HES 54 ANNUAL REPORT on the Health and Sanitary Condition of the District of Heston and Isleworth, FOR THE YEAR 1904, by EDWARD J. STEEGMANN, M.B., D.P.H., Medical Officer of Health and Physician in Charge, Dockwell Hospital. The Health Committee of the Heston and Isleworth Urban District Council. Dr. G. A. S. Gordon, (Chairman). Mr. J. J. Bonnett, „ C. Crush, „ R. L. Devonshire, C.C. „ E. Eva, „ E. W. Goode, J.P. „ W. Mann, „ P. Mecklenberg, „ T. R. Moore-Keys, „ W. G. Palmer. To the Chairman and Members of the Heston and Isleworth Urban District Council. Gentlemen, I have the honour to submit to you the following Report on the health and sanitary condition of the District of Heston and Isleworth for the year 1904, the fourth Annual Report I have been responsible for since you appointed me your Medical Officer of Health. In the Reports for the years 1902 and 1903 an attempt was made to present separate figures for the two parishes of Heston and Isleworth, in addition to the total numbers for the District as a whole. On examining these figures again, I have found that the numbers of births and deaths given for the separate parishes in those two years are not correct, and that therefore the death-rates and birth-rates are also misleading, though the figures for the whole District are correct. This error has arisen from the fact that in the returns supplied to me by the local Registrar the addresses were in many instances not correctly given, and it was not stated in all instances whether births and deaths occurring in Hounslow or other parts were actually in Heston or Isleworth. A considerable number of deaths and births were thus by mistake credited to Heston, when in fact they should have been placed in Isleworth. I have in the present Report eliminated all figures for the two previous years which are not reliable, and I have carefully verified as far as possible the addresses of all births and deaths registered during the year 1904. The statistics for the separate parishes now given may therefore be taken as correct. I would take this opportunity, however, of pointing out that too much importance must not be placed on separate statistics for the two portions of the District, and that the health of the District must be judged from the figures given for the whole. 6 The difficulty of making any real comparison lies in the fact that Hounslow is partly in Heston and partly in Isleworth, and that the separation between the two parishes is more administrative than social or geographical. It is impossible to work out separate statistics for Hounslow, because though the populations for the different wards were enumerated at the last census, this was not done at the census of 1891, and there are therefore no data on which to calculate the present numbers of inhabitants. Generally speaking, I think it will be considered that the Report shows a satisfactory condition of health in the District. There has been no outbreak of disease during the year, and nothing has arisen calling for unusual treatment or special notice. The routine work of the Health Department has been well carried out, in spite of the occasional absence of one or more of the staff on account of illness. Mr. Dowell, one of the Assistant Inspectors, resigned on his appointment to a more responsible post, and was replaced by Mr. Ashworth. A branch office of the department has been established in Isleworth, and it is hoped that a permanent office, at which the Assistant Inspector may attend at stated hours, will be located in the Public Hall in that town. I wish again to express my sincere thanks to the Council, and especially to the Chairman and members of the Health Committee for the help and support they have given to my staff aud myself during the year. I am, Gentlemen, Your obedient servant, EDWARD J. STEEGMANN. 7 Summary of Vital Statistics for 1904. Population, estimated to middle of year 32630 Births 1057 Birth.rate per 1000 of population 32.3 Deaths 55.0 Death.rate per 1000 of population 16.8 Infantile Mortality.rate 169.3 Zymotic Death.rate 2.4 Excess of births over deaths (residents only) 445 Average number of persons per acre 4.7 Comparing these figures with those for 1903, the points worthy of note are:— An increase of 2 only in the total number of births. A decrease of 20 in the number of births amongst residents. A decrease of .5 in the birth.rate. An increase of 95 in the number of deaths. An increase of 2.62 in the death.rate. A most serious increase of 70.73 in the infant.mortality rate. An increase of 1 in the Zymotic death.rate. The following statistics for England and Wales during 1904 are useful for comparison with the figures for the District during the same period:— Births. Deaths from all causes. Zymotic Death. rate. Deaths of Infants under 1 year per 1000 births. England and Wales 27.9 16.2 1.94 146 Rural England and Wales 26.8 15.3 1.28 125 76 great towns 29.1 17.2 2.49 160 142 smaller towns 27.5 15.6 2.02 154 8 In the Annual Report for 1903, some facts as to the general conditions of the district were given, in accordance with a suggestion made by the Local Government Board. As that Report can easily be referred to, it is not necessary to repeat them here, but two important matters must be mentioned. During the year the conversion of the method of sewage disposal has been completed, and the new system has been working for more than half of it. No alteration has been made in the method of collecting the sewage at the works, which was briefly described in last year's report. It may, however, be of interest to add that the engines for compressing air are four in number, tavo of 50 horse-power each being in constant use, and two, each of 25 horsepower, being in reserve for emergencies. These engines supply air to the seven Shone's ejectors used for raising the sewage from the lower level mains. The total amount of sewage to be dealt with amounts to an average flow every 24 hours of about a million and a half gallons. There are five tanks for the bacteriological treatment of this sewage, two being of a capacity of 450,000 gallons, and three of 300,000 gallons each, though the actual capacity of each tank is diminished by the space taken up by the arched supports for the roofs, The filtering of the effluent from these tanks is, carried out on the single contact system by 14 filter beds, each of an average area of about 1000 square yards. At present four of these filters are worked automatically and the remainder are hand controlled. The material used for filtering is coke breeze and clinker, and the average depth of it is rather more than three feet. The effluent was passed through these filters for the first time about the middle of May, when 11 were in use, and by the end of March all of them were working, The final effluent obtained from the filters was fairly good from the first, and there has been an improvement in it as experience has been gained. It is far too soon to criticise the new system, to assume its complete success, or to call attention to faults or defects. Many months of observation and practical experience will be required before its full benefits can be obtained, but even in the few months it has been in use prove its superiority to the old method of chemical precipitation. The Destructor which was under consideration last year, was finally decided on and its erection commenced. It is expected that it will be in use about the end of April, 1905, and that it will be capable of disposing of at least 30 tons of refuse daily. 9 Population. The population of the District, estimated to the middle of the year 1304, is Heston 11305 Isleworth 21325 Total 32630 This gives a total estimated increase of population since the middle of 1903 of 555. The estimation has been made according to the method used by the Registrar-General, and is based on the supposition that the rate of increase that took place between the census of 1891 and that of 1901 will be maintained in the following years. This method is fairly accurate in places where there is little or no development going on, where there are few new houses erected each year, and where the increase of population is due only to the normal excess of births over deaths. It makes no allowance for an increase such has undoubtedly taken place in this district during recent years, due to the development of hitherto unoccupied building.sites. Mr. H. J. Baker, the Clerk to the Council, has made an estimation of the population at the middle of the year 1904, based on the number of occupied houses, and the average number of inhabitants in each, and calculates that the number of the population is 34,275. Mr. Baker's estimate is probably nearer the correct figure than the mathematical estimate, but it is of course impossible to verify either without an actual census. Assuming that the population is 34275 and not 32630, the birth.rate would be reduced from 32.3 to 30.8, and the death.rate from 16.8 to 16.04. The infantile mortality rate would be unaltered, because it is calculated on actual births and infant death, and not on any estimated figures. 10 Excluding non.residents, the excess of births over deaths during the year was 445, compared to an excess of 560 in 1903. The average number of people per aore has increased during the year from 4.67 to 4.7. The number per acre, pased on Mr. Baker's estimate of the total population, is 4 9. Deaths. The death.rate for the year was 16.8. This is 2.6 higher than the rate for 1903, and 0.8 above the average for the last 10 years. This increase in the general death.rate is largely due to the increase in infantile deaths. If the deaths of all children under 12 months of age were deducted from the total deaths registered in 1903 and 1904, and the rates calculated on the remaining deaths the rate for 1903 would be 10.9 and that for 1904 11.3, a difference between the two of only 0.4. The total number of deaths occuring during the year, excluding those of non.residents, was 550. Of these 296 were males and 254 females. There were 200 deaths of non.residents, making the total number registered 750. If all these deaths were included, the death.rate would be 22.9. All the deaths of non.residents took place in public instituions, the great majority in Brentford Infirmary. In addition to these non.resident deaths, 90 residents died in public institutions. The details of these 290 deaths are given in Table 4. The figures for the two parishes are:— Heston Deaths 152 Death.rate 13.4 Isleworth Deaths 398 Death.rate 18 6 72 deaths were registered of residenis aged 75 years and over compared to 61 in 1903, and 86 in 1902. The age.details of these deaths are as follows:— 11 Age at Death, Males. Females. Total. 75 3 5 8 76 2 1 3 77 5 2 7 78 2 5 7 79 2 1 3 80 2 3 5 81 2 5 7 82 0 4 4 83 0 2 2 84 1 4 5 85 1 2 3 86 2 1 3 87 0 3 3 88 1 0 1 89 2 0 2 90 2 0 2 91 0 2 2 92 0 1 1 93 2 0 2 94 1 1 2 30 42 72 These deaths constitute 13.09 per cent, of the total deaths, a result curiously close to the 13 4 per cent. of similar deaths last year. The deaths of infants under 12 months of age amounted to 167 in the year, or 30 36 of the total. Therefore altogether during the year 43.45 per cent. of the total deaths occurred at the two extremes of life, namely under 1 year and over 75 years of age. The causes of Death and the ages at which they occurred are given in detail in table 4, which will be found at the end of this Eeport. This table entails considerable labour in its preparation, but is probably of no great interest to anyone not a specialist in Public Health matters. Certain facts given in it are, however of importance, and should be considered. It will be noticed that the deaths are grouped under six different age.periods. In the first period, infants under 12 months of age, there were 167 deaths; these are dealt with in connection with the infantile mortality, and need not be 12 further referred to here. In the second group, deaths of children over 1 and under 5 years of age there were 40 deaths. The third group, children and young persons between the ages of 5 and 15, includes 19 deaths. In the fourth age-period, 15 to 25, there were 31 deaths. The fifth group contains the deaths of all persons dying between the ages of 25 and 65, and the last group all persons dying at ages over 65. The fifth group which covers 40 years naturally contains a greater number than any of the previous groups, which each covers not more than 10 years. During the year 160 deaths occurred at ages between 25 and 65, and 133 deaths at all ages over 65. In comparing Table 4 this year with the same table in last year's Report, it will be noticed that three additional causes of death are given. These are Broncho-Pneumonia, which last year was included under deaths from other diseases of the respiratory organs, and Cerebral diseases and "Senectus" both of which last year were included under deaths from all other causes. With regard to Broncho-Pneumonia, it will be noticed that of a total of 21 deaths at all ages from this cause, 17 occurred in children under 5 years of age, and more than half of these in infants under 12 months. The fact that all the deaths caused by cerebral disease took place in Isleworth gives no ground for comparing the relative sanity of that place with Heston, but is due to nearly all of them having occurred in public institutions situated in Isleworth. "Senectus" has been included as a separate cause of death on account of the singularly large number of cases in which the cause of death has been registered simply as "Senectus" or old age. All cases in which some secondary disease has been given in addition have been excluded from the total of 39 residents dying from this rather vague cause. Of these 39 deaths 9 occurred in public institutions, the remaining 30 presumably dying at home. In addition 21 deaths of non-residents in public institutions were registered from "Senectus," giving a total of 60 deaths of residents and non-residents from this cause during the year. 13 Of the causes of death detailed in Table 4, not spscially dealt with under the head of Infectious diseases, the following are of interest. Tuberculous Diseases. 62 deaths were registered during the year, of which 51 were pulmonary phthisis, or Consumption. This number gives a death-rate from tuberculous diseases of 1.9 per 1000 of population. Over 70 per cent. of the persons dying from tubercle of the lungs were more than 25 years of age, whereas 54 per cent. of the deaths from tuberculosis other than pulmonary were in infants and young children under 5 years of age. Other Respiratory Diseases. It will be seen from the table that Bronchitis and Broncho-Pneumonia, responsible together for 66 deaths, are generally speaking fatal diseases of the extremes of life, only one of the total having occurred between the ages of 5 and 25, and the great majority either in the first five years or at ages over 65. The deaths from Pneumonia, on the contrary, will be noticed to be fairly evenly distributed over all the age-periods. Heart-Disease. 38 deaths were notified from this cause, 31 of which were persons over 25 years of age. The infant deaths from heart disease were in both cases due to malformation. Accidents of Parturition. Of the 9 deaths due to disease and accidents of birth, in 5 cases the child died, and in 4 the mother. Cancer. Cancer, which in the table includes all forms of malignant disease, is in the majority of cases rare before adult life. During the year 36 deaths from this cause were notified, all but one being in persons aged over 25 years. Of the total, 14 were males and 22 females. 14 » Births. The birth.rate for the year was 32.3. This rate is slightly less than the rate for last year, but is above the average for the past 10 years. It is, however, considerably higher than the probable true birth.rate, being calculated on the estimated population and the total number of births registered, whether the parents of the children were resident or non.resident. Including only the births amongst residents, and calculating the rate on the estimated population, it becomes 30.4, and if the resident births are taken alone and the calculation is based on Mr. Baker's estimate of the population, the birth is still further reduced to 29.02, a figure which is much more likely to be correct than the official one of 32.3. The total number of births registered was 1057, only two more than the number in 1903. 62 of the total were the children of non.residents. The actual number of births amongst residents during the year was 995, a decrease of 20 compared to last year. This decrease in the total number of births is a serious matter, when it is remembered that on the lowest estimate the resident population has increased in the same period by 555. Of the 995 children born, 500 were boys and 495 girls. The figures for the two parishes are:— Heston Births 305 Birth.rate 26.8 Isleworth 690 32.8 Illegitimate Births. 88 births were registered during the year as being illegitimate, this number being equal to 83 per cent. of the total. Of the 88 illegitimate birth, 57 were children of non.residents, giving an illegitimate percentage for non.resident births of 919. 31 illegitimate births were registered amongst residents, this number being 3.1 per cent. of all resident births. This number is slightly lower than last year, but is still much above the average for the rest of the country. Quarterly Rates. The following table gives the birth and death.rates for each of the four quarters of the year 1904, and can be compared with a similar table included in last year's Report:— Birth Rate. Death Rate. 1st quarter 30.9 17.9 2nd ,, 33.0 15.6 3rd „ 30.6 18.9 4th „ 34.4 15.4 These figures are calculated to equal annual rates, that is they represent what the rates, would have been for the whole year if the people had continued during the other nine months to die and be born at the same rate as they did during any particular quarter. 15 Infantile Mortality. The extremely high rate of infantile mortality during the year is the most serious fact to which attention has to be drawn in this Report. The total number 'of deaths of infants under 12 months of age was 167, giving an infantile mortality rate of 167.8 per 1000 births. (These figures are for residents only. The official infantile mortality rate, as given in Table 1, 169 3, is calculated on the total births and infant deaths registered during the year). Several deaths were registered as occurring at the age of 12 months exactly, and these by the instructions of the Registrar are excluded from the number of infant deaths. The rate this year is the highest on record for the district, with the exception of the year 1898, and is much above the average for the last 10 years. It is 70.73 above the rate for last year. The infantile mortality rate for each of the quarters is shown in the following table:— 1st quarter157 per 1000 births 2nd „ 110.6 „ 3rd „ 294.3 „ 4th ,, 134.0 ,, These quarterly infant mortality rates are not calculated to equal annual rates, but are based on actual numbers of infant deaths and births during each quarter. In the Report of the Medical Officer of Health for the third quarter of the year the following statement was made:— "The numbers of the infantile deaths in the two previous quarters of this year were respectively 36 and 28, making a total for the nine months of 131. It is a general experience that more infantile deaths take place during the third quarter of the year than at any other time, but even allowing for this, the number registered during the past three months in this district is out of all proportion. In considering the causes of deaths as notified to the Registrar on the certificates, I have carefully excluded all these where it may be 16 said to have been natural or non-preventable, and I have only takeri into account the deaths of infants of residents. Of the 67 deaths, 51, or over 73 per cent, were stated to have been caused by "Enteritis" in one form or another. In an exceptional number of instances the cause of death was certified as simply diarrhoea. Enteritis and Diarrhœa mean much the same thing, disease of the digestive system, and the cause of it is in the majority of cases some error in feeding. I do not wish to assume for a moment that all cases of diarrhoea in young infants are either due to this cause, or that fatal cases of the disease may not occur in the most carefully and scientifically fed children, but I think no doctor would contradict the statement that a very large proportion of such fatal cases of diarrhoea in infants are due to bad feeding, dirty conditions, and the ignorance of the mothers. Insanitary houses are also an important factor, but in this district such houses are not very commonly met with. The number of cases of enteritis among young children and infants is always above the average in the late summer and autumn, but I believe it to be in the majority of instances a preventable disease. The 51 deaths from Enteritis were registered during the three months of July, August and September, but a larger number occurred in August than in either of the other two months. Whether or not this fact has any connection with the closing of the Schools for the vacation, I am not in a position to say, but it is one worth considering. In many families the girl who is attending school is at the same time acting as nurse to the baby at home out of school hours, and during the holidays the entire care of the infant may be entrusted to her, and if the ignorance of a mother as to the proper diet for a young baby is great, that of a girl of 12 or 13 is still greater. It seems not unreasonable to believe that some definite system of training the elder girls in the schools in hygiene generally and the care, management and feeding of babies in particular might have a material bearing in the future on the health of the infant population and the reduction of the number of deaths amongst them. I have before this called the attention of the Council to the infant mortality rate, I most earnestly do so again, for it is a grave and serious blot on the sanitary condition of the district." As a result of this report, the Council appointed a sub-committee to consider the whole question of infantile mortality in the district, and a special report is being prepared by the instruction of this sub-committee. 17 Dealing only with the infant deaths amongst residents and the year 1904, certain facts are of special importance. The details of the causes of these deaths are given in the third column of Table 4. 58 of the deaths, or 34.7 of the total number, were caused by Diarrhoea in one form or another. 18 deaths, or 10.8 per cent. of the total number, were attributed to premature birth. 27 deaths, or 161 per cent. of the total number were caused by diseases of the respiratory organs. 7 deaths, or 4 2 per cent. of the total number were caused by infectious diseases. (Measles 4, and Whooping.cough 3). A large proportion of the 33 deaths put under the head of causes not otherwise specified were due to "Marasmus" wasting or non.assimilation of food, all three causes which it may safely be said in many cases are preventable with proper care and skill. The deaths from Measles, Whooping. cough and Diarrhcea taken together give a zymotic infantile death.rate of 387 per 1000 births. Special attention having been drawn to the infant mortality at Hounslow Barracks in the last two annual reports, it is satisfactory to note that in 1904 only 4 deaths of infants under 1 year were regisiered as occurring there. As during the same period 36 births were registered, the infantile mortality rate for the Barracks in 1904 was 111.1 per 1000 births, compared to 74.03 in 1903, and 352 99 in 1902. The following table gives the percentage of deaths under 1 year to deaths at all ages from the year 1893. Year. Percentage. 1893 31.86 per cent. 1894 28.81 ,, „ 1895 22.45 „ „ 1896 28.95 „ „ 1897 24.61 „ „ 1898 31.19 „ „ 1899 27.32 „ „ 1900 24.00 „ „ 1901 28.75 „ „ 1902 27.86 „ „ 1903 22.75 „ „ 1904 30.36 „ „ The separate figures for the two Parishes are as follows:— Deaths under 1 year. Infant mortality.rate. Heston 41 134.5 Isleworth 126 182.6 18 Deaths from Zymotic Diseases. The diseases included are, as in previous years, Smallpox, Scarlet Fever, Diphtheria, Typhus, Enteric and simple Fevers, Cholera, Measles, Whooping Cough, Diarrhoea and Dysentry, and Membraneous Croup. In all 80 deaths were registered as occurring from these diseases, giving a zymotic death.rate of 2.4 per 1000 of population. Compared with last year these figures give an increase in the number of deaths from these diseases of 34, and an increase in the death.rate from them of 1 per 1000. Of the total deaths from zymotic diseases, no less than 63, or 85 per cent., were due to Diarrhoea, the death.rate from this disease alone being 2.08 per 1000 of population at all ages. The following table gives details of the zymotic deaths in 1904 and those in the previous year for comparison:— Disease. 1903 1904 Deaths. Rate. Deaths. Rate. Scarlet Fever 4 12 — — Diphtheria 4 .12 2 .06 Typhoid Fever 1 .03 — — Measles 5 .15 6 .10 Whooping Cough 12 .37 4 .12 Diarrhoea and Dysentry 20 .62 .68 2.08 All zymotic diseases 46 1.43 80 2.4 The points in the table most worthy of remark are the entire absence of deaths from either Scarlet Fever or Typhoid Fever, and the marked decrease in those due to Diphtheria and Whooping Cough. The satisfaction that would be felt at these decreases is, however, entirely done away with by the enormous increase in the deaths caused by Diarrhoea. The following table shows the zymotic death.rate since 1894:— Year. Rate per 1ooo of population. 1894 .90 1895 2.7 1896 2.49 1897 1.39 1898 3.73 1899 2.93 1900 1.79 1901 2.58 1902 1.58 1903 1.43 1904 2.4 19 The next table gives the death.rates per 1000 of estimated population for certain other diseases during 1903 and 1904:— Disease. 1903 1904 Phthisis and other tuberculous diseases 1.74 1.9 Cancer 0.74 1.1 Diseases of the respiratory organs, excluding phthisis 1.92 2.9 Heart Disease 1.43 1.1 There were also deaths from Influenza, giving a death rate for that disease of 012 per 1000 of population. 20 INFECTIOUS DISEASES. The total number of cases notified to the Health Department during the year was 145, a decrease of 60 from last year's total. Three years are now available for comparison as to infectious disease, the previous years having included Measles. The total numbers of cases notified in these years are:— 1902 249 1903 205 1904 145 This decrease in the number of cases of infectious disease is all the more satisfactory when the large increase in the total population is considered. The following table gives a comparison between 1903 and 1904 of the number of cases of the different diseases notified in each year:— Disease. 1903 1904 Scarlet Fever 143 65 Diphtheria 29 37 Typhoid Fever 9 15 Puerperal Fever 1 5 Erysipelas 23 23 Total 205 145 In Table 3 at the end of this Report details will be found of the age distribution of the various notified diseases, and the various divisions of the district from which thev came. From this table it will be seen that of the total cases, each division of the district supplied the following numbers:— Division. Cases notified. Population at Census of 1901. Hounslow North 7 3171 Hounslow South 56 8206 Heston 24 7818 Isleworth 41 11688 Brentford Infirmary 17 One case was notified from Mogden Hospital, and one occurred on a canal boat. Both these cases are included in the total for Isleworth. 21 The eases notified do not actually represent all the cases of notifiable disease that occur in the district, for all cases arising in the Barracks or other Government residences are not reported to the Health Department. During the year five cases not previously notified were removed to the Isolation Hospital, and therefore this number at least must be added to the total. The condition of the district as a whole may be considered satisfactory as regards infectious disease. There has been no epidemic or serious outbreak during the year, and very few cases have occurred in which infection could bo traced to a previous case in the same house or family. This fact speaks well for the care with which disinfection is carried out, and the manner in which the Inspectors supervise the isolation of cases not removed to Hospital. Formalin is depended upon entirely now for disinfecting the rooms and some of the clothing of patients, whilst the bedding and heavier articles are removed to the Hospital and there disinfected by heat. In 45 cases of Scarlet Fever, 14 of Diphtheria and 5 of Typhoid it was considered necessary to test the draius of the houses where they occurred. Arising out of these 64 cases the drains of 233 houses were tested, and defects were found in 141. Including the cases notified from the Brentford Infirmary, 82 cases were removed to Mogden Hospital. If Erysipelas and Puerperal Fever, neither of which diseases are admitted to the Hospital, are excluded, this is equal to 70 per cent. of the total cases. Small-pox. An entire freedom from this disease can be again reported for the year 1904, a fact for which the Health Department can claim no credit, but which is none the less satisfactory. A considerable number of cases of Chickenpox was reported from the schools from time to time, but in none of them was there any doubt as to the nature of the disease. Several cases where there was some doubt as to whether or not the patient was suffering from small-pox, were seen by the Medical Officer of Health in consultation with the doctor attending them, and one of these patients, an elderly man, was 22 removed to Dockwell Hospital for observation. The disease, however proved to be Chicken-pox. In this case, till the diagnosis was definitely established all the precautions that would have been observed had the diaease been undoubtedly small-pox, were carried out. All the people in the house were re-vaccinated, and the contacts kept under observation. Measles. 1904 is the third year during the whole of which measles has not been included in the list of notifiable diseases in the district. It is impossible to give any accurate estimate of the number of cases that occurred, but there were certainly many, judging only from the number of voluntary notifications received from the schools. There is no reason to suppose that the total number was above the average. Measles is essentially a disease of childhood, and it is a mistake to suppose that it is always an unimportant one. The fact that it was the cause of six deaths during the year, whereas whooping-cough caused four, diphtheria only two, and scarlet fever not one is worthy of note. In a very large proportion of cases the parents do not consider it necessary to obtain medical advice, even when there is no doubt as to the nature of the disease, till some complication has arisen that might have otherwise have been avoided. It would be well could some means be devised for insisting on all parents of children suffering from measles letting them be seen at least once by a doctor, who would be able to warn those responsible of the necessity for proper care. It is not to be assumed that all voluntary notifications of cases sent from the school-teachers, in which the disease is stated to be measles, are in fact measles. An experienced teacher can in most cases recognise a child suffering from the early signs of the disease, and will send it home and notify the health department. But very often the teacher does not see the child. A message is brought that it is kept at home because it, or one of the family, has measles, and this statement is frequently accepted without verification. The great anxi ;ty of the school authorities to exclude all cases of measles makes this complaint a convenient and favourite excuse for keeping elder children at home, and the unwillingness of the parent to call in a doctor at once makes it often impossible to verify the diagbosis. A number of cases were investigated on the same day that they were stated by the parents to be absent from school on account of measles, and it was found that some of the children were quite well, others were sufferring from complaints not measles, and only a 23 Very small proportion had been seen by a doctor before the notice was sent to the schools. It is important to remember that unless a doctor sees the patient whilst the rash is visible, in many cases he cannot possibly be certain that the disease is measles, and he cannot give a certificate when he sees the child ofter recovery unless he depends entirely for his diagnosis on the word of the mother. And yet in many cases such certificates, obtained to comply with the orders of the attendance officer, are considered satisfactory. Scarlet-fever. 65 cases of scarlet-fever were notified during the year, a decrease of 78 as compared to 1903. One case was an infant under 1 year of age, and one a person aged over 25, but the majority of the patients (84 per cent) were persons aged between 1 and 15. An interesting point is the even distribution of the cases throughout the year. 17 were notified in the 1st quarter, 15 in the 2nd, 14 in the 3rd, and 19 in the last. Taking the ward divisions of the district, the number of cases from each were as follows Hounslow North 2 Hounslow South 32 Heston 11 Isleworth 20 49 of the cases were removed to Mogden hospital. Only one death from scarlet-fever was registered during the year, and this was a patient in the hospital admitted from Richmond. Diphtheria. There was an increase in the number of notifications of Diphtheria during the year, 37 having been notified compared to 29 in 1903. This number was, however, less by 19 than the total cases in 1902. Practically half the cases were notified during the last quarter of the year, when there were 18, 9 in October, 7 in November and 2 in December. In the first and second quarters there were each 7 notifications, and in the third 5. The Wards from which the cases came were:— Hounslow North 5 Hounslow South 17 Heston 7 Isleworth 8 24 Two deaths from Diptheria were registered, both children under 15. Of the total number of cases 27 (72 per cent.) were removed to Mogden Hospital. Typhoid Fever. 15 cases of Enteric were notified, compared to 9 in the previous year, and 10 in 1902. 5 occurred in the first quarter, all being in March, 1 in the second, 7 in the third, and two in the last. 5 of the cases were notified from Heston, 3 from Isleworth, and 6 from the Brentford Infirmary. There were none in Hounslow. No deaths were caused by this disease. Puerperal Fever. 5 cases of Puerperal Fever were notified, compared to one only in 1903. 2 of the cases were in Isleworth, and one each in Heston and Hounslow South. The other one occurred in the Infirmary. Only one death was registered as being caused by Puerperal Fever, but four other women died from other direct results of child-birth. Erysipelas. Very little importance can be attached to this disease as a guide to the sanitary condition of any district, but it is one that is notified under the Act. During the year 23 cases occurred, exactly the same number as during 1903. Of these, 10 were in the Infirmary. The majority of the cases were in old people. Erysipelas is seldom a fatal disease, and during the year no death was recorded as having been caused by it, although in two cases it was given as a secondary cause. 25 MOGDEN HOSPITAL. The following extract is taken from the Annual Eeport for 1903, and is again inserted here to call attention of the Council to this important matter:— "I am anxious to call the attention of the Council to the urgent necessity of increasing the accommodation provided at the Hospital for the reception of Scarlet Fever patients. This is not a new matter. It has been before the Joint Committee for many months; it has been discussed by the Richmond Corporation and the Heston and Isleworth Council, and nobody has even suggested that the necessity does not exist. Plans for the enlargement have been prepared, and the Medical Staff has repeatedly called attention to the danger of delay in carrying them out, and yet at end of the year no practical step has been taken towards providing more beds. I am aware that the Heston and Isleworth Council is prepared to carry out its duty in the matter, and that the delay has been chiefly caused by a difference of opinion between the constituent authorities as to their relative financial responsibility, and the desire of the Richmond Corporation to alter the terms of the agreement entered into when the two districts joined together for Isolation Hospital purposes. It is not my business to hold any opinion regarding the questions at issue between the Authorities. It seems to me that as the arrangement exists, and the Hospital is for the joint benefit of the two districts, they must be considered as one in connection with those diseases which are admitted for treatment, and the total population of both must be taken into account in considering the number of beds that must be provided. The difficulty in connection with Mogden is the more surprising to me, inasmuch as it never arose when I requested that additional accommodation should be provided at Dockwell in 1902, The two Hospitals are maintained under exactly the same agreement, but the question of relative cost was not considered when a new building was erected at the latter for Small-pox cases. The necessity at Mogden is far more urgent than was the case at Dockwell. Dr. Crocker, the Medical Officer of Health for Richmond, and Visiting Physician to the Hospital, reported on the need for increased accommodation in March, 1903, and called attention to the requirements of the Local Government Board, as to the provision of 2000 cubic feet of air space for each patient. In a further Report to the Joint Committee, dated November 23rd, 26 1903, he wrote as follows:—'Since October, 1902, to the present time, this standard has not been maintained, excepting for a period of three weeks at the end of June and beginning of July, 1903. That is for over twelve months out of the last thirteen, there has been more or less overcrowding in the Scarlet Fever wards.' He also said in the same Report:—'The continuous overcrowding has prevented a thorough cleansing of the Scarlet Fever wards, and in conjunction with the overcrowding, this has in all probability aggravated the condition of some of the patients, and notwithstanding every care, led to a certain number of return cases.' There is no legal power except in certain cases, to compel people to enter a hospital when suffering from an infectious disease, but moral persuasion is always used to urge them to do so on the rare occasions when removal is objected to. It is therefore all the more necessary that the Authorities should be in a position to guarantee the best possible treatment in their Hospital. One of the most essential things is sufficient air space. The patients chance of recovery is diminished directly his air space is reduced below 2000 cubic feet, and the possibility of a patient being discharged from Hospital apparently well, but not free from infection is greatly increased when convalescent people are crowded together. Insufficient airspace is therefore a danger both to the individual patient and also to the community. In all Hospitals it may happen at certain times that a temporary overcrowding is unavoidable, and that the air space has occasionally to be reduced to 1500 cubic feet. This is even allowed by the Local Government Board in exceptional times of stress, or where all the patients are young children. At Mogden it was becoming a routine custom of necessity to take in all cases, no matter what theavailable space, and for many months no patient had his proper quantity ; it was generally 1500 cubic feet, and sometimes less." The question of the enlargement of the Hospital has been considered at various times, but no practical steps whatever have been taken towards having the work done during the year. It has been good fortune and not good management that prevented a repetition of the overcrowding that occurred in 1903, but it is certainly not wise to depend on similar fortune in the future, and should the number of cases of infectious disease increase next year, without sufficient accommodation having been provided, the Council will not be able to avoid responsibility. 27 The following Report on the number of cases admitted during the year has been prepared by Dr. Power, the Resident Medical Officer. Return as to Patients for the year ending the 31st day of December, 1904. Admitted. Scarlet Fever. Diphtheria, Enteric Fever. Other Diseases. Totals. From the Borough of Richmond 46 15 – 2 63 ,, Richmond Union – – – – – ,, Heston and Isleworth Urban District 48 26 6 – 80 „ Hounslow Barracks (Garrison) 1 4 – – 5 ,, Brentford Union (Isleworth) 1 1 – – 2 ,, Mogden Hospital Staff 1 1 – 2 4 Totals 97 47 6 4 154 Discharged. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. Totals. From the Borough of Richmond 43 18 1 1 63 ,, Richmond Union – – – – – ,, Heston and Isleworth Urban District 55 20 6 – 81 ,, Hounslow Barracks (Garrison) 1 3 – – 4 ,, Brentford Union (Isleworth) 1 1 – – 2 ,, Mogden Hospital Staff 1 1 – 2 4 Totals 101 43 7 3 154 Died. Scarlet Fever. Diphtheria . Totals. From the Borough of Richmond 2 1 3 „ Heston and Isleworth Urban District 1 – 1 ,, Hounslow Barracks (Garrison) – l 1 Totals 3 2 5 The following is a Statement shewing the number of admissions for each year since the opening of the Hospital. 28 Year. Scarlet Fever. Diphtheria. Enteric Fever. Other Diseases. Totals. 1898 42 20 7 1 70 1899 182 42 5 0 229 1900 176 56 6 0 238 1901 136 57 13 4 210 1902 183 85 9 2 279 1903 218 48 8 2 276 1904 97 47 6 4 154 Totals 1034 355 54 13 1456 DOCKWELL SMALL-POX HOSPITAL. No case of Small-pox occurred during the year, and only one patient was admitted for observation. The Hospital is in a state of thorough efficiency and is ready at any moment to admit patients should the necessity unfortunately arise. During the year all the buildings were cleansed and re-painted, and a new mortuary and shed for the ambulance were built. Considerable improvements were also carried out in the grounds by Mr. Nicholson, the Caretaker. Mr. Nicholson's interest in and conscientious care for the Hospital are in no small measure responsible for its good condition. 29 Sanitary Work. Some details of the routine work of the Health Department are set out in the four tables numbered CI, C2, C3 and C4, which are printed at the end of this Report. It is a difficult matter to give accurate figures as to the work done, which could be in any way compared to the similar tables published in the annual reports of other districts, without some common definition as to the meaning of the terms "inspection," "re-inspection," and others equally vague in the headings of the various columns in these four tables. It often happens that one of the Inspectors or the Medical Officer of Health, may in passing to other work look at some alteration or improvement that is being carried out to note if it is being done in a satisfactory manner, but this casual visit might be a re-inspection or not according to individual opinion. The work of a Sanitary Inspector is not to be measured only by the number of entries he makes in a book, or the amount of writing he does, though both these things are important parts of his routine duties. Much is done in this District, as no doubt also in others, by friendly advice given and suggestions made to remedy small nuisances and minor defects which owners and occupiers themselves frequently fail to notice, and it is the endeavour of the Staff of the Health Department to carry out its work wherever possible without resort to formal notices and legal proceedings. The total amount of work performed during the year has been slightly less than during 1903, owing partly to loss of time through illness, causing unavoidable absence from duty of one or other of the Inspectors, and partly to the resignation of one of the Assistant Inspectors, and the necessity of his successor becoming familiar with the peculiarities of the District. Mr. Ashworth, who was appointed to the post vacated by Mr. Dowell, has proved himself a most capable and energetic official, and much good work has been done by Mr. Roberts and himself, acting under the general directions of Mr. Smith, the senior Inspector. In last year's Eeport attention was drawn to the fact that on many occasions defects were found in the drains of new houses when they were tested on the occurence of infectious disease in them. By the direction of the Health Committee a system was devised to ensure the more strict testing of the drains of new houses before occupation. It had hitherto been 30 the practice for the Surveyor's Department to carry out this duty, whilst the Health Department was responsible for testing all drains to which suspicion attached in inhabited houses. The methods used by the two Departments being different, it followed that what would satisfy the one, would not always satisfy the other. It was therefore arranged that before the Surveyor granted his certificate of the fitness of any new house for habitation, the drains should be tested by one of his Inspectors in conjunction with one from the Health Department. This method of co-operation came into force at the beginning of November, and during the remaining portion of the year 28 new houses were tested by the two Departments, acting together. In 50 per cent. of these houses defects were discovered and remedied. In the majority of these cases the defects were minor ones, consisting generally of some fault in the ventilating shaft that would not stand the smoke test. It may fairly be assumed that this careful testing of new houses will in the near future greatly reduce the number of defects found. Factories and Workshops. A list of Factories, Workshops and Workplaces is appended, and on comparing it with the similar list given last year, it will be seen that the total number is now 203, as compared to 164 in 1903. The list is possibly not yet complete, and does not of course include the large number of shops in which no manufactures are carried on. The number of inspections of which notes were kept amounted to 257, and the number of contraventions of the Factory Acts found was 16, none of them serious. 31 List of Factories, Workshops and Workplaces. Boiler Fluid Manufacturers 1 Machinery. Labour employed. Builders 15 5 ,, ,, ,, Basket Makers 1 No labour employed. Cigarette Manufacturers 1 Labour employed. Coffee and Dining Rooms 15 3 employing labour ; 12 domestic family only employed. Cycle Makers 9 4 labour employed. Confection Manufacturers 1 Labour employed. Manufacturing Chemists 1 Machinery and labour. Dressmakers 19 8 employ labour, 11 domestic. Dye Manufacturers 1 Machinery and labour. Dry Soap Manufacturers 1 ,, ,, Electricians 2 Labour employed. Engineers 2 Machinery and labour. Fancy Soap and Scent Manufacturers 1 ,, ,, Fancy Blind Maker 1 Outworker. Farriers and Blacksmiths 8 Employ labour. Firewood Manufacturers 1 ,, ,, Foundry 1 ,, ,, Implement Makers 1 ,, ,, Masons 3 ,, ,, Modified Milk Manufacturers 1 ,, ,, Millers 1 Machinery and labour. Milliners 3 Employ labour. Mineral Water Manufacturers 1 „ ,, and machinery. Metal Sheet Workers 1 ,, ,, ,, Plumbers and Decorators 13 ,, ,, Picture Frame Makers 2 1 ,, ,, Pipe Cleaner Manufacturers 1 ,, ,, Printers 7 4 ,, ,,2 machinery. Saddlers and Harness Makers 6 2 ,, ,, Shirt Makers, etc., 2 Outworkers. Shoemakers 30 8 employ labour. 5 outworkers. Tailors 18 5 ,, ,, 8 ,, Upholsterers 4 ,, ,, 2 ,, Wheelwrights 10 ,, ,, Watchmakers and Jewellers 9 ,, ,, Whitesmiths 7 6 „ „ Yeast Manufacturers 2 203 32 Bakehouses. The list of bakehouses given in the table at the end of the Eeport contains one more than the similar list for last year. The very full details given in this table require no comment, but it may be said that on the whole the bakehouses in the district are in a good condition, and will compare favourably with many other places. Dairies and Milkshops. The sanitary condition of these places is a matter of greater moment to the public health than that of bakehouses, or any other places supplying food. A detailed list of them is given at the end of the Eeport, and other information in Table C 2. The number of registered cowsheds is 18, and of dairies and milkshops 43. The total number of inspections made to various places supplying milk was upwards of 1000. Only 7 actual contraventions of the bye-laws were found, but it cannot be said from this that the general condition of these places was altogether satisfactory. It is unfortunately often difficult to obtain in a practical way that which is theoretically desirable. A certain proportion of the milk used in any district may be supplied from places outside it, and the whole matter of the inspection and regulation of the milk trade is possibly one of those things that might with advantage be undertaken by one central authority for the County. The somewhat unsatisfactory condition in which some of the cowsheds and many of the cows are kept arises, in Mr. Smith's opinion, from the want of more labour, and stricter supervision on the part of the occupier and owner. Slaughter Houses. The question of the slaughter-houses in the district is one that will have to be considered by the Council, as it is of great importance to the health of the people. The total number of these places is 14, and a list is given at the end of the Eeport. It is a matter of no great difficulty to inspect each of these slaughter-houses frequently, and to see that in structure, cleanliness and management they comply with the bye-laws. From Table C 2 it will be seen that out of 177 inspections only four contraventions were found. But it is quite impossible to inspect properly the.carcases of all the animals killed in them. There is no law or regulation in the district to compel the owner of the animal killed to submit it for inspection before removing the internal 33 organs, and the existance of disease rendering the flesh unfit for food can frequently only be discovered by examination of these parts. Even if there was such a regulation, and notice was always given of the intention to kill, it would be impossible without the appointment of a special meat inspector to examine all animals, owing to the great distance of one slaughter-house from another. The provision of a central public slaughter-house is needed. It should be under the management of the Council, and in it all animals, such as pigs, cattle and sheep killed in the the district and intended for food should be slaughtered, and no part of any animal should be removed from the slaughterhouse before examination by an inspector. The convenience of the occupiers of the 14 present private slaughter-houses, and the vested interests of the owners are of course important factors to be considered, but the gain to the community seems to outweigh these points. 34 Annual Report of the Canal Boat Officer for the year ending December 31st, 1904. Number of visits to Canal 56 Number of Boats inspected 306 Number of Boats conforming the Acts and Regulations 245 Number of Boats contravening the Acts and Regulations 61 Number of Men on Boats 403 Number of Women on Boats 213 Number of Children on Boats 245 Boys over 5 years 73 Boys 5 years and under 49 — 122 Girls over 5 years 64 Girls 5 years and under 59 — 123 Number of Boats with fore-cabins 82 Contraventions. Particulars of Contraventions. Contraventions. Remedied. Outstanding. Not registered 3 ... 3 Registration, without a certificate 2 1 ... Certificate not identifying boat with owner 2 2 ... Not properly marked 5 3 2 Cabin in a dirty state 4 3 1 Painting not renewed 10 7 3 Insufficient ventilation 16 12 4 Cabin delapidated 12 9 3 Without a pump 3 3 ... Without a proper water vessel 4 1 3 Total 61 41 20 35 I have to report that the Boats inspected by me during the year, with the exceptions reported, have been found in a most satisfactory condition, and the healthy state of the occupants is a pleasure to record. The steps taken to secure compliance with the Acts and Regulations by means of Notices and Cectificates have been the means of clearing 41 of the 61 contraventions found, and with respect to the 20 outstanding contraventions, which were found on 13 Boats, on 7 of these I am assured the contraventions have been remedied, as regards the remaining 7, no information has been received. The 8 outstanding contraventions mentioned in last year's report have all been remedied. On the 3rd of December, 1904, a case of Infectious Disease (Erysipelas) was notified of a male person resident on the Boat " Perseverance", no further particulars were given, and after considerable enquiry by the Medical Officer of Health, and myself, it was found that the boat had proceeded on its journey. I then wrote the Canal Boat Inspector of the district in which the boat was alleged to stop at, but have no information that the boat has yet been met with. With reference to the contravention from insufficient ventilation, following upon my report of 1903, I find the Registration Authorities appear to differ as to the necessary requirement to prevent the Ventilation in bulk-head being blocked ; in some cases iron shields of a satisfactory nature have been supplied, in other cases two small blocks of wood, which are futile so far as I have witnessed; the last mentioned provision, not suggested by me, arose out of a letter, as mentioned in my previous report, to one of the large firms of carriers. As a matter affecting the comforts of the Canal Boat population, it would appear necessary that sufficient sanitary accommodation should be provided at the wharves of places of stoppage ; in this District I find this is provided for men, but not for woman and children; the question arises, who is responsible for this? As Inspector of Nuisances I am not in a position to report any serious nuisance from this cause, yet I submit the need is great. Jas. I. SMITH, Canal Boat Inspector. Table I. Vital Statistics of Whole District during 1904 and previous years. Year. Estimated Population to middle of year. Births. Total Deaths Regicterhd Total Deaths in public institutions in District Deaths of nonresid'ts regist'd in public instit jtions in District Deaths of residents regist'd in public institutions beyond District Deaths at All Ages (Nett). under 1 year. at all ages. N'mber Rate. N'mber Rate per 1000 births. N'mber Rate. * N'mber Rate. * 1 2 3 4 5 6 7 8 9 10 11 12 13 1894 27,541 809 29 3 102 126.0 430 15.6 ... 76 ... 354 12.8 1895 27,895 862 30.9 108 125.0 564 20.1 ... 83 ... 481 17.2 1896 28,325 790 27.8 119 150.6 521 18.3 ... 110 ... 411 14.4 1897 28,765 729 25.3 96 131.6 491 17.0 ... 101 ... 390 13.5 1898 29,185 817 27.7 146 172.5 598 20.4 196 130 ... 468 16.0 1899 29,607 931 31.4 144 154.6 678 22.8 216 151 ... 527 17.7 1900 30,040 813 27.0 127 156.2 682 23.0 262 163 ... 529 176 1901 30,959 874 28.5 140 160.1 678 21.8 232 191 ... 487 15.7 1902 31,531 932 29.5 146 156.6 734 23.3 300 210 ... 524 16.6 1903 32,075 1055 32.8 104 98.5 634 19.7 262 179 ... 455 14.1 Av. for '94-1903 29,592 861 29.0 123 143.2 601 20.2 ... 139 ... 462 15.6 1904 32,630 1057 32.3 179 169.3 750 22.9 290 200 ... 550 16.8 *Rates in Columns 4, 8, and 13 calculated per 1000 of estimated population. Note. The deaths to be included m Column 7 of this table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to be included in Column 12 are the number in Column 7, corrected by the substraction of the number in Column 10 and the addition of the number in Column 11 . By the term "Non-residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public institutions" to be taken into account or the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. (These are ; Mogden Isolation Hospital, Hounslow Hospital, Dockwell Smallpox Hospital, Union Infirmary, Isleworth, and Wyke House Asylum). Total population at all ages, 30,863. Number of inhabited houses, 5,684. Average number of persons per house, 5.4. Area of District in acres (exclusive of area covered by water) 6,859. At Census of 1901. Table II. Vital Statistics of separate Localities in 1904 and previous years. NAMES OF LOCALITIES. Year. Popula ion estimated to middle of each year. Parish of Heston. Deaths under 1 year. Population estimated at middle of each year. Parish of Isleworth. Deaths under 1 year. 1 2 Births registered. Deaths at all ages. Births registered. | Deaths at all ages. 1894 NO PREVIOUS RECORD. NO PREVIOUS RECORD. 1895 1896 1897 1898 1899 1900 • 1901 1902 11108 ... ... ... 20423 ... ... ... 1903 11205 ... ... ... 20870 ... ... ... Aver. '94-1903 1904 11305 305 152 41 21325 690 398 126 Table III. CASES OF INFECTIOUS DISEASE Notified during the year 1904. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. No. of Cases Removed to Hospital. At all ages. At Ages—Years. Hounslow North Ward. Hounslow South Ward. Heston. Isleworth. Union Infirmary. Under 1 to 5 5 to 15 15 to 25 25 to 65 65 and upw'ds Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 37 ... 12 13 7 5 ... ... 17 7 8 ... 27 Memb. Croup ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 23 ... ... ... 3 18 2 ... 5 ... 8 10 ... Scarlet Fever 65 1 26 29 8 1 ... 2 32 11 20 ... 49 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 15 ... ... 6 4 5 ... ... ... 5 4 6 6 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... 3 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 5 ... ... ... 2 3 ... ... 1 1 2 1 ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... 145 1 38 48 24 32 2 7 55 24 42 17 82 Isolation Hospitals: Mogden and Dockwell (Smallpox). Joint Hospitals for Heston-Isleworth and Richmond, Surrey. Table IV. Causes of, and Ages at, Death during 1904. Causes of Death. Deaths in whole District at subjoined Ages. Deaths in Localities at all ages Total Deaths in Public Institutions in the District. All ages. Under 1. 1 and under 2. 5 and under 12. 15 and under 22. 25 and under 62. 65 and upwards. Parish of Heston. Parish of Isleworth Smallpox ... ... ... ... ... ... ... ... ... ... Measles 6 4 2 ... ... ... ... 2 4 1 Scarlet Fever ... ... ... ... ... ... ... ... ... 1 Whooping-cough 4 3 ... 1 ... ... ... 2 2 ... Diphtheria and Membranous Croup 2 ... 1 1 ... ... ... ... 2 2 Croup ... ... ... ... ... ... ... ... ... ... Typhus ... ... ... ... ... ... ... ... ... ... Fever Enteric ... ... ... ... ... ... ... ... ... ... Other continued 2 ... ... ... ... 2 ... 1 1 1 Influenza 4 ... 1 ... ... 2 1 ... 4 ... Cholera ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... Diarrhoea 68 58 7 ... ... 2 1 18 58 3 Enteritis ... ... ... ... ... ... ... ... ... ... Puerperal Fever 1 ... ... ... ... 1 ... ... 1 2 Erysipelas ... ... ... ... ... ... ... ... ... ... Other septic diseases 11 ... ... 1 4 1 5 5 6 10 Phthisis (Pulmonary Tuberculosis) 51 ... 1 2 12 35 1 14 37 64 Other tubercular diseases 11 3 3 1 2 2 5 6 7 Cancer, malignant disease 36 ... ... ... 1 29 6 12 24 20 Bronchitis 45 11 1 1 7 25 10 35 9 Pneumonia 21 6 5 1 4 4 1 5 16 14 Pleurisy 2 1 ... ... ... 1 ... 1 1 ... Broncho-Pneumonia 21 9 8 ... ... 2 2 6 15 3 Other diseases of Respiratory Organs 7 ... ... ... ... 4 3 2 5 4 Alcoholism 6 ... ... ... ... 6 ... 3 3 5 Cirrhosis of Liver Venereal Diseases 3 3 ... ... ... ... ... ... 3 2 Premature Birth 18 18 ... ... ... ... ... 4 14 1 Diseases and Accidents of Parturition 9 5 ... ... 1 3 ... 1 8 2 Heart Diseases 38 2 3 2 20 11 12 26 27 Accidents 17 1 2 5 1 6 2 4 13 14 Suicides 3 ... ... ... ... 2 1 ... 3 2 Cerebral disease 7 ... ... ... ... 4 3 ... 7 1 Appendicitis 3 ... 1 ... 1 ... 1 ... 3 ... Senectus 39 ... ... ... ... ... 39 8 31 30 All other causes 115 33 8 4 2 27 31 37 78 51 All causes 550 167 40 19 31 160 133 152 398 290 LAUNDRIES. Number of Women employed. No. Laundry. Address. No. Employed Single. Married. 1 Anchor Hanworth Road, Hounslow 9 5 2 Chave'a Wellington Road North, Hounslow 9 7 3 Greenwell's Wellington Road South, Hounslow 4 6 4 Folly's Orchard Road, Hounslow 6 3 5 *Fisher's Gordon Road, Hounslow 4 5 6 *Hounslow Sanitary Hanworth Road, Hounslow 6 4 7 Debenham's London Road, Hounslow 6 3 8 Bryant's Worton Road, Isleworth 1 8 9 Ave's Eve Road, Isleworth 0 1 10 *Crush's Heston Road, Spring Grove 28 16 11 Moor's Talbot Road, Isleworth 0 2 12 St. Margaret's Halliburton Road, Isleworth 5 9 78 69 * 1 Motive Power. In addition to the above there are a number of "Domestic" Laundries. C.l. HESTON AND ISLE WORTH URBAN DISTRICT. Sanitary Work, 1904. Inspections. Notices. Dwelling Houses. Houses let in separate Dwellings or Lodgings. Common Lodging Houses. Canal Boats used as Dwellings. Movable Dwellings, Caravans, Tents, &c. Complaints Received. Cases of Infectious Disease Notified. Number of Premises periodically Inspected. Houses Inspected from House-to-House. Total Number of Houses, Premises, &c., 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, &c., Cleansed, Repaired, &c Closed as Unfit for Habitation. Re-opened after Repairs, Alterations, &c. Demolished. Illegal Underground Dwellings 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 Contraventions of Regulations. Number Observed during the Year. Number of Nuisances therefrom Abated. Number Removed from District. 63 145 378 190 7963 7420 15573 2669 154 1 1 273 4 0 9 0 2 189 11 2 96 0 0 306 61 38 7 5 C.2. HESTON AND ISLEWORTH URBAN DISTRICT. Sanitary Work, 1904. Schools. Workshops and Work-places. Laundries. Bakehouses. Slaughter-houses. Cow-sheds. Dairies and Milk-shops. Unsound Food. Adulterated Food. Offensive trad- s. Mortuaries. Number in District. Number of Inspections. Number found defective. Number in District. Number of Inspections. Contraventions of Factory Acts. Number in District. Number of Inspections. Contraventions of Factory Acts. Number in District. Number of Inspections. Contraventions of Factory Acts. Number on Register. Number of Inspections. Contraventions of Bye-laws. Number on Register. Number of Inspections. Contraventions of Bye-laws. Number on Register. Number of Inspections. Contraventions of Bye-laws. Animals seized. Parcels seized. Samples taken. Found adulterated. Number of premises in District. Number of Inspections. Contraventions. Accommodation. Number of bodies received. 42 67 5 203 257 16 16 60 0 36 149 3 14 177 4 18 163 4 43 925 3 0 2 0 0 2 112 0 2 17 Rabbits. 2 Trunks Fish C.3. HESTON AND ISLEWORTH URBAN DISTRICT. Sanitary Work, 1904. Water Supply and Water Service. Privy and Ash Pits, 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. Ash and Earth Closets. Water Closets. Percentage of Houses provided with Water Closets. Drains. Cesspools. Percentage of Houses draining into Sewers. Sewers. New, Sunk. Cleansed, Repaired, etc. Closed as Polluted. New, Provided. Cleansed, Repaired, Covered, etc. Overflow Pipes disconnected from Drains. Above Ground Receptacles Substifor 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, Retested, 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 to Sewer. Yards of New Sewers laid. Yards of Sewers Reconstructed. 0 1 1 37 99 10 51 0 5 0 100 0 1 0 7 78 18 172 0 99 291 321 54 158 4 20 20 10 3 C.4. HESTON AND ISLEWORTH URBAN DISTRICT. Sanitary Work, 1904. Disinfection. Dust. Dampness. Sundry Nuisances Abated. Contagious Diseases of Animals. Infant Life Protection Act. Rooms fumigated. Rooms stripped and cleansed. Articles disinfected or destroyed. Contents of rooms 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, etc. Guttering and rain-pipes repaired, etc. Gardens, Areas, etc., levelled and drained. Yards, paved, drained and repaired. Surface adjoining houses paved. Dry areas provided. Ventilation below floor provided. Basements rendered impervious. Overcrowding. Smoke. Accumulations of refuse. Foul ditches, ponds, etc., 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. 217 0 4340 8 85 0 Fortnightly. 23 79 149 0 78 0 0 29 1 13 3 574 10 28 118 2 No Report. Under the control of Board of Guardians. LIST OF DAIRIES, COWSHEDS, AND MILKSELLERS IN THE DISTRICT, Year ending December 31st, 1904. No. Name of Occupier. Address. Dairy. Cowsheds and Position. Number of Cows. Milk Supply. 1 Arnold, J. Steele Road, Isleworth 1 (1) 1 at rear of premises. Dairy, basement 14 Own cows and Taunton Dairy Co. 2 Baker, A. H. New Heston 1 (2) Taylor, Cranford 3 Best, Mrs. M. Barrack Road, Hounslow (3) J. W. Weekly, Hounslow Heath. 4 Bignell, H. Heston Road, Lampton 1 1 at rear of premises 3 Own cows 5 Bishop, W. Richmond Road, Isleworth (2) Bodger, Isleworth 6 Bodger, T. & A. Lower Square, Isleworth 1 (1) 1 at rear of premises 2 Own cows. Peebles, Brentford End, and Taylor, 7 Butler, H. B. London Road, Hounslow 1 1 at rear of premises 9 Own cows (Cranford 8 Coleman, S. London Road, Brentford End... .(2) Eves, Brentford 9 Connell, G. South Street, Isleworth 1 (2) 1 at rear of premises 1 Own cows and Bodger, Isleworth 10 Cook, A. E. Linkfield Road, Isleworth (3) Taylor, Cranford 11 Davis, R. H. Barrack Road, Hounslow 1 (2) Taylor, Cranford 12 Dean, G. T. Kingsley Road. Hounslow (3) Denew, Isleworth 13 Debenham, G. St. John's Road, Isleworth 1 (2) Goodenough, Isleworth, and Whiteman & Cox 14 Denew, G. London Road, Isleworth 1 (1) Dairy Supply Co. 15 Finch, W. South Street, Isleworth 1 (l) 1 at rear of premises 3 Own cows and Dairy Supply Co. 16 Giltrow, F. High Street, Hounslow (2) Teale, Hounslow 17 Goodenough, E. Wyke Green, Isleworth 1 3 at rear of premises 30 Own cows 18 Gostelow, W. Staines Road. Hounslow 1 (2) Taylor, Cranford 19 Gray, C. High Street, Hounslow (2) Parish, Hounslow 20 Hole, T. O. Albion Road, Hounslow 1 (3) Taylor, Cranford 21 Howard, F. W. Grove Road, Hounslow 1 Tuckett, Alton, Hants, and Gillingliam Dairy Co. 22 Kite, E. Osborne Road, Hounslow 1 Taylor, Cranford 23 Lethbridge, F. Whitton Road, Hounslow 1 (1) Whitton Park 2 Own cows and Taylor, Cranford 24 Mallage, J. H. London Road, Brentford End (2) Vicars, Brentford 25 Neville, W. Cross Lances Road, Hounslow 1 (l) 1 at rear of premises 2 Own cows and Harman, Wokingham 26 Newman, A. High Street, Hounslow 1 (1) Taylor, Cranford 27 Overton, C. London Road, Brentford End (2) Eves, Brentford 28 Parish, A. T. Whitton Road, Hounslow 1 (1) 2 at rear of premises 2 Own cows and Taylor, Cranford 29 Peebles, P. Syon House, Brentford End 1 1 at Syon House, Isleworth 4 Own cows 30 Rehm, 0. Bell Road, Hounslow (3) Denew, Isleworth 31 Roberts, H. Staines Road, Hounslow 1 (l) Andrews, Han worth, Middx. 32 Rouse, S. Staines Road, Hounslow 1 (2) 1 at Benns Common, Hounslow Own cows, and Pridiaux, Dorset 33 Sahler, H. The Square, Isleworth (2) Bodger, Isleworth 34 Sheppard, E. Vine Place, Hounslow (3) Rouse, Hounslow 35 Simmonds, A. Lower Square, Is'eworth 1 (1) Whiteman & Cox 36 Stevens, A. C. High Street, Hounslow (2) Gostelow, Hounslow 37 Teale, E. A. Bath Road, Hounslow 1 3 at rear of premises Own cows 38 Turner, J. S. Whitton Road, Hounslow (2) Lethbridge, Hounslow 39 Upson, J. G. Cromwell Road, Hounslow (3) Dairy Supply Co. 40 Weekley, A. J. Hanworth Road. Hounslow 1 (1) Tuckett, Alton, Hants. 41 Weekley, J. W. George IV. Road, Hounslow 1 Taylor, Cranford 42 Witt, A. Talbot Road, Isleworth (3) Arnold 43 Young, J. Hanworth Road, Hounslow 1 (2) Own cows at Whitton (1) SI o (2) Selling other goods (Confectionery &c.) (3) General Dealer. Number of Cowsheds discontinued for use for Dairy purposes, 2. Number of Shops discontinued the sale of Milk, 9. „ „ closed as unfit 0 „ „ placed on Register 6. LIST OF BAKEHOUSES IN THE URBAN DISTRICT OF HESTON AND ISLEWORTH. Year ending December 31st, 1904. No. Address. Position Occupier. Level of floor. Sanitation. W.C. Sleeping Place. Remarks. Drainage Water Supply 1 New Heston A Paynter & Harle C Con. Co. off main F None near Old, fair, 2 Poplar Cottages, Hanworth Road, Hounslow B C. Jefferyes D 6in. E G.I. tank F „ Do. 3 195, High Street, Hounslow Post Office, Bath Road, Hounslow B A. C. Stevens C E Pump F „ Old. 4 A S. J. Carden and S. May C E G.I. tank F „ Not in use, old. 5 26, High Street, Hounslow A T. Cox D 6in. E „ F „ Good condition. 6 4, Heath Place, Staines Road, Hounslow A W. Butler C E „ F „ New, fair. 7 High Road, Heston A S. Carter D 6in. E „ F „ Old, fair. 8 High Road, Heston Aa S. Carter D 1ft. E „ F „ Do. 9 26, South Street, Isleworth A J. Chapman C E „ F „ Do. 10 The Bakery, Staines Road, Hounslow A The Misses N. & M. Chapman D 3in. E „ F „ Do. 11 The Bakery, Wellington Road, N., Hounslow A A. Baxter C E „ F „ New, fair. 12 66, High Street, Hounslow A Sherwin Bros. C E „ F „ Old, fair. 13 adeline Place, Staines Road, Hounslow B J. Groves C E „ F „ New, fair. 14 13, The Square, Isleworth B E. W. Gunner C E „ F „ Old, fair. 15 Wivenhoe House, Hanworth Road, Hounslow A W. Freeman D 3in. E „ F „ Old. 16 112 and 114, High Street, Hounslow Aa W. F. Lovejoy C E „ F „ New, good, patent hot-air ovens. 17 Inwood Road, Hounslow B A. J. Carden and S. May C E „ F „ New, fair, 18 68, South Street, Isleworth B J. Skinner (Mrs.) C E „ F „ Old, small. 19 46, London Road, Brentford End B A. O. Gregory C E „ F „ Old, fair. 20 1, Tryon Place, Lampton, Heston Aa Paynter and Harle C E Co. off main F „ Not in use. 21 39, Whitton Road, Hounslow Aa J. T. Richardson C E G.I. tank F „ New, fair. 22 3, York Place, Staines Road, Hounslow A Coates' Bakeries Co., Ltd. D 3in. E „ F „ Old, fair. 23 Arundel House, St. Margaret's Road,Isleworth A J. B. Cox C E „ F „ New, fair. 24 1, Upper Square, Isleworth B H. Sahler C E „ F „ Old, fair. 25 1, Upper Square, Isleworth Aa H. Sahler C E „ F „ Do. 26 1, Pembroke Place, London Road, Isleworth A H. K. Scherer D E „ F „ Only underground bakers in district, 27 21, London Road, Brentford End A R. Skilton C E „ F „ Old. (good & well ventilated. 28 5, South Street, Isleworth B Thomas Stracy c E „ F „ Old. 29 Shropshire House, Staines Road, Hounslow A Coates' Bakeries, Ltd. c E „ F „ New; machine mixer. 30 7, Woodford Terrace, Hanworth Road, A W. J. Hankin c E „ F „ Old, fair. 31 Hanworth Road, Hounslow A B. Etches c E „ F „ New, fair. 32 180, High Street, Hounslow B W. & E. Welb c E „ F „ Old, good. 33 7S, Linkfied Road, Isleworth B H. A. Sapsford c E „ F „ New, good, patent hot-air oven. 34 Hanworth Road. Hounslow B Charles Morris c E „ F „ New, good condition. 35 159, High Street, Hounslow B F. Giltrow c E „ F „ New, built 1901, good. 36 4, Midsummer Place, Staines Road, Hounslow J. A. Breed New, built 1904. A.—Attached and communicating with dwelling-house and shop. Aa.—Attached but not communicating with dwelling-house and shop. B.—Detached. C. Above road level. D.—Below road level. E.—Connected with Council's sewer. F.—Not connected or communicating with Bakehouse or tank serving w.c. Bakehouses discontinued for baking purposes—Nos. 3, 12. 22. No. 1 renovated, a new tiled floor and new troughs provided. LIST OF SLAUGHTER HOUSES IN THE DISTRICT During the Year 1904. No. Registered or Licensed. Name of Licensee. Address of Licensee. Situation of Slaughter House. 1 Registered Arnold, William 49, High Street, Hounslow At rear of Premises 2 „ Balch, J. A. 74, South Street, Isleworth „ „ 3 „ Bazeley, Albert U. London Road, Spring Grove „ „ 4 „ Finch, W. P. .. 197, High Street, Hounslow „ „ „ Finch, E. 113, High Street, Hounslow „ „ „ Hunt, Charles Albany Terrace, Bell Road, Hounslow „ „ 7 Licensed Mash, George Heath Place, Staines Road, Hounslow „ „ 8 Registered Payne, John Aberdeen House, Bell Road, Hounslow „ „ 9 „ Roadnight, Thomas 269, High Street, Hounslow „ „ 1o „ Weekly, A. J. Woodford Terrace, Hanworth Road, Hounslow „ „ 11 „ Welch, Frederick 86, High Street, Hounslow „ „ 12 „ Woods, Richard J. 173, High Street, Hounslow „ „ 13 „ Yates, Frederick C. 23, Turks Road, St. Margarets London House, Wellington Road North, Hounslow 14 Licensed Young, Jesse Fern Dairy, Hanworth Road, Hounslow At rear of Premises.