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23
[Stamped] BOARD OF SUPERVISION BOOTLAND RECEIVED 22 APR 92 [1892]
COUNTY OF SELKIRK.
THE
ANNUAL REPORT
OF THE
MEDICAL OFFICER OF HEALTH
FOR 1891. |
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TO THE CHAIRMAN AND MEMBERS OF THE
PUBLIC HEALTH COMMITTEE OF THE
COUNTY COUNCIL.
MY LORDS AND GENTLEMEN,
In compliance with the Regulations of the Board of
Supervision, I have the honour to submit for your considera-
tion my first annual report upon the health and sanitation
of the County of Selkirk.
As I entered upon my official duties in July, and as no
records had been kept for the earlier part of the year, the
report is necessarily incomplete, although I shall endeavour
(as far as they can be compiled from the Registrar General's
reports) to give mortality tables for the year.
I am,
My Lords and Gentlemen,
Your obedient Servant,
M. J. OLIVER.
ANNUAL REPORT, 1891.
VITAL statistics are calculated in ratios to the population
for purposes of comparison, and therefore their accuracy
depends on the exactness with which an estimate of the
population is made. And in order that leap years may be
compared with ordinary years it is necessary to calculate all
annual rates for an average year of 365.24226 days. The
population not being stationary, the number of the people, as
found by the census in March, cannot with accuracy be used
in calculating death rates for June. In dealing with large
populations, such as those of manufacturing towns, it is usual
to make an estimate by means of a formula based on the
assumption that the population is increasing or decreasing
at the same rate as it has done in the interval between the
last census and the one preceding. In a purely agricultural
community, however, the alterations of the population depend
more on differences in the processes of farming than on the
natural increase of the people, and cannot be calculated by
means of a mathematical formula.
In the agricultural districts of Scotland the conversion
of arable into grass land, during the last ten years, has had
the effect of diminishing the population, but this has not been
as marked in Selkirkshire as in many other counties, obviously
because there is little land suitable for cultivation.
Another method of estimating the population is to add the
excess of the births over the deaths to the population of the
preceding year. This, however, would not give a reliable
result, owing to the well-known fact that numbers of the
younger members of the community emigrate to the manu-
facturing towns in search of work, an emigration which also |
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[page] 4
partially accounts for the comparatively large number of
persons who live to an advanced age in country districts.
A third method is to calculate the population on the data
of the number of inhabited houses and the proportion of
persons to a house. I am inclined to consider this the most
correct method at our command, and one which I hope to
make use of in future years. As yet there has not been
sufficient time at my disposal to work it out for last year.
In this report, therefore, the population as given in the
Census Report of March 1891 will be used, and although
there is probably a small error, it is so inconsiderable that
the value of the deduced rates is not appreciably diminished.
According to the Census of 1881, the inhabitants numbered
4401, and by the Census of 1891, 4592, thus showing an
increase of 191 persons.
[table inserted]
Births.
The number of births in 1891 was 113, and the rate per
1000 persons living 24.624. The rate for Scotland in 1891
is 31.2, and the mean rate for the ten years 1881 to 1890 is
32.4.
Deaths.
During the year 1891, 77 deaths were registered in the
County of Selkirk, giving an annual rate of 16.779, or, in other
words, at a ratio of one death to every 59.6 persons living
[page] 5
during the year, and was distributed throughout the quarters
thus:-
[table inserted]
The death rate for Selkirkshire, including the towns of
Selkirk and Galashiels, is 17.37. It is, however, not quite
correct to compare an urban population with a rural, and
deductions made from such a comparison must be received
with caution.
The infantile mortality (i.e., children under 1 year), for the
last quarter was one, giving an annual rate of 0.874 per 1000
persons living, or a rate of 4.3 per cent. of the deaths, or 3.4
per cent. of the births registered in the quarter.
Cause of Deaths.
The causes of deaths have not been ascertained for the
whole year, but Tables I and 2 give the information for the
13 weeks ending 2nd Jan. 1892. The high death rate from
all causes for the quarter is accounted for by the four deaths
from influenza, giving a rate per 1000 of 3.496. The deaths
from influenza and diseases of the respiratory system are
together more than 30 per cent. of the total deaths, and with
phthisis more than 43 per cent. The subjoined table gives
the numbers of deaths of males and females at various ages.
[table inserted] |
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[page] 6
Before leaving the subject of the mortality of the county
I may refer to a paper which was read at the Sanitary Con-
gress recently held in Edinburgh, and published in the
"Sanitary Journal."
In this paper Selkirk is taken as an example of one of the
most insanitary counties in Scotland, and, to prove that the
county is exceptionally unhealthy, the general death rate,
the zymotic rate, and the tubercular rate for the seven years
1855 to 1861 are compared with the same rates for the period
1882 to 1888. The following are the figures:-
[table inserted]
The following quotation is taken from the same paper:-
"It is with sorrow that I find our beautiful Selkirk again showing
herself sanitarily ugly. She ranges in tubercular death far ahead of
any other county, no less than 18:36 per cent. being her average rate
during the last septennial from tubercular disease. This rate of death
is 2.36 more than she was burdened with from 1855 to 1861. Her
position both in respect of zymotic disease and tubercular disease and
death demands, in my opinion, inquiry on the part of our central
authorities into her condition, and as to the causes which are at the
bottom of such an unfortunate state of affairs."
Int the first septennial period the population was almost
purely rural : it consisted of 10,449 persons, of whom about
half lived in the then small towns of Selkirk and Galashiels.
In 1881 4144 lived in the country and 21,420 in the above
[page] 7
towns. There can be no doubt that the increase in the urban
population accounts for the higher rates, and while I am
of course unable to say anything about the state of sanitation
on the burghs, I have no reason to think that there is any-
thing in the country districts to cause the Local Authority
anxiety.
There is, however, no doubt that by improving the
ventilation of cottages and draining the ground on which
they stand, by isolating consumptive patients, or, if that be
too strong a measure, insisting on the systematic use of dis-
infectants, and by preventing the use of tubercular meat,
the death rate from consumption might be considerably
lowered.
An inspection of the above tables shows the necessity, for
public health purposes, of an accurate return of deaths by
the local registrars, and it is here convenient to state the
arrangements that have been made to secure a regular supply
of such information for the future. Under the Registration
Act the Registrar General has no power to require district
registrars to give information to local authorities, and if, as
is said, the Secretary for Scotland has such power, he does
not exercise it. There is, however, nothing in the Act to
prevent a local authority making a private arrangement with
each Registrar, and returns of deaths in Scotland are obtained
in this manner by many local authorities. I was authorised
by the County Council to offer a fee of 3d for each entry,
with a minimum annual fee of five shillings and an additional
shilling for the number of births in the year. All the regis-
trars agreed to these terms, and I hope to have no further
difficulty in obtaining information until the matter is dealt
with by legislation.
There is no hospital for infectious disease in the district,
and therefore all cases of infectious disease have to be isolated
at their homes. This is much facilitated by the isolated
position of many of the houses, so that when the children are
prevented going to school and the housewives are cautioned
not to allow the bakers' and grocers' vanmen to enter the |
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infected houses, the isolation may be as effectual as can be
secured in towns with the assistance of the best sanitary
appliances. There are only two small villages in the district,
and the population is scattered over an area of (approximately)
165,000 acres, more than 35 acres to each person. In many
counties the hospital question is being considered, and it is
naturally one of the first subjects to which a medical officer
turns his attention. The difficulty of forming a definite
opinion on the necessity for such accommodation, and the
amount required, is increased by the total absence of informa-
tion of the mortality caused by infectious diseases in past
years. We are entirely dependent on the few facts we have
been able to learn during the last five months, and, put shortly,
these are as follows - that although there have been cases of
scarlet fever at Galashiels, there has been no corresponding
amount in the county. Until fever, by spreading and becom-
ing epidemic, has forced us to the conclusion that our present
means of dealing with infectious diseases are inadequate, I do
not feel it to be my duty to advise the provision of an isolation
hospital. If, however, an arrangement could be made by
which a single bed in any existing hospital might occasionally
be placed at the service of the local authority it would not
often be occupied, but its existence would enable the sanitary
inspector, if his directions were not carefully observed, to
bring a careless mother to a sense of her responsibilities by
threatening to remove her child from home.
The method pursued at present in dealing with infec-
tious cases is as follows. On hearing of a case (the Act
for notification not being in force in 1891), the sanitary
inspector visits the house and commences by asking a
number of questions, which may possibly appear rather
unnecessary at the time, but which are useful in the event
of other cases of a similar nature occurring in the neighbour-
hood.
This is quickly done, the inspector carrying a small note
book, furnished with a fly leaf on which certain headings are
printed, so that the answers to the questions may be written
[page] 9
on the line corresponding to the appropriate heading. This
leaf is reproduced below:-
Parish. Day. Date.
Address.
Occupier. Owner. Agent.
Patient's Name, Age, Sex.
Workplace or School (Standard).
Sunday School.
Earliest Symptoms and Date.
Disease Notified. Date on Notice.
By whom? Name of Medical Attendant.
Date of his First Visit.
Rest of Family. Names and Ages.
Workplaces and Schools.
Milk Supply.
Sources of Infection.
Afterwards the information gained is entered in a register
to allow of the details of a number of cases being readily
compared. By this means, if an epidemic occur, due to an
infected water or milk supply, or school, the repetition of the
name of the school, or other infected place can hardly fail
to direct attention to the place where investigation is required. |
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[page] 10
The inspector next gives the patient's nurse a printed set
of rules for her guidance in the use of disinfectants, and
explains them, and, if necessary, supplies a bottle of carbolic
acid gratis. He makes several calls to see whether his direc-
tions are being carried out, and when the medical attendant
is satisfied that recovery is complete, he disinfects the sick-
room by means of burning sulphur, in the ordinary manner,
and, by having clothes boiled, and furniture, etc., washed with
a strong solution of carbolic acid, and mattresses burned, he
does that he can to render the house safe.
This process, however, is not very satisfactory, and dis-
infection can never be thoroughly carried out until we have
a suitable disinfecting apparatus. The cheaper varieties are
not very trustworthy, but possibly the County Council could
obtain the use of a really efficient machine by entering into
an arrangement with one of the neighboring burghs, and at
a moderate cost.
The necessity for hospital accommodation is perhaps a matter
for discussion, but there cannot be two opinions as to the
need of such an apparatus as I have referred to.
During the last five months of the year there were 13 cases
of infectious disease, 12 of enteric fever and 1 of scarlet fever.
In July four cases of enteric fever occurred at Philiphaugh,
and one case in November. The cause of the first four cases
was probably the defective condition of the house drain.
Rats had made a large hole in the sink waste pipe, and the drain
below being unventilated, a serious escape of sewer gas must
have existed for some time. New drains were laid and the
waste pipes disconnected, and disease should not again come
from the same cause.
A case near Selkirk and another near Ashkirk were in
houses of which the drains were in an unsatisfactory con-
dition. In other three cases of enteric fever and in the case
of scarlet fever, there was reason to think that the disease
was contracted elsewhere or that the infection was brought
from a neighbouring town. It is satisfactory to be able to
add that all the patients recovered.
[page] 11
Factory and Workshop Act.
No action was taken under the above Act, there being no
bakehouses in the county.
Contagious Diseases (Animals) Act.
There are a considerable number of dairies in the county,
and as soon as byelaws, now under consideration, are in
force, a number of cases must be dealt with. Many byres
are undrained and dirty, and some of the dairymen have
no suitable place in which to put the milk previous to sale
It is almost unnecessary to point out, as the fact must be known
to every one, that persons consuming fouled milk are not
unlikely to contract an infectious disease. More than a
hundred epidemics have been traced to the use of contami-
nated milk.
Food and Drugs Act.
This Act is administered by Inspector Nicole, of the County
Police. I am informed that during the year eight samples
were analysed, and that they were all found to be unadul-
terated.
Rivers Pollution Act.
No action has been taken by the County Council under
this Act.
General Sanitation.
It is perhaps rather soon to commence writing on the
general sanitation of the county. The impression I have
formed in the short time I have been at work, is that the
county is a fairly healthy one, and the inhabitants may con-
gratulate themselves on the fact that no radical changes are
necessary to render it one of the healthiest districts in
Scotland.
In two directions, however, some improvement may easily
be effected. The important subject of a pure water supply
requires attention, and in the ensuing summer I hope to have |
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[page] 12
a large number of analyses made, and to inspect personally
as many wells as possible.
The other matter to which I would direct the attention of
the County Council is the urgent need of energetic action in
connection with drainage and filth nuisances in farm houses
and cottages. In most farm houses there are sinks and
water-closets, and as these, if trapped, are not disconnected
from the drain, and the soil pipes are frequently inside
the houses and unventilated, it is astonishing that typhoid
fever and sore throats are not prevalent.
The cottages have no privies or ashpits, and therefore
middens close to dwellings are far too common, frequently
polluting the water supply. But in my opinion the most
serious nuisance is caused by the absence of sinks and drains
outside the cottages, and the practice of throwing slop water
on the road near the house door. The soil is rendered sour
and impure, and although it has great power of purifying
refuse, it is yet inadvisable to have a miniature sewage farm
immediately in front of a cottage door. Cottages are also
frequently more damp than is conducive to health.
The Sanitary Inspector is, however, reporting and dealing
with these cases as rapidly as his time permits, and as there
are only about 800 houses in the county, a material improve-
ment should be effected within a short period.
The two small villages in the county are clean when
compared with those of a neighbouring county, and do not
call for any particular action on the part of the local authority.
M. J. OLIVER.
[next page]
Table I. - Births and Deaths occurring in the County of Selkirk during the 13 weeks ending 2d Jan., 1892.
[table inserted] |
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Table II. - Density of Population, Birth Rate, Infantile and other Death Rates.
[table inserted]
Table III. - Cases of Infectious Disease coming to the knowledge of the Medical Officer.
[table inserted]
Note. - The birth rate is for the year, the other rates for the 13 weeks ending 2d January, 1892. |
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