To the Chairman and Members of the Brentford Urban District Council. Annual Report, 1898 Gentlemen, I beg to present my Annual Report upon the health and sanitary condition of the Brentford Urban Sanitary District for the year 1898. Population.—For the middle of the year 1898, I estimate the population of Brentford at 14974, which is based on the census of 1891, but which I think will be found to be under-estimated when the next census is taken in 1901. The population of the several ecclesiastical districts into which Brentford is divided is:—St. George's with St. James's, 5071, St. Paul's, 7880, and New Brentford 2023. Births.—The number of births during the year has been 523, of which 305 were males and 218 females. The birth rate is 34.9 per thousand which is one lower than the average of the last 10 years. Deaths.—The number of deaths during the year is 312, of which 157 were males and 155 females. In St. George's 118, St. Paul's 152, New Brentford 42, and the death rates respectively of these three districts is, St. George's 23.2, St. Paul's 18, and New Brentford 20.7 per thousand. The death rate of the whole district is 20.8 per thousand which is the highest of any year since 1892 and 2.7 above the average of the last 10 years. January, August and September were the months with the highest mortality, caused in the first month by Whooping Cough, and in the other two by Diarrhoea. The principal causes of death have been— Bronchitis, Pneumonia and Pleurisy 59 Diarrhoea 29 Phthisis 31 Whooping Cough 27 Heart Disease 18 There have been 20 Inquests held. Death resulted from accident in 2 of these cases, 7 died from heart disease, 6 from drowning, 2 from apoplexy, 1 each from congestion of the lungs and suicide, and in one case a verdict of wilful murder was recorded. The number of Inquests is about the average of the last ten years, and is greatly in excess of last year. 4 deaths were returned as "not certified," 3 of which were infants. The following table epitomises the ages at which the deaths occurred— Deaths under 1 year 104 170 under 5 years old, ,, from 1 to under 5 years 66 „ „ 5 „ 15 „ 14 142 over 5 years old. „ „ 15 „ 25 „ 16 „ „ 25 „ 65 „ 71 ,, over 65 years 41 4 of these deaths occurred in persons between 80 and 90 years old. The next table shows the distribution of the mortality in the three districts of the town during the last 10 years. BRE 044 2 1889 1890 1891 1892 1893 1894 I895 1896 1897 1898 Average for 10 years. St. George's 16.7 19.8 18.5 22.1 16.2 16.1 17.7 21.3 17.8 23.2 18.9 St. Paul's 18.8 18.1 17.2 20.3 18.9 14.4 15 16.9 13.7 18 17.1 New Brentford 14 22.5 22.2 21,3 22.8 7.5 17.1 21.1 17.2 20.7 19.6 Infant Mortality.—The rate of this mortality or the proportion of deaths under 1 year of age to every 1000 births is 223.7. This is most unsatisfactory and can only be accounted for by the large number of children who have died during the year from whooping cough, diarrhoea and diseases of the respiratory organs all of which are most fatal if neglected. The unfortunate necessity which compels mothers to leave infants in charge of young children whilst they go to work in the laundry or the fields cannot be other than highly dangerous to babies, for they are certain to be neglected, and it is truly a case of ' the survival only of the fittest.' The only remedy I can suggest for this sad state of things is education. The following table gives the rate and average of infant mortality for the last 10 years. 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 Average for 10 years 134.9 152.3 178.1 197.1 184.8 162.4 154.5 184.9 144 223.7 171.6 The following are the deaths from the 8 principal Zymotic Diseases: — Small Pox.—There has been no case of this disease, and it is over 10 years since there was a death from it. Statistics however clearly prove that before the era of vaccination this most loathsome and deadly disease was rampant, and I cannot too seriously advise parents to have their children properly vaccinated and also to see that re.vaccination is performed in youth. Measles.—There have been only 6 deaths from this disease all in children under 5 years old. Scarlet Fever.—This year, as last, there has been one death from this disease, which occurred in a child of 2 years, in June, at the Isolation Hospital. Diphtheria and Membranous Croup.—The former disease caused 2 deaths in December, in children, and the latter 2 deaths in May. Typhus Fever.—There has been no case of this disease this year. Whooping Cough.—In the first three months of the year there was a serious epidemic of this disease, which was principally confined to the parishes of St. George and St. Paul. It caused 26. deaths, all of which were in young children, and the majority were infants There is a widespread be,lief amongst all classes that the proper treatment for whooping cough is taking the patient out of doors in all weathers. I wish to point out that this is entirely wrong. The child should be kept in a warm room, and so avoid, as far as possible, the risk of lung complications, which are so common and so dangerous. Typhoid Fever. — Again as last year there have been only 2 deaths from this disease 1 in March and 1 in November. The continued immunity which the town enjoys from this disease must be a source of congratulation to all. 3 Diarrhœa. —The mortality from this disease is 29, the same as last year. Nearly all the deaths were in infants and during the months of August and September, and so I fear it will always be as long as parents neglect the simplest precautions. Little babies are allowed to eat anything and no attention is paid to cleanliness. The number of deaths from these 8 diseases has been 68, and the Zymotic death rate is 4.5 per thousand which is abnormally high, 2 higher than last and 1.3 higher than the average of the last 10 years. The following table shows the number of births and deaths, and the various birth and death rates for the last ten years:— 1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 Average for 10 years, Number of Births 5°4 512 494 49 2 503 474 537 49 2 576 523 5IO.7 Birth rate per 1000 38.5 38.7 35 9 35.2 35.5 31.1 37.i 33.6 38.9 34.9 35.9 Deaths from all causes 227 256 253 294 263 221 235 278 231 312 257 Death rate per 1000 1.5 19.3 18.3 21 18.6 15.4 16.2 18.9 15.6 20,8 18.1 Deaths from Small Pox 0 0 0 0 0 0 0 0 0 0 0 ,, Measles 8 5 1 1 13 11 0 30 0 6 9.3 ,, Scarlet Fever 2 (3 5 2 7 1 0 2 1 1 3.4 ,, Diphtheria 8 5 3 2 2 3 3 6 3 4 3.9 ,, Typhus Fever 0 0 0 0 I 0 0 0 1 0 0.2 ,, Whooping Cough 3 7 14 4 4 6 4 12 2 26 8.2 ,, Typhoid Fever 3 5 0 1 1 2 3 2 2 2 2.1 ,, Diarrhœa 6 21 14 18 3o 11 J5 16 29 29 18.9 ,, 8 chief zymotic diseases 30 56 37 46 58 34 25 68 38 68 46 Death rate of zymotic diseases 2.29 4.2 2.6 3.4 4.1 2.3 i.7 4.6 2.5 4.5 3.2 Bakehouses and Slaughterhouses.—The 22 Bakehouses and 8 Slaughterhouses in the district have been regularly inspected. They have uniformly been found clean and in good repair. Where any defects have been noticed they have been promptly remedied. Lodging Houses.—The common lodging Houses have been constantly visited and there has not been one case of infectious disease in them during the year. One house has been remodelled and two new rooms added, thus giving additional accommodation. Other Sanitary Work:.—My efforts this year, as in all previous ones, have been principally directed to improving the dwellings of the poor; seeing that they are watertight, properly ventilated, that their sanitary arrangements are not defective, and that their water supply is efficient. Many houses have been repaired and cleansed and 5 have been closed as unfit for habitation and pulled down. I am not an advocate for the wholesale demolition of small property as long as it can be put into a proper condition byreconstruction and repair, for the small houses supply a great want as they are cheap and, under supervision, make good homes for families earning small wages. To me it appears that the great difficulty is to house the poorest class, as they are not always the most desirable tenants. They are not suitable as tenants for workmen's dwellings, and if small houses are done away with they must crowd into lodgings. I would again suggest that a register be kept of all houses let in lodgings as it would materially assist the sanitary authority and tend to check overcrowding with its attendant evils. Prevention of Phthisis.—Last year I called attention to the infectious nature of this ever present disease and I am convinced that if reasonable precautions are taken 4 many valuable lives will be saved. It has caused 31 deaths, 7 in children under 5 years old and 24 above that age. I would again repeat that it is the expectoration which usually spreads the infection. I would advise that a vessel be always used containing a disinfectant and that all rags, etc., containing sputum be burnt. That the room be well ventilated and disinfected as frequently as practicable, and that the sick person sleep alone. As cows milk carries the infection of this and all the zymotic diseases, I advise that it should always be boiled. If phthisis were included amongst the notifiable diseases I am convinced that it would be a great advantage to the community. Isolation Hospital.—This institution continues its career of usefulness, and practically all cases of Scarlet Fever which occur in the town are removed there. I am glad therefore that it has been made free to all and that the only cause of discontent has been removed. There have not been so many patients this year, but every month except August, some have been admitted. Its management is still very popular with all, and Nurse Ward, assisted by her daughter, as Assistant Nurse, has worked with her usual energy and devotion. It would be difficult to find anyone who was at once so able and so zealous. I have again to tender my cordial thanks to the head masters and mistresses of the various schools for their assistance in detecting infectious diseases. Perhaps now that the children can be treated free of cost at the Hospital, there will be a less tendency to concealment. Number of cases admittted during the year. Scarlet Fever 40 Patients under treatment December 31, 1897 31 „ discharged cured 65 „ died 1 „ under treatment, December 31 st, 1898 5 Infectious Diseases (Notification) Act.—Under this Act, I have received 81 certificates, viz:— Scarlet Fever. Erysipelas. Diphtheria and Membranous Croup. Typhoid Fever. 46 18 11 6 Taken as a whole, this has been one of the worst years the town has experienced for many years. The birth rate has been lower than usual and the death rate and especially infant mortality have increased enormously. Whooping cough at the beginning of the year and diarrhoea during the summer account for this to some extent. I cannot give any specific cause for this increase except the usual ones which are always in operation, and I feel convinced that we shall return quickly to our normal condition of steady progress in the matter of health. Mr. Abbot, the Sanitary Inspector, has supplied me with the following particulars:— Summary of Nuisances dealt with during the year, 1898. TABLE I. Number of houses and premises visited including 651 house to house inspections 1684 visits to Courts and Alleys within the District 48 „ special complaints received and attended to 43 „ reinspections after service of notice 335 „ nuisances discovered 1008 5 Number of nuisances outstanding December 31st, 1897 15 „ „ abated 988 „ „ outstanding December 31st, 1898 20 „ preliminary notices issued 165 „ statutory „ „ 213 „ letters written 278 „ summonses taken out 5 „ convictions or orders obtained 5 All the summonses taken out were for the non-compliance with the nuisance notices served. TABLE II. Description of Nuisances dealt with. Accumulation of offensive matter, etc. 32 Animals, etc. kept so as to be a nuisance 7 Cisterns in houses cleansed, repaired, covered, etc. . 63 Overflow pipes disconnected from drains 2 Drains, examined, tested, etc. .. 30 „ unstopped, trapped, repaired, etc. 121 „ disconnecting traps provided 3 „ reconstructed 4 Dust bins, new, provided 73 „ repaired, etc. 17 Dampness, roofs repaired 78 „ gutters and downspouts repaired, etc. 63 „ yard, etc. repaired 4 Houses supplied with water 1 „ cleansed and repaired 198 „ ovecrowded 8 „ closed, unfit for human habitation 5 Water closets, new, provided 8 „ repaired 69 „ new apparatus provided 4 ., supplied with water 211 Unsound food, seizure of fish 2 „ meat 2 „ tomatoes 2 grapes 1 The Common Lodging Houses.—The whole of the Common Lodging Houses within the District 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 during the inspections the houses generally were found to be kept in a fairly clean and satisfactory condition. Number of houses on Register 7 „ lodgers registered for 92 „ visits by day 84, by night 6 90 Dairies, Milkshops, &c,— Number of premises registered January 1st, 1898 25 „ applications to register 1 „ inspections made frequent ' i 6 Bakehouses, Slaughterhouses, &c.—During the year 22 Bakehouses within the district have been frequently visited, and the periodical cleansing of the walls and ceilings attended to, The Slaughterhouses (8 in numher) have also been periodically inspected and found to be comylying with the byelaws. Factories, Workshops, Schools, &c —The Factories, Workshops, Schools, Laundries, &c. have received attention during the year and found to be kept in a satisfactory condition. Infectious Disease.— Number of houses inspected on occurrence of infectious disease 72 „ infectious disease notifications 81 „ houses disinfected 51 „ stripped and cleansed .. 15 „ articles of clothing, bedding, &c. disinfected in steam disinfector 235 „ patients removed to Isolation Hospital 40 Canal Boats Act, 1877 & 1884.—On the 1st of January, 1898, 247 Canal Boats were on the Register at Brentford, and during the year 6 applications have been received to register Canal Boats as dwellings. Of these 3 were new barges and 3 were registered on account of change of ownership, and as each complied with the requirements of the Acts and Regulations the applications were granted. 229 inspections have been made at uncertain times, and during the inspections the occupants of the boats at all times were ready to afford every facility for inspection and the cabins kept in a clean and satisfactory condition. The number of contraventions of the Acts and regulations met with during the inspections has been 39. Complaint notes have been forwarded to the owners in 14 cases, and verbal cautions have been given in the remaining 25 instances. The following is a list of the contraventions met with— Absence of certificate 17 Certificate not identifying 3 Not properly marked 2 Separation of sexes 1 Cabins requiring painting 5 No proper water vessel 6 Overcrowding 3 Change of Master 2 During the year there have been no cases of infectious disease on board the boats. One cabin has been fumigated after the occurrence of a case of fever arising in the Watford District. I am, Gentlemen, Your obedient servant, Brentford, HENRY BOTT, March 27th, 1899 Medical Officer of Health.