EAL 1 THE HEALTH OF EALING. TWENTY-THIRD ANNUAL REPORT (1897), BY DR. C. A. PATTEN, Medical Officer to the Ealing District Council. Ealing, W. "times" printing and publishing works, broadway. THE HEALTH OF EALING Ealing, March 15th, 1898. Gentlemen, In submitting to you the statistics of Births, Deaths, and general sanitary matters for the past year, I am happy to be able to state that on the whole they are of a satisfactory character. Population. In my last report I dwelt somewhat in detail upon the difficulties experienced as we got further away from the last census in enumerating the population of the District for the purposes of this return. Availing myself of all possible sources of information, I have arrived at the conclusion that a fair estimate of our numbers for calculation of the Birth and Death Rates will be to regard 33,000 persons as residing in this district in the middle of the past year. Deaths. I may remark that notwithstanding a very material increase of population, the deaths during last year were exactly the same in number as the previous year, viz., 308 (153 males and 155 females). This number is equivalent to a death-rate of 9.3 per 1000, or one in 107 of the estimated population compared with a death-rate for 1896 of 97; that of London during the same period equalled 18 2 per 1000, and for England and Wales 17.4. The only adjoining district with which I have information relative to the death-rate is the Urban District of Harrow-on-the-Hill which, with only one-fourth of our population was favoured with an exceptionally low death-rate of 8.03 per 1000. It will simplify matters if I follow my rule of submitting a tabular return of the general statistics for the last ten years, 2 during which time, with only one or two exceptions, we show a generally progressive improvement in the matter of diminished deaths from all causes. 1897 1896 1895 1894 1893 1892 1891 1890 1889 1888 Births 589 651 574 532 564 492 605 514 492 510 Deaths 308 308 339 271 307 316 338 352 224 250 Excess of Births over Deaths 281 343 235 261 257 176 267 162 248 260 General death-rate per 1000 9.3 9.7 11.2 9.6 11.13 11.92 13.7 14.4 10.6 10.9 Zymotic death-rate per 1000 14 1.4 0.6 0.9 0.66 1.01 0.61 2.3 0.78 0.39 I do not propose to go into minute details as to the distribution of the mortality as it affects the four Wards; suffice it to say that the North-West Ward, as including the most densely populated and poorer part of our district, shows the highest total, viz , 93, while the North-East Ward exhibits the lowest—58. These statistics are elaborated in Table A. This table also gives the deaths at various ages and from various causes, by which it will be noticed that chest affections claim the largest number. Zymotic Disease. A few remarks relative to zymotic disorders will be appropriate here, and I am glad to report a considerable diminution in mortality from these complaints. During 1897 there were 33 deaths from the seven principal zymotic diseases as against 56 of the previous vear. This reduction is greatly due to the lessened fatality arising from whooping cough and measles. 1897. 1896. Smallpox 0 Smallpox 0 Scarlatina 1 Scarlatina 2 Diphtheria 4 Diphtheria 2 Enteric Fever 4 Enteric Fever 1 Measles 2 Measles 16 Whooping Cough 2 Whooping Coughs 22 Diarrhœa 20 Diarrhœa 13 I may note that the twenty deaths attributed to diarrhœa were, with one exception, of infants, and occurred during July and August. I am of opinion that the causation of these attacks is in many instances due to injudicious feeding rather than insanitary surroundings, aided of course, by the presence of a high temperature during those particular months. 3 The zymotic death-rate was equal to 1 per 1000 of the estimated population, compared with 1.0r 1000 of the preceding year. That for London was 2.58 per 1000. Notifications. The notifications of infectious disease received during 1897 were 156 compared with 141 in 1896. They are shown under the different headings in Table B, and also the districts in which they occurred are explained there. Of this total number there were 87 under treatment in the Isolation Hospital during the year, compared with 56 in 1896. It is satisfactory to learn that of this considerable number only two proved fatal, one case of diphtheria and one of enteric fever. Births. During the period under review the births numbered 589 (males 286, females 303). This is 62 less than in 1896 when the births exceeded in number any former year. The birth-rate, therefore, was 17.8 per 1000 or 1 in 56 of the estimated population. Infant Mortality. The infantile mortality (i.e., the number of deaths of children under one year of age) comprised 63 deaths, and 90 under 5 years. This gives a rate of 106.9 per 1000 births registered; in London the rate equalled 159 per iooo. Old Age. Of old persons 98 died, aged 65 years and upwards, including 19 over 80 years of age, and five over 90. Youthful Mortality. Before leaving the subject of statistics it is interesting to relate that between 5 and 25 years of age only 24 deaths were registered in the whole district, and these are again sub-divided into 8 only between 5 and 15 years of age, and 16 between 15 and 25. Injuries. Thirteen deaths were attributed to injury during the year, and some of these, with others due to natural causes, necessitated the holding of inquests in ten cases. 4 Isolation Hospital. The Isolation Hospital, as will be seen from previous remarks, has continued to fulfil a very useful and important function, and on more than one occasion has been fully occupied. The enlargement of the Institution has become a public necessity, and will ere long be carried out. Buildings, &c. It is estimated that at the end of the past year there were over 5000 occupied houses in the district, and during the same period 175 new buildings were completed. Sanitation. With regard to sanitary administration, I believe all matters appertaining to drainage, removal of house refuse, general scavengering, and water supply, have received careful attention; systematic inspection of all dairies, cowsheds, slaughter-houses, bakeries, &c., has been properly carried out, and numerous improvements have been effected in connection with many of those places. The question of water supply is one that has necessarily occupied the attention of the public generally in a far greater degree than usual, owing to the severe epidemics of enteric fever at Maidstone, Lynn, and elsewhere. As is well-known, we in this district are not dependent upon local sources for our supply, and I think we have every reason to feel satisfied with the excellent quality of the water supplied by the Company that serve us, as evidenced by the usually favourable reports furnished monthly by the responsible authorities. This does not, however, exonerate us from the necessity of seeing that the cisterns and receptacles into which the water is delivered are properly and frequently cleansed; and whenever possible I have never ceased to advocate the water used for drinking and culinary purposes being drawn direct from the main. It may be a useful precaution to drink boiled water, but where the water is obtained directly from the main I do not think that, in this district at least, this measure is at all indispensable. Should the existence of a well in this district come to my notice, I invariably have the water tested by the competent analyst employed by your Council, and whenever there is 5 evidence of organic contamination an order for closure of the well is at once issued. With regard to the dairy farms in the neighbourhood I am, on the whole, well satisfied with their condition, but it is well-known that a large proportion of the milk consumed in this district is obtained from outside sources. I believe most of the farms from which this additional supply is obtained to be under inspection, medical and otherwise, but knowing how prolific a cause of serious diseases, such as Tuberculosis (and this disease more often than is suspected), diphtheria, enteric fever, &c., contaminated milk is, I strongly advise that it shall all be sterilised or boiled before consumption. The appointment of a Certificated Inspector of Nuisances has been made during the year, and I have every reason to commend the zeal and efficiency which he has brought to the performance of his duties. That portion of the work which falls under the more direct working of the Surveyor's Department I have every reason to be satisfied with. More than usual difficulty has been experienced in this district, as in other districts, with the roads during the autumn season, owing to a very great extent to the humidity of the atmostphere which prevents that firmness of roads so necessary to the comfort of pedestrians as well as forming an important item in the expenses of scavengering, and so far as our district was concerned this was largely added to by the work of surface drainage, which has affected more or less all the roads south of the Great Western Line. I am satisfied that the completion of the Surface Water Drainage south of the Great Western is an important factor in our sanitary work. The immense growth of the district renders it most desirable that rain should, as much as possible, be kept out of the sewers and so minimise the work thrown upon our Sewage Works. The Southern Works are kept in their usual efficient condition, and no complaint has been made. The increase of tank space is undoubtedly a most advantageous addition to the Works. The Farm at Perivale is in good working condition ; both these Works (North and South) are visited 6 frequently by Inspectors both from the Thames Conservancy and Middlesex County Council, and from all that I can gather meet with the approval of the Inspectors. I have the honour to be, Gentlemen, Your obedient Servant, C. A. PATTEN, Medical Officer of Health. EALING URBAN DISTRICT COUNCIL. A Return as to the number of houses inspected, houses whitewashed, notices served, overcrowding of houses, etc., during the year ending the 31st December, 1897. Number of houses inspected 575 „ notices served requiring proper water supply to w.c.'s 27 „ houses whitewashed and cleaned 35 „ new dustbins supplied to houses 66 „ roofs repaired 12 „ overcrowded houses discovered 3 „ rooms disinfected 104 „ houses at which a proper supply of water was laid on for domestic purposes 2 The Bakehouses have been inspected during the past year, and found all correct. A return as to the number of nuisances discovered; defective drains repaired; slaughter-houses, cow-sheds, fish shops, dairies, milk shops, and yards inspected during the year ending the 31st December, 1897. Number of nuisances discovered 148 „ nuisances abated without order being served 14 „ orders served to abate nuisances 244 „ defective drains repaired 59 „ new gulleys fixed in yards 19 „ times slaughter-houses inspected 273 „ visits paid to cow-sheds 295 „ visits paid to fish-shops 71 „ times dairies visited 253 „ visits paid to milk shops 351 „ yards inspected 3,591 (A).—Table of DEATHS during the year 1897, in the Ealing Urban District, classified according to Diseases, Ages, and Localities. mortality from all causes, at subjoined ages. 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. North-East waed 58 6 3 1 1 21 26 north-West ward 93 24 10 1 4 26 28 South-East Ward 69 15 6 2 3 22 21 South-West Ward 73 17 7 2 5 19 23 Cottage Hospital 13 .. 1 1 3 8 .. Isolation Hospital 2 1 .. 1 .. .. .. Totals 308 63 27 8 16 96 98 MORTALITY FROM SUBJOINED CAUSES, DISTINGUISHING DEATHS OF CHILDREN UNDER FIVE YEARS OF AGE. Scarlatina. Diphtheria. Enteric or Typhoid Fever, Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Phthisis. Bronchitis, Pneumonia & Pleurisy. Heart Disease. Cancer. Injuries. All other Diseases. Totals. North-East ward Under 5 .. 1 .. .. .. .. .. 1 3 .. .. 1 3 9 5 upwards .. .. 2 .. .. .. 1 3 5 .. 6 1 26 49 North-West Ward Under 5 .. 1 .. .. .. .. 12 2 9 .. .. 1 9 34 5 upwards 1 .. .. 1 .. .. .. .. 15 9 3 1 24 59 South-East Ward Under 5 .. .. .. .. 2 2 2 1 4 .. .. .. 10 21 5 upward .. 1 1 .. .. .. .. 5 3 4 6 4 24 48 South-west ward Under 5 .. .. .. .. .. .. 5 1 4 .. .. .. 14 24 5 upwards .. .. .. .. .. .. .. 7 4 3 5 3 27 49 Cottage Hospital Under 5 .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 5 upwards .. .. .. .. .. .. .. .. 9 2 .. 2 6 19 Isolation Hospital Under 5 .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 5 upwards .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Totals Under 5 .. 3 .. .. 2 2 19 6 20 .. .. 2 36 90 5 upwards 1 1 4 1 .. .. 1 20 29 23 20 11 107 218 (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 l897 in the Ealing Urban District; classified according to Diseases, Ages and Localities. POPULATION AT ALL AGES. Census 1891. In 1891 Estimated to middle of 1897. Registered Births. North-East Ward the District 86 North-west Ward was not 228 South-east Ward divided into 118 South-West Ward Wards. 157 Totals 23,965 33,000 589 New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health. Scarlatina. Diphtheria. Membranous Croup. Enteric or Typhoid Fever. Erysipelas. North-West Ward Under 5 12 2 1 .. 3 5 upwards.. 25 12 .. 4 4 North-East ward Under 5 8 4 .. 2 .. 5 upwards.. 9 4 .. 1 6 South-Kast ward Under 5 5 1 3 1 .. 5 upwards.. 8 7 .. 2 7 South-West ward Under 5 7 2 .. .. 4 5 upwards.. 4 1 .. 4 3 Totals Under 5 32 9 4 3 7 5 upwards.. 46 24 .. 11 20 Number of such Oases Removed from their Homes in the several Localities for Treatment in Isolation Hospital. Scarlatina. Diphtheria. Enteric or Typhoid Fever. Erysipelas. North-West Ward Under 5 . 9 .. .. .. 5 upwards ?3 12 3 3 North-East Ward Under 5 2 1 .. .. 5 upwards 10 5 .. .. South-east Ward Under 5 3 1 .. .. 5 upwards 7 8 .. .. South-West Ward Under 5 3 .. .. .. 5 upwards 3 .. 4 .. Totals Under 5 17 2 .. .. 5 upwards 43 25 7 3 Area and Population of the Ealing: District. Area 3,225 Acres. Population (1891) 23,965. Population (estimated to middle of 1897) 33,000 General, 9.3 per 1,000. Population estimated to middle of 1896. Death Rates Infants under one year of age, 10.69 per 1,000 Births registered.