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386ee451-45e9-4156-bca8-94b45fab0512 | This reduction in the average size of families is not local, and is disclosed by the Census returns for other parts of England and Wales. It is a natural consequence of the increase in the marriage rate in association with a heavily reduced birth-rate and an increased (allowing for war deaths) death-rate. The reduction in the size of families, while it may not abate the demands of individual families for separate dwellings, obviously justifies a review of the general position by reference to the reduced requirements of families in point of accommodation. This reduction in the average size of families explains another phenomenon. The increase in the number of families between 1911 15 and 1921 was greater than the increase in the number of dwellings in the same period, yet the increase of the percentage of the population living more than two persons to a room was only a slight one. |
f465ff30-e92c-46a3-9c15-50d06ea5e1d9 | The ratio of two or more persons per room has been selected as an approximate comparative index figure for the purpose of measuring the prevalence and distribution of overcrowding conditions, but obviously it cannot be accepted as an absolute standard or a definition of overcrowding; other factors enter, such as the size of the rooms, the age-distribution of the population including the number of children. In the intercensal period 1911—1921, there was an increase of 810 or 7.5 per cent. in the number of total dwellings in the district. In the same period there was an increase in the number of private families of 2,012 or 15.6 per cent. A reference to the table giving the number of persons occupying the different number of rooms will show that 6,478 were living more than 2 persons to a room. In 1911, the number was 5,947. |
42d3a7b1-e85c-4a7c-8cbc-249e4a2b9322 | The percentage of the total family population living more than 2 persons to a room in 1921 was 10.7 compared with 10.4 in 1911. This percentage naturally is higher in the 1, 2 and 3 room tenements. In the 1 room tenements the percentage was 21, in the 2 roomed cues it was 28, and in the 3 roomed tenements it was 20. In the 4 roomed tenements it dropped to 8 per cent. For comparative purposes the Registrar-General has adopted a standard based upon the number of rooms per persons in the whole of England and Wales. Based upon the England and Wales standard, the deficiency of rooms in Acton was 3,126 or 4.8 per cent. The average number of rooms per person in a dwelling does not depend on the size of the tenement but on the size of the family. |
a96e6d06-0e11-4958-9854-e3474473792d | In families of one person each the average number of rooms per person is 2.36, and this number steadily and continuously goes down till it reaches .4 in the family of 14. A considerable difference exists in the conditions of the different wards The population of the South-West Ward exceeds that of any other, but in area it is the least. The highest number of private families was in the North-East Ward, but the highest number of structurally separate dwellings was in the South-East Ward. The total number of rooms occupied was highest in the NorthEast Ward, but the highest average of rooms per person was in the North-West Ward. The greatest intercensal increase occurred in the North-East Ward, and the smallest in the South-East Ward. The ratio of females to males was lcwest in the South-West Ward with 1,092 females to every 1,000 males, and highest in the North-West Ward with 1,295 females to every 1,000 males. |
632fe4fe-21c8-4d6b-8210-470499b1200c | 16 In the following table the Ward distribution of the population in given:— N.-East. N.-West. S.-East. S.-West. Area in acres 1,082 789 255 179 Total persons 16,353 12,329 15,094 17,523 Males 7,663 5,371 6,907 8,376 Females 8,690 6,958 8,187 9,147 Persons per acre 15. |
0baa4879-65ec-4427-9f5e-dd89fd3eac3d | 1 15.6 59.2 97.2 Private families 4,053 3,138 3,735 4,015 Population in private families 16,007 12,142 14,982 17,359 Structurally separate dwellings 3,050 2,551 3,092 2,810 Rooms occupied 18,418 16,384 17,297 13,430 Rooms per person 1.15 1.35 1.15 0.77 Population.—The Registrar General estimates the population at the end of June, 1923. to be 62,720, an increase of 330. For the twelve months ending December 31st, 1923, 84 new houses were erected. |
f73d4866-971e-4bb4-8662-7da35898738c | The number of Parliamentary electors on the Register in the autumn of 1923 was as follows:— MEN WOMEN TOTAL 17,062 14,332 31,394 For the corresponding period of 1922, the numbers were:— MEN WOMEN TOTAL 16,477 13,948 30,425 In view of these figures, it is probable that the Registrar General's estimate is under the actual figure. Outdoor Relief.—I am indebted to Mr. Harmsworth, the Clerk of the Guardians, for the figures relating to Poor Law Relief. The amount of out-door relief given by the Guardians for the parish of Acton was:— £ s. d. Ordinary Relief 6,016 3 1½ Unemployment Relief 3,380 10 5 £9,396 13 6½ There is a slight increase in the amount of the ordinary relief, but a very marked decrease in the amount of the unemployment relief. |
5fe937e7-8c43-4ea2-9ceb-7ff1fd59d5ba | The amount of unemployment relief disbursed by the Guardians was less than 30 per cent. of that disbursed in 1922. 17 Births.—Table VII gives particulars of the births registered and notified in the district, and the births registered outside the district. The total number of births belonging to the district was 1,171, and the birth-rate was 18.6 per 1,000 inhabitants, as compared with 19.3 per 1,000 in 1922. This is the lowest birth-rate recorded in the district with the exception of that for the two years 1917 and 1918, when the birthrate was directly affected by the war. The birth-rate for England and Wales was 19.7, for London 20.2 and for the large towns including London 20.4. Forty-three children were born out of wedlock; this number corresponds to an illegitimate birth-rate of 36 per 1,000 births. |
650547fa-6924-4270-b95d-2cffd828e1eb | Deaths.—368 deaths were registered in the district; of these 11 deaths were of non-residents; 243 deaths of residents occurred outside the district. The total number of deaths belonging to the district is 599. The nett number of deaths corresponds to a death-rate of 9.5 per 1,000 inhabitants, which is the lowest recorded death-rate for the district. The death-rate for England and Wales was 11.6 per 1,000, for London 11.2, and for the 105 large towns, including London, 11.6 per 1,000 inhabitants. Possibly these figures do not convey the facts in a very convincing and vivid manner, but the reduction of the death-rate to such a low figure denotes a vast amount of patient and ceaseless work in many directions. Compared with 1913, a reduction in the death-rate has occurred of 2 per 1,000 inhabitants, or a saving of 125 lives. |
d9267d7a-bfd3-42a4-a1e0-5e54f7feaf5a | There is an absolute reduction of 94 in the number of deaths in 1923 as compared with 1913. An inspection of the death-rates from different diseases shows that this reduction has not occurred uniformly from all causes. If we examine the causes of death in the last 10 years we find that the death-rates from certain diseases such as Cancer, Heart Disease, Bronchitis, Pneumonia and Tubercle have remained almost stationary. It is difficult to know how many mistakes are made in diagnosis. One curious instance occurred last year. Early in December a notification was received from a sanatorium that a man aged 41 years had been admitted and was suffering from Pulmonary Tuberculosis. |
ebb95792-df2e-4310-b5c6-3e642714a126 | He was in the sanatorium for a couple of weeks only as at the end of December he had been discharged from the institution, Evidently by this time the lung symptoms 18 had cleared up, and the certificate stated that he was possibly suffering from Laryngeal Tuberculosis; that is, the diagnosis was preceded by a mark of interrogation. The history of the case was indefinite. He had been found at Chertsey in October suffering from loss of memory and was then taken to the sanatorium and treated for tubercular disease of the throat. After his discharge from the sanatorium at the end of December, his throat became more troublesome, and he attended the Middlesex Hospital, when the condition was diagnosed as a malignant growth. He died in January. The doctor who made the post-mortem examination stated that he found death due to the effect of poisoning by some corrosive substance. The man must have swallowed a quantity of acid some months previously. |
dde483cc-c0b9-4b93-a0b4-ce588d94f12a | Cancer.—The subject of Cancer has excited considerable attention both in the medical and the lay Press, and a memorandum was issued by the Ministry of Health in July, 1923. Further memoranda have been issued. A conference of the different authorities within the Union was convened by the Brentford Board of Guardians, and a Cancer Committee appointed. Although in the last 10 years there has been no appreciable increase in the deaths from Cancer in Acton, it is now generally admitted that Cancer is on the increase. The figures of Dr. Stevenson show that a natural increase has occurred, and not merely a statistical increase. He examined the figures for England and Wales for 1.917 and the previous 22 years, and found that a greater increase had occurred in Cancer of accessible sites than in that of inaccessible sites. For instance, Cancer of the tongue caused a mortality three or four times as great as it did 50 or 60 years ago. |
db4ee5e4-c349-4892-b5a0-a4af4061d8f3 | The same work was repeated in the United States and reported in the mortality statistics for 1920. The United States authorities arrived at precisely the same results—a greater increase of Cancer of accessible sites than of inaccessible. In spite of this, in the last 10 years at any rate, there has been no appreciable increase here. The death-rate per 1,000 inhabitants has varied considerably. The highest rates were in 1916, 1917 and 1922, when the death-rate was 1.15 per 1,000, and the lowest was last year when it was 84 per 1,000. It is unnecessary here to discuss the various theories as to the causes of the increase; unfortunately, it is admitted generally that the root cause or causes on which the occurrence of cancer depends are unknown. |
dc36c597-5a7e-45a2-adf2-87fc170d857c | The memorandum of the Ministry suggested that local authorities should consider the question of providing facilities for diagnosis and treatment, and whether propaganda work should be undertaken which would result in persons suffering from the disease seeking early advice and treatment. 19 As far as this district is concerned, there is no lack of facilities for diagnosis or treatment. Our proximity to the large hospitals in London ana the homes of the recognised authorities upon the various forms of Cancer, places all the facilities for diagnosis and treatment within the easy reach of all patients. The Ministry of Health suggests that measures should be considered for improving the local facilities for clinical consultations and for pathological examination, for improving the local facilities for Cancer treatment (operative, provision of X-ray and radium treatment), and the provision of adequate arrangements for this purpose at local hospitals, institutions, etc., which serve the area. For reasons stated above, in this district, the lack of these facilities is not the chief difficulty. The chief difficulty in carrying out curative treatment lies in the reluctance of patients to seek early medical advice. |
469919c4-3c4a-4d3c-a47e-0014893eba18 | In some cases there is a diffidence to seek medical advice. Some people have a suspicion, or even a belief, that there is something the matter with them, but hug the knowledge to themselves from dread of the truth. Probably, these people form but a small minority. In the majority of instances, Cancer in the early stages is painless, and the symptoms of the disease are only a slight deviation or exaggeration of what are considered normal processes. These slight symptoms are disregarded through ignorance of their significance. These early stages are the favourable ones for immediate operation. In any condition in which cancer is suspected, immediate and decisive action is necessary. Quack remedies are only a waste of time and money; at best, they are useless, and at worst, aggravate the disease. At the Conference, it was felt that there is a field for propaganda work in the education locally of the public, and that the two points around which this work should centre are the family doctor and the local public health authority. |
d0481805-5c9f-4a2f-ae60-daa05094ccb7 | If early advice were sought, the one from whom this would be sought would be the general practitioner, but the complaint of the doctor is that the patients do not come to him at a sufficiently early stage to enable him to apply successful treatment. There are certain facts about Cancer which ought to be known, and the dissemination of the knowledge might save lives and alleviate much suffering, and one essential fact is that the patient should not postpone or delay seeking competent medical advice. By whom the advice should be given is a debatable question. It has been suggested that the ordinary agencies of public health departments should be utilised for this purpose, notably by instruction at Welfare Centres, and also by midwives, maternity and district nurses. The Royal Society of Medicine recommended that the British Red Cross Society might be asked to conduct a publicity campaign by means of lectures and phamplets. 20 It must be recollected that Health Visitors, Midwives and Maternity Nurses come intimately into contact with women at an age before Cancer is peculiarly liable to attack the body. |
e39623cb-d363-4293-a3ac-9766558929be | Whatever action is taken, much caution is needed in announcements to the public on Cancer in order to avoid over-statement, the making of promises which are not warranted by evidence or the production of needless and mischievous apprehensions of Cancer. Certain common sense rules of prophylaxis could, without any danger, be emphasised. The liability of Cancer to follow chronic irritation of so many different types is remarkable, and leads to the supposition that beneath them all there lies some common factor—as yet unrecognised—which is fundamental to the passage of a chronic inflammatory and non-cancerous condition into one that is definitely cancerous. This consideration indicates that there are at least some provocative causes of Cancer which can be guarded against. Since Cancer occurs more commonly in certain sites, it is prudent to notice and remove causes for chronic irritation in those sites. |
88f6aade-dd3c-478e-a11f-68a2ad7c2891 | In this category, for example, come the removal of rough stumps of teeth, or replacement of badly-fitting dentures; a change of habit, if smoking is found to produce soreness on the same spot of the lip or tongue; an alteration of clothing which causes irritation of particular regions of the body—for example the breast; the avoidance of constipation and like matters. Heart Disease.—In the table giving the causes of, and ages at, death, it will be noticed that organic heart disease has become one of the most important causes of death. Last year in this district 60 deaths were due to organic heart disease; in 1922, the figure was 78. These figures do not include rheumatic fever, diseases of arteries, embolism and chorea, in which directly or indirectly heart disease is the cause of death. Mortality tables place diseases of the heart in an unenviable position at the head of the list of causes of death. |
29b087db-3928-47de-b3b7-bd4a30714931 | From an economic point of view, heart disease is the most important cause of death in the mortality tables. Owing to the incidence in different age periods the economic wastage in heart disease is greater than in most other diseases, particularly when one takes into account the years of invalidism that antedate the fatal issue in most cases of heart disease. With a causal condition that in the majority of cases is frankly infective something should be possible to mitigate the extent of these diseases. In the School Report attention has been drawn 21 to the importance of tonsillar sepsis and dental caries as aetiological factors in Rheumatic Fever; and as Rheumatic Fever is in the majority of instances associated with Heart Disease, any means which will reduce the incidence of Rheumatic diseases must ultimately react upon the frequency of Heart Diseases. In regard at least to acute rheumatism there is some evidence of the disease becoming less virulent as well as less common. Dr. |
6e338322-fdd6-427f-8fd1-e88a658be22c | Miller has pointed out in a recent paper that the percentage of hospital in-patients suffering with acute rheumatism has been almost halved in recent years. In addition to the work in the School Clinics and other centres there is a necessity to emphasise the importance of rheumatism, especially in children, and the desirability of prolonged rest after an attack of rheumatic fever. In a recent work issued by the Ministry of Health it is pointed out that permanent damage to the heart is much more likely to occur in second or recurrent attacks than in first attacks of rheumatic fever. Recurrence is much less likely to occur in those patients who have been able to have a prolonged convalescence from their first attack. Medical opinion has recently advised in favour of what amounts to bed sanatorium treatment for convalescent patients in special homes of recovery. These special homes of recovery, which differ entirely in their regime from the ordinary convalescent home, have been instituted in Birmingham, Liverpool, and in some other towns in this country. |
cd3775ff-ecf0-4fae-9c1c-f7ac8f4bf455 | In New York, a society has been formed for the prevention and relief of heart disease. One curious fact has emerged from the activities of this society, viz., that Chorea or St. Vitus's Dance in its liability to leave permanent effects upon the heart was more difficult to control than ordinary rheumatic or throat cases. The subject of chorea in the schools is well worth the most serious consideration. Deaths in Public Institutions.—212 of the deaths of residents outside the district occurred in public institutions. In addition, 15 deaths of residents occurred in public institutions in the district. These numbers are exclusive of the deaths which occurred in nursing homes. 227 out of a total of 599, or 38 per cent. of the total deaths occurred in public institutions. SPECIAL CAUSES OF SICKNESS. Fur Rashes.—Mention should be made of the complaints received in the early part of the year from persons who had suffered from rashes on the face and neck, caused ostensibly by the wearing offurs. |
1440acb7-1e24-44fa-99d0-8fe643e84a7f | 22 A recurrence of the complaints occurred later in the year and also in the early part of 1924. In all cases the symptoms were similar. There was an eruption on the neck, and lower part of the face; the eruption was of an irritating character and persisted for a considerable time. In some of the cases in which the fur was not suspected, there was a recurrence of the symptoms, but invariably the eruption disappeared when the sufferer ceased wearing the fur. Frequently there was a difficulty in obtaining the fur which was supposd to be the cause of the trouble. In most cases, when the purchaser complained to the seller, the fur was exchanged and could not be traced. When the fur composed only the collar of a cloth coat, the difficulty of tracing was enhanced. As an instance of the difficulties encountered, when enquiries were made into the origin of one coat it was found that the completed coat was bought in the City of London. |
a993a77f-1d53-4042-9705-68c25e51df88 | The fur was bought from a furrier in another area, and the coat was made on outworkers premises in a third area. We were fortunate in obtaining some of the implicated furs. These were sent to the Ministry of Health. Arrangements were made by the Ministry for the examination of these furs by an eminent chemist. As far as could be gathered, no cases of illness were found among the workers in these particular furs, but the difficulty of tracing was so great that no significance is attached to this fact. Moreover, the conditions under which the rash appears need not be present in the case of workers. The work of Dr. Prosser White of Wigan throws an interesting light upon these fur rashes. Dr. Prossor White is an eminent dermatologist, and has been carrying out investigations into the rashes which occur among fur workers, and bis conclusions have an important bearing upon rashes in fur wearers. |
1fcbee17-98f7-40a9-b4fc-c46466649588 | I had the opportunity of seeing his original photographs of rashes in fur workers and the experimental rashes he had induced on himself and others, and these rashes appeared to be identical with those which had appeared amongst the wearers of the furs. The cause has not been found in all cases, but Dr. Prosser White's work has established the probability that the rashes which were complained of by wearers of furs in this district iast year were caused by one or more of the constituents of the dyes used in the industry. It was noticed that the victims had worn furs which had been dyed, and in most instances, these furs simply formed the collar of a cloth coat. The principal culprit is the coney seal, but the list of counterfeits recognised by the Fur and Skin Trading Section of the 23 London Chamber of Commerce extends to 20 or more varieties of furs. |
89da3da9-f37a-4bb1-959e-0e3162a8b7b1 | Certain furs become fashionable and in order to supply the demand for this particular kind of fur, imitations and substitutes are prepared. There may be only a limited supply of the natural coloured skin which is popular for the season, and the demand of fashion fosters the preparation of the counterfeits. Hare is dyed to represent sable or fox, kid dyed to represent Persian lamb or caracul, rabbit dyed to represent otter or mole, and numerous other skins are dyed to imitate the saleable or fashionable fur. It cannot well be called fraud, as in most cases the public are conscious and willing participator in the counterfeit, though possibly they are not aware of the processes through which the skin has to pass before it emerges in the final form in which it is sold. |
fe394f11-cd69-4930-a773-e954b872c7bf | The process of preparation has become a very complicated one, and though, as a rule, the dyes are the cause of illness, any of the processes may be so negligently carried out as to result in injury to the wearer of the fur. It was suggested that the irritation of the skin was due to arsenic, and a good deal of unnecessary harm caused. The suggestion was probably made because of the large quantities of arsenic which the taxidermist employs, but the taxidermist uses special methods for the curing of his specimens. He applies white arsenic V> the fleshy side of the green skins. The taxidermist also employs a pickle, in which he steeps the dried pelts, and this pickle consists of arsenic, alum, strong sulphuric acid and water. In every instance of rashes in fur wearers, arsenic has been ruled out as. the cause. In one case, a mere trace was found on analysis and in another 1 in 20,000. |
61ce752d-4205-4e1d-8c88-18e20dd6c657 | This means that three pounds of the dyed fur contain about one grain of arsenic. Some furs have been sent for analysis, and particular mention was made that arsenic was not present. Arsenic is very seldom used at all in the curing of coney rabbit furs. The skins of sheep, goats, kids and other smaller animals are sometimes treated by the application of soaps before they come into the hands of the furriers. These soaps, which are rubbed into the fleshy sides of the pelts before they are dry, may contain arsenic, zinc or mercury. Usually salt alone, or mixed with alum, is the sole application. In any case, the chemicals should be. removed completely by the first washing. After washing, the skins are hung up to dry. The next operation is called "killing." Its object is to make the fur more absorbent and permit the dye Honors to penetrate to the very tips. |
bbd578bc-ffb3-473a-87ae-7494a0bcda12 | For this purpose the whole skin is immersed in some alkaline solution for two or three hours. The treatment with lime gives the brightest and clearest colours on dyeing afterwards. 24 Following this process, washing with plenty of water is highly necessary. Any lime left in the furs forms a caustic dust when it becomes dry. A little acetic acid or formic acid will neutralise any traces of lime, but these acids must be removed by another washing. The next process is "mordanting." Mordants attract and fix the colours. For light colours this process is unnecessary, but to obtain deep colours, mordants are always required. Without them the shades are uneven and not so fast to light and rubbing. Metallic salts head the list of mordants either by themselves or together. If these metals are not completely changed into their oxides, the furs will give rise to rashes in the workers and wearers. |
1abc2546-3675-4932-8d13-1e59a7c3ec87 | The skins are now ready for the dyeing process, and according to Dr. Prosser White, it is during this process that residues are left which give rise to the skin troubles among the wearers of, and the workers in, furs. Dyeing is comparatively a new art, a new fashion in the fur industry. Aniline dyes are now used in almost every instance except for the cheapest black which are coloured by basic and acid dyes. The Berlin Aniline Company brought out three dyes under the name of Ursol, Metol, and Amidol. Derivatives of these are the dyes in general use at the present time. All these require, or depend upon, subsequent oxidation, and various oxidisers are used in the different trades. There are two methods of dyeing—the general or common method and the brush or topping method. |
b4ba80bb-de9d-4b2f-a843-cfb2dc7b1c00 | The latter is much more liable to cause trouble, as the solutions used are much more concentrated, ranging from six to twelve times stronger than the liquors required in the general method. Any faults in technique will cause the liberation of the residues of the dying reagents in the dye bath and on the materials. Sometimes these harmful residues are in such quantities that the fur workers suffer very severely and the clothiers are warned before the furs are sent out to the public, but, as a rule, the furs do not give rise to a rash if the skin is dry. If moisture is applied, the rash appears. This explains the frequency with which the neck and face are attacked. The perspiration is sufficient to enable the dye to act as an irritant. Probably this fact explains the relative frequency in which cloth coats with fur collars were the cause of the trouble. The fur collars were turned up, especially when it rained. |
7086953b-37cb-4871-9aed-c919a3d3b5b8 | In these circumstances the rash was not limited to the neck, but occurred also in the lower part of the face. Where a fur cape had been worn, the rash was usually limited to the neck. In some instances, the rash soon disappeared when the patient ceased wearing the fur. In others, the rash persisted for a consider able time in spite of treatment. In one case which came under 25 my notice, the sufferer was away from her work for a couple of months. The prevention of these troubles in the fur industry is a difficult problem, and can only be done by the furriers taking extreme care in the finishing and dyeing processes with particular attention to washing. This is especially necessary after "brush dyeing." The furriers enjoy some degree of immunity because of the difficulty of tracing the furs to the origin. |
c46e658d-cd68-4424-98cb-974ffc69b3b2 | The retailer is not always able to trace the wholesaler from whom the fur was purchased, and between the wholesaler and the furrier, the skins may have passed through many hands, especially in the case of cloth coats trimmed with fur collars. A suggestion has been made that the symptoms—rashes—are due to "anaphylaxis." Anaphylaxis is a term used to indicate a hypersensitiveness some human beings acquire to certain animal and vegetable proteins. It has been invoked to explain obscure phenomena in certain diseases. In these cases, anaphylaxis can be ruled out, as the symptoms appeared only in skins which had been dyed, and have not been caused in the natural furs. HOSPITAL PROVISION. General.—The Acton Hospital in Gunnersbury Lane accommodates fifty beds and has a resident Medical Officer. The War Memorial of the district took the form of an extension to the Hospital, and the new buildings were opened in July, 1923, by Mr. |
762e917a-ec20-4002-9efd-bc5b477f53a2 | Neville Chamberlain, who was the Minister of Health at the time. In addition to the general wards and the out-patient department, it also has private and semi-private wards which are reserved for " paying patients." Fever.—The Isolation Hospital has accommodation for 80 patients. The diseases treated are Diphtheria, Scarlet Fever, and Measles. Small Pox.—The district forms one of the constituent bodies of the Middlesex Small Pox Board. Nursing; Facilities.—In addition to the various nursing associations in the district, there is a district nurse resident in the general hospital, who is available for the home nursing of patients who do not require the whole-time services of a nurse, or who cannot afford the fees of a whole-time nurse. Ambulance Facilities.—There is a motor ambulance for the removal of infectious cases. An arrangement exists with the Chiswick Council for the use of the Chiswick Ambulance for the transport of street accident cases. |
57564dd2-ecbf-40b6-ae0c-d7abfde6e114 | 26 Infantile Mortality.—77 deaths occurred in children under one year of age. This number corresponds to an infantile mortality of 65 per 1,000 births. The infantile mortality is slightly higher than that of 1922, when it was 62 per 1,000 births. It is also slightly higher than that of London—60 per 1,000 births, but lower than that of England and Wales and of the 105 great towns including London—69 per 1,000 births. 38 of the deaths occurred in babies under one month old. 41 of the deaths were due to natal or ante-natal causes. 11 of the deaths were of illegitimate children and the illegitimate infantile mortality was 265 per 1,000 births. Maternity and Child Welfare.—The principal change has been the closer linking of the Child Welfare scheme with the School Medical Service. |
b49ba556-7556-42a0-a68e-b221454db8dc | By arrangement with the Education Committee, children from the Child Welfare Centres have been referred to the School Dental Surgeon and School Oculist. 49 children under five years were treated by the dental surgeon, and twelve were treated by the school oculist. It was found in the inspection of entrants that a very large number of the children suffered from Dental Caries, and it is hoped by an extension of the work to reduce the percentage of those who are found to require treatment when they enter school. Ante-natal Clinic.—63 expectant mothers were examined at the Ante-natal Clinic, and four were treated at the Acton Hospital under the agreement between the Council and the Acton Hospital. Acton has no Maternity Home, but beds for complicated cases are provided at the Acton Hospital. In exceptional cases the whole or part of the fee of midwives is paid by the Council, and last year the fees of midwives were paid in sixteen instances. |
863a1fef-5f20-4f8d-9511-7bdb10d876de | Milk (Mothers and Children Order) 1919.—The procedure followed in previous years was not altered. The scheme which is worked in co-operation with the Guardians has worked quite satisfactorily, and only in exceptional cases was free milk distributed by the Council. 2,329 packets of dried milk were distributed through the Believing Officers, and 432 packets were distributed by the Council to expectant mothers, and in exceptional circumstances where the recipients would not be eligible for Poor Law Belief. 27 These figures are a great reduction upon those of 1922; the reduction is mostly due to the improvement in the economic conditions which obtained in the district during the year. Day Nursery.—The Day Nursery is situated in Bollo Bridge Road. It has accommodation for 28 babies. In the year 4,281 attendances were made at the Nursery. Infectious Diseases.—Table V gives the notifications of Infectious Diseases for the year. There is again a reduction in the number of notifications. |
a397d1e1-1396-461c-9df9-5b3a45de49bb | Scarlet Fever.—160 notifications were received but there was no death. 123 of the cases were removed to hospital. Diphtheria.—61 cases were notified, and there were 3 deaths. 49 cases were removed to hospital. As usual, there is a preponderance of cases in the South West Ward. Encephalitis Lethargica.—One case was notified. The patient lived in another district, but worked in Acton. Ophthalmia Neonatorum.—4 cases were notified and one was treated in hospital. In no instance was the sight permanently damaged. Pneumonia.—28 cases of Pneumonia were notified; 18 of these notifications were received from one doctor. Tuberculosis.—During the year 1923 there were 73 notifications of Pulmonary Tuberculosis and 24 of other forms of Tuberculosis. |
d8335a20-efa8-48ba-bb8f-f537dff0c129 | In the following table are given the notifications of Tuberculosis for the five years 1919-1923 among the principal groups of occupations in the district. MALES. Occupation Numbers employed Notifications in five years, 1919-1923 Rate per 100,000 Metal Workers 2768 31 1120 Clerks, Draughtsmen and Typists 1597 40 2505 General Labourers 1246 22 1765 Persons employed in Personal Service 866 11 1270 Railway Workers 686 9 1312 Road Transport Workers 1264 8 632 Salesmen, Shop Assistants 803 8 996 Electrical Makers and Fitters 544 7 1286 Painters 574 6 1045 Stage Hands and Musicians, etc. |
b6fe31ee-01c0-471c-af5f-ecb83c346012 | 192 5 2604 Boot Makers and Repairers 115 4 3498 Carpenters 330 4 1194 Compositors 361 3 831 Laundrymen 286 3 1049 Tailors 87 2 2299 28 FEMALES. Occupation Numbers employed Notifications in five years, 1919-1923 Rate per 100,000 Laundresses 1827 23 1258 Clerks, Typists, etc. |
0400f5d5-4bf4-4d3e-a1c1-ac098db72d94 | 1437 16 1113 Domestic Servants 1754 13 741 Dressmakers 408 6 — Shop Assistants 615 4 1470 Metal Workers 99 3 3030 The ages of the new notified cases and the deaths were as follows:— Age Periods New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary 1 — 8 1 7 5 1 3 — 2 10 — 4 — — 15 6 1 3 1 20 16 1 12 — 25 25 3 10 3 35 10 2 16 2 45 8 1 5 — 55 4 1 3 — 65 and over 3 — 4 — Totals 73 24 54 15 Isolation Hospital.—During the year 192 cases were admitted into the Hospital. |
3ea546de-a087-4013-b098-6c0c1b9bc2ed | On January 1st, 1923, there were 63 cases under treatment, and on January 1st, 1924, 37. During the year 213 were discharged, and there were 5 deaths. Of the cases admitted 169 were Acton cases. CASES ADMITTED. Scarlet Fever Diphtheria Measles Encephalitis Lethargica Acton 120 44 2 1 Wembley 4 11 2 — Hanwell — 7 — — Kingsbury — 1 — — 124 63 4 1 Total 192. 29 DEATHS IN HOSPITAL. Acton — 2 — — Wembley — 2 — — Kingsbury — 1 — — — 5 — — Total 5. SUPERVISION OF FOOD SUPPLY Milk Supply.—There are one cowshed and 80 dairies and milkshops on the register. |
fdf0db8b-96e8-48f8-a683-7d3eb2ecdf7a | Of the 80 premises from which milk is retailed, 8 are branches of one firm, and 2 of another firm; 21 of the registered purveyors have shops and rounds, 16 have rounds only, 5 are dairy shops. 3 are caterers of food primarily, and 35 have general shops. The latter only sell a small quantity. The Milk and Dairies (Amendment) Act 1922 came into operation in September, 1922. Section 2 provides that if the Council is satisfied that the public health is, or is likely to be, endangered by any act or default of any person who is registered or seeks to be registered as a retail purveyor of milk in relation to quality, storage or distribution of milk, notice must be served upon such person to appear before the Council not less than 7 days after the date of the Notice to show cause why he should not be removed from the register or his name not placed upon it. |
c59e343d-054f-4c17-8341-ee268bf4a7de | Provision is made for an appeal from the Council's decision if notice is given within 21 days. During the year, the Health Committee considered the question of registration of general shops. In many instances milk was sold in general shops. In some of these paraffin, vinegar, wood and other articles were sold and the milk was kept in a vessel on the counter not in any practical and efficient way protected from any contamination which might arise from the other articles. The Committee decided that in no instance would they register a person who sold milk in the same room as paraffin. In the majority of cases the owner of the premises gave up the sale of paraffin, but in six the sale of paraffin was probably more profitable than the sale of milk, and the Committee decided to strike these six off the register. No appeal was made against the decision of the Committee. It will be noticed that 16 purveyors have rounds only. |
7e4a8114-d633-46e5-80fc-23a81c349dfe | As far as this district is concerned, the "round only" business is comparativly a new development. It owes its origin to many causes. 30 Eight licenses were granted to sell "certified milk" and one to sell "Grade A." Butchers and Slaughterhouses.—There are 1 registered and 2 licensed slaughterhouses in the district. There are 27 butchers in the district, but hardly any of the meat sold in the butchers' shops is slaughtered in the district. Most of the butchers obtain their meat from Smithfield. In one of the slaughterhouses very few animals are slaughtered. In the other two slaughterhouses the carcases are used for sausage meat. One is owned by Messrs. T. Wall and Son, Ltd., and the other by Messrs. Woodhouse Hume, Ltd. During the year the following articles of food were surrendered: 4 stone cat fish. 1 pig's carcase (290 lbs.) 1 side pork (90 lbs.) |
3f48158f-27b0-4233-ac6e-221be0420ad2 | 1 pig's head. 3½ barrels crabs. 1 barrel Jersey potatoes 1 pig's head. 1 crate bananas. 1 box cod. 1 case cod. 1 pigs's carcase (4 sc. 11 lbs.) 29 crates plums (20 lbs. each crate). 2 small crates bananas. 1 pig's carcase (156 lbs.) 1 pig's carcase (26 sc. 13 lbs.) 1 sow (330 lbs.) Bakehouses.—There are 33 bakehouses in the district. Of these '-8 are underground. Increase of Rent and Mortgage Interest (Restriction) Act 1920.— The number of applications received under Section 2 of the Act was 19, and the number of certificates issued was 13. Some misapprehension exists as to the powers of the Council under this Act, and some confusion exists as to the work which can be included in the schedule in order to render the house reasonably fit for human habitation. |
504599fd-3369-4426-9517-4fb5de388cdf | It was taken for granted that the conditions which render a house reasonably fit for human habitation should vary according to the locality of the house, and it seems that some suggestion to that effect was made when the Bill was before the House of Commons. Smoke Abatement.—From the tabular statement it will be seen that 92 smoke observations were made and 23 notices served. 31 TABLE 1 COMPARATIVE RATES OF MORTALITY, 1923. Birth-rate per 1,000 total Population Annual Death-rate per 1,000 Population Rate per 1,000 Births Percentage of Total Deaths All Causes Enteric Fever Small Pox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Violence Diarrhoea & Enteritis under 2 yrs. Total deaths under 1 year Causes of Death certified by Registered Medical Practitioners Inquest Cases Uncertified Causes of Death England and Wales 19.7 11.6 0.01 0.00 0. |
74990787-878d-44d1-954d-c4b2997b7b95 | 14 0.03 0.10 0.07 0.22 0.44 7.7 69 92.0 6.9 1.1 105 County Boroughs and Great Towns, including London 20.4 11.6 0.01 0.00 0.15 0.03 0.12 0.09 0.22 0.40 9.9 72 92.2 7.2 0.6 157 Smaller Towns (1921 Adjusted Populations, 20,000-50,000) 19.8 10.6 0.01 0.00 0.19 0.02 0.10 0.06 0.21 0.38 6.4 69 92.6 6.1 1.3 London 20.2 11.2 0.01 0.00 0.08 0. |
ffc16e4f-9ee1-4921-9a18-743f30392c49 | 02 0.09 0.13 0.17 0.45 10.2 60 90.8 9.1 0.1 Acton 18.6 9.5 0.00 0.00 0.00 0.00 0.06 0.05 0.12 0.4 11.1 65 93.2 6.8 0.0 TABLE 2. VITAL STATISTICS FOR WHOLE DISTRICT DURING 1923 AND PREVIOUS YEARS. Year Population estimated to Middle of each Year Births Total Deaths Registered in the District Transferable Deaths Nett Deaths belonging to the District Uncorrected Number Nett Under 1 year of Age At all Ages Number Rate Number Rate of Non-Residents Registered in the District of Residents Registered outside Dist. Number Rate per 1,000 Number Rate per 1,000 i habitants 1918 66,000 (for Birth-rate) 923 954 14. |
cebe925b-499f-4026-ba5a-c0ba1a75898b | 5 611 10.3 16 277 76 78 872 14.7 59,000 (for Death-rate) 1919 64,306 (for Birth-rate) 950 1096 17.1 436 7.0 12 222 72 65 646 10.4 61,732 (for Death-rate) 1920 61,000 1442 1541 25.3 560 9.2 16 217 100 64 671 11 1921 62,000 1225 1314 21.1 445 7.1 . 205 92 70 658 10.4 1922 62,390 1021 1203 19.3 404 6.5 14 214 75 62 632 10.1 1923 62,720 1047 1171 18.6 368 5. |
4eaac242-91b0-48ea-b2d3-55e2bf944309 | 8 11 243 77 65 599 9.5 32 33 TABLE 3. ALL DEATHS, 1923. Causes of Death All ages Under 1 year 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards North East North West South East South West Whooping Cough 4 4 . . . . . . . 1 1 1 1 Diptheria 3 1 1 . 1 . . . . . 1 1 1 Influenza 8 1 . . 1 1 1 4 . 2 1 4 1 Tuberculosis of Respiratory System 54 . 1 . . 15 26 8 1 10 7 13 24 Other Tuberculous Diseases 15 . 1 6 2 1 4 1 . |
a83ea188-fce8-4f12-829b-bd496007596f | 3 3 4 5 Cancer (Malignant Disease) 53 . . . . 1 10 2 22 9 11 16 17 Rheumatic Fever 2 . . . 1 . 1 . . 1 . . 1 Diabetes 5 . . . . . 2 1 2 . 1 1 3 Cerobral Hemorrhage 43 1 . . . . 2 10 30 15 9 11 8 Heart Disease 60 . . . 1 2 8 20 29 25 10 13 12 Arterio Sclerosis 8 . . . . . . 3 5 . 1 5 2 Bronchitis 56 6 1 1 . . |
ea9f2800-08de-4cd9-969b-a2f835879f6e | 3 15 30 18 9 13 16 Pneumonia (all forms) 39 1 4 2 1 3 5 12 11 4 8 13 14 Other Respiratory Diseases 7 . . . . . 2 3 2 1 1 2 3 Ulcer of Stomach and Duodenum 4 . . . . . . 2 2 1 2 1 . Diarrhoea (under two years) 13 13 . . . . . . . 8 . . 5 Appendicitis 1 . . . . 1 . . . . 1 . . Cirrhosis of Liver 1 . . . . . . 1 . . 1 . . Nephritis 14 . . . 1 . 4 5 4 5 3 3 3 Puerperal Sepsis 3 . . . . 1 2 . . . . |
57b67f64-d95d-41c8-a48c-62ec57abadeb | 1 2 Other Accidents and Diseases of Pregnancy and Parturition 5 . . . . . 5 . . 1 . 1 3 Congenital Debility, Malformation and Prematurity 34 34 . . . . . . . 7 6 11 10 Suicide 11 . . . . 1 3 6 1 5 3 2 1 Other forms of Violence 14 2 1 . 2 . 2 5 2 7 2 1 4 Other Defined Causes 140 14 . 1 4 5 17 20 79 40 34 34 32 Ill-defined or Unknown Causes 2 . 1 . . . 1 . . . . 1 1 599 77 10 10 14 31 98 136 223 163 115 152 169 34 TABLE 4. INFANTILE MORTALITY, 1923. |
5ab6b594-22f0-4f9f-9965-9a43560c25f4 | Causes of Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 1 month 1—3 months 3—6 months 6—9 months 9—12 months Total under 12 months Wards North East North West South East South West Diphtheria . . . . . . . 1 . 1 . 1 . . Whooping Cough . . . . . 2 . 2 . 4 1 1 1 1 Meningitis (not Tuberculous) . . 1 . 1 . . . 1 2 . . 1 1 Influenza . . . . . 1 . . . 1 . . 1 . Convulsions . . . . . . 1 . . 1 . . . 1 Bronchitis . . . . . 2 1 2 1 6 . . 1 5 Pneumonia . . . . . . . . |
5b544e61-4b2f-4003-99cd-b8ffc45c0c7c | 1 1 . . 1 . Diarrhoea and Enteritis . 2 1 . 3 3 3 2 2 13 8 . . 5 Congenital Syphilis . . . . . 1 . . . 1 . . 1 . Overlaying . . . . . . . . . . . . . . Injury at Birth 6 . . . 6 1 . . . 7 3 . 2 2 Congenital Malformation 1 . . . 1 . 1 . . 2 . 1 1 . Prematurity 17 1 . 1 19 2 3 . . 24 6 4 4 10 Atrophy, Debility and Marasmus 4 . 2 . 6 1 1 . . 8 1 1 4 2 Other Causes . 1 . 1 2 1 1 . 2 6 2 1 . |
dcc9ed71-05ec-4bc0-8b53-33d006444249 | 3 28 4 4 2 38 14 11 7 7 77 21 9 17 30 35 TABLE 5. CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1923. Notifiable Disease. Cases notified in whole District. At Ages—Years. In Wards. At all Ages Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards North East North West South East South West Scarlet Fever 160 1 25 102 22 10 . . 47 18 68 27 Diptheria 61 3 14 36 3 5 . . 10 13 10 28 Enteric Fever 3 . 2 . . 1 . . 2 1 . . |
58f033b7-3b40-44c9-b981-a43db29358a0 | Pneumonia 28 1 5 3 4 5 9 1 2 1 12 13 Puerperal Fever 3 . . . 3 . . . . . 1 2 Cerebro-Spinal Fever 2 1 1 . . . . . 1 . 1 . Acute Poliomyelitis 2 . 1 1 . . . . . . 2 . Encephalitis Lethargica 1 . . . . 1 . . . 1 . . Ophthalmia Neonatorum 4 4 . . . . . . 2 . . 2 Erysipelas 16 . . . 1 6 9 . 2 3 5 6 Tuberculosis (Resp.) |
f05839e9-8ac7-40fa-8402-33e28affb6a5 | 73 .. .. 1 22 35 12 3 18 4 23 28 Tuberculosis (Other) 24 .. 8 7 2 5 2 .. 6 3 6 9 377 10 56 150 57 68 32 4 90 44 128 115 36 TABLE VI. CASES REMOVED TO HOSPITAL-1923. N.East. N.West. S.East. S.West. |
b106f9f1-8ab1-44be-ba27-3a7d7fe6f2e3 | Total Scarlet Fever 35 10 54 24 123 Diphtheria 7 8 7 27 49 Enteric Fever 2 — — — 2 Pneumonia — — — 1 1 Puerperal Fever — — 1 2 3 Cerebro-Spinal Fever 1 — 1 — 2 Acute Poliomyelitis — — 2 — 2 Encephalitis Lethargica — 1 — — 1 Ophthalmia Neonatorum 1 — — — 1 Erysipelas — — — 1 1 Tuberculosis (Resp.) 10 3 15 25 53 Tuberculosis (Other) 4 1 4 7 16 60 23 84 87 254 TABLE VII. BIRTHS. Total Births. Males Females Legitimate 560 568 Illegitimate 22 21 582 589 Notified Births in District. |
8fcaf185-fcc3-4877-beeb-c7c334d0d3cf | Males 487 Females 470 Still-Births 29. Wards. North East. North West. South East. South West. Total. 267 141 188 361 957 Births Registered but not Notified. Males 33 Females 57. North East. North West. South East. South West. Total. 40 11 27 12 90 Born Outside District, 124. Number of Births Visited 803 Number of Births Re-visited 8,909 TABLE VIII. INFANT WELFARE CENTRES—1923. Health Visitors' Attendances 250 Number of Children who attended 1,486 Number of Attendances by Children 12,183 ANTE-NATAL CLINIC. |
0d18e27e-9dd5-4127-9055-a4ac033abc82 | Number of times Clinic was held 23 Number of Expectant Mothers who attended 63 Number of attendances made by Expectant Mothers 123 Number of cases admitted to Acton Hospital 6 37 Ante-Natal Visits. Number of Mothers visited 200 Number of Visits paid to Mothers 545 TABLE IX. INQUESTS. (Including Non-Residents' Deaths in District). |
513b9d6b-d197-4aee-bb36-174c407fec38 | Heart Disease 5 Suicide 11 Heat Stroke 3 Injury by Motor Vehicle 4 Dilated Heart 1 Accidental Fall 4 Diabetes 1 Found Drowned 2 Hæmorrhage into Kidney Cyst 1 Found Dead 1 Cerebral Hæmorrhage 1 Injury at Birth 1 Status Lymphaticus 1 Suffocation whilst asleep in perambulator 1 Ruptured Aneurysm 1 Ruptured Vena Cava 1 Death under Anæsthetic 1 Gastric Ulcer 1 Fractured Femur 1 Pulmonary Tuberculosis 1 Fractured Skull 1 Collapse of Lung 1 Obstruction of Pylorus from Swallowing Corrosive Poison 1 TABLE X. BACTERIOLOGICAL LABORATORY. |
1893ef91-5c46-4f19-8ac7-1b5bd589e466 | Positive Negative Total Examinations (973) 171 802 Sent by Medical Practitioners (239) 36 203 Sent from Isolation Hospital (228) 57 171 Contacts (199) 36 163 Of These Positive Contacts. 19 were positive on the first occasion only. 12 „ second „ „ 5 „ third „ „ School Sore Throats. Positive Negative Cases Examined (264) 19 245 Four of the Positive sore throat cases had sufficient clinical symptoms to warrant removal to Hospital. FACTORIES AND WORKSHOPS. Premises Number of Inspections Written Notices Prosecutions (1) (2) (3) (4) Factories (including Factory Laundries) 97 34 — Workshops (including Workshop Laundries 403 65 — Workplaces (other than Outworkers' Premises) 38 13 — Total 538 112 Nil 38 Defects found in Factories, Workshops and Workplaces. |
f2f3e1de-fbf0-47b8-816f-0fd1a24fd113 | Particulars Number of Defects Found Remedied (1) (2) (3) Nuisances under the Public Health Acts:— Want of Cleanliness 34 34 Want of Drainage of Floors 7 7 Unsuitable or Defective Sanitary Accommodation 51 51 Total 92 92 HOME WORK. OUTWORKERS' LISTS, SECTION 107. Nature of Work. Lists received from Employers. Sending twice in the year. Lists Outworkers Contractors Workmen (1) (2) (3) (4) Wearing Apparel— Cleaning and Washing 1 — 4 Brush Making 2 11 — Stuffed Toys 2 67 — Total 5 78 4 TABULAR STATEMENT OF INSPECTIONS AND DETAIL OF WORK CARRIED OUT BY THE SANITARY INSPECTORS. Number and nature of Inspection made. |
59c1c973-c1a0-4f51-addb-66e7f6b3f631 | House to house inspections 368 After infectious disease 374 On complaint, etc 903 Premises under periodical inspection 597 Re-inspections after notice served 8,314 Enquiry visits on notification of infectious disease 454 Classified statement of the number of Premises under periodical Inspection. Workshops 219 Slaughterhouses 3 Public House Urinals 37 Common Lodging Houses 1 Houses let in lodgings 103 Butchers' Shops 33 39 Fish Shops 24 Premises where food is manufactured 40 Milk purveyors 80 Cowsheds 2 Piggeries 4 Rag and Bone Dealers 4 Mews and Stables 22 Schools 11 Show Grounds 2 Houses dealt with under Section 28, Housing Acts. Houses in respect of which notices were served 244 Rendered fit by owners 244 Rendered fit by local authority nil Premises dealt with under Public Health Acts. |
a9218bff-cf33-43fb-9baa-1f25e3551460 | Premises in respect of which notices were served 879 Premises in which defects were remedied by owners 879 Premises in which defects were remedied by local authority nil Detail of work carried out. Sanitary dustbins provided 572 Yards paved or yard paving repaired 228 Insanitary forecourts remedied 126 Defective drains repaired or reconstructed 74 Defective soil pipes and ventilating shafts repaired or renewed 53 Defective fresh air inlets repaired or renewed 41 Defective gullies removed and replaced by new 74 Rain water downpipes disconnected from drain 17 Dishing and Curb to gullies repaired and new gratings fixed 142 Defective W.C. pans and traps removed and replaced by new 69 Defective W.C. flushing apparatus repaired or new fixed 274 Defective W.C. |
0a7ea86b-95bb-401a-acaf-86837d64f84a | seats repaired or new fixed 192 Defective flush pipe connections repaired 73 Insanitary sinks removed or new fixed 28 Sink waste pipes repaired or trapped 209 Insanitary wall surfaces over sinks remedied 133 Ventilated food cupboards provided 28 Drinking water cisterns cleansed 187 Defective covers to drinking water cisterns repaired or new fixed 43 Insanitary sites beneath floors concreted 14 Spaces beneath floors ventilated 172 Dampness in walls from defective damp-proof course remedied 195 Dampness from defective roofs, rain water, gutterings, etc., remedied 723 40 Defective plastering repaired (number of rooms) 613 Rooms where dirty walls and ceilings have been cleansed and redecorated 2,411 Defective floors repaired 217 Defective or dangerous stairs repaired 62 Defective doors and windows repaired 402 Defective kitchen ranges and fire grates repaired 274 Defective washing coppers repaired 128 Coal cupboards provided 21 New W.C. |
6dc9997c-bb69-4ef9-a946-34f199ef5428 | apartments provided 6 Accumulations of offensive matter removed 32 Drains unstopped and cleansed 145 Overcrowding nuisances abated 22 Drains tested, exposed for examination, etc. 141 Smoke observations taken 92 Smoke nuisances abated 23 Nuisances from foul pigs and other animals abated 19 Notifications of waste of water sent to Metropolitan Water Board 264 STAFF TO WHOSE SALARY CONTRIBUTION IS MADE UNDER THE PUBLIC HEALTH ACTS OR BY EXCHEQUER GRANTS. D. J. Thomas. m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health. (Medical Superintendent of the Isolation Hospital and School Medical Officer). M. W. Kinch. Member of the Royal Sanitary Institute, holds Meat Certificate; Senior Sanitary Inspector. (Inspector under Diseases of Animals Acts, and the Rag Flock Act). J. J. Jenkins. Cert. Sanitary Institute. Holds Meat ficate. |
8857f21c-26c2-4e01-b3a6-b6e25e2702d6 | Sanitary Inspector. (Inspector under Fabrics Mis-description Act). E. W. Brooks Cert. San. Inst. Sanitary Inspector. J. J. Matthews. Cert. San. Inst. Sanitary Inspector. Miss 4. Cooksey. Cert. San. Inst. Health Visitor. Miss J. Welsh Cert. San. Inst. C.M.B. Health Visitor. Mrs. Light. Clerk. I beg to thank all the members of the staff in the Public Health Department, not only for assistance in the compilation of the report, but for a record of conscientious service throughout the year. I am. Your obedient servant, D. J. THOMAS. |
dd4ebc35-bcd9-4ffe-a4fa-9fc77b459cee | Ac.439(1)ACTON Act 27 MILDLESEY Borouggh of Acton. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1924. Borough of Acton. ANNUAL REPORT OF THE Medical Officer of Health For the Year 1924. 3 ANNUAL REPORT OF THE medical officer of health FOR THE YEAR 1924. Municipal Offices, Acton, W.3. May, 1925. To the Mayor, Aldermen and Councillors of the Borough of Acton. Ladies and Gentlemen, I beg to submit the Annual Report on the work carried out by the Public Health Department, together with the vital statistics for the year 1924. As far as possible, the tables have been arranged in a manner similar to the arrangement in previous years. The birth-rate is again lower than that of 1923, and is now below the general birth-rate for England and Wales. |
13687269-20d0-44c8-b344-d207fe2342a7 | The death-rate is higher than that of 1923, and is the highest for the district since 1918. A higher death-rate has been general throughout the whole of the kingdom, and the rate here is below that of England and Wales. The Infantile Mortality is again lower, and constitutes a record for the district. The Tubercular death-rate, and the death-rate from Consumption are also lower, but there is a very marked increase in the number of deaths from Cancer. The following Table is a summary of the birth-rate and the death-rate from some of the principal causes of death:— Population. 02,980 Birth-rate 18.4 per 1000 inhabitants. |
1eeb02f1-08cb-40b8-b929-2e5eeb49292d | Death-rate, all causes 11.2 „ „ „ Zymotic death-rate .46 ,, „ ,, Tubercular death-rate .89 ,, ,, ,, Death-rate from Consumption or Pulmonary Tuberculosis .74 ,, „ ,, Cancer death-rate 1.4 „ „ ,, Infantile Mortality 56 per 1000 births. 4 Population.—The Registrar General estimates the population at the end of June 1924, to be 62,980, an increase of 260. It is probable that this estimate is below the actual number of inhabitants in the district, but the figure given by the Registrar General has been retained, because it is the figure used for comparative purposes in the different returns issued by the General Register Office. There was an increase of 605 in the number of Parliamentary electors on the registers in the Autumn of 1924, as compared with the same electoral list of 1923. The numbers in 1924 were as follows:— Men. Women. Total. |
d7fd6a15-8277-4eb5-a775-58ea82fe8503 | 17,408 14,591 31,999 The increase in the total number of Parliamentary electors is shown in the following table:— 1921. 30,350. 1922. 30,425. 1923. 31,394. 1924 31,999. It is possible that an increase in the number of persons living at a certain age-period may be disproportionate to the increase in the rest of the population. It may even occur that the increase in the number of persons living in an age-group may be greater than the total increase in the population of a district. A disproportionate increase at different age-periods would occur with a falling birth-rate and with emigration and immigration. Both a falling birth-rate and migration in and out of the district are in operation, but not to such an extent as to limit the increase of population to one age-period. During the year ending December 31st, 1924, 200 new dwelling houses were completed and occupied. |
d60a9649-5f34-4467-be7c-1b34554a4701 | At the Census which was taken on June 19th, 1921, the actual number enumerated in the district was 61,299. Owing to the abnormally fine weather in the summer of that year, some holiday movement was already in progress, and the Registrar General from the figures at his disposal made certain adjustments in the population of certain districts. The adjusted figure for Acton was 62,000. The estimated increase in the population since the Census is less than a thousand inhabitants, though in the 3 years 1922, 1923 and 1924, 406 new houses have been completed and occupied. Outdoor Relief.—I am indebted to Mr. Harmsworth, the Clerk of the Guardians, for the figures relating to Poor Law Relief. |
3e6ccc5f-15d7-43a0-9b86-dbe92ffd158c | The amount of out-door relief given by the Guardians for the parish of Acton was:— 5 Ordinary relief £5,514 2 10 Unemployed relief 1,071 16 9½ Total £6,585 19 7½ There is a decrease in both amounts, compared with 1923, and a most marked decrease in the amount of unemployed relief. HOSPITAL PROVISION. General.-The Acton Hospital, Gunnersbury Lane, provides for the treatment of medical and surgical cases of both sexes. It is maintained chiefly by voluntary subscriptions, and the number of beds is 50. 456 in-patients and 3952 out-patients' were treated in 1924. Fever. The Isolation Hospital has accommodation for 80 patients. |
3a27aebd-866b-497e-9124-3fb2bb3a1c2a | Nursing Facilities.-As recorded in previous reports, in addition to the various nursing associations in the district, there is a district nurse resident in the general hospital, who is available for the home nursing of patients who do not require the whole-time services of a nurse, or who cannot afford the fees of a whole-time nurse. 113 cases were visited by the district nurse in 1924, to whom 3,573 visits were paid, Ambulance Service.—For accidents, an agreement was made with the Chiswick Council for the use of the Chiswick ambulance. The Acton Council paid for the use of the ambulance in respect of street accidents where the ambulance was requisitioned by the police. This agreement was terminated in August 1924, and an arrangement was made with the Ealing Council for the use of the latter's ambulance until the Acton Council obtained its own ambulance. The new ambulance was purchased early in 1925, and is housed in a garage adjoining the Fire Station. |
744bf097-250d-4b5c-974a-a85a8a23cee2 | For the removal of Infectious Cases, the Council has its own ambulance, which is housed in the Isolation Hospital. Births.—Table VII gives particulars of the births registered and notified in the district, and the births registered outside the district. The total number of births belonging to the district was 1,158, and the birth-rate was 18.4 per 1000 inhabitants, as compared with 18.6 in 1923, and 19.3 in 1922. 6 The birth-rate for England & Wales wasl8.8, for London 18.7, and for the 105 County Boroughs and large towns including London 19.4. Throughout the Country the birth-rate is still showing a continuous decline, and Acton shows no exception to the general rule throughout the kingdom. Last year, with the exception of 18, particulars were obtained of the births belonging to Acton, whether registration had occurred inside or outside the district. |
416f5dfc-e98a-4009-80e0-ac16bda17cd1 | It is therefore possible to give a fairly accurate birth-rate for each of the Wards. The Ward birth-rates were as follows: North-East. North-West. South-East. South-West 19.1 11.7 15.3 24.2 34 children were born out of wedlock; this number corresponds to an illegitimate birth-rate of 29 per 1000 births, compared with 36 in 1923. Not since 1910 has a lower illegitimate birth-rate been recorded for the district. One of the most marked features of Table VII has been the increased percentage of births which were notified. Only 19 births were registered which had not been previously notified, compared with 57 in 1923, 109 in 1922, and 66 in 1921. |
8287f0a2-9cc5-4142-bdb5-796dcfe68d43 | In the Autumn of 1923, the numerous infringements of the Notification of Births Act were discussed by the Maternity and Child Welfare Committee and different ways and means were suggested whereby an improvement could be effected. Doctors and Midwives were circularised, and an advertisement issued in the press. The result has been gratifying and the percentage of non-notified births in 1924, has been the lowest since the Act came into force. Deaths.—488 deaths were registered in the district; of these 11 deaths were of non-residents; 235 deaths of residents occurred outside the district. The total number of deaths belonging to the district is 715. The nett number of deaths corresponds to a death-rate of 11.2 per 1000 inhabitants, compared with 9.5 in 1923, and 10.1 in 1922. Although the figures appear unfavourable, there are factors which modify their character. A higher death-rate was common throughout the kingdom. |
a5433de6-d45e-4f4f-ad4a-0c046ea1c5af | Last year the death-rate of the whole of England and Wales was 12.2, of the 105 Great Towns, 12.3 and of London 12.1 per 1000 inhabitants. The greatest increase in the number of deaths occurred in old people. There were 286 deaths among persons over 65 years of age, compared with 223 in 1923, and in the age-periods 45—65 years of age, 180 deaths compared with 130 in 1923. There were slight increases in the age-periods 1-25 years, and a slight decrease 7 in the number of deaths in infants under 1 year and in the ageperiod 25—45 years. There was a higher death-rate in three of the wards and a lower one in the South-East Ward. The death-rate in each ward was as follows:— North-East. North-West. South-East. South-West. |
49b61f11-a42c-4939-953f-72217b7c307a | 12.2 11.8 9.2 12 Among the diseases which caused an increased number of deaths, the most prominent were Measles, Heart Disease and Arterio-sclerosis and Cancer. The increased number of deaths from Measles is dealt with on a later page. Measles is a disease which occurs in epidemic form practically every other year, and in this districtl924 was an epidemic year. The question of heart disease was referred to in last year's Annual Report. The increased number of deaths is probably not due to an increase in the incidence of heart disease, but to the more exact methods of diagnosis and to wider conceptions of the effects of heart disease and more especially to the importance of injury from infection of the heart muscle. The problem of the etiology and treatment of heart disease in early life has frequently been discussed of late, both in this country and in America. |
af9575e1-8d3b-4cc2-a151-a4c1063b1af4 | Although the need for fuller information regarding the whole etiology of rheumatic fever is recognised, there is general agreement on the need for prolonged convalescense after rheumatism if the heart is to be protected and the liability to recurrence lessened. In the course of inspection amongst school children, it is a too common experience to find that the parents have treated an attack of rheumatism as a trivial affair. In many instances the illness has been regarded as growing pains, but permanent damage has resulted to the heart. Cancer.—A very marked increase occurred in the number of deaths from Cancer. In last year's report it was stated that circulars and memoranda had been issued by the Ministry of Health and as a result of a Conference of the Local Authorities within the Brentford Union, a committee had been formed for the purpose of exploring any and every avenue which may lead to a diminution of the ravages of the disease. The Memoranda issued by the Ministry of Health emphasize the advice given by the local committee. |
11b62768-aed5-42d6-ae81-b245f48474a4 | The latter recommend the issue of leaflets pointing out the danger of delay in obtaining treatment and emphasizing the importance of removing any source of chronic irritation. 8 Memorandum 3 of the Ministry of Health contains certain facts relating to Cancer of the Breast and the results of operation in connection with this condition. In every case of Cancer of the breast, the problem of operation is one of primary importance, and two questions naturally arise, viz. the immediate risks of the operation and the chances of nonrecurrence of or cure of the disease. Under modern conditions, deaths directly attributable to the operation, if performed by skilful surgeons and in well-equipped institutions, have been reduced in the case of breast operations to a fraction of 1 per cent. This figure is reassuring in view of the fact, that at the present time early surgical interference affords the one chance for a patient suffering from cancer of the breast. Cases of cancer treated only with internal medicines, or external applications or by dietic methods are not being effectually treated. |
67e519b4-6113-4e26-97dc-455d31b68e45 | What measures of success may be expected from the operation? It is satisfactory to obtain figures from the Ministry of Health as these are authoritative and not biassed by the views of the actual operator. The Memorandum states with confidence that, even under the unsatisfactory conditions imposed by the late stage at which many cases come under surgical observation, the mean duration of life is prolonged several years. In the special circumstances of operation at the most favourable—that is, the earliest moment after recognition of a lump in the breast, there is an average prolongation of life amounting to many years. Although the term prolongation of life is used, it is certain, that cure, in the widest popular sense of the word, has frequently been effected by early operation, i.e., patients have lived ten, fifteen, twenty or more years and died ultimately of some other disease. |
b5f839ad-1c2a-4a90-a05b-a479190c59f1 | Another Memorandum on Cancer issued by the Ministry of Health on the main lines which experimental cancer research has followed in recent years, is interesting to local authorities because of the bearing of such research on the necessity or desirability of disinfection after a death from Cancer. Certain broad conclusions, negative as well as positive, are deducible from the several branches of this work. From very early times men's minds have been exercised by speculation or conjecture on the causation of cancer, and within recent years an enormous amount of research work has been carried out, in order to ascertain the grounds on which the various conceptions and theories of the cause or causes are based. From an administrative point of view the two most important theories are those which may be called the infective theory and the chronic irritation theory. The underlying conception of the first theory is the presence of a microbe or microbes; it was supposed that cancer was due to 9 invasion by a parasitic microorganism and was therefore of an infective nature. |
41a93ac8-7ef9-4524-825e-f09bc4dbb38a | The vogue of cancer houses and cancer areas was propagated as a result of this theory. None of the experiments inspired by this hypothesis has led to the production of a new growth of more than a temporary character, and we are justified in stating that disinfection of premises and clothing after a cancer death has no effect in the prevention of the disease. The theory of chronic irritation was propounded by Virchow, and is based on the conception that chronic irritation was of great causative importance in the production of cancer. The latter theory is the only one which has positive results to record. The substances which have given most results have been tar, paraffin and arsenic, but it is unlikely that any single chemical constitutent is solely responsible. The trend of these researches emphasizes the importance of the advice given by the local cancer committee to remove any source of local irritation either to the tongue, breast, bowels or any part of the body which may be liable to such irritation. |
30045003-54ce-49fe-b39e-2b68b9b7a7ac | Deaths in Public Institutions.-216 of the deaths of residents outside the district occurred in public institutions, and 40 deaths of residents occurred in public institutions in the district. These numbers do not include deaths which occurred in nursing homes. 256 out of a total of 715, or nearly 36 per cent. of the total deaths occurred in public institutions. Infectious Diseases.-On Table V. will be found the ageincidence and Ward distribution of the compulsorily notifiable infectious diseases. Scarlet Fever. There was again a diminution in the number of notified cases, but one death was allotted by the Registrar General, though the circumstances were such that the death could hardly be said to belong to this district. The death was that of a child 14 months old, and occurred in the Infirmary on July 9th, 1924. |
ecae6569-f3b2-42d3-9101-bfa768614fb2 | She was taken to the Infirmary on September 14th, 1923; so that not only the death occurred, but the illness was obviously contracted out of the district. As the child had resided in, and was moved from Acton to the Infirmary, the death was allotted to this district. Diptheria.-There was also a diminution in the number of notified cases of Diptheria, but the number of deaths is higher than that of 1923. As an instance of an extremely virulent kind of Diphtheria, in which an outbreak was probably cut short by prompt measures, I may mention the cases which occurred in the Acton Wells Infant Department in September. The circumstances 10 were noteworthy, not for the number of cases, as only 6 cases altogether occurred, but from the severity of the symptoms, as two of the children died. The first case was notified on September 26th, and the second on September 27th. |
8e94a66e-43b3-4fbf-a1ad-cefc3384ddc4 | Both children attended the same class, and on September 29th, all the children in this class, to the number of 56, were swabbed. Two swabs were found to be positive, and in one of them the culture was almost a pure growth of the Diphtheria bacillus. On further examination of one of the children in whose throat the germs had been found, she was found to be suffering from a sore nose and swollen glands of the neck. From her appearance there could be no doubt that she was a clinical case of Diphtheria that had been missed. The other children in the house were examined and in all probability, two of them had also suffered from a missed attack of Diphtheria. Swabs were taken and in both instances they contained the bacilli associated with Diphtheria. |
9d146bfa-a27f-4fd5-8b17-d4636c33742c | In the other case attending the class implicated, in which a positive swab was obtained, the child was probably only a carrier, but she was excluded from school until negative swabs were obtained. No further cases occurred in the school, and it seems probable, if not certain, that the two fatal cases arose from association with one or both of the children in which a positive swab was obtained and who were excluded as a result. This is not an isolated instance; similar incidents constantly occur. Possibly in no sphere of preventive medicine, can bacteriological knowledge be so successfully applied in the prevention of the spread of disease as in the case of Diphtheria. In almost every instance, the means and the methods adopted are successful, and yet, not infrequently we have complaints from parents. Sometimes they object to the swabbing of the throat, and frequently they protest in vigorous langauge against any suspicion that their children can in any way be responsible for the spread of the disease. |
5d19de09-1618-4a3a-8dee-5c872b1d77b4 | Their objection, of course, is due to ignorance of the true facts or a misunderstanding of our motives. The fact that a child may have had an attack of Diphtheria which was missed, does not necessarily imply that the parents have been remiss or neglectful. The attack may have been so slight as to escape detection. Ophthalmia Neonatorum. 4 cases were notified. One of them was a severe case and was admitted into the Acton Hospital for treatment from June 26th to July 10th. All the four cases made a good recovery, and the sight was not permanently affected by the disease. Encephalitis Lethargica.—6 cases of Encephalitis Lethargica were notified, and 3 deaths occurred. Another of the cases 11 notified also died, but the death was certified to be Meningitis. |
66037c2b-880f-4a4c-a6dc-41b0e783469e | The patient was admitted to the Infirmary, and the diagnosis of Encephalitis Lethargica was not confirmed by the Medical Superintendent. Only 2 of the patients recovered, but it is possible, and even probable, that other cases occurred in which the symptoms were of a mild character. One of the cases notified here, was of an extremely mild type, and the characteristic symptoms could easily have been missed by the doctor in attendance, had the latter not recently seen some other encephalitis cases. In another of the cases two specialists, who were called in, had failed to recognise the nature of the illness, and it was only when a third specialist who had had exceptional experience in this type of disease was called in that the illness was diagnosed as Encephalitis Lethargica. There are many reasons for the difficulties which may arise in the diagnosis of the illness. The most important is the endless variety which the symptoms show. |
6e5be870-f670-48aa-aebb-e126eddcb524 | The original conception of the clinical syndrome now known as encephalitis lethargica has broadened considerably with increased experience. In some quarters doubt has been expressed as to the existence of the disease as a separate entity. Some authorities have claimed that Encephalitis Lethargica, Spotted Fever and Infantile Paralysis are simply variants of Influenza. It is now generally admitted, though, that the disease is a separate entity, having well-marked and well-recognised symptoms. These symptoms vary not only in their severity, but also in their character. In severity the symptoms may vary from those of the mild type which is often missed and in which no after effects are left to those in which the disease is rapidly fatal. The symptoms also may be those of a generalized infection, or those more directly referable to the central nervous system. In the latter, lethargy is a prominent symptom in many of the cases ; the term lethargic is still used in describing the disease. |
e96ba10b-ca57-45b7-98e7-df33158ea9bc | This however, is by no means a constant symptom. Indeed, insomnia is an equally striking phenomenon in many cases, and in some patients both conditions may be present at different times. From a public health point of view, one of the most serious questions is the mental after effects of the disease. The conception of the disease has undergone very considerable modification since the earlier cases were met with in the spring of 1918. At that time the disease was regarded as a more or less acute affection, which, should the patient survive, left residue in its wake somewhat after the manner of infantile paralysis, although more or less oomplete recovery might be eventually anticipated in the majority of cases. 12 Further experience has demonstrated that the ultimate outlook is much more serious than was at one time supposed. In children, especially, mental changes result, persist and prove permanent. It is impossible at present to say what proportion of surviving cases exhibit after effects, whether mental or physical. |
b7b162ee-b6ba-48e5-b533-d1248a1f4b99 | It appears to be probable that mental after effects, especially in children, occur in a large proportion of the surviving cases. Despite the valuable statistics available, nothing definite can be deduced regarding any conditions that might dispose an individual to an attack. The disease appears however, to have selected more particularly those of either sex following sedentary occupations, while, as regards age incidents, the age-period 10-20 years has proved to be the most susceptible. The means and modes by which the infection of the disease is naturally carried from person to person remain obscure; very seldom can an attack in any individual be traced to the patient's contact with an obvious case of the disease. The hypothesis of the "healthy carrier" has been put forward, but it is obvious that no very definite lines of prophylaxis can be laid down until we have the means of determining the individuals who are the unconscious reservoirs of the poison. Small-pox.-No cases of Small-pox occurred in Acton during the year. |
06907600-4c35-4ea9-8fff-808efe5ff250 | Contacts of cases of Small-pox reaching the various ports were on several occasions notified by the port authorities, and were kept under observation until the incubation period had passed. Some cases of Small-pox in a neighbouring district involved the supervision of a large number of contacts in Acton. One of the sufferers was employed in a large factory in Acton, and another patient was employed in a large engineering factory on the borders, and a number of the employees resided in Acton. Tuberculosis.—There were 47 deaths from Pulmonary Tuberculosis and 8 deaths from other forms of Tuberculosis. During the year 85 notifications of Pulmonary Tuberculosis and 9 notifications of other forms of Tuberculosis were received. The Public Health Tuberculosis Regulations, 1924, came into force April 1st, 1925. |
c8687397-a563-497f-9c95-f32a1386daf3 | Under Article 4 of the Regulations of 1921, the Medical Officer of Health was required to remove from the Tuberculosis Register the entries relating to notifications in respect of persons who have, to his knowledge, died or have ceased permanently to reside within the district. 13 In order to comply with the Regulations of 1924, a complete investigation was made into all the cases, which had been notified since the introduction of notification. Cases were removed in which after notification the diagnosis of tuberculosis is agreed not to be established, or the patient in due course attains a condition in which he may be regarded as cured of the disease. After making the necessary corrections and investigations, it was found that there were 198 cases of Pulmonary and Nonpulmonary tuberculosis in the district. During the year 35 patients suffering from Pulmonary Tuberculosis were treated at a Sanatorium under the Middlesex CoUnty Council scheme, and 11 at a hospital. In addition 5 cases of Surgical Tuberculosis were treated at a Hospital. |
01eb78c3-9862-436c-9ddc-6dfcbabb50d3 | Measles.—There were 16 deaths from Measles. This is the highest number of deaths from Measles in one year since 1917. In former Annual Reports it has been commented upon that Measles had become much less virulent. Possibly, this diminished virulence was partly due to the fact that the disease had for some years appeared in epidemic form in the summer. It is known that a summer epidemic of Measles is less fatal than a winter one. Not only are the lung complications less frequent, but the disease itself appears to be of a less virulent type. This is probably not a sufficient explanation. Last year the epidemic was entirely a winter one, and yet the fatality though higher than that of recent years, was much lower than formerly when a winter epidemic occurred. It is too soon to express any general opinion, because, Measles in former times has assumed degrees of virulence. |
780253c1-bf52-4573-a894-83a173a2170f | Towards the end of last century and the beginning of this, throughout the kingdom the mortality from Measles became markedly increased. In the last decade, the mortality has been considerably lower. There does not seem to be much difference in the type of the disease. The reduced mortality may be related to another phenomenon, which is noticeable in our vital statistics. Comment is frequently made upon the greatly reduced infantile mortality, but although not so frequently commented upon, the reduction in the mortality in the age-period 1-5 years is almost, if not fully so marked. This is not the place to discuss the general question of the effect of infant welfare work upon the mortality between the ages of 1 and 5 years. There are or there were two schools of thought. On the one hand it was contended that the work of infant welfare was worse than useless, as it tended to perpetuate the weaklings. Figures have disproved this theory. |
2f3768c1-a139-4014-ac6d-9acd1f9f0af7 | It is now generally held that the infant welfare work results, not only in the saving of infant lives, but in an improved physique in later years. Formerly, when 14 the infantile mortality was high, the mischief extended beyond the age-period under 1 year. For every infant that was killed others were maimed and scarred. When the conditions under which the infants were reared were improved the results were observed not only in a reduced infantile mortality, but in a reduced mortality in the age period 2-5 years, and in an improved physique of the school entrants. It is possible that one explanation of the lowered mortality and fatality from Measles is associated not with a diminished virulence of the germ of Measles, but with a higher resistance of the individual. Last year's epidemic was in time and course a winter epidemic. The First case occurred on November 26th, but as far as can be gathered no extension of the disease beyond the affected house took place. |
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