ACT 15 Urban District of Acton. Annual Report OF THE Medical Officer of Health FOR 1907. ACT 15 Urban District of Acton. Annual Report OF THE Medical Officer of Health FOR 1907. Public Health and Isolation Hospital Commitee. Mr. Councillor E. F. HUNT (Chairman). „ „ H. S. SCHULTESS-YOUNG, M.A., J.P. „ „ E. MONSON, J.P. „ „ G. W. PAGE. „ „ H. L. STORY. „ „ J. F. SHILLAKER. „ „ C. PEAT. „ „ G. R. PARKINSON. 2 By the Order of the Local Government Board, dated March 23rd, 1891, article 18, section 14, it is prescribed that the Medical Officer of Health shall make an Annual Report to the Sanitary Authority, up to the end of December in each year, comprising a summary of the action taken, or which he has advised the Sanitary Authority to take, during the year, for preventing the spread of disease, and an account of the sanitary state of his district generally at the end of the year. The report shall also contain an account of the inquiries which he has made as to conditions injurious to health existing in the district, and of the proceedings in which he has taken part or advised under any Statute, so far as such proceedings relate to those conditions; and also an account of the supervision exercised by him, or on his advice, for sanitary purposes, over places and houses that the sanitary authority have power to regulate, with the nature and results of any proceedings which may have been so required and taken in respect of the same during the year. The report shall also record the action taken by him, or on his advice during the year, in regard to offensive trades, to dairies, cowsheds and milk shops. The report shall also contain tabular statements (on Forms to be supplied by us, or to the like effect) of the sickness and mortality within the district, classified according to diseases, ages and localities. In a memorandum issued by the Local Government Board in November, 1906, it is recommended that the report shall deal with the extent, distribution and causes of disease within the district; and should give an account of any noteworthy outbreak of epidemic diseases during the year under review, stating the result of investigations into their origin and propagation, and the steps taken to check their spread. As these reports are for the information of the Local Government, 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. Under section 132 of the Factory and Workshop Act, 1901, the Medical Officer of Health is also required in his Annual Report to report specifically on the administration of the Act in workshops and workplaces, and to send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State. ANNUAL REPORT of the Medical Officer of Health for the year 1907. 130 Churchfield Road, Acton, W. April, 1908. To the Chairman and Members 0/ the Acton District Council. Gentlemen, I have the honour to submit to the Council a report on the sanitary conditions of the district, together with the vital and other statistics for the year 1907. The death-rate was slightly higher in 1907 than in 1906. The increased mortality was entirely confined to the first quarter of the year, and was due to the large number of deaths from diseases of the lung. Some of these deaths were due to complications of Measles, an epidemic of which prevailed in the district during the earlier months of the year. The number of deaths under 12 months of age was one less than that of 1906. This cannot be considered satisfactory, in view of the favourable meteorological conditions which prevailed during the fourth quarter. There was an extensive outbreak of Scarlet Fever in the autumn, but the majority of the cases were mild in character. The incidence of Diphtheria and Enteric Fever remains very low. 4 In addition to the routine work of the Sanitary Department, at the request of the Local Government Board, a systematic inspection was made by the Inspectors of nearly 2,000 intercepting traps. The results of this inspection are embodied in the report. The year has been an exceptionally busy one for the Hospital staff, and 50 patients from outside districts were admitted. The following is a summary of the vital statistics for the year: Estimated population: 53,000. Birth-rate: 29 per 1,000 inhabitants. Death-rate: 13.9 per 1000 inhabitants. Infantile mortality: 130 per 1000 births. Zymotic Death-rate: 1.3 per 1000 inhabitants. Respiratory Death-rate (including Phthisis): 13 per 1,000 inhabitants. Phthisis Death-rate: 1.2 per 1.ooo inhabitants. Death-rate from other forms of Tuberculosis: 4 per 1000 inhabitants. POPULATION. Of the various methods of estimating the population of a district in any particular year, the most reliable in the case of Acton is based upon the number of new houses erected during the year. But even this method is liable to considerable error. The number of inhabitants in each house rose from 5.9 at the census of 1891 to 6.2 at the census of 1901. This increase was due to the fact that houses formerly occupied by one family were converted into flats. This process is still going on, and an average of 6.2 persons per house is probably below that which obtains at the present time. Between July 1st, 1906, and June 30th, 1907, 245 new buildings were completed and occupied. Of these 218 were dwelling houses, and distributed amongst the wards as follows:— 5 North-East 69 North-West 63 South-East 45 South-West 41 An average of 6.2 per house would represent 1,351 inhabitants, which, added to the estimated population of 1906, would give a population of 53,351. The figures in this report have been based upon an estimated population of 53,000. Seven years have now elapsed since the official census was made, and the further we are removed in time from that census until the next, the more inexact our estimates become, and the less reliable are all vital statistics. It is to be regretted that there is not undertaken by the Government a census every 5 years. There are other methods by which an estimate of the population can be made, but, as explained in previous reports, for Acton these are more unreliable than the one given above. The method adopted by the Registrar-General is based on the assumption that the rate of increase which prevailed in the last completed intercensal period has since been maintained. According to this method, the increase is geometrical, but how fallacious the results obtained by such means are, may be easily understood from the following figures. Between June, 1901, and June, 1905, the average yearly amount of dwelling houses erected exceeded 440, but between June, 1906, and June, 1907, the number was less than one-half. Ver recently the population has not been increasing to the same extent as it did immediately after the census. The results obtained by this method are vitiated by the introduction of factors which formerly were not in existence. In Acton, since 1901, the development of large industries and the introduction of the electric tramway, have rendered the Registrar-General's method of calculation almost valueless, and one is justified in discarding it. Another method is based upon the extent of the excess of the number of births over the number of deaths in any particular year. 6 The excess of births over deaths is known as the "natural increase" in the population, but the accuracy of this method obviously rests upon the absence of any marked difference between the immigration and emigration associated with the district concerned. In Acton, emigration and immigration profoundly affect the population, and any estimate based upon the natural increase of the population would be entirely worthless. It will thus be observed that after a certain period has elapsed since the census was taken all methods of estimating the population are liable to error. On the whole, for this district, the most reliable is the one based upon the number of houses built in each year. As a rule, the birth-rate serves as a means of checking the estimated population. Though the birth-rate is steadily declining throughout the kingdom, it rarely shows any sudden deviation from the normal. Based on an estimated population of 53,000, the birth-rate last year was 29 per 1,000 inhabitants. BIRTHS. There were 1,535 births registered as having occurred within the district. This number corresponds to a birth-rate of 29 per 1,000 ihabitants. Although the aggregate number of births exceeds that recorded in any previous year, the birth-rate last year was 4 per 1,000 inhabitants less than that of 1906, and 1.6 per 1,000 less than the average for the 10 years 1897—1906. On table I. the birth-rates for the last 10 years are given, and it will be seen that the rate for 1907 is the lowest recorded in that period. In spite of this fact; last year the birth-rate in Acton was 2.7 per 1,000 higher than that of England and Wales, 2 per 1,000 higher than that of the 76 large towns, and 3.3 per 1,000 higher than that of the 142 smaller towns. Usually, the number of male children born exceed the number of female ones, but last year the difference was very small—772 males and 763 females. 7 The second quarter contributed the largest number and the third quarter the smallest number of births, the number for the four successive quarters being 386, 420, 362 and 367 respectively. There was a great disparity in the birth-rate of the several wards. In the South-West Ward the rate reached 39.5 per 1,000, whilst in the North-West Ward it was only 18.5. In the North-East Ward the rate was 24.5, and in the South-East Ward 28.2. The infants registered as having been born out of wedlock numbered 37, which figures correspond to a rate of 24 per 1.000 births or .7 1,000 living. This is slightly lower than the illegitimate birth-rate of 1906, and considerably lower than that of the whole of England and Wales. DEATHS. Number 737 Rate per 1,000 13.9 Rate per 1,000 in England and Wales 15 Rate per 1,000 in 76 large towns 15.4 Rate per 1,000 in 142 smaller towns 14.5 There were 605 deaths registered as having taken place within the district; of these 8 were deaths of non-residents. 140 deaths of residents occurred in public institutions outside the district, and this number has to be added. The actual number of deaths, therefore, which has to be regarded in estimating the death-rate is 737. This gives a recorded death-rate of 13.9 per 1,000 inhabitants. It was explained in last year's report that in order to compare the death-rate of one district with that of another it is necessary to make an allowance for the difference in age and sex constitution of the different districts. The method by which this correction is made is based upon the death-rate of each sex at different ages throughout England and Wales. Series of factors are thus obtained by which the recorded death-rates of different towns can be multiplied. The figures by which the recorded death-rate should be multiplied in order to make a correction for variations of sex 8 and age distributions is called the factor for correction for the particular district; 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. There is an increased number of deaths of residents in outside institutions. The increase was most marked in the case of Isleworth Infirmary. The following list gives the names of the institutions, together with the number of deaths in each:— Isleworth Infirmary 82 West London Hospital 18 Middlesex County Asylum 10 St. Mary's Hospital 6 St. George's Hospital 4 St. Bartholomew's Hospital 2 University College Hospital 2 Great Ormond Street Hospital 2 St. Luke's House 2 Brompton Hospital 1 Royal Free Hospital 1 German Hospital 1 King's College Hospital 1 Chelsea Cancer Hospital 1 Paddington Children's Hospital 1 Victoria Children's Hospital 1 St. Pancras Workhouse 1 Hammersmith Infirmary 1 All Saints' House 1 Camberwell House Asylum 1 Marshall Aster's Works, Hammersmith 1 Ward Distribution. Of the 82 deaths that occurred in Isleworth Infirmary, it was impossible to trace the address from which 12 of the patients were removed into the Infirmary. These persons had been in the 9 house or Infirmary for many years. The remaining deaths were distributed as follows:— North-East. North-West. South-East. South-West. 153 105 120 347 Based upon the estimated population, the death-rate of each ward would be:— North-East. North-West. South-East. South-West. 11.3 9.1 10.9 20.4 The death-rate in the North-East and South-West Wards is higher than that of 1906; in the North-West Ward it is lower, and the rate in the South-East Ward is practically the same as that of 1906. In last year's report some of the factors operating towards a high death-rate in the South-West Ward were mentioned. Some of the causes are not dependent upon sanitary conditions. The death-rate of a population is profoundly affected by its age constitution. The tendency to death is greater among persons living at the extremes of life—among infants and old people. The birthrate in the South-West Ward is much higher than in the rest of the district. 44 per cent. of the births registered in the district occurred in the South West Ward. The age distribution of the population, though, is not sufficient to account for the marked difference in the death-rate of this Ward as compared with the rest of the districtNor is the cause a transient one, as a higher death-rate has to be recorded here year after year. We are reticent to recognise that the public health is affected by other causes than sanitary defects. Everyone knows that a defective soil pipe is dangerous. Its effects are immediate. For a similar reason the effects caused by overcrowding, exposure to infection, and unsound food are appreciated by all. But the part played by social conditions is not so readily admitted, either because the effect is more remote, or there may be an immediate as well as an ultimate cause. The diseases which were responsible for the high death-rate in the South-West Ward were Measles, Whooping Cough, Diarrhoeal Diseases, Bronchitis 10 and Pneumonia in children under 5 years of age, and Tubercular Diseases. In all of these social as well as sanitary conditions played a part. We know that in Consumption the immediate cause was exposure to infection by the Tubercle Bacillus, but in addition there was a predisposing cause in the shape of Heredity, Poverty, Intemperance, &c. Defective sanitary conditions were not the only factors in the high death-rate amongst children from the other diseases mentioned. Some of the deaths from diseases of the lungs were due to the exposure which some of the children have to undergo. The mothers go out to work and place their young children under the charge of persons who undertake this duty. On some days of the week the children are not taken home before 9 p.m. The conditions under which some of these children are cared for leave much to be desired. The rooms are badly ventilated, and the vitiated atmosphere undoubtedly tends to lower the resistance of the children to respiratory diseases. Age-Constitution. The ages at death were as follows:— Under 1 year. 1—5. 5—15. 15—25. 25—65. over 65. 200 94 38 28 217 160 Compared with 1906, the increased number of deaths is uniformly distributed over all the age-periods with the exception of that under 1 year of age. ZYMOTIC DISEASES. Deaths, 70. 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. 11 It will be observed that all the preventable diseases are not included in this list, and though the Zymotic death-rate is retained and regarded in some quarters with some degree of importance, it forms no index of the sanitary conditions of a district. As the incidence of each disease varies in its relative importance, most of them will be dealt with separately. SCARLET FEVER. 267 cases of Scarlet Fever were notified, and 6 deaths were caused by the disease. Although there was an increase of 97 in the number of cases notified, there were only 6 deaths in 1907, as compared with 7 in the previous year. It was this mildness of the symptoms in a large number of the cases which was one of the principal factors in the spread of the infection, and whenever a rise in the number of notifications occurred, a search usually resulted in the finding of a missed case. Instances of "missed" cases have been repeatedly brought to the notice of the Health Committee, and it is a significant fact that whenever a missed case was found attending school, the notification of cases from that school ceased on his exclusion. In this connection, too much value cannot be attached to the cooperation received from, and the great care exercised by, the teachers; without their assistance the detection of these mild cases would be impossible. Most authorities are agreed that the missed case plays the most important role in the spread of the infection. Other factors probably enter, and on one occasion last year suspicion was attached to the milk supply. It is only fair to add that no evidence whatever was forthcoming by which the milk could be reasonably condemned. The circumstances were so peculiar as to merit recital. During the fortnight ended October 12th, 26 cases were notified. Of these, 11 occurred in families supplied by one dairyman, and in 12 9 of them the onset occurred either on October Ist or 2nd (Tuesday and Wednesday). The dairyman resided outside the district, and on inquiries, it was found that in Hammersmith and Chiswick about 30 cases had occurred in families supplied by the same milk vendor. The onset of the symptoms in all these cases coincided in point of time with that of the 9 cases in Acton. An examination of the employees was made, but no illness resembling scarlet fever had occurred amongst them. Inquiries were then directed to the milk supply, and it was ascertained that the dairyman distributed about 500 gallons each week day and about 800 gallons on a Sunday. The 500 gallons were obtained from two farms, but the extra 300 gallons were obtained from a large distributing company in Paddington. The Medical Officer of Health for the district in which the two farms were situated was communicated with, but the milk supply from these two farms was free from suspicion. It will be observed, though, from the dates given above, that Sunday, September 29th, would be the most probable day on which the infection occurred, and on that day some of the milk was obtained from the distributing company. The latter company obtains its milk supply from a large number of farms. The milk was mixed, and inquiries had to be made at all the farms. These inquiries were made by the officials of the London County Council with negative results. As far as Acton was concerned, I believe that the milk had absolutely nothing to do with the infection, and that the high percentage of cases which occurred amongst the customers of this particular dairyman was a mere coincidence. Of the 9 cases whose onset of symptoms dated from October Ist or 2nd, 4 attended Southfield-road School, 3 attended Central School, and 2 were not of school age. On October IIth, a case was notified from The Avenue. The skin of the hands and body 13 was peeling, and the child had been suffering from the disease since September 20th. He had attended the Central School from September 28th to October nth. A pupil of Southfield Road School was notified as suffering from Scarlet Fever on September 30th. The child had been ill since September 15th, but the illness was not diagnosed until peeling had commenced. It is true that the patient had not attended school since September 13th, but two other children attended school, and mixed freely with the patient, and in view of the possibility of "carrier" cases of Scarlet Fever, this element could not be excluded as a possible factor in the spread of infection. The disease was distributed almost uniformly throughout the wards. 48 cases occurred in the North-East Ward, 37 in the North-West, 44 in the South-East and 107 in the South-West Ward. The School distribution was as follows:— Beaumont Park 40 South Acton 22 Central 22 Southfield Road 18 Priory 12 Roman Catholic II Rothschild Road 9 St. Mary's 6 Willesden Junction 2 Outside Schools 19 More than one-half of the cases occurred in the last quarter of the year. During the earlier part of the year the district was comparatively free of the disease, but following an increase which occurred in London towards the end of the summer, the notifications increased in number here at the beginning of October. The wave seemed to extend from East to West. The eastern districts of the Metropolis were the earliest ones to experience the increased prevalence, and a rise was noticed in these boroughs about the beginning 14 of August. The increase in Acton did not become abnormal until the first week in October, when the number of notifications increased from 4 in the week ended September 28th to 15 in the week ended October 5th. DIPHTHERIA. 63 Cases of Diphtheria were notified, and 5 deaths resulted from the disease. There is a slight increase both in the number of cases and deaths. The spread of Diphtheria seems to be more intimately connected with school attendance than that of the other infectious diseases. Out of 32 cases that occurred amongst children attending school, 22 of these were in 4 schools, and the history of a limited outbreak in Rothschild Road School will show how easily the disease can be spread. A notification was received on January 30th. The child lived in Kingswood Road and attended Rothschild Road School. The child had been ill since January 13th, and had attended school on January 14th—17th. The children attending the school were examined and a list of those absent on account of illness was obtained. I examined all the children unattended by a doctor and obtained the consent of the parents to swarb all suspicious throats. As a result 3 children were found suffering from the disease. ENTERIC FEVER. 13 Notifications were received, and 3 deaths were registered. In 2 of the cases the disease was contracted outside the district, and in one of these the patient had exhibited symptoms before he arrived in Acton. He was a steward on a steamship and left Southampton for New York on April 25th. He returned to Southampton on May 17th, and came here on a visit to friends on May 18th. He first exhibited symptoms of the disease on May 15th. 15 3 Other cases were proved to have been in contact with a previous case of Typhoid, and in all probability this was the source of the infection. In the 8 other cases the source of the infection was not definitely traced, but recent bacteriological research has thrown a new light on one of the ways hitherto little suspected whereby Typhoid Fever may be disseminated. Several instances have been recorded of outbreaks due to chronic typhoid carriers, and in one instance a typhoid carrier of 29 years' standing was discovered. The discovery of the chronic typhoid carrier and of the mischief which such a person may produce is certainly disquieting, particularly when we reflect that, though the bacillus probably persists in only a very small percentage of enteric fever cases, there must be a considerable number of these dangerous individuals whose condition is unknown, unsuspected, and not likely to be discovered. It is especially disconcerting to realise that some of these unknown carriers may be engaged in occupations which involve the constant handling of food. But however unpleasant this contingency may be, we cannot afford to close our eyes to its possibility; and it therefore seems desirable that special precautions should be taken when persons ascertained to have previously suffered from typhoid fever are employed in work of this nature. PUERPERAL FEVER. Only one case of Puerperal Fever was notified, and the illness resulted in death. ERYSIPELAS. 29 Cases were notified, but there was no fatal case. CANCER. There were 46 deaths from Cancer. 16 The Ward distribution- was as follows:— North-East 14 North-West 9 South-East 5 South-West 16 The previous addresses of two persons who died in Isleworth Infirmary were not ascertained. It is impossible to state accurately the relative prevalence of the disease in the different wards unless we know the age constitution of the population in each ward. The area and the figures are too limited to draw any conclusions, but it is a curious fact that the South-Eastern portion of the district year after year shows a lower death-rate from the disease than that of the rest of the district, inasmuch as it is generally held that cancer is more prevalent in low-lying districts. 13 Deaths were of males and 33 of females. Deducting 16 of the deaths in females, which were due to cancer of the reproductive and generative organs, the preponderance of females is not very marked. The seat of the disease was as follows:— Uterus 10 Breast 5 Stomach 8 Bowels 5 Liver 7 Throat and Neck 4 Panereas 2 Hip, Larynx, Kidney, Ovary, Cerebellum, 1 each. MEASLES AND WHOOPING COUHH. The only knowledge possessed of the cases of Measles and Whooping Cough is that derived from the school notification cards, and from the inquiries made upon the receipt of these cards. Measles. 17 There were 20 deaths from Measles as compared with 27 in 1906. The Ward distribution of the fatal cases was as follows North-East 2 North-West 6 South-East 4 South-West 8 The information we received as to the distribution of the disease is necessarily incomplete, but the fatality from the disease is no index of its distribution. The mortality is in a large degree determined by the social conditions of the population. Out of the 307 cases notified, 113 lived in the North-East Ward, 54 in the North-West, 83 in the South-East and 57 in the SouthWest. There is no doubt that the disease was least prevalent in the South-West Ward, and a glance at the schools affected will bear out this view. Central Infants was closed from Jan. 21st to Feb. 15th. Priory Infants was closed from Jan. 21st to Feb. 15th. South Acton Infants was closed from Jan. 28th to Feb. 22nd. St. Mary's Infants was closed from Mar. 4th to Mar. 28th. Beaumont Park Infants was closed from Mar. IIth to Mar. 28th. From inquiries made, it was found that the majority of the deaths occurred from lung complications, and many lives would doubtless be saved if all cases of Measles which were seriously ill could have skilled nursing. Under Section 21 of the Acton Improvement Act, 1904, the Council may provide or contract with any person or persons to provide nurses for attendance upon any person suffering from infectious disease within the district and may charge a reasonable sum for the service of any nurse so provided. It is probable that this section applies to Measles and Whooping Cough as well as the diseases scheduled in the Infectious Disease Notification Act, but in Acton it is difficult to suggest means by which 18 the provisions of the section can be effectually carried out. Epidemics of Measles are of an explosive character, and the difficulty is to cope with the work during an epidemic with the staff required in interepidemic periods. As far as possible, visits are being paid to the houses where a case is notified, and when necessary, instructions are given, but in many instances, these instructions could be usefully supplemented. There is no doubt but that the visits which are now being paid prove of great educational value. Parents appreciate to a greater extent than formerly the seriousness of the illness. Out of the 307 cases investigated, 191 were attended by a doctor. In last year's report the influence of school attendance, and the question of disinfection were entered into, and it is unnecessary to dwell on these matters. Whooping Cough. Apart from the tendency of both Measles and Whooping Cough to appear epidemically at certain periods, there seems to be some other connection between the diseases. It is commonly found that an outbreak of one of the diseases follows upon the subsidence of the other. The order in which they follow each other is not constant. Sometimes an outbreak of Measles occurs amongst children convalescent of Whooping cough but more frequently Whooping Cough follows Measles. Last year in Acton the usual course of events was noticed, and Whooping Cough made its appearance in the early part of the year in that part of the district which had suffered from Measles during the latter part of the previous year. Altogether 17 deaths were attributable to this disease, and of these 14 belonged to the South-West Ward. But of the 236 cases notified, 155 lived in the South-West Ward, 57 in the SouthEast, 13 in the North-East, and n in the North-West. 119 Cases, or slightly over 50 per cent., were attended by a doctor. 19 TUBERCULAR DISEASES. There were 66 deaths from Phthisis or Consumption, and 22 deaths from other tubercular diseases. The deaths from Phthisis were equally distributed between the two sexes, but of the deaths over 15 years of age 30 were of males and 28 of females. Prior to their attack of illness the 58 persons were employed as follows :— Males. Labourer 4 Traveller 3 Baker 2 Confectioner 2 Groom 2 Painter 2 Cattle Drover 2 Tailor 2 Teacher 1 Clerk 1 Laundryman 1 Plumber 1 Blacksmith 1 Barman 1 Portmanteau Maker 1 Brush Finisher 1 Porter 1 General Dealer 1 Carman 1 Females. Household 19 Laundress 4 Nurse 1 Shop Assistant 1 No Occupation 3 20 18 of the deaths from Consumption occurred at the Isleworth Infirmary, and of the many factors influencing the prevalence of tuberculosis, poverty stands out prominently above all others. Though it is a matter for dispute which elements of poverty are mainly operative, there is no doubt that poverty as a whole, with all that it comprises and implies acts as one of the most potent predisposing causes of the malady. The ward distribution of the deaths would also suggest this view. 33 of the deaths, or exactly one-half belonged to the South-West Ward. It is this aspect of the question which constitutes the chief difficulty in obtaining information Of early cases. Of the number investigated during the year, only 10 were considered likely to derive any permanent benefit from sanatorium treatment, and results proved that some of these were not suitable cases ; two died within a few months of their discharge from the sanatorium. In the report on Sanatoria presented to the Local Government Board, it is pointed out " that Germany seems to be in advance of this country in securing early cases for sanatorium treatment ; a circumstance due, no doubt, in no small degree to the farreaching system of compulsory insurance of work people against sickness and incapacity which is in force in the German Empire. By means of this system the workman, when attacked by tuberculosis, has a legal claim on insurance funds for medical treatment and maintenance in his own case, and for the support also of his own family. Thus it comes about that he can, without social disqualification, such as is associated with Poor Law relief or charity —without, that is, forfeiting in any degree, his sense of self-respectprocure at once at the very onset of his malady treatment requisite for himself, and at the same time maintenance of those belonging to him. Although residence at the sanitorium has not resulted in "curing" the disease of the persons sent there from Acton, the effects from an educational point of view have been considerable. The patients have learnt by what means the disease is spread and what 21 precautions should be taken to prevent the infection of those living in the same house. The example set by one patient is worth all the leaflets which can be distributed. Voluntary notification has been in force for 5 years, and last year 6 cases were notified. INFANTILE MORTALITY. 183 Deaths under 1 year of age were registered in the district. and 17 infants under 1 year of age died in public institutions beyond the district, making a total of 200. This latter figure corresponds to an infantile mortality of 130 per 1,000 births, or a deathrate of 3.8 per 1,000 inhabitants. In 1906 the infantile mortality in England and Wales was 118 in the 76 large towns it amounted to 127; and in the 142 smaller towns it was 122. The deaths were distributed as follows:— North-East Ward 31 North-West Ward 23 South-East Ward 32 South-West Ward 114 The infantile mortality in each ward would be:— North-East 94 per 1,000 births. North-West 108 per 1,000 births. South-East 100 per 1,000 births. South-West 170 per 1,000 births. At the January meeting of the Health Committee, I was requested to report upon the milk supply of the district in so far as it affects directly or indirectly the infantile mortality. Although the question resolves itself to a consideration of the conditions under which children are handfed, it is not advisable that our survey should be limited to this aspect alone, but should also include some of the factors which render hand-feeding inevitable. 22 This is essential for more than one reason. It must be clearly realised that human milk is not only the best food, but that no other milk can be made into a perfect food for infants. In infant feeding, nature is superior to art, and any artificial food should approximate as closely as possible to this ideal. The milk of any species of animal is a highly specialized product, specialized mechanically, chemically and physiologically to suit the digestive system, nutrition, rate of growth, and mode of life of the animals of that species, and it cannot with impunity be displaced by a foreign milk. The so called " humanized " milk, is not humanized in the true sense of the term. It is true that other milks can be modified so as to resemble in chemical composition human milk, but milk is not an inert liquid, depending for its nutritious qualities on the chemical substances it contains ; it is a living liquid with important biological properties. A discussion of these properties would introduce subjects of too technical a character for a report of this kind, but one aspect of the question may be mentioned. There is evidence that human milk contains substances derived from the mother, and that these substances carried by the milk into the infant's body protect it from the attacks of disease-producing bacteria. These facts are in accord with clinical experience. It is extremely rare for infants on the breast to suffer from Measles, Scarlet Fever, or any of the infectious diseases. These observations are made not for the purpose of discouraging any improvement in the conditions under which children are being artificially fed, but in order to show that extreme care is necessary lest an inducement be given to mothers to wean their offspring unnecessarily and prematurely. Premature weaning is a pathological process, and always a regrettable event. Nevertheless, it is often inevitable and Professor Bunge, of Basle, made an inquiry into this subject, and found that only 519 women out of 1,912 were capable of nursing their offspring for nine months. Inquiry into their family history showed that the daughter of a mother who could not nurse her own children is also commonly incapable 23 of suckling. If this function is once lost in a family, it is not likely to be regained in subsequent generations. Fortunately, the human organism is eminently capable of adapting itself to circumstances, and in spite of the above facts, in a majority of instances, healthy children can be brought up on the bottle. We have to consider what are the factors which compel artificial feeding, to what extent they can be obviated, and when artificial feeding becomes inevitable, can the conditions under which the artificial food is handled be improved. At the Census of 1901, there were 2,488 women employed in the laundries of the district. The number has considerably increased since then. There are at the present time 93 factory laundries registered, and 230 workshop laundries. In addition, about 300 women are employed as homeworkers. It is probably no exaggeration to state that 3,500 women are employed in the laundry industry alone, and of these about 1,500 are married women or widows. From inquiries made, it may be stated that one-third of the married women in the South-West Ward are employed in laundry work. In 1906, 724 births were registered in this ward, and in 1907, 671, so that in this ward alone there are over 200 children under one year of age who are, at any rate, +.o some extent, artifically fed, as a result of this one factor. These women are occupied in this employment, not from choice, but from necessity. But whatever may be the cause, whether it be physical or economic, we are face to face with this fact, that a large number of children are brought up, either wholly or partially on the bottle. For practical purposes, the only substitute for human milk is cow's milk, and we have to consider to what extent a cleaner and more pure supply of the latter can be brought within the reach of these children who are brought up on the bottle without at the same time offering an inducement to abandon suckling prematurely. 24 The question of contamination is by far the most important one we have to face when dealing with cow's milk. It is not the only difficulty in its bearing on the infantile mortality. It has been pointed out that cow's milk differs in its chemical composition from human milk. In the vast majority of cases, this difficulty is overcome by a suitable dilution, together with the addition of a little fat and sugar. But after all the modification the question of contamination remains. Human milk is sterile, and is transferred directly from the breast to the infant, but this is far from true of cow's milk. There is no other food so exposed to contamination, or so easily contaminated as milk. The contamination may start with the cow (through unhealthy or unclean udders) supplemented by the milker, and added to in the cowshed. Opportunities for further contamination occur in its transit. It is well known that warm transit means impure decomposing milk. The railway companies do not provide different vehicles for the summer from those used in the winter, and none provide refrigerating vans for milk in this country. 24 Samples were recently taken on delivery at Liverpool Street Station, and examined by Dr. Klein. 13 were found to be fairly clean, 2 were tuberculous, and 9 were dirty and unsatisfactory. To anyone acquainted with dairy farming as carried on in some parts of the country, these results are not surprising. The Dairies and Cowsheds Order is more honoured in the breach than in the observance by many rural authorities. Cattle and cowsheds, if inspected at all, are inspected in a very perfunctory manner. The cowsheds are far from sanitary, and the grooming of the cattle is seldom if ever done. Conditions have so changed in Acton that we have to depend for a large part of our supply on outside sources. 64 Persons are registered to sell milk in the district, and of these only 2 are eowkeepers. The others obtain their milk from sources of supply which are not under the supervision of the officials of our Council. 25 I have not dwelt upon the role of milk as a carrier of infectious disease, but it is well known that some of these diseases are carried by contaminated milk. Outbreaks of Typhoid Fever have been traced to infected milk; these outbreaks are usually due to the pollution of the water used for washing the cans. The germs of consumption are also generally supposed to be transmitted in milk. Outbreaks of Scarlet Fever, and Diphtheria, are said to have originated in a contaminated milk supply. But the influence of bacteria-laden milk on health is not fully understood nor definitely settled. It is possible that our list of milk-borne diseases is far from complete, and that fuller knowledge may add to the dangers we now know to exist in the present state of our milk supply But the possibility of contamination of the milk does not stop with its delivery in the district. Of the premises registered, 25 are dairies or shops selling dairy produce only and the other 37 are general shops, where milk is sold in addition to a variety of articles, including, in some instances, soap, firewood, and other things liable to create a dusty atmosphere. It is a difficult matter to keep the milk clean in these general shops, but there is no power conferred on local authorities to refuse the registration of unsuitable shops. Clause 6 of the Dairy Order of 1885 enacts that every local authority shall keep a correct register of all milk sellers and purveyors in their district, and they shall register every person who applies. Under the regulations, the Council has power to insist upon certain conditions of cleanliness to be observed. In most instances, the counter-pan is covered with muslin, but this only prevents the grosser forms of contamination To what extent can these be obviated, and how can the dangers attendant on them be avoided? On theoritical lines, our obvious duty would be to insist on regulations which would ensure the milk to be absolutely free from contamination, the cows healthy, the 26 udders groomed and milked by clean hands into sterile pails, and all the subsequent processes carried out with a rigid regard to cleanliness. This is, of course, the counsel of perfection, and probably these conditions will some day be accomplished facts, but in order to meet circumstances as they exist, various methods have been adopted by sanitary authorities and others. The question of sterilization and pasteurization has been much discussed of late, both in the medical and lay Press, and the ex perience of those who have tried these methods have been recorded. But the process, as carried out by sanitary authorities, means much more than the mere treatment of the milk. If nothing else be done to the milk but heating it, the same results could be obtained by the use of condensed milk. But the practice of using condensed milk should not be countenanced. It has been pointed out that one of the characteristics of human milk is its high percentage of fat. This fat serves as a fuel and maintains the body heat of the child, and if the percentage is reduced there is a liability of the child to catarrhs of the lungs and bowels. It is true of most of the condensed milks on the market, if the directions for dilution are carried out, there is a large deficit of fat in the prepared mixture. Drs. Park and Holt, of New York, found that children fed on condensed milk, though often apparently in good condition, when attacked with acute disease, offered but little resistence, and seemed to succumb more quickly than any other class of patients. Fuller knowledge will probably reveal further serious disadvantages of patent foods and condensed milk. Nor is condensed milk a "safe" food during the diarrhoea season. Although it may be sterile on opening, a tin usually lasts two or three days, and during that time it is open to contamination in the house. The avoidance of contamination in the house is one of the features of the schemes for the supply of sterilized milk. The milk may be sterilized by simply boiling it, that is, the milk may be raised to a temperature of 212 F° and kept at that temperature 27 for a few minutes. This process effectually kills all the germs in the milk, but it has certain disadvantages. It alters the taste and colour of the milk, it destroys the fine emulsification of the fat and probably makes the milk less digestible. A great deal has been written that boiled milk causes scurvy, but there is no positive evidence of this, and opinions seem to be very much divided on the question. In spite of the drawback, it certainly seems better to drink boiled milk under present conditions, even if it be slightly less digestible than raw milk. Efforts have been made to overcome the drawbacks of boiled milk by pasteurization. By pasteurization is meant the heating of the milk at 165° F for 20 or 30 minutes. It has been claimed for the process that it kills 997 out of every 1,000 germs in the milk. At any rate, it probably kills all the germs that produce specific disease, But pasteurization in practice does more, it necessitates a better method of delivering milk than that employed in most places, and avoids the danger of contamination in the house. Dr. Dufour set the example in 1894, at Fecamp, in France, and the " Goutte de Lait " may be regarded as the precursor and to some extent the prototype of the Infants' Milk Depots in this country. The first depot in this country was instituted in St. Helens, and the example has been followed by many other places, such as Liverpool, Battersea, Lambeth, Finsbury, &c., and one of the most recent ones was opened in 1906, at Woolwich. Most of these are under the control of the Sanitary Authority, but some are the results of philanthropic action. In principle, the system adopted by Mr. Nathan Straus, in New York, is very similar to that of the Infants' Milk Depots of this country. The milk is obtained from a farm where the cows are periodically examined. The cowsheds are frequently inspected, the cattle are groomed, and every precaution is taken that strict cleanliness is observed. The milk is strained and cooled immediately it is drawn from the cow. It will thus be seen that every care is 28 taken to safeguard the milk from pollution before it reaches the depot. It is true that the process of pasteurization destroys the bacteria in milk, but it is important that no poison is manufactured in the milk before its sterilization. The milk, after being cooled, is placed in sealed churns, and conveyed in these churns to the depot. The milk is prepared at the depot by mixing it with a suitable proportion of water, &c., for children under six months, but those over that age receive unmodified milk. After modification, the milk is bottled, and sterilized. The milk is distributed in bottles sufficiently large to contain enough food for one meal. The bottles are supplied in wire baskets, each basket holding from 6 to 9 bottles, and containing a twenty-four hours' supply. The next day the basket of empty bottles is returned, and a fresh supply obtained. Each bottle represents one meal, and is not to be opened until required for use, thereby preventing home contamination of milk by storage in an insanitary pantry or kitchen. Teats are provided for use with each bottle The charge is usually from 1/6 to 1/9 a week, according to the age of the child. In the Straus Milk Charity, two kinds of milk are supplied, pure pasteurized milk in 8 ounce bottles, and modified milk for infants. Dr. Straus endeavours to obtain milk as pure as possible, and it is certified by the New York Milk Commissioners and visited by the veterinarian of the New York Board of Health. It will thus be observed that whatever the agency is, the supply of pasteurized milk means much more than the simple heat of the milk. It involves the supervision of the supply. But in most instances, it goes further than this, and includes a supervision of the infants fed. For instance, in Battersea, care is taken to admit to the depot only those infants for whom satisfactory breast-feeding is impossible to obtain. Domiciliary visits are paid by Health Visitors, and in some places it is claimed that breast feeding has increased through the establishment of a milk depot. It is often true that many women 29 give up suckling and deliver up their babies to the bottle on the advice of ignorant friends and relatives, because the milk appears to disagree with the baby. What results have followed the establishment of these depots? Various figures have been given containing the mortality of depotfed children with the general infantile mortality of a district. This method is so beset with fallacies as to be almost useless. The first year of life is not one period, but a collection of age periods, and the mortality during the first week is higher than that of any subsequent week. The mortality falls gradually from the first day of birth to the eighth month. Naturally, very few children under one month would attend a depot, so that the comparative figures lose their value. There is no doubt, as to the value of these depots in this country, though the period of observation is too short to attach too much importance to the figures. In this connection, the New York figures are of interest. The Straus Milk Charity was established in 1892, and has since steadily increased its area of operation. The infantile mortality has been reduced from 96 per 1,000 to 55 in 1906. But it must be remembered that the Straus Milk Charity was not the only ameliorative influence which came into operation after 1892. But there is one method of comparison which is not vitiated by outside factors. In 1896, Mr. Straus installed in the Infant Asylum at Randall's Island, New York City a complete plant for the pasteurization of milk. The following figures give the death-rate per cent, in the years before and after the installation of the plant:— 1895 42 1896 39 1897 44 1898 19 1899 24 1900 27 1901 18 30 This appears to be a really valuable statistical result, and certainly justifies the expense which the reform of the milk supply entailed. Although feeding is only one of the factors in the mortality amongst infants, it is not one that can be ignored by sanitary authorities. It is, of course, not the only one, and other methods must be adopted, but if it be within the range of possibility, no method should be left untried. The establishment of a Day Nursery in South Acton may also be mentioned as one of the agencies which it is hoped will be instrumental in reducing the infantile mortality in the South-West Ward. Although the Council is precluded from supporting a Creche, the initiation of the movement is due to the advocacy of the Chairman of the Health Committee. As far back as 1904, Councillor Hunt read a paper at the Congress of the Royal Institute of Public Healthpointing out the conditions under which the children of women employed during the day are being cared for. It will be remembered also that a clause was proposed in the Acton Improvement Act empowering the Council to establish and maintain one or more creches. The Parliamentary Committee, though professing sympathy, refused the application. Philanthropic agencies took the matter up, and the Day Nursery was opened in J anuary, 1908. It is too soon to estimate the value of the institution, but it caused no surprise when it was known, that within a few weeks of its establishment, children had to be refused because all the cots and beds were occupied. The nursery can only accommodate about 24 children, but in the South-West Ward there are probably 200 babies under 12 months of age placed out with neighbours, &c.( during the day. The conditions under which most of these children are cared for in these houses are extremely unsatisfactory. The women who take in these children are often old, and the standard of cleanliness observed amongst them is below that of the average for South Acton. It will be observed that no less than 20 infants died from Bronchitis and 42 from Broncho-pneumonia. In the case of a large number of these, 31 the mothers went out to work, and there is reason to believe that the excessive mortality from disease of the lungs is partly due to the injurious effects of the stuffy rooms and the sudden changes of temperature to which the children are exposed. As usual the mortality amongst illegitimate children was excessive. Out of 37 children born out of wedlock, 17 died before reaching the age of 12 months. These figures represent an infantile mortality of 480 per 1,000 births. In 1906 the infantile mortality, amongst illegitimate children was 564 per 1,000 births, so that in the last two years not one illegitimate child in two survives twelve months. ISOLATION HOSPITAL. During the year 342 patients were admitted. On January xst 1907, there were 19 patients under treatment, and on January 1st, 1908, 48. During the year 301 patients were discharged, and there were 12 deaths. Diphtheria. 88 Cases of Diphtheria were admitted; 52 of these were from Acton and 36 from outside districts. There were 5 deaths from this disease ; four of these deaths were of Acton patients. Scarlet Fever. 246 Cases of Scarlet Fever were admitted—232 from Acton and 14 from outside districts. There were 6 deaths, 5 of Acton patients. The following were probably " return " cases :— 1. G.W. Notified on March 23rd, first taken ill on March 20th. The " infecting " case (aged 4 years) was admitted into Hospital on January 29th and discharged on March 12th. The " infecting " case had suffered from no complications whilst in Hospital, and on examination subsequently to her return home, nothing could be detected, which would give rise to a suspicion of the case being still infectious. 32 2. N W. Notified May 10th, ill since May 8th. The "infecting" case (aged 6 years) was admitted to Hospital on March 1st, and discharged on May 2nd. It will be observed that the "infecting" case was detained in the Hospital for 9 weeksIt was a very mild case, but the peeling was protracted. There were no complications, and his stay in the Hospital was prolonged owing to an operation which was performed on him prior to his admission. There could be no suspicion that any infected articles had been left behind in the house as the child was admitted from the Cottage Hospital, where he had been an inpatient for over a week. 3. W. V. Notified on November 28th, ill since November 26th. The "infecting" case (aged 5 years) was admitted on October nth, and discharged on November 21st. The child suffered no complications, but tonsils were enlarged. 4. (a) L. H. Notified December 5th, ill since November 30th. (b) E H. Notified December 5th, ill since December 4th. The "infecting" case (aged 7 years) was admitted to Hospital on October 27th, and discharged November 23rd. She had been ill for over a week before admission. She had no complications. and when discharged had finished peeling. Two days after she went home, she had a slight discharge from the ears. 5. E. R. Notified December 25th, ill on December 24th. J. R. Notified December 30th, ill on December 23rd. The " infecting " case (aged 8 years) was admitted to Hospital on October 31st. and discharged on December 18th. There are features in connection with these "return" cases which are of interest. We may divide the year into 3 periods. 1. From January 1st to May 5th—2 "infecting" and 2 " return " cases. 33 2. From May 5th to November 23rd—no " return " cases, 3. From November 23rd to December 31st—3 "infecting" and 5 " return " cases. In the First Period 45 Scarlet Fever patients were discharged. The average number of patients in the Hospital was 31.4, varying from 18.5 in the week ending January 5th to 51 in the week ending February 9th. The average number of Scarlet Fever patients in the Hospital was 17.6, varying from 13 in the weeks ending March 9th and January 5th, to 22 in the week ending April 20th In the Second Period 126 Scarlet Fever patients were discharged. The average number of patients in the Hospital was 37, varying from 17 in the week ending June 1st to 62 in the week ending November 16th. The average number of Scarlet Fever patients was 30, varying from 14 in the week ending June 1st to 61 in the week ending November 16th. In the Third Period * 45 Scarlet Fever patients were discharged. The average number of patients in the Hospital was 55, varying from 45 to 60. The average number of Scarlet Fever patients was 52, varying from 41 to 59. The age distribution of the cases was almost similar in the 3 periods, about 70 per cent of the patients being under 10 years of age. It will be observed that as far as the average number of all patients and the average number of scarlet fever patients are concerned, the second period stands between the first and third periods, but in one respect it differed from both. In the second period the patients were able to be out of doors throughout the latter part of their convalescence. It is possible that this had some effect on the freedom of the patients from infection at the 34 time of their discharge. Whenever possible, the patients are kept in a " clean " ward for about a week prior to their discharge, but occasionally it is not practicable to carry out this arrangement. Not one of the " infecting " cases was over 10 years of age, and it is extremely rare to find adults or very young children giving rise to " return" cases. Enteric Fever. 7 Cases were removed to Hospital, and one patient died. INQUESTS. 46 Inquests were held, the cause of death being:— Overlaying 5 Accidentally killed by railway engine 4 Accidental burns 3 Suicide 4 Accidental contact with live conductor 2 Accidental fall 3. Fracture of skull 1 Pistol shot wound 1 Want of attention at birth 1 Neglect of mother 1 Natural causes 21 MORTUARY, 39 bodies were removed to the Mortuary, and 25 postmortem examinations were made. OFFENSIVE TRADES. There are two offensive trades registered in the district, This is one less than there were in 1906. The business of fat-extraction which was formerly carried on in Osborne-road has been discontinued. It was pointed out that these premises were entirely unsuitable for the purpose it was used, and in addition, they were badly kept. 35 The other premises where fat extraction is carried on are situated in Hanbury-road. In this place also it was pointed out that the whole process was not carried out under cover, but every care is taken so as to reduce the nuisance to a minimum. Although a nuisance cannot be entirely obviated in the summer, the Council decided, in view of the precautions taken by the occupier, not to insist upon such alterations in the premises as would necessitate the whole of the process to be carried on under cover. The other offensive trade is that of the manufacture of a chemical fertilizer. The premises are situated on the canal bank near Willesden Junction. It was mentioned in the report of 1906 that owing to accidents to the machinery complaints had been received as to a nuisance, but in 1907, no source of complaint was observed. SEWAGE DISPOSAL. A description of the sewage works was given in the report of 1906, and it was stated that the works authorized in the Acton Sewage Act of 1905 were in hand. The work is not yet completed, but before the end of the summer, the whole of the sewage of the district will be emptied into the metropolitan sewers. SLAUGHTER HOUSES. There were 3 registered, and one licensed slaughter house in the district. One registered slaughter house was given up by the occupier during the year. DAIRIES AND COWSHEDS. There are two cowkeepers and 62 purveyors of milk on the register. COMMON LODGING HOUSES. There are two on the register, and both are licensed annually. 36 REFUSE DISPOSAL. The erection of a refuse destructor is in hand, but pending its completion, arrangements were made during the year with the Willesden and Acton Brick Company, whereby most of the refuse is burnt. The process has not been carried out entirely without a nuisance, but it is a vast improvement on the practice formerly in vogue of tipping the refuse on land near the cemetery. INTERCEPTING TRAPS. The following letter, dated March 5th, 1907, from the architect to the Local Government Board, was submitted to the meeting of the Health Committee held in March : "The Local Government Board have recently had occasion to order an investigation to be made of the use of modern intercepting traps, whether in combination or not with inspection chambers, such as are required to be provided in many places by building bye-laws. In the course of this investigation, which has been entrusted to Dr. Mair, of the Medical Department, Mr. Malet, of the Engineering Department, and me, a semi-metropolitan district has come under review, in which it has been shown that in a large number of instances a serious blocking of the house drain had taken place at the intercepting trap, and that, although this had usually resulted in a considerable accumulation of sewage, both in the drain and in the inspection chamber, no obstruction had been apparent to the occupier in the use of the drain. In these circumstances, it is obviously desirable that we should obtain further information for the Board from local authorities in whose districts similar drainage arrangements exist, with a view to seeing whether the use of intercepting traps is commonly found liable to lead to these results, and the board have, therefore, instructed us to invite assistance from your Council, amongst others, in the matter. 37 We would suggest that your Council should allow their officers to undertake, under the supervision of the Medical Officer of Health, the systematic inspection of as large a number as may be practicable of easily assessible insertion chambers at intercepting traps, in order to ascertain facts as to their condition, and that these fact should l>e recorded so as to show formarily:— 1. The number of traps examined. 2. The number of cases in which :— (a) the intercepting trap is blocked, (b) an accumulation of sewage in the chamber, (c) though no accumulation at present exists, appearance of the chamber shows that there has been accumulation, (d) the " cap " of the raking or cleansing arm is displaced. It might be useful also, if in a few selected cases of obstruction of the trap, steps were taken to ascertain the exact cause of the obstruction. It is important for the purpose of the present investigation to exclude from examination the traps of any drains which may be liable to backwatering of sewage from the sewer. Although it is not expected that the above inquiries should be made by your Council's officers in a very short time, especially as their value will largely depend on the total number of chambers examined, it is hoped that they may not take very long, since it would seem that they may be made in the course of ordinary inspectional work. We should also be glad if your Council's technical officers would submit any observations on the subject which their experience of it may suggest, and which they may desire to make. Will you kindly inform me whether your Council will be good enough to assist in the investigation in any way proposed? It will be understood that the use of any information supplied in response to this letter will not involve disclosure of the district to which it relates." 38 The Council accepted the suggestions made, and an examination of the intercepting traps was carried out, but a few remarks may be necessary in order to explain the conditions under which it was deemed advisable that the house drains should be intercepted from the sewer. In No. 65 of the bye-laws made by the Council with respect to new streets and buildings provides that every person who shall erect a new building shall provide, within the curtilage thereof, in every main drain or other drain of such building which may directly communicate with any sewer or other means of drainage into which such drain may lawfully empty, a suitable trap at a point as distant as may be practicable from such building and as near as may be practicable to the point at which such drain may be connected with such sewer, and with convenient means of access from the surface of the ground or paving under which it is placed. The primary object of the bye-law is the prevention of the escape of gas in the sewer into the house drains, but there is reason to believe that in the absence of an intercepting trap, specific bacteria can pass from the sewer into the air in the house drains. Major Horrocks carried out a series of experiments for the purpose of determining the conditions under which specific bacteria derived from Sewage may be present in the air of ventilation pipes, drains, inspection chambers and sewers, and his experiments showed that : (1) Specific bacteria present in sewage may be ejected into the air of ventilation pipes, inspection chambers, drains and sewers by (a) the bursting of bubbles at the surface of the sewage, (b) the separation of dried particles from the walls of pipes, chambers, and sewers, and probably by (c) the ejection of minute droplets from flowing sewage. (2) A disconnecting trap undoubtedly prevents the passage of bacteria, present in the air of a sewer, into the house drainage system. (3) An air inlet, even when provided with a mica valve may be a source of danger when it is placed at or about the ground level. 39 Dr. Butler has pointed out some of the objections to the trap, and he states that " probably the most universally objectionable feature of the siphon is that it prevents the efficient ventilation of the sewers. That the public sewers are inefficiently ventilated in those cases where their communication with the soil-pipe ventilators of the house drains is intercepted, is shown in many ways. It is a common experience with municipal officers that daily complaints are received, during the summer months, of the offensive smells proceeding from the openings of the sewers in the crown of the roadway, placed there originally with the intention of acting as fresh-air inlets to the sewers, and now in many districts being sealed off because they are found to act as vents for the foul gasses of an unventilated sewer." The other objections to the trap are its liability to obstruction and the difficulty of obtaining conditions under which it is selfcleansing. 1,725 interceptors were examined in Acton between the months of May and November, 1907, and of these 124 were found to be stopped. There were 30 other drains in which the manhole was foul, a condition which showed that a stoppage had previously occurred in the trap. Out of the 124, 58 of the stoppages were due to the cap of the raking arm having fallen on to the channel pipe. In addition to these, in 167 of the interceptors there was no cap to the raking arm ; either it had not been fitted on at the time the drain was constructed or it was subsequently removed. Whatever may have been the original cause, in 225 cases, or 13 per cent, of the drains examined, the interceptor, apart from other defects found, failed in its object, and the sewer air had access to the house drains. The result was that the untrapped opening which had been intended as the inlet ventilator of the house drain acted as the outlet ventilator of the sewer. It is true that a mica flap is usually fitted into the inlet pipe, but the flap gets out of repair frequently, and thus fails in its object. To such an extent is the inlet ventilator recognised as a source of nuisance that it is not an infrequent event to find the inlet pipe stopped by the tenants 40 of the house. The unstopping of the raking arm is not the only cause of the reversal of the air currents through the inlet pipe, but we are not now concerned with the other causes. There is no doubt as to the cause of the unstopping of the raking arm in the majority of these 225 cases. The raking arm was unstopped by the pressure of air in the sewer, and the cap falling into the mouth of the intercepting trap, caused an accumulation of sewage in the manhole. There are many types of traps now on the market in which a stoppage cannot take place from this cause. In addition to the 58 traps stopped by the cap of the raking arm, in 66 other instances the interceptors were obstructed, and an accumulation of sewage occurred in the inspection chamber. In the case of some of these, the obstruction was due to the actions of the occupiers of the house, but in the majority of instances it was due, either to an inherent defect in the trap, or to a faulty construction. But apart from an actual obstruction, the 6-inch intercepting traps were generally foul. In hardly a single instance did we find a self-cleansing 6-inch trap, and it is almost impossible for a 2 gallon or even a 2½ gallon flush to scour a 6 inch trap. Under present conditions, most of the 6 inch intercepting traps are miniature cesspools in the immediate vicinity of a house. They hold over a gallon of decomposing sewage. The number of traps inspected is admittedly small, but the results obtained are in accordance with the experience gained in the routine work of the district. It may also be mentioned that these defects are not peculiar to old property, but most of the drains inspected were those of houses erected within recent years, and may I think, be taken as a fair criterion of what obtains throughout the district. The results also coincide with those obtained in other districts where a systematic inspection of these traps has been carried out. For instance, in a neighbouring district 6,745 intercepting traps were inspected. Of these 288 were choked, and in 654 instances the cap of the raking arm had fallen into the inspection chamber. 41 The results cannot be deemed satisfactory. Out of the 1,725 inspected, in 291 there was either an escape of sewer gas into the house drains, or there was an accumulation of sewage in the inspection chamber. In addition, there were others in which the trap although not obstructed, yet was in such a state as to be a nuisance. In view of these facts it is no wonder that some authorities have advocated the total abolition of the intercepting traps. Undoubtedly, this would simplify the problem of sewer ventilation, and the unventilated condition of town sewers is universally recognised to be unsatisfac'ory, but in view of Major Horrocks' experiments, one should hesitate to advocate the abolition of the trap. Moreover, it is the experience of many householders that the presence of the trap is one of the best means against rats. One could name many premises in Acton which formerly were overrun by rats. The drainage system was overhauled ; the house drains were intercepted from the sewer, and the premises have since been immune from the plague of rats. Under present conditions, it would not be advisable or safe to abolish the trap, but further powers should be given to local authorities in the bye-laws. The systematic inspection made between May and November was obviously limited to intercepting traps in which the housedrains terminated in a manhole, but as a large majority of the intercepting traps in the district have inspection chambers in connection therewith, this limitation is not of consequence. Strictly speaking, the trap is simply the method by which the sewer air is kept out of the house drains, and as this is brought about by the interposition of water between the inlet and outlet of the trap, the only essential part is the " water seal." The cleansing arm and the inspection chamber are accessories to the trap, and are placed there for purposes other than those by means of which the house drains are intercepted from the sewer. Theoretically, all that is necessary is a simple siphon placed at the point of the house drain nearest to the sewer, but owners of property as well as sanitary authorities have found it advisable to have also 42 an inspection chamber and a cleansing arm. To be effectual the following requirements should therefore be fulfilled:— 1. There should be a sufficient water seal. 2. The trap should be self-cleansing. 3. The cap of the raking or cleansing arm should not be forced by the pressure of air in the sewer, and it should admit of easy removal should the trap become blocked. The first requirement is generally fulfilled. A water-seal of ¾inch is usually sufficient and most traps have a seal of an inch or over. It was stated in a previous paragraph that most of the 6 inch traps were not self-cleansing. There are very few houses in Acton where a 4 inch trap would not be ample, and if this is properly laid it can be made self-cleansing. Under existing conditions, the best type is that which has a 2 inch or 2½ inch cascade,but occasionally, the " fall " is not sufficient to allow of this arrangement. The opinion prevails among many people that a 4 inch trap is more liable to become blocked than a six inch one. If the drain is properly laid it is difficult to imagine why this should be so. Anything that will pass through a closet trap or through the grid of a yard trap will easily pass through a 4 inch intercepting trap. Moreover, in a trap which is not self-cleansing any solid article acts as a nucleus, and thus sets up an obstruction. The other objection to a 4 inch trap is the possibility of siphonage. Experimentally, it is quite easy to siphon a 4 inch trap, but in practice this must be a very rare occurrence, and if it did occur, the seal would only be broken until one of the contributory drains is used. Where an inspection chamber is provided, the cap of the raking arm should be able to resist any rise of pressure in the sewer, and at the same time admit of easy removal in case of obstruction at the trap. There are many types now on the market which fulfil these conditions, and local authorities should have the power to veto the use of an unsatisfactory type of trap. 13 FACTORIES AND WORKSHOPS ACT. 1901. Section 132 of this Act reads:— '* 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 of it as deals with this subject to the Secretary of State." In the case of factories, the duties of a District Council are few. The Council is charged with the duty of seeing that every factory in its district is provided with means of escape in case of fire. This duty is carried out by the Surveyor's department. The other duty in regard to factories is the enforcement of Section 22 of the Public Health Amendment Act, 1890. The inspection of factories comes within the province of H.M. Inspector of Factories. Where any sanitary defect is discovered by him in a factory, which is remediable under the law relating to public health, and not under the Factory and Workshop Act, he informs the Council of the defect, and it is the duty of the Council to arrange for the remedy of the defect. The Factory Inspector also notifies to the local authority any matter coming under his notice which should be attended to by the local authority. Nine such references from H.M. Inspector of Factories were received during the year, and the following conditions were found :— Excessive steam in wash-house 2 Workshop required limewashing 1 Premises in bad repair 1 Defective sanitary conveniences 4 Insufficient ventilation 1 44 LAUNDRIES. There are 93 factory laundries and 230 workshop laundries in the district. WORKSHOPS AND WORKPLACES. At the end of the year there were 372 workshops on the register. Of these 230 were laundries. This number is 48 less than 1906, but the decrease is only apparent. In the course of inspection, it was found that some of the workshop laundries had been converted into factories, and it will be observed that there are only 230 laundries classed as workshops in 1907, as compared with 288 in 1906. The results of the inspection will be found in the accompanying tables. BAKEHOUSES. There were 28 bakehouses in the district ; of these 8 are underground. HOMEWORK. 178 Lists of outworkers were received ; 124 of these were received from occupiers of workships in the district and 54 were received from other Councils. In 21 instances, the place of employment was in another district, and the names and addresses were forwarded to the Council in whose district the premises were situated. 5 Cases of Infectious Diseases occurred in houses where home work was done, and although no order under Section no of the Act was made, the employers did not send work to the house until the patient had been removed to Hospital, and the premises were disinfected. In conclusion. I may mention that the Chief Sanitary Inspector and both the Assistant Inspectors obtained the Meat Certificate of the Sanitary Institute during the year. 45 I regret to record the resignation of Miss Williams as Health Visitor, and her illness, together with the outbreak of Scarlet Fever in the autumn, handicapped the work of the Department, especially the inspection of workshops where female labour is employed. I remain, Your obedient servant, D. J. THOMAS. p Table 1. 40 VITAL STATISTICS OF WHOLE DISTRICT DURING 1907 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 District. Deaths of Residents registered in Public Institutions beyond 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. Rate * No. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1897 31,952 973 30.4 193 198 470 14.7 ... ... ... ... ... 1898 33,404 995 29.8 181 182 507 15.2 ... ... ... ... ... 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 ... ... ... ... 1905 50,000 1,527 30.5 162 106 537 10.7 27 1 92 628 12.5 1906 52,000 1,533 29.4 193 125 597 11.5 29 7 97 687 13.2 Average for yrs 1897-1906 408,720 12,501 30.6 1860 148 5266 12.9 ... ... ... ... ... 1907 53,000 1,535 29 183 119 605 11.4 25 8 140 737 13.9 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Total population at all ages at Census of 1901, 37,744. Number of inhabited houses at Census of 1901, 6,114. Average number of persons per house at Census of 1901, 6.1. Area of District in acres (exclusive of area covered by water) 2,304. Union Infirmary not in district. Outside Institutions, see body of report. 47 Table 2. VITAL STATISTICS OF SEPARATE LOCALITIES IN 1907 AND 1906. ACTON. 1906 1907 Population estimated to middle of each year 52000 53000 Births registered 1533 1535 Deaths at all ages 687 737 Deaths under 1 year 201 200 North-East Ward. Population estimated to middle of each year 13000 13500 Births registered 325 331 Deaths at all ages 137 153 Deaths under 1 year 32 31 North-West Ward. Population estimated to middle of each year 11000 11500 Births registered 229 213 Deaths at all ages 135 105 Deaths under 1 year 34 23 South-East Ward. Population estimated to middle of each year 11000 11000 Births registered 255 320 Deaths at all ages 122 120 Deaths under 1 year 28 32 South-West Ward. Population estimated to middle of each year 17000 17000 Births registered 724 671 Deaths at all ages 293 347 Deaths under 1 year 107 114 Table 3. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1907. 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. North-West. South-East. South-West. North-East. North-West. South-East. South-West. From outside. Total cases removed to Hospital. Under 1 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membanous Croup) 63 2 16 38 4 3 ... 16 12 11 24 16 7 8 21 36 88 Erysipelas 29 3 2 2 2 18 2 6 5 5 13 ... 1 ... ... ... 1 Scarlet Fever 207 4 68 159 21 15 ... 50 53 57 107 48 37 44 103 14 246 Tythus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 13 ... 1 2 3 7 ... 1 2 5 5 1 1 2 3 ... 7 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis 4 ... ... ... 3 1 ... 2 ... ... 2 ... ... ... ... ... ... Totals 377 9 87 201 34 44 2 75 72 78 152 65 46 54 127 50 342 Table 4. CAUSES OF. AND AGES AT, DEATH DURING YEAR 1907. 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 " NonResi dents" 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-East Ward. North-West Ward. South-East Ward. South-West Ward. untraced. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 20 2 14 4 ... ... ... 2 6 4 8 ... ... Scarlet Fever 6 ... 2 4 ... ... ... 1 ... 3 2 ... 6 Whooping-cough . 17 7 10 ... ... ... ... 2 1 ... 14 ... ... Diphtheria (including Membranous croup). 5 ... 3 2 ... ... ... ... 1 1 3 ... 6 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... Fever Tyhus ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric 3 ... ... ... 2 1 ... 1 1 1 ... ... 1 Other continued ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 9 1 ... 2 ... 4 2 3 1 2 3 ... 1 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea 19 14 5 ... ... ... ... 2 1 3 13 ... ... Enteritis 12 8 ... ... ... 1 3 1 3 2 6 ... ... Puerperal Fever 1 ... ... ... ... 1 ... 1 ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases 6 ... ... 1 ... 3 2 1 ... 1 4 ... ... Phthisis (Pulmonmonary Tuberculosis) 66 1 3 4 8 48 2 13 11 8 33 1 ... Other Tubercular Diseases 22 7 10 2 ... 3 ... ... ... 5 17 ... ... Cancer, Malignant Disease 46 ... 1 1 ... 24 20 14 9 5 16 2 1 Bronchitis 57 20 5 1 ... 10 21 13 8 7 28 1 ... Pneumonia 85 42 19 4 3 13 4 13 8 10 54 ... 3 Pleurisy 1 ... ... 1 ... ... ... ... ... ... 1 ... 1 Other Diseases of Respiratory Organs 8 4 1 ... ... 2 1 1 1 3 2 1 ... Alcoholism— Cirrhosis of Liver 10 ... ... ... ... 8 2 ... 5 2 3 ... ... Venereal Diseases 2 1 ... ... ... ... 1 ... ... ... 2 ... ... Premature Birth. 29 29 ... ... ... ... ... 7 2 3 17 ... ... Diseases and accidents of parturition 4 ... ... ... ... 4 ... 1 2 ... 1 ... ... Heart Diseases 53 1 2 4 ... 24 14 12 14 7 19 1 ... Accidents 17 7 2 1 ... 6 1 8 ... 3 6 ... 4 Suicides 2 ... ... 1 ... 1 ... ... 2 ... ... ... ... All other Causes 237 56 17 6 7 64 87 57 29 50 95 6 2 All causes 737 200 94 38 28 217 160 153 105 120 347 12 25 50 Table 5.INFANTILE MORTALITY Deaths from stated Causes in Weeks CAUSE OF DEATH. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 1 month. Common Infectious Diseases Small-pox ... ... ... ... ... Chicken-pox ... ... ... ... ... Measles ... ... ... ... ... Scarlet Fever ... ... ... ... ... Diphtheria (including Membanous Croup ... ... ... ... ... Whooping Cough. ... ... ... ... ... Diarrhoeal Diseases Diarrhoea, all forms ... 1 ... 1 2 Enteritis, Mucoenteritis, Gastro enteritis ... ... ... ... ... Gastritis, Gastrointestinal Catarrh ... ... ... ... ... Wasting Diseases Premature Birth. 26 1 ... 1 28 Congenital Defects 7 1 ... l 9 Injury at Birth 2 ... ... ... 2 Want of Birth milk, starvation ... ... ... l 1 Atrophy, Debility, Marasmus 1 ... 1 ... 2 Tuberculous Diseases. Tuberculosis Meningitis ... ... ... ... ... Tuberculosis tonitis:Tabes Mesenterica ... ... ... ... ... Other Tuberculous Diseases ... 1 ... ... 1 Erysipelas ... ... ... ... ... Syphilis ... ... ... ... ... Rickets ... ... ... ... ... Meningitis, (not Tuberculous) ... ... ... ... ... Convulsions ... 1 ... ... 1 Bronchitis ... ... ... 1 l Laryngitis 1 ... ... ... l Pneumonia 1 ... 1 2 4 Suffocation, overlaying 1 l ... ... 2 Other Causes ... l ... 2 3 39 7 2 9 57 Population estimated to middle of 1907, 53,000. Births in the year legitimate, 1498 illegitimate 37 DURING THE YEAR 1907. 51 and Months under" One Year of Age. 1-2 months. 2-3 months. 3-4 months. 4-0 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. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... 1 ... 3 7 l 3 2 2 ... 1 1 1 1 ... ... 14 l ... 2 1 1 1 ... ... ... ... ... 6 ... 1 1 ... ... ... ... ... ... ... ... 2 ... ... ... 1 ... ... ... ... ... ... ... 29 1 ... ... 1 ... ... ... ... ... ... ... 11 ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... 2 1 2 ... ... 1 ... 1 10 7 3 1 2 ... ... ... 1 ... 1 ... 17 ... ... ... ... ... ... 2 1 ... ... ... 3 ... 1 1 ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... 1 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 2 ... ... ... ... ... ... ... ... ... 1 3 1 1 ... ... ... 1 1 ... 1 ... ... 6 3 2 2 2 2 3 1 1 2 1 ... 21 ... 1 ... 1 ... ... ... ... ... 1 ... 4 8 3 3 ... 3 4 7 1 3 4 2 42 ... 1 ... 1 ... ... 1 ... ... ... ... 5 ... 1 3 1 1 ... ... 1 ... ... ... 10 28 18 15 15 9 12 14 7 9 7 9 201 Deaths in the year of legitimate 184 illegitimate 17 52 INFANTILE MORTALITY. WARD DISTRIBUTION. North East North West South East South West Total Measles ... 2 ... ... 2 Whooping Cough 1 1 ... 5 7 Diarrhoea 2 ... 1 11 14 Enteritis ... 2 2 2 6 Gastritis ... 1 ... 1 2 Premature Birth 4 5 2 18 29 Congenital Defects 3 ... 5 3 11 Injury at Birth ... ... ... 2 2 Want of Breast-Milk, Starvation 3 ... 1 6 10 Atrophy, Debility and Marasmus 3 2 6 6 17 Tuberculous Meningitis ... ... 2 1 3 Tuberculous Peritonitis and Tabes Mesenterica ... ... 1 1 2 Other Tuberculous Diseases ... ... ... 3 3 Syphilis ... ... ... 1 1 Rickets ... ... 1 ... 1 Meningitis (not Tuberculous) 1 1 1 ... 3 Convulsions ... ... 2 4 6 Bronchitis 5 1 1 13 20 Laryngitis 1 3 ... ... 4 Pneumonia 6 5 4 27 42 Overlaying ... ... 1 4 5 Other Causes 2 ... 2 6 10 31 23 32 114 200 53 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK 1. INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises Inspections Written Notices Factories (including Factory Laundries) 15 5 Workshops (including Workshop Laundries) 198 38 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 6 - Total 219 43 2. DEFECTS FOUND. Found Remedied Nuisances under the Public Health Acts :— Want of cleanliness 31 31 Want of ventilation 3 3 Overcrowding — — Want of drainage of floors 9 9 Other Nuisances — — Sanitary accommodation insufficient 1 1 unsuitable or defective 14 14 not separate for sexes 1 1 Total 59 59 3. HOME WORK. OUTWORKERS' LISTS, SECTION 107. NATURE OF WORK. Twice Yearly. Once Yearly. Outworkers' forwarded to other Councils. Inspection of Outworkers' Premises Infected Premises, Instances. Lists. Outworkers. Lists. Outworkers. Outworkers' received from other Councils. Wearing Apparel— (1) making, etc 96 150 6 9 54 2 35 (2) cleaning washing 78 196 15 46 — 2 67 5 Brush making 2 18 — — — 9 15 Stuffed toys 2 88 — — - 8 46 — Total 178 352 21 55 54 21 193 54 REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Laundries 230 Dressmaking 45 Millinery 8 Tailoring 7 Bakehouses 28 Others 54 Total number of workshops on Register 372 OTHER MATTERS. Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 38 Action taken in matters referred Notified by H.M. Inspector 9 to H.M. Inspector as remediable under the Public Health Acts, but not under the FacReports (of actions taken) sent. tory and Workshop Act (s. 5) to H.M. Inspector 9 Underground Bakehouses (s. 101 :— In use at the end of year 8 Your obedient servant, D. J. THOMAS. April, 1908. 55 ANNUAL REPORT OF CHIEF SANITARY INSPECTOR FOR THE YEAR 1907. 522 Complaints received 1588 Premises inspected 1588 Premises re-inspected 4157 times. 669 Interviews with Owners or Agents 2154 House to House Inspections 2122 Nuisances reported 1876 Nuisances abated 2 Common Lodging Houses inspected 101 times. 298 Houses Let in Lodgings inspected 37 11 Van Dwellings inspected 2 Drainage Examinations under Section 41 131 Drains submitted to smoke or volatile test 218 Drains submitted to water test 78 Re-drainage Plans deposited 85 New Systems of Drainage provided 30 Butchers' Shops inspected 268 „ 18 Fishmongers' Shops inspected 97 „ 30 Greengrocers' shops inspected 106 „ 2 Premises where food is manufactured or prepared inspected 64 „ 24 Dairies inspected 56 „ 38 Milk Purveyors' premises inspected 40 „ 2 Cowsheds inspected 24 „ 28 Bakehouses inspected 215 „ 112 Laundries inspected 15 Other Workshops inspected 4 Slaughter Houses inspected 122 „ 2 Piggeries inspected 49 „ 2 Offensive Trades inspected 70 „ 4 Mews and Stables inspected 164 „ 42 Public House Urinals, &c., inspected 98 „ 11 Schools inspected 16 „ 56 2 Show Grounds inspected 6 times. 145 Smoke Observations taken 12 Visits paid to Infected Houses 413 Rooms disinfected 10 School Rooms disinfected 13 Closets disinfected after Enteric Fever 67 Library Books removed from Infected Houses and dealt with 276 Infectious Cases removed to Isolation Hospital 956 Preliminary Notices served 1233 Statutory Notices served 1141 Letters received 947 Letters written 11 Notices received from H.M. Inspector of tories '22 Notifications of Waste of Water sent to Metropolitan Water Board Cowsheds. There are only two Cowsheds in the district. The construction of one is not altogether satisfactory, but as the cows are kept out for the greater part of the year, and simply brought in daily for milking, it is not a matter of much importance. The other is constructed on better lines, and the lighting and ventilation are more in accordance with what they should be. It is estimated that about 30 per cent. of milch cows are affected with Tuberculosis and about 2 per cent. are affected with Tuberculosis of the Udder. If this be so, it is highly desirable that all milch cows should be inspected by a veterinary surgeon, and I would point out that notwithstanding the power given to Local Authorities under the Dairies and Cowsheds Order to have this done, up to the present no steps have been taken with regard to the matter in this district. Perhaps in the Bill which is to be presented to Parliament, dealing with our milk supply, it will be compulsory that all milch 57 cows shall he periodically inspected, hut in any case I hope the Council will give the matter the consideration it deserves. There are 24 dairies in the district which are satisfactory, but I have to complain of the number (38)0f little general shops which are registered for the sale of milk. Although there is no law to prevent the registration of these premises, it must be plain to the average intelligence that keeping milk under such conditions is contrary to the teaching of Sanitary science. These shop-keepers admit that they are not repaid for the trouble and responsibility of selling milk, but that they do so to oblige their customers. This large number of milk shops considerably swells the cost of administering the Food and Drugs Acts and necessitates, perhaps, sampling one milkman's milk several times the same day, as all the general shops are supplied from the local dairymen. I shall be glad to see the time when all such premises will be annually licensed, so that the Local Authority will have greater control. The Council were very wise in taking steps last May to compel all Dairymen and Purveyors of milk, whose premises are not in Acton (but who come here to sell milk), to register with them.The power under which the Council acted is given by Article No. 6 of the Dairies and Cowsheds Order, 1885, as follows:— 6. (I) It shall not be lawful for any person to carry on in the District of any Local Authority the trade of a Cowkeeper, Dairyman or Purveyor of Milk unless he is registered as such therein in accordance with this article. 44 Dairymen, etc., have registered accordingly. Houses Let in Lodgings. I had hoped to have been able to have compiled a register of these premises, but owing to the large number of houses of this class in the District, I have found it impossible. I estimate that if I could employ assistance solely for this work, that it would take at least two years and by the end of that time perhaps the whole 58 thing would require again revising. I do not think any advantage would be gained to the District by registration over our present system of inspection. Dirty Houses. I am pleased to report that we have very few habitually dirty people in the district, and, in time, I hope we shall be able to persuade these to become clean. The question, " How is it possible to infuse into the minds of habitually dirty people a desire for cleanliness, tidyness, and order in the house ? " is one which has exercised the minds of all sanitarians for a long time. I have carried out some experiments with this object in view, and have come to the conclusion that such a state of things can only be brought about amongst the naturally dirty by making a list of such people and paying them a visit every day. Unfortunately, such inspections are difficult to keep up without neglecting other duties, but I believe if these daily inspections could be continued, the object would be achieved. I have found that as soon as the inspections are dropped, the people drift back into their old habits. Mews. We have four Mews in the district, which are periodically inspected, and I have had no complaints regarding them. In two cases the drainage system was entirely reconstructed. Piggeries. With the exception of two, the Council has been successful in causing the pig-keepers to move into the country. These two are so situate as not to cause offence to anyone, and are kept exceptionally clean. Old Oak Lane, in the summer time,would be a pleasant country walk but for the piggeries in the Hammersmith district. 59 Slaughter Houses. In April the Council granted a license for a new Slaughterhouse (for pigs only) upon the following conditions, viz.:— 1. That slaughtering be carried out between the hours of 8 a.m. and 5 p.m. 2. That there shall be no Sunday slaughtering. 3. That the license is granted for the sole use of the premises by the licensee only. 4. That no glands shall be removed from any carcase. 5. That the carcases shall be hung up so as to facilitate inspection with a passage of at least 2 feet between the rows. 6. That all pigs shall be stunned before sticking. 7. In the absence of the Inspector, should any carcase, after being dressed, be found to show signs of disease, the same and its offal shall be hung up separately from other carcases and the Inspector communicated with upon the matter as early as possible. The carcase and offal not to be interfered with until examined by the Inspector. 8. That no compensation shall be paid in the event of the Council establishing a Public Abattoir. 9. That a copy of these conditions, together with a copy of the Slaughter House Bye-Laws shall be hung in a conspicuous place in the Slaughter House, to be at all times legible. 10. Any disregard of the foregoing conditions will be brought before the Council and taken into consideration when application is made for a renewal of the License. 60 The premises were constructed on the most approved lines, and were opened in October. I can only speak in the highest terms of the manner in which it is conducted and the assistance afforded to me by the manager for inspecting carcases, etc. I am hoping that during the coming year, the use of two registered slaughter-houses will be discontinued. As there are four on the register, this will leave only two in the district, and practically in the same locality, which will be very desirable, as it facilitates inspection and supervision, and I trust the Council will not grant any more licenses without very careful consideration. Smoke Abatement. Observations have been kept upon the chimneys of factories, etc., in the district, and cautionary notices sent to the owners offending. These notices generally had the desired effect, and no proceedings have been necessary. I beg to record my thanks to the Inspector to the Coal Smoke Abatement Society for his co-operation upon many occasions. Round-Abouts and Show Grounds. There are two pieces of land in the district which are periodically used for the above purpose. The Council has insisted upon water and w.c. accommodation being provided on the land (by means of its Bye-Laws), which greatly prevents the creation of any nuisance. Both vans and the ground were regularly inspected. Gas in Sewers. In two or three parts of the district I received complaints of smells of gas in houses, notwithstanding that gas was not laid on. I found, upon inspection, that coal gas was getting into the sewers and from thence into certain defective drains under the houses. At Acton Green, where a Chemical Tester had been inserted in the house drain, an explosion occurred, fortunately doing no damage, but simplv blowing off the manhole covers to the sewer and inspection 61 chambers. The Gas Company were communicated with, and it was found that a collar on their main running through our sewer manhole was broken and allowing a serious leakage to take place. This was immediately remedied. In High Street we were unable to find the cause of the gas smell in the sewer, and notwithstanding the assistance of the Public Analyst. we could not prove that it was coal gas or given off from Petrol or Naptha. Personally, I think it was coal gas. Board of Trade Inspector. In April, the Board of Trade Inspector spent a week in the district, procuring certain details with regard to the Housing Accomodation of Artizans, and the department afforded him all the information it could upon the matter. Inspection of Meat and other Foods. I have frequently inspected butchers, greengrocers, and fishmongers' shops, and other places where food is sold or prepared, and have to report favourably thereon. There seems to be no diminution in Tuberculosis in the country fed pigs. It is a noticeable fact that London fed pigs are practically free from the disease, and, in my opinion, this is largely due to the manner of feeding. London fed pigs are practically fed upon the offal collected from hotels, etc. This is thoroughly boiled and after all the fat has been removed, the residue is given to the pigs with sometimes an addition of meal. These animals are, therefore, fed on sterile food. Hence the comparative immunity from the disease. In the country, I believe, it is the practice not to boil the food (with the exception, perhaps, of potatoes). Milk from the separator is poured into the pigs' troughs, and as it is estimated that 30 per cent. of all milch cows are affected with Tuberculosis, it seems to me that drinking the milk in this state has a lot to do with the large 62 percentage of the disease in these pigs. If this, and all garbage, were thoroughly boiled before being given as food, and the styes well constructed, I think we should soon see an appreciable drop in the number of animals affected. I do not know whether or not the Board of Argiculture have had this matter under consideration, but it would be a good thing if some experiments could be carried out with pigs fed on boiled food and with some on unboiled food, consisting principally of raw separated milk. In many districts, inbreeding amongst pigs is carried on to a very large extent, and this, no doubt, predisposes them to this and other diseases. In only two instances has it been necessary to institute proceedings against persons exposing diseased or unwholesome food for sale. In one case, a butcher exposed three pigs' plucks for sale, which were very badly affected with Tuberculosis, and was fined £5 and costs. In another case, a provision dealer was fined 40s. and costs for exposing unwholesome bacon. Last June, I was successful in obtaining the Certificate of the Royal Sanitary Institute for an Inspector of Meat and other Foods by examination. During the year the following articles were seized or surrendered, and in some cases ordered to be destroyed by a Justice:— 1 Box of apples. 8½ Stone of plaice. 3 Boxes of haddocks. 3 Cases of rabbits. 87 Wild Rabbits. (90) 39 Pigs' heads. 1 Trunk of codlings. 1 Trunk of fresh haddocks. 7 Lungs. 63 6 Livers. 5 Spleens. 6 Pigs' plucks. I Trunk of fish roe. 1 Box of Jaffa oranges. I½ lb. of bacon. 2 Boxes of hake. I Pig. Quantity of offal. 1 Box of plaice, dabs, etc. 2 Boxes of mackerel (58 and 116). 13 Baskets of strawberries. 3 Boxes of kippers. 14 Fowls. 2 Breasts of mutton. 1 Kidney. 1 Case of cod. 120 Turkeys. 1 Mesentery or Caul. Food and Drugs. During the year, I procured:— 61 Samples of New Milk. 38 Samples of Butter. 1 Sample of Margarine. In three cases, the Analyst reported that the Milk samples submitted were inferior in quality and probably adulterated. No action was taken with regard to these, neither was it necessary to take any proceedings regarding any of the other milk samples submitted to the analyst. About the middle of the year, this district and Chiswick was over-run with itinerant butter vendors. These persons usually carried one or two pounds of butter, the rest being margarine. Mr. Clarke, Chief Inspector for Chiswick, and myself worked in 64 co-operation, and succeeded in ridding the district of the trade of these undesirable persons, and I beg to acknowledge his valuable assistance. The results of our work will be seen from the Table of Prosecutions. Our chief difficulty was in serving the summonses, as in the majority of cases, false names and addresses were given. I trust when the law is amended, provision will be made for the registration of these individuals, a copy of which registration they should be required to produce, or in default to immediate apprehension, similar to the law regulating Pedlars. Legal Proceedings. February 6th.—Occupying land without w.c. or water supply provided on such land.—Adjourned for defendant to carry out requirements of Council. February 20th.—Ditto.—Summons withdrawn on defendant paying costs of adjournment and proceedings. February 27th.—Exposing for sale i¾ lbs. bacon which was unwholesome.—Fine 40s. and costs. March 20th.—Exposing for sale 3 portions of pigs' plucks affected with Tuberculosis.—Fine £5 and costs. June gth.—Selling Margarine as better, 100 per cent.—Fine £20 and costs. June 5th.—Selling Margarine in unlabelled packet.—Costs. June 5th.—Obstructing Officer.—Costs. June 5th:—Refusing to sell.—Costs. June 26th.—Selling Margarine as Butter, 100 per cent.—Fine £10 and costs. 60 June 26th.—Selling Margarine in unlabelled packets.—Costs June 26th.—Selling Margarine as Butter, 95 per cent.—£10 and costs. June 26th.—Selling Margarine in unlabelled packets.—Costs. June 26th.—Selling Butter adulterated, 96 per cent. Margarine.— £10 and costs. June 26th.—Selling Margarine not branded as same.—Costs. September 25th.—Selling Butter adulterated with 96 per cent. Margarine.—Fine £5. September 25th.—Ditto.—Fine £5. September 25th.—Ditto.—Fine £3. September 25th.—Selling Margarine in plain wrappers.—Costs. September 25th.—Ditto.—Costs. September 25th.—Ditto.—Costs. Sale of Food and Drugs Acts. Year. No. of samples taken. Adulterated. Inferior. Genuine. Fines and costs imposed. 1905 117 10 6 101 10 10 6 1906 81 4 7 70 6 2 0 1907 109 9 3 97 87 2 6 Totals 307 23 16 268 103 15 0 66 Public Health Acts. Year. No. of proceedings taken. No. of connections obtained. Fines and costs imposed 1902 3 3 Orders made and costs in each case. 1903 3 3 25 12 0 1905 14 14 23 14 6 1906 1 1 7 2 0 1907 4 4 10 3 0 Totals 25 25 66 11 6 The following Tabulated List gives particulars of the Sanitary Improvements effected during the year:— F.J. Fearns J.J.Jenkins North. South. District. District .Ttl. House Drains taken up and reconstructed 56 36 92 „ repaired 81 33 114 „ upstopped and cleansed 60 120 180 „ provided with intercepting traps 37 49 86 „ manholes provided to 54 50 104 „ ventilated 33 48 81 „ Manholes to, cleansed 8 39 47 „ „ repaired 12 65 77 „ Fresh-air inlets repaired 25 25 50 „ „ provided 44 74 118 Water Closets repaired 3 10 13 67 Water Closets, new, provided 86 84 170 ,, new pans provided to 1 21 22 ,, unstopped and cleansed 17 31 48 ,, pan closets and containers replaced by efficient pans - 1 1 ,, provided with new flushing cisterns 20 89 109 „ flushing cisterns repaired 25 51 76 „ flush, disconnected from drinking water cistern - 9 9 „ additional or separate, provided in Factories and workshops - - - ,, apartment, foul and dilapidated 10 11. 21 „ water supply laid on to 1 - 1 Soil Pipes repaired 2 4 6 „ ventilated 7 11 18 ,, increased ventilation provided to 1 4 5 „ reconstructed 20 11 31 Want of stoppers to interceptors 37 119 156 Ventilating shafts repaired 5 11 16 Waste Pipes, sink, disconnected from drain 8 16 24 „ trapped with lead traps 57 42 99 ,, unstopped or repaired 7 14 21 ,, bath and lavatory, disconnected from drain 3 9 12 Sinks, new, provided - 5 5 „ repaired 4 10 14 Rainwater Pipes disconnected from drain 45 48 93 „ repaired 6 5 11 „ provided 1 13 14 Eaves Guttering provided 3 9 12 „ repaired 10 10 02 Gully Traps replaced with stoneware gullies 7 15 22 „ removed from improper situations 4 7 11 „ unstopped - 21 21 „ provided - 13 13 68 Gully Traps, grids provided to 2 6 8 „ cement work around, repaired 3 21 24 Yards, paving repaired 6 24 30 „ paved and drained 86 118 204 „ cleansed — 39 39 Dust bins provided 26 101 127 Ashpits, foul and defective, remedied - 12 12 Cisterns repaired and covered 34 13 47 „ cleansed 11 18 29 ,, removed from improper position — 13 13 Rooms cleansed and whitewashed 221 195 416 „ Plastering of walls and ceilings repaired 57 12 69 „ Dealt with under Housing Acts — — — Workshops cleansed and limewashed 2 17 19 ,, roofs repaired 1 4 5 Roofs of Houses repaired 17 18 35 Floors of houses repaired or relaid 17 17 34 ,, workshops repaired or relaid — 7 7 „ stables repaired or relaid — 4 4 Stables provided with drainage 1 2 3 „ „ ventilation — 1 1 Coachhouse floors repaired — 1 1 „ ceilings repaired 1 — 1 Dampness of house walls remedied 42 13 55 Air spaces under floors of houses ventilated 2 3 5 Accumulations of refuse removed 10 18 28 „ manure removed 25 9 34 „ water in cellars removed 1 2 3 „ in ditches — 4 4 Manure receptacles provided — 8 8 Animals, Fowls, etc., nuisances from, abated 4 16 20 Urinals cleansed 2 4 6 „ provided with water, etc 1 — 1 69 Urinals reconstructed - 2 2 „ removed — 2 2 Overcrowding, number of cases abated — 9 9 Water supplv provided to houses 1 14 15 Taps provided on main — 17 17 Smoke Nuisances 7 — 7 Miscellaneous nuisances abated 24 23 47 Inspections.—Number of premises inspected on complaint 522 Number of premises inspected in connection with Infectious diseases 425 „ Number under periodical inspection 286 „ Houses inspected from house-to-house 21.54 Total number of inspections and re-inspections made 8215 Notices.—Cautionary or intimation notices given 956 „ Statutory orders issued 1233 „ Summonses served 2 „ Convictions obtained 2 Dwelling Houses.—Houses, premises, etc.. cleansed, repaired, etc 559 Common Lodging Houses.—Number registered under Bye-Laws 2 „ Number of inspections made 101 Movable Dwellings. Caravans, Tents, etc.—Number observed during the year 11 Number of nuisances therefrom abated 8 Bakehouses.—Number in district 28 Slaughter-houses.—Number of inspections made and frequency of inspection 122 Slaughter-houses.—Number on register 4 Cow-sheds.—Number on register 2 „ Number of inspections made and frequency of inspection 24 „ Number of milch cows in district 98 Dairies and Milkshops.—Number on register 02 ,, Number of inspections made and frequency of inspection 96 Unsound food.—Artices or parcels seized 331 „ Condemned bv Magistrate 82 70 Unsound food.—Articles and parcels surrendered 329 Adulterated Food.—Samples taken by the District Local Authority 100 „ Found adulterated 14 Offensive Trade.—Number of premises in district 2 • „ Number of inspections made 70 „ Contraventions of Bye-Laws 1 WATER SUPPLY AND WATER SERVICE. Percentage of houses supplied from public water service... 100 per cent. Cisterns.—Cleansed, repaired, covered, etc 89 Draw-taps placed on mains 17 Percentage of houses supplied on constant system 100 per cent. Water Closets.—Repaired, supplied with water, or otherwise improved 450 Percentage of houses provided with water closets 100 per cent. DRAINAGE AND SEWERAGE OF EXISTING BUILDINGS. Drains.—Examined, tested, exposed, etc 351 „ Unstopped, repaired, trapped, etc 956 „ Waste pipes, rain water pipes disconnected, repaired, eto 200 „ New soil pipes or ventilating shafts fixed 112 „ Existing soil pipes or ventilating shafts repaired 45 „ Disconnecting traps or chambers inserted 190 „ Reconstructed 92 Cesspools.—Abolished, and drain connected to sewer 4 Percentage of houses draining into sewers 100 Disinfection.—Rooms disinfected, ordinary infectious diseases 380 „ „ Phthisis 33 Rooms stripped and cleansed 58 Dust.—New bins provided 127 „ Periodical frequency of dust removal weekly „ Method of disposal Destructor Sundry Nuisances abated.—Overcrowding 9 ,, „ ,, Smoke 7 71 Sundry Nuisanees abated.—Accumulations of refuse 62 „ „ „ Foul ditches, ponds, etc., and stagnant water 7 „ „ „ Foul pigs and other animals 20 „ ,, ,, Dampness 60 „ „ „ Yards repaved or repaired 234 ,, ,, „ Other nuisances 47 1 am, yours obediently, MAURICE W. KINCH, A.R.San.I. (Chief Sanitary Inspector). Public Health Dept., 130 Churchfield Road, Acton, W. 5 SE 08 ACTON— EXPRESS PRINTERS LIMITED, 7 CHURCH ROAD. 1908.