An Increase On The Year
General Death-Rate Still Low
Fourteen Victims To Cancer

  In his annual report, from which we published extracts in our last issue, Dr. H. S. Baker, Medical Officer of health for the urban district of Rushden, says:

The Schools

  These have been maintained in their usual state of Sanitary efficiency.  Some complaints of insufficient warming of some of them have been met by re-organization of the heating system with, I believe, satisfactory results, as I have had no complaints this winter, which so far has been unusually mild in character.

  The scholars have been periodically examined by the school Medical Officer, whose report will be included in the annual Report of the M.O.H. for the county, which so far as my observation goes is the chief result of the examination, principally due to the fact that in the absence of school clinics the inspecting Medical Officer cannot carry his opinion to its logical conclusion in the way of treatment, be it right or otherwise.

  The Registers are still in conflict with the physical well-being of some of the scholars.  I refer to the fact that children are often sent to school when in the incipient states of colds and other maladies, sometimes because of, sometimes for fear of, a visit of the attendance officer.  There would appear to be more in enthusiasm for a fat register than for the education factor involved; and in my experience the harm that is done thereby outweighs any good that follows from their periodical medical examination.  Unfortunately it is part of the educational formula, and the attendance officer and the teacher cannot well help themselves in carrying it out.  But it is in my opinion answerable for some severe illnesses and spread of epidemics and occasional fatalities, which might be avoided if more judgement were allowed and less formula exacted.

The Water Supply

  This throughout the year has been abundant in quantity and good in quality, the bulk of it coming from the extensive gathering ground at Sywell.  With very few exceptions every house has its supply for sanitary and domestic purposes.

  One or two wells that have been brought under my notice have had the water examined, found unfit for domestic use and condemned, the well in consequence being closed and the town supply laid on.

Drainage and Sewage

  The water carriage system is now practically universal throughout the district, except in outlying tenements where the town water supply has not yet been laid.

  Any complaints received have been promptly attended to, and any defects found remedied by the Sanitary Inspector.

  The drainage throughout the town is efficient, and the sewage disposal leaves little to be desired, having worked throughout the year without tangible drawback.

Scavenging

  This in the later months of the year fell somewhat into arrears owing to the difficulty in supplying the necessary horses and conveyances for its removal.  A new electrically propelled trolley has now been provided, and has so far I believe given satisfaction.  It is a much more fitting sanitary refuse conveyance than the old open carts and should expedite the work and make it easier for the men employed.

Housing, Town Planning, Etc. Act, 1909

  Little but minor items have been done under this Act since the beginning of the late war, building construction, except of the most meagre nature, has been undertaken by few.

  Some of the houses under the Council scheme on the Newton-road are slowly emerging from obscurity after various vicissitudes.

  Private enterprise in the erection of dwellings to be let as tenements is for obvious reasons in abeyance.

Sale of Food and Drugs Act

  Fourteen samples of Milk and two of separated Milk were taken by the Inspector of the County Authority in this district during 1919.  All were found to be genuine.

  In a few instances articles damaged or otherwise unfit for human food were voluntarily surrendered to the Sanitary Inspector and destroyed by him.

  No other cases of confiscation of foods are to be recorded.

Milk Supply

  Though not abundant, no complaints of inability to obtain what was necessary have come under notice.  Any cows that have been found unsuitable to milk for human supply have been vetoed by the Veterinary Inspector.

  The cowsheds have been periodically inspected by the Acting Sanitary Inspector and in the main mostly kept in a tolerable condition, but to my mind the housing of cattle supplying human foods require equally as much attention as the housing of human beings themselves.

Prevalence and Control Over Acute Infectious Disease

  Except for the outbreak of Influenza which occurred in the early months of the year, which was not confined to this district, but was pandemic in its incidence, we were not visited in an untoward manner by any serious outbreak of epidemic disease.  Even this, although a large number of people of all ages were affected and laid up for short periods was not marked in this district by any undue mortality rate, in comparison with that recorded in some less fortunate and more populous districts, owing one may conclude to the higher individual resistance of the inhabitants over those dwelling in more crowded areas, for although the house shortage has affected us as most other industrial districts nothing pertaining to overcrowding prevails.

  The total number of infectious cases notifiable as Infectious Diseases for the year was 118, compared with 211 in 1918, 278 in 1917, and 279 in 1916, a very marked diminution, and in spite of the fact that Malaria and Pneumonia have been added to the list.  I append the monthly incidence table.

	Malaria	Diphtheria	Scarlet Fever	Erysipelas	Ophthalmia Neonatorum	Enteric Fever	Measles	Tuberculosis	Pneumonia
January	0	1	0	0	0	0	0	4	0
Feb.	0	1	1	0	0	0	2	4	0
March	0	0	0	1	0	0	7	3	10
April	2	0	0	0	0	0	0	5	5
May	0	4	0	0	1	1	40	0	3
June	1	1	1	0	0	1	3	0	0
July	0	0	2	0	0	0	1	1	0
August	0	1	0	1	0	0	2	2	0
Sept.	0	3	0	0	0	0	0	2	0
Oct.	0	1	3	0	0	0	0	11	1
Nov.	0	2	2	0	0	0	1	1	3
Dec.	0	0	5	0	1	0	2	4	0
Totals	3	14	14	2	2	2	22	37	22

Total for the year …  118 cases.

  Upon analysing this table in comparison with that for the previous year, it will be noticed the greatest difference in the incidence is shown in measles and tuberculosis, being 22 compared with 91 in the case of measles and 37 compared with 60 for tuberculosis.

  In the latter part of the year measles was expunged from the list of notifiable diseases, which may in some way account for the drop in the number of cases notified, but only in a minor degree.  The removal of one or two other diseases might reasonably be accomplished without danger to the public health or fear of extension of the disease.

  A decline in the number of cases of Diphtheria notified is another gratifying factor, there being only 14 cases in the table in place of 37 the previous year, fewer than half;  3 ended fatally.

  Scarlet Fever shows 14 cases against 12 for 1918.

  Erysipelas 2 against 7.

  Enteric Fever 2 against 1.

  Most of the 22 cases of Pneumonia reported will be seen to have occurred at the time the Influenza epidemic prevailed, of which it occurred as a complication.

  None of the other diseases in the table present any features for special comment.

Prevalence and Control Over Tuberculosis

  Number of cases notified:

Total at all ages – 37

  The total compares favourably with 60 notified in 1918, 41 in 1917, 35 in 1916, and 27 in 1915.

  The drop in the numbers must be taken with some amount of gratification, but does not altogether reflect satisfaction upon the present methods of prevention and cure, but these are approaching the limit on existing lines so far as public measures can go until the people themselves come to realise their personal responsibilities in the matter.

  In my opinion Tuberculosis is not likely to be stamped out while sentimental views with regard to segregation prevail, nor while the principal schemes in regard to it are formulated chiefly from office experience, or the more or less narrow side of institutional practice.  Those who see most of the disease from its inception to its end, and who know how the people live and conduct their lives, the general practitioner, have little voice in the matter.  I think if they had there would be fewer futile promises held out, and consequently fewer disappointments for the public.

  At present the people themselves do not realise their personal responsibility in the matter, and that the health of the community depends very largely upon the conduct of their own lives.  In the absence of this no Government, no Department, no Local Authority can do more than provide the means; the carrying the means to a successful issue depends largely upon the individual, and it is my experience that at present he is somewhat heedless, thoughtless, and often indifferent until it is too late.  It is difficult to awake in him the true perspective of things and make him distinguish between the thing that matters and the thing that does not, not only with regard to his health but also his general happiness.

Birth and Death Rate

  Estimated population as furnished from General Register, Somerset House.

For Birth rate……14,428
For Death rate……13,880

Births.  The total number returned for the district for 1919 was 206, of which 107 were males and 99 females.  None of the total number were illegitimate – 4 males, 5 females.  The number is an increase of 21 on that for 1918, when 185 births were recorded.

  On the estimated population of 14,428, the rate per 1,000 for the year will be 14.27, a slight increase on that for 1918, which was 12.79 among an estimated population of 14,454.

  The estimate of population is an official one from the office of the Registrar general, and is I think below the actual number of persons resident in the town, for while the same number of houses are occupied, these have in many cases more than one family resident therein.  This being so the actual birth rate would be somewhat below the figure given, but only a fractional one at that.

  The latter months of the year show the increase most markedly, gradually increasing as demobilization of the forces progressed and the men returned to family life.

  The birth rate for the whole of England and Wales for the same period is 18.5.  We are thus a good bit below the average for the whole country and below that which should be the natural increase for a young and virile population, and is in part I think a reflex of the general trend of mentality of the times, which seeks to claim its full privileges of citizenship, but fails to grasp its full responsibilities as to its obligations.

Death Rate.  The total number of deaths credited to the district includes not only those actually occurring in the town itself, but also those occurring away, such as in hospitals, asylums, workhouses, etc., who would have their permanent residence here under normal conditions.

  These deaths make a total of 153 in a population estimated at 13,880, compared with 129 in an estimated population of 12,900 in 1918.  76 were males and 77 females.

  The rate per 1,000 works out at 11.02, an advance up 1918 and 1917, when the rate was 10 and 9.98 respectively.  That for the whole of England and Wales during the corresponding period was 1.38.  So that although a little higher than in the preceding years the rate is satisfactorily below the average.

  The greatest difference of increase is in the number of deaths below the age of one year, nearly the whole being accounted for by the increase in that category, there being 27 deaths recorded against 8 in 1918.

  Infant Mortality, that is, the number of deaths occurring annually n 1,000 infants born.  This owing to the number of deaths as recorded above shows what might be an alarming increase at first sight, bringing the mortality rate among infants up to 131 per 1,000 against a rate of only 43.24 in 1918, a remarkably low one and one not likely to be maintained under the best of circumstances.  Those who attach sentimental import to this feature of the report will naturally deplore this increase, but it is quite as likely to be as accidental in the height as the previous year was low.  On analysing the cause of these 27 deaths, 15 were recorded as being due to premature advent into the world and other congenital defects, so that it may be left a debatable point whether their survival was desirable from the point of view of citizenship.  Whether the premature arrival might be preventable is not always ascertainable and belongs to antenatal causes;  it is perhaps in some way accounted for by the disinclination for a quietude of life that is entailed if the child bearing period is to be carried to a successful and satisfactory issue that prevails among a section of the populace.

  Twelve of these deaths can then be put down to causes that might be preventable, arising after their birth, but even some of these would have had a least a precarious existence.  My experience of infantile mortality in this district is that not many infants are lost that it might be considered would survive to useful citizenship.

  Two cases of the 27 were illegitimate.

  Between the ages of 1 year and 25 years sixteen deaths were recorded; between 24 and 45 yers, 12; from 45 to 60 years, nineteen, a total of 74 under 60 years of age, so that it will be seen that more than 50 per cent. of deaths occurred at over 60 years of age, so that it will be seen that more than 50 per cent. of deaths occurred at over 60 years and of these 12 were over 80 and one over 90.

  The Infantile Mortality rate for the whole of England and Wales for 1918 was 89 per 1,000.

  I append a table of the causes of death;

  Analysis of this table shows that apart from Influenza and tuberculosis, four deaths occurred from Acute Infectious Disease, 3 from Diphtheria and its consequences, and 1 from Enteric Fever.  Influenza claimed 14 victims against 13 in the previous year, not an undue number by comparison with the fatalities in larger and more densely populated communities.

  Tuberculosis (all forms) was responsible for 11 victims in comparison with 23 in 1918, a marked decrease which should give satisfaction to all.

  Bronchitis accounts for 20 of the deaths.  A greater number than the previous year, mostly as a consequence and complication of Influenza, while Pneumonia is responsible for only 4 fatalities, a remarkably small number considering the generally fatal character of the Spring epidemic.

  The fourteen deaths from Cancer and other malignant diseases compares with 16 in 1918 and 9 in 1917.  A comparatively large number if taken alone, but upon consideration that only one death per 1,000 inhabitants occurred in the year from this disease does not altogether warrant the pessimistic views sometimes one hears expressed about the increase in the incidence of the disease, and considering that every case recognised as such almost inevitably ends fatally.

  It will be obvious that in certain comments in so far as they come into touch with public health, I have strayed into the thorny grounds of political and economic matters, but only so far as they appear to me as the result of my professional experience.  I would further add that I think if we one and all gave up dreaming of a new world we know not of, and set our best endeavours about making the best of this one which we do know, the more likely it is to add to the health, happiness, peace, and content of all.