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NURSERY COUGHS

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MEASLES, FEVER, DIPHTHERIA. Deaths from zymotic diseases numbered 241; death rate. 3.1. These figures show the deaths from the seven principal zymotic diseases, of the Registrar General: Small pox, measles, whocping cough, scarlet fever, diphtheria, fever, and diarrhoea. "Lasc year the rate was 2.5, and the increase is due to a larger number of deaths from whooping cough and diarrhoea. Measles: Deaths, 24; rate per 1,000..31. Last year there were 65 deaths, with a rate per 1,000 of .85. Age distribution: Under 1 £ ear, 6; 1—2 years, 9; 2—3 years, 4; 3—4 years." 3; 4—5 years, 1; 5-6 years. 1. From this table, it will be seen that 19 of the deaths were of children under 3 years of age, that is, below school age. and this bears out the experience of former epi- demics that invasion of a school by measles is of more consequence to the children who re- main at home than to the children attending school. It also shows the necessity of trying to prevent measles epidemics in infant schools, as if we can postpone the attacks till the children grow older, a number of lives will be saved owing to the lessened fatality in older children as compared with infants. The difficulty, as in former years, has been to get sufficiently early infownation of cases to make school closure effective. The teachers are, however, now more alive to the necessity of reporting the first cases that occur, and better results may be anticipated in the future. Whooping Cough: Sixty-five deaths were reg- istered, as compared with 21 last year. Thirty of the deaths were of children under 1 year of age, while 33 were between the ages of 1 and 5 years. The number of deaths indicates a very extensive prevalence of the disease during the year. and all the wards suffered, though in Plymouth there was only one death. Scarlet Fever: Notifications, 306; deaths, 6: death rate per 1,000 of the population, .07; case mortal- ity, number of deaths per 100 cases notified. 0 1.9. Last year there were 307 notifications with 11 deaths. The Town Ward suffered most severely with 97 notifications, while from Dow- lais there were only 3. One hundred and eighty six of the cases were removed to hospital, a much larger proportion than in previous yeara. The difficulty in getting pati-ents removed oc- curs mainly in connection with the lower wards, whfch are some distance from the hospital, but we have succeeded to a large extent in over, coming the prejudice that formerly existed in connection with Pant Hospital. Since the autumn, there has been an extensive prevalence of this disease, mainly in the Penydarren. Park, Town, and Cyfarthfa Wards; and. unfortunate- ly. a number of ca. were notified after the rash had disappeared and when peeling. Al- though, owing to t late recognition, and the non-recognition of mild cases, hospital isola- tion in a district like this, which is mainly work- ing class, may not be effective in stamping out the disease, yet the hospital has proved a great boon to numerous families, where home isola- tion could not be carried out, thus allowing other children to return to school in a few days and adults to go about their everydav affairs. Two return cases were notified as occurring within a week of the return of patients from the isolation hospital. The-se patients had, owing to the hospital being crowded, been de- tained only five weeks, as peeling seem to be completed, and there was no aural or nasal (I s- charge. One of the patients seemed, however. to have developed an aural discharge immed- iately after reaching home. while in the other case "fresh peeling seems to have occurred after discharge. Diphtheria: Notifications, 80; deaths, 9: death rate per 1,000 of population..116; case mortal- ity per cent.. 11.2. Including membranous croup, 80 cas^s were notified, with 9 deaths, compared with 72 notification:; and 18 deaths last year. Only 18 of tho cases were removed to hospital, but this was chieflv owing to the limited aoccmraodation there. There is no diph- theria pavilion, and the cases were isolated in the observation block, where only six patients can be accommodated. Another circumstance was that a number of cases occurred in hour-es where home isolation could b? carried out. On 25th January there was the first, notification in connection with the outbreak at a private school, and on the 27th three more cases were notified. On the 27th I visited the school and advised its closure for a fortnight, in order that thorough disinfection might be carried out. No drainage defect could bs discovered, but as the school was carried on in one room of a private house, th-3 children, of whom there were 18, were rather overcrowded. Three more cases were notiaed a few days later, making a total of 7 out of 18 who suffered from the disease. One of the cases proved fatal. The mother and sis- ter of one of the patients were afterwards noti- fied as suffering from the disease. This was the only inr-tahce of a definite school epidemic, though Edwarsville School, Treharris, was un- der suspicion at one time. There was one rase notified from the Truant School, Tref'.arris. the patient was promptly rr'!OV..HJ te hesmtai. axLd etliejj cafjs dfi.Yejogedi -=- ENTERIC FEVER AND PHTHISIS. Enteric fever: Notifications, 76; deaths, 11; death rate per 1,000 of population, .14; case mortality per cent. 14.4. La-st year there were 57 notifications, with 10 deaths. Fifty-six of the patients were removed to hospital, and ;n the other cases satisfactory arrangements to isolate them at home were made. Dowlais, Penydar ren, Park, and Cyfarthfa were the wards that suffered most severely. In some houses more than one case was reported; thus from one house in Taff-strrwt, Caepantywyil. which has since beer, condemned as unfit for human habit- ation. three cases were reported. Diarrhoeal Diseases: Deaths, 126; death rate per 1,000 of population, 1.6. La-st year there J¡ were 69 deaths, and a death rate of .9 per 1,000; and this low rate was attributable to the large rainfall that we experienced in the autumn months. Last fall we had less rain, and in con- sequence an increased number of deaths from this disease. One hundred and five of the deaths were of children under one year of age, while 20 were between the ages of 1 and 5. and one wa. over 65. As usual, the great majority of the deaths occurred in the months of August. September, and October; thus in August there were 37 deaths, in September 28, and in Octo- her 17. Penydarren Ward suffered most severe- ly, with 32 deaths, and this excessive prevalence is no doubt due to the circumstance that house refuse is still tipped in this ward close to the houses. As long-as this goes on, a high death rate from diarrhoea will inevitably result. In previous reports it has been pointed out that to escape the ravages of this disease, it was neces- sary to have a high standard of both municipal and domestic cleanliness, bi -it as regards the former, no advance ha.s been made, as tipping instead of destruction of the refuse is still go- ing on. In. the matter of'domestic cleanliness, an improvement may be expected from the visits of our health visitor, and I think that some- advance has already- been made since she was appointed a few monihs ago. In. her visits she is able -to point out, the great advantage of breasfi feeding, as it is well known that tne dis- ease is much commoner in bottle-fed. than breast-fed '.infants. Tubercular 'Diseases Ninety-one deaths jrom phthisw were registered during the year, equiv- alent to a death rate of 1.1last year there w^re 73 deaths, and a death ra-te of -9'7. I orty-two deaths were registered f^om other tubercular diseases, so that including the deaths from phthisis there were* 132 deaths from tubercular diseases, equivalent to a death rate of 1.7. There is no system of notification in force within the Borough, and the only action ta-ken is to disinfect tho house, bedding, etc.. after a death. At the Union Infirmarv there is pro- vision for advanced cases to the extent of 33 beds, and there are also 4 outdoor shelters*, one of whioh is double for incipient cases. Those are all the provision for the Union, which in- cludes Aberdare, Gellvgaer and Rhigos, atid Vaynor and Pend-Tvn. with a population 0; about 75.000. in addition to thnt op Merthyr. The Guardian- are c^ntemr.latinT buddinrr a sanatorium. Dr. Ward has constantly to refuse ea-rlv cases of phthisis, where gr-^at b-nefit mi edit be derived from sanatorium treatment, and it is to be hoped that there will be no de ay in pushing on with the scneme. INFANTILE MORTALITY The deaths of children under one year of age amounted to 482, compared with 420 last year. As noted under the heading of diarrnceal dis eases, there were 57 more deaths from these diseases than in the previous year. so that the greater infantile mortality is thus accounted for by the greater number of deaths from diar- rhoea. Thirtv-threa per cent. of the tota. deaths were oi children under one year of age, and calculated per 1,000 births, amountes to lit) per 1.000. The average for the 10 years 189. 1907 is 197.4 per 1,000 births, so that there is some improvement, though we still compare badly with the whole of England and Wa;es, where the death rate for the year 1908 is 121. Sixty-nine deaths, or 14 per cent.. occurred in the first week of life, while during the first month there were 129, or nearly 27 per cent. In the first quarter there were 226 deaths, or 47 per cent. in the second quarter there were 113 deaths, or 24 per cent.; in the third quarter there were 81 deaths, or 17 per cent. whi!e in the fourth quarter there were 62 deaths, or 12 per cent. It is not to be expected that the im- provement in the sanitary surroundings will greatly lessen the number of deaths occurring in the first month of life, as antenatal condi- tions must be held to be largely responsible for them. Premature birth accounted for 50 deaths, 37 of which occurred in the iirst week of life, and 46 in the first month. Congenital defects were the cause of 25 deaths; one was from in- jury at birth 6 from want of breast milk, whne there were 64 from atrophy, debility, and mar asmus. Diarrhoea was the cause of death in 126 instances, and reference has already been made to this disease. Convulsions was the cause o death in 76 cases, while bronchitis and pneu- monia accounted for 75 deaths. Of the common infectious diseases, whooping cough accounted for 31 deaths and measles for 6. Four hundred and fifty-three deaths were of legitimate and 29 of illegitima-to children. Per 1,000 births, the death rate of illegitimate children was 346, compared with 170 among legitimate children. Last year the illegitimate death rato was 200 per 1.000 birthe. When we attained the status of a county borough in April last, the Council appointed a health visitor (Nurse Thompson), who al-o acts as superintendent of midwives and to facilitate her work, the Notification of Births Act was put in force in July. We are thus informed of a birth within 36 hours of its occurrence, and the health visitor is enabled to visit at once where there is no medical man in attendance, and advise the mother as to the proper methods of feeding and clothing to be adopted, laying special emphasis on the necessity for breast- feeding. Since the Act came into force, there have been only 13 omissions to notify, and Nurse Thompson has been able to make 1,383 visits, giving the instructions alluded to above and leaving at each house a pamphlet on the hygiene of infancy. In 64 instances, for various reasons, re-visits were made. but owing to the extent of the district, and the amount of her work in other directions, it has not been possible to develop this part of the work to its full ex- tent. In four instances it was neowsarv to call the attention of the Inspector of the N.S.P.C.C.j and on six occasions the midwives were instruc- ted to call in medical assistance owing to the condition of the children's eyes. In connection with the Notification of Births Act. I may men- tion that 42 still births were notified since its adoption. As a further aid towards reducing infantile mortality, there are now three Jubilee nurses at work in Merthvr, Penydarren, and Dowlais respectively, and their work cannot but be beneficial in this direction. INQUESTS. One hundred and nineteen inquests were held during the year. Accidents underground were the cause of death in 17 instances, while 11 per- sons died as the result of injuries received in the ironworks. Eight persons died as the result of accidents received elsewhere than in the ironworks, or collieries. Five persons were kill. ed on the railway. Ten children died from clothing taking fire or accidental scalding. Con- vulsions was the cause of death of 16 children. Other causes of death were:—Heart disease or cardiac syncope, 13; suffocation by the fumes of a burning tip, 2; epilepsy, 1; accidental drowning. 4; found drowned, 4; suffoca-ted when drunk, 1; exposure to cold, 1; pneumonia, 2; swallowing poison, 1; lock-jaw following in- jury, 1; blood poisoning following injury, 1; premature birth, 1; chronic bronchitis and syn- cope, 3; kidney disease, 2, apoplexy. 4; non- expansion of lung, 2; suicide. 1; over-lying, 2; manslaughter, 1; embolism following fracture of leg, rupture of aneurism, 1; peritonitis, 1; found dead, 1; embolism after child-birth, 1. ISOLATION HOSPITAL. During the year 282 patients were admitted to hospital; of these 262 came from the Bor- ough, while 20 were admitted from Cefn, 17' suffering from typhoid and 3 from scarlet fever. Last year there were 180 patients, eo that the wcrk during the past year -has been much heavier than formerly. The cases were distri- buted as follow: Scarlet fever. 189; enteric 73; diphtheria, 18; and erysipelas, 2. The scarlet fever patients remained in hospital on an average of 41 days. and there were 4 deaths, giving a case mortality of 2.1 per cent. Last year the case mortality was 1.9. A number of the children suffer from enlarged tonsils and adenoids, and when -the parents consent it i" now the practice to cperate durinrr their stay in hospital when they are convalescent from the fever. The average stay of the typhoid cases was 36 days. As in previous years, several of the patients were admitted late in the disease, so that their stay in hospital was a comparative- !y short one. There were 4 deaths, thus giv- ing a case mortality of 5.4, compared with 14 last year. Diphtheria: The average stay of the diphtheria patients was 29 day, and they were discharged only after a l>acteriological examin- ation proved negative. There were 3 deaths; one of the deaths was of a patient moribund on admission, while the other two occurred 011 the fifth and seventh days respectively after admission. In all three cases the parents had not recognised the gravity of the disease, and had postponed callin-g in medical assistance for several days. As mentioned in last year's re- port, there is no diphtheria pavilion, and the Council had decided on building another pavil- ion of the same size and design as the two x- isting ones. The contract has now been given out, and I expect that a beginning will bo made shortly, BQ that it will be ready by next, winter. shortly, so that it will be ready by next winter. The working expenses for the year amounted to 21,554 9s. 2d. As there were 282 patients for a period of 10,920 days, this works out at 2s. lOd. per patielit per day. As further reduc- ing the actual cost to the Council, there is the contribution from the Guardians of L225 and 27 6s. 4d. on account of the maintenance of pauper patients. At Mardy Hospital there is an equifex disinfector in which all bedding and clothes from houses where there have been patients suffering from infectious disease are infected. On referring to the Inspectors' table, it will be seen that 365 premises were disin- fected during the year, and bedding and clothes were removed for disinfection from these houses. Further extracts from the report will be given next week. To Mothers.—Mrs. Winslow's Soothing: S.vrnplias been nsed over fifty years by millions of mothers for j. their children w!i:!e" teething, with perfect Tt will relieve the noor iirerir immediately. It i pleasing to taste: it nrodnces natural fluid slefp, i-v j re'irveintr the c'ii!(l from pain, and the little cherub awakes "as brijrht as a button," Of all chemists, Ls 1i4, sec bftttl*. i

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