SOUT 044 THE SOUTHALL NORWOOD URBAN DISTRICT COUNCIL Annual Report of the Medical Officer of Health for the Year 1920. To the Chairman of the Southall-Norwood Council. Sir, I have pleasure in presenting my annual report upon the health of the district for 1920. In accordance with your wish, I have written briefly and excluded recurring details in order to reduce cost of printing. The statistics for the year are in all respects satisfactory. The gross death-rate is only 8.2 per 1,000, which is * well below the average for recent years and is an unusually low one for a working-class population. The death-rates from the various specified diseases are less than for last year, except that from cancer, which has increased of late years. The most satisfactory feature of the statistics is the low rate of infant mortality, 66.8 per 1,000 births, the lowest ever recorded for the district. It compares with 68.8 for last year, when the climatic conditions were exceptionally favourable for infant health, and the birth-rate was much lower. I am confident that the continued lowering of infant mortality during the last few years is largely due to the preventive work at the Welfare Centre and in the homes by the Health Visitors. In conclusion I beg to express my grateful appreciation of the support and assistance I have received from the members of the Council in carrying out the various measures I have had to ask them to adopt to cope with the unusual prevalence of notifiable illness during the year. I take the opportunity of thanking the members of the Public Health and Hospital staffs for their loyal co-operation and consistent good work under circumstances of unusual stress. I am, Sir, Your obedient Servant, J. D. WINDLE, Medical Officer of Health. April 29th, 1921. The Southall-Norwood Urban District Council. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1920. SUMMARY OF STATISTICS, 1920. Area : Land, 2,575 Acres ; Water, 50 Acres. Population:— Census, 1911 26,323 Estimates for 1920 28,787 Number of Houses on Rate Book Census 4,854 1920 5,402 Births:— Males (Legitimate) 328 „ (Illegitimate) 17 345 Females (Legitimate) 357 (Illegitimate) 14 371 Total Births 716 4 Birth-Rate per 1,000 Population 23.4 Total Deaths belonging to District 237 (Civilians only.) Males 103 Females 134 Death-Rate per 1,000 of Population 8.2 Number of Infant Deaths (under 1 year) 45 Legitimate 41 Illegitimate 4 Infant Mortality per 1,000 Births 66.8 Still Births notified 13 Death-Rate from:— Zymotic Disease 0.3 Respiratory Disease 0.1 Cancer 0.3 Tubercular Disease 0.7 POPULATION. The population of the district for 1920, estimated by the Registrar-General and used for the calculations in this report, is 28,787, not including inmates of Public Institutions in the District. This figure is approximately correct as checked by the number of houses in rating (5,402) and allowing a normal number of inmates (5.3) a house=28,630. It is probable, however, that our population is much larger than this, for in 1919 a house-to-house inspection gave a population of 35,865; an average of nearly seven persons a house then in rating. On this basis our population for 1920 would be 37,814, which, together with the inmates of the Hanwell Asylum (2,897), gives a total of 40,711. For the statistical purposes of the report I estimate the population of the East Ward at 12,137 and of the West Ward 16,650. 5 BIRTHS AND BIRTH-RATE. In calculating the birth-rate and the rates of mortality and morbidity, the figures furnished by the Registrar General are used; the totals differ slightly from those on the local registers, because ours are uncorrected, whereas the official figures are corrected for inward and outward transfers. The total number of births belonging to the district was 716; the number registered in our books, however, was 674. The birthrate per 1,000 population is 23.4. The birth-rate is 23.4 per 1,000 as compared with 16.5 for last year; it is the highest rate since 1914. The rate for the East Ward is 27.1 and the West Ward 20.7. The number of illegitimate births was 31, as compared with 46 for last year. Distributed in Wards, the births are as follows: EAST. WEST. Males. Females. Males. Females. 168 161 165 180 329 345 674 MONTHLY REGISTRATION OF BIRTHS. East Ward. West Ward. Totals. M. F. M. F. January 22 17 17 28 84 February 18 23 18 19 78 March 12 19 14 5 50 April 14 6 7 16 43 May 18 14 13 22 67 June 14 12 14 16 56 July 12 11 15 13 51 August 13 13 16 13 55 September 10 12 16 8 46 October 13 11 10 12 46 November 10 11 5 9 35 December 12 12 20 19 63 Totals 168 161 165 180 674 6 COMPARATIVE TABLE. Year. Births. Rate. Population. 1904 578 36.7 15737 1905 576 32.6 17712 1906 621 33.6 18777 1907 677 31.2 21352 1908 660 29.4 22371 1909 686 29.4 23291 1910 664 27.6 24000 1911 689 29.2 23522 1912 660 25.5 25860 1913 711 26.5 26736 1914 698 25.7 27095 1915 610 22.2 27366 1916 625 22.4 27863 1917 491 16.5 29602 1918 517 15.5 33282 1919 443 16.5 28838 1920 674 23.4 28787 DEATHS AND DEATH-RATE. Whole District. Total, 237 (Males, 98; Females, 139); Rate, 8.2 per 1,000. The total number of deaths registered of persons dying within the district at all ages and from all causes was 175 (males, 72, females, 103). For statistical purposes it is necessary to add to this figure the deaths of persons from your district who died in the Hillingdon Infirmary, the various London Hospitals, and Middlesex County Asylums. These "outside" deaths were 62 in number (males, 26, females, 36). The total number of deaths, therefore, belonging to the district is 237, and the death-rate 8.2 per 1,000. The deaths in Hanwell Asylum were 167 (males, 83; females, 84). Deaths and Death-rates—East and West Wards. In the Fast Ward the deaths registered in the district were 82 (males, 36; females, 46). The "outside" deaths numbered 19 (males, 5; females, 14). Total deaths belonging to this Ward, 101. Rate, 8.8 per 1,000. In the West Ward the deaths registered in the district were 93 (males, 36; females, 57). The "outside" deaths were 43 (males 21, females, 22). Total deaths belonging to this Ward are 136. Rate, 8.1 per 1,000. For the purpose of comparison the following table is shown, giving the birth and death-rates and the rates of infantile mortality in England and Wales during the year 1920, the figures being provisional :— 7 ENGLAND AND WALES. Birth-rate, Death-rate, and Analysis of Mortality during the Year 1920. (Provisional figures. Populations estimated to the middle of 1920 have been used for the purposes of this Table.) Birthrate per 1,000 Total Population. Annual Death-rate per 1,000 Civilian Population. Hate per 1,000 Births. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Violence Diarrhoea and Enteritis (under 2 Years). Total Deaths under One Year. England and Wales 25.4 12.4 0.01 — 0.19 0.04 0.11 0.15 0.48 8-3 80 96 Great Towns, 26.2 12.5 .01 — 0.22 0.04 0.14 0.16 0.13 10-4 85 cluding London (Census Populations exceeding 50,000). 148 Smaller Towns 24.9 11.3 0.02 — 0.19 0.03 0.10 0.14 0.38 7-8 80 (Census Populations 20,000-50,000). London 26.5 12.4 0.01 — 0.22 0.05 0.17 0.22 0.47 9-5 75 Southall-Norwood 23.4 8.2 — — 0.03 — 0.03 0.03 0.31 0-21 66-8 8 The Ages and Causes of Death are shown in the subjoined Tables for the whole District, and separately for the East and West Wards, 1920. Causes of Death. Deaths in or Belonging to whole District at Subjoined Ages. Deaths in or Belonging to Localities (at all Ages). Total Deaths in Public 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. Over 65. East. West. Outside Deaths. Sanatorium. Hanwell Asylum. Meningitis 1 — - — — — — — 1 — — 1 — — Enteric Fever — — — — — — — — — — — — — — Measles 1 1 — — — — — — — 1 — — — — Whooping Cough 1 1 — — — — — — — — 1 — — — Diphtheria and Croup 1 — — — — 1 — — — — 1 — 1 — Erysipelas — — — — — — — — — — — — — — Dysentery — — — — — — — — — — — — — 5 Heart Disease 28 1 — — 1 1 1 12 12 10 16 2 — ft Phthisis 23 — — — 1 8 7 4 3 6 8 9 — 21 Tuberculous Meningitis 3 1 1 — 1 — — — — — 1 2 — — Other Tuberculous Diseases 6 1 — — — 2 2 1 — 3 1 2 — — Cancer 20 — — — — 1 — 9 10 8 8 4 — 9 Bronchitis 10 2 — — — — — 4 4 3 6 1 — 2 Pneumonia (all forms) 21 — — 1 2 2 5 2 3 9 10 2 — 8 Other Diseases of respiratory organs 1 — — — — — 1 — — — 1 — — — Diarrhœa and Enteritis 6 5 1 — — — — — — 1 1 4 — — Appendicitis and Typhlitis 1 — — — — — 1 — — — — 1 — — Alcoholism — — — — — — — — — — — — — — Cirrhosis of Liver — — — — — — — — — — — — — 1 Nephritis and Bright's Disease 9 — — — 2 — 2 2 3 — 8 1 — 8 Diseases of Parturition 2 — — — — 1 1 — — 1 — 1 — — Premature Births 15 15 — — — — — — — 8 6 1 — — Violent Deaths, excluding Suicides 9 — — — 2 1 2 4 — 2 1 6 — 1 Suicide — — — — — — — — — — — — — — Other Defined Diseases 65 2 — — 2 2 6 12 41 25 15 25 — 106 Ill-defined Diseases — — — — — — — — — — — — — 1 Rheumatic Fever — — — — — — — — — — — — — — Influenza 1 — — — — — 1 — — 1 — — — — Marasmus ft 5 — — — — — — — 2 3 — — — Convulsions 8 5 1 2 — — — — — 2 6 — — — All Causes 237 45 3 3 11 19 29 50 77 82 93 62 1 167 9 Deaths, and Death Rates distributed into Wards, 1920. Causes of Death. EAST WARD. Causes of Death. WEST WARD. U nder 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. Over 65. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 4t and under 65. Over 65. Measles 1 — — — _ — — — Erysipelas ... — — — — — — — — Whooping Cough — — — — — — — — Measles — — — — — — — — Diphtheria — — — — — — — — Whooping Cough 1 Erysipelas — — — — — — — — Diphtheria — — — — 1 — — 6 Cancer — — — — — — 4 4 Cancer — — — — — — 2 — Phthisis — — — — 3 2 1 — Phthisis — — — — 1 2 2 3 Tubercular Meningitis — — — — — — — — Tubercular Meningitis — 1 — — — — — — Other Tubercular Diseases 1 — — — 1 — 1 — Other Tubercular Diseases — — — — 1 — — — Bronchitis 1 — — — — — 1 1 Bronchitis 1 — — — — — 2 3 Puerperal Fever — — — — 1 — — — Other Respiratory Diseases — — — — — 1 — — Pneumonia (all forms) 2 — — — 1 3 1 2 Pneumonia (all forms) 4 — 1 1 1 1 1 1 Diarrhoea and Enteritis 1 — — — — — — — Diarrhoea and Enteritis 1 — — — — — — — Alcoholism — — — — — — — — Nephritis — — — 2 — 2 i 3 Cirrhosis — — — — — — — — Cirrhosis — — — — — — — — Nephritis — — — — — — — — Diseases of Parturition — — — — — — — — Diseases of Parturition — — — — — — — — Puerperal Fever — — — — — — — — Premature Births 8 — — — — — — — Premature Births 6 — — — — — — — Suicide — — — — — — — — Suicide — — — — — — — — Accident — — — 1 1 — — — Accident — — — — — — 1 — Heart Disease — — — 1 — 1 5 3 Heart Disease 1 — — — 1 — 6 8 Defined Diseases 5 — 1 1 1 2 3 16 Defined Diseases 7 1 1 — — — 4 11 Ill-defined Diseases — — — — — — — — Ill-defined Diseases — — — — — — — — Appendicitis — — — — — — — — Appendicitis — — — — — — — — Influenza — — — — — 1 — — Influenza — — — — — — — — Totals 19 — 1 3 8 9 16 26 Totals 21 2 2 3 5 6 19 35 10 DEATHS—COMPARATIVE TABLE. DEATHS. 1919. 1920. Increase over 1919. Decrease Comparative Table. Sanatorium. Harwell Asylum. Outside Deaths. Meningitis — 1 1 — — — 1 Enteric Fever — — — — — — — Measles 3 1 — 2 — — — Whooping Cough 2 1 — 1 — — — Diphtheria and Croup 3 1 — 2 1 — — Erysipelas 1 — — 1 — — — Dysentery — — — — — 5 — Heart Disease 27 28 1 — — 5 2 Phthisis 17 23 6 — — 21 9 Tubercular Meningitis 1 3 2 — — — 2 Other Tuberculous Diseases 5 6 1 — — — 2 Cancer 18 20 2 — — 9 4 Bronchitis 17 10 — 7 — 2 1 Pneumonia (all forms) 23 21 — 2 — 8 2 Respiratory Diseases — 1 1 — — — — Diarrhoea and Enteritis 1 6 5 — — — 4 Appendicitis and Typhlitis — 1 1 — — — 1 Alcoholism 1 — — 1 — — — Cirrhosis of Liver — — — — — 1 — Nephritis and Bright's Disease 7 9 2 — — 8 1 Parturition 1 2 1 — — — 1 Premature Births 11 15 4 — — — 1 Violent Deaths, excluding Suicides 8 9 1 — — 1 6 Suicides 1 — — 1 — — Other Defined Diseases 62 65 3 — — 106 25 Ill-defined Diseases 2 — — 2 — 1 — Rheumatic Fever — — — — — — — Influenza 19 1 — 18 — — — Marasmus 4 5 1 — — — — Convulsions 2 8 6 — — — — Scarlet Fever 1 — — 1 — — — Puerperal Fever 1 — — 1 — — — The chief differences in the number of deaths from specified causes compared with last year are: Decrease of 6 deaths from the Zymotic diseases, of 18 from Influenza and 9 from various respiratory diseases. There is an increase of 5 deaths from Diarrhoea and Enteritis, and of 4 from premature birth. The death-rate of 8.2 per 1,000 is a very low one, and if properly corrected it would probably be higher than this, but the data are not available. Compared, 11 however, with the gross rates of previous years, the steady decline which has taken place is an evidence of improved and sanitary circumstances generally. This is borne out by the small number of deaths under one year of age, and the low child mortality, only 6 deaths occurring between the ages 1 to 5 years. Of the 29 deaths at ages 25 to 45, 16 were due to infective diseases (Tuberculosis 9, Pneumonia 5, Influenza 1, Puerperal Fever 1), and 2 to accidents. Indeed, the tables show that more than half the total deaths are due to essentially preventable diseases. The death-rates in the Wards are so nearly alike as not to call for comment. INFANT MORTALITY DURING 1920.—Whole District. The total number of deaths under one year of age was 45. Rate per 1,000 births, 66.8. The rate in England and Wales was 80, and for the 148 smaller towns, 80 per 1,000. Tables of Infant Deaths from Stated Causes in Weeks and Months under 1 Year of Age. Cause ok 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. Tubercular Meningitis — — — — — — 1 — — 1 Premature Birth 12 — 1 1 14 1 — — — 15 Bronchitis — — — — — — 1 — 1 2 Pneumonia — — — — — — 3 3 — 6 Diarrhœa — 1 — — 1 1 2 1 — 5 Whooping Cough — — — — — 1 — — — 1 Measles — — — — — — — 1 — 1 General Tuberculosis — — — — — — — 1 — 1 Other defined diseases 3 1 1 1 6 4 1 — 1 12 Heart Failure — — — 1 1 — — — — 1 Totals 15 2 2 3 22 7 8 6 2 45 12 EAST WARD.—Infantile Mortality during the Year 1920, 63.8 per 1,000. Net Deaths from stated causes at various ages under One Year of Age. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. Pneumonia 2 2 Measles — — — — — — — 1 — 1 Premature Births 7 — — — 7 1 — — — 8 General Tuberculosis — — — — — — — 1 — 1 Bronchitis — — — — — — — — 1 1 Other Defined Diseases 1 — — 1 2 2 — — 1 5 Enteritis — 1 — — 1 1 1 — — 3 Totals 8 1 1 10 4 1 4 2 21 WEST WARD.—Infant Mortality during the Year 1920, 66.4 per 1,000. Net Deaths from stated causes at various ages under One Year of Age. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. Heart Failure — — — 1 1 — — — — 1 Premature Births 5 — 1 1 7 — — — — 7 Bronchitis — — — — — — 1 — — 1 Pneumonia — — — — — — 3 1 — 4 Diarrhœa — — — — — — 1 1 — 2 Tubercular Meningitis — — — — — — 1 — — 1 Other Defined Diseases 2 1 1 — 4 2 1 — — 7 Whooping Cough — — — — — 1 — — — 1 Totals 7 1 2 2 12 3 7 2 — 24 13 Comparative Tables. Whole District. Year. Deaths under 1 year. Births. Birth-rate per 1,000 living. Infant Mortality Rate 1892 27 193 37.2 139.8 1893 14 189 34.6 74.0 1894 27 184 31.9 146.7 1895 26 188 28.1 139.5 1896 31 207 28.1 149.7 1897 28 254 32.1 110.2 1898 32 258 30.2 112.3 1899 51 325 34.8 156.1 1900 44 353 31.4 124.6 1901 65 360 34.3 180.5 1902 62 465 36.6 133.3 1903 64 476 34.4 134.4 1904 85 578 36.7 147.0 1905 58 576 32.5 100.6 1906 96 621 33.6 154.0 1907 64 677 31.2 94.3 1908 63 660 29.4 95.4 1909 65 686 29.4 94.7 1910 63 664 27.6 94.8 1911 81 689 29.2 129.3 1912 73 660 25.5 110.6 1913 70 711 26.5 98.4 1914 50 698 25.7 71.6 1915 69 610 22.2 110.3 1916 41 625 22.9 65.6 1917 55 491 16.5 112.0 1918 39 517 15.5 75.4 1919 33 479 16.5 68.8 1920 45 716 23.4 66.8 The infant mortality rate is the most reliable statistical evidence of healthiness of surroundings; the figure is always accurate because it is calculated on known numbers and not or. estimates. To some extent the rate rises and falls with the birth-rate, and it is largely influenced by epidemic measles, whooping cough and diarrhœa but over a series of years it is an indication of bad sanitary circumstances if the rate exceeds that for England and Wales. The next table shows the steady fall in your district since 1892, from an average of 135.3 to 86.4 per 1,000. Years. Average Rate of Infant Mortality. Average Birth-rate per 1,000 Population. 1892-1901 135.3 32.2 1902-1911 117.7 32.2 1910-1914 100.4 26.9 1915-1919 86.4 18.7 14 The rate for the present year (66.8) is the lowest recorded for the district; it compares with 80 for the country generally. We aim, however, at a standard rate of about 50 per 1,000, and with extension of infant welfare work I believe this will be accomplished in the near future. As in previous years the greater number of deaths from prematurity and enteritis occurred in those areas and particular streets where the domestic circumstances are least favourable, and the illegitimate births had a similar distribution. Turning to the cause of death, there were 5 deaths from enteritis, which together with one between 1—2 years, gives an enteritis rate of 8.3 per 1,000 births, which is somewhat higher than should be considering the low general rate. Sixteen deaths were due to prematurity and 5 to enteritis; that is more than proof the deaths were due to preventable causes. It is noteworthy that one-half the deaths occurred within the first month of life and one-third within the first week of birth. MATERNITY AND INFANT WELFARE CENTRE. Summary of Infant Welfare Work for 1920. (Miss Boyd, Miss Rice Oxley and Miss Stanbridge.) Number of Births Notified:— Males 220 Females 231 Number of Illegitimate Births Notified 21 Number of Still-births Notified 13 Number of Births not Notified:— Males 105 Females 106 Number of Visits paid to:— Infants (1st) 601 Children (1st) 19 Re-visits:— Infants 1,852 Children 2,502 Ineffectual Calls 2,306 Method of Feeding:— Breast 526 Bottle 38 Breast and Bottle 33 Spoon 4 Total number of Visits paid during year:— Mothers and Infants 4,637 Attendances at Infant Clinic 2,445 15 SUMMARY OF ZYMOTIC DISEASE VISITS. (Miss Perrett.) Visits paid to Infectious Cases:— Scarlet Fever 128 Antitoxin 20 „ „ Contacts 1,039 Swabs Taken 252 Diphtheria 20 Whooping-Cough 14 ,, Contacts 190 Eyes 7 Chicken-Pox 24 Small-Pox Contacts ... 4 Measles 527 Erysipelas 19 Tubercular 205 Miscellaneous Visits ... 680 Discharging Ears 20 Scabies 72 Total Visits paid during year 3,271 Pneumonia 24 Sore Throats. 202 INFANT AND CHILD WELFARE. Details of the administration of the Centre are the same as in the report for 1919 except that there are now three infant consultation days a week, on one of which new cases only are seen. The number of notified births during the year was 471, the number of births on the register was 675. The number of babies attending the Centre during the year was 199. This proportion of 1 to 3.3 births is lower than would have been expected, and effort is needed to increase the attendance of children from 1—5 years. The number in the district as ascertained by a house-to-house visitation was 1 271, whereas the number attending was only 254, and of these most between 1—2 years. Some idea of the valuable preventive work done at the Centre can be obtained by comparing the mortality of the babies regularly taken to the Centre with that of the babies not under the supervision of the Centre. Of the babies whose names were on the Register of the Clinic 8 died during the year. The cases are summarised in the following table:— 16 DEATHS OF BABIES ATTENDING CENTRE DURING THE YEAR 1920. Name. Age. Cause of Death. No. of Attendances at Centre. A. W. 7 mths. Measles 1 G. A. 6 ,, Pneumonia 12 S. O'C. 1 „ Inanition 1 F. B. 6 wks. Convulsions 1 R. C. 4 mths. Bronchitis and Heart Failure 6 M. L. 7 „ General T. B. 4 C. T. 5 „ Convulsions 8 W. H. 3 „ Pneumonia 2 The mortality is therefore only 40 per 1,000 births, a rate lower than the ideal of 50 per 1,000, which it has been your aim to attain. But this figure needs correction since four of the babies were brought to the Centre as emergency cases of illness, so that the mortality rate of babies regularly attending the Centre was only 20 per 1,000, or no more than one-third of the rest of the infant population. The crucial test, however, of the value of infant welfare work is furnished by the mortality from diarrhœal diseases. The rate for babies attending the Centre regularly was nil, whereas that for babies not attending the Centre was 9.6 per 1,000 births, or corrected for cases not under the health visitor's observation, 7.5 per 1,000. INFANT DEATHS FROM DIARRHœA FOR 1920. Name. Date of Birth. Date of Death. Feeding. No of home visits paid by Health Visitor. Remarks. T. S. 12/3/20 26/7 /20 Breast 5 Birth not notified. Birth and Death registered same week Died in Hilling- don Infirmary. Died in Hospital. C. T. 4 13 /20 4 /8 /20 Do. 11 A. H. 30 /11 /20 20/12/20 Breast & Artificial 2 M. C. 17/7/20 8/9/20 Breast 1 D. H. 31/7/20 31/8/20 D. H. 12/11 /18 23 /1 /20 Artificial 6 J.D. 12/6/20 19/8/20 Do. 6 17 SUPERVISION OF ILLEGITIMATE INFANTS. No. Notified Mother Living. Baby Living. Cause of Death. Occupation of Mother. Remarks. 1 Mother Living Baby Living - Housework Child with Mother. 2 Do. Do. - Do. Do. do. 3 Do. Do. - Do. Do. do. 4 Do. Do. - Do. Do. do. 5 Do. Do. - Do. Do. do. 6 Do. Do. - Do. at Home Do. do. 7 Do. Do. - Do. do. Do. do. 8 Do. Do. - Do. do. Do. do. 9 Do. Do. - Do. do. Do. do. 10 Do. Do. - Do. do. Do. do. 11 Do. Do. - Do. do. Do. do. 12 Do. Do. - Do. Factory Do. do. 13 Do Do. - Do. do. Do. do. 14 Do. Do. - Do. Service Do. do. 15 Do. Do. - Do. do. Child in care of Grandmother. 16 Do. Do. - Needlework Child in care of Foster Mother 17 Do. Do. - — Mother since married 18 Do. Do. - — Removed from district. 19 Do. Do. - — Child born in Institution. 20 Do. Died Malformation of Mouth Still-born — — 21 Do. - - - 18 VOLUNTARY WORKERS AND THE SUPPLY OF MILK. I am indebted to Mrs. Richardson for the following particulars:— Early in 1920 a memorandum was received by the Council from the Ministry of Health, pointing out how necessary it was that a Welfare Centre should have a managing committee, containing voluntary workers, and including working women. Their assistance, it said, both on the Committee and in the practical work of the Institution, creates an atmosphere of human sympathy and friendship, which is eminently desirable. The value of disinterested work of this kind is immeasurable. The voluntary workers will only be of use if they are competent, can attend regularly, and have definite duties allotted to them. Such work as the keeping of records, preparing babies for weighing, showing model garments and giving simple instructions as to their making, may properly be undertaken by voluntary workers. On receipt of this memorandum, all women's organisations in the district were invited to submit names of suitable women, who duly met and commenced their duties by arranging for the Annual Baby Day and Garden Partv in the Manor House grounds in July. All matters connected with the competitions for babies were under the care of the staff at the Centre, but an attractive programme, with an address suitable to the occasion by Dr. Barbara Tchaykovsky, of Harrow, was arranged by the voluntary workers. The profit resulting was devoted partly to form the nucleus of a fund for needy mothers, and partly to the purchase of materials— to which the Council added a grant of £5—with which to start a sewing class for mothers, in accordance with the wishes of the Ministry. At this sewing class model hygienic garments are made by the mothers—the material being supplied at cost price and cut out by the voluntary workers, who also give instruction and assistance, if desired, with the needlework. The Ministry also advise collective teaching and health talks, which are given on the same afternoon bv Nurse Boyd. It has been found best to hold the sewing class and health talk for mothers on Clinic afternoons, when voluntary workers attend to relieve the mothers of the care of the babies while waiting to see the doctor. The model garments have proved very attractive to mothers, who also welcome the assistance given to them. The voluntary workers are also prepared to provide cut-out paper patterns. The voluntary workers number 16, and each has her special duty. Some admit the mothers on Clinic days, prepare teas for them, and serve the drugs, oil and malt, and dried milk ordered by the doctor. 19 Others are responsible for the organisation and management of the sewing class, and those who are members of the Infant Welfare Committee attend on Mondays and Wednesdays to deal with the applications for the supply of milk to necessitous mothers. In the New Year all united to give a delightful tea and social evening to over eightv mothers and as many babies, and have also Created a small fund to provide for any special need of necessitous mothers, such as railway fares to take their children to Hospital. THE SUPPLY OF MILK. At the end of 1919, the Ministry of Health advised the Council as to the importance to the health of the nation of supplying milk at a reduced price to necessitous nursing and expectant mothers, and children under 5, and this was undertaken by the Committee in January, 1920. All mothers receiving milk are expected to bring their children to the Clinic. Milk is only granted free to (1) Poor widows, (2) Single girls, (3) Out-of-works, (4) Special cases of sickness and poverty. All other grants are made on a contributory basis of 4d. and 6d. a quart, according to the net income per head of the family on a fixed scale of income. The net income is defined as: The income, less the outgoings divided by the number in family. The outgoings are: (a) Rent, (b) Insurance, (c) Fares to and from work. Applicants in giving all particulars are required to state their income from all sources, including pensions and wages of such children as are earning. More than half of these are nursing and expectant mothers and most of the remainder have children under 3 years of age. An analysis of the 110 cases in September shows:— Nursing Mothers 48 Expectant Mothers 14 Widows 10 Single Girls 4 Out-of-work 10 Large Families 12 Poverty or Sickness. 12 It was found that many of the applicants had not been in the habit of having cow's milk, and many have testified to the great benefit they have derived, being now better able to continue nursing their babies. 20 ANALYSIS OF MILK SUPPLY. 1920. Cases. Free. Contrib. 4d. a Quart. Contrib. 6d. a Quart. Dried Milk at Half Cost. January 36 36 - - - February 38 13 23 — 2 March 79 13 62 — 4 April 101 15 80 — 6 May 92 13 75 — 4 June 102 30 69 — 3 July 109 35 70 — 4 August 100 31 64 — 5 September 110 29 78 — 3 October 113 33 76 — 4 November 116 32 76 5 4 December 112 30 48 28 6 SUMMARY OF ANTE-NATAL WORK. (Miss Boyd.) Visits paid:— Ante-Natal 136 Number of attendances at Ante-Natal Clinic 183 More than half the confinements in the district are now attended by midwives. There are five in practice in the district ; four live on the South side, while for the equally large population on the North side there is only one midwife. Of the notified births the midwives attended 261 cases; in three of these doctors were called in to apply forceps. There were 26 forceps deliveries in the 414 doctors' cases. The forceps rate for midwives' cases is 1.1 per 100, and for doctors' cases 6.1. Last year the rates were 1.2 and 17.5 respectively. SALE OF DRIED MILK. Cost. Amount Received. Amount Sold. £318 2 0. £318 2 0. 2,909 lbs. 21 NOTIFIABLE DISEASES. The number of notifications was 295, as compared with 591 for last year. The decrease was due to Scarlet Fever (49), Diphtheria (28), Enteric (9), Chicken-pox (116). Sixty-seven of the notifications were from Hanwell Asylum, so that the number belonging to the district was 228. NOTIFICATIONS CLASSIFIED IN LOCALITIES FOR 1920. Diseases. Total for District. East Ward. West Ward. London County Asylum. Scarlet Fever 141 57 84 - Diphtheria 22 9 13 - Enteric Fever — — — - Malaria 4 1 3 - Typhoid Fever — — — - Pneumonia 51 23 28 6 Dysentery 4 2 2 58 Membranous Croup 1 — 1 — Erysipelas 12 5 7 — Puerperal Fever — — — — Ophthalmia Neonatorum 2 — 2 - Chicken-pox 28 8 20 - Encephalitis- Lethargica — — — 1 Tuberculosis—Pulmonary 22 8 14 2 „ Non-Pulmonary 8 4 4 - 295 117 178 67 SCARLET FEVER. The number of cases reported during the year is 141. The incidence is 4.8 per 1,000 population. Forty-six cases occurred on the North side of the railway and 95 on the South. Cases treated in the sanatorium were 112, the rest were isolated at home for 22 special reasons. The following table shows the monthly number of cases, and their distribution North and South of the railway:— Month. North Side. South Side. Total. January 12 16 28 February 4 14 18 March 1 10 11 April 1 4 5 May 2 11 13 June 3 3 6 July — 4 4 August 2 1 3 September 4 3 7 October 1 5 6 November 9 19 28 December 7 5 12 46 95 141 The excess of cases on the South side is due to the greater density of population in those streets and areas from which the majority of the cases came. In most of the houses the crowding limit is reached, and in many exceeded. This rendered control difficult, as evidenced by the fact that in this part of the town by far the greater number of multiple cases in one house occurred. Here, too, street infection and house-to-house infection seemingly played a greater part in the spread of the complaint than elsewhere. TABLE OF AGES. 1-5 Years. 5-15 Years. 15-25 Years. 25-45 Years. Total. East Ward 8 41 6 2 57 West Ward 14 55 11 4 84 22 96 17 6 141 While the incidence was mainly on children of school age, the number of adult cases shows an excess as last year. 23 DIPHTHERIA AND CROUP. Twenty-two cases of Diphtheria were notified, as compared with 51 last year. Month. North Side. South Side. Total. January 1 1 2 February — — — March 2 — 2 April 1 — 1 May — 1 1 June — — — July 2 — 2 August — 1 1 September 1 3 4 October — 2 2 November 1 1 2 December 2 3 5 10 12 22 DIPHTHERIA AND MEMBRANOUS CROUP. TABLE OF AGES. 1—5 Years. 5—15 Years. 15-25 Years. 25-15 Years. 4 14 3 1 Seventeen of the patients were treated in Hospital, and 5 were isolated at home. Two of the notified cases, both adults, proved negative on repeated tests. There was only 1 fatal case, an adult admitted in April. One patient admitted in May was a visitor from Cardiff, and there is no doubt he had the complaint when he came here. Four of the cases occurred in two houses; but there was no grouping of cases in any particular street or locality, nor incidence among the scholars of any school. Only 9 of the patients attended school, 6 of these were attending 4 different schools on the South side, 2 one school on the North side, and 1 a London school. Out of the large number of tests taken from the throats of contacts of the notified cases only 2 were returned positive. 24 I have related our routine method of administration in cases of Scarlet Fever and Diphtheria in other reports. It would take too much space to record here the detailed enquiries into the different groups of cases during the year. The summary of the work is as follows:— As the result of examination of children in the different schools in the district, public and private, it was found necessary to exclude 414 scholars. Of these 142 had rhinorrhoea, 24 were desquamating, 105 had sore throats and 7 enlarged glands. Absentees visited at home for suspicious illness were 404, and children inspected before return to school after exclusion were 310. The total number of swabs taken from diphtheria contacts was 322. House-to-house visitation was made in certain streets to search for overlooked cases. Approximately the families in about 200 houses were examined and in this way a number of children with suspicious symptoms of previously overlooked illness were discovered. As regards the incidence of Scarlet Fever on school children, 60 of the notified cases attended elementary schools on the South side, and of these 27 were infant scholars. On the North side there were 19 elementary school scholars (7 infants). Two scholars attended the County School and 7 private schools. ISOLATION HOSPITAL. There were 132 patients admitted during the year. Of these 112 were sent in as Scarlet Fever and 20 as Diphtheria. The following table gives the numbers admitted and discharged each month:— Number Admitted. Number Discharged. Deaths. Sc. Fev. Diph. Sc. Fev. Diph. Diph. Sc. Fev. Jan. 16 1 14 — — — Feb. 14 — 27 4 — — Mar. 8 2 21 1 — — April 4 1 3 2 — — May 11 1 11 1 1 — June 6 — 3 1 — — July 4 2 9 3 — — Aug. 3 1 5 1 — — Sept. 6 3 6 — — — Oct. 5 3 4 1 — — Nov. 27 1 6 4 — — Dec. 8 5 10 1 — — Total 112 20 119 19 1 — 25 Expenditure for Hospital. 1 am indebted to Mr. Burwell, the Accountant Clerk, for the following particulars of expenditure in connection with the Hospital for the year 1920, £4,098 12s. 9d., compared with £3,274 6s. 4d. for 1919:— £ s. d. Salaries, Wages, etc. 1,277 8 4 Provisions 959 16 3 Fuel, Light, and Cleaning 501 19 10 Dispensary, Medical and Surgical 137 17 3 Rates, Taxes and Insurance 82 17 3 Establishment Charges 207 16 3 Furnishing, Repairs and Maintenance 446 14 4 Repayment of Loans and Interest 184 3 3 £4,098 12 9 EXAMINATION OF PATHOLOGICAL MATERIAL. The Council afford facilities to all medical men practising in the district for the gratuitous examination of pathological specimens. The examinations are made at the Lister Institute. The following are the figures for the year:— Swabs for Diphtheria, etc. 323 Sputa for Tubercle 44 Blood Count 2 Blood for Typhoid 1 Urine Examinations 1 Hair for Ringworm 7 Pus—for presence of Gonococci 4 Total 382 26 HOUSING. 1.—General Housing Conditions in the District. (1) Total number of houses in the district is 5,402; 5,102 are occupied by working-class people, and 300 are "residential" houses. There were 31 new houses erected for the working classes during the year; in course of erection, 95. (2) It is anticipated there will be a great increase in population in the near future, because of the new industries which are springing up in the town and neighbourhood. (3) —(a) The extent of the shortage of houses in the district is given as 300; (b) Measures have been taken to meet the shortage by the scheme now before the Ministry. 11.—overcrowding. (1) The number of houses overcrowded, as shown from the report of a house-to-house inspection, is 45 in East Ward and 31 in West Ward. The number of houses built for one family and occupied by two or more families is 632. In East Ward the average number of persons per house is 12.11. The average number of persons per bedroom is 4. Allowing a standard of 2 children under 14 years of age as one person, the average per bedroom is 3.11, The number of families per house is as follows:— Overcrowded houses of 1 family per house 2 „ „ „ 2 families „ 38 .„ „ „ 3 „ „ 5 Total Number of Families 93 The number of houses let in tenements or flats is 26; registered as flats and comprise 6 rooms. The number of houses containing 5 rooms is 15, and the number of 6-room houses is 4, both of which were originally intended as one house. In West Ward the average number of persons per house is 11 22. The average number of persons per bedroom is 3.8. Accepting the standard of two children under 14 years of age as one person, the average number per bedroom is 2.94. The number of families per house is as follows:— 27 Overcrowded houses of 1 family per house 4 „ „ „ 2 families „19 „ „ „ 3 families „8 Total Number of Families 66 The number of houses let in tenements or flats is one registered as a flat, and comprises 6 rooms. The number of houses containing 5 rooms is 26, and the number of 5-room houses is 4, both of which were originally intended as one house. III.—Fitness of Houses. (1)—(a) The general standard of houses in the district is satisfactory, being in the main erected within the last twenty years and built of brick and slate; (b) The number of unfit houses is small, and the defects found to exist consist chiefly of defective roofs, floors, and walls. (2) The action taken to remedy the defects of unfit houses was to serve Cautionary Notices upon the owners under the Public Health Act. 1875, and Housing and Town Planning, etc., Act, 1909. (3) No great difficulty was experienced in remedying defects. Some delay was occasioned at times through the shortage of labour and materials. Owners express a readiness in most cases to carry out the necessary repairs. (4) The conditions prevailing generally throughout the district so far as they affect housing are good. The water supply is good and plentiful. Closet accommodation efficientlv meets the requirements, and, in the absence of a Refuse Destructor, all refuse is dumped at a place far removed from dwelling houses. IV.—Unhealthy Areas. (1) There are no certified unhealthy areas in the district; no action therefore is necessary to be taken. (2) None. (3) There were no complaints made during the year. V.—Bye-laws relating to Houses, to Houses Let in Lodgings, and to Tents, Vans, Sheds, etc.:— (1) Bye-laws relating to the above are operative in the district, and efficiently meet the requirements for dealing with tents, vans, sheds. There are no houses let in lodgings. (2) The Building Bye-laws are under revision for the last five years, the delay being in consequence of the war. 28 REPORT OF SANITARY INSPECTOR'S WORK. Compiled by Mr. T. A. Drew, C.R.S.I., Chief Sanitary Inspector. Factories, Workshops, Laundries, Workplaces, and Homework. 1.—INSPECTION (Including Inspections made by Sanitary Inspector.) Inspections. Written Notices. Prosecutions FACTORIES) 26 3 — (Including Factory Laundries). WORKSHOPS — ... (Including Workshop Laundries). 204 WORKPLACES — — HOMEWORKERS' PREMISES 26 — — Total 266 3 II.—DEFECTS FOUND. Nuisances unler the Public Health Acts: — Found. Remedied. Prosecutions. Want of Cleanliness 13 13 — Want of Ventilation — — — Overcrowding 1 1 — Want of Drainage of Floors 1 1 — Other Nuisances 6 6 Sanitary Accommodations:— Insufficient — — — Unsuitable or Defective 1 1 — Not Separate for Sexes 1 1 — Offences under the Factory and Workshops Acta — Illegal Occupation of Underground Bakehouses (S. 101) Breach of Special Sanitary Requirements for Bakehouses (SS. 97 to 100) 2 2 Failure as regards List of Outworkers (S. 107) — - — Giving out work to be done on Premises which are : — Unwholesome (S. 105) — ... — Infected (S. 110) — — - Allowing Wearing Apparel to be made in Premises Infected by Scarlet Fever or Small-pox (S. 109) — Total 25 25 29 Matters notified to H.M. Inspectors of Factories:— N umber. Failure to affix Abstract of the Factory and Workshops Act (S. £33) Action taken in matters referred by H M Inspectors as remedial under — the Public Health Acts, but not under the Factory Act (S. 5) 3 Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 3 Other — Underground Bakehouses (S. 101):— In use during 1914 — Homework :— LiU of Outworkers (S.07) Numner of lists, Outworkers, Lists received 17 17 — Addresses of Outworkers: — Forwarded to other Authorities— 7 — Received from other Authorities— 17 — Notices served on Occupiers as to keeping or sending Lists — 3 — Homework in Unwholesome or Infected Premises:— Wearing Apparel. Other. Notices Prohibiting Homework in Unwholesome Premises (S. 108) Cases of Infectious Disease notified in Homeworkers' Premises.— Orders Prohibiting Homework in Infected Premises (S. no) — Workshops on the Register (S. 131) at the end of 1913:— Workshops and Workplaces (2)- 51 Laundries— 5 Bakehouses— 11 Domestic Workshops— 4 Total Number of Workshops on Register 71 inspections:— Number of Premises Inspected on Complaint 108 ,, „ „ in connection with Infectious Disease 171 Number of Premises under Periodical Inspection 51 „ ,, Houses inspected from House to House 279 Total number of Inspections 3.834 Notices:— Number of Cautionary Notices served, P.H. Act 143 „ „ Statutory Orders issued, H.T.P. Act, 1909 407 ., „ Summonses served — „ ,, Convictions obtained — Dwelling Houses:— Number of Houses found to be in a state dangerous or injurious to Health (Section 17I 75 „ „ closed as Unfit for Habitation, H.W.C. Act - „ „ made Habitable without Closing Orders 75 „ „ demolished - „ „ illegal Underground Dwellings vacated —- 30 Houses Let in Lodging:— Number Registered under Bye-laws — ,, of Contraventions — Canal Boats:— Number Registered under Acts — of Contraventions of Regulations 4 Movable Dwellings, Tents, Caravans, Etc.:— Number observed during the Year 2 „ of Nuisances therefrom abated — „ removed from the District 2 Bakehouses:— Number in District 11 of Contraventions of Factory Acts 3 Slaughterhouses:— Number on Register 4 „ of Inspections and Frequency of Inspections (weekly) 208 , „ Contraventions of Bye-laws i Cowsheds:— Number on Register 8 ,, of Inspections and Frequency (half-yearly) 96 „ „ Contraventions of Regulations — „ „ Milch Cows in District 197 Dairies and Milkshops: — Number on Register 17 „ of Inspections and Frequency (half-yearly) 408 „ „ Contraventions of Regulations 1 Unsound Food:— Number (a) Animals Seized: (b) Articles or Parcels seized - ,, Condemned by Magistrates 51 „ Articles or Parcels surrendered 7,931 lbs. Adulterated Food:— N umber of Samples taken (if any) by the District Authority 55 ,, Found Adulterated 2 Offensive Trades:— Number of Premises in District - „ ,, Inspections made - ,, „ Contraventions of Bye-laws - Wells:— - Number New Sunk - ,, Cleaned and Repaired - ,, Closed as Polluted i 31 Cisterns, Etc., Water Supply and Service Number of Percentage of Houses supplied from Public Supply 99-6 „ „ New Provided - „ „ Cleansed, Repaired, Covered 12 ,, ., Draw Taps placed on Mains - ,, „ Percentage of Houses supplied on Constant System 99-6 ,, ,, Samples obtained from Public Supply Wells i Main Supply 2 Water Closets:— Number of Water Closets substituted for dry receptacles — „ Repaired, supplied with Water, etc. 27 Drainage and Sewerage of Existing Buildings:— Drains. Number of Percentage of Houses with Water Closets 996 „ examined, tested, exposed, etc. 42 „ unstopped, repaired, trapped 80 „ Waste Pipes, Rain Pipes disconnected and repaired 32 „ New Soil Pipes or Vent Pipes fixed 20 „ existing Soil and Vent Shafts repaired 11 „ disconnecting Traps and Chambers inserted 1 „ reconstructed 1 Cesspools. Number rendered impervious, emptied, cleansed 6 „ abolished and Drain connected to the Sewer — „ of Percentage of Houses draining into Sewer 99-6 Disinfection:— Number of Rooms disinfected: (a) ordinary Infectious Disease (192); (b) Phthisis (22) 187 ,, Rooms stripped and cleansed 24 „ Articles destroyed or disinfected 2 „ Ordinary Infectious Disease 1.439 „ Phthisis 53 Dust: Number of New Bins provided 350 How frequently is dust removed Weekly Number of complaints of non-removal 12 Methods of disposal Tipping (a) destructor, (6) tipping. 32 Sundry Nuisances Abated:— Accumulation of refuse 17 Foul ditches, stagnant water, etc. 3 Foul pigs and other animals 5 Dampness 162 Yards repaired and repayed 77 Other Nuisances 86 Sanitary Staff: T. A. DREW, Cert.R.S.Inst., Chief Sanitary Inspector; Inspector of Factory and Workshops; Inspector of Canal Boats; Inspector of Petroleum; Inspector under Sale of Food and Drugs Act; Inspector under Shops Acts; Inspector Housing and Town Planning Acts. GEORGE W. STEVENS, C.R.S.Inst., Assistant Sanitary Inspector. Adoptive Acts in Force in the District. (1) Infectious Diseases (Notification) Act, 1889. (2) Infectious Disease Prevention Act, 1890. (3) Public Health Acts Amendment Act, 1890. (4) Housing of the Working Classes Act, 1890 (excepting Part IV of this Act). (5) Public Libraries Act, 1892 and 1893. (6) Public Health Acts Amendment Act, 1907, as to Parts II, III, and IV (except Sections 61 and 66, V, VI, VIII, IX. and X). (7) Notification of Births Act, 1907. 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) Common Lodging-houses. (4) New Streets and Buildings. (5) Slaughterhouses. 33 Bye-Laws—Continucd. (6) Houses let in Lodgings or occupied by members of more than one family, a register of which is now kept (7) Removal of Offensive Matter or House Refuse. (8) Keeping of Animals. (9) Public Baths and Washhouses. (10) Open Spaces. (11) Tents, Vans, Sheds, &c. (12) Regulations as to Dairies, Cowsheds, and Milk Shops. Infectious Diseases (Notification) Act, 1889. Infectious Disease Prevention Act, 1890. Public Health Acts Amendment Act, 1890. Housing of the Working Classes Act, 1890 (excepting Part IV of this Act). Public Libraries Act, 1892 and 1893. Public Health Acts Amendment Act, 1907, as to Parts II, III, and IV (except Sections 61 and 66, V, VI, VIII, IX and X). The Bye-laws of this Authority, recently revised, are based on the Model Bye-laws of the Local Government Board and relate to— Cleansing of Earth Privies, Ashpits, and Cesspools. 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. Common Lodging-houses. New Streets and Buildings. Slaughterhouses. Houses let in Lodgings or occupied by members of more than one family, a register of which is now kept. Removal of Offensive Matter or House Refuse. Keeping of Animals. Public Baths and Washhouses. Open Spaces. Tents, Vans, Sheds, &c. Regulations as to Dairies, Cowsheds, and Milk Shops ANNUAL REPORT of THE SANITARY INSPECTOR, 1920. Public Health Department, Council Offices, Southall. To the Chairman and Members of the Southall-Norwood, Urban District Council. Gentlemen, I have the honour to submit to you my Annual Report dealing with the inspection of your District and other work connected with the Public Health Department, during the year 1920. INSPECTION OF DISTRICT. Inspection of the District has been carried out during the year both systematically and at intervals as occasion required; in order to comply with the General Orders of the Ministry of Health, the Public Health Acts, and Housing (Inspection of District) Regulations, 1910, and Housing (Town Planning) Acts, 1909-1919, all necessary measures have been taken to secure the immediate abatement of any nuisances which were found to exist. The general sanitary condition of the district is good. Four-hundred-and-seven dwelling-houses have been cleansed, repaired and restored to a satisfactory condition as applying to their fitness in every way for human habitation. Notably among the particulars of the report the mortality rate (8.2 per 1,000) for a thickly populated industrial district stands out pre-eminently. 35 Vigorous measures have been employed in the effort to prevent fly breeding. Circulars have been issued to all keepers of cattle, horses, pigs, etc., requesting the removal of all manure twice a week; the application of dry powdered lime to all fermentative material; the use of formalin sprays and fly traps in houses, meat and food shops, and protective covers for meat, milk, fruit, etc. The measures referred to have proved verv effective in the way of ensuring a pure food supply and the prevention of the possibility of the spread of disease. Similar vigorous measures have been extended in the direction for the extermination of rats. In all, 3,834 visits to houses and inspections of premises have been made during the year, these include houses from which complaints of nuisances have been received, houses in which cases of infectious diseases have occurred, inspection of works in progress, also inspections—house-to-house, food shops, dairies, cow-sheds, bakehouses, slaughter-houses, piggeries, workshops, petroleum stores, canal boats, etc. Every effort has been made to remedy all nuisances or insanitary conditions where found to exist. The number of houses inspected from house-to-house is 279. Cautionary notices served to abate nuisances under the provisions of the Public Health Acts, numbered 143, and the Housing (Town Planning) Acts 407. In each instance the works, both of repairs and general cleansing, have been carried out satisfactorily, and in the main expeditiously. HOUSE DRAINAGE. During the year the number of stopped drains opened and cleansed was 80. The drains of 14 premises were entirely reconstructed, 9 inspection chambers, 1 soil pipe, 27 pedestal closets and 4 intercepting traps were built. 36 SUMMARY OF NUISANCES DEALT WITH DURING 1920. Defective Plaster, Ceilings and Walls 197 Floors Repaired 73 Waste Pipes of Sinks 17 ,, Joints of W.C. Pans 14 Roofs 84 „ Water Fittings 23 ,, Lavatory Cisterns 54 Grates 88 Back Yards and Front Approaches Repaired 77 ,, Staircases and Steps Repaired 15 Gutters and Spouting 75 Coppers 9 ,, Water Cisterns in Sculleries 12 „ Waste of Bath 1 „ Masonry of Coppers 40 Damp Walls and Floors 162 Broken Pans of Lavatories Repaired and Renewed 27 Stopped Drains Unstopped and Repaired 80 Rubbish Accumulations 25 Earth Closet Pails Renewed 4 Dirty Rooms Cleansed 254 Soil Pipe Renewed 1 Drains Reconstructed 14 Insufficient Water Supply 6 Lavatory Seats Renewed 4 Window Fasteners and Sash Cords Renewed 29 Ventilating Shafts Renewed 10 Chimney Pots and Brickwork Repaired 13 Miscellaneous 86 Total 1,494 INSPECTION: SLAUGHTER-HOUSES, MEAT AND FOOD. There are four Slaughter-houses in the district, three of which are registered and one subject to annual renewal. The slaughterhouses are kept under constant observation; inspections, usually 37 once a week, and if possible at the time of slaughtering. The necessary steps have been taken to secure proper compliance with the Bye-laws, special attention being given to the conditions regarding cleanliness, water supply, accumulations, and limewashing, etc. The number of inspections was 208. One animal was found to be affected with generalised tuberculosis and was seized and destroyed. There have been 122 cases in which unsound meat and other foods were dealt with; in fifty-one instances seizures were made in accordance with the Public Health Acts, and the articles submitted to a Justice of the Peace, and an order in each case was obtained to destroy the food, so as to prevent it being used for the food of man. DURING 1920 Article of Food. Result of Examination. Weight. Tons. Cwts. Qrs. Lbs. Beef Diseased, Unwholesome and Unsound 1 6 — 6 By burying and chemically treated. Mutton Unwholesome and Unsound — 4 1 9 Chemically treated. Bacon Do. — 13 — 9 Do. Butter Do. — 1 1 1 Do. Corned Beef Do. — — 3 9 Do. Fish Do. — 8 2 1 By burying. Fruit Do. — 9 2 14 Do. Rabbits Do. — 1 2 2 Do. Tinned Milk Do. — — 2 14 Do. Preserved and Do. — — 1 15 Do. Specially Prepared Foods Jam Do. — — — 18 Do. Onions Do. — 1 — — Do. Lard Do. — — — 9 Do. Offal Do. — 2 2 18 Do. Cheese Do. — — 1 8 Do. Ham Do. — — 18 Do. Lamb Do. 24 Do. Oranges Do. — — 630 in Number. By burying. Total 3 10 3 7 38 DAIRIES, COWSHEDS AND MILKSHOPS. There are 8 cowkeepers, 19 dairymen and 14 purveyors of milk on the Register. Inspections of cowsheds, dairies and milkshops have been made throughout the year, to the number of 514. The general sanitary state of the premises and surroundings is on the whole satisfactory. They are well lighted, ventilated, and drained, and all have a sufficient supply of water. SALE OF FOOD AND DRUGS ACTS. Fifty-five samples of milk were purchased and submitted for analysis. The Public Analyst's certificate showed one of the samples submitted to contain 18 per cent. of added water. This sample was taken in the course of delivery at the Southall Railway Station. The hearing of the case was a lengthy one and the opinion expressed by the Clerk to the Court was that it was a highly technical point to decide and one for the Supreme Court. The Bench thereupon dismissed the case. The second prosecution was concerned in the adulteration of a sample of milk taken from a local farmer. The analysis showed 7 per cent. of added water and deficiency in fat to the extent of 21 per cent. This being the first offence and the defendant pleading guilty, the case was dismissed, defendant paying costs, amounting to two guineas. RAG FLOCK ACT, 1911. Sixty-seven inspections of bedding were made during the year and 1 samples of bedding flock submitted for analysis to the Public Analyst. All of these samples were genuine. OFFENSIVE TRADES. No offensive trades as scheduled under the Public Health Acts are carried out in the District. COMMON LODGING HOUSES. There are no Common Lodging Houses in the District. 39 FACTORIES. Factories are not registered with the Council. H.M. Inspector is responsible for the sanitary circumstances generally, and in case of default he reports to the Sanitary Authority any matters coming to his notice which are remediable under the Public Health Acts. Three reports have been received during the year and dealt with. PETROLEUM ACTS. During the year 14 applications for renewals of licences to keep petroleum were received and granted. Two new licences were granted. The number of licences now in force within the District is 16 for petroleum and 2 for carbide of calcium, and the number of gallons of petroleum covered by the licences is 13,100. CANAL BOATS. During the year 54 canal boats have been inspected. The general condition of the boats and their occupants was satisfactory. The infringements of the Acts and Regulations were as follows:— Cabin leaking, 1 ; marking, 1 ; painting required, 3; boat found not registered, 1 ; certificate not produced, 1. No legal proceedings were taken in respect of any infringements. Notices to comply with the Acts and Regulations were served upon the owners whose boats did not comply with the Acts and Regulations. The complaint notes on return showed that the requirements had been attended to. No cases of infectious disease have been notified upon any of the boats during the year. No boats were detained for cleansing and disinfection. This is not a registration authority. 40 ARTICLES DISINFECTED DURING 1920. The Number of Rooms Disinfected was 187 Rooms Stripped and Cleansed as required by the Provisions (Section 5) of the Infectious Disease (Prevention) Act, 1890 24 Beds 186 Blankets 336 Bolsters 103 Books 5 Covers 17 Eiderdowns 29 Mattresses 17 Pillows 296 Quilts 130 Rugs and Shawls 9 Sheets 189 Wearing Apparel 175 Total Number of Articles Disinfected 1,492 I am, Gentlemen, Your obedient Servant, T. A. DREW, Chief Sanitary Inspector, and District Inspector, Food and Drugs Act.