At the meeting of the Rushden Urban District Council on Wednesday evening the Medical Officer of Health (Dr. H. S. Baker) presented his annual report, as follows:-

I have the honour to submit the Annual Report for 1918 of the Medical Officer for the Sanitary District under your administration.

The Local Government Board in their memorandum to Medical Officers suggest that the report for 1918 be brief, giving vital statistics for the year in order to keep the records of the district continuous, and with only a short account of any outbreaks of disease and other prominent sanitary events of the year.

Influenza

In common with other districts throughout the country (as well as being disseminated almost generally throughout all the countries of the world) we were visited by two distinct outbreaks of the malady known as Influenza. The first outbreak which began about the middle of June, reaching its maximum intensity during the month of July, had spent the force of its activity by the beginning of August. A large proportion of the population were affected in some degree, and incapacitated from work for a longer or shorter time, fortunately mostly the latter. The number of fatalities ensuing from it in this district was singularly small in comparison to that of other places both in immediate contact with us and more remote. The second visitation occurred during the months of October and November, and bore a very similar resemblance in its onset and incidence to the first attack, beginning with isolated cases, gradually reaching a maximum, and then gradually declining. The epidemic in this instance seemed to be accompanied by a larger incidence of respiratory complications, Bronchitis, Pneumonia, and allied maladies probably accounted for by seasonal differences. Again the numbers of fatalities occurring in the town were relatively few. Of those attacked the larger number were those of the younger generations, those who had reached middle age and over did not so readily succumb as victims.

Our comparative immunity from fatalities I attribute generally to the satisfactory sanitary conditions that in general prevail in the district, and as a consequence the standard of health of the population being higher in resistance, or the factor of causation less virulent. The latter is unlikely as districts in almost immediate contact with us would appear to suffer a much higher rate of mortality.

The symptoms varied a little with each visitation and were somewhat protean in character, many cases bearing a family likeness to other well-known diseases, such as Scarlet Fever and Diphtheria. One attack did not seem to confer immunity, many persons falling victims during each epidemic.

The cause, though so far as I know not being yet certainly identified, there can be little doubt is an infective organism availing itself of not-understood or ill-understood atmospheric conditions, which may or may not be incidental to the unusual activities of mankind, gaining entrance to the body by the respiratory passages or alimentary tract. The cause of brevity prevents me making further comment.

It was thought advisable to close the infants’ schools in some instances over a short period in consequence of low attendance. The places of public entertainment were flushed with fresh air in the intervals between the performances; otherwise no special precautions were taken over and above the usual sanitary routine.

Latterly, owing to the alarm created by the unusual number of fatalities in the country people began to realise that it was wise to take greater precautions in the early stages than hitherto exercised, and not try and fight the disease. Those who did so reaped the benefit by a short illness and speedy convalescence in the majority of instances; those who did not were more prone to have complications. The number of deaths recorded from this disease throughout the year was 13.

Infectious Diseases

Apart from these two epidemics the incidences of infectious diseases were below that of the two previous years, numbering in all 211 cases, against 278 cases in 1917 and 279 in 1916. The following is the monthly incidence for the year:-

	Diphtheria	Scarlet Fever	Erysipelas	Ophthalmia Neonatorium	Enteric	Measles	Tuberculosis
January	4	3	1	2	0	6	4
February	6	2	1	0	0	2	2
March	7	1	2	0	0	6	7
April	2	1	0	0	0	1	12
May	2	1	0	0	0	4	3
June	4	0	0	0	0	0	6
July	5	0	0	0	0	2	8
August	2	0	1	0	0	2	6
September	1	1	0	1	1	16	7
October	1	1	0	0	0	36	0
November	0	1	1	0	0	12	5
December	3	1	1	0	0	4	0
Totals	37	12	7	3	1	91	60

From this table it will be seen that measles and tubercular affections constitute about three-quarters of the cases,Influenza not being a notifiable disease. Apart from Tuberculosis and Influenza the deaths from infectious diseases number only two (2), both of which were due to diphtheria or the complications ensuing. Measles could hardly be said to have occurred in epidemic form, a few cropping up each month, the greatest number (36) occurring in October, and was largely, I think, the outcome of imported cases from neighbouring districts where it did exist in epidemic form. There were no fatal cases.

Tuberculosis - Number of Cases Notified

	Under 1 year	1 year & under 5	5 & under 15	15 - 25	25 - 45	45 - 65
Males	0	3	8	8	7	2
Females	0	0	7	10	13	2
Totals	0	3	15	18	20	4

The total at all ages will thus be seen to number 60 cases against 41 notified in 1917, 85 in 1916, and 27 in 1915.

Fortunately for the individual concerned and incidentally for the community, notification “per se” does not institute a tubercular deposit in any of the organs of the person notified. Some of the cases which have come under my observation as notified from the schools and other institutions are at least fanciful. Those I have in mind have been under my care and observation from their birth, and either my powers of discernment are lacking in acuteness, or notification does not give a true reflex of the incidence of the disease, as I think it does not either in a positive or negative direction. So long as any child happens to show a bronchitic wheeze on the day of its examination at school is notified as tubercular because there is an equivocal history of a “consumptive” tendency in the parents, and so long as simple cases of adenitis are reported as tubercular glands, so long the list of notified cases will swell beyond its true import. I have used the word consumption advisedly; it has little or no scientific meaning. I am not intimating that much harm if any accrues either to the individual or community. Notification is purely an expression of opinion, not evidence of fact. I only wish to point out that so far as my own experience goes the number of cases notified in several areas is not a true comparison of the actual incidence of the disease in the several areas compared. An area, that other things being equal, compares favourably with others in the general incidence of illness and mortality, is not likely to be singled out for special attention by the Tubercle Bacillus.

That most of us have had a fight at some period or periods of our lives against this Bacillus is amply demonstrated, fortunately most of us have come out successfully in the encounter.

Those communities that are best garrisoned by a healthy, virile, and contented population are likely to come off best. That this district is more prone to develop tubercular disease than those where similar or less favourable conditions prevail and the factors of employment are the same is in my opinion more apparent than actual.

“C” Heads

The institutional treatment of Tuberculosis has been in vogue sufficiently long to demonstrate that the methods at present employed would not appear to have met with the success hoped for. Those of us in general practice with an extended experience who live and grow up side by side with and know the habits of mind and daily lives of industrial populations, many from the cradle to the grave, were not sanguine from the outset. Shorter hours, improved housing, and increased means of improvement and recreation are factors giving an opportunity of improved health, but unless the opportunity is taken advantage of and used with increased intelligence from within, they that build their hopes on these labour but in vain. Whatever may be done to improve conditions from without is likely to end in disappointment unless there is will and ability from within to take full advantage of the means. After 30 years of Medical Practice, I unwillingly come to the opinion that the nation, and the world, is in more danger from C3 heads than from C3 bodies, for given Grade 1 heads, Grade 1 bodies will follow as an inevitable corollary. It is intelligence as distinct from education that we are most in need of, the ability to avail ourselves of education to its most profitable end, not in a material sense, but to promote vigour of mind and health of body, the greatest assets a man can have.

This being my opinion it necessarily follows that I think the decrease and extinction of Tuberculosis will be slow, in confirmation of the maxim “Knowledge comes, but wisdom lingers.”

The cases of Diphtheria notified would appear to be mostly mild in character. Two cases previously mentioned proved fatal.

There are no other infectious diseases in the table that need special comment.

Births and Deaths

I append the list as supplied from the General Register Office, Somerset House:-

Population for Birth Rate	14,454
Population for Death Rate	12,900

The Death-rate population excludes all non-civilian males, whether serving at home or abroad. The Birth-rate population, on the other hand, is intended to include all the elements of the population contributing to the Birth and Marriage rate, which has been distributed over all the districts in the country in proportion to their estimated population, so that the figures relating to Birth and Death rate are approximate, and not actual.

The births, 185 (84 male, 101 female) ten of which were illegitimate, again fall below those of the previous year (200 in a population estimated as being 18,728), giving a rate of 12.39 per 1,000 inhabitants, that of the whole of England and Wales being 17.7 per 1,000; the previous year being 14.55, the average for England and Wales being 17.8 per 1,000. It will be observed that there were as shown by these figures 15 fewer births in a population larger by about 500. The abnormal conditions that have existed during the last 4½ years must inevitably in some degree account for the steady decline in the birth-rate year by year, but does not altogether fill the bill. The shrinking of the responsibilities of parenthood would seem to be a part of the general inclination to a life of greater leisure and less personal responsibility.

The deaths numbered in all 129, compared with 123 in 1917, in an estimated population of 12,315. Sixty-nine males and 60 females.

The causes of death were as follow:-

All Causes	Males	Female	Total
Diphtheria and Croup	1	1	2
Influenza	6	7	13
Pulmonary Tuberculosis	11	12	23
Other Tuberculous Diseases	0	1	1
Tuberculosis Meningitis	3	1	4
Cancer, Malignant Disease	13	3	16
Meningitis	1	0	1
Organic Heart Disease	4	7	11
Bronchitis	1	4	5
Pneumonia (all forms)	4	1	5
Other Respiratory	1	0	1
Diarrhoea, etc. (under two years)	1	0	1
Cirrhosis of Liver	0	1	1
Nephritis and Bright’s Disease	2	0	2
Parturition, apart from child-birth	0	1	1
Congenital Debility	2	1	3
Violence, apart from Suicide	4	1	5
Suicide	0	1	1
Other Defined Diseases	15	18	33
Totals	69	60	129

This number on an estimated population of 12,900 gives exactly 10 per 1,000 inhabitants, compared with that of 9.98 on an estimated population of 12,315 in 1917, a figure with which the town might well be satisfied considering the two outbreaks of Influenza that proved so fatal in other districts. That for the whole of England and Wales was 17.6 compared with 14.4 for 1917.

Upon analysis of the table it will be seen that only two cases of infectious disease occurred apart from Influenza and Tuberculous disease; these were fatal cases of Diphtheria. Influenza claimed 13 victims only out of many hundreds, probably thousands, of cases that occurred. From Pulmonary Tuberculosis 23 victims succumbed to its ravages. From other tuberculous disease 5, compared with 20 and 5 respectively in 1917.

Respiratory diseases other than tuberculosis number 11 in all – Bronchitis 5, Pneumonia (all forms) 5, and one other – against 7, 5, and 1 in 1917.

Cancer and malignant disease account for 16, compared with 9 the previous year. No other diseases in the table call for special comment.

Infantile Mortality, which in view of the natural, or perhaps unnatural, decrease in the population shows again a further trend in the right direction. Eight deaths under the age of one year having occurred during the year, giving a rate of 43.24 per 1,000 births, the lowest that has yet come within my experience of the district. It is hardly to be expected that the scheme in contemplation for infant and child welfare can improve much upon this. That for the whole of England and Wales during the same period was 97 per 1,000.

Sale of Food and Drugs Act

I am informed through the Inspector under the above acts that during the year 1918, 16 samples of milk were purchased in Rushden and submitted for analysis. Of these 14 were genuine and two were deficient in fat to the extent of 14 per cent. and 10 per cent. respectively. In both cases the explanations of the vendors were accepted. They were, however, warned and further samples taken.

I have much pleasure in putting on record the tactful and efficient help of Mr. Lloyd, the Sanitary Inspector.