CHIIS 5 CHISWICK PARISH. ANNUAL REPORT OF THE Medical Officer of Health. 1896. CHISWICK: Printed by Platrier and Sons, High Road. 1897. CHISWICK PARISH. ANNUAL REPORT OF THE Medical Officer of Health. 1896. CHISWICK: Printed by Platrier and Sons, High Road. 1897. Chiswick Urban District Council. Sanitary Department. THE EIGHTEENTH ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH. Mr. Chairman and Gentlemen, Another year having elapsed, it becomes my duty to report to you upon the sanitary condition of our parish during that period, also to render an account of the proceedings taken under the direction of your authority in order to maintain the general health of the district, and improve the conditions under which its inhabitants live. The main features of the year were briefly as follows :— A mild form of scarlet fever was prevalent throughout the year, having shown a tendency to increase during the last month of the previous year (1895). One hundred and twelve cases were admitted into the temporary Isolation Hospital. Measles also prevailed during the first six months of the year. 4 Whooping cough was both prevalent and fatal, commencing in February and terminating in the early part of July. A case of smallpox was brought to my knowledge in May, which was promptly removed to the Smallpox Hospital, and no other case followed. The continuous growth of the parish is evident, as shown by the erection of new dwelling houses and shops, the former more particularly at Gunnersbury, Grove Park, and the Eastern end of the district ; the latter on the main road chiefly. Considerable efforts were made as usual for the improvement of the lowest class of dwellings by the application where necessary of the powers conferred on you by the " Housing of the Working Classes Act," 1890, for closing houses when considered unfit for habitation. The returns of the Registrar of Births and Deaths indicate a birth rate below the average of the past ten years, and almost the same as that of the previous year. The death rate was 14'29 per thousand of the population, being one less than the average for ten years. The zymotic death rate was a trifle higher than the year preceding, and above the average of the past ten years, due in a great measure to the great number of deaths from whooping cough and its complications. Population. In a population enumerated once in ten years only, and subject to fluctuation, the difficulty of forming an approximate estimate increases in proportion as each year of the decennial period passes, also until the next census is taken : in order to avoid this, it has been 5 suggested that a quinquennial enumeration should take place. The excess of births over deaths during the year was 364. I have estimated the population for the middle of the year at 25,182. Births. The number of births during the year was 724 (360 males, 364 females); the birth rate was 28.55 per thousand. For London it was 30.2, and for England and Wales 29.7. Deaths. During the year 360 deaths were registered (166 males, 194 females): five were non-residents not included in the general death rate. The annual rate of mortality amounted to 14.29 per thousand; whilst for London it was 18.2, and for England and Wales 17.1. The deaths tabulated in the usual forms as required by the Local Government Board are to be found at the end of this report. Diseases of the respiratory organs (excluding phthisis) caused 48 deaths, being a decrease of 16 on the previous year (1895). Diseases of the circulatory organs resulted in 23 deaths, showing a decrease of seven on the preceding year. Phthisis and Tuberculosis. Thirty deaths weYe registered from this disease, a decrease of nine on the year 1895. 6 Twenty-five years since this disease was considered to be constitutional, due to inherited weakness aided by unfavourable conditions of life. We now recognise that it is due to a specific micro-organism introduced into the system from without, and that the reception of this micro-organism can be prevented by appropriate means. Tubercular diseases still cause between twelve and thirteen out of every hundred deaths. If these diseases could be entirely removed from the list of diseases, the death rate would be very considerably reduced by the simple elimination of one of the causes of death which is perfectly within the range of preventive medicine. The causes of phthisis are dampness of subsoil, damp houses, which have a decided tendency to predispose to the inroads of phthisis, as also overcrowding, and as a result deficient ventilation. Occupations in which dust is inhaled, more especially when the occupation is of an indoor character, forming a fertile source of the disease. It may also be communicated by means of food, meat and milk more especially. A Royal Commission reported on this subject in April, 1895. The Commissioners report that, "any person who takes tuberculous matter into the body as food, incurs some risk of acquiring tuberculous disease." The chief site of tuberculous disease is in the internal organs. As regards milk, there is little doubt that it is a very fertile source of tuberculous disease, especially in young children. So far as cow's milk is concerned 7 it is fairly conclusive that this disease is conveyed by the milk only when the tuberculous disease affects the udder. The tubercle-bacillus iscontained in the discharges from parts of the body affected with tuberculosis. In lung disease it is discharged by the expectoration ; in consumption of the bowels, known as tabes mesenterica, by the intestinal excreta. Hence the importance of disinfecting these discharges, which when they become dry are a source of danger. The expectoration deposited in a pocket handkerchief, or spat on the floor of the sick room, is so long as it remains moist perfectly innocuous, but when dry becomes dangerous; dust is produced, and when disturbed on the floor or elsewhere, the noxious matter is inhaled, and should a suitable soil be found the disease is propagated. It is a matter of importance that all expectoration should be received into a vessel containing a solution of carbolic acid. Rags should be used instead of pocket handkerchiefs, and at once burnt, or if a handkerchief is used it should be boiled before the matter upon it has had time to become dry or powdery. Should these rules be rigidly carried out there is little or no risk in living with consumptive patients. I find that in Brighton, Bournemouth, and Glasgow, every death which is registered from any form of tubercular disease is fully and carefully investigated by the Sanitary Inspector, who fills up a printed form which gives full details of the illness, the condition of the house, &c., &c. At the time that this information is obtained a 8 notice is served requiring a thorough cleansing and washing of the sick room and its contents. These measures have a tendency to lessen the danger necessarily associated with this disease to other members of the family, or possibly members of another family who may be moving into the infected house. My object in bringing these details before your notice in this report, is with the view of pointing out the great advantage which might be secured by a similar arrangement in this parish. The following table epitomises the ages at which the deaths occurred: Deaths under a year 108 161 under 5 „ from 1 year and under 5 years 53] years of age. „ „ 5 years „ 15 „ 20 15„ ,, 25 „ 12 194 over 5 „ „ 25 „ ,, 65 „ 88 years of age. 11 it 65 „ and upwards 74 Thirty-three deaths were registered between the ages of 70 and 80 and nineteen between 8) and 90, out of which number one attained the age of 90. Infantile Mortality. The rate of this mortality or the proportion of deaths under one year in every thousand births was 149. For London it was 160; and for England and Wales .148. The following diseases proved most fatal to infants and young children (under 5 years of age): 9 Diseases of the Respiratory Organs, viz.: Bronchitis, Pneumonia, and Pleurisy 24 Measles. 10 Whooping Cough 28 Diarrhoea 21 Tubercular Meningitis 10 Tabes Mesenterica 4 Marasmus or General Atrophy 6 Convulsions 31 Total 134 Deaths from Zymotic Diseases. Scarlet Fever 3 Diphtheria 8 Membranous Croup 4 Enteric or Typhoid Fever 1 Erysipelas 1 Measles 10 Whooping Cough 28 Diarrhcea 22 Total 77 The zymotic death rate was 3.05 per thousand against 2.4 for 1895. For London it was 3.1, and for England and Wales 2.18. The following table gives the average births, deaths, and death rates, also the deaths from diseases of the zymotic class for the past ten years.  1887 1888 1889 1890 1891 1892 1893 1894 1895 1896 Average of last 10 years. Births during the year 683 688 678 639 654 679 675 708 692 724 682 Birth rate per thousand 34.84 34.10 32.64 29.89 29.48 29.80 28.86 29.52 28.15 28.55 30.50 Deaths from all causes 318 331 271 358 345 392 338 313 382 360 340.8 Death rate per thousand 16.24 16.40 13.04 16.75 15.55 17.20 14.45 13.05 15.37 14.29 15.23 Deaths from Small Pox 0 0 0 0 0 0 0 0 0 0 O „ Measles 2 8 3 l6 8 34 5 12 11 10 10.9 ,, Scarlet Fever 3 2 8 2 0 1 2 3 3 3 2.6 „ Diphtheria 2 1 0 3 0 3 4 4 5 8 3.0 „ Whooping Cough 3 16 5 10 9 27 9 3 1 28 10.11 ,, Typhoid and other Fevers 3 1 1 0 7 3 4 6 0 1 2.6 Diarrhoea 19 8 8 17 18 20 21 9 26 22 16.8 „ Croup (Membranous and Diphtheritic) 0 1 1 I 1 1 4 1 1 4 1.5 „ Erysipelas 1 1 0 I 0 0 0 2 0 1 06 „ principal zymotic diseases 32 38 26 50 43 89 49 40 50 77 49.6 Death rate from do. 1.58 1.78 1.20 2.38 1.93 3.90 2.09 1.66 2.4 3.05 2.16 11 Infectious Diseases (Notification) Act, 1890. Under the above I have received the notifications: Smallpox 1 Scarlet Fever 214 Diphtheria 30 Membranous Croup 4 Typhoid or Enteric Fever 12 Continued Fever 6 Erysipelas 53 Total 320 Those for the year 1895 numbered 118 and for 1894 they amounted to 132. Scarlet Fever prevailed more or less during the year, the number of cases increased considerably during the month of December, 1895, when it assumed almost an epidemic form. Three deaths were registered from the complaint, and 214 cases notified. Diphtheria. Thirty cases were notified, followed by eight deaths. Membranous Croup. Four notifications were received and four deaths. Enteric Fever or Typhoid. Twelve cases were reported and one death. » Continued Fever. Six notifications but no deaths. 12 Erysipelas. There were fifty-three notifications and one death. Diarrhœa. From this complaint there were twenty-two deaths, twenty-one were children under one year. Taking the year as a whole it was not a very fatal disease, but during the months of July and August when there was absence of rain and excess of temperature the fatality increased as usual, and in London it was very prevalent. A mean temperature of 60 degrees or over, absence of rainfall, a polluted atmosphere and artificial feeding of the infant combined, and are in fact essential, in the production of the malady. Children who are entirely fed on breast milk rarely suffer. Measles. This complaint is not included in the list of notifiable diseases. Many authorities have added it to the list, several however have not retained it after the lapse of four or five years. Ten deaths were registered from this malady. The infectiousness of the disease in its earliest stages, the rapidity of its spread through school agency, the extreme youth of many of the sufferers, and the utter carelessness of many parents in regard to it, frustrate almost every effort made to prevent its diffusion. Some 12,000 deaths a year in England and Wales are due to this malady. Cancer caused twenty deaths which is an increase of five on the previous year. This malignant disease is by many considered to be on the increase; it is however 13 a question as to whether the apparent increase is due to a more accurate diagnosis. The deaths from this disease are in fact more numerous in proportion to population. Influenza. This complaint has not been so prevalent as during previous years, although a certain number of cases occurred, resulting in five deaths; mostly complicated with lung affections. Inquests were held in twenty-one instances, the deaths being mainly due to natural causes and to accidents (one was a case of suicide). With regard to the Meteorological Observations, the first five months were remarkably dry, the rainfall for the year was 22.29 inches, whereas the mean of thirty years was 25.72. The large excess of 3.04 inches in September was mainly instrumental in reducing a deficiency which was becoming very serious. Water Supply. The results of the bacteriological examinations for the year show the continuous efficiency of the filtration, also the excellent character of the supply from the Water Companies serving this district. The important question of a constant supply throughout the parish which I have strongly advocated in most of my previous Annual Reports is at present incomplete. I have however every reason to believe that during the coming year it will be general. Royal Commission on Vaccination. This prolonged and exhaustive enquiry came to a 14 conclusion after having held 136 meetings, and having examined 187 witnesses. Taking the report in sections, Section A is devoted to the enquiry "as to the effect of vaccination in reducing the prevalence of and mortality from smallpox." The Commissioners dealing with the history of the spread of the disease and of its treatment, describe fully the introduction and rapid spread of the practice of vaccination, dating from 1798, finding that about that date "the doctrine that cowpox protects against smallpox was generally accepted in most countries of Europe." At a recent meeting of the Society of Medical Officers of Health, it was decided that they would endorse generally the following proposals of the Royal Commissioners, viz.: 1—To allow Public Vaccinators to offer calf lymph as a substitute for human lymph in all cases in which it may be preferred. 2—To extend the period within which a child is at present required to be vaccinated. 3—To provide for the medical treatment of children after vaccination, so far as it may be necessary to ensure good results. 4—To provide for the more effectual supervision of tramps and common lodging houses. 5—To ensure better means than now exist for enforcing the provision of proper accommodation in every sanitary district for the isolation of smallpox and other infectious diseases. 15 I consider that the transference of vaccination from the Guardians to the Sanitary Authorities, on whom all measures for the prevention of disease and control of epidemics devolve, would be an advantage. It has been advocated that vaccination should cease to be compulsory and be left to the free choice of parents. If no penalty were attached to the failure to vaccinate it is certain that a large number of children would remain unvaccinated, simply from neglect on the part of their parents to incur the trouble involved. They conclude "that the marked decline of smallpox mortality in the first quarter of the present century affords substantial evidence in favour of the protective influence of vaccination." Improved Sanitation and Smallpox. The majority of the Commissioners point out that those who are opposed to vaccination suggest that improved sanitary conditions are mainly responsible for the decline of smallpox. The Commissioners conclude that when all the changes in sanitary conditions which have taken place are considered, it cannot be asserted that they afford an adequate explanation of the diminished mortality from the disease. Isolation. It has been maintained that the decline in smallpox mortality is largely due to more frequent and systematic attempts to isolate those suffering from smallpox. I think however that an answer to this contention is to be found in the fact that it is only in 16 recent years that there has been any systematic practice of isolating patients who were suffering from the disease. At the same time there is little doubt that the efforts at isolation which have characterized recent years have had a beneficial effect on the mortality from smallpox. As regards the protective influence of vaccination, it is an admitted fact that it lessens the liability to be attacked by the disease, and also modifies the character of the complaint, and renders it less fatal and of a milder type. The other means of diminishing smallpox consist of a complete system of notification of the disease, followed by an immediate removal of the patient to a smallpox hospital, together with a careful supervision, and if possible for about sixteen days, of those who had been in contact with anyone suffering from the disease. My opinion is that any relaxation of the vaccination laws would have a decided tendency to the increase of smallpox, and I strongly advocate the use of calf lymph by Public Vaccinators and others. Isolation Hospital. Referring to the temporary hospital which was provided in January, with a view of isolating those cases which could not be treated at home, 112 cases were admitted during the year (12 adults and 100 children). It is a subject for regret that your Council have 17 not as yet been able to secure a site for a permanent hospital in this district which has been so long needed. Housing of the Working Classes Act. The proceedings under this Act applied to a house in Bennett Street, Chiswick New Town, which has since been put into tenantable repair. I attended the West London Police Court in July in order to support a summons against a medical man for neglecting to notify a case of scarlet fever. The Magistrate ordered a nominal fine of 5s. with 2s. costs. General Inspection of the District. I made the usual personal inspections and reported on the same to your Council, viz.: Insanitary dwellings, Slaughter-houses, Bakehouses, Dairies, and Cowsheds. Refuse Removal. The collection of ashes and miscellaneous rubbish during the year has not been on the whole so satisfactorily carried out by the Contractor as might be desired; and I have every confidence that the plan contemplated next year by your Council of collecting the dust by the "motor carts" will prove an economical success, together with the proposed process of cremation by the dust destructor, being by far the most effectual means of dealing with the refuse of this parish, also a great advantage from the public health point of view. Sale of Food and Drugs Act. During the year a large number of samples have 18 been submitted to the County Analyst, three only were found to be adulterated, being two samples of milk and one of butter, which resulted in fines and costs to the amount of £6: 17: 6. These comparatively few adulterations clearly indicate the satisfactory quality of the different articles of diet sold in the district, and which is so necessary to the health of those residing in it. I append the returns of the Sanitary Inspector, giving a summary of the sanitary work carried out by him, and remain, Gentlemen, Your obedient servant, FREDC C. DODSWORTH, Medical Officer of Health. 19 Sanitary Inspector's Office, Vestry Hall, Chiswick. Report of Sanitary Inspector for the year ending 31st December, 1896. N umber of complaints received during the year 141 „ Houses, premises, &c., visited and examined 2175 ,, Notices served for abatement of nuisances 526 ,, Houses, premises, &c., repaired, cleansed, &c. 234 ,, Houses disinfected after illness of an infectious character 141 ,, Drains repaired, cleansed, and ventilated 253 ,, House drains reconstructed and ventilated 133 „ Waste pipes from baths, sinks, and lavatories disconnected from drains 1 „ Cesspools emptied and done away with, and new drainage provided connected with Public Sewer 2 ,, Waterclosetsrepaired,cleansed,&c. 223 ,, Water closets supplied with water separate from domestic supply 11 ,, New water closets provided 23 „ Samples of water analysed taken from shallow wells supplying drinking water 0 „ Houses supplied by Water Co., previously from shallow wells 0 ,, Cisterns repaired, cleansed and covered 35 ,, Dust bins, new, provided 76 ,, ,, ,, repaired, covered, etc. 13 20 Number of Dust complaints received and attended to 333 „ Accumulations of dung and other refuse removed 21 ,, Animals removed,being improperly kept 21 ,, Cases of overcrowding abated 5 ,, Registered cowsheds, dairies, and milkshops regularly inspected 35 ,, Licensed slaughter-houses regularly inspected 8 ,, B.ake-houses regularly inspected 16 ,, Legal proceedings (i.e.) summonses for the abatement of nuisances 4 Your obedient servant, JOHN H. CLARKE, Sanitary Inspector. (A) TABLE OF DEATHS during the Year 1896, in the Urban Sanitary District of Chiswick; classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Typhus. Fevers. Puerperal. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pnuemonia and Pleurisy. Heart Disease. Injuries. All other Diseases. Totals. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Enteric or Typhoid. Continued. Relapsing. (a.) (b.) (c.) (d.) (e.) (f.) (g).. (h.) (i.) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Chiswick Proper 53 17 8 .. 4 13 11 Under 5 .. 2 .. .. .. .. .. .. .. .. 1 3 4 3 .. 3 2 .. .. .. 7 25 5 upwds. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 4 1 .. .. 18 28 Chiswick New Town 33 15 10 2 .. 5 1 Under 5 .. .. .. .. .. .. .. .. .. .. .. 2 5 5 .. 1 5 .. .. .. 7 25 5 upwds. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 .. .. 4 8 Turnham Green 36 12 3 2 3 8 8 Under 5 .. .. .. .. .. .. .. .. .. .. .. 2 6 .. .. .. 2 .. .. .. 5 15 5 upwds. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 4 .. 3 .. 2 11 21 Turnham Green North 77 18 10 9 1 20 19 Under 5 .. 1 2 .. .. .. .. .. .. .. .. .. 1 2 .. .. 2 .. .. .. 19 27 5 upwds. .. .. 1 .. .. .. .. .. .. .. .. .. 1 1 1 7 6 2 .. 1 30 50 Glebe Estate 55 22 10 1 1 11 10 Under 5 .. .. 2 .. .. .. .. .. .. .. .. 1 5 5 .. .. 8 .. .. .. 11 32 5 upwds. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 3 3 4 .. .. 12 23 Sulhamstead Estate 15 7 .. .. .. 7 1 Under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. 1 4 7 5 upwds. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 3 2 .. .. 2 8 Gunnersbury 51 9 7 3 3 14 15 Under 5 .. .. .. 1 .. .. .. .. .. .. .. 1 4 3 .. .. 4 .. .. .. 3 16 5 upwds. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. 3 5 6 .. .. 19 35 Grove Park 8 1 .. .. .. 3 4 Under 5 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 5 upwds. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 6 7 Strand-on-the-Green 15 5 5 .. .. 5 .. Under 5 .. .. 2 2 .. .. .. .. .. .. .. 1 .. 3 .. .. .. .. .. .. 2 10 5 upwds. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 .. 1 .. .. 2 5 Bedford Park 12 2 .. 3 .. 2 5 under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 3 5 upwds. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 1 .. .. 6 9 Totals 355 108 53 20 12 88 74 Under 5 .. 3 6 3 .. .. .. .. .. .. 1 10 26 21 .. 4 24 l .. 1 61 161 5 upwds. .. .. 2 1 1 .. .. .. .. .. .. 2 1 3 26 24 21 .. 3 110 194 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto. Under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths occurring within the district among persons not belonging thereto. 5 2 2 1 Under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 1 5 Area and Population of the District or Division to which this Return relates. Area in Acres, 1,245. Population (1891) 21,965. Death (General, 14.29 per 1,000 Population, estimated to middle of 1896. Rates (Infant (under one year of age) 149 per 1,000 Births Registered. (B) TABLE OF POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the Year 1896, in the Urban Sanitary District of Chiswick; classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Population at all Ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health. Number of such Cases Removed from their Homes in the several Localities for Treatment in Isolation Hospital. Census 1891. 21965. Estimated to middle of 1896. 25182. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Total. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a.) (b.) (c.) (d.) (e.) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 Chiswick Proper 2664 Under 5 3 2 .. .. 1 .. .. .. .. .. .. 6 .. 3 1 .. .. .. .. .. .. .. .. .. 5 upwds. .. 25 .. .. .. 1 1 .. .. .. 5 .. 32 .. 15 .. .. .. 1 1 .. .. .. .. 1 .. Chiswick New Town 2223 Under 5 .. 1 1 .. .. .. .. .. .. .. 1 .. 3 .. 1 1 .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 8 .. .. .. .. 1 .. .. .. 3 .. 12 .. 7 .. .. .. .. .. .. .. .. .. .. .. Turnham Green 3615 Under 5 .. 2 1 .. .. .. .. .. .. .. 1 .. 4 .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 20 .. .. .. .. .. .. .. .. 8 .. 28 .. 11 .. .. .. .. .. .. .. .. .. .. .. Turnham Green North 3630 Under 5 .. 15 3 2 .. .. .. .. .. .. 2 .. 22 .. 3 .. .. .. .. .. .. .. .. .. .. .. 5 upwds. 1 39 1 .. .. 1 3 .. .. .. 11 .. 56 1 19 .. .. .. .. .. .. .. .. .. 1 .. Glebe Estate 2795 Under 5 .. 14 2 .. .. 1 .. .. .. .. .. .. 17 .. 6 .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 43 6 .. .. 3 .. .. .. .. 12 .. 64 .. 20 1 .. .. .. .. .. .. .. .. .. .. Sulhamstead Estate 1435 Under 5 .. 7 1 .. .. .. .. .. .. .. 1 .. 9 .. 2 .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 9 3 .. .. 1 1 .. .. .. 5 .. 19 .. 5 1 .. .. .. .. .. .. .. .. .. .. Gunnersbury 5080 Under 5 .. 5 1 .. .. .. .. .. .. .. .. .. 6 .. 2 .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 8 7 .. .. 3 .. .. .. .. 2 .. 20 .. 3 .. .. .. .. .. .. .. .. .. .. .. Grove Park 860 Under 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Strand-on-the-Green 1390 Under 5 .. 3 2 2 .. .. .. .. .. .. 1 .. 8 .. 2 .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 5 .. .. .. .. .. .. .. .. 1 .. 6 .. 2 .. .. .. .. .. .. .. .. .. .. .. Bedford Park 1490 Under 5 .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 5 upwds. .. 5 .. .. .. 1 .. .. .. .. .. .. 6 .. 3 .. .. .. 1 .. .. .. .. .. .. .. Totals 21965 25182 724 Under 5 .. 51 13 4 .. 2 .. .. .. .. 6 .. 76 .. 19 2 .. .. .. .. .. .. .. .. .. .. 5 upwds. 1 163 17 .. .. 10 6 .. .. .. 47 .. 244 1 85 2 .. .. 2 1 .. .. .. .. 2 .. State here whether "Notification of Infectious Disease" is compulsory in the District? Yes. Since when? January 1st, 1890. Besides the above-mentioned Diseases, insert in the columns with blank headings the names of any that are notifiable in the District, and fill the columns accordingly. State here the name of the Isolation Hospital used by the sick of the District. Mark (H) the Locality in which such Hospital is situated; and if not within the District, state where it is situated. Chiswick has no Infectious Hospital.