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68b061ef-e763-414c-9861-568d090f627d | Croup Feverβ Typhus Enteric 6 4 4 2 4 Other continued Epidemic Influenza 7 1 4 2 5 2 Cholera Plague DiarrhΕa 40 32 7 1 6 10 21 Enteritis 17 11 2 2 2 5 7 5 Puerperal Fever 2 2 2 Erysipelas 2 2 Other Septic Diseases 2 2 Phthisis (Pulmonary Tuberculosis) 43 3 1 6 31 2 8 16 11 Other Tubercular Diseases 31 8 13 5 2 2 1 3 12 10 1 Cancer, |
b579c55a-2f99-4d1e-9d93-65b16d507c58 | Malignant Disease 35 27 8 11 9 7 2 Bronchitis 45 13 7 11 14 5 15 23 Pneumonia 68 21 19 1 2 15 10 11 24 27 2 Pleurisy . |
f0b545ca-e0ac-4f65-ae6c-5a2b3fa50629 | Other Diseases of Respiratory Organs 7 1 1 2 3 2 3 AlcoholismβCirrhosis of Liver 11 10 1 3 4 3 Venereal Diseases 1 1 1 Premature Birth 24 24 4 9 11 Diseases and Accidents of Parturition 4 4 2 2 Heart Diseases 48 2 3 4 20 19 14 10 16 1 Accidents 16 3 4 2 4 3 1 3 7 4 Suicides 8 8 4 1 3 All other Causes 191 47 9 5 5 54 71 50 52 54 9 All Causes 628 172 73 18 24 200 141 139 184 213 27 The deaths allocated to each Ward do not include those of "Residents" who died in outlying Institutions. |
0940d81d-26fb-4282-a688-d6ac5234c9e3 | 28 CAUSE OF DEATH. Under 1 week 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-2 months. 2-3 months. 3-4 months. 4-5 months. 5-6 months. 6-7 months. 7-8 months. 8-9 months. 9-10 months. 10-11 months. 11-12 months. Total Deaths under One Year. Table 5. INFANTILE MORTALITY DURING THE YEAR 1905. Deaths from stated Causes in Weeks and Months under One Year of Age. All Causes. Certified Uncertified 1 1 1 Common Infectious Diseases. |
75f75382-8537-464c-8944-fe270eb6294a | Small-pox Chicken-pox Measles Scarlet Fever 1 1 Diphtheria: Croup Whooping Cough 1 1 1 1 2 6 DiarrhΕal Diseases. DiarrhΕa, all forms 8 2 2 5 4 2 2 1 3 1 2 32 Enteritis (not Tuberculous) 1 2 3 Gastritis, Gastrointestinal Catarrh 1 1 3 1 1 1 1 8 Wasting Diseases. Premature Birth 17 1 1 2 21 2 1 24 Congenital Defects 4 4 1 5 Injury at Birth 3 3 3 Want of Breast-milk Atrophy, Debility, Marasmus 3 1 1 3 8 3 3 1 15 Tuberculous Diseases. |
fea8b122-4287-4668-9594-9386a9d35d0e | Tuberculous Meningitis 1 Tuberculous Peritonitis: Tabes Mesenterica 1 1 1 1 1 5 Other Tuberculous Diseases 1 1 Erysipelas Syphilis Rickets 1 1 1 Meningitis (not Tuberculous) 1 2 1 1 5 Convulsions 4 3 1 8 1 1 1 1 1 13 Bronchitis 1 1 2 3 2 1 3 1 13 Laryngitis 1 1 Pneumonia 4 3 4 1 1 3 1 21 Suffocation, |
c1ad48b1-41ec-498f-a039-326cece191a7 | overlaying 1 1 2 Other Causes 1 1 1 2 1 1 3 9 32 6 2 7 47 22 14 10 18 11 12 6 7 11 6 8 172 29 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. INSPECTIONS. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Factories (Including Factory Laundries.) Workshops (Including Workshop Laundries.) 117 9 Workplaces Homeworkers' Premises 154 7 Total 271 16 30 DEFECTS FOUND. Particulars. Number of Defects. Found. Remedied. |
982831f2-cbe1-4123-8822-9684922cc3dc | Nuisances under the Public Health Acts:β Want of cleanliness 3 3 Want of ventilation 3 3 Overcrowding 1 1 Want of drainage of floors Other nuisances 25 25 Sanitary accommodation insufficient unsuitable or defective not separate for sexes 0ffences under the Factory and Workshop Act:β Allowing wearing apparel to be made in premises infected by scarlet fever or smallpox (s. 109). 2 2 Other offences 6 6 Total 40 40 31 OTHER MATTERS. Class. Number. Matters notified to H.M. Inspectors of Factories:β Failure to affix Abstract of the Factory and Workshop Act (s. 133) 5 Other 15 Underground Bakehouses (s. 101):β Certificates granted during the year In use at the end of the year 8 Number of Homework:β Lists. Outworkers. Lists of Outworkers (s. |
897e1117-127c-4541-ac4d-9e618042359f | 107):β Lists received 164 348 Addresses of Outworkers forwarded to other Authorities 19 received from other Authorities 33 Workshops on the Register (s. 131) at the end of the year 375 Your obedient servant, D. J. THOMAS. March 31st, 1906. 32 SUMMARY OF VISITS PAID AND INQUIRIES MADE BY HEALTH VISITOR. |
97302133-5272-4531-9f0a-4bcb9b67dbb5 | Number of Visits re School Cards 762 β β Health Visits 306 β β Visits re Birth enquiries 347 β β β Death enquiries 64 β β β Scarlet Fever 189 β β β Diphtheria 36 β β β Enteric Fever 26 β β β Chicken Pox 112 β β β Phthisis 74 β β β Erysipelas 25 β β β Measles 13 β β β Puerperal Fever 2 β β Workshops Inspected 117 β β Outworkers Premises Inspected 154 β β Miscellaneous Visits 161 Total 2,388 33 Annual Report of the Chief Sanitary Inspector for the Year 1905. To D. J. Thomas, Esq., m.r.c.s., D.P.H., Medical Officer of Health. |
1686163c-e5cc-4b6e-8c6e-086b26ee47ab | SIR,βI herewith present my sixth annual statement, showing the particulars of the action taken in the suppression of nuisances, &c., and various improvements effected by this department during the year 1905. NOTICES. Nine hundred and ninety-eight Preliminary Notices and 657 Statutory Notices have been served for the abatement of nuisances, and the necessary works asked for were carried out in nearly all cases; police-court proceedings only being necessary in six instances to enforce compliance. DRAINAGE EXAMINATIONS. The smoke test has been applied 36 times, and in addition 99 drains were opened up for examination, after formal written complaints had been made and authority given for that purpose. The volatile or chemical test has also been applied to drains in numerous instances. INSPECTION OF MEAT AND OTHER FOODS. |
b094ec6f-c9c0-4dbd-93fc-b26994d0ff54 | The various butchers' shops, greengrocers' shops, and other places where food is sold or prepared, were frequently inspected during the year, and in very few cases did I find any unsound food, or was it necessary for me to call the occupiers' attention to any insanitary conditions or want of cleanliness. On several occasions I found, upon cutting into the pharyngeal glands of pigs in the butchers' shops, that they were affected with Tuberculosis, and upon pointing this out to the butchers they readily surrendered the pigs' heads to me. 34 According to the recommendations of the Royal Commission, instructions are given to seize the whole of the carcase of pigs affected in any degree with tubercle, owing to the greater tendency to generalisation of the disease in pigs. I do not believe outside London this recommendation is strictly carried out, and unless evidence of the disease is found in other glands it is the practice to seize only the heads. |
cd1900fa-9112-427c-8efd-b33dac410913 | This procedure I have adopted, and have not recommended any proceedings where the butcher has surrendered the part, and if satisfied that the butcher was unaware of the disease and that none of the glands had been cut into. Unfortunately, some butchers and slaughterers make it a practice to cut out the pharyngeal glands whether diseased or otherwise, thereby removing any trace of disease, so that it is preferable that the glands should not be touched by the butchers, but left for the Inspector to examine. Dr. Buchanan, one of the Medical Inspectors of the Local Government Board, is at present obtaining particulars with regard to this matter, and his report is anxiously awaited. I understand that a large percentage of pigs are affected with tubercle. |
3cd63408-afe8-4bda-85ab-da1262942400 | This would mean a tremendous seizure of carcasses, without any compensation, and butchers would seek to remove the slightest evidences of the disease to avoid seizure, and the public would not be so well protected as under the present arrangement of seizing the affected part or parts. During the year, the following were seized or surrendered and taken before a Justice β 6 stone cod fish. 4 boxes tomatoes. 2 barrels apples. 1 trunk plaice. 1 trunk mixed fish. 1 trunk cat fish. 3 pigs' plucks. 1 case skate. 2 cases bananas. 6 pigs' heads. 1 carcase and offal of cow. 35 FOOD AND DRUGS ACTS. This was the first year in which the duties imposed by these Acts were carried out directly under the Council by me. Formerly the duties were executed by the County Council I nspector. During the year I procuredβ 81 samples of new milk, 1 sample of skimmed milk. |
0766c4f8-95bc-452b-9ed3-788a52c513ca | 31 samples of butter. 5 samples of margarine. In four cases where milk was adulterated to a small extent, the Council did not take proceedings, but the Clerk wrote, warning the vendors that in future proceedings would be taken, and advising them to ascertain that the milk was up to standard before offering it for sale. In a number of cases, the Analysts' certificates certified that the milk was of very poor quality and probably adulterated, but unfortunately no action could be taken with regard to these samples. The following table gives the details of the prosecutions during the year :β DATE. OFFENCE. FINE. April 26th Milk deficient of fat 33% Β£ l and 16/6 costs. June 21 st Milk 14% deficient in fat Dismissed. Warranty set up. June 21st Milk adulterated, 12 parts added water Β£ 1 and 16/6 costs. Sept. |
83ef40a0-784c-4e68-b8ed-cea4b41e44a7 | 20th Milk deficient of fat 12% Β£1 and 22/- costs. Sept. 20th Milk deficient of fat 12% Β£1 and 22/- costs. Sept. 20th Adulteration of Butter, 27% of water 10/- and 20/- costs. 36 DAIRIES, COWSHEDS AND MILK SHOPS. There are at present 3 Cowsheds, 23 Dairies, 20 Milkshops, on the Register. I forwarded a notice to the occupier of every cowshed and every dairy reminding him of his duty to have the premises limewashed as required by the regulations. Thirty-six visits were paid to the cowsheds, and 132 visits to the dairies and milkshops, and they were found to be in good order and complying with the regulations, and it has not been necessary to serve a notice with regard to any of these premises. |
ace9aab4-f08f-43ca-a4da-fd5fbeca14ee | Notice was given in the local papers to all cowkeepers, dairymen and purveyors of milk, on the 24th November and 1st December, also on the 23rd November hand-bills were distributed throughout the District calling attention to the duty of such persons to be registered with the Council. BAKEHOUSES. The number of bakehouses on the register is 26, of which eight are cellar or underground bakehouses. A circular letter is sent to the occupiers every six months reminding them of the time to limewash and cleanse as prescribed by the Factory and Workshop Acts, 1901, but in the majority of cases they are whitened and cleansed much oftener than is required by the Act. All these premises have been visited and inspected 190 times. SLAUGHTER HOUSES. There are four Registered Slaughter Houses in the District as follows:β Name. Situation. Date Established. |
c65ce466-30ed-468d-8e08-c6709261a1d0 | Arthur Phillips 50, Hanbury Road 1863 James William Laws l10, Bollo Bridge Road 1865 Edward Dalton 7, Churchfield Road 1867 George Morris 8, Enfield Road 1871 37 Seventy-eight visits were paid to these premises. At three of the slaughter houses there was nothing to complain of at any time, but I cannot say this about the fourth oneβconstant supervision being necessary to keep the occupier up to the markβas regards cleanliness, etc. On the 28th December, I made a report to the Council pointing out the difficulties I experience in carrying out a complete inspection of carcases in the slaughter houses, and herewith submit an abstract therefrom:β "Mr. Chairman and Gentlemen, I beg to report that during the past month I have been continuing a rigid inspection of meats and other foods as far as possible. |
5c401590-e5c6-4b60-aad4-f388aed57f20 | I should like to take this opportunity of pointing out to the Committee the difficulties which prevent a proper control and a systematic inspection of the carcasses in our four registered slaughter houses. 1st.βAs no particular hours are prescribed in the Bye-laws specifying the time when slaughtering may be carried on, it would be necessary for me to be on duty both night and day ; as in one of the slaughter houses, killing does not often begin until 10 p.m., and in the other, killing commences about 3 p.m. and continues until a very late hour at night. 2nd.βThat in two instances slaughtering is carried on at various times on Sundays, which would necessitate me being on duty on this day as well as night and day on week days. Of course, there can be no proper control otherwise than in a Public Abattoir, but our inspection and supervision might be considerably facilitated if the Local Government Hoard would consent to a Bye-law for the following purpose, viz. |
69e14cbd-056b-4f6d-943b-615db090bbc8 | :β " For prohibiting slaughtering in slaughter houses except between the hours of (say) 6 a.m. and 6 p.m." 38 In my opinion, these hours would be quite reasonable, and would allow ample time for the amount of slaughtering which is carried on in the district. I have made enquiries into the matter and have ascertained that the reason why slaughtering is done during the hours stated, is that in the day the men are engaged in some other work, and that in the evening the slaughtering is done as overtime or piece work. |
7d0d41e1-43d7-47b4-a081-c8ec2239ec8f | If such a Bye-law were granted, the Committee will see that it would be possible for me to carry out a proper inspection; and on Sundays the Assistant Inspectors could take their turns at inspecting the slaughter-houses, and if any carcase or organs were found to be diseased, they could be put on one side, I could be informed, and, if satisfied that the same were diseased, I could seize same and submit them to the Medical Officer of Health before obtaining a Magistrates' order for their condemnation, and in due course report the facts to the Committee. Unfortunately, the Council has no power with registered slaughter-houses with regard to prohibiting other persons than the person registered slaughtering therein, so that any registered owner can practically turn his slaughter-house into a public abattoir, and allow slaughtering at all times during day and night." PIGGERIES. With reference to the piggeries, I have to report that they have been frequently inspected. |
74d3d588-d240-41ec-94ae-46452fec2f52 | I have not received any complaints as to the smell from same. We only have three pig-keepers in the district, viz.:β Mr. Morris, Old Oak Lane. Mr. Bosher, Old Oak Lane. Mr. Baggs, Old Oak Lane. 39 Our present Bye-laws provide that no pigs shall be kept within 200-ft. of a dwelling-house, but nothing is mentioned as to the distance they shall be kept from the road. If there was a Rye-law stating the distance from the road it would be very useful, and help us to deal with the piggeries mentioned above, as they abut immediately on to a frequented road. OFFENSIVE TRADES. There are two offensive trades in the district (fat extractors), as follows:β Name. Situation Date Established. |
67df4fef-b41c-4ad2-89b3-ce20d3e97061 | Arthur Phillips 50, Hanbury Road 1863 James William Laws 110, Bollo Bridge Road 1865 These premises have been frequently visited during the year. As you are aware, the buildings are very unsuitable for this kind of business, and steps are being taken to compel the occupiers to carry out certain works. COMMON LODGING HOUSES There are only two common lodging houses in the district. One is most up to date and has accommodation for 147 lodgers. Both premises have been regularly inspected, and on all occasions were found to be in a satisfactory condition. HOUSES LET IN LODGINGS. We have a lot of this class of house in the parish, and I am now devoting my attention to the compilation of a complete Register, with a view to putting into force the Council's Bye-laws dealing with such premises. 40 SMOKE ABATEMENT. |
a452290e-9fcd-479a-945b-38ca4d1339d6 | All factory and works chimneys have been observed at frequent intervals, and several cautionary Notices served upon the owners for emitting black smoke in such quantities as to be a nuisance No Police-court proceedings, however, have been necessary. Many joint observations have been kept with the Inspector to the Coal Smoke Abatement Society, from which Society the Council receives co-operation in dealing with this class of nuisance. The following table gives the details of the cases taken before the Magistrates during the year:β Date. Offence. Fine. Sept. 20th Exposing for sale unwholesome bacon 30/- and 13/6 costs β 20th Trading as milk purveyor without being registered Β£1 10s. and 12/6 costs ,, 20th Trading as milk purveyor without being registered Β£1 and 12/6 costs β 20th Trading as milk purveyor without being registered Β£1 10s. and 9/6 costs Nov. |
1952a05c-b80a-49fb-a37d-df21efe9ae50 | 15th Defective wash-house floor Withdrawn on defendant paying 21/- costs β 15th Sink waste pipe connected directly to drain. Defective w.c. 40/- and costs and order to abate within 14 days β 15th Rain water pipe connected directly to soil pipe Order to abate and 21/costs β 15th Slaughtering on unlicensed premises 20/- and costs β 15th Slaughtering on unlicensed premises 20/- and costs Dec. 13th House without water supply Β£3 and Β£l costs β 13th Depositing for the purpose of sale a tubercular cows carcase Β£5 and costs β 13th Having deposited in his slaughter house the carcas of a tubercular cow Β£5 and costs β 27th Non compliance with Magistrates order Daily penalty 1/- a day 16/- β 27th House without water supply Β£1 and special costs For Food and Drugs prosecutions see Page 35. |
6ebbc5c5-80ee-4adf-a9b1-9f7e94170808 | 41 NUMBER OF INSPECTIONS. &c. Complaints received 225 Premises inspected 1,587 Premises re-inspected 2,908 House to house inspection 557 Nuisances reported 3,091 Nuisances abated 2, |
6c902b95-f0a3-42f7-a4b5-9246d3794049 | 477 Workshops inspected 124 Houses let in lodgings inspected 136 Furnished rooms inspected 97 Two Common Lodging Houses inspected 23 times Three Cowsheds inspected 36 β Forty-three Dairies and Milk Shops inspected 132 β Twenty-six Bakehouses inspected 190 β Four Slaughter Houses inspected 78 β Three Piggeries inspected 36 β Two Offensive Trades inspected 36 β Three Mews inspected 121 β Schools inspected 7 Van Dwellings inspected 10 Visits paid to Infected Houses 237 Patients removed to Isolation Hospital 143 Rooms disinfected 289 Schools disinfected 87 rooms Bedding disinfected (estimated) 51 tons Closets disinfected after Enteric Fever 17 Library Books removed from Infected Houses and dealt with 32 Letters written 1,130 Letters received 1,348 Notices received from H.M. |
7fcfe4e0-5aee-46b4-aba0-35474b75b4a7 | Inspector of Factories 8 Notices to Water Company re Waste of Water 37 The following Tabulated List gives particulars of the sanitary improvements effected during the year:β House Drains taken up and reconstructed 97 β repaired 72 β unstopped and cleansed 89 β provided with intercepting Traps 95 β Manholes provided to 128 β ventilated 66 β Manholes to, cleansed 48 42 House Drains, Manholes to, repaired 34 β Fresh-air Inlets repaired 37 β β β provided 124 Water-Closets repaired 57 β new, provided 12 β β Pans provided to 185 β unstopped and cleansed 68 β Pan Closets and Containers replaced by efficient Pans 8 β provided with new flushing Cisterns 29 β flushing Cisterns repaired 122 β flush, disconnected from drinking-water Cistern 21 β additional or separate, provided in Factories and Workshops 6 β Apartment, |
1f7cdabd-72a1-4959-b824-da9501d97d47 | foul and dilapidated 23 Soil Pipes repaired 20 β ventilated 16 β increased ventilation provided to 21 β reconstructed 15 Want of Stoppers to Interceptors 25 Ventilating Shafts repaired 16 β provided 16 Wast Pipes, Sink, disconnected from Drain 32 β repaired 36 β stopped 14 β Bath and Lavatory, disconnected from Drain 10 β β β trapped with Lead Traps 12 Sinks, new, provided 28 β repaired 30 β trappad with Lead Traps 73 Rainwater Pipes disconnected from Drain 103 β repaired 41 β provided 10 Eaves Guttering provided 21 β repaired 27 Gully Traps replaced with Stoneware Gullies 43 β removed from improper situations 14 β unstopped 38 β provided 26 β grids provided to 19 β Cement Work around, repaired 30 Yards, paving repaired 158 β paved and drained 20 β cleansed 48 Dust Bins, provided 148 Ashpits, |
96abc17f-037e-4b8d-9b13-f77bd033a8fb | foul and defective, remedied 11 43 Cisterns repaired and covered 73 β cleansed 24 β removed from improper position 7 Houses cleansed and whitewashed 278 11 Plastering of Walls and Ceilings repaired 58 β dealt with under Housing Acts Workshops cleansed and limewashed 19 β Roofs repaired . |
40005418-8bda-4b92-a8f8-93e5a81711cc | 2 β Ventilation improved 4 Roofs of Houses repaired 33 Floors of Houses repaired or relaid 69 β Workshops repaired or relaid 23 β Stables repaired or relaid 7 Stables provided with drainage 8 β β ventilation 6 Coach-House Floors repaired 5 β Ceilings β 2 Dampness of House Walls remedied 65 Air Spaces under Floors of Houses ventilated 10 Accumulations of Refuse removed 33 β Manure removed 34 β Water in Cellars removed 14 β in Ditches 2 Manure Receptacles provided 25 Animals, Fowls, &c., nuisances from, abated 17 Urinals cleansed 4 Cesspools abolished 3 Overcrowding, number of Cases abated 10 Water supply provided to Houses 11 Taps provided on Main 14 Miscellaneous Nuisances abated 40 I am, Sir, yours obediently, Maurice W. Kinch, a.r.s.i., Chief Sanitary Inspector. |
c734dc77-de77-436f-9e75-11e24e314e47 | Public Health Department, Gothic Villa, Mill Hill Grove, Acton, W. CONTENTS. MEDICAL OFFICER OF HEALTH'S REPORT. pages. Age Incidence 13 Births 7 Cases of Infectious Disease notified during the year 1905 26 Causes of, and Ages at, Death during the year 1905 27 Deaths 8 Diphtheria and Membranous Croup 12 Diarrhoeal Diseases 18 Diphtheria 23 Defects found 30 Enteric Fever 23 Factories. |
f02a4d74-d913-44e9-a084-c82279b1afac | Workshops, Laundries, Workplaces and Homework 29 General Remarks 3 Hospital Isolation 13 Infantile Mortality 20 Inquests 22 Isolation Hospital 22 Infantile Mortality during the year 1905 28 Measles 17 Other Matters 31 Public Health and Isolation Hospital Committee 2 Population 4 Scarlet Fever 12 Scarlet Fever 23 Summary of Visits paid and Inquiries made by Health Visitor 32 Tubercular Diseases 19 Vital Statistics of Whole District during 1905, and previous years 24 Vital Statistics of Separate Localities in 1905 25 Ward Distribution 10 Willesden Outbreak 14 Whooping Cough 17 Zymotic Diseases 11-12 CHIEF SANITARY INSPECTOR'S REPORT. |
d4656c4d-1a0e-437a-bb5a-a5ac6ccbb756 | Bakehouses 36 Common Lodging Houses 39 Drainage Examinations 33 Dairies, Cowsheds and Milk Shops 30 Food and Drugs Acts 35 Houses Let in Lodgings 39 Inspection of Meat and other Foods 33 Notices 35 Number of Inspections, &c. 41 Offensive Trades 39 Prosecutions 35 Piggeries 38 Slaughter Houses 36 Smoke Abatement 40 Sanitary Improvements Effected during the year 41 |
b7e9cffb-d084-4eaf-becb-de6b2e3e0bad | Act 14 Urban District of Acton. Annual Report OF THE Medical Officer of Health FOR 1906, Urban District of Acton. Annual Report OF THE Medical Officer of Health FOR 1906. Public Health and Isolation Hospital Committee. Mr. Councillor E. F. HUNT (Chairman). F. A. BALDWIN. J.P. E. MONSON, J.P. J. W. JARRATT, J.P. β D. P. CRONIN. A. C. CRANE. S. F. HOLLOWAY. E. E. B. LANDON. |
9e4e9e92-e2ae-4bbb-a31a-4d8253cf20b6 | 2 by the order of the Local Government Board, dated March 23rd, 1891, article 18. jjsction 14, it is prescribed that the Medical Officer of Health shall make an Annual Report to the Sanitary Authority, up to the end of December in each year, comprising a summary of the action taken, or which he has advised the Sanitary Authority to take, during the year, for preventing the spread of disease, and an account of the sanitary state of his district generally at the end of the vear. |
223d6b32-ab31-4b7b-837c-b6e368cf7292 | The report shall also contain an account of the inquiries which he has made as to conditions injurious to health existing in the district, and of the proceedings in which he has taken part or advised under any Statute, so far as such proceedings relate to those conditions; and also an account of the supervision exercised by him, or on his advice, for sanitary purposes, over places and houses that the Sanitary Authority have power to regulate, with the nature and results of any proceedings which may have been so required and taken in respect of the same during the year. The report shall also record the action taken by him. or on his advice during the year, in regard to offensive trades, to dairies, cowsheds and milk-shops. The report shall also contain tabular statements (on Forms to be supplied by us. or to the like effect) of the sickness and mortality within the district, classified according to diseases, ages and localities. |
0a1f2359-a2eb-4bfd-8601-2873957a7c60 | In a memorandum issued by the Local Government Board in November, 1906. it is recommended that the report shall deal with the extent, distribution and causes of disease within the district; and should give an account of any noteworthy outbreak of epidemic diseases during the year under review, stating the result of investigations into their origin and propagation, and the steps taken to check their spread. As these reports are for the information of the Local Government and of the County Council, as well as of the Council of the District, a statement of the local circumstances and a history of local sanitary questions, which may seen superfluous for the latter, may often be needed by the former bodies. Under section 132 of the Factory and Workshop Act, i9or. the Medical Officer of Health is also required in his Annual Report to report specifically on the administration of the Act in workshops and workplaces, and to send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State. |
8f7d7041-27e3-4e2d-93b5-86c850074171 | ANNUAL REPORT OF THE Medical Officer of Health FOR THE URBAN DISTRICT OF ACTON, For the Year 1906. 130 Churchfield Road, March, 1907. To the Chairman and Members of the Acton Urban District Council. Gentlemen, I have the honour to submit to the Council a report on the Sanitary conditions of the district, together with the vital and other statistics for the year 1906. The most noticeable feature in regard to infectious disease was an extensive epidemic of Measles, resulting in 27 deaths. There were limited outbreaks of Scarlet Fever, but in no instance did the disease assume a formidable aspect. The mortality from Diphtheria and Enteric Fever continues very low. There is an increased Infantile mortality to be noted, due in the main, to the large number of deaths from Diarrhoea during the very hot summer which we experienced. |
57173c6e-71d9-4d88-9658-2533a35c0540 | In regard to the sanitary work which has been effected, there is probably little of a startling nature to chronicle. The work has been of a routine kind, and, I believe, of a substantial character. A large amount of progress may be recorded in many directions. 4 The principal features of the vital statistics for the year have been as follows:β Estimated Population: 52,000. Birth Rate: 29.5 per 1,000 inhabitants. Death Rate: 13.2 per 1,000 inhabitants. Infantile Mortality: 130 per 1,000 births. Zymotic Death Rate: 2.4 per 1,000 inhabitants. Respiratory Death Rate (excluding Phthisis): 2 per 1,000 inhabitants. Phthisis Death Rate: .9 per 1,000 inhabitants. Death Rate from other forms of Tuberculosis: .5 per 1,000 inhabitants. TOPOGRAPHY. |
8283926b-d0a4-43b7-b537-ae0385154f97 | The district, with an area of 2,304 acres, is about 3 miles in length, and about 1Β½ miles wide. It is irregularly quadrangular in shape. It is bounded on the north by Willesden, on the east by Hammersmith, on the south by Chiswick, and on the west by Ealing. For Poor-law purposes, the parish forms part of the Brentford Union, and for Parliamentary purposes, it is within the Ealing division of Middlesex. For municipal purposes, the district is divided into four wards, North-East, North-West, South-East and South-West. The underlying stratum of the district is London clay, 200 to 300 feet thick, with a slightly southerly dip. |
5b659294-7d22-4260-a939-ba82d9f41448 | This clay forms the exposed surface over the greater part of the district north of the Great Western Railway, but in the central and western portions the clay is covered with a bed of ochreous gravel, which, in some parts, reaches a thickness of 10 or 12 feet. In the eastern and southern portions, the clay is covered with "Loess," a rich loam or brick earth, with patches of gravel and sand. POPULATION. In last year's report, the various methods by which the population of a district is estimated, were mentioned, and reasons were given for discarding the method adopted by the Registrar-General. It was then stated that the nearest approach to a correct estimate would probably be attained by calculating the number of new houses erected 5 and occupied since the Census, and allowing 6.2 persons for each house. This figure represents the average number of persons occupying each house at the Census. At the present time, the average number of persons to each house is probably higher than 6.2. |
1adddc23-28c2-4f69-a2b9-92ccc7d0cd2a | At the Census of 1901, there were 6,086 inhabited houses in the district, besides 454 uninhabited houses. Between March 31st, 1901, and June 30th, 1906, 2,165 dwellinghouses have been erected and occupied, and 65 public buildings, such as schools, offices, churches, etc. On June 30th, 1906, there would be in the district 8,610 dwelling houses and 160 public dwellings. Allowing 3 per cent, for vacancies, an average of 6.2 persons per house would give a population of 51,782. As there is reason to assume that the average number is now slightly over 6.2, for the purpose of this report, the population has been estimated at 52,000 inhabitants. |
91552161-fd24-4581-9680-a9df6003ca05 | With the assistance of the Surveyor and Accountant, an attempt has been made to estimate the population of each ward, and I believe the following table is fairly correct:β North-East Ward 13,000 North-West Ward 11,000 South-East Ward 11,000 South-West Ward 17,000 BIRTHS. The number of births registered during the year was 1,533β801 males and 732 females. This number corresponds to a birth-rate of 29.5 per 1,000 inhabitants, which is 1.1 per 1,000 lower than that of 1905 and 1.2 per 1.000 below the average rate for the 10 years 1896-1905. The birth-rate for the whole of England and Wales in 1906 was 27 in the 76 large towns it was 27.9. and in the 142 smaller towns 26.5. |
5cd46fe8-8b23-4193-a074-ce4c6b8dcc23 | The infants registered as having been born out of wedlock numbered 39, which figure corresponds to a rate of 25 per 1,000 births, or .7 per 1,000 living. This is lower than the illegitimate birth-rate 6 in England and Wales, but in rural districts illegitimacy is always more prevalent. The figure 29.5 does not represent the actual birth-rate of the district, and the illegitimate birth-rate is higher than 25 per 1000 births. 1,533 is the number of births registered in the district; some births occurred in outside institutions, but a list of these has not been obtained. The birth-rate is not usually considered within the realms of public health, and we are deterred even from an adequate discussion of it by what has been stigmatised as a spurious delicacy, and by a wholly false conception of morality. |
1e771ce6-8c35-4e77-b960-597a24ffade9 | Although the remedy is beyond the control of Sanitary Authorities, it is important that we should ascertain whether the population is being chiefly recruited from the fit or from the unfit Preventive medicine must enlarge its scope if it is to continue to reduce the general death-rate, and if, more particularly, it is to make substantial advance in promoting the physical fitness of the people and to create an impression upon such diseases as infantile diarrhoea and measles. We know that since 1877 the birth-rate in this country has been steadily declining, but "it is as important that the right people should be born as that the wrong people should not be born." Not only has the birth-rate in England and Wales during the last 25 years undergone a decrease of nearly 20 per cent., but there is reason to believe that the fewer beings now born are born of the less healthy and less thrifty classes. It is the birth-rate of the middle classes and the better type of working man that has been falling off at such an alarming rate. |
5bba7b3c-e398-4ffa-ade0-e6af1298d8e6 | It is unnecessary to produce statistics in order to ascertain the relative position of the wards socially. A glance at the number of deaths from the various diseases in each ward will at once convince any observer as to who are best and least fitted for the struggle of life. Consumption or Phthisis is a disease which eminently reflects the influence of poverty, being determined by overcrowding, physical privation, anxiety, want of rest, and all the factors which are dependent on poverty. More than half the deaths from Consumption occurred in the South-West Ward. Similarly, Infantile Diarrhoea, though dependent upon various causes, is most fatal in those children whose general standard of vitality is lowered. 45 out of the 79 deaths from Infantile Diarrhoea occurred in the South-West Ward. 7 A great deal has been written to the effect that its population is the most valuable asset of a country. |
7d7cfb9d-fcfd-4b34-8bd8-8b9d3b060789 | Whether it be so or not depends on the character of the population, and if the diminished birth-rate were operating in the proper quarter it would possibly be a sign to welcome and not to regret. The births have been allocated amongst the wards this year for the first time, and the following table gives the number, and rate per 1,000 livine. in each ward:β Number. Rate per 1,000. North-East Ward 325 25 North-West Ward 229 20.8 South-East Ward 255 23.2 South-West Ward 724 42.6 DEATHS. Number ... ... ... ... 687 Rate per 1,000 ... ... ... 13.2 Rate per 1,000 in England and Wales 15.4 Rate per 1,000 in 76 large towns 16. |
dde12172-fa53-4ecb-9cab-5d3cd11ce34c | Rate per 1,000 in 142 smaller towns 14.4 The total number of deaths registered in the district was 597, but certain corrections have to be made in order to obtain the exact number of deaths belonging to the district. On Table I. instructions are given concerning the corrections which should be made before arriving at the net number of deaths belonging to the district. The first correction is the subtraction of the deaths of non-residents from the total registered in the district. By the term "non-resident" is meant persons brought into the district on account of sickness or infirmity or accident and dying in public institutions here. Seven non-residents died in the district. One of these died of Diphtheria at the Fever Hospital and belonged to Hendon. Six non-residents sustained fatal accidents in the districtβfour on the railway, and two were run over in the street. |
0dcb9dd0-deac-4466-8860-cfd9d3bd84e9 | The second correction which has to be made is the addition to the total of the deaths of "residents," registered in public institutions beyond the district. 8 By the term "residents" is meant persons who have been taken out of the district on account of sickness or infirmity and died in public institutions elsewhere. The "public institutions" to be taken into account are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. Ninety-seven residents died outside the district, and these deaths occurred in the following institutions:β Isleworth Infirmary 44 West London Hospital 12 Wandsworth Asylum 8 St. Mary's Hospital 5 Guy's Hospital 2 Middlesex Hospital 2 Bethlehem Hospital 1 St. Peter's Hospital 1 Evelina Hospital 1 St. |
9e925697-5779-4a55-8d42-09c221dc2e52 | Mark's Hospital 1 Homeopathic Hospital 1 Hampstead General Hospital 1 Children's Hospital, Paddington 1 Mount Vernon Hospital 1 Grove Hospital, Tooting 1 Charing Cross Hospital 1 Queen Charlotte's Hospital 1 University College Hospital 1 Cancer Hospital, Chelsea 1 Cancer Hospital Fulham 1 St. Thomas's Hospital 1 London Hospital 1 Chest Hospital, Bethnal Green 1 Victoria Hospital, Chelsea 1 St. Joseph's, Chiswick 1 Camden Square 1 Beaumont Street, Marylebone 1 Weymouth Street 1 9 One death occurred on the District Railway at Brompton, and another in a cab in Mortimer Street, Marylebone. The total number of deaths belonging to the district is 687, which corresponds to a death-rate of 13.2 per 1,000 inhabitants. Another correction is necessary before a comparison can be instituted between this district and neighbouring ones. |
b0bf96eb-20fb-48ab-bb35-d598ea7c0a41 | This correction is dependent upon the sex distribution and the age constitution of a district. Females live longer than males, and though there is a preponderance of females over males in Acton, the death of males exceeded those of females by 11. Three hundred and forty-nine males and 338 female deaths occurred last year. If the sex distribution has not altered since the Census the death-rate last year among males was 14.8 per 1,000, and among females 11.8. A more important factor is the age-constitution of a population. The tendency to death is greater among persons living at the extremes of lifeβamong infants and old people. The ages at death last year were as follows:β Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 65. Over 65. |
9cd97ff1-ad82-4253-9311-05bc4d7d6919 | 201 91 26 19 194 156 In order to neutralise the errors in death-rate arising from sex and age-constitution, the Registrar-General has devised a method by which they can be corrected. This method is based upon the deathrate of each sex at different ages throughout England and Wales, and by this means series of factors are obtained, by which the recorded death-rates of different towns can be multiplied, so as to make them comparable with that of England and Wales and with each other. The figures by which the recorded or crude death-rate should be multiplied, in order to correct for variations of sex and age distribution, is called the factor for correction for the particular district; and when the recorded death-rate is multiplied by the factor for correction, the result is the corrected death rate for that district. The factor for correction for Acton is 1.04240, so that if the recorded death-rate. 13.2, be multiplied by this figure, the corrected death-rate is 13.7. |
f0223d8d-b63c-4f4d-97b1-344ebc8f38fe | 10 Ward Distributions. The deaths were distributed as follows:β North-East North-West. South-East. South-West. 137 135 122 293 Based upon the estimated population given on a preceding page, the death-rate of each ward per 1,000 inhabitants would be North-East. North-West. South-East. South-West. 10.5 per 1,000. 12.3 per 1,000. 11 per 1,000. 17.2 per 1,000. On Table IV. will be found the number of deaths in each ward from the different diseases, and it will be observed that the excessive mortality in the South-West Ward is confined to 5 diseasesβMeasles, Diarrhoea, Phthisis, Pneumonia and Bronchitis. The three former diseases are dealt with separately, and the five reflect the influence of poverty upon the death-rate. |
130d2288-ae85-4927-92ad-47cbbcef9fee | When one reflects on the various causes productive of ill-health, and of that more intense form which ends in death, the influence of poverty, and more particularly of unsettled poverty, loom larger and larger. The death-rates of those inhabitants who end their lives in the Union Infirmary may be taken as one of the indices of poverty, and the following figures are significant. Forty-four deaths occurred in Isleworth Infirmary; of these, 8 belonged to the North-East Ward, 5 to North-West, 2 to South-East. and 29 to the South-West. The death-rate per 1.000 amongst persons dying in the Infirmary for the several Wards would be: North-East .6 North-West .5 South-East .2 South-West 1.7 ZYMOTIC DISEASES. Deaths 124. Death-rate 2.3. |
cfd02e24-df51-420f-9b35-b5732b533e13 | The so-called Zymotic death-rate includes deaths from the seven Zymotic diseases, namely Small-pox, Measles, Whooping Cough, Scarlet Fever. Diphtheria. "Fever," and Diarrhoea. With the exception of Small-pox, these diseases are dealt with in separate paragraphs. 11 SCARLET FEVER. One hundred and seventy cases of Scarlet Fever were notified, and 7 deaths were caused by the disease. Although occurring within the district, one of the deaths did not belong to Acton. On November 3rd, a child died at Kingswood Road. Her parents lived at Notting Hill. She was notified as suffering from Scarlet Fever in July, and removed to one of the Metropolitan Fever Hospitals. She was discharged in October, and came on a visit to some relatives who lived at the address given above. |
dca908ef-d70c-4ecf-a9e8-35bb0ee6af07 | Though discharged from the hospital free from infection, she was suffering from nephritis, to which complication of Scarlet Fever she succumbed on November 3rd. There is an increase in the number of cases and in the number of deaths. The largest increase of notifications occurred in the NorthEast Ward. The Ward distribution was as follows:β North-East. North-West. South-East. South-West. 62 29 37 42 Possibly, the Ward distribution does not convey a correct impression of the factors which operate in the spread of the infection. Of the total number notified, 109 attended school, and the tion of scholars was:β Priory 26 Central 23 Beaumont Park 13 South Acton 9 St. Mary's 7 Rothschild Road 4 Willesden Junction 3 Southfield Road 2 East Acton 1 Catholic School 1 Private Schools 7 12 Outside Schools. Kenmont Gardens 1 Latimer Road 1 City of London 1 St. |
3ce7a1de-d62f-4416-8952-671365295ec5 | Marylebone, Higher Grade 1 Oaklands Road, Hanwell 1 Private Schools 8 A certain amount of doubt exists as to the role which school attendance plays in the spread of Scarlet Fever, and until we know more of the etiology of the disease, it is unwise to venture upon any very definite opinion. Hitherto, two modes have been accepted whereby the disease is spread. The first is direct infection to other persons in close contact with the actual sufferer. This mode is easily appreciated, but it has been taken for granted that the disease may also be spread in some indirect manner not yet properly understood. There is hardly a disease concerning which opinions have so materially changed as Scarlet Fever. It was formerly held that the disease was not infectious until the skin had commenced to peel, and that it continued infectious as long as the peeling of the skin lasted. Both theories have been discarded. |
57139222-0b4b-4383-9b84-0a21cc38a60e | Scarlet Fever is infectious from the commencement of the symptoms, and the condition of the skin is no criterion of the infectiousness of the patient. It is possible, of course, that the disease is spread in some indirect manner, but the more closely the inquiries are made, the less numerous do the indirectly infected cases become. It is true that the untraced cases constitute the great majority occurring in urban districts, but it is also probable that many, if not most of, the untraced cases have been infected by persons suffering from so mild a form of the disease that the illness has not been recognised. It is these slight, undetected, or "missed" cases, as they are called, which are the most effectual promoting causes of an epidemic, and for this reason mild outbreaks are the most difficult to meet and dangerous to the public. During the year we had several instances of these undetected cases, giving rise to limited outbreaks in different schools. |
272de9b6-8ce1-4941-a4ab-f4c65385889f | Between June 2 and July 11, 17 cases of Scarlet Fever occurred amongst children attending the Central Schools. It was obvious from the distribution of the disease that the school had something to do 13 with the spread, but it was not until July 2nd that a "missed" case was found. He had attended school throughout his illness, and immediately after his removal the outbreak subsided. At other times a "missed" case was found in the house, and the same phenomenon was observed, but as the number of susceptible children was smaller, the spread was not so extensive. In February, a school card was received, intimating that some children were absent from Gloucester Road, and an examination of the inmates of the house revealed the fact that there were four persons on the premises suffering from Scarlet Fever. A similar state of affairs was noticed in a house in the Parade, where four children were found suffering from the disease. |
8bc8a0dc-2d77-4e85-91be-11e4998bca6e | Altogether 34 secondary cases were notified, but with 5 exceptions the first and subsequent cases in the house were notified together; in 3 instances, the patients were nursed at home, and in 2. the first case had been removed to Hospital. In one of the latter it is doubtful though, whether the second case was infected from the previous cases in the house, as the first patient had been removed to Hospital three weeks before the second developed any symptoms. In 3 houses there were 4 cases notified from each, in 5 houses 3 cases occurred in each, and 2 cases occurred in each of 17 houses. There were 3, which in all probability were "return" cases. Two of these occurred at one house in Gunnersbury Lane. The "infecting" case had been in the Isolation Hospital for 12 weeks, and was discharged on August 28th. |
a602a567-3834-42ab-ae1b-bc76cf33a305 | Two sisters had been staying at Hawley, and returned on September 9th; one of them developed symptoms on September 12th. and the other on October 1st. 1 was on my holidays when the first child was discharged from the Hospital, and could not make an examination of the child until September 18th. On my return, I examined the "Infecting" case, and though it was stated that the child had had a small sore on his nostril since his discharge from the Hospital. I could detect nothing which could give rise to infection, except the presence of adenoid growths at the back of the throat. There had been no running from the ears during the course of the illness, and the skin had finished peeling some time prior to his discharge from the Hospital. It is impossible to state positively what was the cause of the prolonged infection, but it is probable that the germs β were retained in the throat, owing to the abnormal condition of its lining. |
f5226975-b919-475d-a652-ac3b7d8eb386 | 14 The third case occurred in Kingswood Road. The "infecting" case was discharged from the Hospital on November 7th. On November 14th, a sister was taken ill, and notified of Scarlet Fever on November 19th. The "infecting" case had been in the Hospital for over 6 weeks, and had not suffered from any complication. I examined him again on November 18th, and could detect no symptom or sign which would lead one to suspect his freedom from infection. The second case in the same house may have been merely a coincidence; and the infection may not have been conveyed by the child discharged from the Hospital. The following incident will illustrate this possibility. A child living at Weston Road was a patient in the Hospital. On November 11th, the parents were informed that probably the child would be discharged on November 12th, but after an examination of the child on the latter date, it was decided to detain her in the Hospital for at least another week. |
d386fabd-fb4d-40df-88f2-e2eb13436794 | On November 13th her sister at home was taken ill, and removed to the Hospital on November 18th. If the first child had been discharged on November 12th (which originally, had been our intention), the second one would have been considered a return case. It is possible, in the last case, that some article which had been in contact with the child before removal to Hospital, had escaped disinfection, and was brought forth in the preparation made for the reception of the convalescent. Complaints are sometimes made that Isolation Hospitals have not been instrumental in stamping out Scarlet Fever in districts where most of the cases are removed to a Fever Hospital. The above instances are given to showhow difficult it is to fulfil the most essential conditions if the spread of the disease is to be prevented. The infection must not be handed on by the patient before seclusion, and all infected material left behind must be rendered sterile. |
f674f803-5a80-4be4-abef-92e5880d032c | Very rarely is isolation practised at the commencement of the illness, and we have no means of ascertaining if all the infected articles have been disinfected. Moreover, the patient should have recovered perfectly before he is cleansed and discharged from seclusion, but we have no means of ascertaining whether the patient is absolutely free from infection or not. In Diphtheria, the conditions are different; the germ has been isolated, and a bacteriological examination can always be made before the patient is discharged from the Hospital. 15 DIPHTHERIA. Forty-five cases of Diphtheria were notified, and 2 deaths resulted from the disease. In each instance death had resulted before the notification was received. With a case-fatality of less than 5 per cent. it is unnecessary to state that the disease was of a very mild character. |
38220b15-d8aa-46d0-a839-9b0d79d482c8 | To what extent the introduction of Antitoxin into general use has modified the type of disease it is difficult to venture an opinion, but as far as Acton is concerned, nothing has been more significant than the diminished mortality witnessed within the last 10 years. Since 1897, the decline has been almost continuous, as the following figures show: 1897 28 deaths. 1898 8 β 1899 7 Β» 1900 4 ,, 1901 4 β 1902 6 β 1903 4 β 1904 2 ,, 1905 4 β 1906 2 β Last year, only three towns in England and Wales showed a lower mortality incidence. Diphtheria is essentially a disease of childhood, and as the birth-rate in each of these three towns was under 20 per 1,000, the comparative freedom of Acton from Diphtheria is eminently satisfactory. ERYSIPELAS. |
1af20cbd-c453-4535-9876-164da795b27f | Thirty-five cases of Erysipelas were notified, and 1 death resulted from the disease. The retention of Erysipelas amongst the notifiable diseases is a demonstration of the necessity of fresh public health legislation. The views held as to its causation have undergone a vast change since the 16 Infectious Diseases Notification Act was passed. It is now generally held that Erysipelas can be caused by various organisms, and cannot be regarded as a specific disease in regard to its etiology. It is true that a relationship exists between Erysipelas and Puerperal Fever, but so there does between the latter disease and any ordinary abscess or even a gum boil. Disinfection is carried out after Erysipelas, only when some special circumstances demand it. TUBERCULAR DISEASES. Forty-eight deaths were registered as due to Phthisis, or Consumption. which number is equal to a rate of .9 per 1,000 inhabitants. |
4369759b-c230-46ce-8af5-99d43854c70b | Twenty-six deaths were caused by other tubercular diseasesβTubercular Meningitis 14, General Tuberculous 4, Tubercular-Peritonitis 3, Tubercular Enteritis 2, Tabes Mesenterica 2, and Tubular Kidney 1. Of the total deaths from Tubercular Diseases, 38 were of males and 36 of females. Forty-nine deaths were in persons over 15 years of age, and 25 in children under that age. In England, Phthisis in adults has diminished since 1850 by 48 pet cent., but Tubercular diseases in children have increased by 27 per cent. It is impossible to give comparative figures for Acton, as deaths of residents occurring in institutions outside the district were not obtained prior to 1905, and last year 26 out of the 74 deaths, or 35 per cent., occurred in such institutions. The same phenomenon has probably occurred in this district. |
ebb53fb1-96eb-484b-978e-9dddeed083bc | The increase is due to Tuberculosis of the abdomen, caused possibly by the ingestion of infected milk. Thirty per cent. of all the cows giving milk in this country are tuberculous, but probably such milk is not dangerous until the udder is affected. About 2 per cent. of the cows have tuberculous udders. Our inquiries were more particularly directed towards the deaths occurring from Phthisis, or Tubercle of the Lung. 17 Of the 48 deaths, 24 were of males and 24 of females. Prior to their attack of illness their employment was:β Males. |
0e8258a1-1a30-47ce-b3de-2ebefaaffcb8 | Labourer 5 Laundryman 3 Clerk 2 Mechanical Engineer 2 Plasterer 2 Painter 2 Engine Driver 1 Lift Attendant 1 Dairyman 1 Sword Patentee 1 Railway Guard 1 Carman 1 Messenger 1 No Occupation 1 Females Household 11 Laundress 4 Teacher 2 Nurse 2 Domestic Service 1 No Occupation 4 Out of the 48 deaths from Phthisis, 19 occurred in Public Institutions. This is a high percentage, but it is doubtful if this is due to a full appreciation of the danger during the last four or five weeks of the illness. Twelve of the deaths occurred at Isleworth Infirmary and 3 at Wandsworth Asylum. Although there are numbers of special hospitals and Sanatoria for tubercular patients, with the exception of the Workhouse Infirmary, there are no institutions for advanced cases. |
4b2887eb-1e67-4f9e-b6f0-dfa8d766283e | Early cases, where any traces of the Bacilli occur in the sputum, are dangerous, but the danger from them is trifling compared to that from the advanced and fatal cases. The last 4 or 5 weeks are the most deadly in the spread of the infection. It is a difficult matter in Phthisis to ascertain the source of infection although inquiries were made into all the deaths that occurred in the district. All that can be said as to the source in any case is, that the exposure of a patient to a particular source of infection has been more frequent or prolonged, or that the infection is more actively disseminated in one case than in another, and that, therefore, that cause is the principal one. 18 In 12 instances there was a history of Consumption in the family, but we know that hereditary transmission is so rare as to be left out of the question. |
28745d77-b5c8-44c1-a34b-8fbd38cf2151 | In the majority of cases, the sputum must be regarded as the main source of infection, and the germs must have reached the lungs by inhalation. It is difficult not to infect the rest of the family when a case occurs amongst the poor. The whole family have to live in two or three ill-ventilated rooms, and the patient is left without the nursing he requires. At night he sleeps in the same room as other members of the family do. The sufferer scatters the morbid matter secreted by his diseased lungs every time he coughs, and his relatives close beside him must inhale the poison. Thus whole families are infected. In one case inquired into 9 members out of a family of 11 had succumbed to the disease. In another family, the father, son, and 3 of the daughters died from the disease. Instances of 2, 3, or 4 deaths from Consumption in the same family were not infrequent. |
f2c67687-aa13-4473-9267-29ef655007fc | Such events awaken in the minds of those who do not know the infectiousness of tuberculosis the opinion that it is hereditary, whereas its transmission in the cases in question was due solely to the simplest processes of infection, which do not strike people so much, because the consequences do not appear at once, but generally after the lapse of years The fact that some of the family escape is no argument against its infectiousness. Apart from the question of immunity, the infectivity or communicability of a given disease bears an inverse ratio to the duration of. the malady. The object of the parasite is to provide for the continuance of its species. Tn Measles, Scarlet Fever, and the acute infectious diseases where their duration is short, the communicability is high, since the opportunities afforded to the parasite of reproducing its species are limited. In Consumption, on the other hand, where the duration of the disease is long, the communicability of the disease is low, as ample opportunities are afforded for its propagation. |
fc401252-7110-49ee-826f-7a06eb0f92dc | It is on this assumption that disinfection is carried out after the death of the patient, though in a large majority of the cases the damage has already been done. Disinfection was urged in all cases where death has occurred, but only in 17 instances was the offer accepted. It is pointed out on another page that the most dangerous period is the last month of the disease, and arrangements have now been made so as to obtain a list of those removed to the 19 Infirmary suffering from the disease, so that disinfection may be carried out immediately after removal. Of the 17 instances in which there was no family history of the disease, in 5 there had been a definite exposure to infection. Three had nursed consumptive patients, and in the fourth, the husband probably contracted the disease from his wife, as the latter had died from the disease 3 years previously. |
b76ebe2f-28ab-42fc-8845-6bb4271563b5 | In two instances no information could be obtained, and in ten no definite history of exposure could be ascertained, but in six of the latter, their employment constantly exposed them to infection. Three were employed in laundriesβtwo females and one male. Although laundresses do not appear to suffer excessively from Consumption, yet the sorting of the linen which may contain dried infective sputum must expose them to the risk of infection. (At the Census in Acton, 15 per cent. of the female population over the age of ten years were employed in laundry work; last year 16 per cent. of the deaths from Consumption in females over ten years of age, occurred amongst laundresses). There are two methods by which Tubercle may be prevented; the first aims at strengthening the natural immunity of the race, and the second endeavours to limit the spread of infection. |
56132b2f-53b6-48c3-b475-7ab44259e29b | Although all sanitary efforts tend towards the first object, the special arrangements made by the Council have been directed for the most part with the object of limiting the spread of infection. To attain this end the first essential is accurate information as to the distribution of the disease, and to gain this information the Council adopted the principle of voluntary notification in June, 1903, the sum of 2S. 6d. being paid for each case notified. The result has been far from satisfactory, and only six notifications were received during the year. The want of success is probably due to the impression that notification would have a prejudicial effect on the individual suffering from the disease. It is admitted that it is not absolutely necessary to notify all cases of Consumption, but where owing to domestic conditions the patients are sources of danger to the people in contact with them, it is essential the cases should be notified so that instructions may be given and precautions taken. |
a14eea6a-3c99-43d8-b017-6b5acd1bb7e5 | 20 If the sputum is collected in a spittoon and burnt or otherwise destroyed it is probably dangerous to no one. Even if thrown into dry and well-lighted surroundings, exposed to the rays of the sun. it loses its dangerous properties. But if it remains in dark and damp surroundings it will maintain its activity for a long time, and thus it is that Tubercle claims more victims from gloomy, ill-ventilated and dark dwellings. There is an admitted danger in tuberculophobia, but the fact that Consumption is curable should make notification easier. Half the human race has tubercle and goes on living without knowing it. Stress has been repeatedly laid upon the curability of Consumption, but the greatest difficulty has been experienced to persuade the victims of the disease to take advantage of the arrangements made by the Co uncil. In July, 1905, an agreement was entered into whereby the Council maintained three beds at the Northwood Sanatorium. |
ff0997fe-4b75-4bda-a46c-ef09fdcc154c | Only twelve persons applied for admission during 1906, and of these four were in too advanced a state to benefit from the treatment. Very rarely the three beds were occupied during the year, and from a return issued, it was shown that two beds would more than suffice for the applications received. Our first difficulty is to get at the sufferers in the first stage of the disease. In the earliest stage the patient coughs and has a cold Either he takes no notice of it or goes to a chemist and has a mixture for his cough. Weeks and months go by, and if the weather is inclement he gets worse; if it is mild, he has periods when he appears better, followed by more serious attacks. Then fever and wasting set in and he has to give up his work. This is the time he usually seeks medical advice, but he has entered a stage when skilled treatment is probably useless. The Council has done almost everything in its power to obviate this difficulty. |
9a3486a3-1f55-4f25-b400-124c92a0e0da | It undertakes the bacteriological examination of all suspicious cases, and during the year thirty such examinations were made, but in almost every instance the patient was too far advanced to benefit from Sanatorium treatment. In France anti-tuberculous dispensaries have been established. Foremen are educated and they advise their fellow workmen to seek treatment in the first stage. Besides the difficulty of obtaining early information of the disease, there are other obstacles which prevent some of the sufferers 21 from taking advantage of Sanatorium treatment. Two of the persons admitted to Northwood prematurely discharged themselves from the institution though they were making satisfactory progress. The reason assigned was, that they were the bread winners of the family, and there was no one to maintain the family whilst they were undergoing treatment. To secure early treatment it would be necessary to render aid to the dependents of the sufferer in addition to treating the patient. Freed from anxiety, he would enjoy a better hope for recovery. |
885e9984-6fd4-4afc-96ea-b2a27f11712d | To some of those who have applied, it has been pointed out what "cure" means in consumption, and in one instance the sufferer was able to obtain an outdoor employment after his discharge from the Sanatorium. Unfortunately, a large number of patients do not quite appreciate what a "cure" in consumption means. The disease is not "cured" in the same way as Diphtheria, Scarlet Fever and Small Pox are. There is no disease that is so frequently arrested as Consumption, but it is equally true that there are no subjects so liable to a relapse as the consumptive patients, and this constitutes a fundamental difference between Consumption and the other diseases mentioned above. |
a453306b-7ff9-4ab6-ae10-a2e62fb97900 | Consumption is similar to Scarlet Fever and Diphtheria in this respect, that they are infectious diseases and caused by microorganisms, but there is this broad distinction to be drawn between them βin one class, an attack renders the individual more liable to a relapse, or more correctly, to a recurrence, whilst in the other one attack usually confers an immunity from further attacks of that particular disease. The object of the residence at the Savtorium is two-foldβto arrest the progress of the disease and to inculcate in the patient the principles which underly the treatment. The first can be accomplished in all cases of Consumption that have not advanced too far. To accomplish the second object you must select the class of people treated, otherwise a relapse occurs as soon as the patient returns to the conditions under which he contracted the disease primarily. The disappointment he feels is proportionate to the hope born. To this extent, we should frankly admit the limitations of Savtorium treatment. |
6c84a000-15b6-4877-a51c-bcf2b080fe0d | unless, of course, the authorities governing such institutions can combine them with working colonies, where poor patients could be put in the way of fitting themselves for a useful outdoor life after 2 2 leaving the Sarvtorium. The majority of the poorer classes who suffer are accustomed to an indoor life, and if sent to the country or to one of our colonies would be helpless. MEASLES. In 1906. 27 deaths were registered as due to Measles, but before we deal with the special features of the recent epidemic, it may be cf interest to trace briefly the history of the disease in the district during the last quarter of a century. This survey, I hope, will convince the Council of one important fact; that in spite of the improvement which is noticeable, there is still a deplorable sacrifice of life upon the altar of this one disease alone. For purposes of comparison, Acton is more fortunate than most other centres of population. |
7c0e275d-9d7f-4f54-8400-59e157bd8714 | If the relative incidence of Measles on certain age-groups be considered, it will be found that the mortality from the disease falls heaviest on children under 5 years of age. Throughout the kingdom the birth-rate has been steadily and continuously diminishing during the last 20 years, and, consequently, the proportion of children under 5 years of age, to the entire population, is now less than it formerly was. Where a falling birth-rate has been in progress, a comparison of the death-rate from Measles extending over a number of years would be fallacious. On the other hand, in Acton, since 1890, the birth-rate per 1.000 inhabitants has been fairly constant. It is, of course, understood, that we are now dealing with the proportion of children to the entire population and not with the birth-rate. Owing to various causes, the age-constitution of the population in Acton has changed, and the relative number of women between the ages of 15 and 45 has increased. |
46eda988-d2f4-4055-8ea6-aee3a79ce848 | This accounts for the apparent constancy of the birth-rate, but if the rate be expressed as the ratio of births to the number of married women between the ages of 15 and 45 years, the same phenomenon would be observed here as in the rest of the kingdom. In view of the fact that the relative proportion of children under 5 years has not altered, the usual method has been adopted, and the mortality from Measles has been expressed as the number of deaths per 100.000 of the population. In the circumstances, a comparison with the years 1890-1905, based upon the total number of deaths registered, is a fair and legitimate one. 23 On the following page a chart is given, which shows the number of deaths from Measles per 100,000 inhabitants during the last quarter of a century, but owing to the marked difference in the birth-rate, too much reliance must not be placed upon the figures for the years prior to 1890. |
e8e88b21-1a86-44ee-b2d8-7480d1253376 | It will be observed with what regularity Measles appears in an epidemic form. An epidemic made its appearance almost every second year, and the district was visited by a major epidemic at intervals of 4, 3, 4, and 6 years respectively. If these periods were analysed more minutely, the cyclical character of the epidemic would be made still more evident. For instance, the figures for 1897 and 1898 really belong to one epidemic; the outbreak commenced towards the latter part of 1897 and continued during the earlier months of 1898 The experience of Acton has been somewhat similar to that of the whole of England and Wales. The means adopted for the prevention of Measles have not. up to the present, had the effect of steadily and continuously reducing the death-rate. During the third quarter of the last century, there was a decided improvement, but this was followed by a serious rise towards the end of the century. |
bb247b4f-889a-44ba-a521-d75d5caf6bd8 | This rise will be made more evident if we dissect the figures in the chart and take the mortality for certain definite periods. The following Table gives the annual number of deaths per 100,000 inhabitants in quinquennial periods for the 25 years, 1882-1906: 1882-86. 1887-91. 1892-96. 1897-1901. 1902-1906. 32.6 66.6 50.2 13.6 29 For purposes of comparison, the figures have been expressed as the number of deaths per 100.000 inhabitants, but they may appear clearer and distinct if the actual number of deaths be given. In the 25 years, 259 deaths have been caused by Measles. In the same period Scarlet Fever, Diphtheria and Typhoid Fever combined have been the cause of 286 deaths. |
15990f49-a8eb-4221-8ee4-15236b76bd46 | In the quarter of a century Small-pox has caused 13 deaths, but in Measles we have a disease which claims as its tribute every year almost that number of lives. The victims of the latter form the silent, the innocent and the unprotected portion of the community. 24 Chart showing the number of deaths from measles per 100,000 of the population for the 25 years,1882-1906. 25 The public cannot be aware of the serious drain upon life which an outbreak, of measles entails; if they did, greater precautions would be taken to prevent its spread. It is the commonest of expressions, "Oh, it is only Measles," and the superstition is general that a child must get Measles, and the sooner he gets it the better. Probably, no superstition is attended with more disastrous results. The utter folly of such a belief cannot be too strongly emphasized. |
4fcb565e-76a9-418c-9b04-78028232fabb | After a certain period, the older the child, the less susceptible he is to the disease, and even if they contract the disease, children over 5 years of age rarely succumb. The age at which relatively the greatest number of children die of Measles is the second year of life; while after the third year has passed there is a rapid decrease in the proportion of children dying of this disease. Dr. Theodore Thompson, in his report to the Local Government Board on the control of Measles, states " that the incidence of attack is different from that of death. For while the main incidence of death is on the second year, the incidence of attack is chiefly on the third, fourth and fifth years. From this different incidence of attack and of death it results that the fatality from Measles is very much higher in the second year of life than in any of those succeeding years. |
4da7e08d-f9b8-4a05-89a4-1f26011030e0 | While, therefore, more children die of Measles in the second year of life than at any other age, more children are attacked by this disease in each i f the three years following; so that children in the second year of life, although less susceptible to attack, are much more likely to die if attacked than any other children." It is more than probable that the above remarks hold true of the present epidemic, though it is impossible to produce figures to verify them. Dependent, as we are, upon school notification, it follows that the majority of cases amongst children under school age would not be reported except where children from the same house attended school. The following figures, though, would suggest that the number of deaths which occurred at different age-groups did not represent the relative number of cases at the same ages. Three hundred and forty-five cases were reported and investigated, and the ages of these were:β Under 1 year. |
937e1e29-ae23-4c19-a17c-b98b93f4892e | 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 Age uncertain. 11 21 8 12 55 92 74 36 3 5 28 26 The ages at death were as follows:β Under 6 months 1 6 and under 12 months 3 Total under 1 year 4 1 and under 2 years 14 2 and under 3 years % 6 4 and under 5 years 1 5 and under 6 years 2 Total 27 Of course, it is understood that these figures do not represent the relative number of cases at different ages which occurred during the late epidemic. It is explained above that the majority of the cases which come to the knowledge of the Sanitary Department would be children who attend school, and Measles occurring among younger children would remain unreported. |
520416fd-a44e-4563-9ab7-67cf82e9a5d6 | The above figures, though, do bear out the assumption that the fatality from the disease is lower in children above the age of 2 years. This aspect of the question is worthy of consideration, as bearing upon the epidemicity of the disease. If the assumption be correct, and it probably is. the length of the inter-epidemic period is of importance. If the inter-epidemic period could be lengthened, not only some children would have reached an age when they would be less susceptible to an attack, but a larger number of children will, when the epidemic arrives, have reached ages at which the disease is little fatal. A number of lives would thus be saved, which are now sacrificed to Measles. Our first concern, therefore, would be with the measures adopted to meet epidemic prevalence of the disease, and the means by which it'may be controlled so as to arrest or delay a threatened epidemic. The other measures would be directed towards restraining the spread of Measles in invaded households. |
c0700611-df99-44c2-8a63-12dbb7385264 | 27 These, in the main would constitute our most important means towards attaining our first object, for the isolation of every case of Measles from the first onset to the end of the third week would undoubtedly enable an outbreak to be brought abruptly to a close, as no second crop of cases would occur. This ideal will, probably, not foi the present be accomplished, but the attention paid to invaded households would tend to secure more precaution on the part -of parents. Two factors which play an important part in the spread of an epidemic are the early infectiousness of the disease and the occasional mildness of the symptoms. Measles is infectious during the period in which the patient has running from the eyes and nose, and before the rash appears. It is true that Koplik described some spots on the mucous membrane of the mouth; these make their appearance at the onset of the disease, but their early appearance is often useless for purposes of prevention, as a doctor is not usually called in attendance until a rash is observed. |
a7e28e74-94f9-478b-9d88-115b63d06826 | On account of this early infectiousness, the difficulty of preventing an epidemic will be appreciated. Whatever the ultimate cause may be. the disease is contracted through personal contact with an infected case, and though this personal contact was not clearly proved in every instance, yet the course of the outbreak plainly suggests that its spread was thus facilitated. The main outbreaks were in South Acton, Rothschild Road and Beaumont Park Schools. The disease first showed itself in the south-western part of the district, and on January 29th 13 cases were reported from the South Acton Infants' School. Between January 29th and February 15th, 65 cases were reported from this school. The Infants' School at Rothschild Road was probably attacked about the same date, though information did not reach the Sanitary Department of an outbreak at this school until February 2nd. On that date 34 cases were reported. Both these schools were closed from February 5th to March 2nd. |
256f0e6f-f9c1-4645-bd58-aa4a3040b88b | 28 Roughly speaking, the outbreak spread from west to east, and the number that occurred to the north of the Uxbridge Road was small. The attendance at St. Mary's and.the Priory Schools was not appreciably affected, but cases occurred in Beaumont Park School towards the beginning of February. The earliest cases at the latter school were reported on February 8th, and between that date and April 3rd, 150 cases occurred amongst children attending this school. The school was closed from March 12th to March 23rd. Only 6 cases were reported amongst children attending the Priory School, and all these lived to the south of the High Street. Towards the end of March the outbreak gradually subsided, though 2 deaths occurred in April, 3 in May, and 3 in June, as compared with 11 deaths in February and 8 m March. The street distribution of the deaths was as follows:β Stirling Road 4 deaths. |
cd92ed05-2d01-4eab-9057-1dda2c50dfad | Colville Road 3 β Park Road North 3 β Holland Terrace 3 ,, Cunnington Street 2 β Fletcher Road 2 β Bollo Bridge Road 2 β Antrobus Road 1 death. Bolton Road 1 β Bridgman Road 1 β Somerset Road 1 β Speldhurst Road 1 β Gloucester Road 1 β Bollo Lane 1 β Clovelly Road 1 β The 27 deaths occurred in 25 households, one death each in 23 houses and 2 deaths in each of two houses. Of the 27 children amongst whom Measles proved fatal, 2 only attended school when they contracted the disease, but this proportion does not truly represent the influence of school attendance on the spread of the outbreak. In the case of sixteen of the children, there 29 was a connection between school attendance and infection, as Measles was introduced into the house by one of the children attending school. |
4038659f-cf8b-48e0-a425-e4746c67b544 | This connection of school attendance and infection brings us to a consideration of the preventive measures against Measles. Formerly, it was the practice to exclude all the children of infected houses from attending school, but in the boys' and girls' departments, the classes arc protected to such an extent on account of the pupils having previously suffered from the disease, that there was no fear of Measles spreading in the higher standards. An exhaustive enquiry has recently been made by Dr. C. J. Thomas, for the London County Council, into the spread of Measles among children attending the elementary Schools of Woolwich. He found that " the disease tends to spread whenever a class accumulates unprotected members to the extent of between 30 and 40 per cent., and when spread has begun it continues until the proportion is reduced to between 15 and 20 per cent. unprotected." |
f74373fd-cbf8-40c3-a26d-bf258904b122 | Acting upon this experience, the Education Committee of the London County Council have adopted the following addition to their Code of Instructions to Teachers:β Children suffering from Measles must be excluded for at least one month. Children coming from houses where Measles exists, but who are nor themselves suffering from the disease, should be dealt with as follows:β A child attending other than an infants' school who has had Measles need not be excluded from attendance at school. A child attending other than an infants' school who has not had Measles must be excluded from attendance at school until the Monday following the expiration of fourteen days from the occurrence of the first case. A child attending an infants' school, whether or not it has had Measles, must be excluded from attendance at school until the Monday following the expiration of fourteen days from the commencement of the last case. |
4a701344-de4d-400f-ad28-70f491ad7db8 | In the main, the above rules were carried out here, but there was a lack of uniformity in the various schools, as to the conditions under which a child was excluded from attendance. 30 The desirability of issuing definite rules to teachers and attendance officers might be considered by the Education Committee. As might be expected, though the older children were not generally excluded, Measles did not spread in the boys' and girls' departments. It is now held that in the vast majority of instances, if not in all, Measles is spread as the result of personal contact. It is doubtful if an apparently healthy person can act as a carrier of infection. There is always the danger that lurks in the early infectiousness of Measles, but, for reasons previously stated, the age incidence of the disease at the present time minimises this risk in the case of boys' and girls' departments. It is possible that some of the older classes i-i the infants' departments might be saved the inconvenience of closure. |
1c52b2ee-0e13-45cc-b401-ba21e967e986 | Except in certain better-class districts 75 per cent. of children above 5 are protected; yet owing to the exigencies of attendance, the whole department is closed. Before the withdrawal of Article 10 r of the old Code, separate classes could be closed. Now, if separate classes are closed, the average attendance suffers; whilst closure of the whole department is welcomed when the attendance falls below a certain mark. It may be inferred from the foregoing remarks that closure of the three schools involved w'as resorted to primarily for the sake of average attendance, and not with any decided hope of checking the spread of the epidemic. At any rate, it must be admitted that the latter object was not attained. Under the conditions obtaining in Urban Districts, it is doubtful if school closure has much effect. But if school closure is to be of any avail, it must be done at the earliest opportunity, and at the start of the outbreak. |
f816a0ba-062b-43d9-8460-1007df1e296b | The practice of waiting until the attendance falls below a certain mark does no good, and the responsibility of protecting the average attendance could well be placed on shoulders other than those of the Sanitary Department if some definite rule be adopted. At present a very great difference of opinion exists. Dr. May, the Medical Officer of Health for Aston Manor, submitted to 99 authorities the question of what percentage of children absent from a 31 school or department on account of Measles lead to a recommendation of school closure, and the replies were as follows:β No fixed percentage 47 2 to 5 per cent. 2 5 to 10 per cent. 6 10 to 15 per cent. 10 15 to 20 per cent. 8 20 to 25 per cent. 3 25 to 30 per cent. 1 30 to 35 per cent. 7 35 to 40 per cent.0 40 to 45 per cent. 1 45 to 50 per cent. |