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iii.
disease and the consequent "missed" cases doubtless account for much of its prevalence.
Until about 1902 nothing was done to limit the prevalence of measles and whooping
cough. Since that date every known case has been visited, precautions have been recommended
both to prevent the spread of the infection and to secure the due care of the sick,
and disinfection largely practised. The reductions in the mortality from those diseases show
that the work has not been without success. Although some of the reduction in mortality
from diarrhoea (25 per cent.) is attributable to a sequence of cooler—I might almost say
inclement—summers, part of it may be safely put down to the health visiting of the last three
years. The reduction in the phthisis rate (21 per cent.) is the least among those diseases
commonly known as infectious.
The infantile mortality rate of last year was 110, calculated on the births registered in
the Borough, 105 if calculated on the corrected number of births (see page 38). The former
rate is the lowest on record, save that (108) for 1903. The (corresponding) mean rate for
1904-08 was 119, or 28 per 1,000 less than the mean (147) for 1891-95. Prior to 1903 the
infantile mortality had never fallen lower than 131 per 1,000 (in 1902) ; since that year a rate
exceeding 120 has been recorded twice only, viz., in 1904 (136), and 1905 (122).
As regards the work of your Public Health Department, I have little to add to what is
written in the report. I should like to be able to extend the operations of the Staff with
reference to child rearing and children's diseases. The efforts of the Women Inspectors are
so cordially welcomed and have already accomplished so much that I am encouraged to urge
that that work should be extended. Even with the help of the workers attached to the
Paddington Health Society not much more than half the children who may be expected to
benefit, are visited, and a much smaller proportion re-visited (see page 45). The work of the
Women Inspectors in connection with children's illnesses such as measles, whooping cough, and
diarrhœa, takes up a very large amount of time, but the results achieved justify the work.
Work among the children yields the best results, both educative and hygienic. I cannot leave
this subject without an acknowledgment of the assistance which this Department has
received during the year from the Health Society, whose help in visiting infants and in maintaining
the two "Consultation Centres" has been most valuable.
For some time past I have felt that general sanitary administration has achieved its
maximum effect on consumption, and that more specialised effort is required to hasten the
stamping-out of the disease. The preventive work implied in general sanitary administration
is seriously handicapped by the lack of precise information as to existing centres of infection,
and the compulsory notification of the disease is essential to further progress. That useful
adjunct to sanitary administration is at the service of many public health authorities outside
England, and its early introduction in this country is very necessary. The notification of
Poor Law cases, inaugurated by the Order of the Local Government Board at the beginning
of the current year, is a great step in advance. The opening of the " Paddington Dispensarv for
the Prevention of Consumption "—the first in England—provides a valuable aid towards checking
the disease. Not only will patients receive that advice, both medical and hygienic, which is
necessary for the treatment of their disease and the prevention of the spread of infection, but
they will be visited in their homes by doctor and nurse, who will instruct the patients how to
give effect to the hygienic measures prescribed, and do their best to see that they are carried
out. The "dispensary system," however, requires the help of notification to achieve the best
results.