SOUT 037 THE SOUTHALL-NORWOOD URBAN DISTRICT COUNCIL. Annual Report OF THE Medical Officer of Health. JANUARY, 1903. Southall=Norwood Urban District Council. 1902. Mr. C. T. Abbott. „ R. W. Baxter. „ W. Brown. „ W. E. Eburne. „ G. Gosney. „ Hy. Hanson. Mr. H. Harries. „ T. Jamieson. „ J. T. Stevens. „ T. Watson. „ J. H. Willis. Chairman T. W. Penny, Esq., J.P. Sanitary Department. H. Baxter, Inspector of Nuisances. Reginald Brown, C.E., Engineer and Surveyor. A. L. Houlder, Solicitor, Clerk. J. D. Windle, M.D., Ch.B., M.R.C.S. (Eng.), Medical Officer of Health. Annual Report OF THE Medical Officer of Health, FOR 1902. To the Members of the Southall-Norwood Urban District Council. Gentlemen, I have the honour to submit for your consideration my 12th Annual Report on the Vital Statistics and Sanitary condition of your District for the year 1902. The Report is divided into three Sections dealing respectively with Vital Statistics; Notifiable Diseases; and a Summary of the general Sanitary Work for the year. I have worked out the rates of Mortality and Morbidity for the East and West Wards as well as for the District as a whole, the corrected Census Data for 1901 being now available. SECTION I. Census Data. The following particulars are taken from the recently published Official Report of the Census of the County of Middlesex:—* Ecclesiastical Parishes. Date of Formation. Population. Houses. Norwood—St. Mary the Virgin — 3664 161 Southall Green—St. John 1850 6544 1246 Southall—Holy Trinity 1891 2992 504 * Eyre & Spottiswood, East Harding Street, Fleet Street, E.C.—Price 11d. Area—Houses 1901, and Population 1891 and 1901. Urban Districts. Area in Statute Acres. Inhabited. Houses, 1901. Uninhabited. Building. Population. 1891. 1901. In Occupation. Not in Occupation. Persons. Persons. Males. Females. Southall-Norwood 2,575 1,911 15 244 105 7,896 13,200 6,262 6,938 Civil Parish: Norwood (125 : 3). words: East — 882 10 147 58 7,451 3,280 4,171 West — 1,029 5 97 47 5,749 2,982 2,767 Area, Houses and Population 1891 and 1901, and Separate Occupiers, 1901. REGISTRATION DISTRICTS and SUB-DISTRICTS and Civil Parishes. Area in Statute Acres. HOUSES. Families or Separate Occupiers. POPULATION. Land and Inland Water. Inland Water only. Inhabited. Inhabited. Uniahabited. Building. Persons. Males. Females. In Occupation. Not in Occupation. 1891. 1901. 1901. 1901. 1891. 1901. 1891. 1901. 1891. 1901. 3. Hayes Norwood 2,575 50 1,021 1,911 15 244 105 2,026 7,896 13,200 3,752 6,262 4,144 6,938 Changes in the Boundary of the Civil Parish. No. of Registration District. Name of Registration District. No. of SubDistrict. Name of Sub-District. Description of Change. 1901. Authority and date of change Inhabited Houses. Population. „ „ 3 Hayes Extending Norwood Civil Parish to include part of Heston Civil Parish. 120 701 L.G.B. Order, 51,372 (30th September, 1894). Institutions in the District. Number of District and SubDistrict. Registration District and Sub-District. Civil Parish. Institution. Special Inmates (Patients, Paupers, Lunatics, etc..) Officials and their Families. Persons. Males. Females. Persons. Males. Females. 125 Uxbridge :— 3 Hayes— Norwood Workhouse School (St. Marylebone Parish). 381 210 171 31 6 25 London County Lnnatic Asylum, Hanwell. 2,553 943 1,610 282 53 229 Featherstone Hall Private Lunatic Asylum. 10 — 10 16 1 15 Vine Cottage Private Lunatic Asylum. 11 - 11 6 - 6 Total Tenements and Tenements of less than Five Rooms, distinguishing those occupied by various numbers of persons. Urban Districts. Rooms in Tenement. Tenements of less than Five Rooms. Persons per Tenement. 1. 2. 3. 4. e. 6. 7. 8. e. 10. 11. 12 or more. South all-Norwood 1 12 11 1 - - - - - - - - - - Total Tenements—2026. 2 33 13 8 6 3 1 1 1 - - - - - Tenements of less 3 146 4 35 44 26 20 9 6 2 — — — - than Five Rooms 422. 4 231 4 36 50 48 35 23 12 12 6 5 - - Ages of Persons.—Males and Females. Urban District. All Agf,s. Under 1 Year. l- 2- 3- 4- Under 5 Years. 6- 10- 13- 14- 15- 16- 17- 18- 19- SOUTHALLNo WOOD' R P. 13,200 339 288 312 315 299 1,553 1,527 760 238 212 194 176 178 178 163 M. 6,262 173 145 144 161 160 783 727 376 137 122 112 99 104 93 92 F. 6,938 166 143 168 154 139 770 800 384 101 90 82 77 74 85 71 Urban District. 20- 21- 26- 30- 36- 40. 46- 60- 66- 60- 66- 70- 76- 80- 86- 90- 96- 100 and upwards. southallNorwood 181 876 1,149 1,056 932 866 675 625 521 418 307 212 134 45 17 6 1 - 98 440 576 497 435 393 308 257 211 169 105 75 35 12 3 2 1 — 83 436 573 559 497 473 367 368 310 249 202 137 99 33 14 4 - — Grouped Occupations of MALES aged 10 Years and upwards; also proportion of Children of 10 and under 14 Years of age engaged in occupations, 1901. Males Aged 10 and under 14 Years. Urban Districts. Males aged 10 Year and Upwards. Engaged in Occupations. Proportion per cent. Engaged in Occupations to Total. Total Occupied and Unoccupied. XXIII. Retired or Unoccupied. I. -XXI I. Engaged in Occupations. V. 2. Commercial or Business Clerks. VI. Conveyance of Men, Goods, and Messages. VII. Agriculture— on Farms, Woods and Gardens. X. 3. Engineering, and Machine Making. X. 4-7. Tools; Dies, etc. ; Arms; Miscellaneous Metal Trades. XII. Building and Works of Construction. XIII. Wood, Furniture, Fittings and Decorations. XIV. Brick, Cement, Pottery and Glass. XV. Chemicals, Oil, Grease, Soap, etc. XVI. Skins, Leather, Hair, Feathers. XVII. Paper, Prints, Books & Stationery. XIX. Dress. XX. Food, Tobacco, Drink and Lodging. All Other Occupations. 21 4.1 Southall-Nor- WOOD 4,752 1,632 3,120 83 500 153 83 56 603 118 127 62 8 22 43 278 984 Grouped Occupation of FEMALES aged 10 Years and upward; also proportion of Children of 10 Years and under 14 Years of age; and of Married or Widowed Women engaged in occupations, and proportion of Female Domestic Servants to separate Occupiers or Families, 1901. Females Aged 10 and under 14 Years. Urban Districts. Females Aged 10 Years and upwards. Engaged in Occupations. Proportion per cent. Engaged in Occupations to Total. Total Occupied and Unoccupied. XXIII. Retired or Unoccupied. I.—XXII. Engaged in Occupations. III. 4. Teaching. IV. 1. Domestic Indoor Servants (not in Hotels, etc.) IV. 3. Charwomen. IV. 3. Laundry and Washing Service. V. 2. Commercial or Business Clerks. XV. Chemicals, Oil, Grease, Soap, etc. XVII. Paper, Prints, Books & Stationery. XIX. Tailoresses, Milliners, Dressmakers, Shirtmakers, Seamstresses. XX. Food, Tobacco, Drink and Lodging. All other Occupations. Proportion per cent. of Married or Widowed engaged in Occupations. Proportion per cent. of Domestic Servants to total number of Separate Occupiers or Families. Unmarried. Married or Widowed. 3 .6 Southall-Nor- WOOD 5,368 4,424 796 148 57 269 10 56 12 3 5 123 62 347 5.0 13.3 8 Estimated Population for middle of Year 1902—12680. In estimating the Population and for the statistical purposes of this Report the inmates of the St. Marylebone Schools are included in the Population of the District, whilst those of the London County Asylum (Norwood) are entirely excluded, being dealt with in the Supplementary Tables as a separate District. The corrected increase in population in the inter-census period 1891-1901* was 4,506 persons : giving an average yearly increase of 450: the population to the middle of 1901 was 10,477. Therefore 10,477 + 450=10,927 which gives the population to the end of the first quarter of 1902. In calculating the birth and death rates the basis is the estimated population for the middle of the year which represents the average number of persons living in that year. Since the Census is taken at the end of the first quarter of the year, it is necessary to add one fourth of the yearly increase to the total already obtained thus—10477 + 450+112 = 11.039 is the estimated population. This method is sufficiently accurate in the case of a slowly increasing population. Another method of estimating the population is the formula :— Registered Births in the Year x 1000.= Average Birth Rate for previous 10 years : 465 x 1000, =14,090 population. 33 I consider the first estimate too low and the second too high. In the case of your District which has undergone an abnormal increase since the Census, a more accurate estimate is to be arrived at by taking into account the number of inhabited houses as shown by the rate book and multiplying these figures by the average number of inmates in each. The total number of houses on the Rate Book is 2,536,, allowing 5 persons as the average number of inmates in each house† the total population is 12680. 6,690 West Ward; 5,990 East Ward. Census 1891. Census 1901. West. East. Estimated 1902. West. East. Southall- Norwood 5188 9953 5337 4516 12680 6690 5990 St. Marylebone Schools . 335 412 412 — — — — London County Asylum 2037 2835 — 2835 2835 — 2835 Totals 7560 13200 5749 7451 15515 6690 8825 *See Annual Report for 1901. †Census Return gives 6.91. 9 Number of Inhabited Houses in District.}: 1891 Census Return 1,021 1897 Rate Book 1,425 1892 „ „ — 1898 „ „ 1,634 1893 Rate Book 1,048 1899 „ „ 1,790 1894 „ „ 1,068 1900 „ „2,045 1895 „ „ 1,115 1901 Census Return 1,920 1896 „ „ 1,291 1902. Total number, 2,536. West Ward, 1,338 (a) East Ward, 1,198 (b) {a) 120 brought into rating during the year. (3) 89 brought into rating during the year. At the Census the number of inhabited houses was 1,920: a large number, however, were unoccupied, as a result of the great depression in trade prevailing at that time. Since the inauguration of the Electric Tramway Service to London in July, 1901, there has been a large influx of the middle artizan class, and as a result there are at the present time very few empty houses in the District, which is rapidly changing in character from Rural to Urban. Public Elementary Schools. Total number of Children on School Register 2,497 „ „ „ „ under 5 years of age 176 „ „ „ „ between s—10 years 1,385 „ „ „ „ „ 10—15 years 936 2.497 The Education Department regards the number of children between 3 and 13 years of age as one-sixth of the whole population. General Data. The area of the District is about 2,504 Statute Acres; 2,515 of land ; and 49 acres of water. Including the inmates of the London County Asylum and St. Marylebone Schools, the density of population is 5.12 persons per acre, an increase of 2.06 persons per acre since Census of 1891. The number of inhabited houses per acre is 0.9. The length of the District from North to South is 2 miles 4 furlongs 86 yards, and the breadth from Bull's Bridge to the Sewage Disposal Works 3 miles 0 furlongs 203 yards, the narrowest part being at the extreme northern end of the district, which is 2 furlongs 210 yards. †For this information I am indebted to Mr. Arthur Hanson, Junr., District Rate Collector. IO The highest point above Trinity high water mark is on the Southall Station Bridge, which is 115.5 feet, and the lowest point at the Sewage Disposal Works, which is 21.5 feet above such level. The total length of public roads now under the jurisdiction of the Council is about 11 miles. The mileage of private roads is about 4 miles. The dividing line of the Wards is the centre of the road outside Waxlow Farm entrance, down North Road to Uxbridge Road, thence to the "Three Horseshoes" Beer.house, down South Road, over Station Bridge and on by St. John.s Church, along Western Road, by "Halfway House" Beerhouse, and on until opposite the "Prince of Wales," where the imaginary line leaves the road, going to rear of the two cottages opposite, and again joining the road immediately after passing over Canal Bridge to Watersplash. The left hand being East Ward and the right hand the West Ward. Vital Statistics. Birth Rate 36 6 per 1000. The total number of Births registered during the year was 465, distributed as follows:— 38.1per 1000. 35.0 per 1ooo. West Ward. East Ward. Males. Females. Males. Females. 135. 120. 106 104 255. 210 465. Still Births, not registered, total for year 17. Year. Births. Rate. Population. 1891 208 40.9 5188 1892 193 37.2 5188 1893 189 34.6 5456 1894 184 31.9 5756 1895 188 28.1 6684 1896 207 28.8 7184 1897 254 321 7910 1898 258 30.2 8531 1899 325 34.8 9311 1900 353 31.4 11199 1901 360 34.3 10477 1902 465 36.6 12680 Death Rate 12 2 per 1000. The total number of Deaths registered at all ages and from all causes during the year was 156. This number includes the deaths II of persons dying in the Workhouse and Isolation Hospital from your District (5), and of strangers dying within the District but not belonging thereto. Deaths which occurred in the London County Asylum are not included, since we are concerned only with those deaths occurring amongst members of our population proper. The death rate calculated on the population for 1902 is 12"2 per 1,000—distributed as follows:— West Ward, 12.2 per 1000. East Ward, 11.5 per 1000. Year. Deaths. Rate. Population. Year. Deaths. Rate. Population. 1883 102 24.2 4164 1893 63 11.5 5456 1884 84. 20.2 - 1894 63 10.9 5756 1885 83 19.9 - 1895 93 13.9 6684 1886 77 16.8 - 1896 91 12.6 7184 1887 66 15.8 - 1897 90 11.3 7913 1888 55 13.2 - 1898 121 14.1 8531 1889 77 16.8 - 1899 136 14.6 9311 1890 83 19.9 - 1900 147 13.2 11199 1891 64 12.3 5188 1901 168 16.0 10477 1892 75 14.4 - 1902 156 12.2 12680 As a consequence of the decrease in the number of deaths and the large increase in the population, and there is a very considerable fall in the rate per 1,000 living. It would not be correct to lay too great stress on the lowness of the rate per se since the population has been abnormally increased during the year by the immigration of young adults. This is shown by the very high birth rate. A low death rate and a very high birth rate is however a very favourable indication, and especially since the birth rate has been abnormally high for the last few years, and has thus increased the most perishable portion of the population. A comparison of the Sanitary condition of the two Wards of the District from a consideration of the Birth and Death Rates shows that in the West Ward the number of deaths has been somewhat higher, being 12.2 per 1,000 as compared with 11.5 in the East; and the Birth Rate 38.1 in the West as compared with 35.0 in the East. No accurate conclusion can be drawn from these figures as regards the comparative healthiness of the two Wards The most important Statistical evidence of the healthiness is furnished by Zymotic Death Rate and the Infant Mortality. (See pages 13, 14). There has been a marked decline in the death rate from Zymotic Diseases during the past two years, and the Infant Mortality is 47.2 per 1,000 less than that for last year. The rate in the West Ward has been higher in both cases than in the East, and it has also been slightly higher in the case of Respiratory Death Rate, so that from Statistical evidence one must say that the general Sanitary or Social conditions of the East Ward are better than those of the West, and that as regards the District as a whole it is satisfactory. Causes of, and Ages at, Death during Year 1902. Causes of Death. Deaths in or belonging to Whole District at Subjoined Ages. Deaths in or belonging to Localities (at all Ages.) All ages. Under 1 year. 1 and under | 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. West Ward. East Ward. Hanwell Asylum. Hillingdon Workhouse. Joint Isolation Hospital. Measles 5 2 3 3 2 Scarlet fever 2 1 1 1 1 Whooping cough 4 2 2 4 Diphtheria and membranous croup 3 3 2 1 Diarrhoea 16 13 1 1 1 9 7 3 Enteritis 3 Erysipelas 1 Phthisis 9 1 3 5 4 5 30 Other tubercular diseases 8 3 1 1 2 1 4 4 2 Cancer, malignant disease 6 4 2 3 3 9 Bronchitis 5 1 1 3 3 2 4 Pneumonia 15 4 2 6 3 11 4 11 Other diseases of Respiratory organs 1 1 1 3 Alcoholism 2 2 2 1 Cirrhosis of liver Premature birth 12 12 7 5 Diseases and accidents of parturition 2 1 1 2 Heart diseases 9 1 1 4 3 4 4 14 1 Accidents 7 1 3 1 2 4 3 Suicides 1 1 1 All other causes 49 23 3 2 1 6 14 24 22 131 3 All causes 156 62 13 12 10 33 26 82 69 212 4 1 13 Zymotic Death Rates.* The Death Rate from the Scheduled Notifiable Diseases, viz. :— Small Pox, Scarlatina, Diptheria, Membranous Croup, Typhus, Typhoid, Puerperal Fever and Erysipelas, is 0.3 per 1,000 persons living. West, 0.2. East, 0.3 per 1,000. 1893 1.4 per 1,000 1894 0.3 1895 0.3 1896 0.9 1897 1.5 1898 1.7 1899 0.1 1900 0.3 1901 0.1 1902 0.3 Average Rate, 0.9 per 1,000. The Death Rate Zymotic Diseases not notifiable, viz.:—Measles, Whooping Cough and Diarrhoea, is 1.9 per 1,000 persons living. West, 2.3. East, 1.5 per 1,000. 1893 1.5 per 1,000 1894 1.1 „ „ 1895 1.0 „ „ 1896 2.0 „ „ 1897 1.6 „ „ 1898 1.4 „ „ 1899 2.5 „ „ 1900 2.2„ „ 1901 2.9„ „ 1902 1 .9 „ „ Average Rate, 1.8 per 1,000. The Total Rate from all Zymotic Diseases is 2.2 per 1,000. West, 2.6. East, 1.8 per 1,000. 1893 2.9 per 1,000 1894 2'4 „ „ 1895 1.3 „ „ 1896 2.9 „ „ 1897 3.1 „ „ 1898 3.1 „ „ 1899 3.6 „ „ 1900 3.5 „ „ 1901 3.0 „ „ 1902 2.2 „ „ Average Rate, 2.8 per 1,000. The Death Rate from the Zymotic diseases furnishes a very popular standard of the healthiness of a District. The conclusion to be drawn from a consideration of the total rate from all Zymotic diseases is apt to be fallacious, since this rate may be excessive owing * Corrected rates for past 10 years. 14 to the epidemic prevalence of Measles and Whooping Cough, which are neither dependent upon the sanitary condition of a district nor to to any great degree preventible by the Sanitary Authority. For these reasons, I have divided the Zymotic Death Rate into two portions—a notifiable and a non.notifiable—and it is especially the first which furnishes a clue to the health conditions ot a community, since it includes those diseases which are more or less directly the expressions of faulty sanitary states. It will be seen that the rate from the Scheduled Diseases has decreased approximately 1 per 1,000 for the last two years, which is a very satisfactory feature. In this group is included the Enteric Fever Mortality, and this is held to be the test par excellence of the sanitary conditions, caused as it is by specific foecal contamination of water and air. There has only been 1 death in your District from Enteric Fever during the past 10 years—in 1897. Infant Mortality. The deaths of children under 1 year of is equivalent to 133.3, per 1,000 children born and registered. Deaths under 1 year Death rate per 1,000 living Birth rate per 1,000 living Death rate per 1,000 children born and registered. 1892 27 14.4 37.2 139.8 1893 14 11.5 34.6 74.0 1894 27 10.9 31.9 146.7 1895 26 13.9 28.1 139.5 1896 31 I2.6 28'1 149.7 1897 28 11.3 32.1 110.2 1898 32 14.1 34.8 112.3 1899 51 14.6 31.4 156.1 1900 44 13.2 34.3 124.6 1901 65 16.o 34.3 180.5 1902 62 12.2 36.6 133.3 Deaths under 5 years. The deaths of children under 5 years of age is 48.9 per 1,000, calculated on the number living at that age at the census 1901. The infant and child mortality constitutes a critical index of the health conditions; it is held that the rates of mortality amongst infants and young children exceeding rates for the county generally, are indications of unsatisfactory sanitary conditions in the Districts in which they occur. (The rate for England and Wales in 1896 was 161 per 1,000 births registered). It must be, however, remembered the term " unsatisfactory sanitary conditions," is a very wide one, and in the present instance implies maternal neglect, artificial feeding, and, above all, improper 15 artificial feeding : a state of things which is not directly under the control of the Sanitary Authority, but depends, for its improvement, upon the education of parents and others responsible for the welfare of infants. There has been a marked reduction in the rate during the year. Satisfactory as this is, the average rate is higher than it ought to be for a District like yours, and I am convinced from my own observations, and the registered causes of death support the conclusion, that at least two.thirds of the deaths are due to diseases induced by improper artificial feeding. Table of Deaths from Phthisis and other Tubercular Diseases. Phthisis. Rate. Other Tubercular Diseases. Rate. 1893 3 0.5 — — 1894 — — — — 1895 9 1.3 — — 1896 6 0.8 — — 1897 4 0.5 - — 1898 6 0.7 — — 1899 7 0.7 — — 1900 2 0.1 4 0.3 1901 14 1.3 4 0.3 1902 9 0.7 8 0.6 (For England and Wales, 1888, 1*5 per 1,000. Total Respiratory Death Rate. The Death Rate from diseases of the respiratory organs, viz.: Bronchitis, Pneumonia, Phthisis, &c., is 2.3 per 1,000. 1892 5.2 per 1,000. 1893 1.4 ,, „ 1894 2.3 „ „ 1895 4.6 „ „ 1896 2.9 „ „ 1897 2.2 „ „ 1898 1.8 „ „ 1899 2.4 „ „ 1900 2.0 „ „ 1901 4.6 „ „ 1902 2.3 „ „ The Death Rate for the West Ward was 27 per 1,000. ,, ,, ,, East ,, ,,20 „ „ The diseases included under this rate are most prevalent and most fatal where dampness and over.crowding in dwellings, workshops, &c., exists. (The average rate England and Wales, 1881.90, was 37.) 16 SECTION II. Notifiable Diseases. The number of cases of Infectious Disease which have been reported under the Infectious Diseases Notification Act during the year was 183. Eleven of these cases occurred in the London County Asylum, Norwood, so that the number occurring amongst members of our population proper was 172. The increase was due to the fact that Chicken Pox was a Notifiable Disease for 6 months of the year from March to September, during which period 73 cases were notified. Deducting these the increase in the cases ordinarily notified is 25, due to Scarlet Fever, Erysipelas and Diphtheria. The Certificates related to the following diseases :— Scarlet Fever 65 Membranous Croup 3 Erysipelas 21 Small Pox 2 Enteric Fever ... 2 Chicken Pox 73 Diphtheria 17 Table of Notifications for 10 years. 1893. 1894. 1895. 1896. 1897. 1898. 1899. 1900. I9OT. 1902 Scarlet Fever 76 45 23 56 39 31 60 47 56 65 Diphtheria and 18 15 3 4 88 80 111 44 11 20 Membranous Croup Typhus Fever - - - - - - - - - - Enteric ditto 6 — 1 2 15 7 2 4 3 2 Puerperal ditto 1 - - 1 - - - - - - Erysipelas 16 18 20 7 10 15 13 10 12 21 Small Pox 1 3 4 4 — — — — 2 2 Chicken Pox - - - - - - - - - 73 Divided into East and West Wards, the distribution of cases is as follows :— East. West. Scarlet Fever 25 40 Diphtheria 8 9 Membranous Croup 1 2 Enteric Fever 2 - Erysipelas 13 8 Small Pox 2 — Chicken Pox 47 26 i7 The following Tables shows the various localities in which the diseases occurred:— South side. North side. Hayes Bridge. Norwood Village. L.C. Asylum. St. Marylebone Schools. White St. North Hyde. Scarlet Fever 30 2 . . . 2 4 . Diphtheria 13 4 . . . . . . Membranous 1 2 . . . . . . Croup Enteric Fever 1 1 . . . . . . Erysipelas 3 3 . . 11 1 3 . Small Pox 2 — . . . . . . Chicken Pox 64 3 . 5 . 1 . . Twelve cases of Scarlet Fever, 2 cases of Diphtheria and 3 of Membranous Croup were treated at home, the remainder were removed to Hospital for treatment. Scarlet Fever. The number of cases notified was 65 compared with 56 for 1901. Of this number 36 were males and 29 females. The cases occurred at the following ages :— 1—5 5—15 15—25 25—65 17 43 2 3 Cases were notified every month, May excepted:— Month. Jan. Feb. Mar. April May June Jul y Aug. Sept. Oct. Nov. Dec. No. of cases 5 8 6 5 0 4 8 4 4 9 4 8 The number of infected houses was as follows :— North, South 1, North Hyde, White St., St. Marylebone Schools, 22 22 1 2 1 Incidence of Scarlet Fever per 1,000 of Population. 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 13.8 7.8 3.4 7.7 4.8 3.6 6.4 4.1 5.3 4.3 7.7 4.7 Average incidence per 1,000 for years 1893—1897. Average incidence per 1,000 for years 1898—1902. 1.—In three cases on which I reported in August there appeared to be fairly conclusive evidence as to the origin of infection. One of the Patients was an adult, notified in the peeling stage he had suffered from slight illness and sore throat, a little time previously but had not sought medical advice, A visitor in the house, from Liverpool, had an attack of "sore throat" shortly after her arrival here. 18 At the house in Liverpool, where she had been staying prior to her visit to Southall, there had recently been a case of Scarlet Fever ! 2.—A child returned home from the fever hospital after 10 weeks treatment for Scarlet Fever, a few days afterwards, the two other children in the house, were attacked with Scarlet Fever. The convalescent case had not a trace of peeling, but there was considerable discharge from the nose. This instance illustrates the value of hospital isolation in protecting the other members of the family, and the infectious nature of the nasal and other discharges which occur as sequence of Scarlet Fever. The source of infection in "return cases" is being carefully investigated by the Metropolitan Asylums Board, who have appointed a Medical Inspector for the purpose, and the trend of the evidence is that discharges from the nose and ears are the chief factors concerned, and that the desquamating skin is not so infectious (after a certain lapse of time) as it is usually thought to be. 3.—A child was " taken to the Doctor because of a large swelling in the neck " ; he was found to be peeling on the hands and face. He did not attend school: and was not a milk drinker, and the rest of the family were frse from any evidence of Scarlatina. Enquiries elicited the fact that a relative visited the house for a day, four days before the patient was first noticed to be ill. The relative was an employee at a Fever Hospital in the North of England. 4.—The only child of a family was attacked in October. He did not attend school. His mother had been going backwards and forwards to a house some half-a-mile away in which a case of Scarlet Fever had been recently notified. 5.—In by far the larger number of cases evidence of infection was not nearly so definite as in the instances cited. It was only after the occurence of successive cases and a consideration of the circumstances attending each group that it was possible to say that there must have been some common centre of infection, and the evidence goes to show that the attendance at school of children in an infectious condition has been chiefly responsible for the spread of the disease. This statement must not be taken as a reflection on the School Managers. Measures are taken by the School Board to prevent the introduction of infection into schools by a system of certification and a periodical medical examination of the scholars in all the schools. These cases of Scarlet Fever in the peeling stage were found in the schools by the Medical Officer to the School Board. From a preventative point of view, however, Scarlet Fever in its slight and modified form assumes the disguise of an ordinary Sore Throat, which is especially the cases in adults and children who have previously suffered from the disease. To recognise such cases as Scarlet Fever is a matter of great difficulty and is practically impossible when there is no complaint of illness, which is usually the case. 19 Infection derived from such cases gives rise to the disease in its typical form and it is to these facts we must look for the explanation of its spread and difficulty experienced in tracing the intermediate cases in the various groups. The question of infection by means of milk has been carefully considered with a negative result. There appeared, however, to be some risk of infection from the method in which milk is distributed. The milk vendors, for convenience, leave the morning milk at the various houses in small cans, subsequently collecting them in the evening, a fresh can beirg left with that supply, which is collected the following morning. Clearly, unless the cans are scalded before being used a second time, they may become the means of carrying infection. Circular letters were sent to the various vendors pointing out these dangers, and emphasising the importance of carrying out the instructions contained in Sec. 13 of the Dairies, Cowsheds and Milk Shops Order, which relate to this matter. A copy of the order being sent with each letter. Diphtheria and Membranous Croup. Seventeen cases of diphtheria, occurring in 12 houses, were notified. The majority of the cases were of a slight nature. Cases—Diphtheria. North Side, South Side, I Norwood, 4. 12. | 1. West Ward, East YVard, 9. 8. Membranous Croup. W est, East, 2. i. Ages. 1—5 years. 5—15 years. 15—25 years. 3. 12. 2. Males, Females, 7. 10. Infected Houses, North, South, Norwood, 4. 7. 1. Jan. March. April. May. June. Aug. Sept. Nov. I. 2. I. 3. I. I. I. 7. Incidence of Diphtheria per 1,000 of Population. 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 3.2 2.6 0.4 0.5 11.1 9.3 11 .7 3.9 1.0 1.5 v v . v v . .3.5 . 5.5 Average incidence per 1,000 for Average incidence per 1,000 for years 1893—1897. years 1898—1902. 20 There was no evidence of the disease being transmitted from one case to another, except in those notified in November, five of the seven notified in that month occurred in sequence in one house. The case notified in March occurred in a house from which three cases of diphtheria were notified three years ago, and the patient in question was one of those then attacked. It is known that the germ of diphtheria may cling to a dwelling even for this length of time ; and an attack of the disease rather predisposes to than protects from a second. A case notified in May was the third to occur in the same house within the last 5 years. In one case the infection appeared to have arisen in a very round-about manner. The patient was the only child in the family, he had been going to the Infant School for a year; and he never left the house except for the purpose of going to School. He was accompanied to and fro by a class-mate in whose family a case of diphtheria occurred 3 months previously when the family were living in another house than the one they now occupy. (All the members of this family were examined and found to be free from evidence of throat disease). If he was the means of conveying the infection it is necessary to assume the germs of diphtheria conveyed from the first to the second dwelling, either in the throat or by fomites : their transference to the intermediary and thence to the patient. Such a chain of circumstances seems improbable, but it is certainly not impossible that the infection may have had its origin in this manner. It was the only evidence obtainable for there had been no visitors to the house which was in a perfect sanitary state and exceedingly clean. The patient rarely drank milk and only after boiling. There had been no cases of diphtheria in the immediate neighbourhood for some time. Small Pox. The two cases of Small Pox, details of which were given in the last Annual Report, were eventually certified by Dr. Davidson (the Medical Officer of the Joint Hospital), as cases of Chicken Pox. It will be remembered that Dr. Davidson saw the cases in consultation before removal to the Hospital and notified them as cases of Small Pox. During the time they were under observation in Hospital their true nature became apparent. On the 22nd January, Dr. Manby visited the District in his official capacity as Medical Inspector of the Local Government Board. The details of administration in Small Pox cases were fully discussed at a Meeting held at the Council's Offices. Dr. Manby approved of the steps taken in the above cases, and he made certain recommendations as to the provision of a special staff of re-vaccinated persons for the purposes of disinfection &c., which were adopted by the Council. A case of Small Pox was notified on April 27th, at the Manager's House, at the Council's Sewage Works. The patient was a domestic 21 servant, and was the only inmate of the house who had not been vaccinated. She took the disease in a malignant lorm, and for some time was very dangerously ill. None of the other inmates contractedSmall Pox. It was ascertained on enquiring into the case that a relative living at Acton, had been the only visitor to the house within the incubation period. I subsequently examined him and found a few small scars of recent Small Pox. Dr. Garry Simpsom, the Medical Officer of Health for Acton, quite agreed with the diagnosis, and it was further confirmed by the occurrence of a case of typical Small Pox (notified on the 4th of May, to Dr. Simpson), the patient living in the same house at Acton as this man. On the 10th of Sept., a case of Small Pox was notified from the South side of the District. From the 23rd to the 30th August, she had been living at a house in Acton, in which a child was suffering from Chicken Pox. A person working at the house was said to have recently had Small Pox. Dr. Simpson investigated these cases, and confirmed the Chicken Pox, but there was no evidence of Small Pox, so the source of infection remained untraced. During the year two persons who had been in contact with cases of Small Pox outside the District, were kept under daily observation during the incubation period. Measles. During April, May and June, Measles was very prevalent throughout the District. It first appeared and for a time was limited to the South Side of the District. Since the disease is not notifiable we have no meams of estimating exactly the number of cases which occurred. The outbreak, however, was so widespread that there can have been but very few families with susceptible children which escaped attack. There were 5 deaths registered as directly due to measles, a rate of 0-4 per 1000 living, which is about the average rate for the County generally. The disease was of a mild character and we may assume a low case mortality. This varies from 1 per cent, to 5 per cent, of those attacked, but for the County generally it does not often exceed 1 per cent. : we may therefore infer an outbreak of 400 to 500 cases. The disease chiefly spreads through contact of children in school, and except by school closure in the early stage of an outbreak, but little control can be exercised over its spread. This is due to the fact that the disease is infectious before characteristic symptoms appear. Many parents seem to regard measles as one of the necessary evils of childhood, and in many cases do not seek medical advice or take any measures to isolate their children when attacked. It is true that when measles appears in a family, atttempts to protect the other susceptible members are usually futile: but by very simple precautions it can be prevented spreading outside the house. 22 Enteric—Typhoid Fever. Two cases of this disease were notified, in both of which the infection appeared to have been contracted outside the District. Isolation Hospital. The Buildings are rapidly nearing completion, and will be ready for the reception of patients early in 1903. The site comprises three acres,and is situate on the North side,and approached by a carriage-way from Mount Pleasant. The scheme provides for five blocks of buildings, viz: — Administrative, Mortuary and Laundry, Pavilion, Isolation and Discharging Blocks, to be built at present with provision for two future Pavilion Blocks (the foundations of one of these is built), two Isolation Blocks and Lodge Keeper's Cottage. The present buildings giving accommodation for 17 beds, and the future blocks adding another 34 beds, giving a possible total accommodation of 51 beds. The Administrative Block will contain a Matron's Sitting Room, a Nurse's ditto, a Doctor's Room with Dispensary, Lavatories, Stores, Kitchen and the usual offices on the Ground Floor. A Matron's Bedroom and 5 Bedrooms for Nurses on the 1st Floor, and two Bedrooms for Servants on the Attic Floor. This building is arranged for future additions as occasions may arise. The Mortuary and Laundry Block will contain a Mortuary and an Ambulance Shed, a Laundry and Washhouse fitted with a Drying Closet, a disinfecting building with a chamber for infected clothes, and another for disinfected clothes and fitted with a Dr. Thresh's apparatus. The Pavilion Block is arranged for 13 beds, and will consist of two large Wards each for 6 beds, an Emergency Ward for one bed and a Nurse's Duty Room arranged between the large wards. The Isolation Block is arranged for 4 beds in two Wards of 2 beds each, with a Nurse's Duty Room between. On the West side of this Block a glass verandah will extend the whole length of the building. The I )ischnrging Block will contain an Undressing Room and a Dressing Room with a Bath Room between. 23 SECTION III General Sanitary Matters. Water Supply. Water is supplied to the District by the South West Suburban Water Company. The only houses supplied from wells, are a few in the outlying parts. Samples of water from the mains on the North and South Sides, were submitted for Analysis in July. LABORATORY OF CLINICAL PATHOLOGY. Telephone No.: 1259, Pcuddington. Telegraphic AddressClinician, London 62, Queen Anne Street, London, W. Reference Number J Date, gth July, /902. Report on Chemical Analysis of a Sample of Water. To Dk. Windle, Southall-Norwood Urban District Council. I beg to submit the following Report on the chemical analysis of a sample of water, marked I2w., received from you on 7/7/02 :— Note.—The results are all expressed in grains per gallon. Free ammonia 0.0014 Albumenoid ammonia 0.0053 Total solid residue (dried at 220 F.) J8.97 Chlorine 1.4 Equivalent to Sodium chloride 2.3 Nitrites a minute trace Nitrogen existing as nitrates 0.07 Hardness. Total Hardness 1.27 Permanent Hardness (after boiling) 2.3 Lead or Copper nil Oxygen absorbed in 4 hours 0.102 Physical characters clear and bright This is water of satisfactory quality as regards freedom from organic pollution. It is somewhat hard, but the hardness is largely removed by boiling. (Signed) WALTER H. JOLLYMAN A.I.C., F.C.S. 24 LABORATORY OF CLINICAL PATHOLOGY. Telegrams: "Clinician, LondonTelephone: 1259 Paadington. 62, Queen Anne Street, London, W. Reference Number: /2M July, 1902. 7-2-79. J To Dr. Windle, Southall-Norwood Urban District Council. I beg to submit the following Report on the specimen of water for bacteriological examination, marked I2w., received at the Laboratory on 7/7/02 : This sample of water contains 400 organisms per c.c. No member of the colon group of bacteria was found in 55 c.c. of the water. I am of opinion that in its present condition the water is, from the bacteriological standpoint, free from sewage contamination and suitable for use as a drinking supply. G. L. EASTES. LABORATORY OF CLINICAL PATHOLOGY. Telephone No.: 1259 Paddington. Telegraphic Address: "Clinician, London." 62, Queen Anne Street, London, W. Reference Number: DoU> gth july^ I()02 Report on Chemical Analysis of a Sample of Water. To Dr. Windle, Southall-Norwood Urban District Council. I beg to submit the following Report on the chemical analysis of a sample of water, marked 13W., received from you on 7/7/02 :— Note.—The results are all expressed in grains per gallon. Free ammonia o.ooo6 Albumenoid ammonia 0.0056 Total solid residue (dried at 220 F.) 21.4 Chlorine 1.4 Equivalent to Sodium chloride 2.3 Nitrites nil Nitrogen existing as nitrates 0.07 Hardness. Total Hardness 127 Permanent Hardness (after boiling) 2.9 Lead or Copper nil Oxygen absorbed in 4 hours 0.093 Physical characters clear and bright This sample has practically the same composition as '. I2w.," and there is no reason to suspect that the water has been recently contaminated. (Signed) WALTER II. JOLLYMAN. 25 LABORATORY OF CLINICAL PATHOLOGY. Telegrams : "Clinician, LondonTelephone : 2239, Padding-Ion." 62, Queen Anne Street, London, W. Reference Number: 7-2-80. 12lh July, 1902. To Dr. Windle, Southall-Norwood Urban District Council. I beg to submit the following Report on the specimen of water for bacteriological examination, marked 13W., received at the Laboratory on 7/7/02 : This sample of water contains 160 organisms per c.c. The bacillus coli communis was not found in 55 c-c- I entertain the same opinion of the water as of No. I2W. G. L. EASTES. The Company is erecting a large Water Tower in the District, in order to furnish a more constant supply at a greater pressure. Disposal of Refuse. (a) Household Dust. All houses in the District are supplied by the Council with galvanized iron dust-bins provided with covers. The collection is a weekly one, carried on by a contractor who finds a shoot. The amount of refuse removed from each house averages rather over one load per annum. It will be a constantly increasing difficulty in future, from the rapid extension of huilding operations, to dispose of this material without causing nuisance, and I again urge you to consider the advisability of providing a refuse destructor lor dealing with this and other refuse. (1b). Sewage Disposal. I am indebted to our Engineer Mr. Reginald Brown, A.M.I.C.E., M.S.I., &c., for the following particulars as to the Disposal Works and Farm. The Sewage enters the Disposal Works at two different points. What may be termed the high level outfall Sewer takes the Sewage from the District proper. This enters the works by passing through a small chamber controlled by valves and thence into and through a receptacle in which is fixed one of Smith's Patent Revolving Wire Screens. This screen consists of a water wheel—driven by the momentum of the Sewage—which caus'es an endless band of wire net to revolve slowly, thus catching and lifting out all suspended matters beyond a certain size. A brush revolving in an opposite direction cleans the net as it passes and the solid matters are cleared to one side and removed by manual labour. The sewage then passes through a well, inside the liming house, and from thence through two valves into one or the other of two small detritus tanks covered with corrugated iron. These 26 tanks have a total capacity of 24,000 gallons. At the centre of the length of these tanks scum boards are fixed, the bottom edges of which are at a distance of 24-ins. below the level, the upper edges being above the water level; the outlet end of the tanks have also scum boards projecting to a distance of 12-ins. below the water level, and the top edges of same, of course being above the water level. The Sewage passes under these boards and over a lip in a con tinuous stream into a carrier. Up to this point the description applies to the existing Works, but as extensive alterations are now being made at the Works, the following will apply when the Works are •complete. Four new Precipitation Tanks of 600,000 gallons capacity are being constructed with the necessary apparatus in connection therewith. The tanks are arranged so that they may be used on the intermittent or continuous principle. The effluent from the Precipitation Tanks will then pass through about | acres of first Contact Beds. The feature of the new Works is the ample provision made for the effectual aeration of the whole system. A new storm water sewer has been laid down from Western Road, across the Recreation Ground and along Regina Road and Norwood Road to Norwood Green, which has had the beneficial effect of lowering the level of the sub soil water, and should be of great benefit to the occupiers of houses erected in that part of the District—from a health point of view. The lower outfall takes the sewage from one Institution only, viz., Hanwell Asylum, and discharges into two covered tanks, the combined capacity of which is about 57,000 gallons. The Sewage from these tanks is pumped up through a rising main and discharges into a well at the liming house before mentioned, and then passes through the same process as the District Sewage. The precipitated sludge passes into a sludge well near the low level tanks, and is pressed into cake form by means of a filter press. The whole of the machinery at the works is driven by gas engines, the gas being supplied from a Dowson gas generating plant. Factory and Worshops Act, 1901. The total number of Workshops in the District as per the Register is 26, including 10 Retail Bakehouses, 4 Laundries, and 12 other Workshops. The total number of visits of inspection made during 1902 by the Medical Officer of Health was 26, and by the Sanitary Inspector 70. The chief Workshop industries (as distinguished from Factories) in the District are carpenters, joiners, plumbers, and boot repairing, &c. The Sanitary conveniences of all the Factories, as well as Workshops, have been examined during the year by the Inspector and the Medical Offieer, and the accommodation was found to be suitable and sufficient: in the two of the Factories employing both sexes it was all that could be desired. 27 The condition of all these premises as regards cleanliness was generally speaking good : in two instances notice was served for lime-washing. No instance of overcrowding or deficient ventilation came under notice; in all cases the cubical air space was calculated and the efficiency of the means for ventilation considered with regard to the number of persons employed. No infringements of the Act have come under notice, which required to be reported to H.M. Inspector by the Sanitarv Authority. As re^irds the sanitation of the retail B.ikehouses generally speaking their general sanitary condition is satisfactory. These premises have been regularly inspected for some years past and great improvement has been effected in their condition. Four of the premises are underground Bakehouses, which will require the special consideration of the Council during the coming year as to their suitability for Certification under Section 101 of the Act. An ' underground bake-house' (which is now defined) is not to be used as a bake-house ' unless it was so used at the passing of this Act,' viz: August, 17th, 1901. After the first of January, 1904, an underground bake-house is not to be used, unless certified by the District Council to be suitable for that purpose ; and it is not to be certified as suitable, unless the Council is satisfied that it is suitable as regards 'construction, light, and in all other respects.' Cowsheds, Milk Shops and Dairies. (a). Cowsheds. All the premises on the Register have been inspected during the year. In no instance can it be said that the regulations of the " Order " are observed in their entirety. More especially is there a general breach of Paragraph 5, Section 17 of the Regulations. In no instance was there any evidence of overcrowding, of disease in the cattle, or of infectious illness in those engaged in milking, etc (b). Milk Shops and Dairies. All the premises on the Register have been inspected and were found to be in every way satisfactory. Due attention appears to be given to the cleanliness of the utensils used in the storing and distribution of milk, and the Regulations appear to be carried out in a very satisfactory manner. So far as could be ascertained there has been no infectious illness in any person engaged in this work. Slaughter Houses. I have inspected all the premises on the Register (5), as compared with 7 for last year, two being no longer in use. Speaking generally they were found to be in a satisfactory condition. The butchers' shops have also been inspected with a view to ascertaining that adequate means were provided for the storage and disposal of refuse. 28 General Sanitary Matters. The Sanitary Work for the year is particularised in detail in the manuscript tables appended to the Report which is furnished to the County Council, also an epitome of the same will be found at the end of the present Report, compiled by Mr. Henry Baxter (Assoc. Sanitary Institute) the Sanitary Inspector. (a) Insanitary Houses. In January No i, Mount Pleasant Cottages, Southall, was reported in an insanitary condition. The bedrooms were found to be very damp and dirty, and required to be thoroughly done out. The scullery outer wall dilapidated and letting water in. The Inspector served 3 days' notice to commence the necessary work which was complied with. In February I reported as follows on Newell's Cottages, Mount Pleasant, Southall.—These premises have been inspected by the Inspector, Surveyor and myself. We concluded that the amount of sanitary acccommodation provided is not sufficient, there being but two closets in a common yard for the five houses, with a population of 19-21 persons. Moreover, the buildings are dilapidated, the pans very dirty, which is a source of great annoyance to better tenants of some of the houses. The yard is unpaved : the surface very uneven and must be a source of nuisance in wet weather. In May I inspected numbers 4-18, Featherstone Terrace, Southall Green and found many defects and dilapidations coming under the 91st Section of the Public Health Act. Notice was served to put the premises into a proper state of repair and sanitary condition. This was complied with. (b) Overcrowding. Six cases of overcrowding were investigated during the year. All were of families living on the South Side of the District and in one or two instances were of a very injurious character. In each case the notice served to abate the nuisance was complied with. (c) Nuisances from Refuse. In January complaints were received as to a heap of refuse being unloaded from a barge on the Canal at Windmill Bridge. The refuse consisted of street sweepings, etc., and the chief source of nuisance arose from the burning of sacks, paper, etc. Measures were taken to abate the same. In July, complaints were received as to foul smells in the district which apparently came from the neighbourhood of the canal in the District of the Uxbridge Rural Authority. We made an inspection along the canal bank and found two deposits of refuse which were apparently the cause; a recent deposit adjoining Spike Bridge was in a state of combustion and giving off offensive fumes, and from an enormous heap adjoining the dock at Yeading large volumes of offensive smoke were being given off, which would undoubtedly give rise to the nuisance 29 complained of in our District, with the wind in a westerly direction. The Uxbridge Rural Sanitary Authority were communicated with and have taken action in the matter. Summary of Sanitary Inspector's Work for the Year 1902. Houses Inspected 820 ) ,, Re-Inspected 316 ) Shops, &c.— Butchers 12 Bakers 10 Milk Sellers 7 35 Cowkeepers, Sheds, &c. 6 Canal Boats— No. of Visits for Inspecting 43 „ Boats Inspected 66 Houses Let in Lodgings— No. on Register Inspected 3 Infectious Cases— No. of Rooms, &c. fumigated 85 „ ,, stripped and cleaned 26 „ ,, from which bedding, &c., destroyed 3 No. of Samples, Milk, Butter, &c., sent to Public Analyst 58 „ „ found adulterated 2 Infectious Cases Treated at Home— Scarlet Fever (6 N.) (9 S.) 15 Diphtheria (1 N.) (1 S.) . . 2 Membranous Croup (1 N.) 1 Infectious Cases sent to Hospital— Scarlet Fever (25 N.) 25 S.) 50 Diphtheria (3 N.) (12 S.) 15 Small-Pox (2 S.) 2 Enteric (1 N.) 1 No. of Letters and Notices sent out 389 No. of Nuisances Reported to the Council 2702 Nuisances Reported— Blocked Drains, &c. 127 Defective Water Supply to W.C. 25 Houses and Rooms in a dirty state 21 Accumulation of Manure and Filth 20 Defective Joints to W.C. Pans, &c. 15 ,, Fresh Air Inlets ix ,, Stack Pipes, Guttering, &c. 7 Keeping Fowls dirty, &c. 7 30 Nuisances Reported (continued)— Overcrowding 6 Burst Pipes, &c. .. 6 Burning Refuse 5 Cesspools to be Emptied 4 Roofs Repaired 4 Dirty Urinals 3 Defective Manholes 3 Stagnant Water .. 3 Obstruction to Path .. 1 Fried Fish Van .. .. 1 Unsatisfactory State of Accomodation for Workmen 1 Cisterns to be Cleansed, etc. 1 Henry T. Baxter, Sanitary Inspector, Assoc. San. Inst. Southall-Norwood Urban District Council. Canal Boats Inspected, &c., in 1902. No. of Special Visits for Inspection 43 „ of Boats Inspected 66 „ „ conforming to Act . 64 with Infringements 2 Although I made 12 more special visits to the Canal for the purpose of Inspecting Boats, during the past year than I did in 1901, there is a great falling off in the number inspected. This I believe is partly due to having been for some time a shortage of water up country so that the boats were unable to pass. I am pleased to report that I found the boats inspected kept in a much better condition, and in nearly every case quite satisfactory. Henry T. Baxter, Canal Boat Insp. Assoc. Sanitary Institute. Southall-Norwood Urban District Council. January 6th, 1903. The following will give the number of visits and boats inspected at same visits:— Visits. Boats Inspected at each visit. Total. O — 11 1 II 6 2 12 5 3 15 3 4 12 2 5 IO 1 6 6 43 66 3i Food and Drugs Act. Number of samples of food sent to Public Analyst 58 Found adulterated 2 Offensive Trades. No offensive trades as Scheduled in the Public Health Act, are carried on in the District. Infant Life Protection Act. There are no licensed premises under this Act in the District. No application made during the year. Contagious Diseases Animals Act. No outbreak reported duiing the year. Petroleum Act. One License granted—a renewal. Adoptive Acts in Force. (1) Infectious Diseases (Notification) Act, 1889. (2) Infectious Disease Prevention Act. 1890. (3) Public Health Amendment Act, X890. The Bye-Laws of this Authority recently revised are based on the Model Bye-Laws of the Local Government Board, and relate to— (1) Cleansing of earth privies, ashpits and cesspools. (2) For the prevention of Nuisances arising from snow, filth, dust, ashes and rubbish, and for the prevention of the keeping of animals on any premises, so as to be injurious to health. (3) Relating to common lodging houses. (4) New Streets and buildings. (5) Slaughter houses. (6) With respect to houses let in lodgings, or occupied by members of more than one family, a register of which is now kept. (7) Regulations as to dairies, cowsheds and milk shops. It will be apparent from the foregoing tables that Mr. Baxter has done a great amount of very useful work during the year. He has been most diligent, painstaking and impartial in the performance of the duties of his office. I am, Gentlemen, Your obedient Servant, J. D. WINDLE. TABLE III. Cases of Infectious Disease notified during the Year 1902. Notifiable Disease. Cases notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality. At All Ages. At Ages—Years. 1 2 3 4 1 2 3 4 Under 1. 1 to 5. 5 to 15. 15 to 26. 25 to 65. 65 and upwards West. East. Asylum. St. M'bone Schools. West. East. Asylum. St. M'bone Schools. Small-pox 2 — 1 1 2 2 Cholera — — — — — — — — — — — — — — — Diphtheria 17 — 3 12 2 — — 9 8 — — 9 6 — — Membranous croup 3 — — 3 — — — 2 1 — — — — — - Erysipelas 21 2 — 1 1 9 8 7 2 11 1 — — — — Scarlet fever 65 — 17 43 2 3 — 38 25 — 2 32 18 — — Typhus fever — — — — — — — — — — — — — — — Enteric fever 2 — — — 2 — — — 2 — — — 2 — — Relapsing fever — — — — — — — — — — — — — — — Continued fever - - - - - - - - - - - - - - - Puerperal fever — — — — — — — — — — — — — — — Plague — — — — — — — — — — — — — — — Chicken Pox 73 9 29 35 — — — 25 47 — 1 — — - - Totals 183 11 49 94 8 13 8 81 87 11 4 41 28 — — TABLE I- SOUTHALL-NORWOOD URBAN DISTRICT COUNCIL (EXCLUDING HANWELL ASYLUM)- For Whole District- Year- Population estimated to Middle of each Year Excluding Hanwell Asylum- Births- Total Deaths Registered in the District- Total Deaths in Public Institutions in the District- Deaths of Nonresidents registered in Public Institutions in the District- Deaths of Residents registered in Public Institutions beyond the District- Nett Deaths at all Ages belonging to the District- N umber- Rate-* Under 1 Year of Age- At all Ages- Number- Rate per 1,000 Births registered- N umber- Rate-* Number- Rate-* 1 2 3 4 5 6 7 8 9 10 11 12 13 1891- 5188 208 40-9 15 72T 64 12-3 - - 64 12.3 1892- 5188 193 37-2 27 139-8 89 17-1 1 90 17.3 1893- 5456 189 34-6 14 74 70 12-8 — — 70 12.8 1894- 5756 184 31-9 27 146-7 75 13-0 — — 2 77 13.3 1895- 6684 188 28-1 26 139-5 86 12-8 — — 7 93 13.9 1896- 7184 207 28-8 31 149-7 86 11-8 — — 5 91 12.6 1897- 7913 254 32T 28 110-2 90 11-3 — — 16 106 13.3 1898- 8531 258 30-2 32 112 3 98 11-4 23 121 14.1 1899- 9311 325 34-8 51 156-1 123 13-2 13 136 14.6 1900- 11,199 353 31-4 44 124-6 147 13-2 19 166 14.8 1901- 10,477 360 34-3 65 1805 165 15-7 — — 3 168 16-0 Averages for years 1891-1901- 7,535 256.3 31.3 32.8 129.7 97.6 13.1 — — 8-1 107.5 14,1 1902- 12,680 465 36.6 62 133.3 156 12.2 — — 5 156 12..2 * Rates calculated per 1,000 of estimated population- Area of District in acres (exclusive of area covered by water) 2515. Total population at all ages 10,365 Number of inhabited houses 1,920 At Census of 1901 Average number of persons per house 6.91 34 TABLE II. SOUTHALL-NORWOOD URBAN DISTRICT. Causes of, and Ages at, Death during Year 1902. Causes of Death. Deaths in whole District at subjoined Ages. Total Deaths in Public Institutions in the District. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Small-pox - - - - - - - - Measles 5 2 3 - - - - - Scarlet fever 2 — — 1 — 1 — 1 Whooping-cough 4 2 2 - - - - - Diphtheria and membranous croup 3 - - 3 - - - - Croup - - - - - - - - S 1 Typhus - - - - - - - - > Enteric - - - - - - - - ' Other continued - - - - - - - - Epidemic influenza - - - - - - - - Cholera - - - - - - - - Plague — — — — — — — — Diarrhcea 16 13 1 — — 1 1 3 Enteritis - - - - - - - 3 Puerperal Fever - - - - - - - - Erysipelas - - - - - - - 1 Other septic diseases - - - - - - - - Phthisis 9 — — 1 3 5 — 30 Other tubercular diseases 8 3 1 1 2 1 2 Cancer, malignant dissease 6 - - - - 4 2 9 Bronchitis 5 1 1 — — 3 4 Pneumonia 15 4 2 — — 6 3 11 Pleurisy — — — — — — — — Other diseases of respiratory organs 1 1 3 Alcoholism | 2 — — — — 2 — 1 Cirrhosis of Liver 1 Venereal diseases Premature birth 12 12 — Diseases and accidents of parturition 2 _ 1 1 _ Heart diseases 9 — — i 1 4 3 15 Accidents 7 1 3 1 2 — — Suicides 1 — — 1 — — All other causes 49 23 3 2 1 6 14 134 All causes 156 62 13 12 10 33 26 217