To the Chairman and Members of the Brentford Local Board, A nnual Report, 1893. Gentlemen, % I beg to present my annual report upon the health and sanitary condition of the Brentford Urban Sanitary District for the year 1893. Population—For the middle of the year 1893, I estimate the population of Brentford at 14,134, which is an increase of 184 over 1892, and of the several ecclesiastical districts into which it is divided my estimate is as follows—St. George's with St. James' 4691. St. Paul's 7390. New Brentford 2053. Births—The number of births during the year has been 503, of which 248 were males and 255 were females. The birth rate is 35.5 per thousand which is a fraction higher than last year, but 2.1 lower than the average of the last 10 years. Deaths—The number of deaths has been 263, 122 males and 141 females. The death rate is 18.6 per thousand which is exactly the average of the last 10 years. The highest mortality was in July when the death rate rose to 37.3 per thousand, chiefly caused by Infantile Diarrhoea. The principal causes of death have been— Bronchitis 35 Diarrhoea 30 Phthisis 19 Pneumonia 10 There have been 12 Inquests held. Death resulted from natural causes in 6 of these, 2 died from suffocation, 2 from burns, 1 from drowning and 1 from injury. 5 newly born infants, 1 child 3 months old and 1 woman aged 43 were returned as non-certified. The following table epitomises the ages at which the deaths occurred : Deaths under 1 year 93 136 under 5 years ,, from 1 year and under 5 years... 43 ., 5 years „ 15 13 127 over 5 years. 15 ,, ,, 25,, 8 ,, ,, 25 ,, ,, 60 ,, 58 ,, over 60 ,, 48 7 of these deaths occurred in persons between 80 and 90 and 1 was over 90. The next table shows the distribution of the mortality in the 3 districts of the town during the last 10 years: 1884 1885 1886 1887 1888 1889 1890 1891 1892 1893 Average of 10 years. St. George's 17.8 17.3 28 16.3 18.1 16.7 19.8 18.3 22.1 16.2 59 St. Paul's 20 17.5 21 16.2 17.4 18.8 18.1 17.2 20. 3 18.9 18.5 New Brentford 13.8 16.1 16.5 17.3 20 14 22.5 22.2 21.3 22.8 18.6 2 It will be seen from the table that the average mortality is practically the same in the three districts but during the last four years there has been a steady increase in New Brentford. Infant Mortality.—The rate of this mortality or the proportion of deaths under i year of age to every iooo births has been 184.8. Last year it was 197.1, so that there is a small improvement to be recorded, but the deaths in infants under 1 year of age are still far too high and every effort must be made to reduce it before our town can be considered to be making satisfactory progress. The following are the deaths from the principal zymotic diseases :— Small Pox.—There has been one case of this disease in the district. In June an occupant of a boat on the canal was found to be suffering from Small Pox. Prompt measures were taken to isolate him and he was removed to the Highgate Small Pox Hospital. The boat and contents were thoroughly disinfected. Measles.—There have been 13 deaths from this disease all of which took place in June and July and were in children under 5 years old. Scarlatina.—There have been 7 deaths from Scarlatina, 2 under five years and 5 over 5 years old. Five of these deaths occurred in the Isolation Hospital. This is now the fifth year of the Scarlatina epidemic and in spite of all precautions and disinfections I am afraid that we have not yet seen the end of it. Some parents seem to think they are doing a very clever and praiseworthy action in not notifying the disease and spreading it by means of the schools as far as possible. Diptheria.—This disease has caused one death and there has been one death from Membranous Croup. Whooping Cough.—Four deaths have been caused by this disease which is the * same number as last year and considerably below the average. Typhoid Fever.—Again I have pleasure in recording the very few cases of this disease and the small number of deaths. 5 cases were notified and there was only one death. Typhus Fever.—In January a very healthy and steady young policeman was attacked by this disease and he was removed to the Isolation Hospital where he died. This was the only case which occurred and although I traced his movements for some time previous to his illness I could discover no cause for the attack. This is the first death from Typhus for many years. Diarrhcea.—There have been 30 deaths from Diarrhoea which is the highest number for the last 10 years. 29 were in children under 5 years old, and 20 of these deaths took place in July. I attribute the excessive mortality to the exceptionally hot summer. The number of deaths from these 8 diseases has been 58 and the zymotic death rate has been 4.1 which is higher than the average of the last 10 years and may be accounted for by the very high infant mortality from Diarrhcea and Measles in July. The following table shows the number of births and deaths and the various birth and death rates during the past 10 years. 3  1884 1885 1886 1887 1888 1889 1890 1891 1892 1893 Average of 10 years. Number of Births. 484 480 520 507 437 5°4 512 494 492 503 493-3 Birth rate per 1000 39.3 38.5 41.2 39.7 33.8 38.5 38.7 35.9 35.2 35.5 37.6 Deaths from all causes 225 207 283 210 234 227 256 253 294 263 245.2 Death rate per 1000 18.28 16.6 22.4 16.4 18.1 17.3 19.3 18.3 21 18.6 18.6 Deaths from Small Pox 1 0 0 0 0 0 0 0 0 0 0.1 ,, Measles 1 5 11 9 0 8 5 1 19 13 7.2 ,, Scarlet Fever 0 0 0 2 2 2 13 5 2 7 3.3 ,, Diptheria 0 2 2 0 3 8 5 3 2 2 2.7 ,, Typhus Fever 0 0 0 0 0 0 0 0 0 1 0.1 ,, Whooping Cough 4 3 25 3 10 3 7 14 4 4 7.7 ,, Typhoid Fever 2 2 2 0 1 3 5 0 1 1 1.7 ,, Diarrhoea 7 13 12 10 10 6 21 14 18 30 14.1 ,, 8 chief zymotic diseases 15 25 52 24 26 30 56 37 48 58 37.1 Death rate of 8 zymotic diseases 1.2 2 4.1 1.8 2.08 2 29 4.2 2.6 3.4 4.1 2.7 Influenza.—This is the fourth epidemic of this remarkable disease that I have to notice. It appeared in the middle of November and lasted about a month, but it was of a much milder type than the previous epidemic and not nearly so many people were attacked. 4 deaths were directly attributed to it. Bakehouses and Slaughterhouses—These have been frequently visited and inspected and found clean and in good order. Lodging Houses —The 9 lodging houses have been frequently inspected day and night. On May 31st I made a night inspection and with the exception of one house which was overcrowded and the atmosphere of the rooms and passages very foul, everything was clean and in good order. As I did not consider this house fit to be used for the purposes of a common lodging house I recommended that it be closed and this has been done. Other Sanitary Work.— The line that I marked out some years ago for the sanitary improvement of the town has been closely followed this year. My efforts are mainly directed to reducing the heavy and increasing infant mortality and I am glad to report that there is a slight improvement this year. Many houses have been condemned as unfit for habitation and have either been remodelled or permanently closed. Overcrowding wherever met with has been promptly checked. Frequent visits have been paid to houses with the result that drinking water cisterns are now rarely found connected to water closets. Dustbins are regularly emptied. Manure is not allowed to accumulate, and domestic animals are not kept in wash houses and other unsuitable premises. A large proportion of the women of Brentford are engaged in market gardens, laundries and other occupations which take them from home all day and I consider this one of the principal causes of the excessive number of deaths in infants. Young children are left for hours together to the care of others very little older than themselves and are consequently generally neglected. Isolation Hospital.—The good work that this institution was expected to do has been this year more than verified Throughout the whole year patients suffering from Scarlet Fever have been admitted and since the beginning of August the resources of the Hospital have been strained to the utmost. Nurse Ward's devotion to duty has been remarkable and I can only speak of her in terms of the highest praise both as a nurse and as an administrator. She has also given general satisfaction to those parents who have had children in the institution. 4 The number of cases admitted during the year has been— Scarlet Fever. Typhus Fever. Total. 130 1 131 Remaining under treatment, December 31 st, 1892 12 Discharged cured 98 Died 5 Remaining under treatment December 31st, 1893 39 It will be seen from the above figures that there have been but 5 deaths during the year out of atotal of 132 or 3.7 per 100 patients which I think is highly satisfactory. Infectious Diseases (Notification) Act.—Under this Act I have received 231 certificates made up as follows— Small Pox 1 Scarlet Fever 171 Typhus Fever 1 Typhoid Fever 5 Erysipelas 34 Membranous Croup 2 Diptheria 16 Puerperal Fever 1 Although acknowledging the extreme usefulness of this Act, it cannot be denied that it is very frequently evaded and one can scarcely blame ignorant persons when they refuse to believe a disease is infectious and that a child must be continuously isolated for many weeks, when as in many mild cases of Scarlet Fever that child has not been at all ill at anytime. I am convinced that were it not for the extreme vigilance of the masters and mistresses of the various schools in the town that many more cases of infectious disease would remain undiscovered. I have paid several visits to the schools during the year and only on two occasions have children suffering from infectious diseases been discovered. Mr. Robinson, Sanitary Inspector, has supplied the following particulars— Summary of Nuisances dealt with during 1893. TABLE No. 1. Number of houses and premises inspected (including 472 house to house to house inspections) 1240 ,, special complaints received and attended to 111 „ nuisances discovered 795 „ ,, abated 794 ,, ,, outstanding Dec. 31st, 1892 14 ,, preliminary notices issued 318 340 ,, formal „ „ 22 ,, summonses taken out ... none „ nuisances outstanding, Dec. 31st, 1893 *5 TABLE No. 2. The following is a description of the Nuisances dealt with— Number of defective and choked drains 211 ,, „ w.c. cisterns 140 ,, „ w.c. connections 91 5 Number of defective roofs, gutters, and downspouts 91 ,. drinking water cisterns connected with w.c's 15 „ ,, ,, disconnected 14 ,, ,, ,, provided with covers 17 ,, flushing cisterns fixed (not previously in existence) 15 ,, dustbins provided or repaired 25 ,, accumulations or deposits of manure, ashes, refuse &c. removed 28 ,, nuisances from keeping animals, including pigeons, &c. 3 ,, houses supplied with water 9 ,, ,, found dirty, cleansed and lime washed 5i ,, ,, overcrowded 6 ,, ,, closed under Public Health Act, as unfit for habitation 12 ,, „ reopened after repairs 7 ,, seizures of unsound food 2 „ miscellaneous nuisances 58 ,, drains tested by smoke test 19 Common Lodging Houses.—These have been regularly visited by day, and night inspections have been made. The periodical cleansing and limewashing of the premises has been attended to, and the condition of the houses when inspected has been satisfactory. One house has been closed during the year as unfit for human habitation. Number of houses on register 9 ,, lodgers registered for 128 ,, visits by day 118 ,, ,, night 9 Dairies and Milkshops A.ct.—These have been inspected and found in clean and satisfactory condition. Number of premises registered 17 ,, inspections made frequent ,, applications to register 3 Bakehouses, Slaughterhouses, &c.--Frequent inspections have been made of the factories, workshops, bakehouses, Slaughterhouses and schools within the district and they have all been found in a satisfactory condition. Infectious Disease : Number of houses inspected on occurrence of infectious disease 221 „ „ disinfected 167 ,, ,, stripped and cleaned 33 ,, patients removed to hospital 132 ,, articles of bedding, clothing &c., disinfected in steam apparatus 390 ,, dead bodies removed to mortuary 1 The conveyance purchased by the Board on August 22nd has been of very great service in the speedy removal of patients to the Isolation Hospital and has been used on 79 occasions Canal Boats Acts 1877 & 1884.On January 1st, 1893, 207 canal boats were registered at Brentford and during the year 3 applications to register Canal Boats as dwellings have been received and as each complied with the requirements of the Act, they were granted. 6 Number of inspections made 172 ,, contraventions of acts and regulations 18 ,, complaint notices forwarded to owners 6 verbal cautions given 12 ., certificates absent n ,, boats not properly marked 5 ,. cabins overcrowded 1 ,, ,, requiring painting 1 A case of small pox occurred in the boat " Violet," from Wolverhampton. During the inspections the boats were generally found in a satisfactory condition, the cabins being in most cases remarkably clean and comfortable, and the occupants always very civil and obliging. I am Gentlemen, your obedient Servant, HENRY BOTT. Brentford, April\ 1894. Medical Officer Health.