HES 56 1908. ANNUAL REPORT ON THE Health and Sanitary Condition OF The District of Heston and Isleworth, FOR THE YEAR 1908, BY EDWARD J. STEEGMANN, M.B., D.P.H., Medical Officer of Health. THE HEALTH COMMITTEE Of the Heston and Isleworth Urban District Council, for the year ending April, 1909. Mr. W. G. Palmer (Chairman). ,, J. J. Bonnett. ,, C. Crush. ,, E. W. Goode (ex-offlcio). Dr. T. S. Goodwin. Mr. F. C. Greville-Smith (ex-officio). ,, W. Mann. ,, F. Nowell. ,, H. R. Peake. ,, J. S. Richens (Vice-Chairman). ,, H. C. Sahler. ,, J. Surrage. 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 your district and of the work done by the Health Department during the year 1908. It is the eighth annual report I have presented to you, and it is also the last. The additional work entailed by the medical inspection of the school children made it necessary that more time should be given by the Medical Officer of Health than had hitherto been required by the ordinary work of the department alone. As it was impossible for me to do this, I resigned my post in order that another officer might be appointed who would devote his whole time to the combined duties of the health work and the medical inspection of the schools. I think the new arrangement is to the advantage of the district, and it was a matter of sincere regret to me that I was unable to take advantage of the opportunity you were kind enough to give me of continuing as your Medical Officer of Health under the altered conditions. The public health of the district and its general sanitary condition during the year have on the whole been satisfactory, and will probably be found to compare not unfavourably with those of surrounding localities. By far the most important matter affecting the public health was the coming into force of the law, making the medical inspection of the children in the schools compulsory. I would remind you that for many years past I have urged that this duty should 6 be undertaken by the local authority, and that in 1905, it was frequently the subject of debate and generally of considerable opposition. I dealt with it at some length in my Report to you for that year, and have referred to it in later ones. As the full history will be found set out in my Report to the Education Committee shortly to be presented, nothing further need be said about it here. No useful purpose would be served by giving a detailed review of the administration of the health department for the whole period of eight years during which you have entrusted it to my care, but it may be interesting to refer to one or two of the more important events that have occurred. Most of the members of the Council are in a better position even than I am to realise the growth and progress of the district during this time. The increase in number of houses and population is obvious, but it is impossible to put the increase down in definite figures with any degree of accuracy. I think it is likely that the rate of increase has been less rapid during each of the last four years than in any one of the previous four. The bacteriological disposal of sewage, electric lighting, and an apparatus for the proper disposal of refuse have all been installed in the district, and are all matters affecting the public health. The system of sewage disposal was in process of conversion from chemical to bacteriological treatment at the time you appointed me, and any credit to the Medical Officer of Health for advising the change must be given to my predecessor, Dr. Brind. This district was one of the earliest, if not actually the first, to be allowed to depend entirely on bacteriological treatment without any reserve of land for filtration, and the system, which commenced working in 1904, has so far done well. Your original intention was that the duty of making systematic scientific analyses of the effluent from the different filter beds should be entrusted to the Medical Officer of Health, and I have always wished to 7 carry out this work. When the new Council House was built, at my request you set aside a most suitable room for a laboratory, and even fitted it with gas and water-supply. But unfortunately, money has never been provided to purchase necessary apparatus and a workshop without tools is useless. I would urge you to realise the practical benefit as well as the scientific interest of having a periodical analysis made of the effluent from each filter bed, and to supply my successor with the means of doing the scientific work of what is essentially a scientific system of sewage disposal. A properly equipped laboratory would also be of the greatest use to him for analysis of samples of water and also for simple examinations of many articles of food, both objects for which the idea of having a laboratory at the Council House was originally adopted. The appointment of a County Medical Officer of Health by the Middlesex County Council, only indirectly affects this district, as the only public health questions in it under the control of the County Council are the administration of the Midwives and some parts of the Food and Drugs Acts. But Dr. Young's efforts to obtain more co-ordination amongst the different Medical Officers of Health in the County and greater uniformity in interpretation of bye-laws and annual reports, have already been of value and will lead to increased efficiency in the future. His annual report is a most useful work, as it contains a summary of the work of each district in the County and enables interesting comparisons to be made. Amongst the various local regulations that have been adopted and come into force during the past eight years, three appear to be of great practical importance. In 1901 and the early part of 1902, the Council was engaged in drawing up a new set of building bye-laws, and included one making it compulsory that all drains connecting houses with sewers should be laid on a firm foundation consisting of a minimum depth of cement. 8 Considerable difficulty having arisen in connection with nuisances caused by the keeping of pigs in large numbers, a new bye-law was drawn up and sanctioned by the Local Government Board, giving the Council larger powers for dealing with it. This bye-law came into force in February, 1906, and details relating to it can be found in my Report for the previous year. The third regulation is the adoption of a new bye-law during 1908, limiting the hours in which foul and offensive material may be collected in or carried through the district, and making it compulsory for all such material to be placed in suitable carts for conveyance. These three regulations can now be legally enforced and penalties recovered for their non-observance. In 1903, the attention of the Health Committee was directed to the frequency with which the drains of almost new houses were found to be defective, and as a result new regulations were made by that Committee and the Works Department for ensuring the proper testing of all drains of new houses prior to occupation. This matter is referred to in my Report for 1904. The carrying out of the regulation means a considerable increase in the work of the Sanitary Inspectors, but its value is undoubted. During the eight years there have been one or two small outbreaks of infectious disease, either Scarlet Fever or Diphtheria, such as are the common experience of most similar distrcts, but the only really serious outbreak was that of Small-pox in 1902. The prevalence of this disease in that year was a matter of great anxiety, but no difficulty was found in dealing with it owing to the foresight and wisdom of the local authorities in having a special isolation hospital already provided. In my Annual Report for 1902, will be found a copy of a letter from the Medical Officer of Health for Richmond and myself, sent by us to every medical practitioner in the two districts, suggesting a means for detecting doubtful cases of Small-pox. The plan then instituted of co-operation between the public health officer and the private doctors in connection with one particular 9 disease has since, in this district, gradually extended to doubtful cases of all kinds of infectious disease, and every year I have had the honour of being asked to see a considerable number of uncertain cases in consultation with the doctor under whose care the patient was. Needless to say the'invitation has always come from the doctor. Any benefit that may have resulted from this system is due in part to the wise regulation you have that your Medical Officer of Health should not at the same time engage in private practice, but in far greater measure to the great help and kindness I have invariably received from my medical brethren in the district in the carrying out of my official duties. So far I have referred to matters only that may be considered satisfactory; there are others of a less pleasing kind that must be considered. In the second Annual Report I submitted to you, I referred to the unsanitary condition of certain areas such as Stafford Place, Castle Place and Gordon House Square. In this, my last Report, I have to say that the state of these places remains much the same as it was then. It has not been found possible to clear them away or get them closed. Constant inspection and repeated serving of notices have done something to prevent them becoming worse, but nothing towards permanent improvement. Notices regarding repairs have been complied with by the owners or their agents in the cheapest possible manner, and the habits of the tenants have in many cases soon undone the work. It is difficult to deal with conditions arising partly from dirty habits of occupiers by notices served on owners, and it will be a great benefit to this district if the new powers that appear likely in the near future to be given to local authorities, prove sufficient to remove one or two of the insanitary areas in Isleworth. Fortunately the number is small. One very important part of the work of the Health Department has, I regret to say, been much neglected and very imperfectly done. This is what is known as House-to-House Inspection, which means the systematic inspection throughout the year of ordinary dwelling houses with the object of discovering insanitary conditions. The work is quite apart from the inspections that are 10 made on account of complaints or other reasons, and it is one of the routine duties of all health authorities. A certain amount of house-to-house inspection has been done every year of streets and areas that appeared to most need it, and the results have fully proved the necessity of much more being undertaken. All parts of the district contain a large number of old houses and cottages that are probably unhealthy from causes that might be remedied, but about which no complaints are received, either because the occupiers are ignorant or unwilling to complain. The sole reason why so little has been done is that the staff of the Health Department is not large enough to do more. The time of the Sanitary Inspectors has nearly always been fully occupied in dealing with urgent and pressing matters and many working hours are unavoidably lost in getting from place to place owing to the wide extent of the district and the fact that work may frequently have to be done on the same day in parts several miles away from each other. Except for the appointment of an office boy recently, during the past twelve years there has been no increase in the staff of the Health Department in spite of the great increase of the district, and the question of appointing an additional inspector is one that will before long have to be seriously considered. Your new Medical Officer of Health will in due time place his own views before you, and I cannot of course anticipate what they may be, but in my opinion the employment of a properly qualified female inspector would be a wise and useful proceeding. Such an appointment would be no new thing in this district as some time ago you officially appointed a lady to act as an assistant inspector for a period of six months. There are three particular duties that a woman inspector could undertake if properly qualified; (1) work in connection with the medical inspection of the school children, (2) assisting in the inspection of home-workers and the sanitary condition of workshops and factories employing women and girls and (3) special work relating to the reduction of infantile mortality. This last subject is one that I have so frequently brought before you that I am afraid you may be tired of it. It has often 11 been discussed, but at the present time no practical scheme exists in this district for dealing with it. The infantile mortality rate here is not worse than in many other similar places, but it is far higher than it ought to be, and I have no doubt that the number of infant deaths might be much reduced if some properly organised and continued effort was undertaken. It is a matter of much regret to me that the Notification of Births Act has not been adopted, and I hope that in the near future you will decide to make use of this most valuable provision. The appointment of a women inspector, part of whose official duties would be the visiting and advising of mothers and persons having charge of young infants, would be sufficient to enable you to obtain sanction for the adoption of the Act in this district. During the year there has been no change in the staff of the Health Department. Mr. Smith and the two assistant inspectors, Mr. Ashworth and Mr. Butler, have all carried out their duties in a most efficient manner, and my successor will I believe, receive from them the same willing help they have always given to me. The clerical work of the office has been uniformly well done by Mr. Passey. The kindly relations that have always existed between the departments of the Medical Officer of Health and those of the Clerk and the Surveyor have often enabled difficulties to be overcome and the sanitary work of the district to be carried out without friction. To Mr. Baker, the Clerk, I have to express my special thanks for the skilful advice he has many times given me in legal and other questions. And lastly, I wish to take this opportunity of offering my sincere thanks to the Chairman and Members of the Health Committee, both past and present, for the time they have always been ready to devote to the affairs of sanitary administration in the district, and the careful consideration given to all matters I have brought before them. I am, Gentlemen, Your obedient servant, EDWARD J. STEEGMANN. 12 Summary of Vital Statistics for 1908. Population, estimated to middle of year 34895 Total Births 1211 Birth Rate 34.7 Deaths (residents only) 558 Deate-rate 15.9 Infantile Mortality-rate 107.3 Zymotic Death-rate 2.12 Excess of births over deaths (residents only) 653 Comparing the above figures with the summary given in the Report for 1907 the following differences will be noted:— An increase of 544 in the total population. An increase of 76 in the number of births registered. An increase of 68 in the number of deaths of residents. An increase of 1.7 in the birth-rate. An increase of 1.7 in the death-rate. An increase of 19.2 in the infantile mortality-rate. An increase of 0.84 in the zymotic death-rate. Vital Statistics for England and Wales, 1908. Annual Rates per 1000 Living. Infantile Mortality Annual Deathrate of Infants under 1 Year per 1000 Births. Births. Deaths from all Causes. Deaths from seven chief Epidemic Diseases England & Wales 26.5 14.7 1.29 121 Rural England & Wales 26.2 14.7 0.99 110 76 great towns 27.0 14.9 1.59 128 142 smaller towns 26.0 14.0 1.26 124 13 Statistics for the two separate Parishes of Heston and Isleworth. HESTON, 1908. Births. 1st quarter 102 2nd ,, 105 3rd „ 103 4th „ 111 Total 421 Deaths. Over 1 Under 1 Total. 1st quarter 45 10 55 2nd „ 38 9 47 3rd „ 17 19 36 4th „ 26 11 37 126 49 175 Population 11794 Birth-rate 35.6 Death-rate 14.7 Infant-mortality-rate 116.3 ISLEWORTH. Births. 1st quarter 215 2nd „ 220 3rd „ 176 4th „ 179 Total 790 Deaths. Over 1 Under 1 Total. 1st quarter 96 15 111 2nd „ 66 13 79 3rd „ 49 30 79 4th „ 61 23 84 Total 272 81 353 Population 23101 Birth-rate 34.1 Death-rate 15.2 Infant-mortality-rate 102.5 14 Population. Any statement as to the number of inhabitants in any district seven years after the last census cannot pretend to be very accurate, and at best can only be a careful estimate. In some places where the population is only affected by the normal excess of births over deaths, and little or no addition is being made to the number of houses, it is easier to make a correct estimate than in others in which different conditions exist. In this district it is impossible to state with any certainty what was the total population at the middle of the year 1908. But the effect that an under-estimate or one too high has on the vital statistics for the year is well known, and unless the method adopted for estimating the population is clearly stated, the value of any figures based on the estimate must be reduced. The various methods generally used for calculating populations were explained in the Report for 1905, and the subject was also referred to again in the Report for last year. It is sufficient therefore simply to say that the system adopted in this district is that of the Registrar-General and is the same that has been used in previous years. The fallacy of this method is that it assumes the rate of increase in the years following any census to be the same as in the ten years preceding it. It is obvious in this district that progress has been more rapid in the years since 1901 than in those before, and therefore the official estimate is in all probability lower than the actual number of inhabitants. According to this method the estimated population of Heston and Isleworth at the middle of the year 1908 was Heston 11794 Isleworth 23101 Total 34895 Although separate estimates have been made for Heston and for Isleworth, and statistics have been Worked out for each of them, ] 5 it cannot he too strongly insisted on that for all practical purposes the two constituent parishes form one district and one population. No comparison based on any figures given in this Report as to one being in any respect better or worse than the other from the public health point of view will be of the slightest value. The details given in Table II. and on page 13 have been included during the last few years, partly from mere curiosity, and partly for possible future use if at any time the two parishes should be separated for sanitary administration purposes, and an Inspector of N uisances appointed for each. Mr. H. J. Baker, the Clerk to the Council, has made a separate estimate of the population by which he arrives at a total 5428 more than the official one given above. He based his calculation both on the number of new houses built during the previous few years and on the number of houses in the whole district that, so far as known, were inhabited during the year. According to him the population of the district at the middle of the year 1908 was Heston 12821 Isleworth 27502 Total 40323 In comparing the two sets of figures it will be seen that there is a greater difference between those relating to Isleworth than between those of Heston. Mr. Baker's estimate is possibly too high, but it is probably more nearly correct than the other. In order that the effect of the two varying estimates may be made perfectly clear, separate vital statistics have been worked out for each of them, and will be found in the following pages. 16 Births. Number of births registered 1211. Birth-rate per 1000 of population 34.7. The number of births registered in the district during the year was 1211, an increase of 76 over the number registered in 1907. As all births are registered in the district in which they occur, this total includes a certain number of children of nonresident women. If these outside births are deducted the actual number of resident births becomes 1169, an increase of 84 over the previous year. This increase of births amongst residents is all the more satisfactory as there was an actual decrease in the number of such births in 1907 compared with the total in 1906. The total resident births in these three years were 1099 in 1906, 1085 in 1907, and 1169 in 1908. The question of non-resident births is always a somewhat difficult one to deal with fairly, and is especially so in this district, owing to the fact that the workhouse infirmary for the Brentford Union is situated in Isleworth, and that although women may be admitted for confinement from other places the births are registered as belonging to this district. In this way Isleworth really obtains credit every year for a larger number of births than it is properly entitled to. At the same time it is of course possible that some Heston and Isleworth babies may be born and registered away from home. No official allowance is made in the Local Government Board tables for non-resident births in the same way that non-resident deaths are provided for, and therefore all births that occur in any particular district are supposed to belong to that district, but the point should be considered as in Isleworth at all events it has a very considerable effect on the birth-rate. Of the total number of births registered during the year, 628 were boys and 583 girls. This is the second consecutive year in which the number of boys has exceeded the girls. Normally throughout this country more boys than girls are born every year, 17 but for many years in this district the contrary has occurred, and the number of girls born has exceeded the number of boys. This year, as in 1907, there is also an excess of boys born amongst residents only. It will be seen by reference to the tables given below that in the first two quarters more girls than boys were born, but that in both the third and fourth quarters the number of boy-births was greater than that of girls. Dealing with residents only the number of boys was 604 and the number of girls, 565, giving a total of 1169 for the year. 42 infants were registered as the children of non-resident women. The following tables show details as to the number of births in the quarters of the year :— Total births registered 1211 Non resident births 42 Nett total 1169 Total. Non-resident. Nett. 1st quarter 317 12 305 2nd „ 325 8 317 3rd „ 279 9 270 4th „ 290 13 277 1211 42 1169 Residents only. Boys. Girls. Total. 1st quarter 150 155 305 2nd „ 156 161 317 3rd „ 149 121 270 4th „ 149 128 277 604 565 1169 18 Illegitimate Births. In all the annual reports since 1901 the number of illegitimate births and the ratio of such births to the totals registered in the district have been given, but beyond stating the facts and pointing out that the proportion of illegitimate to legitimate births has frequently been considerably above the average for the rest of the country, no inferences have been drawn. It is often assumed that this question is one of greater concern to the moral than the physical condition of a community, but this assumption is probably wrong, and there can be no doubt that the relative numbers of legitimate and illegitimate births may have a very important, even if somewhat indirect, bearing on the general public health. During 1908, the total number of illegitimate births registered in the district was 80, a decrease of 13 compared to the number in the previous year, although the total number of births was considerably higher. Of the total of 80, 44 were the children of resident women and 36 of unmarried women belonging to other districts in the Brentford Union, but temporarily residing in the infirmary. This total number forms 6.6 per cent. of the total births registered. The similar percentages in the two previous years were 8.1 in 1907, and 6.4 in 1906. If all non-resident births are deducted and the proportion calculated only on the births amongst resident women, the ratio of illegitimate to legitimate births for the year is 3.7 per cent., a figure that compares favourably with the 5.5 per cent. in 1907. 36 of the 42 non-resident births in 1908 were illegitimate, a proportion equal to 85.7 per cent. compared with 66.0 per cent. in the previous year. Birth-Rate. The actual number of births registered is a definite fact about which there can be no mistake. The birth-rate for the year is, however, a much more uncertain figure as it is based on an unknown quantity, that is the total population of the district. 19 The difficulty of correctly estimating the number of inhabitants at the middle of the year has already been referred to under the head of Population, and it has been pointed out that the official estimate is most likely much below the real total. The exceptionally high birth-rate is a very strong argument against the official estimate and in favour of that made by Mr. Baker. Calculated on the official estimate of the population and the total number of births registered in the district, the birth-rate for the year is 34.7, which is 8.2 above the birth-rate for the whole of England and Wales, and 87 above the rate for the 142 smaller towns. Although according to the system hitherto adopted in this district for estimating the population this birth-rate of 34.7 is officially correct, a fairer and probably more accurate figure can be obtained. If the non-resident births are excluded altogether and the calculation based on the official population, the birth-rate is reduced to 33.5 per 1000, and if the basis of population is taken at Mr. Baker's estimate it is still further reduced to 30.0 including all registered births and 28.9 when non-resident births are excluded. The following tabular summary sets out the above facts in a simple manner:— 1. Birth-rate based on official estimate of population (a). Including all births registered 34.7 per 1000 (b). Excluding non-resident births 33.5 ,, 2. Birth-rate based on Mr. Baker's estimate of population (a). Including all births registered 30.0 per 1000 (b). Excluding non-resident births 28.9 ,, In all probability the lowest of these four birth-rates is the one most likely to be correct. Although it is 5.8 per 1000 below the official figure, it is nearly 3 per 1000 above the rate for 142 smaller towns in England and Wales. 20 Generally speaking, a high birth-rate in any particular district implies a healthy as well as an increasing population, and even on the lowest estimate the birth-rate for the year 1908 in this district may be considered very satisfactory. Quarterly Birth-Rates. The following birth-rates for each quarter of the year have, been calculated to equal annual rates, i.e., what the birth-rate for the whole year would have been had the same number of births that occurred in any one quarter been exactly the same in the other three. They are based on the official estimate of the population. All registered births are included, and no allowance is made for some of them having been amongst non-resident women:— 1st quarter 35.1 per 1000 2nd „ 37.2 ,, 3rd „ 32.0 ,, 4th „ 34.3 ,, 21 Deaths. Deaths of residents 558 Death-rate per 1000 of population 15.9 The total number of deaths registered in the district during the year was 801, an increase of 60 compared with the number registered in 1907. The total includes deaths of both residents and non-residents. The number of deaths of non-residents, that is, persons belonging to other districts who died and whose deaths were registered in this district, was 273, making the number of deaths of residents registered during the year, 528, which is 66 more than the number registered in the previous year. The number of persons belonging to this district who died away from it and whose deaths were registered elsewhere during the year, was 30, compared with 28 last year. The net total of deaths of residents registered during the year was therefore 558, a number which compared with the 490 registered in 1907, shows an increase of 68 over that year. The numbers registered in each of the four quarters of the year are set out in the following tables:— Total. Non-resident. Nett. 1st quarter 253 87 166 2nd „ 197 71 126 3rd „ 172 57 115 4th „ 179 58 121 801 273 528 Residents only. Males. Females. Total. 1st quarter 77 89 166 2nd „ 68 58 126 3rd „ 57 58 115 4th „ 65 56 121 267 261 528 The figures included in the above take into account only those deaths that were registered as having actually occurred in the district. 22 Of the 30 deaths of residents that occurred and were registered in other districts, 19 were males and 11 females; 8 were stated to have lived in Heston and 22 in Isleworth. The majority of these persons were over middle age. Eight of them died in lunatic asylums, 15 in general hospitals or infirmaries and 4 in other institutions. The causes of death in most of the cases were chronic diseases. It must be specially noted that these 30 deaths of residents are not included in the details given in Table IV. dealing with the causes of and ages at death. On reference to that table it will be seen that it takes into account only those deaths of residents that actually occurred in the district. Table IV. is drawn up according to Local Government regulations except for the exclusion of these 30 deaths, and may possibly be of interest to anyone who has sufficient energy to study it. It gives the causes of deaths of residents and divides the deaths into six different age-periods. The infant deaths and the causes of death at all ages are separately dealt with further on in this report, but with regard to the age-periods it may be noted here that several interesting facts are brought out. 130 deaths of infants under 12 months of age and 45 deaths of young children aged between 1 and 5 years were registered. These 175 deaths of babies and very young children constitute nearly one-third (33.1 per cent.) of all the registered deaths of residents. 163 deaths of persons aged 65 or more were registered, a number equal to 30.8 per cent, of registered deaths of residents at all ages. In the 20 years covered by the two age-periods of 5 to 15 and 15 to 25, only 36 deaths were registered; that is only 6.8 per cent, of all the residents whose deaths were registered died between the ages of 5 and 25. All deaths of persons over 65 are grouped in the last ageperiod, but as in previous Reports another group may be made of the deaths of persons aged 75 or more, as a considerable number of such deaths occurs every year in this district. 23 84 deaths of residents aged 75 or over were registered during the year, compared with 75 in 1907. Of these, 35 were males and 49 females, compared with 31 and 44 last year. The details of these deaths are as follows:— Age. Males. Females. . 75 5 8 13 76 3 4 7 77 4 3 7 78 4 3 7 79 3 1 4 80 2 3 5 81 1 4 5 82 2 4 6 83 2 6 8 84 2 3 5 85 2 3 5 86 0 2 2 87 2 2 4 88 1 3 4 92 1 0 1 93 1 0 1 35 49 84 These deaths of old persons constitute a percentage of 15.90 of all resident deaths registered. It is interesting to compare the number of deaths of old people and the proportion of such deaths to deaths at all ages in the district during the past six years. It will be seen from the following table that in four years from 1903 to 1906, the percentages of deaths over 75 to deaths at all ages were practically identical. In 1907 there was a marked rise in the percentage, due to the fact that although there was an increase of four in the number of deaths over 75 there was a decrease in the number of deaths at all ages. This year the deaths at 75 and over have increased by nine, but there is a marked increase in the total of deaths at all ages and therefore the percentage is lower than last year. 24  Deaths at 75 and over. Percentage of all deaths. 1903 61 13.40 1904 72 13.09 1905 59 13.05 1906 71 13.67 1907 75 16.23 1908 84 15.90 The above figures include residents only. The number of infant deaths registered during the year formed 24.6 per cent, of the registered resident deaths at all ages. The deaths of residents registered in the district that took place at the two extremes of life, that is before they had reached the age of 12 months or after they had lived 75 or more years formed 405 per cent, of the total of deaths at all ages. The corresponding figure last year was 34.8 per cent. The increase in 1908 is due alone to the increased number of infant deaths. Deaths in Public Institutions. The following deaths occurred in Public Institutions in the district during the year:— Residents. Non-residents. Brentford Union Infirmary 67 265 Mogden Isolation Hospital 4 2 Hounslow Hospital 4 2 75 269 Death-Rate The death-rate for the year calculated on the official estimate of the population and the number of deaths of residents registered with the addition of the 30 residents who died in other places is 15'9 per 1000, an increase of 1.7 per 1000 compared with last year. This death-rate is considerably above that for the whole of England and Wales for 1908, and even higher than the deathrate for the great towns. But this unsatisfactory figure is more apparent than real, and is almost certainly due to an underestimate of the number of inhabitants living. 25 As has been shown in connection with births, an underestimation of the population artificially improves the birth-rate. In the same way it gives an unfairly bad idea of the health of the district if that idea is based on the death-rate, and therefore certain factors must be considered before any accurate deductions can be made. In calculating the death-rate for the year for any district, information on four points is required: (a). the total population at the middle of the year; (b). the number of deaths registered during the year; (c). the number of deaths of non-residents and (d). the number of deaths of residents registered in other places during the year. Accurate facts in connection with the last three points is ohtained from the registrar's returns, but the first depends entirely on the particular method of calculating the population adopted by the Medical Officer of Health. It may seem to some that too much notice is taken of this matter, but it is of real importance when comparisons are made between the health of different districts and it is assumed that one is healtber than another because it has a higher birth or lower death-rate. Such comparisons can only be correct when the rates are calculated on actual census returns, and points b, c, and d, all properly taken into account. To show the effect of these various data in this district, the following table has been prepared. It will be seen that six different death-rates for the year may be quite correctly calculated and all the results obtained may very likely be wrong. Two estimates of the population are taken, and of course the actual number of deaths used in each group are the same:— 1. Death-rates based on official estimate of population (a). Including all deaths registered in district 22.9 (b). Deaths of residents only registered 15.1 (c). Deaths of residents registered in district plus deaths of residents registered outside 15.9 26 2. Death-rates based on Mr. Baker's estimate (a). Including all deaths registered in district 19.8 (b). Deaths of residents only registered 13.0 (c). Deaths of residents registered in district plus deaths of residents registered outside 13.8 In all probability the last figure in the above six is the real death-rate for the district (13.8 per 1000). Anyway it is certainly more nearly correct than either of the two immediately before it, and is more likely to be accurate than the official one of 15.9. But the facts being stated, anyone can of course form another opinion. The following table shows the death-rate for each of the four quarters of the year. It is based on the deaths of residents only registered in the district and does not include any deaths of residents that may have taken place elsewhere during any one of the quarters. It is calculated in the same manner as that adopted for the quarterly birth-rates, i.e., each one is made to equal an annual death-rate so that it can be compared with the death-rate for the whole year:— 1st quarter 18.1 per 1000 2nd „ 14.4 3rd „ 13.1 4th ,, 13.9 The calculations are made on the official estimate of the population. 27 Causes of Death (all ages). The causes of the 528 deaths of residents registered in the district during the year are given in Table IV. The infant deaths are included, but are also dealt with separately and in greater detail in Table V. The work entailed in the preparation of these Local Government Board tables is probably much greater than the interest, if any, taken in them locally, and therefore it may be well to call attention to some of the more important facts they contain, The infant deaths and the fatal cases of zymotic diseases are referred to more particularly later on as they have a direct bearing on the public health. Tuberculous Diseases. 44 deaths during the year were directly caused by tuberculous disease of all kinds, a number equal to 8.3 per cent, of the total deaths. This percentage is almost the same as it was last year (8 8), but the actual number of deaths from tuberculosis is three more. Of the 44 deaths, 36 were due to tuberculosis of the lungs, giving a proportion of deaths from consumption to total deaths of 6.8 per cent. The similar percentage in 1905, was 6.3, in 1906, 6.0, and in 1907, 6.9. It should be noted that these do not include several deaths of residents from tuberculosis registered outside the district. Respiratory Diseases. Excluding consumption, 85 deaths at all ages were caused by other diseases of the respiratory organs, compared with 86 from similar causes in 1907. These deaths are equal to 16.0 per cent, of all deaths of residents registered. The corresponding percentage last year was 18.6. Cancer. 30 death were caused by malignant disease or cancer in one or other of its various forms. This number is equal to 5.6 per cent, of the total deaths. The persons who died from cancer were all aged over 25, and more than half were over 65. During the two previous years the number of deaths registered as being caused by cancer were in 1906, 43 (8.2 per cent.), and in 1907, 38 (also 8.2 per cent). 28 Influenza. It may be noticed that during the year 14 deaths were registered as having been caused by Influenza, compared with only four in 1907. No particular cause can be assigned for this increase, but some explanation for the mortality can be found in the fact that the great majority of the deaths (over 78 per cent.) were people aged over 65, and that in most of these cases the actual cause of death was some complication such as pneumonia or other acute respiratory condition following the primary cause, influenza. Deaths of Residents registered outside the District. It has already been explained that the 30 deaths of residents that occurred outside the district are not included in the total of 528 dealt with in Tables IV. and V., though they are included in the last two columns of Table I. The conditions causing these deaths may be briefly noted, but in general they have little bearing on the health of the district. Of the eight persons who died in lunatic asylums in other districts, but who actually belonged to this, six were males and two females. All were over middle age, and the cause of death in every case was such as is common in asylums. Pour of the 30 died of consumption, three of the deaths occurring in institutions. All were persons aged over 40, two being males and two females. Two females and one male died of cancer, all of them being in general hospitals. Three children under the age of 12 died from tuberculous peritonitis or meningitis in general hospitals outside the district. In these cases it may be assumed that the disease causing death was contracted in the district, and therefore these three deaths are of importance. The deaths of two infants, the children of residents, were registered outside the district. One was aged two days and the other two months. Both were males, and the cause of death was congenital malformation in the one and pneumonia in the other. 29 Deaths from Zymotic Disease. The diseases included under the classification of Zymotic are as in previous years, Small-pox, Scarlet-fever, Diphtheria, Typhus, Typhoid, Measles, Whooping-cough, Diarrhoea and Croup. The number of deaths caused by these diseases during the year was much in excess of the number from similar causes in 1907, though below the large total of the previous year. In considering the facts given under this heading it must be remembered that the deaths from zymotic diseases include deaths at all ages, and in consequence the number of infants dying from diarrhoea has a very material effect on the figures for the whole population. The total number of deaths from zymotic diseases registered during the year was 74, a number equal to 14.0 per cent, of the deaths at all ages from all causes. The deaths from similar causes in 1905 formed 16.8 per cent, of the total, in 1906, 16.0 per cent., and in 1907, 9.5 per cent. The following are the details of the 74 deaths from Zymotic diseases:— 1906. 1907. 1908. Diarrhœa 57 25 48 Diphtheria and Croup 2 3 6 Typhoid Fever 1 0 0 Measles 17 7 4 Whooping-cough 6 5 16 Scarlet Fever 0 4 0 83 44 74 Deaths from similar causes that occurred in the previous two years are given in separate columns for the purpose of comparison. All the above cases were residents; such non-residents as died from Zymotic diseases in the district are excluded from the total, as in their cases the disease was not contracted in the district, and therefore has no relation to local sanitary conditions. If such 30 cases were included, it would obviously be greatly to the disadvantage of this district, since a certain number of cases of infectious diseases from other parishes in the Brentford Union are treated in the workhouse infirmary, and the majority of the cases of Scarlet Fever, Diphtheria and Typhoid occurring amongst residents in Richmond are treated in Mogden Hospital. The 74 deaths give a Zymotic death-rate for the year of 2.12 per 1000 of the population, based on the official estimate of the number of inhabitants. If the calculation was made on Mr. Baker's estimate of the population, the zymotic death-rate for the year would be 1.8 per 1000. The following table shows the details of the deaths and death rates from Zymotic diseases for 1908, with the corresponding figures for the previous two years:— Disease. 1908. 1907. 1906. Deaths. Rate. Deaths Rate. Deaths. Rate. Scarlet Fever ... ... 4 0.12 ... ... Diphtheria 6 0.17 3 0.08 2 0.05 Measles 4 0.12 7 0.21 17 0.53 Whooping-cough 16 0.45 5 0.14 6 0.17 Diarrhœa 48 1.38 25 0.73 57 1.68 Enteric ... ... ... ... 1 0.02 All Zymotic diseases 74 2.12 44 1.28 83 2.15 Note:—The above figures relate only to deaths of residents. The death-rates per 1000 of population from certain other diseases were as follows:— Phthisis and other tuberculous diseases 1.26 Cancer 0.88 Heart diseases 1.40 Influenza 0.40 31 Infant Mortality. In the Report for 1907, a considerable space was devoted to the subject of infant mortality, and the special measures taken during the year in connection with it. It is a matter for very deep regret that nothing was done during 1908 to continue the work begun so efficiently and with such good results by Miss Hall. Beyond occasional discussions as to the benefit likely to result from the distribution of leaflets on the feeding of infants, no steps whatever were taken officially to deal in a practical and commonsense manner with one of the most important parts of public health administration. Printed leaflets or pamphlets may or may not be useful, but experience in other places has proved that their main benefit results when they are left as reminders of previous personal suggestion or teaching by a competent woman visitor. Dr. Young, the County Medical Officer, in his Report on the public health of Middlesex for 1907, referred to the experiment carried out in this district, and expressed regret that it was not continued. Details regarding infant mortality in the various districts of the county are given in that report, and interesting comparisons can therefore be made. It is sufficient here to say that the infant-mortality-rate for the whole of Middlesex, excluding the county of London, was 97 per 1000 births in 1907. The similar rate for this district was 88. The infant-mortality-rate everywhere was exceptionally low last year, and in most places much below that of 1906. In few was the diminution so marked as in Heston and Isleworth. During 1908. 147 deaths of infants under the age of 12 months were registered in the district. 17 of these infants were the children of non-residents, and must be deducted from the total. The actual number of infant deaths during the year was therefore 130 compared with 100 in 1907. This number is less than the average for the last ten years, and lower than any one of the ten years except 1900, 1903 and 1907. The details for all these previous years can be found on reference to Table I. 32 Of the total deaths, 63 were boys and 67 girls. This proportion between the sexes is not in acoordance with the general experience for the whole country, for as a rule more infant boys die than girls, although more boys than girls are born, thus accounting for the excess of females over males in the total population. The numbers of infant deaths registered in the different quarters of the year were as follows:— Boys Girls Total. 1st quarter 10 15 25 2nd „ 10 12 22 3rd „ 24 25 49 4th „ 19 15 34 63 67 130 Infant Mortality Rate. Number of deaths of infants (residents only) 130 Total births registered 1211 Infant-mortality-rate 107.3 per 1000 births It will be seen that the infant mortality rate given above differs from that given in column 6 of Table I. The reason for this is that the rate in the table is calculated on the total number of infant deaths registered in the district during the year, no allowance being made for any of such deaths being non-resident. As already stated, 17 of the 147 infant deaths registered were the children of non-resident women, and must be deducted before a correct rate can be arrived at. Although above the exceptional figure of last year, this infant mortality rate of 107.3 per 1000 births is lower than in any of the previous ten years with the exception of 1903, and it is considerably below the similar rate for the whole of the country in 1908. 33 The rate of infant mortality varied in the four quarters of the year, as will be seen in the following table:— 1st quarter 78.8 per 1000 births 2nd ,, 67.7 „ „ 3rd „ 175.6 „ „ 4th ,, 126.8 „ „ These four separate mortality rates are calculated on the actual number of births and resident infant deaths registered in each of the four quarters of the year, and are not worked out to equal annual rates as is done for the quarterly birth-rate and ordinary death-rate. The infant mortality rate in any district is far more accurate as a statement of fact than any other of the various rates included in vital statistics, as it is based on registered births and deaths, and is not in any way influenced by possible mistakes in the estimate of the total population. But even it can be altered at will by taking into account or leaving out certain factors for which no provision is made in the official tables. One at least of these factors has a very material influence on the rate in this particular district. It has already been explained that nonresident deaths are always excluded in calculating a death-rate. Non-resident births are included because they would otherwise not be counted at all. Therefore in working out the infant mortality which is based on total births and non-resident deaths, this district has an unfair advantage, due to the fact that a large number of non-resident births occur each year in the Brentford Workhouse which are credited to Isleworth. On the other side the infant mortality rate given in Table I. is unfair to this district as it includes the deaths of 17 non-resident infants. To arrive at the correct official rate, all non-resident deaths are excluded, but the number of births is taken as the total 34 registered in the district. To obtain a fair infant mortality rate, the 42 non-resident births during the year should also be excluded. If this was done the mortality rate, based on the registered births and deaths of infants the children of actual residents, would be 111.2 per 1000 births instead of 107.3. Amongst the deaths of residents registered during the year beyond the district, were two of infants. These two deaths are not taken into account in either the official or non-official estimate, as they were only residents in theory and did not in fact ever live in the district. But if they were included the actual number of resident infant deaths would be 132 instead of 130. The following tabular summary, showing five different infant mortality rates for the same district and the same year, proves how important it is in considering vital statistics to know the data on which the figures are based before drawing definite conclusions from them. 147 deaths and all births 121.3 per 1000 130 ,, ,, ,, 107.3 „ 130 deaths and resident births registered only 111.2 „ 132 ,, ,, ,, ,, 112.9 „ 132 deaths and all registered births 109.0 „ Analysis of Table V. The Local Government Board Table numbered V., deals with the causes of and ages at death of the 130 resident infants, whose deaths were registered during the year. The details given are of great value to all interested in the question of infant mortality and are closely connected with the general public health of the district, but some of the points may easily be missed unless specially looked for, and a brief analysis of the table may therefore be of some use. 35 Ages at Death. Total deaths of infants under 12 months of age 130 Died in first week of life 20 15.3 per cent. Died in first month of life 35 26.9 „ Died in first three months of life 63 48.4 per cent. Died in second three months of life 36 27.7 „ Died in third three months of life 19 14.6 „ Died in fourth three months of life 12 9.3 „ 130 100.0 „ This year is the fourth in which table V. has been included in the Annual Report, and by considering all the four together interesting comparisons can be made, and by taking the totals, valuable facts can be obtained as to the various ages at which the majority of the infant deaths occur. The following table shows the numbers of deaths that occurred during each year in the first week, month and quarter of life:— Year. First week. First month. First quarter. Whole year. 1905 29 36 64 125 1906 23 49 79 153 1907 18 34 55 100 1908 20 35 63 130 90 154 261 508 It will thus be seen that during the four years from 1905 to 1908 inclusive, a total of 508 infants died under the age of 12 months, and that of these:— 17.7 per cent, died in the first week of life. 30.3 per cent, died in the first month of life. 51.3 per cent, died in the first three months of life. In other words more than half the infants who died did not survive to complete their first three months of life. 36 The following table gives the ratio of deaths under 12 months to deaths at all ages from the year 1895:— 1895 22.45 1896 28.95 1897 24.61 1898 31.19 1899 27.82 1900 24.00 1901 28.75 1902 27.86 1903 22.75 1904 30.36 1905 27.65 1906 29.88 1907 21.64 1908 24.62 Causes of Death. A careful study of the chief causes of infant deaths in the district is necessary before any useful or practical scheme for reducing infant mortality can be suggested. An inquiry was carried out last year into a large number of infant deaths with a view to obtaining additional information to supplement that given in the death certificate. A special report dealing with that inquiry and other matters related to it was issued, and a summary of it can be found by reference to the Annual Report for 1907. It is sufficient here to say that strong evidence was collected to support the statement so often made in different reports presented to the Council that a very large proportion of the infant deaths in the district were preventable. Possibly at some future time it may be realised that giving printed leaflets on the management of babies to mothers, in most cases too busy to read them, is not all that should be done. Hitherto the slight expense involved by 37 adopting the Notification of Births Act and employing a properly qualified women inspector to carry it out seems to be considered an overwhelming reason against making use of a measure intended to give local authorities at least one definite means with which to attempt to reduce the waste of infant life. Dealing only with the causes of death of infants in 1908 as detailed in Table V., it will be noticed that there were eight fatal cases of infectious disease, seven being Whooping-cough and the other Measles. Last year four infants died from Measles but only one from Whooping-cough. Diarrhoea caused 37 deaths, compared with 24 in the previous year. The total infant deaths from Zymotic diseases during the year were therefore 45, compared with 29 in 1907. The number is equal to 34 6 per cent, of all the infant deaths, and is over 60 per cent, of the deaths at all ages caused by Zymotic disease. The 19 deaths attributed to Premature Birth is four less than the number registered from the same cause last year, but it is an alarming total all the same. The fact that over 14 per cent, of all the infant deaths were due to the babies having been born before full time requires serious consideration. The subject has been referred to in previous Reports. It seems to prove that in any attempt to reduce infant mortality the health and condition of the pregnant woman must be considered as well as the treatment of the baby after birth. Another important fact shown in the table is that 19 infants died from such diseases as Atrophy, Debility or Marasmus. Of course there are exceptions to all rules, but generally speaking, these technical terms mean in simple language, Bad Feeding Errors of diet are also the cause of most, if not all, of the fatal cases of Diarrhoea. Adding together the deaths from Diarrhoea, Marasmus, etc., Premature Birth and those due to overlying (3), most of which it may be quite fairly said might have been prevented by proper knowledge properly applied, it will be seen that during the year 38 about 60 per cent, of the total infant deaths were due to preventable causes. Surely these infant lives are worth as much as the salary of a qualified woman who might have saved some of them at least. Little need be said regarding the remaining causes of death. Respiratory diseases such as bronchitis and broncho-pheumonia accounted for One of the most satisfactory points brought out is that only one death of an infant was caused by tuberculosis in any form. Indeed a reference to Table IV. will show that during the whole year, only three children under the age of five years died from tuberculosis disease. It is always dangerous to jump to conclusions as to cause and effect, but it may perhaps be claimed that this result is due in some measure to the careful inspection of the milk supply in the district. Of the six deaths classified under the heading of other causes, four were due to sceptic diseases, one to atalectasis and one to heart disease. 39 Infectious Diseases. The total number of cases of infectious disease notified during the year was 167, a decrease compared with the previous year of 54, and practically the same number as in 1906. In making comparisons between different years it must, however, be remembered that the total for 1907 included an exceptional number of cases of Diphtheria due to an outbreak of that disease in the Union Infirmary and Schools. The following table shows the number of cases of each disease notified in 1908. The corresponding figures for the two previous years are included for comparison:— Disease. 1908. 1907. 1906. Scarlet Fever 98 80 69 Diphtheria 44 116 63 Typhoid Fever 6 6 7 Croup (Diphtheria?) 1 3 5 Erysipelas 15 14 18 Puerperal Fever 3 2 1 167 221 163 The number of cases notified does not represent the total amount of infectious disease in the district. Measles, Whoopingcough and Chicken-pox, three very common diseases, are not notifiable, and cases of infectious disease that occur in the Barracks or other Government buildings are not legally liable to be notified. On the other hand a considerable number of notifications are received every year from the Brentford Union Infirmary or Workhouse, and probably many of these cases were not contracted in the district. 40 The total number of cases of infectious disease notified in each of the seven years during which Measles has not been included are as follows:— 1902 219 1903 205 1904 145 1905 233 1906 163 1907 221 1908 167 In Table III. will be found the details of the various age periods of the patients notified as suffering from infectious diseases. With one exception all were under 65, and not one was under the age of 12 months. Nearly three-quarters of the persons notified (73 per cent.) were of ages varying between 1 and 15 years, and considerably over half (55.6 per cent.) were over 5 and under 15. The total number of notified cases, including those from the Brentford Union and other public institutions, removed to Mogdeu Hospital were as follows:— Scarlet Fever 71 Diphtheria 31 Typhoid Fever 4 106 The number of cases from the district treated in Mogden Hospital was 63 4 per cent, of the total number notified. But Erysipelas and Puerperal Fever are not admitted to the Hospital, and excluding the 18 cases of these two diseases notified, the admissions to Hospital were 71.1 of the notifications. 41 The following tables give the details of the notifications received in the different quarters and months of the year:— First Quarter Jan. Feb. March Total Scarlet Fever 15 5 2 22 Diphtheria 3 2 4 9 Puerperal Fever 0 0 1 1 Erysipelas 0 1 2 3 Typhoid Fever 1 0 2 3 19 8 11 38 Second Quarter April May June Total Scarlet Fever 5 6 8 19 Diphtheria 3 2 2 7 Membranous Croup . 0 1 0 1 Typhoid Fever 1 0 0 1 Erysipelas 1 1 3 5 10 10 15 35 Third Quarter July Aug. Sept. Total Scarlet Fever 10 3 10 23 Diphtheria 5 2 0 7 Erysipelas... 0 2 1 3 15 7 11 33 Fourth Quarter Oct. Nov Dec. Total. Scarlet Fever 5 12 17 34 Diphtheria 5 11 5 21 Typhoid Fever 1 1 0 2 Erysipelas 1 1 2 4 12 25 24 61 It is interesting to note from the above figures that over 36 per cent. of the total notifications were received in the last quarter of the year, and that in each of the other three practically the same number of cases was notified. The largest number of notifications in any one month was received in November (24) and the smallest in August (7). 42 The cases arising in public institutions situated in the district, so far as can be estimated from the notifications received from such institutions during the year, were as follows:— Infirmary, 16 (Scarlet Fever 7, Diphtheria 1, Erysipelas 5, Typhoid Fever 2, Puerperal Fever 1). Gordon House School (London County Council) 15, all of which were Scarlet Fever. Mogden Hospital, 1 (Scarlet Fever). A considerable number of the notified cases of Scarlet Fever that occurred in Gordon House School were removed to one of the Hospitals of the Metropolitan Asylums Board for treatment. It is well known that in all districts a very large proportion of the cases of infectious disease that arise occur amongst children, and especially those attending snhool. It is not always possible to obtain complete records on this matter, but the following table shows the numbers of children who were notified during the year as suffering from Scarlet Fever, Diphtheria or Typhoid Fever, and were known to be attending schools in the district Disease. Council Schools. Private Schools. Industrial Schools. Total. Scarlet Fever 39 3 16 58 Diphtheria 19 4 2 25 Typhoid Fever 1 — — 1 59 7 18 84 The three chief infectious diseases that are not notifiable are Measles, Whooping.cough and Chicken.pox. The last of these has never been included in the list of notifiable diseases in this district, even at such times as during outbreaks of Small.pox. It is hardly ever a fatal complaint and its main danger is in being sometimes mistaken for Small.pox. Special means are provided n this district to guard against that danger. The precautions have hitherto worked extremely well and have been fully explained in previous reports. 43 Measles. As in former years no reliable data can be obtained for making any accurate estimate as to the number of cases of this disease that occurred during 1908. In the future, owing to the systematic inspection of the children attending the public schools having at last been undertaken, it may reasonably be hoped that not only will more definite information be obtained as to the number of cases arising, but practical benefit will result in much reducing the total by detecting and isolating children found to be suffering from the disease. There is good reason to think that Measles was not so prevalent during the year as during 1907. No definite outbreak was recorded and no special precautions had at any time to be adopted. The number of deaths registered as being caused by the disease was four compared with seven in the previous year, a satisfactory decrease in the mortality from a disease that always causes far more deaths that necessary. Whooping.cough. Unfortunately, Whooping.cough caused an exceptionally heavy mortality during the year. 16 deaths were due to this disease, all being young children aged less than five years. Seven of those who died from it were aged less than 12 months. Beyond excluding children from school when they are found to be suffering from this disease, practically nothing can be done to deal with it by sanitary administration. The heavy mortality is probably due to proper medical skill not having been obtained soon enough. Scarlet Fever. 98 cases of Scarlet Fever were notified during the year, the majority of the patients being children under 15 years of age. This number is greater by 18 than the total last year, but the increase can almost entirely be accounted for by an outbreak that occurred in Gordon House, an industrial school situated in 1sle. worth but under the administrative and sanitary control of the London County Council. 44 Of the total cases, 19 (19.3 per cent.) were children aged from one to five years, and 63 (64 2 per cent.) children between the ages of 5 and 15. Excluding the cases notified from Gordon House, which were treated elsewhere, 83 per cent. of the patients notified were removed to Mogden Hospital. The number of cases of Scarlet Fever notified in each of the seven years from 1902 to 1908 inclusive are as follows :— 1902 112 1903 143 1904 65 1905 85 1906 69 1907 1908 80 98 The average for the seven years is 93. Diphtheria. Including one case of membraneous croup, which to all intents is the same thing, 45 cases of Diphtheria were notified during the year. The following list shows the numbers notified during each of the previous seven years :— 1902 85 1903 29 1904 37 1905 105 1906 63 1907 116 1908 45 45 The total number of Diphtheria notifications during the seven years is 480, and the average number for each year, 68 5. It will be seen that there is a very marked reduction in the number of Diphtheria cases, even when it is taken into account that the large total notified last year was increased by the exceptional occurrence of an epidemic in the Brentford Union Infirmary and schools. It is not so satisfactory to note that in spite of the much smaller number of cases notified, the mortality caused by the disease was exactly doubled. Six deaths were registered during the year as being due to Diphtheria. Three of them were children between the ages of 1 and 5 and three between the ages of 5 and 15. Four of the deaths occurred in Mogden Hospital. It may be noticed that in the last column of Table IV. it is stated that six deaths from Diphtheria took place in public institutions in the district. As a matter of fact six deaths did occur in Mogden from this disease, but two of the patients were Richmond residents. Dockwell Small.Pox Hospital. No patient was admitted during the year, but the hospital was always maintained in an efficient state, ready at any time to take in a case either for treatment or observation. Except when there is a fear of an outbreak of smail.pox the existence of this hospital is almost forgotten. But the fact that a special hospital for the immediate isolation of any case of small.pox that may occur is provided, equipped with a permanent resident nurse and a physician in charge, is one on which the district can congratulate itself. Dockwell is one of the most valuable institutions in the place, and great credit is due to Mr. and Mrs. Nicholson, the caretaker and nurse, for the excellent condition in which it is kept. In October, some works of repair and renovation were undertaken, and it seemed a good opportunity for carrying out certain much needed structural alterations. Suggestions to that effect were made to the Joint Hospital Committee in the form of a report 46 but they were not adopted. The management of the two isolation hospitals is of course entirely in the hands of that Committee, but it may be said here that the more important suggestions were (1) the rebuilding entirely of that portion of the hospital known as the Observation Block, and (2) the provision of additional administrative accommodation. Neither of these matters is of urgent importance at present, but should an outbreak of small.pox occur in either of the two constituent districts both would be much needed. Cases would be admitted both for treatment and for isolation and observation of patients about whom uncertainty as to the actual diagnosis of the disease might exist. It is for these latter cases that the suggested new observation block is required. The practical benefit to the community of isolating doubtful cases is obvious, but there is no law giving power to insist on it and it can only be carried out by the voluntary consent of the patients or their friends, and the provision of suitable accommodation in special wards situated sufficiently far away from those in which undoubted cases are placed to prevent the fear of infection. Mogden Isolation Hospital. The accommodation provided at this hospital for the treatment of patients suffering from Diphtheria, Scarlet Fever or Typhoid, was sufficient during the year for the number of cases that had to be admitted. They included an exceptional number of Scarlet Fever cases from Richmond. Fortunately there was no increase of similar cases in this district at the same time, but if an outbreak of either Scarlet Fever or Diphtheria should occur here and in Richmond together, serious difficulty and danger would arise. The need for increasing the number of beds in the hospital has frequently been pointed out. The remarks made in the Report for 1907 require no alteration. The following report on the work of the Hospital during the year has been prepared by Dr. Power, the Resident Medical Officer:— 47 Return as to Patients for the year ended 31st day of December, 1908. Number of Patients in the Hospital on the last day of the preceding year. Scarlet Fever Diphtheria Enteric Fever Other Diseases Borough of Richmond 7 l — — Heston and Isleworth Urban District 15 l 1 l Isle worth Union 6 l — — Hounslow Garrison 3 — — l 31 3 1 2 ADMITTED during the year. Borough of Richmond 78 20 1 1 Heston and Isleworth Urban District 63 30 4 1 Isleworth Union 7 1 — — Hospital Staff 1 — — 1 149 51 5 3 DISCHARGED during the year. Borough of Richmond 49 16 1 1 Heston and Isleworth Urban District 68 21 5 2 Isleworth Union 13 1 — — Hounslow Garrison 3 — — 1 Hospital Staff — — — 1 133 38 6 5 DIED during the year. Borough of Richmond — 2 — — Heston and Isleworth Urban District — 4 — — — — — — 6 REMAINING IN HOSPITAL on last day of year. Borough of Richmond 36 3 — — Heston and Isleworth Urban District 10 6 — — Hospital Staff 1 — — — — — — — 47 9 The two patients belonging to the Hospital staff, included amongst those admitted during the year, were a wardmaid who contracted measles outside the hospital, and a probationer nurse who contracted scarlet fever. 48 Sanitary Work. The three tables that will be found at the end of this Report, headed Sanitary Work and numbered 1, 2 and 3, are the official forms supplied by the Middlesex County Council to be filled in by all local authorities in the County. They contain a full record of the routine work carried out by the Health Department in this district during the year, but much done by the Inspectors by means of more or less unofficial suggestion and advice, cannot be set out in any written report, though such work is frequently of great value in prevention as well as cure. It can hardly be expected that many will bother to digest all the facts contained in any or all of these tables, or even to read them, but in case anyone should be sufficiently interested in the public health work of the district to do so, it may be pointed out that Table 1 gives details as to the total number of inspections made and notices served, and deals with dwelling houses, tenement houses and common lodging houses. The number of inspections and re.inspections amounted to 17713. Under the head of Notices it will be seen that in only one case legal proceedings had to be taken and that in that a conviction was obtained. Table 2 includes the following matters :— Canal Boats. The inspection of canal boats used as dwellings is under the sole charge of Mr. Smith, and the Government Inspector in his Report paid a well.deserved tribute to the efficient manner in which the work was carried out. That many visits of inspection were made is shown by the fact that 46 contraventions of regulations were found. Dealing with canal boats requires co.operation between the inspectors of districts that may be far away from each other, and it is easier to discover defects or contraventions than to get them remedied. A boat must of course be in the district when inspected, but there is no power to keep it there till a notice can be served or a defect made good. 49 Bakehouses. A list of the bakehouses, with details as to their sanitary condition, is given in a separate summary which includes 35. All were under periodical inspection, and though 37 contraventions of the Factory Acts were found during the year most of these were not serious, and generally speaking, the bakehouses in the district may be said to be fairly satisfactory. Slaughter.houses. A separate list of these is also given. There are 14 private slaughter.houses in the district, either registered or licensed, but several of them are not in use. One public slaughter.house for the whole district would be an immense improvement on this from the public health point of view, but the difficulties of establishing and maintaining such a place are at present too great to make this matter a practical one. In the meantime it is to be hoped that the Council will continue the rule they have wisely adopted during the past eight years, and refuse to allow any additional slaughter.house to be established. It is true that during the past year one new slaughter.house was built, but an old one was given up in exchange. 277 inspections were made and 28 contraventions of the bye.laws dealt with. Cow.sheds, Dairies and Milk.shops. A separate list of these will also be found at the end of this Report. Much importance has been attached during the past years to improving the sanitary condition of all places concerned in the production or sale of milk in the district, but the powers of local authorities are limited, and it has often been difficult or impossible to get wrong, but not illegal, conditions altered. As new legislation appears likely soon to be in force dealing with the whole question of the provision of a pure milk supply, the matter need not be further referred to here. During the year 510 inspections of cowsheds and 2483 of dairies and milk.shops were made, a total of almost 3000 inspections of places occupied wholly or in part by persons engaged in the milk trade. 50 Water Supply, Disinfection, Drainage, &c. Details will also be found in Table 2 relating to unsound food and water supply. With regard to the latter, it may be noted that a very large proportion of the houses in the district are aupplied from the public water service on the constant system. A few, in the more remote parts, still obtain their water from wells. Considerable attention is paid to the condition of cisterns, and it would be an advantage if new houses were so constructed that the cistern could be more easily got at for cleaning than is generally the case. The provision of a draw tap on the main is always urged, and during the year 18 houses were so fitted that did not already possess one. The advantage of a draw.tap is that water may be obtained direct from the main without the danger of its possible pollution by storage in a dirty cistern. Table 3 deals with drainage, dust, disinfection and various nuisances abated. 174 new ash.bins were provided and 27 ashpits were abolished. The paving of yards is a frequent source of difficulty, and the carrying out of the bye.law relating to it, as well as the necessity or otherwise of insisting on proper paving being provided, are amongst the very few matters about which the members of the Health Committee and the Sanitary Officials have not always been in agreement. In connection with disinfection, it will be seen that 125 rooms were disinfected on account of ordinary infectious disease, and six on account of consumption. The necessity of disinfecting a room that has been occupied by a consumptive person is not fully realised yet, but it should be done in all cases. The notification by Poor.law Medical Officers of the removal into Infirmaries of persons suffering from the disease, now in force, will give an opportunity of disinfecting the rooms previously occupied by them. In addition to the facts relating to drainage and sewerage included in Table 3, a separate table has been prepared giving further details of the work done in connection with the testing of drains. 51 In this district the drains of all new houses are tested by the Sanitary Inspectors as well as by the Surveyor's Department before a certificate is given by the Surveyor that the house is fit for occupation. This system was adopted in November, 1904, but it is not general in other localities. During the year the drains of 150 new houses were inspected, and defects in construction wore discovered in 58 instances, though in only 20 was the defect at all serious. The following table shows the number of new houses, the drains of which were tested by the Health Department before occupation, with the number of defects found, in each of the four complete years during which the system has been in force :— Number of houses tested. Defects found. 1905 504 390 77 per cent. 1906 530 165 31 ,, 1907 376 124 32 ,, 1908 150 58 38 ,, An interesting point to note in connection with the testing of drains is the fact that the occurrence of a case of infectious disease in one house may necessitate the drains of several other houses connected with it being examined. During the year, 76 instances occurred requiring the examination of drains. The proper carrying out of the work required that the drains of 305 houses had to be tested to locate defects, and that nearly 500 re.tests had to be made afterwards to ensure that the work of repair had been properly done. Drains Tested. Cause of Tests. Number. No. of houses involved. No. of cases in which defects were not found. No. of cases in which defects were found. Nature of Defects. No. re.tested during and after repairs. No of cases in which defects were found at origin of test. Remarks. 1 2 3 4 5 6 7 serious slight Complaint 12 17 1 16 15 1 26 11 A number of retests mentioned in column 7 are due to tests that took place in 1907, and are made up as follows :— Scarlet Fever... 35 62 4 58 51 7 324 25 Diphtheria 23 70 13 57 50 7 186 21 Enteric Fever 1 1 1 1 ... 2 1 Complaints 6 New Buildings ... 150 92 58 20 38 124 ... Scarlet Fever 75 Diphtheria 79 Other causes... 5 5 3 2 2 .. 4 2 New Buildings 16 176 Total 76 305 113 192 139 53 666 60 52 Table I. Vital Statistics of Whole District during 1908 and previous years. Year. Estimated Population to middle of year. Births. Total Deaths Registered Total Deaths in public institutions in District Deaths of non. resid'ts regist'd in public institutions in Deaths of residents regist'd 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 1898 29,185 817 27.7 146 172.5 598 20.4 196 130 ... 468 160 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 17.6 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 1904 32,630 1057 32.3 179 169.3 750 22.9 290 200 ... 550 16.8 1905 33,194 1030 28.8 141 136.8 675 19.2 288 220 ... 452 13.6 1906 33,767 1134 33.5 158 134.9 725 21.4 304 229 15 512 15.1 1907 34,351 1135 33.0 100 88.1 741 21.5 356 279 28 490 14.2 Av. for 98.1907 31,792 977 30.7 132 135.7 691 21.7 270 195 ... 497 15.5 1908 34,895 1211 34.7 147 112.2 801 23.2 344 269 30 558 15.9 *Rates in Columns 4, 8, and 13 calculated per 1000 of estimated population. Note.—The deaths included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the district. The deaths included in Column 12 are the number in Column 7, corrected by the subtraction 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 for 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. 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 1908 and previous years. Year. NAMES OF LOCALITIES. Parish of Heston. Parish of Isleworth. 1 2 Population estimated to middle of each' year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated at middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. 1898 NO PREVIOUS RECORD. NO PREVIOUS RECORD 1899 1900 1901 1902 11108 ... ... ... 20423 ... ... ... 1903 11205 ... ... ... 20870 ... ... ... 1904 11305 305 152 41 21325 690 398 126 1905 11405 337 143 38 21788 647 309 87 1906 11508 372 162 46 22259 727 334 107 1907 11613 401 130 31 22738 734 332 69 1908 11794 421 175 49 23101 790 353 81 The Isleworth births include 42 children of non-residents. The correct total of births amongst residents of Isleworth during the year was 748. Table III. CASES OF INFECTIOUS DISEASE Notified during the year 1908. 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. 1 Under 1 1 to 5 5 to 15 | 15 to 25 | 25 to 65 65 and upw'ds Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Memb. Croup) 45 9 27 5 4 ... ... ... ... ... ... 31 Erysipelas 15 ... ... 2 ... 12 1 ... ... ... ... ... ... Scarlet Fever 98 ... 19 63 9 7 ... ... ... ... ... ... 71 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 6 ... 1 1 3 ... ... ... ... ... ... 4 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 3 ... ... ... 2 1 ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... 167 ... 29 93 17 27 1 ... ... ... ... ... 106 Isolation Hospitals: Mogden and Dockwell (Smallpox). Joint Hospitals for Heston-Isleworth and Richmond, Surrey. Table IV. Causes of, and Ages at Death during 1908. Causes of Death. Deaths in whole District at subjoined Ages. (Residents only.) Total Deaths in Public Institutions in the District. All ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Smallpox ... ... ... ... ... ... ... ... Measles 4 1 3 ... ... ... ... 3 Scarlet Fever ... ... ... ... ... ... ... ... Whooping-cough 16 7 9 ... ... ... ... 2 Diphtheria and Membranous Croup 6 ... 3 3 ... ... ... 6 Croup ... ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... ... ... ... Enteric ... ... ... ... ... ... ... 8 Other continued ... ... ... ... ... ... ... ... Epidemic Influenza 14 ... ... ... ... 3 11 2 Cholera ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... Diarrhoea 48 37 8 ... ... ... 3 3 Puerperal Fever 1 ... ... ... ... 1 ... ... Erysipelas ... ... ... ... ... ... ... ... Other septic diseases ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 36 ... ... 2 3 31 ... 48 Other tuberculous diseases 8 1 2 2 1 ... 2 7 Cancer, malignant disease 30 ... ... ... ... 14 16 29 Bronchitis 24 10 2 ... 1 3 8 11 Pneumonia 19 ... 1 1 ... 13 4 14 Pleurisy 1 ... ... ... ... 1 ... 1 Other diseases of Respiratory Organs 41 12 8 1 1 13 6 10 Alcoholism Cirrhosis of Liver 9 ... ... ... ... 6 3 1 Venereal Diseases 3 3 ... ... ... ... ... 1 Premature Birth 19 19 ... ... ... ... ... 4 Diseases and Accidents of tion 2 ... ... 1 1 ... ... 2 Heart Diseases 49 1 ... 3 3 25 17 26 Accidents 10 3 ... 1 3 1 3 Suicides 5 ... ... ... ... 5 ... 2 All other causes 183 36 9 3 8 35 92 169 All causes 628 130 45 17 19 154 163 344 Note. Deaths of residents occurring beyond the District are not included in the above Table. Table V. INFANTILE MORTALITY DURING THE YEAR 1908. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—2 Months. 2—3 Months. 3—4 Months. 4—5 Months. 5—6 Months. 6—7 Months. 7—8 Months. 8—9 Months. 9—10 Months. 10—11 Months. 11—12 Months. Total Deaths under One Year. All Causes. Certified 130 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uncertified 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox Chicken-pox Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Scarlet Fever Diphtheria: Croup Whooping Cough ... ... ... ... ... 1 1 ... 1 2 ... ... ... 1 1 ... 7 Diarrhœal Diseases. Diarrhoea, all forms ... ... ... ... ... 4 4 7 5 4 3 3 2 2 2 1 37 Enteritis, Muco-enteritis, Gastroenteritis Gastritis, Gastrointestinal Catarrh Wasting Premature Birth 18 1 1 1 16 ... 2 1 ... ... ... ... ... ... ... ... 19 Congenital Defects 1 2 ... ... 3 1 ... ... ... ... ... ... ... ... ... ... 4 Injury at Birth Diseases. Want of Breast-milk Atrophy. Debility, Marasmus 3 2 2 1 8 1 3 2 2 2 1 ... ... ... ... ... 19 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Tuberculous Peritonitis: Tabes Mesenterica Other Tuberculous Diseas Erysipelas Syphilis ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 3 Rickets 1 Meningitis (not Tub'culous ... 1 ... ... 1 ... ... 2 ... ... 1 ... ... ... 1 ... 5 Convulsions 1 ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... 3 Bronchitis 1 ... ... 1 2 1 2 ... 2 ... 1 ... 1 ... 1 ... 10 Laryngitis Pneumonia Broncho Pneumonia ... ... ... 1 1 1 ... 1 1 2 2 ... 2 ... 2 ... 12 Suffocation, overlaying ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... 3 Other Causes 1 ... 1 1 3 1 ... ... 1 ... 1 ... ... ... ... ... 6 20 6 4 5 35 13 15 14 12 10 9 4 6 3 7 2 130 Population (estimated to middle of 1908) 34,895. Births in the year (residents only)Legitimate 1125; Illegitimate 44. Deaths from all Causes at all Ages (residents only)—558. HESTON AND ISLEWORTH URBAN DISTRICT. Sanitary Work, 1908. Table No. 1. Particulars as to Staff employed in Sanitary Department, specify if Inspectors are engaged in any other duties, and if so, what. Inspections.* Notices. Dwelling Houses. Houses let in Lodgings. (Tenement Houses). Common Lodging Houses. Number of Premises inspected on complaint. Number of Premises Inspected in connection with Infectious Diseases. Number of Premises under periodical Inspection. Houses Inspected from House-to-House. Total Number of Inspections and Re-inspections made. Cautionary or Intimation Notices Given. Statutory Orders Issued. Summonses Served. Convictions Obtained. Houses, Premises, &c., Cleansed, Repaired, &c Closed as Unfit for Habitation. (a) As result of action under H.W.C. Acts, (b) Otherwise. Re-opened after Repairs, Alterations, &c. Demolished. Illegal Underground Dwellings Vacated. Number Registered under Bye-laws. Number of Contraventions. Number Registered under Bye-laws. Number of Inspections made. Number of Contraventions. (1) (2) (3) (4) (5) 1 Inspector of Nuisances. 2 Assistant Sanitary Inspectors. • 1 Clerk. 37 147 376 110 17713 3238 344 1 1 252 0 0 0 0 1 24 2 67 2 1 „ (junior). 1 Drain-tester & Disinfector. Inspections 11289. Re-inspections 6424. Verbal 910 Intimation 2328 (letters, &c.) Cleansed 98 Including 6 Schools. 39 Inspections. *N.B.—(3) Includes all classes of premises under periodical supervision, such as Cowsheds, Dairies, Slaughterhouses, Workshops and Workplaces, too. (5) Includes all visits and re-visits made by Sanitary Inspectors in connection with 1-4. HESTON AND ISLEWORTH URBAN DISTRICT. Sanitary Work, 1908. Table No. 2. Canal Boats used as Dwellings. Movable Dwellings, Caravans, Tents, &c. Bakehouses. Slaughterhouses. Cow-sheds. Dairies and Milk-shops. Unsound Food. Adulterated Food. Offensive trades. Water Supply and Water Service. Number Registered under the Acts. Number of Contraventions of Regulations. Number Observed during the Year. Number of Nuisances therefrom Abated. Number Removed from District. Number in District. Contraventions of Factory Acts. Number on Register. Number of Inspections made & frequency of inspection. Contraventions of Bye-laws. Number on Register. Number of Inspections made & frequency of inspection. Contraventions of Regulations. Number of Milch Cows in District. Number on Register. Number of Inspections made & frequency of inspection. Contraventions of regulations. (a) Animals seized. (b) Articles or parcels seized. Condemned by Magistrate. (a and b). Articles or Parcels surrendered. Samples taken. Found adulterated. Number of premises in District. Number of Inspections made. Contraventions of Bye-Laws. New, Sunk. Wells. Closed as Polluted. Percentage of Houses supplied from public water service. Cisterns. Draw-Taps placed on Mains. Percentage of Houses supplied on constant system. Number of Samples obtained for analysis, from (a) Local Wells (b) Public Supply. Cleansed, Repaired, etc. New, Provided. Cleansed, Repaired, Covered, etc. ... 46 131 28 36 32 37 14 277 28 14 510 32 141 51 2483 68 0 21 52 ... ... 0 0 0 0 0 0 99 3 82 18 100 0 Meat 61bs. Pig-livers 2. Kidneys 161b. „ plucks 12. Rabbits 5. Fish 5 trunks. Fruit 16 lb. Oranges and lemons 19. Bananas 6 crates. Tomatoes 92. Rhubarb 3 bundles. Vegetables 1 bushel. Repaired 7 Covered 74 Cleansed 1 HESTON AND ISLEWORTH URBAN DISTRICT. Sanitary Work, 1908. Table No. 3. Drainage and Sewerage. Disinfection. Dust. Sundry Nuisances Abated. Water Closets. Percentage of Houses provided with Water Closets. Drains. Cesspools. Percentage of Houses draining into Sewers. Rooms disinfected. (a) Ordinary infectious diseases, (b) Phthisis. Rooms stripped and cleansed. Articles disinfected or destroyed. (a) Ordinary infectious disease. (b) Phthisis New bins provided. Periodical frequency of dust removal. Number of complaints of non-removal received (by Health Dept. only). Method of Disposal, (a) Destructor, (b) Tipping, (c) Other, state method. Overcrowding. Smoke. Accumulations of refuse. Foul ditches, ponds, etc., and stagnant water. Foul pigs and other animals. Dampness. Yards repaved or repaired. Other Nuisances. Number of Water Closets substituted for Dry Receptacles. Repaired, Supplied with Water or otherwise improved. Examined, Tested, Exposed, etc. Unstopped, Repaired, Trapped, etc. Waste Pipes. Rain Water Pipes, disconnected, repaired, etc. New Soil Pipes or Ventilating Shafts fixed. Existing Soil Pipes or Ventilating Shafts repaired. Disconnecting Traps or Chambers Inserted. Reconstructed. Rendered Impervious, Emptied, Cleansed, etc. Abolished, and Drain connected to Sewer. 0 413 98 305 236 361 11 83 13 39 0 0 98 131 6 1310 174 Weekly. 0 (a) 13 1 152 2 81 292 180 136 Urinal 15. E.C.'s 8. Re-tested 666. Unstopped 71. Repaired 159. Trapped 6. R.W.P. 101. W.P. 261. Soil 3. Vent 8. New 17. (a). 125. (b). 6. (a). 0. (b). 6. 27 pits abolished. Destructor. 19 observations. Guttering repaired & cleansed 79. Do. provided 56. Roofs repaired 95. Ventilation under floor 72. Paved 139. Repaired 41. Bins repaired 40. Water supply re-instated 22. Conveyance of offensive matter 51. Dung pits provided 6. Ditto repaired 3. Stables drained 7. Scullery sinks provided 7. Report on the administration of the Factory and Workshop Act, 1901, IN CONNECTION WITH FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES & HOMEWORK. 1.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 56 2 Nil Workshops (including Workshop Laundries) 331 9 Workplaces 87 1 Total 474 12 Nil. 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:Want of cleanliness 27 27 1 Want of ventilation 0 0 0 Overcrowding 0 0 0 Want of drainage of floors 1 1 0 Other nuisances 21 21 0 Sanitary accommodation— Nil Insufficient 4 4 1 Unsuitable or defective 10 10 1 Not separate for sexes 0 0 0 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s.101) 0 0 0 Breach of special sanitary requirements for bakehouses (ss. 97-100) 27 27 1 Other offences 0 0 0 Total 90 90 Nil. Nil. 3.—HOME-WORK. The number of persons in the district employed by others but working at home, is not large. During the year lists of such workers were received from employers engaged in umbrella making, the furniture trade and the making of wearing apparel. Tailors and dressmakers employ most of the home workers. The premises occupied by the workers were frequently inspected and their sanitary condition was generally found to be fairly satisfactory. But of necessity, work is often done in small rooms, sometimes quite unsuited for the purpose and frequently used also as the common living-room for the rest of the family, and the making of clothes in such places must be a likely means for the spread of infection. It would be a great advantage if all employers could provide workshops on their own premises, and home work, particularly by those employed in tailoring or dressmaking, done away with. No outworkers premises were found to be in a state requiring the serving of any notice, and no prosecutions had to be undertaken. In one instance infectious disease was found in the house of a home-worker (a woman employed by a tailor) and in this case an order was made and complied with. 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. Bakehouses (Retail) 32 Laundries (non-factory) 15 Workshops (186) and Workplaces 203 Total number of workshops on Register 250 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act, (s.133) Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (s. 5)— 3 Notified by H.M. Inspectors 4 Reports (of action taken) sent to H.M. Inspectors 4 Other 0 Underground Bakehouses (s. 101):— Certificates granted during the year 0 In use at the end of the year 1 LIST OF BAKEHOUSES IN THE URBAN DISTRICT OF HESTON AND ISLEWORTH Year ending December 31st, 1908. 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. 2 113, Hanworth Road, Hounslow B C. Smith, Miss D 6in. E G.I. tank F „ Old. 3 195, High Street, Hounslow B Beckman Bros. C E Pump F „ Old. 4 154, Bath Road, Hounslow A F. W. Harris C E G.I. tank F „ Old, fair. 5 26, High Street, Hounslow A T. Cox D 6in. E „ F „ Good condition. 6 353, Staines Road, Hounslow A W. Butler C E „ F „ New, fair. 7 High Road, Heston B S. Carter C E „ F „ New 1906, patent steam ovens. 8 26, South Street, Isleworth B J. Chapman C E „ F „ New 1907. 9 279, Staines Road, Hounslow A The Misses N. & M. Chapman D 3in. E „ F „ Old, fair. 10 51, Wellington Road, N., Hounslow A A. Baxter C E „ F „ New, fair. 11 66, High Street, Hounslow A Sherwin Bros. C E „ F „ Old, fair, not in use. 12 341 & 343, Staines Road, Hounslow B J. Groves C E „ F „ New, fair. 13 13, The Square, Isleworth B E. W. Gunner C E „ F „ Old, fair. 14 159, Hanworth Road, Hounslow A D. Pullen D 3in. E „ F „ Old, fair. 15 112 and 114,. High Street, Hounslow Aa W. F. Lovejoy C E „ F „ Good, patent hot-air ovens. 16 3, In wood Road, Hounslow B F. Bartlett C E „ F „ Fair. 17 68, South Street, Isleworth B J. Skinner (Mrs.) C E „ F „ Old, small. 18 46, London Road, Brentford End B A. O. Gregory C E „ F „ Old, fair. 19 1, Tryon Place, Lampton, Heston Aa .... ... ... C E Co. off main F „ Not in use. 20 39, Whitton Road, Hounslow Aa J. T. Richardson C E G.I. tank F „ Fair. 21 85, Staines Road, Hounslow A G. Stone D 3m. E „ F „ Old, fair. 22 Arundel House, St. Margaret's Road,Isleworth A J. B. Cox C E „ F „ Fair. 23 1, Upper Square, Isleworth B H. Sahler C E „ F „ Old, fair. 24 1, Upper Square, Isleworth Aa H. Sahler C E „ F „ Do. 25 1, Pembroke Place, London Road, Isleworth A H. Gilbert A Sons D E „ F „ Only underground bakehouse in dis- 26 21, London Road, Brentford End A R. Skilton C E „ F „ Old. (trict, good & well ventilated. 27 5, South Street, Isleworth B E. & F. Brown C E „ F „ Old. 28 85, Staines Road, Hounslow Aa Coates' Bakeries, Ltd. C E „ F „ Machine mixer, good condition. 29 177, Hanworth Road, Hounslow A W. J. Hankin C E „ F „ Old, fair. 30 133, Hanworth Road, Hounslow A B. Etches C E „ F „ Fair. 31 180, High Street, Hounslow B W. & E. Wells C E „ F „ Old, good. 32 15, Linkfield Road, Isleworth B J. Smith C E „ F „ Good, patent hot-air oven. 33 174, Hanworth Road, Hounslow B Charles Morris C E „ F „ Good condition. 34 159, High Street, Hounslow B F. Giltrow C E „ F „ Good, built 1901. 35 199, Staines Road, Hounslow B E. Trill C E „ F Fair, 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 not in use—Nos. 11, 19. LIST OF SLAUGHTER HOUSES IN THE DISTRICT During the Year 1908. No. Registered or Licensed. Name of Licensee. Address of Licensee. Situation of Slaughter House. I 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 „ „ 5 „ Finch, E. 113, High Street, Hounslow „ „ 6 Licensed Ford, Edward, S. 359, Staines Road, Hounslow „ „ 7 Registered Hunt, A. W. 10, Bell Road, Hounslow „ „ 8 „ Marden, J. 62, Wellington Road North, Hounslow „ „ 9 „ Payne, John 57, Bell Road, Hounslow „ „ 10 „ 173, High Street, Hounslow. 11 „ Roadnight, Thomas 269, High Street, Hounslow At rear of premises. 12 „ 169, Hanworth Road, Hounslow. 13 „ Welch, Frederick 86, High Street, Hounslow At rear of Premises. 14 Licensed Young, Jesse 114, Hanworth Road, Hounslow „ „ Slaughter Houses discontinued for use as such: Nos. 10, 11, 12, 14. LIST OF DAIRIES, COWSHEDS, AND MILKSHOPS IN THE DISTRICT, Year ending December 31st, 1908. 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. 6 Own cows and Salisbury Dairy Co. 2 „ „ Worple Road, Isleworth (1) ... „ „ „ 3 „ „ Worton Road, Isleworth ... 1 at rear of premises 4 „ „ „ 4 Barfoot, F. Wellington Road N., Hounslow (3) ... Kite, Hounslow 5 Beckman, P. High Street, Hounslow (1) ... Taylor, Cranford 6 Bignell, H. Lampton 1 1 at rear of premises 3 Own cows 7 Biles, G. W. F. 140, Cromwell Road,Hounslow 1 (2) ... Andrews, Hanworth 8 Bishop, S. M. St. Margaret's Road, Isleworth (2) ... Arnold, Isleworth 9 Bodger, T. & A. The Square, Isleworth 1 (1) 1 at rear of premises 4 Own cows ; Taylor, Cranford: Syon House, 10 Brewster, T. 39, Cromwell Road, Hounslow 1 ... Dairy Supply Co. (Brentford 11 Burnett, A. London Road, Brentford End (2) ... Viccars, Brentford 12 Butler, H. B. London Road, Hounslow 1 1 at rear of premises 9 Own cows 13 „ „ Thornbury Road, Spring Grove (1) ... Own cows 14 Caley, R. Worple Road. Isleworth (1) ... Prideaux, Dorset 15 Clare, W. Kingsley Road, Hounslow (3) ... Spencer, Hounslow 16 Coleman, W. H. Bath Road, Hounslow 1 (2) ... Taylor, Cranford 17 Cordery, Mrs. E. K. Haliburton Road, Isleworth (3) ... Arnold, Isleworth 18 Crees, E. J. Twickenham Road, Isleworth (1) ... Moon, Hook, Surrey 19 Debenham, G. St. John's Road. Isleworth 1 (1) ... Wilts. United Dairy Co. & Goodenough, I'worth 20 Denman, E. W. High Street, Hounslow 1 (1) ... Richens, Hounslow 21 Denman, E. W. Bath Road, Hounslow (3) 3 at rear of premises 35 Own cows 22 Evans, N. W. & A. Grove Road, Hounslow 1 ... Dairy Supply Co. 23 Finch, W. South Street, Isleworth 1 (1) 1 at rear of premises 6 Own cows and Wilts. United Dairy Co. 24 Forrington, J. S. Kingsley Road, Hounslow (3) ... Willows, Spring Grove 25 Goodenough, Mrs. E. Wyke Green, Isleworth 1 3 at rear of premises 50 Own cows 26 Hill, J. E. London Road, Isleworth (1) ... Wilts. United Dairy Co. 27 Hine, D. Lampton Road, Hounslow 1 (1) ... Taylor, Cranford 28 Hinckley, W. J. Staines Road, Hounslow 1 (1) ... Andrews, Hanworth, Middx. 29 Hornsby, E. Heston Road, Lampton 1 (2) ... Taylor, Cranford 30 Howard, F. W. Grove Road, Hounslow 1 ... Wilts. United Dairy Co. 31 Iggulden, M. 4. Bell Road, Hounslow (3) ... Phillips, Hounslow 32 Kenchington, C. Hanworth Road. Hounslow (3) ... Hornsby, Lampton 33 Kinnear, G. T. New Heston 1 (3) ... Poole, Hayes, Middx. 34 Kite, J. Osborne Road, Hounslow 1 ... Taylor, Cranford 35 Knott, J. S. L. Barrack Road, Hounslow (3) ... Hinckley, Hounslow 36 Lake, J. H. South Street, Isleworth 1 (1) ... Dairy Supply Co. 37 Lane, H. J. Cromwell Road, Hounslow (3) ... W. J. Weekley, Hounslow 38 Mellor, F. S. Syon House, Brentford (2) 1 at Syon Park 4 Own cows 39 Newman, A. High Street, Hounslow 1 (1) ... Taylor, Cranford 40 Neville, W. Cross Lances Road, Hounslow 1 (1) ... Van de Beyes, Windsor 41 Overton, C. London Road, Brentford End (2) ... Hughes, Brentford 42 Parsons, A. A. Albion Road, Hounslow 1 (2) ... Taylor, Cranford 43 Peters, J. W. Queen's Terrace, Isleworth (2) ... Arnold, Isleworth 44 Phillips, A. G. Staines Road, Hounslow 1 (1) ... Taylor, Cranford 45 Rehm, E. 0. Bell Road, Hounslow (3) ... Willows, Spring Grove 46 Rouse, S. Staines Road, Hounslow 1 (1) 1 at Benns Common 20 Own cows and Prideaux, Dorset 47 Rouse, G. George IV. Road, Hounslow 1 ... Dairy Supply Co. 48 Russell, F. J. Linkfield Road, Isleworth (3) ... Arnold, Isleworth 49 Sahler, H. C. Upper Square, Isleworth (2) ... Arnold, Isleworth 50 Sanders, H. Staines Road. Hounslow (2) ... W. J. Weekley, Hounslow 51 Smith, A. Whitton Road, Hounslow (3) ... Hinckley, Hounslow 52 Spencer, A. & E. Kingsley Road, Hounslow 1 (1) ... Dairy Supply Co. 53 Turner, J. S. Whitton Road, Hounslow (2) ... Young, Whitton, Hounslow 54 Usher, N. Linkfield Road, Isleworth (3) ... Wilts. United Dairy Co. 55 Weekley, A. J. Hanworth Road, Hounslow 1 (1) ... Taylor, Cranford 56 Weekley, W. J. George IV. Road, Hounslow 1 ... „ „ 57 Widdows, E. High Street, Hounslow (3) ... Spencer, Hounslow 58 Willows, E. London Road, Spring Grove ... 1 (1) ... Harris, Wallingford 59 Witt, Mrs. A. Talbot Road, Isleworth (3) ... Arnold, Isleworth 60 Young. J. Hanworth Road, Hounslow 1 (2) ... Own cows (Twickenham) (i) Shop. (2) Selling other goods (Confectionery &c.) (3) General Dealer. Number of Cowsheds discontinued for Dairy purposes 1 (No. 58) Number of Cowsheds rendered fit and again registered o. ,, Shops discontinued the sale of Milk 7. „ changes of occupiers of Milkshops 11. ,, , placed on Register 5. ,, changes of occupiers of Cowsheds 1. Cowsheds placed on Register 2.