HAY 005 The Annual Report of the Medical Officer of Health of the Urban District of Hayes, for the Year ending December, 1915. To the Chairman and Members of the Hayes Urban Gentlemen, I have the honour to present the Annual Report of the Health and Sanitary Condition of the Urban District of Hayes for the year 1915. Under the directions of the Local Government Board the usual information relating to Natural and Social Conditions, Water Supply, Sewerage and Sewage Disposal are omitted ; they continue satisfactory, and no alteration has been necessary during the year. The number of premises visited by myself in connection with Infectious Disease is 49. The number of premises visited by myself largely in company with the Sanitary Inspector is 15. Inspections made by Sanitary Inspector: Upon complaint 14 In connection with Infectious Disease 48 Periodical 14 Total number of Inspections of all kinds 550 Statutory Orders issued 26 Informal Notices issued 26 Summonses served — District Council SANITARY INSPECTION OF THE DISTRICT. 2 PREMISES AND OCCUPATIONS WHICH CAN BE CONTROLLED BY BYE-LAWS. None in the District. SCHOOLS. There are three Public Elementary Schools in the District: Hayes Council School, Clayton Road ; Dr. Triplett's School, Hayes Town; and Yeading Elementary School. The medical examination of school children is provided by the Middlesex County Council, and cases of Infectious Disease coming to the knowledge of Head Masters and Head Mistresses are at once notified to your Medical Officer of Health and dealt with by him, but there is no provision for the treatment of other ailments pointed out by the Medical Examiners. The general sanitary condition is good. FOOD. (A.) Milk Supply.—The milk produced within the District is of excellent quality. The Dairies, Cowsheds and Milkshops are regularly inspected by myself and your Sanitary Inspector, and all are in a most satisfactory oondition. No samples of milk have been taken for analysis by the Officers of the Council. There are no arrangements in force for the inspection of milking cows for evidenco of Tuberculosis. (B.) Other Foods.—One seizure was made during the year, viz.: a box of fish. The condition of Bakehouses is generally good, and the condition of Slaughter Houses excellent. (C.) Sale of Food and Drugs Act.—No action has been taken. HOUSING. The housing accommodation for the industrial classes in the District is undoubtedly insufficient, and there are still many cottages occupied which in my opinion are quite unfit for human habitation. Closing orders have been issued for a number of these, but owing to scarcity of dwellings the Council has not proceeded to demolition. Land has been acquired for the erection of 22 houses 3 at Yeading, and the Council has also bought about 14 acres of land at Botwell, on which it is proposed to erect 208 houses. Twenty-one houses suitable for habitation by the industrial classes were erected during the year by private enterprise. Efficient supervision over the construction of new houses is exercised by the Surveyor in accordance with modern bye-laws adopted in 1913. The Inspection of the District under section 17 of the Housing and Town Planning Act, 1909, has been practically completed by the Sanitary Inspector, full particulars of which appear in the subjoined tables. C.—SANITARY ADMINISTRATION OF THE DISTRICT. The Sanitary Staff consists, in addition to the Surveyor, of one whole time Sanitary Inspector. Bacteriological aids to diagnosis have been used where necessary. Ample accommodation exists at the Joint Isolation Hospital at Kingston Lane, Uxbridge, and the Small Pox Hospital at Yeading, for the reception and treatment of cases of Infectious Disease, but only three varieties, viz.: Small Pox, Scarlatina and Diphtheria. Typhus, Enteric, Puerperal and Cerebro-Spinal Fever are not received. D.—PREVALENCE AND CONTROL OYER ACUTE INFECTIOUS DISEASES. Thirty cases of Diphtheria and Membranous Croup, 5.7 per 1,000 of estimated population, were reported during the year; twenty-eight were removed to the Isolation Hospital. The outbreak was of a very virulent character, resulting in nine deaths. Energetic measures were used to prevent its spread; patients were promptly removed to the Isolation Hospital and contacts kept under supervision, with daily disinfection of throats for a week. I am able to report that the epidemic was rapidly subsiding by the end of the year. Eight cases of Scarlet Fever, 15 per 1,000 of estimated population, were reported. I would again point out to parents that in every case in which a child develops a sore throat or a rash of any kind, it should be seen as soon as possible by a doctor, in order that a diagnosis of its nature may be made. 4 Three cases of Erysipelas, .57 per 1,000 of the estimated population, were reported during the year. The epidemic of Diphtheria, which existed during the year, was prevalent throughout the country. E.—PREVALENCE AND CONTROL OVER TUBERCULOSIS. (a.) In all primary notifications of Tuberculosis the patients are visited and oral and printed instructions as to self preservation and prevention of the infection of others are given. Spitting mugs are provided by the Council. (b.) As the arrangements for the treatment of oases of Pulmonary Tuberculosis are under the management of the Tuberculosis Department of the Middlesex County Council, subsequent visits are not paid by the Medical Officer of Health, unless requested by the Tuberculosis Officer of that Authority. (c.) The arrangements for the detection of unrecognised cases of Tuberculosis associated with notified cases of the disease are under the direction of the Tuberculosis Officer of the Middlesex County Council. (d.) The arrangements made for utilizing the services of the Tuberculosis Officer or Nurses are as in (c.). (e.) Disinfection is performed when necessary by the Officers of the Hayes Council. The arrangements made by the County Council of Middlesex for the visitation and treatment of cases of Pulmonary Tuberculosis (sanitorium and domiciliary) are working satisfactorily, and, I am of opinion, will in the future tend to produce a considerable diminution iu the number of cases of this dire malady. F.—INVESTIGATION OF OTHER DISEASES. Owing to the nature of the subsoil Rheumatism in all its forms has been very prevalent. I am still of opinion there has been considerable neglect on the part of some of the occupiers of land in allowing the ditches and watercourses to become silted up; many of the ditches by the sides of the roads are not properly attended to. This is, perhaps, due to a shortage of labour, but it must contribute to the land becoming waterlogged and to increased dampness in dwellings, a fertile cause of Rheumatism and Tuberculosis. 5 I wish to express my sincere thanks to Mr. D. C. Fidler, your Surveyor, and to Mr. E. Hoddinott, your Sanitary Inspector (whose services are unfortunately lost for the period of the war, as he has joined His Majesty's Forces), for their valuable and ready assistance at all times in the performance of my duties as Custodian of the Public Health. I am, Gentlemen, Yours faithfully, EDWARD J. PARROTT. 6 TABLE 1. VITAL STATISTICS OF WHOLE DISTRICT DURING 1915 & PREVIOUS YEARS. Name of District- URBAN DISTRICT OF HAYES, MIDDLESEX. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate per 1,000 Nett Births. Number. Hate. Number. Rate. Number. Kate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1911. 4300 125 130 30-212 62 14.418 4 6 17 130.769 64 14.88 1912. 4500 106 108 24 48 10.66 4 11 9 83.3 55 12.22 1913. 4730 117 121 25-473 50 10.526 9 11 11 90.9 52 10.947 1914. 5000 109 110 22 50 10 1 11 6 54.54 60 12 191S. 5250 108 109 20-76 59 11.238 12 23 15 137.6 70 13.33 Area of District in acres (land and inland water) 3284 Land 27 Water 3311 At Census of 1911 Total Population at all ages 4261 Number of Inhabited Houses 887 7 TABLE II. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1915. Name of District—URBAN DISTRICT OF HAYES, MIDDLESEX. Notifiable Disease. NUMBER OF CASES NOTIFIED. total cases removed to hospital. At all Ages. At Ages—Years. Under 1. 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous croup) 30 1 3 22 .. 4 .. .. 28 Erysipelas 3 .. .. .. .. 2 1 .. .. Scarlet fever 8 .. 3 4 .. 1 .. .. 7 Typhus fever .. .. .. .. .. .. .. .. .. Enteric fever . . .. .. .. .. .. .. .. .. Relapsing fever .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. Puerperal fever 2 .. .. .. 2 .. .. .. .. Cerebrospinal Meningitis .. .. .. .. .. .. .. .. .. Poliomyelitis .. .. .. .. .. .. .. .. .. Pulmonary Tuberculosis 3 .. .. .. 2 1 .. .. .. Other forms of Tuberculosis 2 .. 1 .. 1 .. .. .. .. Totals 48 1 7 26 5 8 1 .. 35 Isolation Hospital or Hospitals, Sanatoria, &c.:— Hospital for Small Pox, Yeading, Hayes. Joint Isolation Hospital—Kingston Lane, Hillingdon. 8 TABLE III. CAUSES OF, AND AGES AT DEATH DURING THE YEAR 1915. Name of Diitrict—URBAN DISTRICT OF HAYES, MIDDLESEX. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of "Residents" or "Non-Residents" in the District. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified Uncertified .. .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. .. Small Pox .. .. .. .. .. .. .. .. .. .. Measles 1 .. 1 .. .. .. .. .. .. 1 Scarlet Fever 1 .. .. 1 .. .. .. .. .. 1 Whooping Cough 3 3 .. .. .. .. .. .. .. 3 Diphtheria and Croup 9 1 .. 3 .. .. .. .. .. 9 Influenza .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Phthisis (Pulmonary Tuberculosis) 1 .. .. .. .. .. 1 .. .. 1 Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases 2 .. .. .. .. .. 1 .. .. 2 Cancer, malignant disease 12 .. .. .. .. .. .. .. 8 12 Rheumatic Fever .. .. .. .. .. .. .. .. .. .. Meningitis 1 1 .. .. .. .. .. .. .. 1 Organic Heart Disease 7 .. .. .. .. .. 1 5 1 7 Bronchitis .. .. .. .. .. .. .. .. .. .. Pneumonia (all forms) 5 3 1 .. .. .. .. .. 1 5 Other diseases of Respiratory organs .. .. .. .. .. .. .. .. .. .. Diarrhoea and Enteritis .. .. .. .. .. .. .. .. .. .. Appendicitis and Typhlitis .. .. .. .. .. .. .. .. .. .. Cirrhosis of Liver 2 .. .. .. .. .. .. 1 1 2 Alcoholism .. .. .. .. .. .. .. .. .. .. Nephritis and Bright's Disease 1 .. 1 .. .. .. .. .. .. 1 Puerperal Fever .. .. .. .. .. .. .. .. .. .. Other accidents and diseases of Pregnancy and Parturition .. .. .. .. .. .. .. .. .. .. Congenital Debility and Malformation, including Premature Birth 5 5 .. .. .. .. .. .. .. 5 Violent Deaths, excluding Suicide Suicide 3 •• .. .. .. .. 1 .. 1 3 Other Defined Diseases 11 .. .. .. .. 2 .. 4 5 11 Diseases ill-defined or unknown 6 2 .. .. .. .. .. .. 4 6 Totals 70 15 3 5 5 2 4 15 21 70 9 TABLE IV. URBAN DISTRICT OF HAYES, MIDDLESEX. INFANTILE MORTALITY DURING THE YEAR 1915. Nett Deaths from stated causes at various ages under 1 year of age. Cause of Death Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. All Causes Certified .. .. .. .. .. .. .. .. .. .. All Causes Uncertified .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. .. .. 1 2 3 Diphtheria and Croup .. .. .. .. .. .. .. 1 .. 1 Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculuuu) .. .. .. .. .. .. 1 .. .. 1 Convulsions .. .. 1 1 2 .. .. .. .. 2 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. .. .. .. .. .. Pneumonia (all forms) .. .. .. .. .. 1 1 .. 1 3 Diarrhoea .. .. .. .. .. .. .. .. .. .. Enteritis .. .. .. .. .. .. .. .. .. .. Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Injury at Birth .. .. .. .. .. .. .. .. .. .. Atelectasis 1 .. .. .. 1 .. .. .. .. 1 Congenital Malformations 1 .. .. .. 1 .. .. .. .. 1 Premature birth 3 .. .. .. 3 .. .. .. .. 3 Atrophy, Debility, and Marasmus .. .. .. .. .. .. .. .. .. .. Other causes .. .. .. .. .. .. .. .. .. .. Totals 5 .. 1 1 7 2 1 2 3 15 Nett Births in. the year legitimate 106. illegitimate 3. Nett Deaths in the year of legitimate 15. illegitimate 0. 10 SANITARY WORK FOR THE YEAR 1915. Inspections:— Total. Number of Premises Inspected on Complaint 14 „ „ „ in connection with Infeotious Diseases 48 Number of Premises under Periodical Inspection 14 Total Number of Inspections and Re-Inspections made 550 Notices:— Cautionary or Intimation Notices Given 26 Statutory Orders Issued 26 Dwelling-Houses ami Action under H. & T. P. Act, 1909:— Number of Houses dealt with under Section 15 113 Number of Houses found to be in a state Dangerous or Injurious to Health (Section 17) 27 Number of Representations made by M.O.H. — Number of Houses made habitable without Closing Order — Number of Closing Orders made by L.A. (Section 17) 27 Number of Houses closed voluntarily — Number of Closing Orders determined after repairs — Number of Houses demolished:— (a) by order of L.A. (Section 17) 4 (b) Voluntarily 1 Canal Boats used as Dwellings :— Number of Contraventions of Regulations 4 Number Registered (This is not a Registration Authority) Movable Dwellings, Caravans, Tents, Ac. Number of Nuisances therefrom abated 1 Bakehouses:— Number in District 4 Contraventions of Factory Acts 1 11 SANITARY WORK FOR THE YEAR 1915—(continued). Slaughter Houses:— Total Number on Register 4 Number of Inspections 14 Contraventions of Bye-Laws 1 Cowsheds:— Number on Register 2 Number of Inspections made 6 Number of Milch Cows in District about 50 Contraventions of Regulations 1 Dairies and Milkshops:— Number on Register 5 Number of Inspections made 16 Contraventions of Regulations 1 Offensive Trades:— Number of Premises in District none Water Supply and Water Service:— Percentage of Houses supplied from Public Water Service 95 Percentage of Houses supplied on Constant System 95 Drainage and Sewerage of Existing Buildings:— Number of Water Closets substituted for dry Receptacles 15 Percentage of Houses supplied with Water Closets 93 Drains: Examined, Tested, Exposed, &c. 18 Unstopped, Repaired, Trapped, &c. 6 Reconstructed 8 Cesspools : Emptied, Cleansed, &c. 12 Abolished, and Drains connected to Sewer 4 Percentage of Houses Draining into Sewers 90 12 SANITARY WORK FOR THE YEAR 1915—(continued). Disinfection:— Total Rooms Disinfected (a) Ordinary Infectious Diseases 54 (b) Phthisis — „ Stripped and Cleansed 4 Dust:— New Bins Provided 75 How frequently is Dust Removed from each House ?— Weekly Number of Complaints of Non-Removal received — Method of Disposal By Tipping Sundry Nuisances Abated:— Accumulation of Refuse 7 Foul Ditches, Ponds, &c., and Stagnant Water 1 Other Nuisances 2 Foul Swine and other Animals 2