ACT 24 1921 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1921. Municipal Offices, Acton, W.3. April, 1922. To the Mayor, Aldermen and Councillors of the Borough of Acton. Ladies and Gentlemen, 1 beg to submit the Annual Report on the work carried out by the Public Health Department, together with the Vital Statistics for the year 1921. The arrangement of the report differs in some respects from that of previous years. Circular 269 issued by the Ministry of Health indicated that Annual Reports of a full and detailed character known as "survey reports" will normally be required at intervals of not more than five years. The reports of 1919 and 1920 are considered to have been "survey reports." In other years, Annual Reports of a more simple nature are permissible and certain information may be omitted. For instance details as to conditions which do not vary from year to year may be omitted in the ordinary Annual Report. Paragraph 5 of the Circular and the Appendix set-forth the minimum requirements which are necessary, and this report as far as possible conforms with those requirements. Population.—The population of the district is estimated by the Registrar General at 62,000. At the Census, the actual number in the district was 61,314, but there is reason to believe that in some districts the actual enumeration did not represent the whole of the population. The Census of 1921, originally planned for the 24th; 70498 1921 4 April, was unavoidably postponed until the 19th June, and it is now clear that while the latter date avoided the recognised programme of industrial holidays, some holiday movement was, largely owing to the abnormally fine weather, already then in progress. This is reflected in the Census returns by the inclusion, in the case of the more popular holiday areas, of varying and sometimes substantial proportions of visitors. The use of local population figures which depart materially from the figures of normal resident populations would, of course, be unsuitable in connection with statistics of births and deaths classified according to area of residence, and it has been deemed necessary to make an adjustment for these purposes by measuring the extent of the non-resident population in certain areas and by effecting its re-distribution throughout the country. Such an adjustment has accordingly been made by means of the best data available in the preparation of the estimated mid-yearly population for 1921. In most areas the effect of the adjustment has been almost negligible, but it is on account of the adjustment that there is a difference between the Census population and the estimated population in the middle of the year. The following table gives the population at each Census since 1861 together with the increase ratio in each intercensal period. Population. Increase Ratio. 1861 3,151 — 1871 8,306 163 1881 17,110 106 1891 24,207 42 1901 37,744 56 1911 57,523 52 1921 61,314 7 The increase ratio of the more populous districts in Middlesex in the intercensal period 1911-1921 was as follows:— Wood Green 3 Edmonton 3 Hornsey 4 Tottenham 7 Willesden 7 Acton 7 Enfield 8 Heston and Isleworth 8 Ealing 11 Finchley 19 Hendon 44 The population of the district was lower at the Census than it was in the years 1917,1918 and 1919. The number of ration books issued in November 1919 was 62,237, and based upon this issued 1921 5 the Registrar General estimated the total population in June 1919 at 64,236. During the war, large munition factories were established in and near the district and a large influx of population into the district occurred. The closure of the munition works and the cessation of war work accounted for the decrease which occurred in the population between 1919 and 1921. The Registrar General has as yet only published the preliminary report which includes only the tables of the total population in administrative and parliamentary areas, but some detailed information is now available at the Census Office, and the following tables have been obtained for different purposes. ECCLESIASTICAL PARISHES. Males. Females. Total. St. Mary 6,309 7,597 13,906 St. Dunstans, East Acton 2,879 3,219 6,098 St. Peters, Acton Green 3,987 4,425 8,412 St. Thomas, Acton Vale 1,186 1,262 2,448 All Saints, South Acton 5,945 6,463 12,408 Part of St. Alban The Martyr, Acton Green 4,179 4,693 8,872 „ „ St. Martin, West Acton 1,164 1,866 3,030 „ „ St. Michael and All Angels, Bedford Park 883 1,423 2,306 „ „ St. James, Gunnersbury 294 338 632 „ „ St. Saviours, Hammersmith 1,217 1,367 2,584 „ „ All Souls, Harlesden 302 316 618 28,345 32,969 61,314 WARD POPULATION. Males. Females. Total. North-East 7,682 8,679 16,361 North-West 5,375 6,949 12,324 South-East 6,909 8,190 15,099 South-West 8,379 9,151 17,530 28,345 32,969 61,314 VITAL STATISTICS. Population 62,000 Births 1,314 Birth-Rate 21.1 per 1,000 inhabitants. Deaths registered in the District 453 Transferable Deaths:— Non-residents registered in the District 8 Residents registered in outisde Districts 205 Nett deaths belonging to district 650 Death Rate 10.5 per 1000 inhabitants. Deaths under 1 year of age 92 Infantile Mortality 70 per 1000 births. 1921 6 Deaths from:— Enteric Fever 1 Scarlet Fever 1 Diphtheria 16 Whooping Cough 4 Pulmonary Tuberculosis 50 Other forms of Tuberculosis 8 Births—The total number of births belonging to the district was 1314, 666 males and 648 females. These numbers are those registered during the calendar year and are corrected for inward and outward transfers; they differ from uncorrected figures compiled locally either for the calendar year or for a period of 52 or 53 weeks. Of the total births, 50 were born out of wedlock, 18 males and 32 females. These figures are supplied by the Registrar General, and do not include sufficient data to enable me to allocate the births into wards. The figures in table 2, are compiled from the returns under the Notification of Births Act, and the returns received from the local Registrar of Births and Deaths. The birth-rate for the year was 21.2 per 1,000 of the population. The birth-rate is .2 per 1,000 lower than that of England and Wales, 1.1 per 1.000 lower than that of the 96 Great Towns, and .1 per 1,000 lower than that of London. The birth rate of Acton was 2.6 per 1,000 lower than that of 1920. In last year's report it was remarked that there had been a substantial recovery in the birth-rate throughout the kingdom, but that this was probably only a temporary phenomenon. The birth-rate of 1921 is probably a more normal one and shows a marked decline compared with the pre-war birth-rates. There was again a reduction in the illegitimate birth-rate— 38 per 1,000 births, compared with 39 in 1920, 58 in 1919 and 57 in 1918. Deaths—Six hundred and fifty deaths were registered— 275 males and 375 females; of these 445 occurred in the district and 205 outside. The death-rate—10.4 was slightly lower than that of 1920 and exactly the same as that of 1919. The death-rate for England and Wales was 12.1 per 1,000, for the 96 Great Towns 12.3, and for London 12.4. 1921 7 The infantile mortality was 70 per 1,000 births—a rate higher than that of 1920. There was a slight decrease in the number of deaths from diphtheria, but the number—16—is still considerably higher than it has been since the commencement of the war. There was one death from Scarlet Fever; this was the first death from the disease in the district since 1915. There was an extensive outbreak of Scarlet Fever, particularly in the autumn. There was no death from Measles, and the district was almost entirely free from the disease. Amount of Poor Law Relief—I am indebted to Mr. Harmsworth, the Clerk to the Guardians, for the figures relating to PoorLaw Relief. The amount of out-door relief given by the Guardians for the Parish of Acton was:— Ordinary Relief, £5,061 15s. 11½d. Relief to Unemployed, £15,019 5s. 6d. The effect of unemployment upon the Council's Milk Scheme and the Guardians' assistance in the latter part of the year will be referred to in the section upon Milk Distribution. Infantile Mortality—Ninety-two deaths occurred in children under one year of age. This number corresponds to an infantile mortality of 70 per 1,000 births.' The ward distribution and the and incidence of the deaths, and the infantile mortality in England and Wales and the 96 great towns are given in the Tables at the end of the report. The infantile mortality was 6 per 1,000 births higher than that of 1920, and this enhanced rate was entirely due to the increased number of deaths from Summer Diarrhoea. Summer Diarrhoea—Twenty-nine deaths occurred from Summer Diarrhoea in children under two years of age. This is a higher figure than that of recent years. Prior to 1921, the last very dry hot summer was that of 1911. In that year 89 deaths occurred from diarrhoea in children under two years of age. For the years 1897,1898 and 1899, the Infantile Mortality in Acton was 198, 182 and 187 per 1,000 births respectively, and the number of deaths from Diarrhoeal diseases in these years was very high. In 1911 a great improvement had taken place and it is interesting to compare the conditions which obtained in 1911 and 1921. The 1921 8 following table gives the mean maximum temperature and the infantile deaths in the two years:— Weeks ending. Mean Max. Temp. Rainfall (inches.) Deaths from Diarrhoea in Acton. 1911. 1921. 1911. 1921. 1911. 1921. July 9th 65.0 78.1 Nil .3 Nil Nil „ 10th 65.2 85. Nil Nil 1 Nil „ 23rd 69.5 80. Nil .2 1 Nil „ 30th 71. 79.1 .26 .1 3 Nil Aug. 6th 68. 75. .06 .5 6 2 „ 13th 72.5 75.4 Nil .4 4 5 „ 20th 69.4 75.7 .58 .9 14 Nil „ 27th 63.9 72.3 .29 .1 14 Nil Sept. 3rd 65.3 73.1 .41 Nil 11 2 „ 10th 66.9 71.0 .01 .01 10 1 „ 17th 60.3 59.1 .41 1.81 6 Nil „ 24th 54.3 60.8 .48 .00 2 1 In London, a slight increase in the mortality rate amongst children under two was noted in the first week in July, and this steadily increased until the first week in September, when it reached 198 per 1,000 births. In Acton, we had no deaths from Summer Diarrhoea in July, and the number of fatal cases was very few, compared with the number which formerly occurred in hot summers. In recent years, it is customary to state that it is unfair to compare the infantile mortality with that of former years, as we have experienced a series of cold wet summers. But the comparson with 1911 is a perfectly fair one. The summer of 1921 was a particularly favourable one for the development of Summer Diarrhoea. As long ago as 1887, Ballard drew attention to the apparent connection between the 4 ft. earth temperature and the incidence of Epidemic Diarrhoea. He gave 56° F. as the critical index which seems to mark some climax in those conditions which bear on the aetiology of Summer Diarrhoea. In 1921, the temperature of the earth 4 feet below the surface reached 56°' F. on July 8th; each week following the earth temperature rose, and in the last week in July it exceeded 59°. F. The mean temperature was maintained above 59° F. throughout August and the early part of September, and did not fall below 56° F. until October. No one has yet explained what are the changed circumstances which initiate an epidemic enteritis. Whether Summer 1921 9 Diarrhoea is produced by one definite micro-organism, or is an illness conditioned by several allied bacilli, is doubtful. Of the nature of the infecting organism we are ignorant; doubt is expressed if there is any one specific germ. So many different micro-organisms have been ascribed as the cause of the disease that we must either believe in them all as a cause, or else discredit all of them. In rare epidemics the primary cause of infection may be the Shiga, Flexner, Morgan or Welch bacillus, but the usual and commonest bacterial cause is probably the abnormal activity of the normal denizens of the bowels. These latter organisms avail themselves of an exaltation of virulence and are able to pass the usual barriers and to pour their poison into the blood. From a preventive point of view, it is of importance to emphasise the fact that there are two factors in the production of Summer Diarrhoea, viz:— (a) Food injury. (b) Bacteria. Infection never comes out of a clear sky, and previous digestive disorders invariably pave the way for the invasion. The success achieved in the prevention of summer diarrhoea is due not to any special measures taken during the hot months of the year, but to the general preventive work throughout the year. Milk (Mothers and Children Order), 1919—During the financial year, 7921 packets of Dried Milk were issued free, and 2,030 packets under the arrangement which the Council made with the Guardians. At the beginning of the financial year, the Council estimated that the cost of the distribution of free milk would amount to £850. By the exercise of great care, the Child Welfare Committee kept within the estimate until the beginning of August when the applications became more numerous, and the amount of milk distributed increased. The cause of the increase was soon apparent. Enquiries at the Local Labour Exchange elicitated the fact that there was no increase in the number of unemployed at that period and the cause lay elsewhere. In February, the Guardians instituted a scheme for outdoor relief to the Unemployed. This came to an end on August 2nd, resulting as far as this Council was concerned in a jump in the amount of free milk distributed. In September, the Guardians 1921 10 reconsidered their resolution and outdoor relief was again granted to the Unemployed. In order to co-ordinate the work of the Guardians with the Child Welfare Scheme of the Council, the Chairman of the Child Welfare Committee—Councillors Mrs. Barnes, and myself, met Mr. Greville Smith, the Chairman of the Guardians, and Mr. Deely, to discuss the question. As a result, the following recommendations were made by the Guardians:— "At that time relief was granted at the rate of 5s. for each child. Half of this was given in money and half in kind. The relief in kind for children under three years of age must be taken in the form of dried milk. The dried milk will be distributed by the Council at a price which involved a loss of 2d. per packet to the Council." This scheme was approved by the Ministry of Health, and since September the scheme has been in operation and has worked most satisfactorily. Day Nursery—Year ended December 31st, 1921. Number of days the nursery was opened 214 Average daily attendance 24 Total number of children on books 381 Highest number of attendances—April 42 Lowest „ „ —August 155 Total number of attendances 5,348 Financial Statement tor Year ended March 31st, 1922 Total cost £848 14s. 7d. Total number of attendances 5,042 Cost per child per day 3s. 4d½. Receipts. £ s. d. Admission Fees 1.81 14 2½ Mothercraft Lessons 61 15 0 Infectious Diseases—At the end of the report, tables are given which show the distribution and incidence of Infectious Disease in the district. There was a great increase in the number of Scarlet Fever notifications, but the disease was of a very mild character, and only one death occurred. Diphtheria—There has been an increase in the number of notifications of Diphtheria, but it is doubtful if the disease was more prevalent than in 1920. Two hundred and five cases were notified compared with 141 in 1920, but the number of deaths was 10 compared with 18 in 1920. In a memorandum issued by the Ministry 1921 11 of Health, it is stated that the notification of cases of Diphtheria under the Infectious Diseases (Notification) Acts should be limited to persons actually suffering from Diphtheria, i.e., those exhibiting clinical signs of the disease, with or without bacteriological evidence of the presence of diphtheria bacilli. In the practice of some districts and of many medical practitioners, including, often, the medical officers of hospitals and residential schools, notification is frequently extended to include diphtheria carriers who themselves present no signs of illness. It is doubtful if this practice is justifiable. Statistically, it leads to much confusion ; indeed, comparisons between diphtheria notification rates in different areas and in different parts of the country have for some years been rendered very unreliable by reason of uncertainty in this respect. Administratively, the effect may be equally unsatisfactory. The healthy carrier, as a result of his notification as a victim of diphtheria is removed to hospital where he may stay to the exclusion of persons urgently requiring treatment. The foregoing remarks were written by a very eminent epidemiologist, but in practice the problem is a much more difficult one. The cases are not limited to the well-marked, easily recognised, clinical types, and the healthy contact or carrier who exhibits none of the symptoms of the disease. It is obviously unnecessary for the medical attendant to swab all the inmates of an infected house, and notify all those who give positive results, and the doctors who follow this practice must be few and far between. Many authorities now swab as a routine the school contacts from an infected house, and the difficulty arises when a decision has to be made when a positive swab has been obtained. Some of the positive contacts have not exhibited any of the symptoms of the disease, but in others a previous history of sore throat can be obtained. It is not always easy to obtain a correct history and it is frequently difficult to decide to what extent must the symptoms develop before it is decided that the case is one of clinical diphtheria. You can have all gradations between the healthy carrier and the severe clinical case. I have seen cases admitted to the hospital with perfectly clean throats, and one is apt to assume that the cases have been sent in simply as a result of the bacteriological examination, but in rare cases these have developed paralysis of some groups of muscles. In this district the danger of over-notification is at present practically non-existent. I have frequently seen examples of the danger attaching to delay in treatment. Even in severe cases, the disease had existed for some days untreated, and almost invariably these were the ones that resulted in death. In others, 1921 12 although the disease had been treated sufficiently early to save life, the treatment did not prevent the occurrence of sequelae and complications. There is no doubt that Diphtheria, even when of a comparatively mild type, is a disease which requires unremitting care from doctors and nurses. In comparatively mild cases, patients have to be kept in bed for three or four weeks and a couple of months is not an unusual period in severe cases. Even then, the patients have to be watched carefully and sometimes put back to bed on account of some cardiac symptoms. In a district like ours, except in a minority of cases, this attention cannot be secured except by removal to hospital. One hundred and fifty nine cases out of the 205 were removed, and in most instances, the cases were nursed at home because the symptoms were extremely mild in character. ISOLATION HOSPITAL. During the year, 718 cases were admitted into the Hospital. This is considerably the highest number of cases that has been admitted in any one year. Prior to 1921, the highest number of cases removed to the hospital was in 1908, when 423 cases were admitted. On January 1st, 1921, there were 38 cases under treatment, and on January 1st, 1922, 102. During the year, 633 patients were discharged and there were 21 deaths. The pressure on the accommodation of the hospital was very marked in the autumn, especially during the latter part of September and October, but no case of diphtheria requiring removal to hospital was refused, and no delay occurred in the removal of diphtheria cases. For a short period there was a waiting list of Scarlet Fever cases, and in some instances a short delay occurred. But all urgent cases of Scarlet Fever, and all cases occurring in houses where the presence of a Scarlet Fever patient interfered with the occupation of the other inmates of the house were immediately removed to the Hospital. Of the 205 cases of diphtheria notified, 157 or 76 per cent, were removed to hospital, and of the 630 cases of Scarlet Fever notified 389 or 62 per cent. were Temoved to hospital. During the greater part of the year, the accommodation at the hospital permitted of the reception of cases from outside districts. The following table shows the distribution of the cases admitted:— Scarlet Fever. Diphtheria. Acton 389 157 Hanwell 76 30 13 1921 Wembley 36 30 Wealdstone — 1 501 218 There were 20 deaths from diphtheria and one death from Scarlet Fever. The average stay in hospital of the Scarlet Fever cases was 39½ days, and of diphtheria cases 32½ days. Tracheotomy was performed upon five patients and one of these died. BACTERIOLOGICAL LABORATORY. Examination of throat swabs for the Klebs Loeffler bacillus. Total examined 965 Negative 648 Positive 317 Sent by Medical Practitioners 285 Hospital cases 530 Contacts 164 Convalescent cases 45 School sore-throat cases 41 1921 14 Table I. BIRTH-RATE. DEATH-RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR, 1921. (Provisional figures. Population as enumerated in 1921 have been used for the purpose of this Table). The mortality rates refer to the whole population as regards England and Wales, but only to civilians as regards London and the groups of towns). Birth-rate per 1,000 total Population. Annual Death-Rate Per 1,000 Population. Rate per 1,000 Births. Percentage of Total Deaths. All Causes. Enteric Fever. Small Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria Influenza Violence. Diarrhæa. & Enteritis under 2yrs. Total deaths under 1 year. Deaths in Public Institutions. Certified Causes Inquest Causes. Uncertified Causes of Death. England and Wales 22.4 12.1 0.02 0.00 0.06 0.03 0.12 0.12 0.23 0.44 15.5 83 25.5 92.5 6.4 l.1 96 Great Towns, including London (1911 Census poplations exceeding 50,000) 23.3 12.3 0.01 0.00 0.08 0.04 0.13 0.15 0.23 0.40 19.3 87 33.2 92.5 6.8 0.7 148 Smaller Towns (1911 Census populations 20,000 to 50,000) 22.7 11 3 0.01 0.00 0.05 0.03 0.11 0.11 0.23 0.35 15.6 84 17.7 93.5 5.1 1.4 London 22.3 12.4 0.01 ... 0.05 0.06 0.12 0.25 0.23 0.42 21.3 80 49.2 91.6 8.2 0 2 Acton 21.2 10.4 0.01 0.00 0.0 0.11 0.06 0.26 0.2 0.15 22. 70 33.3 99.9 5 0.03 1921 15 TABLE 2. BIRTHS. Total Births. Males. Females. Total. Legitimate 648 616 1264 Illegitimate 18 32 50 666 648 1314 Notified Births in District. Males. Females. Still Births. 596 563 21 North East. North West. South East. South West. Total 310 166 235 448 1159 Registered in District, but not Notified. North East. North West. South East. South West. Total 28 9 26 3 66 1921 16 TABLE 3. CAUSES OF, AND AGES AT, DEATH DURING YEAR. 1921. Causes of Death. All Ages Under 1 year 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards North East North West South East South West Measles ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 4 ... 2 2 ... ... ... ... ... 2 ... ... 2 Scarlet Fever 1 ... ... ... 1 ... ... ... ... ... ... 1 ... Diphtheria 16 1 ... 8 6 1 ... ... ... 1 4 3 8 Enteric Fever 1 ... ... ... ... ... 1 ... ... ... ... ... 1 Influenza 11 ... ... ... ... 2 2 5 2 6 1 1 3 Phthisis (Pulmonary Tuberculosis) 59 ... ... ... ... 18 21 16 4 18 10 11 20 Tuberculous Meningitis 2 ... ... ... 1 1 ... ... ... ... 1 ... 1 Other Tuberculous Diseases 6 2 1 ... 2 ... ... 1 ... 1 ... 2 3 Cancer, Malignant Disease 70 ... ... ... ... ... 7 35 28 20 18 13 19 Rheumatic Fever 1 ... ... ... ... ... ... 1 ... ... 1 ... ... Meningitis 6 3 1 ... ... 1 1 ... ... 3 1 1 1 Organic Heart Disease 64 ... ... ... 2 3 9 26 24 15 16 16 17 Bronchitis 64 9 1 ... ... ... 7 13 34 7 19 14 24 Pneumonia (all forms) 49 12 4 2 l ... 6 13 10 11 5 13 20 Other Respiratory Diseases 1 ... ... ... ... ... 1 ... ... 1 ... ... ... Diarrhoea and Enteritis 29 24 4 1 ... ... ... ... ... 7 6 1 15 Appendicitis and Typhlitis 1 ... ... ... 1 ... ... ... ... ... ... ... 1 Cirrhosis of Liver 5 ... ... ... ... ... 1 4 ... 4 ... 1 Alcoholism 2 ... ... ... ... ... ... 2 ... ... ... 2 ... Nephritis and Bright's Disease 13 ... ... 1 ... ... 1 4 7 5 4 3 1 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 1 ... 1 ... ... ... ... ... ... 1 ... ... ... Other Accidents and Diseases of Pregnancy and Parturition 3 ... ... ... ... ... 3 ... ... ... ... ... 3 Congenital Debility and Malformation, including Premature Birth 34 33 1 ... ... ... ... ... ... 10 6 5 13 Violent Deaths, excluding Suicide 9 1 ... l 2 1 1 1 2 1 1 2 5 Suicide 10 ... ... ... ... ... 4 6 ... 2 3 3 2 Other Defined Diseases 188 7 ... 2 4 ... 16 32 127 52 43 52 41 Totals 650 92 15 17 20 28 81 159 238 167 139 143 201 1921 17 TABLE 4. INFANTILE MORTALITY DURING THE YEAR, 1921. Deaths from stated causes in Weeks and Months under One Year of Age. Causes of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 1-3 months 3-6 months 6-9 months 9-12 months Total deaths under 1 year. Diphtheria ... ... ... ... ... ... ... ... 1 1 Measles ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... 1 ... 1 ... 2 Meningitis (not Tuberculous) ... ... ... ... ... ... 1 1 1 3 Convulsions ... ... 1 ... 1 ... ... ... ... 1 Bronchitis ... ... 1 ... 1 3 1 2 2 9 Pneumonia (All forms) ... 1 ... ... 1 2 3 3 3 12 Diarrhoea and Enteritis 1 2 1 ... 4 7 8 2 3 24 Congenital Syphillis ... ... ... ... ... ... ... ... ... ... Overlaying 1 ... ... ... 1 ... ... ... ... 1 Injury at Birth 3 ... ... ... 3 ... ... ... ... 3 Congenital Malformation 6 2 1 ... 9 ... 1 ... ... 10 Premature Birth 8 ... 1 2 11 4 ... ... ... 15 Atrophy,Debility and Marasmus 4 ... ... ... 4 1 1 ... 1 7 Other Causes ... ... 1 1 2 2 ... ... ... 4 Totals 23 5 6 3 37 20 15 9 11 92 TABLE 5. INFANTILE MORTALITY—WARD DISTRIBUTION, 1921. Causes of Death. North East. North West. South East. South West. Total. Diphtheria ... ... 1 ... 1 Measles ... ... ... ... ... Whooping Cough ... ... ... ... ... Other Tuberculous Diseases ... ... 1 1 2 Meningitis (not Tuberculous) 2 1 ... ... 3 Convulsions ... ... 1 ... 1 Bronchitis 1 2 ... 6 9 Pneumonia (all forms) 2 ... 2 8 12 Diarrhoea and Enteritis 6 5 1 12 24 Congenital Syphillis ... ... ... ... ... Overlaying ... ... ... 1 1 Injury at Birth ... 1 1 1 3 Congenital Malformations 1 1 2 6 10 Premature Birth 5 2 3 5 15 Atrophy, Debility and Marasmus 2 2 1 2 7 Other Causes 1 1 1 1 4 Total 20 15 14 43 92 1921 18 TABLE 6. CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR, 1921. Notifiable Disease. Cases notified in whole District. At Ages—Years. Total cases notified in each ward. At all Ages. Under 1. 1 to 5. 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards North-East. North-West South-East. South-West Scarlet Fever 630 ... 95 451 55 27 2 ... 186 119 117 208 Diphtheria 205 2 58 113 16 13 3 ... 40 37 31 97 Pneumonia 13 2 ... 1 3 4 2 1 3 3 3 4 Enteric Fever 1 ... ... ... ... 1 ... ... ... ... ... 1 Puerperal Fever 1 ... ... ... ... 1 ... ... ... ... ... 1 Encephalitis Lethargica 1 ... ... ... ... 1 ... ... 1 ... ... ... Ophthalmia Neonatorum 2 2 ... ... ... ... ... ... 1 ... ... 1 Erysipelas 18 ... ... 5 2 3 5 3 3 5 3 7 Tuberculosis, Pulmonary 96 ... 1 5 26 49 12 3 21 13 23 39 Tuberculosis, (Other Forms) 13 1 ... 5 1 6 ... ... 6 1 2 4 Total 980 7 154 580 103 105 24 7 261 178 179 362 1921 19 TABLE 7. CASES REMOVED TO HOSPITAL, 1921. N. East. N. West. S. East. S. West. Total. Scarlet Fever 100 81 68 142 391 Diphtheria 30 19 23 87 159 Enteric Fever - - - 1 1 Pneumonia 1 - - - 1 Puerperal Fever - - - 1 1 Encephalitis Lethargica 1 - - - 1 Erysipelas - - 1 - 1 Tuberculosis (pulmonary 11 8 13 35 67 Tuberculosis (other) 5 1 3 - 9 148 109 108 266 631 INFANT WELFARE CENTRES—1921. TABLE 8. Priory Schools. Palmerston Mission Health Visitors Attendances 99 99 Number of Children who attended 686 667 Number of attendances by children 4,798 4,704 Children under 1 year of age 342 396 Children over 1 year of age 344 271 Age of Children who commenced attendance in 1921:— Priory Schools. Palmerston Mission. Under 3 months 210 1S1 Between 3 and 6 months 75 46 „ 6 and 9 months 34 20 „ 9 and 12 months 17 12 ,, 1 and 2 years 22 29 „ 2 and 3 years 13 25 „ 3 and 4 years 11 8 „ 4 and 5 years 4 10 Of the above Children 18 had attended for the first time in 1916. 36 1917. 70 1918. 178 1919. 383 1920. 668 1921. ANTE-NATAL CLINIC. Number of times the Clinic was held 24 Number of expectant mothers who attended 66 Number of attendances made by expectant mothers 123 Number of cases admitted to Acton Hospital 3 Ante-Natal Visits. Number of mothers visited 204 Number of visits paid to mothers 516 1921 20 TABLE 9. STAFF TO WHOSE SALARY CONTRIBUTION IS MADE UNDER THE PUBLIC HEALTH ACTS OR BY EXCHEQUER GRANTS. D.J. Thomas. m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health. (Medical Superintendent of the Isolation Hospital and School Medical Officer.) M.W. Kinch. Member of the Royal Sanitary Institute, holds Meat Certificate; Senior Sanitary Inspector. (Inspector under Diseases of Animals Acts, and the Rag Flock Act.) J.J. Jenkins. Cert. Sanitary Institute. Holds Meat Certificate. Sanitary Inspector. (Inspector under Fabrics Misdescription Act.) E.W. Brooks. Cert. San. Inst. Sanitary Inspector. E.F. Eldred. Cert. San. Inst. Holds Meat Certificate. Sanitary Inspector. Miss A. Cooksey Cert. San. Inst. Health Visitor. Miss J. Welsh. Cert. San. Inst. C.M.B. Health Visitor. Mrs. Light. Clerk. TABLE 10. Houses erected during year 1921. Total 125 Under Housing Scheme 118 TABULAR STATEMENT OF INSPECTIONS AND DETAIL OF WORK CARRIED OUT BY THE SANITARY INSPECTORS. Number and nature of Inspections made. House to house inspections 358 After infectious disease 867 On complaint, &c. 711 Premises under periodical inspection 597 Re-inspections after notice served 7609 Classified statement of the number of Premises under periodical inspection. Workshops 224 Slaughterhouses 3 Public house urinals 37 Common lodging houses 1 Houses let in lodgings 103 Butchers' Shops 31 Fish Shops 24 Premises where food is manufactured 38 Milk Purveyors 90 Cowsheds 2 Piggeries 5 1921 21 Rag and Bone dealers 4 Mews and Stables 22 Schools 11 Show Grounds 2 Number of Notices served. Statutory 802 Preliminary intimations 647 Houses dealt with under Section 28, Housing Acts. Houses in respect of which notices were served 358 Rendered fit by owners 343 Rendered fit by local authority 15 Premises dealt with under Public Health Acts. Premises in respect of which notices were served 1091 Premises in which defects were remedied by owners 1077 Premises in which defects were remedied by Local Authority14 Detail of work carried out. Sanitary dustbins provided 763 Yards paved or yard paving repaired 332 Insanitary forecourts remedied 211 Defective drains repaired or reconstructed 78 Defective soil pipes and ventilating shafts repaired or renewed 62 Defective fresh air inlets repaired or renewed 60 Defective gullies removed and replaced by new 43 Rain water downpipes disconnected from drain 27 Dishing and curb to gullies repaired and new gratings fixed 186 Defective W.C. pans and traps removed and replaced by new 37 Defective W.C. flushing apparatus repaired or new fixed 242 Defective W.C. seats repaired or new fixed 234 Defective flush pipe connections repaired 59 Insanitary sinks removed or new fixed 06 Sink waste pipes repaired or trapped 326 Insanitary wall surface over sinks remedied 146 Ventilated food cupboards provided 197 Drinking water cisterns cleansed 171 Defective covers to drinking water cisterns repaired or new fixed 79 Insanitary sites beneath floors concreted 21 Spaces beneath floors ventilated 345 Dampness in walls from defective damp-proof course remedied 364 Dampness from defective roofs, rain water gutterings, &c., remedied 905 Defective plastering repaired (number of rooms) 885 Rooms where dirty walls and ceilings have been cleansed and redecorated 3638 Defective floors repaired 379 Defective or dangerous stairs repaired 56 1921 22 Defective doors and windows repaired 455 Defective kitchen ranges and tire grates repaired 345 Defective washing coppers repaired 198 Coal cupboards provided 40 New W.C. apartments provided 4 Accumulations of offensive matter removed 23 Drains unstopped and cleansed 122 Overcrowding nuisances abated 11 Drains tested, exposed for examination, &c. 98 Smoke observations taken 37 Smoke nuisances abated 20 Nuisances from foul pigs and other animals abated 20 Notifications of waste of water sent to Metropolitan Water Board 174 I am, Ladies and Gentlemen, Your obedient Servant, D.J. THOMAS. Woodgates & Sons, (T.U.), Printers, South Acton. 1921