1916 ACT 64 Urban District of Acton. Annual Report OF THE Medical Officer of Health For the Year 1916. 1916 index of tables. 1. Comparative Mortality Table 2. Vital Statistics, 1911—1916 3. Registered Births 4. Notified Births 5. Causes of Death—Age Incidence 6. „ „ Ward Distribution 7. Infantile Mortality—Causes of Death 8. „ „ Ward Distribution 9. Infectious Diseases Notification 10. Deaths from Tuberculosis 11. Notifications of Tuberculosis 12. Deaths from Measles 13. Infants' Consultations 14. Isolation Hospital 15. Inquests 16. Bacteriological Laboratory 17. Sanitary Inspections 1916 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1916. Council Offices, Acton, London, W. 3. To the Chairman and Members of the Urban District Council of Acton. Miss Smee and Gentlemen, I beg to submit my Annual Report for the year 1916. The Report has been condensed to the smallest possible compass, and the information has been presented, as far as practicable, in tabular form. The Registrar General has made two estimates of the population—one for death-rate purposes and the other for the birth-rate. The former is an estimate of the civil population only, whilst the latter includes the men on military service. The civil population is estimated at 57,913, and the population for birth-rate purposes is estimated at 63,010. Both the birth-rate and the death-rate are lower than those of 1915. The deaths of infants under 12 months, corresponded to a rate of 77 per 1,000 births, compared with 104 in 1915. With the exception of 1912, it was the lowest infantile mortality rate recorded in the district. 1916 4 The Council has extended its activities in the campaign for the conservation of child life, and the scheme outlined in the Annnal Report for 1914 is now in operation. A second Health Visitor was appointed, who commenced duties on May 1st. A second "Infants" consultation centre was opened at the Social Club, Stanley Road, in May. In February, 1917, the agreement between the Council and the Committee of the Cottage Hospital came into operation. An Infants' Clinic and an Ante-natal Clinic were opened, and a bed is provided for complicated cases of pregnancy. Both Clinics are opened on two days in each month. Dr. Cockayne conducts the Infants' Clinic and Dr. Bell conducts the Ante-natal Clinic, and is in charge of the Maternity beds. In November, a Nursery was opened for the reception and care of children of munition workers. For the equipment of the Nursery, the Ministry of Munitions contributed 75 per cent. and the Council contributed the remainder. The Nursery is open both day and night, from Sunday evening to Saturday afternoon. In view of the extended activities of the Council, the recent special report of the Medical Officer of the Local Government Board is of special interest to the district. The last report is the fourth special report to the Local Government Board on Child Mortality, and in it are given statistics for the years 1911—1914. In the second report the statistics for 1907—1910 were given, and the comparative position of Acton was summarized in my Annual Report for 1913. Exigencies of space prevent a similar summary of the fourth special report. Briefly, it may be stated that an improvement has occurred in Acton,—relatively and absolutely. It is gratifying to note that the greatest improvement has occurred' in the mortality from diseases to which particular attention has been paid. In the period 1907—1910, the mortality from Bronchitis and Pneumonia was 14 per cent. above the average rate for the 241 urban areas, and for Diarrhoeal diseases it was 30 per cent. above the average. 5 1916 In the period 1911—1914, the mortality from these diseases in Acton was below the average rate for the large towns. The mortality from these diseases is more influenced by the advice given and the work done by the Health Visitors than that from the other diseases of childhood. The decreased mortality from these diseases is larger accountable for the improved position of the district among the large towns. In 1907—1910, the Infantile mortality was only 5 per cent. below the average rate for the great towns, but in 1911—1914, Acton was over 20 per cent. below the average. The Ante-natal work recently undertaken by the Council will probably reduce the mortality from developmental diseases, and we may reasonably hope for improved statistics from Congenital Debility, &c. There are two diseases, though, which loom largely in child mortality, and the deaths from them have not shown an appreciable diminution. In the control of Measles and Whooping Cough, we have not made any marked advance, and until the Council provides a certain amount of skilled nursing in the homes, we cannot expect much improvement. Steps have been taken to control Measles. On January 1st, 1916, the Public Health (Measles and German Measles) Regulations, 1915, came into force, and these two diseases, under certain conditions, are now compulsorily notifiable. Of the 1,418 notifications received last year, 1,059 were of Measles and German Measles. If the labour and expense involved in the notification and investigation of these cases are to be repaid, further administrative measures must be taken. Both the incidence of, and the mortality from, the principal infectious diseases were lower than in the previous year. The incidence of Scarlet Fever was lower than in any year since the introduction of compulsory notification. Your obedient Servant, D. J. THOMAS. 6 1916 TABLE 1. DEATH-RATE AND ANALYSIS OF MORTALITY-1916. Annual Death per 1,000 Living. Rate per 1,000 Births. All Causes Enteric Fever Small Pox Measles Scarlet Fever Whooping Cough Diphtheria Diarrhœa and Enteritis Deaths under 1 year England and Wales 14.0 0.03 0.00 0.15 0.04 0.16 0.14 12.47 91 9G Great Towns (including London). Census population exceeding 50,000 14.4 0.03 0.00 0.21 0.04 0.21 0.15 16.24 99 146 Smaller Towns (census population 20,000—50,000) 13.0 0.03 0.00 0.14 0.04 0.14 0.16 10.79 90 London 14.3 0.02 0.00 0.19 0.03 0.18 0.14 15.80 89 Acton 11.8 0.00 0.00 0.19 0.017 0.14 0.07 8.3 77 7 1916 TABLE 2. VITAL STATISTICS FOR WHOLE DISTRICT DURING 1916 AND PREVIOUS YEARS. Year Population estimated to Middle of each Year. Births Total Deaths Registered in the District Transferable Deaths Nett Deaths belonging to the District Under 1 Year of Age At all Ages Uncorrected Number Nett Number Rate of Non-residents registered in the District of Residents registered outside District Number Rate per 1,000 Births Number Rate Number Rate 1911 58,048 1,458 1,486 25.6 602 10.3 3 178 205 138 777 13.3 1912 59,000 1,477 1.517 25.7 468 7.9 7 179 107 70 640 10.8 1913 60,000 1,486 1,522 25.3 508 8.4 12 197 , 127 83 693 11.5 1914 61,000 1,474 1,504 24.6 518 8.5 16 191 138 91 693 11.3 1915 62,000 for b'th rate 58,238 ford'th rate 1,390 1,414 22.8 587 9.6 11 204 148 104 780 13.3 1916 63,010 forb'th rate 57,913 Ford'th rate 1,288 1,324 21.0 504 8.7 21 204 102 77 687 11.8 8 1916 TABLE 3. BIRTHS. Registered in the District 1,288 Registered outside District 36 Total 1,324 Rate per 1,000 inhabitants 21 A.—Births Registered in the District:— Male 684 Female 604 Ward Distribution:— North East. North West. South East. South West. 296 201 345 446 B.—"Acton Births" registered outside the District:— Male 16 Female 20 C.—Illegitimate Births:— Registered inside the District 52 Registered outside the District 13 D.—Male 700 Female 624 E.—Legitimate Births:— Male 664 Female 595 F.—Illegitimate Births:— Male 36 Female 29 TABLE 4. NOTIFICATION OF BIRTHS. Live births notified 1,241 Still births notified 27 Births registered but not notified 43 Notifications were received from:— Doctors 635 Midwives 529 Nurses 43 Parents 71 Multiple Notifications received 74 Twins 9 Quadruplets 1 Number of Births visited 915 Number of visits paid to homes of infants 2,513 1916 9 TABLE 5. CAUSES OF, AND AGES AT, DEATH DURING YEAR 1916. Causes of Death Causes of, and ages at death, 1916 Public Institutions in District. Resident and NonResideat All Ages Under 1 year 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Measles 11 2 4 3 2 — — — — — Sarlet Fever 1 — — — 1 — — — — 3 Whooping Cough 8 4 1 2 1 — — — — — Diphtheria and Croup 4 — 1 1 2 — — — — 7 Influenza 14 — — — 1 1 — 5 7 — Erysipelas 1 — — — — — 1 — — — Phthisis (Pulmonary Tuberculosis) 67 2 — 1 2 8 35 14 5 — Tuberculous Meningitis 10 5 1 2 2 — — — — 1 Other Tuberculous Diseases 7 — 2 1 — 2 — — 2 Cancer, malignant disease 67 — — — — — 11 32 24 9 Rheumatic Fever 2 — — — — — 1 1 — — Meningitis 8 2 1 3 2 — — — — — Organic Heart Disease 63 — — — 4 3 13 20 23 1 Bronchitis 53 5 3 1 — 1 3 6 34 1 Pneumonia (all forms) 56 11 11 5 3 2 7 8 9 2 Other Respiratory diseases 12 3 2 1 — — 1 3 2 — Diarrhoea and Enteritis 11 9 2 — — — — — — — Appendicitis and Typhlitis 6 — — — 2 — 1 3 — 5 Cirrhosis of Liver 7 — — — — — 3 3 1 — Nephritis and Bright's Disease 13 1 — — — — 1 7 4 1 Puerperal Fever 4 — — — — 1 3 — — — Other Accidents and Diseases of Pregnancy and Parturition 6 — — — — — 6 — — — Congenital Debility and Malformation, including Premature Birth 50 48 — — 1 1 — — — — Violent Deaths, excluding Suicide 20 2 1 1 1 1 4 6 4 9 Suicide 2 — — — — — 1 1 — — Other Defined Diseases 184 8 3 3 3 6 13 45 103 9 Totals 687 102 32 24 29 24 106 154 216 50 Cerebro-spinal Meningitis 1 1 — — — — — — — — 1916 10 TABLE 6. TOTAL DEATHS—WARD DISTRIBUTION. 1916. North East North West South East South West Total Measles 1 1 2 / 7 11 Scarlet Fever — — 1 — 1 Whooping Cough 3 1 1 3 3 Diphtheria and Croup — — 1 3 4 Influenza 5 2 2 5 14 Erysipelas — 1 — — 1 Phthisis (Pulmonary Tuberculosis) 17 15 16 19 67 Tuberculous Meningitis 2 1 4 3 10 Other Tuberculous Diseases — 2 3 2 7 Cancer (Malignant Disease) 13 18 14 17 67 Rheumatic Fever 1 — 1 — 2 Meningitis 2 1 1 4 8 Organic Heart Disease 18 10 13 22 63 Bronchitis 10 11 10 22 53 Pneumonia (all forms) 10 9 11 26 56 Other Respiratory Diseases 1 1 3 7 12 Diarrhoea and Enteritis — 3 1 7 11 Appendicitis and Typhilitis — 3 1 2 6 Cirrhosis of Liver 1 3 2 1 7 Nephritis and Brights Disease 2 5 4 2 13 Puerperal Fever 2 — 2 — 4 Other Accidents and Diseases of Pregnancy and Parturition 1 — — 5 6 Congenital Debility and Malformation, including Premature Birth 11 7 15 17 50 Violent Deaths excluding suicide 8 3 3 6 20 Suicide 1 — 1 — 2 Other Defined Diseases 44 38 42 60 184 Totals 158 135 154 240 687 Cerebro-spinal Meningitis 1 — — — — 1916 11 TABLE 7. INFANTILE MORTALITY DURING THE YEAR 1916. Deaths from stated causes in Week and Months under One Year of Age. Causes of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. 1-3 months 3-6 months 6-9 months 9-12 months Total deaths under 1 year. Measles — — — — — — — 2 2 Whooping Cough — — — 1 — 1 2 — 4 Tuberculous Menengitis — — — — 1 1 2 1 5 Other Tuberculous Diseases — — — — — — — 1 1 Meningitis (not Tuberculous) — — — — — — — 1 1 Convulsions 1 — — — — 1 — — 2 Laryngitis — — — — — 1 — — 1 Bronchitis — — — — 2 1 1 1 5 Pneumonia (all forms) 1 — — 1 1 3 3 2 11 Diarrhoea — — 1 1 2 2 1 — 7 Enteritis — — — — 2 — — — 2 Syphilis — — — — 1 2 — — 3 Suffocation, overlaying 1 — — — — — — 1 2 Injury at birth I — — — — — — — 1 Atelectasis 3 — 1 1 — — — — 5 Congenital Malformations 1 1 — 1 1 — — — 4 Premature birth 11 — 2 1 — — 1 — 15 Atrophy, Debility and Marasmus 10 3 1 — 9 3 1 1 28 Other Causes — — — — — 1 — 2 3 Totals 29 4 5 6 19 16 11 12 102 1916 12 TABLE 8. INFANTILE MORTALITY. Ward Distribution. Causes of Deaths North East North West South East South West Total Measles — — — 2 — Whooping Cough 2 1 1 — 4 Tuberculous Meningitis 1 — 3 1 Other Tuberculous Diseases . — — 1 — 1 Meningtis (not Tuberculous) — — — 1 1 Convulsions 2 — — — 2 Laryngitis 1 — — — 1 Bronchitis 3 — — 2 5 Pneumonia (all forms) 2 2 3 4 11 Diarrhoea — 1 1 5 7 Enteritis — 1 — 1 2 Syphilis — 1 1 1 1 Suffocation, overlaying 1 — — 1 2 Injury at Birth — — — 1 1 Atelectasis 1 — — 4 5 Congenital Malformations 1 1 — 2 4 Premature Birth 3 — 5 7 15 Atrophy, Debility and Marasmus 6 7 8 7 28 Other Causes 1 1 — 1 3 24 15 23 40 102 13 1916 TABLE 9 CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1916. Notifiable Disease Cases Notified in whole District Total Cases Notified in each Ward At all Ages At Ages—Years North-East North-West South-East South-West Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 & upwards Diphtheria 81 1 27 42 3 8 — — 17 15 29 20 Erysipelas 30 — 3 4 — 8 9 6 8 7 4 11 Scarlet Fever 64 — 16 41 6 1 — — 13 7 22 22 Enteric fever 5 — — 1 1 3 — — 1 1 2 1 Puerperal Fever 4 — — — 1 3 — — 1 1 1 1 Cerebro-spinal Meningitis 2 — — — 1 1 — — — 1 — 1 Poliomyelitis 2 — 1 — — 1 — — 2 — — — Ophthalmia Neonatorum— 6 6 — — — — — — — 1 3 Pulmonary Tuberculosis 139 — — 3 23 83 23 7 32 23 41 43 Other forms of Tuberculosis 26 3 5 12 2 4 — — 6 5 6 9 Measles 692 32 290 323 22 24 1 — 122 73 240 257 German Measles 367 7 70 214 38 35 3 67 76 90 134 Totals 1,418 49 412 640 97 171 ?6 13 269 210 437 502 Isolation Hospital Name and Situation Friars' Place. 1916 14 CASES OF NOTIFIABLE DISEASES REMOVED TO HOSPITAL DURING 1916. Diphtheria 61 Erysipelas 2 Scarlet Fever 45 Enteric Fever 3 Puerperal Fever 3 Cerebro-Spinal Spinal Meningitis 2 Pulmonary Tuberculosis 96 Other forms of Tuberculosis 21 TABLE 10. DEATHS FROM TUBERCULOSIS—1916. Pulmonary Tuberculosis C6 Other forms of Tuberculosis 16 Total 82 Males 48 Females 31 A.—Pulmonary Tuberculosis 66 Females 37 Males 29 Over 15 62 Under 15 4 Occupation prior to illness:— Males. Females. General labourer 7 Household 17 2 Clerk 3 Clerk Chauffeur 2 Nurse 1 Newsagent 2 Governess 1 Boot manufacturer 1 Lacemaker 1 Boot repairer 1 Shop assistant 1 Wire drawer 1' Machinist 1 Dining car attendant 1 No occupation 5 Carpenter 1 French polisher 1 Store keeper 1 Butler 1 Glass-blower 1 Painter 1 Engineer 1 Cricket ball maker 1 Instrument maker 1 Library assistant 1 Pianoforte maker 1 Hawker 1 Paper designer 1 Bus oriver 1 Brush maker 1 Tramway fitter 1 Porter 1 Wheelwright 1 No occupation 1 Deaths in Public Institutions, 37 15 1916 TABLE 11. NOTIFICATION OF TUBERCULOSIS—1916. Pulmonary Tuberculosis 139 Other forms of Tuberculosis 2G A—Pulmonary Tuberculosis:— Cases 139 Notifications 226 (A case may be notified by more than one doctor, or it may be notified more than once by the same doctor.) The Notifications received were from the following:— Infirmaries 75 Private doctors 65 Sanatoria 39 Hospitals 38 Poor Law doctors 13 Military Authorities 3 Other institutions 2 Tuberculosis Officer 1 Insured cases, 75. Non-insured, 59. No information, 5. Mode of Treatment. Insured. Non-insured. Sanatorium 20 11 Hospital 8 5 Infirmary 10 20 Applying for Sanatorium treatment 3 — Applied for Sanatorium treatment but died before receiving it 3 — Not applying for Sanatorium treatment 8 — At home — 12 At home discharged from Infirmary and resumed work 3 — „ „ „ „ Hospital „ „ 2 — „ ,, „ „ Sanatorium „ „ 5 — „ „ „ „ and have not resumed work 2 2 Discharged from Sanatorium and died 2 — „ „ Hospital and have left district 2 — „ „ Infirmary — 1 At home applications for admission to Sanatorium refused 1 — Dead when notification was received 1 — Removed to Asylum — 1 In 7 cases no information was obtained, 5 were removed to the Infirmary, and 2 had left the district. 1916 16 Occupations. Males. Males. Females. Labourer 18 Glazier 1 Laundress 7 Clerk 8 Engineer 1 Domestic servant 3 Discharged soldier 3 Motor bus driver 1 Typist 2 Brush maker 2 Glass blower 1 Grocer's assistant 1 Sword grinder 2 Caretaker 1 Munition worker 1 Munition worker 2 Motor cab driver 1 Dressmaker 1 Royal Flying Corps 1 Printer 1 Milliner 1 Clergyman 1 Silversmith 1 Machinest 1 Coal merchants' manager 1 Map mounter 1 Housekeeper 1 Church organ builder 1 Tovmaker 1 French polisher 1 Telephonist 1 Gold miner 1 Piano tuner 1 Shop assistant 1 Pedlar 1 Frame maker 1 School girl 2 Rag and bone dealer 1 Toolmaker 1 Not any 32 Pensioned postman 1 Wheelwright 1 Unknown 1 Tailor 1 Laundryman 1 Newsagent 1 Bootmaker 1 Manufacturing agent 1 Brass finisher 1 Railway porter 1 Gardener 1 Photographer 1 Journalist 1 Greengrocer 1 Schoolboy 2 Shop Assistant 1 Fitter 1 Railway carman 1 Chemist's assistant 1 Shipping agent 1 Provision dealer 1 Coach painter 1 Poultry farm manager 1 Stoker 1 Timekeeper 1 Engineer turner 1 Storekeeper 1 Not known 4 B.—Non-Pulmonary Tuberculosis. Males—18. Females—8 Situation of Disease. Males. Females. Hip 4 Glands of neck 2 Spine 3 Intestine 2 Glands of neck 3 Peritoneum 1 Meninges 2 Throat 1 Hip and spine 1 Meninges 1 Finger 1 Hip 1 Skin 1 Pericardium 1 Peritoneum and Lungs 1 Miliary Tuberculosis 1 1916 17 TABLE 12 DEATHS FROM MEASLES. Colville Road 2 Church Path 1 Weston Road 1 Seymour Road 1 Hollo Bridge Road 1 Somerset Road 1 Osborne Road 4 Berrymead Gardens 1 Hanbury Road 1 Hooper's Mews 1 TABLE 13. INFAN TS' CONSULTATIONS. Priory School. Social Club. Health Visitors' Attendances 101 41 Number of Children who attended 296 101 Number of Attendances made by the Children 1160 558 Children under 1 year of age 194 72 „ over 1 „ „ 102 29 Ages of Children who commenced attendance in 1916:— Under 3 months 96 40 Between 3 and 6 months 21 20 „ 6 „ 9 „ 19 5 „ 9 „ 12 „ 3 7 „ 1 „ 2 years 19 8 „ 2 „ 3 „ 26 3 „ 3 „ 4 „ 17 10 „ 4 „ 5 „ 3 8 The Consultation at the Social Club, Stanley Road, was opened in May, 1916, but of the 296 who attended at the Priory Schools 1 had attended for the first time in 1912 16 „ „ „ 1913 20 „ „ „1914 55 „ „ „ 1915 204 „ „ „ 1916 1916 18 The attendances which these children had made was as follows:— Date at which they had first attended 1912 1913 1914 1915 1916 1 occasion — 8 5 15 84 2 occasions 1 4 7 14 26 3 „ — 1 3 6 17 4 „ — — 4 4 20 5 „ — 1 — 5 14 6 „ — 1 — 1 7 7 „ — — 1 3 9 8 „ — — — 1 5 9 „ — — — — 4 10 „ — — — — 1 11 „ — — — — — 12 „ — — — 3 2 13 „ — 1 — 2 3 14 „ — — — 2 1 15 „ — — — — 1 16 „ — — — — 2 18 „ — — — — 4 21 „ — — — — 1 25 „ — — — — 1 33 „ — — — — 1 38 „ — — — — 1 TABLE 14. ISOLATION HOSPITAL. Remaining in Hospital, January 1st, 1916 61 „ „ January 1st, 1917 26 Admitted during the year 325 Discharged 319 Deaths 11 Diseases Treated, &c. Residents. Non-Residents. Scarlet Fever 45 88 Diphtheria 61 65 Measles — 38 Septic Throat — 20 Mumps — 7 Heat Stroke — 1 19 1916 TABLE 15. INQUESTS. Held in the District 39 Cause of Death. Run over by a motor vehicle 5 Run over by a train 1 Heart Disease 5 Fall from a train 1 Accidentally drowned 3 Scalds 1 Pneumonia 3 Burns 1 Hæmorrhage into Lungs 2 Fall from a cycle 1 Burns in factory fire 2 Fall from a window 1 Electric Shock 2 Coal gas poisoning 1 Suicide 2 Run over by a tram car 1 Accidental fall from ladder 1 Gastric Ulcer 1 Injuries from machinery 1 Enteric Fever 1 Inquests on Residents who Died outside the District, 7 Cause of Death. Accidental fall from a train 2 Run over by a motor vehicle 1 Accidental fall 1 Suicide 1 Run over by a motor bus 1 Puerperal Fever 1 TABLE 16. BACTERIOLOGICAL LABORATORY. 706 Swabs from the Throats and Noses were examined:— 168 were positive and 538 were negative. The specimens were from— Doctors private patients 129 Hospital cases 448 School contacts 89 School Sore Throats 33 Convalescent cases prior to school attendance 7 1916 20 TABLE 17. SANITARY IMPROVEMENTS CARRIED OUT IN DISTRICT IN PURSUANCE OF INSPECTIONS MADE AND NOTICES SERVED. &c. No of Preliminary Notices 937 „ Statutory Notices 132 „ Bye-law Notices 125 „ Notices received from H.M. Inspector of Factories 5 „ Complaints received (Verbal) 259 „ „ „ (Written) 345 „ Premises Inspected 1040 „ Houses let in Lodgings Inspected 84 „ Contraventions under Bye-laws 233 „ Nuisances abated 2,843 „ Overcrowding Nuisances abated 27 „ Rooms, &c., cleansed, repaired. &c. 320 „ Roofs, rain water pipes, gutters, plastering, repaired 467 „ Cisterns cleansed, repaired, covered. &c. 210 „ Drains examined, tested, exposed, &c. 168 „ „ unstopped, repaired, trapped, &c. 321 „ „ submitted to Smoke Test 55 „ „ „ Water Test 29 „ House Drains reconstructed 24 „ W.C.'s repaired, supplied with water, &c. 319 „ Waste pipes, rain water pipes disconnected, repaired, &c. 160 „ New sinks provided 18 „ New Gullies provided 45 „ New Soil pipes or ventilating shafts fixed 23 „ Existing soil pipes or ventilating shafts repaired 107 „ Disconnecting traps or Chambers inserted 16 „ Dust-bins provided 204 „ Smoke Nuisances observed 57 „ „ „ abated 9 „ Yards paved or repaired 97 Meat or fish seized and surrendered (approximately in pounds) 3205 No. of Inspections of Workshops 287 „ „ Workplaces 8 „ „ Outworkers' Premises 154 ,, „ Bakehouses 98 MAURICE W. KINCH. Chief Sanitary Inspector