BARK 17 Barking Urban District Council. THE Annual Report OF THE MEDICAL OFFICER OF HEALTH AND SANITARY INSPECTOR For the Year 1922. Norman. Hopper & Co.. Ltd.. T.U. Printers. Boleyn Castle. Upton Park. E.13. 3 SUMMARY OF VITAL STATISTICS FOR YEAR 1922. General Statistics. Area of Urban District—3,897 acres land, 209 tidal waters. Population—(1921) 35,543; (1922) 36,680. Number of inhabited houses (1921)—6,716. Number of families or separate occupiers—6,698 Rateable value—£205,563. Sum represented by Penny Rate—£819 8s. 9d. Births. Males. Females. Rate per 1,000 Pop. Legitimate 425 430 Illegitimate 10 17 24.0 Deaths 203 161 9.9 Number of Women dying in consequence of Childbirth: From Sepsis — From other causes 2 Deaths of Infants under 1 year of Age: Legitimate 49 Illegitimate Infantile mortality rate 55.5 Deaths from: Measles (all ages) 3 Whooping Cough (all ages) 2 Diarrhoea (under 2 years) 4 5 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE URBAN DISTRICT OF BARKING TOWN, IN THE COUNTY OF ESSEX, for the YEAR ENDING 31st DECEMBER, 1922. To the Chairman and Members of the Urban District of Barking Town. Gentlemen, The general features of the year have already been referred to in the annual summary given in January. Under the circumstances, it would be hardly wise to dwell unduly on the very favourable state of the public health during the year under review. The figures are allowed to speak for themselves. R. J. EWART. The rates for certain diseases in the following tables, are compared with England and Wales, great and small Towns, and London respectively. Barking Town Arban District Council. Public Offices. Barking. Essex. 6 BIRTH RATE, DEATH RATE, AND ANALYSIS OF MORTALITY (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. Diarrhœa & Enteritis (under Two years). Total Deaths under One 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 0.01 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 BARKING 24.0 9.9 0.01 0.00 0.01 0.04 0.05 0.16 0.55 0.38 3.3 55.5 15.3 — — — It is seen that the area compares very favourably and the conclusion would appear to be justifiable that each inhabitant enjoys certain benefits not granted to other similarly situated areas. The small proportion of deaths (15.3 per cent.) occurring in institutions and its decrease on previous years, does suggest that some progress had been made in respect to housing conditions and that the standards of life have been maintained. 7 Comparing the town with itself, the following shows much cause for gratification as regards the general death rate and infant mortality, which are the lowest on record. VITAL STATISTICS OF WHOLE DISTRICT FROM 1917 TO 1922. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Nett. Of Nonresidents registered in the District. Of residents registered out of the District. Under One year of age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 1917 32394 758 23.4 520 14.4 — 111 89 117.4 631 17.4 36110 1918 31579 728 23.1 542 15.3 — 98 60 82.4 640 18.1 35383 1919 33804 815 33.0 277 8.1 — 95 54 650 372 11.0 35214 1920 35151 1086 30.9 339 9.6 — 110 92 83.0 449 12.6 1921 36250 968 26.0 297 7.1 — 97 74 74.1 394 10.8 1922 36680 882 24.0 308 8.1 — 56 49 55.5 364 9.9 8 NOTIFIABLE DISEASES DURING THE YEAR 1922. The infectious diseases notified in the district are give a in the following tables. The figures are less than in previous years. DISEASE. At all Ages. Total Cases Notified at Ages. Years. Wards. Total Cases Removed to Hospital. North. South. East. West. Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 and over Small Pox — — — — — — — — — — — — — — — — — Diphtheria 51 7 5 7 2 9 10 11 — — — — 4 17 20 10 51 Scarlet Fever 53 2 1 7 — 8 17 10 8 — — — 9 13 24 7 49 Erysipelas 36 1 — — — — — 1 1 5 10 18 5 13 13 5 — Enteric Fever 2 — — — — — — — — 2 — — — — 2 — — Puerperal Fever 2 — — — — — — — — 2 — — — — 2 — — Pneumonia 103 15 13 8 3 4 3 3 8 17 8 21 13 40 30 20 4 Cerebro Spinal Meningitis — — — — — — — — — — — — — — — — — Poliomyelitis — — — — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum 10 10 — — — — — — — — — — — — — — — Encephalitis — — — — — — — — — — — — — — — — — Measles 925 70 159 154 117 174 221 15 6 5 4 — 116 423 286 100 5 Whooping Cough 83 14 17 19 17 14 — — — — 2 — 11 23 43 6 — Dysentry — — — — — — — — — — — — — — — — — Pulmonary Tuberculosis, Male 24 — — — 1 — — — 1 5 7 10 8 2 11 3 5 Female 26 — 1 — — 1 — 2 5 7 6 4 5 9 6 6 — Non-Pulmonary Tuberculosis. Male 10 — — — 2 — 3 1 1 — 1 2 — 4 4 2 — ,, ,, Female 13 — 2 1 2 — 1 3 2 — 1 1 2 5 4 2 — Totals 1,338 119 198 196 144 210 255 46 32 43 39 56 173 551 443 161 114 9 During the year (December) the order making Measles and Whooping Cough compulsorily notifiable was rescinded. A statement relative to certain facts noticed whilst the disease was officially recognised, is given at the end of the report. OTHER INFECTIOUS DISEASES. Number Notified. Number Visited. Number Treated. Removed to Hospital. Ophthalmia 10 10 — — Measles 925 925 — 5 Whooping Cough 83 83 — — No. children injected with Whooping Cough Vaccine — — 10 — MEASLES 1922. Notifications in each Week. Week ending Number Notffied. Week ending Number Notified January 7th 2 May 27th 48 „ 14th 2 June 3rd 38 ,, 21st 2 ,, 10th 11 ,, 28th 1 ,, 17th 17 February 4th 2 ,, 24th 10 ,, 11th 8 July 1st 8 ,, 18th 3 ,, 8th 8 „ 25th 41 ,, 15th 6 March 4th 28 ,, 22nd 6 ,, 11th 49 ,, 29th 4 ,, 18th 47 August 5th 1 „ 25th 73 ,, 12th 3 April 1st 86 ,, 19th 3 „ 8th 102 „ 26th 1 ,, 15th 63 September 2nd 3 ,, 22nd 72 ,, 9th 1 ,, 29th 37 ,, 16th 1 May 6th 58 October 7th 1 ,, 13th 44 November 4th 1 ,, 20th 34 10 TUBERCULOSIS. It is to be noted that out of 38 deaths from Tuberculosis, in eight cases no notification was received. On enquiry it was found that in six instances a change of address or doctor had occurred and no action could be taken. In two instances the diagnosis of Tuberculosis was made late in the illness and the practitioner, for obvious reasons, was reluctant to notify. Beyond this, the notifications can be regarded as a fair reflection of the amount of clinically recognisable disease at present in the district. CAUSES OF SICKNESS AND DEATH. The following tables give the actual causes of sickness and death, and in so far as it shows no marked variation from what is to be expected from year to year, comment is unnecessary. The tables give the causes of death and age distribution (the old wards have been retained as being more suitable for statistical purposes though it is doubtful if this sub-grouping is worth while). 11 DEATHS, 1922. ACCORDING TO AGE AND WARD. Causes of Death. M. F. Under 1 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20-35 35—45 45—65 Over 65 North South East West Total Enteric Fever 1 — — — — — — — — — 1 — — — — — 1 — 1 Small Pox — — — — — — — — — — — — — — — — — — — Measles 2 1 1 1 — 1 — — — — — — — — — 2 1 — 3 Scarlet Fever 1 — — — — — — — 1 — — — — — — — 1 — 1 Whooping Cough 1 1 1 — 1 — — — — — — — — — 1 — 1 — 2 Diphtheria 3 3 1 3 — — 2 — — — — — — — — — 5 1 6 Influenza 11 16 — 3 1 — — — — 3 2 7 8 3 5 12 8 2 27 Encephalitis lethargica — — — — — — — — — — — — — — — — — — — Meningococcal meningitis — — — — — — — — — — — — — — — — — — — Tuberculosis 20 13 — 1 1 — — 1 2 2 12 6 7 1 6 7 8 12 33 Other Tubercular Diseases 5 5 — 2 1 — — — — — — 3 2 2 3 4 3 — 10 Cancer, Malignant Disease 21 11 — — — — — — — — 3 9 12 8 5 11 12 4 32 Rheumatic Fever 1 4 — — — — — — 2 2 — — — 1 1 1 2 1 5 Diabetes 1 2 — — — — — — — — 1 1 1 — 2 1 — — 3 Cerebral Haemorrhage 8 13 — — — — — — — — — 6 7 8 4 6 8 3 21 Heart Disease 21 15 — — 1 — 1 — — — 4 5 10 15 6 10 16 4 36 Arterio-sclerosis 1 3 — — — — — — — — — 1 1 2 1 1 1 1 4 Bronchitis 18 11 6 2 1 — — — — — 2 — 7 11 8 9 5 7 29 Pneumonia fall forms) 14 15 10 8 1 1 — — — — 3 2 — 4 3 6 8 12 29 Other Respiratory Diseases 3 1 — — — — — — — — — 1 1 2 — 2 1 1 4 Ulcer of Stomach or Duodenum 4 2 — — — — — — — — — 1 3 2 — 2 2 2 6 Diarrhoea (under 2 years) 3 1 3 1 — — — — — — — — — — — 2 1 1 4 Appendicitis and Typhlitis — 2 — — — — — — — — — 1 1 — — 1 1 — 2 Cirrhosis of liver 1 — — — — — — — — — — — — 1 — — 1 — 1 Acute and Chronic Nephritis 11 7 — — — — — — 1 — 1 2 7 7 5 6 6 1 18 Puerperal Fever — — — — — — — — — — — — — — — — — — — Other accidents and diseases of pregnancy — 2 — — — — — — — — — 2 — — 1 1 — — 2 Congenital Debility, etc 11 6 17 — — — — — — — — — — — 2 7 5 3 17 Suicide 1 — — — — — — — — — — — 1 — — — — 1 1 Other deaths from violence 7 5 3 1 — 1 — 1 1 — 1 1 3 — 1 3 7 1 12 Other defined diseases 33 22 7 — — — — — — — 3 3 16 26 13 9 19 14 55 Totals 203 161 49 22 7 3 3 2 7 7 33 51 87 93 67 103 123 71 364 12 INFANT MORTALITY DURING THE YEAR 1922. The following table gives the actual causes of death of children dying under one year of age. It is to be observed that the smallness of the number is due to the absence of deaths from diarrhœa. Nett deaths from stated causes at various ages under 1 year. Causes of Death. (All causet certified.) Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total under 1 year. Small pox — — — — — — — — — — Chicken pox — — — — — — — — — — Measles — — — — — — — 1 — 1 Scarlet fever — — — — — — — — — — Whooping cough — — — — — — — — 1 1 Diphtheria and croup — — — — — — — 1 — 1 Erysipelas — — — — — — — — — — Tubercular meningitis — — — — — — — — — — Other tubercular diseases — — — — — — — — — — Meningitis (not tubercular) — — — — — — — — 1 1 Convulsions — — 1 — 1 — — — — 1 Laryngitis — — — — — — — — — — Bronchitis — — — 1 1 2 1 — 2 6 Pneumonia (all forms) — — — — — 1 3 5 1 10 Diarrhœa — — — — — — — 3 — 3 Enteritis — — — — — — — — — — Gastritis — — — — 1 — — — — — Syphilis — — — 1 — — — — — 1 Rickets — — — — — — — — — — Suffocation, overlaying — — 1 — 1 — — — — 1 Injury at birth — — — — — — — — — — Atalectasis — — — — — — — — — — Congenital malformation — — — — — — — — — — Premature birth 9 — 2 — 11 — — — — 11 Atrophy, debility and marasmus 1 1 — — 2 — — — — 9 Other causes 3 2 2 1 8 — — 1 1 10 Totals 13 3 6 3 25 3 4 11 6 49 Nett Births in the Year: — Legitimate 855 Illegitimate 27 Nett Deaths in the Year: — Legitimate 49 Illegitimate — 13 SUMMARY OF NURSING ARRANGEMENTS, HOSPITALS & OTHER INSTITUTIONS, AVAILABLE FOR THE DISTRICT. Professional Nursing in the Home. A. General—A voluntary association (The Plaistow Maternity Charity) has a Branch in the district, and supplies midwives and home nurses, the latter are sent on a requisition from a practitioner. B. Infectious Diseases—If the staff is available the Council supplies nurses for the home nursing of measles and other infectious diseases on the requisition of a registered practitioner. C. Midwives—There are five midwives practicing in the district, two of whom are employed by the Council. The work done is given on another page of this report. D. Clinics and Treatment Centres—Three Infants Clinics are held weekly, as follows:— Infant Clinics and Work of Health Visitors. Name and Situation. Accommodation. Average Attendance. Times Opened. Provided by. Kennedy Hall Gordon Road 2 rooms 20 Monday 2—5 Council Clinic East Street 4 rooms 58 Tuesday 2—5 ,, Abbey Hall Abbey Road 2 rooms 30 Thursday 2—4.30 ,, 14 REPORT FOR THE HOSPITAL FOR THE YEAR 1922. Patients admitted: — Diphtheria—52, including 6 deaths from Cardiac failure, and 3 tracheotomies (all recovered). Scarlet Fever—49, including 1 death (mentally defective). Three return cases of Scarlet Fever. Measles—5. Phthisis—5 including 1 death. Pneumonia—4 including 2 deaths. General sickness—10 including 2 operations. One secondary rise of temperature—Scarlet fever, nursed in the Ward. One secondary rise of temperature—Diphtheria, nursed in the Ward. No secondary rises of temperature of cases nursed in the cubicles. Duration of stay in hospital compared with previous years: — Scarlet Fever. Diphtheria. Year. Days. Days. 1922 37.6 29.9 1921 36.83 30.65 1914 37.26 25.0 1913 37.1 19.5 1912 39.5 41.2 1911 52.44 40.0 15 ANNUAL STATISTICS RELATING TO MATERNITY CASES ADMITTED TO UPNEY HOSPITAL AND ATTENDED ON THE DISTRICT. Hospital. District. Total number of cases admitted 114 — Average duration of stay 14 days — Number of cases delivered— (a) Midwives 109 152 (b) Doctors 1 9 Number of cases in which medical attention was sought by the midwife with reasons for requiring assistance— (a) Ante-natal 1 1 (b) During labour 2 6 (c) After labour 1 4 (d) For infant 6 5 Number of cases notified as puerperal sepsis with result of treatment in each case — — Number of cases in which temperature rose above 100.4 for 24 hours with rise of pulse rate 2 2 Number of cases notified as Ophthalmia Neonatorum, with result of treatment in each case — 1 Number of cases of " inflammation of the eyes " however slight 3 – Number of infants not entirely breast-fed while in the institution, with reasons why they were not breast-fed 12 – (Weakness of mother, depressed nipples) Number of maternal deaths with causes — – Number of foetal deaths (still-born or within ten days of birth) and their causes, and the results of the post-mortem examination, if obtainable: 2 macerated; 1 anencephalus; 2 premature, and 1 heart. 16 CASES OF OPHTHALMIA NEONATORIUM NOTIFIED DURING YEAR 1922. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital Ophthalmia Neonatorum 10 10 — 10 – – – WORK OF HEALTH VISITORS. 1922. 1921. Visits to expectant mothers 192 247 Birth notification (first visits) 1,020 974 ,, ,, (visits under 2 years) 2,257 1,944 Visits to children from 2-5 years 1,096 614 Infant mortality visits 52 54 Tuberculosis visits 360 227 Puerperal fever visits 2 — Miscellaneous visits 128 114 Further details dealing with Maternity and Child Welfare: — BIRTHS AND DEATHS OCCURRING IN EACH AREA OF THE DISTRICT, FOR THE YEAR 1922. North. South. East. West. Total. Births notified 193 295 311 107 906 Deaths (under 1 year) Mortality per 1,000 6 16 14 13 49 births notified 31.08 54.2 45.01 121.4 55.5 Notified by the Plaistow Maternity Charity 50 54 68 15 187 The births were notified from the following sources: — By Doctors 293 „ Council Midwives 161 „ Plaistow Maternity Charity 187 „ Hospital 114 „ Others 151 906 17 GENERAL CONDITIONS INFLUENCING INFANT LIFE AS FOUND BY HEALTH VISITOR. Number Visited. Breast. Artificial Mixed. Cradle Used. Dirty Houses. Mother III. (1922.) 9 Anaemia 1st visit 1 Breast abscess 1922 1,020 955 44 21 113 40 I 1 Phlebitis 1921 974 784 99 91 177 89 2 Tuberculosis 1 Nephritis 2nd visit 1 Rheumatoid arthritis 1922 233 145 69 19 – – 1 P.P. Hœmorrhage (died) 1921 173 109 43 21 – – 2 Puerperal fever 3rd visit 1 Bronchitis 1922 71 35 18 18 – – 1 Spinal deformity 1 Ovarian disease. 1921 57 24 23 10 – – 1 Diarrhoea 22 18 SIZE OF TENEMENTS. AND NUMBER OF OCCUPANTS IN SUCH HOUSES, IN WHICH A BIRTH OCCURRED IN 1922. Rooms per Tenement. OCCUPANTS PER TENEMENT. Totals. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 18 1 – 2 75 34 8 1 3 3 – – – – – – – – – 126 2 — — 70 50 16 11 5 — 1 — — 1 1 — — — — 155 3 — 1 15 17 24 13 7 8 – – 1 – – – – – – 86 4 — — 21 47 49 51 37 35 27 21 8 5 4 3 — — — 308 5 — 1 2 12 27 18 10 8 13 6 3 4 2 — 1 — — 107 6 — — 4 9 8 5 5 8 8 1 1 — 1 1 1 — — 52 7 — — — 2 1 – – – – – – – – – – – – 3 8 — — — — — 2 — — — — — — — — — — — 2 9 – – – – – – – – – – – – – – – – – – Totals 4 187 171 133 101 67 62 49 28 13 10 8 4 2 — — 839 19 STATEMENT DEALING WITH MILK DISTRIBUTION, SUPPLY OF FREE MEALS, AND DOMESTIC ASSISTANCE, DURING THE YEAR 1922. PERIOD. FRESH MILK Supplied Free and at Half-price (per day). DRIED MILK (per week). Pint Free. Pint Half-price 1 lb. Free. 1½1bs. Free. 2 lbs. Free. 3 lbs. Free. l½ lbs. Haft-price. 2lbs. Half-price. 1 month and under 61 3 7 2 21 1 2 8 2 months 65 2 4 3 13 — 1 4 3,, 43 1 — 5 8 1 — 4 4,, 28 1 5 2 7 1 — — 5,, 17 1 1 1 1 — — — 6,, 16 - 1 1 2 - — — 7,, 6 - - - - - - — 8 „ 4 - - - 1 - — — 9 „ 1 — — — — - - — DINNERS (daily). HOME HELPS. @ 1/4 @ 8d. @ 1/- 1 month 13 1 1 For a period of 2 weeks (daily) at 10 - per week 1 2 ,, 8 ,, ,, 2 ,, ,, (free) 1 3 ,, 3 ,, ,, 12,, ,, at 10/- per week 1 4 ,, 1 5 ,, — — — 6 „ — — — 20 DISTRIBUTION OF BIRTHS ACCORDING TO MOTHER S AGE. Age of Mother. Babies Born. Deaths. Still Births. Age of Mother. Babies Born. Deaths. Still Births. 17 2 — — 33 18 1 — 18 6 — 1 34 32 1 1 19 8 — - 35 25 1 1 20 16 1 - 36 31 - 1 21 25 — 3 37 20 - — 22 46 1 - 38 23 2 — 23 52 — - 39 29 - 1 24 57 2 2 40 29 1 2 25 57 3 — 41 16 1 - 26 57 2 1 42 13 2 - 27 40 2 1 43 12 2 1 28 47 1 1 44 7 - - 29 43 3 1 45 3 - - 30 46 1 — 46 - - - 31 37 1 — 47 1 - - 32 31 — — 48 1 - 1 INFANTILE MORTALITY AND PHYSICAL CHARACTERS OF THE MOTHER. Babies Born. Height. Weight. Intelligence. Tall. Medium. Short. Average & above. Below Average. Average. Below Average 255 375 159 714 75 726 63 Deaths. 10 8 9 25 2 20 7 Still Births. 1 9 7 14 3 13 4 Totals 11 17 16 39 5 33 11 Rate per 1.000 Births. 44 45 100 54 62 44 140 The general trend is the same as for previous years. 21 SANITARY ADMINISTRATION. HOUSING CONDITIONS. Statistics—Year ended December, 1922. I.—General:— (1) Estimated population36,680 (2) General death-rate 9.9 (3) Death-rate from tuberculosis 0.8 (4) Infantile mortality rate 55.5 (5) Number of dwelling-houses of all classes 7,400 (6) Number of working-class dwelling-houses 7,323 (7) Number of working-class dwelling-houses erected 303 II.—Unfit dwelling-houses:— (1)—Inspection: — (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,439 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulation, 1910 458 (3) Number of dwelling-houses found to be in a state so dangerous or injurious as to be unfit for human habitation 3 (4) Number of dwelling-houses (exclusive of those referred to under the previous sub-heading) found not to be in all respects reasonably fit for human habitation 204 (2)—Remedy of defects without service of formal notice:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,334 22 (3)—Action under Statutory Powers:— A—Proceedings under Section 28 of the Housing Town Planning, etc., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs ... ... 204 (2) Number of dwelling-houses which were rendered fit (a) by owners180 (b) by Local Authority in default of owners 1 (3) Number of dwelling-houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 320 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 294 (b) by Local Authority in default of owners — C.—Proceedings under Section 17, 18, of the Housing and Town Planning Act, 1909— (1) Number of re-presentations made with a view to the making of closing orders 3 (2) Number of dwelling-houses in respect of which closing orders were made 3 (3) Number of dwelling-houses in respect of which closing orders were determined, the house having been rendered fit 1 (4) Number of dwelling-houses in respect of which demolition orders were made — (5) Number of dwelling-houses demolished in pursuance of demolition orders — 23 SUMMARY of WORK DONE DURING the YEAR 1922. Inspections:— House to house 458 Complaints 374 Infectious disease 136 Factories and Workshops 263 Schools 122 Cowsheds and Dairies 264 Common Lodging Houses 127 Food Shops 215 Miscellaneous 2,717 Total number of Inspections 4,676 Re-inspections of all kinds 5,765 Preliminary Notices served 1,760 Statutory Notices served 144 Housing and Town Planning Notices 204 Main drains cleared 173 Cess-pools cleared 75 Houses without proper dustbins 176 Houses over-crowded77 Houses stripped and cleansed after infectious diseases 35 24 MEASLES-ORDER OF BIRTH. The following points bearing on the incidences of Measles and its spread are of some interest. The point under investigation is an attempt to measure the relative importance of infection derived from a general source as compared with the chance of one member of a family infecting another. The following tables give the order of birth and age of attack. Both records are to some extent incomplete, as the pressure of economic circumstances and increase in parental knowledge prevent medical attention being applied for, as the family gets larger. The economic stress is heavier, the mean size of family is larger, and the mean age of mother at birth is greater in the second than in the first record Further, each case is the first case notified so that each family occurs once only in the record. It is, to be assumed therefore that the chance of family infection will be reduced to a minimum as it must necessarily depend on mild or unrecognisable disease. BIRTH SEQUENCE AND AGE OF ATTACK. MEASLES—1919. Age of Attack. BIRTH SEQUENCE. Totals. 1 a 3 4 5 6 7 8 9 10 0 5 3 1 2 - 1 — — — — 12 1st year 10 6 1 2 - — 1 1 — — 21 2nd ,, 16 10 5 1 1 1 — — — — 34 3rd „ 10 13 4 1 3 1 1 — — — 33 4th ,, 24 6 7 4 1 — — — — — 42 5th,, 30 25 21 9 6 5 2 — — — 98 6th „ 39 31 18 16 2 — — 1 — — 107 7th,, 29 16 14 4 1 1 — 1 — — 66 8th „ 16 11 2 1 — — — 1 — — 31 9th,, 7 3 3 1 - - - - - - 14 10th „ 5 2 - - - - - - - - 7 11th „ 6 1 1 1 - - - - - - 9 12th „ 3 3 1 — 1 - - - - - 8 13th 5 - - - - - - - - - 5 14th 1 1 - - - - - - - - 2 15th 1 1 - - - - - - - - 2 16th 2 - - - - - - - - - 2 17th „ 1 - - - - - - - - - 1 Totals 210 132 78 42 15 9 4 4 — — 494 + r=.144—.034 25 ORDER OF BIRTH AND AGE OF ATTACK. MEASLES-1919. Order of Birth. AGE OF ATTACK. Totals. 0 1 2 3 4 5 6 7 1 8 9 10 11 12 13 14! 15 16 17 18 19 1 5 20 31 26 28 118 120 32 8 1 2 1 6 - 1 1 - - - 1 401 2 6 14 17 12 22 52 64 13 3 2 1 1 - - - - - - - - 207 3 4 13 11 15 25 39 42 10 1 - - - - - 1 - - - 1 — 162 4 6 11 9 9 13 27 25 3 — — — 1 1 — — — - — — — 105 5 4 2 5 6 11 14 15 1 - - - - - - - - - - - - 58 6 1 5 3 2 4 8 3 1 - - - - - - - - - - - - 27 7 3 4 3 2 4 4 2 1 - - - - - - - - - - - - 23 8 2 — 1 — 2 2 2 — — — — 2 — — - - — — — — 11 9 2 1 1 — — — 2 1 — — — — — — — — — — — — 7 10 — — — 1 1 1 1 - - - - - - - - - - - - - 4 11 — 1 - - - - - - - - - - - - - - - - - - 1 12 - - - 2 - - 2 - - - - - - - - - - - - - 4 13 1 — — — — 1 — - - - - - - - - - - - - - 2 14 1 - - - - - - - - - - - - - - - - - - - 1 15 - - - - - - - - - - - - - - - - - - - - -- 16 - - - - - 1 - - - - - - - - - - - - - - 1 Totals 35 71 81 75 110 267 278 62 12 3 3 5 7 — 2 1 — 1 1 1.014 + Standard Deviation. Standard Deviation. r = —15912—.021 Order—1.4191 Age=2.747 26 The fact that the later horn are attacked at earlier ages suggests, (a) the existence of a biological differentiation, or* (b) that infection is introduced into the home by an older member of the family suffering from discomfort or showing recognisable signs. A general case might be stated as follows:— Let n1 n2 represent individuals, then the whole population consists of n1 + 2 n2 4- 3 n3 +persons. These are exposed to an extra domestic risk. The number of families m1 m2 infected from this source is with 1,2,3 extra domestic cases, the intra domestic cases subsequently arising are functions of m. Hence the total number of cases recorded will be drawn in greater proportions from larger families. To some extent this theorum can be tested by comparing the distribution (a) when the first case is notified and (b) when all cases are notified. (Notifications during war period and notifications 1920-1921). The figures are as follows:— INCIDENCE OF MEASLES ACCORDING TO SIZE OF FAMILY. Number of occupants. First cases notified each group of occupants counted once only. All cases notified each group of occupants counted according to number of cases. Number of occupants per tenement which contains a child of one year of age. 1 - - 2 2 8 3 5 3 72 44 99 4 129 105 128 5 114 100 128 6 90 96 119 7 68 68 93 8 59 59 77 9 21 20 54 10 10 6 20 11 7 27 23 12 2 3 3 13 3 1 4 14 Totals 1 582 532 757 27 CHILDREN UNDER 14 ONLY. Number in family. Counted once only. All cases. 1 124 12 2 175 18 3 142 25 4 81 10 5 33 5 6 14 3 7 9 — 8 — — 9 1 — 10 — — T OTALS 580 73 It is to be observed that when all casss are considered, the larger families are unduly represented but not greatly so. Further, if the distribution of susceptible families is represented by those which contain a child of one year of age, there would seem to be little evidence to believe that large families are unduly fit. The suggestion is that during epidemic periods the dosage is so heavy that the difference depending on intra or extra domestic infection is not sufficient to produce a demonstrable effect. Thus, on these lines, the earlier age of attack of the later bom would seem to depend on biological causes. There is also a heavy error of omission affecting the later born attacked at later ages. This point has been dealt with statistically elsewhere. The conclusion would seem to be justifiable that the age of attack of the later birth numbers is more variable, an effect which! may be dependent on parental age at birth. R. J. EWART, M.D., D.Sc., Medical Officer of Health.