At the meeting of the Rushden Urban Council on Wednesday, Dr. H. S. Baker, who succeeds Dr. Morris as Medical Officer of Health, presented his first annual report, in the course of which he says :-

Premises and Occupations Which Can Be Controlled by Bye-Laws

Schools

The Newton-road and North End Schools are satisfactory buildings of modern construction, substantial and well found in most respects from a sanitary and health point of view. The Alfred-street Schools are undergoing reconstruction at an outlay that should produce something Utopian from all points of view except that of the ratepayer.

The Scholars

One matter I consider of greater importance than the periodical examination, and that is with regard to the keeping up of the “attendance.” It comes under my observation frequently as a private practitioner to note cases where children should be kept at home a day or two for observation purposes, but are either sent for by the teacher or shepherded up by the attendance officer and sent to school, because the parents are afraid not to send them, and what would only be a mild ailment is precipitated into something worse by exposure to inclemencies of the weather or other causes coincident with attendance at school, when the child from an hygienic point of view would be better at home. There seems to be a natural affinity between a child of school age and under and every puddle and dirt heap in its course. This cannot be avoided unless the child is personally conducted from school house to door of home, and I am pleased to note that a good many of the more careful parents actually do this, but where a child has any symptoms of impending indisposition it is better left at home until danger signs are past.

I am not apportioning blame to either teacher or attendance officer, it is the system I lament. Better that a few malingerers escape than that one potential citizen’s life should be endangered or lost.

One more matter before dismissing the scholars. In view of the increase in traffic and the speeding-up of that traffic I would call the attention of teachers and parents to the advisability of instilling into the minds of the children the importance of their conduct upon the public highways, and the care they should exhibit in playing upon and crossing these highways. It may not appear to be in my province to comment upon this, but as sponsor for the public health I consider it as important to teach individuals the way to avoid accident as it is to teach them how to avoid disease.

Housing

For the most part the houses of the working classes are of a substantial character and generally decently kept. There are a few of the older type belonging to bygone years that cannot be classified as model dwellings, but as the housing accommodation is at present not equal to the demand it is not desirable in my opinion to recklessly condemn any that can be made decently habitable without injury to health until the supply can be met. There are a few cases where two families occupy one house, which is not desirable, certainly where there are children, but this is unavoidable at present and does not militate seriously against the general health of the community. The Local Authority have decided to apply to the Local Government Board to sanction a loan in order to proceed at once to erect about 40 houses of a class suitable for modern workmen’s dwellings, which, when complete, will ease the situation a little at the present rate of increase. Except in rare cases, no part of the district is overcrowded, and most of the inhabitants can have plenty of light and air if they will. It does not all depend upon providing the populace with suitable dwellings unless the dwellers therein are willing to absorb the fact that sunlight and fresh air are the best disinfectants they can use in addition to cleanliness of person and habitation.

New houses for the working classes erected in the year number 19.

Prevalence and Control Over Cases of an Acute Infectious Disease

One-hundred-and-twenty-four cases of infectious disease were reported, against 187 in 1912. From a numerical aspect Measles (non-notifiable with us) easily takes precedence. An epidemic was started from an imported case or cases in the early autumn, and gradually spreading from one district to another until all the Infant Schools except one were closed for a period. This closing of the schools as previously remarked does not seem to lessen the incidence of the disease; the epidemic goes on until all the susceptibles come along. The larger number of cases are in children under five years of age. There were six deaths in all, two under one year, and four between one and two years. The disease not being notifiable, there are no means of recording the number of cases, but there must have been several hundreds.

I would here point out that this disease is not the trivial ailment it is often, if not generally, looked upon as being. Beside the deaths directly attributable to it, a general impairment of constitution is often left behind, and permanent defect of such organs as to the eye, ear, and nose are frequently a legacy; this, the lay experience does not connect with measles.

Scarlet Fever or Scarletina

Fifty-two cases of this disease were notified during the year as against ninety-eight in the 1912 report. All of the cases notified are visited by the Sanitary Inspector generally within a few house of receiving the notification, and the course of infection traced if possible; this, in a goodly number of cases, is difficult to do. Disinfectants are supplied and the patient is isolated as far as is practicable. No cases have been traced in origin to the food or milk supply.

Diphteria, Including Membranous Croup

Ten cases of the maladies included in this group have been notified during the year, being a drop of over 50 per cent in comparison with 1912, a fact which the town can be congratulated upon. There would appear to be some sort of relationship between the number cases of this disease notified and the incidence of scarlet fever. Most of the cases that occur are treated early with anti-diphtheritic serum, which the Sanitary Authority supplies gratis upon the application of the medical men of the district. In eleven suspected cases specimens of these gave what are called positive results and seven negative. Two deaths were registered from this disease and its complications, both cases being over five years of age and under 15.

Enteric Fever

One case only was reported during the year. A laboratory test of the blood serum in this case was made with a positive result. The origin of it has not been traced and no other case arose.

Erysipelas

Eight cases coming under this classification were reported. None would appear to have been of a serious nature.

Prevalence and Control Over Tuberculosis

The total number of cases of tuberculosis notified during the year was 53 as compared with 57 in 1912. 28 Females and 25 Males.

Of these	41 were due	to diseases	of the	Lung (Phthisis)
	7	..	..	Joints
	2	..	..	Peritoneum
	2	..	..	Brain Coverings
	1	..	..	Cervical Lymphatic Glands

Thirteen deaths were registered in the district from pulmonary tuberculosis, four from tuberculous meningitis, and three from other tuberculous disease.

In comparing the numbers registered this year it must be taken into consideration that 1912 refers to Pulmonary Tuberculosis or Phthisis only, while those reported in 1913 include Tuberculosis Disease of all parts, so that the true comparison is 41 in 1913, to 57 in 1912. Under the system instituted upon the National Health Insurance Act coming into force at the beginning of the year, a Tuberculosis Officer was appointed by the County Council, and mostly all tuberculosis cases are now seen in consultation with him and he keeps in touch with them. Insured persons and their dependents are recommended for institutional or domiciliary treatment depending upon the nature of the case, or as vacancies occur at the institutions. Under this Act where a patient applies for sanatorium benefit, it is possible for his medical man to order such extra nourishment as he may deem necessary, a very important consideration in a large number of cases where, from long continued inability to work or other causes, the resources of the patient are crippled.

Where a death occurs, the bedroom is thoroughly cleansed and disinfected, and in most cases the paper stripped and bedding destroyed. In relation to the disinfection of infected bedding and clothes in general that have been exposed to contagion, I may say that the provision of a steam disinfector is under contemplation by the Sanitary Authority.

Vital Statistics of District

Birth Rate

There were registered during the year 237 births, of which 133 were males, 104 females. This is equal to a birth rate per thousand, based upon the estimated population in June, 1913, of 17.23, as compared with that of 20.8 for the previous year, and of 19.5 per thousand as the average of the previous five years, although it must be pointed out that in arriving at this average, in the three years antecedent to 1911 the population had been over-estimated.

No record of any transferable birth is to hand.

Nine of the births registered were illegitimate.

This birth rate is a very low one, considering that the population is largely composed of comparatively young married people. Taking the whole country through, varying in different towns and counties, there is a general tendency toward a much lessened birth rate compared with that of a generation ago, which, to those who take the view that strength of numbers is one of the principal factors in maintaining the prosperity and well-being of the State, must be viewed with serious misgivings.

Death Rate

There occurred in the district 109 deaths which were registered, giving a death rate of 7.92. To this number has to be added nine transferable deaths of inhabitants which occurred outside the district, mostly in institutions, such as hospitals, asylums, and workhouses, these bringing the aggregate to 118, with a death rate equal to 8.58 per thousand. The comparative lowness of the death rate is a set-off to the low birth rate, and can be viewed with some degree of satisfaction.

Infantile Mortality

That is, deaths occurring under the age of one year, total 19, equal to a rate of 80.16 per 1000 births registered, compared with that of 24 deaths and a rate of 83.6 per 1000 for the previous year. On reference to Table IV it will be noticed that the large proportion of 13 deaths occur in the group of premature births, congenital malformations, etc., and eleven of these in the first four weeks of life; several even only had a few hours of existence. All of these 13 had very little, if any, prospect of continued existence from the outset. So that it would appear that only six of the 19 were due to preventable causes, without taking into account prenatal factors.

Zymotic Diseases

Eleven deaths in all occurred from diseased included in this group, more than 50 per cent. (six deaths) occurring during the measles epidemic and having that disease as the primary cause; one only from scarlet fever; two from diphtheria; and two having influenza as the determining cause; both of these occurred in aged persons over 65 years.

Pulmonary Tuberculosis

accounts for 13 deaths, nine of which occurred between the ages of 15 and 45 years, and four between 45 and 65 years. This compares with previous year’s total of 16 deaths, and from this date onward I hope we shall see the annual deaths from this cause steadily diminish, owing to the better means of treatment available and the opportunity of getting at the early cases more readily than heretofore.

Other Tuberculous Diseases

are responsible for three deaths, all of them being registered as owing to tuberculous meningitis.

Cancer, Malignant Disease

Thirteen deaths were registered as occurring from this group of diseases, twelve of which occurred over the age of 45. This is a disease that usually does not attack the human organism until after middle life, but exceptions occur occasionally where it attacks in early life – the other death occurring between the ages of five to fifteen in the Table. This number is an advance on the previous year, wherein only nine deaths were registered; but nothing is to be inferred from this as to the increase of the disease in the locality. Many factors have to be considered and many comparisons made before it would be just to arrive at such a conclusion.

Respiratory Diseases Other Than Tuberculosis

No deaths would appear to have been registered having acute Pneumonia as a primary cause. This is a somewhat singular fact that not one death should occur from this disease in a community of nearly 14,000 persons.

Bronchitis

is credited with 13 deaths, eleven of which occurred in aged persons over 65 years, one only occurring under one year and four under two years. The comparative immunity from deaths in persons under 65 years of age may be largely put down to the mildness of our last winter; and to this may be added that there is gradually arising less fear of fresh air – therefore a better ventilation of dwelling and sleeping apartments. Here I would call attention to the fact that fully a third of our lifetime is on an average spent in our bedrooms, which should, if possible, be the largest, airiest, and lightest room in the house, with means of obtaining free ventilation, without perceptible draught.

Other respiratory diseases account for another three deaths, all over 45 years of age.

Violent Deaths

occur to the number of six, four of which are suicidal – three from drowning, and one from being run over on the railway.