Birth and Death Rates, Housing, and Disease
The Smallpox “Strike”
Vital Statistics for Five Years
Dr. O. A. J. N. Muriset, Medical Officer of Health for the Rushden Urban Council, in presenting his annual report at the last meeting of the Council, stated that, in accordance with the requirements of the Ministry of Health, the facts were a survey of the past five years. Having given the vital statistics (birth-rate, death-rate, etc.), the Doctor said it was pleasing to note that during the five years there had been 122 houses built by private enterprise and 133 by the Council. Sleepy sickness was not very prevalent in the last two years, but there were still sporadic cases.
Mr. T. Wilmott asked whether sleepy sickness affected males or females the worse, or what law it seemed to follow.
Dr. Muriset said it affected anyone. All were liable to get sleepy sickness, which was no respecter of persons. It was as common among the rich as the poor and among males and females alike. There was no law for it at all apart from local causes. It was believed to be infectious.
Mr. Spencer humorously stated that when he saw Mr. Wilmott rise to speak he expected to hear something about the birth-rate! (Laughter.) He was pleased to see that the town was still making progress. He did not want the race to die out. [Mr. Spencer’s allusion is explained to the uninitiated by the fact that in previous years Mr. Wilmott had adopted the attitude that an increasing population of children for whom parents could not provide was much to be deplored, while Mr. Spencer viewed with satisfaction an ever-increasing birth-rate.]
Mr. T. Swindall said the Council all recognised that there had been a lot of additional work on the Sanitary Inspector and the Medical Officer. The Council could be very pleased with the improvement in public health supervision by the extra power given to the Inspectors. He was glad that the Sanitary Inspector had supervision of the milk supply. Such were steps in the right direction.
Mr. G. W. Coles, J.P., said it was an exceedingly good report – the best, he thought, he had seen since he had been on the Council. There was much valuable detail given. He wished to assure the doctor that the members of the Council appreciated having as much information as they could get. Mr. Coles moved that the thanks of the Council be accorded the doctor for his able report.
Mr. Wilmott seconded, and said he had read through the report and he also thought it was the best he had seen. With regard to Mr. Spencer’s remarks about himself, he hoped that Mr. Spencer was satisfied now that England had been beaten by Rushden, in that Rushden’s birth-rate had gone up and that for England had gone down!
Mr. Coles said he wished also to offer compliments to Mr. Piper, their Sanitary Inspector, whose annual report was presented together with the Medical Officer’s. He moved that the thanks of the Council be passed to Mr. Piper.
Mr. Corby seconded and the resolutions were carried.
The following are extracts from the Medical Officer’s report:-
Natural And Social Conditions
Area, 3,777 acres; population, at 1921 census 13,511, estimated 1925 13,780, number of inhabited houses, in 1921 3,076, in 1925 3,241; number of families, or separate occupiers in 1921 3,361, in 1925 4,065. Rateable value, £50,201; the sum represented by a penny rate, £185.
Physical Features
During the last five years a considerable number of new houses have been erected, both by the Council and by private enterprise. The direction of the development has been chiefly towards the east, on the highest ground of the district. More recently development has been proceeding in the western and north-western directions. During the last five years the Council has erected 131 houses, and 122 have been erected by private enterprise. During the last five years the general amenities of the town have been improved by the widening of certain of the main thoroughfares.
Social Conditions
The inhabitants of Rushden are occupied almost entirely in the manufacture of boots and shoes and in the trades allied thereto. There is, however, the usual proportion of the population occupied in the building and maintenance of private and public property. A proportion of the population are occupied in the retail trade for the supply of the district. Since the war there had been a considerable amount of unemployment, and a few of the factories in the district have been closed down altogether; many of them, although they have still been kept open, have been working at comparatively short hours. In spite of this, there has been little evidence of poverty or want in the town, and there has been little call for assistance from the Poor Law authorities.
Population
The population, as returned after the 1921 census, showed only a comparatively small increase over that of 1911. What the actual cause of this relatively small increment is, is difficult to say, but post-war conditions, combined with the considerable shortage of housing accommodation, may have something to do with it. Previous to 1911 the growth of the town was fairly rapid, as only some half-century ago the inhabitants numbered about 2,000. Apart from those actually engaged in the boot and shoe trade, there are few private residents, and these, for the most part, have local connections.
Local Birth-Rate
The total number of births recorded for this district by the Registrar-General for the year 1925 was 211, of which 111 were males and 100 females, giving a birth-rate of 15.31. For the five years preceding the present one there has been steady decline in the local birth-rate, which has been more or less comparable to the decline in the birth-rate of the whole country. This year, however, there has been a slight rise locally, in spite of the continued fall for England and Wales. This is a feature on which the town may congratulate itself, in spite of the fact that the local birth-rate is still considerably lower than that for the country generally.
Local Death-Rate
The total number of deaths for the district, as shown according to the returns of the Registrar-General, was 138, of which 66 were among males and 72 among females, giving a general death-rate of 10.01. For the last six years the death-rate for the district has been fairly steady, varying very little from year to year. This year (1925) it is slightly above that for 1924.
Infantile Mortality
The infantile mortality rate (the number of deaths among infants under one year per thousand infants born) for 1925 is 61.61. The remarkable reduction of 1923, has, unfortunately, not been maintained. The year’s figure is, however, below that for England and Wales – namely 67. The present year’s figure cannot be regarded as wholly satisfactory, although six of the 13 deaths of infants under one year were due to congenital causes. One wonders how many of these six children might have been saved had more attention been paid to the ante-natal condition of the mothers. The figures rather suggest that the importance of the health of the mother during a pregnant period has not yet sufficiently been realised. The present shortage of work, which appears chiefly to affect the male members of the community, may be a factor in this increase in the infantile mortality rate, as undoubtedly the mothers-to-be continue factory work until just before parturition.
Tuberculosis
During 1925 tuberculosis was the cause of death in 15 instances, giving a mortality rate of 1.08. This figure is much as that for last year. In the case of pulmonary tuberculosis, however, this year’s figure of 1.01 is somewhat higher than those of the previous two years. A comparison of the figures, shows that the death-rate from tuberculosis in the town has for the last five years varied comparatively little. In the main, however, a tendency is in the direction of improvement.
Deaths From Cancer
It is pleasing to note that this year the high figure of 1924 (20 deaths) has not been maintained in 1925 (16 deaths). However, cancer, as shown by the figures for the last five years, is tending to cause an increasing number of deaths each year. This is not by any means a purely local tendency, but appears to be affecting the country as a whole. It is particularly disquieting in view of the great amount of research work which is going on all over the world. Last year, as the result of long research, we were led to hope that the cause of cancer had been discovered, but there is still considerable controversy on this point, and the experiments of Dr. Gye still await confirmation. One hopes that in the not very far distant future some real knowledge of this insidious and fatal disease will be obtained and that something will be done to reduce the increasing fatality of cancer.
Bronchitis, Pneumonia, and Other Respiratory Diseases
After the high figure for 1922 there was a well-marked drop in 1923, but the figures for the last three years suggest again an upward tendency. The influence of influenza, with its accompanying respiratory complications, I believe, has had a great deal to do with the variation.
Death-Rate as a Whole
The local death-rate has remained fairly steady during the last five years, in spite of the increasing number of deaths from cancer and diseases of the heart and blood-vessels.
Causes of Sickness
During the last five years the town has had the usual annual visitation of influenza, particularly in the early spring and late autumn, and this condition has been the cause of a very large amount of invalidity, although on the whole it may be said that it has not been of a particularly severe type. Measles, chicken-pox, and paretitis (mumps) have at varying periods during the last five years caused a considerable amount of absence from school, but only in one instance was it found necessary to close a school on account of infectious disease. Again I wish to draw attention to the fact that these so-called childish ailments are not treated sufficiently seriously, and I think the neglect of isolation has been largely the cause of the prevalence of these conditions. It is difficult to make parents realise the infectivity of these diseases, and, in spite of instructions to the contrary, children still in an infectious condition are allowed to mix with their playmates. It is unfortunate that the child of the present generation appears to be the master in the home and for peace sake allowed to dictate in the matter of its wishes to the rest of the household.
General Health Services
Under the heading of hospitals, there is in the area a Smallpox Hospital provided by the Council, and also a Cottage Hospital provided by voluntary contributions. These two institutions are reserved strictly for the use of local residents. The Rushden House Sanatorium, provided by the County Council, is within the urban area. This institution serves the whole county, in which the town is, of course, included. It has not been deemed necessary to provide a fever hospital locally, as, fortunately, the town has been remarkably free from the diseases usually treated in such an institution. It has been felt that the cost of erection and maintenance of a fever hospital would hardly be justified at the moment.
The Smallpox Hospital is situated on the Bedford-road, about a mile outside the town. Up till the early part of the year this building was regarded as a white elephant, and the likelihood of its being used was scoffed at. The hospital then consisted of a corrugated-iron building partitioned off into two wards, one opening out of the other, and an administrative part consisting of a kitchen-living-room, with scullery and larger attached, and one bedroom. There were two earth closets, and the slop-water ran into the ditch at the side of the road. A so-called caretaker occupied the administrative side of the building rent free, in return for which he was expected to keep the building clean. At that time the whole place was in a most unsatisfactory condition for the treatment of smallpox, which fact had already been pointed out in previous reports. However, when smallpox became prevalent in the county improvements were commenced. The building was put in a good state of repair, the earth-closets were replaced by water-closets, and a proper cesspool, with pump arrangements, was provided. Shortly after the completion of these arrangements, and when smallpox seemed likely to break out in the town, the provision of another ward was sanctioned. Work had actually commenced when smallpox did, in fact, make its appearance. The Council was now faced with a new difficulty, for a certain section of the workmen employed on this new extension threatened that if the smallpox cases were admitted to the old building they would cease work on the new. They stated that they were willing to work night and day if the cases were kept away. A special meeting of the Sanitary Committee was called to deal with this matter, and it was decided that the cases should be admitted in spite of opposition. This was carried out, and a certain section of the workmen immediately ceased work. It should be mentioned that this disaffection did not affect the Council’s employees. The new building was ultimately completed by volunteers. It contains a store, a ward capable of housing twelve beds, a bathroom, a water-closet, and a slop-closet. There is attached an outbuilding which houses the heating apparatus and washhouse. A short distance to the south of the main building a small sectional wooden hut, divided into three small rooms, with a bathroom and sanitary accommodation, was erected for the nursing staff. The Smallpox Hospital, as it now stands, has accommodation for 24 patients, a cook, and two nurses. It is sufficiently equipped at the moment for three patients, a cook, and one nurse.
The Cottage Hospital, which is situated in Griffith-street, is very central. It has accommodation for two beds. A nurse is resident on the premises. The Cottage Hospital is only used for minor cases, the majority of persons requiring hospital treatment being sent to the County Hospital at Northampton or Bedford.
The Rushden House Sanatorium is under the administrative control of the County Council and forms part of its anti-tuberculosis scheme. The institution has accommodation for some 78 patients. It is primarily intended to serve the county as a whole, but a few patients are admitted from other districts. Eleven local patients have been admitted during the year. Although one has no official knowledge of the results of treatment in this institution, one’s own observation leads one to believe that they are excellent and will compare favourably with those of any other similar institution in the country.
There are no local arrangements for dealing with the problems of the unmarried mother, illegitimate infants, or homeless children.
Ambulance facilities in the district are excellent, and they are in the efficient hands of the Rushden and District Motor Ambulance Association, an entirely voluntary body. This association possesses a Ford motor-ambulance, which is utilised for the transportation of patients to hospital and other local service. The service is a most efficient one, calls, either night or day, being answered with great promptitude.
Apart from the brougham purchased by the Council for the transportation of smallpox cases, there is no local provision for the removal of infectious cases.
Clinics and treatment centres have not yet been established in the town, for the most part such services are in the hands of the County Council.
Nursing In The Home
The Rushden District Nursing Association retains the services of one fully trained nurse, who, when the necessity arises, has the assistance of another trained nurse. The services of the nurse are available for the nursing of sick persons in their own homes. The nurse is also a qualified midwife. She has done much excellent work. The local association is affiliated with the county association.
The provision for the nursing of infectious diseases at home – e.g., measles – is in the hands of the County Council.
Under this heading mention must be made of the excellent work done by the local branch of the St. John Ambulance Association. In every factory there is at least one member of the association. It is very striking to note the efficient way in which these Ambulance men and women deal with the injuries resulting from factory accidents, while certain members are also deputed to attend public gatherings.
Sanitary Circumstances – Water
The water supply is derived from the reservoir situated at Sywell, some eleven miles from the town. The waterworks and supply are under control of the Higham Ferrers and Rushden Water Board, which is comprised of members of the two local authorities. The reservoir at Sywell has a capacity when full of 236,000,000 gallons and a surface area of 68½ acres. The gathering ground, which comprises about 1,747 acres, consists of pasture, arable, and wood land.
The water, after passing through filters, of which three are provided, is pumped to the service reservoir on the Bedford-road, which is about 1½ miles outside and above the town. The capacity of this service reservoir is some 826,426 gallons, and the top water level is 338½ ft. above sea-level. A smaller reservoir at Wymington is also in use. From these reservoirs the mains of the two towns are supplied by gravitation. The supply is constant and the pressure good. With the exception of a few houses in outlying districts, all the houses in the truly urban area are “on” the supply. In the majority water is laid on; in only a comparatively small number of cases is there a stand-pipe for the supply of several houses.
The water is of excellent quality, and the supply practically unlimited. It exhibits no tendency to plumbo solvency. The total hardness is about 15 degrees, and the figure for the temporary hardness is relatively high. During the year 1925 17.36 gallons per had per day were supplied for all purposes.
Rivers and Streams
A stream known as the Brook runs through the town, roughly from south to north. In places it is open, but for the most part where it passes through inhabited portions of the town it is culverted. Where it is open the bed has been bricked, which renders periodical cleansing easy and enables it to be kept in good sanitary condition. During the last year a further portion of the stream was covered in where it runs by the side of the South-End Schools in High-street South. After passing through the town the brook runs alongside the sewage works and receives sewage effluent. It eventually empties itself into the Nene, which river forms one of the northern boundaries of the urban district.
Drainage and Sewerage
A water-carriage system is universal in the town, except in some of the outlying districts where the sewers do not reach, and in these parts either the pail-closet system or cess-pools are provided, these being empties periodically. During last year the sewer was extended along the Hayway, where a number of houses previously depended on the cess-pool system and have now been connected up with the sewer. A further extension of the sewer to meet the needs of new houses will have to be considered.
Scavenging
House refuse is collected weekly in two closed and two open carts. The refuse is disposed of at two refuse tips, one being situate close to the Newton-road on the eastern borders of the district and the other actually within the precincts of the land occupied by the sewage works. This present method of disposal can hardly be looked on as satisfactory, and the Council have under consideration the erection of a proper refuse destructor.
Practically all houses are, and have been for some time, provided with galvanised-iron sanitary ashbins, these being provided by the owners of property.
Smoke Abatement
This question does not arise, power for all factories in the district being provided for either by gas engines or by electricity.
Schools
There are five Council schools in the district, one of which has recently been converted into a secondary school. With the exception of the school situate in High-street South, which was formerly a Church school, the buildings are modern, and they are all provided with proper water supply and ample sanitary accommodation. The schools are disinfected periodically, disinfection being carried out more frequently during the time of epidemic of infectious disease. On the notification of infectious disease, any other children resident in the house are excluded from school and are not allowed to return until a certificate that the house is clear of infection is issued by the Sanitary Inspector.
General Housing Conditions
The houses for the most part are comparatively modern brick-built houses of the artisan-cottage type. In the early days apparently little attention was paid to town-planning, but in the case of houses of more recent construction the question of town-planning has been taken into serious consideration. There is still a considerable amount of very old property in the town, some of which is in a somewhat poor condition. Many of these old houses would have long ago been closed as unfit for human habitation if there was proper accommodation to be obtained elsewhere. There is still a very considerable shortage of houses in the district, and at the present time there are no less than 317 applications for Council houses. The number of persons affected by this, taking an average of four persons per family, appears to be some 1,268.
It is somewhat difficult to explain the present shortage of houses in view of the fact that since 1911, when I am led to understand there was quite a number of empty houses in the town, the population has only increased by some 426. (Estimated population in 1925, 13,780; 1921 census, 13,511.) One explanation of this may be that the young people now marry earlier in life than previously, but this fact is rather contradicted by the steady reduction in the birth-rate.
During the last five years a considerable amount has been done to reduce the shortage in housing accommodation. During that period 122 houses have been erected by private enterprise and 131 have been erected by the Council. At the present moment there are 45 houses, both private and Council, in course of erection, and plans are being prepared for the erection of a further 40 Council houses. Furthermore, at the moment plans for the laying-out of 50 acres for Council houses are in course of preparation.
Overcrowding
At the present time roughly 150 houses in the district are overcrowded. This is due chiefly to the present housing shortage, but may in some measure be due to the present industrial depression. No particular measures for overcoming this are in contemplation beyond the provision of more houses. Among the principal cases of overcrowding, one occupier was called before the committee, and be promised to procure a reduction in the inmates of the house in question; this having been done, no further action was taken.
Fitness of Houses
The general standard of houses in the area is good, being mainly of brick and of the artisan-cottage type. Only in those most recently erected have baths been provided. A few of the older houses are constructed of stone with rough slate or thatched roofs, and a considerable amount of this older property can hardly be said to come up to the standard expected under modern conditions. The general character of the defects found to exist in these unfit houses is lack of proper accommodation and ventilation. In many instances floors and ceilings are defective and the roofs are not watertight. On the whole, it may be said that property-owners in the district remedy the defects in their property without too much persuasion being necessary. Much of the dilapidation is traceable to acts of omission or commission on the part of the tenants. One has been particularly struck by observing a general lack of attention to cleanliness, etc., in certain of the new Council houses occupied by families who previously had inhabited some of the bad property in the town. The most common defect which has required the attention of the Sanitary Department in connection with the houses in general is that of defective of blocked drains. Unfortunately, owing to the absence of proper local by-laws the definition of a drain and that of a sewer is not clear, and in many instances the local authority has been responsible for the repair of what should have been defined as a drain but came under the heading of a sewer. There were 67 new houses erected during the year (23 by the Council).
Milk Supply
There is no municipal milk depot, milk being supplied entirely by private traders. There does not appear to be any shortage in the supply, and the local methods of distribution are, as far as they go, satisfactory. No graded milk is procurable in the town. Under the Dairies, Cowsheds, and Milkshops Order, 1899, a Veterinary Inspector was appointed by the Council. There were no applications for licences for the sale of milk as classified by the Fourth Schedule of the Milk (Special Designation) Order, 1923, and no registration was refused during the year. Up to the present no samples have been bacteriologically examined, but samples will be taken in the future as the necessity seems to require.
Meat
The meat inspection is carried out by the Sanitary Inspector, who is also a qualified Meat Inspector. There is no public abattoir in the district, and this fact adds considerably to the difficulties in carrying out efficient meat inspections. Slaughtering is carried out in the private slaughterhouses at regular times, and the Inspector visits these premises for the purpose of meat inspection as soon as practicable after actual slaughtering, but it has not been found necessary to “mark” carcases. Stalls and shops where meat is exposed for sale are inspected periodically and necessitated some 437 visits during the year. One ton 7 cwt. 1 qr. 33¾ lb. of meat unfit for human consumption was seized or surrendered during the year and, in the absence of a proper refuse destructor, was buried at the sewage works.
Infectious Diseases
Tables drawn up show the number of cases of notifiable diseases which have occurred during the year and also the numbers of those diseases in each year for the last ten years. The figure for this year appears to be extraordinarily high, but the reason for this is that chicken-pox was made notifiable in the early part of the year, when smallpox was prevalent in the county, and of this year’s figure – viz., 203 – 126 were cases of chicken-pox. If this figure is subtracted from the total, the number of 77 compares favourably with those of the previous three years. The figures for pneumonia have remained fairly constant throughout the years since it has been made notifiable, with the exception of 1922, when it reached 22 cases. No cases of malaria, dysentery, or trench-fever have been notified during the last five years.
Smallpox
There have been three cases of smallpox during the year. On May 18th information was received from the Medical Officer of Health for Bedford that two men resident in Rushden had been in contact with a case of smallpox in Bedford on May 10th. These men were immediately visited and, although the time for protection by vaccination had long passed, they and their families were urged to be vaccinated. In one case the man and all the other members of the family were vaccinated. In the other the man and all the other members, with the exception of a baby, were vaccinated immediately. The men were visited daily by the Medical Officer of Health, and when they began to show suspicious signs they were, with their families, isolated, no one being allowed to enter or leave the houses. Food was supplied to the families through the Sanitary Department and delivered to them by one of the members of the Sanitary staff who had been recently vaccinated. On May 27th one of the men was definitely diagnosed as suffering from smallpox. He was removed to hospital the next day. On May 30th the second case was notified and removed to hospital the same day. On May 31st the Medical Officer of Health was called, in consultation with another practitioner, to see a child who showed suspicious signs. The diagnosis being agreed, the child, after vaccination, was admitted to hospital on the same day. The last-admitted patient was discharged from hospital on July 17th, and the two men admitted on May 28th and 30th were discharged on July 23rd. The other members of the families were kept isolated in their homes until proper disinfection had been carried out. The contacts of these three cases of small pox were, as can well be understood, very numerous, as the men had been employed in factories in the town and the child had been attending school until a few days before the signs of the disease became apparent.
An attempt was made to inspect daily all the discoverable contacts. This entailed some hundreds of visits by the Medical Officer of Health and the Sanitary Inspector. All contacts were urged to be vaccinated, and on the whole the success of this vaccination campaign was marked, only a comparatively few refusing vaccination altogether. At or about this time it is estimated that roughly 1,000 persons were vaccinated in the town. A very striking lesson as to the usefulness of vaccination is to be learned from an observation of these three cases of smallpox. Although the majority of their immediate contact (i.e., other members of the family) had not previously been vaccinated, they were entirely protected by vaccination. Particularly is this notable in that the mother of one of the patients volunteered to nurse her son at the hospital. As he had a young infant, she of necessity took this child to the hospital with her. Although this infant was not vaccinated until after the appearance of the disease in his brother’s case, at no time has he shown any sign of smallpox.
The thanks of the town as a whole are, I am sure, due to this mother who bravely volunteered to go to the hospital and look after the smallpox cases there; more especially are thanks due to her because for several days she carried out alone this work of compassion before a nurse could be procured to carry on the work.
Between 400 and 500 vaccinations and revaccinations were carried out by the Medical Officer of Health during the smallpox outbreak, but no particular attention was paid to the 1917 Regulations and no very accurate records could possibly be kept during the period when the work of looking after smallpox cases in hospital and the examination of contacts entailed an enormous amount of extra work being thrown on the shoulders of the Sanitary Department.
Scarlet Fever
Scarlet fever was notified in seven cases this year. During the first three years of the quinquennium comparatively few cases of scarlet fever were notified, but during the last two years the number has increased (22 last year). It cannot, however, be said that scarlet fever has in any way been epidemic.
Diphtheria
This year eleven cases have been notified, which is the highest figure since 1920, when 13 cases were notified. A stock of diphtheria antitoxin is kept at the Council Buildings and is available for the use of general practitioners. As suggested by the Ministry of Health, phials of three different strengths are kept.
No cases of enteric or puerperal fever were notified during the year.
Sleepy Sickness
In 1924 encephalitis lethargica first made its appearance in the town, when three cases were notified. During 1925 two further cases have been notified. Of these five cases three have come under the personal observation of the Medical Officer of Health. One of the cases is a child of school age, and her condition has markedly deteriorated since the date of notification. It is deplorable that we have so little knowledge of the cause of this crippling disease and therefore can do little or nothing towards its prevention or cure and that little can be done to mitigate the symptoms.
Disinfection
There is no proper disinfecting station in the town, and there are no facilities available for the cleansing and disinfection of verminous persons. A small disinfecting chamber has, however, been fitted up and is presided over by the Sanitary Inspector. During the year 498 articles have been disinfected and 177 articles have been destroyed. Two hundred and nine rooms have been disinfected after infectious disease. The means of disinfection utilised is sulphur dioxide and formaline spray.
In conclusion, I wish to thank all members of the Council for the ready assistance and kindness which have been shown to me at all times in the carrying out of my duties. I wish also to thank the officers of the Council for their ready assistance, and particularly Mr. Piper, whose untiring energies, more especially during the time of the outbreak of smallpox, have been in a large measure responsible for the protection of the town from the spread of infectious disease.
