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VITAL STATISTICS OF LONDON DURING OCTOBER, 1920.
1020
Public Health. SCHOOL MEDICAL SERVICE. Colchester. AT Colchester the average number of children on the school registers in 1919 was 6315, with an attendance ratio of 89’4 per cent.; the. number medically examined in the routine inspections was 2208, the group of " leavers " being very numerous (1212), on account of the routine examinations having been in abeyance during 1917 and 1918. A special inquiry was made as to the effect of child labour during the war. It was found that 420 children were employed before or after school hours, and that 141 employers were infringing the Employment of Children By-laws of 1913, the worst - cases being those of errand boys and boys delivering newspapers. Steps were taken to bring these by-laws to the public notice, and employers were warned. There can be little doubt that benefit will result to the children, and that school teachers and health officers will welcome the reduction of the hours of work allowed, especially before attending school in the morning. Dr. W. H. Corfield, the medical officer of health and school medical officer, mentions in his report that, owing to the year’s work having to be completed in six months, only routine cases (that is, children in the code groups) were examined in the schools, all " specials " being sent to the Treatment Clinic. Dr. R. H. Vercoe, the assistant school medical officer, draws attention to a large school recently erected (Canterbury-road Infants) in which all the classrooms, with one exception, face due north, and remarks with justice that " this appears to be an extremely unfortunate design." With the many years’ experience in school-planning and construction now available it is difficult to understand how such an arrangement can have been either designed or approved. Dr. Vercoe also gives some interesting details as to children with heart disease. Of 20 such cases 8 had suffered from rheumatic fever or rheumatism, 3 from diphtheria, and 2 from scarlet fever; 1 girl had had five attacks of rheumatic fever, with marked dilatation and mitral disease. She "showed some dyspnoea after severe exercise ; she was stopped from drill and the parents given general advice." Unless such cases as these are definitely placed under regular medical care and supervision there will always be risk of serious and even fatal consequences, the effect of which (if happening in school) may be deplorable. Dr. Vercoe contributes a very useful appendix on Pediculosis capitis in school children, based on extensive observation. As to causation, with reference to the relative importance of school contact, as compared with parental negligence, he shows that the latter is the more important factor. Immediately after the summer holidays of five weeks two schools were examined (girls only): in one of these, out of 92 girls 45 per cent., in the other 27 per cent. out of 293 girls, were found to be badly infested. In the first school all of the badly infested children (42) were excluded; in the second and larger school it was found inadvisable to exclude all of therefore the committee decided that these (81); 16 only should be excluded; but the school nurse visited the homes of all affected and instructed the parents as to treatment. The result was that all the excluded children in both schools (58) were clean enough to be readmitted within periods ranging from three days to four weeks ; while of the 65 children not excluded, none were really clean at the end and in 67 per cent. there was of the period, no improvement. Parental negligence is certainly an important factor, but there may be extenuating in Dr. Vercoe considers detail circumstances. the various methods of treatment for this condition. Warm vinegar, as commonly recommended, he has not found to be satisfactory; kerosene is dangerous. Actual lice can be got rid of by the usual methods without difftculty; for removal of nits solutions of 20 per cent. acetic acid, 5 per cent. potash, and 10 per cent. hydro-
chloric acid were compared. Cold solutions had no effect whatever ; with hot solutions nits could be easily drawn off the hairs. Hot vinegar (not warm) is recommended, "as hot as can be "borne by the scalp." exclusion from school The main recommendation is at the beginning of term, together with clear printed instructions, and prosecution of those who have no extenuating circumstances and are not clean within two weeks, appears to be the best course."
URBAN VITAL STATISTICS. (Week ended Nov. 6th, 1920.) English’
ana
welsn Towns.-in Lne 96
English
ana weisn
towns, with an aggregate civil population estimated at nearly
18 million persons, the annual rate of mortality, which had been 10-7, 10’9, and 11’7 in the three preceding weeks, further In London, with a population of rose to 11-8 per 1000. nearly 4 million persons, the annual death-rate was 11’7, against 11’8 per 1000 in the previous week, while among the remaining towns the rates ranged from 3-8 in . Rotherham, 4-3 in Smethwick, and 5’5 in Tottenham, to 18-6 in West Bromwich, 23-4 in South Shields, and 24-1 in Stockton-on-Tees. The principal epidemic diseases caused 245 deaths, which corresponded to an annual rate of 0-7 per 1000, and comprised 129 from infantile diarrhoea, 69 from diphtheria, 15 from scarlet fever, 14 each from measles and whooping-cough, and 4 from enteric fever. The deaths from diarrhoea, which had been 207, 193, and 185 in the three preceding weeks, further fell to 129, and included 26 in London, 13 in Sheffield, 10 in Liverpool, 8 in Manchester, and 7 in Birmingham. The mortality from the remaining diseases showed no marked excess in any of the large towns. There were 5374 cases of scarlet fever and 2353 of diphtheria under treatment in the Metropolitan Asylums Hospitals and the London Fever Hospital, against 5167 and 2301 respectively at the end of the previous week. The causes of 26 of the 4046 deaths in the 96 towns were uncertified, of which 5 were registered in Tynemouth, 4 in Birmingham, and 3 in Liverpool. Scottish Towns.-In the 16 largest Scottish towns, with an
aggregate population estimated at nearly 2 million persons, the annual rate of mortality, which had been 11-5, 12-1, and 13-9 in the three preceding weeks, further rose to 14-7 per 1000. The 348 deaths in Glasgow corresponded to an annual
rate of 16-3 per 1000, and included 11 from infantile diarrhoea, 3 each from measles, scarlet fever, and diphtheria, and 2 each from enteric fever and small-pox. The 89 deaths in Edinburgh were equal to a rate of 13-6 per 1000, and included 2 from diphtheria and 1 each from enteric fever, measles, and infantile diarrhoea. Irish Towns.—The 117 deaths in Dublin corresponded to an annual rate of 14-7, or 0-8 per 1000 above that recorded in the previous week, and included 4 from infantile diarrhosa, 2 each from whooping-cough and diphtheria, and 1 from enteric fever. The 100 deaths in Belfast were equal to a rate of 12-6 per 1000, and included 4 from infantile diarrhœa, and 2 each from scarlet fever and diphtheria.
VITAL STATISTICS OF LONDON DURING OCTOBER, 1920. line
accompanying tacie will oe louna summarisea relating to sickness and mortality in the City of and in each of the metropolitan boroughs. With regard to the notified cases of infectious diseases, it appears that the number of persons reported to be suffering from one or other of the ten diseases notified in the table was equal to an annual rate of 16-3 per 1000 of the population, estimated at 4,358,309 persons; in the three preceding months the rates had been 6-5, 6-6, and 11-3 per 1000. Among the metropolitan boroughs the lowest rates from these diseases were recorded in Kensington, Chelsea, the City of Westminster, Hampstead, Stoke Newington, and Lewisham ; and the highest in Bethnal Green, Stepney, Poplar, and Bermondsey. Scarlet fever showed a marked increase in prevalence-50 per cent.-over the already high number of the preceding anonth ; this disease was proportionally most prevalent in Bethnal Green, Stepney, Poplar, and Bermondsey. The Metropolitan Asylums Hospitals contained 5117 scarlet fever patients at the end of the month, against 1940, 2251, and 3683 at the end of the three preceding months ; the weekly admissions averaged 873, against 284, 335, and 603 in the three preceding months. Diphtheria also showed a considerable increase in prevalence-25 per cent.-over the month of September; the greatest proportional prevalence of this disease was recorded in Paddington, Islington, Hackney, Holborn, Poplar, and Battersea. The number of diphtheria patients under treatment in the Metropolitan Asylums Hospitals, which had been 1470, 1388, and .1773 at the end
statistics m
London
1021 ANALYSIS OF SICKNESS AND MORTALITY STATISTICS IN LONDON DURING OCTOBER, 1920.
(Sloecially compiled.for THE LANCET.) __-
i
,
*
Including membranous croup.
of the three preceding months, further rose to 2284 at the end of October; the weekly admissions averaged 364, against 179, 173, and 266 in the three preceding months. The prevalence of enteric fever was about equal to that in the two preceding months ; of i the 25 cases notified during the four weeks ended Oct. 30th, 4 belonged to Islington, and 3 each to Hampstead, St. Pancras, Shoreditch, and Lambeth. There were 19 cases of enteric fever under treatment in the Metropolitan Asylums Hospitals at the end of the month, against 24, 17, and 14 at the end of the three preceding months; the weekly admissions averaged 4, against 6,3, and 3 in the three preceding months. Erysipelas was proportionally most prevalent in Hackney, Finsbury, Shoreditch, Bethnal Green, and Stepney. The 31 cases of puerperal fever included 4 in Poplar, 3 in Fulham, 3 in Stepney, and 3 in Bermondsey. The 9 cases of cerebro-spinal meningitis included 2 in Stepney and 2 in Battersea; while of the 9 cases of poliomyelitis, 2 belonged to St. Marylebone. The mortality statistics in the table relate to the deaths of civilians actually belonging to the several boroughs, the deaths occurring in institutions having been distributed among the boroughs in which the deceased persons had previously resided. During the four weeks ended Oct. 30th the deaths of 3523 London residents were registered, equal to an annual rate of 10-5 per 1000; in the three preceding, months the rates had been 9-6, 9-3, and 9-9 per 1000. The death-rates ranged from 8-3 in Hampstead, 8’4 in the City of London, 8-6 in Chelsea, 8-7 in Bermondsey, and 8-8 in Woolwich, to 12-0 in Shoreditch, 12-7 in Southwark, 13-0 in St. Marylebone, 13-3 in Bethnal Green, and 18-8 in Holborn. The 3523 deaths from all causes included 253 which were referred to the principal infectious diseases; of these, 6 resulted from measles, 14 from scarlet fever, 63 from diphtheria, 12 from whooping-cough, 3 from enteric fever, and 155 from diarrhoea and enteritis among children under 2 years of age. No death from any of these diseases was recorded in the City of London. Among the metropolitan boroughs the lowest death-rates from these diseases were recorded in Chelsea, the City of Westminster, St. Marylebone, Hampstead, Stoke Newington, Southwark, and Woolwich; and the highest in Islington, Shoreditch, Bethnal Green, Poplar, Wandsworth, Deptford, and Greenwich. The 6 deaths from measles were 14 below the
average number in the corresponding period of the five preceding years; of these, 2 belonged to Bethnal Green. The 14 fatal cases of scarlet fever exceeded the average by 1; of these, 2 belonged to Islington and 2 to Poplar. The 63 deaths from diphtheria were 3 above the average number; of these, 14 belonged to Islington, 7 to Poplar, 5 to Bethnal Green, and 5 to Lambeth. The 12 fatal cases of whooping-cough were 9 fewer than the average; of these, 3 belonged to Bermondsey and 2 to Woolwich. Three deaths from enteric fever were registered during the month, against an average of 10. The 155 fatal cases of infantile diarrhoea showed a decline of 131 from the average ; the greatest proportional mortality from this disease occurred in Shoreditch, Bethnal Green, Stepney, Deptford, and Greenwich. In conclusion, it may be stated that the aggregate mortality in London during October from these principal infectious diseases was 38 per cent. below the average in the corresponding period of the five preceding years.
ROYAL UNITED HOSPITAL, BATH.-The committee
of this hospital is appealing for funds for the establishment of a hospital for paying patients and a maternity home to contain about 40 beds. The entire cost of the scheme, which includes the transfer of the Royal United Hospital to a more healthy site, is estimated at jE150,000. At present the subscriptions for the undertaking amount to about £24,000.
THE
LATE
DR. JOHN MICHIE.-Dr. Michie, who
died recently in a London nursing home, qualified M.B., B.S. Melbourne in 1889, and afterwards held the appointments of house surgeon to the Adelaide Hospital, South Australia, and surgeon to the Adelaide Children’s Hospital. Coming to England, he first practised in London, and then for many years resided at Bognor, where he took a prominent part in local affairs, and was elected to the chairmanship of the urban council. He retired from practice some four years ago, and intended to return to his native land, but was prevented by ill-health. A prominent Freemason, he was a Past Master of the Gordon Lodge at Bognor.
Public Health. SCHOOL MEDICAL SERVICE. Colchester. AT Colchester the average number of children on the school registers in 1919 was 6315, with an attendance ratio of 89’4 per cent.; the. number medically examined in the routine inspections was 2208, the group of " leavers " being very numerous (1212), on account of the routine examinations having been in abeyance during 1917 and 1918. A special inquiry was made as to the effect of child labour during the war. It was found that 420 children were employed before or after school hours, and that 141 employers were infringing the Employment of Children By-laws of 1913, the worst - cases being those of errand boys and boys delivering newspapers. Steps were taken to bring these by-laws to the public notice, and employers were warned. There can be little doubt that benefit will result to the children, and that school teachers and health officers will welcome the reduction of the hours of work allowed, especially before attending school in the morning. Dr. W. H. Corfield, the medical officer of health and school medical officer, mentions in his report that, owing to the year’s work having to be completed in six months, only routine cases (that is, children in the code groups) were examined in the schools, all " specials " being sent to the Treatment Clinic. Dr. R. H. Vercoe, the assistant school medical officer, draws attention to a large school recently erected (Canterbury-road Infants) in which all the classrooms, with one exception, face due north, and remarks with justice that " this appears to be an extremely unfortunate design." With the many years’ experience in school-planning and construction now available it is difficult to understand how such an arrangement can have been either designed or approved. Dr. Vercoe also gives some interesting details as to children with heart disease. Of 20 such cases 8 had suffered from rheumatic fever or rheumatism, 3 from diphtheria, and 2 from scarlet fever; 1 girl had had five attacks of rheumatic fever, with marked dilatation and mitral disease. She "showed some dyspnoea after severe exercise ; she was stopped from drill and the parents given general advice." Unless such cases as these are definitely placed under regular medical care and supervision there will always be risk of serious and even fatal consequences, the effect of which (if happening in school) may be deplorable. Dr. Vercoe contributes a very useful appendix on Pediculosis capitis in school children, based on extensive observation. As to causation, with reference to the relative importance of school contact, as compared with parental negligence, he shows that the latter is the more important factor. Immediately after the summer holidays of five weeks two schools were examined (girls only): in one of these, out of 92 girls 45 per cent., in the other 27 per cent. out of 293 girls, were found to be badly infested. In the first school all of the badly infested children (42) were excluded; in the second and larger school it was found inadvisable to exclude all of therefore the committee decided that these (81); 16 only should be excluded; but the school nurse visited the homes of all affected and instructed the parents as to treatment. The result was that all the excluded children in both schools (58) were clean enough to be readmitted within periods ranging from three days to four weeks ; while of the 65 children not excluded, none were really clean at the end and in 67 per cent. there was of the period, no improvement. Parental negligence is certainly an important factor, but there may be extenuating in Dr. Vercoe considers detail circumstances. the various methods of treatment for this condition. Warm vinegar, as commonly recommended, he has not found to be satisfactory; kerosene is dangerous. Actual lice can be got rid of by the usual methods without difftculty; for removal of nits solutions of 20 per cent. acetic acid, 5 per cent. potash, and 10 per cent. hydro-
chloric acid were compared. Cold solutions had no effect whatever ; with hot solutions nits could be easily drawn off the hairs. Hot vinegar (not warm) is recommended, "as hot as can be "borne by the scalp." exclusion from school The main recommendation is at the beginning of term, together with clear printed instructions, and prosecution of those who have no extenuating circumstances and are not clean within two weeks, appears to be the best course."
URBAN VITAL STATISTICS. (Week ended Nov. 6th, 1920.) English’
ana
welsn Towns.-in Lne 96
English
ana weisn
towns, with an aggregate civil population estimated at nearly
18 million persons, the annual rate of mortality, which had been 10-7, 10’9, and 11’7 in the three preceding weeks, further In London, with a population of rose to 11-8 per 1000. nearly 4 million persons, the annual death-rate was 11’7, against 11’8 per 1000 in the previous week, while among the remaining towns the rates ranged from 3-8 in . Rotherham, 4-3 in Smethwick, and 5’5 in Tottenham, to 18-6 in West Bromwich, 23-4 in South Shields, and 24-1 in Stockton-on-Tees. The principal epidemic diseases caused 245 deaths, which corresponded to an annual rate of 0-7 per 1000, and comprised 129 from infantile diarrhoea, 69 from diphtheria, 15 from scarlet fever, 14 each from measles and whooping-cough, and 4 from enteric fever. The deaths from diarrhoea, which had been 207, 193, and 185 in the three preceding weeks, further fell to 129, and included 26 in London, 13 in Sheffield, 10 in Liverpool, 8 in Manchester, and 7 in Birmingham. The mortality from the remaining diseases showed no marked excess in any of the large towns. There were 5374 cases of scarlet fever and 2353 of diphtheria under treatment in the Metropolitan Asylums Hospitals and the London Fever Hospital, against 5167 and 2301 respectively at the end of the previous week. The causes of 26 of the 4046 deaths in the 96 towns were uncertified, of which 5 were registered in Tynemouth, 4 in Birmingham, and 3 in Liverpool. Scottish Towns.-In the 16 largest Scottish towns, with an
aggregate population estimated at nearly 2 million persons, the annual rate of mortality, which had been 11-5, 12-1, and 13-9 in the three preceding weeks, further rose to 14-7 per 1000. The 348 deaths in Glasgow corresponded to an annual
rate of 16-3 per 1000, and included 11 from infantile diarrhoea, 3 each from measles, scarlet fever, and diphtheria, and 2 each from enteric fever and small-pox. The 89 deaths in Edinburgh were equal to a rate of 13-6 per 1000, and included 2 from diphtheria and 1 each from enteric fever, measles, and infantile diarrhoea. Irish Towns.—The 117 deaths in Dublin corresponded to an annual rate of 14-7, or 0-8 per 1000 above that recorded in the previous week, and included 4 from infantile diarrhosa, 2 each from whooping-cough and diphtheria, and 1 from enteric fever. The 100 deaths in Belfast were equal to a rate of 12-6 per 1000, and included 4 from infantile diarrhœa, and 2 each from scarlet fever and diphtheria.
VITAL STATISTICS OF LONDON DURING OCTOBER, 1920. line
accompanying tacie will oe louna summarisea relating to sickness and mortality in the City of and in each of the metropolitan boroughs. With regard to the notified cases of infectious diseases, it appears that the number of persons reported to be suffering from one or other of the ten diseases notified in the table was equal to an annual rate of 16-3 per 1000 of the population, estimated at 4,358,309 persons; in the three preceding months the rates had been 6-5, 6-6, and 11-3 per 1000. Among the metropolitan boroughs the lowest rates from these diseases were recorded in Kensington, Chelsea, the City of Westminster, Hampstead, Stoke Newington, and Lewisham ; and the highest in Bethnal Green, Stepney, Poplar, and Bermondsey. Scarlet fever showed a marked increase in prevalence-50 per cent.-over the already high number of the preceding anonth ; this disease was proportionally most prevalent in Bethnal Green, Stepney, Poplar, and Bermondsey. The Metropolitan Asylums Hospitals contained 5117 scarlet fever patients at the end of the month, against 1940, 2251, and 3683 at the end of the three preceding months ; the weekly admissions averaged 873, against 284, 335, and 603 in the three preceding months. Diphtheria also showed a considerable increase in prevalence-25 per cent.-over the month of September; the greatest proportional prevalence of this disease was recorded in Paddington, Islington, Hackney, Holborn, Poplar, and Battersea. The number of diphtheria patients under treatment in the Metropolitan Asylums Hospitals, which had been 1470, 1388, and .1773 at the end
statistics m
London
1021 ANALYSIS OF SICKNESS AND MORTALITY STATISTICS IN LONDON DURING OCTOBER, 1920.
(Sloecially compiled.for THE LANCET.) __-
i
,
*
Including membranous croup.
of the three preceding months, further rose to 2284 at the end of October; the weekly admissions averaged 364, against 179, 173, and 266 in the three preceding months. The prevalence of enteric fever was about equal to that in the two preceding months ; of i the 25 cases notified during the four weeks ended Oct. 30th, 4 belonged to Islington, and 3 each to Hampstead, St. Pancras, Shoreditch, and Lambeth. There were 19 cases of enteric fever under treatment in the Metropolitan Asylums Hospitals at the end of the month, against 24, 17, and 14 at the end of the three preceding months; the weekly admissions averaged 4, against 6,3, and 3 in the three preceding months. Erysipelas was proportionally most prevalent in Hackney, Finsbury, Shoreditch, Bethnal Green, and Stepney. The 31 cases of puerperal fever included 4 in Poplar, 3 in Fulham, 3 in Stepney, and 3 in Bermondsey. The 9 cases of cerebro-spinal meningitis included 2 in Stepney and 2 in Battersea; while of the 9 cases of poliomyelitis, 2 belonged to St. Marylebone. The mortality statistics in the table relate to the deaths of civilians actually belonging to the several boroughs, the deaths occurring in institutions having been distributed among the boroughs in which the deceased persons had previously resided. During the four weeks ended Oct. 30th the deaths of 3523 London residents were registered, equal to an annual rate of 10-5 per 1000; in the three preceding, months the rates had been 9-6, 9-3, and 9-9 per 1000. The death-rates ranged from 8-3 in Hampstead, 8’4 in the City of London, 8-6 in Chelsea, 8-7 in Bermondsey, and 8-8 in Woolwich, to 12-0 in Shoreditch, 12-7 in Southwark, 13-0 in St. Marylebone, 13-3 in Bethnal Green, and 18-8 in Holborn. The 3523 deaths from all causes included 253 which were referred to the principal infectious diseases; of these, 6 resulted from measles, 14 from scarlet fever, 63 from diphtheria, 12 from whooping-cough, 3 from enteric fever, and 155 from diarrhoea and enteritis among children under 2 years of age. No death from any of these diseases was recorded in the City of London. Among the metropolitan boroughs the lowest death-rates from these diseases were recorded in Chelsea, the City of Westminster, St. Marylebone, Hampstead, Stoke Newington, Southwark, and Woolwich; and the highest in Islington, Shoreditch, Bethnal Green, Poplar, Wandsworth, Deptford, and Greenwich. The 6 deaths from measles were 14 below the
average number in the corresponding period of the five preceding years; of these, 2 belonged to Bethnal Green. The 14 fatal cases of scarlet fever exceeded the average by 1; of these, 2 belonged to Islington and 2 to Poplar. The 63 deaths from diphtheria were 3 above the average number; of these, 14 belonged to Islington, 7 to Poplar, 5 to Bethnal Green, and 5 to Lambeth. The 12 fatal cases of whooping-cough were 9 fewer than the average; of these, 3 belonged to Bermondsey and 2 to Woolwich. Three deaths from enteric fever were registered during the month, against an average of 10. The 155 fatal cases of infantile diarrhoea showed a decline of 131 from the average ; the greatest proportional mortality from this disease occurred in Shoreditch, Bethnal Green, Stepney, Deptford, and Greenwich. In conclusion, it may be stated that the aggregate mortality in London during October from these principal infectious diseases was 38 per cent. below the average in the corresponding period of the five preceding years.
ROYAL UNITED HOSPITAL, BATH.-The committee
of this hospital is appealing for funds for the establishment of a hospital for paying patients and a maternity home to contain about 40 beds. The entire cost of the scheme, which includes the transfer of the Royal United Hospital to a more healthy site, is estimated at jE150,000. At present the subscriptions for the undertaking amount to about £24,000.
THE
LATE
DR. JOHN MICHIE.-Dr. Michie, who
died recently in a London nursing home, qualified M.B., B.S. Melbourne in 1889, and afterwards held the appointments of house surgeon to the Adelaide Hospital, South Australia, and surgeon to the Adelaide Children’s Hospital. Coming to England, he first practised in London, and then for many years resided at Bognor, where he took a prominent part in local affairs, and was elected to the chairmanship of the urban council. He retired from practice some four years ago, and intended to return to his native land, but was prevented by ill-health. A prominent Freemason, he was a Past Master of the Gordon Lodge at Bognor.