HES 60 HESTON and ISLEWORTH URBAN DISTRICT EDUCATION COMMITTEE. SEVENTH Annual Report OF THE School Medical Officer FOR THE Year ending 31st December, 1914. 4/15. 350. 75 (S.M.O.) (IC. M.O.H.) MEMBERS OF EDUCATION COMMITTEE, 1914-15. H. J. NIAS, Esq. (Chairman). S. SMITH, Esq. (Vice-Chairman). Members of the Council:— A. A. BERGIN, Esq., J.P. (ex-officio), (Chairman of the Council). C. CRUSH, Esq. (ex-officio), (Vice-Chairman of the Council). S. SMITH, Esq. (Vice-Chairman of the Education Committee). J. J. BONNETT, Esq. S. CARTER, Esq. F. T. CHAPMAN, Esq. E. W. HEATH, Esq. F. W. LANGSTONE, Esq. W. G. LOBJOIT, Esq., J.P.,C.C. T. S. GOODWIN, Esq , M.B.,C.M. W. E. SHUFF, Esq. J. SPENCER, Esq. Selected Members: Mrs. C. F. EVA. Mrs. W. FUNGE. E. W. GOODE, Esq. P. MURPHY, Esq. H. J. NIAS, Esq. School Medical Officer: THOMAS STRAIN, M.D., D.P.H. INDEX. Report of School Medical Officer, 1914. Page. Backward Children 25, 34 Blind Children 32 Body, Cleanliness of 14 Children, Number Inspected 9 Clinic (see Special Cases) 26 Clothing 12 "Code" Groups 9 Deaf Children 23, 32 Deformities 25, 40 Dental Conditions 17, 43 Domestic Economy and Hygiene 47 Dull or Backward Children 25, 34 Ears 23, 32 Education Committee, Members of 2 Enlarged Glands 19 Epileptic Children 25,39 Exceptional Children 31 Extent of Examination 10 Eyes 21,32,43 Feeble-minded Children 25, 38 Footgear 12 Glands, Enlarged 19 Head, Cleanliness of 14 Hearing 23, 32 Heart and Circulation 24 Heights 11 Hygiene, Teaching of 47 Infant Care and Management, &c. 47 Infectious Diseases, History of in Scholars 29 ii. Index—Continued. Page. Infectious disease, Notification of 30 Introduction 5 Lessons, Infant Care and Management, &c. 47 Lung Conditions 24 Meals, Provision of 47 Measles 29, 30 Medical Treatment 42 Members of Education Committee 2 Mental Conditions 25, 33 Methods of Inspection 6 Nervous Diseases 25, 40 Nitty and Verminous Conditions 14 Nose and Throat 20, 43 Number of Children examined 9 Nutrition 16 Open-air Recovery Schools 41 Parents Present 10 Physically Defective Children 25, 40 Prosecutions 14 Pulmonary Tuberculosis 24, 41 Routine Medical Inspection 10 School Meals 47 School Medical Service, co-relation with Public Health Service 6 Schools, Sanitary Condition of 6 Skin Diseases 24 Special Cases 26 Speech 25 Teaching of Hygiene 47 Teeth 17, 43 Throat and Nose 20, 43 Tuberculosis 24,41,47 Verminous Conditions 14 Vision 21, 32, 43 Weights 11 5 Health Department, Council House, Hounslow. 31st March, 1915. To the Chairman and Members of the Heston and Isleworth Urban District Education Committee. Ladies and Gentlemen, I have the honour to present the seventh Annual Report of the School Medical Officer. The report is prepared for the information of the Committee and the Board of Education, and follows the directions laid down in Circular 596 governing the Annual Reports of School Medical Officers. I have endeavoured also to give the information in tabulated form, as required by the Board, with regard to the children inspected, together with the percentages shewing different defects. I have again to draw your attention to the small percentage of the children who have secured the necessary treatment for the defects requiring remedy, but I am glad to be able to record that the Committee have now decided to provide treatment for Ringworm and Eye cases. I can also record that the Committee have again under consideration the question of providing a Special School for defective children. I desire to tender my thanks to the members of the Committee for the interest they have taken in the work of this department during the year. I am, Ladies and Gentlemen, Your obedient Servant, THOMAS STRAIN, School Medical Officer. 6 General review of the hygienic conditions prevalent in the Schools in the area of the Local Education Authority in respect of such matters as surroundings, ventilation, lighting, warming, equipment and sanitation, including observations on the type and condition of sanitary conveniences and lavatories, water supply for washing and drinking purposes, the cleanliness of schoolrooms and cloakrooms, arrangements for drying children's cloaks and boots, and the relation of the general arrangements of the School to the health of the children. With the exception of Brentford End, Hounslow Town, Isleworth Blue and Woodlands Schools, the buildings are of more or less modern types. In some instances thelighting of classrooms might with advantage be improved upon; in several instances the windows are at the rear of the scholars. Wherever possible, the desks should be so arranged that the windows are on the left of the scholars, as by this means less fatigue is caused to the scholars and teacher, and no shadows are thrown in front of the scholars. With regard to artificial light also, the distribution of the points of illumination might be altered for the same reasons. The heating arrangements in some of the schoolrooms require alteration or amplification. I hope with the opening of the new school (Alexandra) those schoolrooms where two classes are carried on, separated from each other by a curtain, will have such increased accommodation that this arrangement can be dispensed with. General description of the arrangements which have been made for the co-relation of the School Medical Service with the Public Health Service and for the organization and supervision of medical inspection, and an account of the methods of inspection adopted. The work of the School Medical Service is carried out in the Health Department under the School Medical Officer, who is also Medical Officer of Health. It was found necessary in order to 7 take the arrears of work to appoint a part-time Assistant School Medical Officer to devote two half-days per week to this work. Dr. W. B. Reid was appointed and has diligently carried out this work, after having acted as Deputy School Medical Officer during my illness in June—July. The duties of School Nurse are carried out by the two Health Visitors, who have each allotted to them a part of the district and the schools therein. The clerical work is performed by the Clerical Staff of the Health Department. The following short resume gives the steps taken in connection with each visit to the schools for the purpose of Medical Inspection. The afternoon sessions are chosen as it is found to be more convenient for those parents who desire to be present. The suggested dates are submitted to the teachers, when, if they are found to be convenient, an intimation is sent to the Secretary, who informs His Majesty's Inspector of Schools. Formal notice of the inspection is sent to the school, together with cards, which are given to the children to take home, inviting their parents to be present at the inspection. The head teachers take much interest in the inspection, and frequently direct attention to defects which have been observed in any child in school. The parents of those children who have been found defective, or to be in need of medical treatment are, personally if present, and in writing, informed of the condition and advised to seek medical advice. The accommodation utilised for the purpose of medical inspection during the year varied in different schools. In some cases the head teachers' rooms have been used, but as a rule these are not large enough for vision-testing, in others a classroom or even a part of a classroom more or less screened off, or a corridor or cloakroom is the only accommodation available. Where it is necessary to utilise a classroom for medical inspection it is evident that the crowding of other children in the remaining rooms will cause some disturbance of the school arrangements, but it is endeavoured in all cases to cause as little interference with ordinary school work as is practicable. 8 Ninety-one visits were made to school departments for the purpose of Routine Medical Inspection. In addition, numerous other visits were made regarding Special Cases, Infectious Diseases, etc. Each Health Visitor has, during the year, paid many visits to each department in investigating infectious disease, special children, as well as for the purpose of a fortnightly lesson to the elder girls on Infant Care and Management. Two half-days in each week are devoted to an Inspection Clinic, where cases are referred by the School Attendance Committees, School Attendance Officers and Teachers, and also children found on medical inspection in need of further examination. A clinic is held at the Health Department, and also at the Isleworth Public Hall. The accommodation at the Public Hall is not very suitable, no waiting room being provided. Non-notifiable infectious diseases are reported by the School Attendance Officers to the School Medical Officer. SCHOOL MEDICAL INSPECTION. The following statements show the children who have been inspected during the year:— 9 Table I a.—Number of Children Inspected (Code Groups). Entrants. Leavers. Intermediate. Grand Total. Year of Birth. 1908 1907 1906 Total 1902 Total 1905 Total Half Year. 1st 2nd 1st 2nd 1st 2nd 1st 2nd 1st 2nd Boys 179 89 ... 7 ... ... 275 157 168 325 149 150 299 899 Girls 148 91 2 1 1 ... 243 152 144 296 158 159 317 856 Totals 507 10 1 518 621 621 616 616 1755 Special Cases. Re-examinations. No. examined 1298* 411 *These 1298 special cases involved 3722 examinations. 10 934 parents, or 53 2 per cent., attended the inspection. Objections were received in seven instances from parents to the examination of their children. Prom these two tables it will be seen that this year the total number of children examined was 3,464, as against 2,915 last year. These 3,464 children were examined 5,888 times, as against 5,441 examinations during 1913. ROUTINE MEDICAL INSPECTION. The selection of children due for this inspection during 1914, included:— 1. Those born during the year 1908. 2. Those born in the year 1902. 3. Those born in the year 1905. 4. Those absent at last medical inspection. 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. 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:— 11 Height, Boys and Girls. Year of Birth. No. of observations. Average height. Inches. Centimetres. Boys Girls Boys Girls. Boys Girls 1902—1st half year 157 152 51.85 56.80 131.70 141.88 2nd „ 168 144 52.56 54.61 133.50 138.71 1905—1st. 149 158 49.54 49.00 125.83 124.50 2nd ,, 150 159 49.08 49.97 124.66 124.38 1908—1st 179 148 43.70 43.53 110.99 110.57 2nd ,, 89 91 42.64 42.80 108.31 108.71 Weight, Boys and Girls. Year of Birth. No. of observations. Average weight. In pounds. Kilogrammes. Boys Girls Boys Girls Boys Girls 1902—1st half year 157 152 64.87 67.89 29.42 30.79 2nd „ 168 144 63.45 67.81 28.78 30.76 1905—1st 149 158 55.08 53.61 24.98 24.32 2nd „ 150 159 53.76 51.87 24.38 23.53 1908—1st 179 148 40.56 41.33 18.40 18.75 2nd ,, 89 91 39.74 40.12 18.03 18.20 12 Clothing and Footgear. The table shews the conditions found in respect of each of these matters:— Entrants 1908. Intermediates 1905. Leavers 1902. Total. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. Clothing— Satisfactory 241 227 468 90.5 277 289 566 91.9 295 263 558 89.9 813 779 1592 90.7 Unsatisfactory 34 16 50 9.5 22 28 50 8.1 30 33 63 10.1 86 77 163 9.3 Footgear— Satisfactory 251 226 477 92.1 278 291 569 92.3 299 267 566 91.1 828 784 1612 91.8 Unsatisfactory 24 17 41 7.9 21 26 47 7.7 26 29 55 8.9 71 72 143 8.2 No. observations 275 243 518 ... 299 317 616 ... 325 296 621 ... 899 856 1755 ... It will be observed that the percentage of both clothing and footgear found in an unsatisfactory state varies in the different groups. Still, the large percentage (9%) who were found to have unsatisfactory clothing and footgear calls for remedy, and should be reduced. I am convinced that the teacher can exert a great influence on the pupils both with regard to cleanliness and to the state of repair of clothing. The following table gives a more detailed analysis of the state of clothing and footgear classified first into clean and dirty, and further sub-divided into satisfactory, fair or poor, according to the state of repair and suitability as regards warmth and protection:— 13  Entrants 1908 Intermediates 1905 Leavers 1902 Total. Boys Girls Boys Girls Boys Girls Boys Girls Clothing. No. of observations 275 243 299 317 325 296 899 856 Clean Satisfactory repair 241 227 277 289 295 263 813 779 Fair repair 22 11 12 18 21 25 55 54 Poor repair 10 3 4 7 4 7 18 17 Dirty Satisfactory repair 1 2 I 2 4 1 6 5 Fair repair 1 ... 3 1 ... ... 4 1 Poor repair ... ... 2 ... 1 ... 3 ... Footgear. No. of observations 275 243 279 317 325 296 899 856 Clean Satisfactory repair 251 226 278 29I 299 267 728 784 Fair repair 10 9 10 15 13 18 33 42 Poor repair 11 7 6 10 7 11 24 28 Dirty Satisfactory repair 2 1 1 1 2 ... 5 2 Fair repair 1 ... 3 ... ... ... 4 ... Poor repair ... ... 1 ... 4 ... 5 ... It is a feature too commonly met with to find children attending school with garments secured only by means of a few pins, when a little time regularly devoted to the clothing with a needle and cotton would preserve the garments and allow the children to come to school neat and tidy. Unfortunately also a few children are found attending school whose garments, as well as being ragged, are found to be so dirty as to make it unpleasant to be in their vicinity. In many of these cases it is found that the child's mother goes out to work, but even so there can be little excuse for allowing the children to attend school in that state. 14 I am of opinion that the general well-being of the children would be greatly benefitted if some arrangement could be made for those children who come to school with wet feet to have their wet shoes removed while in school. Cleanliness of Head and Body. Entrants 1908. Intermediates 1905. Leavers 1902. Total. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. NO. observations 275 243 518 ... 299 317 616 ... 325 296 621 ... 899 856 1755 ... Head— (1) Clean 264 200 464 89.5 281 236 517 83.9 306 242 548 88.2 851 678 1529 87.1 (2) Dirty 1 1 0.2 8 1 9 1.5 13 3 16 2.6 21 5 26 1.5 (3) Nitty or Verminous 11 42 53 10.3 10 80 90 14.6 6 51 57 9.2 27 173 200 11.4 Body — (1) Clean 262 234 496 95.7 282 312 594 96.4 310 286 596 96.0 854 832 1686 96.1 (2) Dirty 1 1 0.2 11 1 12 1.9 6 2 8 1.3 18 3 21 1.2 (3) Flea-bitten 10 8 18 3.5 5 4 9 1.4 9 8 17 2.7 24 20 44 2.5 (4) Verminous 2 1 3 0.6 1 ... 1 0.3 ... ... ... ... 3 1 4 0.2 (Special cases examined during the year :—- Nitty and Verminous conditions ... ... 149) The above table shews the conditions present among the children inspected during 1914. Among those children found to have nitty or verminous heads warning notices were sent in 62 cases, and in 178 instances the children were excluded from school until the head was free from nits. In accordance with the Education Committee's resolution of 9th April, 1912,—"That in future in the case of a child absent from school owing to nitty conditions of the hair after a period 14 days from the date of examination by the School Medical Officer, legal proceedings be instituted forthwith against the parent in respect of such absence from school,"—6 of the parents of the children excluded have been prosecuted, penalties being inflicted varying from 2/6 to 5/-. 15 It is to be regretted that these conditions should still be so common in our schools, and it is very hard on respectable parents to have their children running the risk of getting their heads infected in this way. Still, it is noteworthy that a reduction from 20 5 to 11-4 per cent, has occurred since last year. Need for more Public Facilities for Cleansing. Dr. Hope, School Medical Officer of Liverpool, reports in this connection as follows:— "In many districts of the City it is exceedingly difficult to cleanse children who have been allowed to become verminous. If the head is affected the hair can be cut, and that cures the condition, but when the clothing is verminous it is necessary to boil it and to iron the seams with a hot iron. Many families have no utensils for boiling water in except a kettle, and obviously cannot undertake the sterilizing of verminous garments. Others have perhaps a small tin in which one garment at a time can be boiled, but there is difficulty in drying the garments afterwards, and not infrequently children have returned to school in wet garments after the cleansing has been effected at home. Consequently, a very strong case can be made out for more public facilities for enabling poor people firstly, to cleanse themselves, and secondly, to rid themselves and their garments from vermin. It is, however, an unwise policy to restrict such facilities to school children only, as these children get re-infected at the home by the older and younger members of the family, to whom they may have brought vermin from school, and facilities must be provided for these also. Not only that, but these other members have an equal claim with the school children to have cleansing facilities provided. So important and desirable an object is cleanliness, that these facilities should be provided either quite free or at quite a nominal charge. Cleanliness is an enemy to disease, and if these facilities could be provided it would tend further to promote the health of the City." Similar remarks apply to this district. 16 There were some children found to be dirty, badly flea-bitten, or lousy as regards their bodies. In the worst cases an effort has been made by disinfection of the room and bedding to remedy matters, but without much success, relapses occurring. Nutrition. Entrants. Leavers. Intermediates. Total. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. No. observations 275 243 518 ... 296 325 621 ... 299 317 616 ... 870 885 1755 ... Normal 228 212 440 84.8 269 271 540 86.9 230 271 501 81.3 727 754 1481 84.4 Below Normal 33 26 59 11.4 24 52 76 12.2 56 35 91 14.9 113 113 226 21.8 Bad 14 5 19 3.9 3 2 5 0.8 13 11 24 3.9 30 18 48 2.7 From this table it will be seen that 84% of the children submitted to Routine Medical Inspection were classed as being normal in nutrition. The children are classified on general grounds, regard being had to the condition of the skin and mucous surfaces, the glands, the muscular development, subcutaneous fat, and the mental state of the child. This means that 16% of the children were not receiving the proper nutriment necessary for growth and activity. This does not, of course, mean that all these children do not receive a sufficiency of food. The state of affairs may be due to one of several other causes, among which it is probable that an unsuitable dietary is responsible for a large proportion of the cases. Other factors which produce this condition of malnutrition are environmental conditions (such as lack of sleep, air, light, etc.), while in some cases employment out of school hours will have a material effect on this condition. It may be, however, that in some children who do receive an otherwise sufficient and suitable dietary, there is some disease condition which prevents due benefit being derived from the nutriment given. 17 Dental Conditions. Entrants. Leavers. Intermediates. Total. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. No. observations 277 246 523 ... 328 295 623 ... 301 317 618 ... 906 858 1764 ... Sound 88 72 160 30.9 109 106 215 34.6 62 80 142 22.05 259 258 517 29.4 Less than four decayed 120 105 225 43.6 169 165 334 53.8 153 150 303 49.2 442 420 862 49.7 Four or more decayed 69 69 138 26.6 50 24 74 11.9 86 87 173 28.1 205 180 385 21.9 Sepsis ... ... ... ... 4 ... 4 0.6 1 ... 1 0.16 5 5 0.3 (Special cases :—Decayed teeth 5). It will be seen from the tables appended hereto that there is a large proportion of the children inspected suffering from decayed teeth. In 1247 out of 1764 children examined, or 71.6%, decayed teeth were present. In 22% of the cases the condition is serious, while in 49% the defective condition, although not so serious, will probably become so unless the condition is remedied. In a few cases the dental conditions had resulted in producing a septic condition of the mouth, which cannot but have a prejudicial effect on the child's health. There is little doubt that decayed teeth play a very important part in undermining a child's health, as apart from the pain and discomfort caused by a decayed tooth, the continued absorption of the poisonous decayed matters into the body produces enlarged glands and lowered general health; while with decayed and aching teeth it too often happens that the child cannot, because of the pain, masticate his food properly, thus the legacy of an impaired digestion so often found in later years. It will be seen that in only 95 instances had children any bad teeth extracted, and in only 7 cases had any teeth been filled, thus shewing the extent to which diseased conditions receive timely attention. This is due in a large proportion of cases to the feeling that conservative dentistry is beyond their means. 18 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. All teeth. No. of children with septic conditions. 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 15 1902—2nd half-year 232 28 40 68 49 29 9 2 2 ... ... ... ... ... ... ... ... ... 1 25 2 1st „ 309 28 53 74 38 13 12 6 1 ... ... ... ... ... ... ... ... ... 3 26 3 1905—2nd „ 311 24 37 65 46 49 16 14 7 3 ... 1 ... ... ... ... ... ... ... 11 1 1st „ 307 24 44 66 43 34 21 10 12 2 ... ... 2 1 ... ... ... ... 1 18 1 1908—2nd ,, 188 20 13 36 25 15 16 10 3 ... 1 1 1 ... ... ... ... ... ... 6 ... 1st „ 329 20 41 63 44 36 16 11 9 3 ... 1 ... ... ... ... ... 1 ... 9 ... 228 372 245 176 90 53 34 8 1 3 3 1 ... ... ... 1 5 95 7 Total 1676 1215 19 There is, unfortunately, also a feeling amongst parents that as the teeth are only temporary teeth, which will in time come out of themselves, no treatment is called for. There is no doubt that if a septic condition of the skin were present it would be treated, and the surface layers of the skin, like the teeth, are only temporary, yet the temporary teeth are untreated and result in enlarged glands and impaired digestion, besides which the process of decay is contagious and will spread to the permanent teeth when these erupt. It is regrettable to find in what a large number of instances the first permanent molar is decayed within a few months of its eruption, yet this tooth is a most valuable tooth to human beings, as throughout life it plays the largest part in mastication. I believe that the use of the tooth-brush is becoming more common. The nightly cleansing of the teeth to remove the food particles which have collected between the teeth during the day, together with the use of proper articles of food-stuffs such as will give the teeth some work to do, will, to a" great extent, prevent the teeth from decaying. Enlarged Glands. The figures submitted hereunder refer to glands which are found enlarged on palpation as well as those which are enlarged on visual examination. These figures refer mostly to Cervical Glands, and are caused by one or other of the following:—Decayed teeth, enlarged tonsils, sores on the head or face, discharging ears, and verminous condition. No. of Observations. No. with Enlarged Glands. Boys entering 275 57 Boys intermediate 299 102 Boys leaving 296 120 Girls entering 243 43 Girls intermediate 317 81 Girls leaving 325 41 Total 1755 444 (There was one special case with Enlarged Glands.) 20 A gland which is enlarged is diseased, and has its resistance so lessened that the germ of Tuberculosis which may be introduced through decayed teeth or enlarged tonsils, may thus find a very suitable place for commencement of Tuberculosis. Nose and Throat Conditions. Entrants. Leavers. Intermediates. Total. Hoys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. No. observations 268 239 507 ... 325 296 621 ... 299 317 616 ... 892 852 1744 ... Enlarged Tonsils 28 29 57 11.2 20 53 73 11.7 26 31 57 9.2 74 113 187 10.7 Adenoids 8 5 13 2.5 11 3 14 2.2 9 7 16 2.5 28 15 43 2.4 Enlarged Tonsils and Adenoids 17 4 21 4.1 26 6 32 5.1 13 13 26 4.2 56 23 79 4.5 Deflected Nasal Septum 2 ... 2 ... 3 ... 3 ... 1 1 2 ... 6 1 7 ... Enlarged Turbinates 14 3 17 3.3 2 12 14 2.2 7 6 13 2.1 23 21 44 2.5 Tonsillitis 3 6 9 ... 1 1 2 ... 4 ... 4 ... 8 7 15 ... Pharyngitis 1 4 5 ... 2 2 4 ... ... 1 1 ... 3 7 10 ... (Special cases examined during the year :— Cases coming under observation, 74. Enlarged Tonsils, 3; Enlarged Tonsils and Adenoids, 8; Tonsillitis, 25; Pharyngitis, 21; Other diseases of nose and throat, 17). The above table shews the abnormal conditions found in the examination of those children inspected this year. Those conditions, for which I have worked out the percentages, are due to an overgrowth of the lymphoid tissue, and apart from the immediate effects on the quantity of air entering the lungs and the impairment of hearing invariably present, produce other more remote effects on the mental and physical condition of the child. From a large experience of Scarlet Fever and Diphtheria, I have arrived at the opinion that these diseases, when they attack children the subject of this lymphoid hypertrophy, are always more severe and more frequently attended by complications. 21 But in addition to these effects, the presence of this overgrowth of tissue in these children's naso-pharynx is a potential danger to the public health, as in the great majority of "carrier cases" of Diphtheria (i.e., children who, although not suffering from the disease, yet harbour the bacilli in the throats) the child has enlarged tonsils or adenoids. Eye Conditions and Defective vision. External Eye Diseases. Entrants. Leavers Intermediates. Total. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. No. observations 275 242 517 ... 325 296 621 ... 299 318 617 ... 899 856 1755 ... No Disease 272 238 510 ... 316 293 609 ... 291 313 604 ... 879 844 1723 ... Blepharitis ... 3 3 ... 3 1 4 ... 6 4 10 ... 9 8 17 ... Conjunctivitis 1 1 2 ... 3 1 4 ... 1 1 2 ... 5 3 8 ... Corneal Opacities ... ... ... ... ... 1 1 ... 1 ... 1 ... 1 1 2 ... Other Disease 2 ... 2 ... 3 ... 3 ... ... ... ... ... 5 ... 5 ... (Special cases:—No. observations, 35; Blepharitis, 7; Conjunctivitis, 23; Other Disease, 5). I have included in the above table the external eye diseases met with during routine inspection; the figures, however, are not large enough to calculate a percentage, but from the 35 special cases it will be seen that a not inconsiderable amount of eye disease occurs amongst the school population. Vision. The subjoined table shews the results of the examination of the children at Routine Inspection when tested by Snellin's Types. It is not practicable to test in this way the Entrants, but this has been done where it was deemed urgently necessary:— Vision. Entrants. Intermediates. Leavers. Total. Boys. Girls. Total. Percentage Boys. Girls. Total. Percentage Boys. Girls. Total Percentage. Boys. Girls. Total. Percentage. 6/6 each eye (normal vision) ... ... ... ... 212 214 426 69 228 190 418 67 440 4°4 844 68 6/6 R ... ... ... ... 23 31 54 8 23 28 51 8 46 59 105 8 6/6 L ... ... ... ... 16 16 32 5 22 21 43 7 38 37 75 6 6/9 R ... ... ... ... 33 47 80 13 43 38 81 13 76 85 161 13 6/9 L ... ... ... ... 45 49 94 15 39 38 77 12 84 87 171 14 6/12 R ... ... ... ... 12 12 24 4 12 15 27 4 24 27 51 4 6/12 L ... ... ... ... 13 17 30 5 17 19 36 6 30 36 66 5 6/18 R ... ... ... ... 12 10 22 4 7 7 14 2 19 17 36 3 6/18 L ... ... ... ... 7 11 18 3 12 10 22 3 19 21 40 3 6/24 R ... ... ... ... 4 1 5 1 4 11 15 2 8 12 20 2 6/24 L ... ... ... ... 1 6 7 1 2 13 15 2 3 19 22 2 6/36 R ... ... ... ... 2 ... 2 ... 6 3 9 1 8 3 11 1 6/36 L ... ... ... ... ... 3 3 ... 3 3 6 1 3 6 9 1 6/60 R ... ... ... ... ... 3 3 ... 1 3 4 ... 1 6 7 ... 6/60 L ... ... ... ... 2 2 4 ... ... 2 2 ... 2 4 6 ... 6/0 R ... ... ... ... 2 ... 2 ... 1 1 2 ... 3 1 4 ... 6/0 L ... ... ... ... 2 ... 2 ... 2 ... 2 ... 4 ... 4 ... Squint 3 3 6 ... 7 7 14 2 9 4 10 2 16 14 30 2 (Special cases:—Defective Vision, 31). 23 From this table it will be seen that 36 children were found to have a squint in one or both eyes. Only 68% of children tested were found to have average vision, while 14% had average vision in one eye only, yet only 18 children were found to be wearing spectacles out of the total examined. Ear Disease and Hearing. In the undermentioned tabulated statement is the condition found with regard to external ear disease:— Entrants. Leavers. Intermediates. Total. Boys. Girls. Total. Percentage.; Hoys. Girls. Total. Percentage. Hoys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. No. observations 275 243 518 ... 325 296 621 ... 299 317 616 ... 899 855 1755 ... No Disease 265 234 499 ... 322 284 606 ... 293 312 605 ... 880 830 1710 97.4 Obstruction 7 7 14 ... 1 12 13 ... 3 5 8 ... 11 24 35 2.0 Otorrhœa 2 2 4 ... 2 ... 2 ... 2 ... 2 ... 6 2 8 0.5 Other Disease 1 ... 1 ... ... ... ... ... 1 ... 1 ... 2 ... 2 0.1 (Special cases:—Chronic Suppuration of Bar, 26). The table herewith explains the results of the hearing (whisper) tests employed:— Boys. Girls. Total. Percentage. Total no observations 899 856 1755 ... Normal hearing in each ear 856 834 1690 96.3 No. with good hearing in R ear 876 843 1719 97.9 L ear 877 845 1722 98.1 No. with fair hearing in R ear 18 5 23 1.3 L ear 13 5 18 1.0 No. with bad hearing in R ear 3 6 9 0.5 L ear 7 4 11 0.6 Deaf 2 2 4 ... (Special cases:—Deafness, 8). 24 It will be noticed that in 1% of cases the hearing was classed as "fair," and in 0.5% the hearing is classed as " bad." I need hardly point out how defective hearing interferes with a child's progress in life, and how important it is that these children should have the condition treated. A certain number of these cases may be due to "wax," and a certain proportion to adenoids, but the more serious and the most untractable is that due to middle-ear disease, which was present in .5% of cases examined at routine inspection and in 26 special cases referred by teachers, etc. Heart and Circulation. No case of organic heart-disease was detected. In all such cases, the teacher, as well as the parent, is duly notified of the condition and appropriate advice given regarding the child's life in school. Murmurs and irregularities were detected in 60 other cases on auscultation, which were probably functional in origin. Anaemia was diagnosed in 9 instances. (Special Cases:—Heart-disease, 93; Anaemia, 17). Lung Conditions. In 1755 examinations 9 cases of Bronchitis and Bronchial Catarrh were discovered; no children were definitely diagnosed as suffering from Pulmonary Tuberculosis; but in 4 instances children were classed as Pretubercular, or "Suspicious"; while 12 other children were suffering from other diseases of the lungs. (Special Cases:—Bronchial Catarrh, 2; Pulmonary Tuberculosis, 19; Pretubercular or "Suspicious," 18; other Disease of Lungs, 68). Other Tubercular Diseases. No children were found to be suffering from other forms of Tuberculosis. (Special Cases:—Tubercular Disease, 4). Skin Diseases. During Routine Inspection of 1755 children, 17 were found to be suffering from some skin disease. Ringworm of the body or head was found in 3 instances. Impetigo was present in 2 cases. Other skin diseases were detected in 12 other children. 25 (Special Cases:—Ringworm, 133; Impetigo, 122; other Skin Diseases, 120). It will be seen from these figures that a large number of skin diseases come under observation, and as most of these necessitate the child's exclusion from school, a considerable loss of grant is entailed. I believe that if these were treated at a clinic by a nurse under medical supervision a considerable gain in attendance would be secured. Mental Condition. Of those children inspected at Routine Groups 51 were classed as mentally abnormal; 49 children were mentally backward, while 2 were classed as mentally defective. (Special Cases:—Backward, 8 ; Defective, 6). Speech Defects. A large number of children inspected had defective articulation, due to evanescent causes, but 4 children were found who were stammerers. Nine children were found to have other defects of speech. (Special Cases:—Defective Speech, 3). Deformities. (Special Case: — Deformities, 2). Nervous Diseases. One case of Epilepsy and one of Chorea were detected during the year among those submitted to Routine Inspection. (Special Cases:—Chorea, 7; Epilepsy, 5; other Nervous Diseases, 11). During Routine Inspection at the Code Age-groups, the following children were found presenting deformities as set out hereunder:— Dislocated hip 1 Paralysis 2 Wry neck 1 Pigeon and flat chest 6 Harelip 1 Uvula missing 2 Scoliosis 2 Paresis 2 Rickets 1 26 SPECIAL CASES. The figures in the accompanying table give in greater detail information relating to children coming under notice for the various conditions set out in the table. It will be seen that 1298 new cases were brought under observation during the year, because they were referred by either: — (a). The School Attendance Sub-Committees, (b). School Attendance Officers, (c). Head Teachers, (d). Health Visitors, or the School Medical Officer at Medical Inspection. Of these 1298 children 846 were in such condition that their exclusion from school was deemed necessary, losing thereby over 65,313 attendances. In some of these cases the disease is easily remedied when properly treated, but untreated, the cure of the disease is much protracted; this refers especially to skin diseases, eye diseases, and ear diseases. It will be seen that nearly half the total number of attendances lost have been due to skin diseases, of which Ringworm and Impetigo form the greater proportion. Those children referred to in the table and excluded are reexamined at frequent intervals, and are closely followed up in order to encourage the parents to have the condition remedied and permit the child returning to school. The number of children who are referred to the School Medical Officer in this way still remains very large. This fact is very gratifying as shewing an increased desire on the part of the teachers, etc., to see that the children are in a fit state to attend school. The work under this heading is carried out one half-day a week at the Health Department, Council House, where suitable accommodation is provided, and another half-day at Isleworth Public Hall; unfortunately, the arrangements at Isleworth are not at all suitable. Cases remaining excluded at 27-12-13. Cases coming under observation 1914. Cases excluded during 1914. Cases readmitted during 1914. Cases remaining excluded or under observation at 26-12-14. No. of examinations made of cases during 1914. Total No. attendances lost in cases excluded for a known period. Skin Diseases 70 375 345 377 41 1657 30885 Ringworm 29 133 131 113 35 648 ... Impetigo 28 122 120 130 1 395 ... Other Diseases 13 120 94 134 5 606 ... Nitty and Verminous Conditions 8 149 143 149 2 545 5769 Diseases of the Eye 15 68 33 43 6 243 3598 Defective Vision 4 30 2 6 ... 35 ... Blepharitis ... 7 4 4 ... 14 ... Conjunctivitis 11 19 27 31 4 140 ... Other Disease ... 12 ... 2 2 54 ... Mouth, Nose, Throat and Ear 9 123 69 77 4 236 3658 Carious Teeth ... 6 1 1 ... 6 ... Pharyngitis 1 21 I7 15 ... 39 ... Enlarged Tonsils and Adenoids ... 11 1 1 ... 10 ... Tonsillitis 3 25 15 17 ... 31 ... Other Throat Diseases ... 16 11 18 1 63 ... Diseases of Nose. ... 11 7 6 1 21 ... Deafness 1 7 1 ... 1 9 ... Diseases of Ear 4 26 16 19 1 57 ... Lung Diseases 36 107 90 104 20 346 10442 Bronchitis and Bronchial Catarrh 17 28 24 30 4 95 ... Pulmonary Tuberculosis 16 10 16 18 13 75 ... Suspected Tuberculosis 3 18 11 11 3 44 ... Other Lung Diseases ... 42 30 45 ... 132 ... Heart & Circulatory System Diseases 11 50 35 41 5 126 3286 Heart Disease 2 0 5 1 4 12 ... Anaemia 9 18 l7 17 1 39 ... Other Diseases of Heart, etc. ... 23 I3 2? ... 75 ... Rheumatism ... 12 8 6 1 27 162 Nervous System Diseases 8 23 19 20 4 62 2216 Epilepsy 3 5 4 3 3 1 ... Chorea 2 10 10 8 1 21 ... Other Nervous Diseases 3 8 9 30 ... Cases remaining excluded at 27-12-13. Cases coming under observation 1914. Cases excluded during 1914. Cases readmitted during 1914. Cases remaining excluded or under observation at 26-12-14. No. of examinations made of eases during 1914. Total No. attendances lost in cases excluded for a known period. Mentally Abnormal 4 15 ... 1 1 20 40 Defective ... 5 ... ... 1 5 ... Backward ... 8 ... ... ... 15 ... Deformities 4 2 ... 1 2 16 426 Spinal Curvature 2 ... ... 1 1 5 ... Hernia 1 ... ... ... 1 ... ... Other Deformities 1 2 ... ... ... 11 ... Tuberculosis of Bones & Joints, etc. 3 2 ... 1 ... 8 280 Enlarged Glands 3 1 ... ... ... 1 ... Dis. of Urinary & Generative Organs ... 18 11 11 ... 38 590 Diseases of Abdomen 4 26 14 14 4 66 1334 Diarrhoea 1 4 3 3 ... 6 ... Gastritis 1 1 ... ... ... 1 ... Constipation ... 1 ... ... ... 1 ... Other Diseases 2 20 11 11 4 58 ... Injury 8 4 4 ... 10 36 Goitre and Myxodema ... ... ... ... ... ... ... Infectious Diseases 1 41 26 26 1 47 218 School Meals and Nutrition 2 14 ... 2 ... 29 156 Defective Speech ... 3 ... ... ... 3 ... Other Reasons 4 111 51 47 5 183 2217 Nil ... 90 ... ... ... 59 ... 178 1238 846 923 96 3722 65313 29 History of Infectious Illness among Scholars. During medical inspection, the infectious disease history of each child was recorded if the parent attended. The following table gives the results:— Entrants 1908. intermediates 1905. Leavers 1902. Boys. Girls. Total. Percentage. Boys. Girls. Total. Percentage. Ys. Girls. Total. Percentage. No. of cases in which parents attended 180 129 309 ... 151 183 334 ... 131 157 288 ... Measles 142 115 257 83.2 119 151 270 80.8 115 143 258 89.5 Whooping Cough 99 75 174 56.3 68 107 175 52.4 70 109 179 62.1 Scarlet Fever 12 8 20 6.4 9 16 25 7.5 11 22 33 11.4 Diphtheria 2 1 3 0.9 2 5 7 2.1 6 10 16 5.5 Chicken Pox 24 24 48 15.5 34 27 61 18.2 39 23 62 21.5 Mumps 19 5 24 8.0 15 23 38 11.4 8 21 29 10.1 Enteric Fever 1 ... 1 0.3 2 ... 2 0.6 ... ... ... Poliomyelitis ... ... ... ... ... 1 1 0.3 ... ... ... ... Rheumatic Fever ... ... ... ... 2 ... 2 0.6 ... 1 1 0.3 It is seen from this table that in the cases of Measles and Whooping Cough the influence of school life does not have an appreciable effect in increasing the incidence of those diseases. In the case of Scarlet Fever and Diphtheria, however, it will be seen that the percentage who have had these diseases is greater at the end than at the commencement of school life, but even here I am of opinion that this is not due to school attendance alone, as there are many other influences at work during these years that cannot be eliminated, and of course there must always be an increasing incidence of children who have already had the disease at each advancing age period. 30 Notification of Infectious Illness by School Attendance Officers. The following oases of infectious illness have been notified by Teachers and School Attendance Officers during the year ending 31st December, 1914:— School. German Measles. Mumps. Chicken Pox. Measles. Whoopi'g Cough. TOTAL. Brentford End Infants ... 7 ... ... ... 7 Grove Road Boys ... ... 3 ... ... 3 Girls ... l 4 ... l 6 Infants ... 2 20 ... 6 28 Heston Boys ... ... ... ... ... — Girls ... 1 ... ... ... 1 Infants ... ... 4 1 3 8 Hounslow Heath Boys ... ... ... ... 1 1 Girls ... ... 1 ... ... 1 Infants ... ... 5 ... 24 29 Hounslow R.C. Mixed ... 1 1 ... ... 2 Infants ... ... ... ... 4 4 Hounslow Town Boys ... ... 3 ... ... 3 Girls ... 1 3 l ... 5 Infants ... 1 29 ... 20 50 Isleworth Blue Boys ... 2 ... ... 5 7 Girls ... 4 2 ... 2 8 Infants ... 10 7 l 12 30 Isleworth Central Boys ... 8 2 ... 1 11 Girls ... 12 1 ... 1 14 Spring Grove Boys ... 1 1 ... ... 2 Girls ... ... 1 ... 2 3 Infants ... 2 1 ... 11 14 St. Mary's Boys ... 4 2 ... ... 6 Girls ... 1 1 ... 1 3 Infants ... 3 14 ... 15 32 W. St. John's Infants ... 35 10 ... 12 57 Worple Road Mixed ... 16 2 ... 3 21 Infants ... 24 18 1 16 59 Totals — 136 135 4 140 415 31 EXCEPTIONAL CHILDREN. The following pages and tables give a short statement of the numbers of the children and the conditions from which they suffer, together with suggestions on what steps have been taken and what steps should be taken to secure that these children receive proper education without interfering with or exaggerating the physical disabilities from which they suffer. Boys. Girls. Total. Blind. Attending Public Elementary Schools. — — — Attending Certified Schools for the Blind. 2 1 3 Not at School 2 1 3 Deaf and Dumb (including partially deaf). Attending Public Elementary Schools. 11 6 17 Attending Certified Schools for the Deaf. — — - Not at School 1 1 2 Mentally Deficient. Feeble Minded. Attending Public Elementary Schools. 5 9 14 Attending Certified Schools for Mentally Defective Children. - - - Not at School 5 5 10 Epileptics. Attending Public Elementary Schools. 2 5 7 Attending Certified Schools for Epileptics. - — — Not at School 4 4 8 Physically Defective. Pul. Tuberculosis. Attending Public Elementary Schools. 6 1 7 Attending Certified Schools for Physically Defective Children. — — — Not at School 15 10 25 Other forms of Tuberculosis. Attending Public Elementary Schools. 5 5 10 Attending Certified Schools for Physically Defective Children. — — — Not at School 5 5 10 Cripples, Ac., other than Tubercular. Attending Public Elementary Schools. 15 9 24 Attending Certified Schools for Physically Defective Children - - — Not at School — 4 4 Dull or Backward* 73 32 105 * Judged according to age and standard. 32 Blind Children. There are six children who can be classed under this heading. The degree of blindness varies, but in all the degree of blindness is such that the children are not able to read the ordinary school books used by children. Name. Sex. Date of Birth. School attended. A.S. M. 9-1-02 None. J.M. M. 9-12-03 London Society for Teaching the Blind. R.B. M. 15-2-04 None. (also deaf). A.S. F. 20-6-05 None. G.C. F. 11-12-05 London Society for Teaching the Blind. A.C. M. 5-2-06 Royal College for Blind. In the case of 3 children the cause of the blindness has apparently been an attack of Ophthalmia Neonatorum; 2 other cases are the results of Keratitis, probably hereditary. In these cases, although it is true that the education is expensive, it is none the less necessary, as by means of special educational methods these children can be trained into self-supporting members of society. Deaf Children. The children in the table below are all so deaf as to come within the meaning of the Elementary (Blind and Deaf Children) Act, 1893. One child is, however, under the age for which the compulsory education for the deaf is applicable. Name. Sex. Date of Birth. School attended. I.H. F. 7-6-04 Spring Grove Infants. G.D. M. 18-3-08 Nil. M.T. F. 13-9-08 Spring Grove Infants. 33 Partially Deaf. There are, however, in the district a certain number of children who suffer from various degrees of partial deafness; these children I set out below:— Name. Sex. Date of Birth. School attended. W.M. F. 4-4-00 Nil. G.W. F. 4-11-00 Isleworth Blue Girls. E.B. F. 4-8-01 do. do. W.C. F. 13-12-01 Hounslow Town Girls. W.H. M. 2-9-03 Worple Road Mixed. J.R. M. 16-11-04 Grove Road Infants. F.K. M. 2-3-05 St. Mary's Boys. L.S. M. 17-3-05 Isleworth Blue Boys. F.S. M. 3-4-05 Hounslow Heath Boys. F.T. M. 20-4-05 Hounslow Town Boys. C.H. M. 6-9-05 Hounslow Roman Catholic Mixed. A.C. M. 22-6-07 Spring Grove Infants. R.M. M. 5-I0-07 Worple Road G.S. M. 24-6-O8 Worple Road Infants. E.S. F. 21-9-08 Hounslow Town Infants. G.S M. 30-9-08 do. do. do. Mentally Abnormal Children. A preliminary classification has been made of those children who have come to rny knowledge as being mentally abnormal. At present no special means are taken to educate these children, whom one finds collected together in the lower standards in the school. In most cases the progress made by the ordinary methods of education is practically nil after a hard year's work. These children are very trying to the teacher, and if any endeavour is 34 made to deal with one or two backward children in the ordinary class it must be at the expense of the others in the class. I am strongly of opinion that the education of these children by special methods is urgently necessary if they are to take their proper place as useful and intelligent citizens in later life. I think provision should be made either by special classes or by a special school for the education of 40 of these children. Mentally Abnormal, dull or backward Name. Sex. Date of Birth. School attended. D.T. F. 14:3:99 Spring Grove Girls. L.H. F. 25:5:00 M.W. M. 26:9:00 Hounslow R.C. Mixed. A.W. M. 17:10:00 Heston Boys. L.K. F. 14:11:00 Hounslow Heath Boys. W.W M. 7:11 :oo Spring Grove Boys. F.S. M. 29:4:00 Isleworth Central Boys. G.C. M. 10:12:00 Isleworth Blue Boys. E.V.P. F. 2:3:01 Hounslow Heath Girls. W.B. M. 2:3:01 Hounslow Town Boys. G.B. M. 15:5:01 Central Boys. L.E. F. 26:6:01 Hounslow Heath Girls. R.McE. M. 28:6:01 Worple Road Mixed. W.W. M. 21:11:01 St. Mary's Boys. F.G. M. 4:12:01 Worple Road Mixed. E.S. F. 18:2:01 Hounslow Heath Girls. A.T. M. 10:4:02 Hounslow R.C. Mixed. A.S. M. 22:4:02 Spring Grove Boys. A.S. M. 2:5:02 Grove Road Boys. I.D. F. 10:2:02 Spring Grove Girls. 35 Name. Sex. Date of Birth. School attended. K.D. F. 29:4:02 Worple Road Mixed. F.M. M. 23:6:02 Hounslow Town Boys. I.M. F. 24:8:02 Hounslow Heath Girls. W.W. M. 16:8:02 Worple Road Mixed. C.W M. 5:9:02 Hounslow Heath Boys. B.P. F. 17:9:02 Hounslow Heath Girls. G.M. M. 19:10:02 Grove Road Boys. M.L. F. 24:10:02 Grove Road Girls. E.B. F. 24:11:02 Hounslow Heath Girls. F.N. F. 30:11:02 Hounslow Town Girls. D.F. F. 4:12:02 Hounslow Heath Infants. R.T. M. 22:1:03 Hounslow Town Boys. F.W. M. 12:2.03 Hounslow Town Boys. R.T. M. 18:3:03 Hounslow Town Boys. R.D. M. 14:9:03 St. Mary's Boys. H.E. M. 24:9:03 Hounslow Town Boys. E.P. F. 28:10:03 Isleworth Central Girls. H.K. M. 10:2:04 St. Mary's Boys. J.W. M. 1:3:04 St. Mary's Boys. F.L. M. 16:3:04 Truant School. P.T. M. 20:3:04 Brentford End Infants. N.S. F. 4:6:04 Worple Road Mixed. W.T. M. 1:7:04 Hounslow Town Boys. R.G. M. 18:9:04 Grove Road Infants. P.G. M. 18:9:04 Grove Road Infants. W.N. M. 27:9:04 Hounslow Town Boys. J.K. M. 9:ii:04 Hounslow Town Boys. A.H. M. I9:ii:04 Hounslow Town Boys. 36 Name. Sex. Data of Birth School attended. W.S. M. 1:12:04 Worple Road Mixed. A.W. M. 4:12:04 Hounslow Town Boys. F.W. M. 23:12:04 Isleworth Central Boys. P.H. F. 21:1:05 Hounslow Heath Girls. J.N. M. 23:1:05 Hounslow Heath Boys. F.L. M. 31:1:05 Hounslow Heath Boys. A.S. M. 1:2:05 Hounslow Heath Boys. W.L. M. 8:2:05 Grove Road Infants. R.C. M. 13:2:05 Isleworth Central Boys. G.D. M. 19:3:05 Hounslow Heath Boys. C.L. M. 31:3:05 Grove Road Infants. S.W. F. 7:4:05 Isleworth Blue Girls. A.W. M. 9:4:05 Worple Road Mixed. J.W. M. 16:4:05 Worple Road Mixed. W.B. M 18:4:05 J.R. M. 25:4:05 Worple Road Mixed. H.C. M. 30:4:05 Hounslow Heath Boys. A.B. F. 14:4:05 Isleworth Blue Girls. J.V. M. 18:5:05 Grove Road Boys. A.A. M. 13:6:05 Hounslow Heath Boys. W.P. M. 21:6:05 Hounslow Heath Boys. D.W. F. 24:2:05 Hounslow Town Girls. T.D. M. 13:7:05 Isleworth Central Boys. R.J. M. 18:7:05 Isleworth Central Boys. L.S. M. 21:7:05 Heston Boys. E.T. F. 28:7:05 Isleworth Central Girls. F.J. M. 15:8:05 Hounslow Heath Boys. J.B. M. 17:8:05 Hounslow Town Boys. 37 Name. Sex. Date of Birth. School attended. A.McN. M. 31:8:05 Grove Road Infants. C.J. M. 1:9:05 Hounslow Town Infants. D.J. F. 13:9:05 Grove Road Girls. R.C. M. 17:10:05 Grove Road Infants. M.G. F. 3:11:05 Grove Road Infants. R.R. M. 18:11:05 Worple Road Mixed. J.L. M. 6:11:05 Hounslow Heath Boys. E.C. F. 21:11:05 Hounslow Town Infants. G.B. M. 18:12: 5 Isleworth Central Boys. R M. F. 31:12:05 Hounslow Town. H.A. F. 30:11:05 Grove Road Boys. 15.B. F. 23:10:05 Hounslow Town Infants. P.H. M. 24:5:06 E.R. F. 14:10:06 Worple Road Infants. E.S. F. 13:10:06 Worple Road Infants. E.G. F. 8:2:07 Grove Road Infants. E.K. F. 18:2.07 Woodlands St. John's Infants. A.W. M. 29:4:07 Hounslow Heath Infants. A.E. M. 8:5:07 Hounslow Heath Infants. J.H. M. 17:8:07 Hounslow Heath Infants. A.S. M. 24:9:06 Spring Grove Infants. A.L. M. 20:12:06 Woodlands St. John's Infants. A.H. M. 2:4:05 Isleworth Blue Boys. A.S. M. 14:1:08 Woodlands St. John's Infants. 1.8. F. 2:7:08 Spring Grove Infants. F.S. M. 14:7:08 Spring Grove Infants. F.F. M. 5: 10:08 Grove Road Infants. J.G. M. 23;i0:08 Spring Grove Infants. C.L. M. l8:il.08 Spring Grove Infants. 38 Feeble minded. Those children (24) who are provisionally classed as feebleminded are quite ineducable by the ordinary methods, and I am of opinion that before any case is given up as totally ineducable the child ought to have a trial by special methods in a special school. I believe the best way of dealing with these children is by educating them in a residential special school. Name. Sex. Date of Birth. School attended. D.G. F. 17-5-00 None. W.W. F. 13-7-00 Hounslow R.C. Mixed. A.G. F. 27-9-00 Hounslow Heath Girls. H.C. M. 2-11-00 Spring Grove Boys. R.F. M. 15-11-00 Nil. E.S. F. 22-12-00 Nil. W.G. F. 16-2-01 Hounslow Heath Girls. E.W. F. 17-7-01 Nil. C.T. M. 18-9-01 Nil. V.H. F. 15-3-02 St. Mary's R.C. E.G. F. 29-8-02 Isleworth Central Girls. C.R. M. 27-10-02 Nil. C.J. M. 14-11-02 Nil. E.W. F. 16-6-03 Hounslow Town Girls W.W. M. 15-2-04 Hounslow Heath Boys. W.P. M. 10-8-04 Nil. F.M. F. 1-1-06 Worple Road Mixed. G.W. M. 11-5-06 Worple Road Mixed. E.K. F. 15-6-06 Isleworth Blue Girls. D.L. F. 19-9-06 Grove Road Girls. A.C. F. 6-10-05 Nil. M.C. M. 10-4-07 Worple Road Infants. F.D. F. 27-5-07 Nil. J.B. M. 7-6-07 Isleworth Blue Infants. 39 Epileptic Children. At present 15 children are known to be the victims of Epilepsy in a greater or less degree. Seven of these children are not fit to attend the ordinary schools. In the other cases the fits occur at such infrequent intervals, and the children seem to be quite normal in the periods between the fits, that I have not taken steps to have them excluded, except for temporary periods. Name Sex. Date of Birth. School attended. R.M. M. 10/2/00 Nil. E.G. F. 31/12/00 Nil. E.E. M. 10/8/01 Nil. C.T. M. 18/9/01 Nil. I.C F. 5/3/02 St. Mary's Girls. F.B. F. 19/3/02 Hounslow Town Girls. C.J. M. 14/11/02 Nil. I.H. F. 27/4/03 Spring Grove Girls. N.S. F. 4/10/04 Hounslow R.C. J.K. M. 9/11/04 Hounslow Town Boys. A.P. F. 27/3/04 Nil. J.T. M. 19/1/05 Isleworth Central Boys. E.J. F. 16/5/05 Grove Road Infants. G.D. F. 25/5/o6 Nil. V.H. F. 26/8/08 Hounslow Town Infants. Epilepsy is a disease which produces a progressive and marked deterioration on the mental development. All these children, except the boy who suffers from Minor Epilepsy, or Petit Mal, are all backward in their mental condition. These children ought to receive special care, education and treatment if they are to be expected to become useful members of the community. 40 Physically Defective Children. Other than Tubercular Cripples, there are 25 physically defective children known to be in the district. Of these 25 children, 18 have paralysis in one or more limbs, the remainder having congenital defects. Name. Sex Date of Birth. School attended. Nature of Defect. R.W. M. 12/9/99 Heston Boys Peroneal Paralysis. W.W. M. 19/8/00 Hounslow Town Boys Hemiplegia. S.C. M. 5/1/01 Worple Road Infants Paralysis of left leg. A.M. M. 3/5/01 Spring Grove Boys Paralysis of left upper arm. A.B. M. 20/8/0I Isleworth Central Boys Paralysis of left arm. L.C. M. 20/9/0I Grove Road Boys Congenital Paralysis of arm. E.G. B.W. F. F. 3/10/01 26/3/02 St. Mary's Girls Hounslow Heath Girls Paralysis leg and right arm with Spinal Curvature. Paralysis right leg. A.G. M. 27/9/02 Grove Road Boys Paralysis of leg. J.W. F. 16/1/03 Hounslow Heath Girls Curvature of Spine. R.D. F. 20/2/03 None Hydrocephalus. M.N. M. 13/8/02 Isleworth Blue Boys Paralysis below right knee. R.D. F. 18/7/04 Spring Grove Infants Paralysis. K.A. F. 28/8/O4 Brentford End Infants Heart Disease. C.K. F. 3/1/105 None Curvature of Spine. M.P. F. 15/4/05 Spring Grove Infants Paralysis of left leg. E.C. D.J. F. F. 17/5/05 13/9/05 Grove Road Infants Grove Road Girls Congenital Dislocation of left hip Paralysis of left arm. A.B. F. 18/9/05 Grove Road Infants Paralysis of left leg. W.W. M. 24/11/05 Hounslow Town Boys Paralysis of left arm. H.E. M. 27/12/05 Hounslow Town Infts. Congenital Deformity left leg M.G. F. 21/3/06 Nil Paralysis of legs. F.B. M. 21/4/06 Hounslow Heath Infts. Paralysis of legs. W.D. M. 18/6/08 Grove Road Infants. Paralysis of legs. s.s. M. 16/9/08 Worple Road Infants. Congenital Dislocation right hip. 41 Pulm0nary Tubercul0sis. There are 32 children in the district kn0wn t0 be suffering fr0m Pulm0nary Tubercul0sis, 0f wh0m 25 are n0t attending sch00l. Year 0f Birth. 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 Open. Cl0sed. Open. Cl0sed. Open. Cl0sed. ( Open. Cl0sed. Open. Cl0sed. Open. Cl0sed. Open. Cl0sed. Open. Cl0sed. Open. Cl0sed. Open. Cl0sed. Open. Cl0sed. B0ys 0 0 0 1 1 4 1 1 2 0 2 0 2 0 1 0 3 1 0 0 1 0 Girls 1 0 0 1 1 1 1 1 0 0 1 0 1 1 1 0 0 1 0 1 0 0 1 0 0 2 2 5 2 2 2 0 3 0 3 1 2 0 3 2 0 1 1 0 Nineteen of these 25 children are the subjects of active tuberculosis of the lungs, accompanied with cough and expectoration. In addition, there are 13 children the subjects of incipient or healed Lung Tuberculosis at present attending school, and for whom an open-air school would be of immense value. Eighteen children are classed as being pre-tubercular, which means that these, unless placed in suitable environment, will probably develop the disease. Other Forms of Tuberculosis. Of the children suffering from Tuberculosis other than Lung Tuberculosis, 1 is the subject of Skin Tuberculosis, 3 have Tuberculosis of the Glands of the Neck, 8 have Tuberculosis of the Abdomen, 7 have the joints involved in Tubercular Disease, 4 have Tubercular Disease of the Spine. These 23 children are all suitable for special schools, yet in 12 instances the children are attending the ordinary elementary schools, while in the remaining 11 the children are not in attendance at any school. MEDICAL TREATMENT. The following table gives the results of the work undertaken during the year in the "following up" and re.examination of cases referred for medical treatment:— Condition. No. of defects found for which treatment was considered necessary. No. of defects for which no report is available. No. of defects treated. Results of Treatment. No. of defects not treated. Percentage of defects treated. From previous year. New. Total. Remedied. Improved. Un. changed. Clothing Footgear Cleanliness of Head Cleanliness of Body Nutrition Nose and Throat 199 285 484 240 141 99 33 9 103 57.7 External Eye Disease 1 1 1 Ear Disease 1 1 2 1 1 1 Teeth 60 110 170 143 6 1 3 2 21 22.2 Heart and Circulation Lungs 1 1 1 Nervous System Skin Eickets Deformities 1 1 2 1 1 1 Tuberculosis, non.pulmon'y Speech Mental Condition Vision and Squit 86 180 266 128 56 24 24 8 82 40.6 Hearing Miscellaneous Total 349 577 920 515 205 126 60 19 206 49.8 42 43 From this table it will be seen that 205 out of 411 did obtain treatment, i.e.. 49.8%. This figure is certainly an improvement over that of last year, 44 4%, but it is still evident that a very large proportion of cases remain untreated. Treatment of Eye Cases. The children re.examined in order to see if they had secured treatment was 138, of whom 56, or 40.6%, had been treated. The source of the treatment in 95% of the cases was one or other of the Voluntary Hospitals : the remaining 5% were treated by private doctors. Throat, Nose and Ear Cases. The number of children examined was 244, of whom 57 7% obtained treatment. In 74% of these the treatment was obtained at a Voluntary Hospital. Dental Conditions. It is very important to observe that only 22.2% of cases had obtained treatment. The reasons which operate to produce this unsatisfactory result, are— (1) The expense in securing proper treatment. (2) Parents do not fully appreciate the evils of decayed teeth. In most cases the only treatment which is secured is the extraction of the most decayed teeth or those actually causing pain, practically no preservative work being done. General. The principal object of Medical Inspection is the detection of defects, and it is only reasonable to expect that these defects should be remedied. A considerable amount of time and money is spent in detecting and following up the defects ; that being so, it is desirable that this expenditure should not be unfruitful. I do not think it is so entirely now, but I do think there is not a good enough return. It does not of course concern materially the 44 Committee, how these defects are remedied, provided the treatment secured is efficient, but it does concern the Committee that less than 50% of the cases receive any treatment at all. With the existing facilities only 49.8% of those requiring treatment have secured it, of this number 82 2% have had recourse to the Voluntary Hospitals. The Hospitals most taken advantage of are the West London Hospital, Sick Children's Hospital, Richmond Hospital and the Hounslow Hospital. There is every reason to believe that more children would go to these hospitals for treatment if hospital letters could be obtained, but I do not think the machinery at these institutions, already taxed to its utmost capacity, would be adequate to deal with the problem, which is that 25% of the school population require some treatment. Another factor which must be borne in mind, and which is of especial importance in this district, where a very large proportion of mothers are engaged in earning money outside their own homes, is the expense involved in losing a day's work and paying travelling expenses to attend the hospital and in many cases carrying out the treatment at home. The Poor.law is not of much service in this respect, as it is well nigh impossible to persuade parents to take advantage of its machinery, because although there is no disqualification to the recipients of medical relief, yet there is a feeling that the stigma of pauperism remains. It is a matter for congratulation that the Committee have now decided to provide treatment for Ringworm cases and for Eye cases. I think, however, that further treatment is required for minor ailments and for dental conditions. With regard to the latter, I am informed that defective teeth was the commonest cause of the rejection of recruits for the Army in this district. Open.air Schools. The provision which the Committee are in a position to make is as follows :— 1. Establishing a scheme of play.ground classes. 2. Establishing an open.air school with a special class for Tuberculous children. 45 3. Making arrangements for the education and treatment of certain cases at a Sanatorium School certified by the Board of Education. Open-air Classes. Play-ground Classes. This provision can easily be, and in a modified way is carried out in some schools in the district. During Spring, Summer and Autumn such classes might, with advantage, be made general, the children attending these classes being selected on account of their physical condition. Each such class may be formed by selecting the delicate children from one school of different educational standards ; or by selecting delicate children of the same educational standard from different schools. I would recommend that some general scheme of this nature be carried out. Open-air School. There is no doubt that if such a school were provided in this district, it would prove of immense value in improving the health and mental condition of many children who are either receiving no education at present, or are receiving education while in a physical state which precludes them from receiving full benefit from it. The following detailed requirements of such a school are set out in the School Medical Officer's Annual Report, 1911 :— " III this district a school for 50 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 classrooms should be constructed for 25 pupils. 46 4. The classrooms 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 being 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 classrooms. 8. Baths should be provided. 9. Each child should have the following numbered articles :—A washable bag, containing brush and comb, tooth brush, 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." In considering the cost of an open-air school, it is important to remember that special grants are made amounting to £7 per child, and that the construction of a Doecker building would be inexpensive. This school would also be of benefit to children who suffer from such conditions as Anaemia, Mal-nutrition, Enlarged and Tubercular Glands, Heart Disease, Chorea, Spinal Curvature, Paralysis, etc. It has been found, as a result of experience, that children who have been in attendance at an opeu-air school after several months are frequently able to return to the ordinary day school equal in intelligence to other scholars of their age. 47 Sanatorium School. The function of this institution is to provide education at the same time as the child is receiving treatment. It has been found that children undergoing prolonged treatment, as in certain tubercular diseases, fall hopelessly behind in educational matters, and much depends in these cases (which are mostly unable to do manual work) on a good mental development, in order that they may be selfsupporting in later life. The Board of Education have certified several schools of this class, but I think it would be inadvisable at the present juncture for the Committee to provide such a school, although a grant of three-fifths of the capital expenditure on building, site and equipment is made. It will probably be more advantageous at present if the Committee desire any case to go to this class of school to make arrangements for each case to go to a certified school. The Board of Education make grants totalling £12 for each child sent to such a school. But if the child is sent by the County Council for the purpose of sanatorium benefit the grant amounts to one-half of the sum paid. Teaching of Hygiene. The course of lessons on Infant Care and Management given by Health Visitors once a fortnight to the girls over 12 years has continued to be much appreciated by the girls. The answers to questions set on each lesson shew that the girls do take much interest in the work ; some girls who are rather dull in much of their other school work are particularly careful in this essentially practical and useful subject. Administration of the Education (Provision of Meals) Act, 1906. The dietary, as in previous years, has been arranged by the School Medical Officer and submitted for the approval of the Committee. The centres for providing the dinners which are supplied are at the schools, and have been visited by the School Medical Officer or the Health Visitors. 48 The dinners are prepared and served by the caretakers at the schools. The school meals might, however, be given a greater educational value, were the services of the teachers and other voluntary workers more utilised. The procedure adopted by the Committee in deciding whether any child is to receive meals is that the parent or guardian is asked to appear before a Sub-Committee who have before them reports :— (a). From the School Medical Officer on the physical state of the child. (b). From the Head Teachers on the educational progress of the child. (c). From the School Attendance Officer on financial conditions of the family. It appears to me that to gain the best results from the granting of meals, the important factor in determining whether any child ought to have meals, is the physical state of the child. There are cases where the income of the family is such that the parent should be in a position to provide all that is necessary, yet owing to various causes such as dissipation, illness, etc., the child does not receive the necessary food. Again, there are children who do receive sufficient food of a kind that is within the power of the parent to provide, but for whom some extra nourishment such as a glass of milk daily would be of much value. There are again certain parents whose children are undernourished, and who, although doing the best they can to supply food for their children, are willing to have the meals, yet when they are aware that the required application will necessitate their appearing before a Committee, shrink from applying for meals. Provision of Meals. In the Annual Report for 1912 of the Chief Medical Officer of the Board of Education, it is stated that in the Board's view, the points of fundamental importance in the administration of this Act are summed up as follows :— 49 1. The closest connection should subsist between the working of the Education (Provision of Meals) Act and the School Medical Service. 2. The scheme for selecting children for admission to the meals should be determined by the need for securing that no child is prevented by reason of lack of food from taking full advantage of the education provided for it. The basis of selection should therefore, as a rule, be the physical condition of the child. 3. Due regard should be had to the need for making the dietary a suitable one. It should also be borne in mind that there will frequently be children for whom a special dietary is needed, which should be prescribed by the School Medical Officer. 4. Attention should be given to the educational side of the provision of meals. Any scheme which neglects this aspect of the work stands in need of revision. 5. Steps should be taken to ascertain the effect of the meals on the health and physical and mental condition of the children fed. 1914. REPORT on The Health of the HESTON and ISLEWORTH URBAN DISTRICT FOR THE YEAR 1914 by THOMAS STRAIN, M.D., D.P.H., Medical Officer of Health. INDEX. Report of Medical Officer of Health, 1914. Page Adoptive Acts in force in District 28 Antitoxin, provision of 37 Appendix 58 Area 4 Bakehouses 14 Births 48 Bye-laws in force in District 28 Canal Boats, Annual Report 76 Cancer 43 Closet Accommodation 10 Common Lodging Houses 14 Contacts, Tuberculosis 40, 42 Cowkeepers and Cowsheds 15 Deaths 46 Infectious Diseases 32 Residents in Public Institutions 7 Tuberculosis 41, 42 Diagnosis of Diseases 30 Diphtheria 35 Provision of antitoxin 37 Disinfection in cases of Tuberculosis 42 Dockwell Isolation Hospital 29 Drainage 10 Erysipelas 38 Factory and Workshop Act, 1901 26 Tables 65 Food 15, 17 Health Committee, members of 1 Hospital Accommodation 29 Cases removed to 29 Dockwell Isolation 29 Hounslow Voluntary 9 Mogden Isolation 29 Hounslow Hospital 9 iii. Index—Continued. Page. Housing 18 Houses with sanitary defects 20 „ unfit for human habitation 22 Houses let in Lodgings 14 House Refuse 10 Illegitimate Births 49 Infantile Mortality 49, 64 Infectious Diseases 31, 01 Deaths 32 Nett notifications 33 Non-notifiable 43 Notifiable 31 Other diseases 43 Inquiries, Local Government Board 24 Inspections 10 Introduction 2 Isolation Hospital Accommodation 29 Laboratory 30 Local Government Board Inquiries 24 Medical Belief 7 Members of Health Committee 1 Milk 15 Cleansing of vessels 16 Source of supply 16 Storage of 16 Vendors of 16 Mogden Isolation Hospital 29 Natural and Social Conditions 4 Non-resident Births 48 Deaths 47 Notification of Births Act, 1907 49 Non-notifiable infectious diseases 43 Notifiable infectious diseases 31 Nuisances 11 iv. Index—Continued. Page. Offensive Trades 14 Ophthalmia Neonatorum 55 Physical Features 4 Population 4 Premises controlled by Bye-laws or Regulations 13 Prevention of Infantile Mortality 49 Public Institutions, Notifications of Infectious Diseases in 33 Deaths of Residents in 7 Deaths of Non-residents in 47 Pulmonary Tuberculosis 38 Regulations in force in District 29 Residents, Deaths of in Public Institutions 7 Sanitary Administration 10 Circumstances 9 Tables 68 Scarlet Fever 34 Scavenging 10 Sewerage 10 Shops Acts 57 Table of Trades 73 Slaughter-houses 14 Social Conditions 5 Staff 27 Statistics, summary of 3 Storage of Milk 16 Summary of Statistics 3 Tuberculosis 38 Deaths from 41, 42 Disinfection after 42 Examination of Contacts 42 Treatment of cases of 41 Typhoid Fever 37 Venereal Diseases 44 Vital Statistics (in Wards) 3, 56 Tables 59 Water-closets 10 Water Supply 9, 16 Examination of 9 THE HEALTH COMMITTEE of the HESTON AND ISLEWORTH URBAN DISTRICT COUNCIL For the Year ending April, 1915. T. S. Goodwin, Esq., M.B., C.M. (Chairman). F. W. T. Margetts, Esq. (Vice-Chairman). A. A. Bergin, Esq., J.P. (Chairman of the Council). C. Crush, Esq. (Vice-Chairman of the Council). C. Arnold, Esq. G. A. S. Gordon, Esq., M.A., L.R.C.P. & S. W. G. Lobjoit, Esq., J.P., C.C. W. Mann, Esq. P. F. C. Meyers, Esq. W. G. Palmer, Esq. W. E. Shuff, Esq. J. J. Wilmot, Esq. Medical Officer of Health:— Thomas Strain, M.D., D.P.H. 2 Health Department, Council House, Hounslow. 31st March, 1915. To the Chairman and Members of the Heston and Isleworth. Urban District Council. Gentlemen, I have the honour to submit to you the Annual Report on the Health and Sanitary circumstances of the district for 1914. I am, Gentlemen, Your obedient Servant, THOS. STRAIN, Medical Officer of Health. 3 SUMMARY OF STATISTICS, 1914. Area: Heston acres 3708 Isleworth „ 3185 6893 Population: Residents 47547 Non-residents in Public Institutions 814 48361 Birth rate (nett) 21.05 (crude) 21.48 England and Wales 23.8 London 24.3 Death rate (nett) 11.43 (crude) 17.86 Corrected for age and sex constitution (standard) 10.75 England and Wales (standard) 13.7 London (standard) 14.4 Infantile Mortality Rate 97.90 per 1000 births. England and Wales 105.00 „ „ London 104.00 „ Census Population: 1891 26271 1901 30863 1911 43316 Inhabited Houses (Census 1911) 8006 Uninhabited „ „ 572 8578 4 Average number of persons per inhabited house 5.48 „ „ „ acre 6.78 Rateable Value: Agricultural Land £15,203 Other Hereditaments £216,435 Assessable Value (1914) £209,668 General District Rate (1914-15) 4s. 3d. Poor Rate: Heston (1914-15) 4s. 4d. Isleworth 4s. 6d. 1d. in the £ for District Rate purposes produces £804 NATURAL AND SOCIAL CONDITIONS. AREA. The Urban District of Heston and Isleworth, in the County of Middlesex, has an area of 6,893 acres. It comprises the two parishes of Heston and Isleworth, and is divided for civil purposes into five wards. Heston Parish includes Heston and Hounslow North Wards, and has an area of 3,708 acres. The Parish of Isleworth lies to the east and south of Heston, and is situate on the western bank of the River Thames where that river winds to the north-east towards Kew. The area of this Parish, which embraces Isleworth North and South and Hounslow South Wards, is 3,185 acres. PHYSICAL FEATURES. The level of the District rises gradually from the River Thames and reaches at Heston a height of 100 feet above Ordnance Datum. The geological subsoil formation is valley gravel, which is covered in large areas by loam. This thin loamy covering is of great value for market gardening, to which considerable portions of land within the district are devoted. POPULATION. The population enumerated at the Census of 1911 for the entire district was 43,316, and the population to the middle of 1914 was estimated as 48,361. This figure has been used throughout the report as the estimated gross population. 5 The number of persons per acre over the whole district is 6.78, and the figure varies in the different wards as under:— Heston Ward 2.47 Hounslow North Ward 9.99 „ South 12.09 Isleworth North „ 6 67 „ South „ 11.37 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 814. These are technically known as "non-residents." This number, when deducted from the estimated gross population, gives the estimated nett population, namely, 47,547. SOCIAL CONDITIONS. In order to comply with the desire of the Local Government Board that the Medical Officer of Health should give in his report information with respect to the social conditions of the district, I have extracted the following information from the Census of occupations of 1911:— The occupation of the inhabitants may be divided into—(a) Workers who travel daily to London. (b) Workers employed locally. The former class are either—(1) Clerks or those engaged in clerical work; (2) Professional men, merchants, agents, etc., or (3) Artisans. Increased facilities are provided by railways, tramways etc., for the latter class, the proportion of whom residing in the district is gradually increasing. According to the Census, out of 12,812 occupied males in the district, the following three groups accounted for 1541:— Commercial Clerks 551 Professional Occupations and Subordinate Services 533 Merchants, Agents: Accountants: Banking: Insurance 457 6 In regard to the second class—the local workers—the work engaged in may be again classified into— (1) Building work. (2) Factory work. (3) Railway, Tramway, and Motor-bus employees. The factories in this district include, Drug, Soap, Chemical Dye and Metal Factories, Confectionery Works, Flour mills, Laundries, and Breweries. The following five groups of occupations include 6,304, or practically half of the total occupied males in the district:— Building and works of construction 1562 Food, tobacco, drink, and lodging 1420 Agriculture : on farms, woods and gardens 1357* Defence of country 1202 Conveyance: on roads 763 *Including '210 Nurserymen, Seedsmen, and Florists, and 543 Market Gardeners. With regard to women, out of a total of 4,732 occupied females 1,446 are engaged as Domestic Servants (equal to a rate of 165 per 1,000 separate occupiers or families). The next four highest groups are:— Laundry and washing service 449 Dressmaking 386 Teaching 257 Chemicals, Oil, Grease, Soap, etc. 238 A class of work largely engaged in locally is fieldlabour in the market gardens. In this class of work the wages paid are low, and a considerable amount of female labour is used. The number of women returned as engaged in agriculture is 146, but this is largely a seasonal trade, and it should be borne in mind that the Census is taken in April: probably the actual number is much greater. 7 Female labour is also largely used in the Chemists' Works, the Soap Factory, the Confectionery Works, and the Laundries. The Census of Occupations gives the proportion of (industrially) occupied married women as 95 per 1,000 of all occupied women. I have been unable to furnish the information with respect to the amount of poor-law relief. There are approximately, however, 750 old age pensioners in this district. In addition to this, there are the Heston Charity Trustees and the Isleworth Parochial Charities, who provide monies for pensions. To state the extent to which Hospital and other forms of gratuitous medical relief are utilised, is somewhat difficult. If, however, the number of deaths occurring in Institutions is stated, it will probably give a rough idea of the extent to which these hospitals are used for the treatment of in-patients from this district. Deaths of Residents in Public Institutions. (a). Within the district 134 (b). Outside „ 53 187 8 Institution, No. of Deaths. Within the District:— Brentford Union Infirmary 89 Hounslow Hospital 23 Mogden Isolation Hospital 10 Nazareth House 7 Wyke House, Isle worth 4 Military Hospital 2 The Barracks 1 Outside the District:— Middlesex. County Asylum 12 West London Hospital 10 Richmond Hospital 6 Northern Hospital 3 St. George's Home, Chelsea 3 Victoria Hospital 2 Great Ormond Street Hospital 2 St. John's Hospital, Twickenham 2 St. George's Hospital, S.W. 1 Guy's Hospital 1 University College Hospital 1 R.N. Lunatic Hospital 1 Otto House Private Lunatic Asylum 1 Royal Hospital for Incurables 1 The Quintin Pole-Clinic 1 St. Luke's House, Kensington 1 2nd W. General Hospital, Manchester 1 Military Hospital, Falmouth 1 2nd London General Hospital 1 Total 187 The extent to which the out-patient departments are utilised may be measured with approximate accuracy from the figures available in respect of school children medically inspected and found in need of treatment: 82.2% of these children went to hospitals for treatment. 9 The Hounslow Hospital is the only voluntary hospital within the district; it is a modern and well-equipped institution, doing very valuable work in the district. The number of patients treated in this hospital for the year 1914 and belonging to this district was as follows:— In-Patients. Out-Patients. Hounslow 181 438 Isleworth 17 81 Heston 24 56 Total 222 575 The hospital is supported by voluntary effort but in certain cases charges are made from patients. Other medical relief is given by various voluntary organisations in the district as follows:— Hounslow Central Aid Society. Isleworth District Nursing Association. Ellis Day Nursery. SANITARY CIRCUMSTANCES. Water Supply. The water supply for the district is from the mains of the Metropolitan Water Board; the quality of water has throughout this year been good, and the service is a constant one. 42 houses in Heston Parish are supplied from the main of the South-West Suburban Water Co. There were, as far as is known, at the end of the year 38 private wells from which the water was used for domestic purposes. Six samples of water were analysed during the year. In two cases the water was found to be contaminated and unfit for domestic use, and as a result the use of the contaminated supply was discontinued. 10 In 222 instances draw-taps were placed on the main to the house, in compliance with notice from the Health Department, in lieu of a supply drawn from an inaccessible and uncovered cistern. Drainage and Sewerage. The arrangement of the sewerage of the district is the separate system, and the method of disposal at the outfall works is that of precipitation and bacterial filtering beds, the effluent being passed into the Thames. New bye-laws are required governing the re-construction and alteration of existing drainage. Closet Accommodation. Accommodation on the water carriage system is almost general throughout the district, 98 per cent. of the houses having water-closets. Scavenging. The removal of house refuse and the scavenging of streets are under the control of the Surveyor's Department. The collection of house refuse is conducted once a week from every house and from business premises by arrangement. Sanitary Inspection of the District. Details of inspections and work done is set out in Table X. of this report. The number of premises inspected on receipt of complaint was 368, and the number of house-to-house inspections 122. Investigations at houses where infectious diseases had been notified numbered 222. The number of nuisances recorded was 589, but at the end of the year 431 of these had been remedied, leaving 158 premises in which nuisances still existed. 11 Nuisances, Contraventions of Bye-laws, Defective Drainage, etc. Table shewing Nuisances, etc., reported to and directions given and action taken by the Health Committee, together with the results of such action during 1914:— Premises. No. of houses dealt with. No. of houses in respect of which notices were authorised No. of houses in respect of which notices were served. No. of houses in respect of which the notices were complied with. No. of houses carried forward to 1915. Brought forward from 1913— 1913 1914 20, St. Stephen's Road l l - - l — 44, Haliburton Road l l 1 - l — 18, Gumley Gardens l l 1 - l — 49, 51, London Road l l 1 - 2 — 1914— 9, London Road l l - 1 1 — 123-153, Hartham Road 16 16 - 16 16 — unoccupied "Holmdene," Woodlands 1 1 - 1 - l 8. 10, Lampton Road 2 2 - - 1 — 18, St. Stephen's Road 1 1 - - l — Clare Lodge 1 1 - - 1 — 15, Avenue Gardens 1 1 - 1 l — 43, Bulstrode Road 1 1 - 1 1 — 2, Field's Cottages 1 1 - 1 1 - 10, 12, 14, York Road 3 3 - 3 3 — 5, Lampton Road 1 1 - - 1 — 12 Premises. No. of houses dealt with. No. of houses in respect of which notices were authorised No. of houses in respect of which notices were served. No. of houses in respect of which the notices were complied with. No. of houses carried forward to 1915. 11-23, Parkside Road 7 7 - - 7 — 21, Haliburton Road 1 1 - 1 1 — 36a, Wellington Road, N. 1 1 - 1 1 — "Wayside," Lampton Rd. 1 1 - - 1 — 19, Grainger Road 1 1 - 1 1 — 2, 4, Algar Road 2 - - - 2 — 10, Queen's Terrace 1 1 - 1 1 — 5, Myrtle Cottages 1 1 - 1 1 — Jubilee Works, South St. 1 1 - 1 1 — Knight's, London Road 1 1 - 1 1 — 31—37, Strafford Road 4 4 - - 4 — 14, Bulstrode Avenue 1 1 - 1 1 — 48, Derby Road 1 1 - 1 1 — 25, Stanley Road 1 1 - - 1 — 8, York Road 1 1 - 1 1 — 6, Silverhall Place 1 1 - 1 - 1 *4, Algar Road 1 1 - 1 - 1 St. Edmunds, Woodlands 1 1 - 1 1 — 22, Kendall Road 1 1 - 1 1 — 37, Worple Road 1 1 - 1 - 1 Marden Lodge 1 1 - - 1 — "In Court, 31/12/14. 13 Premises. No. of houses dealt with. No. of houses in respect of which notices were authorised No. of houses in respect of which notices were served. No. of houses in respect of which the notices were complied with. No. of houses carried forward to 1915. 17, 19, 21, Aylett Road 3 3 - - 3 — 2—5, Field's Cottages 4 4 - 4 4 — Lack ham House 1 1 - 1 - l Clevedon 1 1 - 1 - l 35, Cromwell Road 1 1 - - 1 1 Queen's Terrace 1 1 - 1 - i 24, Northcote Road 1 1 - 1 1 — St. Margaret's Lodge 1 1 - - 1 — 64, Standard Road 1 1 - 1 - i 7—9, Osborne Road 2 2 - - - 2 PREMISES AND OCCUPATIONS CONTROLLED BY BYE-LAWS OR REGULATIONS. There are 381 premises in this district which call for periodical inspection and are made up as follows:— Houses let in Lodgings 12 Common Lodging Houses 2 Bakehouses 25 Slaughter Houses 9 Cowsheds 18 Dairies and Milkshops 58 Offensive Trades 20 Laundries (non factory) 34 Workshops and Work Places 203 With regard to underground sleeping rooms, no regulations have yet been made. 14 Houses let in Lodgings. The number of houses registered under the bye-laws as houses let in lodgings is 12, hut it is certain that a greater number of houses in this district are let in lodgings. According to the results of the Census, there were 8,786 families in the district, whereas there were only 8,006 occupied houses. This shews that over 9 per cent. of the houses in this district are occupied by members of more than one family. Common Lodging Houses. There are two houses in the district registered as Common Lodging Houses. One is licensed to receive 61 and the other 35 persons. The number of inspections made during the year was 23, the majority of which were made at night. These houses, having regard to the class of lodger received, are kept in a very satisfactory condition. Bakehouses. There are 25 bakehouses in the district, of which one is underground. Seventy-nine visits were made and 11 contraventions of the Factory Act detected. Improvements were effected in regard to ventilation and lighting in one. Water supply (direct from the main) was provided in one instance. Slaughter-houses. There are nine slaughter houses in the district; one is on annual license, and eight are registered. These were visited 161 times during the year, the visits taking place as far as possible when slaughtering is occurring. In 6 instances contraventions of bye-laws were found. Offensive Trades. Twenty fried fish shops are in existence in the district. 278 inspections were made of these premises during the year. Bye-laws for the regulation of this trade have now been prepared and approved by the Local Government Board. 15 The fat-melting business referred to in my report last year still exists, and it will be necessary for the Council to consider the advisability of framing bye-laws for the regulation of this offensive trade. FOOD. Milk Supply. The following pages will shew the condition under which the milk trade is carried on in this district. It will be seen that there is still room for improvement in the conditions under which milk is sold. I believe that as milk is such an important food-stuff and is so liable to harbour germs of disease, that the trade should be regarded as a highly specialised one, and that special premises should be provided for this trade alone. Cow-keepers and Cowsheds. The number of persons registered as cow-keepers in the district is 10. The registered cow-keepers carry on their trade in 18 cowsheds. These cowsheds were visited by the Sanitary Inspectors 127 times during the year, or an average of 7 times each cowshed. There are usually about 94 milch cows housed in these premises. In the case of five cowsheds, the animals are wholly stall fed. In 9 instances contraventions of the regulations were noticed and certain improvements or alterations carried out, these included improvements to the ventilation, lighting, drainage and repairs to floors and walls. There are, however, certain matters which it is difficult to remedy. I refer more especially to means for cleanliness being provided to prevent the milk being contaminated ; it is somewhat unusual for grooming of cows or cleansing of the udders to be carried out as a routine, or for facilities for the milkers to wash their hands or wear overalls before milking, yet I believe the non-observance of these points is a prolific source of dirty milk. 16 Milk Vendors and their Premises. There are 58 persons, excluding cow-keepers, registered as dairymen or purveyors of milk within the district. Ten of these persons carry on their business within this district from premises situated elsewhere. The premises from which the trade is carried on within the district are composed of two classes—(1) premises in which only dairy-produce is sold and (2) premises in which other business is carried on. Among the latter there are many persons who sell only comparatively small quantities of milk over the counter and whose premises are in no way specially adapted for the milk trade. These premises were visited 364 times, and in 19 instances contraventions of the Regulations were found and remedied. Source of Supply. The majority of the small vendors receive their milk from other and larger vendors in the district, the latter in turn receive their milk from several sources. Storage of Milk. In those premises where only a small counter trade is carried on, the milk is kept in a covered vessel on the counter, no special facilities being provided for storage. Facilities for Washing Utensils. In a certain proportion of cases there is provided a special and suitable washing place for cleansing utensils and apparatus. In other cases a part of the ordinary domestic dwelling is used for the purpose. Water Supply. The majority of vendors have a supply provided direct from the main, but in some instances the supply is drawn from a storage tank. In 4 cases the water supply is drawn from wells. 17 Means for Heating Water. In 15 cases special coppers, boilers or other appliances are provided for heating water for cleansing purposes. In other cases the kitchen kettle or even the general copper of the house is used for this purpose. Use of Coolers. In 6 cases only is a cooler used. Other Foods. Each Inspector possesses the Certificate of the Royal Sanitary Institute in meat inspection, and with the exception of the Inspector of Nuisances, has been appointed under the Towns Improvement Clauses Act. During the year 3007 visits have been paid to premises where food is sold. Special evening inspections are periodically made in connection with the sale of fruit, etc., from hawkers' barrows. The quantity of unsound food found during the year was:— Fruit 60 lbs. Meat 16 lbs. Fish 1 cwt. 105 lbs. The procedure adopted with regard to unsound food during the year has been, that during slaughtering any food deemed unfit for human consumption is pointed out to the owner, who surrenders this and signs a certificate to that effect. Other unsound food is accepted for surrender only when an application is made to the Health Department before the Inspector sees it. Otherwise all unsound food is seized in accordance with the Public Health Act. In 11 cases parts of carcases of animals were surrendered and condemned—in 4 cases owing to the presence of tuberculosis of limited extent. No special supervision has been exercised over other premises, such as Restaurants, Eating-houses, etc., where food is prepared, stored, or exposed for sale. 18 HOUSING. Housing and Town Planning Act, 1909. Housing (Inspection of District) Regulations, 1910. The procedure as set out in the Regulations has been followed during the year as in previous years. The list of houses, the early inspection of which is desirable, is being gradually worked through, but certain properties are added to the list from time to time. At each meeting of the Authority, the records are taken into consideration and instructions are given as to the action to be taken in each case. As in previous years, the houses inspected came within either of the following categories:— 1. Houses with sanitary defects. 2. Houses unfit for human habitation. 19 The following table summarises the work done under this Act in this district since it came into force:— Year. Number of houses inspected. Number of houses closed (i.e. Closing Orders made). Number of houses in respect of which Notices were served. (i.e. Intimations). Number of houses demolished. Number of houses put into a satisfactory state of repair. Number of houses inspected and outstanding. 1909* 12 12 ... ... 4 8 1910 38 30 8 22 1 23 1911 114 29 86 26 45 66 1912 87 28 42 17 22 114 1913 153 37 101 9 124 134 1914 101 15† 80 13 125 97 *Act only in force for one month. †In addition, 1 house was closed voluntarily, and 1 has become unoccupied. The above table shews a progressive increase in the work done under the Housing Acts in respect of the number inspected, and a still more marked increase in the number put into a satisfactory state of repair. It has, however, been somewhat interrupted owing to the national crisis. I believe it is necessary to increase the number inspected per annum to about 200 houses, but I do not feel that it would be safe to go beyond that number with the present staff without causing a sacrifice of the efficiency with which the other work is carried out. The general character of the defects dealt with are— Dampness due to (1) Absence of damp-proofing. (2) Gutterings and roofs. (3) Defective brickwork. Water-cisterns so placed and kept as to render the water liable to contamination. Want of paving and draining to yard surface. Absence of proper and sufficient dustbins. Absence of ventilated food cupboard. 20 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) Begulations, 1910. Table shewing the number of dwelling houses inspected and dealt with during 1914:— Premises. No. of houses. No. of houses in respect of which Intimation Notices were served (1914). No. of houses in respect of which Statutory Notices were served. No. of houses in which the notices were complied with. No. of houses carried forward to 1915. Brought forward from 1913. Inspected during 1914. 1913 1914 Brought forward from 1913— 63-73, Linkfield Road l ... ... ... ... l ... †1, 1 a, 2, 2a, 3, 3a, 4,5,6, Cresswell Gardens 8 ... ... 8† ... 8 ... 85-93, Albion Road 4 5 4 ... 2-12, Nicholes Road 5 ... ... 6 ... 5 ... Rose House Cottage 1 ... ... 1 ... * ... Bell's Almshouses 3 ... ... ... ... 3 ... ‡l, Douglas Road 1 ... ... 1 ... ... ... 1-11, Inverness Road 5 ... ... ... ... 5 ... 1-35, Brickfield Yard 14 ... ... ... ... 14 ... 64, Linkfield Road 1 ... ... ... ... 1 ... 96-106, Linkfield Road 4 ... ... ... ... 4 ... 1-5, Grove Road 2 ... ... ... 2 2 ... 13-21, Inverness Road 5 ... ... ... 2 5 ... 12-16, Brickfield Yard 3 ... ... ... 1 3 ... Excelsior Cottage 1 ... ... ... 1 1 ... 7-12,Maswell Park Villas 6 ... ... ... ... 6 ... 1-7, Bridge Road 7 ... ... ... 5 7 ... 253-267, High Street 8 ... ... ... ... 8 ... ...† Notices re-served. ‡ Unoccupied. * House closed voluntarily. 21  No. of houses inspected,1914. No. of houses in respect of which Intimation Notices served. No. of houses in respect of which Statutory Notices were served. No. of houses in which notices were complied with. No. of houses carried forward to 1915. 1913 1914 1914— 1-7, Prince Regent Road 7 7 ... ... 7 ... 2, 3, 6, 7, Castle Place 4 4 ... 4* ... 4 297, Staines Road 1 1 ... ... ... 1 6-14, Inverness Road 5 5 ... ... 5 ... 46-54, Derby Road 5 5 ... ... 5 ... 1, 2, Retreat Cottages 2 2 ... ... 2 ... 2-10, Brickfield Yard 5 5 ... 5 ... 5 1-7, Retreat Terrace 7 7 ... ... ... 7 1-13, 120-130, 143, 169, Linkfield Road 15 15 ... 13 2 13 11-17, Tivoli Road 4 4 ... ... 4 ... 1-4,Gilbert's Cottages, W. 4 4 ... ... ... 4 2, 4, Inverness Road 2 2 ... ... 2 ... 1-31, Derby Road 16 16 ... 4 7 9 30, South Street 1 1 ... ... 1 ... 83, 85, Pears' Road 2 2 ... ... ... 2 80 80 ... 26 35 45 "Under Section 15 of the Housing, Town Planning, etc., Act, 1909. 22 The procedure adopted in these cases is to give the owner a written intimation of the defects requiring remedy; after the lapse of a reasonable time the Health Committee give instructions to serve Statutory Notices. Houses Unfit for Human Habitation. The procedure adopted in dealing with houses represented under this heading by the Medical Officer of Health has been the same as in previous years. At the same time as the representation is made, a report is presented to the Health Committee by the Medical Officer. A copy of this report is forwarded to the owner, who is given an opportunity of making a statement verbally or in writing, personally or by a duly accredited representative, at the next Health Committee meeting. The Health Committee then having duly considered the Medical Officer's Report and the owner's statement, decides as to whether 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, 1914, in relation to houses represented by him as unfit for human habitation:— Number of houses represented by Medical Officer of Health 21 „ Closing Orders made by the Local Authority 15 „ appeals against Closing Orders 1 (In respect of 7 C.O.) „ notices served on occupying tenants 6 „ occupying tenants summoned 0 „ Orders made by Court requiring occupying tenants to quit 0 „ Closing Orders determined 4 (C.O. made in 1913) „ Demolition Order made 9 (1 in respect of 1913) „ appeals against Demolition Orders 0 „ Demolition Orders obeyed 13 (D.O. made in 1913) „ Demolition Orders enforced 0 „ demolitions carried out without Orders being made 0 23 The following table gives more detailed information in regard to the houses represented as unfit during the year 1914, and the action taken in those remaining on the records at the end of 1913: — Housing (Inspection of District) Regulations, 1910. Table shewing dwelling houses represented as unfit for human habitation:— Premises. No. of houses represented by M.O.H. Date Closing Order made. Date Closing Order determined. Date Demolition Orders made. Date Demolition Orders obeyed. Date demolition enforced. Br't forw'd from 1913— *1-10,Courtney Place 10 16/7/12 25/2/13 20-26, Inwood Road 4 25/11/13 20 27/1/14 22-26 24/2/14 28-34, 4 28/1/13 ... 22/7/13 20-42, Bath Road 12 25/2/13 ... 23/9/13 7/2/14 a4, Poplar Cottages 1 22/4/13 ... 28/10/13 l-4,Sunnyside Cotts. 4 25/11/13 5-8,Sunnyside Cotts. 4 24/6/13 Orchard Cottage 1 28/10/13 ... 24/3/14 31/12/14 6a, Bridge Road 1 61-7, Castle Place 7 1914— 1-3, Poplar Cottages 3 24/2/14 ... 22/12/14 c299-311, Staines Rd. 7 28/4/14 42, Derby Road 1 28/4/14 ... 27/10/14 d40, 44, Derby Road 2 Wild's Rents 1 26/5/14 ... 22/12/14 13, 14, Town Wharf 2 26/5/14 ... 22/12/14 17, Town Wharf 1 26/5/14 ... 22/12/14 10-16, Church Street 4 21 15 8 a—Appeal lodged against Demolition Order 10-11-13. Inquiry held 17-3-14. b—Nos. 2, 3, 6 and 7, dealt with under Section 15. c—Consideration of Closing Orders postponed 9-3-14. Appeal lodged against Closing Orders 18-5-14, subsequently withdrawn. d—Consideration of Closing Orders postponed 6-4-14. 24 Twenty-two houses were erected by the Council in 1902 under Part III. of the Housing of the Working Classes Act, 1890. I am informed by the Surveyor that 14 houses suitable for the working classes were erected during the year. Towards the end of last year, when the London General Omnibus Garage was opened, a sudden influx of well-paid artisans took place into the district, with the result that a somewhat acute state of affairs arose in connection with housing accommodation. The matter was brought before the Council and was considered by the General Purposes Committee. Finally it was resolved to inform the Local Government Board that having regard to the large proportion of houses of the working class type already existing in the district, and to the number of persons of the working class employed in the district, the Council did not think that any additional workmen's dwellings were required. It appears to me that there is a shortage of small houses suitable for the lower paid workers. I have arrived at this conclusion on three grounds, namely— 1. From the tendency to raise the rents of small houses. 2. From the small number of empty houses. 3. From the large proportion of small houses allowed to fall into bad repair. In order to furnish certain information required by the Local Government Board, I deemed it advisable to have a census taken of all the vacant houses in the District. This was carried out on March 25th last by the Inspectors, each commencing at 7 a.m. and completing the census on that day. The following is a summary of the information collected, viz. (a). Total number of vacant premises 255 Houses 198 Houses and Shop 43 Flats 14 25 (b). Accommodation. No. of rooms (excluding shop or scullery): No. of houses with 2 rooms 13 „ „ 3 „ 20 „ „ 4 „ 51 „ „ 5 „ 42 „ „ 6 „ 49 „ „ 7 „ 31 „ „ 8 rooms or over 49 (c). Rental. No. of houses at 4/- per week (or less) 11 4/6 „ 4 „ 5/- „ 15 .. 5/6 „ 17 6/- „ 6 6/6 „ 12 „ „ 7/- „ 5 „ „ 7/6 „ 6 „ „ 8/- „ 3 „ „ 8/6 „ 2 „ „ 9/- „7 „ „ 9/6 „ 8 „ „ 10/- „ 8 „ „ 10/6 „ 5 „ „ 11/- or over per week 143 (d). No. of vacant houses included in the above not reasonably fit 29 No. of such houses at 2/6 per week 1 „ „ 3/- 2 „ „3/6 „ 1 „ „ 4/- „ 4 „ „ 5/- „ 2 „ „ 5/6 „ 9 „ „ 6/6 „ 3 „ „ 10/6 „ 3 „ „ 11/- or over 4 (e). No. of vacant houses not including (d) on the Housing List 18 26 (/). No. of houses in course of erection:— With 4 rooms or under 0 „ 5 „ only 7 „ 6 „ „ 8 „ 7 „ „ 12 „ 8 rooms or over 0 Whether private enterprise is sufficient to supply the shortage of houses to let at weekly rents under 6/- is a matter for consideration. In the absence of private enterprise, and although it appears to me to be an economically unsound principle to provide houses subsidised by the rates, yet so long as wages are paid which do not allow of rent sufficient to secure to the worker a habitable dwelling, so long will it be necessary for the Local Authority to adopt palliatory measures and provide the houses required. FACTORY & WORKSHOP ACT, 1901. 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 Assistants, and a statement of the number of inspections made and defects noted is to be found in Tables V., VI., VII., VIII. and IX., as required by the Home Office. 27 The names and addresses of 39 home-workers were forwarded during the year by employers or Councils to the Medical Officer of Health, as required by the Act. One of these 39 home-workers resided outside the district. The premises of the home-workers residing in the district have been visited. No case of infectious disease was reported on the premises of out-workers during the year. SANITARY ADMINISTRATION. Staff. There are four inspectors on the active staff of the Health Department— the Inspector of Nuisances and three other Sanitary Inspectors. Each Inspector has allotted to him one of the four districts in which the Urban District has been divided. Two of the Inspectors are further appointed Inspectors under the Canal Boats Acts. Each Inspector is appointed an Inspector under the Housing Acts and as Inspectors for the purposes of the Local Authority under the Factory and Workshops Acts, and Dairies, Cowsheds, and Milkshops Regulations, 1900. In addition to these the Sanitary Inspectors are appointed Inspectors for the purposes of:— (1) Towns Improvements Clauses Act, 1875 (Sec. 131). (2) The Sale of Horse-flesh Regulation Act, 1889. (3) Shops Acts, 1912-13. (4) Petroleum Acts. Two Health Visitors, who are also engaged part time in School Inspection work, are appointed for the work in connection with the Notification of Births Act, 1908. Certain other health work is carried out by these officers, such as the work arising out of the " Tuberculosis Order," enquiries in connection with certain cases of infectious diseases, notifiable and non-notifiable. The Clerical Staff consists of 4 clerks and an office boy, who also carry out the clerical work in connection with the Medical Inspection of School Children. 28 Towards the end of the year, the Chief Clerk, Mr. H. A. Passey, was appointed to a similar position in the Borough of Finsbury, after a long service under this Authority. Mr. Passey's position was filled by the appointment of Mr. J. Henry Lloyd, previously in the Public Health Department of the Battersea Borough Council. The following members of the Staff have joined the Military Forces:—Mr. W. E. Balchin, Sanitary Inspector, who is in the 2nd London Sanitary Company, Royal Army Medical Corps; Mr. A. G. Hubbard, who is in the Middlesex Yeomanry; Mr. F. G. Boto, who is also in the Royal Army Medical Corps. It has not yet been possible to find a temporary Inspector to fill Mr. Balchin's place, but two girls have been engaged as temporary clerks. Adoptive Acts in force in District: * Infectious Diseases (Prevention) Act, 1890. * Public Health Acts Amendment Act, 1900, 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). 29 *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). *Fish Frying (P.H.A. 1875, s. 113). 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 unstarred are administered by other Committees of the Council. 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 (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 230 of the 312 cases notified were removed to Hospital. Of these 230, 21 were admitted to the Infirmary, 6 entered Metropolitan Asylums Board's Hospitals and 2 the London Fever Hospital, leaving 201 chargeable to the District Rate at Mogden Hospital. 30 COUNCIL LABORATORY. The following table gives a statement of the work in the Laboratory during the year 1914:— Diagnosis of Disease. Result. Total. Positive. Negative. Diphtheria 68 224 292 Tuberculosis 15 44 59 Typhoid Fever 1 3 4 Ringworm 18 5 23 Total 102 276 378 Sundry Examinations. Chemical Examinations of Water Samples 6 There has been a steady increase in the number of bacteriological examinations made in the laboratory since it was opened on the 14th April, 1910, as shown in the following table:— 1910 (8½ months) 49 1911 79 1912 134 1913 173 During the year under report, however, the number of specimens examined jumped to twice that for 1913 and is practically equal to the number dealt with in the whole of the previous three years. The time of the Medical Officer of Health taken up by this work is therefore becoming an important consideration. 31 PREVALENCE OF AND CONTROL OYER ACUTE INFECTIOUS DISEASES. (a). Notifiable Diseases. Table II. at the end of the report shews the various infectious diseases notified daring the year, and the incidence of these 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 1901:— Table shewing the total number of notifications received annually under the Infectious Disease (Notification) Act, 1889, since 1901. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Total. 1901 104 40 11 21 4 180 1902 112 85 10 20 ... 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 1912 98 25 3 ' 32 4 162 1913 106 53 3 24 6 192 1914 135 112 14 40 11 312 32 DEATHS FROM INFECTIOUS DISEASE. The following table gives the number of deaths from certain infectious diseases in each year since 1901:— Table shewing deaths from infectious diseases occurring annually since 1901 :— Scarlet Fever. Diphtheria, Typhoid Fever. Measles. Whooping Cough. 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 1912 ... 4 ... 1 4 1913 ... 3 1 38 9 1914 1 9 1 ... 2 Total 14 87 8 130 124 The number of notifications received of cases occurring in or removed into Public Institutions in the district was 41, as is shewn in the subjoined table 33 Table showing the number of cases of infectious diseases notified during the year 1914 from Public Institutions in the district. PUBLIC INSTITUTION. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Puerperal Fever. Total. Poor Law Institutions:— Union Infirmary 6 5 2 14 5 32 Borough Rd. College, Spring Grove 1 ... ... ... ... 1 Gordon House School,St. Margaret's 2 ... ... ... ... 2 Mogden Hospital 3 ... ... ... ... 3 St. Mary's Orphanage 3 ... ... ... ... 3 Total 15 5 3 14 5 41 The following table gives the number of ease of infectious diseases other than institution cases occurring each year since 1908 : 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 61 22 9 15 2 112 1912 90 21 1 22 1 135 1913 103 43 1 14 2 163 1914 120 107 12 26 6 271 34 SCARLET FEYER. The following table shews the number of cases which have been notified during each of the years since 1901, 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 1901. Year. No. of cases notified. No. of cases removed to Hospital. Percentage of cases removed to Hospital. 1901 104 77 74.03 1902 112 79 70.53 1903 143 97 67.83 1904 65 49 75.38 1905 85 77 90.58 1906 69 55 79.71 1907 80 73 91.25 1908 98 71 72.44 1909 130 100 76.92 1910 81 60 74.07 1911 75 62 82.66 1912 98 78 79.59 1913 106 80 75.47 1914 135 110 81.48 Total 1381 1068 77-33 The incidence rate of Scarlet Fever in the population was 2.8 per 1,000, as compared with 2.4 last year. 35 The number of households affected with Scarlet Fever was 95. Fifteen cases occurred in public institutions in the district. The following statement shews the occurrence of secondary and return cases in those hospital and home-treated respectively:— Number of Hospital-treated cases 110 (a). Giving rise to secondary cases 15 (b). Number of secondary cases 22 (c). Not giving rise to secondary cases 95 (d). Number giving rise to return cases 3 (e). Number of return cases 3 Number of Home-treated cases 25 (a). Giving rise to secondary cases 3 (b). Number of secondary cases 3 (c). Not giving rise to secondary cases 22 (d). Giving rise to return cases 0 (e). Number of return cases 0 The prevalence of the disease was greatest in February and during September and October. The disease continues to be of a mild type, only one death having taken place from this cause during the year. DIPHTHERIA. The following table shews the number of notifications received, and the percentage of cases of Diphtheria removed to Hospital during the past 14 years:— 36 Table shewing cases of Diphtheria notified and removed and percentage removed to Hospital each year since 1901. Year. No. of cases notified. No. of cases removed to Hospital. Percentage of cases removed to Hospital. 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 1912 25 20 80.00 1913 53 30 56.60 1914 112 85 75.89 Total 808 547 67.69 The incidence rate per 1,000 of the population was 2.31, as against 1.18 for last year. Five cases occurred in public institutions during the year. Fourteen secondary cases occurred in the same households as the primary cases. In five of these households there was a third case; and in three of them a fourth case. One carrier case (i.e. a case which though not actually suffering from the disease is capable of conveying the infection to others) was kept under observation. 37 Nine deaths took place from this cause, i.e., a case mortality rate of 8.0 per cent. Antitoxin. The Council's arrangements for providing antitoxin were the same as in previous years. A supply of this Serum is always maintained at the Health Department, and is supplied free of charge to the poorer inhabitants of the district. During 1914 in 45 instances antitoxin has been supplied to medical practitioners, and in 24 cases the Council have paid the charges. TYPHOID FEVER. The following table shews the cases notified and the percentage removed to Hospital each year since 1901:— Table shewing cases of Typhoid Fever notified and removed and percentage removed to Hospital each year since 1901. Tear. No. of cases notified. No. of cases removed to Hospital. Percentage of cases removed to Hospital. 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 1912 3 2 66.66 1913 3 1 33.33 1914 14 14 100.00 Total 126 64 50.79 38 Two of these cases occurred at the Union Infirmary and all were removed to hospital. Only one case proved fatal. ERYSIPELAS. Forty cases of this disease were notified, of whom 14 were institution cases. Four cases (among non-residents in institutions in the district) proved fatal. PREVALENCE OF AND CONTROL OYER TUBERCULOSIS. Pulmonary Tuberculosis. The number of cases notified during the year was 111, the age and ward distribution being set out in Table II. at the end of the report. The ratios of notifications to deaths were as follows:— Deaths. Notifications. Notifications per 100 deaths. Males 26 64 246 Females 22 47 213 During the year investigation was made, as required by the Tuberculosis Regulations, into the cases notified and re-visits were made into cases notified in previous years. The following statement shews the incidence of the total cases known in the various wards at the end of the year Heston Ward. Hounslow N. Ward. Hounslow S. Ward. Isleworth N. Ward. Isleworth S. Ward. Heston and Isleworth U.D Population 6887 10338 13534 9539 7249 47547 Number of Cases 25 26 49 40 21 161 Incidence Rate per 1000 3.6 2.5 3.6 4.2 2.9 3.4 This table demonstrates that while the case incidence over the whole district was 3.4 per 1000 of the population, this incidence 39 rate is exceeded in Heston, Isleworth North and Hounslow South Wards. It is probable, also, that the greater proportion of insanitary houses are in these districts. The following table gives the age and sex distribution of the cases which have been notified during the time this disease has been notifiable, and who were still alive at the end of the year and in respect of whom information is available. Age. 0-1 year. 1-5 years. 5—15 years. 15—25 years. 25-35 years. 35—45 years. 45—55 years. 55—65 years. 65— years. Total. Male ... I 25 18 18 18 1O 3 2 95 Female ... ... 13 19 12 II 6 4 I 66 ... 1 38 37 30 29 16 7 3 161 In 79 instances it is known that the patients are expectorating in greater or less quantity, i.e. these are cases which are more dangerous to the Public Health than consumptives who have no expectoration. It is, however, a comparatively easily controllable infection, by using reasonable precautions in collecting and disposing of their sputum. The following statement shews how the patients were disposing of the sputum when the investigation was made:— No precautions adopted 9 Sputum emptied into drain 13 Disinfectant used 7 Paper or rag used and burnt 38 Using sputum bottle 12 In 112 instances where more or less reliable information could be obtained, the duration of the disease was as follows:— In 4 cases the date of onset was less than 6 months ago. In 17 „ „ „ between 6 mths. & 1 year. In 22 „ „ „ „ 1 year & 2 years. In 24 „ ,, „ „ 2 years & 3 years. In 13 „ „ „ 3 „ & 5 „ In 32 „ „ „ over 5 years. 40 Occupations. In 142 cases the information as to occupation is available and is set out hereunder:— Domestic Workers 24 Outdoor Workers 27 School 34 Shop 4 Factory and Workshop 17 Clerical and Sedentary Work 9 Other Occupation 13 None 14 Source of Infection. Among the cases investigated, it was possible to find a definite history of a more or less intimate association with a previous consumptive person in 64 instances. The probable sources of infection in these cases were as follows: — From Husband in 2 cases. „ Wife in 2 cases. „ Mother in 13 cases. „ Father in 7 cases. „ Sister in 9 cases. „ Brother in 6 cases. ,, Other Relatives in 22 cases. „ Fellow Worker in 3 cases. Size of House. In 120 instances the cases were distributed in houses as under:— No. of Houses. of 2 rooms. of 3rooma. of 1 rooms. of 5 rooms. of 6 rooms. of 7 rooms. of 8 rooms & over. No. of Cases 5 4 16 29 42 12 12 Census population 1317 2715 8857 11496 7417 2717 3622 Incidence per 1ooo 3.79 1.47 1.81 2.52 5.66 4.42 3.31 41 Insured Persons. Out of the cases investigated there were 73 who were known or presumed to be insured persons. I have, however, no information as to the number for whom treatment was provided by the Insurance Committee. Sleeping Accommodation. Among 104 cases for whom information was available, the number who had a separate bed-room was 36, and the number who had only a separate bed was 25; in 43 instances the persons were sharing a bed with another. Mortality. The deaths from this cause per 1000 of the population was 0.99. The average age at death among the 20 cases which died in institutions was:— Males 41 years. Females 35 „ Among the 28 cases dying at home, the average age at death was:— Males 40 years. Females 33 years. Treatment. Out of the 161 cases belonging to the district, the following are known to have received or to be receiving medical treatment:— At Sanatoria 17 At Hospital 49* At Home 36 Of these persons, 12, 15 and 19, respectively, are believed to be insured. * Including both In-Patients and Out-Patients. No information is available up to the present as to the numbers who received treatment under the scheme of the County Council. I am, however, sanguine as to the help this scheme will afford us in the prevention of Tuberculosis. Each case of Pulmonary Tuberculosis treated is a valuable preventive step, as 42 thereby a cessation or minimising of the amount of sputum and ipse facto of the infection is brought about. But it is important that some immediate steps should be taken for the segregation of certain cases who are not fit to look after themselves, and who have no proper accommodation at home and who are not curable. Examination of Contacts. During the year the school children who are known to have been contacts have all been scheduled for examination by the School Medical Officer, and persons over school age who are sub-normal in health have been recommended to see their own doctor. Disinfection and Cleansing. The importance of this procedure in Tuberculosis is twofold, it serves either— (a) to prevent infection of others, or (b) to prevent re-infection of cases after treatment. Disinfection, etc., is carried out in all cases (1) where a fatal termination takes place, (2) where the infected person vacates a room, (3) where a case is removed to an institution, and (4) otherwise where necessary during the course of the disease. Other forms of Tuberculosis. Notifications. The number of cases notified during the year was 27, the age and ward distribution of these being shewn in Table II. at the end of the report. Mortality. The localisation of the disease in the nine fatal cases during the year is shown as under:— 2 Tuberculosis of Mesenteric Glands. 4 „ „ Intestines. 1 „ „ Peritoneum. 1 „ „ Hip. 1 Tuberculous Adenitis. 9 43 The ratio of notifications to deaths was as follows:— Deaths. Notifications. Notifications per 100 deaths. Males 4 14 350 Females 5 17 340 Cases known. The cases known to exist in the district at the end of the year are shewn in the following tables:— Sex. 0—1 1—6 5—15 15 -25 25—35 85—45 45—55 55-65 65- Total. Male ... 3 9 5 ... 2 ... .. 1 20 Female 2 3 8 5 2 1 1 ... ... 22 42 The localisation of the disease in these 42 cases was as follows:— Joint Tuberculosis— Knee 2 Hip 4 — 6 Gland Tuberculosis— Neck 9 Mesenteric and other 4 — 13 Spinal Tuberculosis 5 Abdomen 13 Skin Tuberculosis 2 Other 3 INVESTIGATION OF OTHER DISEASES. 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:— 44 Number of deaths from Cancer during— 1900 29 Average for 5 years 27.8 1901 19 1902 31 1903 24 1904 36 1905 16 Average for 5 years 33.4 1906 43 1907 38 1908 30 1909 37 1910 31 Average for 5 years 43.4 1911 36 1912 41 1913 54 1914 55 It is noteworthy that this year again the figure has increased ; the number of deaths this year from this cause is more than equal to the number of deaths during the two years 1900 and 1901. This continually increasing figure is a matter of importance. Venereal Diseases. Two infant deaths have been registered as having occurred from these diseases, while there were four deaths occurring in Lunatic Asylums from the after effects of Syphilis. I do not think that these were the only deaths resultiug from this cause, as there is a great difficulty under the present law for death registration whereby the death certificate is to be handed by the family doctor to the nearest relative. It will be apparent that the result of plainly stating the cause of death in these cases would result in further misery to the stricken family. I believe that if it were the duty of the medical man to send death certificates direct to the registrar, a much more accurate certification of the cause of death would result. It would be of value in dealing with these diseases if the Council were to provide facilities for the bacteriological diagnosis 45 in Syphilis and Gonorrhoea, as thereby an early and accurate diagnosis could be made and a valuable index as to the value of treatment provided. In this connection it may be of interest to quote from the Annual Report of the Medical Officer to the Local Government Board for 1914-15:— "The venereal diseases requiring serious consideration are Gonorrhoea and Syphilis. The first-named is the less important of the two, although it is a frequent cause of chronic suffering and sterility in women, as well as the chief source of blindness occurring as the result of Ophthalmia of the new-born. For preventing the serious consequences of this last-named disease much active work, happily, is already being done by Sanitary Authorities The serious extent to which Syphilis affects the national health is not generally realised. It is an important cause of arterial degeneration and of Heart Disease; the chief if not the only cause of locomotor ataxy and general paralysis of the insane, as well as of various forms of skin and bone diseases. The virus of Syphilis can be and commonly is transmitted from the parent to the foetus in utero. The immediate result often is abortion or miscarriage. All the evidence available indicates that complete notification of still-births followed up by medical enquiry would lead to the discovery of a large amount of hitherto undetected Syphilis, and would thus enable a large mass of disease to be treated, and its transmission prevented. Apart from still-births, Syphilis is a frequent cause of premature birth and of the 'Marasmus' and 'Atrophy' which bulk largely in the causes of mortality in the first month after birth. As shewn in a recent report to the Board (Cd. 6909), the death-rate in the first and to a less extent in the next two months of infancy has yielded to improved conditions much less than the death-rate in the later mbnths. Evidence is accumulating to shew that an important share of this early infant mortality, as well as of 46 still-births, will be avoided when systematic measures are taken for the recognition and treatment of Syphilis in expectant mothers. Inherited Syphilis in later years may cause blindness, deafness, and various bone, skin, and visceral lesions in the infected child In his report, Dr. Johnstone emphasises the practical point that Syphilis is spread less by habitual or professional prostitutes, than by women who are only occasional prostitutes and by men 'who have neglected to secure competent advice or to observe it when given.' Hence it is impracticable to attempt to repress this disease by restrictive measures of the type of the former Contagious Diseases Acts. We must look to other means of control applicable with a fair degree of equality to all concerned, of both sexes. The possibility of securing these has been greatly increased by the discovery of the causal micro-organism, the elaboration of the Wassermann test for presence of the disease, and the use of salvarsan for the rapid removal of infectivity by removing the symptoms of the disease. In view of the invaluable aid in the prompt recognition and treatment of Syphilis at all its stages rendered available by these means, it is of primary importance, in the public interest, that facilities for gratuitous Wassermann and allied tests should be made available throughout England and Wales." DEATHS. The number of deaths registered in the district was 864, but 385 of these did not belong to this district, while 65 residents died without the district. Thus the actual number of deaths properly attributable to the district was 544, which gives the death-rate for the district of 11.43 per 1,000 of the population. The death-rate for the district, when corrected for the age and sex constitution of the population, is 10 75 per 1,000, and this is comparable with the following figures: 13.7 for England and Wales 47 and for London 14 4 per 1,000. This death-rate shews a slight decrease below that of last year, and is lower than the average of the 145 smaller towns, which is 13.1 per 1,000. The following table gives information with respect to nonresident deaths and where they occurred:— Non-residents Deaths in Public Institutions. (a). Districts to which such deaths belonged:— District. No. of Deaths. Acton 107 Chiswick 71 Brentford 54 Ealing 45 Twickenham 60 Hanwell 19 Greenford 2 Southall 2 Feltham 4 Longford 1 Colnbrook 1 Willesden 2 New Southgate 1 Hammersmith 3 Barnes 1 Richmond 2 Fulham 1 Woolwich 1 Hackney 1 Portsmouth 1 Islington 1 Bethnal Green 1 Paddington 1 Other 3 385 48 (b) Institutions in which the above deaths occurred :— Institutions. No. of Deaths. Union Infirmary, Isle worth „ Workhouse „ 364 Tuberculosis Dispensary 4 Mogden Hospital 3 Hounslow „ 5 Wyke House 1 Military Hospital 1 378 Elsewhere in district 7 385 BIRTHS. The total number of births registered during the year was 1,039, but 47 of these do not belong to this district, while 9 births properly belonging to this district occurred outside the district. The following table shews the births and birth.rates attributable to residents in this district since 1907:— Year. Nett Births. Nett Birth Rates. 1907 1,085 28.95 1908 1,169 2910 1909 1,129 27.34 1910 1,050 2501 1911 10,18 23.94 1912 1,017 23.09 1913 1,095 24.01 1914 1,001 21,05 The birth.rate of England and Wales is 23.8 per 1,000. This low and falling birth.rate is especially serious if we bear in mind the fact that the Infant Mortality Rate is nearly 100 per 1,000 births. Illegitimacy. 49 The following table shews the facts with regard to illegitimate births:— Resident Births. Heston. Isleworth. legitimate. illegitimate. legitimate. illegitimate. 313 13 642 33 Non-resident Births (all occurring in Isleworth). legitimate. illegitimate. 12 35 MEANS FOR PREVENTING MORTALITY IN CHILD-BIRTH AND IN INFANCY. The accompanying table shews the work done under the Notification of Births Act, 1907, during the year 1914:— 50 Heston Ward. Hounslow North Ward. Hounslow South Ward. Isleworth North Ward. Isleworth South Werd. Heston and Isleworth Urban District. Births notified 96 185 302 143 113 839 Births visited 65 161 269 132 119 746 Feeding—Natual 60 141 237 122 110 670 Artificial 5 12 20 8 6 51 Both ... 6 8 1 3 18 None ... 2 4 1 ... 7 Still Births 4 2 7 2 3 18 Sleeping with parents 46 116 192 94 64 512 Using comforter 24 76 128 40 39 307 Mother working during pregnancy 8 16 44 17 11 96 Births unnotified 16 18 22 32 49 137 Births unvisited 47 42 55 43 43 230 Births revisited 58 103 164 143 95 560 The percentage of the births notified under this Act during 1914 was 83, an increase over the figures 80 for 1913 and 70 for 1912. The percentage of children (89) who are receiving mother's milk shews a slight increase over that of last year, 87. The number of Still Births notified this year is 18; it is noteworthy that this is the only reliable figure which is available as to the number of Still Births in the district. It is a matter which requires further investigation that one child in 46 born is still-born. It is extremely likely that the causes operating to produce Still Births are of the same nature as those which produce 51 deaths in infants from premature causes. These causes, to my mind, while not capable of removal entirely, are in certain cases removable. The question of the employment of women during pregnancy has an important bearing on this question, and is largely an economic question, the solution of which does not rest in the hands of the Local Authority. There certainly has been a reduction this year in the number so employed, 13 per cent. as compared with 15 per cent. last year. It is to be hoped that there will be a still further reduction as a result of a wise administration of maternity benefit under the National Insurance Act. I am pleased to say that the use of the comforter is gradually diminishing. Also the practice of infants sleeping with their parents. For this latter practice little excuse can be found, because it is very easy and inexpensive to improvise a crib for the child. Two deaths were recorded from overlying as a result of this practice during the year. During the year, re-visits were paid by the Health Visitors. The number of infants re-visited was 545; these were visited as early as possible after an interval of three months. The number who were being fed naturally at the first visit was 487, which had diminished to 322 after an interval of three months. Nine infants were receiving artificial feeding in addition to mother's milk on the first visit, while on the second visit. 44 infants were found to be so fed. Forty-nine infants were being fed wholly artificially on the first visit, but this number had increased to 126 on the second visit. In 53 cases the family had either removed or no information could be obtained when the second visit was made. It was of course anticipated that a certain reduction in the percentage of children being fed naturally would be found on re-visiting after a certain interval, because there are certain circumstances which make it necessary to supplement or supplant natural feeding. That there should be a reduction of 33 per cent. is to be regretted, because of greater mortality among those infants who are receiving artificial feeding. 52 Ee.visits : Notified Births. Feeding Natural. Artificial. Both. Using Dummy. Sleeping with Parents. In charge of Mother. Removed or no information. 1st visit 487 49 9 223 371 433 . 2nd „ 322 126 44 209 278 . 53 Infant Deaths. The total number of Infant deaths during 1914 was 98, giving an Infant Mortality rate of 979 per 1,000 births. This figure is less than that of 1913, which was 100.76 per 1,000 births. The figure for this year is lower than the rate for England and Wales for the same period (105), or 104, the rate for London. The Infant Mortality rate, as seen in the table on page 53 (Vital Statistics), varies from 28.8 in Heston Ward, which is the lowest, to 136 in Isleworth North Ward, where the rate is highest. The steady reduction of the Infant Death Rate in the district during the three last Quinquennia is shewn by the following figures:— Quinquennial average. 1899 154.6 145.2 1900 156.2 1901 160.1 1902 156.6 1903 98.5 1904 169.3 128.2 1905 136.8 1906 134.9 1907 88.1 1908 112.2 1909 91.2 107.9 1910 100.0 1911 162.01 1912 85.5 1913 100.7 1914 97.9 53 The following table gives the result of investigations made into 68 of the infant deaths:— The largest number of Infant deaths (17) occurred during September, when the incidence of Diarrhœal diseases was greatest and the smallest number (5) during May and June. Disease. Number of Deaths. Natural Feeding. Artificial Feeding. Nurse Child. Poor Home. Previous death from same cause in family. Mother working during Pregnancy. Tube-bottle used. Unvisited. Bronchial Diseases 17 5 10 ... 4 6 l ... 2 Diarrhoea, Malnutrition, etc. 16 ... 15 l 2 5 3 ... 1 Prematurity, etc. 17 2 1 ... .. ... ... ... 8 Whooping Cough 1 ... ... ... ... ... ... ... 1 Convulsions 2 1 1 ... ... ... ... ... ... Tubercular Enteritis 1 ... ... ... ... ... ... ... 1 Suffocation 2 2 ... ... 1 ... 1 ... ... Other Causes 12 4 4 ... ... ... 3 ... 2 Total 68 14 31 1 7 11 8 ... 15 The largest number of Infant deaths were those arising from Premature Causes, as was the case last year. It is probable that one of the causes, already referred to, which operates to produce this result is capable of mitigation. The most readily preventable of these causes of death is that from Diarrbœal and Nutritional diseases, and from this table it 54 will be seen that in the 15 cases enquired into, all were being fed artifically. This fact, when considered with the information given in a previous table that 487 children were being fed naturally at the first visit, and the information derived from a second visit that there was a reduction in the number so fed of 33 per cent., means that out of 322 cases where natural feeding was persisted in, there was a death-rate from these diseases of 3 per 1,000, as against a death-rate from the same cause of 119 per 1,000 among bottle-fed babies. From these facts it will be apparent that the first principle to be followed in combating Infant Mortality is the encouragement of natural feeding, the second guiding principle is the better education of mothers in the choice and use of substitutes for mother's milk, because even the best of artificial foods are only imitations. The next largest number of deaths from one cause was from Bronchitis and Pneumonia. These diseases when they occur are specially fatal to infants, and are always prevalent during the colder months of the year, and more especially when Measles is prevalent. In Hounslow North Ward the Ellis Creche is provided and maintained by voluntary effort for the care of children whose mothers require to go out to work during the day. In the Isleworth Wards, where there is. much female labour employed, such an Institution would be of great benefit, as meantime many infants are either left in the hands of a neighbour who has her own duties to carry out, or are left in charge of children, themselves of tender years. In the Isleworth parish, certain help is given by voluntary agency, a Maternity Society connected with the Church, in loaning poor expectant mothers with a box containing requirements necessary at these times. 55 Ophthalmia Neonatorum. In this district 14 children were notified as suffering from this disease, 7 of the cases occurring at the Infirmary. This is equal to a case rate of 13 4 per 1,000 births occurring in the district, but it will be noted that half the cases occurred at the Infirmary, many of them probably coming from addresses outside the district. I know of no other disease where true appreciation of the principles of preventive medicine when carried into effect are attended with such marked results, and there is no disease when it does occur which requires such thorough and continuous treatment to bring about a cure. 56 VITAL STATISTICS for 1914, in Wards. Heston. Houn. slow North. Houn. slow South. Isleworth North. Isleworth South. Whole District. Population 6887 10338 13534 9539 7249 47547 Total Births 104 222 324 191 160 1001 Birth Bate 5M 21.4 23.9 20.0 221 2105 Totals Deaths 66 93 166 141 78 544 Death Rate 9.5 8.9 12.2 14.8 10.7 11.4 Total Infant Deaths 3 16 41 26 12 98 Infant Death Bate 28.8 72.1 126.5 1361 750 97.9 Illegitimate Births 4 9 16 11 6 46 Illegitimate Infant Deaths ... 4 6 5 1 16 Illegitimate Infant Death Bate ... 444 375 454 166 347 Deaths registered from — Enteric Fever ... ... ... ... 1 1 Smallpox ... ... ... ... ... ... Measles ... ... ... ... ... ... Scarlet Fever ... ... ... 1 ... 1 Whooping Cough ... 1 ... 1 ... 2 Diphtheria & Croup 3 1 2 1 2 9 Influenza ... ... 2 1 2 5 Pulmonary Tuberculosis 6 7 13 17 5 48 Cancer 7 14 17 12 5 55 Diarrhoea, Enteritis ... 4 10 8 3 25 Congenital Debility, Malformations, Premature Birth, etc. 3 8 11 9 4 35 57 Notes to above Table. Population.—This is a net population obtained by deducting from the gro&s population, estimated to the middle of the year, the average number of inmates not belonging to the district in public institutions. Total Births.—Births occurring in but not belonging to the district have been excluded. Birth Rate.—This is calculated per 1,000 of the population per annum. Total Deaths.—Deaths occurring in but not belonging to the district have been excluded. Death Rate.—This is calculated per 1,000 of the population per annum. Infant Deaths.—These are Deaths of Infants under one year belonging to the district. Infant Mortality Rate.—This is calculated per 1,000 births. ADMINISTRATION OF THE SHOPS ACT. For the purposes of this Act each Sanitary Inspector is also appointed and has carried out the duties of an Inspector under the Shops Act. The number and character of the shops on the register prepared for the purposes of this Act is set out in the appendix to this report. The number of contraventions of the Acts which were reported during the year was as follows:— Open on half-holiday 1 Notices not exhibited 16 Notices not exhibited in a conspicuous position - Notices not in prescribed form - Notices (assistants) not exhibited 7 24 No legal proceedings were taken. 58 APPENDIX. Page Vital Statistics:— Table I.—Vital Statistics for Whole District 59 Table II.—Cases of Infectious Disease 61 Table III.—Causes of and Ages at Death 63 Table IV.—Infantile Mortality 64 Factory and Workshop Act, 1901:— Table V.—Inspection of Factories, Workshops and Workplaces 65 Table VI.—Defects found in Factories,Workshops and Workplaces 65 Table VII.—Homework 66 Table VIII.—Registered Workshops 67 Table IX.—Other Matters 67 Sanitary Work:— Table X. 68 Shops Act:— Table shewing the number and character of the shops on the Register 73 Canal Boats:— Annual Report, 1914 76 59 Note.—In recording the facts for the year 1914, under the various headings of the following Tables I., 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 1914 and previous years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the Transferable Deaths.‡ Nett Deaths belonging to the District. Uncorrected Number. Nett. District. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 year of age. At all Ages. N umber, † Rate. * Number, † Rate per 1,000 Nett Births. N umber, † Rate. * Number. Kate. * 1 2 3 4 5 6 7 8 9 10 11 12 13 1907 38,547 1135 1085 28.95 741 19.22 279 28 100 92.2 490 13.08 1908 41,272 1211 1169 2910 801 19.41 269 30 130 111.2 562 13 99 1909 42,414 1182 1129 27.34 810 29.10 292 27 103 91.2 545 13.20 1910 43,120 1117 1050 25.01 738 1711 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 1912 45,191 1087 1017 23.09 786 17.38 312 29 87 85.55 474 10.76 1913 46,749 1141 1095 24.01 807 17.57 324 53 117 100.76 536 11.73 1914 48.361 1039 1001 21.05 864 17.86 385 65 98 97.90 544 11.43 60 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 1914. Union Workhouse 263 „ Infirmary 283 „ School 207 Mogden Isolation Hospital 10 Wyke House Private Lunatic Asylum 32 Gunnersbury House 19 Spring Grove House ... Total 814 †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 subtraction 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 (b) 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 110 fixed residence at the time of admission, the death is not transferable. If the patient has been 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; (b) 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 occurred, if known; (d) failing this, to the district where the body was found. Total population at all ages, 43,316. Number of inhabited houses, 8,006. Average number of persons per house, 5.4 At Census of 1911. Area of District in acres (exclusive of area covered by water) 6,893.631. 61 Table II. Cases of Infectious Disease notified during the Year 1914. Notifiable Disease. Number of Casks Notififed. 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 HoudsIow 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 (c) Plague (p) Diphtheria (including Membranous croup) 112 ... 29 65 10 8 ... ... 23 9 35 37 8 22 8 22 28 5 85 Erysipelas 40 1 ... 1 1 19 9 9 3 5 8 22 2 1 1 ... 13 ... 15 Scarlet Fever 135 ... 26 97 8 4 ... ... 18 16 44 32 25 17 13 29 28 23 110 Typhus Fever Enteric Fever 14 ... 2 7 2 2 ... 1 1 3 5 1 4 1 3 5 1 4 14 Relapsing Fever Continued Fever Puerperal Fever 11 ... ... ... ... 11 ... ... ... ... 4 5 2 ... ... ... 4 2 6 Cerebro-spinal Meningitis Poliomyelitis... . Ophthalmia Neonatorum 14 14 ... ... ... ... ... ... ... 2 4 5 3 ... ... 1 5 3 9 Pulmonary Tuberculosis 11 ... ... 19 24 45 19 4 16 23 30 27 15 Other forms of Tuberculosis 27 2 2 14 5 3 1 ... 3 5 8 8 3 Totals 464 17 59 203 50 92 29 14 64 63 138 137 62 41 25 57 79 37 239 62 NOTES FOR TABLE 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 beds for this district, 5. Number of diseases that can be concurrently treated, 1. 63 table III. Causes of, and Ages at Death during 1914. 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 under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified 543 98 15 17 20 24 81 99 189 507 Uncertified 1 ... ... ... ... 1 ... ... ... ... Enteric Fever 1 ... ... ... ... 1 ... ... ... 2 Smallpox Measles Scarlet Fever 1 ... ... ... 1 ... ... ... ... 4 Whooping-cough 2 2 ... ... ... ... ... ... ... ... Diphtheria and Croup 9 ... 2 5 2 ... ... ... ... 9 Influenza 5 1 ... ... ... 1 1 1 1 ... Erysipelas ... ... ... ... ... ... ... ... ... 4 Phthisis (Pulmonary Tuberculosis) 48 ... ... ... 1 8 26 11 2 60 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... 2 Other tuberculous diseases 9 3 ... 1 3 ... 2 ... ... 4 Cancer, malignant disease 55 ... ... 2 ... 1 5 22 25 43 Rheumatic Fever 2 ... ... 1 ... 1 ... ... ... 1 Meningitis 6 2 1 ... ... 2 1 ... ... 3 Organic Heart Disease 38 ... ... 1 2 ... 3 10 22 55 Bronchitis 42 8 ... 1 ... ... ... 7 26 59 Pneumonia (all forms) 49 9 6 2 1 2 9 5 15 17 Other diseases of Respiratory Organs 9 ... ... ... 1 1 3 ... 4 3 Diarrhoea and Enteritis 25 23 2 ... ... ... ... ... ... 17 Appendicitis and Typhlitis 7 ... ... ... 2 2 2 1 ... 6 Cirrhosis of Liver 3 ... ... ... ... ... 1 1 1 2 Alcoholism Nephritis and Bright's Disease ... 19 ... ... ... ... ... 5 8 6 9 Puerperal Fever 3 ... ... ... ... 1 2 ... ... 5 Other accidents and diseases of Pregnancy and Parturition 2 ... ... ... ... ... 2 ... ... 3 Congenital Debility & Malformation, including Premature Birth 35 34 1 ... ... ... ... ... ... 18 Violent Deaths, excluding Suicides 25 4 2 4 6 4 5 ... ... 10 Suicide 1 ... ... ... ... ... 2 2 ... 4 Other defined diseases 143 12 1 ... 1 ... 12 30 87 162 Diseases ill-defined or unknown 2 ... ... ... ... 1 ... 1 ... 5 544 98 15 17 20 25 81 99 189 507 64 Table IV. Infantile Mortality during the year 1914. Nett Deaths from stated Causes at various Ages under 1 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 2 7 3 3 1 34 20 22 13 9 98 Uncertified ... ... ... ... ... ... ... ... ... ... Smallpox Chickenpox Measles Scarlet Fever Whooping Cough ... ... ... ... ... ... ... 1 1 2 Diphtheria and Croup Erysipelas • Tuberculous Meningitis Abdominal Tuberculosis 1 ... ... ... 1 1 ... 1 ... 3 Other Tuberculous Diseases Meningitis (not Tuberculous) ... ... ... ... ... ... 1 1 ... 2 Convulsions 1 ... ... ... 1 ... 1 ... ... 2 Laryngitis Bronchitis ... ... 1 ... 1 3 2 1 1 8 Pneumonia (all forms) ... ... ... ... ... 2 1 3 3 9 Diarrhoea ... ... ... ... ... 2 7 3 1 13 Enteritis ... ... ... ... ... ... 6 1 1 8 Gastritis ... ... ... ... ... 2 ... ... ... 2 Syphilis ... ... 1 ... 1 ... ... 1 ... 2 Rickets Suffocation, overlying ... ... ... ... ... 2 ... ... ... 2 Injury at Birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Congenital Malformations 1 ... ... ... 1 ... 1 ... 1 3 Premature Birth 13 2 1 1 17 4 ... ... ... 21 Atrophy, Debility and Marasmus 5 1 ... ... 6 1 2 ... 1 10 Other Causes 2 ... ... ... 2 3 1 1 ... 7 27 3 3 1 34 20 22 13 9 98 Nett Births Legitimate 955 Illegitimate 46 Nett Deaths Legitimate infants 72 Illegitimate infants 16 65 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 Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. 1 2 3 4 Factories (including Factory Laundries) 26 4 Nil. Workshops (including Workshop Laundries) 187 8 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 65 4 Total 278 16 Nil. Table VI.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. 1 2 3 4 5 Nuisances under the Public Health Acts:- Want of cleanliness 27 25 Want of ventilation 5 5 Overcrowding 1 1 Want of drainage of floors 4 4 Other nuisances 14 16 †Sanitary accommodation— Nil. Nil. Insufficient 3 6 Unsuitable or defective 12 16 Not separate for sexes Offences under the Factory and Workshop Act: — Illegal occupation of underground bakehouse (s.101) Breach of special sanitary requirements for bakehouses (ss. 97-100) 1 1 Other offences (excluding offences relating to outwork which are included in Part 3 of this report) 2 2 Total 69 76 Nil. Nil. †Section 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 Out workers' 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 Councils. Lists. Outworkers. Lists. Outworkers. Contractors Workmen. Contractors Workmen. 1 2 3 4 5 . 6 7 8 9 10 11 12 13 Wearing Apparel— making, &c. 10 ... 14 1 ... 6 12 ... 22 Do., washing and cleansing ... ... ... 1 1 Furniture and upholstery 6 ... 6 ... ... ... ... ... 1 Brush making Total 16 ... 20 2 1 6 12 ... 23 66 67 Table VIII.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. Bakehouses (Retail) 25 Laundries (non-factory) 34 Workshops and Workplaces 203 Total number of workshops on Register 262 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) 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory Act (s. 5)— Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector Other Underground Bakehouses (s. 101):— Certificates granted during the year In use at the end of the year 1 68 Table X. Sanitary Work. Inspections:— Number of premises inspected on complaint 368 Number of premises inspected in connection with Infectious Diseases (No. of visits made—552) 222 Number of premises, such as Cowsheds, Dairies, Slaughter-houses, Workshops, Workplaces, &c., under periodical inspection 381 Houses inspected from house-to-house (Housing, Town Planning, etc., Act, 1909) 122 Total number of inspections and re-inspections made 11,163 Action Taken (other than under Housing, Town Planning, &c., Act, 1909): Cautionary or Intimation Notices given verbal 48 579 written 531 Statutory Orders issued 180 Summonses served 2 Convictions obtained - Summons withdrawn (case settled out of court) 1 Summons dismissed 1 Dwelling Houses and action under Housing, Town Planning, &c., Act, 1909:— Number of houses dealt with under Section 15 7 Number of houses found to be in a state dangerous or injurious to health (Section 17) 21 Number of representations made by M.O.H. (Sec. 17) 21 Number of houses made habitable without closing orders - Number of closing orders made by L.A. (Section 17) 15 Number of houses closed voluntarily - Number of closing orders determined after repairs (Section 17) 4 Number of houses demolished— (a) by order of L.A. (Section 17) 13 (b) voluntarily - Illegal Underground Rooms vacated - 69 Houses let in lodgings (Tenement Houses): Number registered under Bye-laws 12 Number of inspections made 24 Number of contraventions - Common Lodging Houses: Number registered under Bye-laws 2 Number of inspections made 23 Number of contraventions 3 Canal Boats used as Dwellings: Number registered under the Acts - Number of contraventions of Begulations 24 Movable Dwellings, Caravans, Tents, &c.: Number observed during the year 16 Number of inspections made 17 Number of nuisances therefrom abated 23 Number removed from district 15 Bakehouses: Number in district 26 Number of inspections made 79 Contraventions of Factory Acts 11 Slaughter-houses: Number on register 9 Number of inspections made 161 Frequency of inspection fortnightly Contraventions of Bye-laws 6 Cowsheds: Number on register 18 Number of inspections made 127 Frequency of inspection fortnightly. Contraventions of Regulations 9 Number of Milch Cows in district 94 70 Dairies and Milkshops: Number on register 58 Number of inspections made 364 Frequency of inspection fortnightly. Contraventions of Regulations 19 Inspection of Food : Meat 966 Fish 431 Provisions 290 Greengroceries and fruit 873 Hawkers' foodstuffs 341 Other premises 106 Unsound Food: (a) Animals seized — (b) Articles or parcels seized — Animals condemned by Magistrate — Articles or parcels condemned by Magistrate — Articles or parcels surrendered 12 Organs or parts surrendered during slaughtering 11 Adulterated Food: Samples taken — Found adulterated — Offensive Trades: Number of premises in district 20 Number of inspections made 278 Contraventions of Bye-laws 3 Water Supply and Water Service: Supply provided 29 Percentage of houses supplied from public water service 99 96 Cisterns— New provided 1 Cleansed, repaired, covered, &c. 5 Abolished 28 71 Draw-taps placed on mains 222 Percentage of houses supplied on constant system 99 96 Number of samples obtained for analysis from— (a) Local wells 6 (b) Public supply — Drainage and Sewerage of existing Buildings:— Water closets — Number of water closets substituted for dry receptacles 2 Repaired, supplied with water or otherwise improved 613 Percentage of houses provided with water closets 98 Drains— Examined, exposed, Ac. 21 Unstopped, repaired, trapped, &c. 165 Waste pipes, rain-water pipes, provided, disconnected, repaired, &c. 81 New soil pipes or ventilating shafts fixed 8 Existing soil pipes or ventilating shafts repaired 66 Disconnecting traps or chambers inserted or repaired 83 Constructed 16 Reconstructed 22 Total No. of tests and re-tests applied 158 Other works 173 Cesspools— Rendered impervious, emptied, cleansed, &c. 1 Abolished and drain connected to sewer — Percentage of houses draining into sewer 98 Disinfection : Rooms disinfected— (a) Ordinary infectious diseases 269 (b) Tuberculosis 70 Rooms stripped and cleansed 177 Articles disinfected or destroyed— (a) Ordinary infectious diseases 2476 (b) Tuberculosis 502 72 Dust: New bins provided 110 Receptacles repaired 25 Periodical frequency of dust removal weekly. Number of complaints of non-removal received Method of disposal destructor. Sundry Nuisances abated: Overcrowding 10 Smoke 1 Accumulation of refuse 30 Foul ditches, ponds, &c., and stagnant water Foul pigs and other animals 54 Dampness 1036 Internal repairs (walls, ceilings, &c.) 2079 Yards paved or repaired 250 Other nuisances 251 Other Inspections: Petroleum Acts 92 Shops Act 411 73 SHOPS ACTS. Table shewing the number and character of the shops on the Register in each district in September, 1912:— District. No. of shops. Heston 69 Hounslow North 262 Hounslow South 284 Isleworth 230 Principal trades. Number of trades in each district. Heston and Isleworth. Heston. Hounslow North. Hounslow South. Isleworth. Refreshments— Eating Houses 1 7 4 4 16 Intoxicating Liquors 15 26 20 28 89 Fried Fish, etc. 1 6 3 3 13 Other 2 2 4 Grocery and Provisions 8 23 30 37 98 Grocery, Oil and Colour 1 2 3 6 Bread and Flour Confectionery 3 10 8 10 31 Sweet Confectionery 5 7 23 26 61 Dairy Produce 3 7 7 6 23 Fresh, Pickled and Cooked Meat 2 8 14 10 34 Fishmongers 1 8 5 5 19 Poultry 1 2 3 Fruiterer and Greengrocer 5 13 24 14 55 Carried forward 43 119 144 146 452 74 Principal trades. Number of trades in each district. Heston and Isleworth. Heston. Hounslow North. Hounslow South. Isleworth. Brought forward 43 119 144 146 452 Florist 5 1 6 Ice 1 1 2 Chemists 1 4 5 2 12 Corn Chandlers 1 4 1 4 10 Coal and Coke 1 7 5 13 Tobacco and Sweet Confectionery 7 11 11 3 32 Tobacconists 1 1 4 6 Yeast manufactory 2 2 Boot repairing and selling 5 20 19 16 60 Tailors 5 3 2 10 Drapery, Hosiery, Millinery, &c. 2 12 10 9 33 Outfitter and Hosier 7 6 13 Wardrobe Dealer 2 4 3 9 Pawnbrokers 2 2 4 Hairdressing 1 11 6 8 26 Ironmongery, hardware, china and glass, oil and colour 2 6 8 5 21 House Furnishers 2 11 15 2 30 Music and Musical Instruments 1 2 1 4 Watchmakers and Jewellers 1 8 2 11 Newspapers, Magazines, &c. 1 10 8 6 25 Carried forward 67 231 264 219 781 75 Principal trades. Number of trades in each district. Heston and Isleworth. Heston. Hounslow North. Hounslow South. Isleworth. Brought forward 67 231 264 219 781 Printing,Stationery,Fancy Goods 2 5 6 2 15 Photography and Picture Frame making 7 1 1 9 Domestic Machines 3 3 Saddlers 1 2 2 5 Leather and Grindery 1 1 1 3 Marine Store Dealer 2 2 Naturalist 1 1 Artificial Wreaths 1 1 2 Builders Merchant 3 3 1 7 Electrical Accessories 1 1 Gas Company Showroom 1 1 Scale Maker 1 1 Motor & Cycle Agents & Repairs 7 5 2 14 Total 69 261 284 231 845 76 HESTON & ISLEWORTH URBAN DISTRICT COUNCIL. Health Department, Council House, Hounslow. January hid, 1915. To the Secretary, Local Government Board. Canal Boats Acts, 1877 and 1884. Sir, In accordance with Section 3 of the Canal Boats Act, 1884, I beg herewith to present the Annual Report for the year ending December 31st, 1914, 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. Messrs. W. E. Balchin and L. Marsden have continued to act as Canal Boat Inspectors, and during the year Mr. R. H. Butler has also been appointed. 78 inspections were made of 64 boats. On 8 of these boats 6 infringements of the Acts and Regulations were found, as under :— No. of boats with 1 infringement only 6 The following table gives details as regards these contraventions :— 77 Infringements with respect to— Carried forward from 1913 Found during 1914. Remed'd during 1914. Carried forward to 1915. (a). Registration ... ... ... ... (b). Notification of change of Master ... ... ... ... (c). Certificates 1 1 1 1 (d). Marking ... ... ... ... (e). Overcrowding ... 1 1 ... (f). Separation of the sexes ... 2 2 ... (:g). Cleanliness ... ... ... ... (h). Ventilation ... ... ... ... (i). Painting 2 ... 2 ... (j). Provision of water cask ... ... ... ... (k). Removal of bilge water ... ... ... ... (1). Notification of infectious disease ... ... ... ... (m). Admittance of Inspector ... ... ... ... (n). Habitable condition 1 2 2 1 4 6 8 2 No case of infectious disease was reported as occurring amongst the Canal Boat population during the year. I am, Sir, Your obedient servant, Thos. Strain, Medical Officer of Health.