- Email: [email protected]
VITAL STATISTICS OF LONDON DURING SEPTEMBER, 1921.
873 adenoids. One hundred and thirty children were VITAL STATISTICS OF LONDON found to be dull and backward, and for these also DURING SEPTEMBER, 1921. An open-air school is no provision has been made. IN the accompanying table will be found summarised greatly needed in the county. Dr. Davies finds that although school closure is of very little use in the statistics relating to sickness and mortality in the City of in each of the metropolitan boroughs. With prevention of infectious disease, the fact that teachers Londontoand the notified cases of infectious disease it appears regard are paid according to the average attendance is an the number of persons reported to be suffering from I inducement to them to desire school closure. It isthat of the ten diseases notified in the table was unfortunate that so much lethargy in regard to one ortoother an annual rate of 14-0 per 1000 of the population, health matters prevails in the county, and that the equal estimated at 4,531,971 persons in the middle of 1920 ; in school medical service is subjected to such the three preceding months the rates had been 9-4, 10-3, and restrictions. 8-5 per 1000. Among the metropolitan boroughs the lowest rates from these diseases were recorded in Chelsea, HYDE. St. Marylebone, Lambeth, Wandsworth, Deptford, and Out of 2056 children examined, 1747 suffered from Lewisham ; and the highest in Hackney, Finsbury, Shoredental defects,’267 from non-tuberculous lung trouble, ditch, Bethnal Green, Stepney, Poplar, and Bermondsey. three from definite pulmonary tuberculosis, 348 from The prevalence of enteric fever was nearly a third greater of the 45 cases notified nose and throat diseases, including 87 cases of en- than in the preceding month ; the four Oct. ended weeks 1st, 8 cases belonged Dental treatment during tonsils and adenoids. was larged received by 116 children, while 16 cases of nose and to Wandsworth, 6 to Poplar, 5 to St. Marylebone, 4 to Kensington, and 3 to Camberwell. There were 37 cases throat troubles were treated under the authority’s of enteric fever under treatment in the Metropolitan Asylums Of 1363 cases of which new scheme. minor ailments, at the end of the month, against 23, 27, and 32 Hospitals received treatment, the majority consisted of impeti-i the end of the three preceding months ; the weekly at ginous and other skin affections. The clinic is openadmissions averaged 7, against 4, 5, and 5 in the three months. The prevalence of scarlet fever showed for two hours daily, excluding Saturdays, and Dr. C. S. Thomson has arranged for all children suffering a marked increase over the previous month-76 per cent.from bronchial catarrh to be seen weekly. Where,and was considerably higher than in any preceding month November, 1920 ; this disease was proportionally medicine is required the child is sent to the family since most prevalent in Hackney, Finsbury, Shoreditch, Bethnal doctor. Twenty per cent. of the children Green, Stepney, Poplar, and Bermondsey. The Metrodirty heads ; this appears a high percentage, but it Ipolitan Asylums Hospitals contained 4847 scarlet fever must be remembered that the same standard of patients at the end of the month, against 3621, 3722, and cleanliness is not accepted by all authorities. If 3408 at the end of the three preceding months ; the weekly school nursing was thoroughly carried out the numbers admissions averaged 840, against 506, 567, and 467 in the could be reduced considerably. The report shows three preceding months. Diphtheria also was considerably at least 50 children with crippling defects, and Dr. more prevalent-53 per cent.-than in August, and was about to the average of the first three months of the year ; equal Thomson suggests the formation of a guild of ! the greatest proportional prevalence of this disease occurred to deal with these cases. An earnest endeavour isin Hampstead, Hackney, Holborn, Shoreditch, Stepney,
severe
preceding
had
help
being made borough.
to raise the
hygienic
standard in
this
Greenwich. i, patients underandtreatment Bermondsey, in
The number of diphtheria the Metropolitan Asylums
ANALYSIS OF SICKNESS AND MORTALITY STATISTICS IN LONDON DURING
(Specially compiled for
*
THE
LANCET.)
Including membranous croup.
SEPTEMBER, 1921.
874 Hospitals, which had been 1896, 1969, and 1709 at the end of the three preceding months, rose to 2031 at the end of September ; the weekly admissions averaged 322, against 235, 250, and 209 at the end of the three preceding " Audi alteram partem." months. Erysipelas was proportionally most prevalent in Paddington, Islington, Finsbury, Shoreditch, Bethnal Green, Stepney, and Poplar. Of the 10 cases of poliomyelitis THE REDUCTION OF THE CAPITATION FEE. Five cases or polioencephalitis 2 belonged to Fulham. To the Editor of ’rIlE LANCBT. of encephalitis lethargica were notified during the month, is not without some feeling of shame that the three months. The and 5 in SIR,-It preceding against 10, 9, notified cases of cerebro-spinal fever numbered 5, against members of the medical profession will note on reading 5, 7, and 9 in the three preceding months. The 23 cases of the report of the Minister of Health’s reply to a deputapuerperal fever included 4 in Battersea, 3 in Fulham, and tion of the British Medical Association concerning 2 each in Islington, Poplar, Southwark, and Lambeth. reduction of the panel capitation fee that he had The mortality statistics in the table relate to the deaths the " I told you I was not going to of civilians actually belonging to the several boroughs, occasion to remark, the deaths occurring in institutions having been distributed haggle about this thing, and I am not." Well one among the boroughs in which the deceased persons had may ask what provoked this retort, so little befitting previously resided. During the four weeks ended Oct. 1st, negotiations between a Minister and a deputation of the deaths of 3788 London residents were registered, equal medical men, and the answer appears to be that to an annual rate of 10-9 per 1000 ; in the three preceding the latter attempted by argument to save a few pence months the rates had been 9-4, 9-8, and 10-6 per 1000. The death-rates ranged from 7-3 in Hampstead and in of the impending reduction. Great publicity has been given to what is represented Wandsworth, 8-9 in Greenwich, 9.7 in St. Pancras, 9.8 in Lewisham, and 9-9 in Woolwich, to 11-9 in Hackney, 12-0 as the fighting attitude of the profession regarding in Stepney, 12-2 in Bethnal Green, 13-5 in Shoreditch, this matter, and perhaps it is well that the view held 13-7 in Finsbury, and 14-1 in Southwark. The 3788 deaths by no inconsiderable section of the profession of from all causes included 629 which were referred to the medicine should be stated also. In his reply to the principal infectious diseases ; of these, 7 deaths resulted memorandum forwarded bv the Federation of Medical from enteric fever, 3 from measles, 17 from scarlet fever, 50 from whooping-cough, 73 from diphtheria, and 479 from and Allied Societies on Oct. 4th (published in your diarrhoea and enteritis among children under 2 years of issue of Oct. 8th), the Minister states his appreciation age. Among the metropolitan boroughs the lowest death- of the grounds on which the Federation supports an rates from these diseases were recorded in St. Marylebone, inquiry into the National Health Insurance system Hampstead, Holborn, Wandsworth, Greenwich, and and that he has under careful consideration the Lewisham ; and the highest in Shoreditch, Bethnal Green, question of setting such an inquiry on foot. He Stepney, Poplar, Southwark, and Bermondsey. The states also that the financial condition of the country 7 fatal cases of enteric fever exceeded the average in the necessitates such reduction of the insurance praccorresponding period of the five preceding years by 2. titioner’s fee as is fair to both the country and the The 3 deaths from measles were 19 below the average ; 2 of these deaths belonged to Poplar, and the remaining medical profession. He has announced now that the 1 to Bethnal Green. The 17 fatal cases of scarlet fever inquiry, originally asked for by the Federation in were 7 in excess of the average ; of these, 2 belonged to January, 1920, is going to be held, that it must Hackney. The 50 deaths from whooping-cough were 27 cover all the ground and must be without prejudice. above the average ; the greatest proportional mortality Practitioners on the panel are informed that they from this disease occurred in Paddington, Fulham, Stepney, are expected to share in the reduction of income that 73 fatal and The cases of Deptford. Poplar, Southwark, diphtheria exceeded the average by 33 ; this disease was their non-panel colleagues and practically all other proportionally most fatal in St. Marylebone, Hampstead, sections of the community have experienced already. Finsbury, the City of London, Poplar, Bermondsey, and Therefore it is interesting to estimate exactly what Battersea. The deaths from infantile diarrhoea numbered that reduction will be. Three examples will suffice :479, and exceeded the average by 171. This is the largest 1. The doctor with 3000 panel patients accepting the number of deaths from infantile diarrhoea recorded in reduction of ls. 6d. per capita will lose ;E225 of the 91650 London in September since the corresponding period of The B.M.A. to save annum he receives now. per 1915, when they numbered 739 ; the greatest proportional him jE75 of this sum. 2. Recently a practi.ceattempts of 2400 includmortality from this disease occurered in Kensington, ing a panel of 1300 was advertised. Under the proposed Shoreditch, Bethnal Green, Stepney, and Southwark. The reduction the value of this practice is reduced by JE97 10s. The aggregate mortality in London during September from B.M.A. attempts to save the vendor 232 10s. of this. 3. The these principal infectious diseases was 54 per cent. above practitioner with a panel of 500 stands to lose B38 10s., the average. of which sum the B.M.A. proposal would save him 212 10s. The deaths from influenza registered in London during All will sympathise with the men, and many there the month numbered 21, against 30, 15, and 9 in the three preceding months, and an average of 23 in the corresponding be, who have given of their best to the service regardless of remuneration and are likely to continued so period of the five preceding years.
Correspondence.
to do. Others will find consolation in the fact that the present reduction is equivalent to less than half NEW BIRMINGHAM UNION CON- the increase awarded in March, 1920. But we believe CRIPPLES’ Oct. 5th The , Forelands, that a majority in the profession are too proud of VALESCENT SCHOOL.-On Bromsgrove, was formally opened by the Lord Mayor as a their calling and too jealous " in their service to the convalescent school for crippled children. A spacious community to condescend to haggle over sixpence," mansion, beautifully situated, has been well adapted for and we believe these will agree that the only proper accommodating 80 children. There are two open-air dorto mitories, with large schoolroom and dining-room, and everyand dignified course as take lies in acceptance of the proposal part of a necessary national provision for open-air treatment. Education up to ordinaryMinister’s I shared by all. standards will be combined with gardening, manual instruc-economy This enterprise, made possible At the same time it appears necessary to press for tion, poultry keeping, &c. by an appeal through the Birmingham Mail which raised an early and independent inquiry into the working ;i;15,000, marked the consummation of 25 years’ work in ,of the Acts to ascertain not what the profession is Birmingham on behalf of crippled children. The Cripples’ willing to give the people for 9s. 6d., but how far Union was founded to link up existing organisations, but it 1 were was soon found that these inadequate and the the system has tended to improve the nation’s health Union itself undertook to make the necessary provision.and how a more fully efficient service can be provided, 1 There is now an admirable system of home visiting linked up with general practice and with specialised with an out-patient clinic, an organisation for " after- branches. 1 No fee that the people of this country care work, the Woodlands Surgical and Nursingcan c afford would be too high for such a service and Home, and finally the new convalescent school, a pioneerccertainly they would not begrudge it. <
"
institution. In addition to the .615,000 a grant has been obtained from the Ministry of Health and the school was opened free from debt. Its maintenance will cost from ;i;5000 to 27000 a year. Mr. Naughton Dunn and Mr. Wilson Stuart are to act as surgeons to the Union, and Dr. Rowlands, of Bromsgrove, will be visiting medical omcer.
We are, Sir,
yours
faithfully,
MALCOLM MORRIS, Vice-President. CHAS. BUTTAR, Hon. Secretary. N. HOWARD MUMMERY, General Secretary. ] Federation ofMedical and Allied Societies, 12, Stratfordplace, W. 1, Oct. 17th, 1921.
severe
preceding
had
help
being made borough.
to raise the
hygienic
standard in
this
Greenwich. i, patients underandtreatment Bermondsey, in
The number of diphtheria the Metropolitan Asylums
ANALYSIS OF SICKNESS AND MORTALITY STATISTICS IN LONDON DURING
(Specially compiled for
*
THE
LANCET.)
Including membranous croup.
SEPTEMBER, 1921.
874 Hospitals, which had been 1896, 1969, and 1709 at the end of the three preceding months, rose to 2031 at the end of September ; the weekly admissions averaged 322, against 235, 250, and 209 at the end of the three preceding " Audi alteram partem." months. Erysipelas was proportionally most prevalent in Paddington, Islington, Finsbury, Shoreditch, Bethnal Green, Stepney, and Poplar. Of the 10 cases of poliomyelitis THE REDUCTION OF THE CAPITATION FEE. Five cases or polioencephalitis 2 belonged to Fulham. To the Editor of ’rIlE LANCBT. of encephalitis lethargica were notified during the month, is not without some feeling of shame that the three months. The and 5 in SIR,-It preceding against 10, 9, notified cases of cerebro-spinal fever numbered 5, against members of the medical profession will note on reading 5, 7, and 9 in the three preceding months. The 23 cases of the report of the Minister of Health’s reply to a deputapuerperal fever included 4 in Battersea, 3 in Fulham, and tion of the British Medical Association concerning 2 each in Islington, Poplar, Southwark, and Lambeth. reduction of the panel capitation fee that he had The mortality statistics in the table relate to the deaths the " I told you I was not going to of civilians actually belonging to the several boroughs, occasion to remark, the deaths occurring in institutions having been distributed haggle about this thing, and I am not." Well one among the boroughs in which the deceased persons had may ask what provoked this retort, so little befitting previously resided. During the four weeks ended Oct. 1st, negotiations between a Minister and a deputation of the deaths of 3788 London residents were registered, equal medical men, and the answer appears to be that to an annual rate of 10-9 per 1000 ; in the three preceding the latter attempted by argument to save a few pence months the rates had been 9-4, 9-8, and 10-6 per 1000. The death-rates ranged from 7-3 in Hampstead and in of the impending reduction. Great publicity has been given to what is represented Wandsworth, 8-9 in Greenwich, 9.7 in St. Pancras, 9.8 in Lewisham, and 9-9 in Woolwich, to 11-9 in Hackney, 12-0 as the fighting attitude of the profession regarding in Stepney, 12-2 in Bethnal Green, 13-5 in Shoreditch, this matter, and perhaps it is well that the view held 13-7 in Finsbury, and 14-1 in Southwark. The 3788 deaths by no inconsiderable section of the profession of from all causes included 629 which were referred to the medicine should be stated also. In his reply to the principal infectious diseases ; of these, 7 deaths resulted memorandum forwarded bv the Federation of Medical from enteric fever, 3 from measles, 17 from scarlet fever, 50 from whooping-cough, 73 from diphtheria, and 479 from and Allied Societies on Oct. 4th (published in your diarrhoea and enteritis among children under 2 years of issue of Oct. 8th), the Minister states his appreciation age. Among the metropolitan boroughs the lowest death- of the grounds on which the Federation supports an rates from these diseases were recorded in St. Marylebone, inquiry into the National Health Insurance system Hampstead, Holborn, Wandsworth, Greenwich, and and that he has under careful consideration the Lewisham ; and the highest in Shoreditch, Bethnal Green, question of setting such an inquiry on foot. He Stepney, Poplar, Southwark, and Bermondsey. The states also that the financial condition of the country 7 fatal cases of enteric fever exceeded the average in the necessitates such reduction of the insurance praccorresponding period of the five preceding years by 2. titioner’s fee as is fair to both the country and the The 3 deaths from measles were 19 below the average ; 2 of these deaths belonged to Poplar, and the remaining medical profession. He has announced now that the 1 to Bethnal Green. The 17 fatal cases of scarlet fever inquiry, originally asked for by the Federation in were 7 in excess of the average ; of these, 2 belonged to January, 1920, is going to be held, that it must Hackney. The 50 deaths from whooping-cough were 27 cover all the ground and must be without prejudice. above the average ; the greatest proportional mortality Practitioners on the panel are informed that they from this disease occurred in Paddington, Fulham, Stepney, are expected to share in the reduction of income that 73 fatal and The cases of Deptford. Poplar, Southwark, diphtheria exceeded the average by 33 ; this disease was their non-panel colleagues and practically all other proportionally most fatal in St. Marylebone, Hampstead, sections of the community have experienced already. Finsbury, the City of London, Poplar, Bermondsey, and Therefore it is interesting to estimate exactly what Battersea. The deaths from infantile diarrhoea numbered that reduction will be. Three examples will suffice :479, and exceeded the average by 171. This is the largest 1. The doctor with 3000 panel patients accepting the number of deaths from infantile diarrhoea recorded in reduction of ls. 6d. per capita will lose ;E225 of the 91650 London in September since the corresponding period of The B.M.A. to save annum he receives now. per 1915, when they numbered 739 ; the greatest proportional him jE75 of this sum. 2. Recently a practi.ceattempts of 2400 includmortality from this disease occurered in Kensington, ing a panel of 1300 was advertised. Under the proposed Shoreditch, Bethnal Green, Stepney, and Southwark. The reduction the value of this practice is reduced by JE97 10s. The aggregate mortality in London during September from B.M.A. attempts to save the vendor 232 10s. of this. 3. The these principal infectious diseases was 54 per cent. above practitioner with a panel of 500 stands to lose B38 10s., the average. of which sum the B.M.A. proposal would save him 212 10s. The deaths from influenza registered in London during All will sympathise with the men, and many there the month numbered 21, against 30, 15, and 9 in the three preceding months, and an average of 23 in the corresponding be, who have given of their best to the service regardless of remuneration and are likely to continued so period of the five preceding years.
Correspondence.
to do. Others will find consolation in the fact that the present reduction is equivalent to less than half NEW BIRMINGHAM UNION CON- the increase awarded in March, 1920. But we believe CRIPPLES’ Oct. 5th The , Forelands, that a majority in the profession are too proud of VALESCENT SCHOOL.-On Bromsgrove, was formally opened by the Lord Mayor as a their calling and too jealous " in their service to the convalescent school for crippled children. A spacious community to condescend to haggle over sixpence," mansion, beautifully situated, has been well adapted for and we believe these will agree that the only proper accommodating 80 children. There are two open-air dorto mitories, with large schoolroom and dining-room, and everyand dignified course as take lies in acceptance of the proposal part of a necessary national provision for open-air treatment. Education up to ordinaryMinister’s I shared by all. standards will be combined with gardening, manual instruc-economy This enterprise, made possible At the same time it appears necessary to press for tion, poultry keeping, &c. by an appeal through the Birmingham Mail which raised an early and independent inquiry into the working ;i;15,000, marked the consummation of 25 years’ work in ,of the Acts to ascertain not what the profession is Birmingham on behalf of crippled children. The Cripples’ willing to give the people for 9s. 6d., but how far Union was founded to link up existing organisations, but it 1 were was soon found that these inadequate and the the system has tended to improve the nation’s health Union itself undertook to make the necessary provision.and how a more fully efficient service can be provided, 1 There is now an admirable system of home visiting linked up with general practice and with specialised with an out-patient clinic, an organisation for " after- branches. 1 No fee that the people of this country care work, the Woodlands Surgical and Nursingcan c afford would be too high for such a service and Home, and finally the new convalescent school, a pioneerccertainly they would not begrudge it. <
"
institution. In addition to the .615,000 a grant has been obtained from the Ministry of Health and the school was opened free from debt. Its maintenance will cost from ;i;5000 to 27000 a year. Mr. Naughton Dunn and Mr. Wilson Stuart are to act as surgeons to the Union, and Dr. Rowlands, of Bromsgrove, will be visiting medical omcer.
We are, Sir,
yours
faithfully,
MALCOLM MORRIS, Vice-President. CHAS. BUTTAR, Hon. Secretary. N. HOWARD MUMMERY, General Secretary. ] Federation ofMedical and Allied Societies, 12, Stratfordplace, W. 1, Oct. 17th, 1921.