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373fed13-c8ae-4545-bbe6-b892ace1ead7 | 3 37.1 43.2 43.6 45.7 44 INFANTS.—BOYS. South Acton 115 36 33 38½ 38 40½ 38½ 42 39½ 41 38 Roman Catholic 19 35 31½ 39½ 37¼ 42 38½ 44½ 44 42¾ 40½ Priory 95 36½ 31½ 38½ 35 37½ 37¾ 43 41 45½ 45½ Beaumont Park 93 37 32½ 38¾ 35 41½ 39 41 40 41 400 St. |
804b0c2e-7dc2-4642-9789-4ee1d7414356 | Mary's 40 37¼ 33½ 38½ 35½ 40¾ 39½ 43 42¾ 44 47 Southfield Road 117 30½ 33 40 36 42 38½ 44 42 45 43 Central 73 37½ 33½ 40½ 36½ 42¾ 39 45½ 46½ 46¾ 44½ Rothschild Road 77 38 33¼ 39* 35¾ 43 40¾ 43½ 45½ 45½ 46 East Action 20 . . 39¼ 35¼ 41¾ 41½ 44½ 40½ 48 47 Willesden junction 23 37¼ 34 39¾ 37 41 39¾ 43½ 43¾ 46 48 101 The numbers are too small to draw any definite conclusions, but taken in conjunction with the inquiry made into the question of underfed children, |
17dfa4de-a80c-45b7-8b77-225c60223619 | the figures are significant. At almost all age periods the children in the South Acton, Priory, Roman Catholic and Beaumont Park Schools are below the weight of the children in the other schools of the district. Last summer 86 children were selected by the teachers in the schools as being badly nourished. These children were weighed at intervals, and it was found that 26 of them were below the normal weight, and had not increased in weight during the 3 months they were under observation. Out of the 26, in 19 of them poverty was the probable cause of the malnutrition. To find out the real state of affairs with regard to the underfeeding of children attending elementary schools is an almost insoluble problem. Teachers, as a rule, have a fairly intimate acquaintance with the home circumstances. Each teacher in his own class has a good idea, inasmuch as he knows that certain children turn up at school, either looking pinched and pale, or very neglected. |
00b5e3ea-f3f3-4b45-a9c0-e5f4f375fd3b | The child bears in his own person some evidence that the home is not altogether what it might be. But in dealing with a large number of children, it is difficult to separate completely the robust from the delicate, and still more difficult to detect those who are slightly under-noutished, and whose home conditions upon enquiry are found to be deplorable. Poverty probably is the most common cause of the malnutrition in the children attending the Beaumont Park, Priory, Roman Catholic and South Acton Schools, but it does not account for all the cases. Improper and injudicious feeding is common, and though not restricted to the poorer classes, would seem to be more frequent among the children attending these schools. Out of the 26 children mentioned above, in 7 instances the parents were earning good wages and in constant employment, but in most of the cases the mother was employed in some work which took her away from her home. Habitual use of improper food produces every evidence of malnutrition. |
b7ad7fd0-5408-461d-8d40-c74fd486faa2 | Among the social factors peculiar to the district, the occupation of the parents, which has a bearing direct or indirect upon the children's health, must be considered. 162 In Acton at the census of 1901, there were 2488 women employed in the laundries of the district. The number has considerably increased since then. There are at the present time 93 factory laundries registered and 230 workshop laundries. In addition, about 300 women are employed as homeworkers. It is probably no exaggeration to state that 3500 women are employed in the laundry industry alone, and of these about 1500 are married women or widows. From enquiries made, it may be stated that one third of the married women in the S.W. ward are employed in laundry work. |
df072744-691b-4a9e-a366-9f136da5e880 | These women are occupied in this employment, not from choice, but from necessity, but as a result it follows that a large number of infants are artificially fed, often on tinned milks deficient in fat or on preparations of various foods. In South Acton a Creche has been established since January 1908 which will accommodate about 24 children. It is too soon to fully estimate the value of the institution, but within a few weeks of its establishment, children had to be refused because all the beds were occupied. In the S.W. ward alone, there are about 200 babies under 12 months of age placed out with neighbours during the day, and the conditions under which they are cared for is extremely unsatisfactory. Children placed in these circumstances cannot tail to show signs of their faulty upbringing when they reach school age, and it was found that a higher percentage of children attending South Acton Schools suffered from rickets than in any of the oiher schools of the district. |
8233eaa8-ef80-453f-aa6a-2eaeaf816683 | The ill-effects due to the employment of the mothers does not end with those attending the Infants' Departments. As so many of the women work in the laundries it follows that many of the school children do not obtain a proper meal in the middle of the day, either because the mothers do not come home, or because they have not time or energy to prepare a meal. The children are often given coppers to buy food which they spend on attractive but unwholesome material, and thus acquire a habit of passing over wholesome food which is not tasty. In this district poverty, and to a minor degree married female 103 labour, are probably the most common causes in the production of malnutrition. In the one case, the diet is insufficient, and in the other, it is improper. In both, null ition is affected, and every endeavour should be made to improve the knowledge of correct feeding, and to direct attention to instances of inadequate feeding. |
01d46e02-4137-40c4-b977-f5c9fcb516b3 | In the Report of the Royal Commission on Physical Training occur these sentences: "We consider that the question of the proper and sufficient feeding of children is one which has the closest possible connection with any scheme which may be adopted for the physical, and equally for their mental work. It is evident that among the causes which tell against the physical welfare of the population, the lack of proper nourishment is one of the most serious. The subject demands special notice, not only as regards the existing state of affairs, but still more in view of any increase of physical training, throughout the State-aided Schools which may commend itself. We are aware of the danger of further encroaching upon the independence of parents, and of entering upon the wide question of how far the State should go in relieving them of their primary responsibility. But we are not on that account deterred from calling attention to the necessity for better feeding, which, in our opinion, has been fully demonstrated, nor from considering a practical remedy. |
21af01ef-b823-43d4-94a2-1967dfd03c58 | We have no desire to give encouragement to any inclination of the parent to abandon any of his duties and responsibilities in regard to the feeding and clothing of his children; but it must be remembered that, with every desire to act up to their parental responsibility, and while ready to contribute in proportion to their power, there are often impediments in the way of the home provision of suitable food by the parents. The proper selection, cooking and preparation may often be a matter of serious difficulty to many parents." The matter has attracted the earnest attention of the Education Committee, and as a result of the inquiries made locally the Provision of Meals Act 1906 has been adopted. Physically and mentally defective children, In May 1908 an enquiry was made as to the number of school children in ihe district considered either physically or mentally defective. Lists were obtained from the teachers of those children whg 104 were considered unable to obtain educational advantage from the ordinary work in the School. |
3e3e9e39-2fc7-403e-a9aa-f944fb0fa4b8 | Sixty-two cases were reported and 56 of these children were specially examined. The examination either took place at the school or in the homes of the children. Those cases which by reason of physical or mental defect were unable to attend school were visited at home and there examined: special enquiry being made to discover what medical treatment the child had previously undergone, and what arrangements (if any) were being adopted by the parents for the education of these children. Briefly, the children may be classified as follows:— a. Very backward 23 b. Mentally defective 9 c. Imbecile 6 d. Infantile paralysis 4 e. Infantile paralysis and epilepsy 2 f. Defect of vision 2 g. Epilepsy 1 h. Deafness 1 i. Dumbness 1 j. Microcephaly 1 50 a. Backward The 23 backward children show variations from a slight deviation from the normal to a condition closely approaching the mentally defective. |
3cc18e94-5c9a-424e-97f2-6947ef885d67 | Their ages vary from 6 to 13 years. Many of the children are about 3 years behind the normal development to be expected from their age, and remain in the same standard nearly 2 years. They are not specially troublesome in class but make very little progress and are a source of much difficulty to the teachers. b. Mentally defective By this term are included those who to some extent fail to reach a certain level in the general summation of mental qualities. 105 The class is a wide one, and presents many shades of difference, ranging from the most backward children to those who appear slightly imbecile. Ages vary from 6 to 14. The nine children examined are at present all attending School. The highest standard reached was Standard III in the case of a boy of 14, but his mental attainments were not typical of this class. c. Imbeciles. |
ee6725eb-a02d-4474-a673-5df6fadcdb98 | Are those individuals whose mental powers are at present beyond the reach of reason and appear likely to remain so. Among the imbecile children examined, four would be unable to attend any school, two children might possibly obtain benefit from special schools. d. Infantile Paralysis. One case examined is unsuitable for school, another child might obtain benefit from a school for the physically detective. e. Infantile paralysis and epilepsy. One child has such frequent fits that school is impossible, another has had no fits for two years, and the paralysis is improving, but the child is mentally defective. f. Vision One of the two children with defective vision is unable to attend school as an operation will be necessary during the next six months. The second child is suffering from a high degree of astigmatism and the parents have been urged strongly to take the child to a hospital to obtain glasses. |
72411507-4718-459a-8663-0e8687826d1c | Special arrangements were made to have the child seen at Moorfields Eye Hospital, but so far the parents have not availed themselves of the opportunity. g. Epilepsy. The child examined is attending school as the fits do not occur too frequently to make school attendance inadvisable. h. Deafness- The child who is deaf speaks much better than is usual with completely deaf children, and therefore would not gain much benefit from an ordinary school for the deaf. 106 i. Dumbness The child who is dumb, has never been to school but is somewhat mentally weak. A special school might produce some improvement. j. Microcephalv This child was unsuitable for school attendance. The Committee asked for a further report on these children showing what classification should be suggested for their education in special classes or schools. Roughly, the following classification might be adopted:— 1. Those who might remain in an ordinary school—26 cases. 2. |
1a09d85a-3008-449c-97dc-0a4f4b0af824 | Those for whom a special school is advisable—8 cases. a. Mentally defective 5 cases. b. Physically defective 3 cases. 3. Those for whom a special class is advisable—14 cases. 4. Those unsuitable for any school—8 cases. At present it has not been found possible to arrange a special class for backward or mentally defective children though in some ways this would be a great advantage. In favour of the special class are the benefits derived from the greater individual attention which the pupils would obtain, and there is a tendency for the pace of the rest of the class in an ordinary school to be slackened in order that the backward children may keep abreast of the others. On the other hand the association of the backward children with the brighter ones undoubtedly tends to sharpen the wits of the former. Deaf children in the district are sent to the L.C.C. school for the deaf in Ackmar Road. |
70c4ba4c-e05f-4585-8941-5be74aa4f0fa | They are conducted to school and fetched from it by a guide, and at present six Acton children are attending this school. Blind children are provided for in a similar manner to those who suffer from deafness, and attend the Blind School in Edinburgh Road. No children from the district are now in attendance, but arrangements are being made to take a child from Beaumont Park Girls' School who is suffering from progressive myopia in a high 107 degree. Two other blind children are being kept under observation, but they are young children receiving medical treatment, and a special school is not necessary at present. Physically defective Children Are sent to the special school at Brook Green, arrangements being made for their safe conveyance to and from school. At present no children from the district require this method of education. Epileptic Children No children suffering from fits are in attendance at a special school. Examination of Teachers Eleven candidates, who desired to become pupil teachers were medically examined since May 1908. |
4b98a971-2566-4ba4-9db5-f55479eafda2 | Of these 10 were passed and 1 postponed. This candidate was passed on a subsequent medical examination. Twenty-two teachers have been examined on appointment to schools in this district, 21 of these were passed and one was rejected on account of defective health. A record of each physical examination together with the family history of the candidate is entered on a card and filed for subsequent reference. This method has been found useful, when for various reasons, it is necessary to make a second examination. Special examination of Teachers One teacher has been examined as the Committee required a special report concerning her health. 108 SWIMMING. During Season of 1908, 16 Swimming Classes were held during School hours and 8 out of School hours. Total 24. School.3e Classes per week. Total No, of Scholars who have attended the baths during the season. Total No. of attendances made during the season. No of Scholars in the School who can swim No. |
d7e19d9a-3a27-47c5-9b5e-246cea5f9c43 | of Scholars who have learned to swim this season. Acton Boys 1 24 182 13 6 Beaumont Park Boys 3 104 951 57 38 Beaumont Park Girls 1 39 402 5 3 Central Senior 5 128 1,800 82 31 Central Junior 3 100 1,440 36 26 Priory Boys 4 131 1,173 57 49 Priory Girls 1 44 368 12 10 South Acton Senior Boys 2 45 990 38 28 Southfield Rd. Senior 2 119 990 49 30 Willesden Junction 2 35 490 20 12 Totals 24 769 8,786 369 233 In conclusion we beg to thank the staff of the Education Depart ment and the teachers for the assistance we have received, not only in compiling this report, but also in the work of medical inspection. |
0904d3ea-5b22-472a-abc5-5fda03c4a918 | We remain, Your obedient servants, D. J. THOMAS. L. E. WILSON. Woodgaths' Electric Printing Works, Strafford Road S. Acton. |
66ee4a88-f2db-40af-aa28-952367305146 | 1 Urban District of Acton. ANNUAL REPORT OF THE Medical Officer of Health TOGETHER WITH THE REPORT ON THE Medical Inspection of Schools FOR THE YEAR 1909 . BS X 1/ 18 Act 17 1 Urban District of Acton. ANNUAL REPORT % OF THE Medical Officer of Health FOR THE YEAR 1909 2 By the Order of the Local Government Board, dated March 23rd, 1891, article 18, section 14, it is prescribed that the Medical Officer of Heath shall make an Annual Report to the Sanitary Authority, up to the end of December in each year, comprising a summary of the action taken, or which he has advised the Sanitary Authority to take, during the year, for preventing the spread of disease, and an account of the sanitary state of his district generally at the end of the year. |
6bc57533-32a5-4935-8832-1410cd8189cd | The Report shall contain an account of the inquiries which he has made as to conditions injurious to health existing in the district, and of the proceedings in which he has taken part or advised under any Statute, so far as such proceedings relate to those conditions; and also an account of the supervision exercised by him, or on his advice, for sanitary purposes, over places and houses that the sanitary authority have power to regulate, with the nature and results of any proceedings which may have been so required and taken in respect of the same during the year. The Report shall record the action taken by him, or on his advice during the. year, in regard to offensive trades, to dairies, cowsheds and milkshops. The Report shall also contain tabular statements (on Forms to be supplied by us, or to the like effect) of the sickness and mortality within the district, classified according to diseases, age and localities. In a memorandum issued by the Local Government Board. |
7e253c6b-3703-4e86-861e-0901bf46acfc | in November 1908, it is recommended that the Report shall deal with the extent, distribution and causes of disease within the district; and should give an account of any noteworthy outbreak of epidemic diseases during the year under review, stating the result of investigations into their origin and propagation, and the steps taken to check their spread. As these Reports are for the information of the Local Government Board, and of the County Council, as well as of the Council of the District, a statement of the local circumstances and a history of the local sanitary questions which may seem superflous for the latter, may often be needed by the former bodies. Under section 132 of the Factory and Workshop Act, 1901, the Medical Officer of Health is also required in his Annual Report to report specifically on the administration of the Act, in workshops and workplaces, and to send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State. |
9cf67299-4b41-4a37-8c34-8442501b5db3 | ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 19O9. To the Chairman and Members of the Acton Urban District Council. Gentlemen, I have the honour to submit to the Council a report on the sanitary conditions of the district, together with the vital and other statistics for the year 1909. The population lias been estimated at 56,000. The death-rate was again lower than that of the preceding year. The death-rate amongst infants under 12 months of age was also lower. There is another extensive epidemic of Measles to be recorded, which accounted for 40 deaths. The outbreak of Scarlet Fever which commenced in 1907 and had continued throughout 1908, shewed 110 signs of abatement until the autumn. A considerable drop occurred then with the result that the number of notifications is slightly lower than in 1908. Diphtheria was more prevalent and together with Membranous Croup accounted for 22 deaths. |
6806951a-1220-4a04-829f-5524f06c1dae | The district was remarkably free from Enteric Fever, only 4 notifications being received. The Zymotic death-rate was the same as in 1908. The death-rate from Phthisis and other Tubercular diseases was lower. Changes in the Staff have to be recorded. 4 Mr. Fearns resigned in April owing to ill-health and Mr. A. Thomas was appointed to his post. Miss Stevens resigned in January to take up a similar post in Lewisham. Miss Bhose, the Assistant Health Visitor, was promoted, but resigned in August owing to ill-health. Miss Cooksey has been appointed Health Visitor. In lieu of an Assistant Health Visitor the Education Committee appointed a School Nurse, and Miss James was appointed. Owing to a re-arrangement of the Staff in the Surveyor's Department Mr. Brooks has been assisting in the Health Department, and has carried out a house-to-house inspection in the South West Ward. |
5a8d7bc1-17c0-45a5-b055-8f6995308b4a | The following is a summary of the vital statistics for the year:— Estimated population, 56,000 inhabitants. Birth-rate, 26.4 per 1,000 inhabitants. Death-rate, 126 „ Infantile Mortality, 106 per 1,000 births Zymotic Death-rate, 2.2 per 1,000 inhabitants. Phthisis Death-rate, .87 „ Death-rate from other forms of Tuberculosis, .32 per 1,000 inhabitants. Respiratory Death-rate excluding Phthisis, 2.2 per 1,000 inhabitants. POPULATION. Of the various methods of estimating the population of a district in any particular year, the most reliable in the case of Acton is based upon the number of new houses erected during the year. But even this method is liable to a considerable error. The number of inhabitants in each house rose from 5.9 at the census of 1891 to 6.2 at the census of 1901. |
a8dae0fd-4e8f-46d7-ac6a-4fe9d617b23f | This increase was not due to larger families, but to the conversion of houses formerly occupied by one family into flats. To 5 what extent the process is still going on it is difficult to estimate, but it is possible that the next census will reveal a still higher average number of persons to each house. On the other hand, the percentage of empties is higher at the present time than in 1901. Between July 1st, 1908, and June 30th, 1909, 187 new dwelling houses were completed and occupied. An average of 62 persons per house would represent 1159 inhabitants. The estimated population for 1908 was 55,000, and the estimate for 1909 has been placed at 56,000 inhabitants. Nearly nine years have now elapsed since the official census was made, and the further we are removed in time from that census until the next, the more inexact our estimates become, and the less reliable are all vital statistics. |
8912c068-f83e-46cb-b0d7-1f9c03234601 | It has been repeatedly urged that a more frequent enumeration should be made, and it is hoped that the Census Act of 1910 will provide for a quinquennial census. A quinquennial census appears especially necessary for places like Acton. When the census of 1911 has been made, it will be assumed that the increase since 1901 has been uniformly distributed throughout the 10 years, and the vital statistics for the intervening years will be based upon such an estimate. How incorrect that estimate will be is manifest when we consider that during the earlier 5 years the average yearly number of new houses erected and occupied was nearly 450, whilst during the later 5 years the number will probably not amount to one-half that total. BIRTHS. |
c124b52d-d18d-43b4-af21-130dc9894e84 | Number 1480 Rate per 1,000 26.4 Rate per 1,000 in England and Wales 25.6 Rate per 1,000 in 76 large towns 25.7 Rate per 1,000 in 143 smaller towns 24.8 6 There were 1480 births registered as having occurred in the district. This number corresponds to a birth-rate of 26.4 per 1,000 inhabitants. On Table 1 the birth-rates for the last 10 years are given, and it will be seen, on reference to the Table, not only is the birth-rate for 1909 the lowest on record, but that the number of births registered in 1909 is lower than that of 1905, 1906, 1907 or 1908. Except that the actual number of births is lower than in previous years, the experience of Acton is not different to that of the whole of the kingdom. |
b258fdfb-cb50-4a77-acfe-66dada937908 | The birth-rate is not usually considered within the realms of public health; and when a spurious delicacy does not deter one from an adequate discussion of it, it is the fashion nowadays to lament the decline in national fertility. Although the remedy is beyond the scope of a Sanitary Authority, it is important to ascertain the source from which the population is being recruited, and whether the recruits are likely to be fit or unfit. We know that since 1877 the birth-rate in this country has been steadily declining, and during the last 25 years the rate has undergone a decrease of nearly 20 per cent. It is not self-evident that the fact of a declining birth-rate is an occasion forgeet. It is too readily assumed that decrease of the birth-rate in this country is intimately connected with physical degeneracy, and this would be true if the decline were noticed only among the healthy and the thrifty. |
3f62a921-cdbe-436d-b420-eae568356ed1 | We are not concerned with the economical, political and other considerations, but we may inquire into some of the causes which are operative in bringing about a result as to the main value of which we suspend judgment. The Registrar-General has for several years in his Annual Report given a table showing the movement of the birth-rate in relation to the number of women living at procreative age periods in England and Wales. These results, as summarised in the Annual Report of 1907, are for 1876-1905 as follows:— 7 Birth-rate per 1,000 rate per 1,000 Female age 15—45 years. |
146e9e91-1578-4d5a-be46-27e6a51e029e | Females age 15—45 years 1876—1880 153.3 1891—1895 126.8 1881 — 1885 144.3 1896—1900 118.8 1886—1890 133.3 1901—1905 112.5 From this table it is clearly seen that the decline in the birth-rate is due to a diminished fertility of women capable of child-bearing. The same phenomena is observed in Acton, but since 1903 the diminution has been greater than in the rest of the kingdom. |
81b0b5a8-bffb-44c7-ac04-ee386adeb5ad | The following table gives the birth-rate per 1,000 females in Acton between the ages of 15 and 45 years:— 1901 113 1905 110 1902 107 1906 106 1903 116 1907 104 1904 112 1908 102 1909 94 When we turn to the Registrar General's statistics of illegitimate births, we find that in 30 years the birth-rate of illegitimates has declined from 14.4 per 1,000 unmarried or widowed females at procreative age periods in 1878 to 7.8 per 1,000 in 1907. The number of unmarried or widowed females at different ages is not obtainable for Acton, but the number of children born out of wedlock sensibly diminished last year, and the illegitimate birth-rate is low in view of the industrial The following table gives the illegitimate birth-rate for the last four years:— Number. 1 Rate per ,000 births. |
07f16b10-bd49-4366-b0e0-6d976e024bc8 | per 1,000 living. 1906 39 25 .7 1907 37 24 .7 1908 42 26.8 .76 1909 29 19.2 .52 8 Some small allowance must be made for the fact that the Union Infirmary is situated outside the district. So far as the general decline in the birth-rate is to be ascribed to this contributory cause it must be contemplated with satisfaction. In the last four years nearly one-half the illegitimate children born in Acton died before reaching the age of 12 months. Last year out of the 29 children born out of wedlock, five died before reaching the age of 12 months. These figures represent an infantile mortality of 172 per 1,000 births. In 1908 the infantile mortality amongst illegitimate children was 404 per 1,000 births; in 1907 480per 1,000; and in 1906 564 per 1,000. |
4393e81c-dd94-44e4-be99-b1d764ed3170 | Another factor that has operated in the production of a lower birth-rate is the higher age at which women enter into matrimony. Throughout the kingdom the average age at which persons marry is higher than formerly, and as a result the number of years spent by women of child-bearing age in wedlock has been proportionately diminished. As far as this directly affects the birth-rate there will be few who regret the loss resulting from a cause which has been accepted as a desirable change. These two factors, though, are not the most important in the reduction of the birth-rate. We learn from the RegistrarGeneral's report that the operation of these combined causes accounts for only 21 per cent. of the decline in the birth-rate. There are sufficient grounds for stating that during the past 30 years approximately 14 per cent. |
7645d54a-e5c7-4537-809c-37cc2fb3f97c | of the decline in the birthrate (based on the proportion of births to the female population aged 15—45 years) is due to the decrease in the population of married women in the female population of conception ages, and that over seven per cent. is due to decrease of illegitimacy. With regard to the remaining 79 per cent. of the decrease, although some of the reduced fertility may be ascribed to 9 changes in the age constitution of married women, there can be little doubt that much of it is due to deliberate restrictions of child-bearing. The fact is also significant that at the last Census period, 1900—02, the fertility of English wives was lower than that recorded in any European country, except France. It is this restriction of child-bearing among English wives which calls forth the fulmination of some class of people each time the Registrar-General makes a report, but a statistical phenomenon can in itself hardly ever be an object of approval or opprobium. |
d9a2ae9b-7cb1-474f-a212-5deb6b2827d8 | Upon the whole question of a falling birth-rate we are not inclined to express an opinion, but there is an aspect of it which is of interest to all hygienists, and to which attention might profitably be called. Everyone admits that a high infantile mortality is hygienically and economically unsound. Infantile mortality is an extreme expression of inefficient breeding and nurture. It is a phenomenon which can be measured in figures, but one of the causes of a high infantile mortality gives birth to other results, which, though less tangible and apparent, are as real and of more importance to the nation. The unaided mother of a family, even when she is fortunate enough to escape being a contributory wage-earner, can rarely do justice to the numerous progeny which she is capable of bearing. It may be admitted that the birth-rate in the North-West Ward is too low, but no one will argue that in the South-West Ward a still further reduction would be a calamity. |
5d560614-753d-4d1b-8b55-3350fdc4bbf5 | Last year the birth-rate per 1,000 of the population in the different wards was as follows:— North-East. North West. South-East. South-West. 228 17.6 26.7 37.4 With the exception of the South-East Ward, the birthrate in all the Wards has been steadily undergoing a reduction. In like manner. the infantile mortality in the three Wards was 10 lower than it has been since the district was divided into four Wards. In the South-West Ward the birth-rate has decreased from 42.6 per 1,000 in 1906 to 37.4 per 1,000 in 1909. If restricted child-bearing is compensated in improved mothering of a fewer offspring, and if smaller families mean a higher individual fostering and culture, a greater personal attainment and efficiency, most people will agree that the numeral decrease in the growth of the population will not be a high price for the purchase of so desirable a result. |
62e52e8f-b9b5-42e2-a449-c124f544e057 | The Ward distribution of the births was as follows:— North-East. North-West. South-East. South-West. 331 220 294 635 Compared with 1908, fewer births occurred in the NorthEast, South-East and South-West Wards. In the NorthWest Ward there were 5 births more than in 1908. Of the births registered, 754 were of males, and 726 of females. DEATHS. Number 706 Death-rate per 1,000 12.6 Death-rate per 1,000 in England and Wales 14.5 Death-rate per 1,000 in 76 large towns 14.7 Death-rate per 1,000 in 143 smaller towns 13.9 Although certain directions are issued as to the deaths that should be credited to a district, there is no uniformity of practice. |
bf220f36-3b7a-4b10-bb41-5ea449f52e67 | In the notes attached to the Local Government Board Tables it is stated that all deaths of residents occurring in public institutions, whether within or without the district, are to be included among the deaths of the district and in the columns for the several age-groups, and in their respective Wards according to the previous addresses of the deceased as given by the Registrars. 11 Deaths of non-residents occurring in public institutions in the district are in like manner to be excluded. By the term "non-resident" is meant persons brought into the district on account of sickness or infirmity and dying in public institutions there; and by the term residents" is meant persons who have been taken out of the district on account of sickness or infirmity and have died in public institutions elsewhere. The "public institutions" to be taken into account for the purposes of the Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. |
e06c1b69-8398-4d28-8217-cd79955a67f7 | These regulations do not include those who die before they can be removed to a public institution. For instance, if a man from an outside district is injured on the railway here and the injury is instantaneously fatal the death is to be credited to Acton, If on the other hand he can be removed to a Hospital before he dies the death is to be credited to the district in which he resided. Four deaths of persons living in an outside district occurred as the result of accidents received on a railway in Acton, and one other occurred in a tramcar. In the list of deaths of "residents" of Acton who had died outside the district are included two which occurred on the platform of Westbourne Park Station, one which occurred in a cab in a London Street, Marylebone, and two others which do not come within the category of public institutions receiving persons on account of sickness or infirmity. It is obvious that both classes should not be included in our list of deaths. |
2cc665cd-5b2a-4aec-b919-b988fb6ed239 | I have therefore excluded the five belonging to other districts, and retained those who died outside the district. Five hundred and seventy-six deaths were registered in the district; five of these are referred to in the preceding 12 graph. These five were non-residents, but who had not died in a public institution. One non-resident died in the Cottage Hospital. One hundred and thirty-seven deaths of "residents" occurred outside the district. The total number of deaths belonging to the district is 708, which corresponds to a death-rate of 12.6 per 1,000 inhabitants. It has been explained in previous reports that in order to compare the death-rate of one district with that of another it is necessary to make an allowance for the difference in age and sex constitution of the different districts. Females live longer than males, and a district containing a preponderance of women would show a lower death-rate, other things being equal. But the most important factor is the age-constitution of a population. |
c0aeea70-c730-44a5-ba9e-ffdd45aab034 | The tendency to death is greatest among persons living at the extremes of life—among infants and old people. The ages at death last year were as follows:— Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 65. over 65. 158 102 40 30 208 170 The Registrar-General has published a table of "factors" for all the large towns, &c., by applying which to the "crude death-rate" it becomes corrected for age and sex distribution, so that the "corrected death-rate" gives the death-rate of any place, calculated on the basis that the age and sex distribution in that place is the same as that for the whole country. Thus all "corrected" death-rates, being reduced to a common basis, may fairly be compared. The "factor for correction" for Acton is 1.04240. |
95acb371-8367-4a54-81de-448e8a890edf | If the "crude death-rate," 12.6, be multiplied by this figure, the "corrected" death-rate is 13.1. The corrected d?ath-rate for the 76 large towns is 15.6, and for the 143 smaller towns 14.5. 13 The death-rate is .5 per 1,000 lower than that of 1908, and 1.3 per 1,000 lower than that of 1907. There was a decrease in the number of deaths among infants under 12 months old, and among children between the ages of 1—5 years. There was an increase in the age periods, 5—15 years, and 15—25 years. Between the ages of 25—65 years, there was one death less than in 1908, and above the age of 65 years, two deaths more than in the previous year occured. |
6462fd88-177b-4269-8997-dcff830851da | The deaths of infants under 12 months are dealt with in a succeeding paragraph, but almost as important is the agegroup, 1—5 years. It will be observed on Table IV. that the mortality of children between the ages of 1—5 years is much lower than that of children under 12 months. The burden of disease in childhood falls most heavily and disproportionately upon the first two years of life. In the age-group. 1—5 years, the largest contributory causes of death are Measles, Pneumonia, Tuberculous Diseases and Membranous Croup. Measles and Whooping Cough accounted for 36 per cent of the deaths in this age-group, and 15 deaths occurred from Pneumonia. It is not sufficiently recognised how great is the annual mortality due to these conditions at this age-period, and how little improved sanitary conditions during recent years have affected any substantial reduction in them. But it is not the immediate effects of these diseases that are fatal. |
47aea960-e57e-4683-aaee-28d73c8450dc | They leave behind them the seeds of future ailments. The diseases which kill infants affect a still larger number of the survivors, leaving behind sequelae which so affect the tissues as to create a favourable ground or nidus for subsequent disease. Ward Distribution.— North-East. North-West. South-East. -West. 124 122 137 325 Based upon the estimated population of each Ward, the death-rate per thousand was:— North-East. North-West. South-East. -West. 8.5 9.7 11.4 19.1 14 The death-rate in the North-East, North-West and SouthWest Wards was lower than in 1908 and higher in the SouthEast Ward. On Table IV. will be found the number of deaths in each Ward from the different diseases, and it will be observed that the excessive mortality in the South-West Ward is due to those diseases which reflect the influence of social conditions upon the death-rate. |
abdf01d8-4c97-4b26-ae18-6401d4999da4 | There is an excessive mortality from all the common infectious diseases, and from Digestive diseases. Diseases of childhood would naturally be more prevalent in the Ward, but the number of deaths from such diseases as Measles and Diarrhoea is far greater than the age constitution of the Ward would warrant. Out of 40 deaths from Measles, 24 occurred in the South-West Ward; out of 22 from Diphtheria and Membranous Croup, 20 belonged to this Ward and no less than 36 out of 43 from diseases of the digestive organs. The results of the house-to house inspection of certain portions of the South-West Ward are given in a succeeding paragraph, and an amelioration of insanitary conditions would undoubtedly bring about a direct reduction in the excessive mortality of the Ward. But a reduced death-rate would reflect itself in the social conditions of the people. |
fedb467e-64f3-4b2b-b3d6-c9d9671bb563 | It is known that the poorest classes in our large towns suffer much more heavily from disease and loss of life than do the better class of artizans and wealthier classes. It does not follow that their poverty is the cause, although it may be granted that malnutrition produces disease. These classes may be poor through sickness. Any illness in a family adds to the expenses. A fatal illness, by removing the head of the household, frequently leaves the widow with a family for whom she is unable to provide and who are deeply injured in health and habits by the enforced absence of her care, as well as by physical privation. For a determination of the degrees of poverty prevailing in a community, and of the relative influence exerted by 15 different causes of impoverization, there is ultimately no other way than to make an investigation into the conditions of every household. |
193a0b75-b331-4d41-9e39-3c346bca4323 | This investigation, of course, has not been made in Acton, but from the facts obtained in the investigation of infectious diseases and of malnutrition in school children, it is evident that poverty is an important factor in the causation of an excessive mortality in the South-West Ward. As poverty deepens, the death-rate rises at every age-group. The diseases which respond most clearly to differences of social position are in childhood those in which the fatality depends most intimately on good nourishment and instructed care, and particularly diseases of the digestive and respiratory systems. As stated above, 24 out of 26 deaths from Diarrhoea in infants under 12 months occurred in the South-West Ward; from Enteritis, all the five deaths occurred there; from Pneumonia, 8 out of 17, and from Bronchitis, 9 out of 11. In later years it is lung disease which responds clearly and unmistakably to poverty. It is, however, Phthisis which shows the sharpest reaction and the widest differences. |
82521e46-4c2a-45ae-9a0d-c46bbbfa468d | More than one-half the deaths from Phthisis occurred in the South-West Ward. MEASLES. In 1909, 40 deaths were registered as due to Measles, 39 of these deaths occurred in Acton, and one in the Children's Hospital, Paddington Green. A glance at the history of the disease in Acton reveals some interesting points in its behaviour. With the exception of Diarrhoea, Measles has been responsible for more deaths than any two of the principal Zymotic diseases. Though it is the most prevalent of all children's diseases, and practically every child is susceptible to the disease, no satisfactory plan of campaign has yet been formed against it. Measles is one of the most difficult diseases to control, and the means adopted for its prevention have not, up to the present, 16 had the effect of steadily and continuously reducing the death-rate. |
85b3c084-2dfe-4fa2-ba9f-1e7917f72490 | During the third quarter of the last century there was a decided improvement, but this was followed by a serious rise towards the end of the century. The following table gives the annual number of deaths in Acton per 100,000 inhabitants, in quinquennial periods for the 25 years 1886—1906. 1882—1886 1887—1891 1892—1896 1897—1901 1902—1906 32.6 66.6 50.2 13.6 29 During the past three years the death-rate per 100,000 has been as follows:— 1907 38 1908 65 1909 71 From the year 1881 to 1902, the difference between epidemic and interepidemic periods was most marked. |
82eb3f90-0ba9-4af7-93bf-703c63eccee0 | The major epidemic years were as follows— 1885, with a Death-rate of 120 per 100,000 1889, with a Death-rate of 115 per 100,000 1892, with a Death-rate of 98 per 100,000 1896, with a Death-rate of 80 per 100,000 1902, with a Death-rate of 78 per 100,000 Since 1902 the death-rate has not in any year reached 75 per 100,000 inhabitants. But whereas the peak observed in epidemic years has become flattened, the trough in interepidemic years has become raised, so that the actual number of victims to the disease has not diminished. Following the major epidemic year of 1885, in 1886 the death-rate was only 10 per 100,000; there was a minor epidemic in 1887, and in 1888 there was no death from Measles. |
30db69f7-269d-4857-a372-93b1b408f3e0 | Following the epidemics of 1892 and 1902, there was no death from the disease in 1893 and 1903. There was a minor epidemic in 1900, followed by complete immunity in 1901, and preceded by a similar state of affairs in 1899. 17 Since 1903, not a single year has passed without a death from Measles, although the death-rate in 1905 was only 8 per 100,000 inhabitants. This altered behaviour of Measles is probably accounted for by the altered character of the district. Formerly it was a detached suburb. Now it is a part of London, and the opportunities for the introduction of a children's ailment from other districts are more frequent than formerly. The population is also of a more shifting" character, and the percentage of protected and unprotected children is not so uniform as it used to be. It is almost certain that we had to deal with two separate outbreaks during the year. |
a052a2ec-a80f-449e-9a6a-dfee5ccdfb27 | The first outbreak was limited to a few cases, and the introduction of the disease into the district can be traced with a fair degree of definiteness. A case of Measles, N. S., was notified from the South Acton Infants' School on December 16th, 1908. The child had been ill since December 11th, and the rash had appeared on December 14th. N. S. used to live in Bollo Bridge Road but had recently moved. In the same house at Bollo Bridge Road was another child, D. J., aged 14 months. D.J. attended the out-patients department of the Paddington Green Children's Hospital on November 19th. At the time, Measles was prevalent in the Western Boroughs of the Administrative County of London. D. J. exhibited symptons of Measles on November 28th, and the rash appeared on December 3rd. |
bbc85c73-cb36-4578-979e-b0bfbcba3fbf | The disease was of a severe type and the child died on December 5th. As stated above, N. S. was notified on December 16th and inquiries made amongst children absent from school revealed two more cases. The infection could in all cases be traced to the case D.J. Two classes in the school were affec ted, and the three children above referred to had attended when suffering from the initial symptoms of Measles. The first crop 18 would be due to fall somewhere between December 18th and December 23rd. As the interference with the work of the school would be very slight, it was decided to close the department for the Christmas Holidays on Friday, December 18th, instead of December 23rd. The names and addresses of all the children attending the two classes were obtained, and the houses visited before the school re-opened after the holidays. Five cases of Measles were found, and these had sickened after the closure of the school. |
ec65de57-2fc9-45a7-82e6-eed4fd65c8ec | The regulations for the exclusion of children from premises where Measles existed were observed, and no cases occurred in other houses. It is true that the South Acton School was well protected, as an outbreak of Measles had made its appearance amongst its pupils in 1908, but as will be shown later, 64 cases were reported from this school in June, 1909, and it was some advantage to postpone the appearance of these cases for only six months. As far as our knowledge goes, this minor outbreak was completely stamped out, and the second outbreak was the result of a fresh introduction of the disease. The second outbreak made its appearance towards the end of February or the beginning of March. The earliest cases were notified from Beaumont Park School, and during the first week in March seven cases were reported. During the second week in March only one case was reported from this school, and in the fourth week 11 cases. |
d1f5435c-1fd0-430e-968f-0573b40fca9b | The disease did not spread very extensively amongst the children attending this school; 43 cases were reported in April and one each in July and August. The explanation is probably to be found in the fact that Beaumont Park and South Acton were the two schools that suffered most severely from the epidemic of Measles in 1908. 19 Five classes were affected in the Beaumont Park School, viz.:— Class IV. with 5 cases Class V. with 6 cases Class VI with 19 cases Class VII. with 5 cases Class VIII. with 20 cases The outbreak seems to have spread in two directions, eastward to Southfield Road School and westward to Rothschild Road School. During the first week of April 13 cases were reported from Southfield Road School, in the second week 28, in the third week 67, and in the fourth week five. The outbreak then subsided, as in the first week in May only 13 cases were reported, and in the second week four. |
00447fc2-d22d-4166-a03c-faca6c7496c8 | One case was reported in July and one in September. The outbreak spread far more extensively here than in Beaumont Park, but Southfield Road had escaped the epidemic of 1908 and the soil would therefore be more fruitful. In Beaumont Park five classes were affected, and in Southfield Road 15. Although better means of isolation would be available in the families of children attending Southfield Road School, in 25 instances two cases occurred in the same family, in one three cases and in another family four cases. In Beaumont Park, on the other hand, in only two families did more than one case occur. During the first week in April 13 cases were also reported from Rothschild Road School, and altogether 61 cases were notified from this school—49 in April, 10 in May and two in June- The next school to be attacked was the Turnham Green School, but only 13 cases were reported from this school. The first case was notified in the first week in May. |
2762c588-588d-4abf-a427-003fa0c7cbf3 | 20 During the third week in May 12 cases were reported from the Priory School, and altogether 104 cases were notified from the Priory Infants Department. In June the disease had made its appearance in South Acton and St. Mary's Schools. During the second week in June 27 cases were notified from the South Acton Infants' Department, and 64 cases were altogether notified. Forty-one cases were notified from St. Mary's School, the first case being in the third week in June. The epidemic made no headway in the schools situated to the north of the High Street, only three cases being reported from the Central School, and one each from Willesden Junction and East Acton Schools. The above dates give a fair idea of the course which the epidemic took. In most instances its detection in a school only takes place on the occurrence of the first crop. |
ebfa94c3-c400-4984-a394-cc263ea9c18a | Under such conditions Measles once introduced into the Infants' Departments of a school spreads with the greatest rapidity and often assails the whole of the susceptible children within a few weeks. If information could be obtained of the earliest cases school closure could then be resorted to with some prospect of success. But unless the earlier cases are detected the outbreak has got beyond the stage of effective control by school closure. With the exception of Southfield Road school closure was not resorted to. The ordinary rules for the exclusion of affected children and contacts were adopted. Southfield Road Infants' Department was closed from April 25th to May 24th. If school closure is to be of any avail it must be done at the earliest opportunity, and at the start of an outbreak. Under the conditions obtaining in Urban Districts it is doubtful if school closure is ever resorted to with any decided hope of checking the spread of an epidemic. |
723eb215-15ee-4a10-b067-8a3505c40e77 | It is possible, though, 21 that school closure may have an effect on the fatality of an epidemic. It is well known that the principal danger of Measles lies in the size of the epidemic. There is a greater proportional case fatality in large than in small epidemics. The cases increase in severity as an epidemic progresses. This phenomenon is illustrated by the following table : Cases Notified. Deaths. |
84931225-70e5-4206-8407-8023fffd9fa9 | March 1st week 7 ,, 2nd ,, 0 ,, 3rd ,, 1 1 ,, 4th ,, 13 April 1st ,, 59 1 ,, 2nd ,, 5 ,, 3rd ,, 100 ,, 4th ,, 31 2 May 1st ,, 22 2 ,, 2nd ,, 14 3 ,, 3rd ,, 13 3 ,, 4th ,, 14 3 June 1st ,, 26 2 ,, 2nd ,, 47 2 ,, 3rd 39 3 ,, 4th 23 2 July 1st ,, 12 1 ,, 2nd ,, 17 2 ,, 3rd ,, 10 3 ,, 4th ,, 7 6 August 3rd ,, 1 ,, 4th ,, 2 The drop in the number of notifications received in May was partly due to the closure of Southfield Road Infants' Department. |
413dcbc4-fe10-4ef1-9b3f-2c48e79f2fb4 | The outbreak reached its height during the third week in April, and began to decline towards the end of May. The number of deaths, though, was higher in July than in any other month. Of course a certain interval generally 22 elapses between the appearance of the rash and death, but in this epidemic the deaths in most of the cases occurred early in the illness. The increased fatality towards the end of the epidemic cannot therefore be accounted for on the assumption that the deaths in July were of cases notified in the earlier months. Neither can the geographical distribution of the epidemic account for the increased fatality during the later stages. (As will be pointed out, on a later page, social conditions play an important part in the mortality from Measles.) It is almost the general experience that as an epidemic progresses the cases become more severe in character. The increase of severity seems to be entirely due to the concentration of the poison, and school closure may have the effect of diluting the poison. |
cd5bb4a2-c87e-4dee-b83f-feaa2ecfe013 | School closure may diminish the virulence of an epidemic by removing children from a vitiated atmosphere. It has been pointed out in previous Annual Reports that the age at which relatively the greatest number of children die of measles is the second year of life. After the third year has passed there is a rapid decrease in the fatality of the disease. It is impossible to state in figures what is the case fatality at different age periods. Practically, all cases occurring amongst children of school age are reported, but, unless there are children of school age in the house, very few children under three years of age are notified as suffering from the disease. The ages at death were as follows:— Under 1 year, 1 to 2. 2 to 3. 3 to 4. 5 to 6. 6 to 7. 6 19 6 5 3 1 The ages of the cases reported from the schools were as follows:— 3 to 4 years. |
05d0ceec-6673-432c-a202-d058143a1d4d | 4 to 5. 5 to 6. 6 to 7. 7 to 8. Over 8 years. 41 120 140 105 56 31 Although the above tables are not complete, they are sufficient to show that the incidence of attack is different from that 23 of death. The main incidence of death is on the second year, while the incidence of attack is on the fourth, fifth and six years. The fatality of Measles is therefore much higher in the second year than in any of the succeeding years. It will thus be seen how important it is to endeavour to lengthen the interepidemic period. To secure this end many administrative measures have been proposed. Among these, the question of the exclusion of children under five years of age has been the subject of investigation by a Departmental Committee of the Education Department. |
4cfde8ac-4075-4fb4-9b1e-face9a05e179 | Raising the age of attendance to five years would diminish the spread of infection for a time, but it must be recognised that in the southern portion of Acton the exclusion of children under five must lead to the establishment of Creches. The question of controlling infection in Creches would have to be considered, as in poor districts such institutions would certainly have to be introduced for the care of young children whose mothers have to go out to work. It is of interest to note in this connection that the district of South Acton has been visited on two occasions with an epidemic of Measles since the institution of the South Acton Day Nursery and in no instance has the disease spread amongst the children attending the Nursery. This immunity may have been partly due to the size of the Creche, and very large Day Nurseries may serve as foci of infection. There is one significant difference between the two outbreaks which occurred last year. |
da5bf533-a463-424f-8a72-7524063d10cf | In the first one, that is the one that was controlled and in which only nine cases occurred, we were fortunate in being notified of the first case at the time of its occurrence. In the second, and more extensive outbreak, the first notifications referred to the first "crop" and not to the first "case." The difficulty of obtaining information of the earliest cases constitutes one of the chief obstacles in the control of Measles. To overcome this difficulty the compulsory notification of Measles has been tried in several places. Nowhere has 24 compulsory notification been a complete success, and the reason is not far to seek. The notification was probably of an incomplete character. Until Measles comes to be regarded by the public as a serious disease it will be impossible to obtain the necessary co-operation of parents. It is certain that parents would not, under present conditions, notify all the cases, and a doctor is not in attendance on one-third of the cases. The street distribution of the deaths was as follows:— St. |
bc918029-7211-42cb-866a-f4043c4bbd09 | Margaret's Terrace 5 deaths. Somerset Road 4 ,, Stirling Road 2 ,, Junction Road 2 ,, Hanbury Road 2 ,, Nelson Place 2 ,, Berrymede Road 2 ,, Southfield Road 2 ,, Stanley Road 2 ,, St. Alban's Avenue 1 death Shirley Road 1 ,, Whellock Road 1 ,, Bolton Road 1 ,, Rothschild Road 1 ,, Palmerston Road 1 ,, Acton Lane 1 ,, Antrobus Road 1 ,, Steele Road 1 ,, Beaconsfield Road 1 ,, Western Road 1 ,, Ramsey Road 1 ,, Berry mead Gardens 1 ,, Petersfield Road 1 ,, Osborne Road 1 ,, Strafford Road 1 ,, Steyne Road 1 ,, 25 It was pointed out in last year's report that social conditions play an important role in the case-fatality of Measles, and the above list will show how the disease is particularly fatal amongst unfavourable surroundings. |
c95270c1-2d65-4c89-990f-ac91831bdaa9 | Poverty re-acts on the case-fatality of Measles in many ways. One authority asserts that a fire in the bedroom is one of the most necessary items in the treatment of the disease. Where poverty so great as to render this fire impossible exists, the children develop complications which make the percentage of deaths abnormally high. The liability to complications is enhanced by the fact that the employment of the mother renders efficient nursing impossible. On the subsidence of the symptoms associated with the eruptive stage the child is often 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. Amongst the poor, medical attendance is obtained only in a small minority of the cases. |
0f87b4f0-0d69-4c4e-b37d-36031096ca59 | Out of 141 cases reported from Southfield Road, in 69 there was a doctor in attendance ; from Beaumont Park, out of 65 cases reported, a doctor attended in 32 of them, and from Rothschild Road a doctor was in attendance on 30 out of 61 cases reported. In the Priory, on the other hand, out of 104 cases reported, in 6 only was there a doctor in attendance, and in South Acton, out of 64 cases notified, a doctor attended in 5 cases. Doubtless many lives would be saved if all cases of Measles which were seriously ill could have skilled attendance. 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. A saving of life might be accomplished if a few cases were selected for hospital treatment. |
43efc410-b027-4228-9d7c-297513a4080f | It would be impracticable to nurse even a majority of the cases in a 26 hospital, and the experience of Glasgow has not been attended with very encouraging results. WHOOPING COUGH. Thirteen deaths occurred from Whooping Cough. Six of the deaths occurred in the South-West Ward, four in the SouthEast, two in the North-East; and one in the North-West Ward. Six of the deaths were in children under 12 months old and the other seven were in children between the ages of one and five years. The age of the persons attacked constitutes one of the chief difficulties in the control of the disease. All efforts must be centered in the home, but unless the child attends school the sanitary authority is in complete ignorance of the cases. Another difficulty lies in the fact that the illness is ushered in with indefinite symptoms. 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. |
1a05ee28-0047-4491-833d-8d1c534cc7e0 | School children suffering from Whooping Cough are notified by the teachers, and the houses are visited by the school nurse and instructions are given as to the isolation of the patient and general treatment of the illness. SCARLET FEVER. Scarlet Fever continued in its prevalence almost throughout the year. Towards the late autumn the notifications. diminished in number, but altogether 468 cases were notified. In 1908, 484 cases were notified, but though the number notified in 1909 was less the deaths exceeded those of 1908. 16 deaths resulted from the disease last year, compared with 15 in 1908. 27 It is a well-known fact in laboratories that pathological germs may, under certain conditions, become attenuated of intensified in their effects. It is also held that the virus of Scarlet Fever may become attenuated or intensified. It is a rare occurrence to notice successive cases, infected one from the other, to exhibit symptoms of the same degree of intensity. |
1e6da816-0133-4e92-9a0b-3476f3959546 | The source of infection in a fatal case may have been an individual suffering from the mildest of symptoms. The intensity of the symptoms, of course, depends upon two factors—the seed and the soil. Children with enlarged tonsils and adenoids, for instance, usually exhibit symptoms of a severe type. But apart from the susceptibility of certain individuals, the virus sometimes loses "if not its infective potencv, at any rate its power of reproducing typical scarlet fever on normal soil. The virus, in fact becomes attenuated or recessive." On the other hand a process of intensification often occurs, and this latter phenomenon was exhibited during the recent outbreak. The outbreak commenced in the autumn of 1907, andi continued throughout 1908, and up to the beginning of the fourth quarter of 1909. |
fc97176f-b102-472a-8d1e-64204f9c8c4d | Throughout the earlier part of the epidemic the majority of the cases exhibited very mild symptoms, but during the last quarter of 1909 the symptoms were of a severe type, and this latter fact rendered the control of the disease easier. Elementary schools rank first in importance as centres, where infectious diseases are spread amongst school children. It is generally assumed that there are two methods by which the infection is spread in schools—the direct and the indirect method. The indirect method (such as dust, slated, &c.) by which the infection is spread will be dealt with later. Its importance has probably been magnified by interested persons, who thereby 28 profit by the sale of disinfectants to school authorities. Scarlet Fever may be directly spread in schools in three ways. 1. The disease may be of so mild a type that the children attend school throughout their illness. 2. The child may be infectious during the initial stages of the illness, and before the case is notified. 3. |
fcfc4c05-2790-4ad2-a622-77d3600dd7fe | A child may return to school before he is free from infection. During the earlier part of the year probably the "missed " case was the most important factor in the spread of the disease. During the first week in February there was a sudden increase in the number of notifications received. The school principally affected was the South Acton Junior, and almost all the cases were from the same class. An examination of the children revealed two of them with peeling hands and body, and on inquiry a history of sore throat about three weeks previously was obtained. Later in February a "missed" case occurred in Beaumont Park School and gave rise to a number of cases. In the Priory Schools "missed" cases occurred in May, August and September. On the re-opening of the schools after the summer holidays 15 cases occurred amongst the children attending the Beaumont Park Schools. |
d263fee0-bade-46c4-8960-6b548fc6e30f | A child attending Rothschild Road was being kept under observation; on examining the children at the house, a sister aged 12, attending Beaumont Park School, was found profusely peeling. The detection of these "missed" cases usually results in the cessation of notifications from the schools affected, and the absence of "missed" cases during the fourth quarter of the year rendered the control of the disease a matter of comparative ease. 29 It was pointed out in last year's report that Scarlet Fever may spread in the early stages of the illness. The disease is infectious, at any rate in the eruptive stage if not earlier. It is probable that this early infectiousness accounts for the large number of secondary cases which occur. It was formerly held that Scarlet Fever was not infectious until the peeling commenced, and the secondary cases that occurred in houses remained unexplained. Last year 371 houses were affected. |
b0e1b6c6-a669-4e3d-bba4-8c702a7bd6d6 | In 43 houses two cases occurred in each, in 12 houses three cases each, in seven houses four cases each, and five cases occurred in one house and six in another house. In 21 instances two of the cases occurred on the same day, in 15 instances the second notification was received within a week of the first, in nine cases less than a fortnight elapsed. and in three instances there was an interval of over three weeks between the receipt of the first and second notifications'. In a Majority of these instances the first case was removed to the Isolation Hospital before the rash had disappeared. It is difficult to explain the secondary cases which occur in the above circumstances except on the assumption that the disease is infectious during its early stages. There are grounds to believe that the disease is infectious from the commencement of the sore throat and the initial symptoms. It is extremely rare for the disease to be introduced into the same house simultaneously by two persons. |
42604890-4600-4fa5-a2d9-fcffff9d228b | In the 21 instances where the two notifications were received on the same day, one of the children infected the second in the house. This early infection is consistent with the views now held of the mode in which the disease is propagated. The infection probably lies in the throat, nose and mouth. When a person is sick, the epithleial layer of the mucous membrane is denuded and the vomit is certain to be infectious. The disinfection of the premises is often suspected, but, where the disinfection has 3° been faulty or incomplete, 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. The following cases are interesting as showing the possibilities of the early infection of articles that were not subjected to disinfection. |
d80e2c5f-18c7-4d86-afd4-7c0945597eee | F. N. was removed to the Hospital on December 17th, 1908, and discharged on January 30th, E. N., a sister of F. N., was notified of Scarlet Fever on* January 22nd. E.N. could not possibly have been infected directly by F. N. unless we assume that the incubation period of Scarlet Fever extended over a period of five weeks. The more reasonable explanation lies in the assumption that some articles infected during the early stages of the disease in F. N. were not disinfected, and when F. N. was ready to be discharged from the Hospital these were brought out and exposed. A somewhat similar case was the following: A. A. was removed to the Hospital on December 12th, 1908, and was not discharged until March 15th, 1909 On March 1st, 1909, C. A., his brother, was notified. |
28593736-4573-42c0-8880-86e465d74cc5 | It had been intended to discharge A. A. in the first week in February, but owing to the development of a complication he was not discharged until March 15 th. More difficult of control is the third class of cases where the child may return to the home or the school before he is free from infection. Whether isolated at home or in the Hospital the patient should have recovered completely before he is cleansed and discharged from seclusion, but we have no means of ascertaining whether the patient is absolutely free or not from infection. It was pointed out in last year's report that probably the so-called "return" cases are closely related to those cases which recur in houses after a prolonged period. It has been usual to regard the two groups of cases as distinct from each other, and where a case has occurred within a 31 month of the discharge of a patient from the Hospital such a case is called a "return" case. |
bee3a550-8a01-477c-9053-49ea966f976a | Nine cases discharged from the Hospital were followed within one month by the occurrence of other cases of Scarlet Fever in the same house. This is a great improvement on 1908 when 27 such cases occurred. Many authorities believe that the phenomenon of return cases is essentially due to imperfections in Hospital management, and that recent association of discharged patients with acute cases is responsible for most, if not all, return cases. I am convinced that, no matter what care may be taken, "return" cases will not be entirely eliminated under existing conditions. As throwing some light on this matter the following case may be mentioned. H. R. was notified of Scarlet Fever on October 17th, 1908. He exhibited very severe symptoms probably on account of the presence of adenoids and enlarged tonsils. Before he was discharged from the Hospital his parents were advised to take him to a place where convalescent Scarlet Fever cases were admitted. |
401b46d2-823b-43f7-81a2-e7d8fd25a1cd | No matter what care would be taken prior to his discharge from the Hospital I felt convinced that he would probably give rise to a "return" case. He was discharged from the Hospital on December 7th, 1908, and was taken to the Mary Wardell Home for three weeks. On January 2nd, 1909, P. R., his brother, was notified of Scarlet Fever. H. R. must have infected his brother almost immediately on his return from the Mary Wardell Home. Possibly a removal of theadenoids and tonsils of P. R. might have obviated the return case, but no antiseptic would ever penetrate the crypts of his tonsil. 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, auditory canals, not a single case had occurred. |
7972b8b8-884a-44d8-8101-42ff14a8d177 | This statement is probably true, but it is certain that it would not meet the case of P. R. mentioned above, and it does not explain everything in connection with "return" cases. "Return" cases 32 are not solely hospital phenomena. They occur after home isolation. Last year seven "return" cases occurred after home isolation. One of the latter was somewhat similar to the case of P. R. G. J. and M. J. were notified of Scarlet Fever on July 29th and 31st respectively. They were nursed at home and every care was observed in the isolation of the patients. They were isolated for six weeks and on the disinfection of the premises the patients were sent to the seaside. A few days after their return the servant developed Scarlet Fever. It is not fair as a rule to compare home isolation with hospital isolation, as far as "return" cases are concerned, but last year the percentage of "return" cases after home isolation was higher than after hospital isolation. |
a6a220ee-2325-42ac-a120-7944c5d77665 | 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 the Annual Report for 1908, instances were given which showed the tendency of Scarlet Fever to recur in families and houses after a prolonged period, and the same feature characterised the disease in 1909. In 1909 Scarlet Fever was notified in 371 houses, and during the last four years 1,079 houses have been invaded. During the year recurrent cases occurred in 110 houses. In 64 of these houses the secondary case occurred within a month of the removal of the previous case to Hospital; in nine the recurrent case occurred within a month of the return home of a patient from the Hospital, and in seven the recurrent case occurred within a month of the discharge of a patient home isolation. The remainder, 30, referred to houses from which a recurrent case was notified after a lengthened period had elapsed. |
66ce5e84-908f-48de-b6e6-a209dac6e768 | In 13 of these the recurrent case occurred amongst members of the same family as the primary one, and the interval which elapsed between the first and second case was as follows:— 33 3 months 2 cases 4 , 1 case 7 , 1 , 9 , 1 , 11 , 2 cases 17 , 2 , 21 , 1 case 27 , 1 , 36 , 1 , 40 , 1 , 45 , 1 , In 17, the recurrent case occurred in the same house as the primary one, but the two cases did not belong to members of the same family, and the interval which elapsed between the first and second case was as follows:— 5 months 1 case 6 , 1 , 8 , 3 cases 11 , 1 case 19 , 1 , 20 , 1 , 21 , 2 cases 30 , 2 , 36 , 3 , 42 , 2 , |
97fe5a97-81b2-487e-b2ec-7d1ee73f2010 | It has been suggested that 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. One of the conditions under which the infection of Scarlet Fever seems to be relighted is what is termed a "cold in the head" Inquiries were made during the year into the cases where a recurrent case had occurred after a prolonged interval, and in many instances it was found that the primary case had, 34 prior to the occurrence of the recurrent case, suffered recently from an inflamatory condition of the nose and throat. Whether the question of the occurrence of recurrent cases after prolonged intervals and the persistence of inflamatory conditions of the throat and nose are coincidences, or effect and cause, will probably remain unanswered until the specific germ of Scarlet Fever has been found. In 1909, three of the cases had had a previous attack of Scarlet Fever. |
43ed1835-9b5c-4a72-9533-1f1dc39344a8 | In one case, the interval which had elapsed between the first and second attack was 13 months, in the second case, the interval was 21 months, and in the third, the interval was four years and eight months. The ages of the patients and the ward distribution of the disease will be found on Table 3, of the Local Government Board Tables. DIPHTHERIA. One hundred and four cases of Diphtheria were notified and 22 deaths were caused by the disease. The cases reported as Membranous Croup are included in the above totals. There is an increase both in the number of notifications and deaths. Sixty-six cases were removed to the Hospital and ten deaths occurred there. Of the 44 cases not removed to the Hospital 12 resulted fatally. There was a large increase in the prevalence of the disease during the last quarter of the year. |
a8544180-d5c1-429d-95b6-7d0432d98819 | Sixty-two out of the 104 cases were amongst children attending school, and probably the school plays the most important part in the spread of the disease. It is noteworthy that Diphtheria was not most prevalent in the elementary schools situated in the poorest part of the district. This was 35 partly due to the fact that "carrier" cases are responsible for a majority of those attacked, and under such conditions the disease is more difficult of control in schools like the Central. 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. |
91349bf1-0d5b-49a5-8033-b715bbc224be | There is another explanation why the incidence of the disease is heavier on some schools than on others. "Carrier" cases may be divided into three Classes:— 1. Those who show or have shown no signs of disease. 2. Those who suffer from a mild attack. 3. Those who have recovered from a recognised attack. Those belonging to the third group are, of course, notified ; some are removed into the Hospital and some are nursed at home. No cases are discharged from the Hospital until the results of at least two consecutive swabs taken from the throat show that the Klebs Loeffier bacilli are not present One bacteriological examination is insufficent, but I find, from inquiry, that a majority of the doctors are satisfied with one negative result in the case of those nursed at home. |
cf2ffb15-e046-4694-b7c6-48f86822a80d | It is true that the patients are kept out of school for three weeks after the premises have been disinfected, but experience shows that it is possible to obtain a single negative result after the disappearance of the clinical symptoms, and yet detect the germs in the throat many weeks afterwards. "Carrier" cases are rarely found in the Priory, Beaumont Park and South Acton Schools, and a majority of the cases occurring amongst the children attending these schools are removed to the Hospital. 36 Although the germs of Diphtheria are frequently found in the throats of the immediate contacts, the disease does not appear to be so virulently infectious as Scarlet Fever. Secondary cases do not appear so frequently. In 1909, in only one instance were two cases of Diphtheria notified simultaneously from the same house. In two other instances where a case was notified, a previous case had occurred earlier in the year. |
54049699-5e3f-4876-873e-8f417e56c454 | In one of these an interval of two months had elapsed between the occurrence of the first and second cases, and in the other an interval of four months. In two other instances where Diphtheria was notified, a previous case had occurred in the house. In one of these the interval between the first and second notification was two years, and in the other it was three years. In the latter, the two cases belonged to the same family. During the fourth quarter Diphtheria occurred in several houses where a case of Scarlet Fever had been notified earlier in the year. In seven instances the Scarlet Fever patient was nursed at home and in six the Scarlet Fever patient had been isolated in the Hospital. Of the six instances, where Hospital isolation had been observed, two of the patients who had suffered from Scarlet Fever subsequently developed Diphtheria. In both cases the Diphtheria infection was probably contracted after discharge from the Hospital. |
6248ddb5-e1c7-4acb-8ec2-e5904b9a5dda | W. P. was discharged from the Hospital on October nth, and notified of Diphtheria on December 14th. O. H. was discharged from the Hospital on August 20th and notified of Diphtheria on November 6th. W. B. was discharged from the Hospital on June 28th and a sister was notified of Diphtheria on December 30th. In this case also the dates are not suggestive of Hospital infection. 37 In the following three instances Hospital infection is possible : — 1. Scarlet Fever patient discharged from the Hospital on March 15th; sister notified of Diphtheria on April 5th. 2. Scarlet Fever patient discharged from the Hospital on October 2nd; brother notified of Diphtheria on November 14th. 3. Scarlet Fever patient discharged from the Hospital on October 2nd; a child living in the same house notified of Diphtheria on October 25th. |
072a9924-94be-40f1-bd88-bc02a7944dea | In view of the possibility of hospital infection the throats of the Scarlet Fever patients were swabbed on admission and prior to their discharge. As a result it was found that two of the children suffering from Scarlet Fever harboured also the germs of Diphtheria on their admission to the Hospital. It is interesting to note, though, that the instances where Diphtheria followed Scarlet Fever were more numerous amongst the cases who were nursed at home. Four children notified of Scarlet Fever during the first quarter of the year subsequently developed Diphtheria. The intervals between the receipt of the notifications of Scarlet Fever and Diphtheria were seven months, eight months and ten months respectively. In the other three cases it was another member of the family that developed Diphtheria. 1. Scarlet Fever notified on March 15th; sister notified of Diphtheria on March 22nd. 2. |
216e6432-dfd8-4139-8cf9-af0722d7f426 | Scarlet Fever notified on June 1st; sister notified of Diphtheria on August 6th. 3. Scarlet Fever notified on March 29th; brother notified of Diphtheria on May 19th. The question is naturally asked are Scarlet Fever and Diphtheria interchangeable, or are they distinct diseases. Dr. 38 Hamer, in a paper before the Epidemological Society, stated that " if the Klebs-Loeffler Bacillus be regarded as a 'secondary invader,' the difficulties experienced in differentiating between the Klebs-Loeffler Bacillus and closely related non-pathogenic or feebly pathogenic forms having a wide distribution and very commonly met with in healthy mucous membranes, cease to have any serious significance. |
650b81b1-53d2-43bd-8081-ad745191fe44 | It is easy to understand how it happens that, provided the soil is once prepared, whether by some unknown specific organism or by a specific 'ferment,' the widely distributed ' secondary invader' finds scope for its development, and the well-known bacteriological phenomena associated with an attack of Diphtheria intervene. Under other conditions, the same cause of disease, operating for the most part not with the Klebs-Loeffler Bacillus, but with streptococei or with other bacteria, brings about an outbreak of Scarlet Fever. On such an hypothesis the well-known tendency to interchangeability of the two diseases may perhaps find explanation; it would apparently be necessary to assume that the nature of the malady set up in an individual becoming the subject of throat affection would largely be determined by the character of the organisms already present in his throat and capable of taking up the role of "secondary invaders.'" The view generally held, though, is that the two diseases are not interchangeable, and the more careful the inquiries the more distinct the two diseases seemed to be. |
43981218-a433-4dc1-9231-cfbfe3e1a5b7 | The "carrier" theory seemed to fit more easily to the facts. Cases of Diphtheria crop up in different districts at intervals until a " missed " case is detected, when the outbreak immediately ceases. Instances were given in last year's report of such outbreaks in Valetta Road and The Avenue. A somewhat similar instance occurred in The Steyne in July 1909'. Four cases were reported, the last of whom had had "sore throat " for over three weeks. No further cases resulted after the removal of the latter case to the Hospital. 39 28 cases were notified from the North East Ward 19 „ „ North West Ward 11 „ „ South East Ward 46 „ ,, South West Ward TUBERCULAR DISEASES. There were 49 deaths from Phthisis or Consumption, and 18 deaths from other Tubercular Diseases. The mean annual death-rate from pulmonary tuberculosis in England and Wales has, with occasional slight rises, steadily declined since 1851. |
7d9a33a5-b256-429f-acad-bb33cb4cfe78 | The decline has occurred at every age-period and in both sexes, but the rate of decrease has varied widely, and has been much greater in the female than in the male sex. At the present time the incidence of Pulmonary Tuberculosis or Con" sumption is appreciably heavier on males than females. From 1851 to 1863 the greatest incidence of the disease was on females. From 1864 to 1868 the rates for the two sexes were parallel, but from 1868 the incidence became substantially less upon females than upon males. Between the ages of five and 25 years females are more liable to die from the disease than males, but at the other age periods the liability is considerately less in females. Of the 49 deaths from Phthisis in Acton in 1909, 29 were of males and 20 of females. Under the age of 15 years the deaths were evenly distributed between the two sexes, four occurring in each sex. |
c0ffb084-ddd3-420f-ae22-ffcff37af9d4 | But of the 41 deaths in persons over 15 years of age. 25 were in males and 16 in females. Nor was last year unique in this respect. The following table gives the number of deaths from Phthisis in Males and Females since 1905: 40 Under 15 years. Over 15 years. Male. Female. Male. Female. 1905 4 6 18 15 1906 1 24 23 1907 3 5 30 28 1908 2 2 39 13 1909 4 4 25 16 There are more females than males living in the district. At the Census of 1901 there were 20,715 females and 17,029 males. Various theories have been advanced to account for the peculiar incidence of Phthisis upon the sexes, but most of them seem to be inapplicable to Acton. |
8b1c3bb3-dc43-40cd-828e-9eddcde1c732 | It has been suggested that the higher incidence upon the male during adult and later life is due to occupational conditions. In some occupations, such as those of the Cornish miners and Sheffield grinders, the heavier incidence may be due to an actual wounding of the lung substance. In this district there are hardly any men employed in occupations which do, per se, render the worker therein peculiarly prone to develop Phthisis, In so far as occupational conditions give rise to increased opportunities of infection, these conditions in this district would be as, if not more, liable to affect the incidence of the disease on females. There are probably over 3,500 females employed in the laundry industry alone, and if occupational conditions affect the workers through the increased opportunities of infection, laundry workers would be peculiarly liable to contract the disease. But laundresses are not peculiarly liable to contract the disease. Prior to their attack of illness the 41 persons over 15 years of age dead of Phthisis last year were employed as follows :— 41 males. |
a7782b1e-4e0e-435f-8b32-86da18a0ec43 | females. General Labourer 3 Household 8 Butcher 1 Laundress 3 Clerk 2 Dressmaker 2 Hairdresser 1 Domestic Cook 1 Hay-binder 1 Lace Worker 1 Schoolmaster 1 Upholstress 1 Printer 1 Plumber 1 Plasterer 1 Carman 1 Carpenter 1 Baker 1 Tobacconist 1 Steel-grinder 1 Rag Sorter 1 Bricklayer 1 Jeweller 1 Physician 1 No Occupation 1 Independent Means 1 Total 25 Total 16 In 1908 three laundresses died of Consumption, in 1907 four, and in 190b four. These figures would represent, roughly, an annual death-rate of 1 per 1,000 of women employed in the laundries. This is slightly below the death-rate for all persons above 15 years of age in the district, and slightly above the death-rate of females above 15 years of age. |
6029db1a-1020-4c03-8486-7c20b21adfca | It has also been suggested that men are more liable to ■infection in public houses and common lodging houses. The researches of Dr. Niven in Manchester prove how potent both these factors are in the etiology of Phthisis, but last year there were no deaths among persons removed from a common lodging house to the infirmary. In 1908 there were two deaths 42 at Isleworth Infirmary of persons removed from a common lodging house in Acton, and in 1907 there were also two such deaths. Factors other than liability to infection enter into the causation of a death-rate from Phthisis among common lodging house inmates, and these factors are probably common in both male and female. Improved housing conditions have largely influenced the incidence of the disease among the poor, and these conditions would be responsible for a greater reduction among females as the men are absent from the home during a large portion of the day. This subject will be referred to when dealing with the distribution of the disease. |
5acc6970-8666-4375-baf4-e6a37081b24c | It has also been suggested that the explanation may in part be a physiological one, and as such the case would be outside the range of activity of a sanitary authority. It would serve no purpose in discussing the subject in an annual report. It is now generally held that Tuberculosis is an infectious disease caused by the tubercle bacillus, but opinions differ as to the degree of communicability in ordinary social intercourse. The question as to whether any given series of exposures to infection is to be regarded as the actual source of infection must be decided upon a balance of probabilities, and having regard to the widespread prevalence of pulmonary tuberculosis and chronic cough, which may well be of a tuberculous nature, it is extremely difficult to fairly measure the value of irregular and intermittent associations and to ascertain how far chance may have been operative. The evidence clearly points to the conclusion that in most instances short exposure to infection does not suffice to infect healthy persons to an extent that will produce serious disease. |
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