London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1909

[Report of the Medical Officer of Health for London County Council]

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8
the percentage of the whole number, constituted by beds on which any evidence of the presence of
lice was found, varied from a maximum of 31 per cent in the first week of February to a minimum
of 12 per cent. in the first week of June. The results are of course based on the examination of
beds in many houses. In particular premises the percentage was found to be quite low. On the
other hand, the lodgers frequenting some of the shelters, for example, are more often verminous than
not, and it is thus found that each time a bed is used it becomes verminous. The seasonal curve
formed by the weekly figures is shown in Diagram IV. It maintains a high level for the first three
months of the year, is low in April, May, and June, rises a little in July, more decidedly in the late
summer and autumn months, and shows a tendency to maintain a high level for the remainder of
the year. The seasonal variations stand in marked contrast to those to be now referred to as having
been observed in the case of bugs and fleas.
Evidence of the presence of bugs was, for the purposes of this statistical inquiry, searched for
in some 550 beds weekly. The seasonal curve thus obtained (see Diagram IV.) was at a low level in
the early part of the year, rose in April, May and June, and after some irregularities attained a maximum
in the thirty-fifth week (first week of September). It then fell, with some interruption in midOctober,
reaching a low level again at the end of the year. It will be seen that the percentages for
bugs are far lower than for lice. In the former case the conditions can be and are more effectually
controlled by keepers of common lodging houses.
In dealing with fleas, it was originally intended to count, as flea-infested, all beds in which any
evidence of the presence of a flea was found (either a flea itself or a flea-mark being discovered).
As will be seen later, this rule was not in all instances strictly adhered to. The curve in Diagram
IV. follows much the same course in relation to season as does that for bugs. At first the level is low,
it then rises in April, May, June, July and August to a maximum in the first week of September : from
thence onwards, however, the decline is less abrupt than in thecase of bugs, though after the 45th week
the flea curve descends quite suddenly to approach the level at which it started early in the year.
The following possible sources of error need to be borne in mind in studying the curves showing
the seasonal distribution of vermin.
(1) The disturbing influences attendant upon the introduction of a special system of inquiry of the kind
here in question.
It was only to be anticipated that the fact that on given occasions a minute and detailed
examination of particular beds was made, and a record of the results entered up, would be likely to
cause special carc to be devoted to cleanliness by the keepers and deputies having control of those
beds. With a view, therefore, to preventing disturbance of statistical results the scheme of investigation
was so ordered that the beds, examined week by week, were selected from a considerable
number and constituted, as far as possible, a random sample from each inspector's district. The principle
has, speaking generally, been adhered to, but detailed study of the dates of examination of beds
in individual houses shows some departure from it, and in correspondence there is observable a maintenance
in two districts of the high level originally attained in September for some weeks after that
date: the phenomenon is less marked in the figures relating to the other nine districts.
(2) The difficulty of preserving an uniform standard with regard to the severity of the test applied.
In the case of lice and bugs, no serious trouble has been experienced. In that of fleas, two
main difficulties have been encountered. It was arranged at the outset that beds, in which either
fleas or flea-marks were found, should be placed upon the black list. This rule has not been absolutely
adhered to. Thus, by some misunderstanding, no regard at all was paid to flea-marks in the earlier
months of the year in two districts. Attention was not directed to this defect until the middle of May
but from that time onwards the two inspectors in question included flea-marked as well as flea-infested
beds. The presence of fleas in bed-clothing is difficult of ascertainment owing to the rapid movements
of the flea, and the possession of particularly good sight may have had influence in determining
that comparatively large numbers have been returned in some instances. A more serious question
arises in respect of flea-marks, for, while no difficulty can be felt as regards the majority, occasionally
marks are encountered as to the nature of which there is doubt, and, in practice, it is found
that some observers record a larger number of flea-marks than others, even when they have subjected
to examination beds in the same lodging houses. Indeed, as time went on, there was manifested
a tendency on the part of the investigators to take a broader view of the interpretation of the definition
of a " flea-mark."
Furthermore, during the summer holidays, when there was an interchange of districts between
the inspectors, attention was necessarily directed to differences of standard, and this circumstance
may have had some disturbing influence for the remainder of the year. In point of fact, the figures in
three districts, over and above the two already mentioned, show that the number of flea-marks
returned during the later months of the year was disproportionately large.
(3) The migratory habits of the common lodging house population.
A third difficulty has clearly to be faced in connection with these observations. The common
lodging house population is not a stationary one. As regards quantity, the variation in numbers
is not so great as to make it likely that this in itself would be a serious disturbing influence. As
regards quality, however, the increase in numbers, noted as the autumn advanced, was, in part, due to
the return to London of persons who had been engaged in work in the hop fields, and of tramps and
others driven into town by the approach of winter. These persons were found in a considerable proportion
of instances to be verminous. The " hoppers " returned to the lodging houses in late September and