ACT 25 1922 Borough of Acton. HEALTH REPORT of the Medical Officer of Health FOR THE YEAR 1922. 1922 ANNUAL REPORT of the j medical officer of health FOR THE YEAR 1922. Municipal Offices, Acton, W.3. May, 1923. To the Mayor, Aldermen and Councillors of the Borough of Acton. Ladies and Gentlemen, I beg to submit the Annual Report on the work carried out by the Public Health Department, together with the Vital Statistics for the year 1922. The report is arranged in accordance with the suggestions issued last year by the Ministry of Health, and as far as possible, in the form of Tables. As "Survey Reports" are only normally required every five years, certain information which was included in former reports is omitted. Population.—The Registrar-General estimates the population at the end of June, 1922, to be 62,390. In last year's report the procedure adopted in adjusting the local census populations of 1921, in order to arrive at estimates of resident populations was described. The estimated population as at June 30th, 1922, has been based on the adjusted 1921 figures after allowance for the varying rates of natural increase as evidenced by the births and deaths in the area and of migration as indicated in the numbers on the Parliamentary Register and the migration returns obtained by the Board of Trade. The number of Parliamentary electors on the Register in the Autumn of 1922 was as follows: men women total 16,477 13,948 30,425 1922 4 For the corresponding period of 1921, the numbers were: men women total 16,529 13,821 30,350 For the twelve months ending December 31st, 1922, 122 new houses were erected, 112 by the Council and 10 by private persons. Births.—Table 2 gives particulars of the births registered and notified in the district, and the births registered outside the district. The Ward distribution of all the births is not given, as the home addresses of all the mothers who have given birth to a child outside the district are not given. The addresses of the births notified and registered within the district are obtained and of most of the outside births, but the inward transfers of the Registrar-General include some births whose addresses have not been supplied to the local sanitary authority; this latter number only totals 35 and does not materially affect the birth-rates of the respective Wards. The total number of births belonging to the district was 1,203. This number corresponds to an annual rate of 19.3 per 1,000 inhabitants. The birth-rate of Acton is lower than that of England and Wales, of London and of the 106 Great Towns. The birth-rate is 1.8 per 1,000 lower than that of 1921, and considerably lower than that of 1920. With the exception of the years 1917, 1918 and 1919, it is the lowest birth-rate recorded for the district. Approximately, the birth-rate for each Ward was as follows: n. east n. west s. east s. west 19.6 13.4 14.5 25.7 Forty-one children were born out of wedlock: this number corresponds to an illegitimate birth-rate of 34 per 1,000 births. This is the lowest illegitimate birth-rate since 1911. Although during the years of the war, the illegitimate birth-rate increased, it would be unfair to assume that the phenomenon was entirely due to the war. For two or three years prior to the outbreak of war, there had been an increased rate in this district. In the last three years there has been a very marked decrease in the illegitimate birth-rate, but it is still considerably higher than it was 12 and 15 years ago, as the following Table will show: 5 Illegitimate Birth-rate per 1,000 Births. 1907 24 1915 63 1908 26.8 1916 49 1909 19.2 1917 61 1910 24 1918 54 1911 29 1919 56 1912 47 1920 39 1913 50 1921 40 1914 50 1922 34 Compared with ten years ago, there is a considerable falling off not only in the birth-rate but also in the actual number of births. The year 1912 is taken as an average year with an interval of ten years, though in 1912 there was not only a diminished birth-rate, but there were less births registered in the district than in the immediately preceeding years. The birth-rate in 1922 was 19.3 compared with 25.7 in 1912 —a decrease of 25 per cent. The number of births registered in 1922 was 1,203, compared with 1,517 in 1912—a decrease of 21 per cent. The decrease was not uniform throughout the district. For instance the figures for the four Wards were as follows: n. east n. west s. east s. west Decreased number Same 22% 42% 20% Decreased rate 10% 30% 40% 22% Deaths.—Four hundred and four deaths were registered in the district; of these 14 belonged to non-residents. Two hundred and fourteen deaths of residents occurred outside the district. The total number of deaths belonging to the district is 632. The nett number of deaths corresponds to a death-rate of 10.1 per 1,000 inhabitants, which is the lowest recorded death-rate for the district. On Table 1 will be found the death-rates for England and Wales, Etc., and it will be seen that the death-rate of the district is lower than that of England and Wales, the 106 Great Towns, the 155 Smaller Towns and of London. Compared with 1921, there is a fairly uniform decrease in deaths from most diseases. The most notable exceptions are the deaths from Cancer and Organic Heart Disease. Seventy-two deaths occurred from Cancer, compared with 70 in 1921 and 57 in 1920. Allowing for the more accurate diagnosis of to-day, there is no reasonable doubt as to Cancer being on the increase. 1922 6 Age periods are not equally affected. It is definitely an adult disease. In this district 66 out of the 72 deaths were in persons over 45 years of age. One death out of every six which occurred in persons over 45 years of age was due to Cancer. As a rule women are more subject to Cancer than men, owing to the special organs of the former that are liable to attack. In this district, last year, the difference was very slight, and not as much as could be accounted for by the sex distribution of the population. Thirty-five of the deaths were in males and 36 ip females. Some local authorities have issued pamphlets, dealing with preventive measures, and pointing out the value of early operative treatment, but the value of such advice is doubtful. Our knowledge of the disease is not sufficiently definite to enable us to give any precise advice. We have numerous applications to disinfect after a death from Cancer, but the disease may or may not be contagious. Cancer houses and Cancer districts are reported from time to time, but the reports do not bear much investigation. Possibly, the tendency to Cancer may be hereditary, but there is no evidence that the disease itself is hereditary. Some of the quack remedies are based on the assumption that Cancer is a deficiency disease. The so-called Katassium remedy is vaunted because it is assumed that there is an absence or scarcity of potassium salt in the diet. But there is no definite evidence that Cancer is a deficiency disease, much less do we know wherein lies the deficiency. If anything definite were known of the nature and causes of the disease, the public should know officially, but until our knowledge has advanced the use of pamphlets is doubtful. Organic Heart Disease.—There is a slight increase in the number of deaths attributed to Organic Heart Disease, but the increase is probably due to a more definite system of certification and possibly as a result of a more correct diagnosis. Formerly many deaths were certified as due to syncope and similar terms were frequently used, but the importance of myocardial and other degenerations of the heart is recognised and more deaths are included under the term Organic Heart Disease. There is another diminution in the number of deaths from Tubercular diseases. During the war, not only the incidence of Tubercular disease increased, but there was a marked increase in the number of deaths from these diseases. For the last two or three years the number of deaths has decreased, but we have not yet arrived at the pre-war figures. 1922 7 Certified Causes of Death.—From Table 1 it will be seen that there were no uncertified causes of death. One hundred per cent. of the deaths were certified by a doctor and on 45 persons an inquest was held. The laws of this country make it illegal for a person to be buried unless an order for burial can be produced either from the registrar of deaths or from a coroner. The registrar gives the order on receiving a certificate as to the cause of death from a registered medical practitioner. If such certificate is not forthcoming, he may, on his own responsibility register the death as uncertified and give the order for burial, or he may report the circumstances to the coroner, who either sends a notification to the registrar that the death may be registered and the burial order given, or he may hold an inquiry as to the cause of death, summoning a jury to assist him. Forty-five inquests were held here during the year, and more than half the deaths on which an inquest was held were due to natural causes. Although the select and departmental committees have reported on Death Registration and Certification, nothing has been done to amend the law or the procedure. In 1909 a departmental committee reported that the present law of death certification offered every opportunity for premature burial and every facility for the concealment of crime, yet no steps have yet been taken to remedy this unsatisfactory state of affairs. The procedure of a coroner's court has been described with some truth as mediaeval and as producing waste and undue publicity of the affairs of a family at a time of considerable distress. The Bill now before Parliament entitled "Coroners' Law and Death Certification Amendment," is not regarded as a solution of the problem, but it may prepare the ground for further action in the future. Amount of Poor Law Relief.—I am indebted to Mr. Harmsworth the Clerk to the Guardians, for the figures relating to Poor Law Relief. The amount of out-door relief given by the Guardians for the Parish of Acton was: £ s. d. Ordinary Relief 5,833 10 3½ Unemployment Relief 11,729 17 11 Total £17,563 8 2½ 1922 8 Infantile Mortality.—Seventy-five deaths occurred in children under one year of age. This number corresponds to an infantile mortality of 62 per 1,000 births. On Table 1 will be found the Infantile Mortalities for England. and Wales and the large Towns, and it will be seen on reference to that Table that the Infantile Mortality of Acton, is lower than that of England and Wales and than that of the 105 Great Towns with a population of over 50,000 inhabitants. It is also the lowest Infantile Mortality on record for the district. A reference to the Table giving the causes of death in weeks and months under one year of age will show how difficult it is to make much further reduction in the Infantile Mortality. Thirtynine of the deaths occurred in babies under one month old. Eighteen of the 75 deaths were due to Premature Birth, 11 to Congenital Malformation, 2 to Injury at Birth and 7 to Atrophy and Debility, in most cases Congenital Debility. Milk (Mothers and Children Order), 1919.—The scheme adopted by the Council, whereby milk is distributed by the Council in co-operation with the Guardians, was explained in last year's report. Six thousand, four hundred and fifty-five packets of dried milk were distributed through the Relieving Officers, and 516 packets were distributed to expectant mothers and in exceptional instances where the recipients would not be eligible for Poor Law Relief. The number of packets distributed weekly through the Guardians varied from 199 in the week ending April 15th to 53 in the week ending December 30th. The number of packets given free varied from 19 in each of the weeks ending January 14th and 21st to four in each of the weeks ending April 1st, 8th, 15th and December 30th. Infectious Diseases.—Table 5 gives the notifications of Infectious Diseases for the year. There is a considerable reduction in the number of notifications received, and a decrease in the number of deaths from Diphtheria, but an increase in the deaths from Scarlet Fever. Scarlet Fever.—Three hundred and five notifications were received and 3 deaths occurred from the disease. These figures do not represent the true case fatality of the disease. The deaths occurred in the early part of the year, and were partly a legacy of the notifications received from the last quarter of 1921. It will be recollected that incidence of Scarlet Fever increased in 9 1922 the Autumn of 1921, and. an extensive epidemic occurred in London and Greater London. The epidemic continued during the early part of 1922 and gradually subsided in the Summer. In 1921, 630 cases were notified and 1 death occurred. In the two years 935 cases were notified with 4 deaths—a case fatality of .42 per cent. In other words 1 death occurred in every 234 cases. It will be seen from these figures that the type of disease has become a very mild one. Diphtheria.—Two hundred and twenty-three cases were notified and 12 deaths occurred. The case fatality was 5.3 per cent. The case fatality of Acton patients admitted to the Fever Hospital was the same—5.3 per cent., and the fatality of all Diphtheria cases admitted to our Hospital was 5.5 per cent. This is a remarkably low mortality and several factors have contributed to this result. Foremost, probably, in the list of causes is the early and sufficient use of Antitoxin. In pre-antitoxin days, Diphtheria was one of the most terrible and formidable of diseases, with a case fatality of 25 to 30 per cent. The curative use of Antitoxin has robbed the disease of much of its terror. The preventive use of Antitoxin has not been extensively used in this country. In America the Schick test has been used extensively, and toxin—antitoxin immunisation carried out, especially amongst school children. It is doubtful if the test is practicable as a universal method of immunisation; but its use opens up a vast field in the prevention of Diphtheria. It would not be fair to claim that the reduction in the case fatality is entirely due to the administration of Antitoxin. The improved technique in the bacteriological examination of Diphtheria, the increased facilities for such examination, and the appreciation by doctors of the existence of mild cases, have led to the notification of a greater number of cases. The notified cases thus tend to increase, whilst the number of deaths from the disease may diminish. On Table 5 is given the Ward distribution of the disease. In contrast with Scarlet Fever, which was almost evenly distributed throughout the district, there was a marked preponderance of cases from the South West Ward. Cerebro-Spinal Meningitis.—One case was notified and the patient died. The case was notified from the West Middlesex Hospital, but the patient was removed there from a common lodging house. The man was working at the British Empire 1922 10 Exhibition at Wembley Park, and had been in this country about a month. He came from Ireland, and the only relatives he had in this country were two brothers. No information could be obtained of the patient's movements before he came to this country. Encephalitis Lethargica.—There was one notification and one death, but they did not refer to the same person. The case notified recovered; a death was reported from the disease, but the patient had not been notified as suffering from the disease. Ophthalmia Neonatorum.—Four cases were notified, and in all instances the final result was satisfactory and vision was not affected. One of the cases was treated in St. Margaret's Hospital for two periods. The baby was admitted in the first instance for about a month, but within a short time of her return home, she apparently got reinfected and she had to be re-admitted to the Hospital. Measles.—During the late Spring and early Summer, a minor epidemic of Measles was experienced throughout the district. Measles is not compulsorily notifiable at the present time, but from the information derived from other sources, it appeared that the disease was prevalent throughout the whole of the district, and the cases were fairly uniformly distributed. Nearly 600 cases were brought to the notice of the School Medical Department, and probably very many more cases occurred. The total number of deaths, though, was only 5, so that the disease was of a very mild character. It would be very pleasing if we could claim that these results are due mainly to successful efforts to control epidemics or to better methods of treatment, but candour compels us to admit that such a conclusion would be unwarrantable. In the Annual Report for 1920, I endeavoured to show that under present social conditions, the majority of children contract the disease, and the control of an epidemic is very ineffectual after the second crop of cases have fallen. There is a vast difference though, in the mortality of a winter epidemic to that of a summer one. The latter is comparatively a benign one. If isolated cases of Measles occur during the winter months, almost every means is justifiable and every effort should be made to postpone an epidemic until the summer. It is probable that our efforts will only be successful to the extent of postponing an epidemic for a few months, but frequently, 1922 11 this slight postponement will mean the saving of many lives. In recent years, we have been fortunate in the occurrence of summer outbreaks of Measles. One of the most satisfactory features in connection with Measles in the district has been the benign character of the disease during the past five years. The following are figures giving the total number of deaths in the last thirty-five years: Year Deaths Year Deaths Year Deaths Year Deaths 1922 5 1917 39 1912 13 1907 20 1921 0 1916 11 1911 44 1906 27 1920 9 1915 26 1910 1 1905 4 1919 0 1914 8 1909 40 1904 15 1918 7 1913 25 1908 38 1903 0 Total 21 Total 109 Total 136 Total 66 Year Deaths Year Deaths Year Deaths 1902 32 1897 2 1892 24 1901 0 1896 24 1891 9 1900 16 1895 6 1890 11 1899 0 1894 15 1889 25 1898 6 1893 2 1888 1 Total 54 Total 49 Total 70 ISOLATION HOSPITAL. During the year 587 cases were admitted into the Hospital. On January 1st, 1922, there were 102 cases under treatment and on January 1st, 1923, 63. During the year 606 were discharged and there were 20 deaths. Of the cases admitted, 379 were Acton cases and 208 belonged to outside districts. Cases Admitted. Scarlet Fever Diphtheria Measles Acton 207 170 2 Han well 74 53 — Wembley 40 25 — Staines 12 — — Wealdstone — 3 — Kingsbury — 1 — Deaths in Hospital. Scarlet Fever Diphtheria Acton 3 9 Hanwell 3 3 Wembley — 2 Sixty-eight per cent. of the Scarlet Fever cases notified in the district were removed to Hospital and 71 per cent. of the Diphtheria cases. 1922 12 TABLE 1. BIRTH-RATE, DEATH-RATE AND ANALYSIS OF MORTALITY DURING THE YEAR 1922. (Provisional figures. Populations estimated to the middle of 1921 have been used for the purposes 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 Diarrhoea & Enteritis under 2 yrs. Total deaths under 1 year Deaths in Public Institutions Certified Causes of Death Inquest Cases Uncertified Causes of Death England and Wales 20.6 12.9 0.01 0.00 0.15 0.04 0.16 0.11 0.54 0.44 6.2 77 25.6 92.7 6.2 1.1 105 County Boroughs and Great Towns, including London 21.4 13.0 0.01 0.00 0.22 0.05 0.19 0.13 0.56 0.41 7.6 82 32.9 92.6 6.7 0.7 155 Smaller Towns (1921 Adjusted Populations 20,000—50,000) 20.5 11.7 0.01 0.00 0.10 0.03 0 15 0.09 0.58 0.35 5.6 75 16.9 93.6 5.1 1.3 London 21.0 13.4 0.01 0.00 0.35 0.07 0.25 0.25 0.57 0.45 7.1 74 48.7 92.1 7.8 0.1 Acton 19.3 10.1 0.00 0.00 0.08 0.04 0.06 0.19 0.29 0.3 10. 62 34.6 100 7. 0.0 13 1922 TABLE 2. VITAL STATISTICS FOR WHOLE DISTRICT DURING 1922 AND PREVIOUS YEARS. Year Population estimated to 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 Number Rate of Non-Residents Registered in the District of Residents Registered outside Dist Number Rate per 1000 Number Rate per 1,000 Inhabitants 1917 65,219 (for Birth-rate) 936 972 14.9 480 8.2 18 225 94 96 687 11.7 58,507 (for Death-rate) 1918 66,000 (for Birth-rate) 923 954 14.5 611 10.3 16 277 76 78 872 14.7 59,000 (for Death-rate) 1919 64,306 (for Birth-rate) 950 1096 17.1 436 7. 12 222 72 65 646 10.4 61,732 (for Death-rate) 1920 61,000 1442 1541 25.3 560 9.2 16 217 100 64 671 11 1921 62,000 1225 1314 21.1 445 7.1 ... 205 92 70 658 10.4 1922 62,390 1021 1203 19.3 404 6.5 14 214 75 62 632 10.1 1922 14 TABLE 3. CAUSES OF AND AGES AT DEATH DURING THE YEAR 1922. 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 5 1 1 2 1 ... ... ... ... 1 1 ... 3 Whooping Cough 4 2 1 1 ... ... ... ... ... ... 1 2 1 Scarlet Fever 3 ... ... ... 2 1 ... ... ... 1 ... 1 1 Diphtheria 12 ... 1 4 6 1 ... ... ... 2 1 4 5 Influenza 17 1 ... ... ... 2 ... 3 11 3 2 10 2 Phthisis (Pulmonary Tuberculosis) 48 ... ... ... 2 10 21 12 3 13 5 16 14 Tuberculous Meningitis 2 ... ... ... 2 ... ... ... ... 2 ... ... ... Other Tuberculous Diseases 6 1 2 ... ... 1 1 ... 1 2 1 1 2 Cancer (Malignant Disease) 72 ... ... ... ... ... 6 30* 36 19 18 18 17 Rheumatic Fever 1 ... ... ... ... ... 1 ... ... ... 1 ... ... Meningitis 1 ... ... ... ... 1 ... ... ... ... ... ... 1 Organic Heart Disease 78 ... ... ... 1 ... 7 25 45 25 18 12 23 Bronchitis 40 l 1 ... ... 1 3 5 29 9 6 9 16 Pneumonia (All Forms) 53 15 5 1 1 3 11 9 8 10 6 14 23 Other Respiratory Diseases 10 ... ... 1 ... 1 2 4 2 3 4 ... 3 Diarrhoea and Enteritis 11 9 2 ... ... ... ... ... 2 ... 2 7 Appendicitis and Typhlitis 5 ... ... ... ... 2 1 1 1 1 1 1 2 Cirrhosis of Liver 1 ... ... ... ... ... ... ... 1 ... ... 1 ... Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis and Brights Disease 15 ... ... ... ... 1 1 11 2 3 3 3 6 Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 1 ... ... ... ... 1 ... ... ... 1 ... ... ... Other Accidents and Diseases of Pregnancy and Parturition 3 ... ... ... ... 1 2 ... ... 1 1 ... 1 Congenital Debility and Malformation, including Prematurity 36 36 ... ... ... ... ... ... ... 9 10 5 12 Violent Deaths (excluding Suicide) 18 1 ... ... 1 4 5 2 5 4 2 8 4 Suicide 6 ... ... ... ... 1 1 3 1 3 1 1 1 Other Defined Diseases 184 8 2 3 6 3 19 48 95 61 39 42 42 632 75 15 12 22 34 81 153 240 175 121 150 186 15 1922 TABLE 4. INFANTILE MORTALITY DURING THE YEAR 1922. 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 1 month 1—3 months 3—6 months 6—9 months 9—12 months Total under 12 months North East North West South East South West Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... Whooping Cough ... ... ... ... ... 1 ... ... ... 2 ... ... 1 ... Phthisis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... Meningitis (Not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... Influenza ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... Bronchitis ... ... ... ... ... ... ... ... 1 1 1 ... ... ... Pneumonia ... ... 1 ... 1 1 4 3 6 15 3 ... 2 10 Diarrhoea and Enteritis ... ... 1 ... 2 4 ... 3 ... 9 2 ... 2 5 Congenital Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Overlaying 1 ... ... ... 1 ... ... ... ... 1 ... ... 1 ... Injury at Birth 2 ... ... ... 2 ... ... ... ... 2 1 1 ... ... Congenital Malformation 4 ... 3 ... 7 1 2 1 ... 11 3 2 4 2 Prematurity 15 1 1 1 18 ... ... ... ... 18 5 5 1 7 Atrophy Debility and Marasmus 1 ... 2 1 4 1 2 ... ... 7 1 1 1 4 Other Causes 4 ... ... ... 4 ... ... ... 1 5 2 2 ... 1 27 2 8 2 39 10 9 9 8 75 21 12 13 29 1922 16 TABLE 5. CASES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1922. 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 305 2 45 213 22 21 2 ... 86 59 73 87 Diphtheria 223 1 47 138 16 18 2 1 36 33 52 102 Enteric Fever 1 ... ... ... ... 1 ... ... ... 1 ... ... Pneumonia 30 4 9 3 2 5 5 2 3 1 16 10 Puerperal Fever 2 ... ... ... ... 2 ... ... ... ... ... 2 Cerebro-Spinal Meningitis 1 ... ... ... 1 ... ... ... ... ... ... 1 Encephalitis 1 ... ... ... ... 1 ... ... ... 1 ... ... Dysentery 1 ... ... ... ... 1 ... ... ... ... 1 ... Ophthalmia Neonatorum 4 4 ... ... ... ... ... ... 2 ... ... 2 Erysipelas 14 ... ... 1 1 9 3 ... 3 7 1 3 Tuberculosis (Resp.) 87 ... ... 6 20 41 19 1 19 7 26 35 Tuberculosis (Other) 11 ... 1 3 4 2 ... 1 2 4 1 4 Totals 680 11 102 364 66 101 31 5 151 113 170 246 1922 17 TABLE 6. CASES REMOVED TO HOSPITAL, 1922. N. East N. West S. East S. West Total Scarlet Fever 60 36 39 74 209 Diphtheria 27 22 28 96 173 Enteric Fever — 1 — — 1 Pneumonia 2 - - - 2 Puerperal Fever — — — 2 2 Cerebro Spinal Meningitis — — — 1 1 Ophthalmia Neonatorum 1 — — — 1 Erysipelas — 2 — 1 3 Tuberculosis (resp.) 15 6 17 24 62 Tuberculosis (other) — 3 1 2 6 105 70 85 200 460 TABLE 7. BIRTHS. Total Births. Males Females Legitimate 563 599 Illegitimate 19 22 582 621 Notified Births in District. Males 493. Females 519. Still-Births 24. Wards. North East 270 South East 183 North West 150 South West 409 Total 1,012. Registered in District, but not Notified. North East 49 South East 27 North West 15 South West 18 Total 109. Information received of Fifty-Seven Live and Two Still-Births Registered outside the District. North East 23 South East 9 North West 3 South West 22 Total 57 Thirty-five other Births occurred outside the District, but of which no information was received, except through the Registrar-General's Annual Summary. Number of Births Visited 887 Number of Births Re-visited 8354 1922 18 TABLE 8. INFANT WELFARE CENTRES, 1922. Priory Schools Palmerston Mission Health Visitors' Attendances 102 99 Number of Children who attended 693 694 Number of Attendances by Children 5,031 4,989 Children under 1 year of age 305 401 Children over 1 year of age 388 293 Age of Children who commenced Attendance in 1922. \ Priory Offices Palmerston Mission Under 3 months 206 172 Between 3 and 6 months 61 57 „ 6 and 9 months 23 25 „ 9 and 12 months 15 9 „ 1 and 2 years 18 22 „ 2 and 3 years 10 33 „ 3 and 4 years 3 19 „ 4 and 5 years 1 9 Of the above Children 31 had attended for the first time in 1917 50 „ „ 1918 96 „ „ 1919 195 „ „ 1920 357 „ „ 1921 661 „ „ 1922 ANTE-NATAL CLINIC. Number of times the Clinic was held 22 Number of Expectant Mothers who attended 71 Number of attendances made by Expectant Mothers 129 Number of Cases admitted to Acton Hospital 4 Ante-Natal Visits. Number of Mothers visited 199 Number of Visits paid to Mothers 502 TABLE 9. INQUESTS HELD WITH CAUSE OF DEATH. Heart Disease 9 Knocked down by Motor Vehicle 8 Pneumonia 2 Miliary Tuberculosis 1 Motor Accident 1 Hernia 1 Suicide 6 Intestinal Obstruction 1 Accidental Fall 1 Syncope 1 Overlaying 1 Cancer 1 Accidentally Drowned 1 Marasmus 1 Found Drowned 1 Cerebral Abscess 1 Blood Poisoning after Cut Finger 1 Nephritis 1 Pleurisy 1 Tetanus 1 Status Lymphaticus 1 Burns 1 Bronchitis 1 Puerperal Fever 1 19 1922 TABLE 10. BACTERIOLOGICAL LABORATORY. Positive Negative Total Examinations (2,773) 1,136 1,637 Sent by Medical Practitioners 144 292 Sent from Isolation Hospital 384 678 Contacts 322 532 Of these Positive Contacts 244 were postive on the first occasion only. 53 „ second ,, „ 25 „ third „ „ School Sore Throats. Positive Negative Cases 59 129 Swabs 77 175 Nineteen of the Positive Sore Throat Cases had sufficient Clinical symptoms to warrant removal to Hospital. TABLE 11. STAFF TO WHOSE SALARY CONTRIBUTION IS MADE UNDER THE PUBLIC HEALTH ACTS OR BY EXCHEQUER GRANTS. D.J. Thomas. m.r.c.S., l.rc.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. TABULAR STATEMENT OF INSPECTIONS AND DETAIL OF WORK CARRIED OUT BY THE SANITARY INSPECTORS. Number and nature of Inspections made. House to house Inspections 331 After infectious disease 544 On complaint, Etc. 878 Premises under periodical inspection 591 Re-inspections after notice served 7,102 Enquiry visits on notification of infectious disease 574 1922 20 Classified statement of the number of Premises under periodical Inspection. Workshops 225 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 39 Milk purveyors 83 Cowsheds 2 Piggeries 4 Rag and bone dealers 4 Mews and stables 22 Schools 11 Show grounds 2 Houses dealt with under Section 28, Housing Acts. Houses in respect of which notices were served 167 Rendered fit by owners 161 Rendered fit by-local authority 6 Premises dealt with under Public Health Acts. Premises in respect of which notices were served 974 Premises in which defects were remedied by owners 974 Premises in which defects were remedied by Local Authority Nil Detail of work carried out. Sanitary dustbins provided 634 Yards paved or yard paving repaired 283 Insanitary forecourts remedied 191 Defective drains repaired or reconstructed 63 Defective soil pipes and ventilating shafts repaired or renewed 41 Defective fresh air inlets repaired or renewed 66 Defective gullies removed and replaced by new 57 Rain water downpipes disconnected from drain 28 Dishing and curb to gullies repaired and new gratings fixed 159 Defective W.C. pans and traps removed and replaced by new 73 Defective W.C. flushing apparatus repaired or new fixed 291 Defective W.C. seats repaired or new fixed 203 Defective flush pipe connections repaired 64 Insanitary sinks removed or new fixed 58 Sink waste pipes repaired or trapped 201 Insanitary wall surfaces over sinks remedied 152 Ventilated food cupboards provided 108 Drinking water cisterns cleansed 163 Defective covers to drinking water cisterns repaired or new fixed 55 Insanitary sites beneath floors concreted 48 Spaces beneath floors ventilated 267 1922 21 Dampness in walls from defective damp-proof course remedied 240 Dampness from defective roofs, rain water gutterings, etc., remedied 715 Defective plastering repaired (number of rooms) 649 Rooms where dirty walls and ceilings have been cleansed and redecorated 2,790 Defective floors repaired 228 Defective or dangerous stairs repaired 43 Defective doors and windows repaired 242 Defective kitchen ranges and fire grates repaired 243 Defective washing coppers repaired 121 Coal cupboards provided 36 New W.C. apartments provided 3 Accumulations of offensive matter removed 28 Drains unstopped and cleansed 134 Overcrowding nuisances abated 10 Drains tested, exposed for examination, etc. 112 Smoke observations taken 48 Smoke nuisances abated 17 Nuisances from foul pigs and other animals abated 23 Notifications of waste of water sent to Metropolitan Water Board 281 HOME WORK. Nature of Work. Outworkers' Lists. Section 107. Lists received from Employers. Sending once in year. Lists. Workmen. Brush Making 1 7 Stuffed Toys 1 63 Total 2 70 1922 22 ANNUAL REPORT ON THE ADMINISTRATION OF THE FACTORY AND WORKSHOP ACT, 1901, IN CONNECTION WITH FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1.—Inspections of Factories, Workshops and Workplaces, made by the sanitary inspectors. Premises. (1) Inspections. (2) Written Notices. (3) Factories (including Factory Laundries) 32 17 Workshops (including Workshop Laundries) 483 74 Workplaces (other than Outworkers' Premises included in Part III. of this Report) 18 4 Total 533 95 2.—Defects found in Factories, Workshops and Workplaces. Particulars. (1) Number of Defects. Found (2) Remedied (3) Nuisances under the Public Health Acts: Want of cleanliness 22 22 Want of drainage of floors 5 5 Other nuisances 31 31 Sanitary accommodation: Insufficient 9 9 Unsuitable or defective 18 18 Not separate for sexes 1 1 Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (S. 101) 1 1 Total 87 87 I am, Ladies and Gentlemen, Your obedient Servant, D.J. THOMAS. 1922