ACT65 1917 Urban District of Acton. Annual Report of the Medical Officer of Health For the Year 1917, 1017 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1917. 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 1917. The Report is again condensed and presented in tabular form. Two estimates of the population are made by the Registrar General—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 58,507, and the population for birth-rate purposes is estimated at 65,219. Both the estimates are approximately correct. Over 58,000 sugar cards were issued and there are over 7,000 Acton inhabitants on military duty. 1917 4 A lowered birth-rate was expected, but it is doubtful if we were prepared for the great reduction that has occurred. Coupled with a greatly reduced birth-rate, we have a higher infantile mortality. Although the infantile mortality was lower than that of 1915, it was considerably higner than that of 1916. Space will not permit me to enter into all the causes of this increased mortality, but I ought to point out some factors which were beyond our control. Five newly born children were found dead in open and other spaces in the district, and probably these children did not belong to Acton. The illegitimate birth-rate was higher last year, and, in spite of a^l efforts, the infantile mortality remains higher amongst those born out of wedlock. 60 illegitimate births were registered last year, and 23 of the deaths under 12 months were of illegitimate children, giviug an infantile mortality of 371 per 1000 births. The death-rate in 1917 was slightly lower than in 1916, but an examination of Table 1 will show that from at least two of the principal diseases, Acton shows up badly. From Measles the death rate in Acton was '67 per 1000 inhabitants compared with '30 in the whole of England and Wales. The question was discussed by the Health Committee earlier in the year and negotiations were opened with the Committee of the Cottage Hospital It was hoped that arrangements could be made with the Cottage Hospital for the home nursing of cases of Measles, but, unfortunately, the Committee of the Cottage Hospital did not see their way clear to undertake the work. 1 he Council should again consider the question, and a scheme will shortly be placed before the Health Committee. 1917 5 The Infants Clinic and the Ante-natal Clinic at the Cottage Hospital were opened in February. Difficulties have been encountered on account of the exceptional circumstances of the war, and the arrangements are only temporary. One of the most satisfactory features of the statistics is the low incidence of infectious disease. The notifications of Scarlet Fever received were the lowest on record for any year since the introduction of • compulsory notification. Not only the notification rate was the lowest on record, but the actual number of notifications was the lowest. There is also a steady decline in the incidence of Diphtheria, and the number of deaths from this disease was lower than that in any year since 1907. Your obedient servant, D. J. THOMAS 19 17 TABLE 1. BIRTH-RATE, DEATH-RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1917. (ProvisionaTfigures. Populations estimated to the middle of 1917 have been used for the purposes of this Table ) Birth-rate per 1,000 total population. Annual Death-Rate per 1,000 Civilian Population Rate per 1,000 Births Percentage op Total Deaths. All Causes. Enteric Fever. Small-pox Measles. Scarlet Fever. Whooping Cough. Diphtheria Violence. Diarrhoea & Enteritis under 2 yrs. Total D'ths under 1 vear. Deaths in Public Institutions. Certified Causes. Inquest Cases. Uncertified Cause of Death. England and Wales 17.8 14.4 0.03 0.00 0.30 0.02 0.13 0.13 0.62 12.18 97 25.7 91.6 7.0 1.5 90 Great Towns, including London. (Census populations exceeding 50,000) 18.1 14.6 0 02 0.00 0.41 0.03 0.16 0.18 0.63 16.14 104 31.2 91.5 7.6 09 148 Smaller Towns (census! population 20,000—60,000) ' 18.0 13.2 0.03 — 0.30 0.02 0.16 0.13 0.45 10.08 93 17.5 92.8 6.4 1.8 London 17.5 16.0 0.02 — 0.48 0.02 0.13 0.14 0.59 18.70 103 47.1 90.5 9.4 0.1 Acton 21.0 11.8 — — 0.67 — 0.13 0.05 0.4 28.8 96 37.5 100 6.8 — Non-Civilians ate included in these figures for England and Wales, but not for other areas. 7 1917 TABLE 2. VITAL STATISTICS FOR WHOLE DISTRICT DURING 1917 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 Uncorrected Number Nett Under 1 Year of Age At all Ages Number Rate of Non-residents registered in the ' District of Residents registered outsi le District Number Rate per 1,000 Births Number Rate per 1,000 Inhabitants. Number Rate 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 forb'th late 58,238 ford'th ratr 1,390 1.414 22.8 587 96 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 1917 65,219 forb'th-rate 58 507 for d'th rate 936 972 14.9 480 8.2 18 225 94 96 687 11.7 19 17 8 TABLE 3. BIRTHS. (a).—Registered in the District Total 936 Males 473 Females 463 Illegitimate 46 (b.)—Registered odtside District :— Total 36 Males 21 Females 15 Illegitimate 14 TABLE 4 NOTIFICATION OF BIRTHS. Live Births notified 945 Still „ „ 14 Births registered but not notified 73 Ward Distribution op the Births notified :— North Fast. North West. South East. South West. 230 154 211 350 Ward Distribution of the Births Registered but not notified :— North East. North West. South East. South West. 17 15 21 20 Notifications were received from: — Doctors 467 Midwives 367 Nurses 30 Parents 54 Number of Births visited 599 Number of visits paid to homes of Infants 4523 1917 9 TABLE 5. CAUSES OP, AND AGES AT, DEATH DURING YEAR 1917. Causes of Death Ages at death 1917. c Institutions in District, Resident and NonResident 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 39 6 14 17 2 — — — — 3 Scarlet Fever — 1 Whooping Cough 8 2 1 5 — — — — Diphtheria and Croup 3 — — 1 2 — — — 10 Influenza 7 — — 1 — — 1 3 2 — Erysipelas — — — — Phthisis (Pulmonary Tuberculosis) 63 — 3 9 32 19 2 Tuberculous Meningitis 11 1 — 3 4 1 2 1 Other Tuberculous Diseases 9 — 1 1 3 2 2 Cancer, malignant disease 67 — 1 — — 7 31 28 4 Rheumatic Fever — — — — Meningitis 5 1 1 1 1 1 Organic Heart Disease 67 — 1 1 4 4 11 24 22 2 Bronchitis 53 5 4 3 1 — 12 28 1 Pneumonia (all forms) 43 8 7 3 3 2 6 9 5 3 Other Respiratory diseases 9 2 — 2 1 1 2 1 Diarrhoea and Enteritis 28 23 5 — — — — — — 1 Appendicitis and Typhlitis 4 — — 1 1 — 1 1 2 Cirrhosis of Liver 1 — — — — — 1 — Alchoholism 2 — — — — — 1 1 Nephritis and Bright's Disease 10 — — 3 2 5 Puerperal Fever 1 1 Other Accidents and Diseases of Pregnancy and Parturition 3 — — — — — 3 — — — Congenital Debility and Malformation, including Premature Birth 35 32 1 1 — 1 — — — — Violent Deaths, excluding Suicide 23 2 5 4 1 3 5 3 4 Suicide 1 — — — — — 1 — — Other Defined Diseases 193 12 3 3 7 1 13 41 113 9 Totals 687 94 38 43 34 23 86 154 210 41 1917 10 TABLE 6. TOTAL DEATHS—WARD DISTRIBUTION, 1917. Causes of Death. North East North West South East South West Total Measles 2 — 6 31 39 Scarlet Fever — — — — — Whooping Cough 3 2 — 3 8 Diphtheria and Croup 1 — 2 — 3 Influenza 3 1 1 2 7 Erysipelas — — — — — Phthisis (Pulmonary Tuberculosis) 14 9 15 27 65 Tuberculous Meningitis ' 4 1 3 3 11 Other Tuberculous Diseases 1 1 3 4 9 Cancer (Malignant Disease) 16 17 11 23 67 Rheumatic Fever — — — — — Meningitis 1 2 1 1 5 Organic Heart Disease 16 12 16 23 67 Bronchitis 10 7 9 27 53 Pneumonia (all forms) 12 9 10 12 43 Other Respiratory Diseases 3 1 — 5 9 Diarrhoea and Enteritis 2 9 2 15 28 Appendicitis and Typhilitis 3 — 1 — 4 Cirrhosis of Liver — 1 — — 1 Alcoholism — — 2 — 2 Nephritis and Brights Disease — 3 3 4 10 Puerperal Fever — — 1 — 1 Other Accidents and Diseases of Pregnancy and Parturition 1 — 1 1 3 Congenital Debility and Malformation, including Premature Birth 10 2 9 14 35 Violent Deaths (excluding Suicide) 4 3 4 12 23 Suicide — — 1 — 1 Other Defined Diseases 47 39 40 67 193 Totals 153 119 141 274 637 11 1917 TABLE 7. INFANTILE MORTALITY DURING THE YEAR 1917. Ward Distribution. Causes of Death. North East North West South East South West Total Measles 2 1 3 6 Scarlet Fever — — — — — Whooping Cough — 1 — 1 2 I'iptitheria and Croup — — — — — Tuberculous Meningitis — — 1 — 1 ( ther Tuberculous Diseases — — — — — Vening'tis mot Tuberculous) — 1 — — 1 Convulsions — — I 1 2 laryngitis — — — — — Bronchitis — 2 1 2 5 pneumonia (all forms) 2 — 2 4 8 Diarrhoea 1 3 — 3 7 Enteritis 2 3 1 10 16 Syphilis — —. — 2 2 Suffocation, overlaying — — 1 — 1 Injury at Bijth 2 2 2 1 7 Atelectasis — — 1 — 1 Congenital Malformations 2 — 1 — 3 Premature Birth 3 — 4 6 13 Atrophy, Debility and Marasmus 4 2 1 7 14 Other Causes 1 — 1 3 5 19 14 18 43 94 1917 12 TABLE 8. INFANTILE MORTALITY DURING THE YEAR 1917. 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 3-6months| 6-9 months| 9-12mnths| Total deaths un der 1 yen Measles — — — — — — 2 4 6 Scarlet Fever — — — — — — — — — Whooping Cough — — — — 2 — — 2 Diphtheria and Croup — — — — — — — — — Tuberculous Menengitis — — — — — — 1 — l Other Tuberculous Diseases — — — — — — — — Meningitis (not Tuberculous) — — — — — 1 — — l Convulsions 1 — — — — — 1 2 Laryngitis — — — — — — — — Bronchitis — — — — 1 2 — 2 5 Pneumonia (all forms) — — — — 2 3 1 2 8 Diarrhoea — — — — 2 1 2 2 7 Enteritis — — 1 — 5 5 4 1 16 Syphilis — 1 — — — — 1 — — Suffocation, overlaying — — — — 1 — — — 1 Injury at Birth 7 — — — — — — 7 Atelectasis 1 — — — — — — — 1 Congenital Malformation — — — — 1 2 — — 3 Premature Eirth 10 — 1 1 1 — — — 13 Atrophy, Debility and Marasmus 2 1 2 7 2 — 14 Other Causes — — — — 2 2 1 — 5 Totals 21 2 4 1 24 18 13 11 9. 13 TABLE 9 CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1917. Notifiable Disease Cases Notified in whole District Total Cases Notified in each Ward Removed to Hospital. At Ages—Years At all Ages 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 Measles and German Measles 48 602 627 109 58 11 — 1455 341 285 282 547 8 Scarlet Fever 1 6 30 6 2 — — 45 20 14 7 4 26 Diphtheria — 14 46 2 2 3 — 67 24 10 24 9 54 Enteric (Typhoid) — — 1 1 1 1 — 4 — — 3 1 2 Puerperal Fever — — — — 1 — — 1 — — 1 — Erysipelas — — 6 2 4 6 2 20 5 5 3 7 — Ophthalmia Neonatorum 6 — — — — — — 6 2 1 — 3 2 Tuberculosis (Pulmonary) — 1 7 29 76 21 5 139 31 16 38 54 19 (Other) 2 4 11 10 1 1 29 9 4 7 9 97 Totals 57 627 728 159 145 43 7 1,766 432 335 365 634 208 1917 14 TABLE 10. OUTSIDE DEATHS AND PLACE OF OCCURRENCE. Isleworth Infirmary 134 Middlesex Cpunty Asylum 20 West London Hospital 12 Middlesex Hospital 4 Children's Hospital, Great Ormond Street 4 St. George's Hospital 3 St. Mary's Hospital 3 Royal County Sussex Hospital 3 The Northern Hospital 9 Victoria Hospital 3 St. Bartholomew's Hospital 2 Hostel of God 2 Chiswick Hospital 2 33, Hardwick Road, Southgate 1 Stoathes Hall Asylum 1 In River Thames, off Bishop's Road, Fuliiam 1 Union Workhouse. Isleworth 1 16, Grange Park, Ealing 1 Holborn Infirmary 1 Grand Junction Canal, Wembley 1 London Hospital 1 Chelsea Infirmary I Camberwell House 1 12, York Road, Kingston 1 St. George's Home 1 David Lewis Epileptic Colony, Marthall 1 Queen Charlotte's Hospital 1 Electric Light Station, Prince Consort Road, Westminster 1 69, Matthias Road, Islington 1 The Mansion, The Park, Beckenham 1 8, Elliott Road, Chiswick 1 F.dmonton Temporary Infirmary I Wyke House, Isleworth 1 Croydon Mental Hospital 1 West Suffolk General Hospital 1 University College Hospital 1 On the way to the Middlesex Hospital 1 Clare Hall Sanatorium 1 Uxbridge Road, Hammersmith 1 Royal Sea Bathing Hospital, Margate 1 The General Hospital, Nuneaton 1 Clavering Avenue, Barnes I 73, Oxford Road. Chiswick 1 Grand Junction Canal, Brentford 1 County Lunatic Asylum, Barnwood, Gloucester 1 Claremont, Florence Road, Boscombe, Bournemouth 1 Royal Free Hospital 1 385, High Road, Chiswick 1 Devon Nook, Barrowgate Road, Chiswick 1 Melbourne Road, Newbury 1 Northcote College Crescent, Hampstead 1 Total 232 15 1917 TABLE 11. DEATHS FROM TUBERCULOSIS. Pulmonary Tuberculosis 65 Other forms of Tuberculosis 20 Males 45' Females 40 Total 85 Pulmonart Tuberculosis. Occupation prior to death. Males. Females. Clerk 7 Household 19 Labourer 3 Schoolgirl 3 Painter 2 Laundress 2 Carman 2 Housekeeper 1 Glass Blower 2 Housemaid 1 Electric "Wireman 1 Greengrocer 1 Ticket Collector- 1 Railway Checker 1 Platelayer 1 Pedlar 1 Knife Grinder 1 Printer 1 Bayonet Bar Fitter 1 Sand Blaster at Sword Factory 1 Engineer's Fitter 1 Blacksmith 1 Stoker 1 Engineer's Miller 1 Baker 1 Watchmaker 1 Photographer's Assistant 1 Licensed Victualler 1 Grocer 1 Stained Glass Window Designer 1 Commission Agent 1 Journalist 1 No occupation 1 TABLE 12. NOTIFICATION OF TUBERCULOSIS. Pulmonary 139 Other forms of tuberculosis 29 Pulmonary -139 Cases 229 Notifications The Notifications received were from the following:— Infirmaries 43 Private doctors 62 Sanatoria 59 Hospitals 52 Poor Law Doctors 8 Other Institutions 4 Military Authorities 1 Insured cases—90. Non-insured—49. 1917 16  Mode of Treatment. Insured. Non-insured Sanatoria 44 9 Hospital 22 5 Infirmary 9 24 Applying for Sanatorium 2 — Not applying for Sanatorium 6 3 Applied for Sanatorium treatment, but died before receiving it 1 — Discharged from Sanatorium and died at home — 2 Refused Sanatorium treatment — 1 6 5 Occupations. Males. Organ builder 1 Females. Discharged Soldier 14 Bar fitter 1 Household duties 17 Labourer 14 Shirt cutter 1 Laundress 9 Clerk 10 Storekeeper 1 Munition Worker 6 Engineer 2 Printer 1 Domestic Servant 4 Draper 2 Aeronautical Inspector 1 Schoolgirl 3 Warehouseman 2 Mechanic 1 Telephonist 1 Photographer 2 Traveller 1 Needleworker 1 Grinder 2 Tram Driver 1 Dispenser 1 Engineer's Turner 2 Draughtsman 1 Milliner 1 Garage Cleaner 2 Accountant 1 Dressmaker 1 Schoolboy 2 Commission Agent 1 Fur toy-maker 1 Barman 2 Ganger 1 Dyer 1 Coal Merchant 1 Sand blaster 1 Laundry Packer 1 Manager 1 Postman 1 Art Student 1 Shop assistant 1 Shoemaker 1 School Teacher 1 Harness maker 1 Pedlar 1 Not any 5 Dentist 1 Not known 2 Night watchman... 1 Not any 4 Non-Pui.monary Tuberculosis. Males—16 Females—13 Situation of Disease. Males. Females. Meninges 3 Meninges 3 Hip 3 Glands of Neck 2 Spine 2 Knee-joint 3 Glands 2 Hip and Spine 1 Throat 1 Hip 1 Wrist and Back 1 Spine 1 Knee-joint 1 Elbow-joint 1 Tendon of right arm 1 Ankle-joint and Skin 1 Hip and Spine 1 General 1 General 1 17 JQ 17 TABLE 13. DEATHS FROM MEASLES. Antrobus Road ... 5 Osborne Road ... 1 Bollo Bridge Road 4 Meon Road 1 Hanbury Road 3 Ramsay Road ... 1 St. Margaret's Terrace 3 Strafford Road ... 1 Palmerston Road 3 Pretoria Terrace 1 Rothschild Road 3 Bollo Lane 1 Park Road North 2 Seymour Road ... 1 Colville Road 2 Shakespeare Road 1 Junction Road ... 2 Midland Terrace 1 Packington Road 2 Evelyn Road TABLE 14. INFANTS' CONSULTATIONS. Priory School. Palmerston Mission. Health Visitors' Attendances 100 100 Number of Children who attended ... 292 227 Number of Attendances made by Children 1777 1673 Children under 1 year of age 131 133 Children over 1 year of age 161 94 Ages of Children who commenced attendance in 1917:— Priory School. Palmerston Mission. Under 3 months 90 62 Between 3 and 6 months 22 23 „ 6 and 9 months 13 25 „ 9 and 12 months ... 6 23 ,, 1 and 2 years 16 18 „ 2 and 3 years 13 16 „ 3 and 4 years 14 10 ,, 4 and 5 years 4 7 Of tne above Children :— 1 had attended for the first time in 1912. 9 „ „ , 1913. 15 „ 1914. •24 „ „ 1915. 108 1916. 362 „ „ 1917. 1 PI 7 18 The attendances which these children made were as follows :— Date at which they first attended. 1912 1913 1914 1915 1916 1917 1 occasion — 7 4 4 23 83 9. occasions — 1 5 3 8 48 3 — — 1 8 7 39 4 — — . — 2 5 40 5 1 — 1 — 8 21 6 — 1 — 1 12 18 7 —- — 1 1 4 14 8 — — — 1 1 12 9 — — 1 2 6 10 » — — 2 1 2 13 11 —> — — —- 1 9 12 — — — 1 3 6 13 — — — — 3 8 14 ft — — — — 2 3 15 — —; 1 — — 5 i« — — — — 3 6 17 — — — — 2 3 18 — — — 1 3 19 — — — — 2 2 20 — — — — 2 1 21 „ — — — 1 1 — 22 — — — — 4 6 23 ,, — — — — 1 1 24 — — — — 2 5 25 — — — - — 2 26 r — — — — 1 — 27 S — — — — 1 — 28 — — — — 2 1 30 — — — — — 2 31 1 32 — — — — 1 1 34 — — — — 1 l 35 — — — 1 — 36 — — — — 1 1 40 — — — — 1 1 Expectant Mothers. Number of Mothers visited 122 Number of Visits 406 Number attended Ante-natal Clinic 26 Number of visits to Clinic 51 Infants Clinic. Number of Infants attended 45 Total number attended Clinic 78 1 9 1-7 19 TABLE 13. ISOLATION HOSPITAL. Remaining in Hospital. January 1st, 1917 26 „ ,, 1st. 1918 23 Admitted during Year Civilian 176 Military 49 Discharged during Year ... 215 Deaths IS Diseases Treated, &c. Residents. Non-residents. Scarlet Fever 26 31 Diphtheria 54 60 Measles 5 37 Other Cases 1 11 TABLE 16. INQUESTS. Held in the District 43 Cause of Death. Heart Disease 6 Accidental fall from a balcony 1 Pneumonia 5 Injury at birth 1 Run over by a motor vehicle 4 Homicide 1 Want of proper attention at birth 4 Suicide 1 Burns 2 Overlying 1 Aortic Aneurism 2 Accidentally drowned 1 Accidentally kicked 2 Pthisis . 1 Bronchitis and Pleurisy 2 Ptomaine Poisoning 1 Scalds 1 Congenital Debility 1 Fall of shell on foot 1 Epilepsy 1 Fractured skull 1 Cerebro Spinal Fever 1 Fall out of a box 1 Disease of I.iver 1 Inquests on- those who Died outside the District, 10. Cause of Death. Fractured Skull 5 Run over by a motor car 1 Found Drowned 1 Fall from a canal boat 1 Crushed by machinery 1 Empyema 1 20 bacteriological laboratory. 563 Swabs from the Throat and Nose were examined :- 112 were positive and 451 were negative. The specimens were from— Doctors private patients 125 Hospital cases 356 School contacts 27 School Sore Throats 43 Convalescent cases prior to school attendance 12