HES 3 Heston and Isleworth Urban District Council. ANNUAL REPORTS OF THE Deputy Medical Officer of Health AND School Medical Officer FOR THE URBAN DISTRICT OF HESTON & ISLEWORTH For the Year ending 31st December, 1916. 1916. REPORT on The Health of the HESTON and ISLEWORTH URBAN DISTRICT FOR THE YEAR 1916 by W. BRAMWELL REID, M.B.,D.P.H., Medical Officer of Health. THE HEALTH COMMITTEE of the HESTON AND ISLEWORTH URBAN DISTRICT COUNCIL For the Year ending April, 1917. W. G. Palmer, Esq. (Chairman). W. Mann, Esq. (Vice-Chairman). A. Bergin, Esq., J.P. (Chairman of the Council). F. Nowell, Esq. (Vice-Chairman of the Council). C. Arnold, Esq. J. J. Bonnett, Esq. C. Crush, Esq. A. L. Lang, Esq. F. W. Langstone, Esq. W. G. Lobjoit, Esq., j.p.,c.c. P. F. C. Meyers, Esq. W. W. Woods, Esq. Medical Officer of Health: W. Bramwell Reid, m.b.,d.p.h. 4 Health Department, Council House, Hounslow. December, 1917. To the Chairman and Members of the Heston and Isleworth Urban District Council. Gentlemen, I beg to submit herewith my report for the year 1916. The report has been still further reduced in size compared with last year's. The birth and death rates do not show any material change, but the uncertainty as to the present population of the district makes it impossible to rely on these figures. The infant death rate is, however, quite reliable, and this shows a marked improvement over last year. The longer time now taken to get nuisances remedied necessitates more inspection being made than in normal times,and this accentuates the shortage of staff. Mr. Ashworth, Assistant Sanitary Inspector, joined the Army at the end of the year. I wish heartily to acknowledge the continued loyal support of the staff, both technical and clerical, permanent and temporary. I am, Gentlemen, Your obedient servant, W. B. REID, Medical Officer of Health. 5 SUMMARY OF VITAL STATISTICS, 1916. Area: Heston acres 3708 Isleworth „ 3185 Total 6893 Population (Civil Residents) (nett) 42000 Registrar-General's estimate of nett civil population 40770 Birth rate (nett) 20.1 England and Wales 21.6 Death rate (nett) 12.6 England and Wales 14.0 London 14.3 Infantile Mortality Rate 77.3 per 1000 births. England and Wales 91 „ „ Loudon 89 „ „ VITAL STATISTICS. Population. The primary difficulty in presenting the vital statistics for the year under report is that of estimating the population of the district with any degree of accuracy. The data obtained under the National Registration Act is not available to this department, nor, of course, is the number of enlistments known. It has only been possible, therefore, to estimate in very round figures that the nett civil residents, (i.e., excluding enlistments, etc.), at the middle of the year were 42,000. This basis has been adopted for the calculation of the death rate, but the re-estimated nett number of civil residents in 1915 has been adopted as a more reasonable basis for the calculation of the birth rate. The Registrar-General has furnished an estimate of the civil population as 40,770, but it is not quite clear whether this figure, like the similar figure for 1915, does not exclude residents in local institutions. Deaths. The number of deaths registered in the district was 975, but 493 of these did not belong to the district, while 47 residents 6 died without the district. Thus the number of deaths properly attributable to the district was 529, which gives the death-rate for the district of 12.6 per 1,000 of the population. Adopting the basis of the population estimated by the Registrar-General, the death rate for the district comes to 12.9 per 1,000. These figures are comparable with the following figures:—14.0 for England and 14.3 for London. Births. The total number of births registered during the year was 934, but 50 of these did not belong to this district, while 8 births properly belonging to this district occurred outside the district. The nett number of births thus attributable to the district is 892, giving a birth-rate of 203 per 1,000. The birth-rate of England and Wales is 21.6 per 1,000. Adopting the population basis suggested by the Registrar-General for the calculation of the birth rate, this comes to 20.1 per 1,000. Legitimacy. The following figures give the number of illegitimate births:— Legitimate. Male. Female. Total. 454 395 849 Illegitimate. Male. Female. Total. 27 16 43 Notification of Births Act, 1907. The following figures give some idea of the work done under the Notification of Births Act, 1907, during the year 1916. The number of births notified during the year was 856 or 91.6% of the births registered, as compared with 89.7 % in 1915. 7  Heston and Isleworth Urban District. Births visited 696 Feeding—Natural 617 Artificial 63 Both 15 No information 2 Still births 17 Sleeping with parents 461 Using comforter 223 Mother working during pregnancy 115 Births revisited 4077 It will be noted that 4077 revisits were made to infants, as compared with 2282 in the previous year. Most infants are revisited now at least three times in the first three months, once every three months until a year old and again at the ages of two, three and four years. The percentage (88) of children who are receiving mother's milk remains stationary, which, in view of the increasing employment of married women, must be considered as satisfactory. The number of women employed during pregnancy has slightly increased, the percentage being 16 as compared with 13 last year. Maternity and Child Welfare Centres. The centres opened in September, 1915, have developed in usefulness during the past year. One centre is located at the Council House, where an Infant Clinic is held every Monday afternoon from 2 to 4. The other centre is located at the Isleworth 8 Public Hall, where an Infant Clinic is held every Wednesday from 2 to 4. Maternity cases are seen between the same hours. The Infant Clinics are proving successful, but very few persons have, as yet, taken advantage of the Maternity consultations. The infants seen numbered 252 and their attendances at the centres were 922. Eight maternity cases were seen and made 13 attendances. Infant Deaths. The total number of infant deaths during 1916 was 69, giving an Infant. Mortality rate of 77.3 per 1,000 births. This figure is very much lower than that of 1915, which was 102.4 per 1,000 births. It is also distinctly lower than the rate for England and Wales for the same period (91), and London (89). The Infant Mortality rate, as seen from the following table, varies from 52.9 in Hounslow North Ward, which is the lowest, to 93 9 in Isleworth North Ward, where the rate is highest:— Heston. Heston 69.5 Hounslow North 52.9 Isleworth. Hounslow South 86.0 Isleworth North 93.9 Isleworth South 78.1 INFECTIOUS DISEASE. Cases removed to Hospital. During the year, 126 of the 1278 civil cases notified (other than Tuberculosis) were removed to Hospital. Of these 126, 20 were treated in the Infirmary, and one entered a Metropolitan Asylums Board Hospital, leaving 105 chargeable to the District Bate at Mogden Hospital. Scarlet FeYer. The following table shews the number of cases which have been notified, and the number and percentage of cases which have been removed to Hospital:- No. of civil cases notified 77 No. of civil cases removed to Hospital 63 Percentage of cases removed to Hospital 81.8 9 Five cases were also reported among the military population. The incidence rate of Scarlet Fever in the civil population was 1.8 per 1,000. The prevalence of the disease was greatest in April, May and November. Three deaths took 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:— No. of civil cases notified 49 No. of civil cases removed to Hospital 40 Percentage of cases removed to Hospital 81.6 In addition to these cases, one military case was reported to me and was removed to Mogden Isolation Hospital. The incidence rate per 1,000 of the civil population was 1.1. Three cases occurred in public institutions during the year, one of the persons affected being a non-resident. Five deaths took place from this cause, i.e., a case mortality rate of 10.2 per cent. Antitoxin. During 1916, 15 vials of Antitoxin were supplied to medical practitioners. Typhoid Fever. Two cases were notified, one of which was removed to Hospital, but no deaths were recorded from this cause. Erysipelas. Twenty-one cases of this disease were notified, of whom 8 were institution cases, 6 of the persons affected being non-residents, while one case occurred among the military. One death was recorded from this disease. Puerperal Fever. Nine cases of this disease were notified, of which 8 were institution cases, 6 of the persons affected being non-residents. Five cases proved fatal, three being non-residents. 10 Ophthalmia Neonatorum. In this district 11 children were notified as suffering from this disease, 4 of the cases occurring at the Infirmary. This is equal to a case rate of 11.7 per 1,000 births occurring in the district. Cerebro Spinal Meningitis. Six cases of this disease were notified, 5 of them being military cases. One (civil) case was removed to Mogden Hospital. Acute Polio Myelitis. No cases of this disease were notified. Measles and German Measles. From the beginning of the year, Measles and German Measles were made notifiable under regulations of the Local Government Board, and the earlier part of the year was characterised by an epidemic of both these diseases. The Measles epidemic was principally located in Isleworth, while the German Measles cases occurred mostly in Hounslow. In addition to the doctor (if any) in attendance, the householder has also been made responsible for notification under the regulations, but only 5 per cent. of the notifications came from this latter source. The bulk of the civil cases were visited by the Health Visitors. The total numbers of notifications received were:— Civil. Military. Measles 612 19 German Measles 496 71 Pulmonary Tuberculosis. The number of cases notified during the year was 75, including 3 military cases. Forty-three (or 59.7%) of the civil cases were notified as receiving institutional treatment (Infirmary, 11; Sanatoria, 32). Other Forms of Tuberculosis. The number of cases notified during the year was 19, including 1 military case. Nine (or 50%) of the civil cases were notified as receiving institutional treatment (Infirmary, 6; Hospitals, etc., 3). 11 COUNCIL LABORATORY. The following specimens were examined in the Laboratory during the year 1916:—Diphtheria, 232; Tuberculosis, 192; Typhoid Fever, 13; Ringworm, 34; Gonorrhoea, 5; Other diseases, 3; Total, 479. Two samples of water were analysed. SANITARY ADMINISTRATION. The remarks which were made in last year's report with regard to the water supply, drainage and sewerage, closet accommodation and scavenging of the district, apply generally to the year under report. Sanitary Inspection of the District. Some particulars of the work done are set out in the Appendix to this report. Nuisances, Contraventions of Bye-laws, Defective Drainage, etc. The number of unremedied nuisances* brought forward from 1915 was 293. The number of nuisances recorded during the year was 294, but during the year 297 nuisances were remedied, leaving 290 premises in which nuisances still existed at the end of the year. During the year, nuisances at 72 houses were reported to the Health Committee, which, added to the 23 brought forward from 1915, make a tonal of 95. Statutory notices were authorised and served in most of these cases, and by the end of the year, the nuisances were remedied in 65 of the houses, leaving 30 cases to be carried forward to 1917, 14 of them being cases already brought forward from 1915. * More properly, houses in which nuisances were found. Premises and Occupations controlled by Bye-laws or Regulations. There are about 350 premises in this district which call for periodical inspection such as the following:— 12 Houses let in Lodgings, Common Lodging Houses, Bakehouses, Slaughter-houses, Cowsheds, Dairies and Milkshops, Offensive Trades, Laundries (non factory) and Workshops and Work Places. Owing to pressure of work, the Inspector of Nuisances has been unable to tabulate the number of inspections and other work in connection with these premises. HOUSING. Houses with Sanitary Defects. The following statement 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:— Houses. Brought forward from 1915 18 Transferred from "Houses Unfit" list 3 21 Disposed of during the year 14 Carried forward to 1917 7 Houses Unfit for Human Habitation. The following statement gives the information which the Local Government Board requires the Medical Officer of Health to furnish for the year ending 31st December, 1916, in relation to bouses represented by him as unfit for human habitation:— Number of houses represented by Medical Officer of Health 2 " Closing Orders made by the Local Authority 2 " appeals against Closing Orders nil. " notices served on occupying tenants 1 " occupying tenants summoned nil. " Orders made by Court requiring occupying tenants to quit nil. " Closing Orders determined nil. " Demolition Orders made nil. 13 Number of appeals against Demolition Orders nil. " Demolition Orders obeyed 4 " Demolition Orders enforced nil. " demolitions carried out without Demolition Orders being made nil. The following table gives more detailed information in regard to the houses represented as unfit during the year 1916, and the action taken in those remaining on the records at the end of 1915:— Table shewing dwelling houses represented as unfit for human habitation. Premises. No. of houses represented by M.O.H. Date Closing Orders made. Date Closing Orders determined. Date Demolition Orders made. Date Demolition Orders obeyed. Date Demolition enforced. Br't forw'd from 1915— al-3, Poplar Cottages 640-44, Derby Road 3 24/2/14 ... 22/12/14* 10-16, Church Street 4 23/2/15 ... 26/10/15* 15, South Street 1 27/4/15 ... 23/11/15* 1-4, Gilbert's Cottages, E. 4 23/3/15 ... 26/10/15 13/6/16 1-4, Baker's Cotts. 4 18/12/15 1916— St. Alban's Farm and cottage adjoining, Staines Road 2 25/7/16 18 18 — 12 4 a—Appeals lodged against Demolition Order. L.G.B. enquiry held 15/3/15. Order made 18/5/15 operative 18/8/15. b—Consideration of Closing Orders postponed 6/4/14. Being dealt with under Public Health Acts.—See table shewing houses with defects. *—Demolition deferred until after the War. New Houses. I am informed by the Surveyor that no houses suitable for the working classes were erected during the year. 14 FOOD. Milk Supply. No material change has been observed during the past year in the conditions under which cow-keeping and milk-vending are carried on in the district. Other Food. The quantity of unsound food found during the year was approximately:— Fruit and vegetables 153 lbs. Meat 62 lbs. Fish 378 lbs. This includes parts of carcases of animals surrendered and condemned during slaughtering. As I reported last year, a consignment of 22 rabbits to the Brentford Union Infirmary was seized and condemned, and upon subsequent proceedings being taken against the vendor, he was fined £44. During 1916, the vendor appealed against this conviction, and on a point of law his appeal was upheld. Having regard to the incontrovertible evidence as to the condition of the rabbits, this decision must be regarded as most inequitable and unsatisfactory. FACTORY AND WORKSHOP ACT, 1901. It has been found impracticable to tabulate the inspections made and other work done during the year in connection with premises under this Act. SHOPS ACTS. The number of contraventions of the Acts which were reported during the year was as follows:— Open on half-holidays 2 Notices not exhibited 2 Notices not exhibited in a conspicuous position — Notices not in prescribed form 2 Notices (assistants) not exhibited — 6 No legal proceedings were taken. 15 APPENDIX. Certain tables have been omitted either at the suggestion of the Local Government Board or because the necessary data could not be collected. Table III. Causes of Death among Civil Population during 1916. Causes of Death. Residents all ages.* Non-residents in Institutions in the District. All causes Certified 527 471 Uncertified ... ... 1 Enteric Fever ... ... 2 Smallpox ... ... 3 Measles 9 ... 4 Scarlet Fever 3 ... 5 Whooping-cough 3 ... 6 Diphtheria and Croup 5 1 7 Influenza 6 ... 8 Erysipelas 1 ... 9 Phthisis (Pulmonary Tuberculosis) 38 50 10 Tuberculous Meningitis 3 5 11 Other tuberculous diseases 8 7 12 Cancer, malignant disease 44 40 13 Rheumatic Fever 4 2 14 Meningitis 6 4 15 Organic Heart Disease 66 44 16 Bronchitis 49 26 17 Pneumonia (all forms) 55 21 18 Other Diseases, Respiratory Organs 6 4 19 Diarrhoea and Enteritis 21 11 20 Appendicitis and Typhlitis 4 1 21 Cirrhosis of Liver 3 7 21a. Alcoholism 1 ... 22 Nephritis and Bright's Disease 9 9 23 Puerperal Fever 1 3 24 Other accidents and diseases of Pregnancy and Parturition 3 2 25 Congenital Debility & Malformation including Premature Birth 17 13 26 Violent Deaths, excluding suicide 12 13 27 Suicide 2 ... 28 Other defined diseases 147 207 29 Diseases ill-defined or unknown 1 1 527 471 *According to figures furnished by the Registrar General. Table IV. Infantile Mortality during the year 1916. Nett Deaths from stated Causes at various Ages under I Year of Age Cause of Death. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks. 4 weeks and under 3 rats. 3 mts. and under 6 mts. 6 mts. and under 9 mts. 9 mts. and under 12 mts. Total Deaths under 1 year. All causes Certified ... ... ... ... ... ... ... ... ... ... Uncertified ... ... ... ... ... ... ... ... ... ... Smallpox Chickenpox Measles Scarlet Fever Whooping Cough ... ... ... ... ... ... ... ... 1 1 Diphtheria and Croup Erysipelas Tuberculous Meningitis Abdominal Tuberculosis Other Tuberculous Diseases Meningitis (not Tuberculous) ... ... ... ... ... ... 1 ... ... 1 Convulsions 1 1 1 3 Laryngitis Bronchitis ... ... ... ... ... 3 1 1 1 6 Pneumonia (all forms) ... ... ... ... 2 1 3 3 5 14 Diarrhoea ... ... ... ... ... ... 2 3 1 6 Enteritis ... ... ... ... 2 2 1 4 1 10 Gastritis ... ... ... ... ... 1 ... ... ... 1 Syphilis ... ... ... ... 1 1 ... ... ... 2 Rickets Suffocation, overlying ... ... ... ... 1 ... ... ... ... 1 Injury at Birth ... ... ... ... 2 ... ... ... ... 2 Atelectasis Congenital Malformations ... ... ... ... 4 ... ... ... ... 4 Premature Birth ... ... ... ... 6 1 ... ... ... 7 Atrophy, Debility and Marasmu ... ... ... ... 7 1 ... ... ... 8 Other Causes ... ... ... ... 1 ... ... ... 1 2 ... ... ... ... 27 10 8 12 11 68 Nett Births Legitimate 849 Nett Deaths Legitimate infants 6 Illegitimate 43 Illegitimate infants 5 17 HESTON & ISLEWORTH URBAN DISTRICT COUNCIL. Health Department, Council House, Hounslow. 22nd January, 1917. 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 31st December, 1916, 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. During the absence of Mr. TV. E. Balchin on military duty, Mr. R. H. Butler, Inspector of Nuisances, has acted as Canal Boat Inspector. Owing to the reduction of the Inspectorial Staff due to enlistment and removal, it has only been possible to make a few inspections. Twelve inspections were made of 12 boats. On 1 of these boats 1 infringement of the Acts and Regulations was found. The following table gives details as regards the contraventions dealt with during the year:— 18 Infringements with respect to— Carried forward from 1915 Pound during 1916. Rpmed'd during 1916. Carried forward to 1917. (a). Registration ... ... ... ... (b). Notification of change of Master ... ... ... ... (c). Certificates ... ... ... ... (d). Marking ... ... ... ... (e). Overcrowding l 1 2 ... (f). Separation of the sexes ... ... ... ... (g). Cleanliness ... ... ... ... (h). Ventilation ... ... ... ... (i). Painting l ... 1 ... (j). Provision of water cask ... ... ... ... (k). Removal of bilge water l ... 1 ... (l). Notification of infectious disease ... ... ... ... (m). Admittance of Inspector ... ... ... ... (n). Habitable Condition ... ... ... ... 3 l 4 ... Two cases of Ophthalmia Neonatorum and one case of measles were notified as occurring amongst the Canal Boat population during the year. I am, Gentlemen, Your obedient servant, William Bramwell Reid, Medical Officer of Health. 19 Table X. Sanitary Work. Inspections:— It has been impracticable to tabulate the number of inspections made. Action Taken (other than under Housing, Town Planning, &c., Act, 1909:— Preliminary or Intimation Notices given 278 Second notices sent 122 Statutory notices issued 183 Summonses served 5 Dwelling Houses and action under Housing, Town Planning, &c., Act, 1909:—See Page 12. Unsound Food: (a) Animals seized — (b) Articles or parcels seized 1 Animals condemned by Magistrate — Articles or parcels condemned by Magistrate — Articles or parcels surrendered 7 Organs or parts surrendered during slaughtering 2 Water Supply and Water Service: Supply provided 4 Cisterns cleansed, repaired, covered, &c 10 Draw-taps placed on mains 33 Wells closed as polluted 2 Drainage and Sewerage of existing Buildings: Water closets— Repaired,supplied with water or otherwise improved 159 Cesspool repaired (1) Privy emptied and cleansed (1) 2 Drains— Unstopped, 50; repaired, 1, trapped, &c. 51 20 Waste pipes (14), rain-water pipes (30), provided disconnected, repaired, &c. 44 Gullies inserted or improved 36 Fresh air inlets provided or repaired 15 Soil pipes (5) or ventilating shafts (7) fixed or repaired 12 Disconnecting traps or chambers inserted or repaired 19 Constructed or reconstructed 4 Disinfection:- Articles disinfected or destroyed— (a) Ordinary infectious diseases 856 (b) Tuberculosis 470 Dust: New bins provided 153 Receptacles repaired 4 Ashpits abolished 2 Sundry Nuisances abated: Overcrowding 3 Smoke 32 Urinals cleansed 4 Accumulation of refuse 9 Dampness 152 Roofs repaired 50 Internal repairs (walls, ceilings, &c.) 396 Yards paved, repaired or drained 47 Other nuisances 41