BRE 048 ANNUAL REPORT of the Medical Officer of Health of the BRENTFORD URBAN DISTRICT COUNCIL, 1 9 O 8 . BY HENRY BOTT, M.R.C.S., L.R.C.P. London, MEDICAL OFFICER OF HEALTH, AND SUPERINTENDENT, ISOLATION HOSPITAL. THE URBAN DISTRICT COUNCIL OF BRENTFORD. SANITARY COMMITTEE 1907-8. Chairman. J. B. MILBURN, Esq. The Chairman of the Council. EVAN PHILLIPS, Esq., J.P. The Vice=Chairman of the Council. J. J. DOREY, Esq. Messrs. J. CLEMENTS, H. NEWENS, and C. E. SAUNDERS. Medical Officer of Health and Superintendent, Isolation Hospital. HENRY BOTT, m.r.c.s., l.r.c.p., London. Sanitary Inspector. H. COLEMAN, assoc. royal san. inst. Brentford Urban District Council. ANNUAL REPORT of the MEDICAL OFFICER of HEALTH FOR THE YEAR 1908. To the Chairman and Members of the Brentford Urban District Council. April 1st, 1909. Gentlemen. I beg to present my report upon the health and sanitary condition of the Brentford Urban Sanitary District for the year 1908. POPULATION. I estimate the population for the whole district at the end of June to be 16,194, and of the several ecclesiastical districts into which it is divided. I allot to St. George's with St. James' 4919, to St. Paul's 9277, and to New Brentford 1998. Thus the population of Old Brentford is 14,196, and New Brentford 1998. BIRTHS. The number of births has been 464, of which 234 were males and 230 females. The birth rate is 28.6 per thousand, which is 3.7 lower than last year, and 4.8 lower than the average of the last 10 years, in fact it is the lowest birth rate for many years. DEATHS. The number of deaths occurring in Brentford during the year has been 174, of which 87 were males and 87 females. In St. George's 47, St. Paul's 100, and New Brentford 27. The death rate in the three districts respectively is St. George's 9.5, St. Paul's 10.7, and New Brentford 13.5. The Cottage Hospital is in New Brentford where 2 deaths occurred, and the Isolation Hospital is in St. George's where I am happy to say no death took place during the year. The death rate for the whole district is 10.7 per thousand which is 3.2 lower than last year, and 5.1 lower than the average of the last 10 years, and also the lowest I have ever recorded. 4 CORRECTED DEATH RATE. I have again been supplied by the County Medical Officer with the names of the inhabitants of Brentford who have died outside the district, but I am unable to allot them to the several districts as the addresses are not always given. It is likewise impossible to say which came from New Brentford and which from Old Brentford. The total number is 67, who died in the various institutions given below as against 75 last year. These when added to the 174 deaths which occurred in the town give a total of 241, which, presuming that all the deaths which were registered in Brentford were inhabitants, is a correct account of the total number of deaths which Brentford suffered during the year, and gives a total death rate of 14.9 per thousand. The first correct return was made in 1905 when it was 17.6, in 1906 it was 17, and in 1907 it was 19.2 per thousand. Brentford Workhouse Infirmary 42 Middlesex County Asylum 9 West London Hospital 8 St. Bartholomew's Hospital 1 St. Thomas's Hospital 1 Lying-in Hospital 1 Fulham Infirmary 1 Butchers' Almshouses 2 River Thames 1 Hammersmith Baths 1 14 of these deaths were due to senile decay, 6 to tubercular disease, and 13 to diseases of the lungs. INQUESTS. 19 inquests have been held, being 3 more than last year. Death resulted from drowning in 5 cases, suffocation in bed 4, heart disease 4, accidents 2, bleeding 1, pleurisy 1, asphyxia 1, and syncope 1. The following epitomises the ages at which death occurred. Deaths under 1 year 56 73 deaths under 5 years ,, from 1 to under 5 years 17 ,, ,, 1 5 ,, 5 ,, 15 ,, 6 101 deaths over 5 years ,, ,, 15 ,, 25 ,, 5 ,, ,, 25 ,, 65 ,, 59 ,, over 65 years 31 8 of these deaths occurred in persons over 80 and 1 was over 90 years. The next table shows the distribution of the mortality of the three districts of the town during the last ten years. 5  1899 1900 1901 1902 1903 1904 1905 1906 '1907 1908 Average for 10 years St. George's 16.6 10.1 18.9 11.7 13.5 19.2 15.6 14.5 15.7 8.5 14.5 St. Paul's 19.5 17.5 15.4 16.4 11.9 13.2 11.0 12.4 13.5 10.7 14.1 New Brentford 22.3 24.3 20.7 20.7 15.8 21.3 19.9 16.4 16.4 13.5 19.1 INFANT MORTALITY The rate of this mortality or the proportion of deaths under I year to every 1000 births is 120.6, which is 7 higher than last year, (which was the lowest recorded for many years), but 34.6 lower than the average of the last ten years. In analysing the causes of these deaths I find that 15 were due to Diarrhceal diseases, 8 to premature birth, 3 to Congenital Defects, 7 to Debility and Wasting from birth, 4 to Convulsions, 10 to Diseases of the Lungs, 4 to overlying, which could easily have been prevented if parents would give up the evil habit of sleeping with their babies in bed with them, and the remaining 5 to various other causes. The following table gives the rate and average Infant Mortality for the last 10 years. 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 Average for 10 years 187.1 138 193.8 176.6 125 161.4 115 140.7 113.6 120.6 147.2 The following are the deaths from the principal Zymotic diseases. SMALL POX.—None. MEASLES.—None. SCARLET FEVER.—None. WHOOPING COUGH.-One. DIPHTHERIA AND MEMBRANOUS GROUP.-Two. TYPHUS FEVER.—None. ENTERIC FEYER.—One, in a child 6 years old. DIARRHŒA AND ENTERITIS.—17, 15 of which were in infants under the age of 1 year. The number of deaths from these 8 zymotic diseases has been 21 and the zymotic death rate is 1.2 per thousand, which is .8 lower than last year and 1.9 lower than the average of the last 10 years. This year there has been no epidemic. There were 42 cases of Scarlet Fever notified but they were all in mild cases and consequently caused no deaths. The greater majority were treated at the 6 Isolation Hospital. There were 26 cases of Diphtheria notified and as there were only two deaths I am led to believe that parents now recognize how necessary it is to send at once for a doctor in all cases of sore throat so that Antitoxin may be used early, and I may here mention that the Council still supply medical men with Antitoxin free for use in the town. The number of deaths from Diarrhoea is too large, although less than usual, and I would again impress upon parents that they can- not be too particular in the food they give their infants. The milk should be boiled as soon as it arrives, the bottle cleansed directly after use and kept in cold water till it is required, and, above all, don't let babies sit at your table, which is so common a practice. 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 Average for 10 years. Number of births 497 500 516 532 536 545 530 476 519 464 511.5 Birth rate per 1000 32.8 32.6 33.9 34.7 34.8 34.8 33.6 29.9 32.3 28.3 32.8 Deaths from all causes 297 244 262 237 200 252 208 216 234 174 232.4 Death rate per 1000 19.6 15.9 17.2 15.4 12.9 16.1 13.1 13.5 13.9 10.7 14.8 Deaths from Small Pox 0 0 0 0 0 0 0 0 0 0 0 ,, Measles 3 10 7 5 0 26 0 4 12 0 6.7 „ Scarlet Fever 3 1 1 0 0 0 4 7 5 0 2.1 ,, Whooping Cough 4 0 7 0 7 3 2 3 8 1 3.5 „ Diphtheria 2 7 2 8 3 3 11 12 6 2 5.6 ,, Typhus Fever 0 0 0 0 0 0 0 0 0 0 0 ,, Enteric Fever 2 1 2 0 1 4 1 1 1 1 1.4 „ Diarrhœa 53 23 38 22 13 34 16 32 1 17 24.9 „ 8 Zymotic diseases 67 42 57 35 24 70 34 59 33 21 44.2 Death rate of Zymotic diseases 4.4 2.7 3.7 2.2 1.5 4.4 2.1 3.7 2.0 1.2 2.7 PHTHISIS. Last year I drew your attention to the large number of deaths caused by pulmonary tuberculosis and other tuberculous diseases, which numbered 45. This year the number of deaths inside and outside the district has been reduced to 26, and I feel sure it will be further reduced if proper care is taken to prevent the spread of the disease. I will again repeat the simple measures which should be taken in all cases. 7 (1) Always live and sleep in a room with the windows open. (2) Sleep alone. (3) Expectorate into a pot containing disinfectant, or into a rag which must be immediately burnt. (Note the Council supply disinfectants free to the poor.) (4) Do not spit on the floor, in the street, or in any public conveyance. I feel sure that the compulsory notification of Phthisis by Poor Law Medical Officers will be of great benefit, and I hope at no distant date that, notifications will be generally compulsory as much can be done by periodical disinfection and instruction to check the spread of this dreadful scourge. INSANITARY PROPERTY. Continuing the work which was commenced last year after the visit of the Local Government Board Medical Inspector, several blocks of insanitary property have been reported on as being unfit for human habitation. Nos. 1, 6 and 7, Troy Town Passage, and No. 4, Back Lane. As mentioned in my report for 1907, the magistrates adjourned the hearing of these cases for a month to enable the defendant to submit specifications of proposed works. This was not acted upon and the court ordered a second adjournment with a like result. The court thereupon made a closing order in each case with costs. The houses are now unoccupied. Nos. 1, 2, 3 and 4, Cromwell Place, and Nos. 6 and 8, Back Lane. These cases were also adjourned for the same reason as above. Eventually a closing order was granted in respect of 6 and 8, Back Lane and 4, Cromwell Place. The owner appealed against the decision of the magistrates. The appeal was heard before the Lord Chief Justice on May 28th, and was dismissed with costs. The three houses remain unoccupied. Nos. 10 and 11, Back Lane. The owner upon receipt of the notices served under the Housing of the Working Classes Act, 1890, closed the houses but refused to give an undertaking not to relet. Shortly afterwards it was ascertained that the owner had entered into negotiations for the sale of the property, presumably to evade the notices. Upon this the Council authorised proceedings to be taken, and the magistrates granted an order in each case prohibiting their occupation with £3 3s. costs. The houses remain unoccupied. Nos. 1, 2, 3, 4, 5, 6, 7, 8 and 9, Harding's Court. As a result of an inspection with the Sanitary Inspector this block of property was found to be in an extremely dilapidated and uninhabitable condition. The property consists of 4 tenements and 5 self contained dwellings, containing 28 rooms. No less than 7 cases of Overcrowding were detected, and in two instances your Inspector was compelled to institute proceedings in order to procure an abatement of the nuisances. The owner was communicated with, and he, accompanied by the Sanitary Inspector, visited the property and 8 convinced himself that the houses were unfit for habitation and gave the tenants notice to quit, No further proceedings were taken in the matter and the houses are all unoccupied. Nos. 74 and 75, High Street. These houses were reported upon. Certain repairs have been carried out and the houses are now occupied. Nos. 29, 30, 31 and 32, Catherine Wheel Yard. I reported that these houses were unfit for human habitation being back to back with some houses which were closed several years ago. In accordance with a resolution of the Council the owner was communicated with and requested to close the houses. I am pleased to say he readily acquiesced, and the houses remain unoccupied. In addition 8 houses in Pottery Road, known as Pottery Cottages, and 10 houses in Brook Road, North, known as Crane's Cottages have been reported upon. The owners have expressed their willingness to carry out the necessary works in order to put the houses in habitable condition. It will be seen from the above that something has been done to remove the black spot from Brentford, but very much more will be required before the Town can be modernised. There are scores of back to back houses very old and dilapidated which ought to be closed, some are built chiefly of wood which are extremely dangerous in case of Fire. The difficulty I find in dealing with any of these properties is the organised delay which is adopted. After I have inspected the houses a letter is written to the owner who promises to do everything required. He is so leisurely in doing this, that he is pressed to make a beginning. Then he sends in a specification of what he thinks is necessary which is always quite inadequate, and so the ball is kept rolling. Meanwhile it is hoped that this business will occupy my attention and that I shall not worry the owners of other property as bad as this one. Although progress is thus slower than I could wish I am determined to continue my efforts, and in the end overcome the passive resisters. ISOLATION HOSPITAL. The following table shows the number of patients treated at the Brentford Isolation Hospital during the year 1908. Patients under treatment Dec. 31st, 1907. Scarlet Fever 8 4 Diphtheria 1 9 Admitted in 1908. Scarlet Fever 39 Diphtheria 8 47 Total 56 9 Discharged during 1908. Scarlet Fever 46 Diphtheria 9 55 Under treatment Dec. 31st, 1908 1 Scarlet Fever 1 Total 56 No deaths occurred in the Hospital during the year. The number of cases admitted during the year was small, there being 47, against 119 in 1907. One case of Puerperal Fever was removed to the workhouse infirmary. Although the work at the Hospital has not been so heavy as in previous years the nursing has been carried on to my entire satisfaction, and the matron and the nurses have been most zealous in the discharge of their duties, and the Hospital has been a model of cleanliness and order. The porter also has carried out all his duties thoroughly and efficiently, and the grounds are always a model of tidyness. INFECTIOUS DISEASES (NOTIFICATION) ACT. Under this Act I have received 89 certificates, being a decrease of 86 on the previous year. The following table shows the number of notifications received from Medical Practitioners during the various months of the year. Month. Scarlet Fever. Diphtheria & Memb. Croup. Enteric Fever. Puerperal Fever. Erysipelas. Total. January 5 3 .. .. 2 10 February 4 4 .. .. 3 11 March 7 3 .. .. 1 11 April 5 2 .. .. .. 7 May 9 4 .. .. 1 '4 June .. 1 .. 1 1 3 July .. 2 .. .. 2 4 August 3 .. .. .. .. 3 September 3 1 .. .. 2 6 October .. 3 .. 4 7 November 5 1 1 .. .. 7 December 1 2 1 .. 2 6 Totals. 42 26 2 1 18 89 10 There has been a considerable decrease in the number of cases of Scarlet Fever during the year, 42 cases being notified as compared with 105 cases in 1907. The following table shows the School Incidence St. Paul's 9 Ealing Road 5 Rothschild 5 St. George's 2 St. Lawrence's 2 Private Schools (outside) 2 St. John's 1 Boston Road Temporary 1 Schools outside (not private) 1 Over School Age 7 Under School Age 7 Total 42 DIPHTHERIA AND MEMBRANOUS CROUP. Twenty-six cases were notified during the year, 25 being Diphtheria and 1 Membranous Croup, being a decrease of 26 from 1907. The following shows the School Incidence: St. Paul's 5 Private Schools 3 Rothschild 2 St. Lawrence's I Over School Age 9 Under School Age 6 26 ENTERIC FEVER. There have been 2 cases of Enteric Fever notified during the year. Both cases were nursed at home and 1 case proved fatal. The following table shows the number of cases of Enteric Fever notified during the past six years:— 1903 1904 1905 1906 1907 1908 Total. Average for 6 years. 9 30 6 5 8 2 60 10 CLOSURE OF SCHOOLS. It has not been found necessary to close any of the schools on account of epidemic diseases. 11 I wish again to express my thanks to the Masters and Mistresses of the various public elementary schools for the help they have given me and for the vigilance which they have exercised during the past year. From the constant information received, and by bringing children with suspicious symptoms at once to me, I have been able to trace infection at its commencement and prevent an epidemic. I earnestly hope that they will not relax their efforts and that they will continue to assist me. I must not omit to express my gratitude to Sister Lucas and the Nursing Staff at the Cottage Hospital who work with such devotion in tending the sick and infirm poor. When I picture the state of affairs before the Hospital was founded I wonder how we got on at all, and 1 am convinced that many lives are saved by their care and skill, besides the enormous amount of good that they do in bringing habits of cleanliness into so many poor homes. I sincerely trust that the good work may continue and that the subscriptions to the Hospital will not fall off. Before I conclude, I should like to say a few words about Mr. Coleman your Sanitary Inspector. During the whole time 1 have been Medical Officer, the Council have never had an Inspector so capable, or one who has served so faithfully, and carried out his difficult and dangerous duties at the same time so efficiently and with so little friction. I hope that his services will be retained for a long time for it would be disastrous to lose him now he has made himself thoroughly acquainted with the difficult problem of dealing with houses under the Housing of the Working Classes Act which has been commenced. He has now been appointed over two years and I feel that his salary is too small for his abilities and insufficient for his position. I earnestly hope that the Council will take this into consideration at an early date. I am, Gentlemen, Your obedient Servant, HENRY BOTT, Medical Officer of Health. 12 TABLE I. Vital Statistics of Whole District during 1908 and previous years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Non-Residents Registered in Public Institutions in the District. Deaths of Residents Registered in Public Institutions beyond the district Nett Deaths at all ages belonging to the District. Under I Year of Age. At all Ages No. Rate* No. Rate per 1000 Births registered No. Rate * No. Rate * 1898 14974 523 34.9 104 198.8 312 20.8 1899 15142 497 32.8 93 187.1 297 19.6 1900 15478 500 32.6 69 138.0 244 15.9 No Public Institutions in District. 1901 15163 516 33.9 100 193.8 262 17.2 1902 15330 532 34-7 94 176.6 237 15-4 1903 1904 15474 15618 536 545 34-6 34.8 67 88 125.0 161.4 200 252 12.9 16.1 1905 15762 530 33-6 61 115-0 208 131 7° 278 17.6 1906 15906 476 29.9 67 140.7 216 13-5 55 271 17.0 1907 16050 519 32.3 59 113.6 234 ■3-9 75 309 19.2 Averages for years 1898-1907 15489 517 33.4 80 155 246 15.8 1908 16194 464 28.6 56 120.6 174 10.7 67 241 14.9 *Calculated per 1000 of estimated Population. Total population as per Census, 1901.—All ages, 15163. Number of inhabited houses, 3035. Average number of persons per house, 6. Area of District in acres (exclusive of area covered by water), 1080. Institutions outside the District receiving sick and infirm persons from the DistrictBrentford Workhouse Infirmary, Isleworth. Middlesex County Asylum, Wandsworth. West London Hospital. St. Thomas' Hospital. St. Bartholomew's Hospital. Lying in Hospital. Fulham Infirmary. Butchers' Alms Houses. 13 TABLE 11. Vital Statistics of separate Localities in 1908 and previous years. Names of Localities. Whole District Year. Population estimated to middle of each year Births registered Deaths at all Ages Deaths under 1 year 1898 14974 523 312 104 1899 15142 497 297 93 1900 15478 500 244 69 1901 15163 516 262 100 1902 15330 532 237 94 1903 15474 536 200 67 1904 15618 545 252 88 1905 15762 530 278 61 1906 15906 476 271 67 1907 16050 519 309 59 Averages of Years 1898 to 1907 15489 517 266 80 1908 16194 464 241 56 14 TABLE III. Cases of Infectious Disease notified during the Year 1908. Cases notified in Whole District. Total Cases Notified in Each Locality No. of Cases Removed to Hospital from Each Locality. Notifiable Disease. At all Ages. - At Ages—Years. St. Lawrence's or New Brentford. St. Paul's St. George's Totals. St. Lawrence's or New Brentford. St. Paul's St. George's. lotal cases removed to Hospital. | Under 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwards Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including MembranousCroup 26 2 8 7 5 4 .. 5 20 1 26 .. 8 .. 8 Erysipelas 18 2 .. 1 2 11 2 3 7 8 18 .. .. .. .. Scarlet fever 42 .. 10 26 3 3 .. 5 26 11 42 5 24 10 39 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 2 .. •• 1 •• 1 .. 1 1 .. 2 .. .. .. .. Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 1 .. .. .. 1 .. .. .. 1 •• 1 •• 1 •• 1 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 89 4 18 35 11 19 2 14 55 20 89 5 33 10 48 Isolation Hospital—Claypond's Lane, Brentford Total available beds 28. Number of Diseases that can be concurrently treated 3. 15 TABLE IV. Causes of, and Ages at, Death during the Year 1908. Causes of death. Deaths at the subjoined ages of "Residents" whether occurring in or beyond 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. Small-pox ». .. .. .. .. .. .. .. Measles .. .. .. 1 1 .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. Whooping Cough 1 .. 1 .. .. .. .. Diphtheria and Membranous Croup 2 .. 2 .. .. .. .. Croup .. .. .. .. .. .. .. Fever— Typhus .. .. .. .. .. .. .. Enteric 1 .. .. 1 .. .. .. Other continued .. .. .. .. .. .. .. Epidemic Influenza 2 .. .. .. .. .. 1 Cholera .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. Diarrhoea 5 5 .. .. .. .. .. Enteritis 12 10 2 .. .. .. .. Puerperal Fever 1 .. .. .. 1 .. .. Erysipelas .. .. .. .. .. .. .. Phthisis (Pulmonary Tuberculosis) 16 .. .. .. 3 13 .. Other Tuberculous Diseases 10 3 1 3 1 2 .. Cancer, Malignant Disease 9 .. .. .. .. 2 7 Bronchitis 23 5 1 .. .. 9 8 Pneumonia 24 5 7 .. 2 8 2 Pleurisy 1 .. .. .. .. 1 Other Diseases of Respiratory Organs 2 .. .. .. .. .. 2 Alcoholism—Cirrhosis of Liver 4 .. .. .. .. 4 .. Venereal Diseases 1 1 .. .. .. .. .. Premature Birth 12 12 .. .. .. .. .. Diseases and Accidents of Parturition 2 1 .. .. .. 1 .. Heart Diseases 25 1 .. .. .. 14 10 Accidents 12 4 .. .. 1 6 1 Suicides 2 .. .. .. .. 2 .. All other causes 73 13 3 3 1 29 24 All causes 241 61 17 7 9 92 55 16 TABLE V. Infantile Mortality during the year 1908. Deaths from stated causes in weeks and months under one year of age. Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4. Weeks. Total under 1 Month. 1-2 Months. 2-j Months. 3-4 Months. 4-5 Montns. 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. All causes Certified 13 3 .. 3 19 11 6 6 3 .. 1 2 2 2 4 56 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Common Infectious Diseases— Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diplitheria: including Mem branous Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoeal Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea, all forms .. .. .. 1 1 .. 1 1 1 .. .. .. .. .. .. 2 6 Enteritis, Muco-enteritis, Gastro-Enteritis .. .. .. .. .. 5 1 .. .. .. 1 1 .. .. .. 1 9 Gastritis, Gastro intestinal Catarrah .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Wasting Diseases— Premature Birth 5 2 .. .. 7 1 .. .. .. .. .. .. .. .. .. .. 8 Congenital Defects 2 .. .. .. 2 .. 1 .. .. .. .. .. .. .. .. .. 3 Injury at Birth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Want of Breast-milk, Starvation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Atrophy, Debility, Marasmus 2 .. .. .. 2 .. 1 8 .. .. .. 1 .. .. .. .. 7 Tuberculous Diseases— Tuberculous Meningitis .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 2 Tuberculous Peritonitis: Tabes Mesenterica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases.. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. Other Causes — Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Convulsions 1 1 .. .. 2 1 .. .. .. .. .. .. .. .. 1 .. 4 Bronchitis 1 .. .. .. 1 3 .. .. .. .. .. .. .. .. .. 1 5 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia .. .. .. .. .. 1 1 1 .. .. .. .. .. 2 .. .. 5 Suffocation, overlying 1 .. .. 2 3 .. .. 1 .. .. .. .. .. .. .. .. 4 Other Causes 1 .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. 2 Totals 13 3 0 3 19 11 6 6 3 0 1 2 0 2 2 4 56 Deaths from all causes at all ages .. .. . „ 241 Population, estimated to middle of 1908 .. .. 16194 17 Annual Report of the Medical Officer of Health for the year 1908, on the Administration of the Factory and Workshop Act, 1901, in connection with Factories, Workshops, Laundries, Workplaces and Homework. 1.—INSPECTION. Including Inspections made by Sanitary Inspector. Premises. Number of Inspections. Written Notices Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 13 3 Nil. Workshops (Including Workshop Laundries) 69 8 Nil. Total 82 11 Nil. 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions, Found. Remedied. Referred to H.M. Inspect'r (1) (2) (3) (4) (5) Nuisances uuder the Public Health Acts: — Want of cleanliness 3 3 .. .. Want of ventilation Overcrowding Want of drainage of floors 1 1 .. .. Other Nuisances 1 1 1 .. Sec. 22 Public Health Act Amendment Act has been adopted. Sanitary accommodation— Insufficient 1 Unsuitable or defective 3 3 .. .. Not separate for sexes Offences under the Factory and Workshop Act:— Illegal occupation of Underground Bakehouse (s. 101). Nil. Nil. Nil. .. Breach of special sanitary requirements for Bakehouses (ss. 97 to 100) 4 4 .. .. Other Offences (Excluding offences relating to outwork which are included in Part III. of the Report 1 1 .. .. Total 14 13 1 .. 18 3 —HOME WORK. Nature of Work. Lists received from Employers. Addresses of Outworkers received from other Councils Inspections of Outworkers' Premises. Lists. Outworkers. Contractors. Workmen. Wearing Apparel. Making, &c. 2 •• 3 i 4 5.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the Year. Number. (1) (2) Important Classes of Workshops, shop as Workshop Bakehouses, may be enumerated here Workshops 84 Bakehouses, Under Ground 2 Ditto Above ground 12 Total number of workshop on Register 98 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories: — Failure to affix Abstract of the Factory and Workshop Act (s. 133) 1 Action taken in matters referred by H.M. Inspectors as remediable under the Public Healths Acts, but not under the Factory and Workshop Act (s. 5) Noticed by H.M Inspector 1 Reports (of action taken) sent to H.M. Inspector. 2 Other .. Underground Bakehouses (s. 101): Certificates granted during the year Nil. In use at the end of the year 2 19 ANNUAL REPORT OF THE SANITARY INSPECTOR FOR THE YEAR 1908. Public Health Department, Clifden House, Brentford, 15th Jan., 1909. To the Chairman and Members of the Sanitary Committee. Gentlemen, I have the honour of submitting to you my second Annual Report, in which is recorded particulars of the work done in connection with the Sanitary Inspection of the District during the year 1908. INSPECTION OF DISTRICT. During the year a systematic inspection of the district has been made, in accordance with the General Orders of the Local Government Board, and the nuisances discovered during such inspection have been dealt with in the manner provided by the Public Health Act and Bye-laws in force. In all some 2,067 visits were paid to premises in connection with the work of the department, and include visits to Dairies, Cowsheds, Milkshops, Canal Boats, Common Lodging Houses, ordinary inspections, visits to houses from which complaints of a nuisance have been received, visits to works in progress, and to houses in which cases of infectious disease have occurred. COMPLAINTS. Sixty-one complaints relating to nuisances in the district have been received. Each complaint was duly recorded in the Complaint Book, the premises visited, and all necessary steps were taken in respect thereof. NOTICES SERVED. As a result of these inspections 225 intimation and 114 statutory notices were served, of which the following is a summary: Intimation Notices 225 Notices under Section 94 Public Health Act, 1875 39 ,, ,, 41 ,, ,, 45 ,, ,, 5 Infectious Disease (Prevention) Act 26 Notices under Canal Boats Act 4 Total 339 20 Wherever nuisances were found to exist preliminary notices were served upon the person responsible calling attention to the matter and pointing out the necessary remedial works. If these notices were not complied with reports were made to the Sanitary Committee, and the usual statutory notices were authorised to be served. I regret to record that in two instances it was found necessary to institute legal proceedings to procure the abatement of nuisances arising from overcrowding; in each case an order was made with costs (vide Table ia). Both were extremely bad cases. Father, mother, and four children were discovered occupying one room, used as a living room by day and as a sleeping room at night, having a cubical capacity of 800 cubic feet. In the other case three adult persons (two males and one female) occupied one room under the same conditions with a cubical capacity of 673 cubic feet. It has not been necessary to institute legal proceedings in matters regarding drainage, &c., although at times it has been difficult to obtain compliance with requests made. Indeed I am afraid that in order to secure greater efficiency it will be necessary to more strictly enforce the provisions of the Public Health Act. The following table shows the number and nature of nuisances dealt with during the year. These do not include nuisances abated or prevented at the verbal request of your Inspector. Nature of Nuisance dealt with. Number. Accumulation of offensive matter removed 4 Animals so kept as to be a nuisance 10 Caps fixed to intercepting traps 6 Drains unstopped, cleansed and repaired 29 ,, reconstructed 55 Downspouts disconnected from drains 10 Dustbins provided 63 Dustpits abolished 1 Cesspools abolished 2 Effective means taken to prevent damp walls 5 Gutters and downspouts affixed 4 ,, „ repaired 29 Houses and rooms cleansed 50 House floor, walls and ceilings repaired 15 Manure pit provided 1 „ repaired 1 New soil pipes erected 6 Overcrowding 20 Pedestal w.c.'s fixed 51 Pans and traps fixed 11 Carried forward 373 21 Nuisances Dealt with—Continued, Nature of Nuisance dealt with. Number. Brought forward 373 Roofs repaired and rendered watertight 21 Stable drain disconnected from storm water drain 1 Surface water drain disconnected from foul water drain 1 Surface water drains provided 10 Sink waste pipes repaired, provided, or trapped 19 „ ,, disconnected from drain 8 Sinks provided 2 Stable floor paved 1 Smoke nuisances abated 2 Water cisterns cleansed and provided with covers 9 ,, ,, provided 4 Water-closets abolished 10 ,, erected 9 ,, repaired, ventilated, or cleansed 68 ,, flushing cisterns provided 29 „ provided with water 13 Yard areas paved 62 ,, repaired 4 Miscellaneous 11 Total 657 Bakehouses. Floor cemented 1 Drain removed from interior 1 Bakehouse to lime wash 3 Total 5 Dairies and Cowsheds. Cesspool removed from interior of cowshed 1 Drains amended 1 Gullies removed from dairy and cowshed 3 Manure pit abolished 1 Yards cleansed 2 Cowshed limewashed 1 Dairy ventilated 1 Dairy floor concreted 1 Walls cemented 1 Total 12 22 MEAT AND FOOD INSPECTION. Frequent inspections have been made of premises and shops where food is prepared or kept for sale ; and in fourteen instances the food which came under my observation was found to be unwholesome. In seven instances the articles were destroyed by consent of the owner upon attention being called to the condition of the food; and in seven instances application was made before a Justice of the Peace and an order, in each case, obtained to destroy the food so as to prevent it being used for the food of man. The carcases of two pigs in an extremely emaciated and dropsical condition were seized from a butcher's shop, and a quantity of beef and pork from another shop. The matters were fully reported to your Committee, and the persons in whose possession the same were found were severely reprimanded, and no further action was taken. In another instance a quantity of beef and mutton was seized from the basement of a sausage maker's premises, the same being utterly unfit for food. Proceedings were taken, and the defendant was fined 20s. and £3 3s. costs (vide Table ia). The following table shows the amount of food condemned during the year as being unfit for human food : Article. Quantity. Pears 28 lbs. Apples 19 lbs. Bananas 25 Strawberries 134 lbs. Tomatoes 4½ lbs. Rabbits 9 Fish 250 lbs. Bacon 82 lbs. Shrimps 48 lbs. Beef, Mutton and Pork 84 lbs. Crabs 67 Winkles 19 cwts. Carcases of 3 pigs DAIRIES, COWSHEDS and MILK-SHOPS. The above have been inspected as occasion required and the regulations enforced. Five applications for registration as Purveyors of Milk have been made during the year, three being in respect of existing premises the occupation of which have changed hands. The interior drainage 23 of one cowshed at Boston Farm has been amended so as to comply with the regulations. In one instance milk was found stored in a building wherein a drain inlet existed. Notice was given to the owner, who had the gully removed. The floors and walls of another dairy have been rendered with cement and the ventilation improved. Proceedings were taken for carrying on the trade of a Dairyman and Purveyor of milk without being registered; the defendant was fined 20s. and costs (vide Table ia). OFFENSIVE TRADES. The premises whereon offensive trades are carried on have been regularly inspected and kept, as far as the nature of the business will allow, in a clean manner. It was discovered that the business of a rag, bone and skin merchant had been established in Boar's Head Yard without the consent of the Local Authority. The occupier was warned that he had committed an offence under the Public Health Act and requested to discontinue the business. The warning given did not have the desired effect. Proceedings were taken, and the defendant was fined 20s. and costs (vide Table ia). Notice of appeal was given but afterwards withdrawn. SLAUGHTER-HOUSES. There are eight slaughter-houses in the district, three of which are subject to annual renewal. Two licenses have been granted during the year, one for premises formerly licensed in the Ham and the other for premises at rear of the High Street. They have been periodically inspected and the bye-laws enforced. At the request of a local butcher I examined the carcase of a pig which had been slaughtered the previous night. The condition of the carcase was such as to suggest Swine Fever. The matter was reported to the Inspector of Police (as Inspector under the Contagious Diseases Animals Act), who communicated with the Board of Agriculture. After an examination had been made by the Board's Veterinary Surgeons the carcase was destroyed by burning at the Destructor and the interior of the slaughter-house cleansed and disinfected. In October I discovered that the slaughtering of pigs, &c., was being carried on in a shed at the rear of Walnut Tree Road. As the premises referred to had not been registered or licensed by the Council I warned the occupier that he had committed an offence 24 under the Public Health Act, and requested him to cease using the premises for the purpose mentioned. I have every reason to believe that the warning given has had the desired effect. COMMON LODGING HOUSES. The number of Common Lodging Houses remains the same as last year, viz., 7. The houses afford accommodation for 178 lodgers. They have been inspected both by day and night. I am pleased to report that no cases of infectious disease have been notified at, or traced to, any of the houses. CARAVANS. The dwelling vans of showmen, who visit the town for the purpose of attending the fairs, were inspected in order to ascertain their sanitary condition, and also for the purpose of detecting any infectious disease which might exist among the inmates. The condition of the vans was satisfactory, and no cases of infectious disease were found among the occupants. BAKEHOUSES. There are fourteen bakehouses on the register. They have all been inspected during the year. In three instances it was found necessary to request the occupier to have the interior walls and ceilings limewashed. The floor of one bakehouse has been concreted and a drain removed from the interior. HOUSE DRAINAGE. During the year the drains of fifty houses and premises have been reconstructed. A large portion of the drains dealt with were exposed and examined under section 41 of the Public Health Act, 1875. The work of reconstructing drains has been carefully supervised by your Inspector, and frequent visits have been made to the premises while such work was in progress. This work involved the laying of 1014 yards of stoneware pipe, and 38 yards of heavy coated cast iron pipe drains, 87 gullies, 15 intercepting traps, 47 pedestal water closets, 4 soil pipes and 17 ventilation shafts were fixed and 55 manholes built, the whole necessitating the application of 156 watertests and 32 smoke and chemical tests. The following is a list of the premises the drains of which have been relaid under my supervision. 25 Situation of Premises. Material used in construction, etc. Remarks No. of Houses Disconnecting and access chambers built Intercepting traps Fresh air inlets fixed Gullies fixed Ventilation shafts fixed Soil pipes fixed Pedestal w.c.'s fixed Water-closets demolished New Water-closets erected Goddard's Yard 1 3 1 1 4 1 •• •• •• •• Stables Nos. 67 and 69, Enfield Road 2 4 1 1 5 •• •• 2 •• •• Iron pipe under each house Nos.21, 23, 25, 27, 29, 31 & 33. Boston Road 7 3 1 •• 4 1 •• 5 2 2 Iron pipe under house New Inn, New Road 1 2 1 1 3 1 •• •• •• •• Existing soil pipe connected Nos. 59, 61, 63 & 65. Enfield Road 4 4 1 1 4 •• •• 4 •• •• •• up Nos. 32 & 33, Eastbourne Road 2 3 1 1 5 1 •• 2 •• •• •• No. 63, Boston Road 1 3 1 1 5 1 1 2 1 •• •• Nos. 103 & 105, Whitestile Road 2 2 1 1 7 •• 2 4 •• •• Nos. 97 to 101, Whitestile Road 8 11 1 1 18 I 1 9 •• •• •• Nos. 55 & 57. Ealing Road 2 3 1 1 4 1 •• 2 2 2 •• Nos. 2 to 20, Phoenix Cottages 10 7 1 1 10 •• 10 •• •• •• No. 11, Westbury Place 1 1 •• 1 1 •• 1 •• •• •• No. 92, Windmill Road 1 1 1 I 2 1 •• 1 •• •• •• Nos. 8, 9, 10, 11 & 12,Town.Meadow 5 3 1 1 11 1 •• 5 5 5 •• No. 326, High Street 1 1 1 1 •• •• •• •• •• •• •• No. 7, The Butts 1 3 1 1 2 •• •• •• •• Existing soil pipe connected No. 154, High Street 1 1 2 1 •• •• •• •• ••up 5° 55 *5 16 87 17 4 47 10 9 CANAL BOATS. During the year 65 canal boats have been examined. I am pleased to report that the condition of the boats and their occupants was satisfactory. The infringements of the Acts and Regulations detected were few and not of a serious nature. They are as follows — 26 Boats not registered 3 No water vessel 2 Cabin leaky 1 No certificates 2 Insufficient ventilation 1 No legal proceedings have been taken in respect of any infringements. Four complaint notes were issued, two of which have been returned to me signed by some duly appointed canal boat officer. Likewise I have signed seven complaint notes issued by various sanitary authorities. One case of Scarlet Fever was notified on board the barge "Colne." The patient (the captain) was at once removed to the hospital, and the remaining occupants of the cabin (mother and two children) were transferred to the barge " Walter," which, fortunately, was void at the time. The cabin was then thoroughly and effectually disinfected with a strong solution of corrosive sublimate, the bedding being sent to the hospital for steam disinfection. Afterwards the occupants were removed back to their own boat, and the cabin of the barge "Walter " disinfected in the same manner. No extension took place although the patient was peeling at the time of removal. There are 312 canal boats on the register, five new boats having been registered during the year (including one which was previously registered by a neighbouring authority). INFECTIOUS DISEASES AND DISINFECTION. During the year 89 cases of infectious diseases have been investigated and reported upon to the Medical Officer of Health, being a decrease of 86 cases as compared with last year. Nature of Disease. Investigated. Removed to Hospital. 1907 1908 1907 1908 Small Pox 1 .. 1 .. Diphtheria 52 25 23 8 Membranous Croup .. 1 .. .. Enteric or Typhoid Fever 3 2 2 .. Erysipelas 14 18 .. .. Scarlet Fever 105 42 96 39 Typhus Fever .. ,, .. .. .. .. .. Puerperal Fever .. 1 .. 1* Totals 175 89 122 48 * Removed to the Isleworth Infirmary. 27 Sixty-seven rooms have been disinfected upon the removal, recovery, or death of a patient, and all bedding and articles likely to retain infection were removed to the hospital for steam disinfection. Twenty-eight rooms of infected houses were stripped and cleansed, as required by section 5 of the Infectious Diseases (Prevention) Act, 1890. One hundred and four reports have been sent to the head masters and mistresses of public and private schools, and to school attendance officers, notifying the presence of disease in houses, and requesting the exclusion of all children from such houses until the premises had been disinfected. Reference to Table 3c shows the precautions taken in order to prevent the spread of disease. In conclusion I again desire to express my appreciation of the support which every member of the Urban District Council has extended to me in my efforts to carry out the oft-times difficult and dangerous duties imposed by the Public Health Acts. I am, Gentlemen Your obedient Servant, H. COLEMAN, Sanitary and Workshop Inspector, and Canal Boats Officer. 28 TABLE I A. PROSECUTIONS. The following particulars are extracted from the Register of Prosecutions. No. Nature of Offence. Fines. Costs. Total. Remarks. £ s. d. £ s. d. £ s. d. I House unfit for habitation •• 7 7 0 7 7 0 Order made to close house 2 Ditto do. 3 Ditto do. 4 Ditto No order made by Justices 5 Ditto • • • • 6 Ditto • • • • do. 7 Ditto • • 5 5 0 5 5 0 do. 8 Ditto Order made to close houses 9 Ditto 10 Ditto 11 Occupying condemned house 0 10 0 •• 0 10 0 12 House unfit for habitation • • 3 3 0 3 3 0 Order made to close house 13 Ditto • • do. 14 Nuisance caused by overcrowding •• 0 6 6 0 6 6 Order made to abate nuisance 15 Ditto • • 0 6 6 0 6 6 do. 16 Carrying on trade of dairyman and purveyor of milk without being registered 1 0 0 1 8 0 2 8 0 17 Being in possession of unsound meat deposited for purpose of preparation for sale 1 0 0 3 3 0 4 3 0 18 Establishing business of a rag and bone merchant without consent of the Local Authority 1 0 0 3 3 0 4 3 0 3 10 0 24 2 0 27 12 0 29 TABLE 2 B. Table showing number of oases of Infectious Disease notified in various Streets in the URBAN DISTRICT OF BRENTFORD during the year 1908—alphabetically arranged. Street or Road. Scarlet Fever *Diphtheria Erysipelas Enteric Fever Puerperal Fever Adelaide Road 1 1 .. .. .. Albany Road 1 .. .. .. .. Avenue Road .. .. .. 1 .. Barge "Colne" l .. .. .. .. Bollo Lane 3 .. .. .. .. Boston Road .. 2 .. .. .. Braemar,, .. .. 2 .. .. Brook ,, ,, 1 1 .. .. .. Caroline Place .. 1 .. .. .. Catherine Wheel Yard 2 1 .. .. .. Clifden Road 1 1 .. .. .. Cressage Road .. .. 1 .. .. Distillery Road 1 .. 1 .. .. baling 2 .. .. .. .. Enfield „ 1 .. .. .. .. Ferry Square .. .. 1 .. .. Green Dragon Lane .. 1 .. .. .. Grosvenor Road .. 1 1 .. .. Grove ,, l 1 .. .. .. Hamilton ,, 1 2 1 .. .. High Street 3 4 2 .. .. Ivy Crescent 2 .. .. .. .. Junction Road .. .. .. .. .. Kew Bridge Road .. .. 1 .. .. Lamb Passage 1 .. .. .. .. Lateward Road 1 1 .. .. .. Layton Road 1 .. 2 .. .. Mafeking Avenue 1 .. .. .. .. Netley Road .. .. 2 .. .. New Road 1 .. .. .. .. North Road 2 .. .. .. .. Old Spring Gardens 1 .. .. .. .. Orchard Road 3 1 .. .. .. Pottery Road .. .. 1 .. .. Starnage Road West .. .. 1 .. .. St. George's Court .. 1 .. .. .. Somerset Road .. .. 2 1 .. The Ham 1 .. .. .. .. Town Meadow 3 1 .. .. .. The Butts .. 3 .. .. .. Westbury Place 1 .. .. .. .. Whitestile Road 1 1 .. .. .. Windmill Road 1 2 .. .. .. York Road 3 .. .. .. .. Totals 42 26 18 2 1 *Including one case of Membranous Croup. 30 TABLE 3 c. PRECAUTIONS TAKEN AGAINST INFECTIOUS DISEASE. Number of cases investigated and reported upon 98 „ re-visits to infected houses 83 ,, rooms disinfected 67 ,, canal boats disinfected 2 ,, ward ,, 1 „ library books „ 18 ,, reports to Head Masters and Mistresses 46 ,, ,, School Attendance Officer, Brentford... 45 ,, ,, ,, ,, Acton 3 „ „ Librarian 11 ,, proceedings under Infectious Diseases Act none ,, convictions none STEAM DISINFECTION. The following articles were removed from infected houses to the Isolation Hospital and subjected to steam disinfection : Number of beds and mattresses 85 ,, pillows 112 ,, bolsters 51 ,, blankets 161 ,, sheets 147 „ quilts, counterpanes, etc. 87 „ other articles 243 Total 886