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32736bf4-97a8-46a8-b02c-6aee9dbb545c | In 1834, Graves in referring to what he terms " the destructive epidemic of Scarlet Fever " then prevailing in Dublin, goes on to say that in September, October, November and December, 1801, Scarlet Fever committed great ravages in Dublin and 38 continued its destructive progress until the Spring of 1802. Then he says that for the next 27 years, epidemics of Scarlet Fever though frequent, were always of a benign type. In 1831 however, there was a notable alteration in the character of the disease when occasional cases unexpectedly proved fatal. According to Farr, Scarlet Fever was an exceedingly fatal disease in England and Wales during the years 1848-1855. There is no doubt that in the past, Scarlet Fever has varied greatly in severity, having been at times a benign disease and at others a very fatal one. Scarlet Fever has evidently remained a mild disease for periods amounting to about a quarter of a century and then assumed a grave form. |
76f3a09a-2a58-455c-8a39-83bf71372ca1 | It would seem then, that the behaviour of this disease during recent years is not unlike what has happened in the past, and consequently it would be wise to regard it with suspicion and to be on our guard. From personal observation it appears that the type of Scarlet Fever prevalent in 1932 was less benign than in the immediately preceding years. There were 6 deaths from the disease during the year, corresponding to a death rate of .096 per 1,000 of the population. This is the highest death rate in the Borough since 1911. 1 of the deaths occurred outside the Borough, but the other 5 occurred at the Borough Isolation Hospital. One of these patients, a man of 29 years, was undoubtedly a true case of toxic Scarlet Fever. He was admitted to hospital in an almost moribund condition and died in three hours, and within 48 hours of the onset of illness. There was an intense dusky rash with only moderate faucial symptoms. |
3d71b270-430a-40b7-aa5d-8863b9a7beec | Another patient, a child of 18 months, was admitted on the 2nd day of illness, with a heavy rash and severe faucial symptoms. In spite of anti-scarlatinal and anti-streptococcal sera the child died on 15th day of the illness. The third patient, a woman of 33 years, was admitted on the 3rd day of illness with a sharp attack of Scarlet Fever. She was treated with anti-scarlatinal serum but the symptoms did not abate with the disappearance of the eruption and the temperature remained up and assumed a remittent type. The possibility of a coincident typhoid infection was considered and excluded, and the patient drifted downhill until her death on 14th day from the commencement of the illness. 37 Age Distribution. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 Over 65 - 185 . |
ea4e21cd-3cc8-4598-8e41-8d3dbfc4a676 | 286 33 32 1 β Ward Distribution. N. E. N. W. S. E. S. W. 115 69 110 243 The type of the disease varied in severity and this will be referred to later on, but it is the mildness of many of the cases which is largely responsible for the increased incidence. Diagnosis is difficult in mild cases, many are overlooked and unattended, while the medical practitioner frequently hesitates to diagnose Scarlet Fever on indefinite symptoms in order to avoid putting a family to inconvenience. For a number of years the mildness of Scarlet Fever has been s subject of comment and the opinion has been expressed that the danger to life of this disease has almost gone. It may be so, but unfortunately the weight of evidence does not justify such optimism. It is not so much the variation in the mortality of Scarlet Fever in different countries in recent years as the past history of the disease which suggests caution in our outlook. |
fd46d44a-8f40-4153-a851-07e364b09297 | In 1675 Sydenham described Scarlet Fever as "an ailment, we can hardly call it more," and yet in the very year of Sydenham's death it was epidemic in London and became the severe disease of which malignant attacks were recorded. Again, that illustrious teacher Bretonneau taught that Scarlatina, which he had formerly heard spoken of as a dangerous malady, was then a mild infection, and he said that from 1799 to 1822 he did not recollect seeing a single fatal case. In 1824 an epidemic of severe type broke out in Tours and its neighbourhood and the result was that Bretonneau who had previously looked upon Scarlet Fever as a slight malady now learned to regard it as equally mortal with plague, typhus and cholera. |
103e1d92-409b-4dcf-a7ea-1a5753afecc0 | In 1834, Graves in referring to what he terms " the destructive epidemic of Scarlet Fever " then prevailing in Dublin, Uoes on to say that in September, October, November and December, 1801, Scarlet Fever committed great ravages in Dublin and 38 continued its destructive progress until the Spring of 1802. Then he says that for the next 27 years, epidemics of Scarlet Fever though frequent, were always of a benign type. In 1831 however, there was a notable alteration in the character of the disease when occasional cases unexpectedly proved fatal. According to Farr, Scarlet Fever was an exceedingly fatal disease in England and Wales during the years 1848-1855. There is no doubt that in the past, Scarlet Fever has varied greatly in severity, having been at times a benign disease and at others a very fated one. Scarlet Fever has evidently remained a mild disease for periods amounting to about a quarter of a century and then assumed a grave form. |
0f4a780a-0c72-42eb-88f7-2f017ba4433e | It would seem then, that the behaviour of this disease during recent years is not unlike what has happened in the past, and consequently it would be wise to regard it with suspicion and to be on our guard. From personal observation it appears that the type of Scarlet Fever prevalent in 1932 was less benign than in the immediately preceding years. There were 6 deaths from the disease during the year, corresponding to a death rate of .096 per 1,000 of the population. This is the highest death rate in the Borough since 1911. 1 of the deaths occurred outside the Borough, but the other 5 occurred at the Borough Isolation Hospital. One of these patients, a man of 29 years, was undoubtedly a true case of toxic Scarlet Fever. He was admitted tu hospital in an almost moribund condition ana died in three hours, and within 48 hours of the onset of illness. There was an intense dusky rash with only moderate faucial symptoms. |
4206474c-7fec-4aa2-9351-2a7fc908e6bb | Another patient, a child of 18 months, was admitted on the 2nd day of illness, with a heavy rash and severe faucial symptoms. In spite of anti-scarlatinal and anti-streptococcal sera the child died on 15th day of the illness. The third patient, a woman of 33 years, was admitted on the 3rd day of illness with a sharp attack of Scarlet Fever. She was treated with anti-scarlatinal serum but the symptoms did not abate with the disappearance of the eruption and the temperature remained up and assumed a remittent type. The possibility of a coincident typhoid infection was considered and excluded, and the patient drifted downhill until her death on 14th day from the commencement of the illness. 39 Our 4th fatal case, a child of 5Β£ years, came into hospital on the 4th day of the illness. |
0ecdb8d8-6146-4bed-8657-b46eaacede63 | There was profuse nasal and ear disdarge, and the glands of the neck were much enlarged. The land was treated with serum on admission, but the symptoms abated only slightly and she died on the 7th day from the onset. The last fatal case was a girl of 8 years who was admitted on the 5th day of illness. The rash had faded and the faucial symptoms were moderate were moderate but the general toxaemia was sevre. Anti-streptococcal serum was given, but signs of Prevmonia developed within a few days of admission and the child diod on the 12th day from the onset of disease. The child who died from the disease outside the Borough was originally a patient at the Borough Isolation Hospital. She was a girl of 5Β½ years. |
423badd2-6e1f-4fcc-acd1-6b353784c2ba | Until the 3rd week she made uneventful progress; purpura haemorhagica then developed and she was freaferred to the London Fever Hospital for blood transfusion and operative treatment. Unfortunately the condition became very much worse and the child died. We have been struck by the fact that the cases admitted to hospital in the early stages of the disease have made more satisfactory progress than those admitted a few days later after the on set. This is undoubtedly due to the fact that anti-scarlatinal Senun is given to all but mild cases on admission to the hospital as long as they are admitted sufficiently early for the serum to be of benefit. The injection of serum is found to have a marked effect upon the course of the disease, provided that it is given sufficiently early. Complications are prevented and the stay of the Patient in hospital considerably shortened. |
caf38c13-7d26-4e94-8675-87acbf44fba7 | Dick testing for susceptibility to Scarlet Fever and immunisation against the disease is less commonly used than is Schick testing for Diphtheria, probably owing to the relative mildness of Scarlet Fever. In the hospital, passive immunisation against Scarlet Fever has been of tremendous value in checking the spread of the disease when a case has arisen in one of the Diphtheria or Measles wards. Meningococcal Meningitis. There were only two cases of Meningococcal Meningitis notofied during the year. 40 Encephalitis Letharigca. There were no notifications of Encephalitis Lethargica and no deaths occurred from the disease, or other germ diseases of the central nervous system. Small-Pox. No cases of Small-Pox were notified during the year. Several contacts of the cases which occurred outside the district have how ever been notified to us and kept under supervision. Ophthalmia Neonatorum. |
3f2122bb-0f31-427a-9d82-324e47bd7fc9 | 5 cases of Ophthalmia Neonatorum were notified. The Council has agreement with the London County Council for the admission, if necessary, of cases into St. Margarets Hospital. Two cases were admitted under the terms of the agreement. All the cases recovered and the sight was not affected. Whooping Cough. During the year 6 deaths occurred from Whooping Cough As Whooping Cough is not compulsorily notifiable, it is not easy to estimate the probable number of cases which occurred here last year. Whooping Cough is admittedly a most difficult disease to prevent. In the early stages, it is impossible to diagnose it. The initial cough is no different from coughs from other causes to which children are liable, and the characteristic spasm and whoop do not occur until about the second week. The disease is infectious dunring the early catarrhal stage and opportunity for contact is abundantly afforded by the usual conditions of urban life. |
2499f158-f7ae-485e-8984-f4fb5ee4a83a | As far as schocts are concerned the efforts to control it are almost useless. Exclusion of cases from the schools after they have become clinically manifest cannot be effective in controlling an outbreak. It has been assumed that the epidemic cycle in Whoopig Cough is due to the fact that there is some cycle of activity of the bacillus influenced by seasonal conditions. It is well known that Whooping Cough is more severe when it occurs during the winter months. This theory however is discounted by the fact that the epidemic period is not identical in different towns. Even in the areas of London streets whose populations are continually mixing with each other, the cycle can be in a different phase by severed months. 41 When an epidemic occurs in the winter months the difficulties of treatment appear to be greater. There is no specific treatment tor the disease. The results obtained from the use of the Bordetbengon vaccine have been unsatisfactory. |
f69a49d9-13b0-4481-848b-a41a1d013413 | The Bordet-Gengon bacillus is characterised by a signal absence of toxin formation in culture, and a remarkably low virulence towards laboratory animals. Cultures of the bacillus in strength of billions of bacteria per c.cm. have been injected into small guinea-pigs without producing untoward results. Similarly, in the use of vaccine for prophylaxis and curative action in cases of whooping cough, children have shown a remarkable tolerance for quite enormous doses of the bacillus. In view of the immunity which an attack of whooping cough confers upon a child, it is reasonable to doubt if the Bordet-Gengon bacillus is the real cause of whooping cough. It is well known that second attacks are very rare, and artificial immunisation should not therefore be difficult. Measles. There were 12 deaths from Measles in 1932. |
454592e1-8491-4b89-84c6-ec9f17fbe47f | In the early part of the year there was an extensive outbreak of Measles, which comemnced in the southern part of the district but which ultimately spread through all the wards. When the schools re-opened after Christmas several cases of Measles were found to have occurred during the holidays. Although we are not self contained as we were formerly, and the first cases which occurred in the district were fairly easily traced, we still frequently trace the source of the infection of Measles. In this instance, though, the original case which gave rise to the present outbreak was not traced. It had been known that Measles became prevalent in London towards the end of 1931. The administrative County of London is such a huge area that deaths from Measles appear in every weekly return of deaths. In this respect it differs from all other towns in England and Wales. |
94556a6f-f3c7-4434-870e-519d2994ae0f | In other places Measles is an explosive outbreak and then "the town is entirely free of the disease for a year or two and no deaths from Measles appear in their returns. In the autumn, London was almost entirely free from the disease, only one death being usually recorded from the disease, and on three occasions two deaths occurred in one week. In the week ended November 14th, 6 deaths were recorded, but the number was only 2 in each of the weeks ended November the 21st and 28th. In December the number of deaths steadily increased, and in the week ended January 16th, the number was 22. 42 Measles may therefore be said to have been prevalent in London towards the end of 1931. Having regard to the intercommunication between Acton and the Metropolitan Boroughs, it can easily be understood that the disease would soon be introduced here. Usually we are able to trace the first case, but in this instance we were unable to do so. |
676a12cb-0d33-4244-bf6e-ba67ac98c015 | We were aware of a case in the South West Ward in December, but this child was under school age, and was probably not the source of infection of the school cases. The family came from Scotland, and the child was ill on arrival, so ill that he was confined either to bed or to the house during his stay in the district. On the reopening of the schools after the Christmas holidays, 3 cases were reported, one from the South-East Ward, and 2 from the South West Ward. The 3 children all attended the Rothschild Infants Department, and the course of the outbreak throughout, coincided with the school distribution of the victims. |
2e975fc2-d705-48dd-9767-59ab8b7e6328 | In January the cases were limited to the South West and South East Wards west of Acton Lane, and south of the North London Railway, because the children of the Rothschild Road Infants Department and Beaumont Park Infants Department were drawn from this area, and these two were the departments in which the disease first made its appearance, afterwards the outbreak spread northwards and eastwards throughout the district. No disease observes so regular a periodicity as Measles, and once an outbreak occurs in a populous district, it is doubtful if any measures are efficient to control an epidemic. In Acton, the disease appears almost regularly every other year. Formerly, we used to have a major epidemic and a minor epidemic or as they are sometimes called an epidemic and a hypo-epidemic at regular intervals. In recent years, the epidemics do not vary much in their virulence or fatality from year to year. Although an epidemic cannot be controlled there has been a very considerable reduction in Measles mortality. |
bb01c693-677b-4f5d-bc52-d4ab7777ef43 | Many factors have entered into the causation of this reduced fatality. Part of it is due to the lowered birth rate, though this only explains a small part of the reduced morbidity of Measles. A fuller appreciation of the causes of death in the sufferers from the disease, and an application of methods of prevention of these causes probably have had a much greater influence. 43 The specific cause of Measles has not been discovered ; it is probable that the disease is due to some living virus in the blood of the sufferer and is of the nature of a " filter passer." Whatever the cause whether it be a "germ" or a " filter virus," the proper mortality from "Measles" is trivial ; nearly all the deaths occurring during the disease are due to added symbiotic infection. We may have little control over Measles, but we have considerable powers over its symbioses. |
bf154f24-f8b8-4a92-8b02-170c24b997ec | These are mainly pneumococci and haemolytic streptococci, which spread by droplet infection, and whose striking distance is short. Consequently, spacing has an enermous influence on the mortality from this disease. These facts have influenced our methods of combating the disease. We have sufficient accommodation for the immediate reception of all Many years ago, Sir Arthur Newsholme when Medical Officer of health for Brighton, showed that terminal disinfection after Measles was useless, and few authorities now trouble to carry out the disinfection. School closure has also been given up as worse than useless. Our efforts are concentrated on preventing the wortality, rather than preventing the spread of the disease. An endeavouris is made to obtain early information of all cases, and to secute good nursing. Where good nursing can be obtained in the home. this is sufficient, but in most industrial districts, this is nof possible in a considerable number of cases. |
295a2c93-a804-4ae4-bf0c-f1d499552753 | Most authorities now andeavour to secure the necessary treatment in hospital, where the home conditions are unsatisfactory. Unfortunately, few authorities have sufficient accommodation for the immediate reception of all cases in which the home conditions are unfavourable with the result that many sufferers are not admitted to hospital until serious complications have intervened. We were comparatively fortunate in the matter of hospital accommodation during the epidemic, but shows impossible to arrange for the immediate admission of all cases which required removal from the home. Many of the cases admitted were suffering from bronchoprenmonia and this fact accounted for most of the deaths in hospital. The great majority of the cases in the disease did not develop complications and rapidly recovered from the disease. Other fators have operated in reducing the mortality from Measles. Among these may be mentioned the work which is done for Child Welfare and in the School Medical Service. |
664065b0-dff8-462c-a362-9c797769e14a | The Health Visctors School Nurses endeavour to teach parents that Meastas is a serious disease and that its spread and danger may a reduced by avoiding the herding together of children during an epcdenic. 44 Moreover the advice given to mothers in the upbringing of children, the improvement in the physical condition of the children and the care of the teeth, nose and throat which is given at clinict have all contributed towards raising the immunity and increasing the resistance of the child to attacks of Measles and its complications. Diphtheria. In the year 151 cases of -Diphtheria were notified and there were 21 deaths from the disease. There was a considerable increase in the number of notifications, but the most marked increase was in the number of deaths which occurred. The increased incidence and fatality were due to a most virulent type of disease which made its appearance in the early autumn. In the early part of the year, the incidence of Diphtheria in the district was low. |
6e515db4-be77-4f40-a354-19744e95a8c9 | Up to the end of July the notifications from the different schools had been as follows: β Berrymede 5 Priory 4 Beaumont Park 3 Southfield Road 2 John Perryn 2 Turnham Green R.C. 3 Acton Wells 1 Derwentwater 1 In the same period, 8 cases occurred in children under school age, distributed amongst the wards as follows: β North East North West South East South West 2 113 In addition, 3 cases occurred in persons over school age in the North East Ward and 1 in the South West Ward. In August 4 cases occurred amongst school children: 2 from Beaumont Park and 1 each from the Central and Turnham Green R.C. Schools. Altogether 37 cases were notified up to thr end of August and 5 deaths had occurred. 45 Until September the disease could be said to have followed a farly normal course. |
6591570c-62d7-4fc2-ad7b-a2a0ae1ebbbe | Its incidence was slightly higher than that obseved in inter-epidemic years, but there were no cases of extreme vorulence in the earlier part of the year. The deaths which occurred were in young childrenβ1 in an infant under 1 year of age, 1 in a child in his second year and 3 in children between the ages of 2 and 5 years.. Although the spread of Diphtheria in recent years has become associated with elementary schools, its fatality is still greater amongest children under 5 years of age. When extensive outbreaks occure. Diphtheria is typically a disease of schools and institutions where children are brought together at susceptible ages. But through its incidence is greatest at school ages its fatality is greater at ages under 5 years. It is not common in the first year but it becomes increasingly fatal, until the maximum morbidity is reached somewhere between the second and fifth year. |
690c0ec5-30af-4f39-8ae5-60b05402bdf0 | The incidence declines slowly in the age group 5-10 years, after which the probaof contracting Diphtheria is small. Daring the earlier part of the year, the incidence of the disease conformed with that observed in other parts of the country, but the autumn the course of the disease was abnormal in many respects. Its age distribution was different, but its most marked characteristic was its extreme virulence. The earlier cases all occurred among pupils attending Southfield Road Junior School. Subsequently cases of a virulent type occurred in other schools, but it is of interest that a connection between these children and those who attended Southfield Road School could be traced. Of the two cases notified from pupils attending Southfield Read School early in the year, one had occurred in January and the other in March. Both were of a mild type and recovered. |
d658be6b-6cf7-4af7-93db-fac9c9622a1e | After the summer holidays, the first case was notified on September 24th and four others were notified in September, the dates being, September 26thβ2 cases, September 27thβ1 case, and September 28th- 1case. From the dates of onset of the latter 4 cases, it is Possible that the infection was contracted on the same date, but if at was a school infection, it was not a class infection. The children were in 5 different classes. These 5 cases were all severe, and three of them proved fatal. In the first fortnight in October, 8 other cases occurred in the school; 7 in the Junior Department and 1 in the Infants' 46 Department. The infection in the case of the child in the Infants Department was probably contracted in the home, as another case occurred in the family a few days previously. The course of the disease in the Southfield Road junior School will be referred to in a subsequent paragraph. |
82c78ea1-fcae-44ce-915e-0c6bf2743b2a | The other schools which suffered were the County School Rothschild Road and John Perryn Schools. It is probable that the infection in the John Perryn School was an independent one. The type was not as virulent as that in the other schools, and there did not appear to be in intimate connection between the cases. 8 case occurred in John Perryn School, but there were no deaths. The first case which occurred in the County School was in a boy who resided in Bedford Park, and some of the cases were similar in character to those which had occurred in Southfield Road School. The type was probably modified, because the pupils were older and it is well known that Diphtheria is more fatal in young children. 4 cases occurred in Rothschild Road Infants Department in October and 5 other cases occurred in the first fortnight in November. There is a connection between Rothschild Road School and Southfield School, the senior boys of Southfield School being recruited from the Rothschild Road Junior School. |
c1aa42a9-83e1-4300-bc37-8cad78c03b1e | Up to the end of the year, most of the cases of school ape occurred in these schoolsβ^Southfield Road, Rothschild, John Perryn and County. 3 cases occurred among Acton girls attendin; Chiswick County School. These cases were also of a very virukm type. Cases occurred amongst children under school age in other parts of the district. The ward distribution is given on another page, but this was of less importance in the incidence of the disease than the school distribution. In the past four years outbreaks of extreme virulence have been reported not only in this country, but in other countries Europe. In this country, outbreaks of unwonted severity have been reported from several parts, and in districts in and around London outbreaks of the severe type of Diphtheria have occurred It has been suggested that Diphtheria generally is entering upon a more severe stage. If the disease is about to vary in virulence the first indication will be increased variation in local fatality. |
ce136573-fab0-4e23-ba39-f709841b7921 | In the last few years, the numbers of districts which record rates higher 47 than the average have been increasing, and various factors have been assigned as a cause of this increased virulence. The chief causes are said to be, an increased virulence of the organism, and a lowered communal immunity. The work originating in Leeds suggests two strains of corynebacterium Klebs Loeffler. In 1931, when investigating a severe outbreak of Diphtheria in Leeds, it was ascertained that there were two kinds of Diphtheria bacilli, to which the names of Diphtheria Bacillus Gravis and Diphtheria Bacillis Mitis were given. The cultural characteristics of the two types are said to be a definite and constant, though there are intermediate types. |
29a5bdb0-0e41-4092-9d7d-e3d1a6fb1c30 | As a result of .this work it was suggested (a) that the gravis type is mainly, or even solely, associated with severe forms of Diphtheria, (b) that the mitis type causes only mild attacks, and (c) that attacks caused by the gravis strains respond less satisfactorily to the ordinary anti-toxin prepared from the Park-Williams bacillus, and that a special anti-toxin is called for. Dr. O'Brien of the Wellcome Research Laboratories kindly examined some swabs from the most severe of our cases. 10 swabs were sent to him, and he reported that 6 were of the gravis type, 2 of the mitis type, and 2 contained bacilli of the gravis and mitis types. Exaltation of virulence has been denied by some bacteriologists, and in an article in the British Medical Journal of November, 19th, 1932, Dr. |
1bd6c25f-5b85-4da6-b8f3-e31dbaf938f4 | O'Brien and his co-workers set forth the result of their experience. They stated that there is no satisfactory evidence that the gravest types of Diphtheria are generally associated solely or even mainly with the gravis types of bacillus. If gravis and mitis cultures are injected into groups of guinea pigs the two groups can be saved with' equal readiness by Park 8 antitoxin given some hours later. Guinea pigs immunised with prophylactic mixture which are impervious to human immunisation in England and which are prepared from Park 8 strain survive the injections of large doses of gravis cultures. Bacteriologists, of course, can only determine virulence of human parasites by the reaction upon adventitious hosts. It is possible that Diphtheria may very in virulence towards man, its natural host, and yet show no alteration in its behaviour to rabbits or guinea pigs. There is room therefore for the clinicians to express their opinion as to the character of the disease. |
68fecdbb-ecde-4fcd-8816-8b9d072fa878 | It is impossible for the clinicians to adduce evidence which is acceptable to the pure scientist. It is always difficult to attain a reliable history in a large number of cases. This is more particularly true of the mild type of disease and of small children. But in some of these cases, we were satisfied that the history was correct and that 48 anti-toxin was given within 36 hours of the onset; in spite of this the patient died. We have been used to a rapid improvement and recovery when anti-toxin is administered early, especially when the disease occurs in older children. The early cases in the autumn were in older children; of the deaths which occurred, 2 were aged 12 years, one 11 years, one 10 years and two 8 years. As previously stated, most of these were admitted in a comparatively early stage of the disease. In these older children anti-toxin was given intravenously and in large doses. |
6fcb1bbf-7f14-48de-b934-625a718bb3c4 | There is always a tendency to blame the therapeutic agent placed in our hands when we are face to face with an outbreak of Diphtheria, but these details are mentioned not with the object of finding fault with the anti-toxin, but to emphasize the difference in the reaction of these cases to treatment as compared with that observed in the ordinary way. It cannot be said that these children would be peculiarly liable to a fatal result if attacked by any serious illness. The children in these particular schools would compare favourably not only with the children in the other schools in the district, but with those of any elementary and secondary school in and around London. We are forced to the conclusion that in the present instance the type of the disease was a very virulent one and this virulence was probably caused by an exaltation of virulence in the germ. The other factor which might have been operative was a low communal immunity. |
25df06c7-8564-4fc6-9699-a2d7a594a670 | In the present century much attention has been paid to the study of epidemics, and the conditions under which outbreaks of infectious diseases occur, and in order to appreciate the importance of certain procedures which have been adopted to prevent Diphtheria, it is necessary to take a wider view of the subject. Diphtheria is not a disease of modern times, but until late in the last century it was confused with other diseases. The discovery of the Klebs Loeffler bacillus in 1883-84 contributed towards the correct diagnosis of the disease. Ten years later antitoxin was discovered and this affected mortality from the disease to an enormous extent. From 1895 onwards, the use of anti-toxin became general and although other factors may have operated, the introduction of anti-toxin has been one of the principal factors in the reduction of the fatality. For nearly 30 years there was a continuous decline, but in the last 10 years the mortality from Diphtheria has been almost stationary. |
b8a30ece-f1bd-404e-92cf-7c281d71fd32 | On account of the smaller population our deathrate has been different from that of the rest of the kingdom, but the tendency has been a downward one. 49 The following table gives the number of notifications and deaths from Diphtheria since the adoption of the Notification of infectious Diseases Act, 1889. Year. Population. Notifications Deaths. 1931 70,560 61 4 1930 69,565 103 9 1929 68,600 68 1 1928 67,645 78 7 1927 66,700 69 1 1926 65,760 42 2 1925 64,845 63 1 1924 63,945 45 5 1923 62,720 61 3 1922 62,170 223 12 1921 61,299 205 16 1920 61,000 141 18 1919 61, |
2df33ee1-6dba-4395-8053-73230620c807 | 732 54 2 1918 59,000 116 2 1917 65,219 67 3 1916 57,913 81 4 1915 58,238 78 14 1914 61,000 116 10 1913 60,000 117 8 1912 59,000 100 8 1911 58,048 115 9 1910 57,000 118 8 1909 56,000 104 22 1908 55,000 83 7 1907 53,000 63 5 1906 52,000 46 2 1905 50,000 49 4 1904 46,780 32 2 1903 43,803 22 4 1902 41,000 33 6 1901 38,373 34 4 1900 36, |
740d1249-487b-412e-b78a-a0f1918c93c3 | 508 28 4 1899 34,901 49 7 1898 33,404 35 8 1897 31,952 89 28 1896 30,564 23 8 1895 27,648 32 5 1894 27,600 22 5 1893 26,000 41 2 1892 25,000 27 4 1890 23,500 14 7 50 Before 1905, the figures for the deaths are not strictly accurate. Since 1905, all the outside deaths have been included but prior to that date, a complete return of the outside deaths was not available. Although I have not worked the figures as percentages of the total population, they plainly show the periodicity ot the disease. |
0026c2d5-effb-4bc5-a34c-4384367a4d34 | In recent years Diphtheria has made its appearand in certain epidemic waves, the crests of which attain their maxima at intervals of a certain number of years, although the general tendency has been towards a diminution of the mortality. What are the factors which influence the appearance of these waves? I have already referred to one factor which may be operative I have mentioned the extreme virulence of the type and it is suggested that this is due Jp an alteration in virulence of the causal agent. This theory would account for the outbreak by the appearance of a very virulent type of bacillus, which has been mentioned in a previous paragraph as the Diphtheria Bacillus Gravis. It means that an alteration in the type of the disease has occurred in the epidemic period. During the inter-epidemic periods the disease is less potent and also less infectious, and it is suggested that this increase in potency and infectivity gives rise to the epidemic. |
4f479a98-d872-44b8-a78b-20a0aecea7b1 | This factor may be operative, but a more important factor probably is the gradual accumulation of susceptible persons in the population. This factor may act over longer or shorter periods We have an example of the shorter period in the periodicity of Measles, which in this country makes its appearance almost regularly in the large towns every 2 years. The same factor probably operates in the case of Diphtheria, but the outbreak of a less explosive character and epidemics occur at longer intervals. It is a matter of common knowledge that any group of individuals contains susceptibles and insusceptibles or immunes In the case of Diphtheria, the immunity is acquired by repeated exposure to diphtheria infection. If a district remains comparatively free from diphtheria for a long time, a considerable amount of susceptible material accumulates in that community, and as explosive outbreak sooner or later occurs. When the herd immunity is lowered to a certain point that community is particularly vulnerable. |
6920bfd3-4e32-4f03-84ef-2410a8160e4f | We do not know what rates of susceptibles cause parasitic infections to become epidemic, and it is quite possible that a slight raising or a slight lowering of susceptibles may make an enormous difference in disease incidence. The measures hither, employed against the spread of this disease which aim at the truction of the germβdisinfection, bacteriological search carriers, isolation of clinical casesβhave proved inadequate. In the past our mode of procedure consisted of hospital treatment of 51 actual cases, swabbing of contacts and the search for carriers. At the onset of an outbreak this method may prove successful in cutting it short, at any rate for a time, but when the cases are distributed throughout a school or are in different schools, the number in which diphtheria bacilli are found in the throats is so oreat, that isolation of all suspected cases is impossible. Our best method of success is by raising the herd immunity of the community. The problem is to render the susceptible, insusceptible. |
e5dc002c-95c2-4d38-8bb6-1dc1e5718cd1 | In the last annual report of the Ministry of Health, Sir George Newman states that in the case of Diphtheria this is not only feasible and practicable but eminently desirable. As far as this district is concerned Schick-testing and active immunization' are inovations, and it may be advisable to give a short account of the process. The Schick-test of susceptibility was introduced in 1913 and involves the injection into the skin of a minute dose of Diphtheria toxin diluted with saline solution. The reaction depends on the local irritant action of Diphtheria toxin when so injected. If the blood of the person injected contains an insufficient amount of anti-toxin to protect him against Diphtheria, he is liable to contract the disease if he comes in contact with another person suffering from Diphtheria. In this case he will give what is called a positive reaction. |
fba50ccb-c99a-4b70-beb4-fef5f8aedfb2 | This reaction is characterised by an area of redness about half &n* inch or more around the site of injection. If the person tested is immune or not susceptible to diphtheria, no redness occurs and he is said to be a negative reactor. The next step is the active immunisation of the susceptible persons or the positive reactors. Passive immunity is frequently brought about by injecting small doses of anti-toxin and this is made use of to protect children in a general hospital exposed to infection when Diphtheria occurs in a ward. Doctors also give doses of anti-toxin to other members of the family when a case has occurred in a house. This kind of immunity is called passive because the cells of the blood do not produce any anti-toxin, but the anti-toxin is introduced from without and circulates in the blood. The immunity thus conferred is transient and probably lasts only for a few weeks. |
d376ce1e-1547-4cb3-8e27-e78434b99a73 | Active and prolonged immunity can only be conferred when the cells of the body manufacture anti-toxin, and this form of immunity is produced when a person suffers from the disease. This is the reason why a person rarely suffers more than once from such diseases as Measles, Scarlet Fever, Diphtheria, etc. The patient tas stored in his tissues sufficient anti-body to fight the particular disease for the rest of his life. The same process can be introduced 52 in the case of Diphtheria without actually suffering from a clinical attack of the disease. Von Behring in 1913 suggested the use ot toxin anti-toxin as an immunising agent, the toxin being sufficiently neutralised by anti-toxin to antagonise its dangerous properties. The use of toxoid-antitoxin as a prophylactic was first adopted on a large scale in 1921 .in New York City. Three injections of the prophylactic are needed to develop gradually an immunity against Diphtheria. |
099e264b-eb0a-4d04-8d02-74126162bc8d | It is estimated that about 95% of the Schick-positives become Schick negatives in less than six months after inoculation. As far as this country is concerned prophylactic immunisation has only been used extensively to deal with staffs of nurses and inmato of large institutions and schools where outbreaks of Diphtheria have occurred or are likely to occur. America and Canada are far ahead of this country in instituting general prophylactic measures against Diphtheria. An idea of the work done in the United States may be gauged by the records of Philadelphia where 364,000 children had been immunised by the end of 1929 ; the attack-rate had fallen to the low level of 0.4 per thousand inhabitants and no hospital for Diphtheria was required. In this country opposition is fairly strong and it is difficult to get people to understand the benefits of the process. |
1d22d54b-84a3-400d-99a2-4b1a70876a61 | Stress is laid upon the accidents which have occurred, these are admitted, but they have occurred under conditions which are not likely to occur in this country. No accidents have occurred in England. The report of the Chief Medical Officer of the Ministry of Health deals with this aspect. "As a necessary preliminary to such a process as immunisation it is necesasry to be satisfied that the reagents employed will in fact effect that which is claimed for them and that they are otherwise innocuous. Thcie is no doubt that given the safeguards now supplied by the provisions of the Therapeutic Substances Regulations, these claims have been fully substantiated as far as the immunising reagents used in this country are concerned." Those who most appreciate the value of immunisation are by no means eager to press it unduly ; they feel that its future is assured if it is allowed to make its own way on its merit. |
41e7e9ad-ad61-4aab-a560-1ff713a4d887 | A report was submitted to the Health Committee and the School Management Committee and it was decided to offer immunisation to all those who desired it. As two of the schools were affected the procedure was primarily adapted to the school population. Requests were also received from parents of children in other schools for the immunisation of their children. It was therefore decided to carry out this part of the work at the School Clinc 53 on Saturday mornings. The Saturday morning clinic is still being carrued on, but it is now attended mostly by children under school ags. It was explained that if the response from Southfield Road and the County Schools was favourable, it would be impossible to carry out the Schick testing without outside assistance. A circular was issued to all the parents, and it was stated that acceptance was to be entirely voluntary, and that the immunisation could be carried out by the family doctor if the patents so desired. There were 484 acceptances from Southfield Road School, and 257 from the County School. |
8b9a1835-e859-4e55-97c0-4c61026f598d | Arrangements were made with Dr. Guy Bousfield to do the Schick test. Dr. Bousfield has probably done more Schick testing" and immunisation than any other person in this country, and we were fortunate in obtaining his services. In the other schools the problem was not so urgent and Dr. Howell and myself were able to arrange to carry out the work. It is impossible at the present time to give a full report of the work done, a.s it is Shell going on. It will be more convenient to give an account of in at a later stage. It may be mentioned that up to the end of February, 1933, we had Schick tested 1,922 children and immunised partly or wholly 1,909 children. Because of the necessity of controlling the epidemic in the Schools we had to concentrate our attention very largely on the children of school age. |
0a7bcee6-528b-4a3e-8180-88b74eb848f9 | It is recognised, though, that if preventive measures are undertaken to stamp out Diphtheria, it is essential that a large proportion of the most susceptible subjectsβchildren' of pre-school age^should be immunised. Recent work has-shown that although fifty to. seventy per cent, of children of school age have been protected, it was not until at least an additional thirty per cent. or more of those under five years had been immunised any fall in the Diphtheria rate of the community as a whole was produced. If success is to be attained, our efforts must be drected towards the protection of the pre-school child who is exposed to greater risk from his higher susceptibility and from home contact with older children attending school. The tendency recently has been to urge immunisation at on earlier age than was formerly the practice. |
8a1e2390-03f4-47a9-aeea-9f0ba5c1c580 | Formerly it was usual to delay immunisation until the second year of life, but It has been found that the supposed maternal transmitted immunity in infants varies considerably during the first twelve months of life. Compared with other districts, we must consider that our compaign has been very successful. This has bene due partly to the severe type of disease which was experienced. Opposition has 54 of course been met, but the opposition has been due to some misundrstanding as to the object of the process, and also to a want of appreciation of the seriousness of the disease. Diphtheria has for some time been mild in character, and the fathers in particular have not been very helpful. The opposition of the fathers has arisen in many instances from their experience of inoculations in the army. Many of them state that unfavourable symptoms followed their inoculation for Typhoid and vaccination for SmallPox. |
522ad6bd-9606-487f-b9e2-b05e9d752323 | The mothers, on the other hand, have seen for themselves the freedom from pain at the inoculatoin and the subsequent absence of reaction. Many mothers have come to us to complain that their children could not possibly have been inoculated, because the children have not felt the prick of the needle, nor was there the slightest mark or reaction following the inoculation. It is not claimed, of course, that there is no reaction in any case. A slight redness of the arm does occasionally result and rarely a local reactions may persist for a day or two. But in the vast majority of cases there is not the slightest local or constitutional reaction. The mothers are also more familiar with the facts connected with cases of Diphtheria which have occurred in their neighbour's homes and that the cases have occurred with a persistent regularity amonges those children whose parents had refused immunisation. |
391b85c8-cae2-4e53-a36c-b3539495f7dd | The fathers, being at work, would not be so cognisant of these facts and possibly not so appreciative of any new procedure in the prevention of the disease. Naturally, some people confuse immunisation with vaccination against Small-Pox. One parent refused because she said that her neighbour's child had been vaccinated but in spite of this, had contracted Measles, Whooping Cough and Scarlet Fever. Many people do not appreciate that immunisation is against one particular disease, and that it has no effect upon any other disease. Tuberculosis. 96 cases of Pulmonary Tuberculosis and 18 cases of other froms of Tuberculosis were notified during the year. There were 48 deaths from Pulmonary Tuberculosis and at deaths from other forms of Tuberculosis. |
431c3417-76a7-42b9-a377-a294746dd208 | 55 The death notification interval of the 48 patients who died of Pulmonary Tuberculosis in 1932 was:β Information from Death Returns 12 Died within 1 month after notification 7 Died between 1 and 3 months after notification 6 Died between 3 and 6 months after notification 2 Died between 6 and 12 months after notification 5 Died between 1 and 2 years after notification 6 Died between 2 and 3 years after notification 3 Died over 3 years after notification 7 On December 31st the following is a statement of the particulars appearing in the Register of cases of Tuberculosis. Pulmonary. Non-Pulmonary. Total Males. Females. M ales. Females. Number of Cases of T.B. |
d3adc4f8-8fba-4eb2-9059-87b32d1e9890 | on the Register at the commencement of year 130 124 28 21 303 Number of Cases notified for the first time during the year 45 42 11 4 102 Number of Cases previously removed from the Register which have been restored thereto during the year 1 2 - - 3 Number of Cases added to the Register other than by notification 4 3 1 2 10 Number of Cases removed from the Register during the year 22 21 5 2 50 Number of Cases remaining on the Register at teh end of the year 158 150 35 25 368 In 1932, the Tuberculosis Officer examined 95 new cases at Pulmonary Tuberculosis and 15 new cases of Non-Pulmonary Tubrculosis. 53 patients were admitted to Sanatoria under the country scheme and 23 were admitted to Hospitals. 56 Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. |
1e84c873-ea6d-4693-be10-89327c455ea6 | Non-Pulmonary. M. F. M. F. M. F. M. F. |
a566c262-2b1b-41ec-b48e-2febad0bb00a | 0β - - - - - - - 1 1β - - 3 1 1 - 1 1 5β 1 1 1 1 - - - 1 10β - 1 1 - - - - - 15β 6 8 2 1 2 4 1 1 20β 4 16 - - 3 4 - 1 25β 10 11 1 2 4 7 - - 35β 9 4 2 1 3 5 - - 45β 11 3 - - 4 3 1 1 55β 7 2 2 - 3 2 1 1 65 and upwards 1 1 β - 2 1 β β Totals 49 47 12 6 22 26 4 7 57 ISOLATION HOSPITAL. |
2475c1ad-92c9-407a-9a22-37dbc76fdf1d | The Acton Council Isolation Hospital contains 88 beds normally. During 1932 we had to increase these to an emergency member of 122 in order to cope with the epidemics of Scarlet Fever and Diphtheria. 758 cases were admitted during the year compared with 262 cases during 1931. On January 1st, 1932 there were 29 cases in the hospital and on January 1st, 1933 there were 107. The following is a list of the cases admitted for the different desease. Scarlet Fever. Diphtheria. Measles. 382 134 81 Wembley 77 25 7 Kagsbury 28 21 3 Total 758 The 39 deaths were distributed as follows: β Scarlet Fever. Diphtheria. Measles. |
fdd67122-10bf-4f9b-96d4-28e4638089ba | 5 20 9 Wembley β 4 1 Kagsbury β β β A discussion on the deaths from Scarlet Fever will be found the report on that disease. A report on the Diphtheria epidemic is given above but the at deaths in hospital need some explanation. While admitting that the type of Diphtheria was in many instances a most virulent one, yet several apparently hopeless cases which were sent in at an early stage of the disease recovered. We must however, emphasise the fact that many of the cases were so ill on admission to hospital that all our efforts were almost bound to be in vain. 9 of the patients who died were admitted on or after the at day of disease while 4 were admitted on the 3rd day. 58 Under these circumstances the case mortality is bound tc be extremely high whether the infecting strain of diphtheria bacillus is of exalted virulence or not. |
82fc9bb0-695c-4067-ad57-529a2fdff109 | 6 patients died within 36 hours of admission to hospital and of these 1 died within an hour and 1 other within 12 hours. 2 patients died on the 2nd day, 5 between the 4th and 6th days, and 7 between the 6th and 14th days. The other 4 developed complications and died later in the course of the disease. All were given large doses varying from 40,000 to 50,0fK) units of anti-toxin intravenously as a first dose together with a solution of glucose and colloidal iodine by the same route. It is perhaps not amiss to remind practitioners of the heavy responsibility which lies upon them in waiting for the result of a swab before giving anti-toxin in a suspicious case during the present epidemic. BACTERIOLOGICAL EXAMINATIONS. (a) For Diphtheria. Positive. Negative. |
a8b0f48c-3b47-4a80-9286-07b3fce79db3 | Total Examinations 2245 231 2014 Sent by Medical Practitioners 97 582 do. (re-examinations) 9 167 Sent from Isolation Hospital 79 683 do. (re-examinations) 1 84 Convalescents (1st Swabs) 2 52 Contacts 33 289 do. (2nd examinations) 4 76 do. (3rd examinations) β 16 Precautionary Swabs β 26 School Sore Throats 6 39 (b) For Ringworm. Total Examinationsβ9 6 3 (c) For Tubercle. Total Examinationsβ137 31 106 59 MATERNITY AND CHILD WELFARE. Infantile Mortality. 17 of the deaths were due to prematurity or to causes Iaocated with prematurity. There is no material change to report upon the conditions generally. Maternal Mortality. |
748f8e4e-eb73-4b07-96d2-1440a3bcdaf0 | 7 deaths occurred in child bearing women, 4 of which spurred within the Borough and were investigated. The first case was a woman of 32 who had received antemantal care during this her first pregnancy. Caesarean section was advised on account of a generally contracted pelvis and the patient was admitted to hospital ; death occurred on the 11th day after operation; post-mortem multiple abscesses were found in the uerus. The second case, a woman of 38 in her 2nd pregnancy was seen twice before her confinement. There was retention of the placenta and post partum haemorrhage. The patient was removed to hospital, but death took place from haemorrhage and- shock. The 3rd case was a woman of 28 who had received antenatal treatment throughout her pregnancy. The home conditions were excellent and we were satisfied that all possible precautions had been taken at the confinement, but the woman died of puerperal septicaemia. |
a7636e23-4831-4bc5-a326-10db2b76290f | The 4th case was a woman who had been admitted to hospital curing the 6th month for severe vomiting. She remained an inpatient for 5 weeks and then returned home ; 3 weeks later she was re-admitted and a healthy child was bom. On the 10th day the discharged herself from hospital but had a fit on arrival at home. She was re-admitted the same day in coma, pneumonia supervened and she died 5 days later. Of the 3 cases which died outside the Borough, 1 died during the 3rd month of uncontrolled vomiting, the 2nd of chorion opitheloma and the 3rd of puerperal sepsis. 60 Pre-Natal Clinic. The clinic is held once a fortnight in the School Clinic premises in Avenue Road and Dr. Bell is in charge. 25 sessions were held with a total of 231 attendances. This dees not represent the whole of the pre-natal work done. |
d95a7096-acd9-4c94-9e3b-147905f3cb47 | In the case of those who apply for admission to Park Royal Hospital, Dr. Bell usually sees the expectant mothers when application is first made and generally refers them to the pre-natal clinic at Park Royal Hospital. Maternity Home. The Council has an agreement with Middlesex County Council for the admission of maternity cases into Park Royal Hospital. The arrangements were reported fully in last year's report. During 1932 122 cases were admitted under this agreement. Day Nursery. The'Nursery is situated in Bollo Bridge Road, and is open on five days a week. The Nursery was open on 231 occasions, and 4,871 whole day attendances were made. There has been an improvement in the number of attendances this year. Nurse Children. |
39fcfb75-bc9c-43d3-a7d5-60c4007b3837 | At the end of the year 1931, there were 53 children and at the end of the year 1932 there were 57 children on the register, and 5 between 7 and 9 years of age. Child Welfare Centres. There has been no change in the arrangements for the Child Welfare Centres since last year. Seven sessions are held weeklyβ 4 in Avenue Road, 1 each in Steele Road Mission, John Perry" School and St. Gabriel's Hall. 61 TABLE F. BIRTH-RATE, DEATH-RATE, AND ANALYSIS OF MORTAL BY DURING THE YEAR 1932 The Mortality rates for England & Wales refer to the whole population, but for London and the towns to Rate per 1,000 Population Annual Death-rate per 1,000 Population. Rate per 1,000 Births Percentage of Toran Deaths Live Births. StillBirths. |
81b88cd1-ce30-4b9e-a9d8-6523e8e3edf7 | All Causes Enteric Fever Small Pox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Violence DiarrhΕa and Enteitti (under 2 year) Total deaths unfar 1 year Certified by Registered Medical Practitioners Inquesy Cases Certified by Coroner after P.M. No Inquest Uncerfied Causes of Death England and Wales 15.3 0.66 12.0 0.01 0.00 0.08 0.01 0.07 0.06 0.33 0.54 6.6 65. 91.1 62 1.8 0.9 118 County Boroughs and Great Towns, Including London 15.4 0.64 12.2 0.00 0.00 0.12 0.01 0.08 0.07 0.28 0.54 8.6 70. |
e4db5201-19a0-4d79-8a40-2368fec13860 | 91.3 5.9 2.3 0.5 126 Smaller Towns (1931 Adjusted Population, 25,000β50,000) 15.2 0.68 11. 4 0.01 0.00 0.07 0.01 0.07 0.04 0.31 0.53 5.3 61. 91.9 5.8 1.3 1.0 London 14 3 0.46 12.3 0.00 0.00 0.19 0.02 0.08 0.07 0.28 0.57 12.5 67. |
69074a33-9793-4dda-8fbe-f2ced37b8b28 | 89.4 6.2 4.4 0.0 Acton 13.7 0.61 11.1 0.00 0.00 0.18 0.10 0.08 0.28 0.24 0.55 8.2 62. 01.6 5.1 3.3 0.00 The maternal mortality rotes for England and Wales arc as follows:β Puerpernl Sepsis. Others. Total. per 1,000 Live Births 1.61 2.63 4.24 per 1,000 Total Births 1.54 2.52 4.06 62 TABLE 2. |
5cc1ea23-b35e-4639-859d-b2b3fa434dfd | VITAL STATISTICS FOR THE WHOLE DISTRICT DURING 1932 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 Nett Under 1 year of Age At all Ages Number Rare 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 1922 62,170 1203 19.35 404 6.50 14 214 75 62 632 10.02 1923 62,060 1171 18.57 368 5.84 11 243 77 65 599 9.50 1924 63,945 1158 18.11 448 7.01 8 235 65 56 715 11.18 1925 64,845 1047 16.15 446 6. |
6500f220-85c9-4b22-b2b7-4720aa2390ec | 88 18 241 80 76 669 10.32 1926 , 65,760 1098 16.70 422 6.42 15 250 60 55 657 9.99 1927 66,700 1026 15.60 445 6.67 21 280 62 60 704 10.55 1928 67,645 1003 14.83 479 7.08 29 244 55 55 694 10.26 1929 68,600 1026 14.96 540 7.87 21 307 85 83 826 12.04 1930 69,565 1105 15.88 440 6.33 31 284 56 50 693 9.96 1931 70.560 1018 14.43 456 6. |
93a5f7bb-0c33-450f-9ca3-6bfdae0f74f9 | 46 35 321 62 61 742 10.52 1932 70,640 970 13.7 486 6.88 29 302 60 62 786 11.11 63 TABLE AGES AT DEATHS AND EARD DISTRIBUTION OF DEATHS IN 1952 AGES IN YEARS Causes of Deaths All age 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 WARD DISTRUBUTION North East North West South East South West Measles 12 2 4 6 - β β β β 1 1 2 8 Scarlet Fever 6 β 1 1 2 β 2 - β 1 3 1 1 Diphtheria 21 1 1 10 9 β β β β 3 3 12 3 Whooping |
64813922-3736-4576-bbc3-489cd9980749 | Cough 6 3 1 2 β - β - β 1 β - 5 Influenza 12 β 1 β β 1 3 3 4 4 5 2 1 Cerebro-spinal meningitis 2 1 β β β β 1 β β β β 1 1 Phthisis 48 β 1 β β 13 19 12 3 11 6 13 18 Other tubercular diseases 11 1 2 β 1 3 β 4 β 5 3 - 3 Cancer 101 β β β- β β 11 40 50 27 32 21 21 G. P. I. & Tabes 3 β β β β β β 1 2 3 - - - Rheumatic Fever 2 β β β. β 1 β 1 β 1 - 1 - Syphilis 1 1 β - β β β β β β |
a5c56e3e-ea03-4bcd-8c9e-c7c5dfc4024c | β β 1 Diabetes 5 β β - β β β 1 4 3 β 2 - Heart Disease 95 β β - 1 2 8 30 54 29 28 18 20 Cerebral HΓ¦morrhage 33 β β β β β β 6 27 11 12 4 6 Other circulatory diseases 54 - - - - - - 16 38 16 17 11 10 Bronchitis 46 β β β β 1 2 21 22 12 10 12 12 Pneumonia 41 9 3 2 2 1 2 12 10 11 8 10 12 Other respiratory diseases 5 β β 1 β β 3 1 β 2 2 1 β DiarrhΕa 8 8 β β β β β β β 3 β - 5 Peptic Ulcer 7 β β β β β 2 |
f5f576ea-0364-437d-816b-349f61f0e62b | 3 2 2 - 1 4 Appendicitis 5 - - - - - 2 2 1 3 1 1 β Cirrhosis of Liver 4 - - - - - 1 3 β - - 2 2 Other Liver Diseases 1 β β β β β - β 1 1 - - - Nephritis 27 1 β β β β 5 7 14 7 3 8 9 Puerperal Sepsis 3 - β β β 1 2 β β 1 β 1 1 Other diseases or accidents of Parturition 4 β β β β 1 3 β β 2 β 1 1 Prematurity &c. |
9dec1edf-7c94-431d-936f-eb6d83ab7a35 | 27 27 β β β β β β β 12 5 2 8 Senility 95 β β β β β β 2 93 19 31 20 25 Suicide 14 β β β β 3 10 1 7 2 3 2 Other violent deaths 25 2 β 2 - 4 5 4 8 8 7 4 6 Other defined diseases 64 4 1 β 4 4 12 21 18 20 14 21 9 TOTALS 788 60 15 24 19 32 86 200 352 226 193 175 194 64 TABLE 4. INFANTILE MORTALITY, 1932. Causes of Death. Ages. Wards. Total Under 1 week 1β2 weeks 2β3 weeks 3β4 weeks 1β3 months 3β6 montns 6β9 |
b7cc2251-b701-444c-b1e0-9fa21073f971 | montns 9β12 montns North East North West South Baal South West Prematurity 17 12 2 2 - 1 - - - 9 4 - 4 Marasmus 3 β - β - - 3 β - - β 1 2 Pneumonia 7 - - β - 4 1 - 2 1 2 1 3 Pyloric Stenosis 3 - - - - 1 1 - 1 β 1 2 - Swallowing vomited matter into trachea 1 - - - - - 1 - - 1 - - - Tuberculous Meningitis 2 β - - - - 1 1 - 1 - 1 - Measles 1 - - - - - - 1 - - - 1 - Cerebro-spinal Meningitis 2 β β β - β β 1 1 β - 1 1 Diphtheria 1 β β β - |
8296ce8e-641e-438d-8f36-72390b518e2e | β 1 - - β - - 1 Whooping Cough 3 β β - - - 1 - 2 1 - - 2 Accidental suffocation in pram 1 β β - - - 1 - - - - - 1 Overlaying 1 - β - - 1 β - - β β - 1 Prolonged labour 1 1 - - - - - - - - β - 1 DiarrhΕa 8 β 2 - - 1 3 1 1 2 1 - 5 Septic Finger toxaemia 1 β - - 1 - - - - - 1 - - Syphilis 1 - - - - 1 - - - - - - 1 Congenital Heart disease 1 1 - - - - - - - 1 - - - Congenital Pyloric Stenosis 1 - - - - 1 - - - - - 1 - Congenital atresia |
d637da7c-9ee7-41cc-87bf-b383b2056e53 | of oesophagus 1 1 - - - - - - - 1 - - - Cellulitis of scalp 1 1 - - - - - - - - - 1 - Acute Nephritis 1 1 - - - - - - - - 1 - - Injury at birth 1 - - - - - 1 - - - - - 1 Pemphigus Neonatorum 1 1 - - - - - - - - - - 1 TOTALS 60 18 4 2 1 10 14 4 7 17 10 2 24 65 TABLE B. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1932. Notifiable Disease. Cases notified in whole District. At AgesβYears. Ward Distribution. |
d4a2b224-02c8-44b2-9b2e-8cdec9fb4102 | At all Ages Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 Over 65 North East North West South East South West Small-Pox 1 - - - 1 - - - 1 - - - Scarlet-Fever 537 β 185 286 33 32 1 - 115 09 110 243 Diphtheria 151 1 47 85 12 5 1 - 38 25 31 57 Enteric Fever 1 β - - - - 1 - - 1 - - Paratyphoid B. |
b2c9b90c-9091-4d33-8073-2cd6fcedda75 | 2 β β - 1 - 1 - - 2 - - Pneumonia 41 1 5 5 4 11 8 7 10 12 5 14 Puerperal Fever 3 - - - 2 1 - - - 1 1 1 Puerperal Septicaemia 1 - - - - 1 - - 1 - - - Cerebro-Spinal Fever 2 - 1 - 1 - - - 1 - 1 - Ophthalmia Neonatorum 5 5 - - - - - - 1 1 1 2 Erysipelas 19 β 2 3 1 6 6 1 3 7 4 5 Acute Anterior Poliomyelitis 1 β β 1 β - - - 1 - - - Tuberculosis (resp.) |
cfde2474-c93f-4080-9ed1-2f05a6faee6b | 96 β - 4 35 35 20 2 28 22 18 28 Tuberculosis (other) 18 - 5 3 2 6 2 - 4 4 3 7 TOTALS 878 7 245 387 92 97 40 10 203 144 174 357 66 OPHTHALMIA NEONATORUM. Cases. Vision unimpaired Vision impaired Total Blindness Deaths. Notified Treated. At home. In hospital. 5 3 2 5 β - - 67 TABLE 6. CASES REMOVED TO HOSPITAL. Total Notified. Small-Pox 1 1 scarlet Fever 382 537 Diphtheria 134 151 Enteric Fever 1 1 Paratyphoid B. |
dfd8f123-f315-4685-83ed-1762b8480a1d | 2 2 Pneumonia 14 41 Puerperal Fever 3 3 Puerperal Septicaemia 1 1 Cerebro-Spinal Fever 2 2 Ophthalmia Neonatorum 2 5 Erysipelas 7 19 Acute Anterior Poliomylitis 1 1 TABLE 7. BIRTHS. Live Births. Male. Female. Total 483 487 Legitimate 465 467 Illegitimate 18 20 Still Births. Total 26 17 Legitimate 25 17 Illegitimate 1 β Notified Live Births. Ward Distribution. Total. N. East. N. West. S. East. S. West. |
8bfa92d4-61e5-469c-a47b-f5681d4bcc4d | Total Births notified in the district 657 208 146 98 205 Notifications received from other districts 298 91 75 55 77 Births registered but not previously notified 2 1 1 β β 957 300 222 153 272 Notified Still Births. Inside 15. Outside 19 Total 34 Notifications were received from: β Doctors and Parents 685 Midwives 304 68 TABLE 8. INFANT WELFARE CENTRES, 1932. |
3bbbd683-5e8b-423d-a51d-5b0e5f178618 | Number of Centres provided and maintained by the Council 4 Total number of attendances at all centres during the year:β (a) by children under 1 year of age 10,490 (b) by children between 1 and 5 years of age 6,668 Average attendance of children per session 53 Number of children who attended for the first time during the year: β (a) under 1 year of age 713 (b) between 1 and 5 years of age 272 Percentage of notified live births represented by number of children who attended a centre for the first time during the year 74.6 Children treated at Dental Clinic 196 Children treated at Ophthalmic Clinic 13 Mothers treated at Ophthalmic Clinic 2 Children treated for Enlarged Tonsils and Adenoids 4 table 9. ANTE-NATAL CLIINC. Number of attendances by Dr. |
4193a40a-0948-472f-be02-cc455cc0fc8e | Bell 25 Number of Expectant Mothers who attended 193 Number of attendances made by Expectant Mothers 231 Mothers referred fro Dental treatment at the Clinic 39 Mothers supplied with Dentures 14 Expectant Mothers to whom Dried Milk was supplied 24 Number of packets of Dried Milk supplied 283 table 10. INQUESTS. Inquestsβ41. |
4a036e3c-7295-47b1-9bb0-c717d13a3ebc | Suidde 13 Fall from Motor Car 1 Run over by Motor Car 6 Accidental Bums 1 ,, ,, ,, Motor Van 2 Found drowned 1 ,, ,, ,, Train 2 Surgical Operation 1 ,, ,, ,, Motor bus 1 Childbirth-retained placata 1 ,, β β Taxi 1 Injury at football 1 ,, ,, ,, Motor Cycle 1 Accidental suffocation in pram 1 69 Motor Collision 1 Overlaying 1 Run over by horse drawn cart 1 Kidney disease 1 Accidental fall 2 Coal gas poisoning 1 Fall from Motor Cycle 1 Coroner's Certificate after Post-Mortem without Inquestβ26. |
045e1a02-429b-4297-a044-865fc4abaddb | Pneumonia 4 Scarlet Fever 1 Thrombosis of Coronary Artery 1 Nephritis 1 Cancer 1 Fatty Heart 1 Myocardial degeneration 5 Valvular Heart Disease 3 Cerebral Haemorrhage 1 Aortic Aneurysm 1 Intestinal obstruction 2 Aortic Stenosis 1 Acute pyelonephritis 1 Influenza 1 Swallowing vomited matter into lachea 1 Coronary artery disease 1 FACTORIES, WORKSHOPS AND WORKPLACES. 1.βInspection of Factories, Workshops and Workplaces including Inspections made by Sanitary Inspectors. Premises. Inspections. Written Notices. (i) (2) (3) Factories (Including Factory Laundries). 103 15 Workshops (Including Workshop Laundries) 427 12 Workplaces (Other than Outworkers' Premises). |
893b8384-5cdf-47ae-b997-2846aa00dfe2 | 16 Nil Total 546 27 -βDefects found in Factories, Workshops and Workplaces. Nuisances under the Public Health Acts: β Particulars. Found. Remedied. (1) (2) (3) Want of Cleanliness 29 29 Want of Ventilation Nil Nil Overcrowding Nil Nil Want of drainage of Floors Nil Nil Other Nuisances 5 5 70 Sanitary Accommodation: β Insufficient 10 10 Unsuitable or defective 28 28 Not separate for sexes Nil Nil Offences under the Factory and Workshop Acts:β Illegal Occupation of underground Bakehouses Nil Nil Other Offences Nil Nil Total 72 72 3.-Outwork in unwholesome premises, Section 108 Nil 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). |
715ff25b-f1da-46d8-9a42-8ca9ae05939d | Nancy G. Howell, m.r.c.s., l.r.c.p., d.p.h., Assistant Medical Officer of Health and School Medical Officer. P. H. Slater, l.d.s.. School Dentist. M. W. Kinch, M.R.San.I., Cert, of Royal Sanitary Institute; holds Meat and Smoke Certificates Sanitary Inspector (Inspector under Diseases of Animals Acts and the Rag Flock Act). J. J. Jenkins, Cert, of Royal Sanitary Institute ; holds Meat and Smoke Certificates, Sanitary Inspector (Inspector under Fabrics Misdescription Act). E. W. Brooks, Cert, of Royal Sanitary Institute. Sanitary Inspector. J. J. Matthews, Cert, of Royal Sanitary Institute ; holds Meat Certificate, Sanitary Inspector. Miss A. Cooksey, A.R.San.I., Certificate of Royal Sanitary Institute. Health Visitor. 71 Miss J. Welsh, Certificate of Royal Sanitary Institute, c.m.b., Health Visitor. |
f7469870-32d4-47db-b25e-a6ab18630e10 | Miss B. G. Sorlie, s.r.n., Certificate of Royal Sanitary Institute, C.m.b., H.V. Diploma, Health Visitor and School Nurse. Miss A. Woosnam, s.r.n., c.m.b., Health Visitor and School Nurse. Miss B. C. Broughton, s.r.n., c.m.b., H.V. Diploma, Health Visitor and School Nurse. W. Goodfellow,* A.R.San.I., Cert, of Royal Sanitary Institute ; holds Meat Certificate, Cert. Bacteriology; Chief Clerk. Miss G. Overall,* Clerk. Miss V. E. Arnold,* Clerk. Miss D. E. Beacon, Clerk. 4 ββββββ Miss M.J. Gilfillan,* s.r.n., c.m.b.. Matron, Isolation Hospital. Miss F. A. Cavendish, Matron, Day Nursery. G. Baker,* Disinfector. |
e9279347-1b13-4869-aeb5-e987a0c6e8a4 | NoteβTo the salaries of all the above officials excepting those marked with an asterisk, contribution is made under the Local Government Act, 1929. I wish to express my appreciation and thanks to all the members of the Public Health Department for their excellent cooperation during the year. I am, Your obedient Servant, D. J. THOMAS, Medical Officer of Health. 73 ANNUAL REPORT OF THE School Medical Officer FOR THE YEAR, 1932 Municipal Offices, Acton, W.3. To the Chairman and Members of the Education Committee. Ladies and Gentlemen, Wc beg to submit the following report upon the schools and school children of the Education Authority for the year 1932. During the year, changes have occurred in the personnel of the School Medical Service. Dr. N. G. Howell was appointed and Commenced duties on March 1st. The medical inspections for the months of January and February were carried out by Dr. |
a2b8ba53-1781-4bdd-90eb-76dd239f6bf8 | L. S. Farquharson. In July, Nurse James resigned under Heage limit after 23 years faithful and conscientious service, and Nurse Broughton was appointed to take her place. Advantage was taken of this change to rearrange and to co-ordinate still further the work of the Maternity and Child Welfare and the School Medical Services. The Infant Welfare Conlre at St. Gabriel's Hall, Noel Road, is now under the charge of Nurse Broughton and the entire work of home visiting is done by one person. Miss Broughton does the home visiting for Acton school, and the area for which she also does the Welfare werle coincides. 74 PUBLIC ELEMENTARY SCHOOLS WITHIN THE DISTRICT WITH ACCOMMODATION. Same of School. Dept. Accommodation Average monthly So. on Register during 1932. Average attendance for Autumn term 1932. Acton Wells Senior 320 252 229 Junior 364 |
2d2edd57-1156-4c3f-a839-0fd94d1de150 | 376 343 Infants' 364 336 285 Beaumont Park Senior Girls' 450 254 220 Junior Girls' 450 292 250 Infants' 400 256 198 Berrymede Junior Boys' 640 506 446 Junior Girls' 542 512 450 Infants' 450 319 270 Central 480 402 363 Derwent water Junior Mixed 441 460 422 Infants' 350 271 225 John Perryn Senior 360 275 236 Junior 288 332 294 Infants' 336 345 286 Priory Senior Boys' 500 417 374 Senior Girls' 499 405 342 Infants' 400 297 235 Rothschild Junior Boys' 450 296 262 Infants' 400 281 224 Southfield Senior Boys' 415 273 236 Junior Mixed 382 400 355 Infants' 350 227 179 Turnham Green R.C. |
b1c532f4-932e-4a31-935e-b6c8e80bcd48 | 327 277 223 Acton Council Special 68 47 39 10026 8108 6986 A comparison of this Table with that of the year 1931, will show a slight reduction in the number of children on the register and a more marked reduction in the number in average attendance. The reduction in the number of children on the register is due to the continued reduction in the birth rate. This matter has been referred to on several occasions and it is unnecessary to make any detailed observations on this aspect in the present report. The reduction in the average attendance has been due to the outbreaks of Scarlet Fever and Diphtheria in the Autumn, and this matter will be referred to in a subsequent paragraph. 75 AVERAGE HEIGHT without shoes and AVERAGE WEIGHT withoUt Clothes. Anthropometric Committee, 1929. MALES. FEMALES. Age last Height in Weight in Height in Weight in birthday ins. lbs. ins. lbs. |
d3708f9b-fed0-48cd-ad80-eb1da10f3108 | 3 36.9 32.9 36.6 31.5 4 39.2 35.9 38.4 33.7 5 41.4 38.7 41.1 37.5 6 43. 41.3 42.8 40.1 7 45.4 45.4 45.1 44.1 8 47.8 51. 47.5 49.4 9 49.2 54.8 48.9 52.6 10 51.3 59.6 51.2 59.8 11 52.7 64.6 52.8 63.9 12 55. 71.6 55.6 73.9 13 . 56.2 76.5 56.9 79. 14 58. |
bd132828-3098-4ea1-b84d-66e61274d8d7 | 86.1 58.9 88.2 15 61.8 99.3 62.3 106.8 TABLE SHOWING HEIGHTS AND WEIGHTS AT DIFFERENT AGES. ENTRANTS (GIRLS). No. Examined. Years of Age. 3β4 4β5 5β6 6β7 No. Height ins. Weight lbs. No. Height ins. Weight lbs. No. Height ins. Weight lbs. No. Height ins. Weight lbs. Acton Junior Mixed 9 . . . 3 40.1 36.2 3 41.9 37 3 45.8 46.3 Acton Wells Infants' 58 . . . 23 40.8 39.2 30 42.9 41.2 5 44.8 4S. |
2381b4a8-20c4-43a0-bbce-4c94a0f56ee5 | 5 Beaumont Park Infants' 56 15 36.7 31.8 10 39.7 35 28 42.6 39.3 3 45.5 41.6 Berrymede Infants' 56 . . . 29 40.1 35.8 19 43.2 42.2 8 44.7 44.9 Derwent water Infants' 60 . . . 26 39.9 38.6 25 43.4 42.8 9 45.4 46 John Perryn Infants' 49 . . . 18 40.4 36.4 22 42.5 39.7 9 45.1 45.6 Priory Infants' 52 . . . 24 40.4 36.6 23 41.9 38.2 5 43.8 38. |
0b542a4e-2a06-426a-a378-daea92747a94 | 5 Rothschild Infants' 42 12 38.4 34.8 13 40.2 37.4 11 40.2 37.5 6 44.9 45.1 Southfield Road Infants' 37 . . . 10 40.3 36.2 22 42.5 40.1 5 46.9 59.9 Turnham Green R.C. 8 ... ... ... 5 40.9 38 1 41 34 2 47.7 46 427 27 161 184 55 (BOYS). Acton Junior Mixed 11 . . . 4 41.1 38.8 6 44.6 44.6 1 46.3 44.3 Acton Wells Infants' 57 . . . 19 41.2 37.8 28 43.7 42.7 10 45. |
efd59d30-7043-4a92-974c-c6a885d19112 | 4 46.5 Beaumont Park Infants' 51 10 37.4 31.6 15 41.3 38.3 24 42.9 41.2 2 44.9 42.8 Berrymede Infants' 61 . . . 33 40.4 38.6 26 42.6 39.7 2 42.7 46 Derwentwater Infants' 56 . . . 20 41.1 40.6 25 44 44.3 11 45.8 48.1 John Perryn Infants' 58 . . . 17 41.5 38.3 36 43.7 41.9 5 45 44.6 Priory Infants' 57 2 40.2 36.4 34 40.8 37.7 12 43.2 40.5 9 45. |
5676f602-ef34-4a70-ad1f-3d1a1c08947a | 9 45.5 Rothschild Infants' 46 13 38.5 36.4 13 40.6 38.1 15 42.7 40.9 5 45.9 47.4 Southfield Road Infants' 47 . . . 17 41.4 40.5 23 44.7 46.1 7 46.6 50.6 Turnham Green R.C 9 . . . 5 39.6 38 3 43.4 42.1 1 43 37 453 25 177 198 53 76 77 TABLE SHOWING HEIGHTS AND WEIGHTS AT DIFFERENT AGES. INTERMEDIATES. (BOYS). No. Examined. No. Years of Age. 7β8 8β9 9-10 Height ins. Weight lbs. No. Height ins. Weight lbs. |
41356172-2d61-4135-a1ab-9bf9674fc910 | No. Height ins. Weight lbs. Action Junior Mixed 12 6 49.6 54.3 6 49.8 52.9 . . . Action Wells Junior 30 6 49.9 55.1 24 51 59.1 . . . Action Wells Infants' 25 11 49.8 56.3 14 49.8 55.5 . . . Beaumont Park Infants' 3 3 49.6 55.6 . . . . . . Berrvmede Junior Boys' 122 70 48.4 52.2 52 49.1 52.7 . . . Berrymede Infants' 2 2 47.6 49.1 . . . . . , Berwentwater Junior 50 38 49.5 56.6 12 49.8 58.1 . . . |
e3e61fff-cffe-49ee-8c1c-a998faa15bea | Derwent water Infants' 1 1 51 52.8 . . . . . . John Perryn Junior 4 . . . 4 51.4 60.7 . . . John Perryn Infants' 56 25 49 53.3 31 49.7 55.2 . . . Priory Infants' 6 6 50.5 57.9 . . . . . . Rothschild Junior 72 27 49.1 54 45 49.4 55 . . . Rothschild Infants' 2 2 49.2 52.6 . . . South field Junior 32 16 50.1 57.7 16 50.8 58.5 . . . South field Infants' 5 5 47.8 54.5 . . . . . . Turnham Green R.c. |
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