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7f66d5aa-b5bd-40a5-b3a7-dcff8f9c142a | The results obtained in the case of school children compare favourably with those in patients of older years, where medical advice is often not sought until the disease is so far advanced that a complete cure is impossible, thus bringing sanatoria into unmerited discredit. TABLE 4. NUMBER OF CHILDREN REFERRED FOR FURTHER EXAMINATION—446. These were from the following Schools:— Infants. Girls Boys. Acton 15 4 2 Beaumont Park 42 38 4 Central 31 5 — East Acton 15 — — Priory 39 12 15 Rothschild Road 28 — — South Acton 44 16 8 Southfield Road 69 24 4 Turnham Green (R.C.) 11 7 3 Acton Wells 8 2 — 302 108 36 93 TABLE 5. AVERAGE HEIGHT, without Shoes and AVERAGE WEIGHT with Clothes. (Anthropometric Committee, 1883) MALES. |
ebf1f05a-423a-42ba-8643-242915090b6b | FEMALES. Age last birthday Height in inches. Weight in lbs. Height in inches. Weight in lbs. |
7548eada-a125-4188-b163-24636c956cdd | 3 35 31.2 35 30 4 38 35 38 34 5 41 41.2 40.5 39.2 6 44 44.4 42.8 41.7 7 46 49.7 45.5 47.5 8 47 54.9 46.6 52.1 9 49.7 60.4 48.7 55.4 10 51.8 67.5 51 62 11 53.5 72 53.1 68 12 55 767 55.6 76.4 13 57 82.6 57.7 87.2 14 59.3 92 59.8 96.7 15 62.2 102.7 60.9 106 TABLE 6. GIVING HEIGHTS & WEIGHTS AT DIFFERENT AGES. No. |
e6980c99-dca7-4050-8c78-d049a020b1ba | examined 13-14 14-15 15-16 16-17 Height Weight Height Weight Height Weight Height Weight SENIOR BOYS. Acton 16 57.8 81.3 58. 84. ... ... ... ... Beaumont Park 18 57. 79.8 55.9 75.5 62.75 102. ... ... Central 5 ... ... 63.7 118.5 64.2 114.3 ... ... Priory 20 56.3 78.2 58.4 84.4 ... ... ... ... South Acton 20 57.3 82. 56. 77. ... ... ... ... Southfield Road 24 58.6 82. 64.5 89.1 65. 115. ... ... Turnham Green R C. 5 60.7 90.5 56. 74. |
0d467afe-2e65-4dd5-b275-5cd6ed8ab072 | ... ... ... ... Acton Wells 4 59. 78. 61 90.7 ... ... ... ... Total 112 SENIOR GIRLS. Acton 14 59.2 88.7 ... ... ... ... ... ... Beaumont Park 90 58.6 83.9 60.8 91. ... ... ... ... Central 14 58.0 88.5 60.9 93.6 63.2 119.08 65.7 .132 Priory 36 25.9 83.1 58.9 80.6 ... ... ... ... South Acton 47 58.3 83.9 61.1 88.1 ... ... ... ... Southfield Road 21 60.2 86.5 60.4 92.4 ... ... ... Turnham Green R.C. 14 60. |
b1881a51-34f0-4f55-a44e-f41c2ce62a31 | 85.5 55.6 74.7 ... ... ... ... Acton Wells 3 ... ... 61. 106.5 ... ... ... ... Total 239 94 TABLE 6—continued. No. of Scholars exam'd Years of Age. 3-4 4-5 5-6 6-7 7-8 8-9 Height Weight Height Weight Height Weight Height Weight Height Weight Height Weight INFANTS (BOYS). Acton 39 36.2 29. 35.3 34.1 40.6 36.5 42.7 39. ... ... ... ... Beaumont Park 96 37.7 33.7 39.8 36.2 41.8 38.9 43.4 40.6 47.5 49. |
7670e9b4-9ddf-4721-a530-6165194a07bd | ... ... Central 79 34.1 30.9 41.1 39.7 42.8 41.2 44.1 46. 46.1 47.9 47.9 51 East Acton 21 40 38.5 38. 34.9 39.7 37 44. 46.2 46.4 51.3 48. 62.8 Priory 83 36.7 32.6 38.9 35.2 41.7 38.3 43.7 43.4 46. 46.5 ... ... Rothschild Road 69 36.7 33.5 39.5 35.5 41.8 39.8 44.3 43.8 45.8 45. 47.1 46.6 South Acton 111 36. |
6b3cb0ed-eb0e-4055-966e-8e27124b9931 | 51.4 39.2 35.5 41.2 38.5 42.5 41.8 44. 46. ... ... Southtield Road 147 38.4 34.6 40.8 37.6 42.5 39.6 45.1 44.9 47.4 47. ... ... Turnham Green R.C. 19 ... ... 40.7 39. 40.9 37.5 43.2 42.2 43. 43. ... Acton Wells 33 36.7 31.1 39.7 38.5 42.9 39.9 43.8 43.8 43.7 44.7 48. 55. Total 697 INFANTS (GIRLS). |
b8deb74d-48ee-4d01-934b-5e1b6a4165ca | Acton 31 36.6 34.2 38.7 36.1 40.9 36.5 43.1 42.9 ... ... ... ... Beaumont Park 92 37.7 31.5 39.5 34.7 41.8 38.9 43.2 40.5 44.0 43. ... ... Central 70 37.7 32.7 40.3 38. 43.6 40.8 45.0 44.3 46.7 47.5 48. 50.5 East Acton 19 37.2 29. 39.7 35.2 38.2 31.2 49. 56. ... ... 48. 50. |
44bdd2ce-5247-4c4e-8574-41df56cd3dc5 | Priory 84 36.8 31.4 39.4 35.2 41.4 38.2 43.5 41.1 43. 39.2 ... ... Rothschild Road 57 38. 30.5 39.9 36.8 42.1 37.5 43. 40.2 26.5 48.1 45.9 48.9 South Acton 122 36.6 32.6 36.8 34.4 40.4 36.6 43.1 42.3 44.4 41.1 ... ... Southfield Road 131 37.3 31.9 40.1 32.1 42.8 39.9 44.5 42.9 46.5 46.3 ... ... Turnham Green R.C. 21 ... ... 37. 33.2 41.2 38. |
966aa131-d0d7-4694-8388-965763d797cf | 40.6 40.1 45.7 42.5 ... ... Acton Wells 25 ... ... 39.75 36.7 40.7 39.1 43.7 42.8 47.3 50.3 ... ... Total 642 95 Nutrition. In last year's report the question of mal-nutrition was discussed and it was also stated that in certain of the schools the average height and weight of the children were consistently and uniformly lower than in some of the other schools. At almost all age periods the children in the South Acton, Priory, Beaumont Park and Roman Catholic Schools were below the weight of the children in the other schools of the district. A reference to Table 6 will show that the results for 1909 were very similar in their character to those of the previous year. An attempt has been made to discriminate between the various causes of mal-nutrition, and the Committee has put in force The Provision of Meals Act, 1906. |
7e564363-106b-4481-8155-b8c0b2de3960 | Dinners are provided by the Education Committee for those children who are so under-nourished that they are unable to obtain full benefit from their education and in whom poverty is the probable cause of the mal-nutrition. There are two restaurants in the district at which arrangements have been made to receive the school children; one of these is in Acton Lane and the other in Osborne Road, South Acton. The dinners are supplied at a cost of 2d. or 2½d. per head, and a fairly varied menu is provided, consisting three times a week of soup and bread followed by pudding, and on alternate days meat and vegetables are given. We have visited the centres on several occasions and found the food was hot and well served. The quantity given was ample for the smaller children—when questioned the older boys generally admitted they could eat more. |
080afd01-e4d7-4805-a446-f9d3914f1bc2 | As far as possible the bigger children are given rather larger helpings of pudding, but this is difficult to administer if many children 96 appear at the same moment, and the restaurant staff is hard worked. Slices of plain cake might be added to the menu to be given to the older children as they leave the premises. Occasionally ladies in the district come to supervise the meals, and this is a great advantage as regards the manners of the children and the speed with which the meal is served. It would be of great service if voluntary helpers could arrange to attend regularly on definite days in the week. Only one helper each day would be required at a Centre, as accommodation is limited. Two ladies already help at the South Acton Centre on two days a week, and four others would be most welcome at this restaurant as the keepers are glad of the refining influence on the children. |
74a427bf-d169-4556-a7f6-4e000840d323 | The Dinner Centres have been visited on various occasions to observe the condition of the children, and those who appeared specially undernourished were medically examined on a later occasion. In one case a child had been receiving dinners for several months but did not show much improvement in nutrition. On examination no signs of phthisis could be detected, but the child was obviously delicate and there was a history of consumption in the family. As this seemed an instance where "prevention was better than cure" arrangements are being made to give this child convalescent treatment either at the seaside or in the country. During the year 1909, 22,762 dinners have been supplied to 448 children at a total cost of £189 13s. 8d. Infectious Diseases. The distribution of Scarlet Fever and Diphtheria in the district will be found on No. 3 of the Local Government Board Tables. |
34c1abda-01cb-4fb6-af68-04924ea2e350 | 97 Sixty-three per cent, of the Scarlet Fever cases occurred amongst school children, the numbers in the different schools being as follows :— Scarlet Fever. Acton Infants 6 Girls 3 Boys 1 Beaumont Park Infants 21 Girls 9 Boys 8 Central Infants 38 Girls 18 Boys 18 East Acton 2 Priory Infants 42 Girls 12 Boys 22 Rothschild Road 15 South Acton Infants 20 Girls 11 Boys 12 Southfield Road Infants 15 Girls 2 Boys 7 Turnham Green R.C. Infants 2 Boys 2 Acton County School Boys 1 Haberdashers' Girls 2 Boys 2 Private School 14 305 98 It will be seen that Acton Wells School contributed no cases to the number, and that the East Acton, Turnham Green R.C and Acton Schools were comparatively free of the disease. |
2fe06d2e-aa90-4de6-a6e9-353c17a9f26a | Fifty-eight per cent, of the Diphtheria cases occurred amongst school children, the distribution of the disease being as follows :— Diphtheria. Acton Infants 1 Boys 1 Acton Wells Boys 1 Beaumont Park Infants 3 Girls 1 Boys 1 Central Infants 8 Girls l0 Boys 3 Priory Infants 3 Girls 6 Boys 3 Rothschild Road 6 South Acton Infants 6 Southfield Road Infants 5 Acton County Boys 2 6o There is a certain amount of similarity in the distribution of the two diseases, but as stated in a preceding paragraph the more carefully inquiries are made the more distinct the two diseases are, and there is no good reason for assuming that the two diseases are interchangeable. It may be of interest, 99 though, to notice that Acton Wells was one of the schools which was not daily sprinkled with a disinfectant. |
56715259-aaa6-4e00-81d1-99ea552fad27 | Both diseases are compulsorily notifiable under the Infectious Diseases Notification Act and on receipt of a notification from the medical attendant a visit is paid to the home and inquiries made as to the probable source of infection. If the case is removed to the Hospital, all the other children living in the infected house are excluded from school attendance for eight days. If the case is nursed at home, other children living in the house are excluded from school attendance until a period of eight days has elapsed since the premises have been disinfected. If the case is removed to the Hospital, the child js excluded from school attendance for three weeks after discharge from the Hospital. Similarly, in home isolation, a period of three weeks is demanded after the disinfection of the premises before school attendance is resumed. The disinfection of the clothing and the rooms is carried out by the Sanitary Authority. The bedding, etc. are stoved in the steam disinfector and the rooms fumigated with formalin. |
c360154f-f15c-4907-aa0d-b748b36f6adb | Without entering into minute details of the means employed, it may be briefly stated that our efforts at the prevention of Scarlet Fever and Diphtheria are directed towards the isolation of the patient and the disinfection of any articles which may have become infected. In other words, it is assumed that the infection in both cases is direct and indirect, but the tendency is to attach greater and greater importance to the direct mode of transmission of infection. It is possible, of course, that the disease is spread in some indirect manner, but the more carefully the inquiries are made, the less numerous do the indirectly infected cases become. It is true that the untraced cases constitute the great majority occurring in urban districts, but it is also probable that many, if not most, of the untraced cases have been suffering from so mild a form of the disease that the illness has not been recognised. It is these 100 slight, undetected, or "missed" cases, as they are called, which are the most effectual promoting causes of an epidemic. |
aa083752-583a-4610-b033-cbaade123195 | During the year we had several instances of these undetected cases, giving rise to limited outbreaks in different schools. In addition to the "missed" cases, there are other factors which render it difficult to fulfil the essential conditions of successful isolation. The infection must not be handed on by the patient before seclusion, but it is not certainly known how early in the disease the patient may be infectious. There is hardly a disease concerning which opinions have so materially changed as Scarlet Fever. It was formerly held that the disease was not infectious until the skin had commenced to peel, and that it continued infectious as long as the peeling of the skin lasted. Both theories have been discarded. Scarlet Fever is infectious from the commencement of the symptoms and the condition of the skin is no criterion of the infectiousness of the patient. If the spread of these two diseases is to be prevented, their early infectiousness must be more clearly recognised. |
1937b095-e0be-4cdd-a7cc-d965be33760d | Moreover, the patient should have recovered perfectly before he is cleansed and discharged from seclusion, but in Scarlet Fever 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 seclusion. In the Fever Hospital two consecutive negative swabs are always obtained before the patient is discharged. The question of "return" cases is dealt with more fully in the Annual Report of the Medical Officer of Health, but it is mentioned here as one of the factors in the direct mode of infection. These matters are mentioned because during the year there has been much controversy as to the value of daily disinfection of the schools in the prevention of infectious disease. 101 It is admitted that, under present condition the school is a potent factor in the spread of infectious disease. |
ff25eba1-b5c2-4095-af91-2b97a9f3edb3 | This admission has been seized by the manfacturers of disinfectants for their own purposes, and the claim is made that school infection can be largely controlled by the routine disinfection of class rooms. Various correspondents in the public press appear to consider that all that is wanted is the expenditure of a quite inconsiderable sum of money in the purchase of a trustworthy disinfectant wherewith to sprinkle the schoolroom floors and the thing is done. No special skill or intellectual effort is required to carry out this method. Various statistics are given and selected areas taken, where, after such disinfection has been carried out, the average attendance improved to such an extent that the grant became appreciably higher. As might be expected these views are highly commended by dealers in disinfectants. No mention, of course, is made of those districts where a trial has been made and success has not followed the experiment. |
0f21f2d4-4c28-4e71-81b0-9ec8fda0e89a | The results, as far as Acton is concerned, have already been published in the Minutes of the Education Committee and it might be of interest to insert them here. The experiment was tried from February, 1909, to February, 1910, and the following table illustrates the results for the five months February—July, 1909. From 8/2/08—24/7/08. From 8/2/09—24/7/09. Scarlet Fever 57 82 Diphtheria 13 12 Membranous Croup — 1 Measles 616 463 Chicken Pox 69 134 Whooping Cough 142 84 Mumps 20 163 Of course, disinfection is of value when it is really needed and properly applied. It is probable that Scarlet Fever and Diphtheria are spread in some indirect manner, but it is 102 generally held that the infection lies in the throat, nose and mouth. |
54048c16-68ba-4165-856e-75ec3cb8de23 | 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 this early infection for disinfection purposes. Disinfection of special class rooms or of particular articles should be undertaken where there is reason to believe that these have been infected, but there is danger of reliance being placed upon the use of disinfectants rather than upon necessary cleanliness of school premises and efficient ventilation. The mechanical removal of dirt is of the greatest importance. Disinfectants when properly applied and in their proper place are of considerable value, but much of the money now spent on disinfectants could probably be more profitably spent on soap and water. An attempt was made in this district during the year to ascertain how far articles used in common such as pencils and penholders might prove a source of infection. Our thanks are due to Drs. Minett and Macalister, who kindly undertook the bacteriological examination. |
ae73dcc4-4e54-47e1-beb2-e2d2ca0f807a | From various schools stumps of pencils or old penholders were procured and cultures were made of the bacteria found upon this material. In another school a class of girls was watched and any pencils which had been placed in the mouth were preserved for examination. Bacteriological examination revealed extensive growths of the commoner pathogenic organisms, such as staphylococci, streptococei, etc. In no case were the germs of Diphtheria detected. In one example the germ of Pneumonia was found, but this germ may be present in the saliva of healthy persons. Although these results proved negative, the importance of these articles in the spread of infection should not be overlooked, and it would be an advantage if arrangements could be made so that each child could have his own books, pencils, etc. 103 The other two important infectious diseases which depend largely on school attendance for their spread are Measles and Whooping Cough. |
1a4e00cd-1c41-4093-a87d-785877800e20 | These two diseases are not compulsorily notifiable under the Infectious Diseases Notification Act, our knowledge of their distribution is confined largely to the notifications made by the teachers. Measles was prevalent in the district during the second quarter of the year, and an account of the epidemic is given in the report of the Medical Officer of Health. Whooping Cough was not so prevalent, but altogether 111 cases were notified from the schools, distributed as follows : — Girls. Infants. Boys. Priory 1 8 — Acton — 4 — Beaumont Park — — 4 South Acton — 1 — Rothschild Road — 41 — Acton Wells 3 21 2 Turnham Green R.C — 5 — Southfield Road 2 14 1 Central — — — East Acton — — 4 6 94 11 In March 1909 on the promotion of Miss Bhose to the post of Senior Health Visitor, the Education Committee appointed a Nurse to carry out school work. |
058d0e4c-c51c-4082-a95d-e75bb3051916 | The following tables represent the visits paid by the Nurse together with the schools where children attended and the diseases from which they suffered. 104 Visits Paid by School Nurse. School. N.-East. N.-West. S.-East. S.-West. Total. Priory 83 112 54 161 410 Acton 9 25 4 55 93 Beaumont Park — — 90 115 205 South Acton 2 2 2 265 271 Rothschild Road — — — 215 215 Acton Wells 65 2 — — 67 Turnham Green R.C 1 — 19 48 68 Southfield Road 42 9 300 18 369 East Acton 13 2 3 — 18 Central 94 67 7 24 192 Totals 309 219 479 901 1908 Diseases- N.-East. N.-West. S.-East. S.-West. Total. |
dc4bb6ef-f0f2-47d0-90f4-b8abe4d58d0a | Scarlet Fever 12 24 35 52 123 Diphtheria 3 2 2 5 12 Measles 52 50 177 265 544 Chicken Pox 21 23 66 71 181 Whooping Cough 55 9 28 36 128 Mumps 60 48 65 202 375 Sore Throats 16 17 8 30 71 Colds 9 8 7 20 44 Scabies 8 — 4 6 18 Eczema 1 3 1 11 16 Ringworm 18 15 14 67 114 Dirty Heads 11 9 36 65 121 Sore Heads and Faces 7 — 8 16 31 Sore Eyes 6 3 12 20 41 Miscellaneous 30 8 16 35 89 Totals 309 219 479 901 1908 105 Following on the consent of the Board of Education the School |
dce415b9-9352-4562-a29c-369d0f9172a1 | Nurse carried out the treatment of certain minor ailments in the schools. During the last quarter 266 visits were paid and 35 children were treated. The distribution of these cases and the diseases treated were as follows:— Priory. Children treated 16 Diseases from which children were suffering:- Ringworm 18 Impetigo 2 Septic Poisoning 1 Blepharitis 1 South Acton. Children treated 5 Diseases from which children were suffering :- Ringworm 2 Impetigo 2 Blepharitis 1 Roman Catholic. Children treated 9 Diseases from which children were suffering:- Blepharitis 6 Discharging Ears 2 Ringworm 1 Beaumont Park. One child treated. Disease—Ringworm 106 Mentally and Physically Defective Children. The problem of educating children who suffer from some mental or physical defect is always a difficult one, and the special local conditions of the district need to be carefully considered. |
d5b94b22-cb90-43a1-88c9-3761e3ce960e | In the case of children suffering from a certain amount of physical deformity, such as slight infantile paralysis, it is often found possible to retain them in the ordinary schools on making special arrangements with the teachers that these children leave school a few moments before the general dismissal. Parents are warned that full responsibility cannot be undertaken in case of accident, but they generally appear glad to keep the children at the local schools. During the past year we visited some of the London County Council Schools for the Physically Defective children to judge what degree of deformity procured admission to these schools. In several instances the defects were not more severe than in the case of those children who attend the ordinary schools in our own district, but the difficulties of traffic in London probably make a special school necessary. In last year's report an account was given of 56 children who were considered either physically or mentally defective. Where necessary, these children have been re-examined and kept under observation through 1909. |
e8cb7949-f277-4798-9108-faad91780f45 | Of the 26 children examined last year who were classified as backward, 4 have left school, 2 have left the district, I shows marked improvement, 19 are making slight progress, but are much behind the normal development to be expected from their age. 107 Of the 22 children for whom some special method of teaching was considered advisable, 2 have left the district, 1 has much improved mentally, 12 show condition unchanged, and 1 was recommended operation for removal of adenoids. Five are unsuited to remain in an ordinary school, and arrangements are being made to send these children to one of the London County Council Schools for Mentally Defective children. In one case the parents removed to Hammersmith to send the child to London County Council School for Physically Defective children. Of two cases classified as unsuitable for any school, one child has left the district, and one will probably need treatment in an asylum as soon as the age limit is reached for admission. |
629c31ec-7c27-4c75-9a2d-a6bbcdd4e35c | In this district one child A. B., aged five, is suffering from tuberculous disease of the knee joint and has to wear an apparatus to keep the knee stiff, which makes an ordinary desk impossible for her. We visited some of the newest London County Council Schools for Physically Defective children in order to obtain information as to the most suitable couches, and found a very good pattern in the Ilkley couch and table, price £1 10s. 6d. The child lives in the district of Rothschild Road School, and the Head Mistress kindly consented to undertake the extra trouble and responsibility which any Physically Defective child involves during school attendance. This arrangement has worked very well, and the child is making good progress both physically and mentally. An alternative method of educating this child would be to arrange for her to attend one of the London County Council Special Schools, but this would cost £10 per annum in addition to the charge of conveyance. |
f36aabce-c700-4ea3-ab5e-6f4543c3ada6 | 108 Another child, F.D., aged 14, is suffering from infantile paralysis and is also mentally weak. Her intellectual powers are considerably below the normal standard, and the lameness is increasing, but as the child lives near the Rothschild Road School she is able to continue school attendance there by special arrangement with the Head Mistress. Deaf Children in the district attend the Ackmar Road School under the London County Council. Six children from Acton are attending this School. Blind Children attend the Blind School in Edinburgh Road. At present one child from the district is attending this School and another child who was being kept under observation has left the district. A girl who was suffering from progressive myopia and attending Moorfields Hospital has sufficiently improved to enable her to attend Beaumont Park Girls' School instead of the school in Edinburgh Road. Dumb Children are also sent to special schools. In one case arrangements are being made with the Brentford Education Committee with regard to a dumb child who attends Turnham Green R.C. |
e1845d81-9400-4bab-8596-0609c8126be5 | School though living in Brentford district. In another case a child is dumb but also mentally deficient and it is doubtful whether much educational improvement would result from sending this child to a Special School. Physical Exercises. Physical exercises are taught in the schools in accordance with the syllabus of Physical Exercises provided by the Board of Education. Drill is given twice a week in two half hour lessons and generally speaking appears to be well taught. In some of the schools variation on the usual exercises is obtained by using wands, Indian clubs and Morris dances. These seem much appreciated by the children especially in those schools where the scholars possess suitable clothing and well 109 fitting shoes which enable them to execute the movements more smartly. Examination of Teachers. Twelve teachers have been medically examined on appointment to schools in this district, all of whom passed the medical examination. A record of each physical examination together with the family history of the candidate is entered on a card, and filed for subsequent reference. |
d3899403-ed71-48bd-a599-4efbbdf330e6 | This method has been found useful, when, for various reasons, it is necessary to make a second examination. SWIMMING. During Season of 1909, 15 Swimming Classes were held weekly during School hours and seven classes out of School hours. Total 22 classes weekly. School. Classes per week. Total No. of Scholars who have attended the Baths during the Season Total Number of attendances made during the season- No. of Scholars in the School who can swim. No. of Scholars who have learned to swim this season. |
0e9c851d-8722-48d3-b63d-21b55fdc03d7 | Acton Boys 1 59 611 16 12 Beaumont Park Boys 3 110 908 54 44 Central Senior 4 155 1,515 100 27 Central Junior 2 64 900 29 18 Priory Boys 4 102 835 39 25 Priory Girls 1 52 439 5 3 South Acton Senior Boys 2 44 273 40 20 Southfield Rd. Senior 3 97 771 47 29 Acton Wells 2 45 587 28 15 Totals 22 728 6,839 358 193 110 In conclusion we beg to thank the Staff of the Education Department and the teachers for the assistance we have •received, not only in compiling this report, but also in the work of medical inspection. We remain, Your obedient servants, D. J. THOMAS, LILIAN E. WILSON. |
4bab51ba-ee83-4c51-9d38-50448a5333ac | Printed by J. Taylor, 66, Avenue Road, Acton. |
9f2d94eb-7c1c-4d73-9e39-12707292e806 | Urban District of Acton. ANNUAL REPORT OF THE Medical Officer of Health TOGETHER WITH THE REPORT ON THE Medical Inspection of Schools FOE THE YEAR 1910 BS X 1/18 ACT 18 Urban District of Acton. ANNUAL REPORT OF THE Medical Officer of Health FOE THE YEAR 1910 3 By the Order of the Local Government Board, dated December 13th, 1910, Article 19, section 14, it is prescribed that the Medical Officer of Health shall as soon as practicable after the 31st December in each year make an Annual Report to the Council, up to the end of December, on the Sanitary circumstances, the Sanitary Administration and the vital statistics of the District. |
adf06de1-55f2-4e55-8a28-f88c237a8fe9 | In addition to any other matters upon which he may consider it desirable to report, his Annual Report shall contain the information indicated in the following paragraphs, together with such further information as We may from time to time require :— (a) An account of any influences threatening the health of the District, the prevalence of infectious or epidemic disease therein, and the measures taken for their prevention. (b) An account of all general and special inquiries made during the year. (c) An account of the work performed by the Inspector of Nuisances during the year, including the statement supplied in pursuance of Article 20 (16) of this Order. (d) A statement as to the conditions affecting the wholesomeness of the milk produced or sold in the District. (e) A statement as to the conditions affecting the wholesomenesss of foods for human consumption, other than milk, produced or sold in the District. |
8bb8f2b5-08d7-4e38-b5ad-d30ea612ccb0 | (f) A statement as to the sufficiency and quality of the water supply of the District and of its several parts, and in areas where the supply is from water works, information as to whether the supply is constant or intermittent. (g) A statement as to the pollution of rivers or streams in the District. 4 (h) A statement as to the character and sufficiency of the arrangements for the drainage, sewerage and sewage disposal in all parts of the District. (i) A statement as to the privy, water-closet, and other closet accommodation in the District, including information as to the approximate number of each type of privy and closet. (j) A statement as to the character and efficiency of the arrangements for the removal of house-refuse, and the cleansing of earthclosets, privies, ashpits, and cesspools in the District. |
7c42f2f6-af14-4594-b0b7-3be91f567d6f | (k) A statement with regard to the housing accommodation of the District as required by Article 5 of the Housing (Inspection of District) Regulations, 1910, and an account of any other action taken by the Council under the Housing, Town Planning, &c. Act, 1909, bearing on the public health. (l) A statement as to the vital statistics of the District, including a tabular statement, in such form as We may from time to time Direct, of the sickness and mortality within the District. Under Section 132 of the Factory and Workshop Act, 1901, the Medical Officer of Health is also required in his Annual Eeport 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. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1910. March 1st, 1911. |
b91449b8-27d0-45e3-8e21-be903a85c538 | To the Chairman and Members of the Acton Distriet 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 1910. The population has been estimated at 57,000 inhabitants. There is again a lower death-rate to record; in fact, last year had the lowest death rate on record. The infantile mortality is also the lowest on record. Scarlet Fever and Diphtheria were less prevalent, and the deaths from the former dropped from 16 in 1909 to 2 in 1910. There was an increase in the number of notifications of Enteric Fever and 2 deaths occurred. Whooping Cough was more or less prevalent throughout the year, but Measles caused but one death. The Zymotic death rate was .95 per 1,000 compared with 2.2 in 1909. |
c7d35a3f-eb6b-4725-b8bc-7bed31eb65ae | The death rate from Phthisis and other tubercular diseases was again lower. The house-to-house inspection in the South-West and SouthEast Wards has been carried on throughout the year without interruption, and proceedings have been taken under the Housing and Town Planning Act for the closure of some of the houses. 6 The additional Pavilion at the Isolation Hospital has been commenced, and the work will probably be completed before the summer. On March 10th, 1910, the new Council Offices were opened and all the departments are now housed under the same roof. A Bacteriological Laboratory has been fitted out, and most of the Bacteriological diagnosis is now made in the building. The following is a summary of the vital statistics for the year:— Estimated Population, 57,000 inhabitants. Birth Rate, 25.8 per 1,000 inhabitants. Death Rate, 10 9 „ Infantile Mortality, 102 per 1,000 births. |
9f696598-95d8-4412-b64a-b2ad06a97adc | Zymotic Death Rate, .95 per 1,000 inhabitants. Phthisis Death Rate, .75 „ Death Rate from other forms of Tuberculosis 16 per 1,000 inhabitants. Respiratory Death Rate, excluding Phthisis, 2.3 per 1,000 inhabitants. TOPOGRAPHY. The district, with an area of 2,304 acres, is about 3 miles in length and 1½ miles wide. It is irregularly quadrangular in shape. It is bounded on the north by Willesden, on the east by Hammersmith, on the South by Chiswick, and on the west by Ealing. The underlying stratum of the district is London clay, 200 to 300 feet thick, with a slightly southerly dip. |
02e52007-62ab-4797-bd30-fa18d813d4c9 | This clay forms the exposed surface over the greater part of the district north of the Great Western Railway, but in the central and western portions the clay is covered with a bed of ochreous gravel, which in some parts reaches a thickness of 10 or 12 feet. In the eastern and southern portions the clay is covered with " Loess," a rich loam or brick earth, with patches of gravel and sand. 7 For Poor Law purposes the parish forms part of the Brentford Union, and for Parliamentary purposes it is within the Ealing Division of Middlesex. For municipal purposes the district is divided into four wards, North-East, North-West, South-East and South-West. Prior to 1906 the district was divided into three wardsNorth, West and East. The North Ward comprised all that portion of the district north of the centre of the High Street. |
5a9acc59-b21b-4193-9e02-d4d7a10b7f53 | The West Ward comprised that portion of the district north of the centre of the High Street from Birch Grove to the Railway Bridge, High Street, and west of the North London Railway, from the Railway Bridge, High Street, to Bollo Lane. The East Ward consisted of that part of the district south of the centre of Uxbridge Road from the Railway Bridge to Wilton Road and east of the North London Railway from the Railway Bridge, High Street, to Bollo Lane. In 1905, the district had developed to such an extent, and in such a manner, that a re-distribution of the parish into four wards was deemed necessary. The North-East was bounded by a line commencing at the northern boundary of the district in Willesden Lane, and continuing along the centre of Willesden Lane, Horn Lane, Acacia Road. |
314eafc3-9e86-48f3-a751-8a76610f4001 | Cumberland Road, Grove Road, Acton Lane (past the Priory Schools), Petersfield Road to the North and Southwestern Junction Railway to the boundary of the parish at the south-east corner of the Sewage Works, and thence along the boundary of the district in a northerly, easterly, northerly and westerly direction to the point in Willesden Lane first named. The North-West Ward was bounded on the east by the western boundary of the North-East Ward from Willesden Lane to Avenue Road. The boundary line between it and the SouthWest Ward ran along the centre of Avenue Road and Gunnersbury Lane to Bollo Bridge. 8 The boundary line between the South-East and South-West Wards ran along the centre of the North and South-Western Junction Railway near the Council's depot in Petersfield Road to the bridge over Acton Lane, thence along the centre of Acton Lane to the boundary of the district at the south-east corner of Chiswick Road. |
071890a5-21b3-430a-a034-659e181ccaaa | In the Annual Reports for 1906—1909, this distribution was followed in the preparation of the statistics, but in 1909, another alteration was made in the boundaries. The last alteration affected only the South-East and South-West Wards. The North-East and North-West Wards remained unchanged. The boundary line between the South-East and South-West Wards now runs along the centre of Acton Lane to Antrobus Road, thence along the centre of Antrobus Road to Bollo Lane, and thence along the boundary of the parish to Thorney Hedge Road. |
65f8a191-972d-4636-b202-6e27f76d7710 | The following streets were transferred from the SouthWest to the South-East Ward:—Acton Lane from the Roman Catholic Schools to the boundary of the district by Chiswick Road, Montgomery Road, Fairlawn Groye, and Fairlawn Avenue, Chiswick Road, Chiswick High Road, Silver Crescent, Thorney Hedge Road, south side of Antrobus Road, Seymour Road, Wolesley Road, Cunnington Street, Ravenscroft Road, Bollo Lane from Railway Hotel to Acton Green Club. The population of the transferred portion is estimated at 3,000 inhabitants. In any study of No. 2 of the Local Government Board's Tables, the above alteration should be taken into consideration. POPULATION. Shortly after this report will have been published, the result of the Census will be made known. Unfortunately, it is not practicable to postpone this report until the result of the Census is known, and one must again make an estimate of the population. |
af787086-4fe7-4d0a-970b-1d7146062c1d | As this estimate is primarily based upon the results of the last Census, it will be readily understood that at best it can only be an approximate one. Nearly ten years have now elapsed since 9 the last official census was made, and the further we are removed in time from that census until the next, the more incorrect our estimates become. 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. Between July 1st, 1909, and June 30th, 1910, 147 dwelling houses, 7 factories, 4 public buildings, and 20 other buildings were completed and occupied. An average of 6 2 persons per dwelling house would represent 901 inhabitants. 6.2 represents the average number of persons in each house at the Census of 1901. |
5935acb5-5391-4e8f-b680-21ce844b34bc | But the average number rose from 5.9 at the Census of 1891 to 6.2 at the Census of 1901 To what extent, if any, the average number per house has increased since the last Census 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. The estimated population for 1909 was 56,000, and the •estimate for 1910 has been placed at 57,000 inhabitants. BIRTHS. |
c967d292-141c-4eec-ac34-ae7e83bad07b | Number 1477 Rate per 1,000 25.8 per 1,000 Rate per 1,000 in England and Wales 24.8 „ 1,000 Rate per 1,000 in 77 large towns 25 „ 1,000 Rate per 1,000 in 136 smaller towns 23.7 „ 1,000 1,477 births were registered in the district This number corresponds to a birth-rate of 25.8 per 1,000 inhabitants. On Table I 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 1910 the lowest on record, but that the number of births registered is lower than that in any year since 1904. 10 In last year's report it was shown that although the crude birth rate of Acton is still higher than that of England and Wales, yet based upon the number of women living at procreative ages it is considerably lower. |
91bc8329-40ef-448c-9a27-05b9cc76c15a | If the age-incidence of the population has not altered since the Census, the birth-rate per 1,000 females between the ages of 15 and 45 years was much lower in Acton last year than in England and Wales. Of the births registered 767 were males and 710 of females. In 1909 the proportion of male births to 1,000 births of females was the same as in England and Wales, viz, 1039. Last year the proportion of males to 1,000 females was 1080. In 1908 the female births exceeded the male births. The highest number of births registered in one week was 42, and the lowest 15,. The births were distributed amongst the Wards as follows:— North-East. North-West. South-East. South-West. 318 219 381 559 The rates per 1,000 inhabitants were as follows:— North-East. North-West. South-East. South-West. |
78844783-384b-47a2-9ea6-0cf668507b89 | 21.2 16.8 25.4 39.2 The birth-rates of the North-East and North-West Wards were lower than in 1909, but in the South-East and South-West Wards they were higher. The infants registered as having been born out of wedlock number 36, which figure corresponds to a rate of 24 per 1,000 births. This is higher than the illigetimate rate of 1909, but lower than that of 1908 and also considerably lower than that of England and Wales. DEATHS. |
aafde102-c1f2-4b14-afc6-1ef7a5e5b91f | Number 623 Death-rate per 1,000 10.9 Death-rate per 1,000 in England and Wales 13.4 Death-rate per 1,000 in 77 large towns 13.4 Death-rate per 1,000 in 136 smaller towns 12.4 11 It was stated in last year's report that although certain directions are issued as to the deaths that should be credited to a district, there is no uniformity of practice. 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. Deaths of non-residents occurring in public institutions in the district are in like manner to be excluded. |
2c406429-c94f-4f32-b726-bb17a670517c | By the term "nonresident" 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. In future the Returns of the Registrar General will refer to Sanitary districts and it will be possible to compare the deathrates as given by the Registrar General with those in thereports of Medical Officers of Health. Unless some uniformity of practice can be established, it will be found that the two sets of figures will differ, sometimes to a considerable extent. |
54a1cc8f-2683-4b4c-9827-ce4a2994a1fd | It will be observed that the Local Government Board Regulations refer to persons brought into a district on account of sickness and infirmity and dying in a public institution thereIf the above definition be accepted, fatal accidents should be included amongst the deaths of the district wherein the accident occurred, whether the persons fatally injured are residents or non-residents. Yet among the returns forwarded to me by the Registrar General were the deaths of three Actonians, one of 12 whom met a fatal accident in Hammersmith, the other was found drowned in the Canal at Willesden and the third was found drowned in the Thames at Kew. The fatal accidents to non-residents on the railways, &c. in the district usually balance the accidental deaths of residents beyond the district, but it is obvious that both sets should not be included in our returns. Again, the returns of five deaths which occurred in private houses outside the district were forwarded here. It is unnecessary to detail the circumstances attending all these deaths, but one example may be given. |
2cbc8815-743b-42df-a361-941618cdd6c5 | A husband and wife living in Acton were appointed care-takers of a house in Kensington. The man died after he had acted five weeks as care-taker, and the widow returned to Acton, and the return of the death was forwarded here. If such a proceeding be correct, we should have to inquire into every death that occurred. It is advisable that definite rules should be adopted as to the deaths that are to be included in the returns. Of the outside deaths sent by the Eegistrar General, 17 were rejected. Three belonged to Hammersmith and one to Brentford. These persons died in public institutions from streets partly situated in this district, but the address given was not in Acton. Five died in private houses outside the district. Three deaths were given as belonging to Acton, but the previous address of one of the persons was given as Bollo Lane. One side of Bollo Lane is in Brentford. |
a0a94647-e67e-4fca-8d8b-7558eee56f37 | The other two were simply stated to have lived in Acton, but no address was given. In two instances wrong addresses must have been given. One of the addresses given was Middle Road, Acton. There is no such street. In the other case, a person died in the Gordon Boad Workhouse, Peckham, and was stated to have lived in Acton Lane. No such person had lived at the address given within the last two years. The other three deaths referred to, were the two found drowned, and the person fatally injured on the railway. 13 509 deaths were registered in the district. Two "nonresidents " died in the Cottage Hospital. 116 deaths of "residents" occurred outside the district. The total number of deaths belonging to the district is 623, which corresponds to a death rate of 10.9 per 1,000 inhaitants. This is probably the lowest death rate on record for the district. |
6fa6fd78-d90b-4d9d-99c0-196973b8390d | Prior to 1905, the deaths of "residents" occurring outside the district were not included in the returns, so that an exact comparison with the earlier years cannot be made. The death rates since 1904 have been as follows:— 1905 12.5 per 1,000 1906 13.2 1907 13.9 1908 13.1 1909 12.6 1910 10.9 The lowest death rate before 1910, of which any record can be obtained, was in 1903. In that year's report, the "outside" deaths were not included, and the death rate was 9.8 per 1,000. On the same basis, the death rate last year would be 8 9 per 1,000. One can safely assert, that last year had the lowest death rate on record for the district. |
0b83384e-aa0f-4113-8368-a1e426e9e28c | 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 The tendency to death is greatest among persons living at the extremes of life—among infants and old people. The Registrar-General has published a Table of "factors'' for all the large towns &c., by applying which to the crude death 14 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 be fairly compared. |
9d33a0ee-5af5-4a55-99f4-8ce8d0337e56 | The "factor for correction" for Acton is 1.04240. If the "crude death rate" 10.9 be multiplied by this figure, the corrected death rate is 11.4. The "corrected death rate" for the 77 great towns for 1910 was 14.3, and for the 136 smaller towns 12.9 per 1,000 inhabitants. The death rate is 1.7 per 1,000 lower than that of 1909, 2.2 per 1,000 lower than that of 1908, and 3 per 1,000 lower than that of 1907. Possibly, if the figures are stated in another manner, they may appear in a more vivid light. Last year, there were actually 114 less deaths in the district than in 1909. If the death rate of 1907 had prevailed last year, 171 more deaths would have occurred. |
c14c6fb4-1879-454c-aa47-0854a65daf02 | If one were allowed to review these figures merely from an economical point of view, it would be interesting to speculate on the financial value of sanitary efforts. It is true that all the saving is not due to sanitary efforts, nor is the greatest saving among the productive elements of the population, but even in the age period 15—65, there has been a considerable reduction in the death rate. 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. 151 55 18 20 203 176 Compared with 1909, there was a decrease in the number of deaths at all age periods, except in persons over 65 years of age. 15 The greatest reduction was noticed in the age period 1—5 years when only 55 deaths occurred as compared with 102 in 1909. |
9b455022-cfe7-4167-a94c-1af6da93e295 | It is true that this age period is not a productive one but it is not sufficiently recognised how important this age-period is. 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. Among infants under one year of age, there was a decrease of seven. The deaths of infants under 12 months are dealt with in a subsequent paragraph. Ward Distribution.— North-East. North-West. South-East. South-West. 132 125 149 217 Based upon the estimated population of each Ward, the death rate for 1,000 was:— North-Bast. North-West. South-East. South-West. 8.8 8.9 9.9 15.5 Compared with 1909, the death rate is slightly higher in the North-East Ward, and slightly lower in the North-West Ward. |
8bd48ff6-8563-484b-906e-5982ac1b3a6b | It is in the South-East and South-West Wards that the reduced death rate is most noticeable. When comparing the death rate in these wards with that of previous years, it should be remembered that the boundaries of these wards were rearranged, and a portion of the South-West Ward was transferred to the South-East Ward. The death rate in the South-East Ward is 1.6 per 1,000 lower than it was in 1909, and in the South-West Ward it is 3.6 per 1,000 lower. For some time particular attention has been paid to the South-West Ward, and during the past two years, a considerable amount of house-to-house inspection has been made in the Ward. It is only fair to infer that the improvement is mostly due to the improved sanitary conditions which obtain as a result of the 16 house-to-house inspection. It is admitted that social conditions exert a potent influence upon the death rate, but these cannot have materially altered within the last few years. |
e04d77a3-37c1-4726-983d-72bcfcce3040 | Although the death rate has been reduced, there is still room for much improvement. The age constitution of the Ward is different to that of the other wards, and for this and other reasons, it is probable that the death rate of this ward cannot be brought down to the level of the other wards, but an excess of nearly 40 per cent. in the number of deaths, as compared with the rest of the district, cannot be regarded as satisfactory. On Table IV. will be found the causes of death from most of the Zymotic diseases. Prom Measles there was one death compared with 40 in 1909; from Scarlet Fever two, compared with 16; and from Diphtheria nine, compared with 22. Whooping Cough claimed more victims, 20 compared with 13, and there were two deaths from Enteric Fever compared with one in 1909. There were fewer deaths also from Diarrhceal Diseases, and Tubercular Diseases. |
bb9d823d-0d28-479b-ae43-b40c17bd5b6c | From the other diseases there was no very marked difference in the number of deaths as compared with 1909. The highest number of deaths occurred in April with 60, and the lowest number occurred in August with 36 deaths. Although the number of deaths occurring in Public Institutions is lower than that of 1908 and 1909, the proportion to the total number of deaths remains the same. Over one-fifth of the total deaths occurs in Public Institutions. The institutions outside the district in which residents died, together with the number of deaths were as follows :— Isleworth Infirmary 73 West London Hospital 10 Middlesex Hospital 5 17 Middlesex County Asylum 4 Cancer Hospital, Chelsea 3 St. Mary's Hospital 2 London Fever Hospital 2 St. Luke's Home 2 Charing Cross Hospital 2 Ear Hospital, Soho 1 St. Peter's Hospital 1 Guy's Hospital 1 St. |
8db0370f-926e-4184-87a5-1bc73c37b7de | Thomas's Hospital 1 London Hospital 1 Belgrave Hospital 1 Infants' Hospital 1 St. George's Hospital 1 King's College Hospital 1 Heart Hospital, Soho1 Hostel of God 1 St. Marylebone Infirmary 1 St. George's Infirmary 1 MEASLES. Only one death occurred from Measles during the year and that was in December. There was a limited outbreak of the disease in the early summer, and towards the end of the year several cases were reported from some of the schools. In the first outbreak, no deaths occurred from the disease although 68 cases were reported amongst children of School age. This number, of course, does not represent anything like the total number of cases that occurred. But not a single death occurred. This was probably due to two Causes. It was partly due to the limited Character of the outbreak. It is almost the general experience that as an epidemic progresses the cases become more severe in character. |
8a6522aa-58d4-4dd0-ae09-54a832e6677a | The increase of severity seems to be due to the concentration of the poison. Of more importance, though, is the season in which an outbreak occurs. In industrial districts, Measles is more fatal in cold than warm weather. 18 Apart from the lessened severity of the initial symptoms the liability to lung complications is much greater in the winter than in the summer. A Measles epidemic is in many ways a less formidable occurrence in the summer than in the winter and one is justified in taking every step, no matter how drastic, to prevent an epidemic during the winter months, though our efforts may result only in the postponement of an outbreak for a few months. It is possible that the disease was introduced into the district on several occasions. Some of the earlier cases reported from the schools were not Measles, and the cases reported from South Acton and Rothschild Road Schools in January probably came within this category. The first undoubted case occurred in the Central Infant's Department. |
9684034f-509b-468f-88dd-e0df7612c48e | The child was excluded from School on January 31st. The symptoms first appeared on the previous Friday (January 28th), and the child had not mixed with the other children on January 31st. The child attended the class in Room V. Great care was exercised to prevent the spread of the disease in this class, and a child who had been excluded on February 10th, on account of suspicious symptoms, subsequently developed the disease. No further cases were reported from this class until May 17th, when three cases were notified. In Room IV, a case occurred in February, one in March, two in April, one in May before the Whitsuntide holidays, and six in May subsequently to the holidays. The earlier cases in Class IV all occurred towards the end of the week, and we wish to emphasize this point as a factor in the postponement of the spread of the outbreak. |
5a2d24a5-7c64-46b2-a848-533d5a5c6240 | The first case in this class exhibited symptoms on February 25th (Friday), and the child was last in school on February 24th. She was kept home on the Friday and the rash had appeared before Monday. 19 The second case exhibited the symptoms on March 14th (Monday), and had not been in school since the previous Friday (March 11th). The third case exhibited the initial symptoms on April 9th (Saturday), and the child was not in school after April 8th. As Measles made its appearance in other class-rooms in April, the history of the other cases in Room IV is not important. During the autumn, Measles again made its appearance. The first case occurred in South Acton Infants' Department. A child attending Class V sickened on October 12th, and was excluded on October 13th. |
fbd59541-01cd-4ffd-8d56-aac6c031832e | Class V in the Infants Department was a particularly well-protected one, 40 of the children being known to have previously had Measles and only 9 were stated not to have had the disease. The class was kept under observation, and no further cases resulted in the school. The second case was entirely independent of the above in its origin. It occurred in the Northern part of the district, and the child attended the mixed department of the Acton Wells School. The onset of the disease was on October 28th, and the child was excluded from school on October 31st. As the senior classes are ail well protected, it was not anticipated that the disease would spread, and no secondary cases occurred in the mixed department. A case did occur though in the Infants Department, but fortunately it was towards the end of the week. |
740abcd1-a51a-40c2-8038-69ac7b57167c | A child sickened of the disease on November 12th (Saturday), and by November 14th (Monday) the rash had appeared, and she was not at school after November 11th. The class was also a fairly well protected one; out of a class of 58, 42 were stated definitely to have had Measles, 5 were uncertain, and 11 had not had the disease. 20 No secondary cases occurred. The next case occurred in the Priory School. A child was excluded from Class VII of the Infants Department on November 9th. The child only sickened on that day and the rash did not appear until the following day. The children were kept under observation, and no further cases occurred in that class. A case occurred, though, in Class IV, and though the infection could not be definitely traced to the previous case in the department, it is probable that there was no other source of infection. |
fd2ae8cc-0dcf-4572-8a59-d392f2d04e34 | The boy attending Class VII infected two other children in his home, and one of the latter died of the disease on Decemher 5th. The death occurred in a child 21 months old—an age peculiarly susceptible to a fatal attack of Measles. Fortunately, the case in Class IV occurred towards the end of the week, and the child was last at school on a Friday, November 18th. As a result only two further cases resulted— One in Class IV, and one in the boys department. Both cases sickened on December 4th, but attended school on December 5th, before the rash appeared. The number of contacts with the child in Class IV was increased owing to the fact that four other classes had been using the same class room simultaneously with Class IV. The Infants Department of the Priory School was not at that time a well-protected one. |
3177cbdb-cdd7-421c-8bd2-d3519bc8e143 | In Class IV, out of a total of 45, 14 had not had Measles; and in Class VII, out of a total of 51, 22 had not had Measles. The other four classes which had been in contact with Class IV were better protected. In Class I, 35 had had Measles and six had not; in Class II the figures were 35 and 6; in Class III, 29 and 12; and Class V, 23 and 4. The situation one had to face was difficult. It was felt that if School closure was to be of any avail, it must be done before 21 the "first crop" fell. If the same conditions had prevailed in the middle, of the session, one would hesitate to interfere with the school arrangements to the extent of closing the department" but as it was so near the Christmas holidays, the interference would not be great. |
762de9be-ec24-46c0-b4fc-0cfbace242d6 | On the other hand, every means should be taken to prevent an epidemic of Measles during the winter months. In industrial neighbourhoods Measles is very fatal in cold weather, owing to the frequency in which lung complications occur. Apart from the question of age incidence, it would be of great benefit if an epidemic could be postponed even if it were only for six months. In the circumstances it was decided to close the Infants Department for the Christmas holidays on December 9th. A list of the children attending the five classes was obtained, and they were visited during the holidays. It was ascertained that 13 cases had occurred between December 12th and January 9th, the date of re-opening the schools. It has been stated that Measles tends to spread whenever a class accumulates unprotected members to the extent of between 30 and 40 per cent., and when spread has begun, it continues until the proportion is reduced to between 15 and 20 per cent. unprotected. |
22d53ec8-c586-45a3-980d-3609dd7350b7 | This simply means that the opportunities for the introduction of Measles in London and the surrounding suburbs are so numerous, a class with a large number of unprotected children is the most vulnerable. But it does not follow that even in such a class efforts to postpone an outbreak will not be successful. In Class IV, at the commencement of the outbreak, only eight children out of 53 had previously suffered from Measles, and yet until a case occurred in the middle of the week, and attended school during the infectious period, the disease did not spread in the class. But more marked even was the experience of Turnham Green and Beaumont Park Schools. A child attending Class 3 of the Turnham Green Schools was last at 22 school on May 6th (Friday); on the same evening the child developed the initial symptoms of Measles, and by Monday the rash had appeared. |
3fd09ff0-247e-4662-9dcc-2b76d1db8e6f | This was the only case that occurred in the school, though only eight out of a class of 22 were protected by a previous attack of Measles. Two cases also occurred in Beaumont Park Infants Department, and in both instances the children were last at school on May 13th (Friday). Before the following Monday the initial symptoms of Measles had appeared, and they were kept away from school. No further cases occurred. One of the classes was particularly well protected, and 43 out of 49 children had previously had Measles, but in the other, 21 out of a class of 47 were unprotected. It is of course a drastic measure to close a whole department on the occurrence of a single case of Measles, but if a case occurs in the middle of a week, and subsequently attends school whilst in an infectious state, the only chance of success lies in the closing of that class. |
72bbe9e2-a0d4-4874-8333-b084c1c8bd63 | A history of the outbreak of Measles in the latter part of the year will show the efficacy of school closure on the appearance of an early case in a class. The closure was rendered less difficult owing to the proximity of the Christmas Holidays. A further history of this outbreak will be given in a subsequent report, but it may be mentioned that no further cases had occurred when this report was written (February 24th). WHOOPING COUGH. Twenty deaths occurred from Whooping Cough. Three of the deaths occurred in the North-East Ward, one in the NorthWest, four in the South-East, and twelve in the South-West Wards. Nine of the deaths were in children under twelve months old, and ten were in children between the ages of one and five years. The age of the persons attacked constitute one of the chief difficulties in the control of the disease. |
3bab9767-c68a-4385-b562-e1b3092648f2 | We have no means of ascertaining to what extent the disease is prevalent 23 except from the death returns, and from the notifications received from the schools. The children of school age, though, constitute only a small proportion of those attacked. 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. 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. It will be appreciated though, from the age incidence of the disease, that all efforts must be centred in the home. |
35f3a8f8-a3c5-4761-bec8-67a3d88e3b33 | When a case occurs amongst school children, the contracts attending the infants departments are excluded, but when a case occurs amongst a child under school age, unless the parents notify the school authorities that there is a case of Whooping Cough in the house, both the teacher and the sanitary authority are in complete ignorance of the existence of the disease. SCARLET FEVER, There was a considerable diminution in number of Scarlet Fever notifications, 109 being received, compared with 468 in 1909 and 484 in 1908. The majority of the cases were very mild in character, and only two deaths resulted from the disease. The elementary schools in which most cases occurred were Central twenty-one, Beaumont Park eleven and Priory eleven. The Ward distribution was as follows:— North-East. North-West. South-East. South-West. 38 12 23 36 DIPHTHERIA. One hundred and eighteen cases of Diptheria were notified and nine deaths occurred from the disease. |
85541aa4-e81e-4b97-8565-dc35c9416eba | 24 There is a slight increase in the number of notifications, but a considerable drop in the number of deaths that occurred. Ninety cases were removed to the Isolation Hospital and four deaths occurred there. One death occurred in a public institution outside the district. Twenty-five cases were nursed at home and four of these resulted fatally. Sixty-six out of the 118 cases were amongst school children, and 60 of these were in the Elementary Schools of the district. The incidence of the disease was highest in the Central School with six cases, Beaumont Park with 13, and Southfield Boad with 25. In all these schools the source of infection could be traced almost certainly to a carrier case. The cases in the Central School occurred early in the year, and the school was free of the disease from the date on which the "carrier" cases were excluded. An examination of the children in some of the classes was made on January 27th. |
c13542e1-81a6-4c6b-ba44-e343af0861c9 | Swabs were taken from the throats of all children suspected of having had a recent inflamation of the throat. Two children were found harbouring the germs of the disease. Both children were excluded from school and the notifications ceased. In Beaumont Park some cases were notified on the reopening of the schools after the Summer Holidays, and one of the children in the school was found to be suffering from a nasal discharge. A cultivation was made and the Klebs-Loeffler bacillus was isolated. In Southfield Road School, the number of cases was higher, and this was due to two batches of "carrier" cases. On the re-opening of the schools after the Summer Holidays a "carrier" case was detected attending school. His exclusion was the means of cutting short the outbreak. 25 A recrudence occurred in October, and on November 1st, aN examination of the children in the school was made. |
3b98d590-3ad7-4376-af96-152290947ba3 | As a result of the bacteriological examination four were found to be harbouring the germs of Diphtheria. These latent cases of diphtheria constantly crop up, and their detection and mode of dealing with them give rise to continual misunderstandings and complaints. Before the specific Bacillus was discovered, it was known that persons who had recovered from recognisable Diphtheria, gave rise to the disease in others, though a considerable time had elapsed since all symptoms had disappeared in the original sufferers. It was also recognised clinically that persons who had not themselves suffered from recognisable Diphtheria, but who had recently recovered from a sore throat were liable to give Diphtheria to others. |
647b5cbd-f2e6-4d91-a3fd-db13f05e0f10 | Moreover, it is not only during convalescence from Diphtheria and after slight attacks of sore throat that the bacillus may be present, but also after contact or association with Diphtheria patients, both adults and children are liable to harbour the bacillus in the throat, even when no local constitutional disorder of any kind has been noticed. These phenomena have become the best known facts of bacteriology, which are of practical every-day interest, and at the same time one of the chief bugbears of general practitioners and Medical Officers of Health. It is with the second and third aspects of the question that we are now concerned. The number of return cases of Diphtheria is probably now reduced to a very low figure, as a negative result is almost invariably obtained before the patient is pronounced free from infection. The question may be approached from three stand points, the clinical, the bacteriological, and the administrative. |
6509a3c1-52e6-4ff9-a65f-b855fe09e0b3 | From a public health point of view the administrative is, of course, the most important, but administrative measures should be based, upon clinical and bacteriological experience. 26 If Diphtheria may be defined as any pathological condition, local or general, due to infection by specific Diphtheria organisms, then Diphtheria is "latent" when such pathological conditions are unaccompanied by obvious illness or by symptoms sufficiently characteristic to be recognisable as Diphtheria. We come in contact with three kinds of cases that may be classed in this group:— 1. Persons who are in poor general health associated with some abnormal condition of the throat, nose or ear. 2. Cases of local Diphtheria lesions, but presenting no general symptoms of ill-health. 3. Cases with no local lesions and no departure from normal health. .. Bacteriologically, Diphtheria is latent when the specific germs are present unaccompanied by any obvious pathological change. |
a6b480eb-e8d1-4af5-8ffe-f8c4ac3cd4f6 | The infective agents are held in check by what we call vital resistance on the part of the tissues, or diminished virulence on the part of the specific microbe. The nature of the immunity enjoyed by the carriers of virulent bacilli is obscure, and the only method as yet available to meet the requirements cf prompt administrative action is not able to differentiate between the comparative virulence of the bacilli. The power of the unrecognised case and the positive contact to infect has been amply demonstrated, though the accident is much more rare than might be anticipated from the large number of mild cases and infected contacts in the community. The number of possible infectors is also reduced when we consider that it is only likely to be persons harbouring virulent bacilli that are capable of infecting others with disease-producing bacilli. When the bacillus gains a lodgement in the throat, it appears to remain for a varying length of time, whether it 27 produces disease or not. |
1bd7e59d-b720-44df-b943-bf10619a5cd1 | The period of the residence of the organisms in the sick and the healthy is probably determined by the same factor, and in both classes of cases the organism has been known to persist for very long periods. In the majority of cases, the germs disappear well within the usual six weeks df isolation. In a disease of such a short period of incubation and rapid clinical course, the development of administrative measures for its control is always a matter of importance. The matter that has excited the keenest interest and often controversy is the segregation of infected contacts and other carriers of infection; for, however desirable it may appear in theory, it is attended with much difficulty in practice. Any hard and fast rule is not warranted from our present knowledge of the subject clinically or bacteriologically. All administrative action depends to some extent upon legal powers, and the first essential is to have clearly before our minds how far we can legally proceed. |
ce4c3640-4138-4127-87f4-f082e0c138b7 | Section 126 of the Public Health Act, 1875, gives powers with regard to "any person who, while suffering from any dangerous infectious disease, expose themselves," etc. Section 52, part 4. of the Public Health Acts Amendment Act, 1907, states that "If any person knows that he is suffering from an infectious disease, he shall not engage in any occupation unless he can do so ' without risk df spreading the infectious disease." In each, of these sections, and in others relating to infectious disease, it is specified that the person must be suffering from the infectious disease, and probably definite illness seems to be implied. In our fever hospitals many cases of Scarlet Fever and Diphtheria are detained, not because there is any clinical manifestation of the disease, but because, in our opinion, they remain in an infectious condition. If any such patient left hospital against advice, prosecution would probably follow, although he is not suffering from the disease. |
63982060-40ec-4253-abe8-4d1ba424eca9 | 28 When one remembers that the Diphtheria carrier is like the above-mentioned fever patient—in an ineffective state although not suffering from the disease; one considers that the legal powers are equal with regard to the two clauses. One would probably be in a stronger position if " in an ineffective condition " were substituted for " suffering." As a matter of fact, one takes no action, except peaceful persuasion, with healthy Diphtheria carriers, and no difficulty is experienced in getting most of the known cases to adopt sufficient precautions. Besides, the most dangerous ones are school children, and under the Acton Improvement Act, 1904, power is given to exclude such carriers from school. Section 27 states that the Medical Officer of Health may at all reasonable times enter any public elementary school within the district, and examine the scholars attending the same, and may exclude from attendance thereat, for such period as he shall consider requisite, any scholar who in his opinion is suffering from an infectious disease, or is likely to spread infection. |
a0f676fd-ed0a-4313-b6db-7fac466dfa90 | Our efforts are directed with the object of the discovery and the sufficient isolation of the carrier case, and the possible spread by the other inmates of the infected household. Whenever a case of Diphtheria is notified, certain inquiries are made with a view of ascertaining the source of the infection. In the past, consciously or unconsciously, we have probably been attaching far too much attention to dead matter and the passive transmitters of disease—namely, soil, water, air, clothes and foods—and have been bestowing far too little consideration on the living storehouses of bacteria. The tendency in soil, water and air is towards the destruction of pathological bacteria; it is living matter which is the probable factor which keeps infectious matter alive, and infected living matter are the carriers, which probably serve to bridge over the gulf between one epidemic and the next. For this reason, particular attention is paid to the possibility of another member of the family having suffered from a sore throat. |
1e6753fd-40da-492f-9074-5a82bbefca07 | 29 If a history of a previous sore throat in the family be obtained, the doctor in attendance is communicated with, and either he is asked to take a swab, or permission is obtained to take one. When two or more cases are notified from one class-room in a school, attention is paid to that class and if that class or department is suspected to be the focus of infection, the scholars are examined, and where necessary a swab is taken of the throat or nose. In some districts the taking of swabs is practised to a far greater extent, and occasionally every member of a household where a case of Diphtheria has occurred is swabbed. A certain proportion of those who are brought into contact with Diphtheria patients harbour the bacilli in their throats or nasal cavities. |
6e3374b9-96e5-42a6-83ee-724b8d30d8d8 | The percentage is highest in the immediate contacts, that is, in members of the same family; next, in classmates at school; it diminishes rapidly as we enlarge the interpretation so as to include such extremely remote contacts as the general inhabitants, and the percentage showing the bacilli is a negligible one. Theoretically, the swabbing of all contacts seems an ideal system, but it would be impossible under present conditions to carry out such a practice here. Moreover, the practice adopted in this district has been sufficient to prevent the spread of the disease in the different schools. It has been reported, on several occasions, how the detection of carrier cases has coincided with the subsidence of the notifications from different schools. When necessary, some of the children are excluded pending the result of the bacteriological examination, but sometimes it is impracticable to take a swab. It is at this stage that misunderstandings occur and difficulties arise. |
f7455986-f9b4-4369-81a4-9a3e996bb567 | Occasionally it is understood that the child will be seen by a private doctor, when as a matter of fact a doctor is not called in. At other times, the child is taken to see a doctor, who pronounces the case not 30 to be Diphtheria, without a bacteriological examination. This only occurs in some of the. schools, but the incidence of Diphtheria is heaviest on those particular schools. Having discovered the carrier case, to what extent should isolation be carried out ? In this respect, the practice of different sanitary authorities differs considerably. Some authorities observe the same rigid rules as in the case of clinical Diphtheria, and advise the removal to hospital, whilst others refuse to admit the carrier cases to the general wards. In Cambridge the Sanitary authority has furnished a house for the reception of carrier cases. In this district, we do not advise the removal to Hospital, except under very exceptional conditions. |
0787d74a-def6-44bc-bf2d-aaabd6b059ed | There seems no risk to the carrier cases themselves in being mixed with ordinary clinical Diphtheria. Although the nature of the immunity is obscure, yet, for the time being, it seems to be absolute, and there is no record of a carrier case exhibiting clinical symptoms in a general Diphtheria Ward. Nevertheless, it is safe to relax and modify somewhat the isolation rules practised in clinical Diphtheria. So long as the carrier case does not come into immediate contact with children, the risk is practically nil. There is no record of indirect infection through clothing, &c., from a carrier case. The carrier case himself, of course, is excluded from school, and so are all the children of the family. The period of exclusion extends until two negative swabs are obtained. The other children are allowed to attend school in eight days after a negative result, and the carrier case in three weeks. The movements of the other inmates of the house are not interfered with, except in very exceptional circumstances. |
9aeec583-9cca-4a1b-91da-ec3cea6d4c65 | The Public Libary is communicated with, and during quarantine books are not given out to members of the family. 31 It will be understood from the foregoing remarks, that it is inadvisable to adopt for all cases a hard and fast rule. An. endeavour is made to deal with each case upon its merits, but, as a result, misunderstandings very often occur. I may record a few instances where recently a difficulty occurred:—A child was examined in Southfield Road School, and a swab taken from the throat. The child was sent home and excluded from school pending the result. The result was positive and the Health Visitor was sent to the house to make further inquiries and give instructions. The father of the child called up at the same time at the office and ridiculed the idea of the child being a disease carrier. He was asked to obtain the advice of another doctor, but stated that he could not afford it, nor could he isolate the child. There was no. |
f16b35ba-f5d5-44ef-9aa2-cfb21efea2f7 | option but to remove the case to the Hospital, which the father reluctantly accepted, but evidently misbelieving the possibility of any risk being attached to the case remaining at home. A few days afterwards another child of the same family exhibited: symptoms of clinical Diphtheria. Both parents were then convinced., A second case was enamined at the same school and the same mode of procedure adopted in the school. The result here also was positive, but before the Health Visitor had called, the mother had taken the child to see another doctor, and the case was pronounced by him not to be Diphtheria, without having a, bacteriological examination made. As a result of this opinion, the other children were sent to. school, but a notice had been sent to the school that all children in the family should be excluded until further notice, consequently they were not admitted. The mother came down to see me at the office, and I explained the circumstances to her. |
241b7128-899c-4999-8d65-0bc1ba97c6a0 | If she cared, a second swab could be taken by the doctor who had seen the child and sent to the Lister Institute at the Council's expense, or I would take another swab, as the doctor was not then in attendance. She preferred the second alternative, and the result was again positive. The mother then called in another doctor, but he, having heard the result of the. 32 bacteriological examination advised the mother to isolate the child and treat him as a case of infectious disease. The third case was also a scholar in Southfield Road Infants Department. The child refused to allow an examination to be made, and it was understood that she had been seen by a doctor. She was excluded and inquiries made on the same day. It was understood that there was an infant in the house suffering from Whooping Cough and being attended by a doctor. The child also had a persistent cough which probably was the commencement of Whooping Cough. |
96650966-32d1-48fa-9cf5-fdc966053141 | Instructions were left as to the manner in which the case should be dealt with pending a definite result. Meanwhile, the child was excluded from school as a Whooping Cough contact. Not hearing anything from the doctor, I called on the third day and found that no doctor was in attendance on the school-girl. Permission being given, a swab was taken and the Diphtheria germs were found. The child could be isolated in the home, but the daughters reported the case to their employers and the former were asked to cease work, unless a certificate could be produced that there was no infection. Such a certificate, of course, could not be given, and the mother requested that the child be removed to Hospital. When it was explained that the employers could be assured that there would practically be no risk of the infection being spread by the daughters following their usual employment, the mother requested the discharge of the child from the Hospital, and the child was isolated at home. |
7248d958-496e-4bb3-b3f2-a847049da58e | During the year the arrangements for the distributions of Diphtheria Antitoxin have been extended. At the October meeting of the Health Committee the Order and Circular of the Local Government Board was considered. Under Section 133 of the Public Health Act, 1875, any local Authority may, with the sanction of the Local Government Board, themselves provide or contract with any person to provide a temporary supply of medicine and medical assistance for the poorer inhabitants of their district. In the Order the Local Government Board sanctioned, in pursuance of Section 133, of a temporary supply of Diphtheria Antitoxin, and of Medical assistance in connection with the temporary supply of antitixin subject to the following conditions, that is to say,— 33 The arrangements with respect to the keeping," distribution and use of the Diphtheria Anti-toxin shall be made in accordance with the advice of the Medical Officer of Health. |
5a14d8ba-cf75-425e-8657-da93424ec513 | To prevent misapprehension it should be observed that the free distribution of Diphtheria Anti-toxin, which is authorised by the Order, must not be regarded as a substitute for removal to hospital of a patient suffering from diphtheria, nor as implying that the patient to whom Anti-toxin has been administered may properly be retained for treatment at home, unless means are available for his efficient isolation to the satisfaction of the Medical Officer of Health. The prompt administration of Anti-toxin before the patient is removed to hospital may, if delay in removal is inevitable, go far towards preventing the attack of diphtheria from being fatal. It has been decided by the Council to store a supply of Anti-toxin in the Public Health Department at the Council Offices and at the Isolation Hospital. If the patient be subsequently removed to hospital no charge is made, but if the case is nursed at home the Anti-toxin is to be replaced and a charge of one shilling made if the Council's syringe is used. |
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