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5ac6832e-a4ee-4487-9927-0474703d52cf | Notified September 17th, 1913. History. The child was suddenly taken ill on September 8th, 1913, and a local doctor was called in. Both legs and the right arm were paralysed, but speech was not affected. A specialist was called in attendance, who diagnosed Acute Poliomyelitis. Death occurred on September 18th. The child returned from Seaford 9 days before date of sickening. At Seaford he was staying in a boarding-house, where another child was staying. The latter had no signs or symptoms of paralysis. 35 The child had always been a healthy child except for the presence of enlarged tonsils and adenoids and a certain amount of difficulty in nose breathing. No paralysis in any near relative. The premises were disinfected on September 25th, 1913. There were no children of school age in the house. 5. Boy, 4 months. |
303d4e5f-8613-4c86-854c-10e4d286a88c | Notified on October 24th, from West London Hospital. History. The mother noticed that the child could not lift his left arm on October 9th, and took him to the West London Hospital. He was admitted on October 15th. He was discharged from the Hospital on November 17th. On his discharge the child was suffering from diarrhoea, and the skin of his hands, feet, arms and legs was peeling, but he could use the left arm and hand. The child was very thin and wasted. There is no paralysis in any near relative. No children from the house attend school. 6. Girl, aged 1Β½ years. Notified on October 25th, from West London Hospital. History. Has been under a private doctor since she was 6 months old, and stated by him to be suffering from consumption of the bowels. |
2b887b0a-bca1-4252-9824-52f02c8e9315 | The child was in Bournemouth in the summer for 2 months, and during the whole of that time she suffered from diarrhoea and vomiting. On her return from Bournemouth she was taken to the West London Hospital and treated as an out-patient. She still attends there fortnightly as an out-patient, and is allowed to mix freely with the others. Progress. The child has now the use of all her limbs, and there does not appear to be any paralysis. She is the only child in the family. There is no history of paralysis in any near relative. 36 MEASLES. 25 deaths were registered as due to Measles, and 23 of these occurred in the first quarter of the year. The other 2 deaths occurred in the second quarter of the year. All the deaths occurred in the outbreak which commenced in September, 1912. The outbreak started in the south-western part of the district, the first case being reported from the Rothschild Road School. |
9ceee9b4-1838-476d-8852-110a21d56459 | The outbreak spread through most of the district, and the distribution of the deaths was as follows :β Gloucester Road 3 Meon Road 3 Junction Road 2 Colville Road 2 Osborne Road 2 Packington Road 2 Acton Lane 1 Avenue Road 1 Bollo Lane 1 Clovelly Road 1 Holland Terrace 1 Mill Hill Terrace 1 Park Road North 1 Park Road East 1 Petersheld Road 1 St. Margaret's Terrace 1 On Table 111. the ages at death are given, and it will be observed that, as usual, the most fatal year is the second one. In the first year of life only 2 deaths occurred, and in the second year 15. |
0eae5434-5f05-4b02-bbe6-fc32000b5eef | In the report on the medical inspection of school children the age-incidence of the notified cases is given, and though these figures are not a criterion of the distribution of the disease, they show that Measles is a comparatively mild disease except in very young children, and exceedingly fatal to children in their second and third year. 37 WHOOPING COUGH. 15 deaths occurred from Whooping Cough. The disease was most prevalent during the early part of the year, and the southern part of the district was mostly affected. 4 of the deaths occurred in the North-East Ward, 1 in the North-West, 2 in the SouthEast, and 8 in the South-West. All the deaths occurred in children under 5 years of age. TUBERCULOSIS. There were 61 deaths from Pulmonary Tuberculosis or Consumption of the Lungs, 8 from Tuberculous Meningitis, and 7 from other Tuberculous diseases. |
2c8b46af-0efa-445d-9ff6-50d649182cd8 | 34 of the deaths from Pulmonary Tuberculosis, 4 of the deaths from Tuberculous Meningitis, and 1 of the deaths from other Tuberculous diseases occurred in public and other institutions outside the district. Of the deaths from Pulmonary Tuberculosis, 37 were of males and 24 of females. Prior to their illness the persons who died of Pulmonary Tuberculosis were occupied as follows :β Males. Labourer 7 Motor Cab Driver 5 Carman 4 Laundry 2 Clerk 2 Mechanic 1 Librarian 1 Army Reserve 1 School Cleaner 1 Cashier 1 Bootmaker 1 Builder's Contractor 1 Omnibus Conductor 1 Brass Finisher 1 F EMALES. |
dab2f483-c218-4f80-84e7-1fb76061e8ae | Laundress 8 Domestic Service 3 Typist 1 Saleswoman 1 Charwoman 1 Boxmaker 1 Unknown 2 No Occupation 7 38 Bricklayer 1 Gunsmith 1 Stonemason 1 Secretary 1 Handyman 1 Painter 1 No Occupation 2 The persons who died of Pulmonary Tuberculosis had been ill for the following periods:β Under 3 months 6 Between 3 & 4 years 3 Between 3 & 6 months 7 , 4 & 5 , 1 β 6 & 12 β 13 , 5 & 6 , 1 , 12 & 18 , 3 ,7 & 8 , 3 β 18 & 24 , 2 , 10 & 11 , 1 , 2 & 3 years 8 Duration Unknown 13 It has been pointed out that one of the chief obstacles in dealing with Pulmonary Tuberculosis has been the difficulty of obtaining information of the early cases, |
054cddc5-fde3-4171-8cc5-36f68e8d003c | but during the year the system of notification has been extended, and all cases of Tuberculosis have been placed amongst the compulsory notifiable diseases. Voluntary notification of cases of Pulmonary Tuberculosis has been in force in this district since June, 1903, the sum of 2s. 6d. being paid for each case notified. The system of voluntary notification was not a success, and the compulsory notification of all cases has gradually been accomplished. The notification of cases occurring in poor-law practice became obligatory on January 1st, 1909. The duty to notify was extended from May 1st, 1911, to cases occurring in Hospital practice. On January 1st, 1912, cases of Pulmonary Tuberculosis in all classes of practice became notifiable. |
fd2a1563-3a47-4a42-a882-12d6b93df82c | On February 1st, 1913, the Local Government Board Order extending compulsory notification in cases of all forms of Tuberculosis, and consolidating the three previo.us Orders as to notification of Pulmonary Tuberculosis, came into force. Modifications of the previous regulations were introduced, but some confusion still exists as to the form on which 39 a case is to be notified. There are four different forms on which the cases may be notifiedβForms A, B C, Dβand some confusion exists as to the kind of form on which a particular case is to be notified. In the circular of the Local Government Board which accompanied the Regulations, the directions are plainly given. The confusion arises between Forms A and C. In the circular it is stated that the notifications to be made by medical practitioners may be divided into two classes, which are described for convenience as " primary " and " supplemental " modifications. |
6bc2d582-d85c-49ba-b698-751bdcd19341 | Primary notification is required of every case of Tuberculosis unless the practitioner has reasonable grounds for believing that the case has already been previously recognised and notified as such to the Medical Officer of Health of the appropriate district. A supplemental notification is an additional notification of a case which has been previously notified. Except in the case of notifications by School Medical Inspectors, all primary notifications are to be made on Form A. School Medical Inspectors not'fy on Form B. Supplemental notifications are to be made on Forms C and I) bv Medical Officers of Poor Law Institutions and Sanatoria only. A certain number of cases of Tuberculosis will be recognised for the first time after the admission of the patient to an institution, and cases may occur among the staff of the institution. |
19cd8b28-db0b-44ad-aa9b-519de4b47407 | Primary notification of such cases is required to be made by the Medical Officer of the institution under Article V. on Form A. The notification is to be sent to the Medical Officer of Health for the district within which the place of residence of the patient was situated before his admission to the institution. But the majority of the patients at these institutions will have been notified before their admission, and supplemental notification is to be made on Form C, to be completed, after the end of each week, of all cases admitted during the week and believed by the Medical Officer to have been previously notified. Supplemental notification is also required to be made after the end of each week on Form D of all cases discharged from the institution during the \Veek. |
7c4e4e4a-931a-4d46-aec0-51cef38279e9 | 40 The intention of the Local Government Board is obvious, despite any ambiguity in the wording of the Regulations, but many cases which should be notified on Form C have been notified on Form A. The notifications received were as follows :β Form A 219 Form B 1 Form C 46 Form D 41 The modifications of the previous Regulations are summarised in the Report of the Medical Officer of the Local Government Board, and are as follows :β The practitioner is not required to notify if he has reasonable ground for believing that the Tuberculous patient when first seen by him has already been notified to the Medical Officer of Health of the district in which the patient resides at the time when seen. The Medical Officers of Poor Law Institutions and of approved Sanatoria are now required to notify all patients admitted to the Medical Officers of Health of the districts from which the patients have been admitted, and all patients discharged to the Medical Officers of Health of the district to which they are discharged. |
eb4797d2-9e55-4644-854a-9b4270d30043 | The diagnosis leading to notification must be based upon evidence other than that derived solely from Tuberculin tests applied to the patient. A positive Tuberculin reaction furnishes no information as to the site of the Tuberculous Focus, nor as to the activity or inactivity of the Tubercular process. It indicates simply that the organism at some time or in some way has been infected with Tubercle bacilli. A positive reaction has been obtained with undiluted Tuberculin in from 90 to 98 per cent, of all adults. The confidential character of notifications is more strongly emphasised than in the previous Regulations. 41 The duty of transmitting to the County Medical Officer of Health weekly lists of cases notified is now imposed not merely on the Medical Officers of Health of Metropolitan Boroughs, but also on the Medical Officers of Health of all urban and rural districts. The notification form has been extended to include the usual place of residence and the occupation of the patient. |
b75841f9-7c83-44d3-aae0-1a965c0dcf10 | Fees for notification are not payable to practitioners notifying in their capacity of Medical Officers of Health, Tuberculosis Officers, School Medical Officers, or Medical Officers of approved Sanatoria. The National Insurance Act and the Finance Act of 1911 should prove powerful auxiliaries in the campaign against Tuberculosis. It was really the passage of these two Acts which enhanced the value of compulsory notificat'on. A knowledge of the disease would not have been of much value if the means of prevention and treatment were absent. A capital sum of about Β£1, 116,000 is granted from the Exchequer towards the erection of sanatoria and other institutions for the treatment of Tuberculosis in England, and by the Xational Insurance Act a sum of is. 3d. per annum for each insured person is made available for the treatment of insured persons, or, in certain circumstances, of their dependents, in institutions or otherwise. |
ad75c13a-535f-4596-8b0c-25a15615ca57 | As some misapprehension exists as to the duties of the different authorities, it may be remarked that " Sanatorium benefit " is not limited to treatment at a Sanatorium, but consists of treatment given at the cost of the National Health Insurance Fund to persons suffering from Tuberculosis ^the chief form of which disease is Consumption) or such other diseases as the Local Government Board, with the approval of the Treasury, may appoint. For the time being the benefit is confined to the treatment of Tuberculosis. Treatment for purposes of Sanatorium benefit may be given :β (a) In Sanatoria, Hospitals, or other residential institutions. (b) At Tuberculosis Dispensaries or other non-residential institutions, or in the patient's home. 42 In administering the benefit, Insurance Committees are not empowered by the Act themselves to provide institutions. Their duty is to make arrangements with suitable persons or local authorities for this purpose. All such arrangements are required by the Act to be made to :he satisfaction of the Commissioners. |
92b959d6-62b9-41c6-b7c8-270efa550d17 | In the case of those who require treatment in institutions, the arrangements must be made with persons or local authorities having the management of Sanatoria or other institutions approved by the Local Government Board. Where treatment is required otherwise than in institutions, arrangements must be made for it to be given by persons or local authorities undertaking such treatment in a manner approved by the Local Government Board. A Departmental Committee was appointed to report upon the consideration of general policy in respect of the problem, which should lead local bodies in their action. The Committee reported that, having regard to the different classes of institutions which are required, to the variety of the cases to be dealt with, and to the proper organisation of comprehensive, efficient, and economical schemes, they were of opinion that the unit area should generally be that of the County, County Borough, or in some cases a group of Counties and County Boroughs. Last year the Middlesex County Council prepared a scheme for dealing with Tuberculosis in the County, and for the purpose divided the County into five Dispensary areas. |
bfd9fa43-7921-4107-9881-e6bddd324543 | Area No. 4, in which Acton is included, comprises Acton, Ealing, Greenford, Hanwell, Hayes, Southall, and Uxbridge. A head dispensary will be situated at Ealing, and sub-centres at Acton and Uxbridge. Premises have now been secured for the purpose of dispensaries. Tuberculosis Officers were appointed early in 1913, but at the commencement insured cases only were dealt with. The Departmental Committee recognised that the provision for dealing with Tuberculosis when occurring among insured persons could not be satisfactorily considered as a separate problem, and that schemes dealing with the whole population should be drawn up by Councils of Counties and County Boroughs. 43 In October, 1913, the County Council decided that sufficient progress had been made with the scheme to make a commencement with regard to the treatment of non-insured persons. |
082bf25c-8187-4f0b-a0fd-c6f8604b3b3c | The Council resolved that where they think it advisable the treatment of non-insured persons suffering from Tuberculosis be undertaken at Hospitals, Sanatoria, and Dispensaries by the County Council upon the basis of a contribution being made, where possible, by the patient towards the cost of maintenance or treatment. The necessity for a comprehensive scheme to include noninsured persons is made evident from the fact that of the 159 cases of Pulmonary Tuberculosis notified, 62 were insured l>ersons and 97 non-insured. Of the 62 insured cases, 8 were treated at a Sanatorium, 10 at a Hospital, 9 were removed to the Infirmary, and 14 received domicilary treatment. 16 insured persons did not apply for Sanatorium benefit, as they were able to follow their employment, though suffering from the disease; 3 have applied for Sanatorium benefit, and the Insurance Committee are considering the applications. |
5d2e77e5-f523-414a-81fb-133750f75db0 | 1 refused Sanatorium benefit after making application, and 1 had removed fron the district before receiving the benefit. Of the 97 non-insured cases, 4 were admitted to a Sanatorium, 27 received treatment at a Hospital, 37 were removed to the Infirmary, 4 were admitted as in-patients of Public Institutions, and 1 attended as an out-patient at a Dispensary. The other 24 cases were attended by private doctors. Of the 159 cases, 93 were males and 66 females. Their occupations were as follows :β Males. Females. Labourer 16 Laundresses 19 Laundryman 8 Domestic Servant 3 Clerk 6 Shop Assistant 2 Fitter 4 Charwoman 1 Taxi-driver 3 School Teacher 1 Bus-driver 2 Typist 1 Boot-repairer 2 Clerk 1 44 Painter 2 Brushmaker 1 Carman 2 Knitter 1 Bricklayer 2 In School 8 |
c730a0d3-8369-44a3-baa6-c59231acab7c | Gardener 2 No occupation 29 In School 5 No Occupation 4 Unknown 5 Mason 1 Harness Maker 1 Hawker 1 Cashier 1 Furniture Remover 1 Railway Carriage Cleaner 1 Waiter 1 Instrument Maker 1 Accountant 1 Electrician 1 Handyman 1 Sailor 1 Bus Conductor 1 Dining Car Attendant 1 Golf-caddie 1 Store-keeper 1 Musician 1 Photographer 1 Mechanic 1 Carpenter 1 Cinematograph Operator 1 Naval Pensioner 1 Greengrocer 1 Shirtcutter 1 Showman 1 Brass Finisher 1 Postman (Pensioner) 1 Draper 1 Secretary 1 The ages of the persons notified were as follows :β 45 Males. i to 5 years 5 to 15. 15 to 25. 25 to 45. 45 to 65. Over 65. 3 5 12 . |
e081d417-ff14-46de-8dd0-73ca1f9b5b30 | Si 2L I Females. 1 to 15 years. 15 to 25. 251045. 451065. Over 65. 9 M 33 9 I In respect of these 159 cases, 259 notifications were received, the notifications being as follows :β From Private Doctors 105 ,, Union Infirmaries 65 ,, Hospitals 63 ,, Sanatoria 20 ,, Other Institutions 5 ,, School Doctor 1 42 cases of non-Pulmonary Tuberculosis were received. Of these 25 were of males and 17 of females. The situation of the disease was as follows :β Male. Female. |
ad6719bb-e565-49e7-814b-5fd197b1406b | Glands of Neck 7 9 Spine 2 4 Peritoneum 3 1 Abdomen 1 1 Mesenteric Glands 1 β Meninges 2 β Hip 4 1 Skin of Neck 1 β Kidney 1 β Glands of Groin 1 β Face 1 β Tendon of Wrist 1 β Breast β 1 INFANTILE MORTALITY. 101 deaths under 1 year of age were registered in the district and 26 occurred in public institutions and other places outside the district, making a total of 127 deaths. This number corresponds to an infantile mortality of 83 per 1,000 births. 46 The infantile mortality in England and Wales in 1913 was 109 per 1,000 births, and in the 96 large towns it was 117 per 1,000 births. |
aacb0cd4-c38c-4666-bc5a-d8d4f2257802 | The deaths were distributed as follows :β Xorth-East Ward 16 North-West Ward 18 South-East Ward 29 South-West Ward 64 The infantile mortality in each ward was :β North-East 48 per 1,000 births. North-West 78 ,, ,, South-East 80 β β South-West 114 ,, ,, The infantile mortality is lower in the North-East and NorthWest Wards and higher in the two others. In the memorandum to Medical Officers of Health on the preparation of their Annual Reports, it is suggested that use should be made of the comparative figures given in the Second Report to the Local Government Board on Infant and Child Mortality. In this Report detailed figures for the years 1907-1910 are given for 241 urban areas. The 241 urban areas were composed of three groups. The first group consisted of the county boroughs, 75 in number, and 26 boroughs and urban districts having a population of over 50,000 at the census of 1911. |
3f1da5eb-1e7e-4a94-9fd8-751d6638f185 | The second group consisted of hi boroughs and urban districts, each of which prior to the census of 1911 had a population between 20,000 and 50,000. The third group consisted of the 29 metropolitan boroughs, each of which, with two exceptions, had a population of over 50,000 at the last census. The 241 areas were classified in order of infant mortality rates into 9 groups of 25, a final group of 16 remaining. The infantile mortality varied from 155.1 per 1,000 births in Group 1 to 74.2 in Group X. Acton is placed in Group V., which group has an average infantile mortality of 116.5. The infantile mortality of Acton for the 4 years 1907-1910 was 115, and the position it holds was number 124 from the top. |
b7217a3d-1e06-41f0-995c-9c11bf66be82 | 47 The comparison is carried still further, and the variations in infant mortality in neighbouring sanitary areas, and within the area of individual sanitary districts. Within the County of Middlesex during the same period Acton had the highest infantile mortality and Hornsey had the lowest, with 66.8 per 1,000 births. Although the analysis in the Local Government Board Report is not carried farther, as far as this district is concerned, vet it is interesting to note that the variations in the different Wards of the district are almost as great as they are in the towns within the same county or in the different towns throughout the kingdom. In the period 1907-1910, the average infantile mortality in the Xorth-East Ward was 74 per 1,000 births, and in the South-West Ward it was 151.5. |
622896d5-a0ba-45f9-b055-03e6e67f0ebd | As our comparison for the years 1911-1913 will be limited to the 101 large towns with a population of over 50,000 inhabitants and the 29 Metropolitan Boroughs, it will be interesting to note that the towns with the highest populations do not necessarily have the greatest infantile mortality. For instance, the group of towns with the highest infantile mortality includes 12 with a population under 50,000, 5 of these having a population under 30,000. The group of 25 towns having the lowest infantile mortality includes only 12 towns with a population under 50,000. Of the 101 large tow ns w ith a population of over 50,000, in the years 1907-1910, 44 had a lower infantile mortality and 56 had a higher one than Acton. |
4b5b765e-b724-48cc-9d4f-8bd5cb7add3e | One remarkable fact emerges from a comparison of the infantile mortality at different ages, and that is, Acton compares very favourably during the earlier periods, but some influences adverse to life operate more severely from the sixth to the twelfth months. These influences really operate to some extent from the third month, but are more marked after the sixth month. In the first week after birth the average rate for the 241 urban areas was 24.3 per 1,000; ir. \cton it was 21.8. In the first month after birth the average rate for the 241 urban areas was 40.2, and in Acton it was 35-8, in the first three months the 48 figures were 63.5 and 56.8 respectively. With the advance in age the difference becomes less. In the 241 urban areas the average mortality rate at ages 3-6 months was 22.9, and in Acton it was 21.5. |
2eb506d5-5e4d-41fb-86a6-c82c1e351ce3 | When the age of 6 months is reached, Acton ceases to occupy a favourable position. In the 241 urban areas the average mortality rate at ages 6.12 was 34.2, and in Acton it was 36.8. Of the iot large towns with a population of over 50,000, 19 only have a lower mortality rate under 1 week after birth, and under 1 month after birth only 17 have a lower rate. Under 3 months after birth Acton occupies 26th place; in the age period 3-6 months it has gone down to the 44th place, and in the age period 6-12 months the position it occupies is the 46th place. |
03414167-807a-4f93-91ae-3b0e22f96188 | An examination of the varying incidence of deaths from different causes in infancy reveals differences which at present are inexplicable, but as far as Acton is concerned the figures bear out the opinion expressed in many Annual Reports, that under present social conditions the employment of married women in laundries does not produce an excessive mortality from those causes attributable to ante-natal conditions. The majority of the deaths ascribed to premature births and congenital defects are probably attributable to ante-natal conditions; but many also to lack of care at and after birth. The average mortality rate for the 241 urban areas from premature births and congenital defects was 25.8 per 1,000 births; in Acton the mortality from these two causes was 23.1, or 10 per cent, below the average for these towns. Prematurity, Congenital Defects, Injury at Birth, Want of Breast Milk, and Atrophy, Debility and Marasmus are grouped together under the name of Group of Five. |
0ea8705a-7dd2-4d8b-b2a5-6f8ec707adce | The average rate of mortality from these 5 grouped diseases in the 241 urban areas was 44.6, and in Acton it was 41.6, or 7 per cent, below. But the mortality from want of Breast Milk was higher than Acton in only 5 urban areas. Want of Breast Milk was responsible for a mortality of 3.8 per 1,000 in Acton. The towns with a higher mortality were Birkenhead with 4.0, Stalybridge 4.8, Leeds 5, Shipley 5.7, and Todmorden with 8.7. 49 Acton compares unfavourably in the mortality from Diarrhceal and Respiratory Diseases. The average mortality rate from Diarrhceal Diseises in the 241 urban areas was 16.5; in Acton it was 21.5. |
e13f791f-648d-4f6f-9705-7ba6a6698c61 | From Bronchitis and Pneumonia the figures were 21.4 and 24.3 respectively; that is, Acton was 14 per cent, above the average rate in the 241 urban areas. From Measles and Whooping Cough the mortality rate was slightly below the average for the 241 urban areas; in Acton the rate was 7.2, compared with 7.8 in the urban areas. Summarised, it was found that in Acton (1907-1910) the death-rate was :β Per cent. At ages 0-1 month 11 below. ,, ,, 0-3 months 11 ,, ,, ,, 3-6 ,, 6 β ,, ,, 6-12 ,, 8 above. From Prematurity & Congenital Defects 10 below. |
db592918-ce5e-41e7-b38c-3ff97ae85570 | ,, the " Group of Five" 7 ,, ,, Measles and Whooping Cough 8 ,, ,, Bronchitis and Pneumonia 14 above. ,, Diarrhceal Diseases 30 ,, For the entire first year of life 5 below. At ages 1-5 years 6 ,, the average rate for the 241 urban areas. |
e8a524df-67cb-44fb-a271-a3a4d3461b81 | Limiting our comparison to the 101 County Boroughs or districts with a population of over 50,000, Acton occupies the following relative positions in the mortality rates for the different diseases :β Convulsions 5 th Measles 18th Atropy, Debility, and Marasmus 23rd Prematurity 33rd Congenital Defects 35th Whooping Cough 56th Tubercular Diseases 65th 50 Bronchitis and Pneumonia 78th Diarrhceal Diseases 86th Injury at Birth 94th Want of Breast Milk 99th Total under 1 year 45th Before extending our comparisons so as to include the last 3 years, it would be well if we examined the causes of the excessive mortality from the different diseases. We shall then probably be in a better position to gauge the value of the work which has been and is being done in this district. The conditions associated . |
644ede5d-3c65-4992-b396-a52a5e94058c | with and assisting in varying degree in the production of excessive infant mortality are partly social and partly sanitary; and it is easy, according to the point of view adopted, to magnify unduly the importance of one set of factors. β’ The effects of unsatisfactory domestic and extra-domestic local conditions are fairly obvious, and their consequences fall most heavily on the poorer members of the community. Of the domestic forms of insanitation, overcrowding and lack of cleanliness are probably the most important. For the infant it means exposure to a stuffy atmosphere, and the storage of milk in a contaminated and vitiated atmosphere. Outside the house, the yards are insufficiently paved and the ground soaked with organic filth. To what extent and in what manner the industrial employment of married women affects the infantile mortality is still a matter of discussion. |
192e7d5e-c54c-4466-b7cc-69f42b2157a3 | Possibly, the case should be stated in a different way, and, under present social conditions, the harmful effects are partly counteracted by the greater comfort and increased nourishment which such employment enables the mother to secure. The figures for the Census have not yet been published, and the exact number of married women employed in the laundries cannot be given, but the approximate number of births where the pregnant mother was in some employment has been ascertained. 51 In former Annual Reports, the effect on the child of married female labour was discussed, and the investigations recently made point to the same conclusions as was arrived at on previous occasions. The figures given on a preceding page also point to the same conclusion. The mortality from Prematurity and Congenital Defects is lower in Acton than the average in the large towns. These two diseases, together with Atrophy, Debility, and Marasmus, are those mostly affected bv ante-natal conditions, and from these diseases the mortality in Acton is below the average. |
5f87ca41-3e40-4950-ad77-4d42eb58fc36 | But if the ante-natal effect of married female labour is not obvious, the conditions under which the child is brought up as a result do affect the infantile mortality. In only 2 of the large towns did want of Breast Milk cause a higher mortality, and deaths from Bronchitis and Pneumonia were 14 per cent, above the average, and from Diarrhceal Diseases the mortality was 30 per cent, above thi* average for the 241 urban areas. The employment of the women in extra domestic duties tends to produce premature weaning, and it is one of the causes of our heavy mortality from Diarrhceal Diseases. Human milk is not only the best food, but no other milk can be made into a perfect food for infants. It is true that other milks can be modified so as to resemble in chemical composition human milk, but milk is not an inert liquid, depending for its nutritious qualities on the chemical substances it contains; it is a living liquid with important biological qualities. |
e1da4e93-60f3-433f-b099-f94b9a0fef57 | Premature weaning is a pathological process, and always a regrettable event. Fortunately, the human organism is eminently capable of adapting itself to circumstances, and, in spite of these facts, in a majority of instances, healthy children can be brought up on the bottle, and on a succeeding page figures will be given showing to what extent our efforts have been successful in counteracting the baneful effects of married female labour. We are not now discussing the various causes of Diarrhoeal Diseases, nor with the factors which underlie the employment of female married labour, but merely with the association of this employment with Diarrhceal Diseases, and we are 52 convinced that one of the reasons why the incidence of Diarrhoeal Diseases has been excessive has been the extensive prevalence of artificial feeding. The disadvantages of artificial feeding were further accentuated by the absence of the mother from the home, and by carelessness and ignorance and lack of cleanliness in the preparation of the food. |
886a656e-a8f0-4565-ac9f-7b175f758cec | It is impossible, of course, to dissociate the effects of married female labour from those of poverty, and in social questions causes and effects may occupy positions of mutual dependence and transferability. Many of the women are occupied in the laundries, not from choice, but from necessity, and are widows or the wives of men whose earnings are insufficient to maintain the home in comfort. The excessive mortality from Bronchitis and Pneumonia is also in part one of the effects of married female labour. The mother has to take her baby to be cared for In the morning as she proceeds to work and fetch him again in the evening. Under the best of conditions the child was liable to contract Respiratory Diseases, but in former years the mother had no option but to leave the child in the charge of a " baby minder." |
cd4d0eeb-889f-4cba-9eb7-66f7fb576311 | The mother did not select the house where the baby was cared for on sanitary grounds, and the standard of cleanliness which usually obtained in the " baby-minder's " house was below that of the average for the neighbourhood. In 1908 the South Acton Day Nursery was opened, and it has been undoubtedly the means of improving the conditions under which the children ire cared for. It is well known that prior to 1901 in very few places had efforts been directed for the specific purpose of reducing the infantile mortality. The passage of the Public Health Act, 1875, marked an epoch in sanitary development, and the work carried out under that Act had for its object the improvement of the sanitary conditions under which the community lived, and to this extent affected infantile mortality. |
86a4ce9f-5337-4bb2-b890-ed3ed3727f52 | The reason why this general work did not affect the infantile mortality figures is probably accounted for by the fact that the increased urbanisation of the population for a time more than counteracted the good 53 work done, but this work formed the foundation on which other preventive measures were based. Health visiting, infant consultations, and other allied measures would be almost useless apart from the remedying of sanitary defects which has been and is proceeding in all directions. Other factors, such as poverty and intemperance, enter into the causation of a high infantile mortality, and their amelioration must react upon the death-rate, but the recent reduction is more than can be accounted for by the general measures which have always been in operation for the removal of these unfavourable conditions. It is more than an accident that the marked reduction here has been coincident with the special measures which have been taken to protect infant life, and a brief review of these measures is more than suggestive that their relation to the reduction is one of cause and effect. |
e9d21414-f7e6-40ad-863c-6fdd865d76ce | In 1905 two Assistant Sanitary Inspectors were appointed, but owing to the increase in other work, in spite of the additional appointments, very little house-to-house inspection was carried out until 1909, when an additional Inspector was appointed. The duties of the latter officer were primarily connected with house-tohouse inspection, more especially in the South-West Ward, where the infantile mortality had been, and is, exceedingly high. The duties of the Inspectors were subsequently rearranged, and house-to-house inspection has since been carried on throughout the district. |
d93a8588-3a5a-4fbf-bfa8-66f1ccff4e48 | The details and results of these inspections have been recorded in the Annual Reports, but the following table gives the total number of house-to-house inspections made since 1909 1909 203 1910 1,080 1911 800 1912 642 1913 594 But in addition to the house-to-house inspections, at the beginning of every summer, a list is prepared of all the houses where a birth has occurred within the previous twelve months, 54 and these premises are periodically visited during the warm weather, and the occupiers warned against the accumulation of any refuse or other organic matter in or about the house. Special leaflets are also distributed giving instructions in the prevention of Diarrhceal Diseases. In 1904 a Health Visitor was appointed by the Council. Prior to this date leaflets had been distributed, in which instruction in the uare of infants was given. These leaflets were probably of some use, but it was felt that personal visits would have a more beneficial effect. |
6044bf93-5661-4dca-9c82-31d00b310f45 | A list of the births legistered in the district was obtained, and the Health Visitor paid visits to the houses in that part of the district where the infantile mortality was excessive. One fact militated largely against the success of these visits. A birth need not be registered until six weeks have elapsed; so that frequently the baby was about 2 months old before a visit could lie paid. In that time occasionally irreparable mischief had been done, and frequently artificial feeding had been resorted to. It is true that the Midwives Act of 1902 has improved the conditions under which the poorer part of the population are treated at their confinement, but some doctors and midwives either did not give advice as to the rearing of the infant or gave improper advice. The midwife is gradually becoming a more reliable person, and it is likely that ere long the instances will become fewer in w hich she will be a party to, or actually encourage, the abandonment of breast feeding on the supervention of minor difficulties. |
5efa7076-4621-46c8-b86e-426d6e949014 | Our efforts to visit the births early were greatly facilitated by the passage of the Notification of Births Act, and Acton was one of the first districts to put the Act in force. It came into operation in January, 1908. Over 75 per cent, of the births are nowvisited, and revisits are paid in many instances. The increased work which the Notification of Births Act entailed, together with the school work, necessitated the appointment of a second Health Visitor, but when the inspection of 55 school children was undertaken, the duties were rearranged, and a School Nurse was appointed instead of the second Health Visitor. At the beginning of 1913 an Infants Consultation was instituted in a room at the Priory School. An account of the year's working will be found on a subsequent page, but its institution was felt to be necessary, as one Health Visitor could not revisit an appreciable number of the homes where a birth had occurred. |
b616011a-b6a5-4fec-ac97-bb4f15580b64 | Although not a municipal undertaking, the initiation of the movement for the establishment of a Day Nursery in South Acton was due to the efforts of some members of the Council. A clause was proposed in the Acton Improvement Act of 1904, empowering the Council to establish and maintain one or more creches. The Parliamentary Committee, though professing sympathy, refused the application. Philanthropic Agencies took the matter up, and the Day Nursery was opened in Strafford Road in January, 1908. The first Chairman of the Committee of Management was Mr. E. F. Hunt, who was at the time Chairman of the Health Committee, and some of the members of the Council have continuously kept in close touch with the work of the Day Nursery. Its establishment has undoubtedly been of value in the reduction of infantile mortality. One of the objections raised against creches is their liability to encourage premature weaning, and in many creches it must be admitted that this danger is not sufficiently appreciated. |
d57b81f2-3eb6-4664-a1a4-2130b1759b76 | In Acton every safeguard is adopted to obviate this. The creche is not too large, and is so situated as to be convenient for the mothers to leave their work for the purpose of suckling their children. The creche has 40 cots, and the mothers work at laundries w ithin easy reach, and every encouragement is given at the creche to the mothers who wish to suckle their children. We are now in a position to examine the progress which has been made in the reduction of the infantile mortality and the possible relation which such reduction bears to the measures specified. 56 As is well known, there was, prior to 1901, no clear indication that the average rate of infantile mortality had declined. |
12a15aa1-bc41-4515-9405-8e1167dd6643 | The following table gives the chief facts for England and Wales as a whole and for London separately :β Annual mortality of infants under 1 year of age per 1,000 births :β 188l-60 1861-70 1871-80 1881-90 1891-190U 1901-10 1911 1912 1913 England & Wales 154 154 149 143 153 127 130 95 109 London 155 162 158 152 159 126 129 90 105 We are not in a position to give exactly the infantile mortality of Acton before 1905. It has been explained that prior to 1905 the outside deaths were not included, and the reductions since 1905 are really greater than appears from the tables. Average annual mortality under 1 year per 1,000 births :β 1878-1880. 1881-189O. 189I-I9OO. |
c3be26d5-5ffe-4e03-b0cc-4229ae88a42e | I9OI-I9IO. I9II. 1912. I9I3 158.1 159.3 175.5 125.8 138 70 83 Throughout the kingdom the steady improvement from 1901 onwards is one of the most striking features of the vital statistics; and the figures for Acton show a greater improvement than those for the rest of the kingdom. Prior to the decade 1901-1910 the infantile mortality of Acton was persistently higher than that of the whole of the kingdom and of London, but since 1902 the average rate has been lower. Even the high infantile mortality during 1911, the climatic conditions of which year favoured a high infantile mortality, showed a great improvement on the experience of former years of a similar character. The course of events since 1878 is more clearly shown in the following diagram :β Infantile Mortality per 1,000 Births. |
d0f1aa71-79d3-425f-aa4a-c22af32e081d | 57 It will be seen that since 1902 the infantile mortality has not once reached 150 per 1,000 births, whilst in the previous 10 years it did not on a single occasion come as low as 150. The progress during recent years has also been very satisfactory. The relative position of Acton in comparison with the large towns has been as follows :β 1907-1910 45th 1911 64 th 1912 6th 1913 25th The relative position of Acton and the progress made will possibly be made more evident in the following tables. Average rate per 1,000 births in the 241 urban areas and in Acton during 1907-1910 :β 241 Urban Areas. Acton. |
a7f0bcf3-4547-4f0b-b46d-0677e22c6c5f | Under 1 week 24.3 21.8 ,, 1 month 40.2 35.8 ,, 3 months 63.5 56.8 Between 3 and 6 months 22.9 31.5 ,, 6 and 12 ,, 34.2 36.8 Under 1 year 120.6 115.0 Prematurity and Congenital Defects 25.8 23.1 Group of 5 44.6 41.6 Diarrhceal Diseases 16.5 21.5 Measles and Whooping Cough 7.8 7.2 Bronchitis and Pneumonia 21.4 24.3 Average rate per 1,000 births in Acton for 3 years collectively and separately :β 1911-1913. 1911. 1912. 1913. |
9ffce4d6-8844-43bc-b266-dcebb52bff47 | Under 1 week 16.1 21.5 17.1 10. ,, 1 month 30. 37. 27. 25.6 ,, 3 months 45.8 56. 37.5 44. Between 5 and 6 months 20.3 32.3 15.1 13.8 ,, 6 and 12 months 33.1 50. 17.8 25.6 Under 1 year 97. 138. 70. 83. |
e7a9e44f-28a4-448e-a05b-2fda4974daee | 58 Prematurity and Congenital Defects 20.3 28.2 16.5 12.4 Group of 5 35.5 45.7 30.9 30.2 Diarrhceal Diseases 22.3 45.7 7.9 13.8 Measles & Whooping Cough 6.63 12.1 3.3 4.6 Bronchitis and Pneumonia 16.1 I7.8 13.1 17.7 It will be seen that a great reduction has taken place, even though the unfavourable year of 1911 is included, and the question arises as to the extent which infantile mortality can be further reduced. What is the irreducible minimum? A decade ago, many eminent authorities imagined that if an infantile mortality could be reduced to 100 per 1,000 births, it would be as low a rate as we could hope to attain. |
e253eb59-7fd6-4e82-851d-f4ce5b1a027f | The ideals of yesterday are the accomplished facts of to-day, and our present ideals are on a much higher level than they were 10 years ago. Among the families of army officers in 1911, the infant mortality per 1,000 births was only 44, of naval officers and soldiers 41, of medical practitioners 39, and the rate of infantile mortality of the middle classes generally was only 61 per cent, of the total mortality rate among legitimate infants. These figures show how little of our present infant mortality is essentially inevitable. Our ideals must be raised with every new discovery or our system must become fossilized. Our opinions must alter, and our methods of dealing with the problem must change and expand, or our efforts are doomed to failure. If the table giving the causes of death under 1 year be referred to, it will be seen that a large percentage of the children die from ante-natal causes. |
31358a91-a952-44b4-b863-a412ff04e147 | There were 19 deaths from Prematurity, 23 from Marasmus, 3 from Congenital Malformation and 2 from Congenital Syphilis. Moreover, under the heading Bronchitis and Pneumonia will be included not only the so-called primary pneumonia, which occurs without any obvious precedent departure from health, but also Pneumonia which occurs in children who have been ailing because of defect existing at birth, 59 or because of various unfavourable general conditions affecting them after birth, and the Pneumonia which follows as a remote effect of the common infectious diseases and when all characteristic symptoms of the primary illness have disappeared. If the general causes predisposing to, and the special conditions associated with, pneumonia amongst young children are viewed broadly; it will be found that in the first year of life gross defects of development and ante-natal infection with syphilis have a distinct influence. |
a1d5b3b9-bf88-4e86-bf2a-9f02b17728e8 | It will be found also that many of the deaths in the first year are associated with Marasmus, whether that condition is due to prematurity of birth, or be caused by artificial feeding. The broncho-pneumonia, which is the chief cause of the heavy mortality from diseases of the respiratory system in children, is believed to be, in the main, an effect of direct infection of the lung, occurring usually under conditions of general enfeeblement in which the power of resistance of the lung against bacterial invasion from without is lowered. It may be taken as a conservative estimate that more than one-half of the deaths under I year are due to ante-natal causes. But the subject is of still greater importance. |
4f4a36a2-666d-4a3b-9cb6-18fa30c9fa5a | It is calculated that the total number of foetal deaths amount to over i1 per cent, of the number of births, and when we are brought face to face with the statement that practically as many infants die during foetal life as during the first year of their independent existence, we are confronted with a problem which clearly requires that means should be concerted with the view of attempting to prevent this waste of human life. There can be little doubt that suitable measures in this direction would be immediately followed by beneficial results, but how the complete solution of the problem is to be reached is not so obvious. Hitherto our efforts have been almost entirely directed to the feeding of infants, and the success attending them has been made sufficiently obvious by the reduction of infantile mortality. Our efforts to improve some of the ante-natal conditions are at present necessarily of a very limited character, but it is hoped that a small beginning may be made through the agency 60 of the Infants' Consultation held in the Priory Schools on Monday afternoons. |
95c736cf-f7e5-44f3-ab0e-107bb3f5e976 | These consultations have proved a bigger success than we had anticipated. The consultations were started primarily because it was physically impossible for one health visitor to re-visit more than a small percentage of the births. They were instituted in November, 1912, in rooms at the Priory Schools hired from the Education Committee, and during 1913, the Health Visitor attended 011 48 occasions. During the first three and a-half months the average weekly attendance of mothers with their babies was 9, and the weekly average for the year was 21. The total number of attendances has been 1,024, the highest number in one afternoon being 57. During the year 18 of the mothers who attended left the district. Altogether 233 children have attended, and of this total 3 died; so that the infantile mortality amongst the infants who attended was 15 per 1,000. |
c5fdcdf6-cab8-42a3-a438-995d43ab7a5d | Of course, it is unfair to compare this infantile mortality with that of the rest of the district, as most of the mothers do not bring their children until they have reached the age of 1 month, and last year 39 deaths out of a total of 127 occurred in infants under the age of 4 weeks. If a comparison be made, it should be based on the ratio of deaths to the number attending at the different age-groups, but such a comparison would be of little value. The ages of the infants when they commenced attendance were as follows :β Under 3 months. 3 to 6 months. 6 to 9 months. 9 to 12 months. 145 29 20 5 1 to 2 years. 2 to 3 year?. 3 to 4 years. 4 to 5 years. IO 13 65 Although the success of the venture could be stated in figures, its influence is greater and deeper than such figures would suggest. |
4b98bd1a-5f3d-4571-8aa2-cff76d4a3f38 | One of the Council's Medical Officers is usually in attendance, and since her appointment Dr. Chubb has attended on almost every Monday afternoon. Most of the mothers bring their infants regularly to be weighed, and although no treatment is carried out, advice is given whenever a child is not making satisfactory progress, and in that case the mother is referred to her own doctor. 61 Some of the mothers are diffident of making a first visit, but readily come afterwards. The object of the consultation was evidently misunderstood, but after the first visit, they came with alacrity and often at a considerable sacrifice. Where the attendances have been irregular, it is found that the difficulties are almost insurmountable. Some of the mothers are at workβthe husbands being out of employment or only irregularly employedβ and although the majority of them are employed in laundries and do not commence work in the laundry until Tuesday, on Monday they do their own laundry work at home. |
c0a4448f-8bdc-45e2-b5de-e27f93ca3303 | In spite of these difficulties a large number manage to find time, so great is their interest in the progress of the baby. They are all keen and anxious to learn, and they undoubtedly do learn a great deal from the simple association with each other, but they ask questions of the Health Visitor and of each other on all matters pertaining to the home and the baby. There is a great need for an educational campaign amongst the mothers, especially as to the nutritive value of the various foods. W'!ant of thrift plays an important part in the poverty of many households; what is meant, of course, by want of thrift here, is an inability to adapt the means at their disposal to the best advantage. The frequent visits of the mothers enable us to touch on many matters which could not possibly be mentioned in one or two visits to the house. These visits to the Priory School also enable us to give better advice as to the clothing. |
50acc99a-877e-4048-a43a-95d22a848ecd | At the commencement of the winter it was not uncommon for the infants to be brought to the Friory School with their lower limbs blue with cold. For the first couple of months the child is swathed in long clothes and can hardly move a muscle. Then comes the process of " short-coating," when the other extreme is reached, and the legs have hardly any covering at all. When the attention of the mothers was called to the condition, a great improvement was observed, and not the least gratifying result during the past winter has been the intelligent and increased care paid to the clothing of the infant. 62 Premature weaning has in many cases been prevented by the advice given to the mother as to her own health and diet. This advice has been instrumental in preventing her to give up suckling the baby without sufficient cause. |
51a1fa46-2d9a-44c7-90d1-6484a787cb61 | Occasionally the flow of milk would slightly diminish, but timely advice would reestablish the function, and where breast feeding was insufficient, she was enabled to keep up partial suckling and simply supplement this with artificial feeding. In spite of all endeavours, a large number of children are brought up by hand, and the usefulness of the consultation is then made still more evident. The mother is able to ask and receive advice as to the best food and the proper quantity. She is not left to the mercy of a neighbour who is more ignorant than she is, but whose volubility enhances the dangers of her ignorance. The mother also has visible evidence of the progress or otherwise of the baby; a gradual increase in weight is, after all, one of the best manifestations of a healthy progress. To stimulate interest, a baby show was held on July 7th, in the Central Hall of the Priory School. The function was really more in the nature of a reception than of a baby show. |
57634834-69da-43fe-9892-2dc88df51088 | The Chairman of the Health Committee invited all the mothers to a tea, and if the mothers desired the babies could be entered for competition. 75 mothers accepted the invitation to tea and 62 babies attended the baby show. The 75 mothers brought their babies with them, but for various reasons, some of them did not wish to enter their babies for competition. The chief reason was that some of the babies were delicate. Although the prizes were not awarded for robustness and development alone, the mothers felt that delicate children would be handicapped. In every instance, where care and attention had been paid in the rearing, though the babies were not entered for the baby show, certificates were awarded to the mothers. The babies were divided into 4 classesβunder 3 months, 3-6 months, 6-9 months and 9-12 months. In the youngest class there were 13 babies, in the second 15, in the third 17 and in the oldest class 17. |
23d46569-1b73-4ba0-8b0d-a51fd4ecb10d | 63 The babies were drawn from the part of the district which has always had an excessive infantile mortality, and even some of the prize-winners came from streets where efforts are necessary to raise the standard of personal hygiene. It was evident that a large amount of intelligent care and attention had been paid to the upbringing of the children. The condition of the children and the character of their clothing made it obvious that the care had been a continuous one, and not a special preparation for the occasion. Although the fuuction was carried out with the sanction of the Council, it was a private and voluntary affair as far as management and finance were concerned. Miss Smee, the Chairman of the Health Committee, made herself financially responsible, and though she was supported by the members of the Council, both financially and otherwise, its success was due to her initiative and whole-hearted support. As previously stated, these consultations were primarily started for the purpose of giving advice to mothers in the rearing of infants, and during the summer months, for instance, Dr. |
9508b1d3-b220-48cf-b8de-4a2dc7cb5b35 | Chubb spoke to the mothers of the special dangers and procautions to be taken to avoid diarrhceal and other digestive diseases in warm weather. These talks were specially helpful to the mothers and fruitful of good. But it is felt that a large field is open in the direction of remedying some unhealthy antenatal conditions, and it is hoped by some means to reach some of the expectant mothers. As a sanitary authority, the means at our disposal and our powers are limited, but in some districts, through voluntary agencies, prematernity work has been commenced and a pre-natal campaign has been organised. The inquirer is in a position to fill in the details and to estimate the hopefulness of attempts which have as their first aim the making of the surroundings of the unborn infant healthy and healthgiving. |
cf00626f-7a33-4f90-823e-3e7930883262 | The environment of the unborn infant is his mother, and the health reformer looks forward hopefully to the improvement in the health of the infant at birth which must follow upon the making of his ante-natal maternal environment all it ought to be. 64 The suggestion of a pre-maternity benefit in connection with the Insurance Act is worthy of most serious consideration. The poverty of the expectant mother must have a direct influence on the nutrition of the child, and her mental and physical state would be much improved by the knowledge that there was some provision for such contingencies as might arise. But one of the most serious causes of intrauterine death and disease is syphilis, and a good deal of the work for the protection of child life will be nullified unless the problem of the prevention of this disease is faced. The favoured germs of this disease are spoken of with bated breath. |
ed96fd9a-10f3-43c6-96e1-15d5ca331cf6 | Large sums of money are spent and endless measures are proposed for the protection of child life and the provision of maternity benefit, and yet these venereal scourges are allowed to go on crippling the mothers, by producing diseases, not only in those who primarily acquire them, but in their wives and children, and their children's children. Our ignorance as to its potency in this direction is paralleled by our lack of knowledge of the general prevalence of this disease in this country. It is to be hoped that the Royal Commission which is at present engaged in the study of venereal diseases in general will not forget the vast importance of this particular branch of the subject, and institute an investigation into this grievous problem of ante-natal mortality. The great advances which have been made in the diagnosis and treatment of the disease in recent years enable us to diagnose it in all its stages, and effectually controt its progress. |
2d2203c6-ea1b-4102-a3d7-749add85180b | They give us the power to limit the disease to its earliest stages, and eventually to abolish, amongst other curses, congenital syphilis. The ages at death and the causes of death, together with the ward distribution, are given in the tables at the end of the report. The deaths from DiarrhΕal diseases require a separate paragraph on account of an outbreak which occurred in an institution in the district. These deaths are not included in our returns, as all the children who died were non-residents. 65 26 deaths were clue to DiarrhΕal diseases. As night be expected, the number of deaths was lower than in 1911 and higher than in 1912. Whatever views be held as to the causation of summer Diarrhoea no doubt exists of the retarding influence of a wet, cold summer, or of the opposite effect of a hot dry summer. |
321cc04e-87ab-4cbc-9591-1dc2d6228020 | In the matter of temperature and rainfall the summer of 1913 came somewhere between those of 1911 and 1912. The number of deaths of infants from Diarrhoeal diseases was as follows : 1911, 68; 1912, 12; 1913, 21. The total deaths from Diarrhoeal diseases were : 1911, 98; 1912, 17; and 1913, 26. There have been many inquiries into the subject of Diarrhoea, some of which, like Dr. Ballard's and Dr. Newsholme's, have dealt with all the aspects of the subject. Others have concerned themselves with special aspects of the subject. There was one aspect of the question which had an especial interest for us last summer. |
044c5c5e-8ce6-4919-b4c7-4e78fa171a19 | That Diarrhoea is an infectious disease capable of spreading from the sick to the healthy is now assumed by a large section of the medical profession, and if the history of institutions were faithfully recorded, it would probably be found that it not infrequently spreads in these. Dr. Sandilands, in a paper before the Royal Society of Medicine, reviewed the evidence for and against the communication of Diarrhoea from the sick to the healthy, and he came to the conclusion that certain fatal forms of summer Diarrhoea are communicable, but that communicability is by no means a conspicuous feature of epidemic Diarrhoea in every case. Laboratory experiments have proved that Diarrhoea is capable of spreading from the sick to the healthy, but there are very few instances in which it has been proved that it does so spread in the epidemics which occur annually throughout the country. |
af367aa5-820d-4f90-a558-fc5358170018 | The establishment in which the Diarrhoea occurred consists really of two houses, but the children and nurses lived entirely in one, and in the other house the proprietor and his family lived. The outbreak was confined entirely to the house in which the infants and nurses lived. The two houses are entirely detached, although means of communication between the two houses exists in the rear. 66 The establishment is used as a training place for nurses and an institution where children are put out to live. Practically all the children are illegitimate. The staff consisted of the matron, a trained nurse and 18 probationers or pupils. A doctor attends almost daily, and of course more frequently when an illness occurs. At the end of last August, when the outbreak of Diarrhoea occurred, there were 30 infants there. The milk is supplied in sealed cans by a well-known and highly respected dairy company. The drains had recently been examined and relaid. |
3017bc17-86d4-4c9a-97d1-1d0b723e742b | Up to the last week in August the place had been remarkably free of Diarrhoea, but on August 28th, a child aged 5 months was taken violently ill with Diarrhoea and Vomiting and died on September 2nd. On August 29th, the second case occurred. On September 1st, 2 cases occurred; on September 2nd, 2 cases; on September 3rd, 4 cases; on September 4th, 2 cases; September 7th, 1 case, and September 9th, 1 case. Altogether 14 children out of 30 were attacked with severe Diarrhoea, and 8 died. During the first week in September, 9 out of the 19 nurses suffered from Diarrhoea, but they all recovered. |
5511c351-2013-4579-9ce2-fc5d2fec2130 | The propositions formulated by Ballard in 1887 as a working hypothesis that, would best accord with the totality of the evidence then, still hold good to a very great extent. He held that the essential cause of Diarrhoea resides ordinarily in the superficial layers of the earth, where it is intimately associated with the lifeprocesses of some micro-organism not yet detected, captured or isolated. The vital manifestations of such organism are dependent, among other things, perhaps principally, upon conditions of season and on the presence of dead organic matter which is its pabulum. On occasion such micro-organism is capable of getting abroad from its primary habitat, the earth, and having become air-borne, obtains opportunity for fastening on non-living organic material and of using such organic material both as nidus and as pabulum in undergoing various phases of its life-history. |
3b723708-2835-4ddc-af7c-63bfeb6874fe | 67 In food inside of, as well as outside of, the human body, such micro-organism finds, especially at certain seasons, nidus and pabulum convenient for its development, multiplication, or evolution. From food, as also from the contained organic matter of particular soils, such micro-organism can manufacture by the chemical changes wrought therein through certain of its life processes, a substance which is a virulent chemical poison; and that this substance is, in the human body, the material cause of epidemic Diarrhoea. Although the specific germ of Summer Diarrhoea cannot be said to have been isolated with certanity, the behaviour of the organism most frequently found in infantile Diarrhoea is interesting. |
dfc5870c-9b9c-4509-a491-15bf709f1600 | When sterilized milk is inoculated with this organism, the germ grows rapidly and is easily recoverable, but when unsterilized milk is inoculated with Morgan's bacillus and incubated at room temperature for 6, 12 and 24 hours, it was impossible to recover the bacillus by the usual methods. The milk delivered to this institution was always pasteurized, so that the condition under which the germs of Diarrhoea would multiply were present, but whether all the cases were due to the same cause, or resulted from a case-to-case infection is open to argument. It may be stated that the measures which were taken to cope with the disease were based on the assumption of a caseto-case infection and they were successful. It is most unlikely that the milk was infected before its arrival in the house. It was obtained from a company which pasteurizes all its milk at the farms, and delivered at the house in a sealed can. |
c9942fdb-da1d-47d5-96de-41c65ec98121 | Moreover, milk from the same churn was supplied to another institution, and no cases of Diarrhoea occurred. It is true that no small children resided in the other institution, but 9 of the nurses were attacked in the affected house. As far as could be ascertained the milk delivered by the dairy company about that period appeared to be free from suspicion, and there is no ground for assuming that the milk was infected before its arrival. 68 The fact that the cases occurred on consecutive dates points to a case-to-case infection. The first case of Diarrhoea occurred on August 28th, and the other cases occurred at intervals up to September 9th. There was no Diarrhaea amongst the nurses before the end of August and the illness started amongst them during the first week in September. |
0b8a79dd-7cc6-48f6-be8d-d6941fa54a2e | It was impossible to fix the exact date of onset in the nurses, but the exact dates could be fixed in the children, as charts were kept recording the temperatures, state of the bowels, etc., and from the dates given in a preceding page it will be observed that the cases occurred, not at the same time, but at varying intervals following each other. It is no objection to the evidence of communicability that all the members of the household were not attacked. In the early stages, no significance was attached to the occurrence of successive cases, but later the probability of communicability was appreciated and precautions were taken. As soon as these precautions were taken the outbreak ceased, although the conditions favourable to Diarrhoea continued for some time. In London the deaths from Diarrhoea did not appreciably drop until the middle of October, and the temperature was comparatively high for a month later. |
6224a5be-5e9d-400a-b58e-6b1c8abe9d96 | Last summer up to the week ending August 23rd, the temperature in London was below the average; for the week ending August 30th, it was below 2.3Β° below the average, and for the weeks ending September 6th and 13th, the temperature was only 0.5Β° and 0.4Β° respectively, below the average. For the week ending September 20th, it was 2.2Β° below the average, but for the week ending September 27th, it was 4.8Β° above the average. It is only fair to state that some authorities believe that Diarrhoea is not an infectious disease. At the Children's Hospital, Vincent Square, no precautions, as in the case of infectious disease, are taken. No attempt at isolation is made. |
53b3f31a-e16c-449e-a5cf-3ef24575dc09 | The infants lie side by side in their cotsβthe case of severe atrophy next to the case of epidemic Diarrhoeaβ and they are attended by the same nurses, who minister to all their requirements, and yet there is no case-to-case infection. 69 But the conditions at the Children's Hospital are very dif ferent to those in the house in question. In a hospital the nurses are fully trained and appreciate the value of asepsis and antisepsis. Here the majority of the nurses were being trained and had onlybeen a short time in the institution. But of more importance is the question of floor space allowed to each child. The superficial floor space at hospitals allowed to each child is at least 30 square feet, here it was little more than half of that. Although there was no legal overcrowding, neither the superficial nor the cubic space was comparable to that allowed in a hospital, and there were 30 children and 19 nurses living in the house. |
9625572c-9bd7-4db2-b8a1-bc09f0e31761 | Under the Children's Act, the Guardians have power to fix the number of children allowed in such institutions, and I understand that the responsible officer has fixed the number so as to allow a floor area of 30 square feet for each cot. MORTALITY BETWEEN 1-5 YEARS OF AGE. 89 deaths occurred in children between the ages of 1 and 5 years, and though this age-period is one of the most important in the life of the child, it is the period when least supervision is exercised. By means of the Notification of Births Act, a child is brought at birth to the cognisance of the Health Department, and a systematic supervision of the first year of life is an established fact. At the age of 5 the child comes under the supervision of the School Medical Service, and remains until he reaches the ages of 13 or 14. |
811072e7-ec3c-4aa7-b704-65b6a6bbb7db | Of course, we are only referring to a portion of the industrial part of the community when we say that the children are brought under the supervision of the Health Visitor, but it may be stated that practically no provision has been made in the past for the supervision of any children between the ages of 1 and 5 years. In last year's school report it was pointed out that during the medical inspection of infants who are newly admitted to school it is regrettable to find that certain complaints may already have become chronic at the beginning of school life. This is specially the case in the poorer parts of the district, and refers to such 70 complaints as blepharitis, chronic ear discharge, deafness, and scars upon the cornea. If we take the case of deafness, the Acton Education Authority have about 10 cases of Hereditary or Congenital deafness under their control. |
e6cfbfdc-f66b-4874-b43e-82d706aea5c4 | 3 of these are at an institution at a cost of Β£35 a year each, 4 are at a school at a cost of Β£12 a year each and will have to be kept later at an institution and 3 are waiting admission to a school. These children have to be sent to an institution after reaching the age of 14, because at that age they have only reached the development of children of about 10. The deaf child at 7 is unequal in many respects to the hearing child of 2 years. Although the children are known to be deaf, no effort is made to teach them a language until they reach the age of 6 or 7. The loss of the years between 2 and 7 is irretrievable. The State does not recognise that the child needs anything for these years, and yet these are the years of language and speech formation, and the most plastic in the child's career. |
c9fc9a81-2a12-4d48-9f6a-e12a41b87f4d | If the mother had been taught a few principles of speech or lip reading, in the opinion of Dr. Kerr Love, we might expect the development of the nascent speech instinct at the time when that development is easiest and most natural. The faculty of imitation, so strong in children, would give the young deaf child a small vocabulary, on which the teacher could at once build when the child entered school. But there is another and a much larger class of deaf people in which the seeds of deafness have been sown in the period under notice. I refer to the acquired deafness which results from chronic ear discharge. Temporary deafness is often cured, discharging ears can be dried up, abscesses of the brain due to ear disease can be evacuated. But old standing deafness cannot usually be cured. |
73a57ff9-0370-434a-883c-32a3bd0cc60a | Most of this kind of deafness results from a chronic discharge of the ears acquired in an attack of Measles or Scarlet Fever in the age-period 1-5 years, and practically no supervision is exercised and very little warning is given as to the seriousness of the complaint. 71 Many children when they attend school have become almost or totally blind in one or both eyes, and the blindness often results from causes which could have been removed. Whatever may have been the cause of a squint, it is admitted that a continuous squint involves a weakening or loss of visual function, and that the younger a child the more readily does this occur. A neglected squint which can be cured in the early years of a child's life may lead to blindness in the affected eye in later years. Usually excellent results follow early treatment. Two of the children attending the Infant Consultation at the Priory School had a very bad squint. They were advised treatment and obtained glasses at a hospital. |
cb4b15d8-688f-460d-9a2c-42dc40c14495 | The squint has almost entirely disappeared and the child's sight appears very good. Very frequently, it requires intelligent care and patience on the part of the mother in addition to the wearing of spectacles, but where the mother has been instructed, the results are most gratifying. The seeds of dental disease suffered from in after-life are sown between the ages of 3 and 5. In the school report stress is laid upon the necessity of care of the temporary teeth. It is generally held that the problem of dental caries is primarily a question of diet, and by far the most important factor in the production of dental caries in children is unsuitabilitv in the character of the food provided from infancy onwards. If an improvement in this direction is to be obtained, it can only come about through education and a change in the dietetic habits of children. Many other ailments could be mentioned, and it all shows that the question is a far greater one than can be adequately dealt with by the means at our disposal. |
457868e6-e138-4448-b6f9-d3909fc7008a | In this district, the question is a wider one still, on account of the industrial conditions which prevail. Not only is there need for some supervision of children who remain untreated for slight ailments, but there are here many children whose mothers for one reason or another are unable to provide the care and attention required to secure a healthy growth and development. 72 There are probably about 4,000 women employed in the laundry industry, and possibly one-half of these are married. There are only two organisations in the district which deal with thc children between the ages of 1 and 5. The Day Nursery in South Acton receives children up to the age of 5, but the Day Nursery has accommodation for only 40 children, and it is unreasonable to expect the Committee to extend their operations without a hope and promise of a larger subscription list. |
0ee9f7bf-11ee-4576-9e86-82a42ec820a4 | Attempts are also made by the Health Visitor to continue the supervision commenced during the first year until the children are of school age, and last year 34 children between the ages of 1 and 5 years regularly attended the Infant Consultation at the Priory School. If this could be extended, some control would be available for a large number of children under school age. It is not suggested that the children should undergo any medical examination, but in most cases advice is required as to feeding, clothing, etc., from time to time. The alternative suggested to the Infant Consultations has been the Nursery School. The advantage of the former would be in the fact that home visits could be paid to selected cases, and it is also generally admitted that children under 5 should remain at home under the care of their mothers whenever possible. It is possible to combine both and limit the Nursery School to children whose mothers are away from their homes. |
2b37b438-05c8-41d9-8876-e470cee93664 | The organisation of a Nursery School would differ in many ways from that of an ordinary elementary school, and these schools are intended to supplement the care which should be given at home. NOTIFICATION OF BIRTHS ACT, 1907. 1,456 live births and 44 still births were notified during the year. 44 births were registered that had not been notified within the statutory period. 579 births were notified by doctors, 729 by registered midwives, 150 by parents and 42 by nurses. In 39 instances the birth was notified by the doctor and the midwife, and in 5 instances by the doctor and the parent. 66.5 per cent. of the births notified were visited by the Health Visitor. 73 CANCER. 55 deaths occurred from Cancer or Malignant Disease. This number is 1 less than that of 1912. The Ward distribution of the disease was as follows:β North-East. North-West. South-East. South-West. |
4af69e53-6936-45b0-b722-5b3293269f21 | 17 9 18 11 19 of the deaths were in males and 36 in females. 36 of the deaths occurred in the district and 19 in public institutions outside the district. The site of the disease in the two sexes was as follows:β Males. es. Stomach 6 Uterus 10 Bowel 2 Breast 8 Aesophagus 2 Bowel 4 Tongue 2 Rectum 2 Mediastinum 2 Stomach 2 Omentum 1 Liver 2 Rectum 1 Ovaries 2 Liver 1 Genital organs 1 Face 1 Mediastinum 1 Glands of Neck 1 Kidney 1 Ear 1 Nasopharynx 1 Axillary Glands 1 INQUESTS. |
75ed8922-d735-45ad-8f14-f184d4b50a6d | 46 Inquests were held, the certified cause of death being:β Accidentally killed by a passing train 3 ,, crushed between Railway Wagons 1 ,, run over by a Motor Car 2 ,, ,, ,, ,, Horse Van 1 ,, ,, ,, ,, Tram Car 1 Accidental Fall 1 Fall from a Scaffold 1 Accidental Burns 1 Accidental Scalds 1 Overlaying 1 74 Fatty Heart 5 Congestion of the Lungs 3 Cerebral Hemorrhage 3 Aneurysm of Aorta 3 Pneumonia 2 Enlarged Thymus Gland 2 Status Lymphaticus 2 Hepatitis 1 Convulsions 1 Phthisis 1 Kidney Disease 1 Alcoholic Poisoning 1 Strangulated Hernia 1 Cirrhosis of Liver 1 Pulmonary Thrombosis 1 The above refer to all Inquests held in the district, and include both residents and non-residents. |
ac5f3d02-f75b-49bd-8901-b0c5c9167de8 | 12 Inquests were held on residents who died outside the district, the cause of death in these cases being:β Suicide 2 Found Drowned ... 2 Accidentally run over by a Motor 'Bus 1 β Electrocuted on Railway 1 Injuries whilst Boarding a Train 1 Puerperal Fever 1 Appendicitis 1 Heat Stroke 1 Fhthisis 1 Bronchitis 1 PUBLIC MORTUARY. 49 bodies were removed to the Public Mortuary; on 47 of these Inquests were held. One of the Inquests was on a stillborn child, and is not included in the death returns. 2 bodies were removed to the Mortuary for convenience. 32 post-mortem examinations were made. 75 COUNCIL LABORATORY. 1,258 examinations were made during the year, and the following table gives a statement of the work done :β Disease. Specimen. Result. . Positive. Negative. |
2196d9ac-c6f4-4d8b-a687-b02cb3061138 | Diphtheria. Swabs from nose or throat 414 830 1,244 Ringworm. Hair of scalp 12 2 14 426 832 1,258 DAIRIES AND COWSHEDS. There are 2 cowkeepers and 85 purveyors of milk in the district. There were 4 changes of occupation and 4 new premises registered. SLAUGHTER HOUSES. There are 2 licensed and 1 registered slaughter houses in the district. All the slaughter houses are regularly visited during the times of slaughter. 175 inspections were made in the year. The following were surrendered as unfit for human consumption :β 6Β½ Pigs Carcases. 29 ,, Heads. l6 ,, Kidneys. 4 ,, Plucks. 2 ,, Livers. 3 ,, Spleens 1 ,, Mesentery. UNSOUND FOOD. |
1a9efd92-2c70-4ca1-ad5c-9393fbb67ec0 | In addition to the meat surrendered in the slaughter houses, the following articles were surrendered and destroyed as unfit for human consumption:β 1 Case of Fresh Herrings. 2 Bags of Whelks. 1 Box of Dutch Dabs. 76 SEWAGE DISPOSAL. The method of Sewage Disposal has been described in detail in former Reports. Under the Acton Sewage Act, all the sewage is emptied into the London sewers, and the flood water, after treatment, is discharged into the Thames No complaints have been received during the year, and the filter beds have worked satisfactorily. With two exceptions, all the houses in the district are connected with the main drainage system, and the sewage is waterborne. REFUSE COLLECTION AND DISPOSAL. A weekly collection of House Refuse is carried out, and the Refuse is destroyed in the Council's Refuse Destructor. The Refuse is collected directly by the Council, and there were no complaints during the year. |
c64e82f8-b4db-46ea-8684-604d17b9b799 | Last year 13,485 tons of House Refuse were collected and destroyed. In addition, 2,682 tons of Clinker were collected and 7,801 loads of Street Sweepings. The fixed ash-pits are gradually being replaced by movable bins, and at the present time there are about 80 ash-pits in the district; during the year 24 were abolished and replaced by movable bins. CERTIFICATES OF EXEMPTION FROM INHABITED HOUSE DUTY. 7 applications were received in respect of 19 houses, and certificates of exemption were signed in all cases. HOUSING, ETC. During the year 594 house-to-house inspections were made, and in the following table the names of the streets and the conditions found on inspection will be found. 77 In addition, 840 premises were visited on complaint, 316 without complaint, and 347 after infectious diseases. |
525ba65d-a384-434e-8223-9f307388b563 | In these, the inspection was generally made into some specific condition which existed, or alleged to exist, and a full detailed inspection was not in all instances carried out. In the 594 houses subjected to house-to-house inspection there were 992 tenements; so that a large majority of the houses inspected were let out into two or mora tenements. These, of course, do not include the houses let in lodgings registered under the bye-laws. At the end of the year 62 houses let in lodgings were on the register. A large number of the latter are let out in single-room tenements, and this class of house seems to be on the increase. At the present time, single-room tenements are practically limited to Junction Road, the southern portion of Shaftesbury Road, and ihe western end of Packington Road. |
49f07671-6c8a-480e-a054-a3a5e8eea8bc | There are isolated instances in other parts of the district, but in the latter single-room tenements are the exception, and the rooms are let out unfurnished to widows and occasionally to spinsters. But in the above 3 streets the houses are let out furnished to families, mostly in single rooms, occasionally in 2-roomed tenements. The rent paid varies from 2s. 6d. to 6s. per room per week, the average being about 5s. to 5s. 6d. The furniture is usually of the most meagre and primitive character, and the bedclothes are frequently in a filthy condition. There is no power to insist upon clean linen, though we can insist upon clean walls and ceilings. The occupiers of these one-roomed tenements have as low a standard of personal cleanliness as can well be imagined, though the condition of the premises depends largely on the landlord, more so than even on the occupier. |
d49a5a54-6cac-4957-9403-7897587ccc1d | The occupiers are undoubtedly poor, but in many instances the poverty is not due to a low wage-earning capacity. In many instances the occupiers earn a higher wage than those who live in 3 and 4 room tenements and than some who live in self-contained cottages. It is only by constant inspection that these premises are kept in a sanitary condition. A recent inspection revealed the fact that a large number of the rooms were overcrowded, though the 78 standard allowed is only 400 cubic feet per adult and 200 cubic feet for children where the rooms are used for sleeping and living purposes, and 300 cubic feet and 150 cubic feet where the rooms are exclusively used for sleeping purposes. As a rule, this standard is lower than the one usually accepted for the estimation of overcrowding. In the Census Returns, any house or tenement which has more than an average of 2 persons per room is considered to be overcrowded. |
aac55378-5a30-4410-946e-780f8038a471 | A reference to the table of house-tohouse inspections will show that on the Census basis there were 39 cases of overcrowding in the 594 premises inspected, compared with 15 based on the cubic capacity of the room. Of the 594 houses (including 992 tenements) in which a house-to-house inspection was made, 839 of the tenements had a rental of 10s. a week or under, and in 247 of these the tenancy had commenced before December 3rd, 1909. 79 * HOUSE TO HOUSE INSPECTIONS, 1913. (were made in the following streets.) Nature of Sanitary Defect All Saints Road Acton Lane Avenue Road Antrobus Road Allison Road Beaumont Road Birkbeck Road Burlington Mews Burlington Gardens Slews Burlington Gardens Berrymead Gardens Bridgman Road Bollo Lane No. |
0456ae61-3af5-4e66-98f1-5e2bc7804c8e | of Houses Inspected 4 35 60 13 22 7 15 12 3 20 64 52 19 No. of Tenements 4 50 72 17 25 20 31 13 2 51 127 101 37 Cases of Overcrowding β 2 β 1 β β β 2 β β 1 2 1 Defects of Drainage System 8 43 75 14 37 8 39 7 7 64 39 32 55 Defective or want of Yard Paving β 12 20 3 5 1 2 β β 9 30 25 6 DefectsofWater-closets (including appliances) β 20 16 6 11 2 13 5 β 17 19 20 16 Untrapped R. W. |
629f7b3b-0627-48f6-b398-f7455e27a205 | Down-pipes β 1 6 1 4 β 10 β β 8 β 24 β Dampness 1 4 29 12 2 4 8 2 β 3 13 5 3 Dirty Walls and Ceilings of Rooms 2 7 6 19 β 5 3 10 β β 18 87 51 Defects of Drinking Water Storage 2 10 8 β 6 3 5 2 1 15 33 52 13 Defective Sinks and Waste Pipes 1 16 28 4 12 3 20 1 β 54 6 8 1 Miscellaneous Defects (Floors, Roofs, Plas-tering, Gutters, &c.) |
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