[Page] 16

patients and their friends. Surely that is an indisputable pro-
position. Just consider (1st) the chances of recovery in such
atmosphere as we know to prevail in, say, the Lews Huts;
and (2nd) the tremendous risk of the spread of the disorder,
to say nothing of the next to impossibility of clearing out
from such premises the inveterate seeds of such disorders as
Typhoid and Diphtheria. We do not think it necessary to
argue all this out. We confidently assume it to be proved to
the hilt. But there is one point (the 3rd), to consider, and
it undoubtedly is a great difficulty and expense in the set-
ting up of local hospitals, viz., providing a suitable staff, effi-
cient and yet not too expensive. Even if money were as
plentiful for ever, as it seems to be just now for any and
every experiment, yet the organisation would rust and fall to
pieces of itself, if complete to start with, and only intermit-
tently made use of.

Our proposal is this, establish a Central Nursing Home,
with a matron and a staff of probationer nurses in training,
in one of the poorhouses, preferably Tain, which might be set
apart for such a purpose. Of course there would require to
be a certain number of beds occupied by the sick for teach-
ing the pupils practical work. These beds might be occupied
with chronic cases unsuited for ordinary infirmaries, or bed-
ridden fatuous cases presently in Asylums. At any rate it
need not compete with existing hospitals. Wherever infec-
tious disease broke out a nurse or nurses might be sent from
the centre, who would open the local hospital, keep it open as
long as necessary and then return to the Home. As a rule,
contagious disease does not break out all along the line, and
thus a few nurses would serve all within an extensive circuit.
The nurses, too, could be much better in hand, besides the
saving of expense, and would have much more interest in
their work. They would be available for district nursing,
so called, outside the hospitals, and also for surgical emergen-
cies and accidents.

On the 7th and last head I might say a great deal, but
my friend, Mr Mackenzie, will doubtless have much to urge
on this subject which more properly belongs to him. I shall,

[Page] 17

therefore, reserve my remarks until I have discussed Infection
as relating to particular diseases in a subsequent portion of
this report. All I shall mention now is my firm conviction
that the sanitary inspector of parishes has, perhaps through
no fault of his own, done his work very perfunctorily, and
that he is destined to play a very important part, if well
directed and seconded by his Local Authority, in the future.

In considering the causes, origin, and distribution of dis-
eases in the County, there are two aspects in which this
question can be looked at. It may be considered in con-
nection with sickness, and also in relation to deaths. If it
were possible to get accurate returns of the former, this would,
of course, give us more information than the latter Many
well intended attempts have been made to secure this result,
but they have broken down. The notification of infectious
diseases, if carried out - as we hope it may soon be - all over
the County, will be extremely useful in collecting statistics
of sickness as distinguished from deaths. As to these the most
important disorders from the point of view of Public Health,
I have made a list, of which more will be said later on, of what
I have called preventible diseases, in which, 23 in number, I
have taken leave to include, besides the diseases usually known
as infectious, likewise cancer and tubercular disease. The
latter is now known to be a parasitic disease, i.e., germs are
always found to accompany it, and may be said to cause it.
The former in Sir James Paget's opinion will, by and by, be
placed in the same category when the germ is found. I fear
Dr Russell's discovery is not likely to be verified just yet.
Using this list, and applying it, not to show the absolute but
the relative presence of 23 common diseases, I find, on ex-
amining the records of sickness in my private practice for
the three years, '70-71, and '72, and again for three years,
'83-84, and '85, the most common cause of sickness was con-
sumption, and its allied diseases, of which I had over 30 cases;
whooping-cough in the second period also shows over 30;
pneumonia, which was undoubtedly epidemic, as it was also
in the practice of my neighbours, Drs Adam and Sutherland,
at the same time, viz., in '85-86, exceeds 30 also in the se:
cond triennium; while typhoid comes close up, being 27 in

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