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ROSS AND CROMARTY COUNTY COUNCIL.
ANNUAL REPORT
FOR 1891
BY
WILLIAM BRUCE, M.A., M.D., LL.D.,
MEDICAL OFFICER OF HEALTH.
DINGWALL:
LEWIS MUNRO, PRINTER AND PUBLISHER.
1892. |
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DINGWALL, 29th March, 1892.
To the County Council of Ross and Cromarty.
GENTLEMEN,
In conformity with the Regulations of the
Board of Supervision, dated May 1st, 1890, issued in virtue
of the Authority conferred by Section 53 (1) of the Local
Government (Scotland) Act, 1889, I herewith beg to present
to you my Report for 1891, drawn up on the lines laid down
in Section 1. of those Regulations.
I have the honour to be,
GENTLEMEN,
Your obedient Servant,
WILLIAM BRUCE,
Medical Officer of Health.
ROSS AND CROMARTY COUNTY COUNCIL.
Annual Report for 1891
BY
WILLIAM BRUCE, M.A., M.D., LL.D.,
Medical Officer of Health.
THE County of Ross and Cromarty covers an area of more
than two million acres, of which about one-third may
be described as cultivated, while the remainder is
either untilled or uncultivable Its length may be set down
at sixty-seven miles, and its breadth at fifty-eight. The chief
division is into Insular, West Coast, and East Coast - the two
former being usually grouped together owing to similarity of
climate and likeness in the occupation of the inhabitants, the
bulk of whom devote their attention partly to fishing and
partly to farming. On the East Coast the two avocations are
kept distinct, and the larger portion of the population is strictly
connected with the land. The aggregate number living in the
County all over, according to the census of '91, was 79,667
The climate, on the whole, may be described as genial, and, as
a rule, it is neither very hot nor very cold. It is said that tem-
pests are comparatively rare, and so are fogs and thunderstorms.
The rainfall varies very greatly, being high in the West, becom-
ing less and less as we proceed eastwards; until at Tarbatness
it amounts to scarcely twenty inches per annum.
The Geological features are thus described by Mr Horne:- |
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"The inland portion of Ross-shire (the Lews) is composed
of crystalline gneiss and schist, with the exception of some small
patches of Torridon sandstone to the east of Stornoway. Boul-
der clay and other glacial deposits are spread over much of the
low-lying ground, and extensive areas are covered with peat.
"In like manner, the greater part of the united counties on
the mainland is composed of various types of crystalline gneiss
and schist.
"But to the west of a line drawn from Ullapool, by the head
of Loch Maree to Loch Kishorn, there is a great development
of Torridon sandstone, giving rise to the lofty mountains of
Coigach and Applecross. Overlying these sandstones we find
other ancient sediment snow forming quartzites and limestone.
Here and there along the western seaboard there are patches of
crystalline gneiss exposed, where the Torridon sandstone has
been worn away.
"Again, along the eastern margin of the County, between
Dornoch and Beauly Firths, there is a belt of Old Red Sand-
stone, forming the most fertile portion of the whole area.
"In all the valleys draining the eastern side of the main
watershed on the mainland there are extensive deposits of
boulder clay, moraines, and alluvial gravels. Similar deposits
are met with in the Old Red Sandstone areas, together with the
deposits belonging to the raised beaches."
Having made these general remarks we propose now to
consider more particularly the sanitary condition of the County
and its inhabitants under the following heads:-
(1) The want of knowledge of the laws of health, and
the best remedies for the same.
(2) The condition from a sanitary point of view of the
county generally, and the best means for improv-
ing the present state of things, more especially
of the villages and schools.
(3) The present supplies of drinking water, and how to
improve these both in quality and quantity.
(4) The state of the dwelling-houses of the poorer part
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of the population, especially those of the labour-
ing classes, and the most likely means of improve-
ment.
(5) The question of recommendations or bye-laws in con-
nection with labourers' houses, more especially as
applicable to new houses.
(6) Segregation of the sick (a) in their own houses, (b)
in hospitals.
(7) Sanitary inspection and disinfection.
Although the death rate in the County is comparatively
low, amounting, as we shall see when we come to look more
closely into the question, to about 16.5 per 1000, taking the
mean of three selected years; yet it does not follow that its
sanitary condition may not be greatly improved, or that the
resident population practise the laws of health. In fact there
are good reasons for believing the opposite, and we shall try to
show, without inquiring too minutely into the present state of
knowledge, at least at this stage, how best this deficiency can
be met. It may be well as a preliminary to point out why this
very important subject has not attracted more attention amongst
us, and how it is that on the whole the state of health with us
is good.
The first and chief reason for the average good health of our
community is undoubtedly the healthiness of the employments
of the great majority of the population, viz., farming and fish-
ing, and the absence of the many occupations deleterious to
health practiced in other places. The second may be set down to
the comparatively small amount of overcrowding. The third
is the fact that there is not the same grinding poverty as a rule
as is to be found in the large towns; and fourth, no doubt much
is due to the high standard of morality so creditable to the
Highlander. So much for the bright side of the picture; the
dark side is the want of personal cleanliness, the bad housing,
the carelessness as to purity of water supply, the ignorance as
to ventilation, proper clothing, avoidance of nuisances, and the
need for proper nursing, segregation, and disinfection of the
sick. On all these heads we shall have to enlarge as we pro |
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ceed in our report. Meantime, assuming that this is the true
state of matters, how are we to set about reform? It is plain
that it cannot go very far and take a good hold unless the
people themselves are more or less in sympathy with it. Mere
coercion will not do.
Having considered this matter very carefully we are con-
vinced that efforts must be consistently made to explain the
principles of Hygiene. Acting on this conviction, at the invi-
tation of the Association for Advanced Education in the County,
I agreed to deliver a course of lectures on Hygiene weekly, both
at Dingwall and Tain, and a similar course is being given in
Stornoway by Dr Macdonald, whose name I took leave to men-
tion to the Association. I am glad to say that these lectures
are well attended, and that several teachers are taking advant-
age of them in order to qualify themselves to, in turn, teach
Hygiene to their pupils. I would press on the County Council
the view that a knowledge of the laws of health must begin in
the Public Schools of the County. It is not to be expected that
the older people will change their ways of living or will even
see anything wrong therein. But it is different with the young.
Their minds are open and plastic, and almost anything can be
made of them by their schoolmasters. Of the close connec-
tion between morals and manners need not insist. And surely
I do not require to point out what civilisers such as agencies
may become. Correct ideas as to personal cleanliness and
decency every boy and girl must feel break down barriers be-
tween himself or herself and the outer world, and allow them
to go forth to the world on equal terms with other competitors.
But I would wish to insist still further on this point because the
schoolmaster can here teach both by precept and example.
Every sanitary arrangement connected with a public school
ought to be perfect, because the health of the children so much
depends on it. The cubic space allowed is as a rule much too
small, hence all the more need for free ventilation. Then it is
almost certain that most outbreaks of epidemics can be traced to
school gatherings - another powerful argument in favour of strict
attention to every sanitary detail. And supposing all these
perfect, it is further essential that the schoolmaster should
himself be thoroughly acquainted with the laws of health, should
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indeed know a great deal about physiology; the working of the
different organs especially of the brain; the care of the senses
such as the eyesight; but above all be an enthusiast in the
cause of sanitation. There are many teachers who both under-
stand and practice the laws of health, but, I am sorry to say,
there are others who are careless or indifferent. I consider
it the bounden duty of every schoolmaster to make a daily in-
spection of the offices connected with the school, to note and
correct any nuisance, to see that the scavenging is properly
done, to make sure that the water supply is abundant and pure,
and to personally supervise the ventilation by freely opening
all the windows during the intervals of work, and specially at
night. Further, he should make sure that the floors are pro-
perly swept, periodically washed, and at longer intervals the
walls cleaned down and whitewashed or painted.
But the teachers cannot be expected to look after all these
matters unless the School Boards do their duty in the first place.
I have taken special pains to visit most of the Schools in the
County, and I am very sorry to have to say that the great
majority are sanitarily disgraceful. I shall give details in
another portion of this report, but I may be allowed to point
out in this place, the chief faults. First, a great many Schools
have no proper supply of abundant and pure drinking water on
or about the premises. A healthy active boy in the summer
season will drink at least a quart of water daily. There are
schools with 200 children in attendance with no water within
a quarter of a mile. How can such children be healthy? Second,
there are very few Schools provided with lavatories, or where
there are such in existence they are out of order. Third, where
water-closets have been provided they have in most cases be-
come broken down. Fourth, there is hardly such a thing any-
where as a proper urinal with some simple flush and drain.
They may be all said to smell vilely. Privies as a rule are
badly planned and ill-kept, and there it a great want of method
in cleansing them out sufficiently often. I have no hesitation
in insisting that every School should have an ample supply
of water for drinking and for cleansing. The first may be
most conveniently obtained, as indeed, in most cases it is obtained
by sinking a well. It is simply marvellous to find that |
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scarcely a School site has been selected on account of the
proximity of a good well - a common point of advantage in
choosing the position of an ordinary dwelling-house. "The
Department," is greatly to blame in not Iaying down a rule in
this respect. Water, for purposes of bodily cleanliness is best
furnished from rain water tanks. They need not be very large
to meet the demands all the year round in our climate. The
water having been provided, then there ought to be lavatories
in every School, with soap and a towel provided by the School
Board. I was much interested to find this privilege taken free
advantage of by the fisher boys and girls in the Cromarty
School. A word from the master on dirty hands or faces
would keep everything right. I have already spoken of the
urinals. They too could be readily flushed automatically and
periodically by the rain water collected from their roofs.
I am opposed to W.C's. as a rule. They require much
water, constant attention, and when out of order need the
expensive and troublesome services of a plumber. An arrange-
ment of dry prviies, such as are so well planned and managed
at Tarbat and Culbokie is simple and sufficient. Indeed, l am
inclined to believe that, after all, the pail system would be at
once the simplest and best. Mr Ross, at Ferrintosh, worsk it
well. In either case, a piece of land should be attached to
the School where the contents could be applied as manure. Mr
Meldrum finds it useful on his small farm, used in this way.
Many Schools want better means of ventilation and heating.
No inlet for cold air should open too near the children, and a
supply of warmed, fresh air, as in the Manchester grate, which
I found working very well in several cases, is to be recom-
mended. The outlets should be always protected by flaps. In
most cases they frequently act, especially in stormy weather
as inlets. It may be thought that I am entering into too
much detail as regards Schools, and perhaps I should have
directed my attention to Churches and Halls. But not only
are the greatest dangers arising constantly from neglect of the
laws of health in connection with children crowded together,
fasting, it may be, and susceptible to all the deadly ailments
of childhood, but I wish the Council to be persuaded that in
the interests of Hygiene here they have an opportunity never
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perhaps to recur, of presenting object lessons of the necessity of
attention to sanitary rules daily, nay hourly, to the young and
open mind. If health be the valuable thing we all believe it
to be, surely we cannot afford to lose the best possible chance
of setting forth its importance and enforcing its safeguards.
My friend, Dr Ross, Barvas, who has sent me a most careful
and thoughtful document on the public health of his parish,
has suggested the printing and publishing of a leaflet in Gaelic
summarising the leading points of Hygiene and especially ex-
pounding the rules for dealing with outbreaks of infectious
disease. I hope that he and I may be able to arrange for this,
which I feel sure would be of great service to many, and I trust
the County Council may give its sanction to such a publication.
The next division is a very wide one, viz., the Sanitary Con-
dition generally of the County, but is really narrowed by the
other sections which follow. The first subject to consider is
the primary one of means of communication. It is only dawn-
ing on our legislators that there are parts of Scotland and
Ireland where there are no roads. It is simply disgraceful
that such a state of things should exist within the bounds of
a rich and prosperous country like our own. The providing
of means of transit is the very first step in sanitary progress, and
without such we officers of public health are powerless. I trust
then, Parliament in its wisdom will see the urgency of the
petition for help, and mercifully grant its prayer. As Dr Ross
in his report well shows, good roads and drainage go together.
In connection with very many townships in the West and
even in the villages of the East Coast, means for loading off
the surface water quickly are urgently needed. Otherwise
stagnant, putrifying pools are left to breed all sorts of noxious,
organic substances, fit hot-bed for the germs of disease, and it
may be of death.
The next most important point is the disposal of slop
waters which may be carried off by the channels spoken of, or
in the absence of sewers, carried into ordinary tile drains
which, where there is sufficient fall, might be used to irrigate,
at a proper depth from the surface, some convenient piece of
ground. The solid refuse, including the excreta, should be |
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collected in a proper midden, well cemented and kept dry
until it could be carted off and applied to the arable ground.
If possible, where there is no W.C. every house should possess
a privy - in connection with the midden as a rule, so situated
as not to be dangerous to the health of the owner or his
neighbours.
Where new houses are to be built, the site should be dry,
well exposed to the sun and air, and yet, if possible, rather
sheltered from north and west winds. Where there are say
over fifty houses together constituting a hamlet or village, some
organised means of dealing with refuse requires to be arranged
for - in other words, there should be a public scavenger.
Unfortunately in the meantime there is no power given even
to Water and Drainage Districts to employ such a useful man.
The Medical Officers of Health Association lately sent a
deputation to the Lord-Advocate on this subject and it is to
be hoped legislation will be passed enabling such sub-Districts
to carry out so highly necessary a means of protecting the
public health. I consider good scavenging in many escas
would save costly schemes of underground drains and sewers -
schemes not only expensive but entailing large and free
supplies of what is not always easy to be got, water. On one
matter I consider it wisest to be quite explicit. I do not
approve of public privies in villages such as Ullapool. They
only meet the wants of one third of the population, and make
no account of the slops and other refuse from the house. I
consider a small water-tight midden with its privy, if well
situated at a little distance from the house and properly and
periodically cleared out to the fields, not at all objectionable
on the score of public health.
Our third Division is the present condition of the Water
Supply and how to amend it.
That water is a common vehicle for carrying poisonous
matter into the human system all sanitarians allow and
deplore. The connection between Cholera, Typhoid Fever,
and fouled drinking water has been proved over and over
again. Not that it follows that this is the only means of
access into the body of these terrible plagues. We shall
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probably have to show that the last mentioned must be
hunted for in other quarters than wells, if we wish to stamp
it out altogether and in every instance. Yet water, it
almost goes without saying, like air, must be pure for health.
Long acquaintance and much study of this question has con-
vinced me that a great deal of the water drunk in the County
is impure, or at least liable to be contaminated at any moment,
and specially on the breaking up of frost or drought followed
by much fall of rain. Most of the common wells are recep-
tacles for merely surface water, liable to have all sorts of dirt
and decaying substances washed into them, and very often
situated on the brink of a burn, ready to be overflowed by the
first spate. Where spring or loch, or river water, cannot be
procured, there is no difficulty in protecting such wells by a
cover and ring of cement, the latter two feet at least in depth,
so as to secure that extent of filtering medium outside, and
with a pump fixed above for drawing the water and preventing
its being dirtied by pails left carelessly about. Villages and
hamlets should, if possible, and the expense be not too great,
set agoing a Water District, with the sanction of the District
Committees, and provide themselves with water from pipes.
In considering the increase to their rates, they should allow
for the saving of trouble in having water brought into their
houses or near them, instead of having to be carried for some
distance. I am not an advocate for the Districts taking
burdens upon their constituents at large for such purposes.
The work should be done locally; and the superiors whose feus
such amenities improve, ought to help freely - as so many
proprietors have already so generously done. We, as guardians
of the Public Health, will not rest content until every house-
holder has a fair supply of unchallengeable water brought as
near his door as possible - only every one interested must
lend a helping hand in providing what is, next to food and air,
so necessary an element of health.
Our fourth head is the state of the Houses of the Poorer
Class, and especially of those of the labouring portion of the
population. This may be described, after roads and bridges,
as the question of the hour. A comfortable healthy living
house will tempt many a labouring man to stick to the country |
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in spite of the attractions of the town. Looking at the ques-
tion, as we have the right only to look at it, as sanitarians, the
addition of a sufficient piece of ground to mainly keep himself
and his family will be likely to add to his health and comfort,
and in this light I would advocate such holdings strongly.
Do the houses referred to us as a rule, come up to the require-
ments of health? We are bound to answer they do not.
The most clamant failures are, we need scarcely say, on
the West Coast and in the Lews. There the primitive huts,
so well if rather truculently described by Dr Macaulay in his
last year's report, are very far removed from what might be
called the minimum of sanitary necessity. The wall of
separation must be, as soon as possible, built up between man
and beast. It is to be hoped that the Lewis District Com-
mittee will put its foot down in this respect, and give notice
that such partitions of stone and clay (without any direct
passage between house and byre), must be erected within say
the next five years in every cottage in the island. This is the
first step; the next will be providing proper chimneys; and
windows to open, and then carrying the roof to the extreme
outside of the house wall. The present practice of supporting
the roof on the inner wall directs all the water off the former
into the soil between the two skins, as it were, and keeps the
whole tenement in a constant state of damp. The large fires
and the peat smoke are the two counteracting agents; otherwise
the evils resulting from the present state of things would be
much worse than they are. Here, too, the erection of proper
middens and other conveniences must, by and by, be enforced.
The problem on this side of the country is mainly one of
how best to set about improving the cottages of the plough-
men. Their houses undoubtedly require such looking after.
Luckily, or unluckily, in many cases the only cure is entire
reconstruction. The roof is leaky and bad; the walls are
merely stone and clay; the floor is a sodden mass of irregu-
larly moulded filth; the windows are too small and do not
open; the cubic space is ridiculously small for a family, and
the necessary adjuncts are conspicuous by their absence. The
model to be aimed at would be something like the following:-
They should have a slated roof, stone and lime walls covered
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inside with lath and plaster, hollow bricks, a cement floor -
partly of wood - well-sized windows, hinged or hung with
weights; the living rooms sufficient in number and cubic space;
with middens, &c., put down in the proper place, and at a fair
distance from their doors and windows. Where the present
dwellings are fairly good, improvements ought to be gradually
made, in order to bring them up to a proper standard. It may
be necessary in order to secure all these reforms that provision
be made by statute to enable proprietors to borrow money at
an easy rate of interest and repayment for this improvement,
one so intimately connected not only with the health of our
working class, but also with the due supply of labour to our
fields and farms.
I have placed in a separate section the question of whether
District Committees, with the sanction of the County Council
should, or should not, draw up a list of recommendations,
showing what they deemed to be the minimum requirements
in ploughmen's houses that may hereafter be built as looked at
from the point of view of Public Health.
Dr Bell of Scatwell, in his well-known interest, not only in
Public Health generally, but particularly in that of the
labouring classes, has put his shoulder to the wheel in this
good work, and is assisting me to draft these "bye-laws," as
they might be called. Such a code would give us a standard
with which to measure any case complained of, and might very
well be applied to all new houses - the numbers of which, in
any one year, cannot be great. Of course care must be taken
not to make excessive demands; and the rules must possess a
certain amount of elasticity, otherwise the effect would be to
discourage all new erections - a very untoward result of well-
intentioned regulations. In no department of sanitary work
is more attention required than in this. Overcrowding - while
the most insidious of all "nuisances" - is undoubtedly the
most deadly. Attention will be drawn further on in this report
to the excessive death rate from consumption and its allies.
It may be very safely asserted that bad air, it may be,
breathed over and over again, is of all causes the most likely to
engender lung disease; and lung disease costs the country |
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more than possibly all other diseases taken together take out
of the pockets of the nation at large.
We pass on now to consider the highly important question
of the provision made for segregating the infectious sick. In
the Lews and many parts of the West Coast if there were an
organisation so well constituted as to meet this difficulty, very
little infectious disease should prevail. A great deal has been
said lately, and no doubt with truth, as to the dangers of
Militiamen and others introducing disease from the East Coast
to the Lews. But to be forwarned is forarmed. With a
proper staff of sanitary officials, guided by what Dr Ross allows
has done good service already, the notification of disease, no
difficulty should be experienced in at once stamping out most
fevers and allied diseases. I grant that with measles and other
complaints which incubate for long periods there would be
more risk of spreading. But even with them a very strict
system of quarantine would prove, I doubt not, effectual in
stopping the infection from extending. A great deal would
depend upon the zeal of the local doctor. It is evident that a
medical man on the spot has the best chance of extinguishing
incipient flames, so to speak, and hence the folly of not enlist-
ing every local doctor in the great army of public sanitarians,
instead of restricting the duties to a select few. No more
pernicious or defamatory doctrine could be preached than that
of defining the functions of the private medical attendant as
those of encouraging disease, his trade, forsooth, whereas every
such individual worthy of the name of physician, every day in
his life, and often it may be in the space of twenty-four hours,
does his best to stamp out and destroy all the seeds of
disease! Much might be said on the subject of domestic pre-
ventive medicine. But we hope, as we have already said, to
put the public on its guard by distributing ample printed
directions or leaflets on Scarlet Fever, Typhoid Fever,
Measles, &c. The second means of checking the spread of
disease is by hospitals built for that purpose. At present
we have only two - one at Dingwall, and another at Storno-
way, With regard to the latter, doubtless it has done good
service in its day, as hardly any retreat of the kind could be
set apart for its purpose without proving of much service.
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And yet, it is indeed a poor affair, and utterly unworthy such
a thriving, pushing, populous place and international shipping
town as Stornoway is fast becoming. The dangers of imported
disease into the town must be very great, especially at the
busy herring harvest season, and a means of segregating at
once a case of serious infection is a great desideratum. The
present infirmary is ill situated for a proper water supply, has
no thorough and safe system of drainage, is cold and ill ar-
ranged, and, above all, does not possess, I understand, any staff
- even the neucleus - of skilled nurses. The building should
be at once remodelled and extended, the walls doubled in
thickness, a proper system of heating adopted, and a trained
nurse with an assistant provided. Perhaps, in the circum-
stances, it would be most economical to add on a Surgical and
Medical ward, or wards, and thus to economise the nursing
staff when epidemics were absent, in ordinary nursing work.
This we find to answer in Dingwall with a little care and
extra trouble, and is to be tried, I am glad to say, at Cro-
marty. As yet no other hospital is spoken of, except it may
be, proposition to turn Fortrose Poorhouse into such an in-
stitution. This would be a mistake. It is not built as an
hospital should be from the foundation, for its own peculiar
purpose. It is by far too big, and would only serve a corner
of the Black Isle itself. Patients will only go so far when ill
from fever with safety to themselves, and without causing
danger to the public at large. What is wanted is a small
hospital in every corner of the County which is of sufficient
size to steadily support a resident medical man of good stand-
ing and experience. Properly speaking we want in this
County about 10 such Infirmaries. How are they to be built,
maintained, and staffed? The Public Health Acts enjoin on
every Local Authority to provide such retreats, and it is legal
to lay on rates for such purposes. Surely in these days of
equivalent grants there will be no difficulty, after Mr Dar-
roch has got his roads, in erecting and providing the expense
of what a moment's thought must convince anyone of the
need for such "pest-houses." The worse the dwellings the
more the necessity for the removal of the sick when labouring
under infectious disease of a severe kind, for the sake of the |
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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 |
| HH62/2/ROSS/19 |
[Page] 18
the former and 20 in the latter. Diphtheria, including croup,
accounts for 14; rheumatic fever for 5 in '70-71 and '72, and
8 in the second period. Cancer, which was only 4 in the
first period; in '84-85 and '86, amounted to 10; erysipelas,
2 and 4; scarlatina 12 in the latter, and did not occur at all
in the earlier period. These figures are merely fragmentary;
but so it must be allowed are those which we have to deal with
in comparing the deaths in a selected triennium also. They are
so because there are so many deaths, as we shall see further
on, uncertified. This is a great stumbling block to the statis-
tician; and has also to be lamented in some respects for the
sake of the sick and dying. Opinions may differ as to the
real value of medical services in the way of prolonging life.
But it must be allowed that such help in serious sickness
should be within the reach of everyone. It is to be feared
that in outlying districts many die, who could not, if they
would, obtain such assistance. One or two such districts are
known to me, and, in default of a living being found for a
local doctor, I think the attention of those who send medical
missionaries abroad should be turned to dark places at home.
It humbly seems to me that a man who proposes to devote his
life to the spiritual care of such people as those referred to,
might very well spend his probationership in studying for
and securing a diploma of medicine which would serve him
and his parishioners in good stead in the too common cases
where the nearest doctor is half-a-day's journey away. But
taking the death tables as they stand over the whole County,
during the three year period again, '85-86 and '87, we find 395
deaths set down as due to consumption and its allies = to an
annual death rate of 1.68 per 1000. Next to it comes croup
- probably, really diphtheria, which we include in the 131
cases a large and terrible record = annually to .543 per 1000
living; measles accounts for 73 deaths = to .300per 1000 per
annum; cancer to 67 = .284 per 1000 annually; diarrhoea
61 = a rate of .258; whooping cough 46 = .195; influenza 21
(there will be a bigger record we fear, for '91-92) = .089;
typhoid fever 19 = .080; scarlatina 14 = .059; puerperal fever
13 = .055; tetanus 11 = .047; typhus fever 6 - .025; and blood
poisoning - a vague term - 7 = .029, all per 1000 per annum.
[Page] 19
The total per centage of deaths per annum, taking the
whole County together on an average of three years, comes
to about 16 1/2, a creditable enough figure.
(C) DISTRIBUTION of DISEASE as SHOWN
by REGISTERED DEATHS.
I have mentioned that I have selected twenty-three dis-
eases as either preventible or which we hope in course of time
may become so. I shall shortly run over the different regis-
tration districts, noting peculiarities in the survey. The period
embraced is from 1885 to 1889 inclusive, or a quinquennium.
Beginning with
In Applecross (population, 917.2) there were 6 deaths
from tuberculosis, 2 from influenza, and 1 each from pneumonia
and diarrhoea. Total deaths 70, of which 57 were uncertified.
Avoch (population, 1817), in the Black Isle, wher fisher-
men bulk largely, and where the water supply is scanty, and
the village of Avoch is somewhat overcrowded, and drainage
rather inefficient, we find from 1885 to 1889 inclusive that
there occurred 9 cases of pneumonia, 1 of diarrhoea, 1 of
measles, 1 of typhoid fever, and 19 of consumption and allied
disorders, but none from cancer. Total mortality, 138.
In Alness (population, 1036.6), there died - 2 from pneu-
monia, 4 from diphtheria, and 2 from croup, 1 from puerperal
fever, 5 from whooping cough, and 10 from tuberculous
diseases. Total mortality, 87.
The record in Barvas (population, 4612.6), is 2 of blood
poisoning, 8 of cancer, 13 of pneumonia, 7 of diarrhoea, 1 of
erysipelas, 6 of measles, 2 of puerperal fever, 5 of typhoid, 6
of typhus (the first time we have come across this virulently
infectious disease), 3 of whooping cough, 4 of diphtheria, and
41 of croup, so called, while tuberculous diseases account for 27
Total mortality, 351.
In Carloway (population, 2965), there were 4 from
diarrhoea, 2 from pneumonia, 3 from cancer, 1 from erysip-
elas, I each from puerperal and rheumatic fever, 7 from
whopping cough, 40 from tuberculous diseases, 40 from croup, |
| HH62/2/ROSS/21 |
[Page] 20
and none from diphtheria. (We shall have to notice this
terrible death-rate from what must have been really diph-
theria in connection with other districts in the Lews.) Total
mortality, 246.
Carnoch (population, 267.8), has 2 deaths from diph-
theria, 1 from whooping cough, and 1 from consumption.
There were only 6 deaths in 5 years.
Coigach (population, 1111.2) has 1 death from whooping
cough, 5 from consumption, &c.; but there are 61 deaths
uncertified out of 74 in the 5 years.
Contin (population, 638.4), has 2 deaths from pneumonia,
1 from measles, 1 from croup (none from diphtheria), 1 from
whooping cough, and 5 from consumption, &c. Total imor-
tality, 37.
Cromarty (population, 2007.8), has 2 deaths from cancer,
8 from pneumonia (7 in '86), 6 (as we would expect from bad
and careless feeding of infants) from diarrhoea, 1 from erysip-
elas, 1 from puerperal fever, 1 from typhoid, 1 from croup, and
13 from consumption, &c. (The proportion of uncertified
deaths is one-third.) Total mortality, 169.
Dingwall (population, 2453.2), shows 1 from blood poison-
ing, 9 from cancer, 9 from pneumonia (4 in April, '89), 3 from
diarrhoea, 2 from diphtheria, 1 from croup, 1 from erysipelas, 5
from measles, 1 from tetanus, 2 from typhoid, 42 from con-
sumption, &c. (The proportion of uncertified deaths is low,
as we would expect here = 1 only in 17.) Total, 245.
Edderton (population, 700.8), has one death each from
cancer, pneumonia, and puerperal fever, 2 from whooping
cough, and 4 from consumption, &c. Out of a total of 43.
In Fearn (population, 1994), the record is 1 death from
blood poisoning, 4 from cancer, 1 from diarrhoea, 1 from diph-
theria, 2 from measles, 1 from puerperal fever, the same
number from rheumatic fever and scarlatina, 1 from lock-jaw,
6 from typhoid (all in the summer of '85), and 17 from con-
sumption, &c. In a total death-rate for 1 to 5 years of 151.
Fodderty (population, 1871.6), shows 2 deaths from
[Page] 21
pneumonia, 3 from diarrhoea, 1 from diphtheria, 1 from measles,
1 from puerperal fever, and 19 from consumption, &c., out of
a total of 160.
Glenshiel (population, 406), shows 1 death from blood
poisoning, 1 from cancer, and 1 from consumption, &c., out of
a total of 27 (of which 15 are uncertified).
Gairloch (N. and S., population, 4257.6), has - cancer,
6; pneumonia, 6; diarrhoea, 1; diphtheria, 3; erysipelas, 1;
mumps, 1; rheumatic fever, 1; scarlatina, 1; typhoid, 1; con-
sumption, &c., 42. Total deaths, 304, out of which 200 are
uncertified.
In Knockbain (population, 1765.2) there was 1 death
from pneumonia, 3 from diphtheria, 1 from croup, and 4 from
consumption, &c., out of a total of 111.
Kintail (out of a population of 628) has one death each
from blood poisoning, pneumonia, and cancer, 3 from whoop-
ing-cough, while there are 7 from consumption, &c., out of a
total of 59, of which 34 are uncertified.
In Kinlochluichart (population, 630.8) there were in
all 37 deaths, of which 2 are set down to whooping-cough, 3 to
consumption, &c. 14 are uncertified.
Killearnan (population 975.6) shows 2 deaths from
pneumonia, 1 from whooping-cough, and 7 from consumption,
&c., out of a total of 82, more than half being uncertified.
In Kilmuir (population, 1072.8) their died in the
three years 83, of these 1 died of cancer, 4 of pneumonia,
3 from diarrhoea, 1 each from rheumatic and scarlet fever, 1
from orcup, [croup] 5 from typhoid (in 1886 between February and
May) 13 from consumption, &c.
Kiltearn (population, 1253.4) shows 2 deaths from pneu-
monia, 3 from scarlatina, and 9 from consumption, &c., out of
a total of 83 (30 of which are uncertified).
Kincardine (population, 1106) has 4 deaths from cancer,
5 from diarrhoea, 2 from measles, 1 from scarflatina, [scarlatina] 1 from
typhoid, and 11 from consumption, &c., out of 85 in all, 40
being uncertified. |
| HH62/2/ROSS/23 |
[Page] 22
Logie, in a population of 852.8, had 80 deaths, out of
which there were 4 from cancer, 2 from pneumonia, 2 from
rheumatic fever, 1 from scarlatina, 2 from typhoid, and 4 from
consumption, &c., out of 80 altogether.
Lochbroom (population, 2911.2) shows a total of 236
deaths, 1 being ascribed to blood poisoning, 7 to cancer, 5 to
pneumonia, 2 to diphtheria, 2 to croup, 2 to diarrhoea, 2 to
erysipelas, 1 to measles, 1 to tetanus, and 27 to consumption,
&c., out of a grand total of 236 (113 being uncertified).
Lochs (population, 7612.4) shows deaths as follows - 1
from blood poisoning, 4 from cancer, 9 from pneumonia, 3
from diarrhoea, 2 from diphtheria. 13 from croup, 20 from
influenza, 21 from measles, 3 from rheumatic fever, 1 from
typhoid, 1 from typhus, 56 from consumption, &c., and 6 from
whooping-cough, out of a total of 347 (154 of which are un-
certified).
Lochcarron (population, 1416.4) has a death aggregate
of 120, of which 3 are put down to cancer, 3 to pneumonia,
2 to rheumatic fever, 2 to typhoid, 1 to typhus, 3 to whoop-
ing-cough, and 7 to consumption, &c. More than half are un-
certified
Lochalsh (population, 1940.8) shows the large return
of 13 deaths from cancer, 2 from pneumonia, 4 from
diarrhoea, 1 erysipelas, 1 from typhoid, while there are 15
from consumption, &c., out of a total of 134 (54 being un-
certified).
Nigg, with a population of 956, has 1 death from cancer,
4 from pneumonia, 2 from erysipelas, 2 from whooping-
cough, 1 each from typhoid and croup, out of a total of 79
(29 being uncertified).
Rosskeen has a population of 3597.4, and there were
in all 280 deaths. Of these 1 was ascribed to blood poison-
ing, and 1 only to cancer. From pneumonia there were 10,
from diarrhoea 3, from diptheria 2, from croup 1, measles 4,
rheumatic fever 1, and scarlatina 2, while, strange to say,
there is not one put down to typhoid. 6 died from
[Page] 23
whooping-cough, and the deaths from consumption, &c., were
33. Only about one-seventh were uncertified.
In Resolis (population, 1373) there died in the quin
quennium altogether 116. 2 were put down to cancer, 6 to
pneumonia, not one to typhod, [typhoid] 1 to croup, 19 to consumption,
&c. The proportion uncertified was about one-third.
The population of Rosemarkie is 1348.9, and the deaths
in 5 years 134, which gives an annual death-rate of [blank] per
1000. Of these there died 1 from blood poisoning, 10 from
pneumonia (of which 7 died in 1888), 1 each from diptheria
and erysipelas, 4 from whooping-cough, and 13 from con-
sumption, &c. One-sixth uncertified.
In Applecross (Shieldaig) the population is 1300.6,
and the total deaths in 5 years 109, of which 87 are uncerti-
fied. The returns show 1 death from each of the following
diseases in our list: - Cancer, erysipelas, influenza, rheumatic
fever, typhus, whooping-cough and croup, while 2 are ascribed
to consumption, &c. This is, on the whole, the most barren
return we have yet come across, and is really of little use in
any inquiries as to the statistics of disease.
Strathoykel (with a limited population of 330) shows
1 death from pneumonia, 1 from whooping-cough, and 1 from
consumption and allied diseases. The totals are 17, of which
11 are uncertified.
Stornoway (population, 11,235) parish and burgh is the
largest of all the registration districts, and, consequently, the
number of deaths is greatest, viz., 885. The chief diseases
in our list are, as we would expect, consumption, &c., showing
an aggregate of 98, next comes diphtheria with 2 and croup
with 54, together 56, then pneumonia with 41, measles with
40, whooping-cough 33, diarrhoea 18, puerperal fever 13 (an
alarming number), cancer 11, erysipelas 6, blood poisoning 4,
typhoid fever 4, scarlatina 3 (very small), and tetanus 1.
There were 250 uncertified, or in the proportion of rather
over one-fourth of the whole number.
Tain, landward and burgh, has a population of 2894.4,
and the total deaths amounted in 5 years to 266. Of these 9 |
| HH62/2/ROSS/25 |
[Page] 24
are set down to cancer, and an equal number to pneumonia,
while diarrhoea is credited with 21 (far too high, and implies
bad infant feeding, and probably a dearth of milk), of measles
there are 5, of typhoid fever 4, of diptheria none, but of
croup 2, there were also 2 from whooping-cough, and 25 are
set down to consumption, &c. The uncertified amount to 46.
In Tarbat the population amounts to 1773, while the
deaths were 147 in the five years referred to. Of these 7 (a
very high proportion) are set down to cancer, 1 to pneumonia,
2 to diphtheria, 3 to scarlatina, 2 to typhoid, and 3 to
whooping-cough, while 11 are said to be connected with con-
sumption and its allies. About one-third are not certified.
Urray (population, 2367.4). The deaths for 5 years
sum up to 145. 1 is put down to cancer, and the same
number to blood poisoning, puerperal fever, scarlatina, and
croup, and 2 to diphtheria. There were 2 also from pneu-
monia, while there were 6 from typhoid, and only 3 are put
down to consumption, &c. There is the very large number
of 83 uncertified, which is hard to understand with four or
five doctors practising within the parish. Certainly there is
no resident doctor, and many are far away from medical aid.
Uig (population, 2352) had 137 deaths in the period of 5
years. Here there must have been a great deal of influenza,
as the record shows 16 deaths. There was also the startling
number of 12 deaths from tetanus. 1 is ascribed to cancer,
2 to pneumonia, 3 to erysipelas, 2 to measles, 1 to puerperal
fever, none to typhus, none to diphtheria, but 6 to croup, 1
to whooping-cough, and 18 to consumption, &c. The propor-
tion of uncertified is a little over one-fourth.
Urquhart, or Ferintosh (population, 2406.8) concludes
our lists of districts. The deaths amounted to 201. Cancer
counts for 3, pneumonia, typhoid fever, and whooping-cough
for 1, diphtheria and croup for 2 each, scarlatina for 3, while
consumption, &c., are set down for 16. The uncertified are at
a rate of nearly 1 in 3.
Note. - The population is the estimated mean number
living, for the period of 5 years - '85, '86, 87, '88, and '89 -
under consideration.
[Page] 25
Looking at these results as a whole the most striking fact,
where the deaths are fairly well certified is, the large propor-
tion of them, which are due to tuberculous diseases, i.e., to con-
sumption and its allies. These, in many cases, amount to 12
per cent. If we consider that a certain number is put down to
pneumonia, a larger still to bronchitis and pleurisy - that
tuberculous disease attacking the abdomen, is frequently certi-
fied as due to dioerrhea, and probably a considerable propor-
tion of the uncertified cases of which in every district there is
a large number, is composed of cases of tuberculous disease;
I believe we shall not be far wrong in alleging that tuber-
culous diseases probably account for 20 per cent. or one-fifth
of the whole mortality. It is pleasing to think that cancer is
not credited generally with many deaths, though here too it
need not be doubted that amongst uncertified cases a large
number is really due to cancer, it being a disease in the
majority of cases of degenerating old age. I think it will be
surprising to many as it was to me to find so many deaths
ascribed to pneumonia. It will be very interesting to discover
later what part of this rate is due to "infectious" pneumonia.
It is gratifying to be assured that there are not many deaths con.
nected with lying in or the puerperal period. It is also a
pleasure to !earn that smallpox was not the cause of a single
death in the period examined, and that scarlatina and typhoid
were not fatal to many. On the other hand whooping-cough,
measles, typhus and diphtheria must have prevailed largely;
and they undoubtedly caused many a fatal issue. But a study
of the facts as recorded prove that these were very unequally
distributed and as portions of most districts escaped so should,
with proper precautions, all. Whooping-cough and measles
visit in turn almost all localities, but they are not equally fatal
everywhere. Something must be set down to the age of
those attacked. Where there are many very young children
in proportion to the older people it follows that the mortality
will be heavier - and this is the condition of things where the
population is increasing most rapidly, and where too the
dangers of overcrowding are worst, say in towns and in fisher
townships. The remedy here is plain, to prevent overcrowd-
ing and discourage too early marriages to be secured coin- |
| HH62/2/ROSS/27 |
[Page] 26
cidentally by stringent regulation as to cubic space in every
dwelling. But reverting to the point at which we started viz. -
The Distribution of Disease, it will be convenient to con-
sider the remaining diseases, viz. : typhus and diphtheria, in-
cluding croup, puerperal fever and tetanus as they occur; first
on the West Coast and second on the East Coast. As regards
tetanus or lockjaw it is almost unknown on this side and pro-
bably that which occurs in the Lews, and scarcely anywhere
else is the lockjaw of very young infants - newly-born babes.
It is I understand dying out, but the matter requires and will
secure attention by and by. Investigations in St Kilda point
to filth and some absurd notions of dealing with the umbilical
cord as the real cause. It is interesting to know that in
Germany the germs found in persons suffering from tetanus
have been also discovered in garden soil. If this come to be
proved, there need be no difficulty in stamping out the lockjaw
of infants.
With regard to puerperal fever, investigations on the spot
are urgently required. If it be true, as I have been informed
that puerperal fever is even more frequent than the returns
would imply - the great majority of the cases being of a mild
type, it seems from what I hear of the nursing of women in
childbed pretty plain, that here too filth is the great agent in
propagating the disease. I have spoken already of the miser-
able condition of the houses of the crofter fishermen on the
West Coast. Much is due to that state of things, but more
is really owing to habits of sloth and dirt which education
ought to correct - aided it might be by providing well-trained
nurses to play the part of midwives amongst the West Coast
and Island populations.
But the most striking contrast between the East and West
Coasts is the prevalence of typhus and diphtheria to a much
greater extent on the latter side of the County. Let us try
to account for this fact. The question of the origin of in-
fectious disease is in most cases a very difficult one. Typhoid
fever too common, alas, on this side of the county, breaks out
again and again and in spite of our efforts to discover its
vagaries we get lost in our search after its track. But modern
[Page] 27
science by making it plain that these diseases are due to germs
has completely upset all the de novo notions of the source of in-
fections and distinctly settled that every single case is due to a
previously existing one of the same kind. The practical de-
duction is that in every outbreak all the germs should be
killed; and then of course the breed would be stamped out.
A grand result, truly, if possible! alas not practicable but
surely an ideal point to aim at. Disinfection if it be worth
the name at all, must be thorough and complete. Here let me
stop for one moment to say that a great deal of so-called dis-
infection is not only of no avail but does harm. The great
disinfectors are fresh air, clean water, soap and elbow grease.
Without these all the vaunted disinfectants which are usually
only deodorants are utterly useless. Careful experiments
have conclusively proved that dry heat, steam, carbolic acid,
chlorine, corrosive sublimate, and these almost exhaust the list
of real disinfecting agents, will only kill germs and the seeds of
germs when used at a strength which would quickly kill all other
animal life exposed to their action. What then is to be done,
more especially on the West Coast and islands to really destroy
contagion? I fear it must be said that we must destroy the
nest as well as the eggs. The body and bed clothes ought
to be boiled - woollen garments thoroughly baked, steamed,
or exposed for long periods outside to sun, wind and rain, and
everything comparatively valueless burnt; the roof sent to
the fields for manure; the wood work burnt in great measure
or steeped in chloride of lime solution; the floors removed
and replaced with concrete; and the walls knocked down and
built up afresh. Plainly, this cannot be done at the expense
of the tenant. It ought to be carried through at the sight and
charge of the Local Authorities, and if well and completely done
it would pay them to do it. Consider not only the waste of
human life but the expense involved in a serious outbreak of
typhus or diphtheria! Surely if we can afford to slaughter
valueable herds of cattle for the sake of the remaining stock
we can pay for the stamping out of human disease. It seems
to me the difficulty lies in convincing Local Authorities that such
diseases can be prevented. Both philosophy and practice point
decidedly to this result, if only the instruments and means are |
| HH62/2/ROSS/29 |
[Page] 28
perfectly suited to the end in view. Here lies the difficulty,
a difficulty not to be overcome without an earnest desire on
the part of officials and masters to do their duty irrespective
of trouble and with an eye to a sure and certain result rather
than to a saving of expense.
A point may here be noted. I have been told that fevers,
and particularly puerperal fever is more common at the season
when the dung-pits are emptied. I have compared the figure
very carefully and made a note of them for April and May.
I find the mortality is rather under than over the average
monthly bill in these months. Mere bad smells per se do not
cause disease.
The next division of this Report is that which contains
an account of my inquiries and proceedings during the past
year.
I shall take these two heads in turn, and begin with the
inquiries I have conducted.
My first duty was to try to find out the incidence of
disease in the different localities within the County, and for
this purpose I obtained leave from the Registrar-General for
Scotland to consult the local registers in his office. As these
Death Returns were likely to be of permanent value, and, once
begun, could be easily kept up for future reference, I ven-
tured to employ a clerk to make copies of them, beginning at
1885 and coming down to the close of 1890. When written
out they were bound into volumes, each parish separately.
They have proved of great interest and importance, as afford-
ing solid ground for further investigations, and as time passes
they will become more and more useful. I have brought the
books down to the Committee for their inspection, and when
an office has been provided they will always be at the disposal
of any one who is curious in vital statistics. I have made
free use of the tables in the 2nd division of my Report.
My next desire was to make a general survey of the
County, and in going my rounds I had chiefly in view the
sanitary inspection of villages and schools. As to the former,
the County Sanitary Inspector, who accompanied me in several
[Page] 29
of my tours, is, I know, prepared to report very fully. It is
not therefore necessary for me to trouble the Council with
details. I shall content myself with saying that, as far as I
am aware, and I have visited all the more important com-
munities in the County, his notes and criticisms are well
founded. Much, as I have already said, waits to be done in
the ways of a better water supply, thorough drainage, and
organised scavenging, before their condition becomes, from a
public health point of view, even respectable.
In the sanitary condition of schools, for reasons already
stated, I have taken great interest, and I shall now give short
notes on those I have visited, making remarks, chiefly under
the three heads of cubic space and ventilation, water supply,
and provision for dealing with excreta.
Culbokie School. - Fair cubic space; ventilation only
by the windows, which causes cold draughts when the tem-
perature is low; water supply suspicious (I pointed this out
to the Managers at the time the well was dug), being within
a few feet of the site of the privies. The supply fails in
summer. Steps should be taken to protect the well, or
remove it altogether, and to procure a constant supply. The
arrangements connected with the privies are excellent. Mr
Fowler deserves great credit for his interest in securing good
sanitation. There is no lavatory in the school.
Mulbuie School. - Cubic space sufficient, according to
code rules; but the ventilation is deficient in so far as there
is no special means for admitting fresh air other than by the
windows, and no cross current established above so as to ensure
the withdrawal of foul air quickly. There is good water from
a pump in the playground; but no lavatory. The privies
are clean, and in daily use. The urinal would be better to
have a flushing tank provided. A scavenger attends regularly.
Kinkell School. - Ventilation deficient in small class
room. Here and in Conon School there is a system of closed
pipes devised to carry the foul air into a flue, but it is out of
order in both cases, and should be discarded. There are com-
plaints of cold draughts during winter. The privies are clean |
| HH62/2/ROSS/31 |
[Page] 30
and well-kept; but the boys scarcely make use of their's at
all. Here is a point worth attention. In some cases the boys
are actually told not to use them. Now, in the interests
of decency, if not of public health, I have to say that this
is quite wrong. The boys should be told that they must
use the privies provided, and that it is unseemly and wicked
to squat down at the first quiet corner they come across.
This may seem a trivial matter; but surely the moral, civilis-
ing training of school life is a mighty engine in advancing
the progress of the nation, and every means must be used to
improve the condition of poorer classes in the Highlands and
Islands. There were at Kinkell defects in the drains requir-
ing attention. These have been remedied since my visit. The
ash-pit should be removed further off, cemented, and covered.
Mr Ross uses the pail system partly, with great advantage.
There is good water from a pump-well; but no lavatory in
the school.
Conon School. - The remarks made about Kinkell
School apply here as well as regards ventilation. The boys'
privies smelt a good deal. The arrangement for the school-
master's family is bad. It could be improved by making a
door into the yard used by the girls. There is a good supply
of water and lavatories are in use. The urinal should possess
a flushing tank.
Strathconon School. - There is little to criticise here.
The privies might be more visited, and their ventilation im-
proved.
Scatwell School. - This school is very dirty. The
openings for ventilation are pasted up. The privies are not
in use, and there is no urinal here or at Strathconon. There
is no water supply at either school, and, of course, no lava-
tories. The drains about the house look to be choked, and
there is no provision for the disposal of slops here or at any
of the schools visited.
Ullapool School. - A model school when it comes to
be enlarged. Children evidently filthy in their habits; but
the more need for steady supervision. Some of W.C. seats
[Page] 31
should be lowered and urinals provided. Water should be
accessible to all the class-rooms, and lavatories provided with
soap and towels. The scavenger should make his rounds
more frequently and be well paid for his work.
Strathcannaird School. - The only remarks needed
here are that there is no drinking water or lavatories, and
that the privies are too far off, and not used. Here, as in
most other cases, the roof water is not stored as it might well
be for the use of the teacher, if not of the pupils.
Plockton School was shut when I was in the village
inquiring as to its water supply. The school is not supplied
as it could easily be, if water be obtained, as I was told it
could, from the pipe supplying Duncraig House. I believe
also that the school on the east side of Lochcarron has no
water supply. Dr Mackay reports that this has been at-
tended to since.
Alness School requires more ventilation, especially in
the lobbies. These lobbies are, as a rule, ill ventilated, and,
being used for hanging up overcoats, &c., often smell most
vilely. If possible, they should be both warmed and venti-
lated. A little planning at the beginning might, in many
cases, easily secure this. No doubt many infectious diseases
are propagated by dirty clothes, and damp garments must be
very bad for the children who wear them. No water supply.
Privies very close to class-room.
Applecross School. - Warming and ventilation here
good. This is an instance of a school provided with W.C.'s
They are all more or less out of order, and the boys' one,
which is very badly situated, not in use at all. The school-
master should not have a W.C. in his house, but get the use
of one of those outside (of which there are three), exclusively
for himself and family.
Edderton School. - Ventilation good. Buildings clean.
Privies fairly clean, but a drain is wanted to carry off urine
and slops. No water in the building (it could be easily got
from a burn quite near) and no lavatories.
Ardross School. - Ventilation good. Buildings clean |
| HH62/2/ROSS/33 |
[Page] 32
and well kept. Manchester grate does not seem to be of much
use, probably air inlets too small. There are W.C.'s here.
The boys' is well looked after, but the girls' is not so tidy.
The drain and cesspool connected with them has no ventila-
tion. The back yard is damp and wants gravel, and requires
a drain put in to take off surface water with a proper gully.
Tullich School. - Heated by a Manchester grate, and
well ventilated. Boys' and girls' privies fairly clean. Diffi-
culty about scavenging. Pump-well machinery not quite in
order. Rain water should be stored, as the well water is very
hard. No lavatories.
Scotsburn School. - School here too small for the
number. No thorough ventilation. Heating seems sufficient.
Privies clean, but require remodelling. No flushing for the
urinal. No water in the building, and no lavatories. Rain
water should be caught and stored in a suitable tank. Scant
provision for children's hats and cloaks.
Newmore School. - Ventilation good. Heating suffi-
cient by Manchester grate. Privies not in very good order;
cleaned out only once a year. Pump water hard, no provi-
sion for taking advantage of rain water. No lavatories.
Achmore School (the Lews). - Too small for number
of children (if they attend), being only 60 cubic feet for each
child. Ventilation fairly good. Privies fairly clean, but no
division for the sexes. The water supply is deficient in quality
and quantity, the arrangement being a tank from a burn, which
is nearly dry. Any other supply is 200 yards off. There are
no lavatories.
Barvas School. - Rooms good. Fairly warm and well
ventilated; but there should be more roof openings for the
exit of foul air, and protected with flaps in case of down
draughts. Infant department overcrowded, but space could
be got off some of the other class-rooms. Privies very little
used, and no proper provision for storing dry earth as a deo-
doriser. The water is chiefly from a pump-well, and, as usual,
is very hard. The rain water tank should be enlarged. There
are no lavatories.
[Page] 33
Laxton School. - Complaint is made of the rooms being
cold, and a better grate should be put in. No ventilation
except by the windows. There is no division between the
boys' and girls' privies, and they are unventilated. The
system is of the worst kind, the closets being supplied
occasionally by bucketfuls of water drawn from the well, and
a plug then removed to allow the excreta to escape into a
drain! There is a sunk well with very hard water, but there
is no attempt made to exclude surface pollution; and in fact
it is so polluted. The rain water tank should be en-larged.
Here, as in many other places, there is evidently no systematic
rule of opening the school windows when the children leave
school for the day.
Portnaguran School. - Well ventilated and well kept.
Schoolmaster's house very smoky. Privies unclean. Urinals
out of order; neither used at all. Water supply from pump
quite red and evidently very strongly inpregnated with iron.
There should be a second cask supplied for rain water. No
lavatories.
Bayble School. - Locked up when I called. Privies
nt [not] in use. No apparent supply of potable water, and no
lavatories.
Gairloch School. - Ventilation sufficient. Privies
little used. Water supply might be got near by.
Poolewe School answers its purpose fairly well. Seems
rather cold. No water supply, and no lavatories.
Torridon School. - (The same remarks apply also to
Kinlochewe School.) In both cases there were burst
pipes. The overflow from the cesspool in the latter case is likely
to soak into and contaminate the well water. There are no
lavatories. In both schools more attention should be given
to promoting ventilation by regularly opening doors and
windows.
Achnasheen School. - Ventilation good, but com-
plaints of cold. Grate is too small, and probably the allowance
of coals, 1 1/2 tons yearly, too scanty. Girls' privies disused, and
out of order; boys' pipe burst. No water in school, and no
lavatory. |
| HH62/2/ROSS/35 |
[Page] 34
Cullicudden School warmed by Manchester grate,
which is out of order. Ventilation by ceiling openings, pro-
tected by flaps. (Pulleys out of order). Smells heavy at 11
A.M. Windows all shut, though the day is fine. Ventilators
in class-room not working. Boys' privies cleared out once a
year; fairly clean. Girls' scarcely used at all. No entrance
to these, except through school. Sunk well water much im-
pregnated with iron, and hard. Cover of well not watertight,
and surface water gains admittance. Should be cemented up.
Lavatories dependent on a pail. No rain water stored.
Newhall School. - Want of floor space and over-
crowding. Warming sufficient. Privies cleared out once a
year. Boys' little used. Girls' clean. No flushing for urinal.
The same remarks apply to the well and water as at Culli-
cudden. Playground untidy with pools about. Gate posts
rotten. Both here, and at Cullicudden, the School Board
neglecting its property, and showing no interest in well-being
of children or masters.
Cromarty School very complete with late additions.
Wide lobbies. Large storage for rain water. Lavatory with
3 basins, with soap and towel. Much used and appreciated by
children. Special lavatories for teachers, an excellent hygienic
feature. The privies are kept sweet by fresh ashes being
thrown in every day; emptied by scavenger for 2s 6d as
required. The whole cost for cleaning, lighting fires, and
keeping lavatories, is £9 per annum for 320 children on roll.
Mr Copland takes much interest in every domestic detail.
Kiltearn School. - Fairly clean and well ventilated.
Privies locked up. The Schoolmaster complains that the
smell is unbearable in summer, being too close to his house.
No water supply or lavatories.
Glenglass School. - Rather cold, but airy. Privies
not very tidy. No water supply or lavatories.
Bridgend School, Rosskeen. - A model building,
and everything well kept by the teacher. The ventilation
and warming are very good, but a plan and directions should
be hung up in every school where a Manchester grate is in use.
[Page] 35
In this case the inlets for fresh air are blocked up to a great
extent. There are lavatories, but they are outside and unpro-
tected. One pipe was frozen at my visit. They should have a
shed put over them at once. There are trough W.C.'s in good
order, but they require daily discharging into the sewer -
perhaps a recommendation rather than a drawback.
Invergordon School. - There is a blow down from
the ventilators here, which should be remedied by providing
them with flaps. Boys' and girls' closets very clean, but
dependent for water by pumping - cistern dry when I saw it.
There is no lavatory inside the school, or W.C. in the
teacher's house. The sewer is said to pass under the school,
and there seems to be a cesspool somewhere (?). A good
supply of drinking water from a tap in the ground.
Saltburn School. - Abundant supply of good water.
The building looked deserted and ill kept. The privies were
dirty.
Kilmuir-Easter School. - Well kept in every respect.
The ventilators are permanently open, and must cause down-
draughts of cold air in winter. The privies are clean, and
superintended by Mr Meldrum himself daily, who makes good
use of the excreta as manure to his land, of which he is lucky
enough to hold as much as makes a schoolmaster's croft. Good
water from a pump at a little distance, but no lavatory.
Logie-Easter School. - Ventilators permanently open
as at Kilmuir. No proper place for hanging the clothes of
the children. The same remarks apply to water and lavatory
as at Kilmuir. The boys' and girls' privies are quite clean.
There is no flushing for the urinals. The kitchen sink pipe
was choked, but a promise was given by a member of the
School Board that it would be put right.
Inver School. - Ventilation and cleanliness defective.
No proper means for the admission of fresh air. The privies
are exceedingly filthy, and there is no proper method of
scavenging in practice. The pump is out of order, and the
children drink out of a dirty ditch near the school.
Portmahomack School.—Ventilation good, privies |
| HH62/2/ROSS/37 |
[Page] 36
rather dirty, urinals smell strongly. No water supply, and
no lavatories for more than 200 children, the nearest well
being 1/4 of a mile off. Some remedy should be quickly found
for this state of matters.
West Tarbat School. - Ventilation fairly good, but
some means for admission of fresh air should be tried other
than windows, which, besides, are not working properly.
Water from pump, no lavatories. Privies well kept.
Balmuchy School. - Ventilation good. Privies in
good order. No water supply, a pump well being disused on
account of its proximity to liquid manure pool on the neigh-
bouring farm. No lavatories, and, of course, no flushing of
the urinals.
Hilton School. - Ventilation imperfect, and school-
rooms not very clean. Privies dirty. No drinking water on
the premises, and a surface well liable to contamination is in
use.
Pitcalnie School. - Ventilation and general cleanli-
ness very satisfactory. Privies well kept. No water on the
premises.
Nigg School. - ln good sanitary condition. Privies
tidy, urinals flushed. Pump-well in the playground out of
order at visit - to be attended to.
Ardgay School. - Mr Macleod takes a strong personal
interest in sanitary arrangements, which are all in good
working order.
Knockbain School. - Ventilation indifferent, sufficient
openings if properly used. Privies in a wretched condition,
quite neglected, and have not been cleaned out for some time;
wet, which could be kept out, as is done at Culbokie. Water
supply, a spring 100 yards off. Water seems good, but no
protection from surface pollution.
Munlochy School. - Ventilation all right. Privies too
near the main building. Lavatories, but no water. Here I
would recommend W.C.'s, as the supply of water in the
village is ample, and the excreta would be carried off the pre-
[Page] 37
mises at once. The girls' privies, as usual, are clean, but the
boys' very dirty.
Tarradale School. - Cubic space rather scanty. Ven-
tilation arrangements good and well attended to. The privies
are unclean, untidy, and scavenging very ill done. The last
refuse had been lying for a week or more, close to the school,
unremoved. The drainage of the schoolhouse entirely out of
order. Complaint was made by letter to the School Board,
and this was remedied.
Avoch School. - Undergoing extensive repairs when
visited.
Redcastle School. - Shut up when I passed. Water
in the playground ample, but none in the school, and no lava-
tories. Privies in fairly good order.
Tore School. - Supply of water urgently required.
Only source a drain some distance off. Schoolroom cold in
winter. Boys' privies very dirty.
Fodderty School. - Ventilation good on the whole,
but sometimes a down-draught. Openings are perhaps rather
small when the weather is warm. Lobbies where children's
clothes are hung ill aired. Boys' privies very little used, being
in too exposed a place. No regular scavenger. There is an
ample supply of good water, and there should be no difficulty
with lavatories. A good feature here is a large shed where the
children get their meals.
Contin School. - Ventilation good, and well looked
after. There should be moveable flaps over the openings in
the roof. A plentiful supply of good water. The girls' W.C.
is out of order; the boys', from being badly placed, is not used
at all. The Manchester grate does not seem to have an inlet
for air, and is not working. The school is dirty, being used
for other purposes than for the pupils alone, and would require
more frequent washing out.
Maryburgh School. - Everything here well looked
after. I am rather doubtful about the moveable box arrange-
ment, which is the plan for dealing with excreta here. There |
| HH62/2/ROSS/39 |
[Page] 38
is a good well close to the school, but some plan of pumping
the water into the building itself should be adopted, and
lavatories supplied for the use of the pupils. Additions are
being made to the accommodation.
I have thus visited and carefully inspected, from the public
health point of view, almost all the schools on the mainland,
with the exception of a few in Gairloch, and one or two in
Lochbroom. In the Lews the majority have not been so
visited. The County Sanitary Inspector has kindly given me
an opportunity of consulting the notes of his inspections.
Generally, I find the ventilation is defective, and where there
are W.C.'s, and there seem to be many in the Lews, a large
number of them are out of order. They are usually supplied
with water from a force pump, and, if this fails, of course the
closets are not flushed, and become a source of danger to the
health of the children, and a nuisance generally.
So much for inquiries ex proprio motu. I shall next take
up the other branch of my proceedings, matter, in which I have
given advice or rendered assistance other than those connected
directly with infectious disease, which will be dealt with under
a division of their own.
The largest portion of my time and attention has been
devoted to arranging the organisation of public health service
in the County. Ross and Cromarty, besides having one-third
of its population situated at a distance by sea of nearly eight
hours' steaming from Strome Ferry; has the other two-thirds
very much scattered, and the configuration of the land and
water is such that it is necessary in travelling, if saving of
time is the main object, to return to the centre and start afresh.
It is simply impossible for one M O. H. to be at once the
County and District servant unless he is expected to be half
the year from home. Even with the Lews cut off, a very large
portion of his time would be wasted on the road and great
expense incurred. It became therefore necessary to devise a
scheme of a central authority with efficient local assistance,
and after many meetings and much deliberation, the County
Council, through its Public Health Committee, fixed upon the
plan of giving the services of the County Medical Officer and
Sanitary Inspector gratis, as Head District Officers, provided
the Districts themselves afforded the necessary help on the
spot. The Mid Ross, Western, South Western, and Black Isle
Districts have agreed to this proposal, but have not as yet
quite settled on the District Staff. No difficulty is apprehended
[Page] 39
on this score. The Lewis and Easter Ross Districts have not
up to this time come to a decision on the subject. I believe this
scheme, if adopted, will satisfy the Board of Supervision, and I
am sure is the one most likely to work without friction and
to the greatest advantage of the Public Health. It will enlist
almost every medical man in the County in the army of
sanitarians, and if disease is to be quickly, safely, and
pleasantly stamped out, this is the most promising way of
doing it.
The other matters in which I was engaged, were visiting
and reporting on a ruinous tenement in Lochcarron, visiting
and corresponding with the Highland Railway Company in re-
gard to insanitary surfacemen's houses at Coulin, which they
promised to renew; inspecting Tarradale village on several
occasions, where the water was deficient and the drainage bad;
attending a public meeting at Alness in connection with pro-
posed introduction of water, and giving advice and assistance
to the Easter Ross District Committee in regard to nuisances
alleged to exist at Culisse. It may be useful to enlarge upon
this latter, as it may form a precedent in regard to the manner
of dealing with such cases. The District Sanitary Inspector
had found some sanitary defects in the farm house and had
reported his opinion to the Local Authority, going the length
of condemning the house as a nuisance. His zeal outran his
discretion in so far as he should have first courteously asked
the proprietors to have the nuisance abated. If he had done
so it is said the mischief would at once have been put right.
This has invariably been the practice of the County M. O. H.
and S. I., and in every case our recommendations have, as
soon as possible, been complied with. The County S. I.
and myself advised this course to be taken in the Culisse
case, and I have lately seen a letter from the District Sanitary
Inspector stating that everything has been carried out to
his satisfaction. While the Public Health Officers of the
County are ready to hear all complaints and most anxious to
discover and remedy all nuisances, they are very loth to take
the high hand; or be guilty of anything like oppression of
the rich or poor. It is past the wit of man for instance to
devise a W.C. which will exclude every atom of sewer gas.
The best must be made of the existing arrangements, and let
me add much, very much, depends on the personal, close,
steady supervision of the tenant over traps, ventilation open-
ings and discharges.
It is to the next Division (d) of our syllabus that we must look
chiefly for fruit from our proceedings. With the general adop-
tion of the Notification of Infectious Diseases Act - an adoption |
| HH62/2/ROSS/41 |
[Page] 40
which has already borne good fruit in the Lews — the starting-
point of most of our sanitary investigations and improvements,
will be the inquiry into individual cases of fevers and septic
illnesses generally.
No one can legally or even reasonably refuse the utmost
facilities to the Sanitary Officers to investigate the cause and
origin of such devastating diseases, nay, they will rather wel-
come their presence and second their efforts. But to make a
close scrutiny (and unless it be thorough it is not likely to
lead to any good result) of premises where no trouble has de-
clared itself would only lead to opposition and bad feeling. I
say this much because it may be alleged that we Officers of
Health should at once ferret out and extinguish every nuisance
existing within the County. This idea is both impracticable
and impossible.
The only serious epidemics that prevailed within the County
- if we leave that of influenza alone, as the greatest number
of cases will fall within the next year, and will then be better
discussed - were those of measles in the camp of the Inver-
ness-shire Militia at Muir of Ord, typhus in the Lews, and
whooping-cough also mostly confined to that district of the
County (at least in fatality), and typhoid at Achilty. With
regard to the outbreak of measles I went every day to the
camp for a week and can testify that all possible precautions
against the spread of the disease were taken by Dr Macfadyen,
the surgeon in charge, and by the P.M.O. for Scotland, Brigade-
Surgeon Dr Allan. It can scarcely be said that the War Office
authorities were sufficiently prepared for such an extensive series
of cases. Neither the hospital tents, the nursing nor the medi-
cal care was on a sufficiently generous scale. On the whole
the results were good considering the gravity of the type of
the disease, a gravity which at the time it was wisest not to
emphasise. The origin of the epidemic was distinctly traced
to Harris; and to the West it unfortunately was carried
afresh. There was no law, legal or martial, to keep them
apparently well - who had been in contact with the sick -
from travelling home and carrying in their bodies, the unde-
veloped seeds of the disease. Every possible precaution was
taken, but unless these men could have been forcibly detained,
the untoward result was sure to flow and infection to spread in
the poor fellows' homes. If some power of quarantine were
given to Local Authorities such difficulties might be met and
overcome.
Whooping-cough was extremely fatal in Barvas; no doubt
a great reason being the bad atmosphere within and the un-
[Page] 41
fortunate dread of fresh air from without, which equally pre-
vail in the Lews. The hope of this result not again occurring
lies in the better housing of the people and the coincident spread
of wholesome hygienic knowledge. For these latter improve-
ments we look with confidence to the schools and schoolmasters.
It would be easy to prove almost to a demonstration the con-
nection between deaths from whooping-cough and bad air, or
the want of air; but I need not, I think, trouble the Council
with what they are well assured of. I pass on to consider the
epidemic of typhus, which prevailed in the Lews in the summer
and autumn of '91, and I fear I must enter at some length into
the subject, as it affords lessons for the future management
and the possible stamping out of such outbreaks.
On the 13th October I had a letter from the County Clerk,
enclosing a complaint from the Lews, and alleging that fever was
present in the Village of Limerva and elsewhere.
I immediately telegraphed to Dr Macaulay. the M.O.H. for
that parish, and received the following reply:-
"Some children and a young man in Limerva, had apparently
mild typhus fever - all now convalescent." In answer to a letter,
asking for further information, Dr Macaulay wrote to me as
follows - (l omit portions of the letter of no general interest):-
"I could find no evidence of its being introduced from
without. . . There had been 11 cases of typhus at Limerva
- all recovered. The Lews Sanitary Inspector had been to
Limerva to disinfect all the fever infected houses. The Public
School at Limerva has been closed by medical certificate."
In reply, I again wrote to Dr Macaulay, asking him to re-
port any fresh outbreak, and to try by further enquiries to
ascertain the origin of the epidemic, and directing his attention
to the fact that typhus fever had been prevailing recently, as
I myself knew, at Stornoway. Having no further information,
and having discussed the subject with the Chairman of the
Lews Committee, I considered the disease had ceased to prevail.
But on the 26th October I had a fresh complaint that typhus
fever had broken out at Eishken Lodge, and that efficient means
of disinfection had not been carried out by the district S. I. I
now considered it my duty to visit the locality and make en-
quiries on the spot in connection with the whole matter. I
went to Stornoway on the 1st November, and on the 3rd pro-
ceeded to Eishken Lodge, and went on also to the village of
Limerva, where Dr Macaulay was good enough to meet me.
I took very careful notes of what I saw and heard, but I |
| HH62/2/ROSS/43 |
[Page] 42
shall only trouble the Council with a short summary of these
and a few observations. Everything was right at the Lodge,
and the bothy had been thoroughly disinfected. From careful
inquiry I am satisfied that the disinfection carried out by the
district S. I. was of the most perfunctory character, while that
done subsequently by a woman employed by Mr Platt, from
Stornoway, was, as I have said, most effectual and complete.
At Limerva there were still several cases of fever. I cannot
say positively whether they were typhus or typhoid, but that
they were cases of fever - and of a highly infectious character
- there could be no doubt. Cases had been present, at any
rate from midsummer, without any proper attempt having been
made to check the progress of the epidemic. Disinfection was
a mere farce - the Sanitary Officer simply leaving a bottle of
something with only verbal directions. and not entering the
houses in which the disease had occurred. I could not ascer-
tain whether Dr Macaulay had reported the cases to anybody
but himself. Certainly he had not done so to me, although in
my letter of the 10th, I had specially asked him to report any
fresh cases. Here was an undoubted outbreak of epidemic
disease of a most serious kind without any effectual means having
been taken to check it, and though the notification of Infectious
Disease Act is in force in the island, yet nothing was done to
draw the attention of the County S. I. or M.O.H., or the Board
of Supervision, as laid down in their regulations, to the
occurrence.
It humbly seems to me that the only proper remedy for
this state of matters is to appoint the County S.I. and M.O.H.
respectively Chief District Officers. and so secure that such cases
of infectious disease are not merely notified to the notifier him-
self, or even to one district Medical Officer for the Lewis, but
periodically reported (say once a week) to the head officials -
whose duty it will be to see that thorough means of, as far as
possible, checking the spread of such deadly diseases as typhus
fever, are efficiently carried out.
For this end it will be necessary not only to have a Princi-
pal Sanitary Officer for the Lews. who will devote himself with
skill and energy to the work, but also a sufficient Local Staff
as mentioned in our scheme of sanitary organisation submitted
to the Public Health Committee, and which will probably be
laid before you at your May meeting. Disinfection, we say it
again, is a task which requires time and great attention. The
duties of Sanitary Inspectors must be performed in a very
different spirit from that in which they have hitherto been
carried on in County Districts. The aim must be to follow
the example of such towns as Glasgow and Aberdeen, where
[Page] 43
the inspection and disinfection are most effectively done. All
this will imply attention on the part of District Committees, and
it must be confessed considerable outlay of money. To get
such disagreeable work done it must be well paid for. But I
am confident the return in the improved health of the district
will amply recoup the expenditure.
The fourth epidemic I shall notice is that of an anamalous
outbreak of typhoid which occurred at Achilty. By the kind-
ness of Dr Tregelles Fox I was supplied with full notes of all
the cases. Their great general peculiarity was the mild charac-
ter of the majority of them. Few were ill more than seven
days. But two, at least, were grave; one recovering after be-
ing a very long time in the Hospital at Dingwall, and the other
dying. The outbreak could be traced back to a point where it
seemed highly probable that the milk was the means of dis-
seminating the disease all over the place, but I failed to carry
out the story of the beginning of the epidemic much further.
The drains of the farmhouse were found to be somewhat de-
fective. The proprietor at once had them put in order, and
they are now, I hear from the County Sanitary Inspector, work-
ing satisfactorily. I do not believe the faults found in these
sanitary arrangements go any way to explain the real origin of the
disease, though they may be held to account in some measure for
its spread. While there is great mass of evidence to the
effect that the germs of typhoid live and thrive in water, and
consequently in sewers, where they may possibly escape into
living rooms along with sewer air, yet, on the other hand, facts
are accumulating showing probability of direct bodily trans-
ference, and also that the infective germs find a nidus in clothes,
&c. I made some statistical investigations a quarter of a cen-
tury ago, which I showed to the late Dr Murchison, the great
authority at that time on fevers. They convinced me, at least,
that typhoid fever does frequently spread by direct infection,
exactly as do typhus and the other exanthematous disorders.
If this view be correct we have, as I have already said, one strong
argument more in behalf of thorough disinfection of the right
kind. and the greatest inducement to detect the disease early,
to isolate it if possible, and to, in short, stamp the disease out
entirely. One aspect of the natural history of typhoid must also
be kept in view, that it seems to cling with affection to some
particular places or localities. It is to be hoped that the re-
searches of bacteriologists will show us both the favouring and
unfavouring conditions of the life of the microbe, and thus put
us in a position to cope with its growth and reproduction.
An account of the hospitals for infectious disease must, as
yet, be short. We have only two in the County - first, the |
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[Page] 44
Ross Memorial Hospital at Dingwall; and second, the Hospi-
tal at Stornoway. The latter I have already spoken of in my
general survey of the County. I have also indicated the pres-
sing need for more Local Hospitals, and the means I would
suggest of organising a Nursing Staff for their due and efficient
working. We can fortunately point to our Infirmary in Ding-
wall as an encouragement to other districts. Beginning in a
modest way, it has expanded to its present position where it
supplies the needs for an infectious hospital to a large part of
the County - not, of course, to the larger portion, which is, as
yet, unsupplied. Having had the experience of starting and
carrying on perhaps the first County Hospital for infectious
and other diseases opened in Scotland, I persuaded the mana-
gers to add infectious wards to the original scheme. I can
confidently affirm that these wards have done an incalculable
amount of good in this community, both in staying the spread
of infectious disease and in providing the best of nursing to
those unfortunately affected. On several occasions Strathpeffer
has had to thank Dingwall for, it may be, preventing a panic in
that fashionable watering-place and a stampede of its visitors!
The Dingwall Hospital can claim to possess the first ambulance
on wheels existing in Scotland I may be allowed to add that
I think the medical attendants of fever cases in the hospitals
should be paid fair fees for their services. Most of the patients
can afford a fee and would have had to give it if they had re-
mained and been attended at their own homes; and such being
the case it is scarcely reasonable or just that the doctor should
suffer by recommending, as he invariably does, his clients to
take advantage of the care, nursing, and increased medical at-
tention they get in that valuable institution.
We should properly at this point, consider the different dis-
trict reports, more especially as bearing on the condition of
Slaughter-Houses, Dairies, Bake-Houses and Common Lodging-
Houses. As regards the latter they may be said to be non-
existent in the County proper, and are few even in the Burghs.
But there is, it must be feared, much overcrowding. Only a
house to house visitation can cope with this mischief, and so
the question must be postponed until a proper working staff
is organised. We hope shortly to have these matters arranged
and then to be able to set to work, not only with this source of
disease, but also with the condition of the other subjects already
mentioned. We may note in passing, that we have found the
Bake-Houses almost all in good order with the exception of one
in Ullapool. The Slaughter-Houses, as far as inspected, are
much in want of regulation and supervision, and so also are
Dairies. As regards these latter, there are not many accord-
ing to the technical distinctions in the County. The condition
[Page] 45
of Graveyards too will have to be carefully noted, and where
the ground is too limited as it is in many cases, additional
Cemetery accommodation will have to be recommended and it
may be enforced.
In conclusion, I have to express the hope that the Public
Health organisation in the County may soon be fixed on a satis-
factory and permanent basis. The views of the Sanitary In-
spector and myself are before the Public Health Committee,
and would, we believe if carried out, secure the wished-for re-
sult of all sanitary efforts, viz., the steady improvement of the
health of the County, and the restriction of preventible disease
within the narrowest possible limits. |
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TABLE 1.
[Table inserted]
TABLE 11. - BIRTHS AND DEATHS OCCURRING IN THE COUNTY DURING THE YEAR 1891.
[Table inserted] |
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TABLE III. - BIRTH RATE, INFANTILE, AND OTHER DEATH RATES.
[Table inserted]
NOTES TO TABLE III.
(a) The population rates for '91 are not corrected to the middle of the year, as there was no time to do so, owing to the fact that many of the local returns only came in at the last moment.
(b) The Dingwall rates are corrected by deducting the deaths in the Ross Memorial Hospital for the corresponding periods. From Tain returns, for Easter Ross Poorhouse, there ought to be deducted from 1885 to 1889 inclusive, 10.6; from '90, 12; and from '91, 15. From Rosemarkie, for the Black Isle Poorhouse, the deductions are 5, 5, and 6 for the same periods.
(c) Croup has, as far as possible, been kept to a category by itself. In the Lews the term is frequently applied to capillary bronchitis, &c.
(d) I have included phthisis in the respiratory diseases. It would be more symetrical to exclude it.
(e) I have not differentiated the deaths under 5 and over 5. Those under 5 are almost entirely uncertified, and the information would only be misleading.
(f) With regard to uncertified deaths I do not think they affect the numbers set down under zymotic diseases to any appreciable extent. But, doubtless, the figures under cancer and consumption, &c., would be much larger if all the causes of death were known.
(g) Carnoch has no deaths during '91.
I would have liked to have analysed the Returns and compared the different results; but, for the reasons above given, this must stand over till a future opportunity. Meantime the facts will be accumulating, and the inferences to be drawn will be more reliable.
II No Returns for '91. |
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