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DENBIGHSHIRE HEALTH RETURNS. NOTEWORTHY REPORT rFROM AN EXPERT. MANY IMPROVEMENTS: SERIOUS DIFFICULTIES YET TO OVERCOME. Dr. R. Stenhouse Williams, assistant lecturer on public health bacteriology at the Liverpool University, lias just issued his eighth annual report on the health returns and vital statistics for Denbighshire. The following particulars are culled from it ae indicating the value of the work al- tready accomplished by the Health Com- mittee, .and al&o the importance of what yet temains to do — There can be no doubt, writes Dr. Wil-, that many improvements have been effected in the county during the last few Years, the whole atmosphere of the reports Ileoe;ved is more hopeful than it once was. It may be worth while to mention a few of the works that have been iktomplished. C'ol- "wyn Bay has been supplied with excellent water and sewage schemes. The dairies and 'OOws.h<Cds in the Wrexham rural have been ^evolutionised. This y-cax there is a very &ood report upon tlio housing accommoda- tion of Wrexham, which shows that the con- ditions are not nearly so dark as rumour had painted them, yet there are serious difficul- ties which remain to be overcome. There is *10 provision for small pox in the county. Infectious diseases hospitals are not found Iln thirteen out of sixteen districts. The Notification of Births Act is only in force in one district. The attack upon tubercu- iosis is of a very limited description. The bacteriological examination of milk is mot Itud-artaken. The slaughter-houses in some districts require many improvements, where possible public slaughter-houses should be sabstEtuted for private. Last year's report of the Local Government Board's Inspector fchows that there is much work to be done in St. Asaph (Denbigh), and many of the tn.edieal officers of health deplore the ahsonce Accommodation for the working classes. AREA AND POPULATION. L "re are. sixteen separata sanitary dis- tricts in the administrative county, none of "vlllch are county boroughs, amd as each, of them claims the repayment of half of the salary of its medical officer of health from th>d County Council, -each of these officials is Required to supply you with a copy of his O-tm-uad report, a.nd any special reports pre- B0nted to the Council during the year. These Mparts cover the whole of the administrative bounty. This summary relates to the an- nual reports, and to four special reports. These include (a) a report on dairies and Llanrwst urban; (b) a report on ^^irios and oowsheds, Llanrwst rural; (c) a it'port on the Holt water supply, Wrexham (d) a report on slaughter-houses, 'Waxtdiam rural. The sixteen districts include seven urban acd mine rural areas, varying in size and Popubotiom. One table shows that the estimated popula- °n for the county for the middle of 1909 was *47,041 persons—of whom two-thirds reside in rural districts; but when it is remem- '"Gr*ed that large portions of the Wrexham 'and Chirk rural districts are practically ^ban in character, it becomes evident that proportion by no means re presents the -actUa.1 iirbam and rural conditions under the people live. And although there 36 increase of population on the census ^■ear in both rural and urban districts, the 7^creasf,u the rural districts is confined to -*o&d of Wrexham and Chirk, leaving a de- in the real rural parts of the county. -J"13 shows that the continuous inflotw of the Puliation to the urban areas, and con- C--nt reduction in the strictly rural locali- ti. is stall going on. c -Mother table shows the peroentagei in- cases and decreases in the urban and rural jgtioas 0f the- county upon the census of I'h-o estimated increase of the population 'Of the year 1908-09 is 2230 persons, equaJ »o a percentage increase of 1.5. adETILs DECREASING. lQn nuin^eT birtlis registered during 9 in tliti whole county was 3G82, a, slight mjcrease on the numbers of the previous year. rpk? }>er 1000 of the population is 25.0. 8 18 considerably below the average of the tli r-f 1899-1908 it is also slightly beCow the 1-909 rate for England and W a.les 25.6 per 00 population. The county of Denbigh is part in the general decline of the lrwi-rate. „ FEWER DEATHS. -Uie number of deaths registered in the Unty during 1909 was 2119, last year the £ «Ures were 2150. The gross death-rate for year is 14.4, practically identical with ^at of last year. It is necessary, howefver, i **iake corrections for n on-iesidents who di«+e in public institutions in the various and for residents who have died j, 0 in institutions outside their districts. .Of ananv years tlie inaccuracy of the reports the compilation of these statistics has recorded in these summaries. This year ^tt'ort has been made by the medical officers health to correct these errors, but Ldan- urban and rural, and Ruthin ruraJ rJr Dot give any corrections for "residents." •jTf6 figures corrected as far as possible mim- 2039, equal to a death-rate of 13.8, com- pared with 14.24 in 1908, 14.39 in 1907, 15.4 19 06. The fall in the death-rate lias I been maintained. It is largely due 0„ ''he diminution in the numbctr of deaths ^fante, these numbered 55 fewer than in It is gratifying to note that the rate beJow that of previous years, and is also "^OTV that of England and Wales. INFANTILE MORTALITY. in? number of deaths of infants undtt' one year of age amounted to 416 in 1909, com- P rj'^1 with 471 in 1908. « Ihe rate per thousand registered births the county is 112.9, the lowest recorded, « in the yefir 1907. It is above the in- mortality rate for England and •es, which is 109 ■per 1000 births. tch Auth-er table shows the causes of death, jT*6 figures foir 1906, 1907, and 1908 axe given 0«r °°mparison. It is seen that the number deaths under one year is less than in any ^ar except 1907. The heading "diarrhoea forms" awarding to the most recent in- ^^■ctions of tihe Local Government Boaird ^aris epidemic diarrhoea only. There h-avei deaths from this cause during the ai > and 20 deaths from gastritis and en- ^1-tis. The weather in 1909 was on the iuri° °°^, is therefore very difficult to how far the great drop in the diarrhoea th-rate is due to improved sanitation and far it is due to weather conditions. There been a diminution in the numbefr of aths from the notifiable infectious disease. One-third of tlie deaths occurred during the Tst month of life. The Notification of J-rths Act has not been generally adopted in county. A great opportunity for good OIrk is thus lost. Without the adoption this Act the medical offioeir of health is not >T>u«ht into contact with the newly-born '•■d, and the valuable advice and assistanoe nic.h he might render are wanting. A ~^ady diminution in the infantile death-rate not only lives saved to the nation, fit improved physique generally, for it is to remembered that the death-rate only re- a portion of the damage done, the remainder, and probably tlie greater part, .to be found m the" crippled lives of Jj^ldren who have just struggled through. e practical experieaoe of the working of Act is that it is of the greatest assist- °° to the public health authorities. TUBERCULAR DISEASES. The deaths from'tubercular diseases in the CoUiJlty give a rate of 1.16 per 1000 of the population. In 1908 the --rate was 1.29, and In 1907 aimost the same. In the 1907 report the urgency of energetic measures to cope J?'-tli this disease was pointed out -as it is at "he most useful period of life that the num- of deaths is highest. In the T.MS report a table was given showing this question from another aspect, the ratio of deaths from fibercular diseases to deaths from all other pauses, and to tliose from "all"'the notifiable ^factious diseases, of which serven at least well recognised as indigenous in this country. Onø in every 12.5 deaths is caused by tubercle, and tJiis one disease has killed near- ly four times as many persons in the ye&r a.11 the infectious diseases added together. *t may be well to enquire what steps are bei-ng takcta in the county, (a) Notihcvfcion i under the Poor Law. Of these there were I 28 during the year, Abergele, 1; St. Asaph, 1; Uwchalod, 1; Wrexham borough, 6; Wretxham rural, 19. Glan Conway, Llaon- rwst urban, and Llanrwst rural record that there were no notifications. The subject is not mentioaied in the other reports. Ap- parently the necessity for the inclusion of these in the repoxts is hardly yet realised, (b) Voluntary notifications, patients other thane Poor Low patients. This is only mentioned in five reports. Colwyn Bay no notification, but private information is given to the medical officer of health by medical men in the district. This rnxUhod, if at all complete, should bo quite good. Denbigh borough, ino notification. Ruthin borough, no notification. Wrexham borough, no noti- fication. Wrexham rural: A circular was sent to the local practitioners asking them to notify the medical offiocr of health; no fee was offered. No oases were notified during 1909. Colwyn Bay alone in the whole county of Denbigh seems to have a method capable of useful application during the illness of the patient. It would be interesting to know what proportion of the cases tejxist.ingl in Colwyn Bay are reported to the mcdica-1 officer of health. The system of notification throughout the county, with a small fee at- tached, should be adopted. The medical offioetr of health would thus be able to render valuable assistance in the prevention of this disease. (c) Methods of prevention in use in the county. This subject is mealtion-cd in nine of the reports. The statements are that disinfection after death, in onq district also .after removal, is carried out, if de- sired. In Ruthin borough it is specifically mentioned that this disinfection is free. This is really.all that is being done in the oounty, "disinfection aftor death, if de- sired." "During the long months of the patients' illness no cohesive measures are taken." It would be of great interest to know how .many disinfections were carried out during the year, we should then have some measure of theani-ount of work that is being accomplished. The medical officer of health for Chirk gave a lecture on the sub- ject of tuberculosis, and distributed leaflets; he (records that subsequently "people came to him for advice." He is the first in the county to ,adopt this method, which must have beneficial results. The need for a sana- torium has been consistently pointed out year by year, and it is .not to be forgotten that so high an .authority as Dr. Newsholme is of opinion that the recemt improvement in the death-rate from tuberculosis is largely due to institutional treatment where the consumptive learns so to live that he may not be a souiroe of infection to all his neigh- bours. HOUSING THE GREATEST NEED. The greatest (need in the county is the adequate supply of workmen's dwellings. Abergele.—Die town of Abergele is largely composed of old houses, which would not nowadays have passed the bye-laws. Many are without backyards or the neeoKsary facili- ties for sanitation. The conditions might be much improved by throwing two houses into one. The street surface of New-straet has not been? adopted; it is in a very dirty state. Oolwy.n Bay.-Thorc is need of a gtreateír supply of workmen's houses. Seventy-two now houses were granted certificates, only eight, were suitable for the working classes. Denbigh Borough. — Tlie re is need of a greater supply of workmen's houses. Many of the house.s having a rental within the reach of the labouring classes are old and structurally defective, but owing to lack of houses it is only possible to make these houses as habitable as conditions will allow. Sixteen back to back houses have been irooonstruct.ed with through ventilation, etc. Six houses have been closed, two remain dosed, one was converted into a workshop, one .iemolished, two rendered fit for habitation. Llanrwst Urban. Much work has been done. Notices were served upon the owners of 131 houses. Seventy-one of these* houses harve beem repaired, six closed as unfit for habitation. The owner of these, has given notice to his other tenants that he may put all his property in proper repair. Four other owners have taken this work in hand. There are 125 back to back houses; of these 19 have a window at the back or sides, which gives a certain amount of through ventila- tion. Ruthin Borough.—Accommodation for the working classes is inadequate.. The Council has considered the matter, and a report upon workmen's dwellings is being prepared. Ruthin Rutml.Much work has .been done. Forty-two dwellings— mainly cottages and small farm houses have been much im- proved; some have been entirely recon- structed. Eleven new houses were erected; the plans were submitted to the Council. St. Asaph (Denbigh). A terrace of new houses stands in Rhyd-y-voel, but without a water certificate. THE SCHOOLS. On the whole the reports are favourable. Improvements are still required in several of the districts, especially in St. Asaph. TUBERCULOSIS AND THE MILK SUPPLY. In the last few years a great deal has been accomplished in the county in regard to dairies and cowsheds, especially in the Wrex- ham rural district, but tuberculosis will never be stamped out until the tuberculin test and the bacteriological examination of milk be- come universal. It is within the power of the County Council to .adopt the latter at once. In another part of this report it is pointed out how high is the proportion of deaths from tuberculosis, compared with other in- fectious diseases, yet there is hardly any other infectious disease the control of which is so entirely in our own hands, because all the details of its infection have now been so carefully worked out that it only needs to put our knowledge into practice. "Uhat is the summary of the many years' work which Professor Dalepine has accomplished in Man- chester. It amounts to -this, that not only does the milk of the tubercular cows contain the infecting bacillus, but that they are pre- sent in the other exer-eta as well, and there- fore such a cow in a herd is a constant source of infection to the otheir cows both in the shippon amd in the fields. vFrom the purely economical point of view it is cheaper in the end to weed out tubercular stock; fromi the point of view of the consumer onei cow may be the source of untold suffering. The Tuberculosis Order of the Board of Agricul- ture, of which a resume was given last year has been postponed; it is hoped that it may not be long now before it comes into force. The poweirs that it twill give will! greatly strengthen (the ha.nds of the sanitary authori- ties m Denbighshire.







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