HES 57 1910. Annual Report on THE HEALTH of the HESTON and ISLEWORTH URBAN DISTRICT For the Year 1910, by GEORGE F. BUCHAN, m.d., d.p.h., Medical Officer of Health. 2 CONTENTS. Page Introduction 5 Area 6 Physical Features 6 Population 6 Births and Birth Rates 7 Corrected Birth Rates 7 Illegitimacy 7 Death Rate 8 Infantile Mortality 8 Causes of Death 12 Tuberculosis 12 Cancer 15 Deaths from Infectious Diseases 15 Infectious Diseases:— Notifications 16 Scarlet Fever 18 Diphtheria 20 Provision of Diphtheria Anti-toxin 22 Typhoid Fever 26 Tuberculosis 28 Council Laboratory 32 Isolation Hospital Accommodation 34 Sanitary Work 35 Housing 37 Water Supply 43 Nuisances 45 Drainage 50 Houses Let in Lodgings 54 Common Lodging Houses 56 Dairies, Cowsheds and Milkshops 58 Slaughter-Houses 66 3 Contents—Continued. Page Bakehouses 71 Food 71 Ice Cream 73 Offensive Trades 75 Tents, Vans, Sheds, and similar structures 77 Factories, Workshops and Workplaces 78 Hairdressers' Saloons 80 Canal Boats 81 Vital Statistics: Table I.—Vital Statistics of Whole District. Table II.—Vital Statistics of Separate Localities Table III.—Cases of Infectious Disease. Table IV.—Causes of and Ages at Death. Table V.—Infantile Mortality. Factory and Workshop Act, 1901:— Table VI.—Inspection of Factories, Workshops and Workplaces. Table VII.—Defects found in Factories, Workshops and Workplaces. Table VIII.—Homework. Table IX.—Registered Workshops. Table X.—Other Matters. Sanitary Work:— Table XI. THE HEALTH COMMITTEE of the HESTON AND ISLEWORTH URBAN DISTRICT COUNCIL for the Year, ending April, 1911. W. G. Palmer, Esq., Chairman. H. C. Sahler, Esq., Vice-Chairman. F. C.greville-smith,Esq.,j.p., Chairman of the Council. W. Gr. Lobjoit, Esq., j.p.,c.c., Vice-Chairman of Council. J. J. Bonnett, Esq. C. Crush, Esq. Gr. Gentry, Esq. H. Harris, Esq. W. H. Lowry, Esq. W. Mann, Esq. F. Nowell, Esq. G. E. Pecover, Esq. Medical Officer of Health: George F. Buchan, m.d., d.p.h. 5 Health Department, Council House, Hounslow. January 9 th, 1911. To the Chairman and Members of the Heston and Isleworth Urban District Council. Gentlemen, I have the honour to present the Annual Report on the Health of the District for the year ending 1910. The total number of deaths which occurred in the district during the past year has fallen to 493, from 545 in 1909. It is unsatisfactory to record that during the same period there has been a rise in the number of deaths of infants under one year from 103 in 1909 to 105 during the year under review. This represents an increase in the infantile mortality rate of 8.8. A large number of these infant deaths might well be prevented, and I am sure that the decision of the Council to appoint a Health Visitor and to adopt the Notification of Births Act, 1907, is likely to produce the best possible results in the reduction of the high infantile mortality which prevails in the district. I desire to call attention to the large number of deaths which occur year by year from Measles and Whooping Cough, as compared with Scarlet Fever and to the necessity of making certain provisions with regard to isolation hospital treatment for these diseases. During the year the Council decided to promote a Bill in the Parliamentary Session 1912 to enlarge their powers with regard to the Local Government of the district. I have included in the present report the powers which it is necessary that the Council should obtain for the improvement of conditions affecting or likely to affect the health of the district. I would take this opportunity of thanking the members of the Health Committee for the encouragement and support they have given me in the performance of my duties during the year. I am, Gentlemen, Your obedient servant, GEORGE F. BUCHAN, Medical Officer of Health. 6 AREA. The Urban District of Heston and Isleworth, in the County of Middlesex, has an area of 6,893 acres. It comprises the two parishes of Heston and Isleworth, and is divided for civil purposes into five wards. Heston Parish includes Heston and Hounslow North Wards, and has an area of 3,708 acres. The Parish of Isleworth lies to the east and south of Heston, and is situate on the western bank of the River Thames where that river winds to the north-east towards Kew. The area of this Parish, which embraces Isleworth North and South and Hounslow South Wards, is 3,185 acres. PHYSICAL FEATURES. The level of the District rises gradually from the River Thames and reaches at Heston a height of 100 feet above Ordnance Datum. The geological subsoil formation is valley gravel, which is covered in large areas by loam. This thin loamy covering is of great value for market gardening, to which considerable portions of land within the district are devoted. POPULATION. The figure used for this report has been 36,311, the estimated gross population. It has been obtained by assuming, according to the method of the Registrar-General, that the population of each parish has increased at the same rate per annum since the census of 1901 as during the inter-censal period 1891-1901. Population at middle of 1910:— Parish of Heston 11,859 Parish of Isleworth 24.452 Urban District of Heston & Isleworth 36,311 (by summation) This estimate is probably low, as the Clerk to the Council basing bis calculation on the asumption that the number of inhabitants per occupied house is the same for censal and intercensal years figures the population at April, 1910, as 41,067. 7 It will be noted in Table I. that the number of people living in institutions in this district but belonging to other districts has been estimated at 1,295. These are technically known as "nonresidents." This number if deducted from the estimated gross population gives the estimated nett population, namely, 35,016. BIRTHS AND BIRTH-RATES. The total number of births registered in the district during the year was 1,117. This gives a birth-rate per 1,000 of the entire population of 30 76 as compared with 33.13 last year. The birth-rate in the Parish of Heston is 3179 per 1,000 of its estimated gross population, and in Isleworth 30.26. Last year the corresponding birth-rates in the two parishes was 32 05 in Heston, and 33 66 in Isleworth. CORRECTED BIRTH-RATES. In this district every year, a certain number of births occurs in the Union Infirmary which do not belong to the district. For the year 1910, this number was 67 as compared with 53 in the pievious year. This number must therefore be deducted from the total number of births to give the nett births belonging to the district, namely, 1,050. The corrected birth-rate means the number of births belonging to the district per 1,000 of the estimated nett population, and for the entire district is 29.98 as compared with 32.94 for the year 1909. For each parish separately, the corrected birth-rates are, for Heston 31.79 for 1910 as compared with 32.05 for the year 1909, and for Isleworth 29.06 for 1910 as compared with 33.45 per 1,000 for the year 1909. It is right to observe that even these corrected birth-rates are probably too high, simply because the estimated gross population of the Registrar-General is too low. ILLEGITIMACY. The following table gives the number of illegitimate births which occurred in this district during the year. The term "non- 8 resident "refers to children born in this district of parents who belonged to other districts. All such births occurred, in point of fact, in the Brentford Union Infirmary, Isleworth. RESIDENT BIRTHS. Heston. Isleworth. legitimate. illegitimate. legitimate. illegitimate. 369 8 646 27 NON-RESIDENT BIRTHS (all occurring in Isleworth). legitimate. illegitimate. 14 53 DEATH RATE. The total number of deaths registered during the year was 738. Of this number 462 were residents and 276 non-residents. In addition, 31 deaths of residents were registered in public institutions outside the district. The total number of resident deaths, therefore, was 493 giving a nett death-rate as shewn on Table I., column 13, of 14.07 which is a record for this district. This estimate is again probably too high as the officially estimated population is too low. INFANTILE MORTALITY. During a year in which the general death-rate has shewn a considerable fall, it is unpleasing to record an increase in the infantile mortality rate. 118 deaths of infants were registered during the year, which gives an infantile mortality rate of 105.6 per 1000 births as compared with the corresponding figure for last year of 94.8, or an increase of 10 8 Dealing only with resident 9 as against registered deaths, we find that the infantile mortality rate is 100.0, or an increase of 8.8 over the corresponding rate for the year, 1909. Table V. gives the causes of all resident deaths, namely 105 amongst infants, of which the most important are:— Diseases attributable to errors in feeding:— Atrophy, Debility, Marasmus 22 Diarrhoea, Enteritis, Gastritis 10 Want of breast milk, starvation 1 33 Diseases associated with ante-natal causes:— Congenital Defects 11 Premature Birth 10 Injury at Birth 2 23 Common Infectious Diseases:— Whooping Cough 6 Measles 4 Diphtheria 1 11 Total 67 A large proportion of the above deaths could be saved. The majority of all deaths attributable to errors in feeding should not occur, and the great proportion of deaths associated with ante-natal causes. I am of opinion, too, that with better medical attention and nursing, many deaths from whooping cough and measles could be saved, but I deal more particularly with this part of the question under " Deaths from Infectious Diseases." The whole subject of Infantile Mortality has continued to engage the attention of the Health Committee and the Council during the year, and in June last I presented a report to the Health Committee dealing with the matter in detail and advising the appointment of a Health Visitor and the adoption of the Notification of Births Act, 1907. It was pointed out that this district has one of the highest infantile mortality rates in the 10 County of Middlesex, and that effective steps require to be taken to ascertain and counteract the causes which bring about this excessive loss of child life. The Medical Officer of the Local Government Board, during the year issued a report on the subject of infantile mortality, in which he places the responsibility for its continuance on sanitary authorities and parents alike. He repeats and emphasises the various points which were brought to the notice of the Health Committee in my special report, and I think it well to quote here the main conclusions at which he arrives and the recommendations he makes in regard to this subject. "Conclusions. (1). Every county and most districts whose experience when summarised as a whole, show a low infant mortality, have within their borders areas in which infant mortality is excessive. (2). The subject of child mortality is of national importance. (3). Infant mortality is the most sensitive index we possess of social welfare and of sanitary administration, especially under urban conditions. (4). A heavy infant mortality implies a heavier death-rate up to five years of age; and right up to adult life the districts suffering from a heavy child mortality, have higher death-rates than the districts whose infant mortality is low. (5). It is strictly correct to say, that a high infant mortality implies a high prevalence of the conditions which determine national inferiority. (6). There are strong reasons for concluding that much of this mortality in the first month of life is preventable, if appropriate action is taken. (7). Infant mortality is higher among the poor than among the well-to-do, although natural feeding of infants is probably more general among the former. 11 (8). The chief means for a low infant mortality are efficient, domestic and municipal sanitation, good housing and intelligent and painstaking "mothering." (9). Breast feeding is the greatest natural protection against infant mortality. It is not a complete protection, in part because breast-fed infants are often exposed to excessive changes of temperature in air-polluted rooms; and in part because mothers frequently give their breast-fed infants other food of an unsuitable character." "Recommendations. (1). He emphasises the importance of more detailed investigation of all deaths occurring in infancy as a guide to administrative action. (2). He states that experience is already showing the value of the work being done by health visitors, who under present conditions, form an almost indispensable aid in influencing mothers in the management of their infants. (3). The adoption of the Notification of Births Act, is a necessary preliminary to the giving of such aid promptly ; and the medical officer of the Board expresses the hope that ere long this Act will be generally adopted in all districts. (4). The adoption and efficient administration of the Notification of Births Act and additional arrangements for giving instruction to mothers in infant hygiene, are urgently called for in districts in which infant mortality is excessive. (5). The measures indicated above furnish an incomplete remedy in districts in which insanitary conditions are rife. Sanitary authorities in compactly populated districts should decide to remove all dry closets, if a water-carriage system is practicable, to introduce and maintain efficient scavenging, and to provide for a satisfactory paving of streets and yards when required. Doubtless these measures will be expensive; but they are much more economical than the sickness and impaired efficiency of the population which are their alternative; and no sanitary authority can justify neglect in undertaking 12 these elementary tasks. Sanitary authorities in the words of Sir John Simon, the first medical officer of the Local Government Board are the 'appointed Guardians of masses of human beings whose lives are at stake in the business.'" So far as this district is concerned, it is satisfactory to be able to report that the Council at its meeting in July, 1910, resolved to appoint a Lady Health Visitor during the financial year 1911-12, and I feel certain that this appointment will exert the most beneficial influence in reducing the infant mortality rate of the district. CAUSES OP DEATH. 493 deaths occurred in the district during the year, and the causes of these deaths are detailed on Table IV. Diseases of the respiratory organs including pulmonary tuberculosis accounted for 117 deaths, diseases of the heart for 49, and cancer for 31. Tuberculosis. This disease gave rise to 48 deaths, of which 30 were due to consumption. The number of deaths from consumption per annum in this district has diminished since 1900, as the following table will shew:— Number of deaths from consumption during- 1900 42 Average for 5 years 40.6 1901 39 1902 29 1903 42 1904 51 1905 30 Average for 5 years 340 1906 31 1907 32 1908 36 1909 41 1910 30 Of the 30 deaths due to pulmonary tuberculosis, the following is a statement of the ages at death and occupations of these cases:— 13 Deaths occurring at home. Males. Females. Occupation. Age. Occupation. Age. Child 1.25 Brushmaker 22 No occupation 17 Typist 26 Labourer 19 Dressmaker 23 Labourer 33 School Child 11 Billiard Marker 21 School Child 13 Stoker 27 Domestic Servant 19 Surveyor 36 Domestic Servant 25 Factory Hand 41 Domestic Servant 31 King's Messenger 63 At Home 16 Average age at death 28.7 At Home 24 At Home 27 At Home 27 At Home 28 At Home 30 At Home 65 At Home 71 Average age at death 28.6 Deaths occurring in Public Institutions. Males. Females. Soldier (Royal Albert Hospital). 28 No occupation (Friedenheim Hospital). 23 Labourer (Union Infirmary). 34 Labourer (Union Infirmary). 42 Labourer (Union Infirmary). 43 Average age at death 36.8 Average age at death of all males 31.2 Average age at death of all females 28.3 The numbers above are small and it is unwise to base definite conclusions on them. But looking at the average age at death, 14 which in the case of the males is 31.2 and in the case of the females 28.3 years, it seems clear that consumption exerts its most powerful influence on young lives. Having regard to the fact, too, that women are longer lived on the average than men, it would appear that the female sex is specially exposed to this disease. While it is known that some special trades, e.g., filemakers, potters, etc., lead to consumption in the workers, an examination of the foregoing tables for this district cannot lead us to believe that generally industrial employment, especially in the case of women, has any large prepondrance in determining consumption. It would rather appear that the home influences are supreme. It may also be the case that the woman is the first to contract the disease in the household and later spreads it to the man—at least she succumbs to it as a rule at an earlier age than the man. We also know that as death approaches in this disease and the sputum becomes more abundant, the infectiousness of the patient increases. The large number of deaths which occur at home in this district, make it obvious that certain of these persons must be a source of great danger to the other members of the family and perhaps to the neighbourhood. It would be well if the Council had power in certain cases to isolate dangerous consumptives as well as to control spitting. It is also to be noted that any provision made at the Union Infirmary for pauper cases can exert no practical influence in lessening the spread of consumption. Only three cases occurred there during the year and in these cases the age at death was in all cases several years above the average. This would lead us to believe that such cases were chronic cases of consumption, who having suffered from chronic ill-health for a number of years, had exhausted their resources and been then obliged to become chargeable to the rates. The fact that, in spite of hard times, these patients lived longer than the others, holds out reasonable hope that if provision had been made for their treatment at the early stage of the disease, they would have been cured at less cost and less danger to the community than their continued ill-health over a number of years and ultimate deaths in the Union. 15 Cancer. The number of deaths which have occurred in this district as due to Cancer, is given in the following table for each year since 1900. Number of deaths from Cancer during— 1900 29 Average for 5 years 27.8 1901 19 1902 31 1903 24 1904 36 1905 16 Average for 5 years ... 33 4 1906 43 1907 38 1908 30 1909 37 1910 31 The exact nature and origin of Cancer has not been finally determined, but recent research seems to shew that it is not infectious and that the presence of persons suffering from Cancer in the community constitutes no menace either to the public or to the immediate relations of the sufferers. DEATHS FROM INFECTIOUS DISEASES. The following table gives the number of deaths per annum from certain infectious diseases in each year since 1900:— 16  Scarlet Fever. Diphtheria. Enteric Fever. Measles. Whooping Cough. 1900 3 6 4 7 1 1901 2 9 ... 17 18 1902 2 18 ... 1 8 1903 4 4 1 5 12 1904 ... 2 ... 6 4 1905 ... 14 ... ... 8 1906 ... 2 1 17 6 1907 4 3 ... 7 5 1908 ... 6 ... 4 16 1909 ... 4 1 13 8 1910 ... 3 1 12 8 Total 15 71 8 89 94 The above figures are remarkable and again shew, as I pointed out last year that what is necessary is that some provision should be made for isolating and nursing Measles and Whooping Cough. No diseases require better nursing and better hygienic conditions than these, and few have worse. If steps were taken to have the most serious cases of these diseases treated in the Isolation Hospital, I am sure that a number of deaths would be saved every year. INFECTIOUS DISEASES. The following table shews the number of cases of each disease notified under the Infectious Diseases (Notification) Act, 1889, for each year since, 1900:— 17  Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Total. 1900 181 50 7 35 2 275 1901 104 40 11 21 4 180 1902 112 85 10 20 0 227 1903 143 29 9 23 1 205 1904 65 37 15 23 5 145 1905 85 105 8 33 2 233 1906 69 68 7 18 1 163 1907 80 119 6 14 2 221 1908 98 45 6 15 3 167 1909 130 34 8 29 3 204 1910 81 31 6 28 3 149 It is satisfactory to note, that with the exception of the year 1904, the total number of notified cases is the smallest recorded in any one year since the Notification Act has been in force. This result has occurred without any large proportion of the cases being isolated in hospital, only those cases being removed in which home isolation could not reasonably be carried out. Out of the 149 cases of infectious illness referred to in the foregoing table, 29 occurred in institutions in this district receiving persons from outside as under:— 18 PUBLIC INSTITUTION. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Total. Poor Law Institutions:— Union Infirmary 2 4 3 13 2 24 Percy House Schools 1 ... ... ... ... 1 Industrial School for R.C. Girls ... ... 2 ... ... 2 Borough Road Training College ... 1 ... ... ... 1 Mogden Isolation Hospital 1 ... ... ... ... 1 Total 4 5 5 13 2 29 Scarlet Fever. The following table shews the number of cases which have been notified during each of the years since 1900, and the number and percentages of those cases which have been removed to hospital— Year. No. of cases notified. No. of cases removed to Hospital. Percentage of cases removed to Hospital. 1900 118 120 66.29 1901 104 77 74.03 1902 112 79 70.53 1903 143 97 67.83 1904 65 49 75.38 1905 85 77 90.58 1906 69 55 79.71 1907 80 73 91.25 1908 98 71 72.44 1909 130 100 76.92 1910 81 60 74.07 Total 1148 858 74.73 19 No fair conclusion as to the value of Hospital Isolation can be drawn from the above figures, as during the early years 1900-1903 the Hospital was continuously full and many cases could not be admitted. If we could obtain a series of years in which every case was removed, and compare the number of notifications under these conditions with the number notified over a series of years during which no case was removed to Hospital, we should have a fair basis of comparison. A critical analysis of the 81 notifications received, enables us to draw certain conclusions. Four of these notifications occurred in public institutions in the district and are therefore excluded from further consideration. The remaining 77 cases occurred in 63 households, from 47 of which the cases were removed to hospital, and in 16 of which the cases were kept at home. The following table gives certain particulars with regard to these hospital and home treated cases:— Hospital treated cases. Home treated cases. Number of cases 57 20 „ households affected 47 16 „ households in which 9 4 secondary cases occurred „ secondary cases in 10 4 households Average duration of isolation 54 39.5 (excluding 2 patients who were still isolated at the end of the year.) *Number of return cases 1 0 *A return case is defined as a case which occurs in the same house within 28 days of the recovery of a case, nursed therein or within the same period after its return home from Hospital. 20 The figures in the above table are small but they shew:— (1). That cases treated at home get better in a shorter time than cases treated at Hospital. (2). That the number of times secondary cases occurred in hospital treated cases was 1 in 5.7, and in home treated cases 1 in 5. (3). That no return cases occurred after home isolation. Return Case. One such case came under notice during the year. It occurred 20 days after the discharge of the infecting case from the Isolation Hospital. The infecting case was apparently well on discharge from Hospital, but developed a sore on the nose about 12 days after reaching home. Diphtheria. The most important fact in relation to this disease brought to light during the year, was the discovery of a carrier case. This case was notified as a case of Diphtheria on February 3rd, 1910, and was kept at home isolated under medical supervision. She was declared free from Diphtheria on February 22nd, 1910, and from that time until about November 14th, 1910, there was no reason to believe that she was in an infectious state. About that date she developed a cold and her brother aged 11 months shewed evidence of diphtheria and was duly notified on November 14th, and the notification of the mother followed on November 18th. Swabs were submitted from each of these three cases for bacteriological examination at the Council Laboratory and all three were found to contain the Bacillus diphtheriae. These cases were removed to Hospital until the throats were clear. No other case followed. This is one instance in which bacteriological equipment prevented the occurrence of a number of cases of this disease in the district. The following table shews the number of notifications received and the percentage of cases of diphtheria removed to Hospital during the past eleven years:— 21 Year. No. of cases notified. No. of cases removed to Hospital. Percentage of cases removed to Hospital. 1900 50 37 74.00 1901 40 28 70.00 1902 85 53 62.35 1903 29 20 68.96 1904 37 27 72.97 1905 105 87 82.85 1906 68 54 79.41 1907 119 52 43.69 1908 45 31 68.88 1909 34 22 64.70 1910 31 21 67.74 Total 643 432 67.49 It will be noted, that the smallest percentage of removals occurred in the year when the greatest number of cases were notified, but that on the other hand, the highest percentage of removals was associated with the next greatest number of notifications. It is not, therefore, possible to draw any definite conclusion from the above table. An intensive study of the 31 cases which were notified during the year, brings certain interesting points to light. Five of these 31 cases occurred in public institutions and are therefore excluded from further analysis. The remaining 26 cases occurred in 20 households, and the following table presents certain facts in regard to them:— 22  Hospital treated cases. Home treated cases. Number of oases 16 10 „ households affected 11 9 „ households in which secondary cases occurred 4 1 „ secondary cases in households 5 1 A scrutiny of the above table shews that, however valuable an Isolation Hospital may be in the treatment of Diphtheria, it exerts practically no influence in controlling the spread of the disease. Five secondary cases occurred in the case of 16 cases removed to Hospital, while only one occurred in the case of 10 cases kept at home. Provision of Diphtheria Anti-toxin. The Health Committee had under consideration during the year, the Order of the Local Government Board in regard to the above matter. The Medical Officer of Health was instructed to present a report thereon, and the following is an extract from the minutes of the Committee meeting of 5th October, 1910:— "Provision of Anti-diphtheria Anti-toxin. The Medical Officer reported as follows:— As instructed by the Committee, I beg herewith to report on the Order issued by the Local Government Board in regard to the above matter. The Order directs:— 1. That the Council may provide a supply of Diphtheria toxin for the poorer inhabitants of the district; 2. That the Council may provide medical assistance in nection with the use of such Anti-toxin so supplied; 23 3. That the arrangements with respect to the keeping, tion and use of the Diphtheria Anti-toxin shall be made in accordance with the advice of the Medical Officer of Health; 4. That the Medical Officer of Health shall be assigned the duty of the execution of the order; 5. That the Council are authorised to pay to the Medical Officer of Health a reasonable compensation for all action taken by him in the execution of the Order. Diphtheria Anti-toxin has been provided by this Council for a number of years, and the arrangements now in force and approved by the Health Committee are as follows 1. Diphtheria Anti-toxin is stored in a cool place in the Council House. 2. When a medical practitioner makes application personally or in writing for the Anti-toxin it is supplied to him for curative or preventive injection. 3. A form is sent to the medical practitioner to sign if the patients for whom the Anti-toxin was required are not in a position to pay for the same. If the patient is removed to the Isolation Hospital no charge is made. 4. The charge made is the cost charge (2/6 per 2000 units). These rules do not, I think, require to be altered. But in connection with medical assistance as included in the Order, I would suggest that payment for medical assistance be made only in those cases in which the patients are not in a position to pay for Anti-toxin. A fee of 2/6 per injection should be allowed, the account to be rendered on a prescribed form by the medical practitioner and to be accompanied by a statement in writing from the patient or his representative that he is unable to pay." "Resolved to recommend, (a) That the rules now in force with regard to the provision and supply of Diphtheria Anti-toxin be approved and be confirmed. 24 (b) That in any case where an injection of the Diphtheria Anti-toxin is necessary for curative or preventive purposes, and the patient or the person responsible for his maintenance is unable to pay the fee of a medical practitioner for making such injection, a fee of 2s. 6d. per injection be paid by the Council to such medical practitioner subject to an account being rendered to the Council in a form to be prescribed, and to the account being accompanied by a statement in writing by the patient or the person responsible for his maintenance, that he is unable to pay the fee." The recommendations of the Health Committee were duly approved by the Council, and the following letter was directed by the Medical Officer of Health to the several medical practitioners in the district informing them of the arrangements made:— Health Department, Council House, Hounslow. November 10th, 1910. Dear Sib, Control of Diphtheria. I beg to inform you that the Health Committee had before them at their last meeting, a report from their Medical Officer of Health upon the importance of the use of Diphtheria Anti toxin as a preventive and curative measure in the control of Diphtheria. They were advised that in a certain number of cases the prompt injection of Diphtheria Anti-toxin may prevent the development of the disease in a person who has been exposed to its attack. The Committee view the subject with so much importance from the point of view of reducing the mortality from and preventing the spread of Diphtheria that they have adopted the following rules with regard to the supply and use of Diphtheria Anti-toxin, and they trust you will co-operate with them in their desire to lessen the risks attendant upon this disease. 25 Diphtheria Anti-toxin is stored at the Council House, (Telephone 56 Ealing National), 9, The Grove, Spring Grove (Telephone 166 P.O. Hounslow), 121, Bath Road, Hounslow, and at 53, Percy Road, Isleworth, and may be had on application by a medical practitioner either personally or in writing. If the person or persons for whom Anti-toxin is obtained is or are able to pay for the same, the cost charge of the Anti-toxin will be debited against the medical practitioner who applies for the Anti-toxin. If the person or persons for whom the Anti-toxin is obtained, is or are unable to pay for it or for its injection, the Council will make no charge for the Anti-toxin used and will also pay the medical practitioner's fees for injection up to a charge of half-a-crown (2/6) per injection of 2.000 units. In the event of any application for Anti-toxin being made, certain forms, which will be duly forwarded from this office to the medical practitioner, will require to be signed if the Anti-toxin is not to be debited to his account. I am, Yours faithfully, George P. Buchan, Medical Officer of Health. The following is a fac-simile of the form referred to in the foregoing letter:— Heston and Isleworth Urban District Council. Health Department, Council House, Hounslow. 19 I hereby certify that the Anti-toxin (vial) supplied to me by the Health Department on the day of 191 was used in the case of:— 26 Name. Address. No. of injections of 2000 units each. and that the above patient unable to pay for same. Signature of Medical Practitioner Address Signature of Patient (Or of Guardian if Patient is under 21 years of age). Address Unless this form is returned to the Medical Officer of Health at the Council House, Hounslow, within 14 days from the date hereof, the Medical Practitioner on whose requisition the supply is obtained will be debited with the cost of supply and no payment will be made for injections. It is not necessary that the Medical Practitioner should obtain the signatures of the patients or patients' guardians. If this form is returned duly signed by the Medical Practitioner within 14 days, the necessary signatures of patients or patients' guardians will be obtained by the officers of this department. Typhoid Fever. Six cases were notified, but five of these occurred in institutions within the district and had no connection with the district. The final diagnosis in the remaining shewed that it was not a case of typhoid fever. I am sure that the continual vigilance of the Sanitary Authority as regards nuisances, exerts a powerful influence in 27 keeping this disease under control. A high standard of individual cleanliness and general sanitation will do much to prevent the spread of epidemic diseases generally and Typhoid Fever particularly. The principal factors exerting an influence on the spread of this disease are:— (1) The existence of midden or pail privies; (2) Accumulation of refuse near houses; (3) Exposure of food stuffs to contamination in the home, e.g., flies; (4) The consumption of shell-fish contaminated by sewage. The following table gives the number of cases of Typhoid Fever notified and removed to Hospital each year since 1900:— Year. No. of cases notified. No. of cases removed to Hospital. Percentage of cases removed to Hosptial. 1900 7 3 42.85 1901 11 6 54.54 1902 10 6 60.00 1903 9 3 33.33 1904 15 9 60.00 1905 8 2 25.00 1906 7 3 42.85 1907 6 2 33.33 1908 6 4 66.66 1909 8 1 12.50 1910 6 3 50.00 93 42 45.16 28 TUBERCULOSIS. Twenty cases of Pulmonary Consumption have been brought to the notice of the Health Department during the year, 16 cases having been notified under the Public Health (Tuberculosis) Regulations, 1908, and 4 voluntarily. The number of times the above twenty cases were notified is as follows Public Health (Tuberculosis) Regulations, 1908. 12 cases were notified once. 1 case was notified twice. 2 cases were notified three times. 1 case was notified five times. Voluntary. 4 cases were notified once. Total number of cases notified 20 Total number of times notified 29 The cases which are notified under the Public Health (Tuberculosis) Regulations, 1908, are poor law cases and require considerable supervision. The above case which was notified five times this year, was also notified four times last year. One of the cases notified three times was notified on two occasions from different addresses. one of them being a common lodging house in the district. The moving about from place to place of consumptive patients in an active stage of this infectious disease without adequatesupervision from the Health Authority is not satisfactory. These cases require to be visited and instructed as to the best means they can take to prolong their own lives and ensure the safety of the public. During the year, the Joint Isolation Hospital Committee have had before them the advisability of admitting early consumptives into their Isolation Hospitals for (1). Treatment and (2). Educational reasons. The Committee have decided to make use of the Small-pox Hospital at Dockwell for this purpose. 29 This is a step in the right direction, but the Health Committee should have before them the following other methods which are necessary for the complete control and eradication of this disease. 1. Notification.— By this means all cases are brought to the notice of the Health Authority. 2. Visitation.—All cases notified should be visited, and advice should be given as to separate sleeping accommodation, the disposal of the sputum, the necessity for cleanliness, fresh air, freedom from overcrowding, and generally the steps to be taken in order that the health of the sufferer and the public is protected. 3. Medical examination.—The other inmates of the house should be medically examined, and the sputum of any submitted to bacteriological examination with a view to the detection of early cases for sanatorium treatment at Dockwell. 4. Sanatorium treatment.—This should be provided as above. But it is also necessary, in the interests of the public health, that the Council should have power, as I have already stated, to isolate consumptives who are in a dangerously infectious condition living under circumstances in which isolation is impossible. 5. Tuberculosis dispensary.—This should exist so that all who desire may be examined as to the existence of Consumption. In point of actual practice it would be the centre of the tuberculosis organisation. The onset of Consumption is insidious, and many a bread-winner does not seek medical advice at a time when Consumption would be curable on account of the fee to be paid. The result often is, that in the end the family becomes a charge upon the rates when the early diagnosis at relatively small cost and subsequent Hospital treatment would have enabled him to live a self-supporting life. In addition, the danger of such a case to wife, family, fellow-workers and the general public has to be borne in mind. 30 Legal powers necessary. In connection with infectious diseases generally, and Tuberculosis particularly, certain further powers are necessary, and the following clauses are suggested for insertion in the Council's Bill:— Information to be furnished to Medical Officer and penalty for furnishing false information. (1). The occupier of any building in the district which is used for human habitation and in which there is or has been any person suffering from an infectious disease, shall on the application of the Medical Officer at any time during the illness of such person, or within six weeks from the occurrence of such illness, furnish such information within his knowledge as the Medical Officer may reasonably require for the purpose of enabling measures to be taken to prevent the spread of the disease. (2). Any occupier knowingly furnishing false information shall be liable on summary conviction to a penalty not exceeding forty shillings. (3). In this section, the expression "occupier" shall have the same meaning as in the Infectious Disease (Notification) Act, 1889. (Middleton). Council may supply antidotes against infectious disease. The Council may provide and supply (with or without charge therefor) to any medical practitioner, antidotes and remedies against infectious disease. (Middleton). Compensation to person ceasing employment. If any person shall at the request of the Council or of the Medical Officer stop his employment for the purpose of preventing the spread of infectious disease, the Council may make compensation to him for any loss he may sustain by reason of such stoppage. (Acton). Power to Medical Officer to examine school children. The Medical Officer may enter any public elementary school within the district at all reasonable times and examine 31 the scholars attending the same, and may exclude from attendance thereat for such period as he shall consider requisite, any scholar, who in his opinion is suffering from infectious disease or is likely to spread infection. The Medical Officer shall, upon the exclusion of any scholar in manner aforesaid, give notice thereof in writing to the principal or person in charge of such school or (if such school is divided into separate departments, and there is no principal or person in charge of the whole school) the person in charge of the department which such scholar attends, and shall send a copy of such notice to the parent or guardian of the scholar. Any person who shall obstruct the Medical Officer in carrying into effect the provisions of this section, or who shall permit any scholar to attend school after he shall have been excluded as aforesaid, and before the expiration of the period of exclusion, shall be liable to a penalty not exceeding forty shillings. (Acton). Power to isolate or detain dangerous consumptives. Any Justice of the Peace acting in or for the district on proper cause shown to him, may on the application of the Council, make an order directing the detention at the cost the Council in Hospital, temporary shelter or house accommodation provided by the Council or of any person suffering from Tuberculosis if such person is not provided with lodging or accommodation in which proper precautions can be taken to prevent the spreading of the disease by such person. Any order so to be made by any such Justice may be limited to some specified time, but with full power to any Justice to enlarge such time as often as may appear to him to be necessary. It shall be lawful for any Officer of the Council or Inspector of Police acting in the district or for any Officer of the Hospital temporary shelter or house accommodation on any such order being made to take all 32 necessary measures and do all necessary acts for enforcing the execution thereof. Spitting. The Council may make Byelaws for the prevention, regulation and control of spitting. (New York, Chicago, Philadelphia and other American Cities). COUNCIL LABORATORY. The equipment of the Council Laboratory was completed at the beginning of April, 1910, and the following letter was issued to medical practitioners in the district informing them of the arrangements made by the Council for the diagnosis of Diphtheria, Typhoid Fever and Consumption:— Health Department, Council House, Hounslow. April 14 th, 1910. Dear Sir, Laboratory, Council House, Hounslow. A Laboratory has been established in connection with the Health Department at the Council House, Hounslow. The diagnosis of Phthisis, Enteric Fever and Diphtheria, will be conducted in the future at this Laboratory instead of at the Lister Institute. I am forwarding outfits for use in suspected cases of the above diseases and the results of the examinations of specimens you send will be forwarded to you without delay. Yours faithfully, George F. Buchan, Medical Officer of Health. The following tables give a statement of the work done at the laboratory since it was opened on April 14th, 1910, until the end of the year 1910:— 33 Diagnosis of Disease. Disease. Nature of Specimen. Result. Total. Positive. Negative. Diphtheria Swabs from throat 7 22 29 Swab from nose 1 0 1 — 30 Tuberculosis Sputum 0 9 9 Aural discharge 0 1 1 — 10 Typhoid Fever Blood 0 2 2 Faeces 0 1 1 Urine 0 1 1 — 4 Ringworm Hair of scalp 5 0 5 Total 13 36 49 Water Examinations. Unpolluted. Polluted. Doubtful. Total. Chemical 0 7 2 9 Bacteriological 2 9 1 12 Total 2 16 3 21 Sundry Examinations. Total. Milk examination for Bacillus Tuberculosis Bacillus Tuberculosis absent l Microscopic examination of meat Coenurus Cerebralis present l Microscopic examination of pig's gland Bacillus Tuberculosis absent l Total 3 I have already referred in the foregoing pages, to the fact that a carrier of the Bacillus Diphtherias was discovered during 34 the year by the examination of throat swabs. The discovery and isolation of this case, which caused two others in the same household, undoubtedly prevented an outbreak of this disease. The above tables, too, show that the laboratory is supplying a want, and that it is an important factor in the efficient organisation of the Public Health work of the district. Isolation Hospital Accommodation. This district, with the Borough of Richmond (Surrey), maintains two Isolation Hospitals:— (1). Mogden Hospital for Scarlet Fever, Diphtheria and Entertic Fever. It has 61 beds, allowing 1,500 cubic feet of air space to each bed. (2). Dockwell Hospital for Small-pox. It has 13 beds, allowing 1,500 cubic feet of air space per bed. No definite number of beds is assigned to either Authority, but on the basis of the amount of money spent by each in the upkeep of the Hospitals, it may be said that there are 45 beds (37 at Mogden and 8 at Dockwell) for Richmond, and 29 beds (24 at Mogden and 5 at Dockwell) for Heston and Isleworth. Cases removed to Hospital. During the year, 85 cases were isolated in Hospital. But of this number, 4 entered the Metropolitan Asylums Board Hospitals, 1 was a nurse at Mogden Hospital, and 8 were cases entering the Hospital from public institutions in the district receiving persons from outside the district. Seventytwo cases, therefore, entered Mogden Hospital, which were chargeable to the District Rate. The total cost of these 72 cases was £1,568 or £21 15s. 0d. per patient for an average stay of 49 days per case. Where the object at stake is the prevention of disease, it is not easy to estimate in terms of hard cash what the cost should be. But I think that for the results obtained, Isolation Hospitals are much too expensive. The usual idea of an Isolation Hospital is that it is a place to which all and sundry cases of Scarlet Fever, Diphtheria, Enteric Fever and Small-pox must be removed. If this is correct, our Isolation Hospitals at present are lamentably undersized, and increasing and ever-increasing expenditure has got to be faced by the advocates of that view. 35 Excluding for the moment, Small-pox, I have already shewn on the preceding pages, that removal to Hospital exerts little influence on the spread of disease. I have further shewn that judging from the number of deaths in Measles and Whooping Cough (183 over 11 years) as compared with Scarlet Fever (15 over the same period) that the Hospital treatment of this latter disease might well be done without in favour of the Hospital treatment of the two former diseases. I am therefore prepared to state, that if the district is to receive the greatest possible benefit reckoned in terms of lives saved from its infectious diseases hospital, the following provisions with regard to it must be made:— (1). Arrangements must be made for taking in Measles, Whooping Cough, Diphtheria, Scarlet Fever and Typhoid Fever. (2). The cases to be admitted must be selected and only the following should be treated:— (a). Those in need of medical attention and skilled nursing. (b). Those in which isolation cannot be reasonably effected at home. The duty of making arrangements under (1) would devolve on the Resident Medical Officer in charge of the Hospital. The duty of administering (2) (a) would fall upon the Medical Officer of Health in consultation with the medical attendant in charge of the case, and (2) (b) would be again the duty of the Medical Officer of Health. SANITARY WORK. Table XI. gives a statement of the sanitary work done during the year. 17,672 inspections and re-inspections have been made, or an average of about 20 per day, by the Inspectors of Nuisances and each of the two Assistant Inspectors. These numbers are exclusive of the inspections which the Inspector of Nuisances 36 carries out under the Petroleum Acts and the Towns Police Clauses Acts. It is essential in a developing district like this, that nuisances of any kind should not be allowed to exist, and full and adequate routine inspection of the district is necessary. One of the earlier lessons of sanitary reformers, was that filth meant death, and in these more salubrious days this fact should never be forgotten. From year to year, the duties of your Sanitary Staff continue to increase. I referred in my Annual Report for 1909, to the fact that the Local Government Board's Order of 1891 required systematic house-to-house inspection to be carried out, and that this had not been done on account of the inadequacy of the present Staff to overtake it. The Housing (Inspection of District) Regulations, 1910, made by the Local Government Board under the Housing, Town Planning, etc., Act, 1909, make it an imperative duty of the Local Authority to make provision for carrying this out. A new General Order as to the duties of Medical Officers of Health and Inspectors of Nuisances was issued on the 13th December, 1910. During the past ten years, no addition has been made to the Sanitary Staff, and during this period the population has increased by at least 10,000, and very considerable work has been placed on the Health Department by the following Acts, Orders and Regulations:— Factory and Workshop Acts, 1901 and 1907, and three Orders, 1903—1907, and Regulations 1908 made thereunder. Petroleum Acts, 4 Regulations, 1900—1905, and 2 Orders, 1904, made thereunder. County Council of Middlesex (General Powers) Act, 1906, Part V. Bye-Laws with respect to Nuisances in connection with the Removal of Offensive or Noxious Matters, 1907. Public Health Acts (Amendment) Act, 1907. Public Health (Tuberculosis) Regulations, 1908. Housing, Town Planning, etc., Act, 1909. Housing (Inspection of District) Regulations, 1910. The Sanitary Officers (outside London) Order, 1910. 37 In order to deal with the district in a thoroughly businesslike and efficient way, it is necessary that the offices of Assistant Inspector of Nuisances be abolished, and that the Council have power to appoint such a number of Inspectors of Nuisances with full powers as they deem advisable. The effect of this would be that each Inspector would be able to discharge the full duties of an Inspector in that portion of the district allotted to him, and there would not be that overlapping which is a necessity at the present time. The following clause is suggested for insertion in the Council's Bill to be promoted in 1912 to cover this point As to appointment of Inspectors of Nusiances.—The Council may appoint more than one Inspector of Nuisances, and Sections 189 and 191 of the Public Health Act, 1875, and Section 24 of the Local Government Act, 1888, shall, for the purposes of the execution of those Acts and the Public Healths Acts Amendment Act, 1907, within the district be construed accordingly (Birmingham). HOUSING. The total number of houses in the district on April 1st, 1910, was 8,927 or an average of 13 houses per acre. The rental of these houses varies from £10 to £100 per annum, but very few houses are let at these lower or upper limits. The majority of all the houses in the district let at from £20 to £35 per annum. Twenty-two houses were erected by the Council in 1902 under Part III. of the Housing of the Working Classes Act, 1890. On September 2nd, 1910, the Local Government Board issued Regulations with regard to the inspection of houses within the district in pursuance of sub-section (1) of Section 17 of the Housing, Town Planning, etc., Act, 1909. The main points of the Regulations are contained in Articles II., III. and IV. thereof as follows:— Article II.—The inspection under and for the purposes of sub-section (1) of Section 17 of the Act of 1909 shall be made by the Medical Officer of Health, or by an Officer designated by the Local Authority but acting under 38 his direction and supervision, and the Officer making inspection of any dwelling-house shall examine the state of the dwelling-house in relation to the following matters, namely.— (1) The arrangements for preventing the contamination of the water supply. (2) Closet accommodation. (3) Drainage. (4) The condition of the dwelling-house in regard to light, the free circulation of air, dampness and cleanliness. (5) The paving, drainage, and sanitary condition of any yard or outhouses belonging to or occupied with the dwelling-house. (6) The arrangement for the deposit of refuse and ashes. (7) The existence of any room which would in pursuance of sub-section (7) of Section 17 of the Act of 1909 be a dwelling-house so dangerous or injurious to health as to be unfit for human habitation. (8) Any defects in other matters which may tend to render the dwelling- house dangerous or injurious to the health of an inhabitant. Article III.—Records of the inspection of dwelling-houses made under and for the purposes of sub-section (1) of Section 17 of the Act of 1909 shall be prepared under the direction and supervision of the Medical Officer of Health, and shall be kept by the officer of the Local Authority making he inspection or by some other Officert appointed or employed for the purpose by the Local Authority. The records may be kept in a book or books, or on separate sheets or cards, and shall contain information, under appropriate headings, as to:— (1) The situation of the dwelling-house, and its name or number. (2) The name of the Officer who made the inspection. (3) The date when the dwelling-house was inspected. (4) The date of the last previous inspection and a reference to the record thereof. (5) The state of the dwelling-house in regard to each of the matters referred to in Article II. of these regulations. (6) Any action taken by the Medical Officer of Health, or other Officer of the Local Authority, either independently or on the directions of the Local Authority. (7) The result of any action so taken. (8) Any further action which should be taken in respect of the dwelling-house. 39 Article IV.—The Local Authority shall, as far as may be necessary, take into consideration at each of their ordinary meetings the records kept in pursuance of Article III. of these Regulations, and shall give all such directions and take all such action within their powers as may be necessary or desirable in regard to any dwelling-house to which the records relate, and a note of any directions so given and the result of any action taken shall be added to the records. The property inspected under these Regulations comes broadly under two heads:— 1. Houses with sanitary defects. 2. Houses in such a state as to be unfit for human habitation. (1). Houses with Sanitary Defects:— The following statement gives the information required by the Local Government Board, relative to this class of property for the year ending December 31st, 1910:— Number of houses inspected 8 „ houses on which notices were served 8 „ outstanding notices at December 31st, 1910 8 (2). Houses Unfit for Human Habitation. The procedure adopted by the Health Committee when a house is represented as unfit for human hahitation by the Medical Officer of Health is as follows:—The owner of the house is forwarded a copy of the report of the Medical Officer and is given an opportunity of making a statement verbally or in writing, personally or by a duly accredited representive, at the next meeting of the Health Committee. The Health Committee having duly considered the report of the Medical Officer of Health and the statement of the owner, decides as to whether or not a Closing Order shall be made in respect of the property represented. During the year, 30 houses have been represented as unfit, and a Closing Order has been made in each case. In no case has any appeal against the judgment of the Committee been lodged. 40 The following statement gives the information which the Local Government Board requires the Medical Officer to furnish in relation to this matter for the year ending, December 31st, 1910:— Number of houses represented by Medical Officer of Health 30 Closing Orders made by the Local Authority 30 „ appeals against Closing Orders 0 „ notices served on occupying tenants 14 „ occupying tenants summoned 2 „ Orders made by Court requiring occupying tenants to quit 2 ,, of Closing Orders determined 1 ,, Demolition Orders made 22 „ appeals against Demolition Orders 0 „ Demolition Orders obeyed 19 „ demolitions carried out without Orders being made 3 During the year, in addition, 3 houses were closed by Justices Orders under Section 97 of the Public Health Act, 1875. No repairs have been yet carried out in connection with these 3 dwelling houses. In the course of inspections under the Housing Acts, the limitations of the Council's powers in certain urgent sanitary questions have been strikingly brought to light. These matters are referred to under water supply, nuisances, drainage, etc., and I mention here only those matters more particularly concerning the structure of, and the outhouses, yards and passages belonging to the dwelling-house. The absence of food cupboards and the consequent storage of food in coal cupboards in a large proportion of houses are conditions which are not likely to conduce to the good health of the population. In connection with many houses, there is no accommodation for the washing of clothes, and in connection with many others the washing accommodation provided is out of repair. 41 Unoccupied cellars and the roofs of outhouses are often allowed to become store-houses for refuse and all kinds of dirty and unsightly accumulations, but the Council have no power to require the cleansing of the same. Another point is this, that while under Section 25 of the Public Health Acts Amendment Act, 1907, the Council have power to call upon an owner to pave a yard in connection with a single dwelling-house, they have not the power to require paving and draining of yards or passages common to two or more dwelling-houses. The insanitary conditions arising from want of paving in many of these common yards and passages, urgently demand that the Council should have this power. In the case of one house reported to be in an insanitary state, it was impossible to get such information as to ownership or occupancy as to enable the Council to take legal proceedings. Legal powers necessary. The following clauses are suggested for insertion in the Council's Bill of 1912, to enable the Council to take action in such of the above cases as they deem advisable:— Provision of accommodation for washing and the preparation and storage of food. 1. If it shall appear to the Council on the report of the Surveyor, Medical Officer or Inspector of Nuisances, that any dwelling-house within the district, whether built before or after the date of the passing of this act, is without sufficient and suitable accommodation for the washing of clothes and the cooking, preparation and storage of food, including a properly lighted and ventilated food cupboard suitably constructed and placed, the Council may give notice in writing to the owner requiring him, in the manner and within the time to be specified in such notice, not being less than 28 days, to provide any such accommodation. If the owner makes default in complying with such requirement to the satisfaction of the Council within the time specified in such notice, he shall be liable to a penalty not exceeding five pounds and to a daily penalty not exceeding forty shillings. 42 Cleansing of cellars, etc. 2. The Council may from time to time make such byelaws as they think fit for the cleansing of unoccupied cellars and roofs of outhouses by owners. (Glasgow). Courts to be flagged. 3. (1) The owner or owners of any exising court or yard or of any passage used in common by two or more occupiers (not being a highway repairable by the inhabitants at large) or of any part of such court, yard or passage, shall flag, asphalt, concrete or pave such court, yard or passage or any part thereof and make a drain through or along the same or such part thereof as the Council require, and keep such flagging, asphalting, concreting or paving and drain in good repair. (2) If such owner or owners shall for one month after notice in writing from the Council fail in any respect to comply with the provisions of the foregoing sub-section, he or they shall be liable to a penalty not exceeding five pounds and to a daily penalty not exceeding forty shillings, and the Council may themselves, if they think fit, do the work and recover the expense incurred by them in that behalf from such owner or owners. (Southampton). Occupier to furnish name and address of owner or to be responsible for repairs. 4. (1) The occupier or occupiers of any premises must disclose to the Medical Officer of Health or Inspector of Nuisances on written or verbal application by either of the said Officers, the name and address of the owner or owners of the said premises. In the event of the occupier or occupiers not supplying or not being able to supply this information within a period of fourteen days from the date of a written request from the Medical Officer of Health or the Inspector of Nuisances, it is hereby enacted that for the purposes of this Act and the Public Health Acts, a notice serviceable upon the owner may be served upon the occupier or occupiers, who for the purposes of the said notice shall be deemed to be the owner or owners of the premises. 43 (2) If a notice of the Council so served is not complied with within the time specified on the notice, not being less than 28 days, the Council may serve notice on the occupier or occupiers requiring him or them to vacate the house within 14 days, and he or they shall cease to inhabit the premises, and in default shall be liable on summary conviction to be ordered to quit the dwelling house within such time as may be specified on the Order. WATER SUPPLY. Ninety-nine per cent. of all the houses in the district are supplied with water by the Metropolitan Water Board. The supply is derived from the River Thames, and is stored and filtered before delivery to the consumers. It is excellent in quality and the service is constant. A few houses still draw their water from wells. Samples of water from ten wells were examined during the year. In two cases the samples shewed that the water, although of doubtful purity, was useable. In four instances the wells were closed and action was pending at the end of the year in the case of the remaining four wells which were yielding polluted water. In the majority of houses in which water is obtained from the Metropolitan Water Board, cisterns are placed on the premises for the storage of water therein before delivery to the consumer. These cisterns are usually uncovered and situated so as to be inaccessible for cleaning purposes. Many of them have not been cleansed for years. One such cistern which came under notice during the year was situated uncovered immediately under the floor of the first floor back addition. To those who are aware of the amount of dirt and filth which accumulates under the floor boards over a period of years, it will be no surprise to learn that during the cleansing of the cistern, the water ran like ink from the tap over the sink. The Council requires to have power to make bye-laws for the cleansing of cisterns. It is further of extreme importance from the point of view of public health that water for household use should be beyond all 44 possibility of contamination, and therefore the Council should have power in all necessary cases to require the provision of a draw-off direct from the main supply pipe. Sometimes a sink is provided in connection with a dwelling house but the water tap is not placed over it. In such cases the sink and especially the waste pipe become foul from want of insufficient and irregular flushing. It is also necessary to have power to deal with an owner of a dwelling house who occupies it or who allows it to be occupied, without providing a proper and sufficient water supply in connection therewith. As a point of administration, the Council should have the same power to require the provision of a proper water supply to a house as well on the report of their Medical Officer as their Surveyor. It is in point of fact the Medical Officer of Health, whose duty it is to report on any such house, but the Council cannot act on his report. Legal powers necessary. To overcome these difficulties, the following clauses are suggested for insertion in the Council's Bill:— Cleansing of cisterns, etc. 1. The Council may make byelaws for securing the cleanliness and freedom from pollution of tanks, cisterns and receptacles kept for storing water used or likely to be used by man for drinking or domestic purposes or for manufacturing drink for the use of man. (Acton). Provision of water supply to house directly from main-supply. 2. The owner or owners of every dwelling house, whether built before or after the passing of this Act, and within or in connection with which the supply of water is by means of pipes and storage cisterns in connection with a main water supply shall provide, if required to do so by the Council, an efficient draw-off to be taken directly from the main water supply pipe to the said house and fixed in a suitable position to the satisfaction of the Council. (Liverpool). 45 Provision of water supply over sinks. 3. If it shall appear to the Council on the report of the Surveyor, Medical Officer or Inspector of Nuisances, that a proper and efficient water supply ought to be provided over any sink in a building built before or after the passing of this Act, the Council may give notice to the owner or occupier of such building, requiring him within the time to be specified in such notice, not being less than 14 days, to provide such a water supply. If the owner or occupier makes default in complying with such requirements to the satisfaction of the Council within the time specified in such notice, he shall be liable to a penalty not exceeding five pounds and to a daily penalty not exceeding forty shillings. Provisions as to houses without water supply. 4. The owner of any dwelling house which is not provided with a proper and sufficient water supply who shall occupy or allow to be occupied such dwelling house shall be liable to a penalty not exceeding five pounds and to a daily penalty not exceeding forty shillings. (Acton). Extending provisions of Section 62 of the Public Health Act, 1875. 5. From and after the commencement of this Act, Section 62 of the Public Health Act, 1875, as to report, shall extend and apply to the Medical Officer of Health, and the said Section so far as it affects the district, shall be read as if the words "Surveyor or Medical Officer of Health" were inserted instead of the word Surveyor. NUISANCES. During the year, 3018 nuisances were detected and it is satisfactory to record that all were abated. In only 33 instances or 1-09 per cent. was it necessary to have recourse to legal proceedings. As the Health Committee meet only periodically, it has been the custom in the department to send a written intimation to any person of the existence of a nuisance which he may be called upon 46 to abate. I think this should be a statutory and not an optional duty on the officers of the Health Committee, and I have accordingly drafted a section for the Council's Bill, similar to one which occurs in the Public Health (London) Act, 1891. As a point of some administrative importance, it should obtain that the authentication of notices, as required by Section 266 of the Public Health Act, 1875, when served by the Health Committee, should extend and apply to the Medical Officer of Health. The question of overcrowding has been brought to the notice of the Health Department from time to time during the year. There are two points with regard to this matter which require amendment:— (1). A definition of overcrowding is required. (2). The Council's officers should have right of entry on premises at all times, and not only during the day as at present, when there is reason to believe that overcrowding exists. Another cause of nuisance on the streets is meat exposed outside any shop, from which blood is dripping. It is not within the power of the local authority to take action in these cases, and this omission requires rectification. There is no class of structure which is more frequently a cause of complaint to your Health Department than the public house urinal, and power should be given to the Council to compel owners of these to wash the same at least once a day and to keep them at all times clean. The ash-bin has for long been recognised as the most sanitary receptacle for the storage of house refuse. It is easily emptied, it is not large enough to allow its contents to remain until they are actively decomposing, and it is easily replaced when worn out. It has, however, no legal status and it is proposed that this be amended in the Council's Bill of 1912. In the same connection it is to be noted that a manure-pit is the only recognised place in which the dung of any animal may be put. The same reason which make an ashbin suitable for the storage of house refuse suggest some similar structure as the best for manure. 47 The keeping of pigs is another frequent source of nuisance. It is stated that pigs are specially prone to tuberculosis, but I think this statement requires modification. I venture to say that if other animals susceptible to this disease were kept under the same filthy conditions as those under which pigs live, the incidence of tuberculosis among them would be greater than amongst pigs. I am certain that by keeping pigs under clean conditions, tuberculosis amongst them would be lessened and the risk of infection from this source of our food supply would in proportion be diminished. During the year, many complaints have been received by the Health Department as to nuisances arising from animals, especially poultry, kept at the rear of premises. In the interest of adjoining residents and of public health generally, it is necessary that the Council should have power to control the keeping of animals under these conditions. Legal powers necessary. The following clauses are suggested for insertion in the Council's Bill of 1912, to cover the above points:— Information of Nuisances to Sanitary Authority. 1. Information of a nuisance liable to be dealt with summarily under Acts in force within the district, may be given to the Council by any person, and it shall be the duty of every officer of the Council to give that information and also the duty of the Council to give such directions to their officers as will secure the existence of the nuisance being immediately brought to the notice of any person who may be required to abate it, and the officer shall do so by serving a written intimation. (London). Extending provisions of Section 266 of the Public Health Act, 1875. 2. From and after the commencement of this Act, Section 266 of the Public Health Act, 1875, as to authentication of notices, shall extend and apply to the Medical Officer of Health and the said Sections, so far as they affect the district, shall be read as if the words "Surveyor or Medical Officer of Health" were inserted instead of the word " Surveyor." 48 Penalty for Overcrowding. 3. If any dwelling house is used for the purposes of sleeping in by a greater number of persons than in the proportion of one person of the age of ten years or upwards for every 400 cubic feet of space, or of one person of an age less than ten years for every 200 cubic feet of space contained therein (exclusive of lobbies and closets and of recesses not perfectly clear from the floor to within two feet of the ceiling and from wall to wall), every person so using or suffering it to be used, shall be liable to a penalty not exceeding twenty shillings for every day or part of a day during which it is so used or suffered to be used, and any person duly authorised by the Council and exhibiting his authority if called upon to do so, may at any time enter such dwelling houses if they believe the provisions of this Section are being contravened. If any such person duly authorised by the Council and exhibiting his authority, is obstructed in the performance of his duty under this Section, the person so obstructing shall be liable on summary conviction to a fine not exceeding forty shillings. (Glasgow). Extension of Section 91 of the Public Health Act, 1875. 4. For the purposes of the Public Health Act, 1875, in its application to the district, the dripping or oozing of blood on to a public footpath from meat exposed for sale and for the purposes of sale, shall be deemed to be a nuisance liable to be dealt with summarily in the manner provided by that Act. Cleansing of urinals. 5. The owner or occupier of any inn, public-house, beerhouse, eating-house, refreshment-house or place of public entertainment to which a urinal or other sanitary accommodation for the use of customers or the public is attached, shall keep the same at all times in a clean and inoffensive condition and shall cause the same to be cleansed, scrubbed and flushed 49 as often as may be necessary to keep the same in a clean and wholesome state. If such owner or occupier fails to comply with the terms of this Section after written notice thereof has been given to him by the Council, he shall be liable to a penalty not exceeding twenty shillings and to a daily penalty not exceeding ten shillings. Regulation Dustbins. 6. The Council may by notice in writing, require the owner or occupier of any dwelling house to provide galvanised iron or enamelled iron dustbins for the convenient removal of house refuse, and such dustbins shall be of such size and construction as may be approved by the Council, and any owner or occupier who fails within fourteen days after notice given to him, to comply with the requirements of the Council, shall be liable to a penalty not exceeding twenty shillings and to a daily penalty not exceeding five shillings. Provided that this Section shall not authorise the Council to require the provision of a dustbin thereunder in any case in which a dustbin or ashpit in use at the passing of this Act is of suitable size and in proper order and condition. (Acton). Provisions as to Manure Pits. 7. The Council may by notice in writing, require the owner or occupier of any building or premises wherein or whereon any horse or other beast of draught or burden, or any cattle or swine may be kept, to provide in connection with such building or premises, a receptacle for dung, manure, soil, filth or other offensive or noxious matter which may from time to time be produced in the keeping of any such animal in such building or upon such premises. Such receptacle shall be constructed so that its bottom or the floor on which it stands shall be impervious and shall not be lower than the surface of the adjoining ground. Such receptacle shall be constructed in such a manner and of such materials and be maintained at all times in such a condition as to prevent any escape of the contents thereof or any soakage therefrom into the ground or into the wall of any building. 50 Such receptacle shall be of such size and drained in such a manner as the Council may determine, and shall be emptied and cleansed at least once a week. Pigs and Pigstyes. 8. The Council may make byelaws for describing the materials to be used in the construction of pigstyes, promoting cleanliness and ventilation of pigstyes and promoting cleanliness in the keeping of pigs. Keeping of Animals. 9. The Council may make byelaws for describing the animals which may be kept on any premises and the conditions under which such animals may be kept as regards (a) size of yard, (b) position and proximity of dwelling house or dwelling houses, (c) number of animals, (d) construction of sheds in which animals are kept. DRAINAGE. Tests. During the year 158 tests and re-tests were applied by the Health Department, and the following table gives a statement of the reasons for the tests, the number of houses involved and the number of houses in which the drains were found defective:— On complaint. By request. New buildings. Total. No. of houses tested 11 9 109 129 No. of houses in which drains were found defective 10 3 22 35 No. of houses in which drains were found intact 1 6 87 94 No. of re-tests during and after repairs 13 1 15 29 51 In connection with the testing of drains conducted by the Health Department during the year, difficulties have arisen in connection with testing for the following reasons :— 1. Drains have been altered without notice, and consequently the necessary alterations have not been made in the Surveyor's plans. 2. Drains have been re-constructed contrary to the Council's Bye-laws with respect to new buildings. Repairs. Under Section 41 of the Public Health Act, 1875, in connection with the repair of drains, it is often necessary for the Council to undertake the work and charge the owner with the cost. Under these circumstances it is right that the Council should not be liable for damages except in case of negligence. It also happens that certain workmen undertake to repair drains who are quite incompetent to do so and the Council should have power to proceed against these persons in case of improper construction or repair. Sanitary Conveniences. On the erection of a new building where a sewer and water supply can be obtained, the Council have power to require that such new building shall be provided with proper and sufficient water-closets. This power requires to be extended so that where a sewer and water-supply are not available the Council may require the provision of proper and sufficient earth closets or pail closets. The Council should also have the power to require the provision of water-closets, pail closets, earth closets and urinals for workmen engaged upon any works or buildings. Soil-Pipe. In the course of inspections it is found that the soil pipes within certain houses or buildings are not ventilated, and the Council have no power to require the provision of the necessary ventilation by which the health of the occupiers may be safe-guarded. Legal Powers necessary. The following is the text of suggested clauses to give the Council power to deal with the foregoing matters:— 52 Notice of intention to repair Drains. (1). It shall not be lawful for any person to expose, open, alter or repair any drain communicating with any sewer of the Council, without giving to the Council or the Medical Officer twelve hours previous notice in writing of his intention to do so, except in case of emergency, and in that case it shall not be lawful for any person to cover over the drain without giving the like notice of his intention to do so. Free access to such drain shall be afforded to the Medical Officer or the Inspector of Nuisances, or any Officer of the Council authorised in writiug by the Medical Officer for the purpose of inspection. Any person who shall offend against this section shall be liable to a penalty not exceeding five pounds (Middleton). Re-construction of Drains. (2). It shall not be lawful for any person to construct, reconstruct, or alter the course of any drain, except in accordance with the provisions of the Byelaws relating to the drainage of new buildings. Any person who shall offend against this section shall be liable to a penalty not exceeding five pounds and to a daily penalty not exceeding forty shillings. (Birmingham). In executing work for owner Council not liable for damages save in case of negligence. (3). Whenever the Council under any enactment or Byelaw for the time being in force within the district, execute, reexecute or alter any work, act or thing in default of the owner or occupier, and in the absence of misconduct or negligence on the part of the Council or any contractor or person employed by them, are required to pay any damages, penalties, costs, charges and expenses for or in respect of or consequent upon the executing, re-executing or altering such work, act or thing, the amount thereof when paid shall be deemed to be part of the expenses payable by such owner or occupier, and shall be recoverable accordingly. (Acton). 53 Improper construction or repair of Water-closet or Drain. 4. If a water-closet, drain or other sanitary fitting or waste is so constructed or repaired as to be a nuisance or injurious or dangerous to health, the person who undertook or executed such construction or repair shall, unless he shows that such construction or repair was not due to any wilful act, neglect or default De liable to a fine not exceeding twenty pounds. Provided that where a person is charged with an offence under this section, he shall be entitled upon information duly laid by him, to have any other person being his agent, servant or workman whom he charges as the actual offender brought before the Court at the time appointed for hearing the charge, and if he proves to the satisfaction of the Court that he had used due diligence to prevent the commission of the offence, and that the said other person committed the offence without his knowledge, consent or connivance, he shall be exempt from any fine, and the said other person may be summarily convicted of the offence. (Acton). Poiver to require Earth Closets for New Buildings. 5. (1). The Council may, on the erection of any new building when a sewer and water supply sufficient for a water closet are not reasonably available, by written notice require one or more proper and sufficient earth closets or pail closets to be provided at or in connection with such building. (2). Any person offending against any requirement of the Council under this Section shall be liable to a penalty not exceeding forty shillings. (Acton). Sanitary Conveniences for Workmen engaged on Works or Buildings. 6. (1). The contractor or builder engaged in or upon the construction, re-construction or alteration of any building or works in the district, shall provide to the reasonable satisfaction of the Council and until the completion of any such work or operation, such water or other closets and urinals. (2). Any person offending against this Section shall be liable to a penalty not exceeding five pounds. (Middleton). 54 Soil Pipes to be Ventilated. 7. The soil pipe of any water closet within a house or building shall be properly ventilated by means of a pipe carried up therefrom or by such other method as the Council shall direct, and any owner or occupier of such house or building who shall neglect or fail to comply with any requirement of the Council under this Section for a period of twenty-eight days after notice in writing of such requirement and the mode in which the same is to be complied with, shall be liable to a penalty not exceeding five pounds and to a daily penalty not exceeding twenty shillings. (Acton). HOUSES LET IN LODGINGS. Many of these houses are to be found in the district. Only 15 have been put on the register. This is due to the fact that it is not possible to carry out the necessary inspections for this purpose with the present Staff of the Department. In these sublet houses it is known that overcrowding and insanitary conditions exist, and no time should be lost in getting to work to have these conditions remedied. In connection with the present Byelaws with respect to houses let in lodgings, it is to be noted that the duty is placed on the Sanitary Authority of giving notice to the landlord when his house is sublet instead of making it a duty of the landlord to give such notice to the Sanitary Authority. In addition, power should be granted to the Local Authority to place any house, which is a house let in lodgings, on the register of such houses, whether notice has been given by or to the landlord or not. It is found, too, that in houses let in lodgings, separate sanitary accommodation is not provided for each family. This, in my opinion, is a sine qua non for any house so let, and power should be given to the Council to enforce it. Certain alterations are also made in the size of the rooms of the houses of this kind, so as to form passage ways or partitions between parts of the house occupied by different 55 families. These structural alterations should be regarded as the erection of a new building and the Byelaws with respect thereto should apply. Legal poivers necessary. The following clauses are suggested for adoption in the Council's Bill to be promoted in the session 1912: - Houses let in Lodgings. 1. (1). When a house or part of a house is let in lodgings or occupied by members of more than one family, it shall be the duty of the landlord to notify immediately to the Sanitary Authority that a house or part of a house is so let or occupied and to furnish the address of the house and such other particulars as the Sanitary Authority may require. (2). Any landlord failing to comply with Sub-section (1) of this Section shall be liable to a penalty not exceeding five pounds. 2. The Sanitary Authority shall cause to be kept a register in which shall be entered such particulars as the Council's Byelaws require with regard to any house or part of a house let in lodgings or occupied by members of more than one family, whether or not notification has been received from or given to the landlord that such house or part of a house is let in lodgings or occupied by members of more than one family. 3. (1). No house or part of a house shall be let to two or more tenants or occupied by members of more than one family, unless and until separate sanitary accommodation (including closet accommodation, sinks, sink-wastes and water supply) is provided to the satisfaction of the Sanitary Authority. (2). The landlord of any house let in contravention of Sub-section (1) of this Section shall be liable to a penalty not exceeding five pounds. Alterations on Existing Premises. 4. Every person who proposes to alter the structure of any existing dwelling house, or to alter the mode of occupancy 56 of any existing dwelling house in such a manner as to increase the number of rooms, houses or occupiers, and whether the alterations be or be not such as to affect the external dimensions thereof shall be deemed to erect a new building. (Glasgow). COMMON LODGING HOUSES. There are two registered common lodging houses within the district. There are probably others, but considerable difficulty attaches to proving that any house is a common lodging house, as the Officers of the Local Authority have no right of entry for this purpose. For the proper control of common lodging houses and common lodging house keepers, it is requisite that registration should operate for one year only. The effect of this would be, that the Council would require to be satisfied from year to year, that the common lodging house was properly managed under the Byelaws before registration would be re-granted. In dealing with common lodging houses, it is essential that the Council should bave power to state which rooms, if any, are to be occupied by females, and which to be occupied by both sexes. The Council should also be empowered to require that sufficient means of escape are provided in case of fire at common lodging houses. Legal powers necessary. In connection with the above matters, the following clauses are suggested for insertion in the Council's Bill to be promoted during the Session of 1912:— As to entry. 1. (1). Where the Medical Officer of Health or Inspector of Nuisances has reason to believe that any premises are being occupied as a common lodging house, and on sufficient cause being shewn, the Local Authority may authorise such Medical Officer of Health or Inspector of Nuisances, with or without assistants, to enter the premises at any time of day 57 or night and make such inspection or inspections as may be necessary, and to report the results of each and every inspection or inspections authorised by them to the Local Authority. (2). Any person or persons obstructing the duly authorised Officers of the Local Authority acting under Sub-section (1) of this Section, shall be liable for each offence to a penalty of five pounds. Registration of Common Lodging Houses and Keepers. 2. (1). Notwithstanding anything in the Public Health Act, 1875, the registration of a common lodging house or of the keeper of a common lodging house shall operate for one year only, and application for the renewal of such registration shall be made to the Council on or previous to the 31st day of December in every year. (2) a. The Council may, notwithstanding the provisions of Section 78 of the Public Health Act, 1875, refuse to register or to re-register any person as a common lodging house keeper unless they are satisfied of his character and fitness for the position. b. Any person aggrieved by such refusal may appeal to a Court of Summary Jurisdiction within fourteen days after such refusal, provided he give twenty-four hours notice of such appeal and of the grounds thereof to the Clerk, and the Court shall have power to make such Order as they may think fit and to award costs. (3). Every person, who, without being registered in accordance with the Public Health Act, 1875, and this Act, shall keep a common lodging house within the district and every person, who, after the 31st day of December, 1912, shall keep a common lodging house without the registration of such person and of such house being renewed for the current year, shall be liable to a penalty not exceeding forty shillings. (Birmingham). 58 Separation of the Sexes. 3. No part of a common lodging house shall be used or occupied as a sleeping apartment without the consent in writing of the Council by any person of the female sex. An offence against this enactment renders the keeper liable to immediate cancellation of his registration by the Council. Means of escape from Common Lodging Houses in case of fire. 4. From and after the passing of this Act, the keeper of any common lodging house situate within the district, shall provide in connection therewith such means of escape in the case of fire for the persons dwelling therein as may be reasonably required under the circumstances of the case to the satisfaction of the Council. Any person offending against the provisions of this Section, shall be liable to a penalty not exceeding five pounds and to a daily penalty not exceeding forty shillings. DAIRIES, COWSHEDS AND MILKSHOPS. There are 17 cowsheds, with 158 cows and 71 dairies and milkshops in the district. These are subjected to fortnightly inspection, but the condition of many is not such that clean milk is likely to be produced therein. During the year, one prosecution was undertaken by the Council under the Dairies, Cowsheds and Milkshops Orders and the Council's Regulations, with the result that the occupier was fined £5 and ordered to comply with the regulations within a period of two months. In my opinion, the condition of the premises was such that they were not fit for occupation as cowsheds, having regard to the fact that there is no food on the market more susceptible to contamination, more prone to carry disease or more in use for babies, young children or invalids. It is necessary that power should be granted the Council, not only to register cowkeepers but also their premises, provided always they are suitable for the purposes of the business to be carried on. 59 The relationship of Tuberculosis and other infectious diseases to the milk supply has now been established, and as the Council are the guardians of the health of the inhabitants of the district, they should be in a position to deal with all milk produced within or without the district by which disease is spread therein Legal powers necessary. For the better regulation of the milk traffic and the prevention of diseases communicable by milk, further power's are required. The following clauses are suggested for insertion in the Council's Bill to be promoted in 1912 :— Registration of Dairies and Dairymen. 1. (1). A person shall not carry on the trade of dairyman in any dairy from which milk is supplied within the district of Heston and Isleworth, unless he and the dairy are registered with the Council in accordance with this Act, and if he does so he shall be guilty of an offence and shall be liable on summary conviction to a fine not exceeding five pounds. Provided that, (a). In the case of a farm comprising several cowsheds, it shall not be necessary to register each cowshed as a separate dairy. (b). In the case of a purveyor of milk not having a dairy within the meaning of this Act, the place where he keeps the vessels used by him for the purpose of the sale of milk, shall be deemed to be a dairy for the purposes of this Section. (2). The District Council may remove any dairy from the register, or may refuse to register any premises as a dairy, if (a). The premises become or are unsuitable to the purposes of the business carried on, or proposed to be carried on, therein ; or (b). The premises are a nuisance or do not comply with the provisions of this Act; 60 but any person who feels himself aggrieved by such removal or refusal may appeal to a Court of Summary Jurisdiction, which may, if it thinks just, make an order requiring the Council to restore the dairy to, or enter the dairy in the register. (3). On the second or subsequent conviction of a dairyman of an offence against this Act, the Court by which he is convicted, may, if it thinks fit, having regard to the nature of the offences of which he has been convicted, in addition to or in substitution of any other penalty, order that the name of the offender he removed from the register of dairymen either absolutely or for such period as may be specified in the Order. Power to take samples of Milk. 2. (1). It shall be lawful for the Medical Officer or any person provided with and if required, exhibiting the Authority in writing of such Medical Officer to take within the district for examination, samples of milk produced or sold or intended for sale within the district. (2). The like powers in all respects may be exercised outside the district by the Medical Officer or such authorised person, if he shall first have obtained from a Justice having jurisdiction in the place where the samples are to be taken, an Order authorising the taking of samples of the milk, which Order, any such Justice is hereby empowered to make. (Acton). Inspection of Dairies and Prohibition of Supply of Milk. 3. (1). If the Medical Officer for the district has evidence, that any person is suffering from an infectious disease attributable to milk supplied within the district from any dairy situate within the district, or that the milk from any such dairy is likely to cause any such disease to any person, such Medical Officer shall visit such dairy and shall examine the dairy, and every person engaged in the service thereof and resident upon the premises, or who may 61 be resident in any premises where any person employed in such dairy may reside, and if accompanied by a Veterinary Surgeon, shall inspect the cows kept in such dairy and shall forthwith report the results of his examination, accompanied by the report of the Veterinary Surgeon, if any, to the District Council or any Committee of the District Council appointed to deal with such matters, and to the Local Government Board. (Acton). (2). If the Medical Officer has evidence that any person in the district is suffering from any infectious disease attributable to milk from any dairy without the district, or that the milk from any such dairy is likely to cause any such disease to any person residing in the district, the powers conferred by this Section may in all respects be exercised by such Medical Officer. Provided that the Medical Officer or other authorised person shall first have obtained from a Justice having jurisdiction in the place where the dairy is situate, an Order authorising such entry and inspection, which Order, any such Justice is hereby empowered to make. Provided also that the Medical Officer or other authorised person aforesaid shall in all cases where reasonably practicable without involving delay in the exercise of the powers of this Section, give to the Medical Officer of the district in which the dairy is situate, previous notice in writing of his intention to enter such dairy for the purposes of this Section. (Acton). (3). If, on any such inspection, the Medical Officer or the Veterinary Inspector or Surgeon, has reason to suspect that any cow in the dairy is suffering from Tuberculosis with emaciation or from Tuberculosis of the udder, or is giving tuberculous milk, he may require the cow to be milked in his presence and may take samples of the milk, and the milk from any particular teat shall, if he so requires, be kept separate and separate samples thereof furnished. (Acton). (4). Every dairyman and the persons in his employment shall render such reasonable assistance to the Medical Officer 62 of Health or a Veterinary Inspector or Veterinary Surgeon as he may require for all or any of the purposes of this Section, and any person refusing such assistance or obstructing such Medical Officer of Health or Veterinary Inspector or Veterinary Surgeon in carrying out the provision of this Section, shall, on summary conviction, be liable to a fine not exceeding five pounds. (Acton). (5). On the receipt of such a report, the District Council may serve on the dairyman, notice to appear before them within such time, not less than forty-eight hours after service of such notice, as may be specified in the notice, to show cause why an Order should not be made prohibiting him, either absolutely or unless such conditions as may be prescribed in the Order are complied with, from supplying for human consumption, or using or supplying for use in the manufacture of products for human consumption within the district any milk from the dairy or from any particular cow kept therein, until the Order has been withdrawn in accordance with the provisions of this Section. (Acton). (6). The Council, if, in their opinion, the dairyman fails to show such cause, may make such Order as aforesaid, specifying the ground on which the Order is made, and shall forthwith serve a copy of the Order on the dairyman, and shall serve notice of the facts on the Council of the County in which the dairy is situate, and on the Local Government Board, the Board of Agriculture and Fisheries, and, if the dairy is situate within the jurisdiction of another Local Authority, also on that Authority. (Acton). (7). It shall be lawful for the Council, if they think fit, to repay to any dairyman who shall have appeared before them pursuant to any notice in that behalf served on him by the Council, the whole or any part of the expenses reasonably incurred by such dairyman in attending for the purpose of such appearance. 63 (8). If any dairyman, whilst any Order made under this Section of which he has notice is in force, supplies or uses any milk in contravention of the Order, he shall on summary conviction be liable to a fine not exceeding five pounds, but a dairyman shall not be liable to an action for breach of contract if the breach is due to any such Order. (Acton). (9). An Order made under this Section shall be forthwith withdrawn, on the Council being satisfied that the milk supply has been changed or that it is not likely to cause infectious disease. (Acton). (10). The dairyman may appeal against an Order made under this Section or a refusal to withdraw any such Order:— (a). To a Petty Sessional Court having jurisdiction within the district; or at his option if the dairy is situate outside the district. (b). To the Local Government Board, if the Order is made on the ground that an infectious disease (other than Tuberculosis or any other disease with respect to which the Local Government Board order that the appeal in all cases should be to the Board of Agriculture and Fisheries) was or was likely to be caused by the consumption of milk from the dairy or from any cow kept therein; and (c). In any other case, to the Board of Agriculture and Fisheries; and on any such appeal, the Officer appointed by the Board to hear the appeal shall report to the Board. (Acton). (11). The Court or the Board, as the case may be, may confirm, vary or withdraw the Order which is the subject of the appeal, and may direct to and by whom the costs of the appeal are to be paid, and the Board may at any stage of the proceedings require the dairyman to pay such sum, not being more than ten pounds, as the Board consider proper to secure- the payment of the expenses incurred by the Board in the matter of the appeal, and the expenses so incurred by the Board (including the remuneration of the Officer appointed 64 to hear the appeal not exceeding three guineas a day) shall be treated as part of the costs of the appeal. Pending the decision of the appeal, the Order shall remain in force unless previously withdrawn. (Acton). (12). For the purposes of an appeal under this Section, the Local Government Board and the Board of Agriculture and Fisheries, and any Officer appointed by either such Board shall have the same powers as the Local Government Board and their Inspectors have for the purposes of an inquiry under the Public Health Acts. (13). If any Order is made under this Section by the Council without due cause, or if the Council unreasonably refuse to withdraw any such Order, the dairyman shall, if not himself in default, be entitled to recover from the Council, full compensation for any damage which he has sustained by reason of the making of the Order or of the refusal to withdraw the Order, and in the case of an appeal, the Court or Board to whom the appeal is made, may determine and state whether an Order, the subject of appeal, has been made without due cause, and whether the withdrawal of the Order has been unreasonably refused and whether the dairyman has been in default. (Acton). (14). Any dispute as to the fact whether the Order has been or maintained without due cause, or as to the fact of default (where any such fact has not been determined on appeal by the Court or Board to whom the appeal is made) or as to the fact of damage, or as to the amount of compensation, shall be determined in the manner provided by Section 308 of the Public Health Act, 1875, and that Section shall accordingly apply and have effect as if the same were herein re-enacted and in terms made applicable to any such dispute as aforesaid. (Acton). (15). Where the Council have delegated their powers under this Section to a Committee, anything authorised or required by this Section to be done to or by the Council, shall be done to or by the Committee. 65 Compensation to Dairyman. 4. If any dairyman shall, at the request of the District Council, stop his milk supply within the district on account of the spread or suspected spread of infectious disease or the probability that the consumption of such milk may cause infectious disease to persons residing within the district, the Council may make compensation to him for any loss occasioned by such stoppage, and any such compensation may be paid out of the District Fund or General District Rate. (Acton). Obligation to notify cases of Tuberculosis. 5. (1). Every dairyman who supplies milk within the district, and has in his dairy any cow affected with or suspected of or exhibiting signs of Tuberculosis of the udder or Tuberculosis with emaciation or yielding Tuberculous milk, shall forthwith give written note of the fact to the Medical Officer, stating his name and address and the situation of the dairy or premises where the cow is. (2). Any dairyman failing to give such notice as required by this Section, shall be liable to a penalty not exceeding forty shillings. (Birmingham). Prohibition of sale of Tuberculous milk. 6. (1). If a person (a). Knowingly sells or offers or exposes for sale or suffers to be sold or offered or exposed for sale, for human consumption or for use in the manufacture of products for human consumption; or (b). Knowingly uses or suffers to be used in the manufacture of products for human consumption; Tuberculous milk or the milk of any cow which is suffering from Tuberculosis or other disease of the udder, or which is emaciated from Tuberculosis, he shall for each offence be liable on summary conviction to a fine not exceeding ten pounds, unless he proves that the milk has been boiled or otherwise sterilised. (Acton). 66 (2). Any dairyman after he becomes aware that any cow in his dairy is suffering from Tuberculosis with emaciation or from Tuberculosis of the udder, or is giving Tuberculous milk, shall so far as is practicable, not keep that cow or permit it to be kept in any field, shed, or other premises along with other cows in milk, and if he does so he shall be liable on summary conviction to a fine not exceeding five pounds. (Birmingham). SLAUGHTER HOUSES. On the 13th December, 1910, the Local Government Board issued a letter from which the following is quoted :— " The Board desire to be informed precisely what arrangements are made by the Council for the inspection of meat in the district, and they request that the Medical Officer of Health may be instructed to include in his Annual Report an account of these arrangements, showing how many slaughter-houses there are in the district; whether they are visited at times of slaughtering ; whether there is an Inspector with a special certificate in meat inspection; whether any, and, if so, how many carcases or parts of carcases were found to be tuberculous; and what action was taken in each case in which tuberculosis was detected." There are 11 slaughter-houses in the district, three of which are licensed and the rest registered. The Inspector of Nuisances acts as Meat Inspector, but holds no certificate in meat inspection. One of the Assistant Inspectors possesses the required qualification, but has no status under the Public Health Act to seize meat. In a wide district like this with a number of slaughter-houses to supervise, in all of which killing takes place on Thursdays, it is impossible for one man to cover the ground. This is one reason why the Council requires power to appoint more than one Inspector of Nuisances, i.e., to convert its Assistant Inspectors into Inspectors with statutory powers. Under existing conditions meat inspection cannot be thorough. 368 visits have been paid during the year, or about 33 visits to 67 each slaughter-house. No carcases or parts of carcases were found to be tuberculous. So long as the district is without a public slaughter-house in which all meat must be killed, or to which all meat must be brought before being deposited for sale within the district, the public are without any security as to the quality or wholesomeness of the meat offered for sale. In the promotion of a Bill it is essential if the public health is to be safeguarded in this very important particular, that provision should be made for the establishment of a public abattoir, and the prohibition of slaughtering in all places other than those provided, licensed or registered by the Council. Legal Powers necessary. The following clauses are suggested for insertion in the Council's Bill to be promoted during 1912 :— Slaughtering prohibited except in Slaughter-houses provided, licensed or registered by the Council. 1. It shall not be lawful for any person, except with the conseut of the Council, to slaughter for sale any cattle, or to dress for sale the carcase of any cattle in any place within the district other than a slaughter-house provided or licensed by the Council, or an existing registered slaughter-house, and any person acting in contravention of this enactment shall be liable to a penalty not exceeding five pounds. (Birmingham). Provision as to Registered Slaughter-houses. 2. If any registered slaughter-house within the district is not used for a period of three months, the Council may forbid the slaughtering of cattle therein, and may refuse to grant a licence in respect of such slaughter-house. Any person who slaughters cattle in a slaughter-house in which the slaughtering of cattle has been forbidden under this section, or who allows such slaughter-house to be used for the purpose of the slaughter of cattle, shall be liable to a penalty not exceeding five pounds for such offence, and to a penalty of five pounds for every day on which such offence is committed after the conviction of the first offence. 68 Slaughtering prohibited except in Council Slaughter-houses when provided. 3. (1.) At any time after the passing of this Act the Council may— (a). Acquire by agreement any premises within the district used for the purpose of slaughtering cattle (hereinafter referred to as a "slaughter house") and the interest or interests of any owner, lessee and occupier of such premises. (b). Agree with the owner, lessee or occupier of any slaughter-house for the abolition of slaughtering therein, on such terms and conditions as may be arranged between the parties. (2.) At any time after the expiration of three years from the passing of this Act, and after the Council have provided an adequate slaughter-house in a convenient position (to the satisfaction of the Local Government Board), and after the expiration of six calendar months from the date of publication by the Council in a local newspaper circulating in the district of notice to that effect, no person shall slaughter for sale for human food any cattle within the district except in slaughter-houses provided by the Council, but this shall not apply to the slaughtering on premises by the owner, lessee or occupier thereof of any cattle belonging to him and not slaughtered for the purpose of sale for human food, and if any person acts in contravention of this Section he shall be liable for each offence to a penalty not exceeding five pounds. (3.) The Council shall pay compensation to the owner, lessee and occupier of every slaughter-house who may be injuriously affected by the exercise of the above powers, and the amount of compensation shall in case of difference be settled as cases of disputed compensation are settled under the Land Clauses Acts, and the provisions of those Acts shall apply accordingly. (Acton). 69 Power to License Slaughter-houses. With respect to the licencing of slaughter-houses the following provisions shall have effect, (namely) :— 1. The Council may from time to time grant licences for the use of buildings as slaughter-houses, and they may demand a sum not exceeding twenty shillings for any such licence for twelve months, and in the like proportion for any shorter period, and they may grant such licences on such terms and conditions and subject to such restrictions as may be specified in such licence. 2. They may by order suspend or revoke the licence for any slaughter-house if in their opinion the same is a nuisance, or if the owner or proprietor thereof has been twice convicted of offending against the provisions of any Act, Order or Byelaw relating to slaughter-houses or the slaughtering of cattle, but an appeal shall lie from any such Order at any time within three months from the date thereof to a Court of Summary Jurisdiction, who may confirm, vary or revoke such Order. 3. In case of any such suspension or revocation the Council shall give notice thereof to the owner or occupier of such slaughter-house. 4. He shall not be obliged to discontinue the use of the slaughter-house pending an appeal by him against the Order. 5. If any person, except during the pending of such appeal as aforesaid, slaughters or dresses for sale any animal in any slaughter-house the licence for which is suspended or revoked, he shall be liable to a penalty not exceeding five pounds. 6. If any licensed slaughter-house is not used as such for the space of three months the Council may revoke the licence thereof. 70 7. The Council may from time to time make byelaws for the management and inspection of licensed slaughterhouses and for the prevention of cruelty therein, and for the cleansing thereof, and for the supplying thereof with water. (Birmingham). Council to collect refuse from Slaughter-houses provided by them. 5. The Council shall have the sole and exclusive right to and property in the filth, dung and other such refusearising in the slaughter-houses provided and established by the Council, and shall collect and dispose of the same as they shall deem expedient. (St. Helens). Provision as to Animals, dtc., slaughtered outside the District, and brought into the District for Sale. 6. After the Council have provided an adequate slaughterhouse in a convenient position (to the satisfaction of the Local Government Board), any animal carcase, meat, poultry, game, flesh or fish brought into the district shall be brought forthwith to the clearing house of the said slaughter-house, and be duly certified by a qualified meat inspector duly appointed by the Council before being exposed for sale, or deposited for the purpose of sale, or of preparation for sale, and intended for the food of man within the district. Any person acting in contravention of this Section shall be liable to a penalty not exceeding five pounds for the first offence, and in the case of each succeeding offence to a penalty not exceeding fifty pounds, or at the discretion of Justices may be sent to prison for a term of not more than six months without the option of a fine. Poiver to establish Cold-air Stores, &c. 7. (1.) The Council may, on any land for the time being belonging to them, or acquired by them for the purpose, construct and maintain in connection with any markets or public slaughter-houses or abattoirs established by them, a refrigerator or cold-air store with all machinery, apparatus and appliances necessary for the proper working and use thereof and for the 71 storage and preservation of meat and other articles of food, provided that the Council shall not use for the purpose of this Section any lands vested in them for any other purposes except with the consent of the Local Government Board, and upon and subject to such terms and conditions as that Board may impose. 2. The Council may demand and take in respect of the use of any such refrigerator or cold air store, such charges as the Council may determine. 3. The Council may lease for any term not exceeding twenty-one years, any such refrigerator or cold-air store, or any part thereof, at such rent and on such terms and conditions as the Council may think fit. (Birmingham). BAKEHOUSES. There are thirty-four bakehouses in the district, only one of which is underground. Seventeen of the bakehouses are old. The majority are in good or fair condition. A certain proportion do not have a water supply taken directly off the main. In all places where food is prepared the storage of water in a tank before use is not to be recommended. FOOD. It is difficult to estimate the misery which may result from the ingestion of unsound food stuffs, or the continued ingestion of food stuffs which have been stored or treated without a due regard for cleanliness. The practice of blowing or inflating carcases is one which is calculated to allow disease germs from the breath or air to gain access to meat, to multiply therein and cause disease to the consumer. Again, the barrows on which fish, fruit and meat are found exposed for sale on the street are usually found in a filthy state and saturated with the liquids of many previous loads. The excess which is not sold from these barrows is not as a rule stored under clean or suitable conditions. 72 Upon all occasions tbe housewife is anxious to get the best value for her money, but with all due respect to this excellent object, it must be stated emphatically that the practice of handling meat and fish by numerous prospective purchasers without any precautions involves the risk of spreading disease, and should be controlled. For the proper inspection of food stuffs brought into the district, it is also necessary that the Medical Officer of Health and Inspector of Nuisances should have power to open boxes of provisions. Legal Powers necessary. With the object of properly controlling the food of the inhabitants of the district, the following clauses are suggested for insertion in the Council's Bill to be promoted in 1912 :— Prohibition of Blowing or Inflating Carcases. 1. (1.) It shall not be lawful to blow or inflate the carcase, or any part of the carcase, of any animal slaughtered within or brought into the district. (2.) Any person who shall offend against the provisions of sub-section (1) of this Section, or shall expose or deposit for sale within the district a carcase so blown or inflated, or any part thereof, shall be liable to a penalty not exceeding twenty shillings. (Acton.) To ensure Cleanliness in the Manufacture and Sale of Food, &c. 2. The Council may make Byelaws— (1.) For ensuring cleanliness in the manufacture and sale of food or drink. (2.) For preventing undue exposure, or risk of contamination of articles of food or drink. (3.) For providing that food and drink shall be conveyed within or through the district under clean conditions, and without risk of contamination. 73 Power to Medical Officer of Health and Inspector of Nuisances to open boxes, &c., containing Provisions. 3. For the purpose of enabling the Medical Officer of Health or Inspector of Nuisances to effectually inspect and examine under the provisions of Section 116 of the Public Health Act, 1875, any article sold or exposed for sale or deposited in any place for the purpose of sale, or of preparation within the district and intended for the food of man, such Medical Officer of Health or Inspector of Nuisances may, subject to the provisions of Section 308 of the Public Health Act, 1875, open any box or other receptacle in which any such article may be contained, and any person who shall obstruct any such officer or inspector in the execution of this Section shall be liable to a penalty not exceeding ten pounds. ICE CREAM. There are several manufacturers of this commodity in the district. It is prepared here as elsewhere, without a proper regard for the production of a clean and wholesome finished product. Many diseases have been attributed to the eating of contaminated ice cream, and when it is remembered that it forms one of the luxuries of children, the necessity for regulating the trade becomes obvious. Legal Powers necessary. With a view to the efficient control of this trade, the following clauses are suggested for the Council's Bill to be promoted in 1912 :— 1. (1.) Any officer duly authorised by the Council in that behalf, shall at all reasonable times have the same power of entry and inspection into, and of the premises of any manufacturer or vendor of, or merchant or dealer in ice cream or other similar commodity, for the purpose of inspecting such premises and the materials, or commodities, or articles of food therein, as an officer of the Council would have under Section 102 (Power of entry of Local Authority) of the Public Health Act, 1875, in the cases therein mentioned. 74 2. Any person refusing entry into such premises as aforesaid or obstructing such officer as aforesaid in the execution of his duty shall be liable to a penalty not exceeding forty shillings. 2. In the event of any inmate of any building (any part of which is used for the manufacture of ice cream or similar commodity) suffering from an infectious disease, the Medical Officer may seize and destroy all ice cream, or similar commodity, or materials for the manufacture of the same, in such building, and the Council shall compensate the owner of the ice cream commodity or materials so destroyed. (Birmingham, 1903). 3. In the event of any ice cream or similar commodity or materials for the manufacture of the same being manufactured, or in process of manufacture, or stored for purposes of manufacture contrary to the provisions of this Act, or any Byelaw made thereunder, the Medical Officer of Health may seize and destroy the aforesaid ice cream or similar commodity or materials for the manufacture of the same, and the manufacturer or owner of the said ice cream or similar commodity or materials for the manufacture of the same, shall be liable to a penalty of twenty pounds. 4. Every dealer in ice-cream or other similar commodity vending his wares from any cart, barrow or other vehicle or stand, shall have his name and address legibly painted or inscribed on such cart, barrow, vehicle or stand, and any person who shall fail to comply with this sub-section shall be liable to a penalty not exceeding forty shillings. For regulating the Manufacture and Sale of Ice Cream. 5. The Council may make Byelaws 1. For regulating the manufacture and sale of ice cream. 2. For securing the cleanliness of ice cream, and the vessels used in its manufacture and sale. 75 3. For prescribing the precautions to be taken against infection and contamination. 4. For the registration of ice cream vendors, manufacturers, shops, stores, carts and places of manufacture. OFFENSIVE TRADES. Section 51 of the Public Health Acts Amendment Act, 1907, came into force in this district on 31st May, 1910, and it is necessary under this Section to specify which trades are offensive. The matter has been before the Council on two occasions, and so far the following trades have been declared offensive by the local authority:— Blood-drier. Tanner. Leather-dresser. Fat-melter or Fat-extractor. Glue-maker. Size-maker. Gut-scraper. Fish-frier. Parchment-maker and Marine store dealer. In the case of the last named, it is to be noted that all parts of this trade are not necessarily offensive, and it will probably be necessary before the sanction of the Local Government Board can be obtained to the order, to specify the articles dealt in which make certain departments of this trade offensive. Since the Council's resolution on November 22nd, 1910, declaring the above trades to be offensive, the question of establishing a varnish-making factory within the district has been before the Council. In order to give the Council discretionary power to deal with such questions as they arise, it is necessary that varnish-making and all and every offensive trade should be added to the above list. This matter is at present under consideration. 76 The relationship of Town Planning to offensive businesses is also a matter for consideration, and was duly put forward by me in the following letter on the establishment of the above.mentioned varnish.making factory, addressed to the Clerk of the Council on 24th December, 1910. December 24th, 1910. Dear Sir, Proposed establishment of a Varmsli.Making Factory at Walnut Tree Cottage, Jersey Road, Lampton. I have duly considered the above matter and beg to inform you that the processes employed in varnish.making are of an offensive nature. The vapours given off are very pungent, irritating and far.reaching, affecting the eyes and causing headache, malaise, nausea and vomiting. I have also inspected the proposed site and am of opinion that the establishment of a business of this kind here, would prevent the development of the land for some distance round, At the same time it should be borne in mind that certain methods can be adopted to minimise the nuisance arising in connection with varnish.making and other offensive trades, and it is a point for consideration, if a portion or portions of the district under the control of the Council, might not be set apart for such businesses with due regard to proper sanitary conditions, amenity and convenience, as provided for in the Housing, Town Planning, etc., Act, 1909. I am, Yours Faithfully (Signed) Gb;orge F. Buchan, H. J. Baker, Esq. Medical Officer of Health. Clerk. The point has been referred to the General Purposes Committee of the Council for consideration. Legal Powers Necessary. With reference to the adequate control of these offensive trades, the following clause defining the establishment of a new business is suggested for insertion in the Council's Bill to be promoted in 1912:— 77 De.fining the Establishment of a New Business. For the purpose of Section 112 of the Public Health Act, 1875, and Section 51 of the Public Health Acts Amendment Act, 1907, and any bye.laws made thereunder, a trade, business or manufacture shall be deemed to be established anew not only if it is newly established, but also if it is removed from any one set of premises to any other premises, or if it is renewed on the same set of premises after having been discontinued for a period of one month or upwards, or if any premises on which it is for the time being carried on are enlarged without the sanction of the Council, but a trade, business or manufacture shall not be deemed to be established anew on any premises by reason only that the ownership of such premises is wholly or partially changed or that the building in which it is established having been wholly or partially pulled down has been reconstructed without any extension of its area. (Acton). TENTS, VANS, SHEDS AND SIMILAR STRUCTURES. The question of these buildings has received attention at the hands of the Health Committee, during the year. Two prosecutions were instituted under the bye.laws in respect of tents, vans, sheds and similar structures, on December 1st, 1910. In one case the tent.dweller did not answer the summons, and the justices adjourned the other case for a month, to give the tent.dweller an opportunity to conform to the bye.laws. At the expiry of the month the two tents had disappeared, but; other tents with similar contraventions of the bye.laws, had taken their places. At the end of the year, thirteen tents and vans were occupying the field on which the two original offenders had camped, and the Health Committee had under consideration, the question of proceeding under Section 34 of the County Council of Middlesex (General Powers) Act, 1906, for " an order prohibiting the further occupation of the land by any squatter, gipsy or other person, so as to cause injury to residents in the neighbourhood, or to be a nuisance or dangerous or injurious to health." 78 The van and tent.dwellers on this land informed me that they each paid a weekly rent to the owner, and I am of opinion that it is necessary that the Local Authority should have power to proceed against an owner of land who allows it to be occupied by tents and vans which contravene the Council's bye.laws with respect to these structures. It is not a practical proposition that the Council should have power to summons only the tent or van.dwellers, who are here one day and gone the next, and have no authority to deal with the owner of land who allows it to be occupied by dwellers in tents, vans, sheds, or similar structures, without exercising any supervision over, or making any provision for them. In the case of the field referred to above and occupied by 13 tents and vans and a population of at least 32 persons (including children) at the end of the year, 1910, the only water available for domestic purposes, was that running in a ditch at the foot of the field and derived from land drainage. Legal Powers Necessary. The following is the text of a suggested clause for insertion in the Council's Bill to be promoted in 1912:— With respect to Tents, Vans, Shells and Similar Structures. The owner or occupier of any land, after receiving due notice of the bye.laws of the Council relating to tents, vans, sheds and similar structures, and notwithstanding anything contained in the said bye.laws or other Act in force in the district, shall be responsible for such contraventions of the said bye.laws as exist in connection with any tent, van, shed or similar structure lodged upon his land. REPORT ON THE ADMINISTRATION OF THE FACTORY AND WORKSHOP ACT, 1901, IN CONNECTION WITH FACTORIES, WORKSHOPS AND WORKPLACES. The above Act places upon the Local Authority the following duties relating to:— 79 A. Factories: (1) Seeing that means of escape in case of fire are provided ; (2) Enforcing the provision of suitable and sufficient sanitary conveniences. B. Workshops and Workplaces. (1) Sanitary condition, including (a) cleanliness, (6) air space, (c) ventilation, (d) drainage of floors, and (e) sanitary accommodation ; (2) Provision of means of escape from fire in workshops ; (3) Special sanitary regulations for bakehouses; (4) Home work. These duties are discharged by the Inspector of Nuisances, and a statement of the number of inspections made and defects noted is to be found in Tables VI., VII., VIII., IX. and X., duly filled in as required by the Home Office. The names and addresses of 19 home.workers were forwarded during the year by employers or other Councils, to the Medical Officer of Health as required by the Act. Five of these 19 home.workers resided outside the district. The premises of the remaining 14 have been visited. No case of infectious disease was reported on the premises of out.workers during the year. Sanitary Accomviodation. The administration of the Factory and Workshops Act so far as it relates to the above, is placed in the hands of the Medical Officer of Health, subject to the control of the Council, and in the Annual Report which this Officer is required by Section 132 of the Act to present to the Home Office, he is asked to state whether Section 22 of the Public Health Acts (Amendment) Act, 1890, is in force in the district, and what standard of sufficiency and suitability of sanitary accommodation is adopted. 80 Section 22 above referred to is in force in the Urban District of Heston and Isleworth, but gives the Local Authority power to act, in cases where sufficient and suitable sanitary accommodation has not been provided in workshops and work places, only on the report of their Surveyor, whose duties do not require him to visit specially these places For obvious administrative reasons, the provisions of Section 22 (2) of the Public Health Acts (Amendment) Act, 1890, should be extended so as to apply as to report to the Medical Officer of Health or Inspector of Nuisances. Legal powers necessary. The following is the text of a suggested clause for insertion in the Council's Bill to be promoted in 1912 :— Extending Provisions of Section 22 (2) of the Public Health Acts (Amendment) Act, 1890. From and after the commencement of this Act, Section 22 Sub.Section (2) of the Public Health Acts (Amendment) Act, 1890, as to the report of the Surveyor, shall extend and apply to the Medical Officer of Health or Inspector of Nuisances, and such Sub.Section so far as it affects the district, shall be read as if the words " their Surveyor or Medical Officer of Health or Inspector of Nuisances" were inserted instead of the words " their Surveyor." (Birmingham) HAIRDRESSERS' SALOONS. Many of these saloons are small, ill.ventilated and not over. clea.n. It is well known, too, that a number of cases of ringworm of the beard (barber's rash) are traceable to the use of brushes, towels or instruments infected by some previous customer. Cases of this kind can be prevented if proper precautions are taken. Legal powers necessary. The following is the text of a suggested clause to give the Council power to make Byelaws in connection with the above The Local Authority may make Byelaws, (1). For the registration of hairdressers and hairdressers' saloons. 81 (2). For promoting cleanliness and ventilation in such saloons. (3). For prescribing the measures to be adopted for the prevention of the spread of disease therein. (City of London). CANAL BOATS ACTS, 1877 AND 1884. The following is the Annual Report on the administration of the above Acts in the form required by Section 3 of the Canal Boats Act, 1884 :— Health Department, Council House, Hounblow. January 3rd, 1911. To the Secretary, Local Government Board. Sir, In accordance with Section 3 of the Canal Boats Act, 1884, I beg herewith to present the Annual Report for the year ending December 31st, 1910, as to the execution of the Canal Boats Acts, 1877 and 1884, and of the Regulations made thereunder, within the Urban District of Heston and Isleworth, Middlesex. James Isaac Smith, whose office is at the Council House, Hounslow, continued to act as Canal Boat Inspector during the year. He receives £20 per annum as Inspector of Canal Boats and Inspector of Dairies, Cowsheds and Milkshops. Three hundred and six inspections were made of 211 boats. On 28 of these boats, 44 infringements of the Acts and Regulations were found as under :— Number of boats with 1 infringement only 15 Number of boats with 2 but not 3 infringements 10 Number of boats with 3 infringements 3 82 The following table gives details as regards these contra ventions:— Infringements with Respect to Carried forward from 1909. Found during 1910. Remedied during 1910. Carried forward to 1911. (a) Registration 2 2 (b) Notification of change of Master (c) Certificates 3 6 7 2 (d) Marking 1 5 4 2 (e) Overcrowding 1 1 (f) Separation of the Sexes 2 2 (g) Cleanliness 6 6 (h) Ventilation 6 4 2 (i) Painting 1 1 (j) Provision of Water Cask 2 3 5 (k) Removal of Bilge Water (l) Notification of Infectious Disease (m) Admittance of Inspector (n) Habitable Condition 2 12 12 2 8 44 44 8 Legal proceedings were taken against an owner in the case of two boats for contraventions under (n) in the foregoing table. A fine of ten shillings with half.a.guinea costs was inflicted in each case. 83 Last year, I referred to the want of provision in the Canal Boats Acts for identification of the owner of the boat, as illustrated by a case which came under notice. This year, I desire to call attention to the fact that the Inspector of Canal Boats for this district has no right of entry on a Canal Boat under the Canal Boats Acts, except he has reasonable cause to suppose that there is a contravention of the Acts on board the Canal Boat or that there is on board a person suffering from an infectious disorder. In two cases, the Canal Boat Inspector entered a boat on which he had no cause to suppose either of the above conditions. The certificates of registry were not produced by the man in occupation, but as he was not the Master, no offence under the Acts was committed. No case of infectious disease was reported as occurring amongst the Canal Boat population during the year. I am, Sir, Your obedient servant, Geobge F. Buchan, Medical Officer of Health. 84 Note.—In recording the facts for the year 1910, under the various headings of the following Tables I., II., III., IV. and V., attention has been given to the notes on the Tables sent to Medical Officers of Health by the Local Government Board. Table I. Vital Statistics of Whole District during 1910 and previous years. Year. Estimated Popula tion to middle of year. Births. Total Deaths Registered Total Deaths in public institu tions in District Deaths of non. resid'ts regist'd in public institu tions in District Deaths of re sidents regist'd in public Institu tions 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 1900 30,040 813 270 127 156.2 682 23*0 262 163 ... 529 17.6 1901 30,959 874 28.5 140 1601 678 21.8 232 191 ... 487 15.7 1902 31,531 932 295 146 156.6 734 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 330 100 88.1 741 21.5 356 279 28 490 14.2 1908 34,895 1211 34.7 147 112.2 801 23.2 344 269 30 558 15.9 1909 35,672 1182 3313 112 94.75 810 22.71 374 292 27 545 15.91 Av. for 1900.1909 32,911 1042 31.36 135 129.91 723 21.96 301 223 ... 510 15.5 1910 36,311 1117 30.76 118 105.64 738 20.31 352 276 31 493 14.07 * Rates in Columns 4 and 8 are calculated per 1000 of the estimated gross population. The rates in Column 13 for the years 1900.1908 are calculated per 1000 of the estimated gross population. But since 1908 this rate has been calculated on a nett population, obtained by deducting from the estimated gross population the average number of inmates not belonging to the district in public institutions, viz. : — Average number of inmates not belonging to Name of Institution. District. Union Workhouse ,, Infirmary 1122 ,, Schools Mogden Isolation Hospital . 20 Wyke House Private Lunatic Asylum 35 Gunnersbury House 19 Nazareth House 99 Total 1295 85 NOTES FOR TABLE I. 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 011 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. A list of the Institutions in respect of the deaths in which corrections have been made is as follows :— Institutions within the District receiving Institutions outside the District receiving sick and infirm persons from sick and infirm persons from outside the District. the District. West London Hospital. Friedenham Hospital, London. Kensington Infirmary. Victoria Hospital. Richmond Hospital. Middlesex County Asylum, Wandsworth. Royal Herbert Hospital. St. John'8 Hospital, Twickenham. Italian Hospital, Queen's Square. Middlesex Hospital. Hammersmith Infirmary. Longgrove Asylum. Throat Hospital, Golden Square. 26, Belsize Avenue, Hampstead. 10, Rosslyn Hill, Hampstead. Is the Union Workhouse within the District ? Yes. Total population at all ages, 30,863. ) Number of inhabited houses, 5,684. L At Census of 1901. Average number of persons per house, 5*43. J Area of District in acres (exclusive of area covered by water) 6,893.631. Workhouse Infirmary. Mogden Isolation Hospital. Wyke House, Private Lunatic Asylum, Isleworth. Nazareth House, Isleworth. Cottage Hospital, Isleworth. 86 Table II. Vital Statistics of separate Localities in 1910 and previous years. Year. NAMES OF LOCALITIES. Whole District. Parish op Heston. Parish of Isleworth. 1 2 3 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. Population esti- | mated to middle j of ea^h year. Births registered. Deaths at all ages. Deaths under 1 year. a. b. c. d. a. b. c. d. a. b. c. d. 1899 NO PREVIOUS RECORD. NO PREVIOUS RECORD. NO PREVIOUS RECORD. 1900 1901 1902 1903 1904 32630 1057 550 167 11305 305 152 41 21325 690 398 126 1905 33194 1030 452 125 11405 337 143 38 21788 647 309 87 1906 33767 1134 512 153 11508 372 162 46 22259 727 334 107 1907 34351 1135 490 100 11613 401 130 31 22738 734 332 69 1908 34895 1211 558 130 11794 421 175 49 23101 790 353 81 1909 35672 1182 545 103 11762 377 179 35 23910 805 366 68 Aver, of yrs. 1904 to 1909. 34084 1124 517 129 11564 368 156 40 22520 732 348 93 1910 36311 1117 493 105 11859 377 133 44 24452 740 360 61 Notes.—(a). Deaths of residents occurring in public institutions beyond the district are included in sub.columns c of this Table, and those of non.residents registered in public institutions in the district excluded. (See note on Table I. as to meaning of terms "resident" and "non.resident.") I b). Deaths of residents occurring in public institutions, whether within or without the district, are allotted to the respective localities according to the addresses of the deceased. 87 Table III. CASES OF INFECTIOUS DISEASE Notified during the year 1910. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. No. of Cases Removed to Hospital from each Locality. At all ages At Ages—Years. Heston Parish. (H)* Isleworth Parish (H)*(W)t Heston Parish. Isleworth Parish. Total cases removed to Hospital. Under 1 1 to 5 5 to 15 | 15 to 25 | 25 to 65 | 65 and 1 upw'ds 1 Smallpox ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Memb. Croup) 31 1 6 15 6 3 10 21 6 15 21 Erysipelas 28 2 ... ... 1 19 6 5 23 ... ... ... Scarlet Fever 81 17 51 12 1 30 51 21 40 61 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 6 ... ... 3 ... 3 ... ... 6 ... 3 3 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 3 ... ... ... ... 3 ... ... 3 ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis —Public Health (Tuberculosis) Regulations,1908 10 ... ... 2 4 10 ... 3 13 ... ... ... Voluntary 4 ... ... ... 3 1 ... 1 3 ... ... ... Totals 169 3 23 71 26 40 6 49 120 27 58 85** *(H) marks the localities in which the isolation hospitals are situated. t(W) marks the locality in which Brentford Union Workhouse is situated. Isolation Hospitals—name and situation: (1). Mogden Isolation Hospital, Isleworth. Provided by Borough of Richmond, Surrey, and Heston and Isleworth Urban District. Available beds for this district, 24. Number of diseases that can be concurrently treated, 3. (2). Dockwell (Smallpox) Hospital, Heston. Provided by Borough of Richmond, Surrey, and Heston and Isleworth Urban District. Available beds for this district, 5. Number of diseases that can be concurrently treated, 1. ""Included in this number are 4 cases which entered M.A.B. Hospitals, and a nurse at Mogden who contracted Scarlet Fever. 88 Table IV. Causes of, and Ages at Death during 1910. Causes of Death. Deaths at the subjoined Ages of "Residents" whether occurring in or beyond the district. Deaths at all Ages of " Residents " belonging to Localities, whether occurring in or beyond the District. Total Deaths whether of " Residents" or "Non.residents" in Public Institutions in theDistrict. All ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Heston Parish. Isleworth Parish. 1 2 3 4 5 6 7 8 9 10 11 Smallpox ... ... ... ... ... ... ... ... ... ... Measles 12 4 7 ... ... ... ... 3 9 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping.cough 8 6 2 ... ... ... ... 5 3 ... Diphtheria including Membranous Croup Croup 2 1 1 1 2 1 3 Fever Typhus ... ... ... ... ... ... ... ... ... Enteric 1 ... ... ... ... 1 ... ... 1 1 Other continued ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 4 1 ... ... 1 2 2 2 ... Cholera ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... Diarrhoea 5 4 1 ... ... ... ... 1 4 5 Enteritis 4 4 ... ... ... ... ... 1 3 1 Gastritis 5 2 2 ... ... ... 1 2 3 ... Puerperal Fever 1 ... ... ... ... 1 ... ... 1 ... Erysipelas 1 1 ... ... ... ... ... 1 ... ... Phthisis (Pulmonary Tuberculosis) 30 ... ... 1 10 17 2 7 23 45 Other tuberculous diseases 18 ... 4 6 4 3 1 4 14 6 Cancer, malignant disease 31 ... ... ... ... 17 14 3 28 25 Bronchitis 33 8 3 1 ... 3 18 10 23 27 Pneumonia 20 4 3 3 3 4 3 10 10 6 Pleurisy 2 ... ... ... ... 1 1 1 1 1 Other diseases of Respiratory Organs 32 14 6 ... 1 6 5 11 21 8 Alcoholism 11 ... ... ... ... 9 2 5 6 5 Cirrhosis of Liver Venereal Diseases ... ... ... ... ... ... ... ... ... ... Premature Birth 10 10 ... ... ... ... ... 3 7 3 Diseases and Accidents of Parturition 1 ... ... ... 1 ... ... ... 1 ... Heart Diseases 49 1 2 3 1 18 24 16 33 25 Accidents 4 ... 1 ... 1 1 1 ... 4 6 Suicides 8 ... ... ... 2 6 ... 3 5 1 All other causes 200 46 3 5 3 55 88 45 155 179 All causes 493 105 36 21 26 143 162 133 360 352 89 NOTES TO TABLES IV. AND V. (a). In Table IV., all deaths of " Residents " occurring in public institutions, whether within or without the district, are included with the other deaths in the columns for the several age groups (columns 2.8). They are also, in columns 9 and 10, included among the deaths in their respective "Localities" according to the previous addresses of the deceased as given by the Registrars. Deaths of "Non.residents" occurring in public institutions in the district are in like manner excluded from columns 2.8 and 9 and 10 of Table IV. (b). See notes on Table I. as to the meaning of "Residents" and " Non.residents," and as to the "Public Institutions" to be taken into account for the purposes of these Tables. (c). All deaths occurring in public institutions situated within the district, whether of "Residents" or of "Non.residents," are, in addition to being dealt with as in note (a), entered in the last column of Table IV. (d). All deaths certified by registered Medical Practitioners and all Inquest cases are classed as "Certified"; all other deaths are to be regarded as " Uncertified." 90 T ART.TJ! V INFANTILE MORTALITY DURING THE YEAR 1910. 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. j 7—8 Months. 8—9 Months. 9—10 Months. 10—11 Months. 11—12 Months. Total Deaths under One Year. All Cases Certified 17 4 1 5 27 12 11 4 6 3 7 9 11 5 5 5 105 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 ... 1 2 ... ... ... ... 4 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 lWTbooping Cough ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 3 ... 6 Diarrhceal Diseases. ' Diarrhoea, all forms ... ... ... ... ... ... ... ... 1 ... 2 1 ... ... ... ... 4 Enteritis, Muco-enteritis I Gastro-enteritis r ... ... ... ... ... ... 3 1 ... ... ... ... ... ... ... ... 4 Gastritis, Gastrointestinal Catarrh ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 2 Wasting Diseases. Premature Birth 5 2 ... 1 8 2 ... ... ... ... ... ... ... ... ... ... 10 Congenital Defects 5 2 ... 1 8 2 1 ... 11 Injury at Birth 2 ... ... ... 2 ... ... ... 2 Want of Breast-milk, Starvation 1 ... ... ... 1 ... ... ... 1 Atrophy, Debility, Marasmus 1 ... ... ... 1 2 5 1 3 1 2 4 1 1 1 22 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... OtherTuberculous Disease s ... Erysipelas ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 Syphilis ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... 1 Rickets Meningitis (not Tub'culous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions 2 ... ... 1 8 1 ... 1 ... ... ... ... 1 ... ... ... 6 Bronchitis ... ... ... 1 1 2 1 1 ... ... ... 2 ... ... ... ... 8 Laryngitis ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Pneumonia ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... 1 4 Suffocation, overlaying ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes 1 ... 1 ... 2 1 ... ... 1 2 3 1 3 2 1 1 17 17 4 ..1 5 27 12 11 4 6 3 7 9 11 5 5 5 105 Population (estimated to middle of 1910) 36,311. Births in the year:—Legitimate 1029; Illegitimate 88. Deaths in the year of:—Legitimate infants, 91; Illegitimate infants, 14. Deaths from all Causes at all Ages—493. 91 Report on the administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. Table VI.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecution. 1 2 3 4 Factories (including Factory Laundries) 62 2 N il. Workshops (including Workshop Laundries) 705 16 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 171 8 Total 928 26 Nil. Table VII.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Nuisances under the Public Health Acts:. Want of cleanliness 85 80 Want of ventilation 2 2 Overcrowding 1 1 Want of drainage of floors 4 4 Other nuisances 19 19 Insufficient 3 2 Nil. Nil. Unsuitable or defective 29 27 Not separate for sexes 0 0 Offences under the Factory and Workshop Act: — Illegal occupation of underground bakehouse (s.ioi) 0 0 Breach of special sanitary requirements for bakehouses (ss. 97.100) 7 4 Other offences ('excluding offences relating to outwork which are included in Part 3 of this report) 7 7 Total 157 146 Nil. Nil. fSection 22 of the Public Health Acts Amendment Act, 1890, has been adopted by the District Council, and the standard of sufficiency and suitability of sanitary accommodation for persons employed in factories and workshops enforced is that required by the Sanitary Accommodation Order of 4th February, 1903. 92 Table VIII.—HOMEWORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Inspections of Outworkers' premises. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. Lists received from Employers. Addresses of Outworkers. Sending twice in the year. Sending once in the year. Received from other Councils Forwarded to other Councils. Instances. Notices served. Prosecutions. Lists. Outworkers. Lists. Outworkers. Contractors Workmen. Contractors Workmen. 1 2 3 4 5 6 7 8 9 10 11 12 13 Wearing Apparel— making, &c. 8 0 12 4 0 4 4 5 50 4 4 Nil Furniture and upholstery 4 0 6 1 0 2 0 0 29 3 3 Umbrellas, &c. 0 0 0 0 0 0 0 0 0 0 0 Total 12 0 18 5 0 6 4 5 79 7 7 Nil. 93 Table IX.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. Bakehouses (Retail) 34 Laundries (non.factory) 29 Workshops (177) and Workplaces (26) 203 Total number of workshops on Register 266 Table X.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act, (s.133) Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory Act (a. 5)— 0 Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspector 1 Other 0 Underground Bakehouses (s. 101):— Certificates granted during the year 0 In use at the end of the year 1 94 Table XI. SANITARY WORK 1910. Staff employed in Sanitary Department: 1 Inspector of Nuisances, who is also Inspector under the Factory and Factory Act, Dairies, Cowsheds and Milk. shop Orders, Canal Boats Acts, Petroleum Acts and Town Police Clauses Acts. 2 Assistant Inspectors of Nuisances. 1 Drain.Tester and Disinfector. 1 Clerk. Inspections: Number of premises inspected on complaint 107 Number of premises inspected in connection with Infectious Diseases 270 Number of premises such as Cowsheds, Dailies, Slaughter.houses, Workshops, Workplaces, <fcc., under periodical inspection 382 Houses inspected from house.to.house 91 Total number of inspections and re.inspections made 17672 Notices: Cautionary or Intimation Notices given 3018 Statutory Orders issued 185 Summonses served 33 Convictions obtained (2 withdrawn) 31 Dwelling Houses: Houses, premises, &c., cleansed, repaired, &c. 245 Closed as unfit for habitation— (a) As result of action under H.W.C. Acts 30 (b) Otherwise 3 Re.opened after repairs, alterations, etc. (a) 1 Demolished (b) 22 Illegal Underground Dwellings vacated 0 Houses Let in Lodgings (Tenement Houses): Number registered under Byelaws 15 Number of contraventions 33 95 Common Lodging Houses: Number registered under Byelaws 2 Number of Inspections made 92 Number of contraventions 12 Canal Boats used as Dwellings: Number registered under the Acts — Number of contraventions of Regulations 44 Movable Dwellings, Carayans, Tents, &c. Number observed during the year 84 Number of nuisances therefrom abated 31 Number removed from district 9 Bakehouses: Number 34 Contraventions of Factory Acts 23 Slaughter.houses: Number on register 11 Number of inspections made 368 Frequency of inspection fortnightly Contraventions of Byelaws 13 Cowsheds: Number on register 17 Number of inspections made 441 Frequency of inspection fortnightly Contraventions of Regulations 84 Number of Milch Cows in district 158 Dairies and Milkshops: Number on register 71 Number of inspections made 2503 Frequency of inspection fortnightly Contraventions of regulations 97 Unsound Food: (a) Animals seized 0 (b) Articles or parcels seized 2 Condemned by Magistrate (b) 8 Articles or parcels surrendered 66 96 Adulterated Food: Samples taken 0 Found adulterated 0 Offensive Trades: Number of premises in district 0 Number of inspections made 0 Contraventions of Byelaws 0 Water Supply and Water Service : Wells: New, Sunk 0 Cleansed, repaired, &c. 0 Closed as polluted 4 Percentage of houses supplied from public water service 99 Cisterns : New, provided 2 Cleansed, repaired, covered, &c. 21 Draw.taps placed on mains 140 Percentage of houses supplied on constant system 100 Number of samples obtained for analysis from— (a) Local wells 14 ,(b) Public supply 0 Drainage and Sewerage: Water Closets: Number of water closets substituted for dry receptacles 4 Repaired, supplied with water or otherwise improved 274 Percentage of houses provided with water closets 98 Drains : Examined, tested, exposed, &c. 122 Unstopped, repaired, trapped, <tc. 157 Waste pipes, rain.water pipes, disconnected, repaired, &c. 126 New soil pipes or ventilating shafts fixed 6 Existing soil pipes or ventilating shafts repaired 9 Disconnecting traps or chambers inserted 5 Re.constructed 6 97 Cesspools: Rendered impervious, emptied, cleansed, Ac. 0 Abolished and drain connected to sewer 4 Percentage of houses draining into sewers 98 Disinfection: Rooms disinfected— (a) Ordinary infectious diseases 123 (b) Phthisis 10 Rooms stripped and cleansed 0 Articles disinfected or destroyed— (a) Ordinary infectious disease 1230 (b) Phthisis 100 Dust: New bins provided 161 Periodical frequency of dust removal weekly Number of complaints of non.removal received (by Health Dept. only) 6 Method of Disposal destructor Sundry Nuisances abated: Overcrowding 16 Smoke 1 Accumulations of refuse 67 Foul ditches, ponds, &c., and stagnant water 1 Foul pigs and othfer animals 47 Dampness 182 Yards repaved or repaired 185 Other nuisances 260 HESTON and ISLEWORTH URBAN DISTRICT EDUCATION COMMITTEE. third Annual Report OF THE School Medical Officer FOE THE Year ending 31st December, 1910. Members of the Education Committee. H. J. Nias, Esq., Chairman. F. C. Greville.Smith, Esq., j.p., Vice.Chairman. Members of the Council: F. C. Greville.Smith, Esq., j.p. (ex.officio) (Chairman of the Council). W. G. Lobjoit, Esq., j.p., c.c., (ex.officio) {Vice.Chairman of the Council). H. G. Alaway, Esq. W. H. Lowry, Esq. J. J. Bonnett, Esq. G. E. Pecover, Esq. G. Gentry, Esq. S. Smith, Esq. T. S. Goodwin, Esq., m.b.,c.m. J. Surrage, Esq. J. D. Hodges, Esq. J. Wilmot, Esq. Selected Members : Mrs. W. H. Dumsday. A. E. Hales, Esq. Mrs. C. F. Eva. P. Murphy, Esq. H. J Nias, Esq., (Chairman of the Education Committee). School Medical Officer : George F. Buchan, m.d., d.p.h. Health Department. Council House, Hounslow. s 30th January, 1911. To the Chairman and Members of the Heston and Isleworth Urban District Education Committee. Ladies and Gentlemen, I have the honour to submit the third Annual Report of the School Medical Officer on the work in connection with Medical Inspection of School Children for the year ending 31st December, 1910. The total number of children examined during the year was 1,743, and the total number of examinations made 2,576. Parents take a very considerable interest in the medical inspection of their children at the schools, as many as 55 6 per cent. attending the examinations. Seven hundred and ninety-five of the total number examined proved to be suffering from defects requiring treatment. Investigation was made into 404 of these cases, and it was found that only 18.5 per cent. sought medical or dental help. I am sure that all parents desire that their children should be made fit and the main reason for neglect to provide medical aid is want of means. It is noteworthy that 22,368 attendances were lost by children unfit to attend school owing to the state of their health or uncleanness. This loss of attendance represents a loss to the Committee and the State of £223 13s. 7d. It is impossible to hope that all this money can be saved, but I have no doubt that treatment promptly and efficiently applied would result in the immediate saving of the greater part of it. The ultimate gain to the community of having the children of to-day made physically fit cannot be computed, but any investment in this direction would certainly repay itself in the course of a few years. 4 I desire to express my thanks to the Chairman and members of the Committee, for the assistance and support they have given me in the discharge of my duties during the year. I am, Ladies and Gentlemen, Your obedient servant, GEORGE F. BUCHAN, School Medical Officer. The Children examined. During the year, 1110 children have been medically inspected. This number includes all children who began school life in the schools of the Heston and Isleworth Urban District Education Committee in 1910, and all those likely to leave school before 31st July, 1911. The following table gives the number examined in each school within the district:— Name of school. Entering. Leaving Boys. Girls. Boys. Girls. Brentford End 8 10 — — Grove Road 72 97 33 12 Heston 31 36 27 24 Hounslow Heath 61 33 31 21 Hounslow R.C. 16 14 3 1 Hounslow Town 57 54 13 9 Isleworth Blue Boys 29 ,, „ Girls & Infants 32 33 ... 23 „ Green Girls ... 3 St. Mary's R.C. Boys 3 „ Girls & Infants 33 21 4 Spring Grove 33 45 32 21 Woodlands St. John's 21 19 Worple Road 36 41 10 8 Totals 400 403 181 126 1110 Conditions under which Medical Inspection was conducted. In all cases the medical examination of scholars as required under the Education (Administrative Provisions) Act, 1907, was carried out on school premises. In the case of children just entering school, examination of the eyes by means of Snellen's 5 test type is not practicable, as the children do not know the letters. But in the case of "leavers" the acuity of vision is invariably tested. For this purpose, a room 21 feet long is required. In this district also, the parents of children to be examined are invited to attend. Six hundred and seventeen or 55 6 per cent. attended last year, and it is obviously proper that reasonable waiting accommodation should be provided for them. These requisite conditions as regards sight-testing and waiting room accommodation are not to be found in all the schools in the district, and it is probably impracticable to make the necessary provision in established schools. It would be wise, however, to give attention to these points in the erection of new schools. Extent of the Examination. The Board of Education has prescribed the extent of the medical examination of scholars attending public elementary schools. In this district, the examination of scholars has been couducted on the lines laid down by the Board, and the following matters have accordingly received attention:— Height and weight. Clothing and footgear. Conditions of hair, scalp and body. Previous infectious illnesses. Nutrition. Diseases of the mouth, nose and throat. Condition of the glands. Diseases of the eyes and ear. Diseases of the heart, circulation and lungs. Any other disease or defect. Only three objections were made by parents to the examination of their children during the year 1910. The number of objections received in this district, year by year, is so small as to be negligible. Height and Weight. The following tables give the average heights and weights of the scholars examined. The scholars have been grouped according to the year of birth, so that it may be possible in subsequent years to compare the children born in any one year with those born in another:— 6 Height, Boys and Girls. Year of Birth. No. of Observations. Average height. Inches. Centimetres. 1905—2nd half-year Boys Girls Boys Girls Boys Girls 59 58 41.28 41.01 104.85 104.16 1st „ 166 166 42.12 41.44 106.98 105.15 1904—2nd 105 110 42.12 41.56 106.98 105.56 1st „ 39 36 43.64 42.11 110.34 106.95 1903—2nd 19 24 43.80 45.41 111.25 115.34 1st „ 6 ... 46.08 ... 117.04 ... 1902—2nd 2 4 49.00 46.25 124.46 117.47 1st „ 2 1 49.00 50.00 124.46 127 00 1901—2nd „ ... 1 ... 51.00 ... 129.54 1st ,, ... 1 ... 48.00 ... 121.92 1900—2nd ,, 1 1 53.00 56.00 134.62 142.24 1899—2nd ... 1 ... 51.00 ... 129.54 1st ,, 1 55.00 ... 139.70 ... 1898—1st 1 1 57.00 58.00 144.78 147.32 1897—2nd 28 25 56.16 58.04 142.64 147.42 1st „ 81 41 57.72 59.34 146.61 150.72 1896—2nd „ 52 47 57.60 59.21 146.30 150.39 1st „ 12 11 58.32 42.45 148.13 107.82 1895—2nd ,, 5 ... 60.24 ... 153.01 ... 1st ,, 1 1 59.00 61.00 149.86 154.94 1894—2nd 1 ... 60.00 ... 152.40 7 Weight, Boys and Girls. Year of Birth. No. of Observations. Average weight. In pounds. In kilogrammes. 1905—2nd half-year Boys Girls Boys Girls Boys Girls 59 58 39.48 36.89 17.94 16.76 1st ,, 166 166 39.06 37.82 17.75 17.19 1904—2nd 105 110 39.90 38.95 18.10 17.70 1st ,, 39 36 41.58 41.11 18.90 18.68 1903—2nd 19 24 44.10 41.79 20.04 18.99 1st „ 6 ... 46.48 ... 21.12 ... 1902—2nd 2 4 56.00 47.72 25.45 21.68 1st ,, 2 1 50.96 52.00 23.18 23.63 1901—2nd ... 1 ... 52.00 ... 23.63 1st ,, ... 1 ... 49.00 ... 22.27 1900—2nd 1 1 65.00 64.00 29.53 29.09 1899—2nd „ 1 ... 59.00 ... 26.81 1st ,, 1 ... 71.00 ... 32.22 ... 1898—1st 1 1 78.00 70.00 35.45 31.81 1897—2nd 28 25 78.54 80.20 35.70 36.45 1st „ 81 41 80.50 88.02 36.59 40.00 1896—2nd 52 47 79.94 85.41 36.33 38.77 1st „ 12 11 85.40 84.09 38.81 38.22 1895—2nd 5 ... 93.80 ... 42.63 ... 1st „ 1 1 80.00 78.00 36.33 35.45 1894—2nd 1 ... 90.00 ... 40.90 ... 8 Clothing and Footgear. Attention was paid to these in all cases. They were first classified into clean and dirty, and afterwards sub-divided into satisfactory, fair or poor according to the state of repair and suitability as regards warmth and protection. The following tables give the results:— Clothinq. Boys. Girls. Entering. Leaving. Entering. Leaving. No. of observations 400 181 403 126 Clean Satisfactory repair 339 170 370 114 Fair repair 34 6 25 11 Poor repair 8 3 0 0 Dirty Satisfactory repair 0 0 0 0 Fair repair 13 2 6 0 Poor repair 6 0 2 1 Footqear. Boys. Girls. Entering. Leaving. Entering. Leaving. No. of observations 400 181 403 126 Clean Satisfactory repair 357 169 356 112 Fair repair 19 9 32 Poor repair 10 3 9 5 Dirty Satisfactory repair 0 0 0 0 Fair repair 7 0 3 0 Poor repair 7 0 3 1 From the above tables it will be seen tnat the clothing of 117 children was not in a satisfactory state of repair, and the footgear of 116 children was likewise unsatisfactory. Doubtless in some cases this was due to poverty, but in a number of instances parents do not put into action the principle contained in the old adage that " a stitch in time saves nine." The tendency that exists amongst a certain class of the population to allow children to wear garments until they are dirty and torn, without washing and repairing, afterwards replacing them by new, does not give the children those object lessons in industry and thrift which ought to be considered of primary importance. 9 Hair, Scalp and Body. The state of cleanliness of the children attending the public elementary schools has engaged the attention of the Education Committee during the year. The following tables state the results of the medical examination of the school children in relation to these matters:— Hair Boys. Girls. Entering. Leaving. Entering. Leaving. No. of observations 400 181 403 126 Clean 353 169 230 61 Nitty 44 11 170 65 Verminous 3 1 3 0 No. of children excluded on account of nitty or verminous conditions 2 0 14 6 Total No. of attendances lost by children excluded 90 0 740 260 The 1110 children submitted to routine medical inspection were not in any way specially selected. Yet 297 or 26 7 per cent. were in a nitty or verminous condition. Twenty-two of this number were in such a state that they were not fit to associate with other children at school, and were consequently excluded, the total number of school attendances lost by them, being 1090. Reference to the special cases classified on page 19 will shew that in addition to these 22, 141 other children were excluded on account of nitty and verminous conditions, involving a further loss of 5660 attendances. The total number of attendances lost therefore, was 6750. As £4 represents the value to the Committee and the State of every 400 attendances, it may be put that £67 10s. Od. was lost on account of these conditions. It has been decided to appoint a school health visitor to assist in getting these children cleansed, and it is certain that by her exertions much of this loss will be recovered. 10 Prosecutions. Nine cases were prosecuted under the Attendance Acts during the year for being in such a verminous or nitty condition as to be unfit to attend school. Convictions were obtained and small fines inflicted in all the cases, but only after an argument by the Bench that such cases should be dealt with by Section 122 of the Children Act, 1908. Scalp. Boys. Girls. Entering. Leaving. Entering. Leaving. No. of observations 400 181 403 126 Clean 385 179 398 126 Dirty 8 1 2 .. Eczema 2 1 1 .. Ringworm 5 ... 2 ... No. of children excluded on account of ringworm 5 ... 2 ... No. of attendances lost by children excluded 680 ... 130 ... 1 desire to call the attention of the Education Committee to the fact that the seven cases of ringworm referred to in the above table were actually found attending school out of 1110 examined. Having regard to the long absence from school of cases of ringworm of the scalp, 810 days for these seven cases, it is highly important that facilities should be provided for getting such cases well. The disease is infectious and a child suffering from this condition is a source of danger to others as well as a financial loss to the Committee 11 Body Boys. Girls. Entering. Leaving. Entering. Leaving No. of observations 400 181 403 126 Dirty 3 0 3 ... Flea-bitten 3 2 2 ... Impetigo 3 ... 1 ... No. of children excluded on account of impetigo ... ... 1 ... No. of attendances lost by children excluded ... ... 20 ... Itch 2 1 ... ... No. of children excluded on account of itch 2 1 ... ... No. of attendances lost by children excluded 260 80 ... ... Ringworm ... 1 ... No. of children excluded on account of ringworm ... ... 1 ... No. of attendances lost by children excluded ... 20 ... Eczema ... 1 ... Acne 1 ... 1 Seborrhœa ... ... 1 ... Ichthyosis ... ... 1 ... The expression, flea-bitten, refers to cases in which the number of flea bites was very great indeed. Itch is an infectious parasitic disease, and if efficiently treated, a case should be well in a fortnight. It is therefore unsatisfactory to find that the three cases which were excluded on account of this condition, took 340 days or practically three months each to get well. Nutrition. The following table supplies a record of all those children noted during medical inspection, whose nutrition appeared to be below normal:— 12 Year of Birth. No. of Observations. Fair. Poor. 1905—2nd half-year Boys. Girls. Boys. Girls. Boys. Girls. 59 58 4 3 0 0 1st „ 166 166 6 6 3 0 1904—2nd 105 110 6 11 2 3 1st ,, 39 36 5 3 1 1 1903—2nd 19 24 0 2 0 1 1st ,, 6 0 0 0 0 0 1902—2nd 2 4 0 0 0 0 1st ,, 2 1 1 0 0 0 1901—2nd 0 1 0 0 0 0 1st „ 0 1 0 0 0 0 1900—2nd 1 1 0 0 0 0 1899—2nd 0 1 0 0 0 1st ,, 1 0 0 0 0 0 1898—1st 1 1 0 0 0 0 1897—2nd 28 25 1 2 0 1 1st ,, 81 41 1 2 0 0 1896—2nd 52 47 2 2 0 0 1st ,, 12 11 0 1 0 0 1895—2nd 5 0 0 0 ;o 0 1st „ 1 1 0 0 0 0 1894—2nd 1 0 0 0 0 0 Total 581 529 26 32 6 6 1110 58 12 70 13 Teeth. The following table gives in detail the number of children suffering from defective conditions of the teeth, and the number of teeth actually decayed in each case examined :— Boys and Girls. Year of Birth. No. of Observations. Possible No. of sound teeth per child. No. of children, shewing the number of decayed teeth at the head of each column. No. of children with abscesses of gum. No. of children with teeth extracted. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 1905—2nd half-year 117 20 8 15 12 12 11 9 3 1 2 1 1 ... ... ... 1 ... 1st ,, 332 20 22 47 29 32 15 22 8 9 2 6 1 1 1 1 1 4 2 1904—2nd ,, 215 22 18 20 30 20 17 8 7 4 3 4 ... 2 2 ... ... 2 ... 1st „ 75 24 3 14 9 6 6 4 5 3 1 ... ... ... ... ... ... ... 1903—2nd ,, 43 24 3 6 9 5 0 4 1 ... ... 1 ... ... ... ... ... ... ... 1st „ 6 24 1 2 ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1902—2nd ,, 6 24 ... 2 ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... 1st „ 3 24 ... 1 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1901 —2nd ,, 1 24 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1st „ 1 24 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1900—2nd ,, 2 24 ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1899—2nd ,, 1 24 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1st ,, 1 24 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1898—ist „ 2 28 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1897—2nd ,, 53 28 7 7 10 5 3 2 2 ... ... 1 ... ... ... ... ... ... ... 1st ,, 122 28 16 23 17 18 7 3 1 ... ... ... ... ... ... ... ... ... ... 1896—2nd ,, 99 28 17 20 11 7 7 4 ... ... ... ... ... ... ... ... ... ... ... 1st „ 23 28 3 4 4 ... 1 1 1895—2nd ,, 5 28 ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1st ,, 2 28 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 1894—2nd ,, 1 28 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 1110 98 163 134 107 73 57 3° 17 5 '5 2 5 3 1 1 9 4 711 14 A scrutiny of the above table shews that about 64 per cent, of all the children examined had carious or decayed teeth. In some cases the number of decayed teeth was very large, and in others abscess formation was going on in the gums or at the roots of the teeth. In only four instances, so far as I could ascertain, had skilled dental interference been sought. The decay of teeth is due to several causes:— (1). Failure to keep the teeth clean. (2). Chipping of the enamel by hard or gritty substances in the food-stuffs, thus allowing the entrance of bacteria. (3). Septic conditions of the throat, or mouth or passages communicating with the mouth, e.g. tonsillitis, abscess of gums, etc. (4). Over-lapping, irregularity, or too close an arrangement of the teeth in the gums preventing the teeth being thoroughly cleansed. (5). Mouth breathing due to adenoids or other nasal obstruction. (6). Rickets leading to early decay of the teeth. (7). The retention of decayed first teeth without adopting means to prevent the spread of the decay to the second teeth upon their appearance in the gums. (8). The consumption of sloppy food-stuffs and the consequent decay of the teeth as they become functionless. To this list of causes may be added many others, but it is easy to see from the above that much dental mischief and decay may be prevented. It is also important to remember, that all material for the upkeep and growth of the body must pass through the mouth. If then the oral portal is not kept fit and clean the other organs of the body are bound to suffer. Enlarged Glands. The glands to which attention was directed were the submaxillary and neck glands. Enlargement of these glands is due as a rule to infection passing along the lymph ducts from some inflammed focus, e.g., decayed teeth, enlarged tonsils, adenoids, abscess of the gums and so on. 15 Enlarged glands may be considered to result from a condition in which the first line of defence of the body, namely, the lencocytes or blood cells, has broken down under the attack of some invading organism which has thus come to be deposited in the glands. It is clear that if the power of resistance of the glands in its turn gives way, abscess formation or blood poisoning results. Enlarged glands must therefore be considered as an index of a weakened condition of the system as regards power of resistance to certain inflammation producing bacteria. The following table gives the results of the observations conducted on enlarged glands :— Enlarqed Glands. No. of Observations. No. with Enlarged Glands. Boys entering 400 183 Boys leaving 181 45 Girls entering 403 181 Girls leaving 126 43 Total 1110 452 Diseases of the Mouth, Nose and Throat. Deafness. No. of Observations. Enlarged Tonsils only. Adenoids only. Enlarged Tonsils and Adenoids. Otorrhoea. Chronic Catarrh of middle ear. Deflected nasal septum. Tonsillitis. Boys entering 400 32 n 17 11 l l l Boys leaving 181 16 3 5 l ... l ... Girls entering 403 27 4 11 5 l ... ... Girls leaving 126 11 1 4 3 ... ... ... Total 1110 86 19 37 20 2 2 l 16 In considering the above table I desire to call attention to the 22 children suffering from deafness. Everyone of these cases was associated with enlarged tonsils, adenoids or deflected nasal septum. If these conditions had been remedied at a sufficiently early period, deafness would not have resulted. The commercial disadvantage at which a deaf child, as he becomes a man, is placed, is a matter of very considerable moment and should be borne in mind in connection with all children suffering from the conditions above mentioned. Prevention is better than cure, and it is not wise therefore to wait until deafness has occurred before seeking a remedy. One hundred and forty-four children were found suffering from enlarged tonsils, adenoids or deflective nasal septum. I referred in my last annual report to the conditions to which these were antecedent, namely, deafness, backwardness, tonsillitis, bronchitis, chronic laryngitis, etc., and to the importance of seeking the remedy early to avoid permanent damage as above. Eye Diseases. The following tables give the results of observations as to external eye diseases and defective vision among the children medically inspected External Eye Diseases. Boys Entering. Boys Leaving. Girls Entering. Girls Leaving. No. of observations 400 181 403 126 Blepharitis 13 4 13 6 Conjunctivitis ... ... 7 2 Strabismus 7 ... 2 ... Ulcer ... ... 1 ... Ptosis 1 ... ... ... Vision. Boys Leaving Girls Leaving. No. of observations 181 126 Both eyes normal 150 98 Only one eye normal 6 7 Both eyes 6/8 6 4 One eye 6/8, other 6/12 or less 7 3 Both eyes 6/12% or less 12 14 No. wearing spectacles 4 5 17 From the above table as regards vision, it will be seen that 307 children were tested and that 59 were found to suffer from defective eyesight. In my opinion, 36 of these children were in real need of spectacles and yet it was found that only nine children had them to wear. The enormous disadvantage that a child is at from the educational standpoint, who is unable to see quickly and accurately, is a matter to be borne in mind. The suffering too, of the individual who is the subject of constant eye-strain, requires likewise to be appreciated, as also the fact that strain on the growing eye distorts its shape and causes a progressive loss of acuity of vision. Other Abnormal Conditions. The following table gives a list of children found suffering from other abnormal conditions as below, during medical inspection:— Diseases of the lungs— Bronchitis 34 Consumption 4 Empysema 1 Pneumothorax 1 —40 Diseases of the heart and circulation— Endocarditis 17 Anaemia 2 —19 Rickets 9 Lateral curvature 8 Phimosis 5 Rupture 4 Injury 4 Paralysis 2 Incontinence of urine 2 Goitre 2 St. Vitus' Dance 1 Herpes Zoster 1 Stone in the bladder 1 Total 98 18 Many of the above are cases for an open air school, e.g., the cases of consumption, empyæma, pneumothorax, anaemia, rickets, lateral curvature, paralysis, goitre and St. Vitus' Dance, i.e., 30 out of 1110 examined. The establishment of a school of this kind in the district, would, I am sure, provide a large number of children with continuous education, which their state of health will not permit them to acquire under ordinary school conditions. Special Cases. The foregoing review relates to the routine medical inspection of 1110 children at the schools. In addition, G33 children were referred to me during the year 1910 by the Attendance SubCommittee, the Canteen Sub-Committee and the teachers. The following table gives a statement of the diseases from which these children suffered, the number excluded on account of these diseases, the number advised to seek medical aid and the number who obtained medical aid:— 19 DISEASES. No. examined. No. of times seen. No. excluded. No. excluded in which period of exclusion known definitely. Total No. of attendances lost by cases excluded for known period. No. advised to obtain medical aid. No. obtaining medical aid. Nitty and verminous conditions 172 581 146 141 5660 ... ... Skin diseases 111 279 97 64 5960 97 13 Diseases of eyes including defective vision 62 83 10 6 370 24 15 Diseases of nose, throat and ear 58 88 6 3 100 58 6 Diseases of the heart and circulation, rheumatism and St. Vitus' Dance 30 51 10 9 730 10 3 Diseases of the lungs excluding phthisis 23 32 15 2 160 15 1 Tuberculosis 23 38 8 7 910 8 Infectious diseases 20 23 20 4 70 20 1 Defective and epileptic children 14 21 3 ... ... ... Diseases of the mouth 10 11 2 ... ... 2 1 Defective clothing and footgear 10 12 ... ... ... 1 Injury 6 8 2 1 20 2 ... Diseases of the abdomen 6 7 1 1 30 1 ... Diseases of the nervous system 5 6 1 1 120 1 ... Defects of speech 5 5 ... ... ... ... ... Diseases of urinary and generative systems 4 6 2 1 40 2 2 Dirty conditions of person 4 7 2 2 11 ... ... Malnutrition 2 4 ... ... ... ... ... Other diseases 14 19 6 2 140 6 2 Nil 54 54 ... ... ... ... ... Total 633 1335 331 244 14321 246 44 20 Total number of Children examined and total number of examinations made. The following table gives the above figures:— No. of children examined. No. of examination and re-examinations made. Medical inspection 1110 1241 Special cases 633 1335 Total 1743 2576 Defects brought to the Notice of Parents. When any condition remediable by medical or dental means was noted upon examination of the 1743 children above-mentioned, notice was given to the parent verbally or in writing. In this way, 795 notices were issued to parents. Extent to which Medical Aid is sought by Parents. In 401 of these 795 cases I have collected information either by subsequent examination or through visits by the school attendance officers, as to the extent to which medical aid is sought by parents, and I find that parents obtained treatment for their children in 75 cases or 18 5 per cent. of the cases investigated. This is a serious matter for the sufferer, as I have already shewn under the various sections of this report. In the next paragraph I propose to show that it is equally a loss to the Education Committee. Children excluded from School under Section 53 (b) of the Code. Section 53 of the Code reads as follows :— " Where the Board are satisfied (i.) that proper arrangements have been made by the Local Education Authority for enabling the School Medical Officer to ascertain and certify cases in which the exclusion of children from school is desirable, and (ii.) that the School Medical Officer has authorised the exclusion of certain children from the school, 1. On the ground that their exclusion is desirable to prevent the spread of disease, or 21 2. On the ground that their uncleanly or verminous condition is detrimental to the other scholars, or 3. On the ground that, owing to their state of health or their physical or mental defects, they are incapable of receiving proper benefit from the instruction in the school, the exclusion of such children shall be deemed for the purposes of this Code, to be exclusion on reasonable grounds. For the purposes of this provision, the Local Education Authority may direct that no children who have been excluded under the authority of the School Medical Officer, or under Article 57, or who have been absent from school owing to sickness, shall be re-admitted to school if the School Medical Officer is not satisfied that they can attend school without risk to themselves or others. Every direction or authority given by the School Medical Officer must be embodied in a certificate signed by him. A copy of every certificate must be furnished to the Local Education Authority, and must be produced, if required, to any Inspector or Officer of the Board's Medical Department." Action under the above section was taken in 371 cases, of which 279 were re-admitted after subsequent examination. The remaining 92 cases were cases of mumps, whooping cough, bronchitis, etc., who were excluded until the swelling of mumps subsided or the cough got better so that they might return to school without any delay. The 279 cases thus excluded lost 16,821 attendances and by proportion it may be assumed that the total of 371 cases lost 22,368 attendances. Four hundred attendances represent £4 so that a loss of 22,368 attendances means a loss of £223 13s. 7d. to the Committee and the State. Take diseases of the skin. 76 cases lost 7170 attendances and only 13 of these procured treatment. It is certain that if treatment were obtainable by all these children excluded it would save a large portion of the £223 13s. 7d. lost and at the same time the children would be put into a fit and proper condition to enable them to maintain healthy lives. 22 History of Infectious Illness amongst Scholars. During medical inspection, the infectious disease history of each child was recorded if the parent attended. The following table gives the results:— No. of observations. Boys entering 250. Boys leaving 58. Girls entering 262. Girls leaving 47. No. who have had Per cent. who have had No. who have had Per cent. who have had No. who have had Per cent. who have had No. who have h ad Per cent. who have had Measles 152 60.8 55 94.8 176 67.1 45 95.7 Whooping Cough 88 35.2 43 74.1 120 45.8 29 61.7 Scarlet Fever 7 2.8 10 17.2 8 3.0 7 15.0 Diphtheria 1 0.4 3 5.2 4 1.5 2 4.3 Chicken Pox 45 18.0 31 53.4 58 22.1 18 38.3 Mumps 33 13.2 19 32.7 30 11.4 14 30.0 Typhoid Fever 1 0.4 2 34.5 0 00 0 0.0 The figures above recorded are small, but the conclusion from them is that the number of children who have measles and whooping cough before they go to school is greater than the number who contract it during school years. I think that in an Urban District this must always be true, as children have facilities for meeting outside school hours which are as great if not greater than those afforded during school hours. It is when at play that children come into closest contact with each other. Notification of Infectious Illness by Teachers and School Attendance Officers. The following cases of infectious illness have been notified by Teachers and School Attendance Officers during the year ending 31st December, 1910:— 23  Mumps. Measles. Whooping Cough. Chicken Pox. German Measles. Total. Brentford End ... ... ... ... ... ... Grove Road Infants 3 9 62 3 ... 77 Girls 6 4 2 2 ... 14 Boys 1 2 1 ... ... 4 Heston Infants ... 9 ... 1 ... 10 Girls ... ... ... 1 ... 1 Boys ... ... ... 2 ... 2 Hounslow Heath Infants 6 22 2 ... 1 31 Girls 6 1 4 3 ... 14 Boys 5 1 2 1 9 Hounslow R C. Infants 1 ... 2 ... ... 3 Mixed ... ... ... ... ... Hounslow Town Infants 1 2 13 3 ... 19 Girls 4 ... 1 1 ... 6 Boys 1 4 2 1 ... 8 Isleworth Blue Infants 20 37 ... 21 ... 78 Girls 7 2 ... 1 ... 10 Boys 1 ... ... ... ... 1 Isleworth Central Girls 3 ... ... 1 ... 4 Boys 1 ... ... ... ... 1 Isleworth Green Girls ... 1 ... ... ... 1 St. Mary's R.C. Infants 2 22 ... 1 ... 25 Girls 2 6 ... 1 ... 9 Boys 1 1 ... ... ... 2 Spring Grove Infants 1 39 ... 19 ... 62 Girls ... ... ... 8 ... 8 Boys 2 ... ... ... ... 2 Woodlands St. John's Infants 1 24 ... 13 ... 38 Worple Road Infants 20 31 1 1 ... 53 Mixed 6 1 3 2 12 101 218 98 86 l 504 These cases which are notified from the schools require to be followed up with a view to ascertaining the source of infection, the means of isolation and the necessary period of exclusion from school. It is also necessary that parents should have instruction in the importance of protecting their children from all infectious diseases. Measles and whooping cough are usually considered trivial diseases, but during the past eleven years in this district they have caused 183 deaths, while scarlet fever has caused only 15. It is further 24 important to observe that the younger a child is the more liable he is to infectious illness, and the younger a child is the greater is the likelihood of infectious illness proving fatal. There is thus a double reason for protecting children against all infectious disease. As shewing the ignorance which prevails amongst parents with regard to infectious illness, I may state that two children were found in school suffering with mumps during medical inspection, and in the case of a third, the mother brought the child, who had been at home a week with measles, to be examined by me at the school amongst other children. Education (Provision of Meals) Act, 1906. During the year, I was instructed by the Education Committee to prepare a scheme of dietaries for necessitous school children. This was duly presented to the Canteen Committee at its meeting on September 19th, 1910, and approved as under:— Monday.—Suet pudding containing flour, suet and syrup. Bread and margarine or dripping or lard. Tuesday.—Mutton stew containing scrag-ends of mutton (breast and neck), onions, turnips, carrots, potatoes and barley. Bread and margarine or dripping or lard. Wednesday.—Pea soup containing peas, turnips, onions and carrots. Bread and margarine or dripping or lard. Thursday.—Lentil soup containing clods and stickings, lentils, haricot beans, turnips, onions and carrots. Bread and margarine or dripping or lard. Friday.—Boiled rice containing rice, milk and sugar. Bread and margarine or dripping or lard. The following table shews the approximate cost (exclusive of the cost of preparation and condiments, service and wear and tear of dishes) per child as well as the physiological value of each day's dinner :— 25  Cost in pence per child. Quantities in grammes per child of Energy supplied per child in calories. Proteins. Fats. Carbohydrates. Monday 1½ 41 43 274 1700 Tuesday 13/4 28 15 153 900 Wednesday l 30 16 120 800 Thursday 2 72 40 136 1300 Friday 11/4 21 41 140 1062 Total 7½ 193 155 823 5762 Daily average 1½ 38 31 165 1153 The physiological value of the daily average is short by about 600 calories of the total daily requirements of the normal school child of average age (10 years). It is certain that to supply this physiological quantity, the additional cost to the parent will not be more than Id. per child. The meals supplied to the school children under the above Act provide an opportunity for teaching them table manners. I think there is in this respect, an improvement this year as compared with last, but I do not feel satisfied that the most is being made of this opportunity. Number of dinners supplied—7,065 meals have been supplied on 68 days during the year 1910, and assuming that children were regularly fed, this means that 104 children were supplied with meals. In this connection, I would draw attention to the fact that the nutrition of 70 out of 1,110 children inspected appeared to me to be below normal, and this by proportion means that about 400 children attending the schools are chronically underfed. Sanitary Condition of Schools. As instructed by Circular 596 of the Board of Education the following reports were presented to the Education Committee by the School Medical Officer on the above subject:— 26 Spring Grove. Boys, Girls, Handicraft, Laundry, Cookery. The general hygienic conditions prevailing at these schools is satisfactory. Spring Grove Infants' Schools. Lighting. Room (Classes I. and II). All dull glass should be re-placed by plain. The windors are too high above the scholars. If this room requires to be divided it should be by means of a wood and glass partition and not a curtain, which obstructs light, collects dust, does not prevent the carriage of sound above, and in this case is unsafe, as the gas piping carrying it is not securely fixed at one end. Room (Class III). Additional windows are required for the adequate lighting of this room. All dull glass should be replaced by plain. The present windows are too high above scholars. The partition between this and the adjoining classroom should be replaced by one of wood and glass. Room (Class IV). Same remarks apply as in case of room (classes I and II.) except that the gas piping carrying the curtain in this room is apparently securely fixed. Heating. This is by means of open fireplaces. None of the rooms are adequately or uniformly heated and provision for this purpose requires to be made. Ventilation. This is provided in the case of all the rooms by i. Pivot windows. ii. Sheringham valves. iii. Openings into roof. iiii. Open fireplaces acting as extractors. Additional fixed ventilation is required. 27 Cloakroom. No proper cloakroom is provided. A porch is used in one part of the school. Clothes are taken into the room where Class IV. is at work in another part and thrown down, wet or dry, across the benches. Another section of the scholars use a room which is also used as a store room. This last room could be made into a good cloakroom if well lighted, ventilated and heated so that children's clothes are properly dried during school hours. It should be the duty of some responsible person to see that infants' clothes are properly hung up in the cloak rooms provided. Ashpit. This should be done away with as it can be emptied and cleansed only with extreme difficulty, and replaced by a covered galvanized iron bin. Urinal. This is not sufficiently large and should be extended where space is provided by the removal of the ashpit. The partitions are unnecessary and give rise to a nuisance, as no provision is made for flushing them. Vent-pipe. No cone is provided. Yard. Where the urinal is situated the yard should be completely paved. Playground. This requires to be re-gravelled and adequately drained. A shelter should be provided for the children. All other conditions at this school are satisfactory. 28 Worple Road Schools. Lighting. The back corners in the large room in the infants' department should be provided with additional windows, and the lighting of the classrooms in both infants and mixed schools can be greatly improved by the provision of extra windows. Flower pots should not be deposited on the school room windows. The blinds should be fixed on the inside surface of the wall so as to allow the bottom of the blinds when drawn up to be clear of the window. Curtains should not be used for sub-dividing the rooms. Heating. This is by open fires which are inadequate and do not heat the room uniformly. A low pressure hot-water system should be installed. Ventilation. This is provided for by i. Pivot and casement windows. More of these should be made to open on the hopper principle, and the pivot windows should be made to open more fully. ii. Inlet ventilators provided in some of the window bottoms. The lid of these is for the most part closed. It should be removed and means of cleansing the air-duct should be provided. iii. Ventilators in flues. iiii. Openings in ceilings. The regulating cords to these should be kept in thorough order, and the openings use as fully as the weather will permit. Lavatory. The situation of wash-hand basins in a cloakroom is not to to be recommended. The matchboarding boxing in the lavatory wastes should be removed. 29 The water taps to these basins require easing, adjusting and repairing. The fender of the foul-water gulley of the boys' school is too low. Drinking Fountains. The position of these on the outside walls of the urinals is unsuitable. Urinals. Infants.—Unprovided with any flush. The paving of blue bricks with numerous joints is unsuitable for a urinal. The crevices retain some of the urine and an offensive odour was to be noted here during my inspection. Boys.—The urinal is not of sufficient size and the unrendered walls are consequently used by the boys as supplementary to it. Blue brick paving is also laid down here. Water Closets. Of the trough pattern. The seats in several instances had deposits of faeces upon them on the occasion of my visit. The closets are closed in and no impervious floor is provided under the seats. These conditions should be remedied. All other conditions at these schools are satisfactory. Green School, Isleworth. Large Boom. Heating. An iron stove is provided. The teacher informs me it is insufficient, and that in order to get the necessary heat in cold days she is forced to resort to lighting the gas. Under these circumstances the atmosphere becomes vitiated from the following causes :—- (1). Over-heating of the particles in the air on the hot parts of the stove. (2). Over-drying of the air (this is prevented to some extent by the provision of a basin of water on the stove). (3). Passage of carbon monoxide gas through the warm parts of the iron plates when red hot. (4). The escape of gases of consumption into the air from the lighted gas. 30 Classroom. Lighting. The window of this room is so small as to make the room suitable only for a few pupils. Walls. Those require cleansing. Lavatory Accommodation. Three basins are provided, of which one is not in use on account of the trap beneath leaking. Closet Accomviodation. Two are piovided and both are of the long hopper pattern with spiral flush. They cannot, therefore, be considered self-cleansing. A foul odour emanated from one of these closets on the day of inspection and probably arose from its being insufficiently trapped. It is doubtful if these closets are connected with the Council's sewer. Playground. This is in good condition, but the gravel walk from the gate to the entrance door of the school requires re-making and re-gravelling near the gates. All other conditions at this school are satisfactory. Grove Road Schools. Heating. The open fire places provided are insufficient. A low pressure hot-water system consisting of a single pipe or a single radiator suitably placed in each room should be added for the purpose of maintaining a uniform temperature throughout. Heating should also be provided in the cloakrooms for drying the children's clothes. Lighting. At the corners of many of the rooms the lighting is bad. Especially is this the case in the main rooms of all three departments and additional windows should be inserted in the walls here. 31 The artificial lighting is inadequate in all the rooms with the exception of the boys main room. The curtains swung across the rooms obstruct light and collect dust. Where a partition is necessary it should be of wood and glass. Ventilation. The gratings in the windows would be of considerable service if properly used and if means were provided for regulating the supply of air. At the present time these gratings are used to stand flower pots upon and are permanently shut. Lavatory Accommodation. The position of this in the cloakrooms is not to be recommended as it keeps theplace damp. All waste pipes should be exposed for purposes of cleanliness, inspection and repairs. Urinals. For infants.—The floor is laid with a fall to the outside, and the gravel at the entrance is consequently swampy. The floor should have a good fall towards the channels. The flush pipe along one side is broken off. This requires to be remedied and an automatic flush properly directed against the walls of the urinal should be instituted. For boys.—Blue bricks as a paving with many crevices should never be used for school urinals. Teachers' w.c.'s.—These should be provided with some permanent ventilator in the walls. Hounslow R.C. Schools. Infants' Department. Cloakroom.—No means of heating is provided for drying the children's clothes. Classroom.—I am informed that this room is not in use at present. An additional window at one corner is required and the low ventilators about 1ft. from the floor level, which allow the air to blow across the children's legs should be replaced by Tobin's tubes. 32 Main-room.—Additional means of heating is required along the wall remote from the fire places. An additional window should be provided at each corner. The low ventilators should be dealt with as in Classroom. The use of stained or muranese glass for the lower panes of school room windows as in this school should be discontinued. Mixed Department. Cloakroom.—The plaster is defective in places. It should be renewed, the whole re-coloured and the ceilings whitewashed. Classroom.—The main lighting is to the left of the scholars and the window sills are about 7ft. from the floor. An additional and lower window extending to the back wall is required. Playground to Infants' School.—The space between the school and the infant girls' water-closets should be paved and drained. The gravel road leading to the boys' urinals should be made up to fall towards the gullies which at present are above the gravel. Water supply taps.—These should be provided with drinking cups, and means should be taken to prevent splashing from the gully over the surface of the playgrounds when the taps are in use. Boys' urinals and closets.—These are in an insanitary state and require some re-constructing. A foul odour was emanating from them on the occasion of my visit on May 24th, 1910. About two-thirds of the wall around is of wood and is certainly used as a urinal. The floor is of blue brick with crevices. The partitions provided to the slate slabs should be removed and an automatic flush provided for the urinal. The woodwork of the three tough closets is decaying in places. The front of the closets should be removed so that the whole surroundings may be cleansed. Some of the tiles on the roof are defective. A cone is required to the vent pipe. 33 Girls' closets.—The cement paving in front requires refloating. The guttering in front has been removed and should be replaced. Several of the tiles have come off the roof. The fronts of the closets should be removed to allow for cleansing as in the case of the boys' closets. All the other conditions at this school are satisfactory. Isleworth Blue Boys. Ventilation. More windows should be made to open in the classrooms of the ground floor. Artificial Lighting. This is insufficient. If it is not possible to install electric lighting, the old flat gas burners should be replaced by inverted incandescent burners. Lavatory. There are four basins in the lavatory on the ground floor for the use of scholars using the ground floor rooms. In two of these the waste-pipes are disconnected, in another the bottom has been knocked out and in the fourth the waste-pipe is choked. Drinking water. There is no supply provided directly from the rising main for drinking purposes. The supply comes from a tank which is not accessible for cleansing. Urinal. Only a small portion of the cement rendered walls are supplied with a flushing pipe, and the consequence is that the walls are in places heavily coated with deposit. The partitions provided are of no use and are unflushed and should be removed. Covered Playground. The plaster is commencing to fall away from the ceiling. The limewashed walls and the painted woodwork are 34 dirty and wood blocks have been removed from the floor for an area of about 3 square yards. These matters require attention. The other conditions at this school are satisfactory. Cleanliness of Scholars. Lessons on Hygiene.— At the meeting of the Education Committee in September, 1910, I was instructed to prepare bi-monthly circulars addressed to the children in simple language on the Importance of Cleanliness. Up to the end of the year the following circulars had been issued :— Heston and Isleworth Urban District Education Committee. CARE OF THE BODY. The Importance of Cleanliness. To the Children. Your Skin. Unless your skin is always kept clean and so allowed to act properly, you will take " colds" frequently and your health will be injured. Warm water and soap should be used for cleansing and your face, arms and neck should be washed— (1). Before going to school, (2). During the mid-day interval and (3). Before going to bed. A bath with soap and warm water should be taken at least twice a week. Your hands should always be washed immediately before taking food. This will prevent harmful germs being taken into the body. Cold bathing or swimming, if your heart is sound, invigorates the body. George F. Buchan, m.d., d.p.h., School Medical Officer. 15th September, 1910. 35 Heston and Isleworth Urban District Education CommitteeCARE OP THE BODY. The Importance of Cleanliness. To the Children. Youk Hands. Your hands should always be kept clean. They should be washed often with a brush, soap and warm water. They should always be washed immediately before taking a meal. The hands should always be dried thoroughly to prevent roughness and chapping of the skin. Your Feet. Your feet also should be kept clean. They should be washed just before going to bed. They should always be dried thoroughly. You should never wear small boots, as they will cause corns and spoil the shape of the feet. Your Nails. Dirt collects under the nails of both hands and feet and should be removed. This can be done by keeping the nails short and using a brush for washing them with soap and warm water. The nails can be cut more easily after washing. You should never bite your nails, as this practice may cause wounds which may become infected and lead to serious results. Your nails should be cut with a clean, sharp pair of scissors. George F. Buchan, m.d., d.p.h.. School Medical Officer. 2nd November, 1910. Cleansing of Verminous, Nitty and Dirty Children. I presented a report on this subject to the Education Committee at its November meeting. Action on this report was deferred until 1911, but it may be stated here that the Committee have resolved to appoint a School Health Visitor, and to seek powers to enable them to have the cleansing of such children carried out at home. 36 Infant Care and Management in Public Elementary Schools. Circular No. 758 of the Board of Education on the above subject has also been considered by the Committee, who have resolved to take such action as may be necessary to put the principles laid down in it into practice. Detailed information regarding this and the foregoing matter will not be available until next year, as both these matters are at present under consideration.