EAL 2 THE HEALTH OF EALING. THIRTIETH ANNUAL REPORT (1904). BY Dr. C. A. PATTEN, Medical Officer to the Borough oe Ealing. Ealing, W.: "TIMES" PRINTING AND PUBLISHING WORKS, BROADWAY. THE HEALTH OF EALING. To His Worship the Mayor, Aldermen and Councillors of the Borough of Ealing. I have the pleasure of submitting my annual report for the year 1904. which I believe will be considered favourable in most of its aspects. In comparison with the foregoing year, we can at least feel satisfaction that no serious epidemic of a fatal type, such as small pox or enteric fever, has prevailed, and compared with former, and what may be termed normal, years, I think you will agree that there has been no falling away from the usual standard of good health our borough is known to enjoy. Population. It is a matter of common knowledge that, for several years, a large increase of population has taken place in our locality, but especially, and in a marked degree, since the taking of the census of 1901. In localities such as this—one of a highly progressive and very rapidly increasing character—the estimate of the population presents many difficulties during the intercensal periods, and the ordinary methods of calculation, both geometrical and arithmetical, afford less assistance at arriving at a conclusion than is the case in slowly-developing districts. It is unnecessary to dwell upon, or to explain in any detail, the causes of our rapid local growth, which, without doubt, has exceeded in proportionate increase that of any previous year, The single fact that houses actually in occupation at midsummer last year, viz, 8,756, exceeded by 1,248 those of the previous year at the same date, and that 803 houses were passed by the Surveyor's department during the year, will go far to confirm my statement as to the very great increase that occurred during twelve months. I estimate the number of inhabitants in this borough on the 24th day of June last at 43,780 persons. 4 Deaths. The deaths registered were 466 in number (202 males and 264 females); this is exclusive of those of non-residents, but inclusive, as far as can be ascertained, of those residents who died outside the district. This gives us a death rate of 10.6 per 1,000, or 1 in 93 of the estimated population. This may he considered satisfactory, although I am sanguine that under normal conditions of the public health we may in future years hope to have a reduced rate not only generally, but especially under the heads of infantile and zymotic mortality. The annual death rate from all causes in England and Wales equalled 16.2 per 1.000 living; in the seventy-six great towns it was 17.2, and in rural England and Wales 15.3. A table is appended showing the distribution of deaths in the different wards, and classified according to age and causation. Infantile Death Rate. With regard to the infantile death rate, i.e., that of children under one year of age, it is gratifying to report a considerable decrease. The deaths under this head, calculated on the ratio of the deaths under one year to the number of births registered during the year, equals 105.3, as compared with an infantile mortality for the previous year of 136.8. I may add that this mortality for the whole of England and Wales was 146 per 1,000 registered births. Old Age. Of the total number of deaths (466), 148 were those of persons aged 65 years and upwards. Zymotic Death Rate. With regard to the deaths from the seven chief epidemic diseases—erroneously termed the zymotic death rate—it will be seen from the perusal of the accompanying table to equal in its entirety 1.5 per 1,000 persons living, the total number of such deaths being 69, and of this number no fewer than 53 were due to diarrhoea. Excluding this latter disorder from calculation, the mortality rate would only have been .36 per 1,000, the remaining 16 deaths being apportioned as fc1 lows:—Scarlatina, 4; enteric fever, 1; diphtheria, 1; measles, 7; and whooping cough, 3. For England and Wales the rate was 1.94. There was a considerable outbreak of diarrhoea during the spell of very hot weather we experienced last summer, but the attacks were by no means confined to young children, as several persons of ad\avced age suffered from the same cause. 5 withstanding the fact that the largest proportions of deaths from this complaint occurred in the Lammas Ward (many of the children being artificially fed), I am of opinion that the exciting cause was due to climatic influence, and that they were in no way to be attributed to insanitary surroundings. Measles at one time of the year was very prevalent and the same remark at plies to whooping cough. Scarlatina of a benign type prevailed throughout the year, but towards its close the number of cases greatly diminished. They were by no means confined to any particular locality, but pervaded all parts and all classes. No case of small pox was reported, and only five cases of enteric fever were brought to my knowledge. Phthisis. I do not consider that special reference is required on this occasion to any " general disease," with the exception of phthisis, from which 33 persons died during the past year. In my last report, and also on other occsations, I have suggested that the disease should be made voluntarily rotifiable, especially in the interest of the poor class of patients, and in the event of provision being made by the sanitary authority for the treatment of certain cases occurring amongst the poor, it appears to me that such notification should be made compulsory. The question of the treatment and the early arrest of this grave affiction is as I know, receiving the serious attention of the Council, and it requires, therefore, no words from me to enforce its importance. I hope that it may be my privilege another year to put upon record the fact of some arrangement for the treatment of this class of sufferers having been made. Inquests. It may be recorded here that 19 inquests have been held. The deaths are returned as 6 being due to accident; 9 to natural causes; and 4 to suicide. Notifications. Under the Notification of Infectious Diseases Act, I had intimation of 232 cases as against 324 in 190-3. This gratifying decrease was not confined to any particular disease, but was general under all headings. They are tabulated as follows:— Scarlatina 177 Erysipelas 33 Diphtheria 15 Enteric Fever 5 Puerperal Fever 2 6 As I have previously mentioned, there was no case of small pox. and the notifications of enteric fever have, as will be seen, greatly diminished in number, and with only one death. The cases of erysipelas were generally slight, and all resulted ie. recovery. The two cases of puerperal fever unhappily ended fatally; every necessary precaution in reference to these was carried out, and, in addition, compensation was granted to the nurses in attendance during the period they were suspended from work under my orders. Of the total number of notified cases 148 received treatment in the Council's hospital, which, at one time of the year, was unable (owing to the excess of scarlatina patients requiring admission) to receive them all. This difficulty will be met by the erection of the new hospital buildings which are rapidly approaching completion, and will be available before long for occupation. Indeed. it is anticipated that one at least of the new blocks will be available for patients in May next. Beyond saying that these additional buildings will amply provide for the needs of the borough in this respect for many years to come, I defer for a future occasion any detailed description of them. Births. The births registered during the year numbered 1,054 (males 512, females 542) being an increase of 133 over the previous year. This is the first occasion upon which the total births have reached 1,000 in the borough, and it is satisfactory to note that the birth rate, which is equivalent to 24.07 per 1,000 of the population, exceeds that of 1903 by 1 per 1.000. Natural Increase. The natural increase of the population, i.e., the excess of births over deaths, is 588. A tabular return of the birth and death rates for the last ten years is here appended. With regard to general sanitarv administration and inspection on the part of' myself and staff, a large and serviceable amount of work has been performed. This borough contains no factory buildings of any large size, but every attention has been bestowed upon such establishments as come under the provisions of the Factory and Workshops Act of 1901, viz.. workshops, laundries, bakehouses, etc., and in all these I believe compliance with the above Act in every material respect is strictly carried out. Few communications have been received from the inspector of factories, and I am able to state that Section 7 22 of the Public Health Acts (Amendment) Act, 1890, is in force in the borough, and that the aim of our standard of "sufficiency and suitability" in respect of all these buildings is to be in conformity, as the circumstances permit, with the various sanitary Acts, regulations and orders officially promulgated concerning them and the workers therein. The table required by the Secretary of State, in connection with this subject, is duly filled up, and will afford, I believe, the required detailed information. In the course of the year a system of meat and food inspection was set in action by the Council, and carried out by the senior sanitary inspector, who holds the necessary certificate of qualification for the duty. The total amount seized as diseased or unsound was as follows, viz.:—Meat, 1,1671 bs; fish, 22¾bs.; and fruit and vegetables 85¾lbs. In all instances, before being condemned, it was examined by myself and by a justice of the peace. As a sequence to these proceedings thirteen prosecutions ensued, and fines and costs to the amount of £50 14s. 6d. were the result. A short statement concerning the works under the control of the Borough Surveyor will not be out of place here. With reference to the Northern Sew age Works at Perivale, I am able to state that the flooding of the bacteria beds and the farm was not experienced in any appreciable degree, but this satisfactory result does not appear to be due to any preventive steps taken by the reservoir authorities, but simply to the diminished rainfall throughout the year. The sample of effluent taken by the county authority and by the Thames Conservancy, have in each case proved very satisfactory. Owing to the very large increase of the borough population, the "sludge question" became a difficulty, and improved means for its disposal and treat ment had to be seriously entertained. After careful consideration it was decided to deal with this sludge by means of "presses." Plans were prepared and submitted to the Local Gov eminent Board, and the necessary inquiry was held by that body. It is hoped the official sanction for the commencement of this important work will very soon be received. Improvements in connection with the older and much taxed Southern Works have been kept in view, and material progress has been made with the extension of the bacteria beds there situated. Two of these beds are being prepared for continuous filtration by a revolving automatic sprinkler, and it is believed the first of these beds will be in actual 8 operation at the end of February. During the year surface water relief sewers have been laid down—one from Ealing Green, taking the route of The Grove, Oxford-road, The Broadway, Haven Green, and Mount Park-road; and the other, in the west, from the valley watercourse to the Uxbridge-road, nearly opposite the Green Man Hotel. There has been practical evidence of their beneficial effect in relieving the existing sewage sewers (by taking the surface water) anil in getting rid of the water quickly. A large tract of Billing hitherto only partially draine . is being dealt with by what is termed the southern boundary scheme started in September last. It follows, as a necessary consequence, that owing to the considerable disturbance of the roads, due to the carrying out of the works I have alluded to, the usual effective scavenging and flushing have been in same localities matters of temporary difficulty. In each instance, however, every effort has been made to minimise inconvenience, and all these thoroughfares are now being restored to their normal condition. Since my last report a very important publ'C improvement has been carried out in connection with the old mortuary. This from my own experience, and that of other medical men was a very pressing necessity, and I must bear personal testimony to the skilful manner in which the Borough Surveyor has carried cut the alterations. Not only is there now provided a mortuary entirely suitable to its purpose, but the added post-mortem room is most complete, duly equipped with all modem requirements, and may easily form a model for similar buildings. In conclusion, may I be permitted to express my sincere sense of appreciation of the kindness and indulgence shown me by the Council during my long illness of last year. I am, Your obedient servant, G. A. PATTEN, Medical Officer of Health. February 27th, 1905. 9 BOROUGH OF EALING. SANITARY WORK, 1904. form 1. INSPECTIONS— Complaints received 142 Cases of Infectious Disease Notified 251 Number of Premises Periodically Inspected 358 Houses Inspected from House-to-House 74 Total Number of Houses. Premises. &c., Inspected 1,059 Total Number of Re-Inspections after Order or Notice 2 ,859 Unsound Food Inspections 2,369 Total Number of Inspections and Re-Inspections 6,2S7 NOTICES— Letters Written 358 Cautionary Notices Given Statutory Orders Issued 44 DWELLING HOUSES— Houses, Premises, &c., Cleansed, Repaired &c 33 MOVABLE DWELLINGS, CARAVANS, TENTS, &c.— Number Observed during the Year 33 Number Removed from District 33 form ii. WORKSHOPS AND WORK-PLACES— Number in District 184 Periodical Frequency or Number of Inspections Half Yearly BAKEHOUSES— Number in District 27 Periodical Frequency or Number of Inspections Quarterly SLAUGHTER HOUSES— Number on Register 5 Periodical Frequency or Number of Inspections Quarterly COW-SHEDS— Numbfir on Register 8 Periodical Frequency or Number of Inspections ... Quarterly DAIRIES AND MILK SHOPS— Number on Register 34 Periodical Frequency or Number of Inspections Quarterly UNSOUND FOOD— Inspections 2,369 Seizures 34 Summonses Served 13 Convictions Obtained 13 10 FORM III. WATER SUPPLY AND WATER SERVICE— Cisterns—New, Provided 3 Cleansed, Repaired, Covered, &c. 5 Draw-Taps Removed from Cisterns to Mains 35 Wells Closed 2 DRAINAGE AND SEWERAGE— Water Closets—New, Constructed 6 New Apparatus Provided 140 Ventilated 2 Repaired, Cleansed, &c. 44 Supplied with Water,or Supply Rendered Efficient 107 Drains—Examined, Tested, Exposed, &c iss Unstopped, Repaired. Trapped, &c 109 Waste Pipes, Rain Water Pipes, &c., Disconnected 76 Soil Pipes and Drains Ventilated 30 Disconnecting Traps or Chambers Inserted 139 Reconstructed 67 New, Laid 1 Cesspools Rendered Impervious, Emptied, Cleansed, &c 1 Cesspools Abolished 1 Cellars Draine 0 FORM IV. DISINFECTION— Rooms Fumigated 227 Rooms Stripped and Cleansed 25 Articles Disinfected or Destroye 4,630 DUST— Dustbins Repaired 3 42 New Bins Provided Movable Receptacles substituted for Fixed 2 Periodical Frequency of Dust Removal Weekly Number of Complaints of Non-Removal Received 41 DAMPNESS- Roofs Repaired. &c 29 Guttering and Rain-Pipis Repaired. Sac. 18 Yards Paved and Drained, and Paving Repaired 77 Surface adjoining Houses Paved 8 Dry Areas Provided 1 Ventilation below Floors Provided 4 Basements Rendered Inpervious 5 SUNDRY NUISANCES A RATED— Overcrowding 7 Smoke 2 Accumulations of R 36 Foul Pigs and Other Animal 32 Other Nuisance 65 Foul Ponds, Ac 1 11 BOROUGH OF EALING. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. 1.—inspection. Includings Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Inspections. Written Notices. FACTORIES (Including Factory Laundries). 4 — WORKSHOPS (Including Workshop Laundries). 459 24 HOME WORKERS' PREMISES 8 — Total 471 24 2 —defects found. Found. Remedied Want of Cleanliness 32 32 Want of Ventilation 2 2 Overcrowding 1 1 Want of Drainage of Floors 1 1 Other Nuisances 9 9 Sanitary Accommodations:— Unsuitable or Defective 21 21 Not Separate for Sexes 2 2 Total 68 68 3.—OTHER MATTERS. Matters Notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 4 Underground Bakehouses (S. 101):— In use during 1903 8 Certificates granted in 1904 7 In use at the end of 1904 7 Number of Homewnrk: — Lists. Outworkers. Lists Received 9 17 Addresses of Outworkers:— Forwarded to other Authoriles.. 5 Received from other Authorities 6 Workshops on the Register (S. 131) at the end of 1904:— Workshop Bakehouses 26 Workshop Laundries 7 Dressmaking 68 Miscellaneous 109 Total number of Workshops on Register 210 Table I. Vital Statistics of Whole District during 1904 and Previous Years. BOROUGH OF EALING. Year. Population estimated to Middle of each Year. Births. Total. Deaths Registered in the District. Total Deaths in Public Institutions in the District. Nett Deaths at all Ages belonging to the District. Number. Rate.* Under 1 Year of Age. At all Ages. Number. Rate per 1000 Births registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 1896 29000 651 20 6 70 107.5 308 9.7 13 321 10 6 1897 30000 509 17.8 63 106.9 308 9.3 15 323 10.26 1898 31000 539 15.62 61 113.17 309 8.9 15 324 9.96 1899 32000 589 16.36 76 128 350 9.72 24 374 10.95 1900 33000 608 16.2 67 110 333 8.9 20 353 10 09 1901 33274 708 21.2 81 1144 370 11.1 24 370 11.1 1902 33855 789 23 8 89 112.8 400 11.8 15 400 11.8 1903 39920 921 23.07 126 136.88 409 10.2 21 409 10.2 Averages for years 1894. 1903 — 673 19.3 79 116 2 359 9.9 — — — 1904 43780 1054 24.07 111 105.3 466 10.6 — 466 10.6 * Rates in Columns 4, 8, and 11 calculated per 1000 of estimated population Area of District in acres (exclusive of area covered by water) —3225. Total population at all ages 33040 Number of inhabited houses 5991 Average number of persons per house 5 5 At Census of 1901. Institutions within the District receiving sick and infirm persons from outside the District:—(i) Rochester House, Little Ealing Lane; (2) Cottage Hospital, Northfield Lane ; (3) Chiswick Isolation Hospital. Institutions outside the District receiving sick and infirm persons from the District:—Union Workhouse, Isleworth. Other Institutions, the deaths in which have been distributed among the several localities in the District:— None. Table II, Vital Statistics of Separate Localities in 1904 and Previous Years BOROUGH OF EALING. Names of Localities Year. Population estimated to middle of each year Births registered. Deaths at all Ages. Deaths under 1 year. * Whole District 1896 29,000 651 321 70 1897 30,000 589 328 63 1898 31,000 539 324 61 1899 32,000 589 374 76 1900 33,000 605 353 67 1901 33,274 708 370 81 1902 33,855 789 400 89 1903 39,920 921 409 126 Averages of Years 1894 to 1903 — 673 359 79 1904 43,780 1,054 466 111 *Population of separate Wards not known. Table III. Cases of Infectious Disease Notified during the Year 1904. BOROUGH OF EALING Notifiable Disease. At all Ages. Cases Notified in Whole District. Total Cases Notified in Each Locality. No. of Cases Removed to Hospital from each Locality. At Ages—Years. Drayton Ward. Castlebar Ward. M ount Park Ward. Grange Ward. Manor Ward. Lammas Ward. Drayton Ward. Castlebar Ward. Mount Park Ward. Grange Ward. Manor Ward. Lammas Ward. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox - - - — - - - - - - - - - - - - - - - Cholera — — — — — — — — — - — - — — - - - - - Diphtheria 15 — 3 9 1 2 — 3 3 3 — 2 4 1 - 1 — 1 — Membranous croup — — — — — — — — — — — — — — - - — — — Erysipelas 33 1 — 3 2 24 3 8 2 3 3 6 11 — - - — — 1 Scarlet fever 177 1 48 101 19 8 — 34 13 13 21 40 56 22 7 10 19 35 48 Typhus fever — — — — — — — — — — — — — — — — — — — Enteric fever 5 — 1 — — 4 — — 1 1 — 3 — — 1 — — 2 Relapsing fever — — — — — — — — — — — — — — — — — — — Continued fever - - - - - - - - - - - - - - - - - - - Puerperal fever 2 — — — — 2 — 1 — — 1 — — — — — — — — Plague — — — — — — — — — — — — — — — — — — — Totals 232 2 52 113 22 40 3 46 19 20 25 48 74 23 7 12 19 36 51 Borough Isolation Hospital at South Ealing (Grange Ward). Table IV. Causes of, and Ages at, Death during Year 1904. BOROUGH OF EALING. Causes of Death. Deaths at the Subjoined Ages of "Residents," whether occurring in or beyond the district. Deaths at all. ages of "Residents " belonging to localities whether occurring in or beyond the district. Total Deaths whether of Residents or Non-Residents" in Public Institutions in 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. Drayton Ward. Castlebar Ward Mount Park Ward. Lammas Ward. Manor Ward. Grange Ward. Measles 7 - 6 1 - - - 1 2 - 4 - - - Scarlet fever 4 - - 4 - - - - - - - 1 1 8 Whooping cough 3 — 3 — — — — — — — 3 — — — Diphtheria 1 — 1 — — — — — — — 1 — — 4 Enteric fever 1 — — — — i — — - — — — — 1 Epidemic influenza 5 — — — — 4 1 — 1 2 1 — 1 — Diarrhoea 53 39 12 — — — 2 8 1 4 35 2 3 — Enteritis 5 4 — — — — 1 3 — — 1 — 1 — Other septic diseases 3 — — — — 3 — — 1 — 1 — — 1 Phthisis 33 — — — 2 29 2 9 4 4 3 9 3 1 Other tubercular diseases 7 3 3 — — 1 — 2 1 — 3 1 — — Cancer, malignant disease 30 — — — — 12 18 5 3 1 5 6 9 1 Bronchitis 44 9 7 1 1 5 21 7 4 5 10 17 — 1 Pneumonia 27 6 3 1 3 12 2 I 2 — 13 4 2 5 Pleurisy 5 — — — 1 3 1 1 — — 1 — 1 2 Other Diseases of the Respiratory Organs 1 - - - — 1 - — — — — 1 — — Alcoholism 6 — — — - 2 4 — 1 2 2 1 — Cirrhosis of liver Venereal Diseases 1 1 - - - - - - - - 1 - - - Premature births 19 19 — — — — — 4 — — 9 6 — — Diseases and accidents of parturition .3 - - - - 3 - 1 - — - 1 1 - Heart diseases 45 1 — — 3 20 21 7 11 7 8 9 2 1 Accidents 5 1 — — — 2 2 1 2 — I — — 1 Suicides 5 — — — 1 2 2 — 4 1 — — — — All other causes 153 28 4 7 6 37 71 18 16 23 39 40 7 10 All causes 466 111 39 14 17 137 148 68 53 49 141 98 31 36 27th February, 1905. C. A. PATTEN, Medical Officer of Health.