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[Page] 34

Condensing these tables by taking the mean of the five years,
we get the following rates:-


Mean of the Annual Death-rates per 100,000 of population, 1885-89.

[Table Inserted]

It will be seen from these figures that in the Small Town
Districts Stirling has a considerably lower death-rate than
Scotland. The phthisis rate, and the total zymotic rate are
decidely lower, and of the six individual zymotic diseases in the
above list, enteric fever is the only one which shows an excess
over the average of the Small Town Districts of the country as a
whole. This is very satisfactory. But in the Rural Districts
the case is far different. The total mortality is 25 per cent.
higher than that of rural Scotland, and the mortality from each
disease in the list, with only one exception, is also very much
higher. The phthisis death-rate is 16 per cent. higher than the
average, and, worst of all, the zymotic rate is no less than 60 per
cent. higher.

[Page] 35

Taking the individual zymotics on the list, we find that enteric
fever, measles, and whooping-cough have a rate about double that
of Scotland. Diphtheria is 25 per cent. above the mean, and the
only disease which forms an exception to these remarkable figures
is diarrhoea, which is fractionally lower than the average of rural
I stated at p. 15 that there were better standards than the total
death-rate by which to measure the health of a community.
One of these is the zymotic death-rate, and its application to
the county goes to show that in the Small Town Districts the
health conditions compare favourably with the rest of Scotland,
while in the Rural Districts they compare very unfavourably. In
partial explanation of the high death-rate of the Rural Districts, it
is to be borne in mind that a great part of the so-called "rural"
population of the county lives in villages of from 300 to 2000
inhabitants, and that such villages are likely to have a higher
mortality than smaller hamlets or isolated farm-steadings. On
p. 14 I give figures showing that the village population of the
county is much greater, and the purely rural population con-
siderably less, than in Scotland as a whole. This, however, will
not account for the whole facts, nor will it explain, still less explain
away, the high death-rate from enteric fever in the rural population.
Bad sanitation in general, and, in regard to enteric fever, bad
water supply and improper excrement disposal in particular, must
be set down as at the bottom of the unsatisfactory condition
disclosed by these figures.
There is too much tendency in the public mind, and perhaps
even in the professional mind, to talk of sanitation as if it had
exactly the same meaning with relation to all infectious diseases.
This is not so. It is true indeed that, in its measure, dirt fosters
all diseases, whether zymotic or tubercular, or belonging to any
other of the Registrar-General's genera and species. But special
diseases have special propagating and preventive agencies. For
enteric fever sanitation means pure water supply and strict dairy
inspection; for typhus it means the abolition of overcrowding and
the admission of fresh air; for measles it means the closure of
schools; for smallpox, vaccination; for hydrophobia, Pasteurism;
for phthisis, good house accommodation; for relapsing fever a
sufficient supply of good food; for scarlet fever, lengthened and

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