ACT 13 Urban District of Acton. Annual Report of the Medical Officer of Health for 1 9 0 5. Urban District of Acton. Annual Report of the Medical Officer of Health for 1 9 0 5. 2 Public Health and Isolation Hospital Committee. Mr. Councillor E. F. HUNT (Chairman). „ „ F. A. BALDWIN. „ „ W. EYDMANN, Jun. „ „ S. GOODHALL. „ „ S. F. HOLLOWAY. „ „ J. W. JARRATT, J.P. „ „ E. E. B. LANDON. „ „ G. PIKE. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the URBAN DISTRICT OF ACTON, For the Year 1905. Gothic Villa, Mill Hill Grove, March, 1906. To the Chairman and Members of the Acton District Council. Gentlemen, I have the honour to present the Council with a Report on the sanitary condition of the district, together with the vital and other statistics for the year 1905. The report has been so arranged as to comply, as far as possible, with the recommendations issued by the Local Government Board:— Every Medical Officer of Health, appointed under order of the Local Government Board, is required to make an annual report with regard to each sanitary district which is under his superintendence. This report is to be for the year ending 31st of December, and is to be made to the Council by whom he is appointed. The Medical Officer of Health himself should send a copy of it to the Local Government Board, and to the County Council within which his district may be situated. 4 The report should deal with the extent, distribution and causes of disease within the district; and should give an account of any noteworthy outbreaks of epidemic diseases during the year under review, stating the results of his investigations into their origin and propagation, and the steps taken by him, or on his advice, to check their spread. As these reports are for the information of the Local Government Board and of the County Council, as well as of the Council of the District, a statement of the local circumstances and a history of local sanitary questions, which may seem superfluous for the latter, may often be needed by the former bodies. The tabular statements of sickness and mortality in the district during the year, are appended on forms supplied for that purpose, and are the subject of comments in the rest of the report. These Tables are given at the end of the report; Table 5 appears in that form this year for the first time. One Table is supplied by the Home Office for the guidance and convenience of Medical Officers of Health in preparing that part of their Annual Report which relates to Factories, Workshops, Workplaces and Homework. Section 132 of the Factory and Workshops Act, 1901, requires that the Medical Officer of Health of every District Council shall, in his Annual Report to them, report specifically on the administration of this Act in Workshops and Workplaces ; and he shall send a copy of his Annual Report, or so much as deals with this subject to the Secretary of State. POPULATION. As population is the basis of all our vital statistics, it is of the greatest importance that we should arrive at a fairly correct estimate of it, if any reliance is to be placed on the mortality and other statistics. Our knowledge rests primarily on the Census returns which have been made regularly since 1801, and the numbers of the latest enumerations are utilized as a basis to calculate the probable increase or decrease in the population. 5 For statistical purposes, the estimated population at the end of the second quarter in each year is taken, and various methods have been devised by which an estimate is arrived at, but it is obvious that the correct figures can only be ascertained for the end of the first quarter of the actual year in which the Census was taken. If there had been neither emigration nor immigration, the exact population could be ascertained by calculating the natural increase or decrease in each year, i.e. the increase or the decrease would correspond to the number by which the births exceeded or fell short of the deaths. In Acton, emigration and immigration profoundly affect the population, and though no information is obtainable as to the extent of these factors, we are perfectly aware of their effect. Any estimate based upon the natural increase of the population would be entirely worthless. The method adopted by the Registrar General is based on the assumption that the population increases in geometrical progression, that the rate of increase which prevailed in the last completed intercensal period has since been maintained. Such an assumption is constantly being demonstrated to be unreliable by the results of the Census. The result may be vitiated by the introduction of factors which formerly were not in existence. Any abnormal development within the district is liable to upset any calculation based on such an assumption. In Acton, since 1901 the development of large industries and the revolution of the mode of transit, have rendered such a method of calculation almost valueless, and one is justified in discarding it. The nearest approach to a correct estimate will probably be attained by calculating the number of new houses erected and occupied since the Census, and allowing 6.2 persons for each house. This figure represents the average number of persons occupying each house at the Census, but there is reason to believe 6 that now the average number is slightly higher, owing to the character of the buildings erected. A large number of the houses recently built are let in tenements, and this fact accounts for the increase in the average number of occupiers per house from 5.9 in 1891 to 6.2 in 1901. At the Census of 1901, there were 6,086 inhabited houses in the district and the population was 37,744. There were besides, 454 uninhabited houses ; 95 of the latter were in occupation and 359 were not in occupation. The point should be emphasized that the above figures have been abstracted from Table 9 of the Census report, as some confusion has arisen, and a distinction was not made between Tables 9, 12 and 15 of the Report. The number of tenements together with the number of rooms to each tenement is given in Table 15, and there were 8,326 separate tenements in the parish at the Census. The figure 6,086 represents the number of separate dwelling houses, and if a house is let in flats, the building is reckoned as a single house, and each tenement is not taken separately. Between March 31st, 1901, and June 30th, 1905, 1,865 dwelling houses or shops have been erected, and 63 public buildings, such as schools, factories, offices, workshops, &c." On the latter date there would be in the district 158 public buildings and 8,320 dwelling houses ; 310 of the latter were vacant, leaving a total of 8,010 houses inhabited and in occupation. An average of 6.2 persons per house would give a population of 49,662. As there is reason to assume that the average number is now slightly over 6.2, for the purposes of this report, the population has been estimated at 50,000 inhabitants. Unless great changes in the industrial and social conditions of a district have recently taken place, the birth rate serves as a means of checking the estimated population. Though the birth rate has shown a tendency towards a steady and continuous decline, these stages have not been marked by sudden and abrupt changes, and if the deviation from the average birth rate 7 of the district he abnormal, there is always reason for suspecting a mistake in the estimated population. On Table i is given the birth rate since 1895, and based upon an estimate of 50,000, there is only a difference of 1 per 1000 between the rate of 1905 and the decennial average. BIRTHS. The number of births registered during the year was 1,527, 807 males and 720 females. This number corresponds to a birth rate of 30.5 per 1,000 inhabitants, which is 16 per cent. higher than that of 1904, and slightly below the average rate for the ten years 1895-1904. The above figures have been obtained by estimating the number of births as the rate per 1,000 of the population living at all ages. The result obtained by this method may be described as the crude birth rate. As a means of comparison with the birth rate of the district in former years, it is satisfactory, unless there are strong reasons to assume that the age constitution of the population has considerably changed. If the number of women living at child-bearing years differs in the districts compared, the above method would be useless as a basis of comparison. As a ratio of the births to the total population, the birth rate of Acton is higher than that of England and Wales, and even higher than it is in the 76 large towns. But if we calculate the ratio which the births registered bears to the women living between the ages of 15 and 45 years, the birth rate in this district is lower than it is throughout the kingdom. If we assume that the age and sex distribution has not altered since the Census, the births registered last year correspond to a rate of 108 per 1,000 women living between the ages of 15 and 45 years. 8 DEATHS. On Table I, instructions are given by the Local Government Board concerning the corrections necessary before arriving at the net number of deaths belonging to the district. The deaths of "non-residents" are to be subtracted from the total registered in the district, and the deaths of "residents" registered in public institutions beyond the district are to be added. By the term "non-resident" is meant persons brought into the district on account of sickness or infirmity and dying in public institutions here. By the term "residents" is meant persons who have been taken out of the district on account of sickness or infirmity and died in public institutions elsewhere. The "public institutions" to be taken into account for the purposes of the Local Government Board Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses, and lunatic asylums. Five hundred and thirty-seven deaths were registered in the district ; three of these were of persons belonging to other districts, but only one non-resident died in a public institution, leaving 536 as the total deaths belonging to, and registered in, the district. This figure would correspond to a death rate of 10.7 per 1,000 inhabitants. Hitherto, the deaths of "residents" registered in public institutions beyond the district have not been included, but last year the County Council made arrangements whereby a list of these deaths was obtained by the County Medical Officer of Health, who forwarded to the local Medical Officers of Health particulars of the deaths belonging to the respective districts. For Poor Law purposes, this parish is included in the Brentford Union, and 54 persons belonging to Acton died in the Workhouse Infirmary. 9 Owing to the proximity of Acton to the large London hospitals, a large number of residents are yearly treated in public institutions outside the district, and any deaths which may result have to be added. Altogether, 92 residents died outside the district, and these deaths were distributed as follows :— Isleworth Infirmary 54 West London Hospital 7 St. George's Hospital 5 Great Ormonde Street Children's Hospital 5 Wandsworth Asylum 5 St. Mary's Hospital 3 St. Thomas' Hospital 2 Mount Vernon Hospital 2 Guy's Hospital 1 University College Hospital 1 Brompton Hospital 1 Homaepathic Hospital 1 Cancer Hospital 1 Kensington Infirmary 1 Hackney Infirmary 1 Bethnal House Asylum 1 Colney Hatch Asylum 1 The total number of deaths belonging to the district is 628, which corresponds to a death rate of 12.5 per 1,000 inhabitants. There is another correction which is necessary before a comparison can be instituted between this district and neighbouring ones. When one considers to what extent a death rate is affected by the sex distribution, and, more especially, by the age constitution of a population, its small value for comparison with other towns will be appreciated. 10 Females, as a class, live longer than males, and a town with an undue proportion of women would show a lower death rate than a town with an undue proportion of men, although the former might not necessarily be a healthier district. The age constitution of the population affects the death rate in a more marked manner. The tendency to death is much greater among persons living at the extremes of life—among infants and old people—and the liability to die reaches its minimum among persons living between the ages of ten and fifteen years. In order to neutralise the errors in death rate arising from sex and age constitution, the Registrar General has devised a method by which they can be corrected. This method is based upon the death rate of each sex at different ages throughout England and Wales, and by this means series of factors are obtained bv which the recorded death rates of different towns can be multiplied, so as to make them comparable with that of England and Wales and with each other. The figures by which the recorded or crude death rate should be multiplied, in order to correct for variations of sex and age distribution, is called the factor for correction for the particular district ; and when the recorded death rate is multiplied by the factor for correction, the result is the corrected death rate for that district. The factor for correction for Acton is 1.04240, so that if the recorded death rate 12.5 be multiplied by this figure the corrected death rate is 13.1. In 1905, the death rate for the whole of England and Wales was 15.2 per 1,000; for the 76 large towns it was 15.7 per 1.000, and for the 141 smaller towns it was 14.4 per 1,000. Ward Distribution— It is desirable and important that the statistics should be subjected to as minute an analysis as possible, if we are to ascertain the results obtained, and in what direction progress has been made. It is by such means that the actual influence of 11 sanitation upon the public health can be measured. Unfortunately, it is somewhat difficult to ascertain the exact death rate of each ward. The previous address of persons who died in public institutions outside the district was not this year ascertained ; it is hoped that this defect will be remedied next year. Of the deaths registered within the district, 139 belonged to the North Ward, 184 to the East Ward, and 213 to the West Ward. Again, the population of each ward can only be approximately estimated. With the assistance of the Surveyor and Accountant, the population of each ward has been calculated as follows:— North Ward 15,000 East Ward 19,000 West Ward 16,000 The death rate of each ward based upon the estimate would be:— North Ward 9.3 per 1,000 East Ward 9.7 per 1,000 West Ward 13.3 per 1,000 These figures do not include the deaths of the residents in public institutions outside the district. ZYMOTIC DISEASES. Deaths 66. Death rate 1.3. The so-called Zymotic death rate includes deaths from seven Zymotic Diseases namely, Small Pox, Measles, Whooping Cough, Scarlet Fever, Diphtheria, Fever and Diarrhoea. In some quarters it still retains its popularity as an index of the seven diseases. An epidemic of Measles or Whooping Cough may affect the magnitude of the Zymotic death rate more profoundly than an excessive prevalence of Diphtheria, Enteric Fever or Diarrhoea, though the former diseases may be but little dependent on sanitary conditions. Moreover, some of the other preventable diseases, such as Phthisis and Puerperal Fever are not included. 12 To obviate any fallacious conclusions, the diseases are separately dealt with. SCARLET FEVER. One hundred and thirty-seven notifications were received and two deaths occurred. As may be inferred from a case fatality of l.5 per cent., most of the cases exhibited very mild symptoms. On one occasion 5 children were found attending school in the peeling stage of the disease. In other instances, when the history of a case was being investigated, other children were found in the same house who had suffered from the disease, but in so mild a form that no doctor was called in attendance. DIPHTHERIA AND MEMBRANOUS CROUP. Fifty-one cases of Diphtheria were notified, and 4 deaths were registered as caused by the disease. Ward Distribution— Thirty-one notifications were received from the North Ward, 10 from the East Ward, and 10 from the West Ward. There is a large increase in the North Ward, and this is entirely accounted for by an outbreak which occurred in the Willesden Junction district during the latter portion of the year. In recent years, the Northern portion of the district had been comparatively free of Diphtheria, and the disease was much more prevalent in the East and West Wards. The same course of events was observed during the earlier part of 1905. Up to the end of July, 20 cases were notified, and of these 10 were from the West Ward and 8 from the East Ward. Between August 1st and December 31st, 29 cases were reported, and 26 of these were from the North Ward—-19 living in the Willesden Junction district. 13 Age Incidence— Of the notifications, 18, or 38 per cent. of the total, were between the ages of 1 and 5 years; and 26, or 51 per cent., were between the ages of 5 and 15 years. On the other hand, 75 per cent. of the deaths occurred in children between the ages of 1 and 5 years. Between the ages of 1 and 5 years, the case fatality was 17 per cent., whilst between the ages of 5 and 15 years it only reached 4 per cent. The figures are too small upon which to base any general conclusions, except in so far as they coincide with those gleaned in other districts, and, to this extent, they serve to illustrate a few facts in connection with the disease. In the first place, the incidence of attack is different to the incidence of mortality. Diphtheria is more prevalent between the ages of 5 and 15 years, but more deaths occur between the ages of 1 and 5 years. Translated into other words, these figures mean, that the younger the child the less chance it has of recovery if attacked by the disease. If there be anything in the theory that school attendance is one of the most potent factors in the spread of Diphtheria, this phenomenon forms a strong argument against the encouragement of attendance at school of children between the ages of 3 and 5 years. Hospital Isolation— Thirty-nine cases were removed to the Isolation Hospital and 12 were nursed at their homes. The deaths were evenly distributed, 2 occurring in the Hospital and 2 occurring outside. Twenty-six cases from the North Ward were removed to the Hospital, 6 from the East Ward, and 7 from the West Ward. 14 Willesden Outbreak- To obviate the necessity of a further report, four cases which occurred in 1906 are included in this portion ; these are omitted from the preceding figures and also from the Tables for 1905. The first case in the Willesden neighbourhood was reported from Victoria Road on April 26th, but no others occurred until August 8th. Two cases were notified in August, but neither was a pupil in the Willesden School. Between September 8th and September 20th, ten cases were notified from Railway Cottages, eight of whom attended the Willesden School. On September 11th the School was closed for 3 weeks No fresh cases occurred between September 20th & October 18th; on the latter date two notifications were received. A month elapsed before another case was notified, but between November 18th and November 25th, four notifications were received ; and on December 23rd, a case was removed to Hospital from Railway Cottages, which case subsequently proved fatal. Between January 18th and February 2nd, 1906, four cases were notified from Railway Cottages, all of whom attended school. Altogether, 24 cases were notified from this neighbourhood, and 16 of the children attended the Willesden School. The cases occurred in 20 houses, three in one family, two each in two houses, and a single case in 17 houses. Eighteen cases were notified from Railway Cottages, four from Inverness Terrace, one from Victoria Road, and one from the Huts. 15 Five of the children were between the ages of 3 and 4 years, six between 4 and 5 years, three between 5 and 6 years, one between 7 and 8 years, three between 8 and 9 years, and six over 10 years. A report was presented to the Health Committee upon the condition of the school, and though certain improvements were suggested, it must not be inferred that school buildings in themselves have much (if any) influence upon the propagation of Diphtheria. Even where gross insanitary conditions exist, these only act as predisposing causes in the spread of infectious disease. Sewer gas, for instance, may cause an ulceration of the throat and thus make the individual more susceptible to contract Diphtheria; but the exciting cause must always be contact, either direct or indirect with somebody who is harbouring the germs. A person may be a carrier of the germs in his throat or or nose without exhibiting any clinical symptons of the disease ; or the symptons may be as mild, or even milder, than those of an ordinary sore throat. It is this peculiarity of Diphtheria which causes school attendance to be a factor in the spread of the disease. It will be observed that the cases occurred in groups, and the cessation of notifications followed the detection of a mild case, which was in attendance at school whilst suffering from the disease. When the cases from Railway Cottages were notified in September, an examination of other children suffering from a sore throat led to the discovery of Diphtheria in one of the pupils. In the circumstances, it was deemed wise as an additional precaution to close the school for 3 weeks. Similarly, when a notification was received in October, a child, in whose throat the Diphtheria baccili were found, was attending school. As previously stated, following this last case, freedom from the disease was experienced for a month; but on 16 November 18th two cases, and on November 22nd one case were notified. The source of infection could not be traced, until an examination of all suspicious cases of sore throat was undertaken, and a mild case of Diphtheria was again discovered. Almost similar circumstances were observed in January, 1906, and probably the same conditions obtained in December, but as the school was closed on the latter date for the Christmas Holidays, the children were not examined. It is unnecessary to dwell upon the numerous opportunites which children in school have of transferring an infection if present, from one to the other. It is more than probable that the act of coughing or sneezing or even talking, is sufficient to distribute into the atmosphere in the immediate vicinity any germs lurking in the throat or nose. To the sucking of pencils and other pastimes in which children occasionally indulge infection has been traced. Any of these conditions would be brought into operation, and it is not necessary to go further afield, although other paths along which infection is sometimes carried might be mentioned. The periods during which the district was free of the disease are not incapable of explanation. Only a very small percentage of the children was examined, and it is legitimate to assume that someone was acting as a carrier of the disease without exhibiting clinical symptoms. There is another factor which sometimes operates in the spread of Diphtheria. Convalescent children are sometimes discharged from Isolation Hospital in a state of infection, and cause what are termed "return cases." No instance of infection due to this cause was discovered in the Willesden district, but the following case illustrates the possibility of such a source. On February 25th, a child was removed from a house in Westminster to one of the Metropolitan Fever Hospitals, suffering from Scarlet Fever. She was transferred to a Convalescent Hospital and discharged on December 12th. On December 19th, her mother was removed 17 to the hospital, suffering from Diphtheria. Dr. Allan, the Medical Officer of Health for Westminster gave me the above particulars, and stated that the child was staying with some relatives at Acton. The case was traced, and an examination was made of the throat and nose. The result of the bacteriological examination proved the child to be suffering from Diphtheria on December 22nd. These instances are given to show the various paths along which the infection may be carried, and the fact that the outbreak was kept so well under control is due in a great measure to the cordial co-operation of the officials of the Education Committee. Special praise is due to Mr. Syers, the Head Master, and the other teachers for the vigilence and care which they exercised. MEASLES. Eour deaths were registered as due to Measles. Measles is not a scheduled disease under the Infectious Diseases Notification Act, 1889, but cases are kindly notified from the elementary schools by the teachers. Altogether 301 cases were reported, the largest number being from the West Ward. The two schools chiefly affected were the Priory and Central. The case fatality was very low, but this phenomenon is usually observed when an outbreak occurs during the warmer months of the year. In the first and last quarters the district was almost entirely free of the disease. WHOOPING COUGH. Ten children succumbed to this disease. Most of the deaths occurred during the first quarter of the year. One hundred and twenty-six cases were reported to the Sanitary Authority—11 from the North Ward, 72 from the East Ward, and 43 from the West Ward. 18 The notifications do not give a correct index of the distribution of the disease; the information is more promptly obtained from some schools than it is from the others. DIARRHCEAL DISEASES. The number of deaths from Diarrhoea was 40, which is equal to a rate of .8 per 1,000 living. Thirty-two of these deaths were of children under one year, which number is equal to a rate of 21 per 1,000 births. Seventeen deaths were registered as due to Enteritis or Gastro-enteritis. The average number of deaths from Diarrhcea alone, for the ten years 1895-1904, was over 51. This figure alone emphasises the drain of the diseases upon our resources, but it probably does not show to the full extent the amount of mischief wrought. In spite of the power of rapid recuperation which children possess, a large number of those who recover from the immediate effects of Diarrhoea are so debilitated that they succumb later to other diseases, such as Marasmus, Bronchitis. There was, in 1905, a considerable decrease in the number of deaths from diseases of the digestive organs ; and although it is too early to state definitely what effect the attention paid to the rearing of infants, one is justified in assuming that the instructions given by the Health Visitor have borne some fruit. The disease is essentially a symptom dependent on various causes, and the most severe forms occur during the summer heat. It is rarely seen out of large towns, and most observers regard it as a contagious Zymotic disease, though the specific germ has not with certainty been discovered. As far back as 1887, Dr. Ballard included it among the principal Zymotic diseases, and, recently, some observers have claimed the Bacillus of Shiga as the organism that gives rise to the specific symptom. Milk is probably the chief medium by which the germs are carried into the body, and the ignorance of mothers 19 in the proper management of children and their feeding is a most important factor in the causation of the disease. Very frequently the parent believes that a bottle of medicine is sufficient to cure the symptoms, and is quite oblivious of the fact that one of the factors in the illness is improper feeding, and until that is remedied the disease will persist. Even with care, the difficulty of keeping milk sweet in a warm dry summer is considerable. Dust and various other things laden with germs are liable to be deposited in the milk. Although it may seem unnatural to rejoice in a moist summer, there can be no doubt as to the beneficial influence of an excessive rainfall. The total amount of yearly rainfall bears no direct relation to the mortality ; the prevalence of the disease is more closely related to the number of rainy days in July, August and September. In this respect, last year, on the whole, was a favourable one. TUBERCULAR DISEASES. Deaths 74. Rate 1.5 per 1,000. Forty-three deaths were due to Phthisis or Consumption, this number being equal to a rate of .86 per 1,000 inhabitants. Thirty-one deaths were due to other Tubercular Diseases. In June, 1902, arrangements were made for the voluntary notification of Consumption, the sum of 2s. 6d. being paid for each case notified. The result has been unsatisfactory, and five notifications only were received during the year. Even partial information is of some value, and it is hoped that in time the public will appreciate the fact that it is a preventable disease, and that the medical practitioner will not be subjected to odium when he notifies. On the receipt of a notification, inquiries were made and instructions given as to the management of the infective material, &c. The Council also recognised that, as in the early 20 stages the disease is curable, arrangements should be made for the treatment of the patients at a Sanatorium. In July, 1905, an agreement was entered into between the Council and the Managers of the Mount Vernon Sanatorium, whereby the Council contributes towards the maintenance of three beds. Five patients were admitted into the Sanatorium during the year. INFANTILE MORTALITY. The mode of calculating the Infantile Mortality demands a word of explanation. The method usually adopted, and followed here, is to calculate out the ratio of deaths of infants under one year to the actual number of births during the year under consideration. Under certain conditions, a more accurate plan would be to calculate the ratio of deaths in the current year to the number of births in the latter half of the preceding year and the former half of the current year. To work out the infantile mortality as the ratio of deaths under twelve months to the total number of deaths registered, would be misleading and unfair to those districts that have a high birth rate. There were 172 deaths of infants under one year of age— 162 deaths were registered in the district and 10 occurred in public institutions beyond the district. The 172 deaths correspond to an infantile mortality of 112 per 1,000 births. In 1905, the infantile mortality in England and Wales was 128 per 1,000; in the 76 large towns it was 140 per 1,000, and in the 141 smaller towns it was 132 per 1,000. With the exception of 1903, the infantile mortality of 1905 is the lowest recorded in the district, and it is 30 per cent. below the average rate for the ten years 1895-1904. The death rate has diminished most markedly in the later age periods. On Table 5 are given the deaths from stated causes, in weeks and months, under one year of age. An examination of that table 21 affords convincing proof that the term Infantile Mortality is not synonymous with Improper Feeding. There is no intention to minimise the important part which ignorance and carelessness in the feeding of infants play in producing a high death rate ; and it is a significant fact, that of the 30 deaths from Diarrhœal diseases which were inquired into, not one of the children was entirely breast fed; but it is getting more and more patent that a purer milk supply and a juster appreciation of the principles of infant feeding will not completely solve the question of Infantile Mortality. There has been an improvement between the ages of three and twelve months, but the death rate amongst children under three months has been stationary, or, if anything, it has advanced. The Chairman of the Health Committee recently called attention to this matter, and pointed out that one-third of the deaths of infants under one year of age occurred before the birth of the child was made known to the Sanitary Authority. It is true that, under existing conditions, the causes of some of these deaths are beyond the control of any Sanitary Authority. Thirty-three deaths were due to congenital causes; and until some means be devised whereby attention can be directed to the Hygiene of Pregnancy, this sacrifice of life will continue. Possibly, Acton is peculiarly situated in this respect. A large number of married females are employed in the local industries, and it is more than probable that work which necessitates standing, and continued far into pregnancy, does tend to produce an abnormal percentage of premature children. But, this aspect of female labour, after all, is only a symptom ; the cause lies deeper, and presents one of the most difficult of social problems. 22 INQUESTS. Thirty deaths were certified by the Coroner. A Coroner's jury, as a rule, consider death under two main aspects. They distinguish deaths by disease from deaths as the result of violence or negligence. Under the former head 13 deaths occurred. By far the largest number of deaths from violence was due to suicide. No fewer than 8 persons committed suicide during the year, which is exactly double the number for 1904. Two deaths from overlaying occurred ; and, as usual with this kind of accident, one occurred on a Saturday night and the other on a Sunday night. ISOLATION HOSPITAL. The Isolation Hospital is situated in Wales Farm Road, and was opened for the reception of patients on January 18th, 1905. The question of providing an Isolation Hospital had been discussed for years, and the first application to the Local Government Board in connection with it was on February 21st, 1901. The Council had negotiated with the Goldsmith Company for the purchase of the Friars Estates as a site for the Isolation Hospital. The price agreed on for the whole area was £13,400, and of this the sum allocated for the site of the Hospital was £5,000. On the estate was a dwelling-house, and this building was transformed and utilised as an administrative block. The inquiry by the Local Government Board was held on May 20th, 1901, but for some unaccountable reason the sanction was not obtained until January 17th, 1902. The application for the money to erect the Hospital buildings was made on June 2nd, 1902, the inquiry was held on November 6th, and the sanction obtained on December 24th, 1902. 23 The amount originally borrowed for this purpose was £9,900; but application for an additional sum of £3,350 was made on August 30th, 1903, and the sanction obtained on February 6th, 1904. The sum of £2,123 Is. was required for the Disinfecting Station, Mortuary, Electric Lighting, and the laying-out of the grounds, and sanction was obtained for this expenditure on November 23rd, 1904. During the year 1905, 142 patients were admitted. Eight deaths occurred, 124 were discharged, and 10 remained under treatment on January 1st, 1906. Diphtheria— Thirty-six cases of Diphtheria were treated at the Hospital, with 2 deaths. This corresponds to a fatality of 5.2 per cent., compared with 16.6 per cent. amongst the children treated at their own houses. Tracheotomy was performed in two instances, and one of the patients died. Thirty-four of the patients were treated with anti-toxin. Enteric Fever— Four cases of Enteric Fever were removed, with 3 deaths. Scarlet Fever— One hundred and two cases of Scarlet Fever were admitted, with 2 deaths. 24 Table 1. VITAL STATISTICS OF WHOLE DISTRICT DURING 1905, 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 belonging to the District. No. Rate* Under 1 Year of Age. At all Ages. No. Rate per 1,000 Births registered. No. Rale* No. Rate* 1 2 3 4 5 6 7 8 9 10 11 12 13 1895 29,236 874 30 147 168 445 15.2 33 478 16.3 1896 30,564 894 29.2 151 170 435 14.2 29 464 15.1 1897 31,952 973 30.4 193 198 470 14.7 33 503 15.8 1898 33,404 995 29.8 181 182 507 15.2 10 517 15.5 1899 34,901 1,068 30.6 200 187 509 14,6 1900 36,508 1,080 29.5 182 168 528 14.4 15 1901 38,373 1,211 31.5 206 170 519 13.5 6 1902 41,000 1,242 30.3 186 150 593 14.4 12 1903 43,802 1,422 32.4 150 105 430 9.8 8 1904 46,780 1,450 30. 207 143 576 12.3 9 Average for yrs.1895-1904. 366,529 1,1209 30.6 1,803 161 5,012 13.7 1905 50,000 1,527 30.5 162 106 537 10.7 27 1 92 628 12.5 * 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. 25 I. Institutions within the District receiving sick and infirm persons from outside the District. II. Institutions outside the District receiving sick and infirm persons from the District. III. Other Institutions, the deaths in which have been distributed among the several localities in the3 District. Cottage Hospital Isleworth Infirmary Wandsworth Asylum Mount Vernon Hospital West London Hospital St. Gdeorge's Hospital Great Ormonde Street Children's Hospital St. Mary's Hospital St. Mary's Hospital St. Thomas' Hospital Guy's Hospital University College Hospital Brompton Hospital Homœpathic Hospital Cancer Hospital Kensington Infirmary Hackney Infirmary Bethnal House Asylum Colney Hatch Asylum Table 2. VITAL STATISTICS OF SEPARATE LOCALITIES IN 1905. ACTON. Population estimated to middle of year 50,000 Births registered 1,527 Deaths at all ages 536 Deaths under 1 year 162 North Ward. Population estimated to middle of year 15,000 Deaths at all ages 139 Deaths under 1 year 27 East Ward. Population estimated to middle of year 19,000 Deaths at all ages 184 Deaths under 1 year 60 West Ward. Population estimated to middle of year 16,000 Deaths at all ages 213 Deaths under 1 year 75 26 Table 3. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1905. Notifiable Disease. Cases notified in whole District. Total Cases notified in each locality. Number of Cases removed to Hospital from each locality. At all Ages. At Ages—Years. North. East. West. North. East. West. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards Small-pox 1 1 1 1 Cholera Diphtheria 49 16 26 1 6 29 10 10 24 6 7 Membranous Croup 2 2 2 2 Erysipelas 28 1 3 1 20 3 10 14 4 Scarlet Fever 137 2 37 81 11 6 32 50 55 25 42 41 Typhus Fever Enteric Fever 12 1 5 6 4 6 2 3 2 Relapsing Fever Continued Fever Puerperal Fever 3 3 3 Plague Chicken Pox 177 22 64 83 8 38 64 75 Phthisis 5 2 3 1 1 3 Totals 414 25 119 195 28 44 3 117 148 149 52 51 50 27 Table 4. CAUSES OF, AND AGES AT, DEATH DURING YEAR 1905. Causes of Death. Deaths at the Subjoined Ages of "Residents," whether occurring in or beyond the District. Deaths at all Ages of "Residents " belonging to Localities, whether occurring in or beyond the District. Total Deaths whether of Residents or Non '' Residents" 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. East Ward. West Ward. Small-pox Measles 4 2 2 1 1 2 Scarlet Fever 2 1 1 2 2 Whooping Cough 10 6 3 1 2 1 3 Diphtheria and Membranous Croup 4 3 1 2 1 1 2 Croup Fever— Typhus Enteric 6 4 4 2 4 Other continued Epidemic Influenza 7 1 4 2 5 2 Cholera Plague Diarrhœa 40 32 7 1 6 10 21 Enteritis 17 11 2 2 2 5 7 5 Puerperal Fever 2 2 2 Erysipelas 2 2 Other Septic Diseases 2 2 Phthisis (Pulmonary Tuberculosis) 43 3 1 6 31 2 8 16 11 Other Tubercular Diseases 31 8 13 5 2 2 1 3 12 10 1 Cancer, Malignant Disease 35 27 8 11 9 7 2 Bronchitis 45 13 7 11 14 5 15 23 Pneumonia 68 21 19 1 2 15 10 11 24 27 2 Pleurisy ... Other Diseases of Respiratory Organs 7 1 1 2 3 2 3 Alcoholism—Cirrhosis of Liver 11 10 1 3 4 3 Venereal Diseases 1 1 1 Premature Birth 24 24 4 9 11 Diseases and Accidents of Parturition 4 4 2 2 Heart Diseases 48 2 3 4 20 19 14 10 16 1 Accidents 16 3 4 2 4 3 1 3 7 4 Suicides 8 8 4 1 3 All other Causes 191 47 9 5 5 54 71 50 52 54 9 All Causes 628 172 73 18 24 200 141 139 184 213 27 The deaths allocated to each Ward do not include those of "Residents" who died in outlying Institutions. 28 CAUSE OF DEATH. Under 1 week 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-2 months. 2-3 months. 3-4 months. 4-5 months. 5-6 months. 6-7 months. 7-8 months. 8-9 months. 9-10 months. 10-11 months. 11-12 months. Total Deaths under One Year. Table 5. INFANTILE MORTALITY DURING THE YEAR 1905. Deaths from stated Causes in Weeks and Months under One Year of Age. All Causes. Certified Uncertified 1 1 1 Common Infectious Diseases. Small-pox Chicken-pox Measles Scarlet Fever 1 1 Diphtheria: Croup Whooping Cough 1 1 1 1 2 6 Diarrhœal Diseases. Diarrhœa, all forms 8 2 2 5 4 2 2 1 3 1 2 32 Enteritis (not Tuberculous) 1 2 3 Gastritis, Gastrointestinal Catarrh 1 1 3 1 1 1 1 8 Wasting Diseases. Premature Birth 17 1 1 2 21 2 1 24 Congenital Defects 4 4 1 5 Injury at Birth 3 3 3 Want of Breast-milk Atrophy, Debility, Marasmus 3 1 1 3 8 3 3 1 15 Tuberculous Diseases. Tuberculous Meningitis 1 Tuberculous Peritonitis: Tabes Mesenterica 1 1 1 1 1 5 Other Tuberculous Diseases 1 1 Erysipelas Syphilis Rickets 1 1 1 Meningitis (not Tuberculous) 1 2 1 1 5 Convulsions 4 3 1 8 1 1 1 1 1 13 Bronchitis 1 1 2 3 2 1 3 1 13 Laryngitis 1 1 Pneumonia 4 3 4 1 1 3 1 21 Suffocation, overlaying 1 1 2 Other Causes 1 1 1 2 1 1 3 9 32 6 2 7 47 22 14 10 18 11 12 6 7 11 6 8 172 29 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. INSPECTIONS. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Factories (Including Factory Laundries.) Workshops (Including Workshop Laundries.) 117 9 Workplaces Homeworkers' Premises 154 7 Total 271 16 30 DEFECTS FOUND. Particulars. Number of Defects. Found. Remedied. Nuisances under the Public Health Acts:— Want of cleanliness 3 3 Want of ventilation 3 3 Overcrowding 1 1 Want of drainage of floors Other nuisances 25 25 Sanitary accommodation insufficient unsuitable or defective not separate for sexes 0ffences under the Factory and Workshop Act:— Allowing wearing apparel to be made in premises infected by scarlet fever or smallpox (s. 109). 2 2 Other offences 6 6 Total 40 40 31 OTHER MATTERS. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 5 Other 15 Underground Bakehouses (s. 101):— Certificates granted during the year In use at the end of the year 8 Number of Homework:— Lists. Outworkers. Lists of Outworkers (s. 107):— Lists received 164 348 Addresses of Outworkers forwarded to other Authorities 19 received from other Authorities 33 Workshops on the Register (s. 131) at the end of the year 375 Your obedient servant, D. J. THOMAS. March 31st, 1906. 32 SUMMARY OF VISITS PAID AND INQUIRIES MADE BY HEALTH VISITOR. Number of Visits re School Cards 762 „ „ Health Visits 306 „ „ Visits re Birth enquiries 347 „ „ „ Death enquiries 64 „ „ „ Scarlet Fever 189 „ „ „ Diphtheria 36 „ „ „ Enteric Fever 26 „ „ „ Chicken Pox 112 „ „ „ Phthisis 74 „ „ „ Erysipelas 25 „ „ „ Measles 13 „ „ „ Puerperal Fever 2 „ „ Workshops Inspected 117 „ „ Outworkers Premises Inspected 154 „ „ Miscellaneous Visits 161 Total 2,388 33 Annual Report of the Chief Sanitary Inspector for the Year 1905. To D. J. Thomas, Esq., m.r.c.s., D.P.H., Medical Officer of Health. SIR,—I herewith present my sixth 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 1905. NOTICES. Nine hundred and ninety-eight Preliminary Notices and 657 Statutory Notices have been served for the abatement of nuisances, and the necessary works asked for were carried out in nearly all cases; police-court proceedings only being necessary in six instances to enforce compliance. DRAINAGE EXAMINATIONS. The smoke test has been applied 36 times, and in addition 99 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 or prepared, were frequently inspected during the year, and in very few cases did I find any unsound food, or was it necessary for me to call the occupiers' attention to any insanitary conditions or want of cleanliness. On several occasions I found, upon cutting into the pharyngeal glands of pigs in the butchers' shops, that they were affected with Tuberculosis, and upon pointing this out to the butchers they readily surrendered the pigs' heads to me. 34 According to the recommendations of the Royal Commission, instructions are given to seize the whole of the carcase of pigs affected in any degree with tubercle, owing to the greater tendency to generalisation of the disease in pigs. I do not believe outside London this recommendation is strictly carried out, and unless evidence of the disease is found in other glands it is the practice to seize only the heads. This procedure I have adopted, and have not recommended any proceedings where the butcher has surrendered the part, and if satisfied that the butcher was unaware of the disease and that none of the glands had been cut into. Unfortunately, some butchers and slaughterers make it a practice to cut out the pharyngeal glands whether diseased or otherwise, thereby removing any trace of disease, so that it is preferable that the glands should not be touched by the butchers, but left for the Inspector to examine. Dr. Buchanan, one of the Medical Inspectors of the Local Government Board, is at present obtaining particulars with regard to this matter, and his report is anxiously awaited. I understand that a large percentage of pigs are affected with tubercle. This would mean a tremendous seizure of carcasses, without any compensation, and butchers would seek to remove the slightest evidences of the disease to avoid seizure, and the public would not be so well protected as under the present arrangement of seizing the affected part or parts. During the year, the following were seized or surrendered and taken before a Justice — 6 stone cod fish. 4 boxes tomatoes. 2 barrels apples. 1 trunk plaice. 1 trunk mixed fish. 1 trunk cat fish. 3 pigs' plucks. 1 case skate. 2 cases bananas. 6 pigs' heads. 1 carcase and offal of cow. 35 FOOD AND DRUGS ACTS. This was the first year in which the duties imposed by these Acts were carried out directly under the Council by me. Formerly the duties were executed by the County Council I nspector. During the year I procured— 81 samples of new milk, 1 sample of skimmed milk. 31 samples of butter. 5 samples of margarine. In four cases where milk was adulterated to a small extent, the Council did not take proceedings, but the Clerk wrote, warning the vendors that in future proceedings would be taken, and advising them to ascertain that the milk was up to standard before offering it for sale. In a number of cases, the Analysts' certificates certified that the milk was of very poor quality and probably adulterated, but unfortunately no action could be taken with regard to these samples. The following table gives the details of the prosecutions during the year :— DATE. OFFENCE. FINE. April 26th Milk deficient of fat 33% £ l and 16/6 costs. June 21 st Milk 14% deficient in fat Dismissed. Warranty set up. June 21st Milk adulterated, 12 parts added water £ 1 and 16/6 costs. Sept. 20th Milk deficient of fat 12% £1 and 22/- costs. Sept. 20th Milk deficient of fat 12% £1 and 22/- costs. Sept. 20th Adulteration of Butter, 27% of water 10/- and 20/- costs. 36 DAIRIES, COWSHEDS AND MILK SHOPS. There are at present 3 Cowsheds, 23 Dairies, 20 Milkshops, on the Register. I forwarded a notice to the occupier of every cowshed and every dairy reminding him of his duty to have the premises limewashed as required by the regulations. Thirty-six visits were paid to the cowsheds, and 132 visits to the dairies and milkshops, and they were found to be in good order and complying with the regulations, and it has not been necessary to serve a notice with regard to any of these premises. Notice was given in the local papers to all cowkeepers, dairymen and purveyors of milk, on the 24th November and 1st December, also on the 23rd November hand-bills were distributed throughout the District calling attention to the duty of such persons to be registered with the Council. BAKEHOUSES. The number of bakehouses on the register is 26, of which eight are cellar or underground bakehouses. 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 Acts, 1901, but in the majority of cases they are whitened and cleansed much oftener than is required by the Act. All these premises have been visited and inspected 190 times. SLAUGHTER HOUSES. There are four Registered Slaughter Houses in the District as follows:— Name. Situation. Date Established. Arthur Phillips 50, Hanbury Road 1863 James William Laws l10, Bollo Bridge Road 1865 Edward Dalton 7, Churchfield Road 1867 George Morris 8, Enfield Road 1871 37 Seventy-eight visits were paid to these premises. At three of the slaughter houses there was nothing to complain of at any time, but I cannot say this about the fourth one—constant supervision being necessary to keep the occupier up to the mark—as regards cleanliness, etc. On the 28th December, I made a report to the Council pointing out the difficulties I experience in carrying out a complete inspection of carcases in the slaughter houses, and herewith submit an abstract therefrom:— "Mr. Chairman and Gentlemen, I beg to report that during the past month I have been continuing a rigid inspection of meats and other foods as far as possible. I should like to take this opportunity of pointing out to the Committee the difficulties which prevent a proper control and a systematic inspection of the carcasses in our four registered slaughter houses. 1st.—As no particular hours are prescribed in the Bye-laws specifying the time when slaughtering may be carried on, it would be necessary for me to be on duty both night and day ; as in one of the slaughter houses, killing does not often begin until 10 p.m., and in the other, killing commences about 3 p.m. and continues until a very late hour at night. 2nd.—That in two instances slaughtering is carried on at various times on Sundays, which would necessitate me being on duty on this day as well as night and day on week days. Of course, there can be no proper control otherwise than in a Public Abattoir, but our inspection and supervision might be considerably facilitated if the Local Government Hoard would consent to a Bye-law for the following purpose, viz.:— " For prohibiting slaughtering in slaughter houses except between the hours of (say) 6 a.m. and 6 p.m." 38 In my opinion, these hours would be quite reasonable, and would allow ample time for the amount of slaughtering which is carried on in the district. I have made enquiries into the matter and have ascertained that the reason why slaughtering is done during the hours stated, is that in the day the men are engaged in some other work, and that in the evening the slaughtering is done as overtime or piece work. If such a Bye-law were granted, the Committee will see that it would be possible for me to carry out a proper inspection; and on Sundays the Assistant Inspectors could take their turns at inspecting the slaughter-houses, and if any carcase or organs were found to be diseased, they could be put on one side, I could be informed, and, if satisfied that the same were diseased, I could seize same and submit them to the Medical Officer of Health before obtaining a Magistrates' order for their condemnation, and in due course report the facts to the Committee. Unfortunately, the Council has no power with registered slaughter-houses with regard to prohibiting other persons than the person registered slaughtering therein, so that any registered owner can practically turn his slaughter-house into a public abattoir, and allow slaughtering at all times during day and night." PIGGERIES. With reference to the piggeries, I have to report that they have been frequently inspected. I have not received any complaints as to the smell from same. We only have three pig-keepers in the district, viz.:— Mr. Morris, Old Oak Lane. Mr. Bosher, Old Oak Lane. Mr. Baggs, Old Oak Lane. 39 Our present Bye-laws provide that no pigs shall be kept within 200-ft. of a dwelling-house, but nothing is mentioned as to the distance they shall be kept from the road. If there was a Rye-law stating the distance from the road it would be very useful, and help us to deal with the piggeries mentioned above, as they abut immediately on to a frequented road. OFFENSIVE TRADES. There are two offensive trades in the district (fat extractors), as follows:— Name. Situation Date Established. Arthur Phillips 50, Hanbury Road 1863 James William Laws 110, Bollo Bridge Road 1865 These premises have been frequently visited during the year. As you are aware, the buildings are very unsuitable for this kind of business, and steps are being taken to compel the occupiers to carry out certain works. COMMON LODGING HOUSES There are only two common lodging houses in the district. One is most up to date and has accommodation for 147 lodgers. Both premises have been regularly inspected, and on all occasions were found to be in a satisfactory condition. HOUSES LET IN LODGINGS. We have a lot of this class of house in the parish, and I am now devoting my attention to the compilation of a complete Register, with a view to putting into force the Council's Bye-laws dealing with such premises. 40 SMOKE ABATEMENT. All factory and works chimneys have been observed at frequent intervals, and several cautionary Notices served upon the owners for emitting black smoke in such quantities as to be a nuisance No Police-court proceedings, however, have been necessary. Many joint observations have been kept with the Inspector to the Coal Smoke Abatement Society, from which Society the Council receives co-operation in dealing with this class of nuisance. The following table gives the details of the cases taken before the Magistrates during the year:— Date. Offence. Fine. Sept. 20th Exposing for sale unwholesome bacon 30/- and 13/6 costs „ 20th Trading as milk purveyor without being registered £1 10s. and 12/6 costs ,, 20th Trading as milk purveyor without being registered £1 and 12/6 costs „ 20th Trading as milk purveyor without being registered £1 10s. and 9/6 costs Nov. 15th Defective wash-house floor Withdrawn on defendant paying 21/- costs „ 15th Sink waste pipe connected directly to drain. Defective w.c. 40/- and costs and order to abate within 14 days „ 15th Rain water pipe connected directly to soil pipe Order to abate and 21/costs „ 15th Slaughtering on unlicensed premises 20/- and costs „ 15th Slaughtering on unlicensed premises 20/- and costs Dec. 13th House without water supply £3 and £l costs „ 13th Depositing for the purpose of sale a tubercular cows carcase £5 and costs „ 13th Having deposited in his slaughter house the carcas of a tubercular cow £5 and costs „ 27th Non compliance with Magistrates order Daily penalty 1/- a day 16/- „ 27th House without water supply £1 and special costs For Food and Drugs prosecutions see Page 35. 41 NUMBER OF INSPECTIONS. &c. Complaints received 225 Premises inspected 1,587 Premises re-inspected 2,908 House to house inspection 557 Nuisances reported 3,091 Nuisances abated 2,477 Workshops inspected 124 Houses let in lodgings inspected 136 Furnished rooms inspected 97 Two Common Lodging Houses inspected 23 times Three Cowsheds inspected 36 „ Forty-three Dairies and Milk Shops inspected 132 „ Twenty-six Bakehouses inspected 190 „ Four Slaughter Houses inspected 78 „ Three Piggeries inspected 36 „ Two Offensive Trades inspected 36 „ Three Mews inspected 121 „ Schools inspected 7 Van Dwellings inspected 10 Visits paid to Infected Houses 237 Patients removed to Isolation Hospital 143 Rooms disinfected 289 Schools disinfected 87 rooms Bedding disinfected (estimated) 51 tons Closets disinfected after Enteric Fever 17 Library Books removed from Infected Houses and dealt with 32 Letters written 1,130 Letters received 1,348 Notices received from H.M. Inspector of Factories 8 Notices to Water Company re Waste of Water 37 The following Tabulated List gives particulars of the sanitary improvements effected during the year:— House Drains taken up and reconstructed 97 „ repaired 72 „ unstopped and cleansed 89 „ provided with intercepting Traps 95 „ Manholes provided to 128 „ ventilated 66 „ Manholes to, cleansed 48 42 House Drains, Manholes to, repaired 34 „ Fresh-air Inlets repaired 37 „ „ „ provided 124 Water-Closets repaired 57 „ new, provided 12 „ „ Pans provided to 185 „ unstopped and cleansed 68 „ Pan Closets and Containers replaced by efficient Pans 8 „ provided with new flushing Cisterns 29 „ flushing Cisterns repaired 122 „ flush, disconnected from drinking-water Cistern 21 „ additional or separate, provided in Factories and Workshops 6 „ Apartment, foul and dilapidated 23 Soil Pipes repaired 20 „ ventilated 16 „ increased ventilation provided to 21 „ reconstructed 15 Want of Stoppers to Interceptors 25 Ventilating Shafts repaired 16 „ provided 16 Wast Pipes, Sink, disconnected from Drain 32 „ repaired 36 „ stopped 14 „ Bath and Lavatory, disconnected from Drain 10 „ „ „ trapped with Lead Traps 12 Sinks, new, provided 28 „ repaired 30 „ trappad with Lead Traps 73 Rainwater Pipes disconnected from Drain 103 „ repaired 41 „ provided 10 Eaves Guttering provided 21 „ repaired 27 Gully Traps replaced with Stoneware Gullies 43 „ removed from improper situations 14 „ unstopped 38 „ provided 26 „ grids provided to 19 „ Cement Work around, repaired 30 Yards, paving repaired 158 „ paved and drained 20 „ cleansed 48 Dust Bins, provided 148 Ashpits, foul and defective, remedied 11 43 Cisterns repaired and covered 73 „ cleansed 24 „ removed from improper position 7 Houses cleansed and whitewashed 278 11 Plastering of Walls and Ceilings repaired 58 „ dealt with under Housing Acts Workshops cleansed and limewashed 19 „ Roofs repaired . 2 „ Ventilation improved 4 Roofs of Houses repaired 33 Floors of Houses repaired or relaid 69 „ Workshops repaired or relaid 23 „ Stables repaired or relaid 7 Stables provided with drainage 8 „ „ ventilation 6 Coach-House Floors repaired 5 „ Ceilings „ 2 Dampness of House Walls remedied 65 Air Spaces under Floors of Houses ventilated 10 Accumulations of Refuse removed 33 „ Manure removed 34 „ Water in Cellars removed 14 „ in Ditches 2 Manure Receptacles provided 25 Animals, Fowls, &c., nuisances from, abated 17 Urinals cleansed 4 Cesspools abolished 3 Overcrowding, number of Cases abated 10 Water supply provided to Houses 11 Taps provided on Main 14 Miscellaneous Nuisances abated 40 I am, Sir, yours obediently, Maurice W. Kinch, a.r.s.i., Chief Sanitary Inspector. Public Health Department, Gothic Villa, Mill Hill Grove, Acton, W. CONTENTS. MEDICAL OFFICER OF HEALTH'S REPORT. pages. Age Incidence 13 Births 7 Cases of Infectious Disease notified during the year 1905 26 Causes of, and Ages at, Death during the year 1905 27 Deaths 8 Diphtheria and Membranous Croup 12 Diarrhoeal Diseases 18 Diphtheria 23 Defects found 30 Enteric Fever 23 Factories. Workshops, Laundries, Workplaces and Homework 29 General Remarks 3 Hospital Isolation 13 Infantile Mortality 20 Inquests 22 Isolation Hospital 22 Infantile Mortality during the year 1905 28 Measles 17 Other Matters 31 Public Health and Isolation Hospital Committee 2 Population 4 Scarlet Fever 12 Scarlet Fever 23 Summary of Visits paid and Inquiries made by Health Visitor 32 Tubercular Diseases 19 Vital Statistics of Whole District during 1905, and previous years 24 Vital Statistics of Separate Localities in 1905 25 Ward Distribution 10 Willesden Outbreak 14 Whooping Cough 17 Zymotic Diseases 11-12 CHIEF SANITARY INSPECTOR'S REPORT. Bakehouses 36 Common Lodging Houses 39 Drainage Examinations 33 Dairies, Cowsheds and Milk Shops 30 Food and Drugs Acts 35 Houses Let in Lodgings 39 Inspection of Meat and other Foods 33 Notices 35 Number of Inspections, &c. 41 Offensive Trades 39 Prosecutions 35 Piggeries 38 Slaughter Houses 36 Smoke Abatement 40 Sanitary Improvements Effected during the year 41