THE HEALTH OF EALING. THIRTY-NINTH Annual Report (1913) by DR. C. A. PATTEN, Medical Officer of the Borough of Ealing. Together with the Annual Report of THOMAS HILL, Chief Sanitary Inspector. Ealling W.: "Times" Printing and Publishing Works, Broadway. STAFF. Medical Officer of Health: C. A. PATTEN, L.R.C.P., M.R.C.S. Chief Sanitary Inspector: THOMAS HILL, A.R.San.I., M.S.I.A., Cert. Insp. of Meat and other Foods (London). Sanitary Inspectors: H. SHARPE, C.R.San.I., Cert. Insp. of Meat and other Foods (London). J. STUBBS, A.R.San.I., Cert. Insp. of Meat and other Foods (Liverpool University). MABEL COPELAND, C.R.San.I. Clerk: E. W. HILL. 1912-13. BOROUGH OF EALING. 1912 1913 Area in Acres 2,947 2,947 Population at Census, April, 1911 61,235 61,235 Population estimated to end of 1912 64,500 68,500 Birth Rate 20.6 18.23 Death Rate 9.7 8.9 Infantile Mortality 67.61 72.05 Zymotic Death Rate 0.38 0.54 Phthisis (Tuberculosis) Rate 0.62 0.54 1912 1913 Rateable Value £492,921 £518,968 5s.0d. Assessable Value £471,724 £497,850 10s. 0d. Borough of Ealing. Public Health Department, Town Hall, Ealing, W. March 2nd, 1914. To the Chairman and Members or the Public Health Committee. Gentlemen, I have the honour of submitting my Annual Report (the thirty-ninth) for the year 1913, relative to the vital statistics, with a general statement of the sanitary conditions and work carried out during this period. On the whole, I believe it will be found a favourable record, but owing to an unforeseen incidence of Infectious Disorders (especially during the last quarter of the year), it is not quite so good as I hoped it would have been. A reference to the accompanying Tables and forms gives evidence that a large amount of useful sanitary work has been performed, and it can be stated that this has been accomplished with little, or no friction or opposition, and that our usual excellent sanitary position has been well maintained. I have been, as usual, most ably assisted by Mr. Hill, the Chief Sanitary Inspector, and his competent assistants, and thus a very considerable amount of useful work has been effected. I refrain from giving details under this head, as full particulars will be found in the Sanitary Inspector's Report. 6 Population (68,500). I have estimated the population of this Borough, at the middle of the year, to be 68,500, and on this figure the vital statistics and different rates applying to this Report have been calculated. Anv error in this estimate is rather, perhaps, one of under-estimating the number of inhabitants of the Borough than over-estimating it. The area of the Borough is 2,947 acres (with a density of population of about 23.2 to the acre), a rateable value, in May last, of £518,968, and an assessable value of £497,850. The general physical features and sanitary conditions continue as heretofore, and are admitted to be excellent in all material respects. The natural increase of our population, viz., the excess of births over deaths, was 633. New Buildings, etc. The number of inhabited houses in the middle of the vear is estimated at 13,300, being 400 in excess of the number given for the same period of 1912. The rate of progress in the erection of new houses continues, year by year, to be very nearlv even. During the past year 312 were passed for occupation (139 being situated in that part of the Borough north of the Uxbridge Road, and 173 in the part south of the main road) against 317 in 1912. These numbers do not include alterations to existing buildings, such as conversions into flats, but only four of the new houses were built and designed for such, and these for two families. Conversions of any existing premises for flat accommodation are not sanctioned unless all sanitary arrangements are adequately and sufficiently provided for. An actual revival in the letting of empty dwellings took place, and the number of unoccupied houses of all classes, especially of the smaller kind, is 7 small. No really large buildings were erected, either of a public or private character, the exceptions being a large "Kinema Theatre " and a commodious Church Hall. There is evidence that suitable accommodation, although sufficient to meet the average demand of the better classes of the population, is certainly becoming more difficult to obtain by the labouring portion of our population, and doubtless something requires to be done to increase and improve this class of dwellings. To a great degree the working man is called upon to pav rents out of proportion to his wages, and, consequently, an insufficient amount of his wages is left for procuring the necessaries of living, and this is felt more by those having large families. The provision of cheaper and suitable cottages for the labouring classes, however desirable, is, as I know, a very difficult problem. It is not the character of the accommodation I wish especially to refer to so much as its cost. Notwithstanding difficulties, no family is permitted to remain inadequately or unhealthily housed, or to be overcrowded, and all instances of such coming to our knowledge are at once remedied. Deaths. Five hundred and six deaths were registered in the Borough, giving a net death rate of 7.3 per 1,000 of the population, but to the above number there has to be added the deaths of 110 residents which occurred outside the Borough (and were not registered in the district), making a total of 616 deaths, and giving a gross death rate of 8.9 per 1,000 of the population for the past year, or one in every 111.2 of our number. This rate is a reduction of .8 per 1,000 compared with the previous year. The (provisional) death rate for England and Wales is 13.4, and for the ninety-six great towns, including London, 14.3 per 1,000. The deaths of fourteen non-residents were registered in the Borough, and transferred to their respective districts. 8 The distribution of the deaths is distributed as follows for the separate Wards, viz. :— In the Borough. Outside the Borough. Drayton Ward 55 11 Castlebar Ward 78 23 Mount Park Ward 66 7 Lammas Ward 85 26 Manor Ward 110 30 Grange Ward 84 13 478 110 Deaths outside the District 110 Deaths inside the District 478 Deaths in Hospitals (local) 28 Total 616 Twenty-five deaths took place in King Edward Memorial Hospital, and 3 in our Isolation Hospital. Causes of Deaths. The causes of and ages at death of the 616 residents of the Borough (being fourteen fewer than in 1912) are shown fully in the appended official Table No. 3. A comparison of this Table with the corresponding one of the previous year shows no great variety between the two years. I will only refer briefly to a few of the causes of the mortality. Cancer (malignant diseases) and Tuberculosis (of all kinds) are approximately the same for both 1912 and 1913. Seventy-three deaths were registered from Cancer, giving a death rate of 1.06 per 1,000 of the population compared with 1.14 in 1912. Diarrhœa and Enteritis caused twenty-one deaths, being seventeen more than the previous year, when the exceptionally small number of four deaths were regis- 9 tered. Of the total number of fatal attacks nineteen were of infants under one year of age, and nearly all the cases arose during the spell of very high temperature experienced for a while during the summer. Disorders of the circulatory and respiratory organs claimed many victims, especially among old people and very young children. Tuberculosis. One hundred and twenty cases of Pulmonary Tuberculosis, and fifty-five other forms of the disease were notified. Pulmonary Tuberculosis caused thirtyseven deaths, Tuberculosis Meningitis eight, and four were attributed to other tuberculous affections, being a total of forty-nine deaths compared with fifty-one in 1912. The Phthisis death rate equalled 0.54 per 1,000 of the population. We pay visits following notification to all cases when deemed necessary and expedient, and advise as far as practicable on the question of isolation, disinfection, and the supply of Sputum Bottles, etc. These visits are not invariably appreciated by the patients and their medical attendants. I omit visits when I know the sufferers are under continuous medical observation and care, and reside in superior dwellings, but we make no exceptions in the case of the poorer classes. I mentioned in my last Report that Ealing had been selected by the County as one of the areas for the establishment of a Tuberculosis Dispensary. I regret that this has not yet been accomplished, although a Tuberculosis Officer was appointed some months ago. In an interview with him, I was informed all "insured persons" suffering from these diseases (and they comprise a majority of the whole number) would come under his direction. In the absence of an organised scheme, I find some difficulty in obtaining for "non-insured" persons the 10 treatment their cases require. When the "National Insurance Act" became law, this Council necessarily terminated their arrangement with 'Mount Vernon Hospital for the use of several beds in that institution, and owing to this, and for other reasons, I trust no long interval will elapse before we get the Dispensary referred to in working order, and thus get a complete organised system arranged to meet all cases. In the case of any"non-insured" person (and these instances are few) requiring, say. Sanatorium treatment, I refer to the County Medical Officer, who willingly considers and decides upon it. Notifications and Infectious Diseases. I regret to state that a large increase of notifications has to be recorded for the past year, due almost entirely to the prevalence of Scarlatina during the last quarter of the year, and these amounted to 326 cases compared with 187 in 1912. As usual, in such outbreaks, the incidence of the disorder was most felt in the poorer and most thickly-populated Wards of the Borough, but many cases were scattered about other parts of -our district. The number of cases in individual Wards is shown as follows:— Disease. No. Drayton. Lammas. Manor. Grange. Castlcbar. Mount Park. Scarlatina 326 43 136 74 29 32 12 Diphtheria 57 6 24 20 3 2 2 Erysipelas 45 13 15 8 1 6 2 Enteric Fever 5 ... 1 1 ... 2 1 Poliomyelitis 3 l 1 ... 1 ... ... Pulmon. Tubercul. 120 15 33 32 13 18 9 Other forms ,, 55 7 14 18 6 10 ... Totals 611 85 224 153 53 70 26 11 Thus there was an increase of 213 notifications over those of the previous year. In every instance of a notifiable affection, a visit is immediately paid to the dwellilngs of the patients, and instructions are given appropriate to each case with regard to removal to Hospital, isolation, and advice concerning contacts. Very many cases are due to direct infection from an earlier one, and a considerable number of "missed cases "were discovered. The type of the disease is usually so benign that many of the children are considered by their parents to be merely suffering from a "little cold and sore throat," and only when desquamation has set in are parents enlightened as to the disease, or by the occurrence of another case in the family. In the early stage of the outbreak there was reason to infer a particular class in an infants' school was a centre of infection, but its closure for a short time proved successful, and no further cases were traced to that source. The class rooms were disinfected by Formalin spraying, as is the invariable practice with regard to infected dwellings. I am quite satisfied that school aggregation had little, if anything, to do with disseminating the disease. Other adjoining districts have been largely affected as is, or has been, more or less, the case throughout the country, and considering our large population, I do not think we have exceptionally suffered. The greatest number of these Scarlatina cases were admitted to the Isolation Hospital, with two fatal results, and the majority of the Diphtheria patients received treatment in the same institution with happily only one fatality. The Poliomyelitis case arose in a family who were staying at an East Coast watering place, and was soon brought home to a large house on Ealing Common, and has happily recovered, and no further case ensued. Isolation Hospital. This Hospital has proved of excellent service during the Scarlatina outbreak, but at times the 12 sure of admissions caused some embarrassment, not from want of ward accommodation, but due to insufficient room for the increased nursing staff. The difficulty was temporarily overcome, and as early as practicable, the erection of four more nurses' rooms will be undertaken as sanctioned by the Council. A total of 367 patients were admitted in the course of the year, including 313 Scarlatina cases (thirty-six being from Hanwell, and eight from Greenford) and fifty-four Diphtheria patients (including ten from Hanwell, and two from Greenford). The admissions of Ealing cases of Scarlatina and Diphtheria numbered 311. Two fatal results from Scarlatina and one from Diphtheria are only to be recorded. My thanks are due to the Medical Officer and the Matron for the excellent arrangements made for, and the successful treatment of, this large number of patients. No case of Small Pox was notified, but we are always prepared for the occurrence and reception of such. Zymotic Death Rate. This rate was 0.54 per 1,000 compared with 0.38 for 1912. Old Age. Under the above heading I have to report that 246 persons died over 65 years of age. Infantile Mortality. There is an increase under this heading of 4.44, the rate being 72.05 against 67,61 in 1912, this last figure being with one exception the lowest recorded in the Borough. The deaths under one year for England 13 and Wales was equal to 109 to 1,000 births, and for the ninety-six great towns, including London, 116. The chief causes of death among infants under one year of age were three from Whooping Cough against eight in the previous year; sixteen from Chest affections, and three from Tuberculosis Diseases. Sixteen fatal results were due to congenital debility and premature births. Twenty-eight deaths were ascribed to other defined diseases, and five to "violent deaths " (overlying and accidents). The climatic conditions were, on the whole, favourable throughout the year, with the exception of a comparatively short period of very hot weather, and during this the well-known factors at work to conduce to diarrhcel attacks became active, and, as a result, twenty-one children, of whom nineteen were infants under one year of age, succumbed to this disorder, and the remaining two deaths were of children under two years of age. The total number of infantile deaths was ninety. In connection with the care and bringing-up treatment of infants, the services of the Female Sanitary Inspector have proved very valuable. A very large number of mothers are visited about ten days after the births of their infants, and advice tendered concerning the proper feeding of their offspring. Many re-visits are paid to ensure the instructions being carried out properly. Mrs. Copeland's Report is appended. In connection with her various duties, she has paid 2,364 visits during the year. Births. One thousand two hundred and forty-nine births were registered in the Borough during the year. Their distribution among the Wards is shown below. There is a decrease of eighty-two compared with the number of 1912, and a very regrettable lessening of our birth 14 rate has to be recorded to the extent of 2.4 per 1,000 of the population, giving the greatly reduced rate of 18.23 compared with one of 20.6 in 1912. There has been of late a tendency for this important rate to come down, but it has never before reached so low a figure in the Borough as for this vear (1913). For England and Wales the rate is 23.9, and for the ninety-six great towns, 25.1 per 1,000 living:— Males. Females. Total. Lammas Ward 171 201 372 Manor Ward 152 127 279 Drayton Ward 77 70 147 Grange Ward 87 48 135 Castlebar Ward 90 75 165 Mount Park Ward 62 54 116 Inward Transfers 19 16 35 Totals 658 591 1,249 House to House Inspections. In accordance with the several Acts, Orders and Regulations bearing on this subject, duties have been as systematically carried out to as great an extent as possible. This special work was much hindered and curtailed during the last quarter of the year owing to the great demands on the inspector's time, in consequence of the numerous visits required to be paid to houses where infectious disease had broken out. The sanitary conditions of all these dwellings were carefully inquired into during these visits, and any defects discovered remedied. The Sanitary Inspector's Report and Tables afford all details in connection with this work. It will be seen from the Inspector's returns that 261 "House-to-House Inspections" were made, being fifty-seven more than in the previous year, not- 15 withstanding' many unavoidable interruptions. No compulsory powers had to be exercised to obtain the compliance with our orders One house condemned as unlit for occupation was voluntarily pulled down. No scheme of Town Planning has been considered for the Borough, and under the existing conditions of the locality is neither feasible nor possible on any large scale. The small estate of the Ealing Tenants, which is well laid out, continues to gradually increase under the Borough Engineer's supervision. There is a comparatively small amount of really old property left standing, and this receives special attention. The following Table affords information of the Sanitary defects which were discovered in the course of House-to-House Inspection, viz.:— Sanitary Defects Discovered. streets. No. of Houses Inspected. Defective or Obstructed Drains. Defective or Insufficient Sanitary Appliances. Defective Rainwater Pipes, and Eaves Clutters. Defective Roofs. Defective or Insufficient or Foul Water Closets. Defective or want of Yard Paving. Damp Walls. Want of Efficient Ventila tion under floors. Defective or Absence of Dustbins. Want of Covers to Storage Cisterns or improper situation of same. Dirty and Unwholesome Condition of Walls and Ceilings Overcrowding. Other Nuisances or Sanitary Defects. Defective Floors. Church Place 2 1 1 1 4 1 2 2 ... 1 ... 4 ... 6 2 Charles Street 1 1 ... ... 1 1 1 2 ... ... ... 6 ... 2 1 Dane Road 24 15 4 2 7 12 21 37 16 3 10 28 ... 34 13 Eccleston Road 12 4 14 7 3 4 10 12 12 3 7 ... ... 15 6 Ealing Common 1 ... ... ... ... ... 1 1 ... 1 1 ... ... ... 1 Haven Lane 41 13 23 15 9 22 19 22 18 15 6 22 1 38 15 Heath field Cottages 5 ... ... 4 3 ... 1 5 3 ... ... 3 2 7 2 Mount field Road 43 2 15 11 25 20 21 35 31 7 9 44 ... 54 22 North field Road 50 4 3 12 29 10 41 50 22 7 16 76 ... 76 33 Oak Street 10 8 ... 3 7 2 5 10 2 1 1 ... ... 8 8 Oxford Road 37 6 23 10 15 12 22 29 10 5 9 26 ... 24 7 St. Matthew's Road 16 1 8 21 24 13 12 13 11 3 ... 18 ... 48 14 St. Mark's Road 18 ... 6 11 17 12 10 18 10 3 5 27 ... 47 9 Wells Place l ... 1 ... ... ... 1 ... ... ... ... ... ... 1 1 Totals 261 55 98 97 142 109 167 236 135 49 64 254 3 360 134 Total number of defects discovered at time of inspection, 1903. 16 Factories and Workshops Act. The number of these places is 216. They receive constant and also systematical attention, as will be seen by the Chief Sanitary Inspector's return of visits in connection with the above Act. The inspections of all businesses which come under the above Act where female labour is employed are entrusted to the Female Sanitary Inspector, who also visits the out-workers' premises. There has been no difficulty in getting the regulations and requirements under this Act complied with, and, generally speaking, the various premises have been found suitable and satisfactory. Of the Bakehouses, six are underground, but all regulations concerning these are strictly complied with. Dairies and Milkshops. These places are fifty-three in number, and receive frequent and careful attention, and any contraventions of Bye-laws or Regulations have at once been attended to when brought to the notice of the retail milkshops proprietors. I believe all reasonable care is taken to guard the milk against contamination, and with the exception of that given by about 150 cows, which are all in excellent condition, the milk supplied is imported from country districts, and I receive no complaints respecting its condition and quality. I hold stronglv to the opinion that it is advisable to have all milk for "drinking purposes "either brought to the boiling point for a single moment, or, better still, pasteurised, and I believe the bulk of the Health Officers are in agreement with the practice. General Sanitary Administration. I hope the Council will consider, from statements in this Report, and that of the Chief Sanitary Inspector, that a useful amount 17 of general Public Health work has been fulfilled with much good result. We are able to show a rather reduced death rate, an only slightly increased infantile mortality (compared with previous years), but the unfavourable fact of a materially reduced birth rate. Regrettable as this undoubtably is, it is no part of my duty, with regard to its cause, to say more than that Public Health Administration has nothing to do with this decline. If you exclude the unusual amount of Infectious Disease which prevailed during the last quarter of the year, the opinion can be held that the general health conditions of the Borough have been well upheld. The work performed at the School Clinic results in great benefit to health of many children of school age, and this will become more manifest as time goes on. I have also much pleasure in recording my belief that the duties carried out by the Female Sanitary Inspector, with reference to the proper methods of rearing infants, has no small effect in keeping down the infantile death rate, certainly in normal seasons. I append, as is customary, a few remarks in connection with the Department under the control of the Borough Survevor, and I can testify with satisfaction to the high state of efficiency with which all services affecting the health and sanitary condition of the Borough are carried out by this Department. During the past year the amount of house refuse collected and taken to the Destructor at South Ealing amounted to the very large total of 13,886½ tons, and, in addition, 4,592 tons of pressed sludge have been disposed of in the Destructor. At the Northern Works, the two 90 feet diameter continuous filters have been completed and are giving splendid results. Samples of effluent have been taken periodically, both from there and the Southern Works, and in no case has an adverse report been received, the whole of the analyses, as certified by Professor Kenwood, being satisfactory. Negotiations in connection with the laying of the Relief Surface Water Sewer from the River Brent in 18 Hanwell, to the south corner of the allotments here, have made progress, and I understand that, subject to the sanction of the Local Government Board being received, this work will in all probability be carried out during the ensuing summer. The systematic flushing of sewers has received careful attention, as usual, and the scavenging of the roads and alleys of the Borough is well looked after. Largely increased activity on the Borough Surveyor's Staff has been shown in the laying of impervious surface to the carriage-ways of the Borough, and tarred slag and asphalte macadam have been successfully laid in many roads. This, more particularly on the motor 'bus routes, has tended to almost entirely remove complaints in regard to dust, and the improved surfaces have given general satisfaction. In conclusion, I beg to express my sincere thanks to the Chairman and members of the Public Health Committee, and to the members of the Council, for the kind assistance and consideration I invariably receive and greatly appreciate. My thanks are also due to the Heads of all Departments for ready help at all times, and I again acknowledge the valuable work so efficiently rendered by my own Staff. I am. Gentlemen, Your obedient servant, C. A. PATTEN. Medical Officer of Health. 19 BOROUGH OF EALING. SANITARY WORK 1913. ADOPTIVE ACTS : Infectious Disease Notification Act, 1889. Infectious Disease Prevention Act, 1890. Public Health Acts Amendment Act, 1890 (except Part 4). Public Health Acts Amendment Act, 1907, Parts 5 8, and certain sections comprised in Parts 2, 3, 4 and 10. STAFF EMPLOYED: Same as last year. BYE-LAWS: Common Lodping Houses. Slaughter-houses. Tents, Vans, Sheds and similar Structures. Prevention of Nuisances arising from Snow, Filth, Dust, Ashes and Rubbish, and for the Prevention of Keeping Animals in any premises so as to be a nuisance. Removal of Faecal or Offensive Matter through the Borough. New Streets and Buildings. Cleansing of Earth Closets, Privies and Cesspools. REGULATIONS : With respect to Dairies, Cowsheds and Milkshops. FORM I. INSPECTIONS— Number of Premises Inspected on Complaint 162 Number of Premises Inspected in connection with Infectious Diseases 400 Number of Premises under Periodical Inspection 433 Food Inspections 3,916 Houses Inspected from House-to-House 261 Total Number of Inspections and Re-inspections made 13,246 ACTION TAKEN (other than under H. and T.P. Act)— Cautionary or Intimation Notices Given 574 Statutory Orders Issued 194 Summonses Served 5 Convictions Obtained 5 DWELLING HOUSES AND ACTION UNDER H. AND T P. ACT, 1909— Number of Houses dealt with under Sect. 15 138 Number of Houses Closed Voluntarily 1 Number of Houses Demolished Voluntarily 1 20 FORM II. MOVABLE DWELLINGS, CARAVANS, TENTS, &c.— Number Observed during the Year 9 BAKEHOUSES— Number in District 29 Contravention of Factory Acts 59 SLAUGHTER-HOUSES— Number on Register 5 Number of Inspections made 20 Frequency of Inspection Quarterly and at times of Slaughter. COWSHEDS— Number on Register 5 Number of Inspections made 20 Frequency of Inspection Quarterly Number of Milch Cows in District About 150 DAIRIES AND MILK-SHOPS— Number on Register 48 Number of Inspections made 138 Frequency of Inspection three times a year Contraventions of Regulations 27 UNSOUND FOOD— Fish seized and surrendered 447¾ 1bs. Fruit and Vegetables seized and surrendered 330 1bs. Other Articles seized and surrendered 15 Rabbits—37¾ lbs. Method of Disposal Destructor. OFFENSIVE TRADES— Number of Premises in District—Fried Fish Shops 12 Number of Inspections made Weekly Contraventions of Bye-Laws 3 WATER SUPPLY AND WATER SERVICE— Percentage of Houses supplied from Public Water Service. 100% Cisterns—New Provided 7 Cleansed, Repaired, Covered,&c. 11 Draw-Taps placed on Mains 64 Percentage of Houses supplied on Constant System 100% FORM III. DRAINAGE 6: SEWERAGE of EXISTING BUILDINGS — Water Closets—Repaired, Supplied with Water, or otherwise Improved 384 Percentage of Houses provided with Water Closets 100% Drains- Examined, Tested, Exposed, &c 34 Unstopped, Repaired, Trapped, &c. 210 Waste Pipes, Rain Water Pipes, Disconnected, Repaired. &c. 155 New Soil Pipes or Ventilating Shafts fixed 144 Existing Soil Pipes or Ventilating Shafts Repaired 8 Disconnecting Traps or Chambers Inserted 169 Reconstructed 78 Cesspools—Rendered Impervious, Emptied. Cleansed, &c. 1 Abolished, and Drain connected to Sewer 1 Percentage of Houses Draining into Sewers 99.9 21 DISINFECTION— Rooms Disinfected— Ordinary Infectious Diseases 406 Phthisis 61 Rooms Stripped and Cleansed 593 Articles Disinfected ok Destroyed— Ordinary Infectious Disease 4,339 Phthisis 328 DUST— New Bins Provided 102 How Frequently is Dust Removed from each House ? Weekly. Number of Complaints of Non-Removal received 40 Method of Disposal Destructor. SUNDRY NUISANCES ABATED— Overcrowding 19 Smoke 2 Accumulations of Refuse 69 Foul Ditches, Ponds, &c., and Stagnant Water 1 Foul Pigs and other Animals 21 Dampness—Damp-proof Courses 274 Yards Repaved or Repaired 272 Other Nuisances 339 REMARKS— New Sinks and Waste Pipes 110 Windows made to open 88 Ventilation under Floors 163 Floors Repaired 125 Roofs Repaired 157 Eaves Gutters Repaired or Renewed 114 Light and Ventilation provided to Water Closets 32 BOROUGH OF EALING. FACTORIES, WORKSHOPS, WORKPLACES, AND HOMEWORK. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Inspections. Written Notices. FACTORIES (including Factory Laundries) 10 — WORKSHOPS (including Workshop Laundries) 278 — Total 288 – 22 2—DEFECTS FOUND. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts— Want of Cleanliness 46 46 — Want of Ventilation 2 2 — Want of Drainage of Floors 1 1 — Other Nuisances 58 53 — Sanitary Accommodation— Insufficient 6 6 — Unsuitable or Defective 16 16 — Not Separate for Sexes 1 1 — Total 125 125 – 3.—HOME WORK. OUTWORKERS' LISTS, Section 107. Twice in the year. Once in the year. Lists received from Employers— Lists. Outworkers. Lists. Outworkers Wearing Apparel—Making, &c. 12 14 15 49 Household Linen — — 1 2 Stuffed Toys 2 6 — — Total 14 20 16 51 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year— Bakehouses 29 Laundries 23 Dressmakers 107 Tailors 10 Millinery 16 Miscellaneous 31 Total number of Workshops on Register 216 5.-OTHER MATTERS. Underground Bakehouses (s. 101)— In use at the end of the year 6 Table I. Vital Statistics of Whole District during 1913 and Previous Years. BOROUGH OF EALING. Year. Population estimated to Middle of each Year. Births. Total. Deaths Registered in tub District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1000 Nett births Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1908 51000 1251 1251 24.5 497 9.7 – 76 101 80.7 573 11.2 1909 52550 1184 1184 22.5 557 10.5 7 82 90 76.0 632 12.02 1910 54259 1272 1272 23.4 440 8.1 3 96 83 65.2 533 9.8 1911 61723 1246 1246 20.2 722 11.6 8 110 152 121.7 714 11.5 1912 64500 1308 1331 20.6 511 7.9 13 119 90 67.6 630 9.7 1913 68500 1214 1249 182 506 7.3 14 110 90 72.05 616 8.9 Area of District in acres (land and inland water) — 2917. Total population at all ages 61235 Number of inhabited houses 135 5 Average number of persons per house 45 At Census of 1911. Table .II. Cases of Infectious Disease Notified during the Year 1913. BOROUGH OF EALING Notifiable Disease. At all Ages. Number of Cases Notified. Total Cases Notified in Each Locality. Total cases removed to Hospital. At Ages—Years. Drayton Ward. Lammas Ward. Manor Ward. Grange Ward. Castlebar Ward. Mount Park Ward. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Diphtheria (including Membranous croup) 57 1 9 34 8 5 – – 6 24 20 3 2 2 42 Erysipelas 45 — 1 4 5 13 16 6 13 15 8 1 6 2 — Scarlet fever 326 4 60 221 25 15 1 — 43 136 74 29 32 12 269 Typhus fever — — — — — — — — — – – – — — — Enteric fever 5 — — 2 2 1 — — — – 1 – 2 1 — Poliomyelitis 3 — 1 2 — — — — 1 1 – 1 — — — Pulmonary Tuberculosis 120 — — 13 26 55 25 1 15 33 32 13 18 9 — Other forms of Tuberculosis 55 2 12 22 7 10 2 — 7 14 18 6 10 — – Totals 611 7 83 298 73 99 44 7 85 224 153 53 70 26 311 Ealing Isolation Hospital, South Ealing (Grange Ward). Total available beds, 76. Number of diseases that can be concurrently treated, 3. Table III. Causes of, and Ages at Death during the Year 1913. BOROUGH OF EALING. Causes of Death. Nett Deaths at the Subjoined Ages of "Residents," whether occurring within or without the district. Total Deaths whether of "Residents ' or" NonResidents " in Institutions in the District. All Causes Certified All ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Uncertified 2 Enteric fever 1 — — — — — 1 — — — Measles 7 — 2 4 1 — — — — — Scarlet Fever 2 — 1 — 1 — — — — 2 Whooping cough 5 3 1 1 — — — — — — Diphtheria and Croup 1 — — 1 — — — — — 1 Influenza 9 — — — — — 4 2 3 — Phthisis (Pul. Tuberculosis) 37 — — — 3 3 19 12 — — Tuberculous Meningitis 8 3 5 — — — — — — — Other tuberculous diseases 4 — — — 1 1 2 — — — Cancer, malignant disease 73 — — — — — 9 29 35 1 Rheumatic fever 2 — — — — — 2 — — 1 Meningitis 2 — — — 2 — — — — — Organic Heart disease 61 — — — 2 4 6 18 31 1 Bronchitis 51 4 1 1 1 — 1 10 33 1 Pneumonia (all forms) 39 12 2 1 — 2 5 7 10 2 Other Diseases of Respiratory Organs 8 — — — — — 1 3 4 — Diarrhrea and Enteritis 21 19 2 — — — — — — — Appendicitis and Typhlitis 8 — — — 1 — 3 3 1 3 Cirrhosis of liver 4 — — — — — 1 2 1 — Alcoholism 2 — — — — 1 1 — ~~ Nephritis and Bright's Disease 14 — — — — 1 2 6 5 1 Other accidents and diseases of pregnancy & parturition 5 — — — — — 5 — — 1 Congenital debility and Malformation, including Premature Birth 16 16 — — — — — — — — Violent Deaths, excluding Suicide 19 5 — 1 4 1 — 4 4 5 Suicide 5 — — — — 1 2 1 1 — Other defined diseases 206 28 1 2 3 5 18 34 115 7 Ill-defined or unknown 6 — — — 1 1 1 3 — Totals 616 90 15 11 19 19 83 133 246 26 SubEntries. included in above figures. Cerebro-spinal Meningitis — — — — — — — — — — Poliomyelitis — — — — — — — — — — Table IV. Infant Mortality during the Year 1913. Nett Deaths from stated causes at various ages under One Year of Age. BOROUGH OF EALING. Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. All Causes Certified — — — — — — — — — — Causes Uncertified — — — — — — — — — — — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — — — — — — Scarlet Fever — — — — — — — — — — Whooping Cough — — — 1 1 — — 2 — 3 Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — 2 1 — 3 Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — — — — Convulsions 1 1 — — 2 — 1 2 — 5 Laryngitis — — — — — — — — — — Bronchitis — — — — — 1 1 1 1 4 Pneumonia (all forms) — 1 — — 1 — 2 3 6 12 Diarrhoea — — — — — 4 3 2 2 11 Enteritis 1 1 1 — 3 2 3 — — 8 Gastritis — — — — — 2 2 — — 4 Syphilis — — — — — — — — — — Rickets — — — — — — — — — — Suffocation, Overlying 1 — — — 1 2 1 — — 4 Injury at Birth 1 — — — 1 — — — — 1 Atelectasis — — — 1 1 — — — — 1 Congenital Malformations 1 — — — 1 1 — — — 2 Premature Birth 7 3 2 — 12 — 2 — — 14 Atrophy, Debility and Marasmus 4 — 2 — 6 2 1 1 1 11 Other Causes — 1 — 1 2 1 2 1 1 7 16 7 5 3 31 15 20 13 11 90 Nett Births in the year legitimate 1,199 illegitimate 59 Nett Deaths in the year of legitimate infants illegitimate infants 23 MRS. COPELAND'S REPORT. Public Health Department, Town Hall, Ealing, W. February 27th, 1914. Dr. C. A. Patten, Medical Officer of Health. Sir, I have pleasure in presenting the Annual Report of my work to December 31st, 1913. The number of my visits make a total of 2,364, namely:— To homes where births have occurred 1,991 To Workshops, Laundries (Factory and Workshop Act) where women are employed, homes of outworkers 206 Visits, Public Health (Tuberculosis) Regulations, 1908 and 1911 84 Miscellaneous visits 30 Periodical visits to Women's Conveniences 53 Total 2,364 Of the babies visited :— 76.4 per cent, were breast-fed 16.4 per cent, were bottle-fed. 7.2 per cent, were partly breast and partly bottle-fed. The visiting of the homes where births have occurred has been continued. The visits are well received and looked forward to, and the advice given is much appreciated and valued. 24 The Victoria Hall Trustees again made a grant of £5 to provide a few necessitous nursing mothers with an allowance of milk for a short time. Mrs. Dunnett, M.R., of the Ealing Health Society, also allowed a few mothers a pint of milk daily for varying periods. The babies visited were found on the whole to be in a healthy condition, and it was necessary only in seventy-seven cases to advise that the child should be taken to the doctor. Twenty-three mothers owned to giving boiled bread, biscuits, etc., but this improper way of feeding is less prevalent, and the mothers seem to be more intelligent and sensible in the care and management of their children. I am sorry to report that I found eighty-two fathers out of work, and twenty-nine doing odd work. These cases are unsatisfactory, because often for long periods the family is on the verge of starvation, and when the father does find work, it is quite a long time before they derive any appreciable benefit from his earnings, owing to the fact that " back debts " have to be paid off; in these cases very often the mothers go to work, and this, of course, deprives the family of her care in the cooking, etc. In January last, 1913, Mrs. Dunnett, M.B., very kindlv entertained about fifty mothers, whom I invited to tea in the Mission Hall, Northfields Avenue; each baby was weighed and examined, and on several occasions during the year mothers have attended at the Town Hall to have their babies weighed, etc. The Medical Officer of Health has very kindly seen the mothers, and spoken to them individually with reference to their babies. In connection with the workshop inspections, I have reported forty-nine defects. Generally, the places were found to be in a satisfactory condition. 25 I have continued to visit the women and children notified under the Public Health (Tuberculosis) Regulations, 1908 and 1911. The defects found at these homes numbered twenty-eight; four of these were overcrowded. I attended the Conference on Infantile Mortality, held in the Caxton Hall on August 4th and 5th last. The papers read on the various subjects which bear on this work were most instructive and interesting, as were also the discussions. Some of the points raised included the following :—(a) That special education in Infant Hygiene should be included in the curriculum of medical men; (b) that the training of midwives was inadequate; (c) that education should do a great deal to lessen the effects of poverty and its attendant evils, these being great factors in causing infantile mortality. Dr. Truby King, of New Zealand, advocated the use of the Press for disseminating knowledge concerning the rearing of children; he also insisted that the routine practice of making caloric estimates in infant feeding was the only safe, simple, and effective way of avoiding grave mistakes. Dr. Caroline Hedger, of Chicago, in a very instructive paper on "The Relation of the Education of the Girl to Infantile Mortality," pointed out the danger of over-education and wrong education on the reproductive life of the girl. She says, "Few schools show constructive ideas on the conservation of the girl's reproductive life; few schools fit for mother craft." The establishment of pregnancy clinics was urged by Dr. Huntingdon, of Boston, Mass. With reference to the hand-feeding of infants, dried milks were especially recommended. Dr. Hope, of Liverpool, showed that milk can be effectually sterilised by electrical methods, all 26 neous organisms being destroyed. No change is said to take place in the milk, and the process is very much cheaper than the ordinary pasteurisation by heat. Following on the discussions, a series of resolutions were drawn up, and these form a good summary of the Conference. The resolutions were all adopted, and are as follows :— (1) That this Conference urges that the maternity benefit be made the property of the mother, both in practice and in law. (2) That in view of the damage liable to be wrought in growing girls by injudicious stress of education, especially during puberty and adolesence, this Conference feels bound to deprecate any form of education for girls which pays insufficient attention to establishing good bodily health and development and complete fitness for maternity and the practical care of a home. (3) That this Conference urges upon the Government the necessity—in the interests of both mother and child—of legislating for the registration of "stillbirths." (4) That this Conference urges upon the Government the necessity for the more complete medical certification of death, and that the medical death certificates should be forwarded to the registrars as confidential documents under sealed cover. (5) That the time has arrived for steps to be taken with a view to securing the better training of women who apply for the certificate of the Central Midwives Hoard. (6) That this Conference requests the Executive Committee to communicate with the General Medical Council and the degree and licence-conferring bodies, with a view to infant hvgiene being given a more important place in the medical curriculum. 27 (7) In vew of the large percentage of still-births, and infants' deaths directly attributable to venereal diseases, and considering that infant blindness and other congenital defects are in many cases due to the same cause, the English-speaking Conference on Infant Mortality urges the respective Governments of the countries therein represented each to appoint a Commission to inquire into the prevalence, the causes, the provision of treatment, and the possibility of the prevention of these diseases. (8) That the attention of the Hoard of Education be drawn to the extreme desirability of making the grant earned by " recognised " Infant Welfare Centres depend in future on their efficiency, on the number of registered attendances of the mothers at consultations, classes, and talks, and on the number of home visits paid under adequate supervision. (9) That this Conference calls on the Government to give explicit powers of making grants for infant consultations and school for mothers. (10) That the Executive Committee be instructed to take whatever steps they may think desirable in order to ensure a microscopical examination of milk, to be supported by analytical methods. I have to thank the Committee for allowing me to attend the Conference. I am, Sir, Your obedient servant, MABEL COPELAND, Sanitary Inspector. 28 CHIEF SANITARY INSPECTOR'S REPORT. To His Worship the Mayor, the Aldermen, and Councillors of the Borough of Ealing. Gentlemen, I have the honour to submit for your information my Annual Report of the work carried out by the Sanitary Inspectors of the Public Health Department during the year 1913, in connection with the suppression and abatement of the various nuisances which are dealt with under the Public Health Acts and Bye-laws in force in the Borough. In connection with the abatement of nuisances, it is incumbent on Local Authorities to cause such work, or works, to be executed in such a manner as will prevent, as far as practicable, a recurrence thereof. It is, therefore, the aim of your Sanitary Inspectors to see that all works that come under their supervision are carried out in the best possible manner, so as to comply with the existing requirements. In some instances, I am pleased to state that the work carried out exceeds that given in the advice, and above the standard of work which could be reasonably enforced, while the old tendency still exists on the part of some persons to execute work in a very slip-shod manner. This so-called cheap work very often turns out to be the most expensive, as, needless to say, your Inspectors insist upon such work being exposed and exe- 29 cuted a second time. In this respect no serious difficulty has been experienced in petting such inferior work put right, and it has not, therefore, been necessary to report upon the matter. It is, for the reasons mentioned, that we urge upon the owners of property and their contractors the necessity of carefully carrying out all sanitary work as are specified as fully as is practicable in the notices, or in accordance with the verbal advice received from this Department, and which I am pleased to state is, in a large majority of cases, accepted. During the past year, and on reference to the Tables of Sanitary Works, it will be seen that a very large number of insanitary conditions were remedied, much to the satisfaction, the comfort, and beneficial effect on the health of the inmates of the houses, and during the progress of such works no less than 6,778 re-visits were paid to the various premises to insure that every effort was being made to maintain the high standard of sanitation in the Borough. In connection with the abatement of sanitary defects, and other nuisances, I have continued my usual practice, when, on the discovery of anv nuisance, either as the result of a complaint, house-to-house, or other inspection, of forwarding to the owner or agent having charge of the property the intimation notice, which is in the form of a letter, and contains no authoritative threat, specifying the works necessary to abate the nuisance satisfactorily. By continuing such practice, I find, in a large majority of cases, the owners, and others responsible for the removal of a nuisance, are far more willing to comply with the requirements of the Public Health Acts and Bye-laws in force in the Borough. There are some, however, who will not make the attempt to comply with a notice, statutory or otherwise, until a threat to prosecute is sent either by the Town Clerk or myself, and which, I am pleased to say, has had the desired effect. 30 Inspections. Under this headings the total number of inspections and re-inspections made during the year amounted to 13,246 as compared with 14,404 made during the year 1912. This decrease, I have to mention, is to some extent due to the fact that Mr. C. Slade, who was appointed Clerk in the Department during April, 1911, left in March of last year to take up his new duties as Assistant Sanitary Inspector under the Barnes Urban District Council, thus necessitating the importation of a Clerk into the Department whose knowledge of the Public Health work was not to be compared with that which Mr. Slade possessed; in consequence, it was imperative for either myself or one of the District Inspectors to constantly be in attendance in the Department for a greater part of the remainder of the year, during which time the inspectorial work was carefully arranged and carried out. The following Table shows the number of inspections and re-inspections, made up as follows, namely: House-to-house inspections 261 Inspections on complaints 162 Inspections following notifications of infectious diseases 460 Premises inspected periodically 433 Miscellaneous inspections 790 Reinspections to premises during the progress of works 6,778 Inspections under Dairies, Cowsheds and Milkshops Order 138 Inspections under Factories and Workshops Act 288 Quarterly inspections of slaughter-houses 20 Inspections of Meat, Fish, Fruit, etc. 3,916 Total 13,246 House-to-House Inspection. Special attention was paid to the "House-toHouse" inspections during the year under the Housing 31 and Town Planning, etc., Act of 1909, also the regulations made thereunder by the Local Government Board, which imposes upon Local Authorities the special duty of causing to be made from time to time inspection of dwelling houses and premises within their district, with a view of ascertaining whether any house is in such a state so dangerous or injurious to health as to render it unfit for human habitation. As far as has been practicable, systematic inspections have been made of houses the rent of which does not exceed £26 per annum, as required under the Housing Town Planning Act, 1909. In respect of one house in Dane Road, the conditions (after the tenant had vacated the premises] were found to be of a far more serious character than was observed at the time of inspection, with the result that the leaseholder, after consulting the ground landlord, decided to demolish the building and clear the site, which was done in preference to carrying out the works specified in the notices sent from this Department in accordance with the above Act, this Housing Act has increased the work of the Depatment considerably with regard to the inspection and supervision of the various works while in progress at the more older houses in the Borough. There are two other houses the owner of which is undecided whether to carry out the specifications as per notices, or demolish the buildings. Each house visited under the above is carefully inspected, and with regard to the defects found to exist, some of which could not fail to have been prejudicial to health, notices were promptly sent to the owners, or their agents, specifying the necessary works required to remedy the same. The Table of Sanitary Defects reported on by the Medical Officer of Health represents such defects only 32 as were visible at the time of inspection, and which includes all kinds of structural defects and other nuisances amounting to 1,903, while the following Table, herewith attached, represents the total number of sanitary nuisances remedied as the result of such inspections (this greatly exceeds that mentioned in the previous Table), and which, I am pleased to state, were attended to without having resource to legal proceedings. Complaints. During the vear 202 complaints and applications were received, forty of which being in respect of nonremoval of dust. These were carefully investigated and dealt with in respect of 198. With regard to four no cause could be found for complaint, while several of those dealt with were of a trivial character. Needless to say, special attention is paid to all communications, since it enables the visiting Inspector not only to inquire into the matter referred to, but they afford a most favourable opportunity in many cases of making a survey of some of the better class property. As in previous years, I herewith append a summary of the nuisances remedied under the above heading, together with other matters found in need of attention at the time of inquiring into the matter mentioned in the communication :— Summary of the Works carried out following Complaints. Storage water cisterns cleansed and covered 7 Draw taps fixed to main 1 Choked drains cleared and cleansed 34 Drains repaired 2 Drains re-constructed 5 Access chambers constructed 10 New soil-pipes fixed to w.c's 3 New ventilating pipes to drains 9 Cesspool abolished 1 Rain-water pipes disconnected from drains 3 Foul w.c. pans cleansed 8 33 New w c. pans fixed 9 External light and ventilation provided to w.c. 1 New sinks and waste pipes 11 Flush cisterns to w c's repaired 20 Bad smells from sewers attended to 3 1 Eaves gutters and down pipes repaired 9 Leaky roofs repaired 11 Walls and ceilings repaired, stripped and cleansed 63 Floors repaired 14 Damp-proof courses to house walls 18 Ventilation under floors provided 2 Windows made to open 3 Accumulations removed 34 Animals so kept as to be a nuisance 16 Surface of yards paved 25 New dustbins supplied 16 Overcrowding abated 7 Nuisance from vacant and unfenced land 8 Miscellaneous nuisances abated 56 Total 424 As heretofore, all communications in respect of non-removal of house refuse are dealt with by the Borough Surveyor's Department, as also are the nuisances in respect of smells from the sewers and ventilators in connection therewith. The dumping of garden and other refuse on vacant and unfenced land during the year has again been the source of great annoyance and displeasure to the residents where such land is situate. The owners of the land do, in some measure, try to prevent the nuisance by removing or burning the refuse, fixing of notice boards, and, in some cases, erecting a temporary fence on the land, which has been wilfully damaged. It is a most difficult matter to deal with, since it appears that the offenders wait for the most favourable opportunitv before depositing the refuse, sometimes after dark. This nuisance is most prevalent during the early spring and the autumn, and the existence of the ordinarv fence is no preventive, since it enables the offenders to pitch the refuse over without being seen. 34 Infectious Diseases. During- the year, and following the instructions of your Medical Officer of Health, 1,263 visits and revisits were paid to premises where one or other of che notifiable Infectious Diseases occurred. Careful inquiries were made in each case with a view of ascertaining if possible the source of infection, to arrange for the prompt removal to the Isolation Hospital all patients recommended for treatment therein, and the necessary, disinfection of the room or rooms, bedding, and clothing, etc., with a view of preventing the spread of infection. I may also mention that all rooms, passages, staircases, and landings, when necessary, are either fumigated with Formic Aldehyde, or sprayed with a strong solution of 40 per cent. Formaline, after the removal of all infected bedding, clothing, etc., to the Town Council's steam disinfecting apparatus ("Washington Lyons"), which is situate at the Northern Works. No less than 4,667 articles of bedding, clothing, carpets, etc., were disinfected, and, in conjunction with this, 467 rooms, passages, etc., were treated in the manner mentioned above. Owing to a mild attack of Scarlatina, which occurred among the school children, and which was confined to those attending certain class rooms, the disinfection by spraying of the floors, walls, and desks, the cloak rooms, and w.c.'s, was carried out by special request of the Medical Officer of Health. During the year, and in conjunction with infectious diseases, the following work was carried out, by request, for the Urban District Council of Greenford:— Patients removed to the Council's Hospital at South Ealing, 10; rooms fumigated, 18; articles of bedding, clothing, etc., passed through the steam disinfecting apparatus, 217. Applications were also made by local residents for the disinfection of bedding, etc., and fumigation of 35 rooms, following a severe illness, or a death from some malignant disease. As this work is usually carried out in connection with other disinfection, a small charge only is made to cover the extra expenses incurred. As the results of inspection of premises and sanitary arrangements at the infected houses, I herewith append a Table showing the sanitary defects discovered and remedied during the year :— Walls and ceilings stripped and cleancd 80 Overcrowded abated 5 Drains reconstructed 1 Drains repaired 5 Access chambers constructed 5 New w.c. pans fixe 10 Flush cisterns to w.c.'s repaired 12 New vent pipes fixed 18 New sink and waste pipes 10 Draw taps fixed to main 14 Roofs repaired 11 Surface of yards paved and drained 20 Floors repaired 8 Damp-proof courses inserted 9 Ventilation under floors provided 3 Storage water cisterns cleansed I Eaves gutters repaired 4 New dustbins supplied 9 Nuisances from animals 1 Miscellaneous nuisances abated 17 Improvements to Horsrcs, including Sanitary Arrangements and House Drainage. During the year there were78 house drains entirely reconstructed, while 210 were repaired and made water-tight. Some of the repairs necessitated partial reconstruction as the result of an examination, under the Public Health Acts, after reporting to, and obtaining the authority of the Council. 36 In many instances, the drains, on exposure by the contractors to carry out certain repairs, or to remove an obstruction, were found to be in such a defective condition that the owners finally agreed to carry out the necessary work of reconstruction, thereby rendering further action unnecessary. In all cases of difficulty, full details are reported to the Committee, which enable them to decide upon the works to be carried out. Of the total number of house drains reconstructed 25 were in respect of the combined system, and which were reconstructed at the expense of the respective owners, and I was pleased to note the harmony in which the contractors worked with each other during the progress of the works, thereby reducing to a minimum the inconvenience to the occupiers, which is not at all times possible to obviate. Personally, I regard the use of iron pipes for house drainage as having a distinct advantage over the stoneware pipes. The reason being that the modern stoneware drains cannot always be relied upon to retain their water-tight condition, notwithstanding that every possible care and attention are given to see the works carried out in a satisfactory manner. This, in mv opinion, is a serious matter, on sanitarv grounds, on behalf of the inmates of the houses, and, financially, for the owners of the property. Some of the chief causes, I may mention, are probably due to expansion of the cement used for jointing the pipes, and the concrete in connection with same, also the movement of the subsoil and subsidence of buildings in close proximity to the drains. It is a common occurrence to find on exposing a cement-jointed drain, either the sockets are in pieces, or that the pipes are broken at the back of the sockets, sometimes leaving a space of at least oneeighth of an inch between the two parts. With regard to cast iron pipes, I have applied the water test to several iron drains, some of which have 37 been in existence for many years, and found them In a water-tight condition. The pipes used are coated, and usually nine feet in length ; consequently, there are fewer joints than is the case of stoneware pipes; the joints are made with molten lead, and well caulked. There is, however, the additional cost of these pipes to be considered, but when the saving of time and labour is taken into account, together with the greater security against the evils mentioned above, there is a good return for the small additional outlay. In connection with the drainage works there were 174 modern intercepting traps fixed, and water-tight access chambers constructed, and 122 soil pipes to water-closets and ventilating shafts fixed, such works being carried out in accordance with the Council's Building Bye-laws, which are applicable to old and existing buildings. There were 92 rain water pipes disconnected from the drains, and 114 rain water pipes and eaves gutters were repaired or partially renewed, owing to their defective or choked condition; many of the house walls were found damp in consequence, and paper on the inner surfaces hanging loose. Paving of Yards and Damp Walls of Houses. As heretofore, this work continues to form a very important part of our daily work, not only at the time of the inspection of the houses, when damp walls may be found to be due to other causes rather than the want of efficient horizontal or vertical damp-proof courses; but a great deal of attention is required in the supervision of the work to insure that the works carried out will, for some considearble time to come, prevent a recurrence of the nuisance. It is most essentia] that this should be done, since it is admitted that the work in connection with the damp-proof 38 courses to house walls is a most expensive item for the owner, therefore, the conditions are carefully considered before ordering such work to be done. The work carried out under this heading consisted of the paving of 272 yards, passages, and forecourts, and the placing of 274 damp-courses to house walls. There were also 157 roofs repaired and rendered water-tight. Factories and Workshops Act, 1901. The number of these premises visited during the year was 288, and the details of the works carried out are herewith appended. With regard to bakehouses, these have been regularly attended to, and the requirements of the Act carried out. Although no notice was served, it was deemed necessary to request that the lime-washing be carried out on four occasions. Cleansing.—The walls and ceilings of thirty-eight rooms were oleansed. Ventilation.—Efficient light and ventilation was provided to two workrooms. Dampness.—Two roofs were repaired and the surface of five yards were re-paved. Sanitary Arrangements.—W.C. pans cleansed, 22; new w.c. pans fixed, 3; flush cisterns to w.c. put into working order, 9; additional w.c. constructed, 1; defective w.c. seats renewed, 6; external light and ventilation provided to w.c.'s, 2; obstructed drains cleared and cleansed, 6; drains repaired, 2; floors and walls repaired, 6; accumulations of refuse removed, 5; new dustbins supplied, 2; miscellaneous nuisances, 10; total, 125. 39 Dairies, Cowsheds, and Milkshops. There was no application during' the year to register as a cowkeeper. The number of these premises remain as in the past few years, namely, five. Throughout the past year these premises were kept in a satisfactory condition, and the average number of cows kept was about 150. At certain times of the year this number is exceeded, but owing to the selling off of some of the stock, it is usually brought down to this number. The number of persons on the register as dairymen or purveyors of milk is forty-eight against fifty in the previous year, two having withdrawn from the business. Periodical visits were paid as usual, and any matter found to require attention was promptly dealt with under the Regulations. The number of premises found to be in need of lime-washing at the time of inspection was 6 ; paving of yards in need of repair, 7 ; floors and walls of inside dairy premises repaired, 3; roofs repaired, 3; foul w.c pans cleansed, 4; flush cistern to w.c.'s repaired, 1; new w.c. pans fixed, 2 ; and new dustbins supplied, 3. Offensive Trades. The number of premises under this heading remains as last year, namelv, twelve, and these are in respect of fish-frying only, and from these there has been no complaints. The lime-washing, when found to be necessary, as well as any other matter in need of attention, was promptly attended to. With regard to the removal of fish offal, the Town Council's men continue to remove the matter from several of the premises at the usual charges. 40 Dustbins and House Refuse Removal. In accordance with the requirements under Section 43 of the Ealiny Corporation Act, 1905, 102 new galvanised iron dustbins were supplied. As usual, all applications for the removal of house refuse were transferred to the Borough Surveyor's Department for attention. During the year there were forty such applications, several of these being from new tenants giving notice of their occupying the premises, and making inquiries as to the removal of the refuse, all of which were promptly attended to. Public-House Conveniences. These premises, as in the past, are frequently visited, and any nuisances discovered are readily attended to by the respective landlords, who find it most difficult to keep the premises at all times free from a nuisance. There has been no serious complaints made during the year in respect of such accommodation, and, taking them on the whole, they have been fairly well kept. Manufacture of Ice-Cream. The vendors' premises where this commodity is prepared has been found to be kept in a satisfactory condition. The street barrows, in possession of Italians, from which the ice-cream is sold, were constantly visited, and found very little cause for complaint during the summer months. Slaughter-Houses and Food Inspection. There are five private slaughter-houses in the Borough, and these have been frequently visited, especially when it was known that slaughtering was 41 about to take place. These premises, together with the lairs, are at all times kept in a satisfactory condition, the lime-washing and cleansing of the walls is frequently carried out, and the floors kept in a proper state of repair. The visits to premises where the various foodstuffs are sold, which includes butchers' shops, fish and poultry shops, greengrocers' and grocers' shops, and other premises where the foods are sold cooked, amounted to 3,916. During the past year I found it impossible to continue the frequent inspections to all the premises mentioned above, owing to a considerable portion of my time being occupied in other directions. In the course of my inspections, I found the various tradesmen most agreeable, and every facility was accorded me when visiting their premises, and any article of food I deemed it necessary to draw their attention to, although not in a condition to warrant seizure, they readily agreed to carry out my instructions and advice, and I have no reason to suspect that they have not been carried out. With regard to foreign dead meat, I have carefully inspected all carcases, especially those parts which may contain the " Onchocerca cysts," in which there is a small thread-like worm curled up in many ways, but as this appears to be so well sought after by the London Inspectors of meat, I have very little prospect of discovering the troublesome pest in this Borough. I herewith append a list of unsound food which was voluntarily surrendered during the year, and destroyed in the Council's Destructor. In nearly every case the owner of the article, as soon as he became aware that it was not in a satisfactory condition, at once sought my advice, and readily surrendered the same for destruction:— Table of Unsound Food Surrendered. No. Particulars of Surrender. Weight, lbs. Condition. Method of Disposal. i One box of fish—hake 100 Unsound Council's destructor 2 One salmon 113/4 „ „ „ 3 ,, barrel of potatoes 91 Diseased „ „ 4 Three bags of garden peas 336 Unsound „ „ 5 Two trunks of fish—codlin 168 „ „ „ 6 One trunk ,, ,, ,, 84 „ „ „ 7 „ „ „ „ „ „ 84 „ „ „ 8 Fifteen rabbits 37½ „ „ „ Total 912¼ 43 Legal Proceedings. Legal proceedings were taken in respect of the following cases:— No. Nature of Offence. Result of Proceedings. 1 For conveying offensive matter through the Borough during prohibited hours . Fined 10/- 2 Ditto ,, 20/-and costs. 3 Ditto ,, 20/- and costs. 4 Ditto 5/- S For allowing a house to be occupied without a proper and sufficient water supply thereto ,, 40/-or 14 days. Total £2 15s. Od. Clerical Work. Number of letters and intimations written 873 „ „ statutory notices served 194 „ ,, notifications to school teachers 325 „ „ notifications to Libraries 13 ,, „ monthly reports to Public Health Committee 12 „ ,, letters received and filed for future reference 374 In concluding this report, I wish to express my gratitude to the Chairman and Members of the Public Health Committee, and to the Town Council for the support always accorded me in the discharge of my duties. 44 I also tender my thanks to the Medical Officer of Health, Dr. C A. Patten, my colleagues, the Town Clerk and his Assistants, the Borough Surveyor and Staff, for their much apprecated and valuable advice and assistance received during the year. I am, gentlemen, Your obedient servant, THOMAS HILL, A.R.San.I. Chief Sanitary Inspector. HOUSING AND TOWN PLANNING ACT, 1909. Summary of the work done at the end of year 1913, following' House to House Inspection. Streets. Water Supply. Water Closets. Drainage. Ventilation. Dampness. Miscellaneous. Number of houses. Cisterns cleansed and covered. Draw taps fixed to main. W.c. pans cleansed. New w.c. pans fixed. Flush cisterns repaired or renewed. External light and ventilation to w.c.'s. New w.c.'s constructed. Drains cleared and cleansed. Drains re-laid. j Drains repaired. Drains intercepted and ventilated. Inspection chambers constructed. Rainwater pipes disconnected. | New soil and ventilating pipes. Waste pipes cleared, repaired or renewed. haves, gutters and down pipes repaired or renewed. New sinks provided. Windows made to open. Horizontal and vertical damp proof courses. Through ventilation under floors provided. Yards paved. Roofs repaired. Walls and ceilings stripped and cleansed. New dustbins. Floors repaired. Accumulations removed. Animals so kept as to be a nuisance. New storage cisterns fixed. Overcrowding abated. Other Nuisances. House demolished voluntarily. Charles Street 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 1 ... ... 2 ... ... ... ... 4 ... Dane Road 13 ... 6 ... 8 4 ... ... ... 5 2 1 5 ... 2 10 1 10 5 22 14 11 3 9 1 ... ... ... ... ... 5 1 Haven Lane 39 1 4 1 15 17 9 ... 5 10 2 28 37 15 19 7 17 8 15 44 28 25 16 35 16 11 ... 1 ... 1 11 ... Oak Street 10 ... ... 4 7 ... ... ... 1 8 2 8 2 ... 2 2 1 5 6 2 10 6 3 2 8 ... ... ... ... 7 ... Oxford Road 14 1 6 1 12 3 1 1 6 3 4 10 11 11 5 9 6 5 20 7 15 5 7 1 1 ... ... ... ... 8 ... Mountfield Road 28 4 10 11 7 ... ... ... 3 1 3 5 3 3 15 13 13 42 28 16 19 35 5 14 ... 1 ... ... 13 ... Northfield Road 35 ... 5 2 2 2 ... ... 2 4 1 7 8 5 ... 12 1 15 30 64 27 30 15 65 5 23 ... ... ... 1 18 ... Sandringham Mews 1 ... ... ... 2 ... ... ... ... 2 2 1 1 1 1 1 ... ... ... ... ... 6 ... ... ... ... ... ... 2 ... St. Mark's Road 18 ... ... ... 9 2 14 ... ... ... ... ... ... 3 1 11 10 11 7 32 11 13 20 33 4 8 4 5 ... 14 ... St. Matthew's Rd. 9 ... 1 ... 4 3 9 ... 1 ... ... ... ... ... 1 13 9 3 8 8 7 15 18 2 7 ... ... ... ... 8 ... Windsor Road 1 ... ... ... 2 2 ... ... ... 1 ... 1 2 1 1 1 1 ... 2 1 1 12 3 ... ... ... ... ... Western Road 34 ... 4 1 13 5 ... ... 1 12 3 14 20 3 1 1 19 3 41 25 24 11 41 4 8 ... ... ... ... 14 ... Totals 212 2 30 9 85 49 40 1 11 48 14 60 94 46 40 53 89 75 86 281 151 152 111 264 40 85 1 6 5 2 104 1