fail. - The proprietor was notified that he would no longer be per-
mitted to let the premises for dairy purposes.
The other outbreak was of a less serious character. At Neilston,
beginning in the end of September, there occurred a dropping series
of cases of enteric fever. As time went on it appeared that these
cases, with the exception of one, had one point in common, they were
all reported as deriving their water-supply from the "Chapel Well."
The one exception was that of a boy, whose household was supplied
from the 'Big Well,' - of course, a boy roaming about the streets
might very well have drunk from another well. On the other hand,
it was alleged that the people in question were acting misleadingly,
that they really drew their water from other wells, but claimed the
Chapel Well as their water-supply, as being the most reputable well
in the place. I was unable to accept this view of the case and I took
the somewhat summary course of causing the sucker of the pump to
be removed. I am afraid my action was not approved in the village,
the well being very conveniently situated, but I had the satisfaction
of finding that no further cases of enteric fever occurred. There were
in all, nine cases in the course of this outbreak.
During the year there occurred outbreaks of scarlet fever upon six
dairy-farms in the county; in every case our first effort was to secure
the removal of the cases to hospital, and the thorough disinfection of
the premises. Failing that, my next requirement was that no milk
should be sent out from the farm; and that in theory, at least, the
patient should be thoroughly isolated; relying upon our own super-
vision for the fruition of theory in practice. In addition to the
Eaglesham case above referred to, we had three outbreaks of enteric
fever upon dairy-farms. In one case I secured the transference of |
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[Page] 60
the dairy-business (with the dairy-maid) to an adjoining farm. In
another, the two cases which occurred were at once removed to hos-
pital, and radical measures of disinfection resorted to. In the third,
in which no milk was sent out (butter only being made), the place
being remote from any hospital, we obtained satisfactory means of
isolation with a special nurse, and left the case under the daily obser-
vation of the medical officer for the parish. In no case was there
any suspicion of any extension of the disease once the cases came
under our observation.
DAIRIES AND DAIRY REGULATIONS.
The farm-steadings in the county, like most things sub-lunary, may
be divided into the three categories of - good, bad, and indifferent. I
am not in a position to make any sweeping generalization with re-
spect to them. There are, approximately, 850 dairies in the county,
and I have inspected minutely but a few of them. I am not able to
report, as in some other districts has been reported, that the whole
of them have been visited and carefully inspected by the sanitary
staff in the course of a couple of months. The energies of the inspec-
tors have been, in the first instance, devoted to the most profitable
field of sanitary labour, the endeavour to arrest the spread of infec-
tious diseases, and, in the next place, in dealing with complaints
of nuisances, and work of the like sort, which has been forced upon
the attention of the Department. The remaining time at the disposal
of the inspectors has been devoted to a slow-moving but thorough-
going inspection of the farm-steadings within their districts, and in
filling up the details of a minute report upon the structure and con-
dition of every farm-steading visited. The severity and repeated
snowfalls of the winter-months, and the shortened days, have, of
course, materially interfered with the progress of the work; but I
hope, by the beginning of May 1892, to have a full report of the
condition of every farm-steading in the county, as when first in-
spected, engrossed in the office Register of Dairies. The policy I
propose to adopt with respect to this matter is to deal only with the
dairies in the category 'bad,' in the first instance, farm-steadings
which every one who saw them would admit to be bad. From what
I have seen I am satisfied that the dairies in this category will suffice
to absorb the energies of the Department for some time to come.
One qualification of this statement of policy is necessary, - where the
[Page] 61
water-supply of any dairy is in default, where it is found to be liable
to contamination, it will be the duty of the Local Authority and the
Health Department to insist upon a sufficient supply of pure water
being provided, at once, in every case. Upon this point, in view of
the dire results recorded under a previous heading in connection with
the Eaglesham outbreak of enteric fever, it is not necessary for me
to enlarge. While, however, it is not difficult, generally, to arrange
for an uncontaminated water supply, there are almost unsurmount-
able difficulties, in some cases, in obtaining what can be designated a
'sufficient' supply - a supply which shall be sufficient in dry
seasons. Already, in co-operation with proprietors who fully re-
cognised the importance of the matter, we have had the greatest
possible difficulty in projecting suitable systems of water-supply.
In the course of the summer, after the most careful consideration
of the circumstances of the county, I drew up a code of "Regulations
for Dairies, Cowsheds and Milkshops," under the Dairy Orders of
1885 and 1886; this draft I subjected to repeated revision before
presentation to the District Committees. The whole matter was very
discussed by the Committees, the draft code, as amended, was finally
adjusted at a joint meeting of the representatives of the two District
Committees. It was a great satisfaction to me that one uniform
code was adopted for the whole county. - I desire to advert to two
points in connection with this matter. First, I wish to correct any
misapprehension which may have arisen with respect to my attitude
in the matter. As the authorised adviser of the Committees in
respect of sanitary matters, it was my duty to lay before them a
draft code such as I believed sufficient for the sanitary requirements
of the case, and to indicate, when required, reasons in support of my
recommendations. But I entirely recognise that my constitutional
position is that of an adviser; it is the function of the Committees
to legislate in such case. It will be my duty loyally to adhere to and
carry out the requirements of the code as adopted by the Committees.
Nay more, I will say, as the result of considerable practical experi-
ence, that I believe we shall obtain better general results under the
code adopted than under the draft code I originally presented,
backed up as we shall be in our action by the general feeling of the
Committees, and the average opinion of the outside public. One
matter alone I regret - that in view of the serious loss to farmers
resulting from the prevalence of tuberculosis in cowbyres, and the
dangers to the public arising in this way, a higher standard of cubic |
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space was not adopted. Again, I am afraid the Committees may
have been inclined, at the time, to credit me with a certain undesir-
able mental rigidity when I ventured to object to the substitution of
the phrase 'to the satisfaction of the Medical Officer of Health' in
lieu of some more specific requirement. But my governing feeling
in the matter was that the medical officer should, as far as possible,
be placed above suspicion of favouritism or bias; that, as a general
principle, it is undesirable that public officials should have substantial
possibilities of exercising favouritism. The Committees will find, I
trust, that now that a Code of Regulations has been adopted, its re-
quirements will not be interpreted by me in too literal a fashion.
The only two Regulations of the Code which can lay any claim to
originality are the following:-
'15. Every Dairyman or Purveyor of Milk, upon whose premises
the Medical Officer of Health suspects that there is a person suffering
from a dangerous infectious disease, shall afford free access to that
Officer to any part of the premises; and if the Medical Officer of
Health shall certify, in writing, to the occupier or person in charge
of the premises that there is a risk of infection or contamination of the
milk from the presence of an infected person upon the premises, it
shall be the duty of such occupier or person in charge forthwith to
cause the removal of such infected person to an isolation hospital, or
to some other place approved by the Medical Officer of Health; or
otherwise to cease for a sufficient period, to be defined by the Local
Authority or the Medical Officer of Health, to give, sell, or transmit
any milk from such premises.
'NEW DAIRIES AND COWSHEDS.
'16. The Dairies, Cowsheds, and Milkshops Order, 1885, provides
that - "(1) It shall not be lawful for any person following the trade
"of Cow-keeper or Dairyman to begin to occupy as a dairy or cow-
"shed any building not so occupied at the commencement of this
"Order, unless and until he first makes provision to the reasonable
"satisfaction of the Local Authority, for the lighting and the ventila-
"tion, including air space, and the cleansing, drainage, and water
"supply, of the same, while occupied as a dairy or cow-shed. (2) It
"shall not be lawful for any such person to begin so as to occupy
"any such building without giving one month's notice in writing to
"the Local Authority of his intention so to do." In order to give
effect to these provisions it is required that with the notice referred
to, the Cowkeeper or Dairyman shall furnish a plan and sections of
the building upon a scale of not less than 1/8 of an inch (along with a
tracing thereof to be retained for the use of the Local Authority),
showing the provision made for the lighting, ventilation, and internal
drainage of the same, together with a block plan of the premises,
showing the general arrangement and position of the water-supply,
[Page] 63
external drainage, and dungstead, together with a specification of the
mode of construction and the materials to be used."
Already a considerable number of proprietors who proposed to
effect alterations on farm-steadings and dairies, or who desired to an-
ticipate the operation of the Dairy Regulations, have invited us to
consult with them with respect to these alterations, and I believe
such consultations have proved mutually advantageous. A good deal
of quiet work has already been accomplished in this way.
COMMON LODGING-HOUSES.
Believing that it would be of little use to attempt to deal systema-
tically with Common Lodging-houses until a code of Lodging-house
Regulations for the county had been adopted, I made no effort in
that direction during the year, dealing simply with those cases which
circumstances brought immediately under my notice. One Lodging-
house I certified as unfit for human habitation.
In the early winter I drew up a draft code of Regulations for sub-
mission to the District Committee. This was duly discussed, slightly
amended, and finally accepted by the two Districts in common. It
now awaits formal confirmation by the Board of Supervision.
SLAUGHTER-HOUSES.
The condition of the village slaughter-houses in the county leaves
much to be desired - from every point of view. With respect to these,
again, I did not attempt to do much during the past year, crowded
as it was with other more pressing work. I hope to be able to re-
port next year that the question has been dealt with in a systematic
fashion, and upon a uniform plan, all over the county.
BAKEHOUSES.
Retail bakehouses are consigned to the peculiar care of the medical
officer of health, under the Factory Acts; pressure of other work
here again prevented my taking up the subject in earnest, and I
simply dealt with such cases as obtruded themselves upon my
notice.
REFUSE DISPOSAL AND SCAVENGING IN VILLAGES.
Under this heading I must, however briefly, treat of the greatest
blot upon the sanitation of the county, as indeed of all the other
counties in Scotland. |
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Nowadays privy-ashpits in towns are being condemned and extir
pated. As a sanitary contrivance, especially in connection with tene-
ment and poorer-class properties, they are an abomination. Taking
them on the average over the county, they are constructed on the
worst possible principles. They are made as large as possible, in
order that they may go as long as possible without scavenging. They
are so constructed that the excreta and ashes do not mix.The ash-
pits are uncovered - rain and sunshine alike beat into them - so that
the two great agencies favourable to putrefaction, moisture and heat,
are present. The tenants make things as bad as possible by throwing
all their slops into them, so that they are often 'swimming' with
foul putrid sewage. The privy-ashpits are bad when they are full;
they are still worse when they are being emptied. Then, three or
four cart-loads of evil-smelling stuff have to be shovelled out into
wheelbarrows; these have usually to be wheeled through the 'close'
or common passage, and their contents deposited on the street, in
front of the house, there to accumulate until the (nowadays) reluctant
farmer is ready to cart them away. The farmers, naturally, will only
remove the stuff when it suits their convenience, which may be once
in six months or once in twelve. The smell which pervades the street
when the ash-pits are being cleansed vies with the stinks of Cologne.
Things could not well be worse, and so long as matters remain as
they are we cannot wonder if our county villages, with all their natu-
rally advantages, are in so many respects less healthy than the towns.
When, however, we come to discuss the question of remedy, the full
difficulty of the case presents itself. What ought to be is easily de-
scribed. The privy-ashpit should be abolished. In its place should
appear something of the type known as the 'privy-receptacle.' The
first principle of this contrivance is that it shall not contain more
than a week's accumulation of refuse. It follows from this, practi-
cally, that the receptacle shall be of no greater capacity than the
space underneath the seat. Such an arrangement secures (1) that
neither rain nor sun shall beat upon the contents; (2) that the ashes
(generally shot in from the side) shall mingle with, and deodorise,
the excreta; (3) that no undue accumulation of filth shall occur;
and (4) that the excreta, etc., shall be removed in a comparatively
fresh condition. All this is possible, and is carried out with ease, in
a town. But so long as there is no public system of scavenging in
connection with our villages, so long as we are dependent upon the
half-yearly visits of the farmer's carts, such an arrangement is im-
[Page] 65
practicable. It has been held that a Local Authority may employ a
scavenger to cleanse the streets of a village, but beyond that the
Local Authority has at present no power to go, and the mere scav-
enging of the front streets, while those seething abominations exist in
the rear, is a mere whiting of the outside of the sepulchre. The
Society of Medical Officers of Health for Scotland has memorialized
the Secretary for Scotland and the Lord Advocate, with a view to
legal powers being granted for the creation of Special Scavenging
Districts, upon the lines of the existing Special Drainage and Special
Water-Supply Districts. I am certain that proprietors and tenants
generally would be delighted to pay the small rate involved - which
would often be less than the cost of the existing (want of) system -
to be saved the annoyance and worry by running from one farmer to
another, invoking, at the busy seasons, in vain, his assistance in the
matter. But, in the meantime, county sanitary officials are in a
dilemma. These foul privy ashpits exist; it is no use asking proprie-
tors to convert them into privy-receptacles - the most efficient form
of which, by the way, would have a galvanized-iron box, provided
with handles, under the seat; this would be lifted out by the scav-
engers, and tilted into the cart, without any shovel-work being re-
quired, and without any fouling of the street. And yet the greatest
nuisances in the villages are these privy-middens; they cannot, with-
out grave dereliction of duty, be ignored. But any continuance of
the system, even upon much improved lines, will involve partial re-
construction when an improved method of scavenging is introduced.
When, however, is this likely to come to pass? With the existing
and prospective stagnation of business in the Legislature, one cannot
regard the matter with hopefulness. The only interim solution of
the difficulty which the Lord Advocate, on being interviewed on the
subject, could suggest, was the recurrent wholesale prosecution of
proprietors for undue accumulations of refuse! The poor people who
are, for the most part, the sufferers, have become habituated and
case-hardened to the evil; and it does not lie at the door of the better
off classes. Thus there is no volume of public opinion, such as is re-
quired nowadays, to thrust this and like matters upon the attention
of our legislators; I am afraid that 'Privy-middens!' would not
prove a popular electioneering cry. We are, therefore, in a quandary;
whether we do anything or whether we do nothing, we are alike
open to criticism. The policy which I at present pursue is to instruct
the sanitary inspectors to deal only with very bad, dilapidated privy- |
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[Page] 66
middens, and to require the substitution of privy-middens, as small
as possible, protected by a roof from sun and rain, well ventilated,
so constructed that the excreta and ashes mingle, and so arranged
that they can be reconstructed as privy-receptacles, when the time
comes, at the least possible cost. But there remains another evil.
Suppose a proprietor has provided a fairly efficient privy-midden.
The tenants, heedless and dirty, may convert it into a vile nuisance
within a fortnight: slops are thrown into the ashpit until it is seeth-
ing, and the interior and precincts of the privy are covered with
filth. One shrugs their shoulders in despair. For unless a policeman
were stationed in permanence over every privy-midden, it is impos-
sible to prove that any one or other of the tenants is responsible for
the causation of the nuisance; and no nuisance would be committed
while the policeman was about. The Public Health Acts Amend-
ment Act, 1890, has a most useful provision, whereby all the tenants
can be summoned, in such a case, as parties to the nuisance, and this
provision is found effective; nor is any injustice involved, because if
any tenant can show that others were responsible for the nuisance,
he, of course, escapes. As a matter of fact, however, the tenants, in
such cases, are all involved; a tenant of another way of thinking
would not long remain in such vicinity. Unfortunately, however,
and apparently because there was no one to direct attention to the
omission, the Act does not apply to Scotland, being only operative in
England and Ireland.
MEAT INSPECTION.
Something was done in this department of work during the year,
but it promises to be a fruitful source of labour for the next year or
two, as it has come to my knowledge that a considerable trade in
diseased meat is being carried on in the county, which has never been
touched in the past. A good deal of time was spent without corres-
ponding result in watching this interesting traffic; the gentlemen
who devote their attention to it are extremely wide-awake, and the
meshes of the law are large. Our efforts, however, were not utterly
unavailing. Early in the year, when I was the only representative
of the County Health Department, I received intimation from the
Paisley Authorities that a suspicious-looking cow had been seen led
out of the town in the direction of Barrhead. It was then after
dark, and I contented myself, having obtained the sanction of the
[Page] 67
Chief Constable, with telephoning to the county police inspector at
Barrhead asking him to have the animal tracked, and to let me know
if anything particular happened before morning. Early next morn-
ing I learnt that the animal had been followed to its destination in
Neilston. I proceeded thither, and found the carcase in a shed there
with a constable on guard. The purchaser had killed and dressed
the animal, but had kept all the organs for my inspection. It
appeared from his explanation that he had made the purchase rather
for the purpose of scientific experiment then otherwise - he wanted
to see what the animal would look like when cut up. He made no
difficulty about my formally 'seizing' the carcase, which was badly
tuberculosed, and I had it immediately carbolised so as to render it
impossible of sale for food; there were not sufficient grounds, legally,
for any further proceedings.
'From information received' I arranged with the County Veterin-
ary Inspector and the County Sanitary Inspector to make a descent,
one dark night in the early winter, upon a slaughter-house at Barr-
head. The scene presented to our view was weird, but not without
a picturesqueness of its own. In a comparatively small room, by the
light of a couple of dip candles, the carcases of 12 cows could be seen,
suspended from the roof, ready dressed; a quartered carcase hung on
the walls, and another was in process of being dressed. The floor
was floating almost knee-deep with the viscera of deceased animals.
Upon a careful examination of the carcases, in consultation with the
County Veterinary Inspector, I decided to seize the carcases of three
animals, one of which had evidently died, or been on the point of
dying, of some acute inflammatory disease; the two others were
extensively tuberculosed. Mr. Little had the carcases removed to
the Paisley public slaughterhouse. We examined 12 pairs of lungs
found on the premises, and found no fewer than 7 to be more or less
affected by tuberculosis. The parties at first were disposed to show
fight, but subsequently submitted to an order of the sheriff's to have
the carcases 'dipped.' It was much to be regretted that the matter
could not be pursued further, but in view of the fact that the princi-
pals were not present when the carcases were dressed, I was advised
that further proceedings might fail. I need hardly say that matters
will not be allowed to rest thus. I hope to be able to report next
year that the traffic in diseased meat within the county has been
rendered comparatively unprofitable. |
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[Page] 68
FOOD AND DRUGS ACTS.
The administration of the Food and Drugs Acts is at present in
the hands of the County Police. I do not propose to relieve them
of this responsibility for a couple of years - until, indeed, we have
fairly overtaken the arrears of purely sanitary work which have
descended to us.
PROSECUTIONS.
I found it necessary to advise that 21 prosecutions should be
entered upon during the year; that these were justifiable and neces-
sary is sufficiently indicated by the fact that they were in every case
successful, and that rarely was any serious defence offered. Nineteen
arose out of cases occurring in the First District. In one case, pour
encourager les autres, a woman was prosecuted for having, after
repeated warnings, allowed a child while in an infectious condition
from scarlet fever, to run about the street at Inkermann. In another
case the offence was that of making a deposit of decaying vegetable
matter, of which the people in the neighbourhood deeply complained,
at Cathcart. The matter of the diseased carcases has already been
referred to. The other cases had reference to insanitary property.
Four houses was closed as unfit for human habitation - one at Barr-
head and three at Elderslie. In some other cases the Sheriff's decrees
were for the almost entire reconstruction of houses certified by me to
be unfit for human habitation, as at Barrhead. And in cases at
Neilston, Barrhead, and Elderslie, orders were granted for the repair
and alteration of insanitary property.
In the Second District cases of insanitary property at Lochwinnoch
and Bridge-of-Weir were dealt with before the sheriff.
Unless these prosecutions had been undertaken the work of the
department would simply have stagnated. People appear to have
been accustomed in the past to trifle with and ignore the require-
ments of the Local Authorities; in most of the cases above referred
to, the respondents, while admitting their default, expressed them-
selves surprised that summonses had been taken out against them;
and even after we had obtained decree against them, we have often
had difficulty in obtaining its fulfilment - having shown reluctance to
proceed against the defaulters for penalties. Indeed, from a politic
desire to avoid the reputation which attaches to the proverbial 'new
broom,' I had endeavoured to reduce the legal expenses in connection
[Page] 69
with these cases to a minimum. This policy may have been success-
ful in its main object, but I have found that it may be carried too far;
and in future I intend to let the law follow its natural course.
THE DETAIL WORK OF THE DEPARTMENT.
1830 Visits of inspection, under the Public Health Act, were made
by the Chief and Assistant Sanitary Inspectors in the First District.
230 nuisances were dealt with, of which 168 are reported as abated.
I have seen reports in which it has been stated that the whole of the
nuisances dealt with during a particular period have been abated.
Such reports rise to the level of fiction. For, in the first place, there
must always be, at any given date, a certain proportion of notices for
nuisances pending; and, in the second place, there will always be a
proportion of cases in which circumstances have arisen or explana-
tions have been given, which render it undesirable or impracticable to
have the notices, as issued, given effect to. In our own case there
have been additional reasons why a number of notices should be re-
ported as uncomplied with. The first is that I have not considered it
wise to proceed to extremities so early in our career. In a free
country, public opinion, local or general, is a factor which every
administrative official is bound to discount. In taking up the
administration of sanitary affairs in the County, I felt that to do use-
ful work we must carry the average public opinion of the County
with us, and that such public opinion might be aroused and rendered
antagonistic at the outset, if we did not proceed cautiously, and much
would be heard of 'new brooms.' I have therefore allowed some
minor nuisances, which might have led us into difficulties, to drop.
The general result of this policy was, I should say, that at the end of
the year, while some people thought us too exacting, and others
thought us slow to move, most people had no feeling one way or the
other. With that result, as a practical sanitarian, I feel satisfied. -
A second cause of delay arose out of the hindrances to the execution
of structural work imposed by the weather; the winter has been
severe, and we could not reasonably press people to proceed with
certain classes of work amidst snow and frost. - And, in the third
place, and sufficient in itself as a reason, we had so many decrees
pending towards the end of the year, and works being intermittently
- by reason of the weather - carried on, under decree, that we should
have got into confusion had we initiated any further legal proceed-
5 |
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| HH62/2/RENFRE/71 |
[Page] 70
ings at the time. - About 780 visits were made by the inspectors in
connection with cases of infectious disease; 98 patients were removed
to hospital; and 239 houses were disinfected. By the end of the
year 142 farm-steadings had been visited and reported upon in full
detail after the fashion already described. The severity of the winter
has materially interfered with the progress of this work.
In the Second District, 966 visits of inspection, approximately,
have been made by the inspectorial staff, 251 nuisances have been
dealt with, of which 191 are reported as abated; in this connection
the explanation given above holds good. 178 visits were made in
connection with cases of infectious disease, 26 cases were removed to
hospital, and 76 houses were disinfected. 210 dairy-farms were
inspected and reported upon in full detail.
APPENDIX. |
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| HH62/2/RENFRE/72 |
TABLE I. - ANALYSIS OF CENSUS RETURNS, 1891.
FIRST OR UPPER DISTRICT.
[Table inserted] |
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| HH62/2/RENFRE/74 |
TABLE II. - ANALYSIS OF CENSUS RETURNS, 1891.
SECOND OR LOWER DISTRICT.
[Table inserted]
TABLE III.
TABLE III. - DEATH RATES, TEN YEARS, 1891-90.
FIRST OR UPPER DISTRICT.
[Table inserted] |
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| HH62/2/RENFRE/76 |
TABLE IV.
TABLE IV. - DEATH RATES, TEN YEARS, 1881-90.
SECOND OR LOWER DISTRICT.
[Table inserted]
TABLE V.
TABLE V. - Mean Villatic, as distinguished from purely Landward, Death Rates, 1881-90.
[Table inserted] |
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| HH62/2/RENFRE/78 |
TABLE VIII.
TABLE VIII. - Abstract of Meteorological Observations for the Year 1891, taken by Mr. D. McLean,
at the Coat's Observatory, Paisley (107ft.).
[Table inserted]
TABLE VI. - FIRST OR UPPER DISTRICT.
Mean Death Rates from various causes, and percentages of deaths at certain ages, in the different Villages and Landward
Sections of the District, over the Ten Years 1881-90.
[Table inserted] |
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| HH62/2/RENFRE/79 |
TABLE VII. - SECOND OR LOWER DISTRICT.
Mean Death Rates from various causes, and percentages of deaths at certain ages, in the different Villages and Landward
Sections of the District, over the Ten Years 1881-90.
[Table inserted] |
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| HH62/2/RENFRE/81 |
PART II.
THE DISTRICTS.
I.
FIRST OR UPPER DISTRICT.
Population. - The population of the District, for sanitary pur-
poses, as ascertained at the Census of 1891, was 34,505, - the density
of population, 348 persons to the square mile.
Births. - 1071 births were registered within the District during
the year; the birth-rate, calculated upon a population of 34,500, was
thus 31·0 per thousand of the population - as compared with 27·1 in
the Second District. The birth-rate in the Principal Towns was 32·6,
in the Small Town Districts 31·6, in the Mainland-Rural Districts
27·5. The Illegitimacy-rate was only 6·0 per cent., as compared with
7·2 in the Principal Towns, 7·2 in the Small Town Districts, and
9·8 in the Mainland-Rural Districts. The circumstances of the First
District may be regarded as equivalent to those of the Small Town
Districts, while the Second District naturally falls into the category
of Mainland-Rural Districts.
Deaths. - The deaths were 663, to which there have to be added
16 occurring in Public Institutions outwith the District; the total,
679, yields a death-rate for the year of 19·7, as compared with 17·1
in the Second District. The death-rate in the Principal towns was
22·7, in the Small Town Districts 20·1, in the Mainland-Rural Dis-
tricts 17·2.
The infantile death-rate. - That is, the proportion of deaths
under one year per thousand births, was 114, which would have been
a low rate for a town, but is only moderately satisfactory in a rural
district. The corresponding rate in the Second District was 96.
The zymotic death-rate - 2·8, was above the average rate of
the District in the preceding five years. The mean zymotic death-
rate of the country was 3·0 per thousand: I am unable to give the
rates according to the different categories distinguished by the
Registrar-General.
There were no deaths from Small-pox nor from Typhus Fever. |
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[Page] 82
23 cases of Diphtheria were reported between May 15th and De-
cember 31st; the death-rate for the whole year was at the rate of
3·2 per ten thousand of the population.
207 cases of Scarlet Fever were notified after the 15th of May, and
the death-rate for the year was 2·6 per ten thousand.
47 cases of Enteric Fever were notified, of which 9 were from Neil-
ston, and 9 from Eaglesham. The death-rate was as high as 3·2 per
ten thousand, a very unsatisfactory circumstance, indeed.
The Local Authority accepted (and paid for) such notifications of
Measles as were received during the year, although that disease was
not compulsorily notifiable. As a matter of fact, the cases notified
were almost entirely confined to the village of Inkermann, in which
the disease was violently epidemic in the course of the summer. 72
cases were notified from the village, and no fewer than 15 deaths
were recorded. The death-rate from Measles over the whole District
was as high as 8·4 per ten thousand.
Whooping-cough was the certified cause of 17 deaths, yielding a
death-rate of 4·9 per ten thousand.
The death-rate from Diarrhœa was as high as 5·7; of the 20 deaths
out of which this death-rate arose, 16 were of children under five
years of age - victims for the most part to the filth-polluted precincts
of their village homes.
The following table furnishes an analyses of the social conditions,
Classification of Cases of Infectious Disease
according to size of house.
[Table inserted]
[Page] 83
as indicated by the size of the house, amidst which the cases of infectious
disease notified from the 15th May to 31st December arose, from
which it will be observed that 78 per cent. of the cases occurred in
houses of three rooms and under, - in other words, under circum-
stances which rendered any attempt at efficient isolation impracticable.
The succeeding table shows how far our attempts at securing
Proportion of Cases of Infectious Disease removed
to Hospital
[Table inserted]
hospital isolation were successful; we have reason to be fairly well
satisfied with what has been done, especially that we have been able
to secure the removal to hospital of 37·7 per cent. of the cases of
Scarlet Fever - the common zymotic most susceptible to control by
means of hospital isolation.
The subjoined table illustrates the complicated character of the
situation in respect of hospital accommodation during the year.
Hospital Isolation during the year.
[Table inserted] |
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[Page] 84
Other causes of death. - Next in natural order to the zymotic
diseases come the Septic diseases with a death-rate of 2·0 per ten
thousand. - The death-rate from Phthisis was as high as 20·6 per ten
thousand, as compared with 12·9 in the Second District; and the
death-rate from Tubercular diseases other than Phthisis was 12·7 as com-
pared with only 1·6 in the Second District - an inexplicable difference.
The other death-rates were Cancer, 6·7; Diseases of the nervous system,
19·1; Diseases of the circulatory system, (heart disease, etc.) 18·0;
Diseases of the respiratory system, 37·1; from Violence, (accidents, etc.)
2·0.
Summary of the more important work carried over from
1891 to 1892. - 1. Mearns and Giffnock Water Supply. 2. Neilston
Water-Supply. 3. Clarkston Drainage. 4. Eaglesham Drainage.
5. Mearns Drainage. 6. Question of the acquisition of Sir John
Stirling Maxwell's sewer in the village of Nitshill as a public sewer
for the village, and its extension. 7. Hospital accommodation and
ambulance, more especially in connection with Cowglen Hospital.
8. Sanitation of Slaughter-houses. 9. Sanitation of common Lodging-
houses. 10. Sanitation of Bakehouses.
II.
SECOND OR LOWER DISTRICT.
Population. - The population of this District, for sanitary pur-
poses, at the date of the Census, was 19,347; the density of popula-
tion, 148 persons to the square mile.
Births. - 553 births were registered within the District during the
year, yielding a birth-rate of 27·1 per thousand of the population, as
compared with 31·0 in the First District. The Illegitimacy-rate was
as low as 4·0 per cent. of the births. The birth-rate and other rates
for the country generally have already been given in connection with
the figures for the First District.
Deaths. - The deaths occurring within the District were 321, to
which have to be added 10 deaths of persons belonging to the District
occurring in Public Institutions, furnishing a death-rate, over the
year, of 17·1, as compared with 19·7 in the First District.
The infantile death-rate was as low as 96, as compared with
114 in the First District.
The zymotic death-rate was as high as 3·3, which must be con-
sidered a very high death-rate for a country district; the excess is
[Page] 85
due to the excessive prevalence of Measles in the Parishes of Kilbar
chan and Houston during the year, and the mortality arising out of
that prevalence, there having been 26 deaths in the Parish of Kilbar-
chan, and 12 in the more sparsely populated Parish of Houston.
Only 6 cases of Diphtheria were notified between 15th May and
31st December; of these 4 were from Linwood or its vicinity. The
death-rate was 3·6 per ten thousand of the population.
72 cases of Scarlet fever were notified, but no death from this
disease occurred during the year; the largest number of cases
occurred scattered over the Parish of Kilmalcolm.
The death-rate from Enteric fever was only 0·5 per ten thousand,
and only 20 cases of the disease were reported, - of these 7 were
from Linwood.
Measles, as I have said, was excessively prevalent in certain parts
of the District during the year, and resulted in a death-rate as high
as 20·2 per ten thousand. In dealing with this disease, matters are
rendered very difficult in consequence of the fatalistic attitude
assumed by a large proportion of the population, and their heedless-
ness. It is to be hoped that the visits of the sanitary staff, under the
Notification Act, will have an educative effect.
The death-rate from Whooping-cough was 2·1.
In respect of Diarrhœa, the Second District shows up worse even
than the First - the death-rate having been 6·2. The largest number
of deaths from this cause occurred in the Parish of Kilmalcolm.
The following table is notable, in comparison with the corres-
Classification of cases of Infectious Disease according
to size of house.
[Table inserted] |
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| HH62/2/RENFRE/87 |
[Page] 86
ponding table for the First District, for the higher proportion of cases
occurring in houses of four or more apartments.
The subjoined table is interesting from the large proportion of
Proportion of cases of Infectious Disease removed
to Hospital.
[Table inserted]
cases of enteric fever removed to hospital; this, however, is rather a
matter of accident, arising out of the fact that a considerable propor-
tion of the cases removed had occurred in the immediate vicinity of
the Johnstone Hospital. I hope I may be able to report a larger
proportion of removals of scarlet fever cases next year.
Hospital Isolation during the year.
[Table inserted]
Summary of the more important work carried over from
1891 to 1892. - 1. Kilbarchan Water Supply. 2. Extension of the
existing systems of Water Supply at Bridge of Weir (Ranfulry),
[Page] 87
Bridge of Weir (Houston), and Kilmalcolm. 3. Howwood Water Sup-
ply. 4. Water Supply for Crosslee and Houston. 5. Kilbarchan
Drainage. 6. Kilmalcolm Drainage. 7. Inverkip Drainage. 8. Lin-
wood Drainage. 9. Howwood Drainage. 10. Re-consideration of
the relation of the Johnstone Hospital to the District. 11. Sanita-
tion of Slaughter-houses. 12. Sanitation of Common Lodging-houses.
13. Sanitation of Bakehouses. - Surely a large enough programme ! |
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| HH62/2/RENFRE/89 |
TABULAR STATEMENT of SICKNESS and MORTALITY referred to in the Regulations issued by the Board of Supervision for Medical Officers of Districts of Counties.
FIRST OR UPPER DISTRICT.
TABLE I. - Births and Deaths occurring in the District during the Year 1891,
[Table inserted]
* The particulars of the deaths in Public Institutions have not been ascertained. |
|
| HH62/2/RENFRE/91 |
TABLE II. - Density of Population, Birth Rate, Infantile, and other Death Rates.
* Including deaths in Public Institutions.
[Table inserted]
TABLE III. - Cases of Infectious Disease coming to the knowledge of the
Medical Officer during the Year 1891.
[Table inserted] |
|
| HH62/2/RENFRE/93 |
TABULAR STATEMENT of SICKNESS and MORTALITY referred to in the Regulations issued by the Board of Supervision for Medical Officers of Districts of Counties.
SECOND OR LOWER DISTRICT.
TABLE I. - Births and Deaths occurring in the District during the Year 1891.
* The particulars of the deaths in Public Institutions have not been ascertained.
[Table inserted] |
|
| HH62/2/RENFRE/95 |
TABLE II. - Density of Population, Birth Rate, Infantile, and other Death Rates.
* Including deaths in Public Institutions.
[Table inserted]
TABLE III. - Cases of Infectious Disease coming to the knowledge of the
Medical Officer during the Year 1891.
[Table inserted] |
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