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e7713bb1-a646-4f53-9c51-2d7a67ac00e4 | Number of Private Families occupying the following number of rooms. 1 2 3 4 5 6 & 7 8 & 9 10 & over 1. 406 146 133 66 31 57 17 — 2. 286 461 732 447 251 385 125 27 3. 160 410 900 612 355 589 219 50 4. 65 188 737 576 405 588 271 57 5. 12 91 563 386 305 462 160 41 6. 5 44 353 268 214 301 130 39 7. 1 25 213 171 134 176 74 17 8. 1 11 112 100 82 130 45 18 9. 1 5 48 52 48 69 18 13 10. |
d3195368-8077-4e65-952d-21012080a966 | — 1 25 29 33 38 10 10 11. — 1 7 18 15 16 5 2 12. — 1 3 1 3 4 – 5 13. — — 1 1 4 7 – – 14. — — — — 1 2 – – 15 &over — – – – – – – – From this table it will be seen that on that basis, 255 out of a total of 916 1-roomed tenements were overcrowded; 178 out of 1,383 2-roomed tenements were overcrowded; 409 out of 1928 13 3,827 3-roomed tenements and 101 out of 2,727 4-roomed tenements were overcrowded. |
28d2a980-c7a5-4f7d-a1ea-769ce809971f | The conditions probably have not improved since the Census, as a recent inspection of a certain road in the South East Ward shows that in regard to 31 houses (each consisting of 6 rooms—a front living room, a middle room and kitchen on the ground floor, and three bedrooms on the first floor) five of the houses had 12 inhabitants each and 10 had more than 12 inhabitants each. The particulars of the 10 which had more than 12 inhabitants each, are as follows:— No. Adults. Children. No. Adults. Children. 2. 9 7 15. 9 4 6. 10 3 17. 11 3 16. 9 5 21. 10 4 26. 10 3 28. 10 4 36. 7 6 38. |
885c5d51-d20b-4856-b502-da4f73bc51cf | 9 4 A more correct standard of overcrowding is that based upon the cubic capacity of each room in the house, and the number of inhabitants in each room, but this standard, which has been used in the framing of Bye-Laws regulating houses let in lodgings, varies in different districts. The Royal Commission on Housing the Industrial Population of Scotland in their report recommended that 500 cubic feet per adult and 250 cubic feet per child under 10 years of age be adopted as a general standard in cottage property. If one assumes that a bedroom is 8 feet high, this would require 62½ sq. ft. per adult, a figure which closely approximates to that which has been found during the past half-century to be a sufficient standard for barracks. In the Bye-Laws adopted in this Borough with respect to Houses let in lodgings or occupied by members of more than one family, 400 cubic, feet of free air space must be allowed in any room which is wholly or partly used as a sleeping room. |
ed06c371-7eee-4092-87b6-a83e8481099a | But during the operation of the Rent Restriction Acts, the amount of air space has been reduced to 300 cubic feet per adult and 150 cubic feet per child. We use the latter figures as a basis for our work in overcrowding. Cases of legal overcrowding do frequently come under the notice of the Inspectors. Every effort is being made to remedy the nuisance, and in some of the worst cases, legal notices are served. But the abating of overcrowding by mere service of a statutory notice has been difficult and frequently futile. There is a re-shuffling of the accommodation, but the old conditions frequently recur. 1928 14 TABULAR STATEMENT OF INSPECTIONS & DETAIL OF WORK CARRIED OUT BY THE SANITARY INSPECTORS. Number of Inspections and Action Taken. |
24a17381-1928-489d-9a38-20d628092692 | Total number of dwelling houses inspected for housing defects (Under Public Health or Housing Acts) 974 (1) Dealt with by service of Informal Notice 528 (2) Dealt with by service of Statutory Notice under Section 3, Housing Acts 228 (3) Dealt with by service of Statutory Notice under Public Health Acts 186 Premises (other than defective dwelling houses) inspected for nuisances and miscellaneous defects 1005 (1) Dealt with by service of Informal Notice 882 (2) Dealt with by service of Statutory Notice under Public Health Act, &c. 123 Reinspections subsequent to service of Notice 7622 Enquiry visits on notification of Infectious Disease 410 Number of Premises under Periodical Inspection. |
dfaf6423-729b-420e-a34c-cea3d805daf0 | Workshops and Workplaces 148 Bakehouses 29 Slaughterhouses 2 Public Health Urinals 37 Common Lodging Houses 1 Houses-let-in-lodgings 28 Butchers Shops 42 Fish Shops 28 Premises where food is manufactured or prepared 33 Milk Purveyors 61 Cowsheds Nil Piggeries Nil Rag and Bone Dealers 6 Mews 4 Schools 11 Show Grounds Nil 42 Rent Restriction Act. Number of Certificates granted 10 Number of Certificates refused 1928 15 Detail of Work carried out. |
586f1c82-1de7-4d57-9f9d-1969d56862d5 | Sanitary Dustbins provided 534 Yards paved or yard paving repaired 162 Insanitary forecourts remedied 68 Defective drains repaired or reconstructed 55 Defective soil pipes and ventilating shafts repaired or renewed 96 Defective fresh air inlets repaired or renewed 72 Defective gullies removed and replaced by new 85 Rain water downpipes disconnected from drain 27 Dishing and curb to gullies repaired and new gratings fixed 182 Defective W. C. pan and traps removed and replaced by new 76 Defective W.C. flushing apparatus repaired or new fixed 407 Defective. W.C. |
151ea45f-371b-44a1-bfc3-c914cbaf2c20 | seats repaired or new fixed 133 Defective flush pipe connections repaired 104 Insanitary sinks removed or new fixed 123 Sink waste pipes repaired or trapped 182 Insanitary wall surface over sinks remedied 161 Ventilated food cupboards provided 6 Drinking water cisterns cleansed 259 Defective covers to drinking water cisterns repaired or new fixed 63 Insanitary sites beneath floors concreted 12 Spaces beneath floors ventilated 147 Dampness in walls from defective damp-proof course remedied 132 Dampness from defective roof, rain water gutterings, etc., remedied 738 Defective plastering repaired (number of rooms) 722 Rooms where dirty walls and ceilings have been cleansed and redecorated 3744 Defective floors repaired 178 Defective or dangerous stairs repaired 35 Defective doors and windows repaired 352 Defective kitchen ranges and fire grates repaired 271 Defective washing coppers repaired 137 Coal cupboards provided and repaired 26 New W.C. |
8255616a-40eb-42b0-a1c5-077e1577ba20 | apartments provided 9 Accumulations of offensive matter removed 34 Drains unstopped and cleansed 229 Overcrowding nuisances abated 13 Drains tested, exposed for examination, etc 87 Smoke observations taken 192 Smoke nuisances abated on service of notice 6 Nuisances from pigs and other animals abated 10 Notifications of waste of water sent to Metropolitan Water Board 315 1928 16 INSPECTION AND SUPERVISION OF FOOD. Milk Supply. There are 79 dairies and milkshops on the register. There are at present no cowsheds in the Borough, and all the milk is produced outside the district. We are entirely concerned here with the distribution of milk. One of the most important changes in the distribution of milk has been the extension of the sealed bottle system of distribution. There is no doubt that this change has been entirely for the good. |
befaa8cb-9182-4e43-aa2e-897ef8ced2a2 | In many of the milk-shops and dairies, other goods besides milk and butter are sold, and the storage of the milk in bottles conduces towards cleanliness. This mode of delivery also obviates the danger of contamination in the streets. It is far more hygienic than the old method of supplying the milk into a jug from a churn in the street. It has also finished the constant complaints of short measure with which we were familiar in the old days. Meat Inspection. There are two slaughter-houses in the district: in one of these pigs alone are slaughtered, and in the other no pigs are slaughtered. The following tables give the total amount of unsound food surrendered and the carcases of pig's inspected, etc. table i. UNSOUND FOOD SURRENDERED DURING 1928. Diseased Meat. Tuberculosis. Pigs. 14 Carcases and Heads. 1 Foreleg. 194 Heads. 1 Shoulder. 5 Forequarters. |
2c82ab8a-3817-474e-bb56-7cddb2ca9338 | 122 lbs. of Pork. 5 Legs. 116 Plucks. 1 Loin. 1851 lbs. Chitterlings. Bovines. 7 Cows Carcases with offal. 4 Rumps. 3 Calves' ,, ,, ,, 2 Middle Ribs. 15 Forequarters. 71 sets of Lungs. 25 Stirks' Heads & Tongues 56 Livers 1 side of Beef. 62 Hearts. 9 Loins. 2 Stirks' Kidneys. 2 Flanks. 1 Tripe. 4 Briskets. 1 Mesentery 6 Skirts. 1 Bullock's Offal. 1928 17 Parasites. Bovines. 1 thick Skirt of Beef. 5 Hearts. 40 Livers. 1 Kidney. 9 sets of Lungs. Sheep. 2 Sheep's Heads. 248 Livers. 582 sets of Lungs. 20 Hearts. |
3db552d1-07de-45d1-bac0-804c29cffc49 | Pleurisy. Bovines. 3 Forequarters of Veal 1. 21 sets of Lungs. 1 Hindquarter of Veal 21 Hearts. 11 Breasts of Veal. 8 Livers. Sheep. 1 Forequarter. 5 sets of Lungs. 12 Breasts. 5 Livers. 2 Necks. 5 Hearts. Abscess. Bovines. 3 Calves' Heads. 25 Livers. 2 Loins of Veal. 9 Hearts. 4 lbs. of Veal. 9 sets of Lungs. Bruising. Bovines. 2 Flanks of Beef. 1 Knuckle of Veal. 2 Shoulders of Veal. 2 Loins of Veal. 1 Hindquarter of Veal I. 27 lbs. of Veal. Sheep. 1 Side. 1 Forequarter. Actinomycosis. |
80a705a0-ea97-49d6-b7e8-c77f2de2c76a | 11 Ox Heads and Tongues. Nephritis. Bovines. 12 Kidneys. 2 sets of Lungs. Sheep. 2 Kidneys. Congestion. Bovines. 1 Forequarter of Veal. 2 Livers. 2 sets of Lungs. 1 Heart. Sheep. 1 Sheep's Carcase with h Offal. Cirrhosis. Bovines. 15 Livers. Moribund. Bovines. 1 Cow's Carcase with offal 7 Calves' Carcases with Offal. Sheep. 1 Lamb's Carcase with Offal. 1928 18 Pyaemia. Bovines. 1 Calf's Carcase with offal. 2 sets of Lungs. 2 Livers. 2 Hearts. Bacterial Necrosis. Bovines. 2 Livers. Arthritis. Bovines. |
3be26680-ed43-4d7c-88a8-888b65f732aa | 2 Shoulders of Veal. Sheep. 1 Shoulder. Died in Transit. 1 Cow's Carcase with offal. 3 Calves' Carcases with offal. Died. 3 Calves' Carcases with offal. Melanosis. Bovines. 1 set of Lungs. 1 Heart. 1 Liver. Cystic. Bovines. 1 Kidney. • Fractured. Bovines. I Leg of Veal. Cai'ernous Angioma. Bovines. 1 Liver. Pneumonia. Bovines. 1 set of Lungs. Pleurisy & Dropsy. Sheep. 1 Carcase with Offal. Pleurisy & Jaundice. Bovines. 1 Calf's Carcase with OfTal. Pleurisy & Tuberculosis. Bovines. |
b29be620-3d25-4f48-a948-15409f1a89e9 | 1 set of Lung's. 1 Heart. 1 Liver. Pleurisy & general Lymphadenitis with Emaciation. 1 Calf's Carcase with Offal. i Other Foods. Unsound. 6 stones Plaice. 6 stones Skate wings. 7 stones Dogfish. 11 Tins Brawn 19 1928 TABLE II. NUMBER OF PIGS' CARCASES INSPECTED FROM 1st JANUARY TO 31st DECEMBER, 1928, WITH ANALYSIS OF SURRENDERS ON ACCOUNT OF DISEASE (TUBERCULOSIS). 1928 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. |
969eb218-0b01-4a4e-82cf-164933ed3683 | of Shoulders . Diseased. Plucks (Lungs, Livers and Hearts). Mesenteries, Stomachs and Intestines Pieces of Pork, Weights Tons Cwts. Qrs. Lbs January 1023 22 2 — — • — — 1 11 128 lbs. 8 lbs. 8 3 6 February 660 5 – – – – – – 5 104 „ 8 „ 3 8 March 810 14 — — — — — - 6 96 „ 49 „ 2 14 April 889 12 2 — — — — – 5 96 , – 5 3 26 May 907 13 — — — — 1 — 4 96 , 40 „ 2 0 12 June 802 15 1 — 3 1 — – 8 120 „ 40 , |
c3082d1e-339c-4959-a01d-b3bf1776f55a | 0 0 0 July 729 20 2 — 1 — 3 – 10 192 , 17 „ 8 3 13 August 961 19 2 — — — 1 — 4 112 „ – 11 2 14 September 1393 12 3 – – – 2 1 16 26 „ 7 21 October 1780 30 5 – – – 1 – 13 232 , 85 „ 13 1 i 14 November 1859 19 2 – – – – 1 15 280 , 85 „ 10 X 5 December 1528 10 2 — — . — — – 12 240 ,, 35 „ 3 3 17 Total 13341 191 19 – 4 1 8 3 109 1824 „ 340 „ 3 19 3 10 Part sent to refuse destructor. |
e41a122c-b025-408e-9fea-e2704ac7f6fe | 1928 20 TABLE iii. Counties from which animals were consigned, and percentage diseased (1st Jan.—31st Dec. 1928). County No. of Towns from which Animals were consigned No. of Carcases Inspected No. of Animals Diseased Percentage of Animals Diseased Berkshire 2 129 — — Bedfordshire 1 47 — — Buckinghamshire 5 45 — — Cambridgeshire 7 657 10 1.52% Dorsetshire 6 2628 68 2.59% Essex 3 417 6 .14% Gloucestershire 3 269 8 2.97% Hampshire 15 1214 20 1.64% Hertfordshire 3 - 19 — — Huntingdonshire 2 43 — — Ireland 2 742 10 1.35% London 1 82 — — Middlesex 14 683 8 . |
47b0e2d4-f3bc-45ba-a769-1d826702bc5b | 1.17% Norfolk 15 1206 18 1.49% Nottinghamshire 1 12 1 8.33% Somerset - 6 780 30 3.84% Staffordshire 1 10 — — Suffolk 15 3482 29 .83% Surrey 8 178 1 .56% Sussex 2 239 8 3.35% Warwickshire 1 440 4 .91% Wiltshire 3 19 — — Total . 116 13341 231 1.73% BIRTHS. Table VII. gives particulars of the births registered and notified in the district, and the births belonging to the district which have occurred and been registered outside the district. The total number of deaths are those registered during the calendar year and are corrected for inward and outward transfers. The birth-rate was 15.4 per 1000 inhabitants, and it was 7 per 1000 lower than that of 1927. |
0978702a-4114-48ad-bcbc-8c0d9394e72e | With the exception of the two war years 1917 and 1918, it is the lowest birth-rate on record. 1928 21 44 children were born out of wedlock, which number corresponds to an illegitimate birth-rate of 4.3% of the total births. On the whole it may be stated that the Notification of Births Acts work satisfactory. Only 12 births were registered in the district which had not been previously notified. DEATHS. 479 deaths were registered in the district; of these 29 were of non-residents. 244 deaths of residents occurred outside the district. The total number of deaths belonging to the district is 694, which corresponds to a death-rate of 10.7 per 1000 inhabitants. The death-rate was lower than that of 1927, and also lower than the death-rate of England and Wales and of the 107 large towns. Ward Distribution. North—East. North-west. South—East. |
a8698ece-d03a-49be-b1a3-1eb22cee2be4 | South—West. 195 159 143 197 Death-rate of each Ward. 10.3 11.7 9.5 11.2 Among the causes of death which show an increase, one of the most prominent is Cancer. Last year Cancer was given as the cause of death in 104 instances—41 males and 63 females. It is now generally assumed that Cancer is becoming more frequent, but certain important relevant factors must be taken into consideration, otherwise false ideas of the extent of the increase of the disease may lead to unnecessary alarm and anxiety. In last year's annual report it was shown that the average age at death is now much higher than it was twenty years ago. As a result of this we have a much larger proportion of elderly people in the population. Most of the Cancer deaths occur at or after middle life, so that one result of the resultant longevity would be a larger proportion of people who would be particularly liable to be attacked by Cancer. |
abce7fdb-4018-4b2b-ada7-d2e5345aea87 | Besides, modern methods of diagnosis probably result in Cancer being inserted as the cause of death in an increasing number of cases. It is difficult therefore to estimate accurately the increase, if any, that now is taking place in Cancer. It is reassuring to find the London County Medical Officer of Health calling attention to the fact that there had been an actual decrease in Cancer mortality in London during the past 10 years among women, and such decrease is worthy of the consideration that has been given to it, as London is in advance of the rest of the country in respect of facilities for diagnosis. As these facilities 1928 22 become better known, and people come to know of them, the fear of consulting a doctor may cease, and we may hope that on the development of any symptoms which may point to a possibility of Cancer, the sufferer will at once seek medical advice. Other diseases which show an increase are diseases of the heart and blood vessels, and old age. But the cause of death in all these is largely a matter of classification. |
375473e7-4fe8-4086-b5a1-96e01b51c9fd | In the majority of cases of deaths from heart disease in old people the cause is a degenerative one. In young people heart disease is usually due to a preceding attack of acute rheumatism, but in old people it is a degenerative change. Diseases of the arteries or arteriosclerosis and apoplexy or cerebral hæmorrhage are also intimately connected since arterial disease is a necessary precursor of the rupture in the brain which constitutes the apoplexy. Old age itself comprises a group of degenerative processes with, frequently enough, no pronounced disease. It is naturally a very indeterminate term. On Table I. are given the deaths upon which an inquest was held or the Coroner issued a certificate after a post-mortem examination had been held. One of the deaths reported to the Coroner, and where a post-mortem examination was made is important, on account of the prominence which this disease has attained and its bearing on the question of vaccination. |
e93eb838-86ba-4909-b640-b7fbf0c5f998 | The cause of death was certified as acute encephalitis, and the death occurred in a child 5 years of age who had recently been vaccinated. The case presented symptoms which were not usual, but the medical inspector from the Ministry of Health who investigated the case, was, I understand, satisfied that it fell within the category of those which have recently been reported upon by the Committee on Vaccination. The usual onset of Encephalitis is from the seventh to the thirteenth day after vaccination. In this case the child was vaccinated on September 11th, and the onset of symptoms was on September 16th. A post-mortem was made by Dr. Bronte and the cause of death was certified to be Acute Encephalitis. The lymph used in this instance was not Government lymph but was obtained from a private source. |
a67b6fd9-64a7-4d94-a6a4-54d7e00b6fb6 | Post-vaccinal encephalitis is something which is new to us, and like encephalitis Iethargica, which is all but new, it introduces us to new problems, and increases the difficulties of combating Small-pox. It has been suggested that the cases, are a variation of infantile paralysis, but the incubation period and age distribution are different. Moreover, we in Acton, have been particularlv free recently both of infantile paralysis and encephalitis Iethargica. No notification of either disease had been received in 1928 up to and including September. On October 31st a case 1928 23 of encephalitis Iethargica was notified and this was the only notified case of that disease in 1928, and there was no notification of infantile paralysis. The following extract from the "Medical Officer" which translated an article in a foreign journal places the position probably in its proper light. |
105c7975-6101-4958-8ef2-8fa1eebefbca | "Post-vaccinal encephalitis continues to occur in Holland. In the first six months of 1928 its incidence was the same as in 1927, one case per 2800 vaccinations. During five weeks, lymph was used which had been obtained from countries where postvaccinal encephalitis is unknown, but in spite of the small numbers of vaccinations performed with this lvmph, one encephalitis case occurred after its use. The disease is definitely not encephalitis Iethargica, the histological changes are quite different from those of that disease, but are identical with those occurring in small-pox, chicken-pox and measles. The disease occurs only in those countries where primary vaccinations are performed during the school age or where primary vaccination in infancy is not compulsory. There is no modification of the local reaction in cases which develop encephalitis." The incidence of one case per 2800 vaccinations is far higher than the records of this country suggest. Dr. |
dcef1dad-6890-4cf9-9db2-d390a9f6fb05 | Turnbull suggests that in this country there are about one case to 17,000 vaccinations. The occurrence of these cases have been used as an argument against vaccination, but it is really one of the strongest arguments in favour of vaccination in infancy. It is a disease of children rather than of infants or adults, though no age is exempt. The disease is very rare after primary vaccination in infancy and after re-vaccination at any age; nearly all the cases have followed primary vaccination during school age. There is no definite record of the occurrence of post-vaccinal encephalitis after a previous vaccination which "took." There is no use in trying to avoid a difficulty which exists. Small-pox is prevalent in London and it is more than probable that there will be a recrudescence of it in the coming winter. We have amongst us a large number of children who are unvaccinated, and the occurrence of encephalitis will hamper us in the prevention of Small-pox. Scarlet Fever. |
913082ce-79bd-44ad-aa33-ab39400e1e30 | INFECTIOUS DISEASES. 243 cases of Scarlet Fever were notified, but there was no death from the disease. The control of Scarlet Fever has become very difficult. The disease is frequently so mild, that the proportion of 1928 24 missed cases upsets any system for controlling its spread. Not only peelers, but actual sufferers, may be found in Schools, Omnibuses, or Cinemas. Diagnosis of the mildest forms of Scarlet Fever may be theoretically possible, but in practice it cannot be done. Many instances have in the recent outbreak been brought to my notice which show the difficulty of making a diagnosis. Among the contacts examined one morning was a boy who had a sore throat. A doctor had been in attendance and had been looking for a rash, but had not been able tc see any signs. |
918ff823-6766-45d8-92d8-95577d733e0b | When I saw the boy, the condition of the throat and tongue was so typical of Scarlet Fever, that I had no hesitation in admitting the boy to hospital although there had been no history of a rash. The case subsequently behaved like an ordinary case of Scarlet Fever and the skin of the body peeled. The number of sore throats in contacts of Scarlet Fever is undoubtedly higher than that which would be found in school children of similar ages. The question naturally arises whether these sore throats may not be abortive attacks of Scarlet Fever. The theory has recently been put forward that there may be more than one species of Scarlet Fever. This of course is no new theory. Over 30 years ago Dr. Clement Dukes of Rugby suggested that there were at any rate two diseases included in the term Scarlet Fever, and he suggested for one of them the name "Fourth Disease but the suggestion of Dr. Dukes failed to gain acceptance. |
d4258492-e100-4d4f-a8ec-333a3abd53af | All these factors have a bearing upon the spread of infection, especially in schools, and also upon the procedure adopted in dealing with contacts. The difficulty with Scarlet Fever in school control varies inversely with the severity of the disease. Seldom dees a grave clinical condition introduce school problems; a child who is seriously ill is not in school and gives no further trouble there. It is the mild cases that occasion trouble, and are frequently missed until peeling commences. Children in whom the skin of the body and hands is peeling are often found in school. It is possible that these did not exhibit any rash or the rash was of so transient a character as not to be detected by the parents. It is probable that these children did suffer from a slight sore throat, which, of course, is one of the earliest symptoms of Scarlet Fever. The question naturally arises, can we, by supervision of contacts reduce the number of these mild cases which evade detection, and does exclusion of contacts from school attendance reduce the number of cases? |
69c1fe81-4ed0-4973-b44f-423aafe00b99 | In towns, school closure as a preventive measure, has been abandoned, and disinfection is looked upon with suspicion, and when practised at all, done in a manner to satisfy a superstition rather than to remedy a known ill. The modern doctrine 1928 25 is based upon the assumption that endemic infections of children are almost entirely spread by droplet diffusion, and that in the vast majority of instances all other means of spread can be ignored. There are rare instances where articles of clothing have been the means of spreading infection. These instances have occurred in the early stages of illness, when the patient has been sick and the articles soiled have been packed and sent away, or the discharge from the nose and the mouth have been wiped by handkerchief, folded, and sent to a laundry. |
6146bf7a-fecc-4108-9ce3-ed62e28e6a80 | But the contact, unless he is a carrier, or incubating the disease, is no more concerned with the spread or infection than is the desk, and probably the incubator, if at any time the is capable of conveying infection can only do so for very short periods. There is no new evidence to upset the time-honoured doctrine that diseases are not catching during the incubation period. But a contact may be a carrier, and if he is, he is a danger. It is only in diphtheria that the question of whether a person is or is not. a carrier can be answered definitely. Unless the case can be proved to be a carrier, it seems unnecessary to exclude contacts from school upon a supposition which is questionable; especially in view of the fact that if there is any danger at all, it can be controlled better at school than anywhere else. In Acton, the method of dealing with contacts is different from that which has hitherto been adopted in most districts. |
55696bbc-15b2-4ab6-9730-8cdc8f576092 | As far back as 1922 we abandoned the procedure of excluding Diphtheria and Scarlet Fever contacts from school attendance for a certain time placing them, as it were, in quarantine. Formerly it was the practice to exclude from school for a fortnight all children from a house where a case of Scarlet Fever or Diphtheria had been notified. This period of exclusion represented the maximum period of incubation. In practice, it is found that if a second case of Scarlet Fever or Diphtheria occurs in a house, it happens in the vast majority of instances within a couple of days of the first one. Occasionally at the end of two or three weeks, we found that one of the contacts was peeling; during the quarantine period he had suffered from a slight sore throat, and he had had a doubtful rash. When he was examined at the end of his quarantine period the initial symptoms had subsided, but the skin had not commenced to peel. |
ff8353bb-c4b1-413c-8160-c0e4c3a58a35 | Such cases would be more likely to be detected under our present procedure. Now, all the contacts are examined on the day following the removal of the patient to the hospital. If they are free of symptoms they are allowed to return to school, where they can be kept under observation. At the end of a fortnight they are again examined. With Diphtheria contacts, we are, of course, on safer ground, because the specific germ of the disease has been 1928 26 isolated. The detection of carriers and of mild cases is to this extent rendered easier. Diphtheria. 78 cases were notified and 7 deaths occurred. Although the increase of notified cases was small, 78 compared with 69 in 1927 (it is the highest number of deaths in any year since 1922) there were 7 deaths compared with one in 1927. |
23d2e0b6-3ee3-43ea-b30e-8ca49dff0cfa | All the deaths occurred in the first half of the year, and in every instance death was due to delay in carrying out the appropriate treatment. Broadly speaking, no one dies from diphtheria who is treated with antitoxin on the first day of the disease. Each day's delay in giving antitoxin increases enomously the risk of a fatal result and less and less is accomplished by antitoxin, so that by the fifth or sixth day it is questionable if anything is gained by its administration. Some children die because the doctor is not called in early enough, and sometimes there is a difficulty in the diagnosis. The doctor when called in may not be able to obtain a good view of the child's throat, and frequently cannot get a swab from the throat. Moreover, it should be remembered that some of the worst cases of indubitable clinical diphtheria give negative results on the first or even the second swabbing. |
a9d29c89-3a8a-4ffa-8d83-6919a69e8aee | Swabbing should not be relied on for diagnosis except in adults or in children showing no exudate. Many fatalities in children are due to the time lost in awaiting the result of the swab and in relying on a negative result as excluding diphtheria, which it does not; frequently true cases have given negative results prior to admission. Typhoid and Paratyphoid Fever. The two cases of Paratyphoid fever which were notified here belonged to the series of cases which occurred in London in July. All the investigations point to a cream supply as being the agent responsible for the outbreak. The probability is that the infected cream was entirely consumed within three davs and that the cause of its being consumed in a contaminated state was that, the demand for the cream being excessive, there was a breakdown in the safeguarding apparatus. On July 7th, a person from Suffolk had strawberries and cream at a friend's house in Fulham. |
463f4f23-23da-4680-a969-5a4790c807dd | In due course, both host and visitor sickened with paratyphoid. This evidence bv itself is almost sufficient to prove not only against the cream, but to fix the exact date on which it was dangerous. Other evidence, of course, pointed to the same source of infection. 1928 27 As usual opportunity was taken to attack the cream regulations and to assert that the absence of preservatives in' cream was the cause of the outbreak. There is absolutely no foundation for such an assertion. Boric Acid is the usual agent used as a preservative. Boric Acid although it exercises an inhibitory action on the organisms producing decomposition, has no action on the germs of the disease, and particularly has no effect upon the Typhoid group of organisms. Smallpox. 4 cases of Smallpox were notified during the year, but 6 cases occurred amongst the residents of the district. |
d5018bf8-3783-43bc-a3fe-9642e10066fc | Two cases though were diagnosed in the West Middlesex Hospital and were notified to the Medical Officer of Health of Heston and Isleworth. Information of the first case came indirectly through the Infirmary. On May 18th, I received a message from Dr. Nash, Medical Officer of Health for Heston and Isleworth that a man had been admitted from 59, Osborne Road, to the West Middlesex Hospital on a Relieving Officer's order suffering from Small-pox. He had been seen that morning by the district medical officer who had advised his removal to hospital. He gave a history of being ill since May 12th and a rash appeared on May 17th. No. 59, Osborne Road is a Common Lodging House with about 140 inmates. The Common Lodging House is very well kept, a large percentage of the lodgers are permanent ones, and the proprietor knows intimately the habits of the permanent lodgers. |
99e99946-6b48-4027-826d-3d1076e1b1d2 | The only inmate, to the proprietor's knowledge, who had recently been ill was an old man of over 70 years of ageHe was sent for from a neighbouring public house and examined. He was covered with a rash which was easily diagnosed as Small-pox. The history given by the partient was vague, but from information received from other sources, it appears that he felt ill about May 1st and that a rash appeared either on May 2nd or May 3rd. He was an old-age pensioner and worked occasionally at a carpet beating works. He had been employed at these works, on and off, for about 40 years, but recently he has only been employed during the busy periods. He was working there in April, and up to May 3rd. |
9f4b1764-1d2d-4d48-8744-8b9dd0f910ea | On the evening of the latter date he complained of feeling ill, did not turn up on May 4th, and called for his wages on May 5th He attended his panel doctor on several occasions, and had been at the Surgery as recently as May 16th. In the lodging house, he slept in the bed next to the man who was notified from Isleworth on May 18th, and both men had been together frequently. 1923 28 The infected person moved freely about the district between May 3rd and May 18th, and came in contact with hundreds of people. He drew his old-age pension 3 times at the Post Office in Bollo Bridge Road, but as far as can be ascertained the only one who contracted Small-pox was the case notified from Isleworth on May 18th. The inmates of the Common Lodging House were kept under observation. All the lodgers were examined on the night of May 18th and the following Sunday morning. |
ca92c102-74fd-4db6-b109-ae9472c9ca2d | A fairly complete examination is only possible early on a Sunday morning or a holiday, and neither day is an ideal one to carry out such an examination. Early on the morning of Whit-Monday, May 28th I was successful in examining all the inmates except one. I found 2 suffering from Small-pox, one of them had felt seedy on May 25th or 26th, and a rash appeared op May 27th. The other had felt seedy on May 24th, but was unaware of a rash until I pointed out a few spots to him on his face, feet and hands. The person who had avoided me on Whit-Monday was absent again on Whit-Tuesday. He complained of being seedy on May 29th, and the proprietor told him to go and see a doctor. He did not return to the Lodging House, but through the Relieving Officer it was found that he had been admitted to the Workhouse Infirmary. |
2e2ec6ce-5f67-409f-ad58-f34314993327 | I telephoned to Dr. Nash and the man was kept under observation and on June 1st, he was found to be suffering from Small-pox. No more cases occurred in the Common Lodging House but on July 3rd a case was notified from a house in the same street and situated almost exactly opposite the Lodging House. The patient had been ill over a week and the rash appeared about July 1st. although every endeavour was made to trace the source of infection of this latter cast we were unsuccessful. It is natural to assume that a further case may have occurred among someone in or near the Common Lodging House, and the case notified on July 3rd infected from this missed case. The dates suggest that someone was infected by the cases which ocurred at the end of May, developed Smallpox about the middle of June and then infected the woman who developed Small-pox and was notified on July 3rd. |
64b8e9b6-f246-4dcd-ad3e-cf18c65128aa | But these are mere, assumptions and no one was known to have had an illness which might have been Small-pox towards the middle of June. The number of cases reported here was too small to generalise, but they seemed to be similar in character to the cases which occurred in London in 1928, and really formed part of that outbreak. The outbreak in London was of the mild or sub-toxic type which has been wide-spread in the provinces for 1928 29 about 10 years past. The whole question of Small-pox and vaccination is profoundly influenced by the prevalence in the country of what is officially designated "Mild Small-pox." There are at present 2 schools in the medical ranks, whose views are diametrically opposed as to the character of this mild disease, the Dualist and the Unicit. The Dualist view is that so-called Mild Small-pox, though closely related to classical Small-pox, is for all practical purposes a different disease from Small-pox. |
3f43fc5d-8787-405c-b77e-a12e190d1c3e | According to this view, this non-virulent disease, known in America as Alastrim and in Africa as Amaas or Kaffir-pox, is not true Small-pox at all, but another epidemic disease closely resembling but distinct from it. Moreover, it is contended that each has its own clinical characteristics which in many cases at least, enable the two diseases to be identified. The official view is that mild Small-pox and classical Small-pox are one disease, showing differences in epidemic virulence. The distinction between cases of sub-toxic Small-pox and cases of a more severe type cannot be made on clinical examination of individual cases, but only by taking account of associated conditions and the subsequent course of events. That is to say, differentiation of the sub-toxic from the toxic type of the disease is necessarily retrospective, and retrospective differentiation is the only safe course. |
19cbe9a8-ecc8-4543-9012-aa6398fc151c | These arguments are of certain academic and scientific interest, but apart from that they have little bearing upon the all-important factor of prevention, because everybody admits that recent vaccination protects against both mild and severe Small-pox. From an administrative point of view it matters very little whether the mild form is the same as severe Small-pox or a separate disease. The difficulties of control arise from the very mildness of the symptoms. Because of the trivial character of many of the cases, many of the cases easily escaped detection, and some of the public refused to treat it seriously after they become familiar with it. For these reasons the disease has, in certain areas, proved most intractable. We were fortunate, not because of the attitude of the contacts towards the disease, but because other circumstances were favourable. Where the first case was discovered, most of the contacts were at once examined and advised to be vaccinated. Only one consented. When the later cases occurred not one was re-vaccinated. |
e8a65558-febb-410b-97cf-1c6bd7866986 | The man who was re-vaccinated had a painful arm, and was unable to follow his usual occupation. He went to the Guardians for relief, but was told they had no power to relieve him in the circumstances. Reports also were circulated. 1928 30 that the patients were having a very comfortable and very happy time in the Hospital. These facts contributed towards the attitude of the contacts. When the later cases occurred they bluntly informed me that they preferred the disease to re-vaccination and some of them even admitted that they would welcome a few weeks stay in Hospital under the conditions which obtained. The work of these men is casual and they can return to it after their discharge from Hospital. There is not the fear that their job will be taken by another; at the worst, they will go away and seek work elsewhere when they are discharged from the Hospital. Fortunately, most of them had been re-vaccinated during the war. |
4ffdd8b8-a38e-4648-a872-35d6cafee4f2 | Most of the men were middle-aged and had served in the war and had been re-vaccinated then. Some of the contacts were vagrants and the movements of these could not be ascertained. Frequently lists of the vagrants are sent, especially. when a case has occurred or has been found in the Union Workhouse. For the purpose of tracing these contacts these lists are not of much value. The vagrants do not give their real names, and when enquiries are made about them, they are not known by the name given. Sometimes, it is doubtful if they remember their proper name. They have been known for a long time by a nick-name and to their intimates their surname at any rate is not known. Tuberculosis. 72 cases of pulmonary tuberculosis and 14 cases of other forms of tuberculosis were notified during the year. There were 37 deaths from pulmonary tuberculosis and 11 from other forms of tuberculosis. |
dbee5936-d05d-4d29-8b46-f0b58b7f84a0 | There was a decrease of 18 in the number of deaths from pulmonary tuberculosis compared with 1927, but an increase of 2 from other forms of tuberculosis. The following figures have been kindly supplied by Dr. Atkinson, the Tuberculosis Medical Officer:— New cases— Pulmonary 52 Non-Pulmonary 8 Number sent to Sanatoria 27 Number sent to Hospitals— Pulmonary 6 Non-Pulmonary 18 Isolation Hospital. During the year 400 cases were admitted into the Hospital compared with 247 in 1927. On January 1st, 1928, there were 35 cases under treatment and on January 1st, 1929, there were 48. 387 were discharged and there were 9 deaths. |
102cbed9-746e-422d-8994-a5efb14fb4ca | 1928 31 The following is a list of cases admitted:— Acton Wembley Kingsbury Total Scarlet Fever 212 43 6 261 Diphtheria 66 38 3 107 Measles 25 — — 25 Others 7 — — 7 310 81 9 400 Scarlet Fever. 261 cases of Scarlet Fever were admitted with no death. Diphtheria. 107 cases of Diphtheria were admitted with 8 deaths. Measles. 25 cases of Measles were admitted with 1 death. BACTERIOLOGICAL EXAMINATIONS. (a) For Diphtheria. Positive. Negative. |
76b9c173-7db9-4440-bede-95a3f5e1b972 | Total examinations—1264 ... 123 1141 Sent by Medical Practitioners ... 60 433 Sent from Isolation Hospital ... 47 451 Convalescents .... 3 52 Contacts ... 7 195 Precautionary Swabs ... — 6 School Sore Throats .... 6 104 Of the positive contacts :— 5 were positive on the 1st occasion. 1 was „ ,, ,, 2nd „ & 1 was ,, ,, ,, 3rd „ (b) For Ringworm. Positive. Negative. Total examinations—9 ... 7 2 (c) For Tubercle. Positive. Negative. Total examinations—192 .... 39 153 MATERNITY AND CHILD WELFARE. Infantile Mortality. 55 deaths occurred in children under one year of age. This number corresponds to an infantile mortality of a little less than 55 per 1000 births. |
c9f7a7f9-a2e2-40df-8445-51090dd8be6d | Not only was the number of deaths in 1928 the lowest recorded in the history of Acton, but the infantile mortality was also the lowest on record, with the exception of 1926. 1928 32 In 1926 the infantile mortality was exactly the same as that of last year. The reduction of the infantile mortality affords gratifying evidence of the success of the local schemes established for the purpose of dealing with the problem of child life, but it is well to recognise that there are many factors at work other than those comprised within the direct attack on the causes of infant death. On account of the general change of policy in public health administration it is especially misleading to advance the theory of post hoc, propter hoc in this connection, but the mortality figures for Acton are interesting. The general deathrate began to decline in the early eighties of the last century, but the infantile mortality kept up throughout the nineties. |
8694f15f-9603-47e2-8bba-fac5484df262 | Between 1892 and 1902, not once did the infantile mortality come below 150 per 1000 births. Since 1903, the infantile mortality has steadily declined; not once since that date has it reached 150 per 1000 births, and in the last 10 years it has not once reached 80 per 1000 births. Formerly one in six infants died before they reached the age of 12 months; now only one in, sixteen die in the same age-period. Formerly, in a hot summer of the character which we experienced in 1928, deaths from Diarrhoea loomed large in our returns. Last year Diarrhoea caused only six deaths. Diseases of the Respiratory system have declined, but not to the same extent as Diarrhoea. To-day, neo-natal conditions, such as Premature birth, Atrophy, Congenital Malformations head the list. |
ebec8953-35de-46fa-98e5-57d7ca79da3c | Nearly half the deaths of infants are due to these diseases. Pre-Natal Clinic. The Pre-Natal Clinic is held once a fortnight in the School Clinic and Dr. Bell is in charge. 23 sessions were held with a total of 138 attendances. It is unfortunate the pre-natal clinic is not more popular, as only by pre-natal care can we hope to reduce the mortality from neo-natal diseases. Welfare Centres. A new centre was opened in the East Acton School, and is held once a fortnight. It is not the most convenient situation for East Acton, but it was the only place available. The two centres in Church Road and Palmerston Road are open on two afternoons a week—Monday and Wednesday. On table 8 are given the attendances at these clinics. It cannot be too frequently emphasised that these centres are for the inspection of babies and for the guidance of mothers in the norma) rearing and upbringing of their children. |
ec36c960-8743-43aa-8a38-a1be877d01bb | Where any 1028 33 departure from the normal can be observed, advice is given, but no treatment undertaken. In a word, their proper aim is education. Unfortunately, attendances at these clinics frequently are not started sufficiently early. It is not unusual to find that the mothers have taken the babies off the breast before' they attend and have started artificial feeding. In a large majority of instances, the weaning has been done for insufficient reasons, such as " the mother's milk did not agree with the baby," etc. In other instances, the weaning has been only partial, and attempts are made to re-establish breast feeding. Day Nursery. The Day Nursery is situated in Bollo Bridge Road, and is open daily except on Saturdays. An attempt was made to open the Nursery on Saturday mornings, but it was found that there was no demand for facilities on that day. Most of the mothers whose children attend do not work on a Saturday. The Nursery undoubtedly serves a useful purpose. |
69e393b3-e1d9-4c38-8022-faa66ace9c0f | It may be argued that women should not go out to work, but the fact remains that they do, and as things are at present, they have no alternative. The Day Nursery is the outgrowth of modern industrial conditions. It affords a temporary home for the children of mothers while the latter go out to earn their living. Last year 4140 whole-day and 1870 half-day attendances were made. LIGHT TREATMENT. Towards the end of 1927 a report was submitted to the School Management Sub-Committee upon the subject of Light Treatment. After enquiries had been made of other education authorities, it was decided to approach the authorities of the Acton Hospital and ascertain of them if it were possible to carry out the treatment at that institution. The time was opportune as the hospital had recently re-organised its Light department under Dr. Dicks and had engaged special nurses experienced in massage and remedial exercises. |
bf2d7e1b-14b8-4db8-9b56-9d949ed17f32 | Ultimately, terms were arranged with the hospital, the payment being at the rate of one guinea per session—12 children to be treated each session. These terms were subsequently modified, so that payment was to be made of 1/9 for each child. These modified terms were more satisfactory to both parties. It was unnecessary to have special sessions for children sent for treatment by the Committee, and it obviated the necessity of having at least 12 children under treatment at one time. The Maternity and Child Welfare Committee agreed to the same terms for the treatment of children under 5 years of age. 1928 34 These arrangements were sanctioned by the Board of Education and the Ministry of Health, but certain records had to be kept. Cards were printed on which these records were to be kept, but owing to a misunderstanding the heights and weights were not recorded, prior to March, 1929. Arrangements have now been made whereby these details will be recorded. All the cases were treated under the supervision of Dr. |
8e25f61d-b64c-4aba-a2fa-e337a6a87103 | Dicks, and the Carbon-arc lamp was used. The clinical notes are in every instance very full and complete, and it is therefore unfortunate that the heights and weights cannot be given. 17 school children and 14 children under 5 years of age completed a course of treatment before December, 1928,or more correctly, 31 had been treated and as far as we were concerned their treatment was at an end. In some instances the treatment was discontinued for various reasons, such as ' parents had left the district,' or child had contracted some illness which prevented attendance at the hospital. Of the 17 school children 12 attended on more than 12 occasions each: of the other 5, one attended on 2 occasions, one on 4, one on 5, one on 7, and one on 11 occasions. The children who attended on 4, 7, and 11 occasions had their Tonsils and Adenoids removed and were told to discontinue. |
c08f7445-756e-4f97-8851-f95a71a1c50f | The other 2 simply discontinued and no reason was given. Of the 14 children under 5 years of age, 8 attended on 12 or more occasions. Of the other 6, one attended on I occasion, 2 on 4 occasions, one on 5, one on 9, and one on 10 occasions. Of the 6 who did not attend the full course of treatment, 2 left the district, 3 had illnesses which prevented attendance, and 1 simply did not come again. Of the 17 school children, 6 were suffering from enlarged glands, 4 from malnutrition, 3 from debility, 1 from enlarged glands and nervous debility, 1 from blepharitis and anaemia, 1 from old encephalitis, and 1 from intestinal toxaemia. |
68ae2fdb-839e-4335-9a89-f08d29afe483 | Of the 14 children under 5 years of age, 5 were suffering from malnutrition, 4 from rickets, 2 from weak ankles, 2 from debility, 1 from nasal catarrh. Of the 17 school children, all the 7 children who suffered from enlarged glands greatly improved; in 2 of them the glands could not be felt. The case of intestinal toxaemia was also greatly improved ; in 2 of the children the improvement was slight, and in 7 there was no improvement, but the latter included 5 who did not complete the treatment. Of the 14 children under 5 years of age, in 9 the medical officer in charge stated that there was improvement. Apart from the fact that the figures are small, there are 1928 35 other difficulties of estimating the value of the treatment. One has been mentioned, viz; the absence of the recorded heights and weights. |
ff39c9a8-b12d-430b-9db0-87c4aa0fbe47 | The heights and weights before and after treatment could be compared with those of children who had received other treatment. The Council is aware that controversy has arisen concerning artificial Light treatment, and it may possibly desired to have some information about the treatment. The term "actinotherapy" is now generally used to indicate the scientific treatment of disease by artificially produced ultra-violet radiations, as distinguished from treatment by means of natural sunlight which is known as "heliotherapy." Although the exact causes were unknown, the earliest records of history and mythology shew, that, in all ages, man has regarded the sun as a source of health giving energy. Though the beneficial effects of the sun were thus known from the earliest times, it is only towards the close of the last century that organised efforts were made to use the health-giving energy of the sun for the benefit of mankind. In 1893, Prof. |
8cc850c6-ff41-4e51-9c26-4d7750412036 | Nils Finsen published the details of his investigations regarding the physiological action of light and the result of his work in connection with the light treatment of surgical tuberculosis. Owing to the difficulty of obtaining adequate supplies of artificial light, Prof. Finsen, for some of his more important work used the Carbon-arc as a means of producing ultra-violet radiation. The first Finsen lamp used in this country was soon afterwards presented to the London Hospital by the. late Queen Alexandra. Light treatment made but little progress during the next few years, and it was not until 1903 that the first European Clinic for the sunlight treatment of tuberculosis was established at Leysin by Dr. Rollier. During the last thirty years precise observations have been made of the action of light rays in disease. |
b99bbb49-2241-4e2f-946c-d3891c320038 | In addition to the results obtained in surgical tuberculosis, research work in rickets has been rewarded by three important discoveries; (1) That rickets can be cured by ultra-violet radiation of the skin surface: (2) That this action of light could be exercised indirectly by exposing certain food-stuffs to ultra-violet rays: (3) That the antirachitic action of irradiated food-stuffs depended on the presence of Vitamin D. Vitamin D is found particularly in ergosterol which is a constituent of Cod liver oil. Ergosterol is a highly saturated sterol and is the direct precursor of Vitamin D, and this substance is transformed into Vitamin D when the skin is exposed 1928 36 to direct sunlight. Sunlight and Cod liver oil therefore cure rickets because sunlight produces in the skin the substance which Cod liver oil provides ready made. It is now intelligible why rickets is a comparatively rare disease both in natives living under tropical conditions and in the inhabitants of the Arctic zone. |
c834ea9e-21ec-42c7-a366-af377342999b | The extra sunshine experienced by the one set of people makes the smaller amount of calcifying Vitamins in their diet do the work carried out by the larger intake of the Eskimo. People living in a temperate zone under modern industrial conditions of diet are often poorly supplied by both these therapeutic agents, and an intelligent application of the facts which have come to light may confidently be expected to result in the prevention of one of the most serious dsieases to which urban populations are liable. In this country it is difficult to estimate the relative importance of these two factors in the causation of rickets. Possitaly, their relation to rickets varies in different parts of England and Wales, but it is incumbent for Public Health authorities to use every means to apply the results of these researches for the prevention of rickets. |
5b3d4439-fb58-4809-8b2b-5397adacd4a0 | Most Infant Welfare Centres have for years been instrumental in the cheap distribution of Cod liver oil, and the instruction given at these Centres included the importance of proper clothing of infants and the inculcation of the cult of the open air. Very few people are aware of the many and varied efforts of Health Visitors in this respect. We are particularly fortunate in this district in the number and situation of open spaces and public parks, but many mothers are unable to take out the younger children, and frequently, the only chance of the babies enjoying the open air and sunshine occurs when they are put out in the back or front garden in a perambulator. Even perambulators are not always available and many an one has been secured through the kind offices of the Health Visitors among their friends whose children have grown up and can spare the perambulator. |
92897489-2bff-4e2a-b6d7-f2a6b64d437b | We can therefore claim to have applied the results of these researches in the prevention of rickets, but during many months of the year the amount of sunshine in towns is negligible, and certainly not sufficient to exert any curative influence. In this country heliotherapy and actinotherapy are of necessity combined because of the difficulty of obtaining winter sunlight in towns. Antinotherapy is really a natural development of heliotherapy. It was the impossibility of securing reliable sources of natural sunlight at low altitudes and the discovery that a thin film of clouds, smoke or atmospheric moisture completely absorbed the beneficial effects of sunlight that led Finsen 1928 37 and other pioneers to seek for a means of producing these rays artificially. |
71759e36-dbb5-4712-8a85-1e1915808681 | If we are to apply both ultra-violet and Cod liver oil in the treatment of rickets, the former can only be obtained during certain periods by artificial means, and it is not very helpful to be told that Vitamin D can be more economically produced by Cod liver oil alone, unless it can also be shown that such Vitamin can be economically used by the ricketty infant. In the annual report of the Medical Research Council for the year 1927-28, it is stated that a report of Dr. Dora Colebrock upon the effects of light upon the children at school is in the press, and a warning is addressed to those who have the responsibility to advise the adoption of light treatment. As far as the public health and the school medical services are concerned the warning is surely unnecessary. For years past Sir George Newman in his annual reports as Chief Medical Officer of the Ministry of Health, has reminded the public health service that at this stage of our knowledge we must proceed with caution in assessing the value of Light treatment. |
9c139b1d-ddbd-453b-b1bd-36096820681f | In his report to the Board of Education he has been equally careful to discount any extravagant claims for Actinotherapy, and in the latest issue he quotes a number of cases where medical officers draw attention to the limitation of the treatment. The enthusiasm with which the introduction of Actinotherapy into general practice was at first greeted has given place to a certain amount of scepticism. This is regrettable for though Actinotherapy possibly cannot fulfil all the claims made for it by its more sanguine and enthusiastic exponents, amongst those doctors who have had experience of the treatment the opinion is expressed that there exists a definite set of conditions in which its employment is indicated. But there is another danger; when there are doubts as to whether the therapeutic agency can do any good there is the danger of a doubt whether it can do anything at all—even harm. It is important to recognise that the treatment may do the greatest mischief. |
201b1bf2-133f-46da-9020-ba03bbe52c63 | To patients suffering from Pulmonary tuberculosis, diseased arteries, Brights disease, quiescent appendicitis, various forms of neurosis, the application of ultraviolet radiation may do definite and irretrievable damage. That sunlight, both natural and artificial, is a powerful curative agent has been demonstrated, but we have only recently begun to discriminate and to realise that what is highly beneficial to one patient may be positivelv injurious to another. Not much harm can be done if the treatment is limited to the natural effect of the sun, although some people are particuarly sensitive to the effect of the sun's rays. Many people have suffered and deaths have occurred in this country when exposure to the sun has been 1928 38 too sudden or too long-. Overdose of the ultra-violet and violet rays causes "sunburn," overdose by the more penetrating and heat rays applied to the head produces "sunstroke," applied widely causes " heatstroke." |
61698f4b-54ed-4303-a129-41086814113a | But when Actinotherapy is used, wave lengths are introduced which are foreign to sunshine. Sunshine contains some of the longer ultra-violet rays, but the shorter and physiologically more active ones are lacking. Ultra-violet rays are generated by special plants designed for the purpose. The lamps in general use are the mercurv vapour lamp, the Tungsten lamp, and the Carbon-arc lamp. In a water-cooled mercury vapour lamp the ultra-violet rays usually amount to about 28% and sometimes these rays may rise to about 50%. Sunlight at sea-level contains less than 2% ultra-violet and sunlight at its best in England contains not more than 7% ultra-violet rays. Moreover the spectral quality of the ultra-violet light from lamps is different from that of the sun, in that it contains a large proportion of rays of very short wave length. It will therefore be seen that a little knowledge may be a very dangerous thing. |
8acd161d-e4ab-4dc0-a0b6-1a55978e422a | These new methods instead of being confined to those qualified to use them are in danger of becoming the prey of unqualified smatterers and downright quacks. A treatment capable of so much good and of so much harm should be administered only by those with the requisite knowledge and skill. It is well known that the treatment has largely fallen into the hands of persons ignorant of electricity, ignorant of the physiological effects of the different types of radiation, and ignorant of medicine. "Sun-ray Institutes" are springing up all around us. "Beauty parlours" are providing blue-ray baths for their credulous patients, and hairdressers are using forces of which they know little or nothing upon the hair and skin of women silly enough to believe them. Their frauds may be harmless or they may not. If they are harmless they are money-making frauds; if they are harmful, they are a menace to the public. There are no limits to human credulity. |
4b682942-ea65-487f-a3bf-eb2d482c98c8 | Sir George Newman uttered the warning that artificial heliotherapy has been seized upon with avidity by the quack and the charlatan. The results in many cases have been deplorable and tragic: many sufferers have been deceived by specious promises that ultra-violet rays are the modern elixir of life and an infallible remedy for any and every disease. It was for these reasons that the sanction of the Board of Education and the Ministry of Health was hedged in by so many conditions, and no charge of reckless optimism on the part of the public health and school medical services in regard to the value of Light treatment can be substantiated. 39 TABLE I. BIRTH-RATE, DEATH-RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1928. Rate per 1,000 Annual Death-rate per 1,000 Population. Rate per 1,000 Births Percentage of Total Deaths Live Births. Still- Births. |
29e8ef4b-d755-497e-b468-5677fb9c7a17 | All Causes Enteric Fever Small Pox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Violence Diarrhoea and Enteritis (under 2 yrs.) Total deaths under 1 year Certified by Registered Medical Practitioners Inquest Cases Certified by Coroner after P. M. No Inquest Uncertified Causes of Death England and Wales 16.7 0.70 11.7 0.01 0.00 0.11 0.01 0.07 0 06 0.19 0.53 70 65. |
707e6652-6c7c-4d35-ad04-a3b905cf58bf | 90.9 6.7 1.4 1.0 107 County Boroughs and Great Towns, including London 16.9 0.70 11.6 0.01 0.00 0.15 0.02 0.09 0.09 0.17 0.48 96 7 91.0 6.5 1.9 06 156 Smaller Towns (1921 Adjusted Population, 20,000—50,000) 16.6 0.73 10.6 0.01 0.00 0.08 0 01 0.06 0.08 0.21 0.41 4.8 60. |
475448d5-0edb-4902-9264-03b1a8180ceb | 92.6 5.7 0.5 1.2 London 15.9 0 53 11.6 0.01 0.00 0.30 0.02 0.09 0.09 0.13 0.55 10.2 67 88.7 7.6 3.7 0.0 Acton 15.5 0.46 10.7 0.00 0.00 0.17 0.00 0.00 0.01 0.14 0.42 6.0 55. 93.7 4 4 1.9 0.0 >—* CD to CO 40 TABLE 3. VITAL STATISTICS FOR THE WHOLE DISTRICT DURING 1928 AND PREVIOUS YEARS. |
f40952fe-5066-4d46-a9c2-684e1e68af05 | Year Population estimated to Middle of each Year Births Total Deaths Registered in the District Transferable Deaths Nett Deaths belonging to the District 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 Births Number Rate per 1,000 inhabitants 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 6.8 18 241 80 76 669 10.6 1926 63,040 1098' 17.4 422 6.7 15 250 60 55 657 10.4 1927 63. |
3983eea5-a906-433d-b464-ee62c1641a3e | 750 1026 16.1 445 6.9 21 280 62 60 704 11.04 1928 64,870 1003 15.4 479 7.4 29 244 55 55 694 10.7 1928 41 TABLE 3. AGES AT DEATH, AND WARD DISTRIBUTION OF DEATHS IN 1928. Causes of Death. Age in Years. Ward Distribution. 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 3 – I — — — – — 1 – 2 1 Measles 11 2 3 4 2 — — — – 3 1 3 4 Scarlet Fever — — — — — |
c854732b-74e0-4d06-9031-65fc52cac6b3 | — — — – – – – – Diphtheria – — — 5 2 — — — – 2 – 3 2 Enteric Fever – — — — — — — – – – – – – Acute Encephalitis 1 — — — 1 — — — – – – 1 – Influenza 9 — — — – 1 3 — 6 3 1 4 1 Tuberculosis of the Respiratory system 37 — 1 — — 13 13 10 — 7 5 11 14 Other Tuberculosis Diseases 11 — 1 2 1 2 1 1 3 6 3 I 1 Cancer, Malignant Disease 104 — — — – — 12 46 46 28 28 29 19 Rheumatic Fever 3 — — — 1 — 1 1 – 2 – – 1 Heart Disease 76 — — — 1 1 10 3d |
a0c03edf-f681-4423-9d6d-7faba590ccb9 | 26 24 16 13 23 Cerebral Haemorrhage 41 — — — — — — 14 27 11 9 8 13 Arterio-Sclerosis 35 – — — — — — 10 25 8 11 6 10 Diabetes 4 — — — — — — 3 1 1 1 1 1 Bronchitis 65 6 3 — I — 4 12 39 19 8 10 28 Pneumonia 39 6 !1 2 3 1 7 9 9 13 11 3 12 Other Respiratory Diseases 4 – 1 – — — 3 – 1 – 1 2 Diarrhoea 6 6 – – – – – – – 1 – 5 Ulcer of the Stomach and Duodenum 11 – – – – – 2 8 1 2 2 – 3 Appendicitis |
29e1e901-28de-45f8-b172-bc298f7a4f65 | 3 — — — – 1 — 1 1 – 2 – 1 Alcoholism – – – – – – – – – – – – – Cirrhosis of Liver 5 — – – – – 1 1 7 4 2 1 2 Nephritis 22 — — — 1 — 1 11 9 7 6 2 7 Puerperal Sepsis 2 – — — – 1 1 – – 1 – .1 Other diseases of pregnancy and parturition 2 — — — – — 2 – – – – 2 – Congenital debility & malformation, prem. |
a3fddae9-e97c-4a48-8a40-55eb45318d51 | birth 28 28 – – – – – – – 4 8 3 13 Suicide 4 – – – – – 2 2 – 1 1 1 1 Other deaths from violence 23 – – – 1 2 9 5 6 9 4 4 6 Other defined Diseases 133 4 – 1 2 2' 5 21 98 38 39 29 27 Causes ill defined or unknown — — — — — — — — — — — – – Total 694 55 11 15 16 24 74 196 303 >95 159 143 197 1928 42 TABLE 4. INFANTILE MORTALITY, 1928. Causes of Death. Ages. Wards. Total Under 1 week 1—2 weeks 2—3 weeks 3-4 weeks 1—3 months 3—6 months 6—9 months |
134ade84-0165-4b2f-87f5-730aa5071487 | 9—2 | months North East North West South East South West Measles 2 1 1 9 Whooping Cough 3 2 1 1 2 Bronchitis 6 1 2 2 1 1 1 4 Pneumonia 6 1 1 3 1 1 1 4 Convulsions 2 2 1 1 Diarrhoea 7 1 1 4 1 1 5 Asyphxia 2 2 2 Congenital Debility and Atrophy 2 1 1 1 1 Congenital Malformation 2 1 I 1 1 Marasmus 6 9 3 1 2 Premature Birth 12 9 1 1 l 3 9 6 Injury at Birth 1 1 1 Cerebral Abscess 1 1 . |
26885269-b9a8-4a07-b65c-f16c6b4cc464 | 1 Meningitis 2 1 1 1 1 Erysipelas 1 1 1 Total 55 17 1 4 9 10 10 3 8 9 9 29 43 1928 TABLE 5. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR.1928. Notifiable Disease. Cases notified in whole District. At Ages—Years. Total cases notified in Wards. At all Ages Under 1 1 to 5 6 to 15 16 to 25 26 to 45 4R to 65 65 and upwan's North East North West South East South West Scarlet Fever 213 – 60 148 20 13 2 – 68 55 32 88 Diphtheria 78 1 22 46 5 2 2 — 32 19 11 16 Pneumonia 34 3 6 3 9 |
5b22896a-6d56-4697-b11c-e950a6e98c5c | 9 8 3 6 3 9 16 Erysipelas 28 — – 2 2 10 11 3 4 9 7 8 Puerperal Pyrexia 10 — — – 5 5 — — 6 I 1 2 Ophthalmia Neonatorum 5 5 — – – – – — 2 2 1 — Small-Pox 4 — – – 1 1 1 1 – – – 4 Puerperal Fever 2 — – – 1 1 – – – – 1 1 Paratyphoid B. |
c725b68e-2e94-46ec-bfde-9aaa01b538a6 | 2 — — 2 – – _ – 1 1 — — Typhoid 1 — – – – – 1 – 1 — — – Puerperal Septicaemia 1 — – – – I – – 1 Purulent Conjunctivitis 1 1 – – – – – – – 1 – – Encephalitis Lethargica 1 – – 1 – – – – 1 – – – Tuberculosis (Resp.) 72 – 2 2 20 36 11 1 24 11 10 27 Tuberculosis (non-resp.) 14 – 2 2 6 1 2 1 8 2 1 3 Totals 496 10 92 206 62 79 38 0 153 105 73 165 1928 44 table 6. Cases removed to hospital. N. East. N. west. S. East. s. West. |
a2d840b5-c444-489c-8e11-a09bb08278ef | Total Scarlet Fever 63 46 27 83 219 Diphtheria 30 16 11 15 72 Pneumonia 1 — 2 1 4 Erysipelas — — 3 2 5 Small-Pox — — — 4 4 Puerperal Fever — — 1 1 2 Paratyphoid B. 1 — — — 1 Puerperal Septicaemia — 1 —' — • 1 Encephalitis Lethargica 1 — — — 1 96 63 44 106 309 table 7. births. Male Female Total Births 532 471 Legitimate 506 453 Illegitimate 26 18 Ward Distribution of Births notified in the District. N. East. N. West. S. East. S. West. Total 250 130 122 299 801 Outside Births notified. N. East. N. West. |
fb114c97-17b8-45b3-825c-23aac6c16560 | S. East. S. West. Total 46 21 30 48 145 Births Registered but not Previously Notified. N. East. N. West. S. East. S. West. Total 3 4 4 1 12 Still Births. Inside 17. Outside 3. Notifications were received from:— Doctors and Parents 652 Midwives 314 table 8. infant welfare centres, 1928. Health Visitors' Attendances 206 Number of Children who attended 1634 Number of attendances by Children 13703 Number of Children under 1 year of age 677 Number of Children over 1 year of age 957 Children who attended for first time 748 Children treated at Dental Clinic 123 Children treated at Ophthalmic Clinic 7 Mothers treated at Ophthalmic Clinic 7 Children treated for Enlarged Tonsils and Adenoids 12 1928 45 TABLE 9. ante-natal clinic. |
8ef34a57-8c10-48d3-9c72-cb73e5f1e975 | Number of attendances by Dr. Bell 23 Number of Expectant Mothers who attended 87 Number of attendances made by Expectant Mothers 138 Mothers referred for Dental treatment at the Clinic 16 Mothers supplied with Dentures 7 Expectant Mothers to whom Dried Milk was supplied 22 Number of packets of Dried Milk supplied 273 table 10. inquests. Inquests—29. |
aac40e17-52b1-4d70-8ca8-a421121bf90c | Struck by a motor car 5 Tetanus 1 Suicide 3 Fracture of skull working on a building 1 Cerebral Haemorrhage 2 Accidental burns 2 Found drowned 1 Accidental fall downstairs 2 Accidental fall in house 1 Cocaine Anaesthesia 1 Purpura Haemorrhagica 1 Fall from a lorry 1 Accidental drowning in bath 1 Struck by an iron girder 1 Run over by a railway train 1 Injury in motor car 1 Septic poisoning from splinter in finger 1 Struck by a crane 1 Septic poisoning 1 Morphia poisoning 1 Coroner's Certificates—13. |
495ea4ed-4b1e-47fe-8e0b-8dc86aab22d9 | Arterio-sebrosis 3 Bronchitis 1 Fatty heart 2 Acute Encephalitis 1 Cerebral Haemorrhage 1 Heart Disease 1 Chronic Nephritis 1 Duodenal Ulcer 1 Gastric Haemorrhage 1 Pneumonia 1 factories, workshops and workplaces. 1.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. Inspections Number of Written Notices. (1) (2). (3). Factories (Including Factory Laundries). 94 23 Workshops (Including Workshop Laundries) 296 18 Workplaces (Other than Outworkers' premises 7 Total 397 41 46 2.—Defects found in Factories, Workshops and workplaces. (1) (2). (3). Particulars. Found. Remedied. |
6ef25f1c-6c0a-4afb-8902-c5b5b383dc12 | Nuisances under the Public Health Acts:— Want of Cleanliness 15 15 Want of Ventilation Nil Nil Overcrowding Nil Nil Want of drainage of floors 2 2 Other Nuisances 9 9 Sanitary Accommodation:— Insufficient 3 3 Unsuitable or defective 10 10 Not separate for sexes — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground Bakehouses Nil Nil Other Offences Nil Nil Total 39 39 3.—Outwork in unwholesome premises. Section 108 Nil. HOUSING. |
bd4ce417-f408-4d59-9701-2935a8ed5cee | Number of houses erected during the year (a) Total (including numbers given separately under (b)) 196 (b) With State assistance under the Housing Acts:- (i) By the Local Authority Nil (ii) By other bodies or persons 52 1.—Unfit Dwelling Houses Inspection (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 974 (2) Number of dwelling houses which are inspected and recorded under the Housing (Inspection of District) Regulations, 1910, of the Housing Consolidated Regulations, 1925 725 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling houses (exclusive of those referred to under the preceding Sub-Head) found not to be in all respects reasonably fit for human habitation 942 I928 47 2.—Remedy of. Defects without Service of Formal Notices. |
7cdf6b5e-663a-42b2-8784-2ce70b373014 | A.—Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling houses in respect of which notices were served requiring repairs 228 (2) Number of dwelling houses which were rendered fit after the service of formal notices:— (a) by owners 227 (b) by local authority in default of owners 1 (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance, of declarations by owners of intention to close Nil B.—Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which notices. were served requiring defects to be remedied 186 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) by owners 186 (b) by local authority in default of owners Nil C.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925. |
fb00b612-a3bd-493e-af71-cac7c97e0fdd | (1) Number of representations made with a view to making of Closing Orders Nil (2) Number of dwelling houses in. respect of which Closing Orders were made Nil (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit Nil (4) Number of dwelling houses in respect of which Demolition Orders were made Nil (5) Number of dwelling houses demolished in pursuance of Demolition Orders Nil 1928 48 STAFF TO WHOSE SALARY CONTRIBUTION IS MADE UNDER THE PUBLIC HEALTH ACTS OR BY EXCHEQUER GRANTS. There has been no change in the Staff. 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 Animals Acts and the Rag Flock Act). |
827f1555-3cab-47ba-b1ac-90d259d11a33 | J. J. Jenkins. Cert. Sanitary Institute; holds Meat Certificate Sanitary Inspector. (Inspector under Fabrics Mis-description Act) . E. W. Brooks. Cert. Sanitary Institute. Sanitary Inspector. J. J. Matthews. Cert. Sanitary Institute. Sanitary Inspector; holds Meat Certificate. Miss A. Cooksey. Certificate Sanitary Institute. Health Visitor. Miss J. Welsh. Certificate Sanitary Institute, c.m.b., Health Visitor. Mrs. Light. Clerk. I have again to thank all the members of the Public Health Department for ungrudging assistance during the year. I am, Your obedient servant, D. J. THOMAS. Knowles & Co. (Printers $ Stationers) Ltd., Acton, W. s.. Mil* 1 ii |
0e84a533-472b-4c2f-a1d8-7cccd794ac73 | ACT 32 1929 BOROUGH OF ACTON ANNUAL REPORT OF THE Medical Officer of Health TOGETHER WITH THE Report on the Medical Inspection of Schools FOR THE YEAR 1929 70499 1929 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1929. Public Health Department, Municipal Offices, Acton, W.3. To the Mayor, Aldermen and Councillors of the Borough of Acton. Ladies and Gentlemen, I herewith submit the Annual Report required by the Ministry of Health, together with the Annual Report upon the School Medical Services. The birth-rate is slightly higher than in 1928. The birthrate has for years shown a constant tendency to become lower, and probably the slightly higher rate for 1929 was due to the large number of persons of child-bearing age who have recently come to reside in the new houses in the North-East and North-West Wards. |
27e145cb-9b53-4821-99e3-9b5db1c4628a | The death-rate is the highest recorded since 1918, and the cause of the high death-rate in both years was primarily due to an extensive outbreak of Influenza. Although the deaths certified to be due to Influenza numbered only 38, there was an increase in the number of deaths from other Respiratory Diseases such as Bronchitis, Pneumonia and Pulmonary Diseasfes. Another unsatisfactory feature of the vital statistics is the higher infantile-mortality. It is the highest infantile-mortality since 1917. There is a slight increase in the number of deaths from Respiratory Diseases, but the main increase is due to deaths from Premature births and Congenital Debility. 1929 4 For the first time since the pandemic in the early part of this century, Small-Pox appears in our statistics as a cause of death. These cases occurred amongst passengers of the Steamship Tuscania. |
11b7fec5-08c9-415f-8566-e697257977ca | There was only one death each from Scarlet Fever, Diptheria and Enteric Fever, but there were five deaths from Cerebrospinal Meningitis. Most of the latter occurred in the summer and suspicion was directed to the swimming baths as the source of infection. As a Departmental Committee has recently reported upon the hygiene of swimming baths, opportunity is taken of reviewing the question of the possible sources of pollution of swimming pools. The industrialisation of the northern part of the district continues and this brings in its train certain problems. Foremost am ng these is the housing problem. The demand for houses exceeds the supply, as those who are employed in the factories wish to reside as near their place of employment as possible. The prevention of atmospheric pollution by smoke has also become an urgent problem, and considerable time has been expended by the Inspectors on the work of prevention. |
85b8ebba-709b-4c48-8142-530e0c6a0e23 | The enforcement of the Smoke Prevention Acts requires considerable care, tact and ability, but it appears as if more drastic measures than moral suasion will be necessary before some of the owners appreciate that the Council is serious in its efforts to prevent atmospheric pollution. The following is a summary of the vital and other statistics for the year 1929. Area of Borough 2,305 acres. Population (estimated 1929) 65,200 Population (Census, 1921) 61,299 Number of inhabited houses (Census 1921) 11,820 Number of families or separate occupiers (Census, 1921) 14,941 Rateable Value (1st October, 1929) £653,721 Net produce of a penny rate (year ending 31st March, 1930) £3,165 5s. 4d. |
070c123f-9b5e-41d3-bb87-a9a5f16d3860 | Total number of births registered 1,026 Legitimate 973 Illegitimate 53 Birth-rate per 1,000 inhabitants 15.7 Number of deaths 826 Death-rate per 1,000 inhabitants 12.66 Number of women dying in consequence of childbirth— Sepsis 1 5 1929 Other causes 2 Maternal mortality per 1,000 births 3 Deaths of infants under 1 year of age— Legitimate 76 Illegitimate 9 Infantile mortality per 1,000 births 82 Total Deaths Death-rate per 1,000 Population. Measles 0 0.0 Whooping Cough 14 0.2 Diphtheria 1 0.015 Scarlet Fever 1 0.015 Influenza 38 0.6 Tuberculosis of Lungs 52 0.8 Tuberculosis (other forms) 7 0.1 Tuberculosis (all forms) 59 0.9 POPULATION. |
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