Page images
PDF
EPUB

It was not contemplated that extra nourishment should be provided by Local Authorities in other than limited classes of cases where the provision was likely to be of material assistance to treatment; or that more than a limited expenditure should be incurred on this form of provision. In a circular letter dated the 3rd November, 1921, certain suggestions were communicated to the Councils for their guidance in framing arrangements, including advice as to the classes of patients suitable for such assistance, the economic considerations which should be borne in mind in dealing with individual applications for extra nourishment, and the articles of food to be supplied. So far as the Department are aware, 119 Local Authorities have now undertaken the provision of extra nourishment on the lines indicated in that circular letter.

The expenditure of Local Authorities on this service ranking for Exchequer grant is limited to a maximum of £2 per annum per thousand of the population of the area of the Authority.

Compulsory Notification and Deaths.

The following table shows the total number of primary notifications of tuberculosis (after eliminating all notifications which were found to be duplicates) during each of the past seven years :—

[blocks in formation]

The following table shows the number of deaths from tuberculosis recorded during each of these years :

[blocks in formation]

If the figures in this table are compared with the figures in the corresponding tables in previous Reports, it will be seen that the figures for the years up to 1920 differ from those formerly given. This is due to the fact that deaths from miliary tuberculosis, which were formerly included under "Pulmonary" tuberculosis, are now, by international agreement, classified under "Other forms" of tuberculosis, and the tables have been altered accordingly.

VENEREAL DISEASES.

The outstanding feature in the campaign against venereal diseases during the year under report is the large diminution in the number of new patients attending the Treatment Centres, accompanied by an increase in the total number of attendances of patients. The figures given below afford some support for the view that the incidence of these diseases is now declining, and that the importance of persevering with treatment is increasingly appreciated by those affected.

In the previous Annual Reports of the Department, separate figures were not given as to patients, attendances, etc., at the Treatment Centres situate in England as distinct from Wales, but in the following table the figures relate to those Treatment Centres only :

[blocks in formation]

38,000

30,500

2,000

1,500

17,000

1,534,000

Patients found to be suffering from gonorrhœa
Patients found to be suffering from soft chancre..
Patients found not to be suffering from venereal diseases 19,000
Number of attendances at Treatment Centres ..
Number of "in-patient days

"

..1,434,000
165,000 150,000

The returns of the work done at Treatment Centres during 1921 show that, out of 52,000 cases which were recorded as having ceased to attend at the Centres during the year, 13,000 were discharged after completion of treatment and subsequent observation, 14,500 ceased to attend after completion of one or more courses of treatment but before final tests as to cure, and 24,500 ceased to attend before completion of a course of treatment. It should, however, be noted that many of the cases which fail to continue their treatment, or to remain under observation until a cure can be pronounced, are rendered non-infective before ceasing their attendance at the Treatment Centres.

The number of Treatment Centres in England open on the 31st March, 1922, was 185, compared with 184 on the corresponding date in 1921.

During the year ended 31st March, 1922, the Department paid grants in aid of venereal diseases schemes amounting to £467,783. This sum includes £34,396 3s. 10d. paid to Boards of Guardians, and £11,700 paid to the National Council for Combating Venereal Diseases in respect of propaganda work approved by the Department. The total expenditure incurred by Local Authorities in England in carrying out approved schemes during the year ended the 31st March, 1921, was £440,091.

Owing to the exigencies of the financial situation, it has been necessary to confine any extensions of the venereal diseases schemes during the year to those cases in which increased facilities were imperatively required, and steps have been taken, similar to those which have already been described in the section of this Report dealing with tuberculosis, to limit the liabilities of the Exchequer in regard to the venereal diseases schemes of Local Authorities during 1922–23. The amount which the Government have asked Parliament to provide for this purpose is £403,500. The Authorities have been informed of the maximum grant available in aid of their venereal diseases schemes during 1922-23, the amount in each case being sufficient to enable at least the existing services to be maintained.

In May, 1921, a circular letter was sent by the Department to the Local Authorities carrying out venereal diseases schemes, setting out the policy hitherto adopted in this country for dealing with these diseases, and stating that the Government had considered the question whether any modification of that policy was required. Reference was made to the experience gained during the War by different armies in attempting to prevent the spread of venereal diseases, and to the question of the efficacy of self-disinfection for the civilian population. The circular contained the announcement that the Government had decided that they could not give official support to self-disinfection as a policy, and emphasised the importance of continuing and extending public instruction and enlightenment as to the dangers arising from promiscuous sexual intercourse, and the disastrous consequences on the general health of the community which result from the spread of venereal diseases.

OTHER INFECTIOUS DISEASES.

Principal Notifiable Diseases.

The following table shows for each of the years 1918-1921 (a) the total number of cases of each of the principal infectious diseases (except tuberculosis) which are notifiable throughout England and Wales, excluding cases among the armed forces of the Crown and those in which the notifications were subsequently withdrawn, but including cases which, although not notified, were discovered and reported to the Department; and (b) the total number of deaths registered from each of the diseases, including deaths of members of the armed forces.

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][subsumed][subsumed][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][subsumed][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

** Malaria: Number of cases in which the discase was believed to be contracted in England and Wales.

tt Encephalitis Lethargica (Acute): Although only four deaths were registered in 1918 as being due to this disease, the Registrar-General estimates the total number of deaths ascribable to the disease during that year to be 180.

The number of deaths and the death rates in England and Wales from the principal epidemic diseases in successive decennial periods from 1871-80 onwards and in 1921, as furnished by the Registrar General, are shown by the following table :

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

Epidemic diarrhoea and infective enteritis. + Figures not yet available.

Note. In the case of some of these diseases the figures for recent years are not strictly comparable with those for the preceding decades, owing to changes in nomenclature and classification due to increased knowledge of the disease and improved diagnosis. The death rates for 1911-20 are based upon provisional estimates of the population in 1920 and are subject to revision.

Scarlet Fever and Diphtheria.

As in the previous year there was exceptional prevalence of scarlet fever and diphtheria during the autumn, 137,073 cases of scarlet fever and 66,506 cases of diphtheria being notified during 1921. The number of cases of scarlet fever was the highest recorded since complete returns were first obtained in 1911. In London the incidence of these diseases remained practically at epidemic level throughout the summer. The type of disease continued very mild, the mortality being for scarlet fever 9.5 per 1,000 of notified cases, and for diphtheria 72 per 1,000 of notified cases.

Encephalitis Lethargica.

The number of cases of this disease notified during 1921 was 1,470, and showed a progressive increase as compared with the years 1919 and 1920, when the corresponding numbers were 541 and 890 respectively. A large proportion (952) of the cases in 1921 occurred during the first quarter of the year, but the epidemic behaviour of encephalitis lethargica during the winter of 1920-21 has not been repeated in the last winter season (1921-22), when the figures for January and February were unusually low.

There is some reason to think that the dissemination of information concerning encephalitis lethargica has partly accounted for the annual increase in the number of cases notified; and, with the more frequent recognition of mild forms of the disease, the case mortality figures are becoming smaller and more reliable.

The investigation of the disease by Medical Officers of the Department has continued, and a report will shortly be published.

Influenza.

During the greater part of the year there was no special prevalence of influenza in England and Wales. But in November an epidemic of some severity began in South Yorkshire and Nottingham, spreading later to London and the rest of the country. This epidemic reached its maximum in the beginning of February of the present year and then subsided. In the week of maximum incidence there were 1,451 deaths attributed to influenza as compared with 7,557 in the week of maximum incidence in 1918.

Enteric Fever.

During the autumn of 1921 a serious epidemic of enteric fever occurred in the Urban District of Bolton-upon-Dearne and neighbouring districts in Yorkshire. Two separate outbreaks occurred, and in all there were 397 cases with 41 deaths. The outbreaks were investigated by a Medical Officer of the Department, and the infection traced to the water supplies.

Plague.

No case of plague in man occurred in England and Wales during 1921. A suspected case on board a vessel in the port of Liverpool was investigated by one of the Medical Officers of the Department and found not to be plague.

In January, 1921, two rats sent from Liverpool for examination were found infected with plague, but no other infected rats were discovered during the year.

Smallpox.

During 1921, 336 cases of smallpox occurred in England and Wales, including nine cases on shipping in the Ports, one of the latter cases being a soldier.

The cases were distributed over 34 Sanitary Districts and five Ports, but the majority occurred in three areas in which there were serious outbreaks, viz., Nottingham, Colne Valley (Yorks) and Middlesbrough. There were 142 cases in the City of Nottingham and nine adjacent districts, 94 cases in the Colne Valley area of the West Riding of Yorkshire, and 41 cases in the County Borough of Middlesbrough. Each of these outbreaks was promptly investigated by Medical Officers of the Department, who conferred with representatives and officers of the Local Sanitary Authorities and Boards of Guardians whenever the circumstances rendered such a course necessary. In each instance the type of the disease was very mild, and it was frequently confused with chicken-pox; and the cases occurred at intervals throughout the last seven months of the year. There was also a small outbreak involving nine cases in the New Forest Rural District in Hampshire, where the disease was introduced by a seaman who returned home suffering from mild and unrecognised smallpox. In this instance the disease assumed a more virulent form, and one of the patients died.

ISOLATION HOSPITALS, MORTUARIES, ETC.

Continued financial stringency and the high cost of building again prevented Local Authorities generally from embarking on any extensive programme of isolation hospital construction. A few Authorities have put forward unnecessarily extensive schemes which have had to be adversely criticised by the Department, but, on the other hand, some Authorities have been reluctant to incur the expenditure necessary

« PreviousContinue »