HES 53 1+ES K ANNUAL REPORT of the health and sanitary condition of the District of heston and Isleworth, For the Year 1898, by B. HANS10W BRIND, M.R.C.S., L.R.C.P., D.P.H., MEDICAL OFFICER OF HEALTH. The Sanitary Committee of the Heston and Isleworth Urban District Council. MR. C. VEATES, Chairman. MR. J. MARSHAL, J.P.C.C., Chairman of Council. MR. G. R. BUTTON. MR. S. DAVIES. MR. G. ETCHES. MR. J. GAVAN. DR. G. A. S. GORDON. MR. W. H. E. JACKSON, C.C. MR. J. MARSHALL (Isleworth). MR. S. QUINION. TOWN HALL, HOUNSLOW, February 20th, 1899. To the Chairman and Members of the Heston and Isleworth Urban District Council. Gentlemen, I have the honour to submit the following Report upon the health and sanitary condition of the District of Heston and Isleworth during the year 1898:— Death Rate. The Death Rate for the year, taking the estimated population to the middle of the year as 29185 is 16.03 per 1000. The death rates for the preceding five years were as follows:— 1897 13.55 1896 14.49 1895 17.24 1894 12.85 1893 17.28 In calculating the death rate for the year I have followed the usual course taken in this District of omitting the deaths of non-residents which have occurred in the Union Workhouse. I have likewise omitted the deaths of the non-residents which took place at the Mogden Isolation Hospital, these being included in the mortality returns of the Borough of Richmond, but I have included the deaths of residents of this District which have taken place at the Union as well as the deaths of residents and non-residents which have occurred at the Cottage Hospital, Barracks, Wyke House, and the following Homes: Nazareth House, Gumley House and Gunnersbury House. In order to show you what would be the effect, in calculating the general death rate, of including or excluding the deaths of non-residents occurring in this District, I would point out that it I had included the total number of the deaths registered during the year the rate would have been 4 20.38, whereas by excluding the deaths of all non-residents it would have been only 15.11 showing a difference of no less than 5.27 per 1000. In the method of calculating the death rate which has hitherto been adopted the total number of inmates of the Union has been included in the estimated population, and in calculating the birth rate the total number of births which have taken place in the Union has also been included. This method introduces a palpable error and does not tend to produce strictly accurate statistics. I11 my opinion the best way out of the difficulty would be for each District to include only the proportionate number of inmates, deaths and births in the Union referable to that particular District. During the year the number of deaths that took place at the Union was 163. Of this number 36 were residents of this District, the remaining 127 being non-residents, and these deaths were distributed among other Districts as follows :— Brentford 36 Ealing 13 Whitton 1 Richmond 2 Brompton 1 Hanwell 6 Acton 25 Notting Hill 1 Twickenham 20 Chiswick 22 Birth Rate. Including those in the Union Workhouse 817 births were registered during the year. Of this number 414 were males and 403 females. The birth rate for the year is 27.99, showing an increase over that of last year when it was 25.34. Total Number of Births and Deaths. The total number of births registered during the year was 817. The number of deaths registered was 598; deducting 127 deaths of nonresidents in the Union from this, the deaths referable to this District are 468. The following table shows the number of births and deaths (excluding Union non-residents) for the past 6 years. Year. Births. Deaths. 1898 817 468. 1897 729 390. 1896 790 411. 1895 862 481. 1894 809 354. 1893 832 373. 5 The 468 deaths were distributed as follows:— Heston and Isleworth 399 Union (resident) 36 Mogden Hospital 1 Cottage Hospital (residents) 5 „ „ (non-residents) 3 Barracks 9 Wyke House 1 Nazareth House 7 Gumley House 2 Gunnersbury House 5 Total 468 Infantile Mortality. The number of deaths under the age of one year was 146. Excluding the deaths of non-residents at the Union the number was 141, giving the rate of Infantile Mortality as 172.58 per 1000 births. The rates of infantile mortality for the past five years are as follows:— 1898 172.58 1897 131.68 1896 150.63 1895 125 1894 174 41.84 per cent. of infantile deaths were due to Diarrhoea and Tabes Mesenterica (Consumption of the Bowels), 49 deaths being attributed to the former disease and 10 to the latter. Of Diarrhoea I shall have something to say later on, when I treat of the Zymotic diseases, but I do not think it is out of place here to call your attention to the mortality from tubercular affections and especially from Tabes Mesenterica. During the year 20 deaths were registered as having been caused by Tuberculosis in some form or other, 16 having occurred under 5 years of age. Of these 16 deaths, 10 were under the age of 1 year and they help to swell the rate of Infantile Mortality, a rate which I know you, in common with every one else who takes any interest in the public welfare, would like to see sensibly diminished. 6 With regard to the disease known as Tabes Mesenterica or Consumption of the Bowels, I do not think I can do better than quote you some of the facts mentioned by Sir Richard Thorne Thorne, in his Harben Lectures on The Administrative Control of Tuberculosis. He says: "Take the ageperiod 15 to 45 years. The mean of the rate of deaths per million living at that age-period in 1891-95 was 2060 from Phthisis, 2251 from all forms of Tuberculosis, and only 44 from Tabes Mesenterica. But when we come to ages when milk is either largely used, or forms the principal article of diet, the matter is altogether different. The rate of 44 from Tabes Mesenterica at ages of 15 to 45 years, rises to one of 1577 per million living under 5 years of age; and under 1 year of age it reaches no less than 4046 per million births." From these figures you will see that the mortality from this disease increases correspondingly with the increased use of milk as an article of diet, and that the maximum is reached when milk becomes the sole article of diet. It is not, I think, unreasonable to conclude that milk must be one of the principal factors in the causation of the disease, but milk of itself is not sufficient of course to bring about this state of affairs. One other important factor is necessary, and that is, the presence of the tubercle bacillus in the milk, and recent observations have conclusively shown that this bacillus is present in a large amount of milk consumed in this country. I have no doubt that, owing to the recent report of the Royal Commission on Tuberculosis, and the work of various other agencies on the same subject, there will be a great change in England with regard to the control and supervision of the sale of milk, but in the meantime I would suggest that you, as the Sanitary Authority of this District, do all in your power to advance this work by a systematic supervision of the Dairies and Cowsheds in the District, and by insisting upon the carrying out of the regulations which you have laid down on the subject. With the end in view of preventing any possible danger of infection from the ingestion of milk, and more especially with the object of reducing the risks of Tuberculosis to a minimum, I drew up a few simple rules for the guidance of parents. These were printed by you for distribution in the District, and I hope that the bills will be re-distributed in the early summer of the year following. The contents of the handbills are as follows: 7 "COWS' MILK. The Medical Officer of Health advises that— All Cows' Milk should be boiled or sterilised. Milk is capable of conveying the infection of Scarlet Fever, Diphtheria, Enteric Fever (Typhoid Fever), and Consumption. In view of the large number of Deaths that take place every year from these diseases, and in consideration, especially of the large Annual Mortality amongst Infants from the disease known as Consumption, it is highly desirable that all Milk should be boiled before being used, as by this means all danger of infection from milk is prevented. If a Infant is unable to digest boiled milk the following method should be employed:— The Feeding bottle containing the amount of milk, or diluted milk required for the meat is to be placed in a clean saucepan half filled with cold water. This is then placed on the fire and the water in the saucepan is boiled. The feeding bottle must not be taken out of the saucepan until it has been in the boiling water from ten to fifteen minutes. Water used for diluting Cows' Milk should be boiled before being added to the Milk. The Milk used should be fresh. Fresh milk should never be mixed with milk obtained previously. All jugs and other vessels used for keeping milk in, should be washed out with boiling water when empty. Feeding bottles should be scoured out with boiling water every time after being used. Feeding bottles should be of the kind known as Boat-shaped or Slippershaped Bottles. India-rubber tubing to a feeding bottle is extremely objectionable. Parents are advised to pay particular attention to these suggestions during the summer months, as by this means the risk of infants contracting the disease known as summer diarrhoea is greatly diminished. By order of the Council, HUGH R. PEAKE. Clerk." 8 Zymotic Death Rate. In calculating the Zymotic Death Rate I have included the following diseases, Small pox, Scarlet Fever, Diphtheria, Typhus, Enteric and Simple Fevers, Cholera, Measles, Whooping Cough and Diarrhoea and Dysentery. The number of deaths from these diseases was 109 which is equivalent to a Zymotic Death Rate of 373 per 1000 living. This is an extremely high rate and, as the following list shows, it contrasts unfavourably with that of the several preceding years. Year. Zymotic Death Rale. 1898 3.73 1897 1.39 1896 2.49 1895 2.7 1894 0.907 1893 1.61 1892 0.26 1891 0.98 1890 2.26 1889 1.23 1888 1.25 The deaths from Zymotic diseases were distributed as follows: Enteric Fever 2 Diphtheria 8 Whooping Cough 11 Measles 27 Diarrhoea 61 It will thus be seen that the main cause of the increase in this death rate is due to the mortality from Measles and Diarrhoea, these two diseases combined producing a rate of 3.01 the death rate per 1000 from Diarrhoea alone being 2.09 and that from Measles 0.92, whilst that from Whooping Cough is o.37 and from Diphtheria 0.27. I have drawn out the following tables in order to show the age at death and the month during which death occurred from Measles and Diarrhoea. 9 DIARRHOEA. Age January February March April May June July August Sept. October Nov. Dec. TOTAL Under 1 year 1 1 1 1 26 12 2 3 2 49 1 year and under 2 years 1 1 2 3 1 8 2 years and under 3 years 1 1 3 years and under 4 years 4 years and under 5 years. 5 years and under 10 years 1 1 Over 10 years 2 2 Total 2 1 1 1 1 31 15 3 4 2 61 MEASLES. Age January February March April May June July August Sept. October Nov. Dec TOTAL Under 1 year 1 3 1 5 1 year and under 2 years 3 4 4 11 2 years and under 3 years 1 2 3 3 years and under 4 years 4 years and under 5 years 1 1 5 years and under 10 years 4 1 1 1 7 Over 10 years Total 9 9 8 1 27 10 These tables show at a glance the great mortality amongst children under the age of 2 years and especially amongst those under the age of 1 year, 49 deaths having occurred amongst infants under 1 year from Diarrhoea alone, the greater number of these taking place at a time when the infant was probably having other food substituted for the mother's milk. Another noticeable fact with regard to these deaths from Diarrhoea is the number that occurred during the months of August and September, 31 having been registered in August and 15 in September. The notification of Infectious Diseases Act became applicable to Diarrhoea in this district on August 22nd, 1894, but this was rescinded on November 22nd of the same year and has not since been put in force so that the number of cases that now occur can only be based on conjecture, but it is evident from the number of deaths registered that a somewhat severe epidemic took place during the past year, further evidence of which is obtained from the experience of the Medical Practitioners of the District. It is now generally accepted that this Epidemic Diarrhoea is due to a micro—organism which becomes active when the soil temperature has reached a certain height i.e., when the 4ft., soil thermometer has registered temperature of 56°F. I have not been able to obtain Meteorological records of this particular District but the great heat during August and September was only too evident and there is but little doubt that the soil temperature reached the height above mentioned. The presence of a certain micro—organism and a high soil temperature are two important factors in the causation of the disease but they are not sufficient of themselves to bring about the evil results which were so apparent during the year. Other agencies must be at work, and as certain plants require definite kinds of soil as well as definite temperatures in which to flourish, so does this micro-organism demand a suitable nidus upon which it may grow and exert its baneful influence. These other agencies, in the case of infants, may be produced by means of a lowered vitality due to insanitary surroundings and of mal-nutrition brought about by injudicious, indiscriminate and careless feeding. 11 That the first two causes I have named are not sufficient by themselves to induce this disease is evidenced from the fact that the children of the well to do classes, as a rule escape, the great severity of the disease being manifested amongst the children of the working and poorer classes. The ignorance of some mothers amongst the poorer classes as to the management of their infants is unfortunately a matter of common notoriety amongst medical men, and even if this ignorance does not exist, it often happens that stress of circumstances compels the mother to go out to work, thus precluding that attention to the infant which the latter demands, and the baby as likely as not is left in the charge of some child or other irresponsible person. In my opinion the most efficient way in which to combat the disease would be to prevent as far as possible the growth and activity of the special micro-organism by improving the immediate surroundings of the poorer class houses, and by educating the people concerned to the great importance of feeding their children properly. The first measure could be attained, to a great extent, by enforcing, where practicable, the paving of the yards in the immediate vicinity of the houses, and by the prevention of any accumulation of refuse, whether vegetable or animal, but the education of the people could at present be affected only by the distribution of handbills, not an extremely satisfactory method perhaps, but doubtless a means of preventing in some cases a regrettable loss of life. The following is a table giving the deaths from Diarrhoea at ages under and over 5 which have occurred in this District in the past 6 years, during which time no fewer than 157 deaths from this cause have heen registered. Year. Under 5. Over 5. Total. 1898 58 3 61 1897 19 2 21 1896 11 7 18 1895 22 6 28 1894 5 0 5 1893 20 4 24 Totals 135 22 157 12 Infectious Disease. The number of cases notified during the year was 1015. This means that 1 in every 30 of the total population of the District was attacked by some form of infection, and it is a number far in excess of that recorded during the 5 years immediately preceding, as a glance at the following table will show: Year. Number of Cases notified. 1898 1015 1897 184 1896 292 1895 296 1894 281 1893 687 The sudden jump from 184 in 1897 to 1015 in 1898 is due to the Epidemic of Measles which prevailed during the early spring months the number of cases notified having reached the large total of 857. When dealing with the Zymotic Death Rate I showed you how the increase in that rate was due to the number of deaths from Diarrhoea and I briefly touched upon a few points in connection with that disease. I propose now in like manner to say a few words upon the subject of Measles, with particular reference to its inclusion amongst notifiable infectious diseases. The definition of infectious diseases was extended in this District to include Measles in the month of February 1891. This order was rescinded at the end of July 1894. The order for compulsory notification again came into force on September 14th, 1896, and by the decision of the Local Government Board it cannot be again rescinded until September 1901. The following table shows the number of deaths due to Measles from 1890 to the present time and it likewise shows the number of cases notified in those years when the notification of this disease was in force. Year. No. of cases notified. Deaths. 1898 857 27 1897 31 2 Order for Compulsory Notification came into force on Sept. 14th, 1896 1896 9 14 1895 539 17 Previous order rescinded July, 1894 1894 80 4 1893 343 6 1892 89 4 Notification of Infectious Diseases Act applied to Measles on February, 1891 1891 4 1890 952 30 13 The fatality, or case mortality, of Measles varies even in the same District with different epidemics. The case mortality for this year is 3.15 and if the type of epidemic had been similar in the years 1895 and 1890 in which the disease was not notified the number of cases which occurred in those years would have been 539 and 952 respectively. During the year the monthly notifications of Measles cases were as follows. January 11 February 65 March 321 April 280 May 144 June 19 July 5 August 4 September 1 October 2 November 2 December 3 Total 857 It will thus be seen that the epidemic covered a period of 4 months, commencing in February, arriving at a maximum in March and subsiding in June. In the year 1890 as I have shown, there were 30 deaths from Measles and no doubt it was in a great measure owing to this fact that you decided to include Measles as a notifiable disease. In 1893 there were 343 cases with a fatality of 174 per cent, the difference of the case mortality between that year and the present being no doubt due to the fact that the disease was prevalent in a milder form. I have carefully examined the Annual Reports for some years past and can find no mention of anything having been done to cope with the various epidemics until the present year when my predecessor Mr. H. M. Bullock, advised that the Spring Grove School should be closed for a period extending from April 20th to May 9th and be subsequently advised that the 14 Infants' department should be closed for a week longer, until May 16th. The School holidays began on April 6th and work was re-commenced on April 18th but owing to the small attendance and the prevalence of the disease, application was made to the Medical Officer of Health with the result as stated above. The School was closed for nearly 5 weeks, the infants' classes being suspended for nearly 6 weeks, but notwithstanding this, a letter was sent to the Medical Officer, on May 13th, from the Clerk to the Heston School Board, asking for his opinion as to the advisability of again closing the School. In the absence of Mr. Bullock, I visited the School and examined the record of attendances with the Heads of the different Departments, and seeing that there was a slight but steady improvement, I advised that the School should not be closed. The epidemic at this time was gradually subsiding and the improved attendance was maintained, thus showing that in this instance further closure was not necessary. The notification of Measles has now been in force in this District at various times for a period of 6 vears, and the question naturally arises, has any benefit been gained from its adoption? I do not think there has, nor under the existing circumstances do I think that any benefit is likely to accrue therefrom. A glance at the Register of Infectious Diseases kept in the Office will show you what has taken place during the year. At first, when the epidemic started, each house affected was visited by the Inspector or his Assistant, and various details connected with the disease and with the sanitary condition of the house were noted in the book, but as time went on, these inspections became less and less frequent, and finally only the names of the patients and of the Medical Practitioners who had notified the cases were entered. It was manifestly impossible for the work to be properly done with the small staff at your disposal, and I think that the greatest credit is due to your Sanitary Inspector, Mr. Smith, for the manner in which he endeavotired to carry out his duties at this particular time. He was additionally handicapped by losing the services of the Assistant Inspector, and as the rest of the work in the District could not be 15 put aside, it is not surprising that the work in connection with this epidemic was eventually almost entirely neglected. It is of course useless having a disease notified unless some action is taken subsequently, and notification is less likely to be of value in the case of Measles than in almost any other infectious disease. The characteristics of the disease itself are a bar to much advantage being gained from notification, as the infective period is very great before any appearance of the rash, and most frequently medical advice is not obtained until the eruption has shown itself, by which time infection may have spread to several other cases. Then you do not possess in this District any hospital accommodation for the reception of patients suffering from the disease, and even if this means for isolation was provided there would be, I am convinced, the very greatest difficulty in obtaining the parents' consent to the removal of their children. Notwithstanding the large annual mortality from this disease the greater number of parents, educated as well as un-educated, look upon it with something like contempt, as though it was a necessary evil, and part and parcel of the child's curriculum. Far from isolating a case as much as possible, it is not at all an uncommon event for a parent to allow other children to be in the same room, and even sleep in the same bed as the patient, with the express wish that "they may all get it and have done with it," and it is this careless indifference that is at the root of much of the evil we unfortunately experience from epidemics of this disease. Another item which must also be taken into consideration is the expense which would be incurred by providing proper means for isolation and by increasing the staff. This would of course be considerable, and is increased by the amount which has to be paid in notification fees. During the year the total amount of fees paid to Medical Practitioners for notifying infectious cases was £111 8s. od. The fees for notifying Measles alone amounted to about £80, and I do not think that any gain experienced from the notification has hitherto been at all commensurate with the expenditure. The consideration of the other infectious diseases is somewhat more satisfactory, 78 cases of Scarlet Fever having been notified as against 74, 16 199 and 202 in the 3 preceding years, and 42 cases of Diphtheria as against 40, 58 and 48. 54 cases of Scarlet Fever were removed to the Hospital, 38 having been received at Dockwell Lane and 16 at the Mogden Isolation Hospital, and I am pleased to report that no deaths occurred from this disease, either at the Hospitals or in the District from this disease. 12 cases of Diphtheria and 5 cases of Enteric Fever were also admitted into the Mogden Hospital, one case of Enteric Fever ending fatally. I have not so far laid any stress upon the cases of Scarlet Fever, Diphtheria and Enteric Fever which occurred in the District, as they are all within reasonable limits, 133 cases being recorded from these diseases as against 124, 264 and 278 in the three preceding years. I must, however, comment upon the improbability of any epidemic of infectious disease having been brought about by the method you had adopted for the disposal of sludge at the Sewage Works. It is not necessary for me to enter into the details of this method of sludge disposal for you have advocated it use merely as a temporary expedient and not as a permanent process. I pricked out on the six inch scale ordnance map of the District the position of the different houses in which cases of Scarlet Fever, Diphtheria and Enteric Fever had occured during the year and I placed this map in the Council Chamber for your inspection. By drawing a series of circles on the map with the tanks at the Sewage Works as a central point it could be seen that the radius of the circle must measure 1,600 ft. before a case of Infectious Disease (Diphtheria) was met with ; it must measure 2,150 ft. before a case of Enteric Fever was met with, and 2,500 ft. before meeting with another case of Diphtheria, whereas a case of Scarlet Fever was not met with until the radius was extended to a distance of 2,800 ft., so that within the area of a circle of which the Sewage Works is the centre and the diameter is one mile, the diseases I have named have implicated only three houses. The area I have described is certainly not very thickly populated, but there are a number of poorer class houses within it situated nearer to the Works than the houses in which the cases of Infectious Disease occurred, and it is but reasonable to suppose that if the method of sewage disposal had been responsible for the propagation of disease, the greatest sufferers would have been those living nearest to the works, but this is far from being the 17 case, and in the map I marked out, the surroundings of the Works stood out as being markedly exempt from such cases. I have drawn the attention of the Members of the two School Boards in the District to the effect that School influence may have upon Infectious Disease and I suggested one or two ways by which the spread of such disease might be prevented. These recommendations were forwarded to the Head Masters of the different Schools, and I hope that they will prove of some practical value, but there is no doubt that what is really wanted, is a strict medical supervision of the scholars attending these Schools. This method would of course entail an additional expenditure but I have every reason to believe that the results would be far reaching, and that the adoption of this measure would confer a benefit, not only to the Schools but to the community at large. Before leaving the subject of infectious diseases, I would draw your attention to section 15 of the Infectious Disease Prevention Act, 1890, which is as follows: "The local Authority shall from time to time provide, free of charge, temporary shelter or house accommodation, with any neeessary attendants for the members of any family in which any infectious disease has appeared, who have been compelled to leave their dwellings for the purpose of enabling such dwellings to be disinfected by the Local Authority." At present no such temporary house accommodation is provided. I hope that you will shortly consider this question and remedy the defect, as now I am often unable to have a house disinfected as thoroughly as I should like and the occupants of some of the smaller houses are at times subjected to very great discomfort. Dairies and Cowsheds. In the month of July I was instructed by the Sanitary Committee to visit and report upon the various Cowsheds and Daries in the District. I presented my first report 011 July 18th, and my final report on the subject at the first meeting after the recess on October 3rd. In the course of my inspections I found that the greater number of the sheds were in an extremely unsatisfactory state, and in only one instance did I find that attention was paid to all the Regulations made by you under the Dairies, Cowsheds and Milkshops Order of 1885—1886. In one shed I examined I found that 7 cows and a calf were kept in a space which, according to the Regulations, was only sufficient for 3 cows ; the lighting was quite inadequate, there being only one small window which was placed immediately over an uncovered dung pit; the 18 ventilation was insufficient and the shed and its surroundings were in a filthy condition. Add to this the fact that the cows were kept in the shed the whole of the 24 hours, and you have a series of conditions which are most favourable for the existence of disease amongst the cattle and for contamination of the milk. The state of another shed belonging to the same Dairy was very nearly as bad as the one I have described, and the general arrangements connected with the business of the Dairy were about as bad as they could be. This was without doubt the worst Dairy in the District, and owing to the action of the Sanitary Committee, I am glad to say that the business there has been discontinued and the premises are not likely to be again registered as a Dairy and Cowshed unless some radical alterations are effected. Due notice has been served upon the occupiers of those sheds who failed to comply with your Regulations, and in the greater part the dairymen and cowkeepers are endeavouring to comply with the terms of the notice served, and as you have decided to take legal action in those cases where 110 attention has been paid to the notices, I hope before long to see every shed in the District in a much better condition than was the case when I first inspected them. It is very desirable that the Local Government Board should have the power to cause the adoption of the recommendations laid down in the report of the Royal Commission on Tuberculosis of 1896, as by this means there would then be a uniform series of regulations throughout the whole country. Drinking Water. At the end of this report there is appended a list of wells, together with the result of the examination of the water and the action taken. You will notice that that the analysis of the water in the early part of the year was carried out in a qualitative manner, but as your former Medical Officer pointed out, and as I explained to the members of the Sanitary Committee a qualitative examination in the case of drinking water is practically useless. Owing to the absence of a laboratory of your own, all waters for examination have, since the month of June, been sent to an Analyst in London, and the action subsequently taken has been based upon his report. The samples I have hitherto forwarded for analysis have been taken either from wells where the immediate surroundings led me to conclude that the water might be gravely polluted, or in cases where the water was complained of by the user of the well. 19 Notwithstanding the closure of several wells from year to year, there still remain a considerable number in the District, and my efforts will be directed towards the continued maintenance of those wells, especially when they exist in the less populous parts of the District. Bacteriological Examination. In my report to the Sanitary Committee on October 31st, I urged the importance of providing some means of having a bacteriological examination of material from suspected cases of Diphtheria and Enteric Fever when I explained in detail my reasons for the adoption of this course. The question was considered at your next meeting, and I think it is a cause for congratulation that you decided to accede to my wishes in the matter. Arrangements were then made with the Jenner Institute whereby suspected material could be sent to the Laboratories of the Institute for examination. The results so far have been eminently satisfactory, and I wish here to place on record my sincere thanks to the Medical Practitioners of the District for the readiness with which they have made use of the means placed at their disposal for such diagnosis, as without their support this innovation would have been useless. It entails additional work on their part, but this has been cheerfully given, and it is an index of the value they ascribe to this method which I am sure must meet with your warmest approbation, and I hope that in the near future a laboratory will be provided in the District, when the results of such bacteriological examination will be obtained even more speedily than is the case at present. Isolation Hospital. Another cause for congratulation, and one which marks an epoch in the advance of sanitation in the District, is the completion of the joint Richmond and Heston and Isleworth Hospital at Mogden, which is now ready for the reception of patients suffering from infectious disease, the first patient having been admitted for scarlet fever on July 28th. The last patient at the Dockwell Lane Hospital was discharged on September 28th, on which date this Hospital was taken over by the Joint Hospital Committee with the intention of reserving it for a Small Pox Hospital should any cases of that disease arise in either this District or the Borough of Richmond. Mortuary. The completion of the Mortuary has satisfied a long-felt want in the District, and 8 bodies have been taken there since it was opened on the 24th of June. 20 Medical Officer of Health. There have been one or two changes in the personnel of the Office during the year, a matter which is almost invariably a cause for regret, owing to its interference with the systematic work in connection with the various duties of the different officials. In the first instance, Mr. H. M. Bullock tendered his resignation in June, on account of his leaving the neighbourhood, and when I was appointed his Deputy, he showed me the greatest kindness in initiating me into the work of this District, which he had carried out in succssion to his brother, Mr. T. Bullock. I was appointed temporarily as Medical Officer of Health in June, and in October I had the honour of being re-appointed for a further period of 6 months. Sanitary Inspectors. Another loss which you sustained was that of the Assistant Sanitary Inspector who resigned in May, and I have already pointed out that this was a loss which was detrimental to the work of the Department, but your senior Inspector, Mr. J. I. Smith, with that energy and devotion to his work which is so characteristic of him, and for which I have the greatest admiration, endeavoured to minimise the effects of this loss by taking an extra amount of work on his own shoulders. In conclusion, I beg to tender my sincere thanks to you and especially to the Sanitary Committee for the unvarying courtesy you have shown me, and for the readiness with which you have adopted any proposition which has been advanced with a view to improve the general health of the District. I am, Gentlemen, Your obedient Servant, H. HANSLOW BRIND, M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health. (A) TABLE of DEATHS during the Year 1898, in the Heston and Isleworth Urban Sanitary District, classified according to DISEASES, AGES and LOCALITIES. Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. At all Ages Under 1 Year 1 & under 5 5 & under 15 15 & under 25 25 & under 65 65 & upwards 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Smallpox Scarlatina Diphtheria Membraneous Croup Fevers. Cholera Erysipelas Measles Whooping Cough Diarrhoea and Dysentery Rheumatic Fever Phthisis Bronchitis Pneumonia and Pleurisy Heart Disease Tubercular Diseases other than Phthisis Pulmonalis Injuries All Other Diseases TOTAL Typhus Enteric or Typhoid Continued Relapsing Puerperal (a) b c d e f g h (i) Heston and Isleworth Urban District. 468 141 74 19 13 113 108 Under 5 4 20 11 58 1 35 1 16 4 66 216 5 upwds. 4 2 7 3 19 46 34 4 7 126 252 Union Workhouse (Non residents.) 127 5 6 59 57 Under 5 1 1 2 5 5 upwds. 21 19 11 5 1 65 122 Mogden Isolation Hospital (Non residents.) 3 1 1 1 Under 5 1 1 5 upwds. 1 1 2 Totals. 598 146 75 20 20 172 165 Under 5 5 21 11 59 1 35 1 17 4 68 222 s upwdsj 1 5 2 7 3 40 65 45 9 8 191 376 Area of District:- 6893 acres. Population:- (1891) 26,271. POPULATION (Estimated to middle of 1898), 29,185. DEATH RATES:— General 16.03 (per 1000 population, estimated to middle of 1898). Infant 174.72 per 1000 births registered. (B) TABLE of Population, Births and of New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the Year 1898, in the Heston and Isleworth Urban Sanitary District: classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Population at all Ages. Registered Births Aged under 5 or over 5 New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health. Number of such Cases Removed from their Homes in the several Localities for Treatment in Isolation Hospital. 1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11 12 13 Census 1891 Estimated to middle of 1898 Smallpox Scarlatina Diphtheria Membranous Croup Fevers. Cholera Erysipelas Measles Smallpox Scarlatina Diphtheria Membranous Croup Fevers. Cholera Erysipelas Typhus Enteric or Typhoid Continued Relapsing Puerperal] Typhus Enteric or Typhoid Continued Relapsing Puerperal (a) (b) (c) (d) (e) Heston and Isleworth Urban District. 26,271 29,185 817 Under 5 16 8 1 1 468 11 1 upwds. 60 34 1 14 2 14 387 43 11 5 Union Workhouse and District School. Under 5 2 upwds. 3 2 Cottage Hospital. Under 5 5 upwds. 2 Totals. 26,271 29,185 817 Under 5 16 8 1 1 470 11 1 5 upwds 62 34 1 17 2 16 387 43 11 5 State here whether .'Notification of Infectious Disease" is compulsory in the District: Yes. Since when ? January, 1890. Besides the above-mentioned Diseases, insert in the columns with blank headings the uames of any other Diseases that are notifiable in the District, and fill the columns accordingly. State here the name of the Isolation Hospital used by the sick of the District. Mark (H) the Locality in which such Hospital is situated; or if not within the District, state where it is situated: Dockwell Lane, Heston (Within District). Mogden hospital, Isleworth (Within District). T 3 List of COWSHEDS in the District during the Year 1898. No. Name of Licensee. Address of Licensee. Situation of Cowshed. 1 Arnold, J. Steel Road, Isleworth At rear of premises 2 Ansley, A. Whitton Road ,, ,, 3 Bignell, H. Lampton ,, ,, 4 Bodger, J. The Square, Isleworth ,, ,, 5 Crook, G. Vine Place, Hounslow At side of premises 6 Denew, G. Spring Grove London Road 7 Finch, W. Church Street, Isleworth At rear of premises 8 Forman, W. S. North Hyde Farm, North Hyde North Hyde Farm 9 Goddard, E. (Mrs.) Wyke Green, Isleworth At side of premises 10 Godfrey, T. A. Heath Farm, Hounslow 11 Rouse, S. 1, Grantham Place, Staines Road Heath Farm cowshed 12 Teale, F. J. Bath Road, Hounslow At rear of premises 13 Yeates, G. Whitton Road, Hounslow ,, ,, T 4 WELL WATER examined during the Year. PREMISES. Date of Taking Sample. Method of Examination By whom Examined. Report on Examination. Action Taken. Ardmore, Spring Grove January 3rd Qualitative M.O.H. Good None Nursery, Grove Road „ „ „ Not good Well cleansed and protected. Half Moon Cottage, New Heston „ „ „ Fit for Drinking Purposes at present. Well closed, water laid on. Chestnut Cottages, Twickenham Road February 28th „ „ Good None Rose House, Jersey Road April 4th „ „ „ „ 54, Church Street, Isleworth „ „ „ „ „ Paine's Cottage, Heston June 20th Quantitative Public Analyst Unfit for Drinking Purposes Well closed. „ ,, „ July 4th „ „ ,, Water laid on. Gray's Cottage, Jersey Road October 5th „ „ „ Well cleansed, further examination showing improvement. Victoria Villas, Talbot Road „ „ „ „ Well closed—water laid on. Quinion's Cottage, Fern Lane „ „ „ „ „ „ Hall Farm, Heston October 31st „ „ „ „ „ T 5 RETURN of HOUSES dealt with under "The Housing of the Working Classes Act, 1890," during the Year 1898. 1 Half Moon Cottage New Heaton Work done 2 1 Quiniou's Cottages Grove Road „ 32,,,, ,, ,, 43,,,, „ ,, 54,,,, „ ,, 65,,,, ,, „ 7 1 Grove Terrace ,, House closed 82,,,, ,, ,, 93,, „ " 10 51, High Street Hounslow „ 11 53, ,, „ 12 1, Vine Place ,, Repairs in progress 13 2, „ „ ,, 14 3, „ ,, 15 1, Pope's Cottages Tivoli Road House closed 16 2, „ „ „ House not vacated 17 3. „ „ „ House closed 18 2, Clarence Terrace Hounslow Work done 19 3.„ „ ,, „ 20 Old Manor House Whitton House closed 21 10, Ordnance Road Hounslow „ 24 11, „ ,, ,, ,, c.i. Heston and Isleworth Urban Sanitary District. Sanitary Work executed during the Year 1898. Inspections. Notices. Dwelling Houses. Houses Let in Separate Dwellings or Lodgings Common Lodging Houses. Canal Boats used as Dwellings. Movable Dwellings, Caravans, Tents, etc. Complaints Received Cases of Infectious Disease Notified Number of Premises periodically inspected Houses Inspected from Houseto-House Total Number of Houses, Premises, etc., Inspected Total Number of Re-inspections after Order or Notice Total Number of Inspections and Re-inspections Letters Written Cautionary Notices Given. Statutory Orders Issued Summonses Served Convictions Obtained Houses, Premises, etc., Cleansed Repaired, etc. Closed as Unfit for Habitation Re-opened, after Repaires, Alterations, etc. Demolished Illegal Underground Dwelling Vacated Number Registered under Bye-laws Periodical Frequency or Number of Inspections Number of Contraventions Number Registered under Bye-laws Periodical Frequency or Number of Inspections Number of Contraventions Number Registered under the Acts Periodical Frequency or Number of Inspections Number of Contravention of Regulations Number Observed during the Year Number of Nuisances therefrom Abated Number Removed from District 96 101 230 72 6862 1859 8721 3116 109 13 13 127 21 5 0 0 3 51 1 2 55 2 0 156 5 5 15 90 per cent C. 2. Heston and Isleworth Urban Sanitary District. Sanitary Work executed during the Year 1898. Schools Workshops and Workplaces Laundries Bakehouses Slaughterhouses cow-sheds Daries and Milkshops Unsound Food Adulterated Food Offensive trades Mortuaries Number in District Periodical Frequency or Number of Inspections Number found defective Number in District Periodical Frequency or Number of Inspections Contravention of Factory Acts Number in District Periodical Frequency or Number of Inspections Contravention of Factory Acts Number in District Periodical Frequency or Number of Inspections Contravention of Factory Acts Number on Register Periodical Frequency or Number of Inspections Contraventions of Bye-laws Number on Register Periodical Frequency or Number of Inspections Contraventions of Bye-laws Number on Register Periodical Frequency or Number of Inspections Contraventions of Bye-laws Premises Inspected Articles or Parcels seized Samples taken Found adulterated Number of premises in District Periodical Frequency or Number of Inspections Contraventions of Bye-laws Accommodation Number of Bodies received 40 173 8 37 231 1 14 100 0 36 269 13 19 158 9 27 273 12 38 307 12 1332 5 0 0 0 0 0 2 8 C.3. Heston and Isleworth Urban Sanitary District. Sanitary Work executed during the Year 1898. Water Supply and Water Service. Drainage and Sewerage. Wells Houses, Water laid on to Percentage of Houses supplied from Mains Cisterns Flush Cisterns Provided to W.C's Draw Taps Removed from Cisterns to Mains Percentage of Houses Supplied on Constant System Privy & Ash Pits, Ash & Earth Closet Water Closets Percentage of Houses provided with Water Closets Drains Cesspools Sewers New Sunk Cleansed, Repaired, etc. Closed as Polluted New Provided Cleansed, Repaired, Covered, etc. Overflow Pipes Disconnected from Drains Above Ground Receptacles substituted for Pits Movable Receptacles substituted for Fixed Water Closets substituted for Dry Receptacles New Constructed New Apparatus Provided Repaired, Cleansed, etc. Supplied with Water, or Supply rendered Efficient Ventilated Examined, Tested, Exposed, etc. Unstopped, Repaired, Trapped, etc. Waste Pipes, Rain Water Pipes, etc., disconnected Soil Pipes and Drains Ventilated Disconnecting Traps, or Chambers Inserted Reconstructed New Laid Rendered Impervious, Emptied, Cleansed, etc. Abolished and Drain connected with Sewer Percentage of Houses Draining into Sewers Yards of New Sewers Laid Yards of Sewers Reconstructed 1 2 5 22 98 4 74 1 41 0 98 8 7 8 29 4i 91 59 10 97 432 235 31 67 60 23 250 32 49 85 5756 1206 C. 4. Heston and Isleworth Urban Sanitary District. Sanitary Work executed during the Year 1898. Disinfection Dust Dampness Sundry nuisances abated Contagious Diseases of Animals Infant Life Protection Act Rooms Fumigated Rooms stripped and cleansed Articles disinfected or destroyed Dust-bins repaired New bins provided Movable receptacles substituted for fixed Periodical frequency of dust removal Number of complaints of non removal received Roofs, repaired, &c. Guttering and rain-pipes repaired &c. Gardens, Areas, &c., levelled and drained Yards paved and drained Surface adjoining houses paved Dry areas provided Ventilation below floor provided Basements rendered impervious Overcrowding Smoke Accumulations of refuse Foul ditches, ponds, &c., and stagnant water Foul pigs and other animals Other nuisances Outbreaks Animals infected Animals destroyed Number of licensed premises Number of children Number of deaths 583 23 6035 7 108 2 ... 68 27 61 10 37 1 0 8 0 9 1 1025 7 21 20 0 ... ... 0 0 0 (Signed) Jas. I. SMITH, hispector of Nuisances.