Taken from the Lichfield Mercury, Friday 15th July 1910. Thanks to reader Peter Pedro Cutler, who found the clipping. This has taken me weeks to transcribe. Please read it through, a better description of the times we couldn’t hope to find. What we see is a medical officer, fighting disease with limited resources and against grinding poverty. Very, very sobering.

Central Ward – that is, central Brownhills, as Maddever would have known it. From ‘Memories of Brownhills Past’ by Clarice Mayo and Geoff Harrington.

MEDICAL OFFICER’S ANNUAL REPORT.

Dr. J. C. Maddcver, Medical Officer of Health to the Brownhills Urban District Council, in the course of his report on the health of the district during the year ended Deccmber last, states:-—

The extent of the district under your control is 6,285 acres, with a population of 2.8 to the acre. The country lies at an average height of 400 feet above sea level. The soil is very light, lying on a gravel sub-soil in most parts, and on beds of sandstone in others. The consequence of this formation is that rain is rapidly drained array from us, and so leads to a dry atmosphere and country generally.

Our area may be described as forming three fair-sized villages, separated by large open commons. These open spaces would lend themselves admirably to reafforestation, and I think with benefit to the health of the inhabitants, and certainly add greatly to the physical beauties of the surroundings, and I should think with an ultimate pecuniary return.

The chief occupation of the inhabitants is mining in the large coal pits in the immediate neighbourhood. I may say that in my opinion the Central Ward is more or less in decadent condition owing to the exhaustion of the coal beds in the immediate surroundings and the opening up of mines in more distant areas. I do not see that mining has any great danger to the health of the workers other than a tendency to produce afflictions of the heart, due, I think, to the lifting of great weights in their occupation. Of course we have to reckon with the very numerous accidents occurring in the mines, many of them immediately fatal, others leading to permanent disablement and much suffering. In this connection, I may say that the Compensation Act has had a curiously curative eiiect on lumbago, at one time in my experience very prevalent among miners.

I think with a few exceptions the housing accommodation is very good. From the nature of the district already referred to there are ample open spaces about the houses, and the cleanliness of the surroundings is good. The supervision of the erection of new houses is under the control of the Surveyor, and the plains have in all cases to be passed by your Council prior to any building being erected. In former reports I have condemned the houses known as Ten Row and Five Row. I again call your attention to tihe insauitary state in which, they are, and ask if this be not remedied, that they should be at once closed. In some of them I see the people have left them of their own accord. The number of houses in the district aie as follows:-—Central Ward, 864; Walsall Wood Ward, 1,427; Norton Ward, 1,064; total, 3,355.

The water supply of the district is as a whole very good, being almost entirely derived from the South Staffordshire Waterworks Company’s mains. This supply is entirely from wells sunk in areas beyond suspicion of contamination, and forced by pumping stations throughout the district. There is no possibility of lead contamination unless in the house connections, and I have never seen any symptoms of lead poising that could not be traced to the occupation o the sufferer – house-painters. In addition to the public water supply there are a number of wells in the district, 90 in all – in the Central Ward 39, Walsall Wood Ward 20, and Norton Ward 31. These are all sunk rather deep, and their purity is good. The only health drawback I see in them is that the labour involved in drawing the water is apt to make the user use less than is desirable. I would be glad to see, however, that your Council would encourage the disuse of the wells and urge the landlords to lay on the public supply- I am glad to hear that Woodbine Terrace is now to have the public service, and this will lead to others in that neighbourhood getting a supp]y they have long wanted. But of the 90 wells mentioned it is fair to say that 28 of them are supplying houses located in portions of the district in which the mains of the South Staffordshire Waterworks Company are not yet laid down.

The inspection of meat in the district can never be efficiently carried out in the now existing conditions. I have before asked for the setting up of public slaughter houses, seeing that in this is the only safeguard against the danger of tuberculous meat. At the present time there are 16 small slaughter-houses in the area,-—Central Ward 6, Walsall Ward 5. Norton Ward 4. These are all in ihe rear of the shops selling the meat. and though to my my personal knowledge kept scrupulously clean, it is impossible for an inspector to at all times see that the meat is free from disease. All that he can see is the dressed meat ready for sale, and in that state it would not be easy for the most expert to see evidence of the prevalent disease, tuberculosis, in cattle. There has therefore been no condemnation of diseased meat during the year. There is also in the district a fairly large sale of imported chilled meat and mutton, which to the best of my judgement is of good quality.

I find that I have misled some in my former reports on the sewerage question. I have led outsiders to think that water closets were in general use here. I had no intention in my statement that most of the houses were connected with the sewers should lead to this idea. I only meant that the slop water and house refuse were taken into the sewers. The district is essentially a privy-miidden one, and very little human excreta is dealt with in the sewage farm. There are only 105 water closets in the whole area, and I did not think there were so many, but a number of them have been put in very recently. The Central Ward has 74, the WalsallWood ward 26, and the Norton Ward 5.

The sewage is dealt with, so far as the Central and Walsall Wards are concerned, on the Sewage Farm at Walsall Wood, both by treatment in bacterial beds and filtration on the land. In Norton there is no sewage scheme proper, and it is a district that should be dealt with in the future. As it at present stands, it is a public nuisance, especially in the summer season, in front of my own house lere, the sewage of Watling Street is frequently stagnant and very visible to sight and horrible to the sense of smell. This is only a small portion of the Norton area. There are in the Walsall Wood Ward 5 cesspits, in the Central Ward 5, and in the Norton Ward, where no proper system of sewerage prevails, there are 43. The contents of these are removed by the people themselves, and in most cases used in the garden plots attached to the houses. The pollution of rivers has been reduced to a minimum in the Central and Walsall Wood Wards by the treatment on the sewage farm, the effluent from which I consider satisfactory.

The sanitary condition of the public elementary schools is good. In one case the school was built over what had been the site of a refuse heap. At the time of building I called your Council’s notice to this. I must admit, however, that I have lnot been able to trace any disease due to this. The children im this suliool seem to have as good health as those in the others where no siic condition exists. The water supply of the schools is the South Staffordshire Water Company’s mains. There has been little need during the past year to take action for the prevention of the spread of infectious diseases other than the isolation of cases as they arose. Complete isolation in your district is impossible, as the people themselves will insist on going in each others’ houses during illness, many thinking themselves injured if their neighbours do not come to see them in their trouble. I have rcmonstzrated over and over again, and forcibly, but with little effect. One is reluctant to take legal steps in these cases, but it would possibly the best method of stopping this danger. The arrangements for the medical inspection of the children is in the hands of the medical oflicers specially appointed by the County Council. ‘l’heir recommendations as regards the eyes, throat, nose, and ears, and also skin are no doubt admirable, but the point lacking is the means to carry them out. The people themselves are in too many eases too poor to pay the  fees to have the needful treatinient. We have no methods for the control of tuberculosis. There no system of notification. of pulmonary phthisis, either compulsory or voluntary, in operation. I may say that pulmonary consumption is comparatively rare. We have no hospital for such eases, either in their early or later stages. Some of the clubs in the district contribute to homes at the seaside, and cases in the early stages occasionally get sent to them.

During the year there have occurred nine cases of diphtheria, of which number one proved fatal under five years of age. In these cases diphtheria serum was used, and vith good effect. This is supplied by the Council free of charge. It is possible that some cases may not have been true diphtheria, but it was considered better to gave the patients the benefit of the doubt. All these cases were isolated to the best of my power, and I think successful, as the people stand in considerable awe of the disease. Twenty seven cases of erysipelas were reported, but in no case was there a fatal result. There were 38 cases of scarlatina reported, seven in the Central Ward, seven in the Walsall Wood Ward, and twenty four in the Norton Ward, and I am glad to say that in no case was there a fatal result. Isolation to the best of our power was carried out, and disinfection of the premises afterwards by the sanitary officer. We had two cases of puerperal fever, one proving fatal. These were duly visited by the medical ofllcer of the county, and the midwife in the fatal case has since been compelled to cease practice on own account. The Notification of Births Act 1907, has not been adopted. We have no health visitors employed. It is impossible to separate the mortality of the legitimate from the the illegitimate, though I should judge in our district the diflerence will be but slight I should say that the great factor in the infantile mortality here has been, and is, improper feeding, I had some handbills of instruction printed at the Council’s cost, which have been distributed to the best of my power, but I am afraid with but little good. In this connection I may mention the universal use of the dumb comforter. This I believe to exercise a most baneful influence on infantile health and I have carried on an active crusade against its use. I am afraid the total results of this crusade is that one is laughed at as a man with a fad.

The medical inspection of the children attending the elementary schools is done bv the medical officer appointed by the County Council. As yet it is too soon to judge of the benefits to be derived from it. I feel sure that it will only be by prosecution of some of the parents that any particular care will be taken – in the verminous oases more particularly. As iegnrds the suggestions made by the visiting school medical officer, re. the throat and nose cases requiring operative treatment, it seems to me that in many cases the parents are too poor to be able to meet the expenses the necessary treatment would entail. The local medical men cannot be expected to undertake the responsibility and expend the time necessary for proper treatment without fee or reward. They have plenty of gratuitous work already. It seems to me that tlie public must meet the expenses incurred by the order of the public servant. During the rear I have systematically visited and examined the various areas under your control, in some cases in company with the sanitary officer, in others alone. I may put it that I am continually inspecting in the ordinary course of my practice  This takes me daily to every nook and corer of your area. As regards proper isolation of infectious diseases, I should urge that the smallpox hospital, which has never once been used, should be prepared and used for the treatment of scarlatina, diphtheria, etc., those cases it is impossible to isolate in their own homes, and I feel sure that prompt removal and disinfection of the house and clothing would often arrest the spread of the disease. I would suggest to the Council the provision of proper means of removing bedding, clothing etc., from the infected houses, to be stored at the Board Rooms at the Council’s expense. In the meantime this is done by the people themselves, and often in a way well calculated to n read disease.

l find the vaccination laws carried out satisfactorily in those cases where it is allowed. Owing, however, to the new conditions of getting exemption having become so easy, many of the parents, even those put in authority over others, are neglecting this great preventative of disease. I am certain that but few years will elapse, if things go on as they have, before we have smallpox more or less always with us. Let all who have influence and power urge upon the peoiple the benefits of vaccination, and also the reedom from the dangers of disease transmission due to the lymph sent out under guarantee of the Local Improvement Board.

The total number of deaths registered throughout the area was 260, equal to a rate of 14.4 per 1,000; in addition to these 12 deaths occurred in public institutions outside the district among people belonging to the district, making the net total deaths among residents 272. giving c corrected area of 15.1, a rise of that of last year. The rates for ‘the various areas are :— Central Ward 58, 12.5 per 1,000; Norton Ward 76, 13.3 per 1,000: Walsall Wood Ward. 138, 17.9 per 1 000. It is difficult to understand the larger rate of Walsall W00d. seeing that it is a much newer village than the others. The only eiuse I can give is its close proximity to Walsall and the great amount of trafllc betwcn the two places. I notice that disease in Walsall always attacks Walsall Wood prior to the other two areas. The deaths from the seven principal zygotic diseases numbered 38. equal to a rate of 2.11 per 1.000. Measles and whooping cough were largely responsible for this  increase I had in the Central Ward 15 notifications of infectious diseases, in the Walsall Wood Waid 29 and in the Norton Ward 36. The ages of the cases notified cannot properly be given, as it is seldom applied to the notification paper. ‘ The number of deaths under one year was 92, equal to a death rate of 160 per 1 000 registered births.

The Total number of births registered was 572, equal to a rate over the whole urea of 31.7 per thousand. This is considerably lower than that of last year, and I think the lowest recorded in history of the Council. 1 have no idea that can account for this; one thing I can be sure of is that our people have not risen as yet to the practice of race suicide [Dry humour? – Bob]. That, I fancy, lies in a. higher social scale. The rates for the various areas are: Central Ward 127, 27.5 per 1.000; Norton Ward, 183, 32 per 1.000; Walsall Wood Ward, 262, 34.1per 1,000. I am sorry to note again the number ‘of deaths in this part from cancer. I know of no cause, but beyond a doubt the disease is increasing in frequency.