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County Council of Wigtown.
PUBLIC HEALTH DEPARTMENT.
YEAR ENDING 31ST. DECEMBER, 1891
FIRST
ANNUAL COUNTY REPORT
BY
W. LESLIE MACKENZIE, M.A. M.B. C.M. D.P.H.,
MEDICAL OFFICER OF HEALTH
FOR COMBINED COUNTIES OF KIRKCUDBRIGHT AND WIGTOWN.
DUMFRIES:
J. MAXWELL & SON, PRINTERS AND LITHOGRAPHERS, 97 AND 99 HIGH STREET.
1892, |
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County Council of Wigtown.
PUBLIC HEALTH DEPARTMENT.
Year ending 31st December, 1891.
ANNUAL COUNTY REPORT.
PART I.
TO THE HONOURABLE THE BOARD OF SUPERVISION AND TO THE
COUNTY COUNCIL OF WIGTOWN.
My Lords and Gentlemen,
According to the regulations of the Board of Supervision,
under the Local Government (Scotland) Act, sec. 53, I now have the
honour to present my Annual Report on the County of Wigtown.
As Medical Officer for the Districts, I have already had to sketch
the general sanitary state of the county in its main divisions. In the
County Report the District Reports for this year are reprinted in full;
because, being written by a single officer, they form as a total really one
report, and at the same time contain nothing that the County Council
may not consider. Rather, therefore, than summarise those condensed
and comparatively brief documents, I here constitute them part of my
County Report and devote the County Report proper, first, to certain
general remarks on administration; and next, to a preliminary system-
atizing of vital statistics for the County.
I. - ADMINISTRATION.
The County Sanitary Inspector acts in three capacities: he is
Sanitary Inspector under the Public Health Acts, he is Inspector of |
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Dairies under the Dairy Regulations, and he assists the Public Health
Office in the isolation of infectious cases and disinfection of infected
premises. In the Upper District there is a definite understanding for
sanitary purposes between the Local Authority and the police constables
- an understanding that so far has worked admirably. In the Lower
District a resolution was passed to give assistance for certain groups of
parishes.
The resources of this organisation have not been tested to the full,
for the Infectious Diseases (Notification) Act has only recently been
adopted. But there is the best ground to expect that the present
organisation, when completed, will be found in every way satisfactory.
II. - VITAL STATISTICS.
A. - DEATH-INCIDENCE.
In the District Reports I have given the details of deaths and rates
for the year 1891. Those deaths and rates by themselves, however,
give little information.
In the County Report, therefore, my design is so to tabulate the
facts of the past years as to provide a system for a critical estimation of
the present. This year neither the matter at my disposal nor the time
for its elaboration permitted more than the part realisation of such a
system, which, however, as a system must embody in its parts the main
principles of the whole. This is not the place to give a full exposition
of the plan that governs the details of a public service. I expound only
that part of it concerning the vital statistics of the year.
The tables that form the body of the report are designed to exhibit
in serial exposition the varying populations, the incidence of death, and,
through deaths, the incidence of disease within the county. The last
ten years have been chosen for a basis of averages, and for beginning
the construction of a system that shall gather in new facts to itself, and
give them their scientific meaning. Unrelated facts are meaningless
and worthless. A careful study even of these tables will show whether
things are going forward or backward, how the case stands with the
divisions of the county relatively to each other, and how the case for the
whole county stands in the general comparison with all Scotland.
In the arrangement of this table-series I have followed the great
generalities of Time and Space. In the time-incidence of deaths certain
facts, as the part that climate plays, are to be learned from the monthly
deaths; certain others again from averages over longer periods. I have,
therefore, followed the division into months, into years, and into
decennial periods. Yet other facts are to be learned within the county
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itself, others from the comparison with larger areas. Tables, therefore,
are given to show the local deaths and rates, and others to show the
comparative deaths and rates. Once more, deaths arranged according
to age give us many important indications of the health or dishealth of
a people, but tables for this purpose are not yet ready.
Similarly, in the space-incidence of deaths, tables are designed to
show local and comparative facts and averages. The local tables give
the facts within the major and minor divisions of the county, showing,
so far as the death-rate can, the relative healthiness or dishealth of the
areas. Each major division or district has a table showing population,
deaths, and averages within its parishes. For a full estimate of the case
the Burghs should be calculated separately, but for the ten years this is
yet to do. But the figures for each Registration District are given, and
those districts where a burgh or royalty is the chief contributor of
deaths I print in large letters, A little manipulation will, therefore,
quickly discover any contrast between burgh and landward figures. In
this county the contrast is seldom so marked as where burghs are larger,
for the conditions that tend to make burghs unhealthy in the specific
way of large towns as yet hardly exist in this county. For the burghs are
essentially small rural towns, only better organised than the villages.
Lastly, under the Local space-head I give a small table to show the rates
in the districts. The comparative facts for Space are readily got from
the comparative table for Time.
B. - DISEASE INCIDENCE.
The assumptions at the basis of all inference from death-rates are
these:-
First. - Death-rates are disease-rates; for the causes of death may
all be classed as specific diseases or not, and, therefore, causes of disease
are à fortiori causes of death. Second. - It is also true that disease-rates
are death-rates; for some diseases are directly fatal, and the prevalence
of others not directly fatal always accompanies a high death-rate. The
tables for Disease-incidence, then, follow the same plan as those for
Death-incidence. |
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INDEX TO TABLE-SERIES.
I. - DEATH-INCIDENCE.
A. IN TIME.
(1) MONTHLY AND YEARLY.
(a) LOCAL - Confined to two Counties:
TABLE I. - Actual Deaths for Ten Years (Kirkcudbright)
TABLE II. - Actual Deaths for Ten Years (Wigtown).
TABLE III. - Rates per 1000 (Kirkcudbright and Wig-
town).
(b) COMPARATIVE. - Including all Scotland, Mainland-Rural,
Small Town and Principal Town Districts:
TABLE IV. - Annual Rates per 1000 of Average Popula-
tions (Kirkcudbright and Wigtown).
(2.) DECENNIAL - at four Census periods.
(a) OCAL. - Confined to two Counties:
TABLE V. - Births, Deaths, Birth-rates, Death-rates
(Kirkcudbright and Wigtown).
(b) COMPARATIVE. - Tables incompleted.
(3) ACCORDING TO AGE. - Incompleted.
B. IN SPACE - FOR TEN YEARS.
(1) LOCAL. - Confined to two Counties.
(a) KIRKCUDBRIGHT. - District and Parochial:
TABLE VI . - Northern District.
TABLE VII. - Southern District.
TABLE VIII. - Eastern District.
TABLE IX. - Western District.
(b) WIGTOWN - District and Parochial:
TABLE X. - Lower District.
TABLE XI. - Upper District.
(c) BURGHS. - Incompleted separately, but included in above
Tables.
(d) DISTRICTS. - Rates per 1000:
TABLE XII.
(2) COMPARATIVE - See TABLE IV.
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INDEX TO TABLE-SERIES.
II. - DISEASE INCIDENCE .
A. IN TIME.
(1) MONTHLY - Incompleted.
(2) YEARLY - In Decennial Averages.
(a) LOCAL - Confined to two Counties:
TABLE XIII. - Zymotics and Tubercular Diseases.
(b) COMPARATIVE. - Including all Scotland and Mainland-
Rural Districts:
TABLE XIV. - Rates and Per Centages.
B. IN SPACE. - Tables incompleted.
III. - OTHER HEALTH INFLUENCES.
A. METEOROLOGICAL:
TABLE XV. - Barometer, Thermometer, Winds, and Rainfall
(Kirkcudbright).
TABLE XVI. - Annual and Monthly Rainfall for Ten Years (Kirk-
cudbright).
B. SOCIOLOGICAL. - Including Profession, Trade, Housing, Soil, Situation
Drainage, &c. - Tables incompleted.
IV. - DISTRICT TABLES FOR 1891.
See end of District Reports. |
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TABLE I. - KIRKCUDBRIGHT.
Showing Monthly and Yearly Death-Incidence for Ten Years.
[Table Inserted]
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TABLE II. - WIGTOWN.
Showing Monthly and Yearly Death-Incidence for Ten years.
[Table Inserted] |
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TABLE III. - KIRKCUDBRIGHT AND WIGTOWN.
Showing Monthly and Yearly Death-Incidence in Annual Rates per 1000 population living.
[Table Inserted]
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TABLE IV. - KIRKCUDBRIGHT AND WIGTOWN.
Showing Annual Rates per 1000 of Average Populations.
[Table Inserted] |
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TABLE V. - KIRKCUDBRIGHT AND WIGTOWN.
Showing Births and Birth-rates, Deaths and Death-rates at Four Census Periods.
[Table Inserted]
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TABLE VI. - KIRKCUDBRIGHT - NORTHERN DISTRICT.
(INCLUDING BURGH OF NEW-GALLOWAY) .
Showing Actual and Average Deaths for Ten Years.
[Table Inserted] |
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TABLE VII. - KIRKCUDBRIGHT - SOUTHERN DISTRICT.
(INCLUDING BURGHS OF KIRKCUDBRIGHT AND CASTLE-DOUGLAS).
Showing Actual and Average Deaths for Ten Years
[Table Inserted]
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TABLE VIII. - KIRKCUDBRIGHT - EASTERN DISTRICT.
(INCLUDING BURGHS OF MAXWELLTOWN AND DALBEATTIE).
Showing Actual and Average Deaths for Ten Years.
[Table Inserted] |
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TABLE IX. - KIRKCUDBRIGHT - WESTERN DISTRICT.
(INCLUDING BURGH OF GATEHOUSE).
Showing Actual and Average Deaths for Ten Years
[Table Inserted]
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TABLE X. - WIGTOWN - LOWER DISTRICT.
(INCLUDING BURGHS OF NEWTON-STEWART, WIGTOWN, AND WHITHORN).
Showing Actual and Average Deaths for Ten Years
[Table Inserted] |
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TABLE XI. - WIGTOWN - UPPER DISTRICT.
(INCLUDING BURGH OF STRANRAER).
Showing Actual and Average Deaths for Ten Years
[Table Inserted]
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TABLE XII. - KIRKCUDBRIGHT AND WIGTOWN DISTRICTS.
Showing Deaths per 1000 at two periods and per 1000 of
Average Population.
[Table Inserted] |
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TABLE XIII. - KIRKCUDBRIGHT AND WIGTOWN.
Showing Average Zymotic and Tubercular Deaths.
[Table Inserted]
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TABLE XIV. - KIRKCUDBRIGHT AND WIGTOWN.
Showing Comparative Rates and Per Centages at Different Periods.
[Table Inserted] |
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TABLE XV. - KIRKCUDBRIGHT .
Showing Barometer, Temperature, Prevailing Winds, and Rainfall, 1891.
[Table Inserted]
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TABLE XVI. - KIRKCUDBRIGHT.
Showing Monthly, Actual, and Average Rainfall for Ten Years at Two Places.
[Table Inserted] |
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PART II.
ANNUAL DISTRICT REPORTS.
I. - LOWER DISTRICT.
According to the requirements of the Board of Supervision, I now
present my Annual Report with regard to the Lower District of the
County of Wigtown.
I. - GENERAL SANITARY STATE.
(a.) Distribution of Population. - This district includes the following
parishes:- Glasserton, Kirkcowan, Kirkinner, Mochrum, Penninghame,
Sorbie, Whithorn, and Wigtown. The total acreage is 158,800; the
total population at the census of 1891 was 15,489. This gives 0.097
persons to the acre, or, otherwise, about one person to every 11 acres.
The masses of the population, however, lie towards the south. Large
tracts of Penninghame and Kirkcowan are so thinly populated as to be
almost of no account for statistical purposes. Three important centres
are Newton-Stewart (Penninghame) with a population of 2332; Wigtown
(Wigtown) with a population of 1509; and Whithorn (Whithorn) with a
population of 1401. In these three burghs, in twelve villages, and in
the farms this population is housed. In a later part of this report I
shall use the three burghs of Newton-Stewart, Wigtown, and Whithorn
as an index of health for the northern, the midland, and the southern
parts of the district respectively. Since none of these three has
appointed me medical officer I do not consider it my duty to go into
much detail regarding them. I use them rather as an index in placing
the chief of unhealthy areas.
(b.) Occupation. - The district in its whole range is essentially
agricultural. The sanitary question, therefore, raises one main problem
- the housing of a community that depends directly or indirectly on
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agriculture. In one or two places this is complicated to a certain
extent by the fishing industry.
(c.) Housing. - In the general sketch of the Western District of
Kirkcudbright I have emphasized certain points in the housing of the
people. These points are equally prominent in this district. There
are the same defects of situation, the same difficulties of drainage, of
water supply, of ventilation. The bearing of climate on these conditions
and on health generally I leave to the county report. Quite recently
the Sanitary Inspector presented to the County Council a report that
bears out in detail the general remarks I have made. The figures of
the death table, too, confirm the general impression.
(d.) Recommendations. - No one proposal will remove or mitigate
the arrears of sanitation. Nothing will be effective except the systematic
examination of conditions in the detail. The habits of dishealth have
not been formed in a day, and it is not a day that will suffice to change
them. In a district such as this is the wisest policy in public health is -
first, the detailed mastery of facts in sanitary conditions and in health
histories; next, the systematic reversal of undesirable conditions not by
sweeping reforms, the wholesale creation of 'special districts,' or the
hard and fast application of clauses intended for the average, but by
little and little, by persistent instruction, by the use of every educational
means that will enlist the individual localities. The District Committee
can put many facilities in the way of the Public Health Office to make
it not only an administrative office pure and simple, but an educative
office. The first things to grapple with are the villages, which as yet
have nowhere any common or corporate life. The next will be the
further housing of the labouring classes, who suffer relatively more from
defective conditions. These two give material for a very extended
programme, which should be made out at the beginning of the adminis-
trative year. On the basis, then, I have to make certain specific
recommendations:-
First. That the District Committee appoint a small sub-committee
for public health purposes. The object of this committee should be to
keep constantly in touch with the Medical Officer and sanitary Inspector;
to consult with them regarding books, forms, and the mere machinery
of administration; to draw up with them a programme of work affecting
the whole district; to have this realised piece by piece as the casual
necessities of public health and sanitary offices permit. The Committee
should meet regularly once a month to consider progress, and oftener
if need be. Such a committee would advise as to special reports, as to
publishing of reports, as to circulating of special literature, as to the
most economical expenditure for specific objects, as to organising |
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courses of lectures or demonstrations in the various localities, as, in fine,
to the most fruitful methods of making the public health an informing
and real force in the life of the community, not a mere negative and
purely regulative office. The approximation to this ideal will, I am
satisfied, result in the better ordering of our villages and cot-houses and
a gradual displacing of the indifference to unhealthy conditions by an
active impulse for individual betterment.
Second. That in view of the above conceptions the District
Committee order special inspections of all the chief villages. These
should each be examined, and each reported on as time and occasion
permit. Water, drainage, and housing should receive special attention.
These reports should in the first instance come before the sub-committee,
which in special cases would consider the advisability of making them
public or bringing them by any other means under the notice of the
administrations or individuals most concerned. In a civilised com-
munity where expense must always count as an item in any suggested
change, this seems to me the most reasonable course of procedure. The
District Committee as a whole is too large a body for such a purpose;
multitudes of minor, yet essential, changes come up for consideration.
and these it would often be a waste of time and energy to bring before
a large body. The small Committee suggested could, on the other
hand, arrange and apportion the work with complete effect, and the
result at the end of the year would be a continuous record of work done.
At present the other administrative duties of the District Committee
necessitate the relegation of public health to a small proportional place
in the regular agenda.
Third. That the public institutions, such as schools, be similarly
reported on, under the same conditions.
II. - INQUIRIES DURING THE YEAR.
Beyond the detailed collation of figures involved in the death tables
and seventh head of this report, there has been no matter needing a
general and extended inquiry. The only matter I have been requested
to report upon was the retention or non-retention of the existing medical
officers. The Board and Council have already had my report on that
topic. As yet no circumstances have arisen to make me add anything
to that report. In regard to other sanitary matters, the Sanitary
Inspector quite recently finished a detailed inspection of the district,
and will present his results in due course. Nothing existed to demand
another inspection so near the end of the year, and I have, therefore,
put off any systematic health inquiries over the localities until, first, the
comparative study of the death for the year revealed the most
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unhealthy areas; until, second, my laboratory was in order for the
systematic analysis of water; until, third, a more direct and easy means of
approach and access to the administrative body was possible. The first
condition is already fulfilled; the second and third will be fulfilled, I
trust, in a few weeks. The only special inquiry during the year was in
connection with certain nuisances at Kirkcowan and Isle of Whithorn.
These have been attended to.
III. AND IV.
Under those heads there is nothing to report. There are five
bakehouses in the district. These will be visited one by one in the
ordinary rounds of inspection.
V. - HOSPITAL SUPERVISION.
I have received no positive information from any official or member
of Committee regarding any hospital whatsoever. I have been casually
informed that the Dumfries Infirmary is available for the district; also
that the small tenement in a back street in Newton-Stewart is available.
Having no official cognisance of these hospitals as hospitals of the
Local Authority, I am not in a position to report on the same.
VI. - PREVENTION OF INFECTIOUS DISEASE.
During my six months of office no single case of infectious disease
has been brought under my notice. As yet no regular means exist for
doing so. But the District Committee has now before it the proposal
to adopt the Infectious Diseases (Notification) Act, which will constitute
in every way a better intelligence department than the monthly returns
from the registrars. This was my only means of information regarding
the 11 deaths from measles in Kirkcowan. There has been one death
from whooping cough. These facts indicate a very satisfactory condition
in regard to zymotic diseases. What I am able to report on hospitals I
have reported above. It is my opinion that the matter of hospital
isolation should be referred to the Health Committee I have proposed.
But the essential case for such a hospital will not be obvious until the
Notification Act has been some time in force. The proposed Com-
mittee, however, should receive a special instruction to enquire, first,
into the necessity; second, the form and situation of isolation hospitals.
And this in consultation with the Medical Officer.
VII. - CAUSES, ORIGIN, AND DISTRIBUTION
OF DISEASE.
As yet the only means available for determining the cause, origin,
and distribution of disease in the district is the deaths and death-rates |
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of the different localities. The death-rates are, at the most, only a basis
of inference, but they indicate, as long experience has proved, the
relative health or dishealth of various localities. By the end of the next
administrative year I hope to have correlated the main facts now avail-
able in the health history of the different parishes. The research
necessary for this correlation is made more laborious by the fact that the
Registrar-General does not give the full details for his minor areas.
Such details, therefore, must be got from organised investigation of the
death certificates and registrar's returns at head-quarters. Until this is
done, and the present social conditions of the district fully canvassed,
we shall not know what precise amount of reliance to place on the
figures of any one year. With these qualifications I now indicate the
condition of the disease so far as the death-rates enable me to do so. And,
first, I give the general rates; next, some special rates; and, lastly, any
relevant proposals for prevention or migration.
A. - GENERAL.
In the following calculations the parish of Glasserton, for which I
have received no returns, has to be omitted; I have excluded it
altogether. Its population is 1154 - not large enough to make any
serious difference to the main facts. Also, I present two sets of calcula-
tions - one which includes the three burghs of Newton-Stewart, Wigtown,
and Whithorn, and involves a total population of 14,335, and a second,
which excludes those burghs and involves a population of 9093.
(a.) Rates including Burghs. - The total population at the census
of 1891 was 14,335. The number of deaths for year 1891 was 315.
This is equivalent to an annual death-rate of 21.735 per 1000 of
population. This rate is distinctly above the average for a 'mainland-
rural district,' which, even with burghs included, the Lower District of
Wigtown essentially is. Thus, to compare it with the 'mainland-rural'
death-rate for the first three quarters of the year over the whole of
Scotland:- For the quarter ending March 31st - as a rule the worst
quarter of the year - the mainland-rural rate was 19 per 1000; for the
other two quarters respectively 16.7 and 13.8 per 1000. For the same
three quarters the death-rates in the large town districts were 22.8, 21.9,
and 17.4 respectively. For the principal towns the corresponding rates
were 24.1, 23.6, and 17.9 respectively. It thus becomes obvious that
the annual rate for the Lower District approaches rather the large town
rates then the mainland-rural; that is, the Lower District rate must be
regarded as exceptionally high.
(b.) Rates excluding Burghs. - THe total population, exclusive of
burghs, was 9093. Of the 315 deaths, 176 occurred outside the burghs.
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This is equivalent to a death-rate of 19.184 per 1000 of population. It
is thus farther obvious that even when the burghs are excluded the rate
is distinctly high for a mainland-rural district. The facts given below of
the special localities will show that this high rate is pretty uniformly
realised even in the minor areas.
(c.) Rates in Burghs. - The total population of Newton-Stewart,
Whithorn, and Wigtown was at the last census 5242. In these three
burghs 139 deaths occurred. This gives a death-rate of 26.410 per 1000
of population. A comparison with the figures already given will show
that this also is a high rate, and resembles more the current rates of the
principal town districts than the low rates usually found in small towns.
Thus, for the three quarters spoken of the rates for the small town
districts were 20.9, 19.5, and 16.4 respectively. Every test we apply,
therefore, still makes it necessary to pronounce 26.4 per 1000, a high rate
for small towns. Nor do the figures for the individual burghs improve
the case; rather the contrary. For Wigtown, with a population of 1509,
shows a death-rate of 21.8 per 1000; Whithorn, with a population of
1401, shows a death-rate of 23.5 per 1000; and Newton-Stewart, with a
population of 2332, shows a death-rate of 31.2 per 1000. And these
figures cannot be assigned entirely to the exceptional ravages of influenza,
which has disturbed the death-rates in almost every district in Britain.
The influenza deaths in Wigtown and Whithorn I am not able to give,
but in Newton-Stewart 8 deaths were due to influenza. Let these be
deducted and the death-rate still remains 27.8 per 1000. This, too, is
a somewhat arbitrary figure. For if we included in Newton-Stewart the
area still on the Cree side, but extending a little beyond the police
boundary north and south, the deathrate would be more than 31 per
1000. From any point of view, then, the Newton-Stewart death-rate
must be pronounced exceptionally high. A full discussion of this death-
rate I am not here concerned to institute; such a matter would require
a special report. But I may add that for the high death-rate of Newton-
Stewart I was not unprepared; partly on general grounds, partly on the
ground that the highest death-rate of the four Stewartry districts is the
death-rate of the Western (21.9 per 1000). The reasons for assimi-
lating this district to Newton-Stewart will be found in the Western
District report. Further, the detailed analysis of the death-rate shows
that the high rate of Newton-Stewart is not due to any special class of
diseases. The county report will show whether the same rates have
been maintained for a long period, or whether the present year is a
passing increase. In any case the matter is one for special investigation.
These facts I respectfully recommend to the Police Commissioners of
Newton-Stewart. |
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(d.) Rates in the Parishes. - Tables I. and II. show the compara-
tive mortality in the parishes. Wigtown stands highest with a rate
of 29.7 per 1000. But it is to be remembered that the landward part
of Wigtown has a population of only 402, and no rate calculated on so
narrow a basis is to be taken as typical. Kirkcowan comes next with
25.3 per 1000. Then follow in order Kirkinner, 19.9; Mochrum, 19.1;
Sorbie, 18.6; Penninghame, 17.4; Whithorn, 11.1. It is instructive to
compare these with the rates given for the large and small town and
mainland-rural districts.
B. - SPECIAL.
It is proper now to direct attention to one or two special death-rates
from special groups of disease.
(a.) Zymotic Diseases. - The death-rate here is 1.744 per 1000 - not
in itself a high rate - but this year made more than it ordinarily is,
owing to 11 deaths from measles in Kirkcowan, and 6 from influenza.
When these 17, which must be pronounced exceptional, are excluded,
the death-rate from zymotics is very low.
(b.) Tubercular Diseases. - These give 26 deaths or a rate of 2.834
per 1000, or 283.4 per 100,000 of population. This is a high rate from
tubercular disease. For the months of January, February, and March
of 1891, the rates for tuberculosis even in the principal towns were
respectively only 207,255, and 259 per 100,000. This shows that the
Lower District of Wigtownshire is specially favourable to the nurture of
tuberculosis. Previous investigation enables me to say that the present
year is not in any way an exceptional year; it tends rather below the
average than over it. This matter will form the subject of a special
research in future reports.
Note on Tubercular Death-rate in Newton-Stewart. - In the parish
of Penninghame, including Newton-Stewart, 14 deaths were due to
tubercular diseases. 12 being due to phthisis (consumption), the other 2
to other forms of tuberculosis. Of the 14 deaths, 12 occurred in
Newton-Stewart. This is equivalent to the enormous death-rate of
5.136 per 1000 or 513.6 per 100,000 of population. If the Newton-
Stewart cases be included in the district, the district rate becomes not
283.3, but 330.6 per 100,000.
(c.) Other Diseases. - The rates from cancer and circulatory diseases
are not high; the deaths from respiratory disease form not only the
largest percentage of total deaths, but yield a rate of somewhat over the
average of Scotland. What bearing climate has on these facts will be
made obvious in future reports.
[Page] (31)
C. PREVENTION OR MITIGATION.
The systematic inquiry I have above suggested will reveal how
much in these results is due to irremovable and how much to removable
conditions. Doubtless incontrollable conditions of climate and soil play
an important part. It is no less certain that defects of life habit and
housing are in part to blame. This last element the steady growth of
sanitation will reduce; and to the necessary inquiries I would now urge
the District Committee.
II. - UPPER DISTRICT.
According to the requirements of the Board of Supervision I now
present my annual report with regard to the Upper District of the
County of Wigtown.
I. - GENERAL SANITARY STATE.
(a.) Distribution of Population. - This district includes the following
parishes:- Inch, Kirkcolm, Kirkmaiden, Leswalt, New Luce, Old Luce,
Portpatrick, Stoneykirk. It has a total acreage of 165,698 acres, and
a population of 20,377. This population, however, includes the 6193
belonging to the Royal Burgh of Stranraer. When these are deducted
the persons to the acre are found to be 0.086 per acre. As in all thinly-
populated parishes, this ratio does not indicate the distribution of the
people, who tend largely towards the available sea and loch coasts,
leaving large tracts of moor in such places as New Luce and Inch
practically uninhabited. The District is in all essential respects like the
Lower District; the main difference is probably not of the social habit, of
housing, or of water supply, but of climate. The villages present the
same features as in the other district, and invite the same examination.
(b.) Recommendations. - It is not necessary to repeat here the part
of my Lower District report dealing with proposals for betterment. I
have only to refer the Board and the Council to the suggestions con-
tained therein. These suggestions are in every respect equally applicable
to the Upper District Committee, to which I hereby commend their
adoption. |
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[Page] (32)
II. - INQUIRIES DURING THE YEAR.
These have been in brief the following:- Inquiry at Drummore in
connection with scarlet fever cases; examination of and report on the
village of Sandhead; inquiry as to water at Ardwell School; as to
sanitary state of Castle-Kennedy Public School (special report); as to
diphtheria at Castle-Kennedy, with general inspection of village; as to
scarlet fever in Glenluce, Glen of Luce School, and Inch parish; as to
diphtheria outbreak in Leswalt and Kirkcolm (special report).
In the coming year I propose to arrange a programme of general
and special inquiry in the sense indicated by my Lower District report.
III. AND IV.
There is little to report under these heads. Certificates have been
granted in respect of disinfections in Leswalt and Glen of Luce. No
proceedings have had to be taken against bakehouses.
V. - HOSPITAL SUPERVISION.
I have no official information regarding any hospital for this district.
VI. - PREVENTION OF INFECTIOUS DISEASE.
(a.) In November two cases of Diphtheria occurred in Castle-
Kennedy; there was one death. Isolation was easily secured in the
private residence, and no further cases occurred in the village. The
source of the disease was doubtful; but defective drains and cesspool
accommodation in the village received the prompt attention of the
proprietor.
(b.) Two Scarlet Fever cases occurred at Drummore. One case was
in a state of free desquamation when the house was visited. Isolation
was not then possible; but the fever did not spread, and the house was
disinfected by the Sanitary Inspector.
(c.) An outbreak of Diphtheria, amounting to 11 cases, occurred
during the months of October, November, and December, in the
parishes of Leswalt and Kirkcolm. The action taken has been detailed
in a special report. Since the beginning of January, 1892, there has
reached me no report of any fresh case. The Leswalt and Kirkcolm
schools have been closed until further notice. Sanitary improvements
have been made at Leswalt school. It is proper to add that the School
Boards have in both cases done their utmost to assist the Local
Authority in suppressing and forestalling the disease. I recommend an
individual examination of school children in both parishes. Whether
this will be carried out I have no means yet of knowing.
[Page] (33)
(d.) Two cases of Scarlet Fever occurred at Glen of Luce School.
The school was closed and disinfected before re-opening.
The other cases now under the supervision of the Public Health
and Sanitary Offices occurred within the present year.
In present circumstances the Public Health Office has to depend
mainly on private intimations of infectious disease. But notice to adopt
the Infectious Diseases Notification has already been given, and the
District Committee will probably adopt that Act at the next meeting.
I am not aware of any hospital accommodation under the District Com-
mittee. I suggest that the question of hospital be remitted to the small
Public Health Committee I have already proposed.
VII. - CAUSE, ORIGIN, AND DISTRIBUTION
OF DISEASE.
The data at my disposal for determining the causes and distribution
of diseases in the district are very limited. The returns I possess are
for only five parishes out of eight, and the three not given are among
the most populous. This deficiency I shall make up as materials
permit in the county report; at present it is possible only to indicate a
few leading features in the parishes whose death-returns I have in detail.
These parishes are - Inch, Kirkmaiden, Leswalt, New Luce, Port-
patrick. These areas, however, are somewhat typical of the whole
district; they are taken from north, middle, and south; they are partly
inland, and partly sea-board. It is probable, then, that with slight
particular variations the remaining three parishes of the district will
show similar features.
A. - GENERAL DEATH-RATES.
(a.) Of the five parishes the total population at the census of 1891
was 9779. The number of deaths for the year ending 31st December
was 159. This yields a death-rate for these parishes of 16.059 per 1000.
This rate, however, is not equally realised all over the areas named.
The rates of these parishes are in order:- Portpatrick, 23.320; New
Luce, 22.100; Leswalt, 20.180; Kirkmaiden, 12.768; Inch, 10.164.
The rate for Portpatrick is higher than the average rate for small towns,
and resembles more the normal rate for the large or principal town areas.
The rate for New Luce is calculated on a narrow basis (population only
858), and cannot be taken as typical. The rate for Leswalt is also high
for a mainland-rural district. Kirkmaiden and Inch realise more nearly
what the mainland-rural districts commonly exhibit. Thus Kirkmaiden,
whose population is 2193, shows a record of only 28 deaths, or a rate of
12.7 per 1000; and Inch, whose population is 2160, shows a record of
only 22 deaths, or 10.1 per 1000. |
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[Page] (34)
(b.) Analysis of Rates. - When the death-numbers are small it is
instructive to examine the ratios between deaths at different periods of
life. This gives an index to the general health of the area. Thus, in
the parish of Inch there were 47 births, but only 1 death of children
under 1 year. In Leswalt, on the other hand, there were 36 births, and
6 deaths of children under 1 year. Again in Inch the number of deaths
between 25 and 60 (adults) formed only one-third of the number of
deaths over 60 (post mature). In Leswalt the number of adult deaths
formed almost a half of the deaths over 60. Yet in Inch the total
deaths numbered only 22; in Leswalt, 23. In New Luce again, there
was only 1 death under 25. The area is too small to justify any con-
clusive inference; but in New Luce the average age at death this year
is high. In Portpatrick, though the death-rate is high, the proportion
of adult (between 25 and 60) to post-mature (over 60) deaths is very
small - only one-ninth; and only one-fifth of the deaths are under 25.
It is clear, therefore, that the high death-rate is not by itself a sufficient
reason for placing Portpatrick among the most unhealthy areas. On the
contrary, the large number of deaths over 60 gives ground for placing it
among the good areas. All these figures, however, require the check
and interpretation supplied, first, by the past records of the parishes;
second, by an inquiry into the social conditions of each main centre of
population; third, by a precise estimate of the part due to situation and
to climate. These will find their place in future reports.
So far as the figures before me go, the Upper District seems more
favourable to life than the Lower District, as the comparison with the
facts of the Lower District show. Whether this will be sustained when
the full returns are analyzed remains to see; at present a detailed com-
parison would only be misleading.
B. - SPECIAL RATES.
(a.) Zymotic Deaths. - The deaths from zymotic (or infectious)
diseases are not numerous. Four deaths are returned as due to
diphtheria, 4 to influenza, 1 to whooping cough, 1 to diarrhoea. These
give a rate of 1.01 per 1000, or 101 per 100,000 - a rate that is well
within the average for mainland-rural districts.
(b.) Tubercular Death-rate. - Phthisis (or consumption) and other
forms of tubercular disease show a record of 13 deaths. This gives a
rate of 1.313 per 1000, or 131 per 100,000. This, again, like the
zymotic rate, is well within the average for mainland-rural districts. Of
the 11 cases of phthisis, 5 occurred in Leswalt parish, 2 in New Luce,
2 in Portpatrick. To judge by previous investigation of the tubercular
deaths in the county, this rate for the Upper District must either be
[Page] (35)
exceptionally low or my returns do not overtake the most tubercular
areas. The comparison with the Lower District is all in favour of the
Upper District.
(c.) The rates for nervous, circulatory, and respiratory diseases offer
no special feature remark.
C. - PREVENTION OR MITIGATION.
These facts are too few to justify any specific proposal in regard to
any one disease or class of diseases. Personal observation leads me to
place little reliance on such death-rates as an index of the amount of
disease. But my other sources of information are very limited. When
the Notification Act is in force, it will reveal not only to what extent
mild infectious diseases are debilitating the community, but many other
health conditions that are hardly otherwise to be got at. Thus in
Leswalt and Kirkcolm, where diphtheria has recently spread over a wide
area, one is not to suppose that diphtheria is more virulent or more
infectious here than elsewhere; rather the inference is that climate, or
housing, or life-habits, or personal histories predispose to the infection.
It is these preliminary conditions that the Notification Act makes better
known, and these it is that the Local Authority may help to change.
With this view, I would urge the District Committee to the systematic
inquiry recommended in the earlier part of this report. Such inquiry
will check and complete the figures now given, and prepare the way for
the gradual elimination of these unhealthy conditions that sanitation
may reasonably hope to remove or improve. |
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TABLE I. - COUNTY OF WIGTOWN.
TABULAR STATEMENT OF SICKNESS and MORTALITY referred to in the Regulations issued by the Board of
Supervision for Medical Officers of Districts of Counties.
Births and Deaths occurring in the District during the Year 1891.
[Table inserted]
* See Report and County Tables for corrected figures.
[Page] (37)
TABLE II. - COUNTY OF WIGTOWN.
Density of Population, Birth Rate. Infantile and other Death Rates.
[Table inserted] |
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