Hes 58- 1911. Annual Report on THE HEALTH of the HESTON AND ISLEWORTH URBAN DISTRICT For the Year 1911, by GEORGE F. BUCHAN, m.d., d.p.h., Medical Officer of Health. 2 CONTENTS. Page Introduction 5 Area 7 Physical Features 7 Population 7 Births and Birth Rates 8 Illegitimacy 8 Deaths and Death Rates 9 Infantile Mortality 9 Notification of Births Act, 1907 11 Infant Care and Feeding 12 Teaching of Infant Care and Management 18 Causes of Death 18 Tuberculosis 18 Cancer 20 Deaths from Infectious Diseases 21 Infectious Diseases:— Notifications 22 Scarlet Fever 24 Diphtheria 26 Provision of Diphtheria Anti-toxin 27 Typhoid Fever 28 Puerperal Fever 30 Tuberculosis 31 Isolation Hospital Accommodation 30 Council Laboratory 36 Sanitary Work 37 Housing 37 Water Supply 41 Nuisances 42 Drainage 43 Houses Let in Lodgings 43 Common Lodging Houses 43 3 Contents—Con tinned. Page Dairies, Cowsheds and Milkshops 44 Slaughter-Houses 44 Bakehouses 45 Canal Boats 46 Vital Statistics:— Table I. —Vital Statistics of Whole District. Table la.—Vital Statistics of Wards. Table II.—Cases of Infectious Disease. Table III.—Causes of and Ages at Death. Table IV.—Infantile Mortality. Factory and Workshop Act, 1901:— Table V.—Inspection of Factories, Workshops and Workplaces. Table VI.—Defects found in Factories, Workshops and Workplaces. Table VII. —Homework. Table VIII.—Registered Workshops. Table IX. —Other Matters. Sanitary Work:— Table X. THE HEALTH COMMITTEE of the HESTON AND ISLEWORTH URBAN DISTRICT COUNCIL for the Year ending April, 1912. T. S. Goodwin, Esq., m.b., c.m., (Chairman). W. G. Palmer, Esq., (Vice-Chairman). W. G. Lobjoit, Esq., j.p., c.c., Chairman of the Council. G. Gentry, Esq., Vice-Chair man of the Council. J. J. Bonnett, Esq. S. Carter, Esq. C. Crush, Esq. A. E. Hales, Esq. F. W. Langstone, Esq. W. H. Lowry, Esq. W. Mann, Esq. H. C. Sahler, Esq. Medical Officer of Health,: George F. Buchan, m.d., d.p.h. 5 Health Department, Council House, Hounslow. February 16th, 1912. 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 1911. The Census taken during the year has enabled me to estimate with accuracy the birth and death rates. Table I. at the end of the report, shews that the birth-rate is rapidly falling. In 1906, it was 3125, while during the year 1911 it was only 23'94. This low birth-rate emphasizes the importance of making every possible effort to save infant life. The death-rate for the year under review is 13 58, which is higher than the two preceding years, but the average of the three year period 1909—11 is found to be 12.84 as compared with 13.87 in the preceding three year period 1906—08. This reduction in the average death.rate over a number of years is the surest test of sanitary progress, and is a matter which the Council may view with satisfaction. During the year the infant mortality rate has been high, namely, 162 per 1,000. The Notification of Births Act, 1907, came into operation in this district on 1st July, 1911, and two Health Visitors were appointed to deal with Infant Mortality, the Notification of Births, School Medical Inspection and the teaching of Infant Care and Management to the senior girls at the schools. They came on duty on July 18th and August 1st respectively, and since then there have been two changes, so that it is as yet early to speak of the influence of their work. But I feel sure that in the course of a short time their influence will be felt, and that it is to them we must look for the education of the public to a sense of the importance of personal and domestic hygiene in the protection and improvement of the public health. 6 It is again noteworthy that 25 deaths occurred from Measles and Whooping Cough as against 9 from Scarlet Fever. Diphtheria and Typhoid Fever, and I would again point out the importance of making provision for the isolation and treatment of cases of the two former diseases. During the year, the Health Committee have had under consideration the steps to be taken in connection with the Notification of Consumption, which has now been made compulsory by Older of the Local Government Board, and the advisability of establishing a Tuberculosis Dispensary. The matter was still under consideration at the end of the year. I would take this opportunity of thanking the Chairman and 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. 7 AREA. The Urban District of Heston and Isle worth, 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 population enumerated at the Census of 1911 for the entire district was 43,316, and I have estimated the population to the 30th June, 1911, at 43,684, and this figure has been used throughout the report as the estimated gross population. The details of the recent Census have not yet been published, and I am not therefore in a position to make comparison with the Census of 1901. In Table I. at the end of this report, it will be noted that the number of people living in institutions in this district but belonging to other districts is 1,158. These are technically known as " nonresidents." This number when deducted from the estimated gross population gives the estimated nett population, namely, 42,526. In the light of the known population at 1st April, 1911, I have reviewed the estimated figures since 1906, and these figures are to be found in Table I. at the end of the report. 8 BIRTHS AND BIRTH-RATES. The total number of births registered during the year was 1,075. This is the smallest number registered since 1906, in spite of the increased population. Fifty-seven of these births occurred in the Union Infirmary and do not belong to this district. The following table shews the births and birth-rates attributable to residents in this district since 1906:— Year. Nett Births. Nett Birth-Rates. 1906 1,099 31.25 1907 1,085 28.95 1908 1,169 2910 1909 1,129 27.34 1910 1,050 25.01 1911 1,018 23.94 If the birth.rate of 1906 had existed in 1911, the total births would have been 1,328 instead of 1,018. Owing to the diminished birth-rate during the single year 1911, 310 less children have been born, and this fact emphasizes the importance of making every effort to protect and save the lives of infants. ILLEGITIMACY. The following table gives the number of illegitimate births which occurred in this district during the year. The term " non' 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. 339 5 652 22 9 NON-RESIDENT BIRTHS (all occurring in Isleworth). legitimate. illegitimate. 17 40 DEATHS AND DEATH-RATES. This year, the Registrar-General has introduced for the first time the method of transferring the deaths of residents occurring outside the district to this district, and in consequence, the nett deaths belonging to the district, as shewn on Table I. for this year, are not strictly comparable with the preceding five years. The death-rate for the year under review has been 1358, and this is above the corrected figures for the past two years in the light of the recent Census. The increase in the general death-rate is due mainly to an increase in the number of infant deaths, but comparing the three year period 1906—08 with 1909—11, we find that the average deathrate during 1906—08 was 13 87 and during 1909—11, 12 84. A fall in the average death-rate over a number of years is the best test of sanitary progress, and in this respect, the fall of 103 per 1,000 during the past three years is a matter which the Health Committee may contemplate with satisfaction. INFANTILE MORTALITY. The number of deaths of infants belonging to this district recorded during the year was 165, giving an infantile mortality rate of 162 per 1,000 births. The causes of these 165 deaths are shewn in Table IV. at the end of the report, but I mainly wish to draw attention to the deaths from the following causes :— 1. Deaths attributable to errors in feeding :— Total under 1 month. Total under 1 year Diarrhoea 2 56 Enteritis 10 2. Deaths attributable to weakness from birth Total under 1 month. Total under 1 year. Congenital Malformations Premature Birth 32 57 Atrophy, Debility and Marasmus J 3. Deaths attributable to overlying:— Total under 1 month. Total under 1 year. Overlying2 3 4. Deaths attributable to common infectious diseases :— Total under 1 month. Total under 1 year. Whooping Cough 11 Measles 2 Diphtheria 2 1. Deaths attributable to errors in feeding.—Fifty-six Diarrhoea and Enteritis Deaths. It will be noted from Table IV., that 39 of these 56 deaths, or 70 per cent., occurred under the age of 6 months, and 44 occurred during the 3rd quarter of the year. The Health Visitors came on duty during that quarter, but from ehanges occurring subsequently, as under, they were not on full duty during the very necessary period referred to when their services were most required and their influence could have been best exerted .— Health Visitor. Came on Duty. Vacated Office. Miss Williams, 18th July, 1911. 30th September, 1911. ,, Rishton. 1st August, 1911. 20th December, 1911. ,, Sinclair, 3rd November, 1911. ,, Harris, 22nd January, 1912 Subsequently the 44 deaths from Diarrhoea and Enteritis occurring in the 3rd and 4th quarter of the year were visited, and it is to be noted that in only three of these instances was the child being fed naturally at the time of the onset of Diarrhoea. This points to the enormous importance of natural feeding, and coupled with the fact that 70 per cent. of these deaths occurred under the age of six months, shews that if natural feeding is continued during the first six months of life, an enormous number of infant lives will be saved in spite of such very trying weather conditions as were experienced during last summer. 11 2. Deaths attributable to weakness from birth.—Fifty-seven such deaths occurred during last year. Thirty-two of these, or 56 per cent., occurred under the age of one month. These facts are noteworthy, and indicate that in a large number of cases all is not well with the child at birth. The birth-rate has fallen from 3T25 in 1906 to 2394 in 1911, and it is certainly to be questioned if the causes operating to produce a low birth-rate do not also tend to produce weakly off-spring. 3. Deaths attributable to overlying.—It is to be regretted that three deaths occurred during the year from this preventable cause, and it is to be hoped that such deaths will soon disappear from the list of causes of death. Parents under no circumstances should sleep with their young children. 4. Deaths attributable to common infectious diseases.—I desire specially to draw attention to the 11 deaths from Whooping Cough. Whooping Cough and Measles year by year produce more deaths than all other common infectious diseases, and the Local Authority requires to take action in connection with these diseases. Some measure of hospital treatment should be provided for these cases, and the Isolation Hospital might well be made use of for the worst cases. NOTIFICATION OF BIRTHS ACT, 1907. This Act came into operation in this District on July 1st, 1911, and shortly afterwards, the Health Visitors came on duty to work the Act. The dates of their coming on duty are given above. This is an Act which I am sure will have the best possible results. The foregoing analysis of the main causes of infantile mortality in this District, shews that want of breast feeding is one of the most important causes of the loss of infant life. If mothers can be taught that natural feeding is the best and cheapest food for the infant, then many lives of infants will be saved. The education of the mother in this respect must take place early, and to this end the Act is of service in providing the necessary information as regards the births of infants. All births are visited about the 14th day, and 12 the Health Visitor has a talk with the mother on feeding and infant care generally, and the following pamphlet of instructions is left with the parent:— INFANT CARE AND FEEDING. General Rules. CLEANLINESS. Keep the baby at all times clean, dry and warm. Wash the baby's eyes once a day. If they appear red consult a doctor at once. Otherwise the baby may lose its sight. Cleanse the nipple after suckling with clean warm water, it will often save much misery. Always wash your hands and all vessels, bottles and teats used before preparing the baby's milk. Cleanse all vessels, bottles and teats again immediately after use. Don't delay. If the milk, when purchased, is dirty or shows any sediment on standing or straining, report this to the Health Visitor. Store milk in a clean, covered vessel in a clean, cool, airy place, protected from flies and dust. \ Comforters should not be used, as they cannot be properly cleansed, and the child sucks air into the stomach. Biting a bone ring does no harm. REGULARITY. Teach the child regular habits. Feed the child regularly. Put the child to sleep regularly. A young child should get plenty of sleep—15 to 18 hours every 24 hours. Weigh the baby at regular intervals. Use purgatives only very rarely. 13 FEEDING. A mother must be prepared to give herself up to her baby for twelve months. A mother must feed well. If she loses weight rapidly, has night sweats or feels run down, she ought to consult a doctor without any delay. Breast feeding is the best. Put the baby to the breast for five minutes every two hours until the milk comes. Feeding by breast and bottle combined is next best. Bottle feeding alone should be given except when the mother has no milk or is in delicate health. Where bottle feeding is employed, two bottles should be in alternate use. The bottles must be boat-shaped. Do not take the baby off the breast in August or September, as in these months fatal diarrhoea is apt to set in. The milk used must be fresh and clean. A healthy baby will empty the breast in from 10 to 15 minutes. When there is evidence that the baby is not thriving or that its bones are becoming bent or its joints enlarged, a doctor should be consulted at once. Weaning should be gradual and the baby should not have the breast after nine months if four teeth are cut, and in no case after twelve months. No solid food should be given a child until all its teeth have been cut (usually at the age of two years). Infants are unable to digest the food of grown up people. It acts as a poison to them. Do not rock the baby after feeding. Do not sit a child up until it is able to do so—that is, until it is about five months old. 14 Do not give soothing powders or fever powders or any medicine except by a doctor's orders. The Baby's Food. When a baby is fed artificially the following matters require the most careful attention:— Storage of Milk. The hands must be washed before handling the milk. As soon as milk is delivered, strain through clean, fine muslin into a clean, scalded jug. If there is any dirt in the strainings, report to the Health Visitor. Put a quantity of the strained milk (sufficient for the baby till the next delivery of milk) into a saucepan and bring slowly to the boil. Immediately the milk boils, replace it in the clean scalded jug, cover and stand in a cool place. Preparation of a Feed. The hands must be washed before preparing a feed.—When a feed is to be made, add the quantity of strained boiled milk as per table on page 15 to the required quantity of clean boiling water in a clean, scalded jug. Add the amount of sugar of milk, which can be got from any chemist, shewn on the table on page 15. (The teaspoonfuls should be small and not heaped up). The Bottle. The hands must be washed before handling the bottles and teats.—The bottle must be boat-shaped, and both bottle and teats must be cleansed immediately before and after use. 15 The Amounts and Times of Feeding. Age of Child. Amount of mixture of milk and water to be given at each feed. When to be fed. (Whether breast fed or artificially fed). Milk previously strained and heated to boiling. Boiling water. Sugar of Milk. During day 6 a.m. to 6 p.m. During night. 6 p.m. to 6 a.m. At end of 1 month 1 tablespoonful- 3 tablespoonfuls 1/8 small teaspoonful Every 2 hours Every 3 hours 2 months 2 tablespoonfuls 4 ¼small teaspoonful „ 3 ,, „ 3 „ 3 4 4 ½ small teaspoonful „ 4 „ .. 4 „ 4 6 4 ¾small teaspoonful „ 4 „ ,, 4 „ 6 8 4 1 small teaspoonful „ 4 ,, „ 4 ,, 7 12 4 1½ small teaspoonfuls „ 4 „ (but not if sleeping) Every 4 hours 8 16 none 2 small teaspoonfuls „ 4 „ (but not if sleeping) Every 4 hours (but not if sleeping) Take care that the baby's feed is at body heat. 16 Feeding in the later months. At nine months, a little broth made from fresh meat, a few crumbs soaked in gravy, a little bacon fat twice a week, a little milk pudding, porridge, bread and milk or small pieces of bread and butter may be given as well as pure milk. But pure milk should still be the main food. At twelve months, a lightly boiled egg may be added. At eighteen months, a little minced meat, pounded fish, mashed potatoes with gravy or fresh broth may be given once in the day. The child shall be weighed regularly during the above feeding. If the increase in weight is regular, no alteration in the feeding is required. Loss of weight may be due to overfeeding with consequent vomiting or diarrhoea, or both, or to underfeeding. If the child is overfed, reduce the above quantities proportionately. If the child is underfed, increase the above quantities proportionately. Use your common sense in feeding, and obtain the responsible advice of a doctor when you are in doubt. GEORGE F. BUCHAN, m.d., d.p.h., Medical Officer of Health. Council House, Hounslow. NUMBER OF BIRTHS NOTIFIED. During the last half-year of 1911, 436 out of 500 births occurring in the district or 87 2 per cent. were notified under the Act. This is a very good percentage for the first six months of the operation of the Act. 17 BIRTHS VISITED. During the year, 384 births were visited, and the following table gives certain particulars as regards these at the time of the Health Visitor's visits :— No. of births visited 384 No. being fed naturally 320 384 ,, naturally and artificially 33 ,, artificially 31 No. using comforter 114 No. sleeping with parents 183 FEEDING. The above facts are important as shewing that during the first fortnight after birth, no less than 320 out of 384, or 83 per cent., of infants are naturally fed. This is in marked contrast to the number so found to be fed at the time of death—only three out of 44 cases enquired into, or just 7 per cent. These facts shew the enormous importance to be attached to the correct feeding of infants and how essential it is for natural feeding to be maintained. THE USE OF THE COMFORTER. 114, or 34 per cent., of the babies visited had been provided with comforters. A comforter is either used alone or dipped into sweetened water or milk. But however it is prepared it is essentially a dirty article and should not be given to the baby. The following conditions of ill-health arise from its use:— 1. Thrush mouth. 2. Sore throat, tonsillitis and enlarged tonsils. 3. Enlarged neck glands. 4. V shaped or gothic palate. 5. Laryngitis and bronchitis. 6. Diarrhoea. I trust that as the result of the work of the Health Visitors the comforter will soon disappear from this district. 18 SLEEPING WITH PARENTS. It was found that 183 bahies, or 48 per cent., slept with their parents. This custom is prevalent and dangerous, and I would specially direct attention to the three deaths which occurred from this cause during the year. TEACHING OF INFANT CARE AND MANAGEMENT. In connection with the subject of Infantile Mortality, I attribute the highest importance to the teaching of the above subject to the older girls at the schools. Many of these girls, at an eaily age, are left at home to look after the baby while the mother goes out to work, and all of them are keenly interested in the subject. This work is undertaken by the Health Visitors, and is referred to fully in my report as School Medical Officer. CAUSES OF DEATH. 578 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 142 deaths, and Cancer for 36. Tuberculosis. This disease gave rise to 64 deaths, of which 46 were due to consumption. The number of deaths from consumption per annum in this district is diminishing on the average, 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 ... 34 0 1906 31 1907 32 1908 36 1909 41 . 1910 30 1911 46 19 Of the 46 deaths due to pulmonary tuberculosis, the following is a statement of the ages at death and occupations of these cases:— Deaths occurring at home. Males. Females. Occupation. Age. Occupation. Age. Child 1.57 Child 1.75 Child 3 Blouse maker 22 No occupation 61 Laundress 20 Carman and Contractor 32 At Home 15 Labourer 37 At Home 24 Compositor 53 At Home 27 Painter 58 At Home 27 Laundry Proprietor 59 At Home 30 Police Pensioner 59 At Home 30 Architect 24 At Home 36 Civil Engineer 38 At Home 38 Wood Turner 26 At Home 40 Railway Porter 30 At Home 45 Carman (Grocer's) 34 At Home 49 Carpenter and Joiner 62 At Home 49 At Home 52 Average age at death 38.5 At Home 56 At Home 65 Average age at death 34'8 20 Deaths occurring in Public Institutions. Males. Females. Occupation. Age. Occupation. Age. School child (Marylebone Infirmary) 13 No occupation (Union Infirmary). 16 No occupation (St. Catherine's Hospital. 21 No occupation (Union Infirmary). 20 Ramsgate). Motor Cleaner (St. Mary's Hospital) 44 Domestic Servant (Union Infirmary). 22 Powder Mill Hand (Union Infirmary). 28 Domestic Servant (Union Infirmary). 39 Barman (Union Infirmary). 23 Domestic Servant (cook) (Union Infirmary). 44 Average age at death 25.8 At Home (Union Infirmary). 29 At Home (Spring Grove House). 41 At Home (Union Infirmary). 56 Average age at death 33.3 Average age at death of all males 35 3 Average age at death of all females 34 3 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 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 1911 36 The above figures are small, but would appear to indicate that Cancer is on the increase in this district. 21 DEATHS PROM INFECTIOUS DISEASES. The following table gives the number of deaths per annum from certain infectious diseases in each year since 1900:— Table shewing deaths from infectious diseases occurring annually since 1900:— Scarlet Fever. Diphtheria. Typhoid 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 1911 1 6 2 9 16 Total 16 77 10 98 110 The above figures are remarkable and again shew, as I have pointed out during the past two years, 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 22 were taken to have the most serious cases of these diseases treated in the Isolation Hospital, I am sure that a number of lives would be saved every year. INFECTIOUS DISEASES. The following table shews the total number of cases of each disease notified under the Infectious Disease (Notification) Act, 1889, for each year since 1900 :— Table shewing the total number of notifications received annually under the Infectious Disease (Notification) Act, 1889, since 1900. 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 1911 75 25 20 24 3 147 The above figures include notifications received from public institutions in the district, and it is satisfactory to record, that during the past year the total of 147 is the lowest since 1904, when the total was .145. 23 When it is borne in mind that the population has increased by over 10,000, or 30 per cent. since 1904, the figure of the present year bears the most favourable comparison with all others. Out of the 147 notifications received during 1911, 35 occurred in public institutions as shewn on the next table. Table shewing the number of infectious diseases notified during the year 1911, from Public Institutions in the district. PUBLIC INSTITUTION. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Total. Poor Law Instiutions :— Union Infirmary 10 2 11 9 1 33 Mogden Isolation Hospital 1 ... ... ... ... 1 Holme Court Truant School ... 1 ... ... ... 1 Total 11 3 11 9 1 35 Since the year 1908, I have been able to obtain information as to the number of cases notified annually from Public Institutions in the district, and the following table gives the total number of notifications of infectious cases actually belonging to the district, i.e. the total number of notifications received less those occurring in public institutions in the district:— Table shewing number of notifications received annually under the Infectious Disease (Notification) Act, 1889, since 1908, exclusive of those occurring in Public Institutions in the district. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Total. 1908 75 44 4 10 2 135 1909 117 26 3 13 1 160 1910 77 26 1 15 1 120 1911 64 22 9 15 2 112 The total number of 112 notifications of infectious disease occurring in a population of 42,526, or approximately one case to every 400 of the population, represents a phenomenally low incidence rate. 24 While an outbreak of infectious disease may occur at any time under circumstances beyond the control of your Health Department, I am of opinion that the efforts of the Health Committee in getting rid of insanitary conditions and improving the housing conditions of the poorer class of the population, among whom infection rapidly spreads, are bearing and will continue to bear fruit in a reduction of the incidence of infectious disease. 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:— Table shewing cases of Scarlet Fever notified and removed and percentage removed to Hospital each year since 1900. Year. No. of Cases notified. No. of cases removed to Hospital. Percentage of cases removed to Hospital. 1900 181 120 66.29 1901 104 77 7403 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 1911 75 62 82.66 Total 1223 920 75.22 25 In order to be in a position to compare the relative values of Hospital and Home Isolation in Scarlet Fever, it is necessary to consider carefully certain particulars in regard to the cases notified. Eleven of the notified cases occurred in public institutions, and are therefore excluded from further consideration. The remaining 64 cases occurred in 48 separate households, from 39 of which the cases were removed to hospital, and in 9 of which the cases were kept at home. I present certain particulars regarding these cases in a similar form to that presented last year, and I include last year's figures for purposes of comparison. Scarlet Fever.—Hospital and Home Isolated Cases during the years 1910 and 1911. Hospital Isolated Cases. Home Isolated Cases. 1910. 1911. 1 Total. 1910. 1911. Total. Number of cases 57 51 108 20 13 33 ,, households affected 47 39 86 16 9 25 „ households in which secondary cases occurred 9 5 14 4 2 6 ,, secondary cases in households 10 12 22 4 4 8 „ Number of return cases 1 4 5 ... ... ... Average duration of isolation 54 54 54 40 31 36 *A return case is defined as a case which occurs in the same family after a case in the family has been set free from isolation in Hospital or at Home as the case may be. The figures for this year point to the same conclusions as were made last year. Taking the totals for both years it can be said:— 1. That cases isolated at home get better in a shorter time than cases isolated in Hospital. 26 2. That five return cases occurred in connection with Hospital isolated cases, while none occurred in connection with home isolated cases. 3. That the proportion of households in which secondary cases occurred in Hospital isolated cases was one in 614, and in Home isolated cases one in 417. Diphtheria. The following table shews the number of notifications received, and the percentage of cases of Diphtheria removed to Hospital during the past 12 years:— Table shewing cases of Diphtheria notified and removed and percentage removed to Hospital each year since 1900:— Year. No. of eases 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 1911 25 17 68.00 Total 668 449 67.21 27 Three of the 25 cases notified occurred in public institutions, and are therefore excluded from further consideration. The following particulars as regards Hospital isolated and Home isolated cases are presented in tabular form for purposes of comparison. Diphtheria.—Hospital and Home Isolated Cases during the years 1910 and 1911. Hospital Isolated Cases. Home Isolated Cases. 1910. 1911. Total. 1910. 1911. Total. Number of cases 16 14 30 10 8 18 ,, households affected 11 13 24 9 7 16 ,, households in which secondary cases occurred 4 1 5 1 1 2 ,, secondary cases in households ... 5 1 6 1 1 2 The above table shews that during the two years 1910 and 1911, 40 households were invaded by Diphtheria. From 24 of these the cases were removed to Hospital, and yet five secondary cases occurred. In 16 instances, the cases were kept at home, and in these only two secondary cases occurred. It must therefore be concluded that removal to Hospital, while very valuable for purposes of treatment in cases of Diphtheria of a severe type, is not the most important factor in preventing the spread of the disease. Anti-toxin. During 1910, the Council made arrangements for providing Diphtheria Anti-toxin for the poorer inhabitants of the district in accordance with an Order of the Local Government Board. During the year 1911, Anti-toxin has been supplied in 52 instances to medical practitioners, and in 20 cases the Council has paid the charges in accordance with the arrangements in force. 28 Typhoid Fever. The following table gives the number of cases of Typhoid Fever notified and removed to Hospital each year since 1900 : Table shewing cases of Typhoid Fever notified and removed and percentage removed to Hospital each year since 1900. Year. No. of cases notified. No. of cases removed to Hospital. Percentage of cases removed to Hospital. 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 1911 20 8 40.00 Total 113 50 44.25 Eleven of the 20 cases notified occurred in Public Institutions and three were wrongly diagnosed. The remaining 6 cases occurred in one family, and all were of an anomalous type, rendering diagnosis exceedingly difficult. Widal's re-action in none of the cases submitted to the test gave a decided positive re-action, and in the first case it was absent on the 9th and 44th days of the disease. The following table shews the classic signs and symptoms of Typhoid Fever, and indicates which of them were present in these cases:— 29 SIGNS AND SYMPTONS. Case. Date of onset. Fever. Diarrhoea. Spots. Enlargement of spleen. Tenderness or gurgling in right iliac fossa. Widal's re-action. Complications. W.M. 31-8-11 Yes Yes No No No 9th day, negative 44th „ „ Haemorrhage from nose J.M. 16-9-11 „ „ „ „ „ 28th day, feebly positive „ „ DM, 21-9-11 „ „ „ „ „ 19th day, doubtful Double pneumonia 23rd „ feebly positive Haemorrhage from bowel N.M. 23-9-11 „ „ „ „ „ 21st day, feebly positive Haemorrhage from nose F.M. 26-9-11 „ „ „ „ „ 18th day, feebly positive „ „ H.M. 2-11-11 „ „ „ „ „ „ „ 30 One of the above cases, D.M., unfortunately proved fatal. All of them were removed to Hospital and the last two. F.M. and H.M., were still under treatment at the end of the year. These cases were not notified until I was called in to see the cases on the 14th October, and as the disease had already got 6 weeks start of the Health Department, an outbreak was to be feared. The most stringent precautions were adopted. The family was asked to observe a quarantine period and not to have visitors. The house and drainage were submitted to a thorough inspection and test, and all defects were notified with a view to their being remedied. The house was disinfected and cleansed throughout. In addition, every house in this street was visited and warned as to the danger of the disease and the precautionary measures to be adopted and careful enquiries were made from time to time as to any case of suspicious illness. It is satisfactory to record that these measures were successful in safeguarding the public health, and that the disease did not spread beyond the affected household. Puerperal Fever. During the year the Health Committee made arrangements with the Joint Hospital Committee for the admission to Hospital of cases of this disease when the accommodation permitted. Isolation Hospital Accommodation. This district, with the Borough of Richmond (Surrey) maintains two Isolation Hospitals:— (1). Mogden Hospital for Scarlet Fever, Diphtheria, Enteric Fever, and, accommodation permitting, Puerperal 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 31 (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 87 of the 147 cases notified were removed Hospital. Of these 87, 14 entered from Public Institutions, and 2 entered Metropolitan Asylums Board's Hospitals, leaving 71 chargeable to the District Rate at Mogden Hospital. As during the year £1273 were raised for the upkeep of this Hospital, the cost per patient to this district is about £18. In my opinion, having regard to the utility of the Isolation Hospital, this money is not well spent. Hospital isolation of a large number of mild cases of Scarlet Fever is a waste of money. What should be aimed at is the isolation of serious cases of all infectious diseases, especially Measles and Whooping Cough, which in epidemic times cause so many deaths. During last year 25 deaths occurred from Measles and Whooping Cough, as against 9 from Enteric Fever, Scarlet Fever and Diphtheria. It is those two former diseases which specially require skilled nursing, and I am strongly of opinion that provision should be made for them. The isolation in Hospital of all cases of infectious diseases would be impracticable, but a judicious selection of cases urgently requiring skilled and competent nursing might very well be made with considerable advantage to the public. Pulmonary Tuberculosis. 71 cases of this disease were brought to the notice of the Health Department during the year 1911, as compared with 20 during the previous year. This large increase in number is mainly due to the Public Health (Tuberculosis in Hospitals) Regulations, 1911, which came into force on 1st May, 1911, and required the Medical Officers of Hospitals to notify cases of the disease coming under their notice at the Hospitals to the Medical Officer of Health. 42 such notifications were received during the year. 32 In my annual report of last year, I indicated the methods which should be adopted to secure the complete control and eradication of this disease. During the year the Health Committee have given further consideration to the subject, and especially have they had under consideration the advisabilitv of establishing a Tuberculosis Dispensary. The Chairman and Vice-Chairman of the Committee, with Mr. Councillor Gentry and myself, visited the Tuberculosis Dispensary at Portsmouth, as well as the Smallpox Hospital there, which is used for the treatment of cases of consumption. The Chairman and Mr. Councillor Gentry also visited the Paddington and Kensington Dispensary. In this district the campaign against Consumption has still to be organised, and put into operation, and the matter is so important to the community that I shall here briefly review the whole subject and at the same time indicate the work which a Tuberculosis Dispensary would carry out and the important part it must play in any well organised scheme against Consumption. Nature of Consumption. Consumption is a disease of the lungs caused by the Bacillus tuberculosis discovered by Koch in 1882. The bacillus is the causative agent in the production of the disease, and can be seen by the high power of a microscope in the sputum of a consumptive. In the act of coughing, spitting or sneezing, large numbers of these bacilli are discharged by the consumptive into the air, and may subsequently be inhaled by some other person. Light, sunshine and fresh air are inimical to the bacillus, but darkness, bad ventilation, dampness and dirt, favour its growth and dissemination. As is only to be expected, therefore, Consumption has a special incidence on those who live under insanitary conditions in unhealthy dwelling houses. Deaths from Consumption. During the past eleven years (1901-11) 407 persons in this district have died of Consumption. In this, connection it is important to note that Consumption is not a disease like Cancer, which attacks a person near the end of the usual span of life, but it attacks and kills man in his prime, the most fatal period being between 20 and 40 years 33 of age, when a man is of the greatest value to the State, and when he is the main support of a family dependent on him. During the years 1910 and 1911, the average age at death of consumptives in this district was 29.56 and 34.78 years respectively. Cost of Consumption. Dr. Farr, in the 39th Annual Beport of the Begistrar-General of Births and Deaths, estimated the mean economic value of each member of the community as £110, his estimate being based on the low standard of the agricultural labourer of that period, 1876. On the same basis the net value of a man of 25 years (i.e., the present value represented by the excess of his future earnings over cost of maintenance) was estimated by him at £246. Becently, Professor Irving Fisher, of Yale University, has estimated the minimum worth of the average American life as 4,000 dollars at the age of 20 years. These estimates, when applied to a disease like Consumption, make no allowance for loss of wages during the protracted illness, nor the cost of future maintenance of families left destitute by the death of the wageearner. Having regard to all these facts, it is well within the mark to say that each death from Consumption in this district represents an economic loss of £200, or in other words the average loss in this district on account of the 37 deaths per annum due to Consumption is, as a low estimate, £7,400 per annum. Number suffering from Consumption. I have said that 407 persons have died of Consumption during the past eleven years, or an average of 37 deaths per annum. Dr. Philip, of Edinburgh, who has studied this question for 20 years, states that the number of persons living already seriously affected by Consumption may be taken as ten times the mortality in any given district, and we can therefore say that the number suffering from Consumption in this district at any time is 370. That this figure is approximately correct may be shown in other ways, e.g., during the first four weeks of 1912, 24 cases of consumption were notified, making at this rate a total of 312 for the year. 34 On the basis of these estimates, I think we may safely take the figure of 300 as representing the minimum number of cases of Consumption existing in this district at any one time. Curability of Consumption. Consumption is an eminently curable disease. The proof for this statement is found in the post mortem room, where it is found that 80 to 90% of the bodies examined have suffered and recovered from Consumption. It is also well to note that Professor Sir T. Clifford Allbutt, of Cambridge, stated at the Tuberculosis Congress of 1901:— " I am guilty of no extravagance when I suggest that one third of you who hear me, wittingly or unwittingly, are, or have been, infected with tubercle." Tuberculosis Dispensary. All these facts illustrate the importance of the prevention and cure of Consumption within the district, and it is this work which a tuberculosis dispensary would organise and carry out. This work may be summarised as follows : 1. The treatment of consumptives by tuberculin and other methods. 2. The home treatment of cases unfit to attend the dispensary. 3. The searching out of contact and early cases of disease with a view to treatment before the disease has become advanced. 4. The periodical bacteriological examination of the sputum of all cases under treatment. 5. The removal to Hospital of cases in need of complete rest and good food. As to this, arrangements could, I think, be made with the Joint Hospital Committee for the use of some of their Hospital accommodation for this purpose. 6. The visiting of the Consumptives in their homes for the purpose of instructing them as to the best means to be adopted for their own health and for the prevention of the spread of the disease to other members of the family. 35 7. The provision of outdoor shelters in suitable cases. 8. The supply of pocket sputum flasks, if necessary. 9. The distribution of literature for the guidance of Consumptives. 10. The organisation, as far as possible, of voluntary helpers who would assist cases in need of extra food, clothing or other help—e.g., keep the family going for a short period if the bread winner was removed to Hospital for a few weeks. One important difficulty with regard to Consumption, and one which treatment at a dispensary is calculated to surmount, is that Consumption is a disease of gradual onset, and a working man will not seek advice on the occurrence of the early symptoms which are apparently trivial, usually on account of the expense. And then, when he does seek advice, the disease is often too far advanced for a cure to be effected or he finds himself unable to enter a Sanatorium in case he loses his job. A Tuberculosis Dispensary obviates this difficulty, as there advice would be free to all, and tuberculin treatment can be carried out while the usual employment is followed. Cost. Establishment.—The cost of establishment of a Tuberculosis Dispensary would be small—about £50. Annual Charges.—The annual expenditure would consist in the charges for drugs and medical services, which I estimate would be about £350. When this relatively small cost per annum for the efficient treatment of Consumption within the district is balanced against £7,400 per annum, which is the calculated miniumum loss attributable to consumption, the investment must be considered sound, and the expenditure justifiable. It has also to be noted that during the year a sum of more than £1273 was spent on the cure and prevention of Scarlet Fever, Diphtheria and Typhoid Fever in connection with 95 cases, with 9 deaths, and yet nothing was spent in dealing with an estimated number of 300 cases of consumption with 46 deaths during the year 1911. 36 The matter is urgent and requires attention and adjustment. Power of Council to establish Tuberculosis Dispensary. The Council has power under Sections 131 and 133 of the Public Health Act, 1875, to establish a Tuberculosis Dispensary. COUNCIL LABORATORY. The Laboratory has been made use of this year to a greater extent than last, 93 examinations having been carried out in 1911 as compared with 73 during 1910. The following tables give a statement of the work done:— Diagnosis of Disease. Result. Total. Positive. Negative. Diphtheria 9 42 51 Tuberculosis 5 14 19 Typhoid Fever 4 4 8 Ringworm 1 0 1 Total 19 60 79 Sundry Examinations. Chemical Examinations of Water Samples 3 Bacteriological Examinations of Water Samples 6 Bacteriological Examination of Pus 1 „ „ Skin 1 ,, ,, Urine 1 ,, „ Cerebro-Spinal Fluid 1 „ „ Blood 1 Total 14 SANITARY WORK. Table X. gives a statement of the sanitary work during the year. 37 The Health Committee have had under consideration during the year, the question of the re-organisation of the Sanitary Staff, and have made provision for carrying on the various duties of the Health Department by a re-arrangement which involves the retiral on January 1st, 1913, of Mr. Smith from the post of Inspector of Nuisances and his appointment to the post of Consulting Sanitary Inspector. The Committee have also arranged to dispense with the office of Disinfector and Drain Tester. These two vacant posts are to be filled by the appointment of two fully qualified sanitary inspectors. This arrangement is the most satisfactory and cheapest which can be devised, and will, barring unforeseen legislation, enable the Committee to carry on its work for some time to come. HOUSING. The estimated total number of houses in the district on April 1st, 1911, was 8137, or an average of 1.18 house per acre. The rental of the houses in this district varies between £10 and £100 per annum, but very few houses are let at the lower or upper limits. The usual rental may be taken at between £20 and £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. During the year, the Sanitary Staff has made a big effort to cope with the Housing (Inspection of District) Regulations, 1910. A list of houses for early inspection has been prepared, and is submitted to the Committee at each meeting as required by the Regulations. This list comprises about 1,000 houses. The records of the inspections made are also taken into account at each meeting, and the Committee gives the necessary instructions with regard to these. The property inspected under these Regulations comes broadly under two heads :— 1. Houses with sanitary defects. 2. Houses unfit for human habitation. 38 1. Houses with Sanitary Defects. The following table gives the information required by the Local Government Board, relative to this class of property, dealt with during the year under the Housing (Inspection of District) Regulations, 1910:— Housing (Inspection of District) Regulations, 1910. Table shewing the number of dwelling houses inspected, with directions given and action taken by the Health Committee with the results of such action during 1911. Premises. No. of houses infected. No. of notices ordered to be served. No. of notices served. No. of notices complied with. No. of notices outstanding at 31-12-11. 7-9, Holloway Street 2 8 8 8 ... 17-23, „ 4 13 13 13 ... 20-34, „ 8 24 24 24 ... 1-5, 3 13 13 13 ... 25-43, „ 10 41 41 41 ... 2-18, 9 36 36 36 ... 193-203,Hanworth Road 6 35 35 35 ... 2-12, Linkfield Road 6 43 43 ... 43 145-157, „ 7 35 35 ... 35 139-141, „ 2 9 9 ... 9 63-73, 6 29 29 ... 29 14-38, 13 58 Not served ... ... 114-116, „ 2 10 „ ... ... 183-197, „ 8 41 „ ... ... Totals 86 395 286 170 116 39 2. Houses Unfit for Human Habitation. The procedure adopted by the Health Committee when a house is represented as unfit for human habitation 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 representative, 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. The following statement gives the information which the Local Government Board requires the Medical Officer to furnish for the year ending, December 31st, 1911 in relation to houses represented by him as unfit for human habitation :— Number of houses represented by Medical Officer of Health 28 ,, Closing Orders made by the Local Authority 29 ,, appeals against Closing Orders 1 ,, notices served on occupying tenants 13 „ occupying tenants summoned 1 ,, Orders made by Court requiring occupying tenants to quit 1 ,, of Closing Orders determined 3 ,, Demolition Orders made 14 „ appeals against Demolition Orders 1 ,, Demolition Orders obeyed 18 ,, demolitions carried out without Orders being made 8 The following table gives more detailed information in regard to the houses represented as unfit during the year, 1911:— 40 Housing (Inspection of District) Regulations, 1910. Table shewing dwelling houses represented as unfit for human habitation, with action taken and the results of such action during 1911. Premises. No. of houses represented by Medical Officer of Health. Date Closing Orders made. Date Closing Orders determined. Date Demolition Orders made. Date Demolition Orders obeyed. Houses demolishec without Orders. 1-3, Wiseman's Cottages 3 25-5-09 ... 27-9-10 27-5-11 ... 1-15, Stafford Place 15 5-3-10 ... 27-9-10 9-1-11 ... *Whitton Park Stables 1 27-9-10 7-3-11 ... ... ... 4-8, Tivoli Road 3 27-9-10 ... 28-3-11 ... ... †132-6, Linkfield Road 3 25-10-10 ... 25-4-11 ... ... 50-58, High Street 5 29-12-10 ... ... ... 27-5-11 2-6, Stone's Cottages 3 28-2-11 ... ... ... 28-10-11 Holly Cottage 1 25-4-11 ... 28-11-11 ... ... Downton House 1 25-4-11 ... 28-11-11 ... ... 6, Lower Square 1 25-4-11 27-6-11 ... ... ... 7, „ „ 1 25-4-11 26-9-11 ... ... ... **23-33, Inverness Road 6 24-5-11 ... 28-11-11 ... ... ‡1-8, Harris's Cottages 8 27-6-11 ... ... ... ... 2-8, Bath Place 8 25-7-11 ... ... ... ... 45-47, Church Street 2 ... ... ... ... ... For Notes see next page. 41 *The Committee interviewed the owners of these premises on 7th March, 1911, and was informed that these had only been temporarily occupied as a dwelling house, that they had been erected for use as stables and that it was not the intention of the owners to permit their use as dwelling houses in the future. †An appeal was lodged against the Demolition Orders on 16/5/11. ‡An appeal was lodged against the Closing Orders on 8/8/11. **The operation of the Demolition Orders made in respect of this property was postponed for a period of four months. Appeal against Demolition Orders. This appeal was in respect of Demolition Orders made by the Council on 132, 134 and 136, Linkfield Road. The Demolition Orders had been made in accordance with the Act, on the ground that the owner was not using due diligence to render these houses fit for human habitation. A public enquiry was held by the Local Government Board, at which the Medical Officer of Health and Assistant Sanitary Inspector Butler gave evidence for the Council, and the Owner and his Surveyor gave evidence for the Appellant. The Council was represented by the Clerk and the Appellant by Counsel. The Demolition Orders made by the Council were confirmed. Appeal against Closing Orders. This appeal was in respect of Closing Orders made by the Council on 1, 2, 3, 4, 5, 6, 7 and 8 Harris's Cottages, Worton Boad. A public enquiry was held by an Inspector of the Local Government Board, and evidence was given for the Council by the Medical Officer of Health and the County Medical Officer. No evidence was called by the Appellant. The Council was represented by the Clerk. The Appellant was not represented. The Mortgagee made a statement on behalf of the Appellant. The Closing Orders made by the Council were confirmed, and the Appellant was ordered to pay the costs of the appeal. 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. 42 A few houses still draw their water from wells. Samples of water from six wells were examined daring the year. In three cases the samples shewed that the water was fit for use for domestic purposes. In one instance the well was closed, and action was pending at the end of the year in the case of the remaining two wells, which were yielding polluted water. Nuisances, Contraventions of Byelaws, Defective Drainage, etc. Table shewing Nuisances, etc., reported to and directions given and action taken by the Health Committee with the results of such action during 1911. No. of Houses dealt with. No. of notices ordered to be served. No. of notices served. No. of notices complied with. No. of notices outstanding at 31-12-11. Brought forward from 1910 Bland's Farm l 1 l ... l 1911— Mellersh Farm 2 12 12 ... 12 Edward's Cottage 1 3 3 3 ... Dale's Cottage 1 1 1 l ... Toyne's & Field's Cottages 8 8 8 ... 41, Grove Road 1 2 2 2 ... 30, Cross Lances Road ... 2 2 2 ... 143-153, Grove Road ... 6 0 ... ... 226, Grove Road 1 1 1 1 ... 44, 46, 50, Kingsley Road ... 3 3 3 ... Thistleboon, College Road 1 1 1 1 ... 9, Derby Road 1 1 1 1 ... 114, Hanworth Road 1 3 3 ... 3 337, Staines Road 1 3 3 ... 3 2, Devonshire Villas 1 2 2 ... 2 27-29, Loring Road 2 2 2 ... 2 37, Inwood Road 1 3 3 ... 3 Ivy Cottage, North Hyde 1 2 0 ... ... Total for 1911 33 55 47 22 25 Carried forward to 1912 10 28 26 ... 26 43 DRAINAGE. Tests. During the year 281 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. Other causes. Total. No. of houses tested 9 5 117 14 145 No. of houses in which drains were found defective 8 4 44 13 69 No. of houses in which drains were found intact 1 1 73 1 76 No. of re-tests during and after repairs 54 12 55 15 136 HOUSES LET IN LODGINGS. 30 houses let in lodgings are now on the Register, but a much larger number remain unregistered. It is in these sub-let houses that overcrowding and insanitary conditions exist, and I am hopeful that soon, with the staff at its full complement, the Committee will be able to do a great deal of work in ameliorating these conditions and protecting the public health. COMMON LODGING HOUSES. There are two registered common lodging houses within the district. Both are under constant supervision and are kept in good order. 44 DAIRIES, COWSHEDS & MILK-SHOPS. There are 18 cowsheds with 119 cows, and 82 dairies and milkshops in the district. These are subjected to fortnightly inspection as far as practicable, but the condition of some of them is not very satisfactory. The importance to be attached to clean and tubercle-free milk in connection with the questions of infantile mortality and tuberculosis cannot be over-estimated. There is little doubt that the deaths of many infants during hot weather is due to the excessive multiplication in the milk of filth bacteria, carried to it by flies, dust, etc. The work of the Royal Commission on Tuberculosis has shewn that cows suffering from this disease can communicate it to man through the milk supply. A Pure Milk Bill is urgently required, and steps should be taken for the eradication of tuberculosis from herds of cattle. This latter would be expensive, but as it is certain that it would save many human lives, and especially the lives of children dependent on milk for their food, the benefits accruing would, in my opinion, much outweigh the cost. SLAUGHTER HOUSES. 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 qnalification, 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. The Council requires power to appoint more than one Inspector of Nuisances, i.e., to convert its Assistant Inspectors into Inspectors with statutory powers, in order that meat inspection may be thoroughly carried out in this district in the interests of public health. 486 visits were made to slaughter-houses during the year, or about 44 to each slaughter-house. No carcases or parts of carcases were found to be tuberculous. 45 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. BAKEHOUSES. There are thirty-one 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. REPORT ON THE ADMINISTRATION OP 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 :- 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, (b) 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 V., VI., VII, VIII. and IX., duly filled in as required by the Home Office. 46 The names and addresses of 38 home-workers were forwarded during the year by employers or other Councils, to the Medical Officer of Health as required by the Act. Six of these 38 home-workers resided outside the district. The premises of the remaining 32 have been visited. No case of infectious disease was reported on the premises of out-workers during the year. 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 Acts, 1884 HESTON & ISLEWORTH URBAN DISTRICT COUNCIL. Health Department, Council House, Hounslow. January 11th, 1912. To the Secretary, Local Government Board. Canal Boats Acts, 1877 and 1884. Sib, 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, 1911, 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. The remuneration received by him as Inspector of Canal Boats, is, by an Order of the Local Government Board now included in his salary as Inspector of Nuisances. 47 270 inspections were made of 200 boats. On 15 of these boats 16 infringements of the Acts and Regulations were found, as under :— No. of boats with 1 infringement only 14 No. of boats with 2 but not 3 infringements 1 The following table gives details as regards these contraventions :— Infringements with respect to— Carried forward from 1910. Found during 1911. Remedi'd during 1911. Carried forward to 1912. (a). Registration ... 3 3 ... (b). Notification of change of Master ... ... ... ... (c). Certificates 2 3 ... 5 (d). Marking 2 3 2 3 (e). Overcrowding ... ... ... ... (f). Separation of the Sexes ... ... ... ... (g). Cleanliness ... ... ... ... (h). Ventilation 2 2 2 2 (i). Painting ... 1 1 ... (j). Provision of water cask ... ... ... ... (k). Removal of bilge water ... ... ... ... (1). Notification of infectious disease ... ... ... ... (m). Admittance of Inspector ... ... ... ... (n). Habitable condition ... 2 4 3 3 8 16 11 13 48 Legal proceedings were taken against two owners in the case of two boats for contraventions under (n) in the foregoing table. In one case a fine of ten shillings with costs was imposed; in the other information that the contravention was remedied came to hand after the summons had been issued. A fine of two shillings and sixpence was imposed in the latter case. No case of infectious disease was reported as occurring amongst the Canal Boat population during the year. I am, Sir, Your obedient servant, George F. Buchan, Medical Officer of Health. Note.—In recording the facts for the year 1911, under the various headings of the following Tables I., Ia., II., III., and IV. 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 1911 and previous years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. ‡ Nett Deaths belonging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 year of age. At all Ages. Number, † Rate. * Number. † Rate per 1,000 Nett Births. Number. † Rate. * Number. Rate. * 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 36,202 1134 1099 31.25 725 20.03 229 15 153 139.2 511 14.54 1907 38,547 1135 1085 28.95 741 19.22 279 28 100 92.2 490 13.08 1908 41,272 1211 1169 29.10 801 19.41 269 30 130 111.2 562 13.99 1909 42,414 1182 1129 27.34 810 19.10 292 27 103 91.2 545 13.20 1910 43,120 1117 1050 25.01 738 17.11 276 31 105 100.0 493 11.74 1911. 43,684 1075 1018 23.94 850 19.46 340 68 165 162.0 578 13.58 50 NOTES FOR TABLE I. Notes. — 'The Rates in Column 7 are calculated per 1000 of the estimated gross population. The rates in Columns 5 and 13 have 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.: — Name of Institution. Average number of inmates not belonging to District for 1911. Union Workhouse 551 ,, Infirmary 331 ,, Schools 200 Mogden Isolation Hospital 14 Wyke House Private Lunatic Asylum 34 Gunnersbury House 19 Spring Grove House 9 Total 1158 † The deaths included in Column 6 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 6, corrected by the subtraction of the number in Column 8 and the addition of the number in Column 9. The deaths in Column 10 are corrected by substraction of the deaths under 1, included in the number given in Column 8, and by addition of the deaths under 1 included in the number given in Column 9. ‡ "Transferable Deaths" are deaths of persons, who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, are not included in Column 8 or 9, except in certain instances under 3 (ft) below. The following special cases arise as to Transferable Deaths: — (1). Persons dying in Institutions for the sick or infirm, such as hospitals, lunatic asylums, workhouses, and nursing homes (but not almshouses) must be regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an Institution had no fixed residence at the time of admission, the death is not transferable. If the patient has beeu directly transferred from one such Institution to another, the death is transferable to the district of residence at the time of admission to the first Institution. (2). The deaths of infants born and dying within a year of birth in an Institution to which the mother was admitted for her confinement should be referred to the district of fixed or usual residence of the parent. (3). Deaths from Violence are to be referred (a) to the district of residence, under the general rule; (6) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known ; (c) failing this, to the district where death occcurred, if known; (d) failing this, to the district where the body was found. Total population at all ages, 43,316. Number of inhabited houses, — Average number of persons per house, — At Census of 1911. Area of District in acres (exclusive of area covered by water) 6,893.631. Table 1a. Vital Statistics of Wards in 1911. Ward. Population estimated to middle of 1911. Births. Total Deaths Registered in the District. Transferable Deaths. ‡ Nett Deaths belonging to the District. (Uncorrected number. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 year of age. At all ages. Number. † Rate. * Number. † Rate per 1,000 Nett Births. Number, † Rate. * Number. Rate. * 1 2 8 4 5 6 7 8 9 10 11 12 13 Heston 6239 121 121 19.48 67 10.73 4 13 14 115.70 76 12.23 Hounslow N. 9338 223 223 23.88 97 10.38 0 8 29 130.04 105 11.24 Hounslow S. 12225 319 317 25.93 154 12.59 5 10 50 157.72 159 13.00 Isleworth N. 9326 277 222 27.04 466 49.96 318 28 53 238.73 176 21.43 Isleworth S. 6556 135 135 20.63 66 10.06 13 9 19 140.74 62 9.32 Notes.—The same notes as for Table I. apply to this Table. Table II. Cases of Infectious Disease notified during the Year 1911. Notifiable Disease. Number of Cases Notified. Cases Notified in each Ward. Cases removed to Hospital from each Ward. Total cases removed to Hospital. At all Ages. At Ages—Years. Heston Hounslow North Hounslow South Isleworth North Isleworth South Heston Hounslow North Hounslow South Isleworth North Isleworth South Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upw'ds Small-pox Cholera Diphtheria (including branous croup) 25 2 7 13 2 1 ... ... 4 5 4 7 5 3 2 4 6 2 17 Erysipelas 24 ... 1 1 ... 6 8 8 2 4 5 12 1 Scarlet Fever 75 ... 24 41 9 1 ... ... 8 9 14 26 18 7 4 13 23 15 62 Typhus Fever Enteric Fever 20 v 1 12 4 3 ... ... 1 1 ... 12 6 1 1 ... ... 6 8 Relapsing Fever Continued Fever Puerperal Fever 3 ... ... ... ... 3 ... ... ... ... 2 1 Plague Phthisis Under Tuberculosis Regulations, 1908 Under Tuberculosis 29 ... ... 1 4 17 6 1 4 2 9 12 2 Regulations, 1911 Others 42 ... 1 2 9 25 5 ... 7 7 16 8 4 Totals 218 2 34 70 28 56 19 9 26 28 50 78 36 11 7 17 29 23 87 53 NOTES FOR TABLES II. Isolation Hospitals— (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 bods for this district, 5. Number of diseases that can be concurrently treated, 1. Table III. Causes of, and Ages at Death during 1911. Causes of Death. Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without the district Total Deaths whether of ."Residents" or "Non-residents" in Institutions in the District. All ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and nnder 45. j 45 and under 65. | 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified 577 164 32 'j2 20 20 60 104 155 ... Uncei'tified 1 1 ... ... ... ... ... ... ... ... Enteric Fever 2 ... ... ... ... 1 1 ... ... 3 Smallpox ... ... ... ... ... ... ... ... ... ... Measles 9 2 3 2 2 ... ... ... ... 2 Scarlet Fever... 1 ... ... 1 ... ... ... ... ... 6 Whooping-cough 16 11 2 3 ... ... ... ... ... 1 Diphtheria and Croup 6 2 2 ... 2 ... ... ... ... 5 Influenza 3 1 ... ... ... ... ... 1 1 ... Erysipelas 1 ... ... ... ... ... ... 1 ... ... Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 4g 2 1 2 9 19 12 1 57 Tuberoulous Meningitis 7 1 1 4 1 ... ... ... ... 9 Other tuberculous diseases 11 3 3 1 1 ... 1 1 1 2 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... Cancer, malignant disease 36 ... ... ... 1 1 6 15 13 30 Bronchitis 41 9 1 1 ... ... ... 5 25 20 Broncho-Pneumonia 23 8 4 5 ... ... 2 2 2 10 Pneumonia (all other forms) 21 2 1 ... 2 2 2 6 6 13 Other diseases of Respiratory Organs 11 ... 1 ... 1 ... 3 5 1 15 Diarrhoea and Enteritis 68 56 6 ... 1 1 1 1 2 11 Appendicitis and Typhlitis 5 ... ... 1 2 ... ... 1 1 2 Alcoholism ... ... ... ... ... ... ... ... ... 1 Cirrhosis of Liver 3 ... ... ... ... ... 1 2 ... 3 Nephritis and Bright's Disease 22 ... ... ... ... ... 4 7 11 32 Puerperal Fever 1 ... ... ... ... ... 1 ... ... 4 Other accidents and diseases of Pregnancy and Parturition 4 ... ... ... ... 2 2 ... ... 8 Congenital Debility & Malformation, including Premature Birth 59 57 2 ... ... ... ... ... ... 23 Violent Deaths, excluding Suicides 17 5 ... 2 3 ... 2 3 2 10 Suicides 4 ... ... ... ... ... 2 1 1 ... Other defined diseases 150 8 4 1 2 4 13 41 77 115 Diseases ill-defined or unknown . 11 ... ... ... ... ... ... ... 11 31 578 165 32 22 20 20 60 104 155 414 Table IV. INFANTILE MORTALITY DURING THE YEAR 1911. Nett Deaths from stated Causes at various Ages under i Year of Age. Cause of Death. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 1 month. 1-3 months 3-6 months 6-9 months 9-12 months Total Deaths under 1 year. All Causes Certified 22 5 8 8 43 35 41 27 18 164 Uncertified i i 1 Smallpox Chickenpox Measles i i 2 Scarlet Fever... Diphtheria and Croup ... ... ... ... ... ... ... ... ... 2 2 Whooping Cough ... ... ... ... ... ... 4 5 2 11 Diarrhoea ... ... 1 1 2 8 7 5 3 25 Enteritis ... ... ... ... ... 12 1O 5 4 3i .. Tuberculous Meningitis ... ... ... ... ... ... 1 ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... 1 1 Other Tuberculous Diseases ... ... ... ... ... ... 1 1 ... 2 Congenital Malformations 2 ... ... 1 3 2 ... ... ... 5 - Premature Birth 16 2 ... 1 19 ... 1 ... ... 20 I Atrophy, Debility and Marasmus 2 1 5 2 10 10 8 1 3 32 Atelectasis Injury at Birth ... ... ... 1 1 ... ... ... ... 1 Erysipelas Syphilis Rickets Meningitis (not Tuberculous) ... ... ... ... ... ... ... 1 ... ... 1 Convulsions ... ... ... ... ... ... 2 ... 1 3 Gastritis ... ... 1 ... 1 ... ... ... ... 1 Laryngitis Bronchitis 1 2 2 5 1 1 1 1 9 Pneumonia (all forms). ... ... ... ... ... ... 4 5 1 10 Suffocation, overlying . 1 ... 1 ... 2 ... 1 ... ... 3 Other Causes 1 ... ... ... 1 1 1 2 ... 5 23 5 8 8 44 35 41 27 18 165 Legitimate 991 Nett Births 'Illegitimate 27 Legitimate infants 143 Nett Deaths J IIllegitimate infants 22 Report on the administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. Table V.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitaby Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecution. 1 2 3 4 Factories (including Factory Laundries) 21 1 Workshops (including Workshop Laundries) 908 33 Workplaces (other than Outworkers' premises included in Part 3 of this Keport) 193 2 2 Total 1122 36 Nil. Table VI.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Number of Defects. Number of Prosecutions Particulars. Found. Remedied. Referred to H.M Inspector. I 2 3 4 5 Nuisances under the Public Health Acts:Want of cleanliness , 89 89 Want of ventilation 8 8 Overcrowding 1 1 Want of drainage of floors 13 13 Other nuisances . 58 54 fSanitary accommodation— Insufficient 1 1 Nil. Nil. Unsuitable or defective 29 29 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) 2 2 Other offences (excluding offences relating to outwork which are included in Part 3 of this report) 0 0 Total 201 197 Nil. Nil. f Sect ion 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. Table VII.—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. Instances. Notices served. Prosecutions. Sending twice in the year. Sending once in the year. Received from other Councils Forwarded to other Lists. Outworkers. Lists. Outworkers. Con* tractors Workmen. Contractors Workmen. 1 2 3 4 5 6 7 8 9 10 11 12 13 Wearing Apparel— making, &c. 12 0 14 7 0 7 9 4 41 7 1 Do., washing and cleansing 4 1 3 1 1 1 0 2 13 6 1 Nil. Furniture and upholstery 8 0 8 2 2 0 0 28 1 1 Stuffed Toys 2 0 2 1 0 1 2 0 7 2 0 Total 26 1 27 11 1 11 6 89 16 3 Nil. 58 Table VIII.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. Bakehouses (Retail) 31 Laundries (non-factory) 43 Workshops (176) and Workplaces (32) 208 Total number of workshops on Register 282 Table IX.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act, (s.133) 0 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory Act (0- 5)— Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 3 Other ... 0 Underground Bakehouses (s. 101):— Certificates granted during the year 0 In use at the end of the year 1 59 Table X. SANITARY WORK, 1911. Adoptive Acts in force in District: *Infectious Diseases (Prevention) Act, 1890. *Public Health Acts Amendment Act, 1890, Part III. *Public Health Acts Amendment Act, 1907, Parts II., *111., *IV., *V., VI. and VIII. *Notification of Births Act, 1907. Baths and Wash-houses Act, 1846-82. Burial Acts, 1852-85. (Applicable to parts of district only). Private Street Works Act, 1892. Public Libraries Act, 1892. Bye-laws in force in District: *Common Lodging Houses (P.H.A. 1875, s. 80). *Cleansing, etc., and Removal of Refuse (P.H.A., 1875, s. 44). *Houses Let in Lodgings (P.H.A., 1875, s. 90). *Tents, Vans, Sheds, etc., (H.W.C.A., 1885, s. 9 (2)). *Slaughter houses (P.H.A., 1875, s. 169 and T.I.C A, 1847, s. 128). *Prevention of Nuisances (P.H.A., 1875, s. 44). *Keeping of Animals (P.H.A., 1875, s. 44). *Removal of Offensive Matters (P.H.A.A.A., 1890, s. 26). New Streets and Buildings (P.H.A. 1875, s. 157 and P.H.A.A.A. 1890, s. 23). Pleasure Grounds (P.H.A. 1875, s. 164). Regulations made by Local Authority in force in district: *Dairies, Cowsheds and Milkshops (D.C.M.O., 1885, s. 13). Allotments (A.A., 1887, s. 6). •These are administered wholly or partly by the Health Committee. The un8tarred are administered by other Committees of the Council. Staff employed in Sanitary Department: 1 Inspector of Nuisances, who is also Inspector under the Factory and Workshops Act, Petroleum Acts, and Towns Police Clauses Acts. 60 2 Assistant Inspectors of Nuisances. 1 Health Visitor. 1 Drain Tester and Disinfector. 1 Clerk. Inspections: Number of premises inspected on complaint 232 Number of premises inspected in connection with Infectious Diseases ... 140 Number of premises such as Cowsheds, Dairies, Slaughter-houses, Workshops, Workplaces, &c., under periodical inspection 456 Houses inspected from house-to-house (Housing, Town Planning, etc., Act, 1909) ... 86 Total number of inspections and re-inspections made 17,255 Action Taken (other than under Housing, Town Planning, &c., Act, 1909) : Cautionary or Intimation Notices given 4^7' 808 Statutory Orders issued 47 Summonses served 31 Convictions obtained 26 Summonses withdrawn 4 ,, dismissed 1 Dwelling Houses and action under Housing, Town PI &c., Act, 1909 : anning, Number of houses dealt with under Section 15 0 Number of houses found to be in a state dangerous or injurious to health (Section 17) 28 Number of Representations made by M.O.H. (Sec. 17) 28 Number of houses made Habitable without closing orders 0 Number of closing orders made by L.A. (Section 17) 29 Number of houses closed voluntarily 0 Number of closing orders determined after repairs (Section 17) 3 61 Number of houses demolished— (a) by order of L.A. (Section 17) 18 (b) voluntarily- 8 Illegal Underground Rooms vacated 0 Houses Let in Lodgings (Tenement Houses): Number registered under Bye-laws 30 Number of contraventions 0 Common Lodging Houses: Number registered under Byelaws 2 Number of Inspections made 89 Number of contraventions 4 Canal Boats used as Dwellings: Number registered under the Acts — Number of contraventions of Regulations 16 Movable Dwellings, Caravans, Tents, &c.: Number observed during the year 21 Number of nuisances therefrom abated 19 Number removed from district 21 Bakehouses: Number in district 31 Contraventions of Factory Acts 17 Slaughter-houses: Number on register 11 Number of inspections made 486 Frequency of inspection fortnightly. Contraventions of Bye-laws 13 Cowsheds : Number on register 18 Number of inspections made 437 Frequency of inspection fortnightly. Contraventions of Regulations 30 Number of Milch Cows in district 119 62 Dairies and Milkshops: Number on register 82 Number of inspections made 2673 Frequency of inspection fortnightly. Contraventions of regulations 31 Unsound Food: (a). Animals seized 1 (b). Articles or parcels seized ... 6 Animals Condemned by Magistrate 1 Articles or parcels condemned by Magistrate 6 Articles or parcels surrendered Adulterated Food: 23 Samples taken — Found adulterated. — Offensive Trades: Number of premises in district 0 Number of inspections made 0 Contraventions of Bye-laws 0 Water Supply and Water Service: Wells- New Sunk 1 Cleansed, repaired, &c. 0 Closed as polluted 1 Percentage of houses supplied from public water service Cisterns : 99 New Provided 0 Cleansed, repaired, covered, &c. 7 Draw-taps placed on mains 159 Percentage of houses supplied on constant system 99 Number of samples obtained for analysis from— (a). Local wells 6 (b). Public supply 0 63 Drainage and Sewerage of existing Buildings : Water Closets: Number of water closets substituted for dry receptacles 4 Repaired, supplied with water or otherwise improved 194 Percentage of houses provided with water closets 98 Drains: Examined, tested, exposed, &c. 145 Unstopped, repaired, trapped, &c 232 Waste pipes, rain-water pipes, disconnected, repaired, Ac. 108 New soil pipes or ventilating shafts fixed 22 Existing soil pipes or ventilating shafts repaired 7 Disconnecting traps or chambers inserted 4 Re-constructed 6 Total No. of tests and re-tests applied— For Works Department 172 281 For Health Departmen. 1091 Cesspools Rendered impervious, emptied, cleansed, &c. 1 Abolished and drain connected to sewer 2 Percentage of houses draining into sewers 98 Disinfection: Rooms disinfected— (a). Ordinary infectious diseases 148 V / J (b). Phthisis 4 Rooms stripped and cleansed Articles disinfected or destroyed— — (a). Ordinary infectious diseases 1480 (6). Phthisis ... 40 Dust: New bins provided 91 Periodical frequency of dust removal weekly. Number of complaints of non-removal received 8 Method of disposal . desliructor. 64 Sundry Nuisances abated: Overcrowding 21 Smoke 4 Accumulations of refuse 68 Foul ditches, ponds, &c., and stagnant water 5 Foul pigs and other auimals 27 Dampness 139 Yards repaved or repaired 139 Other nuisances 131 HESTON and ISLEWORTH URBAN DISTRICT EDUCATION COMMITTEE. fourth Annual Report OF THE School Medical Officer FOR THE Year ending 31st December, 1911. MEMBERS OF EDUCATION COMMITTEE. T. S. Goodwin, Esq., m.b., c.m., (Chairman). W. A. Davies, Esq., (Vice-Chairman). Members of the Council : W. G. Lobjoit, Esq., j.p., c.c., (ex-officio) (Chairman of the Council). G. Gentry, Esq., (ex-officio) (Vice-Chairman of the Council). T. S. Goodwin, Esq., m.b., c.m., (Chairman of the Education Committee). W. A. Davies, Esq., (Vice-Chairman of the Education Committee). D. Bonnett, Esq. W. H. Lowry, Esq. J. J. Bonnett, Esq. G. E. Pecover, Esq. S. Carter, Esq. S. Smith, Esq. P. W. Langstone, Esq. J. Wilmot, Esq. Selected Members : Mrs. C. F. Eva. G. A. S. Gordon, Esq. Mrs. W. Funge. P. Murphy, Esq. H. J. Nias, Esq. School Medical Officer : George F. Buchan, m.d., d.p.h. 3 Health Department, Council House, Hounslow. 7th March, 1912. To the Chairman and Members of the Heston and Isleworth Urban District Education Committee. Ladies and Gentlemen, I have the honour to submit the fourth Annual Report of the School Medical Officer. The report has been prepared for the information of the Committee and the Board of Education in accordance with circular No. 596 of the Board. The report is divided into seven parts as follows :— 1. Routine Medical Inspection. 2. Special Cases. 3. Medical Treatment. 4. The Administration of the Education (Provision of Meals) Act, 1906. 5. The Teaching of Infant Care and Management and Home Nursing. 6. Defective, Epileptic, Blind and Deaf Children. 7. School Construction. During the year 2076 children have been examined 2634 times. In 399 cases, the parents were advised to seek medical or dental treatment on account of defective conditions noted amongst the scholars examined, but in 229 cases no treatment was obtained, the main reason given by the parents being that they could not afford it. This fact shews the need for the establishment of a school clinic in this district. Medical treatment of school children would have the following beneficial results:— 1. It would allay suffering amongst the children and make them healthy. 4 2. It would increase the regularity of school attendance. 3. It would enable the children to take full advantage of the educational facilities offered. 4. It would prevent destitution in later years. 5. It would tend to the perpetuation of a healthy race. 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, GEOEGE P. BUCHAN, School Medical Officer. 5 I.—ROUTINE MEDICAL INSPECTION. The Children Examined During the year, 973 children have been medically inspected. This number includes all children who began school life in the schools of the Ileston and Isleworth Urban District Education Committee in 1911 prior to medical inspection, and all those likely to leave school before 31st July, 1912. The following table gives the number examined in each school within the district:— Name of School. Entering. Leaving. Boys. Girls. Boys. Girls. Brentford End 10 5 — — Grove Road 19 21 56 56 Heston 17 13 24 20 Hounslow Heath 32 25 51 60 Hounslow R.C. 3 . 4 12 13 Hounslow Town 28 25 50 52 Isleworth Blue Boys — — 60 — „ ,, Girls & Infants 9 2 — 34 Isleworth Central — — 29 36 Isleworth Green Girls — — — 7 St. Mary's R.C. Boys — — 16 — ,, ,, Girls & Infants 14 9 — 16 Spring Grove 11 7 64 21 Woodlands St. John's 14 5 — — Worple Road 14 9 Totals 171 125 362 315 973 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 test type is not practicable, as the children do not know the 6 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. 404, or 41-52 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 conducted 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 ears. Diseases of the heart, circulation and lungs. Any other disease or defect. Only eight objections were made by parents to the examination of their children during the year 1911. The number of objections received in this district, year by year, is so small as to be negligible. 7 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 :— Height, Boys and Girls. Year of Birth. No. of Observations Average height. Inches. Centimetres. 1906—2nd half.year Boys 1 Girls Boys 3800 Girls Bovs 96.52 Girls 1st ,, 56 45 40.76 41.02 103.53 104 19 1905—2nd ,, 81 47 41.84 42.72 106.27 108.50 1st 21 14 42.09 42.57 106.90 108.13 1904—2nd 9 13 43 44 43.61 110.34 110.77 1st ,, 2 2 42.00 45.50 106.68 116.57 1903—2nd 2 47.50 120.65 1902—2nd 1 48 00 121.92 1899—2nd 1 5800 147.32 1st ,, 1 57 00 144.78 1898—2nd 149 107 5614 57.23 142.59 145.36 1st 107 104 55.34 54.51 140.56 138.45 1897—2nd 71 79 57.33 58.53 145.61 148.66 1st 25 23 59.22 6000 150.41 152.40 1896—2nd 5 2 5800 57.75 147.32 146.68 1st ,, 3 1 59 00 62 00 149.86 157.48 1895—2nd 1 63 5 161.29 8 Weight, Boys and Girls. Year of Birth. No. of Observations. Average weight. In pounds. In kilogrammes. 1906—2nd half.year Boys 1 Girls Boys 3100 Girls Boys 1409 Girls 1st ,, 56 45 38.07 37.97 17.30 17.25 1905—2nd 81 47 39.48 40 04 17.94 18.20 1st ,, 21 14 39.71 40.85 1805 18.56 1904—2nd ,, 9 13 40.88 41.61 18.58 18.91 1st ,, 2 2 42.00 47.50 1909 21.59 1903—2nd 2 5300 24 09 1902—2nd 1 48.00 21.81 1899—2nd 1 79.00 35.90 1st ,, 1 73 00 3318 ... 1898—2nd 149 107 64.15 7713 2917 3506 1st ,, 107 104 76.45 6113 34.75 27.77 1897—2nd 71 79 79.49 84.51 3613 38.41 1st „ 25 23 8608 89.52 3912 40.69 1896—2nd 5 2 81.80 75.00 37.18 34.09 1st ,, 3 1 87.66 95 00 39.84 43.17 1895—2nd 1 115 52.27 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. 9 The following tables give" the results :— Clothing. Boys. Girls. No. of observations Entering. Leaving. Entering. Leaving. 171 362 125 315 Clean I Satisfactory repair 153 330 121 302 1 J * i Fair repair 13 27 4 13 j 'Poor repair 2 4 Dirty . Satisfactory repair 'Fair repair 3 1 I Poor repair Footgear. No. of observations 171 362 125 315 Clean , Satisfactory repair 150 332 117 282 1 Fair repair 16 17 7 27 'Poor repair 3 11 1 6 Dirty , Satisfactory repair ! Fair repair 1 2 'Poor repair From the above tables it will be seen that the clothing of 67 children was not in a satisfactory state of repair, and the footgear of 92 children was likewise unsatisfactory. The Education Committee has made during the past few years, serious efforts to deal with the problem of defective footgear among the scholars by voluntary means and much good work has been done. But there is little doubt that in many instances the defective condition of the footgear as well as the clothing is due to the parents not keeping such of these articles as are repairable in repair. Garments should not be worn until they are dirty and torn, but should be washed, cleansed and repaired at regular intervals. I am sure that if this fact were universally acted upon, there would be fewer cases of unsatisfactory repair of clothing and footgear among the scholars. \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 :—- 10 Hair. Boys. Girls. Entering. Leaving. Entering. Leaving. No. of observations 171 362 125 315 Clean 147 319 72 125 Nitty or (warned 271) 0so ion Verminous (excluded 391 - 43 - °3 " 190 From the foregoing table it will be seen that 310 of the 973 children examined had nits or vermin in their hair. In 39 instances, the condition was such that it was deemed necessary to exclude these children from school until the hair had been cleaned. In three of these 39 cases, it was impossible to get the parents to cleanse the hair without resorting to prosecution under the Attendance Acts, when fines were inflicted in each case. In the remaining 271 instances, the parents were warned as to the condition, and given instructions as to how to cleanse the hair. The figures refer to the condition of the hair before the Health Visitors came on duty, and I am hopeful that I shall be able to record a considerable reduction in nitty and verminous conditions among the scholars in future years as a result of their efforts' in this direction. The following tables shew the condition as to cleanliness and disease of the scalp and body in the cases of the 973 children medically inspected during the year:— Scalp. Boys. Girls. Entering. Leaving. Entering. Leaving. No. of observations 171 362 125 315 Clean 168 361 125 315 Dirty 3 Eczema 1 Alopecia 1 Body. No. of observations 171 362 125 315 Dirty 1 3 *Elea-bitten 6 Eczema 2 1 Acne . 1 Seborrhoea 3 Ichthyosis 1 'The expression, flea-bitten, refers only to those cases in which the number of flea bites was very great indeed. The above results are satisfactory, and are better than have yet been recorded. 11 Nutrition. The following table supplies a record of all those children noted during medical inspection, whose nutrition appeared to be below normal:— Year of Birth. No. of Observations. Fair. Poor. 1906—2nd half-year Boys 1 Girls Boys Girls Boys Girls 1st „ 56 45 4 1905—2nd ,, 81 47 2 1st ,, 21 14 1 1904—2nd ,, 9 13 1 1 1st ,, 2 2 1903—2nd „ 2 1902—2nd 1 1899—2nd ,, 1 ... 1st „ 1 ... 1898—2nd ,, 149 107 2 3 ... 1st ,, 107 104 3 ... 1 1897—2nd 71 79 3 ... 1 1st ,, 25 23 ... 1 1896—2nd 5 2 ... 1st „ 3 1 ... 1895—2nd 1 ... Total 533 440 6 14 ... 3 973 20 3 23 12 Teeth.—Boys and Girls. 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:— 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. No. of children with teeth filled. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 IS 1906—2nd half-year i 20 1 ... 1st 101 20 13 12 5 7 1 3 1 1 1 1 i 1905—2nd 128 22 9 26 16 11 2 6 2 4 1 1st 35 24 3 7 6 4 i "i 1 1 1904—2nd ,, 22 24 3 4 4 2 ... 1 1 1st ,, 4 24 2 1903—2nd 2 24 1 1 1902—2nd 1 24 1 1899—2nd ,, 1 28 1 1st 1 28 1 1898—2nd 256 28 41 69 39 11 5 ! 2 3 12 1st ,, 211 28 46 43 29 12 6 3 3 1897—2nd 150 28 17 36 21 6 7 ■ 4 2 1 1st ,, 48 28 11 12 7 5 2 ... 1 1 1896—2nd ,, 7 28 3 2 1 ... 1st ,, 4 28 1 1 1895—2nd i 28 1 145 214 132 59 26 14 14 6 4 7 1 3 1 2 18 2 Total 973 626 13 From the foregoing table it will be noted that 626 out of 973 children, or 64 4 per cent, of the children examined, were found to be suffering from decayed teeth. As illustrating the extent to which diseased teeth conditions receive attention, it is to be noted that only 20 children out of the total of 973 had had any teeth extracted or filled. Dental treatment is certainly required in a large number of these cases, but looking to the future, the important point with regard to the subject of the decay of the teeth is Prevention. Dr. Sim Wallace has given this matter his especial study and his views are embodied in certain simple rules which have been drawn up by the County Medical Officer for Salop, and which I can best emphasize by quoting as follows:— 1. Nearly all the starchy food that is given to children in the first three or four years of life should be in a hard or firm form, compelling mastication, e.g., crusty bread, twicebaked bread, crisp toast and hard whole-meal biscuits. In this way good and well arranged teeth, without irregularities, are likely to be developed, and good habits of mastication to be formed. 2. Mouth breathing in children should always be corrected. 3. Throughout life much of the starchy food should be in a hard form, compelling mastication. Food should rarely be taken in a liquid form, or soaked in liquid or minced. Bread should not be eaten new, and it should have plenty of good firm crust. 4. Sweets should never be taken between meals, nor the last food in a meal; but only along with food requiring mastication. 5. A meal should always be finished with a cleansing food. It is very desirable that fresh fruit should be eaten freely, particularly at the end of a meal. Examples of cleansing and non-cleansing foodstuffs are as follows:— 14 * FOODSTUFFS AND DENTAL CARIES. Not Cleansing and Liable to Induce Dental Caries. Farinaceous and sugary food in general without fibrous element. Examples : — Sweet biscuits and cake; bread and marmalade ; bread and jam ; new bread without crust; bread soaked in milk ; milk puddings ; porridge and milk; stewed fruit; chocolate and sweets of all kinds ; honey. Liquids :—Cocoa & chocolate. The above foods should not be eaten except when followed by foods of the cleansing kind. Cleansing and Preventive of Dental Caries. Fibrous foods generally. Examples : — Fish, meat, bacon, poultry. Uncooked vegetables, lettuce, cress, radish, celery. Cooked vegetables are as a rule cleansing, but in a less degree than uncooked vegetables. Stale bread with crust; toasted bread of all kinds ; twice baked bread ; pulled bread and cheese. Savouries. Fresh fruits, especially those requiring, mastication, e.g., apples. Fatty foods, e.g., butter and margarine. Liquids :—Tea, coffee, water, also soups and beef tea. •Taken from Dr. Sim Wallace's book on the Prevention of Dental Caries. 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 inflamed focus, e.g., decayed teeth, enlarged tonsils, adenoids, abscess of the gums, and so on. Such enlargement of the glands is to be considered as an index of a weakened condition of the system as regards the power of the body to resist disease. The following table gives the results of the observations conducted on enlarged glands 15 Enlarged Glands. No. of Observations. No. with Enlarged Glands. Boys entering 171 95 Boys leaving 362 233 Girls entering 125 70 Girls leaving 315 157 Total 973 555 Diseases of the Throat, Nose and Ear. No. of Observations. Enlarged Tonsils only. Adenoids only. Enlarged Tonsils and Adenoids. Otorrhœa. Chronic Catarrh of middle ear. Deflected nasal septum. Tonsillitis. Cerumen. Rhinitis. Boys entering 171 15 2 7 3 l ... ... ... ... Boys leaving 362 43 1 3 4 l ... 2 ... ... Girls entering 125 15 1 2 3 ... ... ... ... ... Girls leaving 315 38 ... 4 2 ... 2 2 1 1 Total 973 111 4 16 12 2 2 4 1 1 In considering the above table, I desire to state that all the conditions mentioned are known to be causes of deafness, that is to say, that the liability to become hard of hearing existed in 153 out of 973 cases, and actual deafness in point of fact existed in 15 of these cases. When it is remembered that all these children are under 14 years of age, the importance of the above figures becomes apparent. Early treatment is called for in all these cases. These conditions are easily remediable at the beginning, but if allowed to persist, result in deafness of a very chronic form. Eye Diseases. The following tables give the results of observations as to external eye diseases and defective vision among the children medically inspected:— 16 External Eye Diseases. Boys entering. Boys leaving. Girls entering Girls leaving. No. of observations 171 362 125 315 Blepharitis 5 6 6 4 Conjunctivitis ... 1 ... 1 Strabismus 3 ... 3 3 Cyst of upper lid ... ... ... 1 Opacity of Cornea 2 ... ... ... Vision. Boys leaving. Girls leaving. No. of observations 362 315 Both eyes normal 319 250 Only one eye normal 22 23 Both eyes6/8 1 7 One eye 6/8, other 6/12 or less 6 9 Both eyes 6/8 or less 14 26 No. wearing spectacles 8 11 From the above table as regards vision, it will be seen that 677 children were tested and that 108 were found to suffer from defective eyesight. In my opinion, 55 of these children were in real need of spectacles and yet it was found that only 19 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 24 Consumption 4 Forward 28 17 Brought forward 28 Diseases of the heart and circulation— Endocarditis 14 Paralysis 5 Rickets 3 Lateral Cuvatuve 2 Rupture 2 St. Vitus' Dance 1 Spinal Caries 1 Ganglion 1 Petit Mal 1 Total 58 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 106. Boys leaving 88. Girls entering 86. Girls leaving 124. 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 had Per cent, who have had Measles 70 66.0 80 90.9 50 58.1 111 89.5 Whooping Cough 63 59.4 53 60 2 47 54.6 63 50.8 Scarlet Fever 2 1.9 10 11.4 4 4.6 10 81 Diphtheria 1 0.9 4 4.5 3 3.5 3 2.4 Chicken Pox 42 39.6 32 36 3 23 26.7 52 41.9 Mumps 17 160 21 23.8 12 13.9 31 250 German Measles ... ... ... ... 3 35 1 0.8 The figures above recorded are small, but the conclusion from them is, as I pointed out last year, that the number of children who have measles and whooping cough before they go to school 18 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 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 School Attendance Officers. The following cases of infectious illness have been notified by Teachers and School Attendance Officers during the year ending 31st December, 1911:— Mumps. Measles. Whooping Cough. Chicken Pox. German Measles. Total. Brentford End ... 19 ... 3 2 24 Grove Road Infants 11 61 9 41 1 123 Girls 7 5 ... 10 ... 22 Boys 6 3 ... 7 ... 16 Heston Infants ... ... 17 ... ... 17 Girls ... ... 1 ... ... 1 Boys ... ... 3 ... ... 3 Hounslow Heath Infants 2 22 ... 8 ... 32 Girls 1 2 1 1 ... 5 Boys ... 3 1 3 ... 7 Hounslow R.C. Infants ... ... ... 1 ... 1 Mixed ... ... ... ... ... ... Hounslow Town Infants 2 68 12 7 3 92 Girls 1 6 ... 2 ... 9 Boys 1 6 ... 3 ... 10 Isleworth Blue Infants ... 1 3 2 ... 6 Girls ... 1 2 2 ... 5 Boys 3 ... ... ... ... 3 Isleworth Central Girls 1 2 2 2 ... 7 Boys 2 ... 2 3 ... 7 Isleworth Green Girls ... 3 ... 1 ... 4 St. Mary's R.C. Infants ... 3 6 9 ... 18 Girls 2 1 ... 3 ... 6 Boys 2 1 1 2 ... 6 Spring Grove Infants 6 6 32 2 ... 46 Girls 3 1 1 1 ... 6 Boys 6 ... 2 ... ... 8 Woodlands St. John's Infants 8 5 7 8 ... 28 Worple Road Infants ... 4 15 36 ... 55 Mixed 1 1 3 7 ... 12 65 224 120 164 6 579 19 Measles and Whooping Cough are usually considered trivial diseases, but during the past twelve years in this district they have caused 208 deaths, while Scarlet Fever has caused only 16. It is further 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 the younger children in households from infectious illness. I am afraid this is not generally recognised, and that still a large number of parents thinks the sooner their children have these illnesses the better. II.—SPECIAL CASES. This section deals with cases which were referred to me during the year by the Attendance Sub-Committees, the School Teachers and the School Attendance Officers. The following table is a statement of the diseases from which these children suffered and the number excluded on account of these diseases 20 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. Nitty and verminous conditions 138 528 125 116 5650 Skin Diseases 160 342 117 75 6866 Diseases of eyes, including defective vision 106 30 21 9 546 Diseases of nose, throat and ear 107 129 25 9 178 Diseases of the heart and circulation, rheumatism and St. Vitus' Dance 24 35 6 3 502 Diseases of the lungs, excluding phthisis 35 18 19 10 286 Tuberculosis 16 35 13 8 1312 Infectious diseases 17 17 16 2 34 Defective and epileptic children 33 36 1 1 20 Diseases of the mouth 12 17 10 1 72 Injury 14 16 5 1 5 Diseases of the abdomen 7 12 Diseases of the nervous system 10 11 2 2 42 Defects of speech 7 7 Diseases of urinary and generative systems 1 1 Dirty conditions of person 9 14 7 7 122 Malnutrition 14 14 Other diseases 13 19 10 8 226 Nil 68 68 Total 791 1349 378 252 15866 21 The foregoing table shews that a large number of children suffer from diseases requiring medical treatment. In many cases these diseases involve loss of attendance at school with consequent loss of grant. This is notably the case in regard to skin diseases, where 75 children lost 6,866 attendances. This year 378 children lost altogether 15,866 attendances as compared with a loss of 14,321 attendances by 244 children last year. This lost of attendance and consequent loss of grant year by year on account of remediable diseased conditions is a matter for the earnest consideration of the Education Committee. It is certain that treatment would save a large portion of the grant lost, and in addition, the community would reap the advantages stated in the introductory letter to this report. In connection with the 125 cases excluded on account of nitty and verminous conditions, it is to be noted that in three instances, the Education Committee had to resort to prosecution of the parents under the Attendance Acts before the children were sufficiently clean to return to school. Fines were inflicted in these three cases. III.—MEDICAL TREATMENT. During the year, the appointment of a School Health Visitor made it possible to ascertain to what extent medical treatment was obtained in these cases requiring the same. The following table gives the results of the enquiries made in 399 cases:— Eye cases. Throat, Nose and Ear cases. Other Medical or Surgical cases. Dental cases. Total. Obtaining treatment 30 52 4 6 92 Not obtaining treatment 86 88 7 48 229 No information 28 37 2 11 78 In the 78 cases in which no information was obtained, the children had left the school or district before the visit of the Health Visitor. 22 The foregoing table is remarkable as shewing that in only 92 out of 321 cases in which information is available, or 28.6 per cent., was treatment sought by the parents. The main reason given by the parents for not obtaining medical aid was that they could not afford it. I have no doubt that the enormous proportion of these parents was anxious to obtain treatment so that their children might be healthy and strong. The cure of the diseases occurring in childhood is the best form of investment of public funds, in that it tends to prevent destitution in the adult and perpetuate a healthy race. Bye cases, throat, nose and ear cases, dental cases and skin cases are especially suitable for a school clinic. IV—THE ADMINISTRATION OF THE EDUCATION (PROVISION OF MEALS) ACT, 1906 1. The Meals. 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 5th, 1911, 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. 23 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:— 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 1¾ 28 15 153 900 Wednesday 1 30 16 120 800 Thursday 2 72 40 136 1300 Friday 1¼ 21 41 140 1062 Total 7½ 193 155 823 5762 Daily average 1 ½ 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 1d. per child. 2. The Children selected for meals. During the year, the Canteen Sub-Committee decided to have a report from me on the state of nutrition of each child before determining as to whether it required school meals and this has been done in every instance. Altogether during the year applications were made for school meals on behalf of 312 children and in 217 cases the applications were granted. In coming to their conclusions on this matter, the Committee had before them— 1. A report from the School Medical Officer as to the physical condition of the child, 24 2. A report from the Teacher as to the educational progress of the child, 3. A report from the Attendance Officer as to the social circumstances of the child, and the Committee endeavoured to answer in each case the following questions:— 1. Is the physical condition of the child such that it can take full advantage of the educational facilities offered ? and if not, is this physical disability due to lack of sufficient food? 2. Is the educational progress of the child affected by lack of sufficient food? The problem of deciding as to the advisability of feeding any particular child is exceedingly difficult, but I am sure that this method of working is along the right lines and likely to produce the best results as regards the physical and educational improvement of the children. V.—THE TEACHING OF INFANT CARE AND MANAGEMENT AND HOME NURSING. During the year, this subject has been dealt with in the schools by the Health Visitors, and lessons have been given to girls over 12 years of age in accordance with the recommendations of Circular 758 of the Board of Education. The lessons are given fortnightly. Each lesson is of 30 minutes duration, and a class consists of not more than 30 girls. Certain lessons are set apart for practical work and in addition each lesson is accompanied as far as possible by practical demonstrations. All the scholars have been keenly interested in these lessons and the teachers have spared themselves in no way to amplify and expound the lessons in the interval between the visits of the Health Visitor. The following is the syllabus which has been drawn up by me and which has been approved by the Education Committee and the Board of Education 25 LESSON I. The Baby—Its Growth and Development. Weight at birth. Rate of increase of weight. The pliancy of the bones of the infant. Bone formation and solidification. The relatively large size of the skull of the infant. How to support the head and back in lifting and carrying a baby. The age at which the openings at the top of the head close. Movements of the baby. Ages at which a child can hold up its head, sit, crawl and walk. LESSON II. The Baby—Its Growth and Development (Continued). Breathing. The crying of a child at birth. The rate of breathing in infancy as compared with adult life. The Heart and circulation. The Pulse—its comparative rates at different ages. Ages at which the senses of taste, smell, sight and hearing are present. Age and order of appearance of milk teeth. LESSON III. The Baby's Skin and Clothes. Structure of the skin. Functions of the skin. How the skin is continually dying. Why baths are necessary. Relatively greater area of skin in the young. Effects of chills on the skin. Need for warmth. Clothing. Dangers of flannelette. Day and night clothes. Washing of baby's clothes. 26 LESSON IV. The Baby's Bath. Preparation for bath. Room. Choice of bath. Position of bath, chair for nurse, towels, clothes, etc. Temperature of bath and how to take it. Soap—the kind to use. Powder—the kind to use. LESSON V. The Baby's Bath (Continued). Position of baby for undressing. Undressing the baby. Washing face and head. Care of the eyes, mouth and ears. Washing the body. LESSON VI. The Baby's Bath (Continued). Drying the baby. Powdering. Dressing the baby. How the clothes should be put on. The reason that all the clothes are fastened in front. LESSON VII. (Practical). 1. Carrying a baby. 2. Dressing and undressing a baby. 3. Bathing a baby. 4. Washing the eyes. LESSON VIII. Feeding the Baby.—Natural Feeding. Composition and character of human milk. Human milk compared with that of other animals. Advantages of natural feeding. How to hold a child to the breast. Length of times of feeding. Importance of regularity in feeding. The care of the nursing mother. 27 LESSON IX. Feeding the Baby.—Artificial Feeding. Storage of milk. Sterilisation of milk. Cow's milk prepared to resemble human milk. The baby's feed. Times of feeding. Amount of each feed—capacity of baby's stomach. LESSON X. Feeding the Baby.—Artificial Feeding and Feeding Bottles. Patent foods. Different types of feeding bottles—their advantages and disadvantages. Where to keep the bottle between feeds. LESSON XI. (Practical). 1. Demonstration of different kinds of feeding bottles. 2. Washing the baby's bottle. 3. Preparing the baby's feed. 4. Preparing barley water, lime water, albumen water and whey. 5. Measuring quantities. 6. Sterilising milk. LESSON XII. Weaning. How and when to wean. Diet from weaning up to two years. Food stuffs to be avoided. Times of meals. LESSON XIII. Sleeping. The room. The furniture. The cot. When to put a baby to sleep. Position when sleeping. Amount of sleep required. Overlaying. Dangers of soothing powders. 28 LESSON XIV. (Practical). 1. The cot. 2. How a baby should be put to sleep. LESSON XV. Dirt. Visible dirt. Invisible dirt—where it comes from, what it is composed of. How dirt may be carried to the baby's mouth by food, flies, comforter, mouth breathing or hands. How dirt which gets to the mouth may affect the mouth causing thrush, the throat causing sore throat, the lungs causing colds, and the bowels causing diarrhoea. The evils of the comforter. LESSON XVI. Habits, Health and Disease. Early training in regular and cleanly habits. Signs of health. Need for sunshine and fresh air. Signs of ill-health. Constipation. Diarrhoea. Convulsions. Cough. How to take the temperature of the baby. When to send for a doctor. LESSON XVII. Illnesses of Baby. Indigestion—its causes. What to do in cases of illness until doctor arrives. Rickets. Thrush. Skin troubles and parasites. Infectious diseases and disinfection. 29 LESSON XVIII. (Practical). Home Nursing. How to take temperatures. The normal temperature. Counting the pulse. The normal pulse-rate. Counting the respirations. The normal rate of breathing. Use and reading of bath and room thermometers. LESSON XIX. (Practical). Home Nursing. How to make a sick person comfortable. Dressing and lifting patients. Use of feeding cup. Bed making. Changing of sheets and draw sheet. Changing of night gown. Methods of sponging and washing patients. LESSON XX. (Practical). Home Nursing. Measurement of medicines. Making up of solutions of disinfectant. Making of linseed and mustard poultices. Making of fomentations. Equipment. 1 doll, large, washable. 1 feeding bottle, ordinary, with long tube attached. 1 feeding bottle, boat shaped, with reversible teats. 1 brush for cleansing feeding bottle. 2 jugs (I pint). 1 plate. 1 cup and saucer. 1 table spoon. 3 earthenware or enamelled basins. 1 kettle. 30 1 saucepan (2 pints). 1 measure glass. 1 spirit-lamp or gas ring. 6 test-tubes. 1 test-tube stand. 1 test-tube cleaner. 1 bath thermometer. 1 room thermometer. 1 clinical thermometer. 1 banana box for improvised cradle. 1 bath. 1 set clothes :—flannel gown, cotton gown, flannel binder and diaper. ¼ yard cotton. ¼ yard flannel, ¼ yard each, good and poor quality. 1 yard flannelette. 1 yard flannel, thick. 1 yard linen. ½ yard muslin for straining. Diagrams of teeth and skin. Soap. Powder—zinc oxide, starch and boracic acid. Dredger. Eye and mouth swabs. 2 towels (1 large and 1 small). Vinegar. Jug covers. Cot curtains. Chaff bed. Chaff pillow. Cot sheets. Cot blankets. Cot cover. 3 lenses. 1 comforter. Linseed and mustard. Turpentine. 31 Questions set on Infant Care. In the intervals between the visits of the Health Visitors, questions are set from the School Medical Officer's office, and in illustration of this work and the highly satisfactory nature of the answers, I append one set of questions with the best answer received:— Set IV. 1. What are the cheapest and best kinds of cot and bed to use for a young baby? 2. What things would you get ready for the bathing of the baby? 3. How would you take care of the mouth and eyes of a young baby? Answers by Louie Albury, Girls' Blue School, Isleworth. 1. The cheapest and best kind of cot to use for a baby is a banana crate, stained and lined with some washable material. The best kind of bed to use should have a washable ticking on, and the pillow and bed should be well filled with chaff, because of the following reasons:— (a). It is the cheapest and could easily be refilled if soiled. (b). It is soft and comfortable for the baby to lie upon. (c). It will not collect together in lumps, and thus become hard. 2. There are two things to get ready for the bathing of the baby, firstly the room, secondly the clothes. (a). See that the room is sixty-five degrees of heat; and all windows and doors firmly shut, to avoid draughts. A fire should be burning brightly, with the kettle on, in which the water is boiling for the bath, which should be 32 placed with the foot of it nearest the fire. Soap, flannel, sponge, should be placed near by ready for use; and a bath thermometer can be used if possible. A low chair should be stood beside the bath, on the right hand side of the fire, add another chair on which to hang the clothes. (b). The clothes should be placed on the back of this chair, in the order they are going to be put on the baby, that is, the article that is put on the baby last should be hung on the chair first. The following names are those of the clothes which should be placed on the chair in order:—The gown, long flannel, napkin, vest and binder. If there is no room on the seat of this chair, another chair can be placed beside it, on which the basket is stood which contains such articles as these:—Needle, cotton, pins, thimble, scissors, powder, vaseline, and the thin pieces of cotton wool, used for cleansing the baby's mouth and eyes. These pieces of wool should be placed in a basin of boiled cooled water, and the basin covered over with a piece of paper or clean material. If it were left uncovered any dust might settle in it, which would perhaps become injurious to the baby. 3. The best way to take care of the baby's mouth and eyes, is to observe the following instructions, which are:— (а). Take a piece of cotton wool, wind tightly round little finger of right hand, being careful to cover the nail; and cleanse between the gums and lips of the baby's mouth. (b). Gently open the eye and cleanse underneath the lids, taking two separate pieces of wool for each eye. Perhaps there might be a discharge from one eye, and if the same piece of wool were used for the other eye, the dischange would be rubbed in it, and very likely affect the sight of the baby. These pieces of wool should be burned after use. 33 VI.—DEFECTIVE, EPILEPTIC, BLIND AND DEAF CHILDREN. During the year, the cases of the above children were considered by me. Each case was medically examined and in addition information was supplied by the teacher and the parent or guardian of the child. (a). Mentally Defective Children. Definition.—These are children, excluding imbeciles and those who are merely backward, who are incapable by reason of mental defects, of receiving proper benefit from the instruction in the ordinary public elementary schools, but are not incapable by reason of such defects of receiving benefit from instruction in special classes or schools. Powers of Committee.—The Education Committee has power to establish special classes or schools for such children. Number.—I have examined 46 children, or 0.7 per cent, of the school population, who have been placed in this category by the teachers and have classified these children as follows:— Boys. Girls. Total. Over 14 years of age 2 - 2 *Backward 9 4 13 Mentally defectives who will not be able to earn a living under favourable circumstances 3 - 3 Mentally defectives who may be able to earn a living under favourable circumstances 1 3 4 Mentally defectives who will be able to earn a living under favourable circumstances 13 10 23 Morally defective 1 - 1 * In four of these oases the backwardness was due to adenoids, and in other four due to bad vision, no glasses being provided. Special Class.—With regard to the children classed as mentally defectives, who will not be able to earn a living under favourable circumstances, I do not think it advisable to take any 34 action. But with regard to the two other classes of mentally defectives—27 in number—I think it would be advisable to form for them a special class. These children are all defective in divers ways. Some are defective, especially as regards reading, some writing, some arithmetic, and none of them have acquired the attainments of children much their juniors. Others have outbursts of temper, or temporary loss of memory and thus border on the epileptic. As they are unable to keep pace with the children in the ordinary classes, they are allowed to slip further and further behind. Nearly all these cases should receive abundant manual instruction, so as to train their minds by means of their hands. Cost.—A class could be formed for these children under the Elementary Education (Defective and Epileptic Children) Act, 1899. The only extra cost for such a class would be as regards the staff—a teacher for this class of child being allowed only 20 pupils. (b). Physically Defective Children. Definition.—These are children who by reason of physical defects, are incapable of receiving proper benefit from the instruction in the ordinary public elementary schools, but are not incapable by reason of such defects, of receiving benefit from instruction in special classes or schools. Powers of Education Committee.—The Education Committee has power to establish special classes or schools for such children. Number.—An examination of the records of medical inspection for the past three years shows that about 1.5 per cent, of the school population, i.e., about 100 children belong to the class of physically defective as defined above. Diseases.—These children suffer from consumption and other tuberculous diseases, anaemia and mulnutrition, chronic glandular enlargements, rickets, lateral curvature, infantile paralysis, St. Vitus Dance, heart disease, etc. Many of these maladies are of long duration and if the child is to have a chance in after life, 35 it is necessary that his education should proceed at the same time as his cure. To this end the Open Air Recovery School has been introduced. (e). Open Air Recovery School. In this district a school for 40 scholars would probably be a suitable number for which to provide as a beginning, and special attention would require to be given to the following considerations:— 1. The site should be fairly open and easily accessible. 2. It should have at least one acre of land in connection with it. 3. The class-rooms should be constructed for 25 pupils. 4. The class-rooms should consist merely of a smooth impervious floor, with a roof supported by uprights at suitable intervals, without sides. They should be sufficiently large to permit of the desks beings at such a distance from the edge of the floor that they will not get wet. 5. The desks should be single. 6. Accommodation must be provided for a caretaker and his wife, with a kitchen sufficiently large to cook for the 40 children. 7. The dining room should be of the same character as the class-rooms. 8. Baths should be provided. 9. Bach child should have the following numbered articles:—A washable bag, containing brush and comb, toothbrush, hand towel, bath towel, a deck chair, blanket and rain cape. 10. Two teachers would be required and both should have special knowledge of nature study, hygiene and physical exercises. 11. The cost of meals provided should be recovered from the parents. 12. A Health Visitor should visit the school regularly and the School Medical Officer as required. 36 Advantages.—The open air school has been established in order to obtain a better scholastic result by improving the physical conditions of the child. Its functions should be to promote in order, (1) the health, (2) the happiness and (3) the education of the pupils who attend it. Many educationalists have noted that a considerable number of scholars attending public elementary schools, are used up in mind and body by a few hours of school work; their attention flags; they cannot follow the instruction provided, and thus they fall hopelessly behind their fellow pupils. Many of these children possess bright mental powers and, but for certain physical defects, are quite able to keep pace with even the cleverest pupils. These diseases generally which go to produce this condition of inertia have been stated above. The majority of them are chronic in their character, and it is therefore essential that the education of the mind should proceed step by step with the cure of the body. If the mind alone is considered, the child's health is ruined; if the body alone is considered, the child soon reaches adolescence without having acquired sufficient education by which to earn his daily bread. These schools have been established under various authorities and invariably bring about great improvement in the mental and physical powers of scholars who would not get otherwise a chance in life, and probably would never be self-supporting. Cost.—A school of the above type would require to be certified as a school for the Physically Defective under the Elementary Education (Defective and Epileptic Children) Act, 1899. In reckoning its cost as compared with an ordinary public elementary school, it has to be borne in mind that an open air school certified as above, would receive an increased grant from the Exchequer, while its cost of construction would be reduced. On the other hand, an increased staff would be required, and it is likely that additional cost would be incurred in the provision of meals, as their cost would not perhaps be recoverable from all patients. 37 (d). Epileptic Children. Definition.—These are children, excluding idiots and imbeciles, who are unfit by reason of severe epilepsy to attend the ordinary public elementary schools. Powers of Committee.—The Elementary Education (Defective and Epileptic) Act, 1899, gives the Education Authority power to provide special schools for epileptic children. Number.—I have examined five children stated to be epileptic. Two of these have since entered institutions for epileptic children, one is suitable only for an epileptic colony, as he is mentally defective as well as epileptic, the fourth attends school between the fits, which occur about once every three months, and in the fifth I considered the fits to be hysterical and not epileptic in character. (e). Deaf Children. Definition.—These are children whe are too deaf to be taught in a class of hearing children in an elementary echool. Duty of Education Committee.—The Education Committee must make provision for the education of deaf children resident in their district. Number.—I have examined sixteen cases presented by the teachers, and beg to classify these as follows:— Boys. Girls. Total. Totally deaf — 1 1 Suitable for hard of hearing class 4 5 9 Suitable for ordinary school 2 4 6 In addition there is one child, Hubbard, who is at present at a school for the Deaf and Dumb at a cost to the Committee of £28 per annum, the parent contributing 2/- a week to his upkeep. Class.—As deafness is a very serious drawback in after life, and as a child who is "hard of hearing" loses ground at school through missing much that is said, I would recommend that a "hard of hearing" class be established for the above nine children. A teacher for a class of "hard of hearing" children cannot take more than ten such pupils. 38 (f). Blind Children. Definition.—These are children who are too blind to be able to read the ordinary books used by the children. Duty of Education Committee.—The Education Committee must make provision for the education of blind children resident in their district. Number.—I have examined four cases presented by the teachers and beg to classify these as follows:— Boys. Girls. Total. Semi-blind 2 2 4 In addition there are two blind chilnren, Foy and Merryweather, who are at present in Institutions for the Blind at a cost to the Committee of £30 and £'25 per annum respectively, 1/- and 2/- a week being refunded by the parents. The advisability of forming a special class for mentally defective and an open air recovery school for physically defective children, was still under the consideration of the Committee at end of the year. VII.—SCHOOL CONSTRUCTION. It has become necessary to erect a new school in this district and as this matter of school construction is of importance from the health point of view, I append for consideration my views as regards certain points:— Class-rooms.—These should be rectangular in shape, the longer side being placed parrellel to the external wall and corridors. This arrangement has these advantages:— 1. Increased direct lighting. 2. Increased natural ventilation by external windows. 3. The nearer proximity of the further or corridor side of the room to the light. 4. Greater command of a teacher over a long than a broad room. 39 Ventilation.—Natural ventilation by external windows, fire places and flues is the best. All systems of ventilation require to be controlled by the teacher and the controlling mechanism should be simple. There are certain objections to ventilators being placed behind radiators as follows:— 1.—Such ventilators are not likely to be opened in winter. 2.—In summer there is no special advantage in having a ventilator in this position when the radiator is not in use. Cloak-rooms.—These should be well lighted and ventilated on at least two sides, and should be so constructed as to allow a maximum of sunlight. They should be efficiently heated. The spaces between the pegs should be of ample dimensions. No water taps for drinking or washing purposes should be in cloakrooms. Conveniences.—The Board of Education require that the water closets and urinals should be placed outside the school buildings. There are, however, many advantages in having them designed as an integral part of the school building, to wit, 1. The supervision for their perfect sanitary condition is more easily affected by the head teacher and staff; 2. The fittings and appliances are prevented from damage by frost and theft; 3. The possible saving in initial cost of construction and upkeep; 4. The facility of access by scholars and the consequent saving of school time; 5. The gain in unobstructed playground area; 6. The prevention of nuisances to occupants of adjoining premises; 7. The greater facility for the encouragement of discipline by the teachers and the inculcation of more cleanly habits in the younger scholars than is possible in the case of isolated conveniencesin fact the proper use of these conveniences should form a school lesson. 40 On the other hand the main disadvantage of placing the offices inside the school building is the difficulty of preventing unpleasant odours pervading the corridor, but this can be overcome by having a cross ventilated lobby intervening. It is certain that conveniences placed outside the school buildings are often dirty and do not receive the same respectful care from scholars which is required for the preservation of these appliances as sanitary utensils, and there is no reason why a properly lighted, ventilated, constructed, and kept convenience inside a school building should be in any sense a nuisance. Baths.—In the campaign of Local Education Authorities against uncleanness it is important, that these should be provided. It is undoubtedly the case that many children have never been taught how to wash themselves, and the provision of a few school baths would be of great assistance in teaching the children to be clean and a credit to the Local Authority. Medical Inspection.—A medical inspection room with the necessary waiting and lavatory accommodation should be provided. Satisfactory results of this inspection can only be secured by the co-operation of the parent with the School Medical Officer, and it is important that parents should be encouraged, by the provision of suitable waiting rooms, to be present at the inspection of their children. The medical inspection room should be at least twentyone feet in length in a direction at right angles to the principal lighting. It should not be situated near the playground. These rooms should be arranged so that they may be of use when public meetings are held in the school.