THE Urban District Council of Acton. ANNUAL REPORT OF THE MEDICAL OFFICER, FOR THE YEAR 1896. ACTON : Printed by j. Knowles, Market Ti.ace & Hooper's Mews. THE Man District Council of Acton. ANNUAL REPORT OF THE MEDICAL OFFICER, FOR THE YEAR 1896. ACTON : Printed by j. knowles, market tlace & hooper's mews. The Urban District Council of Acton. ANNUAL REPORT OF THE MEDICAL OFFICER FOR THE YEAR 1896. To the Chairman & Members of the Acton District Council Gentlemen, I have the pleasure of submitting to you the various facts connected with the sanitary history of Acton during the past year. The Population has increased, the number of births being the highest ever recorded in this district. The death rate, by no means high, would have been considerably lower but for the epidemics of Measles and Whooping Cough, which were very prevalent throughout England during the Spring. You will notice that in this report I have fully alluded to the causes of the high death rate of these two diseases, and what steps I purpose taking with a view to checking the same. As the weather is one of the most potent factors in determining the health of a community, I may briefly note that we enjoyed a very mild, open winter, followed by a dry and warm Spring and Summer, while the Autumn proved rather wet on the whole, with a considerable decrease of temperature ; but neither in the opening nor in the closing months was there cold of sufficient intensity and duration to prejudicially affect the health of anyone other than the frailest of invalids. 4 POPULATION. In the middle of 1896 the number of inhabited houses was 4,909; allowing as usual six persons for every occupied house, the population is 29,454, an estimated increase of 1,806 compared with 1895. The following table shows the number of the population and the inhabited houses at the four preceding censuses. Year. Inhabited Houses. Population. 1861. 610 3,151 1871. 1,568 8,306 1881. 2,844 17,110 1891. 4,084 24,207 BIRTHS. The total number registered was 894, (450 boys and 444 girls). This is the largest number ever registered in this district. The birth rate is 30-3 per thousand persons living. A high birth rate suggests that a large proportion of young married people reside in the locality. The following table shows the births since 1890. Year. Number of Births. 1890. 704 1891. 772 1892. 763 1893. 831 1894. 834 1895. 874 1896. 894 5 DEATHS. The number of deaths registered was 464,—this includes 29 residents of Acton who died in Public Institutions outside the Parish. The annual death rate calculated upon a population of 29,454 was 15.7 per thousand as against 17.2 in 1895. The average death rate for London was i8-2 per thousand. The following table shows the various ages at which death occurred in the District. Under 1 year 151 Under 5 232 1 year and under 5 81 5 „ „ 15 27 Over 5 232 15 „ „ 25 12 25 „ „ 65 102 65 and upwards 91 464 464 The following table compares the death rate of children under one year per thousand registered births, and the birth rate for the last ten years. Birth Rate Per Thousand. Deaths of Children under 1 year. Per Thousand Registered Births. 1887 28.7 147 1888 31.1 182 1889 34.1 175 1890 28.3 151 1891 30.8 146 1892 30.5 185 1893 31.9 I92.5 1894 30.2 160.6 1895 31.6 168.1 1896 30.3 168.9 6 The following causes, in my opinion, contribute towards making the infant mortality so high in England:— 1. Contagion of microbes in the milk. 2. Ignorance of parents as to suitable food to give a child brought up by hand. 3. Bad ventilation and overcrowding, especially in the houses of the working classes, which induces a lowered state of vitality, and rickets. 4. Children being placed under the care of others during the absence of the mother at her work. It appears to me that the only way to combat the above evils, would be to educate the mothers, which could be done by lectures, say at mothers' meetings, or else the medical practitioner in attendance at the confinement could give the mother written instructions how to bring up her offspring. A Creche under the supervision of an experienced nurse, should exist in the several districts, and be partly self-supporting. ZYMOTIC DEATH RATE. The total number of deaths registered for the Zymotic diseases was 93, as compared with 67 in 1895; this gives a Zymotic death rate of 3-1 per thousand. In the following table the death rate and Zymotic deaths 7 rate are so arranged that comparison can be made for the last nine years. 1888. 1889. 1890. 1891. 1892. 1893. 1894. 1895. 1896. Small Pox - - - - - - - - - Measles 1 25 11 9 24 2 15 6 24 Scarlet Fever 2 1 3 4 - 10 3 3 1 Diphtheria 2 8 7 2 4 2 5 5 8 Whooping Cough 9 13 3 6 25 5 17 5 21 Typhoid Fever - 1 1 — 3 4 2 2 2 Diarrhœa & Dysentery 10 12 18 24 34 60 17 44 37 Puerperal Fever - - - - 1 6 4 2 - Total number of Deaths from 7 Zymotic Diseases 24 60 43 45 91 89 63 67 93 Deaths from other causes 282 377 298 368 334 396 330 411 371 Total Deaths 306 437 341 413 425 486 393 478 464 Death rate from 7 Zymotic diseases per thousand 1.09 2.8 1.9 1.8 3.6 3.4 2.2 2.4 3.1 Death rate from other causes per thousand 12.9 16.1 12.0 15.3 13.4 15.2 12 14.8 12.6 General Death rate per thousand 13.99 18.9 13.9 17.1 17 18.6 14.2 17.2 15.7 In London the Zymotic Death rate was 3-1 per thousand. 8 NOTIFICATION OF INFECTIOUS DISEASES. There were 259 notified, as against 161 in 1895. The following table gives the number reported each year since the act came into force. 1890. 1891. 1892. 1893. 1894. 1895. 1896. Small Pox — — 13 7 2 — — Scarlet Fever 108 63 74 192 86 67 193 Diphtheria 14 8 27 41 22 32 23 Membranous Croup 4 — 13 1 — — — Typhoid Fever 13 13 15 19 15 28 14 Continued Fever — — — 1 — — — Puerperal Fever 1 — 1 2 1 3 3 Erysipelas 22 18 37 77 41 31 26 162 102 180 340 167 161 259 REMARKS. The following is my procedure on receipt of a notification of Infectious Disease. To the Sanitary Inspector I at once forward the following, who visits the case without delay: Notification of Infectious Disease. Received by Medical Officer. Forwarded to Sanitary Inspector. Name and address of Patient. Disease. Medical Attendant. 9 To the head of the house where the disease exists a book of instructions regarding isolation and disinfection; and to the schoolmaster or mistress of the district the following form : Urban District Council of Acton. 189 To the Master or Mistress ot School. I have received notice that living at is suffering from and request that you will not receive any child from that house until I inform you that all danger of infection is passed. G A. GARRY SIMPSON, Medical Officer of Health. When the disease is over and the child or children free from infection, the following form is posted : Urban District Council of Acton. 189 To the Master or Mistress of School. The child or children residing at are now free from infection, and may return to school. G. A. GARRY SIMPSON, Medical Officer of Health. 10 SMALL POX. No cases have been notified since 1894, and it is a noteworthy fact that no deaths have occurred in Acton from this disease during the last twelve years, a forcible proof of the efficacy of vaccination. MEASLES. There was an epidemic of this disease during the spring, and caused the deaths of twenty-four children among the poorer class. This death rate is due entirely to ignorance as to the danger of neglecting this disease, and the serious complications which may supervene if due care is not taken of the patients and medical advise sought early. Witji a view of instructing this class I have written a leaflet in which directions are given how this disease may be recognised in the early stages, and warning the parents of the danger of exposing the children to cold, and neglecting to send for medical assistance. This leaflet will be distributed shortly. Of all diseases Measles is most difficult to arrest the spread of in a household, from the fact that it begins as an ordinary cold, and that it is in this stage highly infectious, so that measures of isolation will in nine cases out of ten be too late, so far as the family are concerned; but it is right to give such measures a trial, and to isolate the first cases directly the disease is recognised. In many districts Measles has been made a notifiable disease, but the utility of this measure is questionable for the above reasons. SCARLET FEVER. One hundred and ninety three cases were notified, but only one death occurred from this complaint; this is highly satisfactory, especially when we compare the figures with the last epidemic in 1893, when 192 cases were notified and 10 deaths took place. The epidemic commenced in Acton Green, and spreading with some rapidity, I found that Beaumont Park School was the 11 centre of propagation; I visited this school daily for some weeks, examining children who had any suspicion of ill-health. On more than one occasion I found children desquamating freely. Such a state of things can only be brought about either by neglect or ignorance on the part of the parents, or the attack may have been so slight as to have escaped notice. From the results obtained by these daily inspections, I am convinced that the surest way to arrest an epidemic is to make the school in the neighbourhood the centre for daily inspection of the children; this step I shall always take in the future should occasion arise. DIPHTHERIA. Twenty-three cases were notified, and eight deaths occurred during the year. In most of the houses the sanitary arrangements were defective; these were rectified. I was able to satisfactorily trace three cases to Kent Piatt, a village near Burrow Green. Many of the cases notified as Diphtheria, turned out to be Follicular Tonsillitis, but as I have previously pointed out the diagnosis can only be settled in the early stages by a bacteriological examination. Probably before long each District will have its own laboratory, where such investigations can be carried out. WHOOPING COUGH. Twenty-one deaths were registered from this complaint, all of children under 5 years of age. If we come to examine the deaths more particularly, we find that three-fourths of the deaths occur in children under two years of age, the mortality of the female sex being in excess of that of the male. The mortality is also increased in the cold weather. This is attributable to the exposure and to the absence of proper precautions on the part of the parents, who are inclined to look upon Whooping Cough as an ailment of little moment and requiring but little treatment. 12 The Whooping Cough itself is rarely fatal. It is the complications that kill, and they are very numerous. The remedy is, as I have remarked under Measles, to enlighten the public. One of the first lessons must be that Whooping Cough is not a necessary disease of childhood, that children are not doomed by any laws of Providence to either Measles, Scarlet Fever, or Whooping Cough, and that children suffering should be isolated and properly cared for. If it were possible on the same day to isolate all the children suffering from this disease, and to keep them in quarantine for a lengthened period, Whooping Cough might be stamped out. This is impracticable. We may, however, do much to check and limit it, but without the intelligent assistance of the public we are powerless. TYPHOID FEVER. Fourteen cases were notified, and only two deaths were registered, one in Acton and one in Bedford Park. Defective drainage was found and rectified. DIARRHŒA. Thirty-seven deaths, all except two being children under five years of age. This is a disease greatly influenced by temperature. It is noticeable that soon after the temperature of the earth, at a depth of one foot, has reached 590 F to 62° F, the causes producing the disease begin to operate. Nearly all the above deaths took place during the summer months. PUERPERAL FEVER. Three cases only were notified, and not a single death occurred. Yet there were no less than 894 confinements attended during the year. This happy result is due to the Medical Practitioners using strict antiseptic precautions. 13 PHTHISIS AND TUBERCULOSIS. Forty-two deaths were registered from this disease. It is evident that much work lies ready for Medical Officers of Health and others in connection with the spread of tubercle. If we can persuade people to look upon Tuberculosis as an infectious disease much will be done to prevent its spread, and a great advance in preventive medicine will be made. The Germans look upon perfect cleanliness in the treatment of phthisical patients as absolutely essential. Pocket handkerchiefs and bed linen are most carefully sterilized by means of steam or germicidal agents. Patients are strongly enjoined not to expectorate, except into receptacles specially made for the purpose, and in which the sputa can be easily disinfected. The results of these precautions are not yet manifest, but it may be confidently anticipated that within a short time a considerable diminution in the number of phthisical patients in Germany will be recorded. As a single example we may take the Grand Duchy of Baden, where there was a diminution of deaths from Tuberculosis, from 3-08 per 1,000 inhabitants in 1882 to 2'8o per 1,000 in 1887, or no less than "28 per 1,000. If similar results were obtained in the British Isles, and the patients were not carried off by other diseases, the saving to our community would be nearly 10,000 lives per annum. I notice that a leaflet has been sent by the Glasgow Health Committee to every ratepayer in that city, explaining in the clearest manner the infectious nature of the disease, and giving brief but excellent directions for the avoidance of infection. WATER SUPPLY. The work of lowering the mains to 2 feet 6 inches below the surface is still being carried on, and will shortly be completed. This will, I trust, prevent the great inconvenience to householders that has occurred on former occasions owing to the frost. 14 DRAINAGE. Soil Sewers were constructed in Emanuel Avenue, Priory Road, Palmerston Road, All Saints' Road, Hereford Road, Shajimar Road, and a portion of Acton Lane. INSPECTION OF THE DISTRICT. Regular inspections of the District have been made. Houses unfit for human habitation have been closed, nuisances arising from offensive trades have been repressed. In conclusion, I append a report of the Sanitary Inspector, and remain, gentlemen, Your obedient Servant, G. A. GARRY SIMPSON Medical Officer of Health. 15 REPORT OF SANITARY IN8PECTOR For the year ending 31st December, 1896. Visits to ensure continued isolation of infectious patients 760 Rooms, Bedding, &c., disinfected 139 Board school rooms, lavatories, and clothes racks disinfected 5 Disinfectantssupplied(exclusiveot supplies from the office) bots. 287 Number of dwellings inspected 238 Found insanitary 225 House drains and sanitary fittings tested (dwellings) 126 House drains taken up and re-constructed t32 Visits to ascertain whether notices were being complied with, and to inspect sanitary work in progress 730 Soil pipes and drains provided with vent pipes 107 Soil pipes taken outside house-walls 6 Scullery waste pipes disconnected from soil drains and made to discharge in the open air over trapped gulleys 30 Rain water pipes disconnected from soil drains (dwellings) 11 Insanitary closets replaced by sanitary apparatus 81 Water-waste preventers fixed for flushing closets 33 Defective roofs made good 8 Defective guttering replaced or repaired (dwellings) 8 Dilapidated walls, ceilings, &c., repaired (dwellings) 39 Complaints registered 129 Notices served (supplemented by letters and personal interviews with owners or agents) 146 Additional closets provided in connection with laundries under the Workshop and Factories Act, 1896 10 Sanitary improvements ordered by Inspector of Nuisances (Acton) 20 Schools inspected 11 16 ORDINARY NUISANCES ABATED. Smoke 8 Manure, fish offal, and other offensive deposits 23 Cess-pools abolished 8 Choked drains, &c. 33 Overcrowding 10 Cellar flooding 13 Non-supply of water to dwellings 3 Pig-keeping abolished 6 Dustbins provided 25 Other nuisances not included in the above 53 GENERAL INSPECTIONS. Bakehouses 26 Cowsheds, dairies, and milkshops 65 Slaughter houses 95 Piggeries 139 Brickfields 13 ARTICLES OF FOOD CONDEMNED. A large quantity of Meat-bones. 1 Trunk of Mackerel. 2 „ „ Plaice. 1 „ „ Haddock. 1 „ „ Cat-fish. WILLIAM T. BOVEY, Inspector of Nuisances.