ids stringlengths 36 36 | texts stringlengths 1 1.43k |
|---|---|
c87c4d35-f563-4539-856e-ba36cf057931 | Palmerston Road 3 βKingswood Road 3 β Winchester Street 2 ,, Somerset Road 2 ,, Berrymead Gardens 2 β Berrymede Road 2 β Park Road East 1 β Junction Road 1 ,, Essex Park Mews 1 ,, Meon Road 1 β Saville Road 1 ,, Fletcher Road 1 β Osborne Road 1 ,, Park Road North 1 ,, Holland Terrace 1 ,, Shaftesbury Road 1 ,, Nelson Place .., 1 ,, York Road 1 ,, Stirling Road 1 β Bollo Bridge Road 2 deaths. Hanbury Road 1 death. Petersfield Road 1 ,, Southfield Road 1 β Measles occurring amongst children who live under favourable conditions may be a benign disease, and such children have a small percentage of fatality; but children with lowered vitality from poor food and insufficient ventilation develop complications which make their percentage of deaths abnormally high. |
408fd064-5b15-4f96-bd0a-3aaa0b4a50d3 | It is estimated that a house is overcrowded if the average number of persons per room exceeds two. Taking this standard as a basis in 13 cases out of the 36 there was overcrowding, and the vitiated atmosphere which resulted, probably caused the large number of deaths from lung complications. 17 Death very seldom occurs during the eruptive stage, and only two deaths took place during the first week of the illness. The period which elapsed between the onset of the disease and death in the other 36 cases was as follows:β 1β2 weeks 15 4β5 weeks 4 2β3 β 7 5-6 β 1 3β4 β 7 over 6 weeks 2 The liability to complications is enhanced by the fact that the employment of the mother compels a large number of them to leave their homes during the day. In 14 instances the mother was employed in laundry work. |
9cea1182-00ad-4ba3-ae64-4a45417d8006 | On the subsidence of the symptoms associated with the eruptive stage, the child would often be left in the care of some person in the house other than the mother, or taken to a neighbour's house to be looked after. In either case, the same care would not be taken to avoid exposure as would be exercised by the mother. In the last Annual Report, it was pointed out that doubtless many lives would be saved if all cases of Measles which were seriously ill could have skilled nursing. Almost every case is now visited and instructions given, but facilities are wanting in many of the houses, not only for the proper nursing of the sick, but also for the isolation of the patients. Once a house in the industrial portion of the district is invaded by the disease, usually, all the susceptible children are attacked. Duritig the late epidemic, there were 3 deaths each in two houses and 2 deaths in 1 house, so that altogether, deaths occurred in 31 houses. |
04e56f1a-4ad2-413e-a989-2ffda08c8c32 | Where a second case occurred in a house, the infection took place during the early stages in the illness of the previous one, and it is very doubtful if systematic disinfection would have any effect in preventing the spread of the disease in a household. In the Annual Report for 1906, reasons were given to show that the ordinary domestic cleansing usually suffices for the disinfection after Measles, and no facts came to light during the late epidemic which would influence one in altering the opinion then held. 18 WHOOPING COUGH. There were 15 deaths from Whooping Cough: 2 of these occurred in the Isleworth Infirmary. The disease was most prevalent during the second and fourth quarters. No deaths resulted in the third quarter and only one in the first. Under present conditions, Whooping Cough is the most difficult of infectious diseases to control. The difficulties arise from many causes. |
e00b8641-4e0d-441f-a793-0c878da4f4cb | Not only is the nature of the virus unknown, but the length of the infection is doubtful. Moreover, the disease is infectious before a diagnosis can possibly be made. It is true that the same remark applies to Measles and Scarlet Fever, but in the two latter diseases, the initial symptoms are fairly characteristic whilst in Whooping Cough, in the catarrhal stage, the child has the symptoms of an ordinary cold, and there is nothing to distinguish the cough until it assumes its "whooping" character. The paroxysmal stage marked by the characteristic cough does not usually manifest itself until a period of a week or ten days has elapsed, and during the whole of this time the child is infectious. Another difficulty lies in the age of the persons attacked. The Registrar General in his Annual Report for 1891 discusses the diseases to which infants succumb. He says "Very notable is the comparative immunity of infants in the earlier months from the several Zymotic diseases. |
9865b311-1d77-448b-a746-cf6e5271b2ba | The earliest to declare itself is Whooping Cough, which is the assigned cause of some deaths even in the first month, but becomes much more frequent later on; next comes Measles, but with no great number of deaths until the eighth or ninth month is reached, after which it takes many victims; while Scarlet Fever is still later in its appearance, and scarcely carried off any infants at all in their first year." This peculiarity in the behaviour of W'hooping Cough is specially noteworthy; it renders the application to it of preventive measures compared with other Zymotic diseases particularly difficult. 19 NOTIFICATION OF INFECTIOUS DISEASES. The following notifications of Infectious Diseases were received:β Diphtheria 83 Enteric Fever 14 Erysipelas 35 Purperal Fever 1 Scarlet Fever 484 Phthisis 3 On Table III will be found the age incidence and the ward distribution of the above diseases, together with the number of cases removed to Hospital. |
283d7a16-237f-4fae-b699-9868059d9616 | SCARLET FEVER. During the past two years, Scarlet Fever has prevailed in much greater degree than in the immediately preceeding years. 484 cases were notified in 1908, and this figure represents the highest number yet recorded in the district. The cases notified are equal to a rate of 8.8 per 1,000 inhabitants. Fifteen deaths were registered as due to the disease giving a case fatality of 3.1 per cent. With the exception of 1906, the case fatality of 1908 was higher than in that of recent years, but this bare fact is not a sufficient criterion that the disease generally was of a more severe type The vast majority of the cases in the district were of a mild character, but on some occasions, a group of cases exhibited symptoms of a most severe type, and usually the primary case of this latter group had contracted the disease outside the district. One instance of this might be given. |
b6e781f8-6d68-4853-a5f9-2dfbb7561321 | On October 12th, W.H. aged 18, was notified of Scarlet Fever. He contracted the disease outside. A second case was notified from the same house on October 26th, and a third on October 30th. On October 25th, a girl L.F, of Antrobus Road, called to see the case notified on October 26th, and on October 30th, L. F. and her brother were notified of the disease. Altogether five cases occurred, and two deaths resulted. It was the mild type of the disease which was one of the factors in its perpetuation. Instances of "missed" cases are given on a later page. The outbreak assumed serious proportions towards the end of September, 1907, and continued with remissions and exacerbations 20 throughout the year 1908. The following table gives the number of notifications in each week throughout the year:β January 4th 5 cases July |
95a132f5-c12f-45a5-9ad5-f615618b4806 | 11th β 6 ceses β 11th 6 β β l8th 8 β β 18th 8 β β 25th 11 β β 25th 7 β August 1st 1 case February 1st 15 β β 8th 4 cases 8th 7 β 15th 3 β β 15th 11 β 22nd 1 case β 22nd 14 β β 29th 1 β β 29th 6 β September 5th 9 cases March 7th 9 β β 12th 10 β β 14th 0 β β 19th 11 β β 21st 2 β β 26th 9 β β 28th 11 β October 3rd 24 β April 4th 13 β β 10th 10 β β 11th 6 β β 17th 15 β β 18th 4 β β |
ba84764e-78c8-4a41-9eb4-271df8ff1259 | 24th 5 β β 25th 6 β 30th 17 β May 2nd 7 β November 7th 16 β β 9th 10 β β I4th 14 β β 16th 11 β β 21 st 9 β β 23rd 11 β β 28th 19 β β 30th 10 β December 5th 16 β June 6th 1 case β 12th 11 β β 13th 9 cases 11 19th 19 β β 20th 9 β β 26th 11 β β 27th 10 β To β 31st 8 β July 4th 8 β There is one point of exceeding interest in the se sonal incidence of the disease. |
e4d3960d-ea0e-4fc0-ab46-b89ff0bf287a | It will be noticed that for the five weeks ended August 29th, there is a sharp drop in the number of notifications, followed by a rise which culminated in the week ended October 3rd. The elementary schools of the district were closed for the summer holidays on July 23rd, and re-opened on August 25th. 21 Allowing the usual time for the incubation of the disease, the period extending from July 26th to August 29th may be represented as that in which the effect of the school holidays operated. During these 5 weeks, 12 cases were notified, while in the ptevious 5 weeks, 43 notifications were received, and in the 5 subsequent weeks 62. It is true that a large number of school children would be out of the distiict during the holidays, but this fact alone is insufficient to explain the sudden drop which occurred on the closure of the schools, and the rise which occurred on their re-opening. |
7f95be0a-5d8a-4b85-9208-6f4615c96ebc | We are compelled to regard school attendance as one of the factors in the spread of the disease. One mode in which school attendance operates, is through the occurrence of "missed" cases, and probably the "missed " case plays the most important role. The distribution of the cases among school children was as follows:β Beaumont Park 91 Willesden Junction 4 Southfield Road 74 East Acton 3 South Acton 72 Roman Catholic 2 Priory 47 Haberdasher's 2 Central 19 County 1 St. Mary's 15 Private 12 Rothschild Road 13 Outside 4 During the earlier part of the year, the incidence of the disease was heaviest on South Acton School, but after the summer holidays, the schools that suffered most severely were Southfield Road, Beaumont Park, Priory and South Acton. In all these schools increased incidence was associated with the occurrence of missed cases. |
b0db2f2b-d23d-4f79-810b-99c97c3e563a | In South Acton, Beaumont Park and Southfield Road, missed cases were found attending school. In South Acton a boy had been ill since August 24th, but was not notified until September 8th. Between August 25th and August 28th, he had attended schcol. similarly in Beaumont Park a case was notfiied on October 5th, and had been ill since Septe nber 17th, and had attended school up to October 2nd, 22 In Southfteld Road School, the "missed" cases, subsequently detected, were more numerous. The first "missed" case that occurred after the re-opening of the school after the summer holidays, was notified on September 17th. The girl had been 111 since September 4th, and had attended school up to September 15th. On October 12th a boy was excluded from school as the skin of his hands was peeling. |
c7fc54d8-e935-4a14-b4e8-129aaf7f1181 | He had had a rash and a sore throat on September 9th, but his doctor had certified that he could attend school. It may have been a coincidence, but the exclusion of the boy from school attendance was associated with the cessation of cases from the class he attended. On October 13th, two children were found in attendance, in both of whom the skin of the body and hands was peeling. In one case there was a history of sore throat and a rash on September 24th, and in the other on September 27th. These 4 cases attended either the Infants or Junior Department. It is also an interesting fact that the disease in Southfield Road was practically limited to these departments. It maybe assumed that the children in the Infants and Junior Departments mix to some extent with those of the Senior Department outside the school, but it seems as if the close aggregation of children in class rooms (and in the homes, &c.) |
2e31da05-9770-47fd-a582-2516a25618de | were a necessary factor in an extensive spread of the disease. The argument that the children in the Senior Department were less susceptible and more protected is hardly a sufficient one. A girl in the Priory School was notified of Scarlet Fever on December 3rd. Two days previously she had a sore throat and was sick at school. Four girls attending the same class, all over the age of 13 years, developed Scarlet Fever within a few days. This case is given as an instance that the age-distribution of the children in the Senior Departments is not a sufficient protection against the spread of infection. A detailed account has been given of some of the "missed" cases, as they play so important a role in the spread of the disease. |
0dbc1967-5d6a-4d61-8960-d203ae5522de | It is admitted that the "missed" case will always be a. problem difficult of solution, as it depends partly upon the type of the disease, 23 But one significant fact should be borne in mind; in spite of the extreme mildness of the disease in this district last year, when enquiries were carefully made afterwards, in all the "missed" cases subsequently detected, there was a history of a sore throat and a rash on the trunk and limbs. These cases had remained undetected in spite of the usual symptoms of Scarlet Fever. True, the sore throat was slight, and the rash was faint, but the conjunction of these two symptoms is known to most people to be associated with Scarlet Fever. There is not the slightest reason to believe that the parents intentionally concealed the existence of the disease. Nor could the dread of removal to Hospital have influenced them, as in many instances, the cases could well be isolated at home. |
58f0d4d6-cf24-4f66-9ba0-e15013788cd7 | Moreover, every care is exercised by the teachers to detect any case of infectious disease at school, and testimony should be borne to the valuable assistance rendered by the teachers. It would be almost impossible to detect the "missed" cases, but for the assistance rendered at the schools. Unless the children are very ill, they are loath to complain, even to their parents, so anxious are they not to be absent from school. It is difficult to suggest a remedy, as under existing conditions an enhanced attendance means, not only an increased grant, but a gain of prestige for the school. The importance of a high average attendance might be less highly magnified, and in some districts the practice of giving medals and prizes for a full attendance has been abolished. The occurrence of missed cases is not the only factor in school attendance which affects the spread of Scarlet Fever. There is little doubt but that the early infection of Scarlet Fever is also one of the means by which the disease is spread. |
41a35dea-a618-44c2-ab2c-0f2dc8973af9 | There is hardly any disease concerning which opinions have recently more profoundly changed. It was formerly held that the disease was not infectious until peeling had commenced, and that the infection was connected with the desquamation. This theory has been exploded, and we now know that infection can be conveyed during the earlier stages of the illness. It is still held in some quarters that until the appearance of the rash, there is no fear of infection. There are grounds to believe that the disease is infectious from the commencement of the sore throat and the initial sickness. Mention may be made again of the case notified in December, and who attended the Priory School, 24 She had a sore throat and was sick in school on December 1st. She did not attend school after the appearance of the rash, but four girls from the same class-room contracted the disease. This early infection is consistent with the views now held of the mode in which the disease is propagated. |
bcba2c80-ce16-4e19-a9b3-993c90779424 | It is generally held that the infection lies in the throat, nose and mouth. When a person is sick, the epithelial layer of the mucous membrane is denuded and the vomit is almost certain to be infectious. It is important to recognise the possibility of this early infection for disinfection purposes. Where disinfection has been faulty or incomplete, often it may be due to something which has been exposed to infection prior to the appearance of the rash, and not subjected to any form of disinfection. Other instances might be given which point to this early infection. It is within the experience of most people that cases will crop up one after the other in a class-room, though no "missed" cases have occurred, and the children have not attended school after the appearance of the rash. But some of them had attended school with a sore throat which proved to be the precursor of the other symptoms of Scarlet Fever. |
0583fbf5-9b00-4826-9346-a9be029a8abe | When the outbreak ceased in a class, sometimes it is found that the last cases had a rash on a Monday or a Tuesday and the sore throat commenced on a Saturday or Sunday. Another factor which may affect the spread of the disease amongst school children is the possibility of prolonged infection. This aspect will be discussed more fully when dealing with return cases and the recurrence of Scarlet Fever after prolonged periods in houses, but an instance may be given of the persistence of the disease in a class due in all probability to a prolonged period of infectiousness in a child. J. B., of Clovelly Road, was notified of Scarlet Fever on June 29th, and removed to hospital on the same day. He was in the Hospital until September 3rd. He suffered from no complications, but the reason for his prolonged detention was the presence of enlarged tonsils and adenoids. Five days after his discharge from the Hospital his brother was notified of Scarlet Fever. |
ce009a5a-784d-4daf-bf4d-9d22a6b4e37a | J. B. was examined on September 8th, and the probable conditions which would give rise to a "return" case, were the enlarged tonsils and adenoids. There was also a slight discharge from the nose, but no abrasion. At the end of three 25 weeks from his discharge from the Hospital, J. B. attended the Beaumont Park School. The two "babies" class-rooms at Beaumont Park are situated in that part of the school farthest from the Girl's Department, and the entrances to the two rooms are nearly opposite each other. Between October 27th and November gth, four children from the same class-room as J. B. were notified of Scarlet Fever, and in the other class room the same number of cases was notified during the same period. All the children in these two class-rooms were examined on several occasions, but there was no suspicion of a "missed" case. |
29c5e5dc-7f01-44a8-9f43-3e47526d46b1 | It was noticed that J. B. had a slight discharge from his nose, but no abrasion of the mucous membrane. On November 9th, it was decided to exclude him from school, and the only case that occurred after J. B.'s exclusion was notified on November 21st, but this case was probably infected at home, as two cases had been removed from the same house on November 2nd, and a third on November 4th. J. B. was kept out of school until the end of the year, and the parents have been advised to have the child's adenoids removed before he resumes school attendance. We have so far dealt mainly with infection as it occurs in the school, but the same factors operate in the home. The number of children exposed under the latter conditions is smaller, and possibly the infection may be more diluted. We shall deal with the spread of infection in the home under three heads:β 1. |
51cd9fb8-acf0-44db-b2d9-3ef847ca7bda | Multiple cases occurring probably as a result of infection from previous cases in the house. 2. Cases occurring in a house within a definite period of the discharge of another member of the family from the hospital. 3. Cases recurring in houses after prolonged periods. It will be convenient when dealing with the first group of cases to adopt some fixed period. The incubation period of Scarlet Fever is stated to be from one to seven days. For various reasons it is advisable not to take so short a period. If we took from the exposure to infection to the time when symptoms were first exhibited ye might be justified in limiting the time to one week. But it is 26 often very difficult to obtain an exact history of the commencement of the illness, and it will therefore be better to take the date of notification of the multiple cases and extend the period to one month from the occurrence of a previous case in the house. Multiple cases coming under the above head occurred in 43 houses. |
184c6b51-442b-4a5b-9668-d194680baf79 | In each of 28 houses there were 2 cases, in 9 there were 3 each, in 5 there were 4 each, and in 2 houses there were 5 each. Of the 28 houses where a second case occurred, in 12 instances both notifications were received on the same day, in the others the interval that elapsed between the receipt of the first and second notifications was as follows:β 1 day 1 case 3 days 3 cases 4 ,, 3 ,, 5 β 1 case 6 1 β 8 days 2 cases 11 β 1 case 12 ,, 2 cases 14 β 1 case 20 ,, 1 ,, With three exceptions, the cases were removed to the Hospital on the date of the receipt of the notification. |
a17e1712-f585-4a85-bea1-7c82d7f6bcdb | The three exceptions were nursed at home ; in one of these the two notifications were received on the same day, and in the two others an interval of 8 days elapsed between the receipt of the first and second notification. In the 9 instances where 3 cases had occurred in each house, in one of them the 3 notifications were received on the same day, in 4 the first and second notifications were received on the same day, followed by the third at intervals of 5, 8, n and 11 days respectively. In one instance the second and third were received on the same day, 11 days after the receipt of the first. The intervals between the three notifications in the others were as follows:β 1. Between 1st and 2ndβ11 days. 2nd and 3rdβ2 days. |
4beccc6e-59b1-4e58-96d0-6f7a6730388f | 2. ,, ,, ,, β 11 ,, ,, ,,,, 4,, 3. ,, ,, ,, ,, 13 ,, ,, ,, ,, 2 ,, In one instance the children were nursed at home ; the first and second notifications were received on the same day and the third after an interval of 11 days. In 2 of the instances where four cases occurred, all notifications 27 were received on the same day. In the third, 2 were received on the same day, with an interval of 8 days between the 2nd and 3rd, and one day between the third and fourth. In the fourth, 2 were received on the same day with an interval of 20 days between the second and third, and 19 days between the third and fourth. In the fifth, the third and fourth notifications were received on the same day, four days after the second case, and 15 days after the first case in the house. |
021a4df1-be63-4e2e-83c8-f653802a8493 | Where 5 cases had occurred the dates of the notifications were as follows :β 1. October 13th, 24th, 29th, 29th, 31st. 2. November 2nd, 2nd, 4th, 21st, 26th. In almost all the instances where two or more notifications were received on the same day, one of the cases had been ill for some time, and the others had been infected in the house. It is most rare to find the disease simultaneously introduced into the house by more than one member of the family. Occasionally the disease is not diagnosed until a second member of the family has been attacked. But even when a diagnosis has been made as early as possible, the other children have already been exposed to infection. It has been stated on a previous page that there is reason to believe that a patient is infectious from the very start of the illness, and before the rash has appeared. |
696c0bb6-520a-4bc9-a7dc-50c4ab2923c1 | Very seldom is isolation practised at the commencement of the illness, and the above instances show how difficult it is to fulfil the most essential conditions of the spread if the disease is to be prevented. One of the conditions is, that the infection must not be handed on by the patient before seclusion, but in all the above instances, in all probability, the secondary cases were infected before the previous patient had been removed to Hospital, or had been isolated in the home. The difficulty of isolation in the early stages is one reason why Isolation Hospitals have not been instrumental in stamping out Scarlet Fever in districts where most of the cases are removed to a Fever Hospital. There can be hardly any doubt, though, that Hospital Isolation was in this district the means of limiting the spread of infection. |
07cc7656-90f4-4a9f-bece-aa3bf7541859 | In the vast majority of instances, there was no possibility of obtaining any kind of isolation in the homes, and the limited outbreaks in classes 28 and families which resulted from "missed" cases are sufficient proof of the necessity of Hospital Isolation. Another factor which militates against the complete success of Isolation Hospitals is the occurrence of what are called "return" cases. Whether isolated at home or in the hospital, the patient should have recovered perfectly before he is cleaned and discharged from seclusion, but we have no means of ascertaining whether the patient is absolutely free from infection or not. In Diphtheria, the conditions are different; the germ has been isolated, and a bacteriological examination can always be made before the patient is discharged from the Hospital. It is this difficulty which gives rise to the second group of cases of Scarlet Fever, viz. those that occur in a house soon after the discharge of a member of the family from the Hospital. |
9e0a2108-2fca-4f6f-a849-d73cbee05e04 | Probably this group of cases is more closely related to the third group (where cases recur in houses after a prolouged period) than we have hitherto recognised, but it will at the present time be convenient to treat the occurrence of cases in the two groups as separate phenomena. For this purpose, an arbitary period of one month has been fixed, and cases occurring within one month have been included either in groups one or two, and those over in group three. Twenty-seven cases discharged from the Hospital were followed within one month by the occurrence of other cases of Scarlet Fever in the same house. Twenty-two of these were discharged from the Council's Hospital and five from the London Fever Hospital. Many authorities believe that the phenomenon of return cases is essentially due to imperfections in Hospital management, and that there is reason to believe that recent association of discharged patients with acute cases is responsible for most, if not all return cases. |
8216ca92-5f06-41b5-82b2-54b0a1c9aa25 | It has been found in some districts that by placing patients in a convalescent ward for about a fortnight before their discharge, and systematically disinfecting the skin, nose and auditory canals, not a single return case had occurred. This statement is probably true, but it certainly will not explain everything in connection with return cases. Return cases are not unknown after home isolation. There was one such instance in this district last year. A case was notified on September 14th. The case was nursed at home, certified as free 29 from infection on November 3rd and disinfected the same day. On November 5th, a sister was taken ill and notified of Scarlet Fever on November 6th. |
e8598f20-cb04-449a-b370-287d1bd97cb4 | It is not even fair, as far as return cases are concerned, to compare home isolation with Hospital isolation Home isolation is usually attempted when there are no other susceptible persons in the house, so that when the patient is released from exclusion, there is little chance of a return case in the house. Moreover, as is shown in dealing with the next group of cases, Scarlet Fever displays a tendency to recur in houses and amongst families after a prolonged period has elapsed since the occurrence of a previous case. But whilst contending that the return case is not solely a hospital phenomenon, it must be admitted that a large majority of them arise as a result of hospital treatment and administration. The most fruitful cause probably is the overcrowding of wards and the failure to separate the convalescent from the acute cases. It has been pointed out to the Health Committee on several occasions that until the proposed extension of our Hospital is completed, the necessary separation and preparation of the patients prior to their discharge cannot at all times be carried out. |
9fe45c33-f2cd-4445-95f9-09e53b63821d | Not only is it necessary to separate the convalescent from the acute cases, but it is desirable that the patients should during the last week or fortnight of their stay in the Hospital, be kept under conditions which approximate as nearly as possible to those which obtain at their homes. In almost all the "infecting" cases, it was found that a few days after their arrival home, there was a history of a slight cold and a discharge from the nose. The causi of this is not far to seek. In the Hospital, the wards are kept at a fairly uniform temperature, but when the patients go home, they sleep usually in bedrooms which have no fire. It was shown in the report for 1907, that between May and November no return cases occurred, and last year there was a sharp rise in November. It is generally found that the relative incidence of return cases is less in the summer than in the winter months. |
3ff349a5-c32f-49bb-b916-679e001dfdbe | Another fruitful cause of nasal discharge after arrival home, was the disinfecting bath, &c., on the morning of discharge, but whenever 30 possible the disinfection and preparation. of the patient is now carried out some days before the day of discharge. Although a better classification and a more satisfactory system of preparation before discharge will greatly reduce the number of "return" cases, it is doubtful if they will entirely disappear. The wider recognition of the occurrence of return cases has been the means of raising other questions. One of these relates to the length of time during which a person attacked by Scarlet Fever may be infectious, and in this connection it is of interest to note the liability of cases to recur in families after a prolonged period. Last year Scarlet Fever cases occurred in 376 houses, and during the last three years 708 houses have been invaded. There are over 9,000 inhabited dwelling houses in the district. During the year recurrent cases occurred in 90 houses. |
20a839da-f712-4b26-9f29-a5a98204a86a | 43 of these houses came under group 1, where the secondary case occurred within the month of the removal of the previous case to Hospital; in 27 of the houses the cases came under group 2βthe "return" cases referred to on a previous page, and the remainder, 20, referred to houses from which a recurrent case was notified after a lengthened period had elapsed, and the interval which elapsed between the first and second case was as follows :β 6 weeks 1 case 7 ,, 2 cases 11 ,, 1 case 4 months 2 cases 5 ,, 3 ,, 10 β 2 β 11 months 1 case 17 ,, 1 ,, 18 ,, 1 ,, 23 ,, 2 cases 24 ,, 2 ,, 27 β 1 case It is impossible to state accurately what are the chances of a second case occurring in a house, apart from contact and return cases. |
5952514c-08c1-4287-8e6a-fdad13691e36 | There are many factors which operate, the most important depending upon the number of susceptible persons in the houses, and the chances of infection in school. Numerically, the last group does not seem very important, but taken in conjunction with the return cases, it may repay analysing, as some light may be thrown on the epidemiology of the disease. 31 In three of the above cases the circumstances in which the disease recurred suggest some connection with incomplete disinfection. G. D. was notified on October 27th and removed to Hospital on the same day. At the end of six weeks the mother was in the usual way informed that the patient was ready for discharge, but after the mother was informed, the glands of the neck became slightly enlarged and he was not discharged. On December 15th, the two other children in the house were notified as suffering from Scarlet Fever. |
8514660a-c923-492e-8ef9-86ac6270aee2 | A somewhat similar case was that of J. W. The two brothers T. W. and W. W. were notified on March 24th, and removed to Hospital on the same day. On account of a nasal discharge, they were kept in the Hospital for a couple of weeks after the mother had been informed that they were ready to go home. They were ultimately discharged on June 20th, but J. W. referred to above, was notified as suffering from the disease on June 11th. In the third case V.B. was removed to Hospital on May 15th, and discharged on the afternoon of June 27th. The child did not arrive home until 2 p.m , and did not come in contact with her brother, J.B. until tea-time, when he came into the house complaining of a sore throat. The same evening he developed a rash. These three cases suggest the possibility of an incomplete disinfection. |
266e58eb-a0b7-4e24-b227-6e06a9513848 | The result of disinfection after Scarlet Fever is rendered, to some extent, uncertain, because the specific germ causing the disease has not been isolated. It is quite as important to know what to disinfect as how to disinfect. Until quite recently, it was held that Scarlet Fever was not infectious "until desquamation had set in, and this theory has taken deep root in the mind of the public. Even now the possibility of infection before the rash has appeared is but seldom borne in mind, and it can easily be understood how articles exposed to infection in the early stage of the illness, can be overlooked and not handed up for disinfection. Apart from this, some of the public look upon disinfection as a fetish, and it is not surprising that some of the more expensive articles are occasionally put aside, before the sanitary authorities arrive to disinfect. These are taken out on the receipt of an intimation that the patient is ready 32 for discharge from the Hospital. |
367a477d-279f-4bca-886c-5a4124ec822e | It is understood that the article referred to are those that have in some way come in contact with the mucous discharged from the patient. The other 16 cases will not allow of this explanation. Even allowing the most liberal margin for error, the occurrence of recurrent cases in these 16 houses in one year cannot be explained on the ground of mere coincidence. Not only is the number too high, but the conditions under which some of these occurred, were not favourable to the recurrence of Scarlet Fever. In 3 instances there were no persons under 20 years of age in the house. The theory has been advanced " that in a small minority of cases, Scarlet Fever may remain infectious for a very long period. It does not follow that such cases are continuously infectious during this time. All the facts seem to indicate that continuous infectiousness is not a feature of Scarlet Fever." Dr. |
6c9efb95-c369-43d8-8a54-fdedb1ab9720 | Butler read a paper on this subject before the Epidemiological Society in November 1908, and emphasized the following three points. 1. Under varying but occasionally recognisable conditions, persons recovered from Scarlet Fever are capable of conveying the infection to others after intervals frequently of prolonged duration, when apparently they had ceased to be infectious. 2. There are persons who have not suffered from the disease who appear to harbour the infection in their tissues in such a manner that while t here is no ground for considering them during this passive stage a danger to others may yet, by a critical lowering of their resistance, become the source of their own infection. 3. There are others again, of whom, while it would be incorrect to say they had suffered from an attack of Scarlet Fever, have yet in some degree reacted to an invasion of the poison and are capable of communicating to those with whom they come in contact the disease to which as such they are themselves immure. |
adf7aec8-674d-4be0-981e-2d9b3363132d | These matters are of great epidemiological interest and three instances may be given which seemed to indicate that it was something in the persons attacked and not in the buildings which was determining the persistence of the infection. 33 A married man was notified of Scarlet Fever on December 5th, 1907, and discharged from the Hospital on January 17th, 1908. On his discharge from Hospital, he and his wife and child moved from the house in which he contracted the disease. He was visited occasionally by an elder sister who fell with the disease on May 22nd, 1908. This sister lived with her parents and the father, mother, sister and servant were the only occupants of the house. No connection with any other case of Scarlet Fever could be traced. H. H. was notified of Scarier Fever on July 18th, 1907. The family then lived at St. Alban's Avenue, but moved from there towards the end of the year. |
9a872826-af81-47e8-be4d-b38ff37038bb | In July, 1908, the brother wasnotified, and no other cases had occurred in the school where he attended. In one sense the following case is more interesting still. J. C., a lodger, contracted Scarlet Fever in September, 1906. He married his landlady's daughter and went to live in another part of the district, and two teachers lodged in his house. One of the teachers contracted the disease in October, 1907, though there was a definite history that she had had the disease in her childhood. It may be objected that this teacher would come in contact with children and thus rendered liable to contract the disease, but in March, 1908, J. C.'s sister-in-law (aged 26) was notified of the disease, and in the latter case, no other source of infection could be traced. These three cases have not been included in the 16 instances where Scarlet Fever had recurred after a prolonged period. |
9964712a-ee39-4cbd-bdd0-e607496db86d | The 16 only include those where the disease had recurred in the same house. A case occurred in the Cottage Hospital during the year, which illustrates the possibility of a person harbouring the infection in their tissues and after some time becoming the source of their own infection. On February 1st, two cases of Scarlet Fever were notified from the Cottage Hospital. One of these, D. M., was a patient who had contracted the disease outside, and the second was a nurse. Both were removed to the Isolation Hospital. In the bed next to D. M. was a boy, W. K., who had fractured his leg. On March 22nd, seven weeks after the removal of the last case, W. K. was notified of Scarlet Fever. Inquiries were made, and no visitors at the Cottage Hospital could be suspected of harbouring infection. |
62adbce9-d7c6-4411-96da-80c46056a55c | The nurse had not been discharged from the Isolation Hospital, 34 It is of course possible, that the infection was harboured in the ward, and it may be mentioned that when the Cottage Hospital was' emptied and the place thoroughly disinfected, no further cases occurred there. On the other hand, it seems that a few days after D. M. was removed to the Isolation Hospital, W. K. had a slight sore throat; he was thoroughly examined, but there was no other symptom of Scarlet Fever. The outbreak has been dealt with at considerable length, as some of the matters discussed involve details of great importance from an administrative point of view. It is obviously insufficient to exclude from school and to isolate acute cases only, when there is sometimes the possibility of a person harbouring the infection for a prolonged period. |
efea70d7-462d-4bec-a7da-4f0407d80f3f | It is proved that the germs of Typhoid and Diphtheria have been harboured for years by a very small percentage of the persons who have suffered fromthe disease, and a similar phenomenon is not impossible in Scarlet Fever. The age incidence and the ward distribution of the disease are given on Table III. DIPHTHERIA. Eighty-three cases of Diphtheria were notified and 7 deaths were caused by the disease. There is a slight increase both in the number of notifications and deaths. The disease was fairly uniformly distributed throughout the year, and in no instance did an outbreak of the disease assume serious proportions. Diphtheria is a disease which stands out in striking contrast to some of the other infectious diseases such as Scarlet Fever, Measles and Whooping Cough. Although the latter diseases have been known for a long time, our knowledge of them is limited. The specific germs have not been isolated, and their mode of spread is open to argument. |
329f99e3-1850-4512-919a-0315d4d37107 | We are in a far happier position when dealing with Diphtheria. Not only is its microbial origin fully proved, but we have means within our reach which enable us to deal with outbreaks of the disease. Diphtheria is only acquired directly or indirectly from another case, and cannot arise from bad drains or insanitary conditions, though the latter conditions may predispose by lowering the resistence. 35 It has been shown conclusively that a certain proportion of those who are brought into contact with Diphtheria patients harbour the bacilli in their throats or nasal cavities. The percentage is highest in the immediate contacts, that is, in members of the same family; it diminishes rapidly as we enlarge the interpretation so as to include school-fellows and when the term is so widened as to include such extremely remote contacts as the general inhabitants, the percentage showing the bacilli is a negligible one. |
1f28d5a6-cab5-43f8-b135-95fa251cf8bc | The following instances show the importance of carrier cases in spreading the disease, and the desirability of making a bacteriological examination of the immediate contacts. Last July, several cases were notified from St. Alban's Avenue and Rusthall Avenue. These children were all in different classes; but an examination of the other members in the families revealed a carrier case. The isolation of the latter was followed by an immediate cessation of the notifications. A similar phenomenon was noticed in Valetta Road, but usually the disease assumes more formidable proportions when a carrier case attends school. There were no extensive outbreaks in any of the schools during the year, but probably this was in part due to the action taken to detect any carrier cases. On the re-opening of Rothschild Road School after the summer holidays, two cases were notified, and both children attended the same class. Swabs were taken from the throats of some of the other children, and this revealed two other cases of Diphtheria. |
373b7947-1b45-424f-b704-8a1236705edd | The exclusion of these cases from school stopped the notifications among the pupils of this school. ENTERIC FEVER. Fourteen cases of Enteric Fever were notified and two deaths occurred. In most of the cases, the disease was introduced from some outside district. Two persons were infected in Hadlow, Kent. One of these was a resident of Hadlow, and came on a visit to his brother in Acton on October 3rd, but had been ailing for some days prior to his 36 arrival here. A brother, a sister and two neighbours in Hadlow contracted the disease about the same time. The second case was a resident of Acton, and contracted the disease when "hopping" in Kent. She was taken ill at Hadlow on September 17th, and returned to Acton on October 1st. This latter case was the direct means of infection to 5 other persons. |
c12a360d-3d20-4480-91c4-6364eabe24e3 | One of these was the patient's husband, and in his case the infection was probably a direct one. Both husband and wife were removed to Hospital, but prior to their removal they were nursed by a woman from Ramsey Road. When the husband and wife went to the Hospital, their baby was taken to Ramsey Road. Four cases occurred in the latter house. Infants often suffer from an undetected attack of Enteric Fever, and it is possible that the disease was introduced to Ramsey Road by the child. The risk attached to the baby was pointed out, but the warning went unheeded. The eighth case probably contracted the disease in Margate. The notification was received on June 1st, and the patient had been taken ill about May 24th. She had been in Margate from May 7th to May 24th. The ninth and tenth cases were probably due to the consumption of contaminated shell-fish. |
64e22936-39a2-4b74-afc2-c06db5becef1 | In the other cases the source of infection was not traced. All of them had most of their meals outside the district. ERYSIPELAS. Thirty-five cases of Erysipelas were notified, but there was no death from the disease. Opinions differ as to usefulness of retaining Erysipelas amongst the notifiable infectious diseases. With the possible exception of Puerperal Fever, no connection with other notifiable infectious diseases has been traced, but Erysipelas can be caused by various organisms, and can no more be regarded as a specific disease in its etiology than an ordinary abscess or a gum-boil is. PUERPERAL FEVER. There was only one case of Puerperal Fever notified, and this patient recovered, 37 TUBERCULAR DISEASES. There were 56 deaths from Phthisis or Consumption and 28 deaths from other Tubercular Diseases. |
f1e88227-ecf2-4a05-9283-db4416ffaf79 | Of the 56 deaths from Phthisis, 41 were Males and 15 Females, and of the deaths over 15 years of age, 39 were Males and 13 Females Prior to their attack of illness the 52 persons over 15 years of age were employed as follows :β MALES. Laundrymen 6 Labourer 3 Clerk 3 Barman 3 Carman 2 Engineer 2 Butcher 2 Horsekeeper 2 Baker 1 Carpenter 1 Upholsterer 1 Brushmaker 1 Gas Fitter 1 Optician 1 Chemist 1 Grocer 1 Polisher 1 Packer 1 Machinist1 Paperhanger 1 Lodging House Deputy 1 Draughtsman 1 Market Porter 1 Sponge-dealer 1 39 FEMALES. |
9c66eb5d-30b7-4d1d-9a78-670b31eefd2c | Household 7 Laundress 3 Barmaid 1 Domestic Service 1 Machinist 1 13 38 18 of the deaths from Consumption occurred in the Isleworth Infirmary, and the vastly increased treatment of advanced cases of pulmonary tuberculosis in infirmaries and other institutions has been most valuable in securing segregation of patients from their families, as well as securing humane treatment for the patients themselves. Early cases, where any traces of the Bacilli occur in the sputum, are dangerous, but the danger from them is trifling compared to that from the advanced and fatal cases. The last 4 or 5 weeks are the most deadly in the spread of the infection. It cannot be too strongly emphasised that Tuberculosis is an infectious disease caused by the tubercle bacillus. It is true that in 9 instances last year there was a history of Consumption in the family, but the transmission of the disease in these cases was due solely to the simplest processes of infection. |
3252f37b-29cc-4c52-bd24-a6cbaa4c783a | The immediate relatives did not regard the process as an infective one, because the consequences did not appear at once, but after the lapse of years. In only 2 of the 9 did the family occupy more than three rooms. At night, the patient had to sleep in the same room as other inmates of of the family, and it is difficult not to be a source of infection to some of the other occupants of the house when a case occurs amongst the poor. In the memorandum issued by the Local Government Board, great stress is laid upon the early diagnosis of the disease. One of the most valuable agencies for securing early diagnosis is the bacteriological examination of the sputum. The Council arranges for the gratuitous bacteriological examination of the sputum, and last year the sputum of 38 patients was examined. In .28 of them the tubercle bacilli were not found and in 10 the bacilli were found. |
7d9973d6-6103-4a5b-b885-5fc6efb02582 | In spite of every facility for securing early diagnosis, the Council has not been successful in obtaining a sufficient number of suitable applicants to occupy continuously the two beds maintained at the Northwood Sanatorium. 10 applications were received for admission during the year ; 3 of these were rejected on account of unsuitability and 7 patients were treated at the Sanatorium. As far back as July, 1905, an agreement was entered into whereby the Council maintained 3 beds at the Northwood Sanatorium. In 1907, the number of beds was reduced to two. 39 The medical inspection of school children will, it is hoped, secure the detection of previously unrecognised cases among school children. Two of the seven cases treated at the Sanatorium last year were detected in the course of the medical inspection of School Children. Voluntary notification of cases of Consumption has been in force in the district since June, 1903, the sum of 2/6 being paid for each case notified. |
3681416e-7fec-4f8c-b06c-dc611b6941d2 | It cannot be said that the system has been a success, as in addition to the ten patients for whom application was made for admission to the Sanatorium, only three notifications were received. The want of success is probably due to the impression that notification would have a prejudicial effect on the individual suffering from the disease. It is admitted that it is not absolutely necessary to notify all cases of consumption, but where owing to domestic conditions, the patients are a source of danger to the people in contact with them, it is essential the cases should be notified so that instructions may be given and precautions taken. In no instance are the enquiries made as to prevent the patient from continuing to earn his livelihood. Our duty ends when advice has been tendered as to the precautions to be taken. Very seldom is our offer to disinfect the premises after a death refused. Last year, with 4 exceptions, all the premises where a death from Phthisis occurred were disinfected. |
6e6307eb-a40f-4477-bc5e-69ea2667eb90 | One hundred and seventy-four deaths under 1 year of age were registered in the district, and 14 infants under 1 year of age died in public institutions beyond the district, making a total of 188. This latter figure corresponds to an infantile mortality of 120 per 1,000 births The infantile mortality in England and Wales last year was 121; in the 76 large towns it amounted to 128; and in the 142 smaller towns it was 124 ; INFANTILE MORTALITY. |
5d3eda1a-e0f7-411c-a5da-102f9dcd38b4 | The deaths were distributed as follows:β North-East Ward 30 North-West Ward 26 South-East Ward 29 South-West Ward 103 40 The infantile mortality in each ward would be:β North-East Ward 82 per 1,000 deaths North-West Ward 121 ,, β β South East Ward 88 ,, β β South-West Ward 155 β β ,, The infantile mortality is 10 per 1,000 lower than it was in 1906 and 1907. Compared with 1907 the mortality is higher in the North-West Ward, but lower in the three other wards. There was a marked increase in the number of deaths from Measles and DiarrhΕal diseases and a more marked decrease in the number of deaths from Bronchitis and Pneumonia. The increase in the deaths from Measles has been referred to in another paragraph. There were 42 deaths from Diarrhoea and 14 from Enteritis. |
fda309fb-4496-4b0b-bf60-9ed4a5418ea9 | In 1907 there were 22 infantile deaths from Diarrhceal Diseases and in 1906 the number was 80. There is an increase in the number of deaths from diarrhoeal diseases as compared with 1907, and whatever views may be held as to their causation their can be no doubt as to the beneficial influence of an excessive rainfall. In this latter respect, 1908 compared unfavourably with 1907. The amount of rainfall may be beyond the control of a sanitary authority, but the manner in which a hot summer operates upon the infantile mortality should teach us something in the prevention of Diarrhceal diseases. Out of the 42 children who died from diarrhoeal diseases only 2 were breast-fed. 18 were brought up on cow's milk, 14 on condensed milk, and 8 on one or other of the patent foods on the market. |
2da5e862-4f77-4799-80e6-a93096bfcef0 | It is difficult to estimate what percentage of the children are breast-fed and hand-fed, but if we contrast the conditions in deaths from respiratory diseases the above figures will appear significant. Out of 21 deaths from Bronchitis and Pneumonia, 12 of the children were breast-fed, 5 were fed on cow's milk, 2 on condensed milk, and 2 on a patent food. 41 Nothing replaces human milk in its nutritious qualities for the infant. Most artificial foods are but poor substitutes for the natural food unless prepared with the utmost care. Breast-milk is comparitively sterile, and it passes directly from the mother to the child, without any intermediate state of transit during which infection may take place. But with hand-feeding, infection may lurk in the milk, in the vessels in which it is carried and in the bottle. |
370ce6ce-7c74-4301-b223-6363954e6207 | In 15 of the cases where death occurred from diarrhΕal diseases the mother was employed in some industry which entailed leaving the home and placing the infant under the care of some other person. Married female labour undoubtedly enters into the question of premature weaning, but under present social conditions it is doubtful if it is so important a factor in infantile mortality as it is somtimes represented to be. The Registrar General in his Report for 1905, discusses the question of Infantile Mortality and the employment of married women. He took two groups of fifteen towns, each containing respectively the lowest and the highest proportions of occupied married women, and compared their birth rate and infantile mortality in two quinquennia. The birth rate is, as might have been anticipated, lower in the towns having a high proportion of the married women industrially employed. The relationship between industrial employment of married women and infant mortality is however, not very visible. |
c65162c1-6832-4713-9ae1-3b4b844dca8c | In the first group of towns, having only 4 to 8 per cent. of its married women engaged in occupations, the infant mortality in 1901-5 varied from 104 in Burton-on-Trent to 202 in Aberdare, the average for the 15 towns being 161; in the second group of towns having from 20 to 39 per cent. of its married women engaged in occupations, the infant mortality varied from 140 in Rochdale to 206 in Longton, the average for the 15 towns being 168. Evidently the result thus stated is dubious. In a former Annual Report for Acton, the effect on the child of married female labour was discussed, and the investigations made last year point to the same conclusion as was arrived at on the previous occasion. |
15e6be76-329b-49e1-a1c1-bb8dd1da7296 | Out of 13 deaths of Prematurity which we investigated, only two of the mothers were employed in industrial 4i Occupations, and out of 11 deaths from Congenital Debility, two of the mothers were so employed. It is doubtful if work is injurious to the expectant mother, provided it be not heavy or prolonged. Possibly, the improved food and greater comfort which their work means, more than counteract its disadvantages. But if the antenatal effect of married female labour is not obvious, the conditions under which the child is brought up as a result, do affect the infantile mortality. Out of 111 infant deaths inquired into last year, in 38 instances, the mother was occupied in some industrial occupation, the majority being employed in laundry work. In former years the mother had no option but to leave the child in the charge of a "baby minder." |
db0e43d8-a1c4-4f17-97ff-43b9c03bd3d1 | The mother did not select the house where the baby was cared for, on sanitary grounds, and the standard of cleanliness which usually obtained in the " babyminder's " house was below that of the average for the neighbourhood. In January, 1908, the South Acton Day Nursery was opened, and undoubtedly it has fulfilled a long-felt want. One of the objections raised against creches is their liability to encourage premature weaning, and in many creches it must be admitted that this danger is not sufficiently appreciated. In Acton every safeguard is adopted to obviate this. The creche is not too large, and is so situated as to be convenient for the mothers to leave their work twice a day for the purpose of suckling their children. The creche has 28 cots and all the mothers work at laundries within easy reach. Every encouragement is given at the creche to the mothers to suckle their children. |
23f8033d-cb52-4490-b746-1089e0f55154 | A glass of milk, or a cup of cocoa and a biscuit are given to the mothers free whenever she comes to suckle her child. In addition, the Notification of Births Act enables the Sanitary Authorities to advise mothers in time against premature weaning. Formerly many mothers weaned their children before the latter had reached the age of one month. Another objection urged against the establishment of creches is based upon their liability to act as foci in the spread of infectious disease. This objection refers almost entirely to Measles. 43 one admits that wherever young children congregate, Measles is liable to spread among these children. It is too early to draw conclusions from our experience in Acton, but as may be seen on a previous page, the district last spring passed through one of the most extensive epidemics in its history, and in no instance did the disease spread amongst the children of the creche. |
5cbe1707-4a9c-41b7-8c7b-e3e6d6208840 | It was stated in a previous paragraph, that the role of married female labour (under present social conditions) in the production of infantile mortality is not very obvious. It was also stated that possibly the better food, &c., which result, outweigh the disadvantages. One fact though, should be borne in mind, that last year in Acton one seventh of the total loss of life in infancy occurs in the first week of extra-uterine life. This fact tends to moderate our hope of affecting a large percentage of the total infantile mortality, unless it be by measures affecting the mother during pregnacy. It is well known that social conditions play an important part but the following figures suggest that ignorance of the duties of motherhood is also an important factor. |
159db382-d84d-4451-982d-70fd772d659b | Out of 42 deaths from diarrhoeal diseases, 7 of the children were first-born, out of 46 deaths from diseases other than diarrhoeal and prematurity, 10 of the children were first-born, but out of 13 deaths from prematurity, 6 of the children were first-born. As usual the mortality amongst illegitimate children was excessive, Out of 42 children born out of wedlock, 17 died before reaching the age of 12 months. These figures represent an infantile mortality of 404 per 1,000 births. In 1907 the infantile mortality amongst illegitimate children was 480 per 1,000 births, and in 1906, 564 per 2,000; so that in the last three years nearly one half the illegitimate children died before reaching the age of 12 months. NOTIFICATION OF BIRTHS ACT, 1907. |
04f05601-4001-42d4-a261-16668f8f8f6a | The Council passed a resolution to adopt the above Act on November 26th, 1907, and application for the sanction of the Local Government Board was made forthwith. The resolution of the Council was advertised in the " Acton Gazette" and "Acton Express" on December 6th, 1907. 44 The sanction of the Local Government Board was obtained and the Act came into force on January 7th, 1908. The provisions of the Act were advertised in the local newspapers, and a copy of the advertisement was posted on hoardings and outside the churches and chapels of the district. Circulars containing the notice of adoption and the provisions of the Act were sent to all the dectors and midwives in the district and stamped notification letter cards were sent to each doctor and midwife practising in the district. One thousand three hundred and fifty notifications were received, 1315 live births and 35 still births. |
75495504-d7e8-4377-b01d-ba017acbd19c | Four hundred and ninty-two of these were made by doctors, 727 by midwives and 131 by the fathers of the children. Over 100 notifications were received as a result of communications sent to those who were responsible for the notifications. Three hundred and eight births occurred which were not notified within the statutory period. During the earlier months of the year the number of births not notified was as high as 30 per cent., but since the Council instituted proceedings against defaulters the number in any week seldom exceeds 10 per cent. CANCER. 48 deaths occurred from Cancer or Malignant Disease. The Ward distribution was as follows :β North-East 14 South-East 9 North-West 8 South-West 17 19 of the deaths were in males and 29 in females, but the preponderance of females is more than accounted for by the number of deaths from Cancer of the Reproductive organs. |
346b0ef6-38d4-46fd-a7c5-aec7309142ef | There were 12 deaths from Cancer of the Breast and 4 from Cancer of the Uterus. The most marked increase was in the number of deaths from Cancer of the Alimentary Canal. In 13 instances the bowels were affected, in 6 the Stomach, in 4 the Liver and Bile Ducts, and in 1 the Pancras. 45 Although the number of deaths from Cancer generally is on the increase, the greatest increase in recent years has been due to the frequency with which the Digestive Organs are attacked. The site of the disease in others was as follows:βThroat and Neck 3. Tongue 1, Face 1, Shoulder 1. In two instances the seat of the disease was not mentioned. ISOLATION HOSPITAL. During the year 423 patients were admitted. |
b66c1464-364d-4d41-aad9-14edfe5ff1b2 | On January 1st, 1908, there were 48 patients under treatment and on January 1st, 1909, 51. During the year, 408 patients were discharged and there were 18 deaths. Diphtheria. Fifty-four cases of Diphtheria were admitted, and there were 4 deaths. Scarlet Fever. Three hundred and sixty-nine cases were admitted and there were 14 deaths "Return" cases have been dealt with in another paragraph. |
e32078c8-955a-4c76-ab6a-c7baaed6901d | The question of extending the accommodation at the Hospital has been considered by the Council during the year, and the following report by the Chairman of the Health Committee and the Medical Officer of Health was submitted to the Works Committee in October:β " At a mseting of the Health Committee held on July 28th " the Chairman of the Committee and the Medical Offier of Health were requested to prepare a statement of the accommodation and kind cf building required and submit the same to the Works Committee at at there next meeting :β 1. Extent of Additional Accommodation. The amount of permanent Hospital accommodation whLh should be provided in proportion to the population will depend upon various considerations, amongst the most important of which are the character of the population, whether urban or rural; the rate of 46 crease of population; the houses and habits of the people ; and the amount of intercourse with other places from which infectious disease may be introduced. |
e772983f-1d19-4b5d-83ce-bf2e508b649c | As a rough estimate, one bed for every thousand inhabitants is sometimes adopted, but in view of the diverse circumstances of different districts, this cannot be regarded as a definite standard. Some idea as to the number and nature of the diseases to be treated, may be gained from the following table, which gives the number of Scarlet Fever, Diphtheria, and Typhoid cases notified since the adoption of the Infectious Disease Notification Act, Scarlet Fever. Diphtheria. Typhoid. |
91512ed5-89da-4067-93d0-6b0eb17f4630 | 1890 108 14 13 1891 63 8 13 1892 74 27 15 1893 192 41 19 1894 86 22 15 1893 67 32 28 1896 193 23 14 1897 93 89 10 1898 167 35 9 1899 111 49 46 1900 243 28 29 1901 82 34 27 1902 109 33 14 1903 76 22 40 1904 129 32 8 1905 137 49 12 1906 170 46 12 1907 267 63 13 It will be seen that, in recent years the number of Typhoid cases is comparatively small, and it is the experience of most districts throughout the kingdom, that this disease is becoming less frequent. |
54e2f256-1947-4a2e-a601-f03bb415ccec | During the first half of the year Acton is usually free from this disease. In the circumstances, we consider that the permanent accommodation for this disease can be provided for in the observation block, 47 The two diseases which take up the major portion of the accommodation at the Hospital are Scarlet Fever and Diphtheria, and more especially the former. Under present conditions the average stay of Scarlet Fever patients in the Hospital extends to a period of 45 days. On this basis 33 beds would be required and continually occupied to accommodate the number of cases notified last year. This figure is given simply as a basis for calculations, but several factors have to be taken into consideration. The first is the fact that Scarlet Fever tends to recur in epidemics, and 1907 was to an extent an epidemic year. The second factor is the seasonal epidemicity of Scarlet Fever. |
b95d2098-3bfc-4a76-8120-0020b188947e | The disease shows a maximum and a minimum seasonal incidence ; that is to say, Scarlet Fever is usually at its height in the Spring and Autumn, and least prevalent in the Summer and W inter. Consequently, it is not sufficient to provide only such a number of beds that would accommodate the cases if spread evenly over the year ; and whilst only 33 beds would have been required in 1907 if the cases had been uniformly distributed throughout the year, the fact was that during limited periods 60 beds were occupied, and at another time not more than ten were used. It is therefore necessary to provide at least 50 per cent. more beds than the average required. Another factor that has to be considered is the increase of the population. It increased from 24,206 in 1891, to 37,448 in 1901. and the estimated population at the present time is 55,000. |
14e75c04-a317-4d16-a688-edbbf7b405ba | It is reasonable to assume that, during the next ten years, it will increase considerably, though possibly not at the same rate as during the past dedennium. All cases of Scarlet Fever need not be isolated in the Hospital, but it has been found in this district that the demand for Hospital accommodation, now that the residents have come to appreciate its benefits, has increased beyond what was anticipated. In 1906, 152 cases out of 170 notified were removed to the Hospital, and in 1907 232 out of 267. This high percentage of cases desiring removal to Hospital will probably be maintained, owing to the character of the housing accommodatiou, and the extent of the laundry industry. A large number of houses formerly occupied by one family, are now 48 sub let and occupied by two or more families, and no facilities exist for nursing and the isolation of the patients at their houses. |
c382d894-4beb-489a-9253-fc5682d9f35d | Moreover, in the southern part of the district where most of the houses are occupied by more than one family, a large number of the households have one or more of their msmbers occupied in the laundry industry, and the importance of the immediate removal of any infectious cases is obvious. It must therefore be assumed that a high percentage of the cases notified will continne to be removed to the Hospital. There is one important paint of difference bjtween Scarlet Fever and Typhoid Fever. Scarlet Fever is essentially a disease of Childhood, and a large proportion of the cases are of children under ten years of age. Less danger, therefore, results if the number of beds in a Ward slightly exceeds that allowed on the 2,000 cubic feet basis, so long as this overcrowding is only of a temporary character. |
b7f96f25-1dd3-4fb7-8bfc-c86a56da094e | Having taken all the factors into consideration, we are of opinion that an accommodation of 50 beds for Scat let Fever would suffice the district for at least ten years, and we propose for the consideration of the Committee the following arrangement of the accommodation:β 1. Two rooms in the observation block for Typhoid patients. 2. The third room for observation purpose. 2 beds. 3. Present Pavilion A for Diphtheria. 14 beds. 4. Present Pavillion B for convalescent Scarlet Fever and discharge purposes. 14 beds. 5. An additional Pavilion of 36 beds for Scarlet Fever cases. 2βAdministration Block. Before considering the kind of building which we suggest for this additional pavilion, it may be well to discuss the accommodation for the staff. For a Hospital of 70 beds, accommodation should be provided for a nursing staff of 15 and a domestic staff of 10. |
90ed0cc4-74b2-4e0c-98e9-f925b021cf0a | At the present time the administrative block is barely sufficient for the present pursing and domestic staff, 49 The accommodation is made up as follows :β A. Basement. 1. Kitchen. 4. Servant's sitting room. 2. Scullery. 5. Attendant's bedroom. 3. Housemaid's pantry. 6. Partitioned off Dispensary B. Ground Floor. 1. Waiting room. 3. Matron's room. 2. Committee room. 4. Nurses dining room. C. First Floor. 5 bedrooms, linen room and 2 bath rooms. D. Second Floor. On this floor are 7 rooms, 6 of which are used as bedrooms, and the seventh is a small room used as a store room. |
df561422-5d27-4c0a-94bf-02b48e452e8a | Of the 6 used as bed-rooms, all have sloping roofs, and 5 of them have a maximum height of only 6 ft. 6 ins., and the roofs slope down to a height of less than 3 ft. It will at once be appreciated that these do not conform to the requirements of a healthy bedroom. The sixth bedrcom also has a sloping roof with a height varying from 5 ft. 6 in. to 8 ft. If the Hospital be extended, the present administrative Block will be inadequate, and the present building is very difficult, if not impossible of extension. The Committee will probably have to decide between (a) taking down the present building and erecting a new Administrative Block (b) erecting a separate building for the accommodation of the increased staff. The former alternative is worthy of the serious consideration of the Committee, as being ultimately the more economical and efficient course to take. |
c12e83bf-9d0c-41df-8f71-20e19f7aa1c0 | The present administrative block is not a suitable one for the purpose. It is an old dwelling house, the repair and maintenance of which will mean a considerable and an increasing annual outlay. The number of bedrooms is too small, and in size some of them are too large. At the present time, 3 of the nurses sleep in one bedroom. The kitchen, for working purposes, is an underground one, and this, of course, necessitates additional labour. Almost every time the telephone rings, one of the domestic staff has to run up a flight of stairs. 50 The rooms on the second floor are damp. In the winter the walls reek with moisture and fires have to be occasionally lit in them. These are only some of the disadvantages, which obviously entail extra expense in the upkeep of the present building. On the other hand, the initial expense of entirely rebuilding will be greater than that of a separate smaller building. |
23694f18-1eb4-4a05-9795-3c752d884095 | But which plan would entail the least annual charge, should be carefully enquired into by the Committee. 3. The Hospital Pavilion. The following suggestions outline briefly the character of the accommodation which should be provided in the pavilion. It should provide accommodation for 36 beds. A separation ward should be provided leading out of the main wards. A bathroom should be provided for each ward with two baths in each room. The walls should be ceiled at the level of the wall plate, as otherwise it is impossible to avoid dust. The walls up to a height of 9 ft. should be covered with some impermeable material, such as Keen's cement. The inlet ventilators should be so arranged that they can easily be cleaned. The hall should be arranged so as to provide cupboard accommodation for the ward linen. There should be a ventilated cupboard for keeping food. |
ab8e7b9e-ae5a-430c-893d-e703a28c15df | The sanitary appliances should be in an annexe at the end of each ward; in each such room one sink should be provided for flushing bed pans and connected directly with the drain. The question of providing hot water should be considered. It would probably be more economical to obtain the hot water for the three blocks from one boiler. At the present time, the hot water for the baths is obtained from a small boiler in the nurses' kitchen. Such an arrangement would be extravagant, if not impossible, for a pavilion of 36 beds, and it might be better to provide one boiler for the three blocks." The recommendations in the report were adopted by the Committee, and the Surveyor was instructed to prepare plans for the 51 erection of another pavilion. These plans have been prepared and approved by the Council. REFUSE DESTRUCTOR. The year 1908 marks the close of the old method of Refuse Disposal. |
6bfad870-f018-4e18-b63c-9e4cb154a9b3 | The Refuse Destructor was completed in February 1909, and all the refuse will in future be burnt. The question of disposing of the town's refuse without creating a nuisance has been before the Council for about 15 years, and during this period the refuse has been tipped on part of the surplus land near the Cemetery. The refuse heap had become so large and obnoxious that in 1907 the Council entered into an agreement with a local brick company to receive and burn the refuse at is. per load. This arrangement was not entirely satisfactory. The company was not able to burn all the refuse as it was collected, and a large heap accumulated near the works. The following description of the Refuse Destructor, together with a history of the scheme has been kindly supplied by Mr. Yorath, the Chief Assistant Engineer to the Council. The question of destroying the town's refuse by burning was first mooted in 1894, and after careful consideration, it was decided to erect a destructor. |
1fbdd220-6963-4f40-ac42-4c07b64066d5 | The original intention was to erect a combined refuse destructor and electricity works on surplus land at the Council's Sewage Works. Tenders were invited, and that of Messrs. Beaman and Deas was accepted. Before the contract could be sealed, a decision was given in the High Court which closely affected the scheme. In the case of Lord Jersey v. Hanwell District Council it was held that land bought for a specific purpose could not be used for another. In the circnmstances, this scheme was abandoned. The next scheme was for the erection of a Refuse Destructor alone, on a portion of the Friar's Estate, but this site was objected to so strenuously that it was deemed advisable not to proceed with that scheme. The Council then obtained Parliamentary powers for the purchase of land adjacent to the Sewage Works on which to 52 erect a destructor. |
76505065-3cb0-4262-b3ae-e558f8dace33 | This was successfully accomplished, but some time elapsed before tenders for the building, &c., could be obtained, and in the meantime an elementary school had been erected on the adjoining land. At the Local Government Inquiry a most strenuous opposition was offered to the erection of a dust destructor on that site. Opinion on the Council was so evenly divided as to the desirability of proceeding with the scheme, that the Local Government Board refused its sanction. The Council then bought the land upon which the destructor has been erected, and the site is in some respects almost an ideal one. The land is a portion of a brickfield, and a considerable area of it had been excavated to a depth of 20 feet. Inclined roadways to the tipping platform were consequently avoided. The Destructor is provided with 8 top charging cells, with drying hearths. Each cell is capable of destroying 18 tons of house refuse per 24 hours. |
bab7dd58-4eee-4488-9e50-6aeda7225eeb | The temperature of the gases in the combustion chambers is to be readily maintained at 2,000 degrees Fahr., and the total residum left after burning the house refuse is not to exceed 27 per cent. by weight of the refuse consumsd. INQUESTS. 26 inquests were held the cause of death being :β Accidental burns 5 Overlaying 2 Fracture of skull 2 Run over by a cart 1 Coal gas poisoning 1 Ptomaine poisoning 1 Injury at birth 1 Heart disease 7 Childbirth 1 Weakness from birth 1 Improper feeding 1 Gastric ulcer 1 Apoplexy 1 Alcoholism & Morphinism 1 MORTUARY. Twenty-six bodies were deposited in the Mortuary and 17 postmortem examinations were made. OFFENSIVE TRADES. Only two offensive trades are carried on within the districtβfatextraction and the manufacture of a chemical fertilizer. |
f8e9e045-2d00-4bd3-8b10-b9cc7897dfe1 | 53 SLAUGHTER HOUSES. There are two licensed and two registered slaughter houses in the district. COMMON LODGING HOUSES. Two Common Lodging Houses are registered annually in the district and there was no addition to the number last year. These two houses have accommodation for 150 lodgers. DAIRIES AND COWSHEDS. There are 2 cowkeepers and 76 purveyors of milk on the register. There were 19 changes of occupation, and 14 new premises were registered. SEWAGE DISPOSAL. The sewage and disposal works carried out for the purpose of giving effect to the provisions of the Acton Sewage of 1905 have now been completed. The reasons which led to an application to Parliament have been given in a previous report and it is not necessary to go over that ground again. |
c4503174-c899-45d6-81c3-3100fe0dc6b5 | Clause 33 of the Act fixes the amount of sewage which will be received by the London County Council, viz., an average of 50 gallons per head per diem of the population and a maximum rate of flow of 100 gallons in the 24 hours. Clause 21 gives permission to discharge storm water into the River Thames, and places upon the Acton Council the obligation of discontinuing the discharge of the same into the sewers of the London County Council. Clause 36 was inserted for the protection of the Chiswick District Council and it provides that storm water up to a flow amounting to 125 gallons per head per diem must be screened and passed through filter beds 4 feet deep and 2| acres in area. The result of the Sewage Act of 1905 will be that all the sewage will be taken out of the district immediately. |
324130be-75b8-45eb-9544-fb603b3e3e78 | In ordinary circumstances the sewage will pass directly into the Metropolitan Sewers, and in cases of storm the overflow will be filtered and emptied into the Thames. 54 FACTORY & WORKSHOP ACT, 1901. The number of Workshops on the Register at the end of 1908 was 394. During the year 22 new workshops were registered. The inspection of Factories comes mainly within the province of H.M. Inspector of Factories. The enforcement of Scction 22 of the Public Health Amendment Act, 1890, is entrusted to the local authority. Where any sanitary defects is discoveted by H.M. Inspector in a Factory, which is remediable under the law relating to public health, and not under the Factory and Workshop Act, he informs the Council of the defect, and it is the duty of the Council to arrange for the remedy of the defect. Twelve references from H.M. |
b76f774c-ea22-4ae9-8569-f90466b2e1e8 | Inspector were received during the year, and particulars of the defects found and remedied will be found in the Home Office Table. LAUNDRIES. On January 1st, the Factory and Workshop Act of 1907 came into force. From a sanitary point of view its most important provisions relate to domestic laundries. Under Section 103 of the Factory and Workshop Act of 1901, if the laundries were worked by members of the family, or with the assistance of not more than two persons from outside, they were excluded from the Act. Section 103 of the Act of 1901 is now repealed, and if any person from outside is employed, the house is deemed a workshop. |
27271547-26c9-4eac-bca7-591eba99b1f3 | If the work is carried on by members of the same family, Section 114 of the Act of 1901 applies, and the premises are not exempt from the provisions of the Act, which apply to domestic workshops, unless the labour is exercised at irregular intervals, and docs not provide the whole or principal means of living to the family. The provisions of the Factory and Workshop Act of 1907 were advertised by the Council, but only three domestic laundries have been registered during the year. The provisions of the Act are of the greatest importance, and the danger of spreading infection is far greater in the domestic laundry than in the factory laundry. In the former the clean and dirty linen comes into close contact in the narrow passage and in the other parts of the house, and there is every opportunity for infection to be conveyed from one article to another. The actual washing is 55 done in some small outbuilding, reeking with steam and in an atmosphere loaded with all forms of impurity. |
1555b49a-179f-45ff-965a-bb3e18fa9562 | The conditions are very different in the large laundry. Although infection may reach the latter, and some of those who sort the foul linen may contract the disease, the temperature in modern rotary machines is sufficiently high, and thorough treatment is carried out for a sufficiently long time to sterilize the linen. In a laundry properly planned and built for the purpose, the sorting room, where the foul linen is received, and the packing room, where it is put into hampers for delivery are distinct. They are frequently separated by the whole length of the laundry, so that the risk of direct infection conveyed from the foul to the clean linen is practically non-existent. I have to thank the staff of the Health Department for assistance throughout the year. The County Council Tables have been compiled entirely by Mr. Kinch. The year has been an arduous one, and I regret that the strain has told upon some members of the staff. |
734c2ed8-f20a-4ca0-b906-f4e083fac501 | Miss Williams had to resign owing to a break down in health Miss Stevens was prcmoled, but the secured a iimilar appointment under the Metropolitan Borough of Lewisham. Miss Bhose was appointed Assistant Health Visitor, and on the resignation of Miss Stevens was promoted to the Senior post. Mr. Fearns also suffered a break down in health in July, and was off duty during the rest of the year. In April, 1909, he sent in his resignation. Mr Arthur Thomas was appointed to Mr. Fearns' post, I may express the sincere regret which these resignations have caused. I remain, Your obedient servant, D. J. THOMAS, 56 Table 1. VITAL STATISTICS OF WHOLE DISTRICT DURING 1908 AND PREVIOUS YEARS. Year. Popula- iion estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. |
6a356529-20a8-43e8-b752-452e4278d847 | Deaths of Non-Residents registered in Public Institutions in the District Deaths of Residents registered in Public Institutions bevond District. Nett Deaths at all Ages belonging to the District. No. Rate.* Under 1 Year of age. At all ages. No. Rate per 1,000 Births Registered No. Rate.* No. Rate.* I 2 3 4 5 6 7 8 9 10 11 12 13 1898 33,404 995 29.8 181 182 507 15.2 . . . . . 1899 34,901 1,068 30.6 200 187 509 14.6 . . . . . 1900 36,508 1,080 29.5 182 168 528 14.4 15 . . . . 1901 38,373 1,211 31, |
542aa6b4-8b13-48b6-93ed-1e9581012c9b | 5 206 170 5'9 13,5 6 . . . . 1902 41,000 1,242 30.3 186 150 593 14,4 12 . . . . 1903 43,802 1,422 32,4 150 105 430 9.8 8 . . . . 1904 46,780 1,450 30 207 143 576 12.3 9 . . . . 1905 50,000 1,527 30,5 162 106 537 10.7 27 1 92 628 12.5 1906 52,000 1,533 29.4 193 125 597 11.5 29 7 97 687 13.2 1907 53,000 1,535 29 183 119 605 11. |
dd8d5746-3c71-49f9-9e1e-3e4dc99fa70f | 4 25 8 140 737 13.9 Averages for yrs 1898-1907 429,768 13,063 30.4 1,850 141 5,401 12.6 . . ... .. ... 1908 55.000 1,568 28.5 174 111 592 10.8 31 1 133 724 13.1 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Total population at all ages, 37,744. Number of inhabited houses, 6,114. Average number of persons per house, 6.2. Area of District in acres (exclusive of area covered by water) 2,304. 57 Table 2. VITAL STATISTICS OF SEPARATE LOCALITIES IN 1908 AND PREVIOUS YEARS. ACTON. 1906. 1907. |
4d309997-d732-4bac-bd2a-b75bc37e8e4f | 1908. Population estimated to middle of each year 52,000 53,030 55,000 Births registered 1,533 1,535 1,568 Deaths at all Ages 687 737 724 Deaths under 1 year 201 200 188 NORTH-EAST WARD. Population estimated to middle of each year 13,000 13,500 14,000 Births registered 325 331 363 Deaths at all Ages 37 53 145 Deaths under 1 year 32 31 30 NORTH-WEST WARD. Population estimated to middle of each year 11,000 11,500 12,000 Births registered 229 213 215 Deaths at all Ages 135 105 124 Deaths under 1 years 34 23 26 SOUTH-EAST WARD. |
ec599f11-13eb-411b-904e-8694c615d561 | Population estimated to middle of each year 11,000 11,000 12,000 Births registered 255 320 328 Deaths at all ages 122 120 124 Deaths under 1 year 28 32 29 SOUTH-WEST WARD. Population estimated to middle of each year 17,000 17,000 17,000 Births registered 724 671 662 Deaths at all Age 293 347 331 Deaths under 1 year 107 114 103 58 Table 3 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1908. Notifiable Disease. Cases notified in whole District. Total cases notified in each ward. Number of cases removed to Hospital from each Ward. At all Ages At AgesβYears. North-East. North-West South-East. South-West North-East. North-West South-East. South-West Total cases removed to Hospital. Under 1. |
0014b70f-ac0f-4fc6-bf72-364e9d42c5b9 | 1 to 5. 5 to 15 15 to 25 25 to 65 Small-pox . . . . . . . . . . . . . . . Cholera . . . . . . . . . . . . . . . Diphthera (including Membranous croup 83 1 33 39 6 4 17 14 18 34 10 10 15 23 58 Erysipelas 35 1 2 . 6 26 8 4 5 18 I . . . 1 Scarlet Fever 484 . 111 317 39 17 76 48 152 209 56 34 107 193 390 Typhus Fever . . . . . . . . . . . . . . . Enteric Fever 14 . . 3 3 8 3 4 1 6 1 3 . |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.