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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London

London County Council 1923

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

Published
1924
Pages
192
Tables
80

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80 tables in this report

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    Accommodation. 3. On 1st January, 1924, the accommodation at the London County mental Accommodation hospitals, according to the requirements of the Board of Control as to bed space, was:— Table 1.
    Mental hospital.Males.Females.Total.
  • Page 6
    5. The number of resident patients on 1st January, 1924, was:— Table 2.
    Mental hospital.Males.Females.Total.
  • Page 6
    9. The statutory returns to the Council by the London boards of guardians, taken with other available information, show that on 1st January, 1924, the Council was responsible to find accommodation for 18,918 insane persons, who were housed as follows:— Table 3.
    Males.Females.Total.
  • Page 7
    11. Contracts in force at 31st March, 1924, were as follows:— Table 4.
    Mental hospital.Number contracted for.Charge a head a week provided for in the original contract.Charge a head a week made at 31st March, 1924.Date of commencement.Full term of contract.Date of expiry.
  • Page 7
    12. The numbers of lunatics for whom the Council has been responsible to find accommodation on 1st January in certain years since 1890 are as follows*:— Table 5.
    Date.Parish and county patients.Chargeable to Prison Commissioners.Patients on private list, etc., and private patients at Horton.Total.Increase.
  • Page 8
    14. Details of the number of lunatics (excluding private cases) under the care of public authorities in London responsible for dealing with them are as follows1:— Table 6.
    Date.L.C.C. Lunatics under reception orders.M..A.B. Lunatics in M.A.B. mental hospitals.Guardians.. Lunatics in workhouses or with relatives and friendsTotal number of lunatics.Annual increase or decrease of
    Lunatics under reception orders.Total number of lunatics.
  • Page 8
    Applications for admission. 15. The applications for beds for cases of lunacy received from the relieving officers in the County of London and dealt with during each month of the period 1913-1924 are as follows:— Table 7.
    1913-141914-151915-161916-171917-181918-19 919-201920-211921-221922-231923-24
  • Page 9
    17. Statistics as to recoveries and readmissions during the past 29 years are as follows:— Table 8.
    Mental hospital.Patients discharged "recovered"between 1895 and 1923.Number of such patients readmitted to any London mental hospital up to 31st December, 1923.Percentage of such readmissions to discharges " recovered."Number of 9uch patients readmitted to any London mental hospital within twelve months of their discharge up to 31st Dec., 1923.Percentage of such readmissions to discharges " recovered."
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    Admissions, Deaths and Discharges. 19. During 1923 1,180 patients died and 881 were discharged " recovered." Admissions The number of such deaths and discharges with statistics as to admissions (excluding dtoharges. transfers from other mental hospitals) during the years 1920-23 are as follows*:— Table 9.
    Year.Patients admitted directly.Weekly average.Deatlis.Weekly average.Discharges recovered.Weekly average.
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    22. The following statement shows the action taken in regard to the classification of patients during the year ended 31st March, 1924:— Table 10.
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    25. The number of patients chargeable to the county, as compared with the total number chargeable to London boards of guardians and the county, for whom the Council was providing accommodation at the commencement of 1924, and of previous years, was as follows1:— Table 11.
    Date, 1st January.Chargeable to the County.Chargeable to London boards of Guardians and the County.Date, 1st January.Chargeable to the County.Chargeable to London boards of Guardians and the County.
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    27. The following return gives particulars of ex-soldier patients at each of the London County mental hospitals during the year ended 31st March, 1924:— Table 12.
    Admission of patients with previous military service.Patients classified as "service" patients during the year.Discharged or transferred after classification as ''service'' patients."Service " patients remaining at 31st March, 1924.
    Under section 91 of Army Act.Under summary reception orders.Transferred from other mental hospitals.
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    47. The number of patients treated during this first year was 1,012, made up Number of as follows patients.
    Female (including wards children).Male (including wards children).(including Total. children).
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    Finance. 77. The income and expenditure on maintenance account on mental hospitals, etc., during the year ended 31st March, 1924, is shown in the following table in comparison with the amounts for the previous eight years—
    Year ending 31st March.Income.Expenditure.Year ending 31s' March.IncomeExpenditure.
    ££££
  • Page 19
    The cases of which the Council received information during the year ended 31st December, 1923, were:—
    Source of information.Total.
    Miscellaneous sources.London Association for the Care of the Mentally Defective.Education authority.Poor-law authorities.Criminal cases.
    Charged with offences before a court of criminal jurisdiction (Sec. 8).Prisons (Sec. 9).Industrial schools (Sec. 9).
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    13. At 31st December, 1923, the centres in use were:—
    Centre.Address.Sessions a week.Average daily attendance during December, 1923, of defectives under statutory supervision.
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    22. Of the cases of mental defect maintained by the Council in institutions during 1923, about one half were accommodated under contract, as detailed below :
    Institution.Males.Females.Institution.Males.Females
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    23. The class of patient received and the charges* made for maintenance were:—
    Institution.Religion.Class of defective received.Charges.
    By contract.Supplemental payments
    Maintenance (a week)Burials.Outfits.Maintenance (a week)Burials.Outfits.
  • Page 23
    Continued from previous page...
    Institution.Religion.Class of defective received.Charges.
    By contract.Supplemental payments.
    Maintenance (a week).Burials.Outfits.Maintenance (a week)Burials.Outfits.
  • Page 24
    33. The following statement shows for the year ended 31st December, 1923. how the Council has discharged the duty of making recovery wherever possible of such contributions as are available in relief of the expenses of maintaining defectives in institutions or under guardianship:—
    (1) Cases under contribution.(2) Sum collectable.(3) Sum collected.(4) Percentage of (3) to (2).(5) Sum written off.
    £s.d.£s.d.£s.d.
  • Page 24
    34. Legal proceedings had to be taken during the year for the recovery of payment from persons liable to contribute, with the following result:-
    (1) In 13 cases. Orders made to pay amounts totalling—(2) In 14 cases. Adjourned on undertaking to pay being given.(3) In 4 cases. Amounts paid at court before proceedings, totalling—
    ArrearsCosts.ArrearsArrearsCosts.
    £s.d.£s.d.£s.d.£s.d.£s.d.
  • Page 26
    APPENDIX I. Financial statement showing the cost of administration of the Mental Deficiency Act during the year ending 31st March, 1924.
    £s.d.£s.d.£s.d.
  • Page 27
    APPENDIX II. Return of expenditure (and cost a head) during the financial year ended 31st March, 1924, on maintenance of defectives at institutions provided by the Council.
    Heading.Cost per patient weekly.
    Brunswick House.South Side Home.The Manor.
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    The downward movement of the birth-rate, dating back to the early eighties, is maintained. The decline in the birth-rate and fertility rate in London boroughs in relation to the reduction in infant mortality between the three-year periods 1911-13 and 1921-23 is shown in the appended table.
    Metropolitan Borough.Birth-rate per 1,000 living.Legitimate births per 100 married women aged 15-45.Infant mortality (Deaths per 1,000 births).
    1911-13.1921-23Decrease per cent.1911-131921-23.Decrease per cent.1911-131921-23Decrease per cent.
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    The downward movement of the birth-rate, dating back to the early eighties, is maintained. The decline in the birth-rate and fertility rate in London boroughs in relation to the reduction in infant mortality between the three-year periods 1911-13 and 1921-23 is shown in the appended table.
    Metropolitan Borough.Birth-rate per 1,000 living.Legitimate births per 100 married women aged 15—45.Infant mortality (Deaths per 1,000 births).
    1911-13.1921-23.Decrease per cent.1911-13.1921-23.Decrease per cent.1911-131921-23Decrease per cent.
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    If the boroughs be grouped according to social condition as shown by the proportion of children of school age scheduled for attendance at elementary schools it is found that the decline in the birth-rate and infant mortality is greatest in those boroughs in which the proportion of children scheduled is highest, thus:
    Group.Decrease in Birth-rate, per cent.Decrease in Fertility, per cent.Decrease in Infant Mortality, per cent
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    The distribution of deaths by ages during 1923 is shown in the following table, with corresponding figures for post-war years:—
    Year.0—1—2—5—10—15—20—25—35—45—55—65 +All ages.
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    Males.
    Period.Age-group.
    0-5-10-15-20-25-35-45-55-65-75-85 +
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    Females.
    Period.Age-group.
    0-5-10-15-20-25-35-45-55-65-75-85 +
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    The expectation of life characterising each of the nine periods for which life. tables were constructed is shown in the following table :—
    Perioi.Expectation of life (years).
    Males.Females.
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    The death.rate (and birth.rate) in the life.tabie population of London for the various periods is shown in the following table :—
    Period.Death.rate (and birth.rate) in Life table population.
    Males.Females.
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    There is probably no branch of public health administration which has achieved better results in the prevention of disease during the past 20 years than that which deals with the control of smallpox in London, as the following table which compares the recent figures with those of earlier years will demonstrate :—
    Quinquennia.Deaths from smallpox.Admissions to M.A.B. hospitals (first hospital opened 1.12.70).Uases of smallpox (i) in London and (ii) in England and Wales.
    England and Wales.London.
    London.England and Wales.
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    The following table shows the age-distribution of the deaths from phthisis in 1923 in relation to 1922 :—
    Year.Age-group.Total.
    0-5-10-15-20-25-35- | 45-55-65-75 +
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    The following is an analysis of the corrected notifications in London durinj (52 weeks):—
    Form of tuberculosis notified.Sex.Notifications on Form A. (Total ofprimary notifications received in London boroughs, other than elementary school cases, injra.)
    0-1-5-10-15-20-25-35-45-55-65 +Total
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    The following is an analysis of the corrected notifications in London durinj (52 weeks):—
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    The following table shows the age incidence of actual cases of cerebrospinal fever, poliomyelitis, polioencephalitis and encephalitis lethargica during 1923.
    1 Under 3.3.5.5.10.10. 20.20. 30.30. 40.40. 50.50.60.Over 60.Total.
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    The following table shows the yearly incidence (of cases notified) of cerebrospinal fever, poliomyelitis and polioencephalitis since 1913 and of encephalitis lethargica since 1919.
    1913.1914.1915.1916.1917.1918.1919.1920.1921.1922.1923.
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    In the following table the mortality from cancer in London is shown for each age and sex for the principal age-groups affected, for three-year periods to which each successive census in and since 1851 is central:-
    Period.Ages.Total of rates.Females. M=100.
    25-35-45-55-65-75-85
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    Housing Act of 1919 ; certain other particulars as to conditions in 1923 ; and the action taken by the metropolitan borough councils under the provisions of Section 17 of the Housing and Town Planning Act with regard to the making of representations and closing orders—the figures for the years 1911-14, 1915—19, and 1920-23 are included for comparison.
    Metropolitan borough.No. of houses.No. of houses for the working classes.No. of representations.No. of closing orders.No. of houses demolished.
    In borough.Inhabited by working classes.Repaired by local authority.Erected.In course of erection.
    1923.1023.1923.1923.1923.1911-141915-191920-231911-141915-191920-231911-141915-191920-23
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    The classification of the 1,741 patients discharged after observation in hospitals :
    Classification—Group A363 casesor 24.90%
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    Action taken with regard to 1,458 cases in which tuberculosis was diagnosed, compared with the figures for 1922 :—
    Year.
    1923.1922.
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    During the year 821 cases were examined with the following results :—
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    TABLE I. COUNTY OF LONDON. Vital statistics for the several metropolitan boroughs and the County of London in the year 1923. (Rates per 1,000 of civil population.)
    Metropolitan boroughs. (Arranged in topographical order.)Estimated civil population, 1923.Births.Death.Infant mortality (per 1,000 births.MeaslesScarlet fever.Diphtheria.Whoop- ing cough.Ty-phoid fever.Diarrhoea and Enteritis, age 0-2 (per 1,000 births).Phthisis.Pneu -inonia.Bronchitis.Cancer.Cases of notifiable infectious disease, la)
    Scarlet fever.Diphtheria.Typhoid fever.Erysipelas.Puerperal fever 'per 1,000 births).Cerebrospinal fever.Acute pneumonia.
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    Tuberculosis Dispensaries—analysis of Returns Jan. — Dec., 1923.
    Borough and dispensary.Under observation on 1-1-1923 pending diagnosis.Examined for first time during 1923, including contacts.Number of contacts included in (3).Number included under (2) and (3) suffering fromNumber included under (2) and (3) found to be non-tuberculous.Under observation on 31st December, 1923,pending diagnosis.Total attend ances.Visits to homes byHome consultations.Number referred to affiliated hospital.No. of specimens of sputum examined
    (a) Pulmonary.(6) Non-pulmonary.
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    Condition of Teeth of Entrant Children.
    1922.1923.
    Sound.Less than 4 decayed.More than 4 decayed.Sound.Less than 4 decayed.More than 4 decayed.
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    Dental condition of twelve-year-old children.
    19131917192119221923
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    In view of the general interest in the question, the following detailed analysis by Dr. Wells of the cases treated by Dr. Friel at his two centres, is here given in full.
    Total.Cured.Lost sight of.Still under treatment.Referred.
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    Details of 20 children who had been excluded from or were very irregular in their attendance at their ordinary schools are as follows, the percentage of attendance at the open-air school of these children being 83.5:—
    N ame.Age.Attendance history at previous school.Percentage of attendance at open-air school.Name.Age.Attendance history at previous school.Percentage of attendance at open-air school.
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    Children absent from school three months owing to illness reported in November— 1920, 1921, 1922, 1923.
    Children.Percentage of total.
    Complaint.1920.1921.1922.1923.1920.1921.1922.1923
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    Under the Council s Employment By-laws no child liable to attend school can be employed out of school hours unless a certificate of fitness has been obtained from the school medical officer. The following summary gives the number of children seen under the By-laws during the past year in each division.
    Division.Children examined.Certificates granted.Certificates issued cri condition that treatment is obtained.Rejections.Application withdrawn fcr various reasons.Certificate revoked.
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    "It is to be regretted that remedial exercise classes are not more frequent in the senior departments. This class is the only one which has come under my observation although in all the schools I inspect I find a number of children who would undoubtedly benefit by such a special course of exercise."
    Kyphosis.Scoliosis.Kypho-Scoliosis.Flat feet.
    Number.Discharged.Number.Discharged.Number.Discharged.Number.Discharged.
    Cured.Improved.Cured.Improved.Cured.Improved.Cured.Improved.
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    The results of the work for several years 1912-1923 under the cleansing scheme are shown in the following table:—
    Year.Examinations at rota visits.Venrinous conditions noted at rota visits.Per cent.Verminous children referred to stations.Subsequently cleansed by-parents.Verminous children cleansed at stations.Scabies cases bathed at stations.
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    The following table shows the working of the scheme in these three outbreaks.
    1920. April-May. (6 weeks).1922. February-April. (10 weeks).1924. January-March. (9 weeks).
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    England and Wales.
    Decennium.Males.Females.Mean.
    0—5-10-0—5-10-0-5—10—
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    London.
    Decennium.Males.Females.Mean.
    0—5.10—0—5—10.0—5—10-
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    In the following table the mortality per million living from the principal causes of death of London children from five to fifteen years of age is compared with that for England and Wales as a whole in the two decennial periods 1901-10 and 1911-20:—
    Cause of death.1901-10.1911-20.
    England and Wales.London.England and Wales.London.
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    Continued from previous page...
    Cause of death.1901-10.1911-20.
    England and Wales.London.England and Wales.London.
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    The following statement shows the nature of the conditions found among the children certified suitable for admission to physically defective schools at the admission examinations during the year:—
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    TABLE I. Medical Inspections.
    (a) ROUTINE INSPECTIONS.(6) OTHER INSPECTIONS.
    Boys.Girls.Total.Boys.Girls.Total.
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    TABLE II. (a) Defects found by Medical Inspection in 1923. ELEMENTARY AND SPECIAL SCHOOLS.
    Defect or disease.Routine inspections.Special inspections.
    Defects.Defects.
    Requiring treatment.Requiring observation only.Requiring treatment.Requiring observation only.
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    Continued from previous page...
    Defect or disease.Routine inspectionsSpecial inspections.
    Defects.Defects.
    Requiring treatment.Requiring observation only.Requiring treatment.Requiring observation only.
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    (b) Children found at routine medical inspection to require treatment (excluding uncleanliness).
    Age group. 1.Number of Children.Percentage of defective children. 4.
    Inspected. 2.Found to require treatment. 3.
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    TABLE III. Exceptional Children in London in 1923.
    Blind (including partially blind)—Boys.Girls.Total.
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    TABLE IV. Defects treated during 1923. TREATMENT TABLE. Group I. Minor Ailments (excluding uncleanliness, for which see Group V).
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    Group III. Treatment of Defects of Nose and Throat.
    Number of defects.
    Received operative treatment.Received other forms of treatment.Total number treated.
    Under Council's scheme.Private practitioner or hospital.Total.
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    The following table shows the provision for residential treatment under the scheme (excluding insured persons and ex-service men)†:—
    Year.New cases admitted during year.Beds occupied at end of year.
    Adults.Children.Total.Adults.Children.Total.
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    The following table shows the provision for residential treatment in London for insured persons and ex-service men:—
    Admissions during year.Beds occupied at end of year.
    Insured adults.Ex-service men.Total.Insured adults.Ex-service men.Total.
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    unnecessary. Some particulars of the Council's work are as follows :—
    Year.Infants removed from foster mothers.Exemptions.Deaths.Infringements discovered.Cautions.Prosecutions.Convictions.
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    Particulars with regard to common lodging-houses licensed by the Council are as follows :—
    Year.Houses licensed.Lodgers authorised.j Prosecutions.Convictions.Penalties and costs.Cases of infectious disease.
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    Particulars of seamen's lodging-houses licensed by the Council are as follows :—
    Year.Houses licensed.Lodgers authorised.Prosecutions.Convictions.Penalties and costs.Cases of infectious disease.
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    The following table gives particulars of licensed slaughterhouses, knackers' yards and registered offensive businesses for 1921-23 :—
    Year.Slaughterhouses.Knackers' yards.Offensive businesses.
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    The quantities of sewage, etc., dealt with during 1923 were as follows :—
    Sewage treated—Million gallons.
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    Repairs, etc., have been carried out during the year to intercepting and main sewers as follows:—
    Feet£
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    Working-class dwellings.—The results of the year s working compared with those of the previous year are as follows :—
    Dwellings—-1923-24.1922-23.
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    The results for the year 1923-24, compared with those for the previous year, are as follows:—
    1923-24.1922-23.
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    The total deficiency is provided for as follows: Chargeable to Special County
    Account—£s.d.£s.d.
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    Although considerable commitments have been entered into by the Council at 31st March, 1924, the accounts this year show little more than preliminary expenses, the net deficiency under all heads being £7,107 18s. 7d., as follows
    Schemes undertaken by the Council-£s.d
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    Net Deficiency, 1923-24—How Met. The financial results for the year under the several sections and sub-sections may be epitomised as follows:—
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    This is borne as follows—
    Exchequer subsidy—£s.d.£8.d.
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    Capital Expenditure and Debt. The total capital expenditure in respect of housing up to 31st March, 1924, amounts to £15,499,566 6s. 11d., as follows—
    Non-assisted schemes.Assisted (1919) schemes.Assisted (1923) schemes.