Knight ACT 12 1 Acton Urban District Council. ANNUAL REPORT ON THE Sanitary Condition, &c., OF THE URBAN DISTRICT OF ACTON, For the Year 1904. BY G. A. GARRY SIMPSON, M.R.C.S., L.S.A., Fellow of the Royal Institute of Public Health. MEDICAL OFFICER OF HEALTH. PRINTED BY ORDER OF THE COUNCIL. - Acton Urban District Council. ANNUAL REPORT ON THE Sanitary Condition, &c., OF THE URBAN DISTRICT OF ACTON, For the Year 1904. BY G. A. GARRY SIMPSON, M.R.C.S., L.S.A., Fellow of the Royal Institute of Public Health. MEDICAL OFFICER OF HEALTH. PRINTED BY ORDER OF THE COUNCIL. CONTENTS. SECTION I.—GENERAL DESCRIPTION AND AREA OF DISTRICT. „ 2.—VITAL STATISTICS. „ 3.—INFECTIOUS AND OTHER DISEASES. „ 4.—ISOLATION HOSPITAL ACCOMMODATION. „ 5.—GENERAL SANITARY ADMINISTRATION. „ 6.—ADOPTIVE ACTS, BYELAWS, AND REGULATIONS. „ 7.—CHIEF SANITARY INSPECTOR'S REPORT. MEDICAL OFFICER OF HEALTH'S REPORT. PAGES. Acton Improvement Act— Tuberculosis in Animals 54-58 Common Lodging-Houses 58-59 Slaughter-houses 59-60 Infectious Disease Prevention 61 Sanitary Provisions 61 Acton Wells 13 Adoptive Acts in Force in the District65 Area of District 16 Ambulance Arrangements 41 Bacteriological Examinations 37 Baxter 14 Births and Birth-rates 19 Boundaries of Parish 13 Byelaws and Regulations in the District 65-66 Cemetery 50 Charities 15 Chicken-pox 29 Contaminated Oysters 30 County Council Byelaws in Force in the District 66 Crèche 25 Cromwell 14 Deaths and Death-rates 20 Diarrhœa 24 Diphtheria 31 Diphtheria Anti-toxin 31-32 Disinfection (Methods of) 42 Enteric Fever 30 Essex Army 14 General Summary 10 „ Remarks 5 Geology 13 3 PAGES. Growth of the District 15 Health Visits 25 and 37 Houses and Housing Accommodation . 45 House Refuse 47-48 Infantile Mortality 23 Industries 16 Isolation Hospital 41 Land Value 15 Longevity 15 Leaflet on Whooping Cough34 Measles 33 Moated Meadow 13 Mount Vernon Hospital 32-33 Mortuary Accommodation49 Name of Parish 13 New Streets and Buildings 47 Office 9 Open Spaces 16 Overcrowding 45 Overlying 23 Phthisis or Consumption 32 Phthisis Death-rates 32 Population 19 Premature Births 23 Public Baths 49 Public Conduit 15 Public Health and Isolation Hospital Committee 7 Registered and Licensed Premises 61 Scarlet Fever 30 Scavenging and Cleansing 48 School Cards 35 Schools Closed 33 Sewage Disposal 46 Sewage 45 Sick Nursing 50 Small-pox 29 and 41 Staff 8 Street Watering 48 Table showing Death-rates for 10 years 20 „ Birth-rate, Death-rate, and Zymotic Death-rate in 12 towns 20 ,, causes of, and Ages at Death for the year 21 ,, Vital Statistics for the past 10 years 22 „ Death-rate and Zymotic Death-rate for 10 years 26 ,, Birth-rate and Deaths of Children under one year per 1,000 Births registered for 10 years 23 „ Deaths from Measles for 10 years 33 ,, Infectious Diseases reported for 10 years 29 ,, ,, ,, notified during the year 38 ,, Population and Inhabited Houses for 5 censuses 19 ,, Wards affected by School Card notifications 36 ,, Diseases discovered through School Card notifications 36 ,, New Sewers laid 46 ,, New Roads made up and Houses passed for occupation 47 ,, Post-mortem Examinations made 50 ,, Inspections, Defects Found, and other matters relating to Factories, Workshops, Laundries, Workplaces, and Homework 51-54 The Manor 14 ,, Church 14 Ward Boundaries 34 Water Supply 45 Whooping Cough 34 4 CHIEF SANITARY INSPECTOR'S REPORT. PAGES. Acton Improvement Act 72 Absence of Bass Brooms in houses of industrial classes 69 Bakehouses 78 Complaints received 69 Common Lodging-Houses 78 Cowsheds 77—78 Dairies and Milkshops 77—78 Dampness in Houses 70 Drainage Examinations 77 Food and Drugs Acts 77 Inspections, &c. 74 Meat and other Foods (inspection of) 77 Notices 76—77 Pharyngeal Glands, cutting from pigs 71 Piggeries 78 Prosecutions 76 Sanitary Improvements (list of) 74-76 Sanitary Institute Conference 70-71 Slaughter-houses 78 Smoke Abatement 79 Staff 73 Superfluous Furniture, Ornaments, and Drapery in Houses 70 Tuberculosis in Animals 71-72 Acton Arban District Council Annual Report of the Medical Officer For the Year ending 31st December, 1904 To the Chairman and Members of the Acton District Council. Gentlemen, I have the honour to submit my Eleventh Annual Report on the health and sanitary condition of your town. At the request of Dr. Young, the county medical officer, I have, besides dividing the report into sections, given a short general description of the district, mentioning at the same time a few points that I thought might be of some interest. It will be noticed that the death-rate continues gradually to fall, and, with the exception of 1903, was the lowest on record. There is no better evidence of the health and sanitary condition of a district than a gradually falling death-rate, and we now well rank as one of the healthiest suburbs of London. The chief public works of importance, from a sanitary point of view, have been as follows:—The opening of the baths, which are a great boon to the district ; the building of a convenience on St. Mary's 6 Mount; the building and subsequent completion at the beginning of the year of the isolation hospital; and the acceptance of the contract for erection of the dust destructor adjoining the sewage works. This latter scheme is, in my opinion, of vital importance, and I trust you will push the work forward without delay. You will notice that a great deal of useful work has been done by the Health Department during the year, and I am much indebted to Mr. Kinch, chief sanitary inspector, Mr. Gough, assistant sanitary inspector, Miss Bulkeley Williams, lady health visitor, and Miss Morton, typist, for their kind help and co-operation. I think you were wise, in your decision, to purchase the Cock and Crown Yard property, as, besides abolishing an unhealthy area, it will be a general municipal improvement, and has avoided the proceedings and litigation that invariably follow closing and demolition orders. We have to think not so much of the present occupiers as of their children and the subsequent generation, and I am afraid at times we err on the side of leniency in dealing with poor class property. I am, Gentlemen, Your obedient Servant, G. A. GARRY SIMPSON. 7 Public Health and Isolation Hospital Committee. Mr. Councillor E. F. HUNT (Chairman of Committee). Mr. Councillor J. W. JARRATT, J.P. (Chairman of Council), ex officio. Mr. Councillor R. AINSLEY. „ „D. P. CRONIN. „ „ W. EYDMANN, Jun. „ „ S. GOODHALL. „ „ S. F. HOLLOWAY, M.R.C.S., L.R.C.P. „ „ E. E. B. LAN DON. M R.C.S., L.R.C.P. 8 Staff. Clerk to Council Wm. Hodson. Engineer and Surveyor D. J. Ebbetts. Medical Officer of Health G. A.Garry Simpson, M.R.C.S., F.R.I.P.H. Chief Sanitary Inspector M. W. Kinch, Cert. San. Inst. (London) Assistant Sanitary Ernest J. Gough, Cert. Inspector San. Inst. Lady Health Visistor Miss L. Bulkeley Williams. Cert. San. Insp. (London). Matron of Isolation Hos- Miss H. Amos. pital Clerk Miss Morton. Disinfector T. Burrows. Cleansing and Scavenging J. Webb. Superintendent Analyst ( E. Bevan, 4, New Court, Lincoln's Inn, W.C. Inspector under Food and M. W. Kinch. Drugs Acts Coroner Dr. Gordon Hogg, South Parade, Bedford Park. Mortuary Attendant J. Hustwitt, 242, High St. 9 The Office of the Health Department is at Gothic Villa, Mill Hill Grove. I attend daily at 9.30 a.m., and may be consulted on all matters connected with the health of the District. Should an urgent matter require immediate attention after office hours, or on Sundays, I can be interviewed at my private residence—Bardon House, East Acton. Ward Boundaries. 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. 10 Summary. Area of District 2,304 acres Rateable Value £293,911 Net Value of a Penny Rate ,£944 2s. 8d. Population at Middle of the Year 52,358 Population in 1901 Census 37.744 Persons per Acre in the District 227 Average Number of Persons per House 1901 Census 6.1 Death-rate 1904 11.0 Average Death-rate for previous 10 years 13.9 Zymotic Death-rate 1904 2.19 Average Zymotic Death-rate for previous 10 years 2.3 Birth-rate 1904 27.69 Average Birth-rate for previous 10 years 30.0 Infantile Death-rate (under one year old per 1,000 Births) 1904 142.7 Infantile Death-rate Average for previous 10 years 163.4 SECTION I. GENERAL DESCRIPTION AND AREA OF DISTRICT. 13 SECTION I. General description and Area of District. Name. Acton is supposed to have derived its name from the quantity of oak timber which it produced; "ac"in the Saxon language signifying an oak. Boundaries of Parish. The Parish is bounded by that of Willesden on the north, Hammersmith on the east, Chiswick and Brentford on the south, and Ealing on the west. Geology. The soil towards the north is a stiff clay, and towards the south a rich loam, the southern part at one time being occupied by market gardeners. Acton Wells. Acton Wells, formerly the site of three wells of mineral water, springing out of a deep clay, were in great repute for their medicinal virtues about the middle of the 16th Century. The Assembly Room was then a place of very fashionable resort; and the neighbouring hamlets of East Acton, and Friar's Place, were filled with persons of all ranks, who came to reside there during the summer season. Moated Meadow. To the north of the Parish near the Great Western Station, in a field called Moated Meadow, is a deep trench inclosing a parallelogram of about 100 yards in length and 40 in breadth, supposed by some to have been a Roman Camp; but the name of the meadow seems to intimate that it is the site of a moated house, of which there have been several in the neighbourhood. 14 Essex Army at Acton. In November, 1642, a few days before the Battle of Brentford, the Lord General (the Earl of Essex) and the Earl of Warwick, marching with their forces out of London, made Acton the place of their rendezvous. Cromwell met at Acton. When Cromwell returned to London after the Battle of Worcester, he was met at this place by the Lord President, the Council of State, many of the nobility, the House of Commons, the Lord Mayor, Aldermen and Common Council of the City of London, &c., &c., forming in the whole a train of more than 300 coaches. The Recorder of London accosted him with a congratulatory speech on the occasion. The Manor. The Manor of Acton has belonged to the See of London from time immemorial. The Church. The Church, which is dedicated to St. Mary, stands in the centre of the town. It consists of a chancel, nave, two aisles, and south chapel, clustered pillars and pointed arches, and many of the windows are of stained glass. The Church was rebuilt, except the tower, in the year 1866, upon the site of the original church of about 600 years old, which had been much altered. The square tower, with battlements, was built in the year 1876, and much resembles the Old Tower of the reign of Henry VIII. Baxter. Richard Baxter, the celebrated Nonconformist divine, resided many years in this parish after the restoration; his house was near the church where he constantly attended divine service and sometimes preached, having a licence for so doing, provided he uttered nothing against the doctrines of the Church of England. Sir Matthew Hale was his contemporary at Acton. 15 Longevity. The Register of Burial shows interesting instances of longevity:— "Wm. Aldridge, wheelwright, was buried the 21st day of November, 1698, aged 114 years." "Dec. 6, 1761, buried Margaret Fieldhouse, aged 100 and odd." "Sept. 4, 1762, buried Mary Hill, aged 100." Charities. Acton seems richly endowed with charities which date back to the year 1612. The parish built some small houses in the Steyne to be used as almshouses in the room of some others which were built in the year 172 5 and had fallen into decay. They were again rebuilt in 1887 to commemorate the Jubilee of Queen Victoria. Public Conduit. In the year 1612, at the entrance of Acton on the London side was a convenient conduit made for the benefit of the public and endowed by Thomas Thorney with a rent-charge of twenty shillings per annum to keep it in repair, the overplus to be distributed to the poor. The parish was in danger of losing this valuable benefaction, when it was recovered by the timely exertions of Samuel Wegg, Esq., who, at considerable expense, instituted a suit in Chancery; and, in the year 1755, obtained a decree in favour of the parish. Mr. Wegg, a few years before, had purchased a house which belonged to Sir Joseph Ayloffe, Bart. Land Value in the 16th Century. It appears by the inventory of goods, plate, &c., belonging to the different parishes in Middlesex (1 Edw. VI.) that this parish had half an acre of arable ground, then valued at eightpence per annum. The value of land since this date seems to have risen considerably, the price of a similar piece of land now fetching about .£1,000. Growth. Acton appears to have steadily grown with the other 16 suburbs around London up to the year 1886, when the Metropolitan Board of Works obtained an injunction against the Council prohibiting the connection of any more house drains to the sewers. Many estates had been laid out and their resewering meant a considerable expense to the owners; consequently they were not resewered and building operations were at a standstill. The Council, however, established a Sewage Disposal Works in Acton Vale, and sewered many parts of the district. And at the present time there are very few streets in which it is impossible to build on account of the sewer difficulty. Industries. The Laundry industry is the principle one, there being about 400 laundries in the district. We have also Breweries, Mineral Water Works, Motor Car Works. Dye Works, Soap Works, Corrugated PaperWorks, Geographical Printing Works, Paper Canvas Works, Fur Toy Works, Potted Meat Works, Printing Works, Metal Works, Engineering Works, and Brick Works, &c. Open Spaces. There are four Open Spaces for recreation in the district, the principle being Acton Park, adjoining the Uxbridge Road, in the eastern part of the district, with an area of about 25 acres. Acton Green on the south side, with an area of 12¾ acres or thereabouts, is the principle Recreation Ground for this part of the district. There is also the South Acton Recreation Ground in Bollobridge Road, with an area of 4½ acres. Near the Western Boundary of the parish, off the High Street, is a small but beautiful open space which has been recently acquired and has been laid out to form a place of rendezvous for invalids and aged persons. Area of District. The area of the district is 2,304 acres. SECTION II. VITAL STATISTICS. 19 SECTION II. Vital Statistics. Population. The population calculated to the middle of 1904 was 52,358, an increase of 2,678 in twelve months. The number of inhabited houses was 8,678, and uninhabited 290. The following table shows the population and the number of the inhabited houses at the five preceding censuses:— Year. Inhabited Houses. Population. 1861 610 3,151 1871 1,568 8,306 188l 2,844 17,110 1891 4,084 24,207 1 901 6,114 37,744 In making my calculations 1 allow six persons to each occupied house, and one for each unoccupied house. The census of 1901 showed the average to be 6.1 per house. This method of calculating the population is the one adopted by previous Medical Officers for the District. Births and Birth-rates. During the year 1904 there were 1,450 births registered. The birth-rate per 1,000 persons living was 27.69. The London birth-rate was 27.9. The following table shows the births since 1894:— Year. No. of Births. Year. No. of Births. 1894 834 1900 1,080 1895 874 1901 1,211 1896 894 1902 1,242 1897 973 1903 1,422 1898 995 1904 1,450 1899 1,068 c2 20 Deaths and Death-rates. There were 576 deaths registered. The recorded general death-rate was 11.0 per 1,000 of the population. The London death-rate was 16.1. The death-rates since 1894 are as follows:— 1894 14.2 1900 13.7 1895 17.2 1901 13.7 1896 15.7 1902 13.4 1897 15.9 1903 8.6 1898 15.8 1904 11.0 1899 It will be noticed that the recorded general deathrate has been gradually falling for the last eight years, which is satisfactory evidence of the health of the district. It will be noticed that 207 deaths were children under one year of age. These figures considerably increased the death-rate. The following table gives the birth-rate, death-rate, and zymotic death-rate per 1,000 per annum in the undermentioned 12 towns:— Birth-rate. Death-rate. Zymotic Death-rate. ACTON 27.69 11.0 2.19 Ealing 24.07 10.6 1.5 Chiswick 27.83 14.46 3.006 Brentford 34.8 16.1 4.4 Willesden 32.86 12.22 1.7 Leyton 30.7 13.1 2.7 Walthamstow 32.79 11.95 2.89 Tottenham 29.5 11.5 1.9 Hornsey 20.4 8.43 0.831 East Ham 31.7 14.4 2.9 Croydon 26.1 13.8 — Reading 26.00 13.89 1.82 21 The following table gives the causes of and ages at death during the year 1904:— Causes of, and Ages at Death during- Year 1904. Causes of Death. Deaths in or belonging to whole District at Subjoined Ages. Deaths in or belonging to Localities at all Ages. Total Deaths in Public Institutions in the District. All Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. North Ward. West Ward. East Ward. Small-pox ... ... ... ... ... ... ... ... ... ... ... Measles 15 2 12 1 ... ... ... ... 10 5 ... Scarlet Fever 1 ... 1 ... ... ... ... ... ... 1 ... Whooping Cough 9 2 7 ... ... ... ... ... 4 5 ... Diphtheria and Membranous Croup 2 ... 1 ... ... ... ... ... ... 2 ... Croup ... ... ... ... ... ... ... ... ... ... ... Fever— Typhus ... ... ... ... ... ... ... ... ... ... ... Enteric 3 ... ... ... ... ... ... ... ... 3 ... Other continued ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 6 4 ... ... ... ... ... 3 1 2 ... Cholera ... ... ... ... ... ... ... ... ... ... ... Flague ... ... ... ... ... ... ... ... ... ... ... Diarrhœa 82 66 15 1 ... ... ... ... 12 40 30 ... Enteritis 11 8 ... ... ... 2 2 3 6 ... Puerperal Fever 3 ... ... ... ... ... ... ... 3 ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 1 ... ... ... ... 1 ... ... ... 1 ... Phthisis 32 ... 2 2 5 22 1 6 13 13 8 1 Other Tubercular Diseases 21 7 7 ... 3 3 1 3 10 ... Cancer, Malignant Disease 18 ... 1 ... ... 12 5 7 4 7 ... Bronchitis 43 10 4 ... ... 10 19 13 19 11 ... Pneumonia 71 29 25 3 ... 8 6 5 43 23 1 Pleurisy 1 ... ... ... 1 ... ... ... 1 ... Other Diseases of Respiratory Organs 7 1 4 ... ... 2 ... 1 4 2 ... Alcoholism — Cirrhosis of Liver 3 ... ... ... ... 3 ... 1 1 1 ... Venereal Diseases ... ... ... ... ... ... ... ... ... ... ... Premature Birth 20 20 ... ... ... ... ... 3 8 9 ... Diseases and Accidents of Parturition 4 4 ... ... ... ... ... ... ... 4 ... Heart Diseases 44 2 1 ... 3 23 14 14 13 17 1 Accidents 15 7 1 ... ... 5 1 4 9 2 2 Suicides 4 ... ... ... 3 1 3 1 ... All other causes 160 44 8 7 2 24 75 47 57 56 4 Totals 576 207 90 16 14 124 125 124 240 212 9 22 Vital Statistics of whole District during: 1904, and previous Years. Year. Population 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 bblonging to the District. Under 1 Year of Age. At all Ages No. Rate.* No. Rate per 1,000 Births regis-. tered. No. Rate. * No. Rate. * 1894 27,600 834 30.2 133 i59.0 368 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 ... ... ... 509 15.1 1900 38,406 1,080 28.1 182 168.5 528 13.7 15 ... ... 528 13.7 1901 37,744 1,211 32.O 206 170.1 519 13.7 6 ... ... 519 13.7 1902 44,565 1,242 27'.8 186 149.8 593 13.3 12 ... 6 599 13.4 1903 49,680 1,422 28.6 150 105.4 430 8.6 8 ... ... 430 8.6 Averages for yrs. 1894-1903. 35,297 1,059 30.0 172 165.7 480 13.6 ... ... ... 494 13.9 1904 52,358 1,450 27.69 207 142.7 576 11.0 9 ... ... 576 11.0 *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.l. Area of District in acres (exclusive of area covered by water), 2,304. 23 Infantile Mortality. There were 207 deaths registered of Infants under one year of age, as against 1,450 births; the proportion which the deaths under one year of age bear to 1,000 births is, therefore, 1427, as against 106.4 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 preceding: 10 years:— Year. Birth-rate per 1,000 Deaths of Children under one year per 1,000 Registered Births. 1894 30.2 l60.6 1895 31.6 168.1 1896 30.3 168.9 1897 30.7 198.3 1898 30.5 181.9 1899 31.7 187.2 1900 28.1 168.5 1901 32.0 170.1 1902 27.8 149.8 1903 28.6 105.4 1904 27.69 142.7 Our Infant Mortality shows a decided tendency to fall. The year 1903 must always be looked upon as quite exceptional, as owing to the heavy rainfall we had very little diarrhœa. It was the zymotic diarrhœa that swelled the deathrate, but other causes of our Infant Mortality were— Premature Birth.—Twenty deaths of Infants were registered as due to premature birth. This is due to the fact that the mothers remain standing at the washtub for hours together. Overlying was responsible for seven deaths, in every case due to ignorance and neglect; and it should 24 be made a penal offence to have an infant in bed with its parents. Every mother on registering the birth of her child is given a leaflet warning her of the danger of this practice. Diarrhœa.—Sixty-six deaths in children under one. year were registered as due to diarrhœa. What was the cause, and what measures did we take to prevent or reduce this high mortality ? First let me state the predisposing causes: 1. The mothers have to leave the infants to the care of ignorant women, or sometimes quite young children, during their absence at the laundries; or Frequently the parents are quite ignorant of the suitable food to give a child brought up by hand. In either of the above cases an unhealthy and inflammatory state of the bowel is set up. 2. When the hot weather comes, the microorganism,—viz.: the exciting cause, and which is found in the dust of the streets, gains an entrance into the infant's intestine by means of its food, and finding in the unhealthy intestine everything favourable for its growth, rapidly multiplies, and throws out a toxin or poison which speedily kills the infant. What measures do we take to prevent this mortality ? House to house visitation and instruction to mothers; the time chosen has to be when the women are most likely to be found at home. Free distribution of leaflets on summer diarrhœa, showing the importance of boiling milk and water, and in keeping the food covered over so as to avoid contamination by dust and flies. 25 The frequent removal of all refuse, especially vegetable matter, which we recommend to be burnt. We lay stress on the importance of keeping the roads frequently watered, so as to lay the dust. (Microorganisms adhere to moist surfaces.) And we want no better evidence of the value of this measure than the Infant Mortality of 1903, which, owing to the heavy rainfall, was the lowest on record. The personal inspection and supervision of all dairies and milkshops, and insisting on the milk standing in the open shop being covered over with damp cloth or metal cover. Every mother is given a leaflet showing the best food for her infant, and how that food should be prepared in the event of her not being able to nurse the child herself. There is no doubt that the establishment of a creche would remove one of the most important predisposing causes, and it is very unfortunate that the measure for providing the same which came before Parliament in the Acton Improvement Act was lost. Much good can be done by education, and there is some slight evidence by the diminished Infant Mortality in the last four years, that the labours of the Health Department are not in vain. During the year Miss Bulkeley Williams, the health visitor, paid 1,292 visits relating to the feeding of infants, and also had 120 dirty premises cleaned. In the following table the death-rate and Zymotic death-rate are so arranged that comparison can be made for the preceding 10 years :— 26  1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1 1904 Small-pox ... ... ... ... ... ... ... ... 6 ... ... Measles 15 6 24 2 6 ... 16 ... 32 ... 15 Scarlet Fever 3 3 1 ... 3 2 6 2 1 2 1 Diphtheria 5 5 8 28 8 7 4 6 4 2 2 Whooping Cough. 17 5 21 ... 10 14 4 16 13 20 9 Typhoid Fever 2 2 2 2 ... 7 4 1 4 5 3 Diarrhoea and Dysentery 17 44 37 80 50 56 50 69 23 21 82 Puerperal Fever 4 2 ... ... 1 1 ... ... 3 Total Number of Deathsfrom seven Zymotic Diseases 63 67 93 130 78 86 85 94 83 50 115 Deaths from other Causes 330 411 371 373 439 423 443 425 516 380 461 Total Deaths 393 478 464 503 517 509 528 519 599 430 576 Death-rate from seven Zymotic Diseases per 1,000 2.28 2.42 3.15 410 2.39 255 2.21 2.49 1.86 1.00 2.19 Death-rate from other Causes per 1,000 11.95 14.86 12.59 11.79 13.48 12.55 11.53 11.26 11.57 7.64 8.8 Genera) Death-rate per 1,000 14.23 17.28 15.75 15.90 15.87 15.11 13.74 13.75 13.44 8.65 11.0 The London Zymotic death-rate for 1904 was 2.14. SECTION III. INFECTIOUS AND OTHER DISEASES. 29 SECTION III. Infectious and Other Diseases. The number of cases notified during the year, excluding Chicken-pox, was 199, against 168 in the preceding year. Two hundred and sixty-two cases of Chicken-pox were notified, against 144 in 1903. The following table gives the number reported during the preceding ten years:— 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 Small-pox 2 ... ... ... ... ... 2 1 31 1 1 Scarlet Fever 86 67 193 93 167 111 243 82 109 76 129 Diphtheria 22 32 23 89 35 49 28 34 33 22 32 Membranous Croup ... ... ... 4 ... ... 1 1 3 2 1 Typhoid Fever 15 28 14 10 9 46 29 27 14 40 8 Continued Fever ... ... ... ... ... ... 2 ... ... ... ... Puerperal Fever 1 3 3 ... 1 ... ... 1 1 ... 4 Erysipelas 41 31 26 25 22 31 28 26 24 27 24 Totals 167 161 259 221 234 239 333 172 215 168 199 I personally visited all cases of Chicken-pox immediately on receipt of notifications. One case of Small-pox, notified as Chicken-pox, I diagnosed as modified Small-pox, and the patient was removed to hospital. A similar case of modified rash occurred in the same house, so I got the opinion of Dr. McC. Wanklyn, the expert retained by the County Council, who agreed with my diagnosis. 30 Scarlet Fever. One hundred and twenty-nine cases were notified against 76 the previous year, but there was only one death, showing that the disease was of a mild type. Too much stress cannot be laid on the fact that the germ that causes Scarlet Fever is found in the throat, and discharges from the nose and ears long after apparent convalescence. It is very important for parents and others to keep their children more or less isolated for a week or two after their return from hospital, and to collect all discharges from nose and ears on rags and burn them, and on no account to allow kissing. No hospital has, so far, succeeded in avoiding return cases, or even in materially reducing them, merely by increasing the length of stay in hospital. In the investigation of return cases of Scarlet Fever, made on behalf of the Metropolitan Asylums Board, it was found that in only 27 per cent. was there reason to suspect the desquamating cuticle as the source of the infection, and no less than 80 per cent. of the cases, which on discharge from hospital had given rise to infection, had discharges from mucous membranes, 40 per cen. having a nasal discharge. Enteric Fever. Eight cases were notified during the year, and three of these proved fatal. This is a marked contrast to the previous year, when, owing to a milk epidemic, 40 cases were notified. Some recent experiments by Professor Klein show that oysters contaminated with sewage containing typhoid bacilli clear themselves more rapidly when kept in sea water than when kept in the dry state. However largely infected, the oysters at no time presented any sign of such infection to the eye. 31 Diphtheria. Thirty-two cases were notified, and two deaths occurred. How many of these 32 cases were true Diphtheria it is impossible to say. Even if a swab is taken and submitted to a bacteriological examination it does not always help one, as we know that the Klebs-Lœffler bacillus is occasionally found in perfectly healthy throats. And, again, cases that clinically are not diphtheria sometimes show that they have been true Diphtheria by the development of diphtheritic paralysis. There is no doubt, however, that a great number of cases are notified as Diphtheria which are only lacunar tonsillitis, or more often what is termed croupous tonsillitis, when a false membrane forms on the tonsil. It has been suggested that the term Diphtheria should be employed in a clinical sense to include all affections characterised by the presence of false membranes, their pathological distinction being indicated by such terms as staphylococcal, streptococcal, mixed lœffflerial, pure lœfferial, &c. Since the introduction of anti-toxin this terrible disease has been shorn of much of its terrors. If injected on the first day of the disease the mortality is nil, and even if the patient has not got Diphtheria it can do no harm. During the year I have had ample proof of the value of Diphtheria anti-toxin as a prophylactic. I have injected 1 c.c. or 16 minims into children who have been playing with and in contact with others suffering from a virulent form of the disease, and have never known a child who has had a prophylactic dose develop the disease. I now always make it a routine practice to give this small dose to every child in the house, on condition I get the parents' consent. I take this opportunity to again remind the general practitioners in this district that I keep a supply of 32 antitoxin from the Lister Institute, which can be had at any time of the day or night by applying at my private residence, and free of charge to necessitous cases. Phthisis or Consumption. There were 32 deaths due to Consumption, and 21 to other tubercular diseases, a considerable increase over the previous years, when the deaths numbered 18 and 14 respectively. The Phthisis death-rate working out at .61. The deaths from Phthisis in London registered during the year numbered 7,526, and were equal to a rate of 1.62 per 1,000 living. I examined the sputum in 33 suspicious cases; the tubercle bacillus was found in 7 specimens. Several meetings were held during the year at the Westminster Guildhall to push forward the scheme promoted by Colonel Gerard Clark to provide an openair sanatorium. It was decided to take three beds, when the Mount Vernon Hospital at North wood made an offer. This was considered more advantageous, as the Mount Vernon Sanatorium already existed, and it would be some time, possibly, before the Middlesex scheme would be in working order. There are prospects that some day "Consumption" may be entirely extirpated. The death-rate from "Consumption" has been reduced in England and Wales during the last fifty years to one-half of what it was before. The reduction of overcrowding, better dwellings, better drainage, and more cleanly habits of the people have all been instrumental in reducing the death-rate. What we have to do now is to induce the people of all classes to recognise the predisposing and, above all, the exciting cause of Tuberculosis, to teach the consumptive that the germ causing the disease is in 33 his expectoration, and that, unless he takes proper precautions, he may be instrumental in causing many deaths and much misery and suffering to others. All cases of Tuberculosis are visited by one of the staff of the Health Department, and every endeavour is made, by leaflets and otherwise, to educate both the patient and the other inmates of the house as to the cause and treatment of the disease. One of the great advantages of sending the poorer class to undergo the open-air treatment is that they continue to follow it out on their return home. It is thus a valuable means of education. Measles. This complaint invariably becomes epidemic every two years. The following are the deaths from Measles during the last 10 years:— 1894 15 1900 16 1895 6 1901 — 1896 24 1902 32 1897 2 1903 — 1898 6 1904 15 1899 — We have reasons to believe that the poorer class are getting to understand the dangerous complications of measles. The school-card system enables us now to visit the homes and give instruction and leaflets. This must bear fruit in time. Owing to the prevalence of the disease it was necessary to close the following schools:— Priory (Infants) 4th March to 25th March. East Acton 25th March to 1st April. „ ,, 27th April to 20th May. d 34 Whooping Cough. This disease caused the deaths of nine young children, mostly from lung complications. The previous year we had 40 deaths. It would be a great help if we could get to hear of these cases of whooping cough when the children are first attacked, so that we can warn the mothers of the importance of taking proper care of the patients and not to look upon whooping cough as a trivial complaint. I have drawn up the following leaflet, which is freely circulated:— The urban District Council of Acton. Instructions to the Public as regards Whooping Cough. This disease is most fatal in young children. Out of every 100 deaths from Whooping Cough 96 occur in children below five years of age. A Child suffering from this Disease should be Isolated, and not brought in contact with any other children until the characteristic spasmodic cough or whoop has disappeared for at least a week. This may be six weeks or more from the commencement of the illness. The Disease is spread by the breath and sputa of the Patient. Whatever the child coughs up should be received on paper or rags and immediately burned. The Medical Officer of Health. Public Health Department, Gothic Vii.la, Mill Hill Grove, Acton, W. 35 Diseases Notified Amongst School Children. Cards as follows are supplied to the Secretary of the Education Committee to be filled up whenever a child is kept away from school for personal illness or illness of others in the house. Upon receiving these cards Miss Bulkeley Williams, our Health Visitor, calls at the house and obtains full particulars. Ward SCHOOL NOTIFICATION CARD. To Be Filled in By School Authorities. School Dept. Disease Name Age Sex Address Class Child Excluded Date For Personal Illness For Illness of others in House Teacher Attendance Officer. Date Ward HEALTH VISITOR'S OBSERVATIONS. Disease No. Dates of Visits Is disease being treated ? Dr. regularly attending. Date of Onset Date of Rash Isolated Is disinfection necessary ? Suspected Cause Sunday School Date of Disinfection Other schools by inmates School notified to prohibit School notified to re-admit (Signed) D 2 36 The following table refers to School Cards which have been received during the year and which the Health Visitor has visited:— Name of School. North Ward. East Ward. WestWard. Total. Priory 35 13 53 101 St. Mary's 9 2 9 20 Beaumont Park 1 23 5 29 South Acton — 8 32 40 Churchfield Hall 8 — 10 18 East Acton 46 36 — 82 Roman Catholic — 13 4 17 Rothschild Road — — — - Willesden Junction 54 — — 54 Totals 153 95 113 361 Table showing the diseases from which the above mentioned cases were suffering:— Disease. North Ward. East Ward. West Ward. Total. Discharge from Eai - - 6 6 Ringworm 9 8 32 49 Chicken-pox 80 16 22 118 Scarlet Fever 10 — — 10 Sore and Dirty Heads 1 4 1 6 Measles 30 40 26 96 Whooping Cough . - 3 — 3 Skin Disease 2 7 12 21 Miscellaneous 22 15 15 52 Totals 154 93 114 361 37 Visits were made by Miss Bulkeley Williams to the following diseases in addition to the necessary visits re School Cards:— Measles 216 Chicken-pox 6 Scarlet Fever 140 Phthisis 46 Diphtheria 25 Erysipelas 22 Enteric Fever 5 Puerperal Fever 6 T otal 466 Bacteriological Examinations. During the year there were 43 Bacteriological Examinations made for the presence of— Positive Results. Diphtheria Bacillus 10 4 Enteric (Widal's reaction) 0 0 Tubercle Bacillus 33 7 38 Cases of Infectious Disease Notified during the Year 1904. ]Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. At all Ages. At Ages—Years. North Ward. West Ward. East Ward. Under 1. 1 to 5. 5 10 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox 1 ... ... ... 1 ... ... ... ... 1 Cholera ... ... ... ... ... ... ... ... ... ... Diphtheria 32 2 9 16 1 4 ... 11 11 10 Membranous Croup 1 ... ... 1 ... ... ... ... 1 ... Erysipelas 24 1 ... 3 3 16 1 4 10 10 Scarlet Fever 129 2 27 81 ]3 6 ... 42 54 33 Typhus Fever ... ... ... ... ... ... ... ... ... ... Enteric Fever 8 ... 2 2 1 2 1 2 1 5 Relapsing Fever ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... Puerperal Fever 4 ... ... ... 1 3 ... ... 1 3 Plague ... ... ... ... ... ... ... ... ... ... Chicken-pox 262 22 113 116 8 3 ... 74 74 114 Totals 461 27 151 219 28 34 2 133 152 176 SECTION IV. ISOLATION HOSPITAL ACCOMMODATION. 41 SECTION IV. Isolation Hospital Accommodation. Ordinary Infectious Complaints. The Isolation Hospital is situated in the Northern part of the district at The Friars. It consists of an Administration Block, a male and female pavilion, with kitchen between, for Scarlet Fever, and a similar one for Enteric Fever. There is a third pavilion for Diphtheria and observation cases. There is also attached a small operating room. The number of beds (not including cots) is as follows :— Scarlet Fever. Enteric. Diphtheria. Observation Cases. 14 14 2 2 The Administration Block was formerly an old mansion, and contains several very large rooms, which in case of emergency could be fitted up as Enteric wards. There is also a building containing the Laundry, the Disinfector, Ambulance and Van Sheds, and the Mortuary. Small-pox. For Small-pox the Council have made arrangements at the Clare Hall Hospital, South Mimms, for 12 beds. Ambulance Arrangements. The Ambulance used for the removal of patients is brougham-shaped, and is kept at the Isolation Hospital, there are also two vans which are used for the removal and return of bedding after disinfection. 42 Methods of Disinfection. Rooms. After a case has been removed to Hospital or has recovered all the textile articles in the room are removed. The rooms and articles of furniture are then thoroughly sprayed with Formalin, fumigated with Formalin, and sealed up for at least 6 hours. Articles of Clothing, &e. The articles of clothing, &c., are all removed from the infected room to the disinfector at the Hospital, and are steam disinfected in a Washington Lyons' Disinfector, and after being thoroughly aired are returned. Transport of Articles. The means of transport of the infected and disinfected articles is by vans provided for the purpose, and which are kept at the Isolation Hospital, No. 1 Van, which is used for infected articles, being lined throughout with zinc. When returning articles after disinfection, the sheets, blankets, &c., and wearing apparel are carefully folded and returned in No. 2 Van, carefully packed in hampers. SECTION V. GENERAL SANITARY ADMINISTRATION. 45 SECTION V. General Sanitary Administration. Houses and Housing Accommodation. Part III. of the Housing of the Working Classes Act, 1890, has been adopted, but its provisions have never been put in force.. Personally, I do not think the Council could build houses to let at rents much less than is being charged by private owners, taking into consideration the present price of land, labour, and materials, and I should recommend the Council, in preference to building, to buy houses already built, and fit them up as may be necessary. This course is being adopted by many Local Authorities in and around London. Overcrowding. No doubt there is a good deal of overcrowding all over the District, but it is very difficult to detect cases, as we have no power of entry at night, and upon making inquiries in the daytime the particulars given by the occupiers are often very unreliable. The only solution of this is the putting into force of the byelaws relating to houses let in lodgings. Water Supply. The District is supplied with a constant supply of water from the Metropolitan Water Board, Acton being in the Grand Junction district. Sewers. In regard to the sewers in the district, a large number of sewers in the centre of the town convey soil drainage from the older houses, as well as surface water from the old and new houses, into the London sewers ; but in the newer streets two sewers are laid, one of which conveys soil drainage to the Council's sewage 46 works, while the other conveys storm water into the London sewers. These sewers are regularly flushed and inspected from time to time. New sewers were laid during the year as follows:— North of the High Street. South of the High Street. Total. Soil sewers for conveying soil 2,283 yards 1,115 yards 3,398 yards For conveying surface water 2,255 yards 1,115 yards 3,370 yards Sewage Disposal. The soil drainage of about 18,000 persons in the District of Acton is conveyed into the London system, and a payment is made to the London County Council in regard to such drainage. The soil sewage from the remainder of the District is conveyed by sewers to the sewage works belonging to the Council in Acton Vale. The larger portion of it is conveyed by the low-level sewers, and this has to be pumped and raised to the surface. The high-level sewer delivers its contents by gravitation. The sewage is passed into open septic tanks, which are covered with a thick, firm crust—so firm that workmen walk across it and work on it with impunity. The effluent from the septic tanks is distributed over continuous filters of large broken clinker, and the effluent is conveyed by a sewer to the river. In consequence of complaints being made in regard to sulphuretted hydrogen, which was given off during the process of filtration, the effluent from the septic tanks is treated with permanganate of potash, and a small quantity of permanganate is also added to the effluent from the filters. The Acton Council is at present promoting a Bill in Parliament in order to ensure that the soil drainage of the whole of the District shall be conveyed into the London sewers, while the storm water of the District is to be conveyed direct to the River Thames. 47 New Streets and Buildings. For the purpose of a thorough inspection of all new buildings and making up new roads, the District has been divided into two, the Uxbridge Road forming the division line. A building surveyor takes charge of each District, under the supervision of Mr. Ebbetts, the Council's engineer. The following new roads were made up and houses passed for occupation during the year:— North of the High Street. South of the High Street. Total. New roads made up 12 16 28 Number of houses passed for occupation during the year 238 257 495 House Refuse. The collection of house refuse, scavenging and cleansing of the streets, and watering is carried out under the supervision of the Council's engineer, and the following particulars have been supplied to me by Mr. Webb, cleansing superintendent:— Collection.—For the purposes of collection of house refuse the District is divided into two, the High Street being the dividing line. The collection is made weekly from house to house. Nine dust fillers and 13 horses and carts—7 Council's, 6 hired—are employed. There is also a motor and trailer, which is capable of removing about 5 tons each journey. Disposal.—All the refuse is still deposited on the vacant land in connection with the cemetery. 48 During the year 40,128 cubic yards of house refuse were deposited at this shoot. Some months ago I received complaints with regard to the nuisance from flies in certain portions of the northern district, and I reported on the best means of disinfecting the dust shoot, as there is no doubt that this shoot is a favourable breeding ground for these pests. I reported that I was of opinion that the method of disinfection would be the cause of another nuisance, so that the Council did not take any action in the matter. If householders would only burn all vegetable matter instead of putting it into the dustbin, this would do much to mitigate the nuisance from flies. In the summer time very few fires are lighted owing to the convenience of gas stoves, and there is no doubt that this is the reason that so much vegetable refuse is put into the dustbins. Scavenging and Cleansing. The District is also divided into two for the cleansing and scavenging of the streets. Eight sweepers are employed to the North of the High Street and 11 to the South. The men work in gangs of two and four. During the year 16,810 cubic yards of road-dust and slop were removed from the roads and street gulleys. Street Watering. The watering of the streets is done by the Council's own vans and men. During the summer months 16 vans are employed on this work, and 24,300 loads of water are spread over the streets in the District. I am very pleased with the manner in which all this work is carried out. 49 The Public Baths. These are a great boon to the neighbourhood. An important source of pollution of the water is the corridor which runs between the edge of the bath and the dressing boxes. Fully dressed persons walk in their dirty boots while bathers with their feet carry the dirt from the corridor into the bath. It must be evident that a large amount of street dirt is needlessly carried into the bath by the bathers. This source of pollution might be prevented in the following ways :—By a frequent washing of the corridors, and by insisting that every bather should remove his boots before entering the corridor. Slippers or sandals might be provided for use in the bath only. Some towns require in the second class bath, besides the above precautions, the bathers to wash themselves with soap and water before entering the swimming bath. This could be managed if two of the Lavatory Baths were given for the purpose and there were an attendant to see the instructions carried out. Mortuary Accommodation. The Public Mortuary is situated at the back of the Fire Station in High Street. It is a modern building, constructed in 1901, and contains three tables for viewing purposes and a Post-mortem room. It is fitted with all the latest improvements, structurally and as regards appliances. The walls of the whole of the interior are constructed of white glazed bricks. During the year 35 bodies were received into the Mortuary, i.e. :— 23 Males and 12 Females—total 36. Post-mortem Examinations were made in 22 cases. B 50 The following list gives the number received during each month— Males. Females. Post Mortems. January 4 1 5 February 2 - 1 March 3 2 3 April 3 1 4 May 1 1 - June 2 - 1 July 1 - - August 1 1 1 September 1 1 1 October 3 — 1 November 2 2 2 December - 4 3 Totals 23 13 22 Cemetery. The old Cemetery in Churchfield Road is now closed. The Council in the year 1893 bought land in the northern part of the District in Willesden Lane, which has been laid out and prepared as a Burial Ground, and is the only Cemetery now used in the District. It was opened in March, 1895. Sick Nursing. The District Nurses in connection with our Cottage Hospital have had under treatment 220 Patients and paid 7,090 visits, an average of 32 to each patient. Excellent work is done by these ladies, whose skill and sympathy are greatly appreciated. 51 Factories, Workshops, Laundries, Workplaces, and Homework. INSPECTIONS Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries.) 71 8 — Workshops (IncludingWorkshop Laundries) 362 45 — Workplaces 49 2 — Homeworkers' Premises 224 72 — Total 706 127 — 52 DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspectur. Nuisances under the Public Health Acts:—* Want of cleanliness 18 18 - - Want of ventilation 7 7 - - Overcrowding 4 4 — — Want of drainage of floors 31 31 — — Other nuisances 59 59 — — †Sanitary accommodation Insufficient — — — — unsuitable or defective 48 48 — — not separate for sexes 8 8 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 2 2 — — Failure as regard lists of outworkers (s. 107) 13 13 — — Giving out work to be done in premises which are unwholesome (s. 108) — — — — infected (s. 110) - - - - Allowing wearing apparel to be made in premises infected by scarlet fever or small-pox (s. 109) — — — — Other offences — — — — Total 190 190 — — * Including those specified in Sections 2, 3, 7, and 8 of the Factory Act as remediable under the Public Health Acts. t Section 22 of the Public Health Acts Amendment Act, 1890, has been adopted by the Council. Sufficiency and suitability of sanitary accommodation for persons employed in factories and workshops is the same standard as that provided under the Factory and Workshop Act, 1901. 53 OTHER MATTERS. Class. Number. Matters notified to H.M. Inspectors of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 22 Action taken in matters referred by H.M. Inspectors as remediable under the PublicHealth Acts, but not under the Factory Act (s. 5). Notified by H.M. Inspector 23 Reports (of action taken) sent to H. M. Inspectors 23 Other 9 Underground Bakehouses (s. 101):— In use during 1903 8 Certificates granted in 1903 18 in 1904 In use at the end of 1904 8 Homework:— Number of Lists of Outworkers* (s. 107):— Lists. Outworkers. Lists received 153 368 Addresses of outworkers forwarded to other authorities 9 received from other authorities 18 Homework in unwholesome or infected premises:— Wearing Apparel. Other. Notices prohibiting homework in unwholesome premises (s. 108) — — Cases of infectious disease notified in homeworkers' premises 2 2 Orders prohibiting homework in infected premises (s. 110) — — 54 Class. Number. Workshops on the Registers. 131) at the end of 1904:— Laundries 256 Bakehouses 26 Dressmakers 25 Others 49 Total number of workshops on Register 356 Acton Improvement Act. The Acton Improvement Act, which came into force in June last, deals with many important matters relating to infectious disease prevention, tuberculosis, common lodging-houses, slaughter-houses, and sanitary provisions. The following sections set forth the provisions as to Tuberculosis:— TUBERCULOSIS IN ANIMALS. Part IV. Section 31 provides a penalty of £ 10 against any person who knowingly sells or suffers to be sold within the district milk for human consumption from a cow suffering from tuberculosis of the udder. This is a new provision, but there is no doubt that the word " knowingly" will be the great obstacle in recovering any penalty under this section. Section 32 provides that any person who has become aware that any cow in his dairy from which milk 55 is used or sold for human consumption is suffering from tuberculosis of the udder and does not isolate such animal, shall be liable to a penalty of £5. This section is also new, and should prove very useful. Section 33 provides that any dairyman having a cow which he suspects or exhibits signs of tuberculosis shall inform the Medical Officer of Health and state his name and the address of the dairy where the cow is. Penalty for default 40s. This is also a very useful section, but there will be a difficulty of the various farmers supplying milk to Acton becoming aware of the provisions of the section. Section 34.—Under this section the Medical Officer of Health, or any person authorized by him in writing, may take samples of milk for examination, if the milk is intended for sale, produced, or sold within the district. The same powers may be exercised outside the district, but a justice's order must first be obtained in the district where it is proposed to take the sample. Under this section there is no penalty imposed upon any person refusing to allow a sample to be taken, neither has the sample to be divided as is required by the Food and Drugs Act. The object of this section is to permit of the milk of any cow being submitted to a bacteriological examination. Section 35. — (a) If milk from a dairy situate within the district is being sold or suffered to be sold or used within the district, the Medical Officer or any person provided with (and, if required, exhibiting) the authority in writing of the Medical Officer may, if accompanied by a properly qualified veterinary surgeon, at all reasonable hours enter the dairy and inspect the cows kept therein, and if the Medical Officer or such person has reason to suspect that any cow in the dairy is suffering from tuberculosis of the udder he may require the cow to be milked 56 in his presence, and may take samples of the milk, and the milk from any particular teat shall, if he so requires, be kept separate, and separate samples thereof be furnished. (b) If the Medical Officer is of opinion that tuberculosis is caused or is likely to be caused to persons residing in the district from consumption of the milk supplied from a dairy situate within the district or from any cow kept therein, he shall report thereon to the Council, and his report shall be accompanied by any report furnished to him by the veterinary surgeon, and the Council may thereupon serve on the dairyman notice to appear before them within such time (being not less than 24 hours), as may be specified in the notice, to show cause why an order should not be made requiring him not to supply milk from any such dairy within the district until the order has been withdrawn by the Council. (c) The same provisions apply as in (3) to dairies outside the district, but a justice's order must first be obtained from a justice having jurisdiction in the district in which the dairy is situated. (d) Every assistance must be given to the Medical Officer of Health or authorized person. Penalty for refusing such assistance or obstruction, £5. (e) If in their opinion the dairyman fails to show cause why such an order should not be made as aforesaid, the Council may make the said order, and shall forthwith serve notice of the facts on the County Council of any administrative county in which the dairy is situated and on the Local Government Board, and if the dairy is situated outside the district, on the Council of the borough or district in which it is situated. (f) The said order shall be forthwith withdrawn on the Council or their Medical Officer being satisfied that the milk supply has been changed, or that it is not likely to cause tuberculosis to persons residing in the district. (g) If any person, after such an order has been 57 made, supplies any milk within the district in contravention of the order, or sells it for consumption therein, he shall be liable to a penalty not exceeding £5, and if the offence continues, to a daily penalty not exceeding forty shillings. (h) A dairyman shall not be liable to an action for breach of contract if the breach be due to an order under this section. This section is an extension of section 4 of the Infectious Disease (Prevention) Act, 1890, so as to include tuberculosis. Section 36 allows the dairyman to appeal against an order made under the preceding section on refusal of the Council to withdraw the order to the Board of Agriculture, who shall appoint an officer to hear such appeal. The Board of Agriculture may require payment from the dairyman of any costs incurred by the appeal, and the Board may confirm, vary, or withdraw the order. Section 37.— If the dairyman shall not himself be in default in consequence of an order being made, or the refusal of the Council to its withdrawal, he may recover full compensation for any damage from the Council. The amount of compensation to be determined as provided by section 308 of the Public Health Act, 1875. Section 38 requires public notice to be given of this Part of this Act, and this has already been done according to the terms of the section. Section 39 provides for the recovery of penalties before a petty sessional court having jurisdiction in the place where the dairy is situated only. Section 40 provides for the testing of cows for discovering tuberculosis by tuberculin or other reasonable test, but this must not be applied unless the consent of the owner is obtained. All expenses incurred in the 58 execution of this part of the Act shall be charged to the general district rate. The attention of the Council must be drawn to the fact that the consent of the owner must be obtained before any test can be applied to any animal. Section 41.—Under this section power is given the Council to delegate its powers for the execution of this Part of the Act to a Committee. COMMON LODGING-HOUSES. Part VIII. Section 98 makes it compulsory on the proprietor of a common lodging-house to register the name of person in charge of the lodging-house when such proprietor is not residing on the premises, and such person must be approved by the Inspector of Nuisances, and must remain in the lodging-house at night between the hours of 9 p.m. and 6 a.m. It also provides that the keeper shall reside constantly on the premises. Penalty of 40s. for default. Section 99 requires every common lodging-house to be provided with sufficient and suitable sanitary conveniences, having regard to the number of lodgers, and with proper separate sanitary conveniences for persons of each sex, upon the report of the Inspector of Nuisances. Penalty for not providing same £20. Section 100 provides for an annual registration day for common lodging-houses and keepers. Applications for renewal to be sent in on or previous to the 15th day of May in every year, and the Council may refuse to register or re-register any person if not satisfied as to his character and fitness for the position. 59 Leave to appeal is also given within 14 days, and a penalty of £5 against any person carrying on a lodginghouse unregistered, or who has not renewed his registration for the current year. Section 101 requires notice to be given of the provision of this Part of the Act, which has already been done. SLAUGHTER-HOUSES. Part XI. Section 117. (1) At any time after the passing of this Act the Council may— (a) Acquire by agreement any premises within the district used for the purpose of slaughtering cattle (hereinafter referred to as a "slaughterhouse") and the interest or interests of any owner, lessee, and occupier of such premises. (b) Agree with the owner, lessee, and occupier of any slaughter-house for the abolition of slaughtering therein on such terms and conditions as may be arranged between the parties. (2) At any time after the expiration of three years from the passing of this Act and after the Council have provided adequate slaughter-houses in convenient positions (to the satisfaction of the Local Government Board), and alter the expiration of six calendar months from the date of publication by the Council in two local newspapers circulating in the district of notice to that effect, no person shall in the way of trade slaughter any cattle within the district except in slaughter-houses provided by the Council, but this shall not apply to the slaughtering on premises by the owner, lessee, or occupier thereof of any cattle belonging to him and not 60 slaughtered for the purpose of trade, or by a farmer or agricultural occupier on his own premises. If any person acts in contravention of this section he shall be liable for each offence to a penalty not exceeding £5. (3) The Council shall pay compensation to the owner, lessee, and occupier of every slaughter-house who may be injuriously affected by the exercise of the above powers, and the amount of such compensation shall, in case of difference, be settled as cases of disputed compensation are settled under the Lands Clauses Acts, and the provisions of those Acts shall apply accordingly. (4) The fees and charges to be demanded and received by the Council in respect of the use of any slaughter-house provided by them, or of any convenience connected therewith, shall be regulated by byelaws to be approved by the Local Government Board, and the Council may make byelaws accordingly, provided that the Council shall have power to charge for any slaughterhouse let at a weekly, monthly, or other rent such sum as may be agreed upon by the Council and the renters. (5) Nothing in this section shall interfere with the operation or effect of the Diseases of Animals Act, 1894, or of any order or licence of the Board of Agriculture and Fisheries made or granted thereunder. Section 118. It shall not be lawful to blow or inflate the carcase, or any part of the carcase, of any animal slaughtered within, or brought within, the district, and any person offending against this enactment or exposing or depositing for sale within the district a carcase blown or inflated, or any part thereof, shall be liable to a penalty not exceeding 20s. This section makes it illegal to inflate any carcase, and very properly, as the air which is blown in may be from a contaminated source. 61 INFECTIOUS DISEASE PREVENTION. Part III. As to the prevention of Infectious Disease provision is made with regard to infected books from Lending Libraries, infectious disease among dairymen and their servants, the inspection of school children, and the requiring of notification from the schools of children absent on account of infectious disease; also provision with regard to the manufacture and sale of ice cream, &c. SANITARY PROVISIONS. Part VII. These sections strengthen the general law with regard to drains and soil-pipes, the abolition of brick ash-pits, the cleansing of cisterns, provisions as to houses without a water supply, the amendment of Section 19 of the Public Health Acts Amendment Act 1890, defining the establishment of a new business, enlarging the definition of nuisances, the improper construction and repair of water-closets or drains, and various other important matters. Registered and Licensed Premises, &c. With regard to— Common Lodging-houses. Houses Let in Lodgings. Moveable Dwellings. Slaughter-houses. Cowsheds, Dairies, and Milkshops. Offensive Trades. Unsound Food. These are fully dealt with in the Report of the Chief Sanitary Inspector, which is appended herewith. SECTION VI. ADOPTIVE ACTS, BYELAWS, AND REGULATIONS IN FORCE IN THE DISTRICT. 65 SECTION VI. Adoptive Acts, Byelaws and Regulations in force in the District. The following Acts have been adopted :— Housing of the Working Classes Act, 1890, Part III. Infectious Disease (Prevention) Act, 1890. Public Health Acts Amendment Act, 1890, section 3. Public Libraries Act, 1892. Baths and Washhouses Acts, 1846-1882. Acton Improvement Act, 1904. Byelaws. The following Byelaws and Regulations are in force in the District:— As to Made under Act. Section. New Streets „ P. H. A., 1875 157 Do. „ P. H. A. A. A., 1890 23 Cemeteries „ Cemeteries Clauses Act, 1847 2 Cleansing of Footways „ P. H. A., 1875 44 Closing of Buildings „ P. H. A., 1875 157 Common Lodging-houses „ P. H. A., 1875 80 Drainage „ P. H. A., 1875 157 New Buildings „ P. H. A., 1875 157 Do. „ P. H. A. A. A., 1890 23 Houses Let in Lodgings „ P. H. A., 1875 90 Offensive Trades „ P. H. A., 1875 113 Public Pleasure Grounds „ P. H.A., 1875 164 Scavenging „ P. H.A., 1875 44 66 County Council Byelaws. The following are in force in the District:— As to Made by Tent Dwellers, &c. Middlesex County Council. Disturbance of Persons Assembled in Public Buildings Do. Indecent Bathing Do. Lights to Vehicles Do. Posting Bills without Permission Do. Street Music Do. Shooting Galleries, Roundabouts, &c. Do. Betting in Streets Do. Abusive and Profane Language Do. Disorderly Conduct and Noisy Animals Do. With regard to the Byelaws made by the Middlesex County Council, and which are in force in the District. These can only be put in execution by the Police and Middlesex County Council. As to Made under Act. Section. Slaughter-houses „ P. H. A., 1875 169 Removal of Snow, Filth, &c. „ P. H. A., 1875 44 Waterclosets „ P. H. A. A. A 1890 23 Paving of Yards „ P. H. A. A. A., 1890 23 Removal of House Refuse „ P. H. A. A. A., 1890 23 Commons „ Metropolitan Commons Supplemental Act, 1882 Employment of Children „ Employment of Children Act, 1903 1, 2, 4. 9 Cleanliness and Position of Water Cisterns „ Acton Improvement Act, 1904 80 Isolation Hospitals „ Action Improvement Act, 1904 19 SECTION VII. CHIEF SANITARY INSPECTOR'S REPORT. f 2 69 SECTION VII. Annual Report of the Chief Sanitary Inspector for the Year 1904. To Dr. G. A. Garry Simpson, Medical Officer of Health. Sir,—I herewith present my fifth annual statement, showing the particulars of the action taken in the suppression of nuisances, &c., and various improvements effected by this department during the year 1904. The amount of sanitary work which has been done through the medium of this department will be seen from the tables which I have compiled. The complaints received at the Health Department are of a very varied character, and are often amusing. For example:—A woman called at the office to ask me to have a mangy dog destroyed belonging to a neighbour, as it had given the disease to seven children living in an adjoining house. Another individual requested a letter from me approving of his action in moving out of a house before I had inspected it on account of the damp condition of the same. I found upon my visit that a water pipe had burst, saturating the ceiling. He informed me that he did not know it was necessary in such a case to turn off the water at the stopcock. One thing I have particularly noticed since I have been in Acton, and that is the absence of bass brooms in the houses of the industrial classes. Without hesitation, I can say that in 90 percent, of the houses such an article would not be found, and, in calling attention to the dirty state of the yards, &c., their excuse invariably is that they have no broom. One of the charities in Acton would be conferring a great benefit to the cause of sanitation by distributing good bass brooms amongst the poorer classes. 70 Another evil I find in their houses is unnecessary furniture, ornaments, and drapery. These are not kept clean, and are receptacles for dust and filth. It is a very common occurrence when passing along a dark, narrow passage to be flapped in the face by some dirty curtains, which have been artistically hung and draped to make the kitchen a little more private, or, as they tell you, to take off the length of the passage. Owners, I find, when served with a notice to abate a nuisance arising from damp walls, try to evade the remedy by covering up the dampness with matchboarding. This is a very old idea, and it is difficult to convince such persons that, although the matchboarding has been erected, the dampness still exists, and that the only permanent remedy is to insert a damp course beneath the lowest timbers, and sometimes a vertical damp course as well, according to the circumstances giving rise to the dampness. In July the Council sent me to Glasgow as a delegate to the Sanitary Conference, and the proceedings were most valuable and instructive. Two important inventions which were on view at the Exhibition I should like to bring to the Council's notice. The first is an arrangement for the cleaning of premises without dismantling. It is not altogether new, but there is no doubt it is the right method for house-cleaning, and should be brought to the notice of the public. By means of air in a high state of vacuum suction all articles are instantly freed from dust by passing a flat-shaped nozzle over the carpets, furniture, &c. The dust is drawn down a tube into a receptacle provided for the purpose outside the building. In the London area alone, during the year, 7,000 houses were thus cleaned and 63 tons of solid dust were removed. As is well known, dust assists in the production of a low state of health, especially among children, and the more general use of such a mode of house-cleaning should be welcomed by all. 71 The second invention was for the prevention of smoke from factory chimneys. The arrangement is very simple and cheap, and consists of tubes made of prepared clay, and fixed beyond the bridge of the boiler. These, soon after the fire is lighted, become white hot, like an incandescent gas mantle, and consume all smoke and incombusted gas which passes through them. From the experiments I witnessed it was most efficient, and if adopted by all manufacturers there is no doubt we should not hear so much about the pollution of the air. It is only to be hoped that such an arrangement will be able to be adopted for use in household grates. In the course of visiting slaughter-houses and butchers' shops, on one or two occasions I found meat showing slight evidences of tuberculosis. On drawing the owner's attention to the diseased parts they were at once destroyed. No prosecution for selling diseased meat has occurred during the year. The slaughtermen, I find, make it a practice to cut the pharyngeal glands from pigs whilst dressing the carcasses. These glands show very clearly the presence of tubercle in the pig, and by their being extracted it is impossible to seize the heads of those affected, or the whole carcase, as recommended by the Royal Commission, who advise that the presence of tubercle (in any degree) in pigs should involve the seizure of the whole carcase. So that one has to cut into and examine other glands, generally the inguinal glands. I communicated with the Local Government Board with regard to the cutting out of these glands, to which they replied that their Inspector, Dr. Buchanan, would make inquiries, and would communicate with me on the subject. It is impossible to impress too strongly upon butchers and slaughtermen that if the lungs, liver, kidneys, or lymphatic glands of a slaughtered animal show even 72 slight evidence of tubercle these parts should be destroyed, and also the neighbouring parts of the carcase, even if they appear healthy. Doubtless, it would be better to destroy the whole carcase, but owing to the widespread prevalence of tubercle, the question of compensation is a serious one; but there can be no question of the wisdom of destroying any portion of a carcase which presents to the naked eye traces, no matter how slight, of tuberculosis. Upon making an inspection of one of the principal cowsheds, I found a cow which appeared to me to be in a very advanced state of tuberculosis. The next day I drew your attention to my discovery, and you visited the premises and confirmed my opinion. I communicated with Dr. Young, the county medical officer of health, and arranged a meeting to inspect the animal, but upon our again visiting the cowshed the animal had been removed. The cowkeeper was questioned as to the whereabouts of the animal, but he denied that any animal had been removed, and pointed out another cow, which he said was the cow in question. You informed him that further investigations would be made, but within six hours he called upon you and apologised for his action, and admitted that the cow had the day before been sold to Messrs. Harrison and Barber for cats and dogs meat. The Acton Improvement Act, which received the Royal Assent on 24th June, contains many useful and beneficial clauses. Although Parliament did not grant all the Council asked for, the application of the sections it does contain will greatly assist us in making Acton the healthiest suburb around London. In many matters it is now not necessary to prove a nuisance or direct injury to health. The clauses dealing with tuberculosis in cows and milk are most important, and will be made use of should occasion arise. 73 I have to thank Mr. E. J. Gough, (assistant inspector) for his able assistance during the year. I can only speak in the highest terms of his abilities and his devotion to duty. Miss L. Bulkeley Williams (health visitor) has assisted me in many ways, and has brought to my notice things which I should not ordinarily have met with, and I beg to record my thanks to her. It was necessary during the year to make a change of typist, and in Miss Morton we have a most capable stenographer and typist. On behalf of the Department I beg to tender to you many thanks for your kind consideration. I am, dear Sir, obediently yours, Maurice W. Kinch. Public Health Department, Gothic Villa, Mill Hill Grove, Acton, W. 74 Number of Inspections, &c. Premises inspected 2,216 Re-inspections to premises where Nuisances were in course of abatement 3.981 Nuisances reported 3.7I5 „ abated 3.427 Letters written 638 „ received 1.525 Notices received from H. M. Factory Inspector 10 Library Books removed from Infected Houses and destroyed 9 Van Dwellings inspected 11 Visits paid to Infected Houses 461 Infectious Patients removed to Hospitals 55 Rooms fumigated 232 Bedding disinfected 35 tons 15 cwt. Closets disinfected after Enteric Fever Cases 8 The following Tabulated List gives particulars of the sanitary improvements effected during the year:— House drains taken up and reconstructed 49 „ repaired 32 ,, unstopped and cleansed 86 ,, provided with intercepting traps 142 „ manholes provided to 181 „ ventilated 20 „ manholes to, cleansed 20 ,, „ repaired 25 „ fresh-air inlets repaired 10 „ „ „ provided 180 Water-closets repaired 10 „ new provided 6 „ „ pans provided to 190 „ unstopped and cleansed 35 „ pan closets and containers replaced by efficient pans 3 ,, provided with new flushing cisterns 123 „ flushing cisterns repaired 64 „ flush, disconnected from drinking water cisterns 13 75 Waterclosets additional or separate, provided in Factories and Workshops 9 „ apartment, foul and dilapidated 23 Soil-pipes repaired 11 „ ventilated 19 „ increased ventilation provided 17 „ reconstructed 14 Want of stopper to interceptor 10 Ventilating shafts repaired 15 „ provided 82 Waste-pipes, sink waste-pipes disconnected from drain 57 „ „ stopped 5 „ bath and lavatory waste-pipes disconnected from drain 13 Sinks, new, provided 4 „ repaired 61 „ trapped with lead traps 28 Rainwater-pipes disconnected from drain 160 „ repaired 68 „ provided 17 Eaves guttering provided 25 „ repaired 64 Gully traps replaced with stoneware gullies 97 „ removed from improper situations 8 „ unstopped 9 „ provided 24 „ grids provided to 15 „ cement work around, repaired 38 Yards, paving repaired 102 „ paved and drained 70 „ cleansed 48 Dust-bins provided 293 Ashpits, foul and defective, remedied 54 Cisterns repaired and covered 33 „ cleansed 21 „ removed from improper position 4 Houses cleansed and whitewashed 364 76 Houses plastering of walls and ceilings repaired 94 „ dealt with under Housing Acts 24 Workshops cleansed and limewashed 26 „ roof repaired 11 Roofs of houses repaired 68 Floors of houses repaired or relaid 36 „ workshops repaired or relaid 32 „ stables repaired or relaid 9 Stables provided with drainage 3 „ „ ventilation 2 Coach-house floors repaired 10 „ ceilings 5 Dampness of house walls remedied 121 Air spaces under floors of houses ventilated 3 Accumulations of refuse removed 34 ,, manure removed 12 ,, water in cellars removed 6 „ in ditches 6 Manure receptacles provided 18 Animals, fowls, &c., nuisances from, abated 22 Urinals cleansed 18 Overcrowding, number of cases abated 10 Smoke nuisances, number of cases dealt with 1 Water supply provided to houses 4 Taps provided on main 6 Miscellaneous nuisances abated 53 Notices. One thousand one hundred and eighty-seven Preliminary Notices and 63 Statutory Notices have been served for the abatement of nuisances, and the necessary works asked for were carried out in nearly all cases, no Police Court proceedings being necessary. As I pointed out last year the very few Police Court proceedings and the number of Statutory Notices compared with the Preliminary ones show that the Statutory Notices are not asked for unless the owners 77 absolutely refuse to comply with what I consider a reasonable request, and necessary in the interests of public health. Drainage Examinations. The smoke test has been applied 173 times, and in addition 42 drains were opened up for examination after formal written complaints had been made and authority given for that purpose. The volatile or chemical test has also been applied to drains in numerous instances. Inspection of Meat and Other Foods. The various butchers' shops, greengrocers' shops, and other places where food is sold were frequently inspected during the year, but I did not find any cause for complaint. During the year the following were seized and taken before a Justice:— 1 box of oranges. 1 barrel of dog fish. 1 pad of skate. 1 barrel of apples. 28 breasts of mutton. ½ bushel of pears. 3½ dozen haddocks. Food and Drug's Acts. Samples under these Acts were taken by Mr. W. Tyler, the County Council Inspector. No returns were supplied to our Council as to the number of samples taken in the district and the result of the analysis. I have now been appointed to carry out this work, and I propose starting on 1st January, 1905. A detailed statement will be presented in the next Annual Report. Dairies, Cowsheds, and Milkshops. There are at present 68 dairies and milkshops and 3 cowkeepers on the Register. Every quarter I forward a Notice to the occupier of every dairy and cowshed 78 reminding him of his duty to have the premises limewashed, as required by the Regulations, 141 visits were paid to the dairies and milkshops, and 18 to the cowsheds, and they were found to be in good order, with the exception of one which was found to be getting into a bad state. I served a notice upon the owner to remedy the defects, and he has given the tenant notice to leave, and proposes putting up some houses on the site. Bakehouses. The number of bakehouses on the Register is 26, of which eight are underground. A circular letter is sent to the occupiers every six months reminding them of the time to limewash and cleanse, as prescribed by the Factory and Workshop Act, 1901. All these premises have been visited, 89 inspections having been made. Slaughter-houses. There are four registered slaughter-houses in the district, 48 visits were paid to these premises, and upon each occasion the byelaws were found to be complied with. Piggeries. With reference to the piggeries I have to report that they have been frequently inspected, but I have never received any complaints as to the smell from same. In Old Oak Lane, Nos. 1 to 4, I have persuaded the owner to make the tenants abolish keeping pigs in the back yards, so that we now only have three piggeries in Old Oak Lane. Common Lodging-houses. Only two common lodging-houses exist in the district. These have been regularly inspected, and on all occasions found to be in a satisfactory condition. 79 Smoke Abatement. All factory and works chimneys have been observed at frequent intervals. No proceedings have been taken against the owners for emitting black smoke so as to be a nuisance. I received complaints from the Coal Smoke Abatement Society during the year and immediately served Notices with reference to same. The observations kept by myself and assistant numbered 19. I have to record the valuable assistance in the suppression of smoke nuisances which I have received from the Inspector to the Coal Smoke Abatement Society. Printed by Knight & Co., La Belle Sauvage, E.C.—(6132-1905)