Embed Size (px)
PUBLIC HEALTH SERVICES
REPORTS OF MEDICAL OFFICERS OF HEALTH.
Registered stillbirths per 100 live births : Lancashire 4.9,West Riding, Essex 3-4.
Lancashire.Dr. J. J. Butterworth’s report contains, as usual,
an enormous mass of detailed information, mostly intabular form, with respect to the 19 municipalboroughs, 81 urban districts, and 19 rural districtswhich make up the administrative county. Largelyowing to the influenza epidemic there were nearly4000 more deaths than in the previous year. Theexcess deaths were chiefly attributed to influenza,heart disease, pneumonia, and bronchitis ; andthe only age-periods which showed no excess werefrom 5 to 25 years. Little use has been made of theHousing (Rural Workers) Act. Up to June 30th,1930, .S1536 in grants had been promised in respectof 16 dwellings and :S936 had actually been paidin respect of 10 dwellings. During 1929, 576 outsidecomplaints of tuberculous milk were received andin each case a veterinary surgeon retained by thecounty council and a sanitary officer visited the farm.The facts found were reported to the county agri-cultural department and the ultimate result is notgiven. There are about 7224 dairy farms and thenumber of cattle is approximately 95,000. Theclean milk competition promoted by the CountyMilk Recording Society, assisted by the publichealth department, only attracted 10 competitors.The number of licences issued for Certified milk by theMinistry is 5.Of 4993 samples examined under the sale of Food
and Drugs Acts, 2-8 per cent. were returned as
adulterated. There was a drop in the percentageadulteration of articles other than milk and a slightincrease in milk adulteration. Mr. G. D. Elsdon, thepublic analyst, commenting on the claim that thepercentage of fat is seriously diminished when thecows are first put out to grass, shows that the reductionis only slight. Of over 48,000 samples of milkexamined during the years 1913-29, the average com-position for the year was 3-68 per cent. of fat and8-91 per cent. of solids-not-fat. When the compositionis examined month by month it is found that theaverage fat percentage for April is 3-63 ; for May,3-59 ; for June, 3-55 ; for July, 3-57 ; for August,3-66 and for September, 3-75. As is well recognised,the assumption that milk contains added water isbased on its content of solids-not-fat. In 1921Hortvet (U.S.A.) devised an apparatus for thedetection of added water in milk, which depended onthe constancy of the freezing-point of genuine milk.Mr. Elsdon has been investigating the reliabilityof the Hortvet apparatus during the year and up to thepresent his work confirms its value. Of 58 samples
of water examined as to potability, 4 out of 10 fromshallow wells were unsafe or doubtful and 2 unfit ;11 out of 16 from deep wells were classed as unsafeor doubtful ; 2 out of 4 from springs, 1 out of 3 fromstreams, and 1 out of 14 from an upland surfacesource were also put in the same category.
There were 406 notifications of small-pox and3 deaths. Scarlet fever cases numbered 6205 andthe deaths 34. At Oswaldtwistle two children wereremoved to hospital leaving two at home. After sixweeks in hospital the patients returned home and thetwo other children contracted the disease. As a resultthe local medical officer of health adopted theeucalyptus oil method and up to now has had 86cases without a secondary case. At Preston (rural)four families with the same milk-supply were attacked.When the farm was visited a girl was found, whowas desquamating, with a typical scarlet fever tongue,following a sore-throat, and her brother had been illseven days previously. In Prestwich there was
a school epidemic caused by scholars attendingschool whilst undergoing very mild attacks. Thecases of diphtheria numbered 1620 and the deaths120, giving the high case-fatality of 7-4 per cent.At Wigan (rural) an outbreak of enteric was attributedto a carrier, and an outbreak at Oswaldtwistle todrinking water from a stream grossly polluted withexcretal matter. In 1924 there were 299 notificationsof encephalitis lethargica and 103 deaths. Thenumbers have slowly declined and in 1929 there were88 notifications and 94 deaths. The notificationfigures for the last ten years evidently underrate thenumber of persons affected. There was a progressivedecline in the county death-rate from pulmonarytuberculosis, from 0-77 in 1922 to 0-58 in 1928, butlast year there was a set-back to 0-60.
Twenty-three years ago 83 per cent. of the midwiveswere untrained ; now, 87-3 per cent. are trained.The county council is the local supervising authorityfor midwives in the whole administrative county, anddirects the maternity and child welfare work in79 out of the 119 districts ; it conducts one ante-natal clinic at Litherland and contracts for the use ofthree antenatal clinics at Widnes, Chorley, and Eccles.The council also arranges for the use of 20 maternityhospitals and for the admission of antenatal casesto hospitals at Blackburn, Burnley, Liverpool, andFulwood. The orthopaedic scheme has been extendedby the inclusion of one county borough, fourboroughs, and three urban districts. 245 crippledchildren were admitted to Biddulph County CouncilHospital, where 202 remedial operations were per-formed. The out-stations treated 2513 children.
West Riding of Yorkshire.Dr. T. N. V. Potts, who presents the report, did
not take over the duties of county medical officeruntil 1930. Dr. J. R. Kaye retired after 33 years’service in June, 1929, and Dr. P. L. Sutherland wasacting medical officer for the remainder of the year.The influenza epidemic showed its effect on the
mortality from heart and respiratory diseases andexacted a toll especially in the earliest and later age-groups. Infant mortality was 27 higher than inthe previous year. The general death-rate was thehighest recorded since 1919. Dr. Potts thinks thecampaign against tuberculosis will be much strength-ened by the provision of the new sanatorium of300 beds at Scotton Banks and the installation ofseven X ray plants at the principal dispensaries.As the result of continued trade depression a definiteimpairment in the nutrition of mothers and childrenattending the centres was noted and greatly increasedquantities of dried milk were issued. A seriousepidemic of enteric fever was recorded at Honley.There were 27 cases with six deaths, and the originof the outbreak appeared to be connected with thecontamination of wells by leakage of sewage into anold culvert. Dr. Potts appeals to all local authorities,
who have not yet done so, to adopt by-laws for smokeabatement in order that there may be uniformity inadministration thioughout the Riding. Some ante-natal work is in operation at about half the childwelfare centres, and Dr. Potts suggests that thereshould be a few centres with more complete equip-ment or maternity homes with an antenatal depart-ment manned by specialists of recognised consultativestanding to which difficult cases could be referredfrom the ordinary centres.
Dr. William Bullough says the death-rate was thehighest since 1919, the increased mortality beinglargely due to influenza, diseases of the respiratorysystem, and heart disease. The infantile mortalityonly showed an increase of two. The new sanatoriumat Black Notley (184 beds) was opened by the Ministerof Health on April 26th, 1930, and X ray facilitieshave been extended and fully utilised. There hasbeen some difficulty in maintaining a full staff ofhealth visitors during the year. The care of thecrippled children has been furthered by the appoint-ment of a whole-time orthopaedic masseuse.The 1929 clean milk competition was limited to
farms which had never received an award, with theaim of extending this educative influence to newentrants. There were 17 competitors. The countycouncil have passed resolutions in favour of amendingthe nomenclature of designated milks, and of a penaltyfor the sale of milk which does not conform to aprescribed standard of cleanliness. The samplesof milk examined for tubercle were 166 with 15positive. The percentage of 9-6 compares with 7-0for the previous years. Dr. Bullough thinks theeffort to deal with unfit houses is meeting with moresuccess. Some of the sanitary authorities are con-sidering the provision of houses within the means of thelowest paid worker. Several old and derelict cottageshave been most successfully renovated under theHousing (R.W.) Act, 1926. Up to December, 1929,the number of cottages reconditioned under this Act
Iwas 104.The low rainfall of the first nine months of the yeardrew special attention to water-supplies. Twenty-oneper cent. of the parishes in rural districts have nopublic supply and depend upon shallow wells, rain-water, springs, and ponds. The public supplies in() parishes failed wholly or partly and in 23 parisheswere depleted, whilst in 244 the supply was main-tained. It is hoped that an improvement will resultfrom the power given to the county council under theLocal Government Act, 1929, to contribute to theexpenditure by local sanitary authorities on water-supplies.
It is considered that the nuisance caused by thedumping of London refuse on the northern bank ofthe Thames has reached a more hopeful stage. It is20 years since Dr. J. C. Thresh made his first completeinvestigation and report on this matter.
MENTAL HOSPITAL REPORTS.
Of the two KENT COUNTY MENTAL HOSPITALS thatat B ARMING HEATH had 1923 patients in residence atthe end of last year and there is need for furtheraccommodation, preferably a new admission villa.3’Iuch valuable room is still occupied by mentaldefectives and old chronic cases who would be betteroff elsewhere. The recovery-rate was 32’3 per cent.and 74-1 per cent. of the recoveries took place afterl33s than a year’s treatment. The death-rate was 7-7per cent. There were two cases of erysipelas andeight of dysentery, and a small epidemic of influenzain the spring. There has been a great increase in thework of the occupations department, and on anaverage 65 per cent. of the men and 90 per cent. of thewomen are engaged in some kind of work. A newoccupations centre for women came into use lastspring and the movement is more than self-supporting,
the profits serving t,o provide trips to the sea, the Zooand the circus, and visits to town and picture theatres.Parole is freely given. Installation of electric lightis under consideration. Fifteen male nurses work onthe male side and 41 attendants and 46 nurses arecertificated or registered. A proposal is on foot toopen an out-patient clinic at the hospital. Therewere 1375 patients at the CilARTHAM DOWN HOSPITALat the end of last year and there also the question ofaccommodation is becoming acute. Mental defectivesare still cared for in the hospital. There was a severeepidemic of influenza in the spring with 30 deaths.Although vigorous malarial treatment is given forgeneral paralysis, many of the cases are admitted solate that the results are disappointing. Tryparsamide,bismuth, the Starke treatment, and " Sulfosin Leo "have been tried, with varying success. An investiga-tion on blood pressure has not revealed any relationbetween the readings and mental disorder. A numberof patients who did not seem to have benefited fromtheir food are being treated with insulin with excellentresults, but collosal calcium has not given any appreci-able benefit in epilepsy. The recovery-rate was 36per cent. and the death-rate 11 per cent. Parole isused extensively and it is hoped to have wireless in allthe wards by next Christmas. The pathologicaldepartment carried out a large number of routineinvestigations and an operating theatre is in course ofconstruction. Craft work and drill classes are heldtwice weekly by voluntary helpers. Plans for a
nurses’ home are under consideration ; 50 male and27 female nurses are certificated or registered. Aconsulting ear, nose and throat specialist has beenappointed to visit fortnightly.The CITY OF LEICESTER MENTAL HOSPITAL at
WEST HUMBERSTONE had 986 patients on its bookson March 31st last. The recovery-rate for the yearwas 40-7 per cent. and the death-rate 6-6 per cent.Malarial treatment for general paralysis is beingcontinued. There were seven cases of dysentery andone of typhoid. Two enteric carriers were found andin one the gall-bladder was removed to clear up thecondition. In addition to a number of routineexaminations, the laboratory has investigated theVernes test and report in favour of it, as being lessliable to human error than the Wassermann. Thepositive Wassermann appears to be more reliable thanthe positive Vernes, but the negative Vernes morereliable than the negative Wassermann. Parole hasbeen given to more than half the men patients andnearly half the women, and leave of absence grantedvery frequently. Although there is no organisedsvstem of occupation, 71 per cent. of the patients havebeen usefully employed. The visiting dentift carriedout 390 operations. The amount of sedative drugsgiven has been greatly reduced during the last twoyears and there appears to be no doubt that patientsare better without them. All the nurses are expectedto enter for the State examinations ; three of themwere successful last year, bringing the total to 50certificated or registered.
The illustrated report of the LANCASHIRE ANDCHESHIRE SOCIETY FOR THE PERMANENT CARE OF THEFEEBLE-MINDED records a happy and uneventfulyear. There are now 101 women and 36 girls, 140 menand 89 boys in the colony. There was one death-an imbecile woman of 35 from very rapid consumption.The report observes that there is nothing in particularto note about the women except the accidentaldiscovery that they had a great dislike to being morethan 30 years old ! In consequence a special expeditionand extra Christmas presents were provided forinmates over that age. The day school is attendedby 81 boys and 36 girls. The health was excellentthroughout the year and the only infectious illnesswas mild epidemics of whooping-cough and chicken-pox, one case of measles, and one of German measles.Two girls suffering from phthisis are isolated in anoutdoor hut.