THE Urban District council of Action. ANNUAL REPORT of the Medical Officer of Health FOR THE YEAR 1901. by G. A. GARRY SIMPSON, M.R.C.S., L.S.A, Fellow of the Royal Institute of Public Health, Medical Officer of Health, Acton, W. ACTON: Public Health Department, Gothic Villa, Mill Hill Grove. 1902. THE Urban District Council of Acton. ANNUAL REPORT of the Medical Officer of Health for the YEAR 1 9 0 1. by G. A. GARRY SIMPSON, M.R.C.S., L.S.A., Fellow of the Royal Institute of Public Health, Medical Officer of Health, Acton, IV. acton: Public Health Department, Gothic Villa, Mill Hill Grove. 1902. The Urban District Council of Action ANNUAL REPORT OF THE MEDICAL OFFICER for the year ending 31st december, 1901 To the Chairman and Members of the Acton District Council. Gentlemen, I BEG to submit to you my Annual Report on the Health and Sanitary Condition of Acton during 1901. The general Death Rate is again satisfactory. We enjoyed a remarkable immunity, compared with other districts, from the more important Infectious Diseases, and with the exception of the Infant Mortality, which I regret to say is again high, the health of the district was above the average. I have again, as in previous years, made suggestions for diminishing the number of deaths of children under one year of age, but we have a very difficult task, owing to the mothers leaving their offspring to the care of others during their absence at the Laundries. I beg to draw your attention to my remarks on Consumption, and trust you will see your way clear to follow the course I have suggested. The purchase of the Friars Estate for an Isolation Hospital is a matter for sincere congratulation, and in my opinion the site is a good one. I have repeatedly pointed out for some years the great need for such an Institution, and how much suffering, anxiety, and danger is caused by having no means of Isolating cases of Infectious Disease. 4 In my tables dealing with Vital Statistics you will notice how rapidly the district is opening out, and, with the improved methods of locomotion, is likely to still further develop in the near future. The works in connection with the Bacterial treatment of our Sewage are near completion, and this instalation will be a great saving to the ratepayers. I beg to draw your attention once again to the need of a Destructor Furnace for dealing with the dust-bin and other refuse of the district. Another matter of great importance, and which I trust will immediately engage your attention, is the great need of sanitary conveniences in the centre of the town. The Sanitary Department is now on a sure footing. We have an excellent office and meet every morning at 9-30 to go through the work of the day, and although urgent matters are attended to at any time, Sundays included, yet we prefer all complaints to be brought to our department, in Mill Hill Grove, at the above specified time. I have received valuable help from Messrs. Kinch and Fraser, Sanitary Inspectors, Nurse Dawkins, and all others connected with my department. I take this opportunity of thanking the Chairman and Members of the District Council for their kind co-operation. I am, Gentlemen, Your obedient servant, G. A. GARRY SIMPSON, Medical Officer of Health. 5 WARD BOUNDARIES. The district is conveniently divided into three Wards, and as the boundaries have not been previously described in these reports, I find it convenient to do do so on this occasion:— North Ward.—All north of centre of High Street. West Ward.—South of centre of High Street, from Birch Grove to Railway Bridge, High Street, and west of centre of North London Railway, from Railway Bridge, High Street, to Bollo Lane. East Ward.—South of centre of Uxbridge Road, from Railway Bridge, High Street, to Wilton Road, and east of North London Railway, from Railway Bridge, High Street, to Bollo Lane. VITAL STATISTICS. The following table gives the Vital Statistics of the whole District during 1901 and previous years:— VITAL STATISTICS OF WHOLE DISTRICT DURING 1901 AND PREVIOUS YEARS. Year. Popultion estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Non-residents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number. Rate.* Under 1 Year of Age. At all Ages. Number. Rate per 1,000 Births registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1891. 24,207 772 31.9 113 146 394 16.2 19 413 17.0 1892. 25,000 763 30.5 141 185 401 16.4 24 425 17.0 1893. 26,000 831 31.9 l60 192 451 17.3 35 486 18.6 1894. 27,600 834 30.2 133 159 368 13.3 25 393 14.2 1895. 27,648 874 31.6 147 168.1 445 16.1 33 478 17.2 1896. 29,454 894 30.3 151 168.9 435 14.7 29 464 15.7 1897. 31.632 973 30.7 193 198.3 470 14.8 33 503 15.9 1898. 32.562 995 30.5 181 181.9 507 15.5 10 517 15.8 1899. 33.684 1,068 31.7 200 187.2 — 509 15.1 1900. 38,406 1,080 28.1 182 168.5 513 13.3 15 528 13.7 Averages for years 1891-1900 29,619 908 30.7 160 175.4 442 15.3 23 471 16.0 1901. * 37.744 1,211 32.0 206 170.1 519 13.7 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. *Total population as per Census 1901. All ages, 37,744. Number of inhabited houses, 6,114. Average number of persons per house, 6.1. Area of District in Acres (exclusive of area covered by water) 2,304. 6 7 Population.—The population according to the census of 1901 was 37,744. The following table shows the number of the population and the inhabited houses at the five 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 1901 6,114 37,744 The increase of population by excess of births over deaths during the year amounted to 692, as against 552 in 1900. Birth Rate.—During the year 1901 there were 1,211 births registered. The birth rate per 1,000 persons living was 32.0. The London birth rate was 28.0. 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 1897 973 1898 995 1899 1,068 1900 1,080 1901 1,211 DEATH RATE. General Mortality.—There were 519 deaths registered. The recorded general death rate was 13 7 per 1,000 of the population. The London death rate was 18.3 per 1,000. The death rates for the preceding five years are as follows:— 1897 15.9 1898 15.8 1899 15.1 1900 13.7 1901 13.7 The following table gives the causes of, and ages at, death during the year 1901:— 8 CAUSES OF, AND AGES AT, DEATH During Year 1901. Causes of Death. deaths in whole district at subjoined ages. deaths in localities (at all ages). Deaths in Public Institutions in Dis. All ages. Under 1 year z and under 5 5 and under 15 15 and under 25 25 and under 65 65 and upwards Acton South Acton Acton Green East Acton Bedford Park Willesden Scarlet fever 2 - 1 1 - - - - 1 1 - - - - Whoopingcough 16 8 7 - - _ 5 7 1 3 - - Diptheria & membranous croup 6 4 2 - - - 1 3 1 - - 1 - Fever:— Enteric 1 - - - - - - - -- - - - - - Epidemic Influenza 8 2 - - 1 4 1 5 1 2 _ - - - Diarrhoea 69 62 4 — — — 3 21 26 17 I 1 3 — Enteritis 10 9 - 1 — — - 3 6 1 — — - — Erisipelas 3 1 — — — 1 1 1 — 1 — 1 — — Other septic diseases 2 1 - - 1 - - 1 - - 1 - - - Phthisis 35 5 I 0 4 23 2 18 7 7 — 3 — — Other cular diseases 9 5 3 1 — — — 3 3 3 — — — — Cancer, malignant 16 disease 29 — — 1 — 16 12 7 4 1 — — 1 Bronchitis 47 17 5 I — 12 12 9 18 12 2 3 3 — Pneumonia 36 9 12 3 — 9 3 18 13 4 — 1 - — Pleurisy Other 1 - - - - 1 - - - - - - - 1 diseases of Respiratory organs 1 — — — — 1 — 1 - - - - - - Alcoholism • Cirrhosis of liver 5 - - - - 3 2 2 1 1 - 1 - - Premature birth 27 27 - - - - - 12 5 7 2 1 — — Diseases and accidents of parturition 4 — — — — 4 — 2 — 1 I — — — Heart diseases 40 3 — 1 — 27 9 12 13 9 2 2 — 2 Accidents 17 6 — 5 — 4 2 6 3 4 1 1 — 2 Suicides 1 — — - 1 - — 1 - - — — — - All other causes 150 51 7 4 1 19 68 75 22 36 5 9 3 — All causes 519 206 44 20 9 125 115 212 136 112 15 28 10 6 In the following table the death-rate and Zymotic death-rate are so arranged that comparison can be made for the last fourteen years:— 1888 1889 1890 1891 1892 I893 1894 1895 1896 1897 1898 1899 1900 1901 Small Pox — — — — — — — — — — — — — — Measles 1 25 11 9 24 2 15 6 24 2 6 — 16 — Scarlet Fever 2 1 3 4 — 10 3 3 1 — 3 2 6 2 Diptheria 2 8 7 2 4 2 5 5 8 28 8 7 4 6 Whooping Cough 9 13 3 6 25 5 17 5 21 — 10 14 4 16 Typhoid Fever — 1 1 — 3 4 2 2 2 2 — 7 4 1 Diarrhoea and Dysentery 10 12 18 24 34 60 17 44 37 80 50 56 50 69 Puerperal Fever — — — — 1 6 4 2 — — 1 0 1 — Total number of deaths from Zymotic Diseases 24 60 43 45 91 89 63 67 93 130 78 86 85 94 Deaths from other causes 282 377 298 368 334 396 330 411 371 373 439 423 443 425 Total deaths 306 437 341 413 425 486 393 478 464 503 517 509 528 519 Death-rate from 7 Zymotic Diseases per thousand 1.9 2.8 1.9 1.8 3.6 3.4 2.2 2.4 3.1 4.1 2.3 2.5 2.2 2.4 Death-rate from other causes per thousand 12.9 16.1 12.0 15.3 13.4 15.2 12 14.8 12.6 11.8 I3.5 12.6 11.5 11.3 General Death-rate per thousand 13.99 18.9 13.9 17.1 17 18.6 14.2 17.2 15.7 15.9 15.8 15.1 13.7 13.7 10 INFANTILE MORTALITY. There were 206 deaths registered of Infants under 1 year of age as against 1211 births; the proportion which the deaths under one year of age bear to 1,000 births is therefore 170.1 as against 168.5 in the preceding year. The following table compares the death-rate of children under one year per 1,000 registered births, and the birth-rate for the last fifteen years:— Deaths of Children under One Year, Per Thousand Registered Births. Birth-rate per Thousand. 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 31.9 192.5 1894 30.2 160.6 189S 31.6 168.1 1896 30.3 168.9 1897 30.7 198.3 1898 30.5 181.9 1899 30.7 187.2 1900 28.1 168.5 1901 32.0 179.1 Districts with a large, poor population invariably have a high infant mortality, which swells the general death-rate. If we deduct the deaths of children under one year of age, our death-rate for 1901 works out at only 8.3 per 1,006 of the population. (; The main causes of our infant mortality are:— 1. Epidemic Diarrhoea. 2. Premature Birth. 3. Overlying. 4. Improper Feeding. 11 (i) Epidemic Diarrhoea was most prevalent during the months of July, August, and September. It was highly infectious, as one found it attacking one member of a family after another. It is also a fact that this summer diarrhcea appears regularly, year after year, in an epidemic form, and that it presents the same symptoms in each individual, and there must be a common cause for it. More than 140 years ago Dr. Cullen wrote concerning the disease, "that it arises in summer and autumn after great heat has prevailed, and especially after very dry states of the weather," and he further says "that the effluvia from putrid animal substances readily affect the alimentary canal, and occasion upon some persons a diarrhcea." I think there are four main channels in which these putrid emanations can reach us by—Milk, Water, Air, Insects. Milk if used unboiled may undergo decomposition, and will cause diarrhcea, especially in the young. We know that milk drawn from a cow in the morning will often during the hot summer months be quite "turned" by the afternoon, and milk in such a state will set up diarrhcea in some people whether young or old. If the milk is boiled, it will keep much longer, but unless precautions are used in the storing of it, the danger will not be very much lessened. After being boiled, the milk should be kept in a closed vessel and in a cool place, for if it is kept uncovered the dust, which is loaded with putrefactive germs, will fall into it. Dirty feeding-bottles and teats are also undoubtedly often a cause of diarrhcea in infants that are bottle-fed. Water.—Drinking water may be a cause of summer diarrhcea. During the hot summer months putrefactive changes are taking place all along our water courses ; the banks of the reservoirs and streams are lined with vegetation, much of which is often in a state of active putrescence. The putrefactive gases are held in solution by the water, and are not removed by filtration, and if oxidation is not complete, the drinking of such water may cause diarrhcea. 12 Air.—During the hot summer months organic matter rapidly undergoes decomposition. The streets are also more or less covered with a layer of dust. This dust is composed of all manner of refuse in a state of active putrescence, one of the chief constituents being the pulverized droppings of horses and cattle. This dust is taken into the lungs of old and young, and settles on all exposed food. Insects.—During the summer months our living rooms are close and warm, and the open windows admit large numbers of insects which have often come direct from feeding on the filthiest of decayed and decaying matter. The legs and bodies of the insects are covered with small particles of the filthy stuff, which they convey to our food. (2) Premature Birth.—Our chief industry is to a great extent responsible for the large number of premature births; the long hours of standing at the wash tub has a tendency to induce premature confinement. (3) Overlying.—Is gross carelessness. In Germany and other Countries it is made a penal offence to have a young infant in bed with its parents. A suitable cot can be made for a few pence out of an orange box, or similar receptacle. It is a significant fact that nearly all the deaths from overlying take place between Saturday and Sunday. This is accounted for by the fact that the wife has to do her weekly shopping on Saturday night, and goes to bed late and tired out with her week's work. (4) Improper Feeding.—Every parent on registering a birth is given full instructions as to the quantity and suitable food to give a child brought up by hand. In this district the mothers are at work the greater part of the day at the laundries, and the infants are left to the care of young girls or ignorant persons with the most rudimentary knowledge of infant feeding. 13 The remedy, which I have before suggested, is to establish a Creche, where for a small fee the infants could be looked after and properly fed. A leaflet giving instructions as to the importance of boiling the milk, and the storage of food, is widely circulated during the summer months. In the houses of the poorer class the household food is put in a cupboard, or simply exposed in the dwelling, or it may be a sleeping room ; in such cases as these contamination of the food is almost certain to take place. PHTHISIS OR CONSUMPTION. Thirty-five deaths were caused by Phthisis, and nine by other Tubecular Diseases. I attended the Congress on Tuberculosis, held in London last Summer, and shortly afterwards wrote the following leaflet, which has been widely circulated. PRECAUTIONS AGAINST CONSUMPTION. (i.e. tuberculosis of the lungs.) Leaflet issued by the Acton District Council. Consumption (with other forms of Tuberculosis) causes one death in every eight in this country, and gives rise to a vast amount of suffering, often long continued. Consumption is to a large extent a preventable disease, and might be almost or entirely exterminated if the nature, causes, and means of prevention were generally known, and if the measures required for this purpose were thoroughly and systematically carried out. 14 The disease is caused by germs or microbes called "tubercle bacilli;" these bacilli are so small that they can only be seen with the most powerful microscopes, and many thousands may be crowded in a few drops of expectoration from the lungs of those suffering from Consumption. Whatever lowers the strength or the vitality predisposes towards the disease. Persons who live in damp, dirty, ill-ventilated, over-crowded and badly lighted houses. Intemperance, repeated colds, unwholesome and insufficient food, attacks of measles, whooping cough and typhoid fever. From a patient suffering from Consumption the germs are given off in the expectoration or phlegm. Where this expectoration or spit lodges, it dries, and afterwards gets lifted up as dust into the air, the germ thereby reaches the lungs of others. For the above reason Consumptive patients should never expectorate on the floors of a house, public conveyance, or into a handkerchief, but either into pieces of rag or paper, which should be at once burned, or into a spittoon or small portable spit bottle containing a little water. The spittoon or bottle should be carefully emptied down the w.c. every morning and evening, then scalded and re-charged with fresh water. A Consumptive patient should, if possible, occupy a separate room, which should be supplied with plenty of fresh air and open to sunlight, both of which tend to destroy the germs. No Consumptive patient should give suck. No Consumptive patient should kiss the lips of another person. All knives, forks, spoons, and cups used by Consumptive patients should be boiled for at least two minutes. 15 On a Consumptive person ceasing to occupy a room, this will be disinfected free of charge, if application is made to the Sanitary Inspector at his Office, Gothic Villa, Mill Hill Grove. In cleansing rooms used by Consumptive patients, all dirt and dust should be removed by damp dusters, which should afterwards be boiled. Any dust from such rooms is liable to contain the living germs of the disease. The milk from Consumptive Cows may contain the germ, and it is dangerous to drink unboiled milk. If the above precantions are carried out a Consumptive patient need not be a source of danger to anyone, and he will at the same time materially improve the prospects of his recovery. Medical Officer of Health. Public Health Department, Gothic Villa, Mill Hill Grove, Acton, W. I think it imperative that every Sanitary Authority should take active steps with a view of diminishing the suffering and death from tuberculosis, and I beg to offer the following suggestions, which I trust will meet with your approval and consent:— 1. That medical practitioners be requested to give voluntary notification (with the consent of the parent, or those in charge of the patient) of any case of consumption which may come under their notice. 2. That the fees paid for such notification be the same as those paid under the Infectious Diseases Notification Act. 3. The Medical Officer of Health to visit the case with a view of inspecting the surroundings of the patient, the conditions of work, &c., and the detection and removal of conditions likely to promote the disease. 16 4. Verbal advice will be given, and written instructions left at the house. 5. An offer will be made, free of all charge, to perform any necessary disinfection of rooms, bedding, &c. 6. The house will be visited from time to time in order to see if the necessary precautions are being observed to prevent the spread of the disease. 7. Arrangements will be made by the Medical Officer to examine, without fee, specimens of sputum from persons the nature of whose illness is dubious, in order to bring about a prompt diagnosis of the disease. WHOOPING COUGH. There were sixteen deaths from Whooping Cough. The lax way in which parents allow the little patients to mix with other children is the cause of the disease spreading, for it is so notoriously contagious that the most rigid isolation should be insisted upon. Whooping Cough is a serious affection, and with its frequent complica tion—broncho-pneumonia—a very fatal disease. I purpose shortly to bring out a leaflet on this disease. SMALL POX. There was one case of Small Pox notified during the year; a nursemaid who contracted the disease in Paddington. She was promptly removed to the South Mimms Hospital. The outbreak of Small Pox in London is disquieting, but if the public will avail themselves of the protecting power of re-vaccination they need have little alarm. 17 I find many anti-vaccinists are converted by being told in simple language what vaccination really means. I tell them how in prevaccination days cows suffered from a disease called Cow Pox, which showed itself by vesicles or blisters on the udder or teat of the cow, how Dr. Jenner came along and took some of the fluid from the vesicle and injected it into the arms of a few people, and how these people after a few days also got vesicles on their arms. Then Dr. Jenner tried to inoculate these same people with Small Pox, and he found they would not take Small Pox, so he found that Cow Pox was a preventative against Small Pox. Small Pox in its natural state is one of the most loathsome, disfiguring, and fatal diseases in the world. Not only so, but it is very infectious, and may be caught in a multitude of ways of which most people take no account. The only trustworthy protection is a com paratively recent vaccination, which not only modifies very greatly the severity of an attack, robbing the disease of half its terrors, but, in the vast majority of cases, wards off an attack altogether. Under ordinary circumstances re-vaccination should be done between the ages of 10 and 15 years; but there being now immediate danger of Small Pox, it would be well that all persons over 7 years of age who have not already been re-vaccinated should have this operation performed without delay. "Of 2,198 persons employed at the Small Pox Hospitals between 1884 and 1900 inclusive, only 17 persons contracted Small Pox, of whom 13 were not re-vaccinated until after they had joined the ship, and four were workmen who escaped medical observation." And again:—"Not one of the staff of the Hospital Ships has ever died of Small Pox, not one has ever suffered from the disease for the past eight years." It is only necessary to add that these facts are only novel in the sense that they relate to the new epidemic. Exactly similar facts have characterised every previous epidemic. 18 PLAGUE. During June a Conference took place between a Local Government Inspector, the Chairman of the Council, the Clerk, and myself, with a view of ascertaining how far we were prepared to deal with cases of Plague, should any cases crop up in the district. It was feared that the return of so many soldiers from South Africa might be a means of importing the disease to England. The following points were discussed and arranged:— 1. The disease to be made notifiable under the Infectious Diseases Notification Act. This was done, and all Medical Practitioners notified to this effect. 2. In the event of any doubt as to diagnosis, the Local Government Board will send down a Surgeon who has had special experience of the disease in Hong Kong. 3. The cases would be isolated at once. 4. All contacts would be taken charge of in a special House which the District Council have secured. 5. The rooms, &c., would be disinfected by formalin and chlorine. 6. Hafkines Inoculation could be used as a prophylactic for those who come in contact with cases. 7. Visitation of Common Lodging Houses. S. Warn all Hospitals. 19 9. Destruction of Rats. Rats are very prone to plague. The first warning that plague is incident may be deaths amongst rats. Plague-infected rats leave their runs, they appear dazed, become seized with convulsions and speedily die. Whether the rat is seized with plague before man and thus infects him, or whether man infects the rat, is a question as yet undecided. Many epidemics are believed to have been traced to rats, yet in other localities, and markedly so in Glasgow, the rats have not been found infected by plague, either before or after the outbreak. It is by the vermin in the rat's coat that infection is probably conveyed to man. The vermin leave the rat soon after the animal dies, and as it is found that the vermin contain the bacilli, the poison may gain entrance to the human body by vermin bites or by the abrasion of skin consequent on the scratching they induce. Parasites, such as fleas, bugs, and lice, acquire the bacillus from feeding on plague-sick persons, or they may gather it from clothing, bedding, &c., soiled by excretions. 10. Removal of Nuisances. 11. House to House Visitation. INFECTIOUS DISEASE. The following table gives the cases of Infectious Disease notified during the year 1901, and the total cases notified in each locality:— 26 NOTIFIABLE DISEASE. CASES NOTIFIED IN WHOLE DISTRICT total cases notified in each locality. CASES OF INFECTIOUS DISEASE NOTIFIED DURING The Year 1901. At all ages Under 1 1 to5 5 to 15 15 to 35 25 to 65 65 and upwards Acton South Acton Acton Green East Acton Bedford Park Willesden Small-Pox 1 1 – – 1 _ _ _ Diptheria 34 — 14 14 2 4 — 11 12 8 — 2 1 Membranous Croup I Erysipelas 26 I I — 4 15 5 7 II 4 1 I 2 Scarlet Fever 82 — 16 45 16 5 — 31 23 16 6 3 3 Enteric Fever 27 — — 8 8 11 — 6 14 5 1 1 — Puerperal Fever I — — — — 1 — — I — — — — Chicken Pox 25 5 12 8 — — — 6 4 10 3 2 — Totals 197 6 43 76 3° 37 5 61 66 44 11 9 6 21 The number of cases notified during the year was 172, a number that contrasts very favourably with 333 cases notified in 1900. The following table gives the number reported each year since the Act came into force :— 1890 '91 '92 '93 '94 '95 '96 '97 '98 '99 1900 '01 Small Pox — — 13 7 2 — — — — — 2 1 Scarlet Fever 108 63 74 192 86 67 193 93 167 111 243 82 Diphtheria 14 8 27 41 22 32 23 89 35 49 28 34 Membranous Croup 4 — 13 1 — — — 4 — — 1 1 Typhoid Fever 13 13 15 19 15 28 14 10 9 46 29 27 Continued Fever — — — 1 — — — — — — 2 — Puerperal Fever 1 — 1 2 1 3 3 — 1 — — 1 Erysipelas 22 18 37 77 41 31 26 25 22 31 28 26 162 102 180 340 167 161 259 221 234 239 333 172 The above table does not include 25 cases of Chicken Pox, which on my recommendation you made a notifiable disease last October. Nearly all other districts have followed our example. Chicken Pox is a disease that somewhat resembles Small Pox in the early stages. We now receive weekly returns of infectious cases from the Local Government Board of all the principal towns in England and Wales, who have adopted the course of notifying every week to the Local Government Board. 22 DISINFECTION AND METHODS TAKEN TO PREVENT THE SPREAD OF INFECTIOUS DISEASE. In my Annual Report of 1899 I drew your attention to the value of Formic Aldehyde as a disinfectant; since then the results of its use have been so praised by Sanitary Authorities that I have finally substituted it for sulphurous gas in the disinfection of rooms, &c., and am very pleased with the change. A Lamp is used for generating the Formalin, which consists of three parts—viz., a spirit lamp, an absorbent block, and a container to hold the Formalin fluid. The action is as follows:— The fluid is poured into the container, from whence it percolates on to the absorbent block, under which is placed the spirit lamp. The block when heated vaporizes the Formalin, which after four hours completely disinfects a room, without damage to pictures or metals, permeating at the same time all woollen and other such articles. A thoroughly up-to-date Brougham Ambulance has been provided. It has every convenience, and patients can now be removed with the minimum amount of discomfort and danger. SICK NURSING. The Nurses in connection with the Cottage Hospital have had under treatment 337 patients, and paid 7,926 visits. An average of 23 to each patient. I can but speak in the highest praise of the excellent work done by these ladies, which undoubtedly helps to keep down our death rate. 23 Nurse Dawkins has paid 1,901 visits, and nursed patients when necessary. She has given out 1,056 bottles of disinfectants, and taken six patients to different hospitals. . DRAINAGE AND SEWAGE DISPOSAL. The Bacterial treatment of a portion of the Sewage delivered to the Sewage Works by means of an open septic tank, followed by continuous filtration, having proved successful, the Council undertook to treat the whole of the Sewage in this manner, but instead of delivering the effluent from the septic tank to the filters by a revolving filter actuated by a pulsometer, they decided to deliver it by gravitation. During the year the new filters have been prepared and will soon be at work. The work has taken a considerable time to carry out, principally on account of the difficulty of obtaining suitable material for the filters, though the work was impeded by the necessity of carrying on the existing chemical treatment of the Sewage while alterations were being made to tanks, &c. It is hoped that the new installation will be at work at the beginning of the next financial year. DRAINAGE. Sewers have been laid by owners of land in the following roads:— Length. Albert Villas Road, Surface Water Sewer 70 yds. Graham Road, Soil and S.W. Sewers 230 „ St. Alban's Avenue, S.W. Sewer 157 Ramillies Road, Soil and S.W. Sewers 630 „ Back Way, Mill Hill Grove, Soil Sewer 120 „ Bedford Road, Soil and S.W. Sewers 110 „ 24 Sewers laid by the Council. Length. Acton Green, 6" Soil Sewer 60 yds. Acton Hill, 9" S.W. Sewer 220 „ Mill Hill Road, 9" Soil Sewer 325 „ Sewers re-laid by the Council. Length. Chiswick High Road, S.W. Sewer 35 yds. Friars Place Lane, S.W. Sewer 35 „ Sewers laid by Contractors for the Council. Length. Braemar Road, S.W. Sewer 20 yds. Rosemont Road, Soil Sewer 900 „ Southfield Road, 6" S.W. Sewer 50 „ Reconstruction of S.W. Sewer at Sewage Works 100 „ DWELLINGS. Considerable amount of building is still going on, and during the year about 450 houses have been erected and inspected by the Building Inspector. Several new roads have been formed and also plans have been passed for the development of several Estates in the West part of Acton. PIGGERIES, SLAUGHTER-HOUSES, AND COW-SHEDS. Four Piggeries have been eliminated from the district. The Slaughter-houses are licensed, and when inspected have been found clean and in good order. The Cow-sheds have been inspected from time to time. 25 REMOVAL OF REFUSE. About 10,500 tons of House Refuse have been removed during the year. 255 Complaints have been received during the year of non-removal of Dustbin Refuse, which received the immediate attention of the Surveyor. BAKEHOUSES. I have personally visited the bakehouses of the district. According to Section 101, Sub-section 2, of the Factory and Workshops Act, 1901:— "After the first day of January, 1904, an underground bakehouse shall not be used unless certified by the District Council to be suitable for that purpose." Personally from a sanitary point of view, I should like to close all underground bakehouses, but, as so many of these exist in Acton, it would mean practically taking the living away from many hard-working and deserving people. Again, many have invested capital in their business, and it would be obviously very hard on them. I intend, however, to utilize my power, and exact all I can as regards lighting, ventilation and cleanliness, and unless they comply with my instructions, I shall advise the Council not to grant the required certificates. The following is the Report I have received from Mr. Kinch, Sanitary Inspector. 26 ANNUAL REPORT OF THE SANITARY INSPECTOR, FOR THE YEAR 1901. To Dr. G. A. Garry Simpson, Medical Officer of Health. Sir, I herewith present the Annual Statement, shewing the particulars of the action taken in the suppression of Nuisances, &c., and various improvements effected by this Department during the year 1901. For the greater part of the year this Department had no separate Office and we were working under many difficulties, but about the end of October we moved across to Gothic Villa, and I am now doing all I can to put the Department into that state of efficiency which is necessary for the effectual carrying out of our duties. Mr. A. W. Fraser, having been appointed Assistant Sanitary Inspector, commenced his duties at the beginning of September. Systematic Inspection, &c.— During the year there were 1,400 Premises inspected. 3,170 Re-inspections of nuisances in course of abatement. 2359 Nuisances were reported. 2128 „ abated. 882 Letters written. 742 „ received. 73 Notices were received from H.M. Factory Inspector. 2 Library Books were destroyed. 29 Van Dwellings Inspected. 27 166 Visits were paid to infected houses. 23 Infectious patients were removed to hospitals. 346 Rooms fumigated. 15 tons of bedding disinfected. 27 Closets disinfected where cases of Enteric Fever were notified, in addition to the ordinary inspections of Cowsheds, Dairies and Milkshops, Bakehouses, Slaughterhouses, Piggeries, and the Common Lodging House, &c. Drainage Examinations.—The smoke test has been applied to drains 155 times and in addition 31 drains were opened up for examination after formal written complaints had been made, and authority given for that purpose. Workshops.—Six workshops, with insufficient w.c. accommodation, erected suitable w.c's so as to provide separate accommodation for persons of each sex in accordance with Sec. 22, Pub. Health Amend. Act, 1890. Notices.—596 Preliminary Notices and 42 Statutory Notices have been served for the abatement of Nuisances and the necessary works asked for were carried out. No Police Court proceedings in respect of Nuisances have been taken before the Magistrates. Dairies, Cowsheds and Milkshops.—There are now 68 Dairies and Milkshops and 8 Cowkeepers on the Register. Regulations relating to these premises were printed last June, and a copy left with each dairyman and cowkeeper, and the principal clauses pointed out to him. I also send to each every quarter a notice reminding him of the time to whitewash. 131 visits have been paid to the Dairies and Milkshops and 24 visits to the Cowsheds. On the 10th June, Police Court proceedings were successfully taken against a Milkman carrying on business in Bollo Lane, for failing to give the necessary one month's notice to the Council before commencing to occupy the premises as a Dairy. Defendant was fined 10/-and 2/- costs. 28 Bakehouses.—The number of Bakehouses on the Register is 23, of which 14 are underground. Notice reminding the occupiers of the time to whitewash is also sent every six months. These have been regularly inspected—79 visits having been paid them. Slaughter Houses and Butchers' Shops.—32 visits of inspection were paid to the four Licensed Slaughter-houses, and they were all found in fairly good condition. No unsound meat was found. A notice re the white-washing is also sent to these every quarter. Piggeries.—Thirteen piggeries still exist in the District, viz.: ten at Old Oak Lane, East Acton, one at Goddard's Farm, Willesden Lane, one at Manor Farm, and one at Elms Farm, Acton Hill. These have been visited 43 times, and it has only been necessary in one case to serve the occupier with a notice to abate any nuisance. Early in October the Council summoned four pig-keepers of South Acton for contravening the bye-law by keeping their pigs within 200 feet of a dwelling-house. The Magistrate held that in these cases he considered the bye-law reasonable, and an order was made to comply with the same within three months, but as the required distance could not be obtained, the defendants have removed their piggeries out of the parish, which will be highly beneficial to the Bollo Bridge neighbourhood. Common Lodging Houses.—The one registered has been inspected 24 times, and was always found to be in a satisfactory condition. Smoke Abatement.—24 observations have been made of the 10 Factory and Works chimneys during the year, and in one case proceedings were taken before the magistrates, with the result that an Order of Abatement was made and the usual costs allowed. Food and Drugs Acts.—Samples under these Acts are taken by Mr. W. Tyler, the Inspector, Brentford. No returns as to the number of samples taken and the result of the analysis is supplied to the Council, 29 During the year I seized and took before a Justice :— 3 rabbits. 1 box mackerel. 2 boxes kippers. 1 box bloaters. 6o boxes plums. 2 boxes whiting 1 box mixed fish. 1 box herrings. 18 rabbits. 2 barrels herrings. Orders to destroy were granted in each case. One offender living at South Acton from whom I seized a quantity of bad fish, was written to by the Clerk, and cautioned not to repeat the offence. The following Tabulated List gives particulars of Nuisances dealt with :— Drains Defective 73 „ stopped 67 „ want of ventilation to 89 Manholes, want of, and Interceptors ... 105 „ defective 27 Fresh Air Inlets, want of 14 „ „ defective 10 Soil Pipes defective 7 „ want of ventilators to 4 „ ventilators defective 48 Ventilating Shafts defective 20 30 Water Closets defective 45 „ pans broken or defective 86 „ pans, &c., foul 24 „ Stopped 26 „ want of water supply to 13 „ flushed directly from drinking water cistern 24 „ defective flushing apparatus 139 „ additional or separate, required in Factories and Workshops 6 „ defectiue pan closets and containers 10 Latrines defective 1 Gullies defective 128 „ want of 96 „ defective cement work around 32 „ stopped 22 Yards dirty 12 „ defective paving of 140 „ want of paving to 36 Stables, defective paving of 13 Laundries, defective floors of washhouses 16 Kitchen and Scullery, floors defective 56 Rain Water Pipes connected directly to drain 312 „ defective 56 „ „ want of 16 Eaves Guttering defective 41 „ „ want of 10 Sinks defective 9 „ waste pipes connected to drain 24 „ want of wash pipes to 7 „ defective waste pipes J9 31 Bath and Lavatory Waste Pipes connected directly to drain 10 Walls and Ceilings dirty 136 „ „ damp 6 Dust Bins, want of 196 Ashpits defective 9 Manure Accumulations 26 „ want of receptacles for 43 Refuse, accumulations of 20 Animals and Fowls kept as to be a Nuisance 19 Water Supply, absence of 4 Cisterns defective 12 „ covers required 18 foul 5 Roofs defective 31 Plastering defective 42 Water in Cellars 6 Cesspools defective 14 Urinals defective 3 „ want of water sapply to 3 Overcrowding 4 Chimneys emitting black smoke 7 Miscellaneous 70 A great deal of work has been done in connection with the abatement of these nuisances, and a large proportion of our time is taken up by the superintendence of this work, but I have to report that there has been improvement in the character of the work done. I am, sir, Yours obediently, MAURICE W. KINCH, Sanitary Inspector. Public Health Department, Gothic Villa, Mill Hill Grove, Acton W.