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1fdeaf38-3a0c-4447-b2de-ba459a56a03b | 7 ,, 8th „ 8 families 1st child 3 ,, 9th ,, 11 „ 2nd 6 ,, 10th „ 2 „ 3rd „ 3 ,, llth ,, 2 „ 4th „ 1 ,, 12th ,, 1 „ 5th „ 1 ,, 13th ,, 3 „ 6th „ 1 „ 14th „ 1 „ 22nd „ 26 Hawkers and Greengrocers. 4 families 1st child 1 2nd ,, 2 „ 3rd ,, 3 „ 5th ,, 3 „ 6th ,, 1 „ 7th ,, 3 „ 8th ,, 1 ,, 9th „ 1 „ 13th „ 1 „ 14th ,, Policemen. 1 family 1st child 1 „ 2nd „ 2 families 3rd „ 1 family 4th „ Painters. |
2a7bc21c-f091-412b-91c0-49dd279bc88d | 5 families 1st child 2 „ 2nd „ 1 family 3rd „ 2 families 4th „ 1 family 6th „ 1 „ 7th „ It has been suggested that the housing shortage has been one of the factors operating in the marked fall in the birth-rate in recent years. There is no doubt as to the shortage of houses, and young married couples are compelled to live with relatives, or in furnished and unfurnished apartments. These conditions are not altogether suitable for the rearing of children, and are operating towards a low birth-rate among a certain class of the population. Another reason for the continued shrinkage of the birth-rate is the difficulty of obtaining domestic help. This applies to the middle, more perhaps than to any other class, for it is in this section of the community that the shortage of domestic labour is most felt. DEATHS. |
467a9822-300c-4b96-8f3f-942529873037 | 446 deaths were registered in the district; of these 18 deaths were of non-residents; 241 deaths of residents occurred outside the district. The total number of deaths belonging to the district is 669. The net number of deaths corresponds to a death-rate of 10.6 per 1,000 inhabitants. It has been explained in former reports that in order to compare the death-rate of one district with that of another it is necessary to make an allowance for the difference in age and sex constitution of the different districts. 1925 27 Females live longer than males, but the most important factor is the age-constitution of a population. The tendency to death is greatest among persons living at the extremes of life— among infants and old people. |
fce959f8-40c8-4ec6-9e22-695992bcb83f | The Registrar-General has published a table of "factors" for all the large towns, by applying which to the "crude deathrate it becomes corrected for age and sex distribution, so that the "corrected death-rate" gives the death-rate of any place, calculated on the basis that the age and sex distribution in that place is the same as that for the whole country. Thus all " corrected " death-rates being reduced to a common basis, may fairly be compared. The "factor for correction" for Acton is 1.001, and may practically be ignored, as it makes a difference of only .01 per 1,000 inhabitants in the death-rate. The interest of the "factors for correction" lies in its demonstration of the change which has occurred in the character of the population during the past quarter of a century. The Registrar-General works out the factors for correction after each census. After the Census of 1901, the factor for correction for Acton was 1.0424. |
4e0a7032-1db7-4a6d-a4da-8fceca9fe9d9 | After the Census of 1911, this factor was raised to 1.064. But after the Census of 1921, the factor was reduced to 1.001. The age and sex distribution of the population has altered, and the proportion of people living in the age groups 5—65 years was much lower at the last Census than at the two previous ones. Table I gives an analysis of mortality for the year 1925, and from this table it will be seen that the death-rate for the district is lower than that of England and Wales, of London, and of the 105 County Boroughs and Great Towns. Table II gives the death-rates for the last 6 years, and it will be seen that the death-rate has been fairly steady in that period. The death-rate last year was higher than that of 1921, 1922 and 1923, and lower than that of 1920 and 1924. |
245b3fac-14cd-4167-9750-9e6bc3463d1a | Compared with 1924, there was an increase in the number of deaths in the age periods under 1 year, over 65 years, and a slight increase in the age period 15 to 25 years. There was a decrease in the number at all other age periods. 192 5 28 Ward Distribution.— The decrease in the number of deaths was spread evenly throughout the district and the death-rate was lower in all the Wards than it was in 1924. The number of deaths in each Ward was as follows :— North-East. North-West. South-East. South-West. 190 135 137 207 The death-rate of each Ward was:— North-East North-West. South-East. South-West. 10.9 10.3 9 11.2 One of the most satisfactory features is the evenness of the death-rate in the several Wards. |
18df295f-f6de-43d5-a06c-c1372273b04a | During the past 5 years, the death-rates in the different wards have been as follows :— North-East. North-West. South-East. South-West. 1925 0 10.9 10.3 9 11.2 1924 12.2 11.8 9.2 12 1923 10 9.1 10 9.6 1922 0.6 10 10 10.6 1921 10 11 9.5 11.5 Twenty years ago, the death-rate of the South-West Ward was consistently nearly twice that of the other Wards, and twelve and fifteen years ago it was considerably higher. I append the death-rates of the several Wards in the years 1909-1912, though at that period a considerable improvement had taken place in the death-rate of the South-West Ward. North-East. North-West. South-East. South-West. |
87dbe16f-7c5d-496d-87ff-f595850d9aae | 1909 8.5 9.7 11.4 19.1 1910 8.8 8.9 9.9 15.5 1911 9.5 10.3 11.2 22.2 1912 8.4 10.4 9.9 14.0 1925 29 Causes of Death.— On Table III the causes of death at the different ages are given. The principal causes of death are the following:— Tubercular diseases 57 deaths Cancer 79 Heart Disease 86 „ Bronchitis 63 „ Pneumonia 52 „ Congenital Debility and Prematurity 39 „ Tubercular diseases and Congenital Debility and Prematurity are referred to in other parts of the report. The number of deaths from Bronchitis and Pneumonia has remained fairly constant; the most important variation results from atmospheric conditions. A severe winter generally results in an increased fatality from respiratory diseases. |
5b74b236-dcc8-4605-8eee-3f0cf7648e4d | Cancer.— Although there were 13 less deaths from Cancer in 1925 as compared with 1924, the number is, with that exception, the highest recorded in the district. During the past 5 years 363 deaths occurred from Cancer, or 11.1 per cent of the total deaths in the district. In the 5 years 1916-1920, the number was 315, or 8.8 per cent. of the total deaths. In July, 1923, the Ministry of Health issued a Memorandum and suggested certain lines of action to combat the disease. A conference of the different authorities within the Union was convened by the Brentford Board of Guardians, and a Cancer Committee was appointed. This Committee met on several occasions to ascertain the means of diagnosis and treatment within the several districts, and drew up a pamphlet which might be issued by the sanitary authorities. Two main difficulties are encountered in any attempt to reduce the mortality and suffering from the disease. |
8633a899-221b-4b70-b95f-9d71a3f806b0 | In spite of all the work which has been done, and is being carried out, it is generally admitted that the root cause or causes on which the occurrence of cancer depends are unknown. But though the actual cause is unknown, the fact that cancer is liable to follow chronic irritation of so many different types, makes necessary the adoption of certain common sense rules of prophylaxis. 30 In this category', for example, come the removal of rough stumps of teeth, and alteration of clothing which causes irritation of particular regions of the body-for example, the breast, the avoidance of constipation and like matters. The other difficulty in carrying out curative treatment lies in the reluctance of patients to seek early medical advice. In any condition in which cancer is suspected, immediate and decisive action is necessary. 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. |
666b7679-0e7a-461e-ab22-9fa83671cc2d | Heart Disease.—Organic heart disease occupies the unenviable position at the head of the list of the causes of death in this country. Last year in Acton, 86 deaths from heart disease were registered and in the last five years 359 deaths, or 11 per cent, of the total deaths occurred from heart disease. The magnitude and importance of the problem have been overshadowed, partly, no doubt, by the consideration given to other scourges of the public health, and in addition from the belief that nothing in the way of preventative measures was likelv to be of any avail. The increase in the number of deaths from heart disease in this district is marked, and even more so than that of deaths from Cancer. It is doubtful, though, if heart diseases are so much more prevalent than formerly as the death returns suggest. Some of the increase is undoubtedly due to changes in method of classification. |
fe3c75fe-dda4-43c4-8b1c-e0341485dee7 | Still, though we may admit that part of the increase may be due to different classification and improved methods of diagnosis, this does not minimise the importance of heart disease as a factor in the public health. There is also another aspect of the question. The economic wastage in heart disease is greater than in most other diseases, particularly when one takes into account the years of invalidism that ante-date the fatal issue in most cases of heart disease. The following outline in Sir George Newman's introduction to the report of the Ministry of Health in Rheumatic Diseases suggests not only the need but the lines on which preventive action may be taken. One sixth of the industrial invalidity of the country arises from Rheumatic affections. The annual cost to the Approved Societies is two million pounds and the work lost to the members equals three million weeks per year. 1925 31 Nearly one half of the patients with Rheumatic Fever show evidences of heart disease. In second and subsequent attacks of Rheumatic Fever the risk of heart affection is greater. |
67f63062-a594-4338-8a4d-2f8e2c3039ba | Fifty per cent. of patients with Rheumatic Fever have enlarged or septic tonsils. MATERNITY AND CHILD WELFARE. Infantile Mortality.— Eighty deaths occurred in children under one year of age. This corresponds to an infantile mortality of 76 per 1,000 births, compared with an infantile mortality of 56 per 1,000 births in 1924. The infantile mortality in the whole of England and Wales was 75 per 1,000 births; in London 67, and in the 105 County Boroughs and great towns, including London, 79 per 1,000 births. The deaths were distributed as follows :— North-East Ward 22 North-West Ward 11 South-East Ward 13 South-West Ward 34 It has been previously explained that the addresses of all the births belonging to the district which occur in outside districts are not obtained. |
84970e1b-d4aa-404d-abb0-5c1198d1a541 | In most instances we are informed of the birth by the Medical Officer of Health in whose district the birth has occurred. But from the Registrar-General's return at the end of the year it is evident that all Medical Officers of Health do not follow this practice, and some births are untraced and cannot be allotted to Wards. The exact infantile mortality of each Ward cannot therefore be given, but approximately the infantile mortality of the Wards was as follows:— North-East Ward 75 North-West Ward 65 South-East Ward 69 South-West Ward 90 1925 32 The infantile mortality is the highest in the district since 1918, but it is probable that the increased mortality is due to transient and temporary causes, and not to permanent ones. Five dead babies were found in different parts of the district, and probably did not belong to Acton residents. |
7aa91cdf-24b5-47c8-90d8-5aefb09311db | Eight illegitimate babies died during the year, and this number corresponds with an illegitimate infantile mortality of 210 per 1,000, compared with a legitimate rate of 71 per 1,000 births. The number of children born out of wedlock last year was 38, which corresponds to an illegitimate rate of 36 per 1,000 births. Although the infantile mortality among illegitimate children has diminished, there is still a sinister difference between the infant death-rate for legitimate infants and that for illegitimate. One of the main factors contributing to this undue mortality is the fact that only a small proportion of illegitimate infants are naturally fed, as generally an attempt is made to separate mother and child as soon as possible, so that the former may return to her work. Such children are usually put out to be " minded." Occasionally in this district illegitimate children are adopted, but the instances are few and far between. |
bf4d3bed-a268-4664-8fed-1618dfec4e3f | There is a popular belief that there are a number of childless homes willing, even anxious to adopt an infant of this class. Only when this theory is put to the test is it found that such a child is unwanted. The National Council for the Unmarried Mother and Her Child are doing good work by trying to keep the mother and child together, with better care of the mother both before and after the birth of the child. There was also an increase in the deaths from Pneumonia, probably due to the severe weather which was experienced in the late autumn and early winter. The two other conditions which caused most deaths were Diarrhoea and Ante-natal causes. There were 10 deaths from Diarrhoea, 5 from Congenital Debility, 5 from Congenital Malformation, 5 from Injury at Birth, 5 from Marasmus and 19 from Premature Birth. |
92e8e787-15d2-4348-8e4e-03c58f72e796 | Apart from the slight check of last year, there is nothing more significant in our death returns than the steady reduction which has taken place in the infantile mortality since the beginning of this 1925 33 century. We have to remember, though, that during the last 40 years there has been a reduction, not only in the infantile mortality, but also in the mortality at all ages. Any study of the changes of mortality at one period of life is incomplete unless their relation to changes at other ages is also noted. Infants and adults live side by side in the same homes, and though some of the conditions prejudicial or favourable to the health of the one will be found to have a similar effect on the well-being of the other, yet the infantile death-rate is a more delicate index of favourable or unfavourable conditions. This is especially true of deaths from diarrhoeal diseases. |
fdf249ef-cfba-4430-bad3-95f9701e01ea | It is desirable to emphasise this fact, that a glance at the changes in mortalities at all different ages of life over a long period of years will show how general in their effect the harmful or beneficial factors have usually been. The following table shows that, although the infantile mortality during the last 40 years has diminished more rapidly than the mortality at other ages, a vast improvement has occurred in the public health and the death-rate at all ages has been reduced. Period. Average yearly General death-rate. Average yearly Infantile Mortality. 1879-1885 16.3 154 1889-1895 16.6 168 1899-1905 13 147 1909-1915 12 99.5 1919-1925 10.5 65.5 I have taken periods of seven years so as to avoid as far as possible the period of the war. |
30525af4-1f14-474f-9c72-aeab26849198 | It will be noticed that the reduction did not take place until the beginning of this century, and that simultaneously a reduction occurred both in the general death-rate and the Infantile mortality. The reduction in Infantile mortality has been greater than the reduction which has occurred in the general death-rate, and over and above the influences which have contributed towards the reduction of the general death-rate the child welfare movement has undoubtedly been responsible for the decline in the infant mortality. 1925 34 It may be instructive to give the infantile mortality of twenty years ago in detail and compare it with the last seven years. |
055df662-7b11-4676-85db-07d7309a0428 | 1899 187 per 1,000 births 1919 65 per 1,000 births 1900 168 „ „ ,, 1920 64 „ „ ,, 1901 170 ,, ,, ,, 1921 70 „ „ ,, 1902 150 „ „ „ 1922 62 „ „ ,, 1903 105 „ „ „ 1923 65 „ „ ,, 1904 143 „ „ „ 1924 56 ,, ,, ,, 1905 106 „ „ „ 1925 76 „ „ ,, It is not claimed that the infant welfare movement is entirely or even mainly instrumental in this remarkable reduction. Other agencies have been at work, but ante-natal inspection and health visiting are those with which we are now concerned, and the comparison is important, because attempts to reduce infant mortality are regarded by many as an interference with natural selection, which must be inimical to the average health of those surviving. |
63ac2115-6a0a-4575-ae1e-8faea344e8ca | According to this school of thought, efforts to save infant life merely prevent the "weeding out" of the unfit, and ensure the survival of an excessive proportion of weaklings. This statement, of course, is difficult of direct proof or disproof. The matter cannot be put to the test of actual experiment. To do this it would be necessary to transfer a large sample of the infant population of a county which has a high infantile mortality, who had survived the excessive dangers of the first year of life, to a county which has a low infantile mortality, and transferring an equal number of survivors from the county which has a low infantile mortality to a county which has a high infantile mortality. The relative experience of two such selected populations might settle the problem. There are indirect ways by which the soundness of these views can be put to the test. If we only saved the weedlings in reducing the infantile mortality, we should expect an increased mortality in the age periods 1-2 years and 2-5 years. |
327e6e91-0253-4229-91ab-539dd48f6450 | But the reduction in the mortality in these age periods is as great if not greater than the reduction in the mortality of infants under 1 year of age. If we take again the last 7 years and compare the number of deaths in the age-period 1-5 years with the number of deaths in the same age period in 1905-1911, we find an average yearly number of 91 in the period of 1905-1911 compared with an average annual number of 30 in the last 7 years. 1925 35 Of course, allowance must be made for the reduced birth-rate, but the average reduction in the number of births has been less than 30 per cent. but the reduction in the average yearly number of deaths has been 66 per cent. In the period 1905-1911, the deaths of children between 1 and 5 years of age formed 13 per cent. |
3b991177-0dd3-48b9-9efa-a46e8aa97e01 | of the total, and in the last 7 years the deaths in the age periods 1-5 years only formed 4.6 per cent. of the total deaths. The following table gives the total number of deaths in the age period 1-5 year in the two periods:— 1925 24 1911 116 1924 48 1910 55 1923 20 1909 102 1922 27 1908 106 1921 32 1907 94 1920 33 1906 91 1919 28 1905 73 There is another table which is of interest in this connection, though it has been extracted from the School Annual Reports. The table gives the heights and weights of the children entering the schools. The periods selected have been slightly different, but this is due to the fact that School Medical Inspection was only instituted in 1908, and the figures prior to that date are not available. |
154263a8-7b45-44aa-a2b8-78315489fdc3 | 1925 36 HEIGHTS AND WEIGHTS OF CHILDREN ENTERING THE SCHOOLS. 1908—1912 1921—1925 4-5 yrs. 5-6 yrs. 6-7 yrs. 4-5 yrs. 5-6 yrs. 6-7 yrs. BOYS— Ht. Wt. Ht. Wt. Ht. Wt. Ht. Wt. Ht. Wt. Ht. Wt. Acton 39.3 36.9 41.8 38.7 44.4 43.6 40.7 36.9 43.3 41.9 45.5 44.3 Acton Wells 40.2 37.2 42.2 39.8 45.2 46.0 40.9 36.9 43.6 42.3 46. |
360249a8-ca66-43d7-a7ac-4f4899d56fbf | 2 47.7 Beaumont Park 39.4 36.8 41.7 39.9 43.1 42.5 40.6 37.7 42.6 41.1 44.5 46.8 Derwentwater 41.0 39.2 42.7 41.4 45.2 46.3 41.4 37.8 44.6 41.6 46.3 47.1 Priory 39.3 35.6 41.5 39.9 43.3 41.5 40.8 37.8 42.8 40.8 44.5 42.4 Rothschild Road 40.4 37.1 42.2 40.0 44.6 43.8 40.7 36.5 42.6 39.9 44.5 43.1 South Acton 39. |
1d78f480-764c-49cb-9df2-86644801f115 | 1 35.7 40.9 38.2 43.0 41.4 40.3 37.6 41.9 40.1 44.3 42.5 Southfield Road 40.8 37.9 42.8 40.3 44.5 43.5 41.4 38.7 43.4 41.6 45.3 45.1 Turnham Green 39.9 39.8 41.2 38.1 43.8 43.7 40.8 38.3 42.5 39.8 45.7 45.9 GIRLS— Acton 39.4 35.5 41.5 38.5 44.1 42.7 40.6 36.5 43.7 40.2 45.2 41.4 Acton Wells 39.9 36.3 41. |
6937b179-ce22-435e-af06-fa8a15984abd | 9 39.0 44.3 43.7 41.4 37.3 43.1 40.3 46.0 45.4 Beaumont Park 37.7 36.2 41.4 38.8 44.2 42.7 39.9 35.5 42.3 39.5 45.0 44.0 Derwentwater 40.3 37.9 43.0 41.2 44.9 44.7 41.0 36.7 43.7 41.9 46.0 45.3 Priory 39.2 35.0 41.7 39.8 43.6 41.7 40.6 37.2 43.2 39.0 44.7 42.8 Rothschild Road 40.3 37.1 42.0 38.5 44.1 42. |
de2314b1-6d26-4468-8119-ae3505f0f27a | 4 41.0 35.9 42.5 38.9 44.3 40.4 South Acton 38.4 35.1 41.2 37.9 43.0 41.7 40.6 36.7 42.0 39.6 44.3 43.1 Southfield Road 39.8 34.0 42.7 39.1 44. |
906d8899-44ad-4206-b4b7-264d7b1ad785 | '6 43.4 40.5 37.2 43.2 40.0 44.7 43.4 Turnham Green 38.2 33.7 40.4 37.8 42.5 41.7 40.9 37.4 41.9 39.8 44.7 43.3 1925 31 This aspect of the subject has been dealt with fully, as it has a bearing upon the whole question of child welfare work, If it were true that the efforts simply resulted in saving children who would grow up to be weedlings and inefficient, then it would be better to scrap the whole organisation of health visiting and begin anew. The figures given in the preceding page I think, prove that the opposite view is the correct one, and that the object of infant welfare work is the improvement of the conditions under which the children are reared, and not simply the treatment of individual cases. |
db350f2c-59f2-4d3b-af3e-0a7154453630 | Consequently, not only infant life is saved, but the children who survive are stronger and healthier. Where the conditions were such as conduced to a high infant mortality, for every child who died, others who survived were scarred and maimed. It was the survivors under the unhealthy conditions which produced a high infantile mortality who grew up as weedlings and inefficients. Notifications of Births Acts. 882 live births and 17 still births were notified. 909 births were registered by the local registrar of births. Over 97 per cent. of the births were notified last year compared with 98 per cent. in 1924. During the past two years, there has been a considerable improvement in the percentage of births which have been notified, but recently there has again been a tendency to neglect this duty. Two years ago, the Council reminded doctors and midwives of their duty under the Notification of Births Acts, and the percentage of births notified appreciably increased as a result. |
e78d112c-ae20-482c-bdef-83bb04bb3ea1 | The following table gives the percentage notified in the last 7 years:— Year Percentage Notified 1925 97 1924 98 1923 91 1922 90 1921 94 1920 92 1919 90 Health Visiting. During the year the health visitors paid visits to 715 infants under one year of age. The total visits paid to infants under 1 year was 4280. 1925 38 In addition, 4172 visits were paid to children between the the ages of one and five years. Although Child Welfare started with the home visiting of infants, it was soon found that not only were the health visitors unable to pay sufficient visits to the homes, but certain other activities could only be carried out in centres. The Council has two Child Welfare Centres—one in the rooms attached to the Church Road Baptist Chapel and the other in the rooms attached to the Mission Hall, in Palmerston Road. |
e029f809-32b9-4f9c-b58f-8d626f30caee | The centres are held every Monday and Wednesday afternoons, and an average attendance of 55 and 56 per session respectively is made. Altogether 1539 children attended the two centres during the year. Maternal Mortality and Ante-natal work. Five deaths occurred in childbed-—four from puerperal sepsis and one from other diseases of pregnancy and parturition. This number corresponds to a maternal mortality of 4.6 per 1000 births. In the last 5 years the number of maternal deaths has been as follows:— 1925 5 1922 4 1924 7 1921 3 1923 8 This question was discussed very fully in last years report, and it was then stated that the district compared unfavourably with the whole of England and Wales, and with most of the metropolitan boroughs. |
24a1e230-53c0-40b8-865e-ba12a6955150 | Moreover, recently, the maternal mortality seemed to be greater now than it was 20 years ago, as the following figures show 1905-1908 3.74 maternal deaths per 1000. 1909-1912 2.7 ,, ,, ,, ,, 1913-1916 4.53 ,, ,, ,, ,, 1917-1920 4.59 ,, ,, ,, ,, 1921-1924 4 6 ,, ,, ,, ,, 1924 6.04 „ ,, ,, ,, 1925 4.6 ,, ,, ,, ,, 1925 39 The most important instrument within our reach to reduce maternal mortality is ante-natal care. No one who has an intimate knowledge of maternity and Child Welfare Work, has any doubt of the importance of ante-natal work. |
562a946a-bb55-4575-b14b-54d7f33fb75c | In the report submitted by Dame Janet Campbell to the Ministry of Health, the paramount importance of ante-natal work was emphasised, and at all recent conferences where Maternity Work or Maternal Mortality is discussed, one cannot but be struck by the insistence with which ante-natal care is stressed as a sine qua non. The young practitioners, most of them fresh from the teaching and practise of the big hospital ante-natal departments. are imbued with this idea The young midwife trom an up-todate teaching school starts her district work determined to visit and examine all her patients ante-natally. With the knowledge and experience gained by all workers in the field of obstetrics at the present time, there should be no weak links in the chain of preventive work. It should be clearly established that every expectant mother should be carefully and fully overhauled by a competent obstetrician at least once before every confinement, and that well before the seventh month. Why is this not always done ? |
4395e5f6-6281-465a-ad43-5d33b4fe6ff7 | It is sometimes said that the expectant mothers do not like it. This is certainly not our experience here. Practical experience in dealing with expectant mothers soon teaches one that no one is more appreciative of proper medical supervision and expert and encouraging advice, than is the expectant mother if dealt with on proper lines. The real difficulty, the real hindrance to ante-natal care, lies, not in the objection of the patient, but in the want of realisation of old-fashioned practitioners in midwifery—doctors or midwives—of the necessity for preventive work and the want of the most elementary knowledge in its routine application. The Ministry of Health have taken the lead in so far as they were able in these matters. The report on Maternal Mortality by Dame Janet Campbell is permeated with the teaching that ante-natal work is the keystone of midwifery. The Central Midwives Board recommend, though they do not yet make it compulsory. |
e063ff16-1a09-4fba-bd2d-126aeebda12b | that all mid-wives engaged for a confinement, should keep a record of their bookings and of their ante-natal visits. 1925 40 During the year the health visitors paid 336 visits to expectant mothers; of these 232 were first visits, that is 232 expectant mothers were seen during the year. From time to time, we have circularised the mid-wives. In spite of these activities only 82 expectant mothers attended the Ante-natal Clinic. The Clinic is held every other Wednesday morning at the School Clinic premises, and Dr. Bell is the consultant in attendance. The average attendance at the Clinic was five Per session. In the 5 years under review, probably the greatest advance in Maternity and Child Welfare has been the closer co-ordination of the School Medical Work, and the Child Welfare Work. |
6d3c7ee5-a490-43ce-b098-d95057687760 | From the commencement there has been close co-operation between the two services, but the establishment of the School medical service has materially affected the trend of preventive Medicine as a whole, and of infant welfare in particular. The number of defects found in children entering school showed that prevention must begin not only in childhood but in infancy and even in Maternity. It became necessary to link the two services together. Miss Loretz. the school dental surgeon talks occasionally to the mothers about the preservation of the children's teeth, and the leaflets issued to the school children are distributed at the Centres. |
178aff2c-d622-40d5-a0e6-fc4e60f5bbb4 | By arrangement with the Education Committee, the mothers and children from the centres are treated by the school dentist, and last year the following number of mothers and children were inspected and treated under the Maternity and Child Welfare Scheme:— Inspected Referred, for Treatment Treated Mothers 35 35 24 Children 109 101 73 Fillings Extractions Permanent teeth 25 Permanent Teeth 127 Temporary teeth 196 Temporary teeth 164 Total 221 Total 291 1925 41 Similarly children with squint, etc., are referred to Dr. Banham, the school ophthalmic surgeon, and last year 9 children under 5 years of age were inspected and treated by Dr. Banham. The Education Committee have an agreement with the Acton Hospital for the operative treatment of enlarged tonsils and adenoids, and the Child Welfare Committee refer cases under 5 years of age for treatment under this agreement. Last year 11 children under 5 years were operated upon for enlarged tonsils and adenoids. Day Nursery. |
4f88c6f0-7bde-4239-9f98-1406653db60b | The Municipal Day Nursery is situated at 169, Bollo Bridge Road. The Nursery is open every day from 7.45 a.m. until 6.40 p.m., except on Saturdays, Sundays and holidays, when it is closed all day. The charges for admission are 9d. a day for one child and 8d. a day each for two or more children of one family. The Nursery is intended primarily for the children of mothers who go out to work, but in exceptional circumstauces other children may be admitted at the discretion of the Matron. Most of the mothers whose children are cared for in the Nursery, are employed in the local laundries. Last year the Nursery was open on 222 occasions. 354 children attended, and the total number of attendances was 4223. INFECTIOUS DISEASES. |
8af97b12-a141-449c-ab06-6ed05d5c2b59 | In connection with the control of infectious diseases, the two outstanding features recently have been the discovery and development of the processes known as the Schick Test for Diphtheria and the Dick test for Scarlet Fev'er. The latter is a recent development and the results shown to follow the application of the Schick test and immunization cannot yet be claimed for the Dick test. 1925 42 As far back as 1911, Schick published a paper in Germany in which he described the test which is now known by his name. The Schick test is used as a means of recognising susceptibility to Diphtheria. A standardised toxin is injected into the skin of the arm, and the re-action which follows, serves as guide to susceptibility or non-susceptibility of the person tested for Diphtheria. The test requires considerable care and experience in the interpretation of the results, but the test has now gone beyond the experimental stage, and in almost every instance the result is a reliable indication of susceptibility. |
b242d690-c9da-4f0f-b143-b823f0f82ec9 | The function of the Schick test is to disclose the fact of the susceptibility or otherwise of an individual to diphtheria toxin and therefore his susceptibility to the disease. It is thus applicable for indicating which members of a community require to be immunized if any danger of attack be present. The importance of the test lies in the procedure which follows. If the person is susceptible, he can be rendered actively immune by means of inoculations of a standard toxin-anti-toxin mixture. The term "active" immunity is used in contradistinction to "passive" immunity which is conferred by the injection of diphtheria anti-toxin serum. The latter kind of immunity is frequently used by doctors when a case of Diphtheria occurs in a family. The doctor injects the members of a family who have been in contact with diphtheria, but who are not themselves at the time suffering from the disease. This "passive" immunity possibly only lasts a few weeks. |
fdee5f48-be06-453e-b127-2fa7e5273ee0 | The injection of toxin-anti-toxin mixtures confers an active immunity of the same nature as that conferred by an attack of diphtheria and lasts for years, possibly for a lifetime. The present wide interest in the use of toxin-anti-toxin mixtures is due to the work of Dr. Park of New York and his collaborators, in particular of Dr. Zingher. In New York, the prevalence of diphtheria has been greater and the mortality from the disease considerably higher than in this country. Dr. Park has carried out the test in hundreds of thousands of children, and the children in many schools have been immunized by the toxin-antitoxin mixture. 1925 43 The Dick test for Scarlet fever is a more recent one. In 1923. Drs. G. F. and G. H. Dick, of Chicago, claimed to have discovered the organism of Scarlet Fever, with which they had produced Scarlet Fever in volunteers. |
1ebaee24-4d21-443f-a189-a040aa73a566 | From this organism, a culture was made, and by the injection of this toxin into the skin, the susceptibility of a person to Scarlet Fever was shown in a similar way to that in which the Schick test does to diphtheria. The reaction usually appears from 4 to 6 hours after injection reaching its maximum size between eighteen and thirty-six hours after the injection. Attempts have been made to immunize patients in a similar manner to the diphtheria immunization, and the serum has been manufactured for the curative treatment of Scarlet. Fever, but so far, the time has not been sufficient to produce results so complete and definite as those which have been gained in Diphtheria. Dr. Zingher points out that the susceptibility to Scarlet Fever as to Diphtheria, is much higher in the well-to-do classes than in the poor. Among 7,000 New York board school children tested, only 8 per cent. |
42ab0392-5f63-4847-abe1-18b4f83e4470 | gave a positive Dick reaction, whereas in a private school 83 per cent. proved susceptible. Both tests have been used extensively by local authorities in this country and can be regarded as a reliable test of susceptibility of the individual to the respective disease. There is also adequate evidence that inoculation with the toxin-anti-toxin produces immunity at any rate in the case of diphtheria. As a natural sequence one must face the further question to what extent can the procedure be grafted on to our existing public health system with a prospect of success. The memorandum of the Ministry asks that this report should state whether any use has been made of the tests known as the Schick and Dick tests in diphtheria and scarlet fever respectively, or of the recently developed artificial methods of immunization against these diseases. |
a0332f7a-96db-4ba9-8749-fe8501560f8d | 44 Except in a few isolated instances in the hospital, no use has been made of these methods, and in the conditions which obtain at present in the district, there is very little hope that any considerable proportion of the inhabitants would avail themselves of any facilities which we might offer. For the last 10 years, Scarlet Fever has been of a mild character, and in the last 3 years diphtheria also has not been very Prevalent in the district. The following table gives the incidence and fatality of Scarlet ever and Diphtheria in the last 10 years. |
3309e5a9-b489-4ad7-b473-58873749bcd8 | 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 Scarlet Fever Notifications 83 105 160 305 630 176 95 38 45 64 Scarlet Fever Deaths 1 1 — 3 1 1 — — — 1 Diphtheria Notifications 63 45 61 223 205 141 54 116 67 81 DiPhtheria Deaths 1 5 3 12 1618 2 2 3 4 As far as Scarlet Fever is concerned, it appears that more Information and experience would be necessary before the Dick test and subsequent immunization could be recommended. Much work though is being carried out both in this country and America, and progress may be expected in both directions. With respect to diphtheria, the conditions are different. |
f4f08ec9-d009-49e1-8897-813586972146 | in this district, we happen to be in what is called the period minimum prevalence of the disease, but an examinarion of the records for the past 50 years shows that the district regularly passes through periods of maximum and periods of minimum prevalence. These periods van,- from 3 to 7 years, and though the deaths which occur in the periods of maximum prevalence are now much less than formerly, thanks mainly to the introduction of antitoxin the depredations of the disease are formidable. Evidence of this is seen in the table; in the 3 years 1920-1922, 46 deaths occurred from the disease. we probably know more about the causal organism of diphtheria than we do of the cause of most infectious diseases, yet the attack on diphtheria has fallen behind that directed against other infection diseases. |
59fd959c-1718-48ba-970b-e9302eac939a | Steady though the progress has been in the treatment of cases, it has recently been slow ; the fact remains that, for reasons not altogether clear, diphtheria appears" in this country to be strenghtening its forces, and gathering power. 45 The experience of New York forms a powerful arguineht for the adoption of some form of immunization in an attempt to stamp out the disease. The age incidence of the various diseases, the ward distribution, and their prevalence in the last 10 years, will be found in tables at the end of the report. Measles. There was no death from Measles in 1925, but in the autumn, an extensive epidemic occurred, and early in the year 1926 some deaths occurred. One of the most remarkable phenomena since the War has been the low mortality from most of the common infectious diseases, and Measles has shared in the general improvement. |
ced3df93-0214-4e5e-b89e-054468cbdd5c | The extent of this improvement may be gauged from the following table which gives the total number of deaths from Measles in this district in periods of 8 years during the last 40 years. 1918-1925 37 deaths 1910-1917 167 „ 1902-1909 176 „ 1894-1901 69 „ 1886-1893 82 „ It is difficult to decide to what this improvement is due. It is certainly not due to any control which we have obtained over the disease. Measles still remains the commonest and possibly the most complicated of the eruptive infections. It is so common that, after a trial, compulsory notification was abandoned. The cost was great and inquiry into each case at the height of an epidemic was almost impossible. During the recent epidemic, we were able to nurse in the Hospital a small proportion of the cases; these were admitted on the application of the doctor in attendance. |
5740f68f-4789-4b14-aa30-2bb9fcb4d5f2 | But it would be impossible to nurse all the cases in hospital. There are no beds available for the treatment of all the cases. Our hospital would be swamped, and all other diseases would have to be excluded. In spite of these considerations, a most remarkable fall in the number of deaths from Measles has recently occurred, as the ; above figures show, and I might suggest some factors which have operated in this diminished mortality. 46 Measles still stands very high among the infectious diseases as a cause of death in childhood. Attempts have been made to decide what proportion of persons pass through an attack of measles, and, it appears, that at least 95 per cent, of the population register one attack of measles before the twentieth year of life. Although a percentage of even 25 of children has been reported to have a second attack, it is generally agreed that a second attack is rare. One attack usually protects the individual from the disease for the rest of his life. |
68acbd2a-8e03-4a9e-8d7f-a11c3d677b13 | From this we conclude that suppression of the disease is udlikely to be attained and may perhaps not be desirable. The aim of modern preventive medicine is not the prevention of infection but the suppression of its damage. The most successful efforts of modern prevention rely not on preventing infection, but diffusing it in a form in which it can be controlled. It is well known that a summer epidemic of measles is far less fatal than a winter one, and one is justified to employ drastic means to postpone an epidemic in the winter even if it be only for a few months. We might feel inclined to close a class or department on the appearance of a single case in December or January, in the hope of avoiding an epidemic, when such a course would not be justified if the outbreak started in the spring. In the years 1921, 1922 and 1923, we were fortunate to have a series of summer epidemics, and in those years only 5 deaths occurred from the disease. |
85339c40-4e1b-4cd1-9988-1a7c71519ea9 | The occurrence of a series of summer epidemics is not the only explanation, as we find that in the last decade there has been a marked fall in the mortality from Measles throughout the kingdom. The reduction throughout the kingdom has not been so great as that which has occurred here, but sufficiently marked as to be accountable in part by some more general cause. It has been frequently pointed out that the great majority oi the deaths from Measles occur amongst children under 5 years of age. Many years ago. Dr. Theodore Thompson in a report to the Local Government Board on the control of Measles pointed out that the incidence of attack is different from that of death. For while the main incidence of death is on the second year, the incidence of attack is chiefly on the third, fourth, and fifth years. 47 From this different incidence of attack and of death, it results that the fatality from Measles is very much higher in the second year of life than in any of the succeeding years. |
79f45d2f-165c-4413-9387-8479d94b5e47 | Children in the second year of life .although less susceptible to attack, are much more likely to die if attacked than any other children. Unquestionably, much is gained by guarding young children between one and four years of age from exposure, for it is at this period of life that most fatalities occur. It is partly for this reason that school attendance before five is generally deprecated by medical officers. In former years, Measles was introduced into a house by one of the younger school children. A child attending an infants department would suffer from Measles and infect the younger children in the house. The lowered birth-rate has altered the age incidence of the population. At the present time the number of families in which there is a younger child at home as well as one in attendance in an infants department is considerably less than it formerly was, and this may partly account for the lowered mortality. |
0cfc735d-440f-4aee-bed8-522030b0c4d5 | Every, attempt is made to prevent children under 5 years of age froul coming in contact with Measles, but possibly the last word in Measles management will be immunization. The most successful method-of preventing Measles known at present is to inject 5 to 10 c.c. of serum from a person convalescing from the disease into the exposed child as soon after exposure as possible. The blood serum of a convalescent contains substances which make him immune to the infection, and by transferrins some of it to a susceptible person, the latter is also rendered tend porarily immune. This is what is called temporary or passive | immunity. Attempts at active immunization, as with vaccines, are stil in the experimental stage. The disadvantage of the methods usee is that they are temporary only. Sail, in the case of young childrei exposed to measles infection, under certain conditions a temporar immunity is of great value. |
aebc0977-9cdc-4c5f-9f56-380078299a5a | At present the method cannot be made generally applicable but it will be useful in individual cases, arid also where Measles has made its appearance in an institution or hospital. 48 Another factor which possibly has been operative in the reduction of measles mortality is the improved health of children under 5 years of age, and the natural resistance which these children offer to disease. In the section dealing with Infantile mortality, it is shown that in the mortality in the age periods 1-2 years and 2.5 years, there has been as great, if not a greater reduction than in the period under twelve months. When a reduced infantile Mortality is effected, an improvement occurs in the conditions under which the babies live, and this improvement continues in to the succeeding years. Encephalitis Lethargica There were two notifications, and no death occurred from the disease, but one of these r otifications was received in December. |
a31005e5-56bc-4360-97ef-ce519dd970b9 | in the other case, it was notified in the summer, ard on enquiry at the end of the year, she was apparently well and rot suffering from any sequelae of the disease. It is too early to express any opinion as to the result in the case of, at any rate, one of these cases, but Encephalitis Lethargica, besides being an acute disease attended in its early stages and even later by considerable danger to life, is in the larger proportion of cases followed by a long period convalescence which is not a mere debility, but has peculiar features which may be regarded as constituting a chronic stage of the disease. These features are usually termed " residua," and upon the particular residua present in any case and their severity, depends the possibility of the patient's restoration in agreater or less time to the normal condition of health. . Since the disease was made compulsory notifiable in 1919, 14 cases have been notified in this district. |
fa2a50c4-f14a-4921-aebc-15a5b558fa33 | One of these was Probably a case of mistaken diagnosis, and has left the district.; Exeluding also the 2 notified last year, there would be 11 cases; 8 are dead, and only one can be said not to exhibit any sequelae. two of those who have survived are totally unable to follow their normal occupation. Tuberculosis. There were 47 deaths from Pulmonary Tuberculosis, or Consumption, or Phthisis, and 10 deaths from other tubercular diseases. The number of deaths from Pulmonary Tuberculosis isthe the same as that of 1924. Since the end of the War, the deathrate from Tuberculosis is steadily though slowly becoming lower. |
a1176e57-3f85-48df-9b74-f847f42541a8 | 49 During the past 5 years, the number of deaths from Tuberculosis has been as follows:— Pulmonary Other Tuberculosis Tubercular diseases 1925 47 10 1924 47 8 1923 54 15 1922 48 8 1921 59 8 Seventy new cases of Pulmonary Tuberculosis, and 13 cases of other forms of tuberculosis, were notified during the year. The age-inciden:i and ward distribution are given on fable V. At the end of the year, the number of cases on the Register was:— Pulmonary. Pulmonary. Total. Male Female Male Female 100 93 24 25 242 During the year, 29 medical cases were admitted to a San- atorium under the Middlesex County Scheme, 24 to Hospital, and 4 surgical cases wree admitted to a hospital. Isolation Hospital. |
51b7e1ed-f061-456b-9fb4-5b598ae27947 | During the year, 183 cases were admitted into the Hospital compared with 188 in 1924. On January 1st, 1925 there were 24 cases under treatment, and on January 1st, 1926, 28. 175 cases were discharged and there were 4 deaths. The following is a list of the cases admitted :— Acton Wembley Kingsbury Total Scarlet Fever 58 31 2 91 Diphtheria 57 10 1 68 Measles 19 — — 19 Others 5 — — 5 Total 139 41 3 183 50 Scarlet Fever. 91 cases of Scarlet Fever were admitted, with two deaths, One of the deaths belonged to Acton, and the other to Wembley, This is a high fatality for Scarlet Fever patients, but one of the Cases when admitted was suffering also from Whooping Cough. Diphtheria. 68 cases of diphtheria were admitted, with one death. |
421a50c0-840e-49d0-a6d9-e7749d3dd7a7 | This is a very low fatality for Diphtheria. A number of mild cases, of course, were admitted, but throughout the year a fair percentage of the cases were severe, and some of them very severe. Measles. There were no deaths from Measles. Others. Amongst other cases admitted was one of Hodgkin's diseasewhich proved fatal. BACTERIOLOGICAL EXAMINATIONS. (a) For Diphtheria. Positive Negative Total Examination—910 88 822 Sent by Medical Practitioners 26 220 Sent from Isolation Hospital 16 168 Convalescents 2 37 Contacts 26 164 Of these Positive Contacts:— 17 were positive on the first occasion only. 6 were positive on the second occasion. 3 were positive on the third occasion. Positive Negative School Sore Throats 18 233 51 Seven of the Positive Sore Throats had sufficient clinical symptoms to warrant removal to Hospital. |
72051729-8206-4a82-b335-daf8a8512257 | (b) For Ringworm. Positive Negative. Total Examinations—20 15 5 (c) For Tubercle. Positive. Negative. Total Examinations—111 13 98 INSPECTION OF FOOD. In recent years, probably the two most important events in connection with food have been the discovery of vitamins, and the increasing attention which is being paid to cleanliness in the production and distribution of food. It is now recognised that all proteins are not of equal nutritive value ; some, particularly most vegetable proteins, are incomplete, while most animal proteins are complete in that they contain the components necessary for growth, repair and replacement. A number of diseases whose causation was heretofore unknown have been definitely proved to be caused by lack of vitamins, and of late considerable evidence has been brought forth to prove that resistance to disease, particularly infection, may be dependent on vitamins and the quality of proteins, or both. |
7fc5e8a1-adac-4507-afd1-45bff3f7613f | The proper selection of foods both in quality and quantity is not merely an individual problem but a public health question of great magnitude. The health worker must recognise that the lay public should possess knowledge between food and disease and of the relation of food to health. Just as the newer knowledge of the nutritive principles of food has made the selection of proper food a matter of public health concern, so have the newer conceptions of food poisoning added greater importance to food hygiene Before last year, with the exception of milk, little attention had been paid to the hygienic handling of food. Certain regulations had been passed for the provision of cleanliness in milk shops and dairies, but in respect of the cleanliness of other food, practically no public control was exercised. It was known of milk that it provided a suitable medium for the growth of certain organis ns, and that certain diseases were 52 conveyed to mail through milk. These facts resulted in the enforcement of certain regulations in dairies and cowsheds. But the other foods were left alone. |
cc488ddd-771c-42c6-80e9-175de53b8d4e | Last year, a start was made, and action can now be taken under the Meat Regulations. Action is long overdue in respect of other foods. It is unnecessary to prove that certain diseases are caused by the dirty handling of food. When obvious facts as to contamination with filth can be adduced, as they very easily may, there is no need for voicing the theories of the experts as to what the effect upon the food and afterwards upon the consumer may be. Public Health Meat Regulations, 1924.—One most notable advance has been made during the past year. I refer to the Public Health Meat Regulations, 1924. which came into force on April 1st, 1925. The Regulations are divided into six parts of which the first part deals with definitions, and indicates the local authorities which are responsible for the executive work imposed by the regulations, and further sets out the officers of the authority who shall be responsible for the work. |
1d70156c-b600-4f68-b3cf-8c0dc971d4ca | Slaughterhouses and Slaughtering.—Part II of the Regulatious contains provisions for the regulation of slaughterhouses and slaughtering, and in particular for requiring notices of slaughtering, and of evidence of disease to be given to the appropriate officer of the local authority. Although there are only three slaughterhouses in the district, and in one of these practically no slaughtering has taken place for a considerable time, and in another an inspector is always present during slaughtering, these regulations have been proved in the past to be necessary ones. It will be recollected that in December, 1924, the Council instituted proceedings and obtained a conviction against a firm for having in its possession diseased meat. Article 10 of the regulations provides that the carcase and the important organs shall not be removed from the place of slaughter until the carcase with its organs has been inspected or its removal authorised by an inspector of the local authority. |
df4569ba-b069-4020-b0c2-218cad469860 | Before dealing with the results of inspection in this district, Part III of the Regulations may be noted as both have bearing upon the meat inspection carried out here. 53 Meat Marking.—Under Part III of the Regulations, the Minister of Health is empowered to authorize a local authority to adopt a distinctive mark for placing on carcases which have been inspected at the time of slaughter and found to be free from disease and fit for human consumption, and to approve the mark so adopted. Before giving authority the Minister will require to be satisfied that the local authority have an adequate and competent staff of inspectors, and that the criteria laid down in Memorandum 62 (foods) are being adopted. Certain difficulties would arise in putting this part of the regulacions in force, and as in the past most of the meat slaughtered in this district is made up into sausages and similar articles of food, | the Council did not deem it necessary to apply for a disrinctive mark. I do not think an application by the Council would be refused. |
4749ec14-0e8c-4b41-ba80-05914f709c3b | The details of the meat inspection carried out here are given on a subsequenc page, and compared with most districts, the inspection is a stringent one. This aspect of the question is an important one, and the value of meat marking will become more and more appreciated by the public. At the presenc time, it was not possible for the purchaser of a joint to distinguish between inspected and uninspected meat, and it is hoped that the demand for inspected meat will become more insistent and frequent by the public. Some retailers objected to " marking " because their customers thought meat so distin- guished was colonial produce, but in the present state of meat inspection in this country, the position might well be reversed, and the importer demand that his reasonably well-inspected product should be protected against the substitution of inferior and um'n- spected home produce. In last year's report it was stated that arrangements had been made for the inspection of all carcases slaughtered in the district. |
5a568956-13f7-40ba-bc63-24330217412b | The vast majority of the carcases are slaughtered in one slaughter- house, and the following particulars of the results are given in the following Tables:— 54 Number of Pigs' Carcases Inspected from 1st January to 31st December, 1925, with Analysis of Surrenders on account of Disease (Tuberculosis). 1925. No. of Carcases Inspected. No. of Heads Diseased. No. of Carcases Diseased. No of Sides Diseased. No. of Fore Quarters Diseased. No. of Hind Quarters Diseased. No. of Legs Diseased. No. of Shoulders Diseased. Plucks. (Lungs, Livers and Hearts.) ' Mesenteries, Stomachs end Intestines. ! Weights. Tons Cwts Qrs Lbs January 1617 112 3 1 - - - - 265 1936 lbs. |
f6706261-f77c-451c-a518-ce64db2833a1 | 1 0 1 20 February 1336 99 4 - - - - 4 119 1240 „ 1 11 0 22 March 773 68 3 - - - - — 92 720 „ 1 5 2 1 April 741 35 3 - 2 1 - — 76 624 „ 1 0 0 10 May 884 54 6 - — 2 - — 65 1120 ., 18 0 0 June 599 75 2 - 1 - - — 61 912 ,. |
d7957bed-05ef-40a3-bf2c-48c6d0e9e596 | I 3 3 22 July 643 65 3 - — — - — 78 896 „ 19 0 16 August, 876 46 5 - — — - 2 80 792 „ 19 1 19 September 1223 116 5 1 — 1 1 2 71 528 „ 1 17 0 19 October 1537 113 6 - — — 1 — 55 576 „ 1 12 2 11 November 1154 92 7 1 - - - 4 66 256 „ 1 19 3 4 December 1016 49 — - — — 2 — 51 176 „ 16 3 16 Total 12399 924 47 3 3 4 4 12 1079 9776 „ 15 4 0 20 55 Counties from which the Animals were consigned and Percentage Diseased. County No. |
76d0b9e6-26b1-46c8-8505-5d9ae1963c1c | of Towns from which Animals were consigned No. of Carcases Inspected No. of Animals Diseased Percentage of Animals Diseased Bedfordshire 1 25 12 48.0% Berkshire 1 40 11 27.5% Bucks 4 64 10 15.6% Cambridgeshire 3 364 11 3.0% Channel Islands (Guernsey) 1 3 0 - Cheshire 1 17 0 — Cork, Ireland 1 215 23 10.7% Derbyshire 1 24 2 8.3% Dorset 10 1,804 185 10.2% Essex 8 2,636 102 3.9% Gloucestershire 1 253 33 13.0% Hampshire 18 1,709 119 7.0% Leicestershire 1 147 24 16.3% London 1 82 21 25. |
6cf6314b-c4d9-487d-aaf8-7cc0e1c47a3d | 6% Middlesex 5 240 44 18.3% Norfolk 3 60 10 16.7% Oxford 1 30 2 6.7% Pembroke 1 28 — — Somerset 7 428 69 16.1% Suffolk 12 2,788 168 6.0% Surrey 4 323 21 6.5% Sussex 2 864 33 3.8% Warwickshire 1 34 — — Waterford, Ireland 1 30 5 16.7% Wiltshire 3 160 15 9.4% Yorkshire 3 31 14 45.2% Total 95 12,399 934 7.5% All the animals slaughtered belong to one firm, and the meat is converted mostly into sai.sages. The firm gives us every assist- ance in carrying out the work, and is in no way averse to the inspection. |
d29ddfe9-ad7b-43b7-82e4-5f2d9198a00e | But the firm does complain, and rightly so, that our 56 inspection is far more stringent than that carried out in sofne places and it is contended that some uniformity should be observed in the inspection. In March, 1922, the Ministry of Health issued a memorandum on a system of meat inspection, recommended for adoption by iocal authorities and their officers. This memorandum—No. 62—was based upon the report of the departmental committee appointed to consider the measures necessary to secure adequate protection for the health of the people in connection with the slaughter of animals and distribution of meat for human consumption. The memorandum gives detailed instructions for the routine inspection of carcases, but the instructions of most interest are those which refer to the action to be taken in the event of evidence of Tuberculosis being found in Bovines and Swine. An organ shall be seized when tuberculosis exists on its capsule, or in its substance, or in the associated lymph glands. |
3967f8f8-9294-402b-9e36-e2820c4abbdb | The head, including the tongue, shall be seized if any of the lymphatic glands of the head are affected. The entire carcase and organs shall be seized when the following conditions are found:— (a) Tuberculosis with emaciation. (b) Generalised Tuberculosis. (c) Lesions are multiple, acute and actively progressive. (d) Multiple and widespread infection of the carcase lymph glands, and certain other conditions. The directions given in the memorandum are carried out in this district and eyery effort is made to inspect the carcases and viscera of all animals slaughtered within the area. An endeavour has been made to ascertain the time required to carry out this inspection. Three of the Sanitary Inspectors have the meat inspector's certificate, and the same Inspector does not carry out all the inspections. Most of the inspection, though, is carried out by Mr. Kinch, the Chief Sanitary Inspector. |
efe36472-8fe3-428e-8106-da15986ba39d | The 57 Inspectors are accompanied by a man who is used to the procedure, and thus the time which the Inspectors spend in inspection is economised Roughly, about 60 per cent, of the time of one; inspector, together with that of the man who accompanies him, is taken up with inspection from September to March, and about 35 per cent, of their time during the summer months. Every endeavour is made to carry out strictly the instructions of the Ministry of Health, as laid down in Memorandum 62. This strict inspection has had unfortunate results. Complaint was made that the high percentage of organs and carcases condemned affected their trade adversely. Traders were diverting the supply of pigs to other manufacturers whose slaughterhouses were situated in districts where the inspection was less stringent Two specific instances were given. In one instance, the firm slaughtered over 24,000 pigs every year. |
d123aa47-154b-46ed-9230-9db4135f8f3e | Last year in this slaughterhouse, the Sanitary Inspector who is also the Borough Surveyor devoted an average of three quarters of an hour three times a week for the inspection. If I give some of the instructions in Memorandum 62, it will be seen how utterly inadequate such an inspection must be. The Memorandum lays down that every effort should be made to inspect the carcases and viscera of all animals slaughtered within the area. All viscera shall be examined as they are removed from the carcase, or in such circumstances as will ensure that they are the viscera of a particular carcase. Every organ and the associated lymph glands shall be examined by the eye and by palpation. When any abnormal condition is observed, the nature and significance of which cannot be determined, the organ or gland shall be incised. The efficient examination of lymph glands shall be by multiple incisions into their substance. |
5cba0e8f-500f-413b-bab1-821797f54779 | The carcase shall be examined for condition of nutrition, evidence of bruising, dropsy, efficiency of bleeding, and swellings or deformities. The pleura and peritoneum shall be examined in every case, and in no case shall they be removed nor shall any evidence of disease be modified or obliterated by washing, rubbing, stripping, or in any other manner before examination. This examination is presumed to be carried out on about 460 carcases in 2¼ hours. The whole inspection is, of course, totally inadequate ; it might be said to be non-existent. 58 The slaughterhouse where this inadequate inspection takes place belongs to one of the largest sausage manufacturers in the country. The inspection of the carcases of pigs should be particularly stringent, as it is well known that the cooking of sausages is generally light and does not res alt in the sterilization of the meat. |
b9ad0ecc-6857-4be9-bbb6-34903a63a780 | I have brought these facts to the notice of the different authorities, and it is some satisfaction to know that certain proposals have been made by the firm for the more efficient inspection of the meat. Another firn>'s name was gives to winch pigs had been diverted. This firm also controls some of the largest sausage manufactories in the kingdom. Although the inspection carried out here is done by veterinary inspectors, the inspectors are employed by che firm, and the percentage of pigs condemned for tuberculosis is extre nely low. The following figures show the results of inspection in one particular week. There were 1,426 pigs slaughtered, no carcases were cordemned, but 3 beads, 16 lungs, 16 livers, 7 stomachs, 8 spleens, and 9 intestines. The loss resulting from the destruction of the lungs, livers, stomachs, spleens and intestines is not very considerable and may be ignored. The important articles are the carcases and the heads. |
0b2083cc-3e10-4418-9292-0c4530c0892c | The proportion condemned in this slaughterhouse would be no carcase per 1,000 compared with 4 per 1,000 here, and 2 heads per 1,000 compared with 74 per 1,000. If a comparison be made with the results in public abattoirs, it will be found that these percentages of condemnations are far too low to assume that efficient inspection is carried out. Unless some uniformity of inspection can be obtained, there is a danger that the pigs will be diverted into districts where inspection is either inefficient or non-existent. We have strong grounds for suspecting that illicit slaughtering does take place on a considerable scale, even in districts quite close to London. 59 Stalls.—The requirements of this part of the Regulations are designed to ensure that meat is exposed for sale from stalls under satisfactory conditions. |
7a265b43-6654-4b88-b888-c23e7c034516 | There was only one stall in the district, and that has now been removed, but the fact that this stall existed caused more discussion and unpleasantness than the remaining regulations, because a distinction is made between stalls and shops. Shops, Stores, Etc.—Part V of the Regulations deals with the cleanliness of meat in shops. The regulations contain provisions for the protection of meat against contamination by dirt, flies, etc. Section 20, Sub-section 5(a) is the particular sub-section around which discussion has been raised and feelings aroused. The subsection reads as follows:— The occupier of any such room (in which any meat is sold or exposed for sale) shall take such steps as may be reasonably necessary to guard against the contamination of the meat therein by flies and shall cause the meat to be so placed as to prevent mud, filth, or other contaminating substance being splashed or blown thereon." |
d2cb3b46-9b4a-45b8-b578-81eadfdfa249 | The Health Committee met the butchers on several occasions and invited suggestions from them, so that some uniformity of action might be taken. The Committee and the butchers were agreed that there were some practices which do not lend themselves to control, and in regard to which, improvement could only be effected by the force of an educated public opinion An instance of this is the common practice of handling meat before purchase. The butchers are the greatest sufferers in this respect, and they asked the Council to issue notices against this practice, and the notices were exhibited in all the shops. An improvement has already been noticed, and this practice, it is hoped, will fall entirely into disuse. No agreement, though, was reached as to the means which should be adopted to prevent contamination by flies and the splashing of mud. The subsection is vague, and righ.ly so, and it would be unreasonable to insist upon some detail of construction which would be applicable to every district. |
a0bd2679-a217-487e-9eca-76d56bc6a7dc | 60 A great point was made that the Ministry of Health had expressed an opinion upon this point and that a glass front should not be insisted upon in every instance. Buc in a busy street with a narrow pavement, the avoidance of splashing of mud and the blowing of dust on to the meat is practically impossible unless a glass front be provided. Bat some of the butchers failed to appreciate less precautions than a glass front. They had been so used to expose meat on the outside of the shop, that no argument was of ar.y avail. Although the Council was loth to prosecute, preceedings had to be taken under this section against one of the butchers. Several warnings were issued, but were unavailing. The butcher was fined 20s. and two guineas costs. In the enforcement of these regulations again, there are . complaints of a want of uniformity on the part of local authorities. |
808bbb50-a3d7-4f9b-8cb1-3dccbcd572b8 | It is reasonably resented by butchers that in a neighbouring area, meat is exposed outside the premises with impunity, and no attempt is made to enforce the regulations. No one wishes co argue that the regulations are perfect, but it is only by a proper enforcement of them that the way is made clear to secure an improvement in the general conditions under which meat is treated before it reaches the public. A start must be made somewhere, and these regulations do call attention to the underlying principle that the great object is to prevent contamination, not only of meat, but also of all food stuffs. Transport and Handling.-—Regulation 21 deals particularly with the vehicle used for transporting meat and sets out the requirements. As far as this district is concerned, this section is not a difficult one, and we are principally concerned with the delivery of the meat by the retailer to the consumer. The delivery of the meat by the wholesaler to the retailer is dealt with by other Authorities. |
70d9b27e-7d71-4a13-9c65-d8ba495986b4 | The van has to pass the City Authorities as most of the meat consumed here is bought at Smithfield Bakehouses.—There are thirty-two bakehouses in the district; , seven of these are underground bakehouses and were in use before the passage of the Factory Act of 1901. Very frequently these bakehouses have been placed underground when there was plenty of room to erect the building above the surface of the ground. 61 It is curious what a predilection our forefathers had fof Underground bakehouses. From a sanitary point of view, there is no comparison between the two types of building. An underground bakehouse is dark and difficult to keep clean and in some, artificial light has to be used in the day. The only point in favour of the underground bakehouse which I heard from its occupants is the fact that it is easier to keep it at an equable temperature. When the dough is made it is placed in a wooden receptacle for some time and fermentation takes places. |
34231acb-175a-4e1c-9bac-a9f1a4582e7c | In order to obtain the best results, a warm equable temperature is necessary, and this is secured, according to the advocates of the underground bakehouse, more easily where no dcors lead directly from the open air to the baking-room. The intractable and relapsing skin eruptions sometimes asso- dated with the baking and confectionery trade have recently;, attracced considerable notice in both the medical and lay press, and according to the report of the Conference of operative Bakers and Confectioners held last August, the Secretary of their Union stated that there were twenty cases of baker's dermatitis to-day where only one existed a few years ago. This statement may be true of some districts, but it certainly is not true of London and Greater London. I have made careful inquiries about the health of the bakers in this district, and I came across only one man who suffered from dermatitis or eczema. Over 200 men are employed in the baking of bread and pastry in the district. |
15454534-5cfb-48e8-8bcc-b02aeb869ecb | I have recently come across cases , of dermatitis in other occupations than bakers, and many authorities group all these eruptions under one generic term—occupational dermatoses. In a discussion which took place at the Royal Society of Medicine in April, 1925, the view was generally expressed that there is no eruption specific to, or distinctive of, the industries of bakers and confectioners. Evidence suggests strongly that the majority of these cutaneous' disorders were incidents rather than consequences of the work. This statement is combated by Dr. Mummery, the Medical Officer to Messrs. Lyons' employees at Cadby Hall. He thinks that there is a definice dermatitis to which persons engaged in factories manufacturing bread and confectionery are liable. To what part of the process the disease is due is doubtful. Sometimes the disease is called " Baker's Itch," but mites are rarely found in English milled flour. |
be6facbc-a127-40f0-9d77-7b4f5669c669 | 62 A great Improvement has recently taken place in the conditions Under which bread is made, and this is due to the fact that in most bakehouses, mechanical mixers have been installed. In all but thr akehouses in Acton, the kneading is now mechanically done, abolition of hand kneading has not only conduced to cleanliness, but hadsuced the prevalence of dermatitis. When hand kneading was in vogue, it was a common occurrence to see caked dough on hands and forearms, and hours might elapse before the baker would wash. It was not a pleasant sight in former days to see a bacer over the wooden mixing trough on a hot summer afternoon with beads of perspiration on his forehead and face. With hand kneading a sack of flour would take about three quarters of an hour to mix. Although it is pleasing to report a great improvement in the conditions, in some of the bakehouses, there is still room for farther improvement. |
c2408f24-700f-4db6-a9fe-8223aba62b61 | I admit the difficulties which exist in underground rooms, but such matters as the prohibition of cigarette smoking, ect. might be taken into consideration. Milk Supply,—There are 85 dairies and milkshops on the register. This number is three less than in 1924. The diminished number is due to the refasal to register persons who kept general shops. When the Dairies Act of 1922 came into force, the coUncil decided that it would not register any person who kept a general shop, but did not refuse to register those who were at that feriod selling milk. On any change of Occupation of general shops, the Council refuses to register the new occupier. Twenty-two of the registered purveyors have shops and rounds, ' eight have: shops without rounds, thirteen have rounds only, four are primarily caterers of food, and thirty-eight have general shops. |
e846a431-d2b5-4bad-921c-b84f0e9fa28c | Under the Milk (Special Designations) Order, 1922, eleven licenses were granted for the sale of Certified Milk, ten for the sale of Grade A (Tuberculin Tested) Milk, and eight for the sale of pasteurised milk. Certified " Milk must comply with the following conditions. every cow must be examined by a veterinary surgeon once in every three months and tuberculin tested once in every six month. the milk must be bottled at the farm and the milk mast not be removed from the bottles before delivery to the customer. A Perof the milk must not contain more than 30,000 bacceria per cubic centimetre nor any bacillus coli in one-tenth of a cubic centimetre. 63 The milk shall not at any stage be treated by heat. " Grade A " milk must comply with the following conditions. The cows must be examined once in every three months by a: veterinary surgeon. |
e0d32c66-7072-4ecc-97e6-5ebe50f2008a | The milk must be delivered in bottles or in containers of not less capacity than two gallons. A sample of the milk must not contain more than 200,000 bacteria per cubic centimetre nor any bacillus coli in one-hundredth of a cubic centimetre. " Grade A (Tuberculin Tested) " Milk must comply with the following additional condition. The cows must be tuberculin tested by a Veterinary Surgeon once in every six months. '* Pasteurised " Milk must comply with the following condition. The milk shall be pasteurized, that is to say, retained at a temperature of not less than 145° and not more than 150° Fahrenheit for at least half an hour, and be immediately cooled to a temperature of not more than 55° Fahrenheit. The milk shall not be so heated more than once and shall not be otherwise treated by heat. |
81e02cb5-91e3-476e-9321-de57884541bd | A sample of milk must not contain more than 30,000 bacteria per cubic centimetre, nor any bacillus coli in one-tenth of a cubic centimetre. Although in the summer months, especially, most milk sold in this district has been heated, from a public health point of view, the term " pasteurization " should be confined to the process of heating to not less than 145° F. and not more than 150 F. for a period of thirty minutes. When milk is treated in this way, no appreciable change takes place in the milk proceins. If ordinary raw milk is allowed to stand, the cream gradually rises to the top and a line of demarcation appears between the cream and the remainder of the milk. This layer of cream, sharply demarcated from the rest of the milk, is known as thp cream line When milk is pasteurized at 145° F. for thirty minutes, the cream line is hardly at all affected. |
a3913c2c-4d11-4d71-bccc-248d605ade13 | The cream line, however, is affected above this temperature; the cream rises slowly and imperfectly and in milk pasteurized at 148° F. the cream line may be decreased by 40 per cent. 64 We frequently have complaints that milk is deficient in fat, but invariably when a sample is taken, the milk is found to Contain more than the legal minimum of 3 per cent, of cream. The effect of pasteurization on the vitamins in milk is important. Milk contains three vitamins—the fat soluble A vitamin, the water soluble B vitamin, and the anti-scurvy vitamin C. The two former have a relatively high resistance .to heat so that pasteurization has Practically no effect upon them. The anti-scurvy vitamin C, however, is sensitive to heat above 122° F., and there seems to be little doubt that pasteurization at 145° F. for thirty minutes Weakens the anti-scorbutic property of milk. |
bfdffa8d-3b77-4285-8c15-cf0c71b69ff8 | The ideal milk, of course, would be that obtained from perfectly healthy cows under the cleanest conditions and consumed immediately with the least possible manipulation or handling, and certified milk complies with. these conditions, but the cost of Producing such a milk places it beyond the reach of most people. The great advantage of pasteurization is that it confers its benefits without any serious disadvantages such as appreciable impairment of appearance, taste, flavour, or nutritive value. It is generally admitted that a great improvement has recently occurred in the conditions under which milk is being produced and distributed. Not only is the milk cleaner, but adulteration is far less frequent than it used to be. The result is seen in the increasing consumption of raw milk. Five years ago, dried milk was rapidly puscing raw milk, especially in infant feeding. But there are Hidications that liquid milk is gaining in popularity, and the sale of dried milk is not advancing and increasing to the extent which it did a decade ago. |
04240bde-b4d9-408f-96ea-31a19720054f | A great deal of propaganda work for the increasing consumption °f milk has been done, but it was pointed out by Medical Officers °f Health that the best means of propaganda was by the production °f a cleaner and purer article. It is admitted that milk is not only a valuable food, but also a cheap one, and for young children it was almost indispensable. But so long as the conditions under which it was produced and distributed were unsatisfactory, the increasing use of milk could not be expected. The conditions have improved, and the money spenc on the improvement is proving a good investment to those concerned. 65 Food Analysis.—List of samples taken during the year endec :31st December, 1925, kindly supplied by Mr. Robinson. Chie: Otlicer, Public Control Department, Middlesex County Council Article. Taken Adulterated. |
92fcca9c-796c-42ac-ab3e-08fcc2149bb9 | Milk 308 4 Cream 5 2 Butter 5 — Cocoa 1 — Corn Flour 2 — Cream of Tartar 1 — Egg Powder and Egg Substitute Powder 2 — Ground Almonds 1 — Mustard 1 — Prescription 1 1 Sweets 4 — Vinegar 4 — Whisky 1 — White Precipitate Ointment 1 — 337 7 The figures given for adulterated samples include soma adulterated informal samples in respect of which no proceedings could be taken. 99 TABLE I. COMPARATIVE RATES OF MORTALITY FOR THE YEAR 1925. 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 and Enteritis under 2 yrs. |
4ca2c3c6-1898-420e-86fe-9cbe29a1dcd9 | Total deaths under 1 year Causes of Death certified by Registered Medical Practitioners Inquest Cases Uncertified Causes of Death England and Wales 18.3 12.2 0.01 0.00 0.13 0.03 0.15 0.07 0.32 0.47 8.4 75 92.1 6.9 1.0 105 County Boroughs and Great Towns, including London 18.8 12.2 0.01 0.00 0.17 0.03 0.18 0.09 0.30 0.43 10.8 79 92.1 7.3 0.6 157 Smaller Towns (1921 Adjusted Populations 20,000—50,000) 18.3 11.2 0.01 0.00 0.15 0.02 0.14 0.06 0.31 0. |
4fa19981-1524-4381-b14b-5a98893be869 | 38 7.6 74 93.0 5.9 1.1 London 18.0 11.7 0.01 0.00 0.08 0.02 0.19 0.11 0.23 0.46 10.6 67 91.1 8.9 0.0 Acton 16.5 10.6 .016 0.00 0.00 .016 0.12 .016 0.17 0.2 10.4 76 93.4 6.6 0.0 67 TABLE 2. VITAL, STATISTICS FOR WHOLE DISTRICT DURING 1925 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 Under 1 year of Age At all Ages Nett Number Rate Number Rate of Non-Residents Registered on the District of Residents Registered outside Dist. |
c1d9441d-1dc2-4974-b496-d7afc3496525 | Number Rate per 1,000 Births Number Rate per 1,000 inhabitants 1920 61,000 1541 25.3 560 9.2 16 217 100 64 671 11.0 1921 62,000 1314 21.1 445 7.1 — 205 92 70 658 10.4 1922 62,390 1203 19.3 404 6.5 14 214 75 62 632 10.1 1923 62,720 1171 18.6 368 5.8 11 243 77 65 599 9.5 1924 62,980 1158 18.4 488 7.7 8 235 65 56 715 11.2 1925 63,110 1047 16.5 446 6. |
9f0fc226-cc39-40dd-9a21-090d15662009 | 8 18 241 80 76 669 10.6 68 table 3. AGES AT DEATH, AND WARD DISTRIBUTION OF DEATHS IN 1925. Causes of Death Ages. Wards. 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 Enteric Fever 1 – – – – – 1 – – – – 1 – Scarlet Fever 1 – – – – – 1 – – – – 1 – Whooping Cough 8 2 4 2 – – – – – 2 2 1 3 Diphtheria 1 – – – 1 – – – – – – 1 – Influenza 11 – – 1 – 1 1 2 6 4 3 3 1 |
57cd7a3d-0dd2-4dd6-9650-e2ff120bfaca | Meningoccal Meningitis 1 – – – 1 – – – – 1 – – – Pulmonary Tuberculosis 47 – – – – 12 25 9 1 10 5 11 21 Other Tuberculous Diseases 10 2 2 2 1 – 2 1 – 2 2 2 4 Cancer 79 – – – – – 6 39 34 22 17 24 16 Rheumatic Fever 3 – – – 1 – – 1 1 – – – 3 Diabetes 9 – – 1 – – – 4 4 4 – 3 2 Cerebral Hemorrhage 39 – – – – – – 17 22 9 11 8 11 Heart Disease 86 – – – 1 7 7 29 42 24 19 13 30 Arterio Sclerosis 9 – – – – – – 3 6 3 2 2 |
14a54043-039e-4823-a558-8f6962cfbfd5 | 2 Bronchitis 63 4 – – – – – 17 42 15 14 12 22 Pneumonia (All Forms) 52 13 3 4 3 2 3 12 12 13 6 12 21 Other Respiratory Diseases 3 – – 1 – – – 1 1 1 – – 2 Ulcer of Stomach or Duodenum 6 – – – – – – 3 3 2 – 3 ] Diarrhoea (under 2 years) 11 10 1 – – – – – – 2 – 4 5 Appendicitis and Typhilitis 4 – – – 1 – 2 1 – 2 2 – – Cirrhosis of Liver 5 – – – – – – 3 2 2 1 1 1 Acute and Chronic Nephritis 17 — — — — 2 1 5 9 7 4 |
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