Sout 040 THE SOUTHALL-NORWOOD URBAN DISTRICT COUNCIL Annual Report of the Medical Officer of Health, FOR THE YEAR 1906. Southall=Norwood Urban District Council. 1906. Mr. J. H. Willis, J.P., Chairman. „ W. E. Eburne, Vice-Chairman. Mr. G. Gosney. Mr. J. Perkins. „ H. C. Hanson. „ P. Hanson. „ H. E. Lucia. „ W. A. Rowe. ,, H. J. Norman. ,, T. Watson. „ T. W. Penny. „ H. E. Willis. Officers of the Council. Mr. A. Lawrence Houlder, Clerk and Solicitor. „ H. E. Burwell, Assistant Clerk. „ Reginald Brown, A.M.I.C.E., M.S.I., etc., Surveyor and Engineer. „ H. J. Amoore, P.A.S.I., Surveyors Assistant. „ J. D. Windle, M.D., Ch.B., M.R.C.S. (Eng.), Medical Officer. ,, H. T. Baxter, Assoc. San. Inst., Inspector. ,, A. J. Hanson, Collector. „ H. W. Woodbridge, Treasurer. Miss E. J. Cooke, Matron of the Sanatorium. Annual Report of the Medical Officer of Health. FOR 1906. To the Members of the Southall-Norwood Urban District Council. Gentlemen, I have the honour to present for your consideration my 16th Annual Report on the Sanitary circumstances and vital Statistics of your district for 1906. So far as health conditions can be judged from vital statistics there is every reason to be satisfied with the conditions prevailing during the year. The rates of mortality are below the average for those of recent years, with the exception of infantile mortality which continues to be the most unsatisfactory feature of the vital statistics. Turning to the registered causes of death, which throw some light on social circumstances, the deaths from alcoholism, phthisis, and prematurity, are considerably higher in recent years. This would be a disquieting circumstance in a stationary population, but in large part the increase is explained by the immigration into the district of persons suffering from these diseases, and is in no way due to circumstances over which you have control. 2 That the Sanitary circumstances of the district generally are good I am perfectly satisfied. Evidence in this direction is furnished by the rates of incidence and mortality from notifiable sickness, and these continue to be remarkably low in spite of the fact that the population contains a proportionately excessive number of persons at ages of greatest susceptibility to these diseases. The details of Administrative work with regard to Slaughter Houses, Milk Shops, Dairies and Bakehouses, that is, supervision of the food supply generally of the District will be found in Section V. With regard to water supply, fresh legislation is urgently needed in relation to the quality of the water supplied by private companies, who are so protected by their own Acts of Parliament that there is practically no re-dress in default of quantity or quality. It is highly desirable that there should be a government standard of purity for drinking water. My best thanks are due to Mr. Brown, Surveyor; Mr. Baxter, Sanitary Inspector; Mr. Burwell, Assistant Clerk; Mr. Hanson, Rate Collector; and Mr. Rayner, Curator of the Cemetery; for statistical information relating to their several departments. On several occasions I have had the advantage of consultation with Dr. Young, the County Medical Officer of Health, on important sanitary matters, and I take this opportunity of tendering to him my best thanks for much valuable advice. I am, Gentlemen, Your obedient Servant, J. D. WINDLE. 3 SECTION I. Sanitary Area. The Urban District of Southall-Norwood is situated on the main road from London to Oxford, 9¼ miles from the Marble Arch. 5½ miles south-east of Uxbridge, and 4 miles north-west of Brentford —the County Town. The area of the District is 2,575 statute acres; 2,525 acres of land, and 50 acres of water. The soil is gravel, with occasional outcrops of brick earth. 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 parts being at the extreme northern end of the District, which is 2 furlongs 210 yards. 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 15 miles. The mileage of private roads is about miles. Wards. For administrative purposes the District is divided into East and West Wards. The division of the Wards is an imaginary line, which begins in the centre of the road outside Waxlow Farm entrance, down North Road to Uxbridge Road, thence to the "Three Horseshoes" Beerhouse, 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 line leaves the road, and goes to rear of the two cottages opposite, and again joins the road immediately after passing over Canal Bridge and thence on to Watersplash. 4 All to the left of the line is East Ward, and all to the right West Ward. Public Open Spaces. Acres. Norwood Green 8 Recreation Ground (Southall Green) 11 Estimated Population for Middle of Year 1906, 18,777. In estimating the population for the statistical purposes of this Report, I have, as in previous years, entirely excluded from the estimate the inmates of the London County Asylum, (Norwood), since the Institution "is of a kind that its population cannot rightly be regarded as belonging to the residential population of the District or County." The Inmates of the St. Marylebone Schools are included in the estimate. To arrive at an accurate estimate of the population of your District is a matter of considerable difficulty, as the increase due to immigration has been abnormal since the last Census, and thus the usual method of estimation which is based on the average yearly increase in population during the inter-census period is not reliable. By this method we assume an increase since the last Census at the same rate as between the inter-censual years. Thus at the Census 1891 and 1901 the population, exclusive of Institutions, was 5,513 and 10,365 respectively. Taking the difference and dividing by 10 we get the annual increase of population. The Census being taken in the first quarter of the year, and we require an estimate at the end of June, that is an interval of 5¼ years. If therefore we multiply the annual increase of population 10365-55133/10 = 485.2 by 5.25 We get an increase of 2,547 to be added to the 1901 population, giving an estimated population of 10,3654-2,547, or 12,912 for the middle of 1906 is much too low: the assumption of an equable rate of increase is not applicable to a district like yours, in which there has been an abnormal increase in population from immigration during the last few years. A much more accurate estimate can be derived from the birth rate. It is based on the assumption that the birth rate remains fairly constant for a series of years. This has been the case: 5 the average birth rate for the past ten years is 33.18. The number of births for the present year is 621. Therefore, assuming that 33.18 is the number of births from 1,000 of population, 621 is the birth rate of 621 x 1,000/33.18 = 18,716 people. The most accurate estimate can be arrived at by taking as a basis, the number of inhabited houses in the District as shown by the rate book, and multiplying that figure by the probable number of inmates in each. In June, 1906, the houses in rating were as follows:— Total. East Ward. West Ward. Houses 3,673 1,615 2,058 Multiplying these figures by 5, the probable average number of inmates in each house, we get the following population:— Total. East Ward. West Ward. Population Southall-Norwood 18,365 8,075 10,290 St. Marylebone Schools 412 — 412 Totals 18,777 8,075 10,702 6 Comparative Table. Census 1891. Census 1901. West. East. Estimated to June, 1903. Estimated to June, 1904. Estimated to June, 1905. Estimated to June, 1906. West. East. West. East. West. East. West. East. SouthallNorwood 5188 9953 5337 4516 13832 7195 6225 15325 8300 7025 17300 9430 7870 18365 10290 8075 St. Marylebone Schools 335 - 412 - - 412 — — 412 - - 412 — — 412 — Total 5513 10,365 14,244 15,737 17,712 18,777 The population is estimated in this way to the middle of the year solely for the purpose of calculating the various sickness and mortality rates, since the population at the middle of the year represents the average number of persons living in that year. 7 Estimated Total Population, including Institutions, at end of Year 1906, 22,617. From June to the end of December, 203 houses were brought into rating; the total number of houses on the rate book at that time was as follows:— End of December, 1906. Total. East Ward. West Ward. Houses on Rate Book 3876 1658 2218 This gives a population of 19,380. To this must be added the inmates of the St. Marylebone Schools and the London County Asylum, Norwood, 412 and 2,825 respectively, so that the total population of the District is 22,61 7. Comparative Table. Census 1891. Census 1901. West. East. Estimated to end of 1901. Estimated to end of 1905. Estimated to end of 1906. West. East. West. East. West. East. Southall- Norwood 5188 9953 5337 4516 16640 9050 7590 18360 10265 8095 - 11090 8290 St. Marylebone Schools 335 - 412 - - 412 - - 412 — — 412 — London County Asylum 2037 — — — - — 2835 — — 2855 — - 2825 Total 7560 13,200 19,907 21,627 22,617 8 SECTION II. Vital Statistics.—Births and Birth Rate. The total number of Births registered during the year was 621 ; males 304, females 317. The Birth-rate is 33.6 per 1,000.* Distributed in Wards the Births and rates are as follows : 32.7 per 1,000 West Ward. 33.3 Per 1,000 East Ward. Males Females. Males Females. 168 184 136 133 352 269 621 Comparative Table. Year. Whole District. East Ward. West Ward. Births. Rate. Births. Rate. Births. Rate. 1903 476 34.4 196 31.4 280 36.8 1904 578 36.7 289 41.1 289 33.1 1905 576 32.5 245 31.1 331 33.6 1906 621 33.6 269 33.3 352 32.7 *The Rate for England and Wales (1906) is 27.0 per 1,000 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 32.1 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 1903 476 34.4 13832 1904 578 36.7 15737 1905 576 32.6 17712 1906 621 33.6 18777 9 The natural increase of population, that is, the number of births over deaths, is 377, compared with 392 in 1905. Deaths and Death Rates. Whole District. Total, 244 (Males 124, Females 120). Rate, 12.9.* The total number of deaths at all ages and from all causes during the year was 244. This number includes the deaths of 30 persons from your District who died in the Hillingdon Infirmary, various London Hospitals, and the Middlesex County Asylums; and also the deaths of strangers dying within the District, but not belonging thereto. The death rate for the whole District, calculated on the estimated population at the middle of 1906 is 12.9 per 1,000, as compared with 10.3 for last year; or it may be stated as one death for every 77.5 persons living, as compared with one death for every 96.2 persons living for last year. Zymotic Death Rates. Deaths from Notifiable Diseases. Total. East Ward. West Ward. 6 2 4 The Death rate from the Scheduled Notifiable Diseases, viz:— Small Pox, Scarlatina, Diphtheria, Membranous Croup, Typhus, Typhoid, Puerperal Fever and Erysipelas, is 0.3 per 1,000 persons living, as compared with 0.2 for 1905. In the East Ward the rate is 0.2, and in the West Ward 0.3, as compared with 0.3 and 0.2 per 1,000 for 1904. 1893 1.4 per 1,0001 1894 1.3 „ „ 1895 0.3 „ „ 1896 0.9 „ „ 1897 1.5 „ „ 1898 1.7 „ „ 1899 1.1 „ „ 1900 1.3 „ „ 1901 0.1 „ „ 1902 0.3 „ „ 1903 0.8 „ „ 1904 0.3 „ „ 1905 0.2 „ „ 1906 0.3 „ „ Average Rate, 0.9 per 1,000. *The rate for England and Wales(1906) is 15.4 per 1,000. 10 Deaths from Zymotic Diseases, not Notifiable. Total. East Ward. West Ward. 41 19 22 The Death Rate, Zymotic Diseases not Notifiable, viz:— Measles, Whooping Cough and Diarrhoea is 2.2 per 1,000 persons living. In the East Ward 2.4 and in the West Ward 2.5 per 1,000 as compared with 1.5 and 1.3 respectively for 1904. 1893 1.5 per 1,000 1894 101 „ „ 1895 1.0 „ „ 1896 2.0 „ „ 1897 1.6 „ „ 1898 1.4 „ „ 1899 2.5 „ „ 1900 2.2 „ „ 1901 2.9 „ „ 1902 1.9 „ „ 1903 1.3 „ „ 1904 2.5 „ „ 1905 1.4 „ „ 1906 2.2 ,, „ Average Rate, 1.8 per 1,000. Total Rate from all Zymotic Diseases for the whole district is 2.5 per 1,000. In the East Ward 2.5 and in the West Ward 2.4 per 1,000 as compared with 1.9 and 1.5 per 1,000 for each ward in 1904. 1893 2.9 per1,000 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 „ „ 1903 2.2 „ „ 1904 2.6 „ ,, 1905 1.5 „ „ 1906 2.5 ,, „ Average Rate, 2.7 per 1,000. 11 Table of Deaths from Phthisis and other Tubercular Diseases. Phthisis. Rate. Other Tubercnlar 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 1903 15 1.0 5 0.3 1904 12 0.7 4 0.2 1905 12 0.6 10 0.5 1906 13 0.6 7 0.3 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 „ „ 1807 2.2 „ „ 1898 1.8 „ „ 1899 2.4 „ „ 1900 2.0 „ „ 1901 4.6 „ „ 1902 2.3 „ „ 1903 3.5„ „ 1904 3.0 „ „ 1905 1.3 „ „ 1906 2.6 „ „ Infant Mortality. For the whole District there were 96 deaths of children under 1 year of age which is equivalent to a rate of 154 per 1,000 children born and registered. In the East Ward there were 43 deaths, giving a rate of 159.8; and in the West Ward 53 deaths at a rate of 150.5. 12 Causes of, and Ages at, Death during the Year 1906. 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. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. East. West. Workhouse. Various London Hospitals. s. Marylebone Schools Sanatorium. Hanwell Asylum Measles — - - - - - - - - - - - - - Scarlet Fever 2 - - 2 - - - - - - 1 - 1 - Whooping Cough 3 3 — — - - - 1 2 - - - - - Diphtheria and membranous croup 1 — 1 — — - - - 1 - - - - - Epidemic Influenza - - - - - - - - - - - - - - Diarrhæa. 32 24 3 1 — 1 3 16 15 - 1 - - - Enteritis 7 6 1 - - - - 3 4 - - - - - Dysentry — - - - - - - - - - - - - 2 Puerpeial fever 1 - - - 1 - - - 1 - - - - - Erysipelas 3 2 — — - 1 - 2 - - 1 - - 1 Other septic diseases 4 — 3 1 - - - 1 1 - 2 - - 6 Phthisis 13 - 1 2 4 6 - 4 7 1 1 - - 30 Other tubercular diseases 7 1 1 4 1 14 - 3 3 - 1 - - - Cancer, malignant disease 20 - - - 1 3 5 6 10 2 2 - - 5 Bronchitis 10 2 — — - 6 5 5 5 - - - - 9 Pneumonia 19 6 3 3 - - 1 5 13 - - 1 - 11 Pleurisy — — — — — — — — - - - - - 1 Alcoholism 5 — - — 2 2 1 1 2 1 1 — — — Cirrhosis of Liver Venereal disease I 1 — — - - - 1 - - - - - - Diseases of Parturition 1 1 — — - - - 1 - - - - - - Premature birth 21 21 — — - - - 7 14 - - - - - Heart Diseases 20 5 - - 1 10 4 9 10 - 1 - - 9 Accidents 5 1 — — - 4 1 3 1 - 1 - - - Suicides 5 - - - 1 3 - 3 2 - - - - - All other causes 64 23 7 2 2 17 12 22 28 5 9 - - 132 All causes 244 96 20 15 13 67 33 93 119 9 21 1 1 196 13 The following Table is for comparison with previous years. Year. Population estimated to Middle of each Year excluding Hanwell Asylum. Births. Total Deaths Registered in the District. Deaths of Residents in Public Institutions beyond the District. Nett Deaths at All Ages Belonging to the District. Number. Rate. Under 1 Year of Age. At all Ages. Number. Rate per 1000 Births registered. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 1891 5188 208 40.9 15 72.1 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 38.1 26 139.5 86 12.8 7 93 13.9 1890 7184 207 28.8 31 149.7 86 11.8 5 91 12.6 1897 7913 254 32.1 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 10,479 360 34.3 65 180.5 165 15.7 3 168 160 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 1903 13,832 476 34.4 64 134.4 169 12.2 18 169 12.2 1904 15,737 578 36.7 85 147.0 195 12.3 13 195 12.3 1905 17,712 576 32.5 58 100.6 184 10.3 25 184 10.3 1906 18,777 621 33.6 96 154.0 214 11.3 30 244 12.9 14 Deaths and Death Rates distributed into Wards. Causes of Death. EAST WARD. Causes of Death. WEST WARD. Total Deaths 111. Males 59. Females 52. Total Deaths 133. Males 65. Females 68. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. Over 65. Under 1 year 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. Over 65. Scarlet Fever - - 1 - - - Scarlet fever - - 1 — — — Whooping cough 1 — — - — — Whooping cough 2 - - - - - Diarrhæa 9 2 1 — 1 3 Membraneous croup — 1 — — — — Enteritis 3 — — — — — Diarrhæa 15 1 — — — — Erysipelas 2 — — — — — Enteritis 3 1 — — — — Other septic diseases - 1 — — — — Puerperal fever — — — 1 — — Phthisis — — — 1 5 — Erysipelas — — — — 1 — Other tubercular diseases 1 - 2 1 - — Septic diseases — 2 1 — — — Phthisis — 1 2 3 1 — Cancer - — — 1 5 2 Other tubercular diseases - 1 2 - — — Bronchitis 1 — — — 2 2 Pneumonia 3 — 1 — 1 — Cancer — — — — 9 3 Alcoholism Cirrohsis of liver — — - 2 1 - Bronchitis 1 — — — 1 3 Pneumonia 3 3 2 — 5 1 Veneral diseases 1 — — — Alcoholism Cirrhosis of liver — - - - 1 1 Diseases of parturition 1 - - - - - Premature birth 7 — — — — — Premature births 14 - - - - - Heart Diseases 5 — - 1 2 1 Heart disease — — — — 8 3 Accidents — — - — 3 1 Accidents — — — — 1 — Suicides - — - 1 1 1 Suicides — — — — 2 — All other causes 9 4 - 2 11 5 All other causes 15 3 2 — 6 7 Totals 43 7 5 9 32 15 Totals 53 13 10 4 35 18 The rate per 1,000 of estimated population is 13.7 as compared with 10.1 for 1905. The rate per 1,000 of estimated population is 12.4 as compared with 10.5 for 1905. 15 Infantile Mortality during the Year 1906. Deaths from Stated Causes in Weeks and Months under One Year of Age. Causes of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months 2-3 Months 3-4 Months 4-5 Months 5-6 Months 6-7 Months 7-8 Months 8-9 Months 9-10 Months 10-11 Months 11-12 Months Total Deaths under One Year. All Causes Certified 23 3 4 3 33 12 8 9 6 6 8 3 6 - 3 2 96 Uncertified — — — — — — — - — - - - - - - - - Common Infectious Diseases— Whooping Cough — — — — — 2 — — — 1 — - - - - - 3 Diarhoeal Diseases Diarrhæa, all forms — — — - - 2 2 6 2 2 5 1 2 — 2 - 24 Enteritis, Muco-enteritis, Gastro-enteritis - - - - - - 2 2 1 - - - - - - 1 6 Gastritis, Gastro-intestinal Catarrh — — — — — 1 1 - - - - - - - - - 2 Wasting Diseases— Premature Birth 11 2 2 1 16 3 1 — 1 - - - - - - - 21 Congenital Defects 2 1 1 — 4 1 - - - - - - - - 1 - 6 Injury at Birth 4 - - - 4 - - - - - - - - - - - 4 Atrophy, Debility Marasmus 2 — — 1 3 — 1 - 1 - 1 1 2 - - - 9 Erysipelas - - - - - 2 - - - - - - - - - — 2 Syphilis — — — — — — — 1 — — — — — — — — 1 Convulsions 1 — — — 1 — — — — 1 — — 1 — — - 3 Bronchitis — — — — — — — — 1 — 1 — — — — - 2 Pneumonia - - 1 — 1 1 — — — 1 1 — 1 — — 1 6 Suffocation, overlying 1 — — — 1 — — — — — — — — — — — 1 Other Causes 2 — — 1 3 — 1 — — 1 — 1 - - - - 6 23 3 4 3 33 12 8 9 6 6 8 3 6 - 3 2 96 District (or sub-division) of Southall-Norwood Births in the year legitimate 606 illegitimate 15 Population (estimated to middle of 1906) 18,777. Deaths in the year of legitimate infants 88 illegitimate infants 8 Deaths from all Causes at all Ages 5244. 16 Comparative Tables. 1906. East Ward. West Ward. Whole District. Population 8075 10702 18777 Births 269 352 621 Birth Rate 33.3 32.7 33.6 Deaths under 1 year 43 53 96 Rate per 1,000 children born and registered 159.8 150.5 154.5 Total Death Rate 13.7 12.4 12.9 1905. East Ward. West Ward. Whole District. Population 7870 9842 17,712 Births 245 331 576 Birth Rate 31.0 33.6 32.5 Deaths under 1 year 25 33 58 Rate per 1,000 children born and registered 100.2 99.6 100.6 Total Death Rate 10.1 10.1 10.3 1904. East Ward. West Ward Whole District. Population 7025 8712 15,737 Births 289 289 578 Birth Rate 41.1 33.1 36.7 Deaths under 1 year 43 42 85 Rate per 1,000 children born and registered 148.7 145.2 147.0 Total Death Rate 13.9 11.1 12.3 1903. East Ward. West Ward. Whole District. Population 6225 7607 13,832 Births 196 280 476 Birth Rate 31.4 36.8 34.4 Deaths under 1 year 28 36 64 Rate per 1,000 children born and registered 148.8 138.5 134.4 Total Death Rate 11.4 12.8 12.2 17 Whole District. Year. Deaths under 1 year. Births. Birth Rate per 1000 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 Statistical Evidence of Sanitary Circumstances. The rates of mortality contained in the foregoing tables— viz: The total death rate, infant mortality and the zymotic death rate furnish the most reliable statistical evidence of health conditions available for small populations, and their relative value for this purpose is in the order given. The Annual Death Rate. The gross death rate of 12.9 for the year is 2.6 per 1,000 more than for last year. The increase is mainly due to deaths from Diarrhoea, Cancer and Respiratory diseases. 1906. 1905. Diarrhæal diseases 39 22 Cancer 20 7 Respiratory diseases 29 11 The increase occurred at all ages, except ages 15 to 25 and over 65, which are approximately the same as for last year. The value of the death rate as a trustworthy test of health conditions, depends largely upon the accuracy of the estimation of the population, which I venture to say is approximately correct. The death rate is a low one for a working-class population, and it should be so in a district like ours in which the population is constantly increasing at an abnormal rate from the immigration of young adults, whose death rate is low. Moreover the birth rate has been high for many years past, and this implies a population containing an undue proportion of children from the age of five, and young adults; that is, of persons at age periods for which a low rate of morbidity prevails. 18 It follows then, that in our district, a lower gross death rate should be expected than in a town equally healthy, in which the ages and sex of the population were less favourable to longevity. A comparison of rates is generally made with that for England and Wales, and in order to this, the age and sex of the population of the district must be approximate to that for England and Wales. By means of a factor calculated from census dates, the gross death rate for the district can be corrected to what it would be if the age and sex distribution of the population were the same as that for England and Wales. The Corrected Death Rate. In the County Report for 1905 the factor is given, viz.: 1.05131, so that 12.9 x 1.05131=13.5 is the corrected death rate per 1,000. Comparative Mortality Rate. If the corrected death rate is compared with the death rate at all ages for England and Wales taken at 1,000, it gives what is known as the Comparative Mortality figure. Corrected local Rate 13.5 Thus Corrected local Ratr 13.5 Rate for England and Wales 15.4 * 1,000=876 the figure of comparative mortality for Southall-Norwood. This may be expressed by saying the same number of persons that gave 1,000 deaths in England and Wales, gave 876 deaths in Southall-Norwood. Infant Mortality. By Infant Mortality is meant the number of children per 1,000 registered births, who die before they complete their first year of life. For the present year the rate of mortality (154 per 1,000), is considerably higher than for some years past: the increase being due to deaths from respiratory diseases, diarrhoea, and premature birth. The causes of death are fully set out in the table at page 15, and it will be there seen that out of the total of 96 deaths, 32 were due to various forms of diarrhoea and 9 to atrophy, debility, &c., which arise as a consequence, 27 were due to premature birth, and 8 to respiratory diseases. The deaths from the last named cause are not excessive, but these from diarrhoea and premature birth which constitute more than two thirds of the total is higher than it ought to be, but this is the case for the country generally. The total infantile mortality for the district for the year is considerably higher than the average rate for the County and also for that of London and England and Wales. 19 Infant Mortality (1906) per 1,000 Births. England and Wales 133 76 Great Towns 146 142 Smaller Towns 148 England and Wales, less the 218 Towns 115 It is generally held that the infant death rate affords conclusive evidence of sanitary conditions, and that when the rate is in excess of that for the country generally, it is an indication of a bad sanitary state of the community in which it occurs. This I venture to say is only partially true. I think it would be more correct to say that it is an indication of the social and moral conditions which prevail. The deaths from diarrhæal disease strictly come under the category of preventible deaths, since they are largely engendered by neglect and ignorance of the simple, yet all important precautions necessary for the artificial feeding of infants, and thus their prevention is largely a matter of education in domestic hygiene. I find from the registered deaths that the mortality is practically confined to the working class, and has occurred chiefly in the streets where the poorer members of this class live; but there is no difference in the sanitary circumstances of families in which deaths have occurred, and families in the same areas where there have been no deaths. I believe the explanation is to be sought in domestic and personal circumstances, and not in Municipal Sanitation. With regard to deaths from premature birth and congenital defects which constitute so large a part of the infant death rate, the causes in operation are of a social and moral character, and unquestionably alcholism is directly or indirectly responsible in a great many cases. In this connection there were five adult deaths from alcholism registered during the year. The teaching of Hygiene in the Public Elementary Schools will do much in the future to diminish the rate of infantile mortality, by instructing the future mothers on the care and feeding of infants, and domestic Hygiene generally. The present need is, to get in touch with the mothers of to day, and instruct them practically as to the proper method of infant feeding and management. In many Districts qualified women health visitors have been appointed, who visit all the houses in the District where there is a young baby. She sees whether or not, the baby is fed and clothed properly, and at the same time observes the condition of the house, to see whether it is clean, well-ventilated, and in a sanitary state. 20 All conditions which might be supposed to bear on the causation of diarrhceal diseases are enquired into and reported upon; for instance, what kind of food is given, how it is stored and prepared for use, the kind of bottle used, how it is cleaned and so on. Practical instruction in these matters is given, and the visits are made systematically until the baby is a year old. There can be no doubt that domestic cleanliness, and proper food properly prepared, are the greatest factors in the prevention of diarrhceal diseases, and I certainly think that the appointment of a woman health visitor is a matter which is well worthy of your consideration. I feel sure that it would result in a permanent diminution in the rate of infantile mortality, and the effect of this on the total death rate would be such as to make it lower than most districts of similar character and population. Zymotic Death Rate. The total death rate from Zymotic diseases is a popular standard of healthy conditions, but as a matter of fact it is of little value for this purpose, since it is liable to great fluctuations owing to the prevalence of diseases which are included in it, as Measles, and Whooping Cough, which are neither usually nor truly dependent upon defective Sanitary conditions. It rises and falls too, with the infant mortality, since it includes Diarrhoea and Enteritis. In order to make the rate a more reliable test, I have tabulated the various rates, so as to show the deaths from Zymotic diseases which are notifiable, and those which are non-notifiable. The tables will be found at page 9. The death rate from notifiable diseases is the most satisfactory criterion. Of the six deaths recorded, Erysipelas was responsible for three, and of the two deaths from Scarlet Fever, one was a patient from this district who contracted the disease in a London Hospital, so that although the rate is 0.1 higher than last year, the causes show that the conditions have been much more satisfactory. Of all the Zymotic diseases, the death rate from Enteric Fever is the most reliable criterion of sanitary conditions. There has been no death from this disease for many years past. Death Rate from Respiratory Diseases. This rate furnishes some evidence of sanitary circumstances,, since the diseases comprised in this rate are prevalent and fatal, in proportion to density of population, and dampness and overcrowding in dwellings, workshops, &c. The rate 26 per 1,000. The average rate, England and Wales 1881-90, was 3.7. 21 SECTION III. Notifiable Diseases. The number of cases of Infectious Disease reported under the Infectious Diseases Notification Act during the year was 165. Eight of the cases occurred in the London County Asylum, Norwood, and n in the St. Marylebone Schools, so that the number occurring amongst members of our population proper was 146, which is an increase of 35 as compared with 1905. The increase was due to Scarlet Fever. The certificates related to the following diseases:- Diseases. Total for District. East Ward. West Ward. London County Asylum. St. Marylebone Schools. Scarlet Fever 99 43 49 2 5 Diphtheria 27 8 14 — 5 Membranous Croup 4 1 3 - - Enteric Fever 9 5 4 - — Puerperal Fever 1 1 1 — — Erysipelas 25 7 11 6 1 Small Pox - - — — — Totals 165 64 82 8 11 In the tables and comments which follow, cases occurring in Institutions in the district are not included. 22 The following Table shows the number of Infectious Diseases notified, the Infectious Sickness Rate, and the mean for the previous ten years. Years. Population. Scarlet Fever. Small Pox, Diphtheria. Croup. Typhoid Fever. Erysipelas. Puerperal Fever. Totals. Infectious Sickness Rate, per 1,000 Population. 1896 7184 56 4 2 2 2 7 1 74 1.0 1897 7913 39 — 88 — 15 10 — 152 19.2 1898 8531 31 — 80 — 7 15 - 133 15.5 1899 9311 60 — 110 1 2 13 — 186 19.9 1900 11199 47 — 39 5 4 10 — 105 9.3 1901 10477 56 2 8 3 3 12 — 84 7.8 1902 12680 65 2 17 3 2 21 — 110 8.0 1903 13832 80 — 16 2 9 20 2 129 9.3 1904 15737 145 — 17 2 4 15 — 183 11.8 1905 17712 69 - 25 4 3 15 — 116 6.5 Mean 1145.7 64.8 0.8 40.2 2.2 5.1 13.8 0.3 127.2 10.9 1906 18777 99 — 27 4 9 25 1 165 8.7 23 The following Table is to show the number of Cases notified each month during the year 1906. 1906. Notifications. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Deaths. Small Pox Under 5 years - - - - - - - - - - - - - - Over „ — - — — — — — — — — — — — — Scarlet Fever Under 5 years - — 2 1 2 1 11 — 1 2 4 2 26 — Over ,, 1 6 1 5 8 10 11 3 4 3 12 2 66 1 Diphtheria Under 5 years — — 1 1 1 — 1 - 2 - 1 1 8 — Over „ — 2 — - 1 1 — — 1 4 4 1 14 — Membranous Croup Under 5 years - 1 1 - — — — — — 1 — — 3 1 Over ,, - - - - - - - - - 1 - 1 — Enteric Fever Under 5 years — - - - - — - — — - - — - Over „ — — — 1 — 2 2 1 2 1 — — 9 — Puerperal Fever 21 to 46 years — 1 — - - - - — — — — — 1 1 Erysipelas Under 5 years — 1 1 2 — — - — — — — — 4 2 Over „ - 3 1 2 1 2 - 2 1 1 - 1 14 1 24 The Distribution of the above Cases into East and West Wards is shown in the following Table. Wards. Estimated Population. Small Pox. Scarlet Fever. Diphtheria. Croup. Erysipelas. Typhoid. Puerperal. Totals. Increase or Decrease on last year. East 8075 — 43 8 1 7 5 — 64 14 West 10702 — 49 14 3 11 4 1 82 22 Compared with Table for 1905. East 7025 — 24 15 4 6 1 - 50 - West 8712 - 42 8 — 9 2 — 61 — The Distribution of the Cases, North and South of the Railway, &c., is as follows : North. South. Hayes Bridge. New ell's Fields. Norwood. London County Asylum. Schools. White Street. North Hyde. Scarlet Fever 31 53 3 1 2 5 3 1 Diphtheria 6 11 - 4 - 5 1 - Membranous Croup 2 2 - - - - - - Enteric 2 3 - - - - - 4 Erysipelas 6 12 - - 6 1 - - Puerperal Fever 1 - - 1 - - - - 25 The following Table shows the Ages of the Cases notified, and the number removed to Hospital from each locality. Notifiable Disease. Cases Notified in whole District Including Institutions. Total Cases notified in Each Locality. No. of Cases removed to Hospital from each Locality. At Ages—Years. 1. West. 2. East. 3. Asylum. 4. St M'bone Schools. 1. West. 2. East. 3. Asylum. 4. St. M'bone Schools. At all Ages. Under lto 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards Small-pox - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - Diphtheria 27 1 14 9 2 1 — 14 8 — 5 14 7 5 (c) Membranous Croup 4 — 3 1 — - 3 1 — - - — - - Erysipelas 25 4 — 1 2 12 6 11 7 6 1 — - 1 Scarlet Fever 99 — 27 67 3 2 49 43 2 5 43 37 - 5 (b) Typhus Fever - - - - - - - - - - - - - - - Enteric Fever 9 - - 3 2 4 — 4 5 — — — 4 (d) - - Relapsing Fever - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - Puerperal Fever 1 — — 1 - — 1 — - - - - - - Plague - - - - - - - - - - - - - - - Chicken-pox - - - - - - - - - - - - - - - Totals 165 5 44 81 10 19 6 82 64 8 11 57 48 — 11 (b) Five Cases Removed to Metropolitan Asylum Board Hospitals. (c) Five Cases Removed to Metropolitan Asylum Board Hospitals. (d) Four Cases Removed to General Hospitals (London). 26 Scarlet Fever. The number of cases notified, excluding Institutions, was 92, as compared with 66 for 1905, of these 41 were males and 51 females, with the exception of 12 all were removed to the Isolation Hospital, where one proved fatal. The cases occurred at the following ages:— Ages. Under 1 year 1—5 5—15 15—25 25—65 — 26 63 2 1 Cases were notified every month as follows :— Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. 1 6 3 6 10 11 22 3 5 5 l6 4 The notified cases for the months of 1905 were:- Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. 10 14 4 3 5 4 0 0 2 4 8 12 Incidence of Scarlet Fever per 1,000 of Population. 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 5.6 13.8 7.3 3.4 7.7 4.8 3.6 6.4 4.1 5.3 5.1 5.7 7.1 5.2 Average incidence per 1,000 for years 1892—1897. Average incidence per 1,000 for years 1898—1903. The rate for the year is 4.8 per 1,000, as compared with 3.2 for 1905, and 9.2 for 1904. For the purpose of considering the comparative distribution of the cases in the District, the area may be divided into quadrants by the Railway which passes through from East toWest, dividing the District fairly equally into North and South parts each of which is sub-divided into East and West portions by South Road, King Street and Norwood Road, passing from North to South. The distribution of the cases has been much the same as for previous years; that is to say, the larger proportion occurred on the South side of the Railway. Of the total number of cases 36 occurred on the North, and 56 South of the Railway. This distribution is shown in the following table; the distribution for the previous five years is also given for the purposes of comparison. 27 SOUTH SIDE OF DISTRICT. Steamfield Estate. 1901. 1902. 1903. 1904. 1905. 1906. Dudley Road 5 5 - 10 6 3 Gladstone Road 1 - - 1 - - Queen's Road 10 3 2 6 7 6 Clarence Street - - 1 17 7 3 Spencer Street 3 - - 4 - 2 Hartington Road - 2 1 10 7 2 Sussex Road - 3 - - 1 2 Totals 19 13 4 48 28 18 Streets between Featherstone Road and Western Road, inclusive. (And the part of North Hyde, East of the Common). 1901. 1902. 1903. 1904. 1905. 1906. North Hyde - - - 1 2 1 Featherstone Road 2 2 1 4 - 2 Featherstone Terrace - - 2 9 1 - St. John's Road. - - - 5 - - Walt ham Road - - - 2 - 1 Elmfield Road - - - 3 3 2 Western Road 2 3 1 6 1 1 Totals 4 5 4 30 7 7 Streets between Western Road and Adelaide Estate (Including West side of King Street and North Hyde Common). 1901. 1902. 1903. 1904. 1905. 1906. North Hyde Common 1 - 2 5 - - King Stree - - 2 2 - - Dagmar Road - 2 3 1 — — Pluckington Place 1 — 4 1 — — Florence Road - - - - 3 3 Totals 2 2 11 9 3 3 28 ADELAIDE ESTATE and adjoining Streets. 1901. 1902. 1903. 1904. 1905. 1906. Regina Road 1 2 14 11 3 7 Adelaide Road - - 2 8 4 1 Clifton Road - - - 2 - 1 Gordon Road - - 4 1 - 2 Inverness Road - - - - 1 1 Talbot Road - - - - - 1 Lea Road - - 2 - 1 2 Beverley Road - - - 1 - - Endsleigh Road - - 1 - - - Totals 1 2 23 23 9 15 Streets East of King Street. (Including Norwood Road and Norwood Green). 1901. 1902. 1903. 1904. 1905. 1906. Woodland Place - - - - 1 - Kingston Road 1 - 2 4 - 4 Osterley Park and adjoining Roads - - - - - - Havelock Road - - - 1 4 1 East side King Street 1 1 - - - - Hammond Road 5 3 3 4 1 3 Norwood Road 1 3 - - 1 3 Hammond Road E. - - - - - 1 Rectory Road - 1 - - - Norwood Green 2 - 14 — 4 1 Top Locks 1 - - - - - Totals 11 8 19 9 11 13 1901. 1902 1903. 1904. 1905. 1906. Totals 37 30 61 119 58 56 North Side of the District. (Divided by the Railway.) 1901. 1902. 1903. 1904. 1905. 1906. White Street 5 4 1 4 2 3 29 Streets on the Hambro' Estate and vicinity. 1901. 1902. 1903. 1904. 1905. 1906. Beaconsfield Road - - - 9 1 - Oswald Road - - 2 1 - - Abbott's Road - - - 2 1 2 Hambro' Road - 1 - 1 1 1 Grange Road - - 1 - - - Randolph Road 1 1 2 3 - 1 The Crescent - - 1 2 - 2 Totals 1 2 6 18 3 6 1901. 1902. 1903. 1904. 1905. 1906. South Road - 4 1 - - 8 Avenue Road - 1 - - - 3 Cambridge Road - - - - - 1 Hamilton Road - 9 1 - - - High Street - 3 2 1 - 1 Lady Margaret Road - - - 1 1 - North Road 2 3 1 - 1 1 Shrubbery Road - 4 3 - - 2 Victoria Terrace - - 1 - - - Grove Cottages - - 1 - - - Grove Terrace - - 4 - - - Durdan's Cottages 3 2 - - - Mount Pleasant 2 1 1 - - 3 Waxlow Farm - - 1 - - - Mill Farm - - 1 - - - Beachcroft Avenue - - - 1 - 1 Northcote Avenue - - - - - 1 West End Road - - - - - 1 Saxon Road - - - - - 1 Newell's Fields - - - - - 3 King's Parade - - - 1 - - Trinity Road - - - - 1 1 Totals 4 28 19 4 3 27 1901. 1902. 1903. 1904. 1905. 1906. Totals. 10 34 26 26 8 36 Although the number of cases of Scarlet Fever notified is considerably in excess of that for last year, and they were more widely spread over the district, being approximately equally distributed to North and South of the railway, yet there was no epidemic prevalence of the disease; the total being constituted of a series of isolated outbreaks occurring largely amongst children attending the public elementary Schools. It was not, however, until the 30 occurrence of cases in May to July that evidence pointing in this direction was forthcoming. For the origin of the majority of the cases occurring in the earlier months of the year, there was no very satisfactory explanation. One of these cases was a child suffering from the disease who came to live in the district from Hanwell, another case was a scholar found in St. John's Infant School in the peeling stage. I have so often in previous reports dealt with the subject of the spread of Scarlet Fever by means of slight unrecognised cases, that I do not think it necessary to detail the circumstances under which this happens. A brief history is furnished by the following extracts from my reports. August. "I need scarcely say that the fresh outbreak of Scarlet Fever is engaging my serious attention. I feel fairly sure that infection is due in great part to unrecognised cases going about." "On July 2nd, the head-mistress of Dudley Road Girls' School sent home a scholar she found peeling on the hands. The girl was absent from school April 28th—May 14th, and after that attended regularly up to July 2nd. I have no doubt she was the means of infecting two children in an adjoining house in Newell's Fields, which we could not previously explain. Four of the other admissions to the Hospital were children attending Clifton Road Schools; there is reason to suppose they gave it to each other." I reported on July 5th that the evidence was fairly clear, that most of the cases of Scarlet Fever which had been recently admitted to the Hospital were probably due to the infection contracted from children attending Clifton Road Schools; further evidence in this direction has since come to light. "On July 6th we had two fresh cases in connection with this School. One, a case which had been going to School regularly for a fortnight whilst peeling freely; the other was a child in the same standard at the same School." On July nth, Dr. Young, the County Medical Officer, kindly came down to Southall, and investigated the matter very thoroughly. We visited all the Schools on the south side, and examined the scholars in certain class rooms at Clifton Road School; one child was found desquamating and was removed to Hospital, this case proved subsequently to be undoubtedly Scarlet Fever. Since July nth there have been two cases of Scarlet Fever of scholars attending this School, notified on July 17th and 24th. Unfortunately, cases have occurred in connection with the North Road Schools, and six of the admissions to the Hospital since last meeting were scholars attending there. A case in the peeling stage was found in this school. 31 October. I reported on August 9th, that "as the Schools were closed for the summer holidays, I did not anticipate there would be many fresh cases until they re-opened. As a matter of fact no case occurred at all until August 30th —that is—three days after the schools re-opened, from which date until September 28th, seven fresh cases have been admitted to Hospital, three of the patients were from one house in Clarence Street, so that altogether there were only five freshly-infected houses. In none of the cases is there very definite evidence as to where infection was contracted. November. "Five of the fresh admissions of Scarlet Fever are children who have attended North Road Schools. How far these children contracted infection at School there is no very definite evidence to show. "I have visited the School principally implicated i.e. North Road Infants, to which four of the patients went, and I am satisfied that one of them at least contracted infection outside by coming into contact with an unrecognised case, which has since been notified." I have made investigations both at the School and the patients houses with a view to detecting unrecognised cases, which I feel sure are responsible, but so far without any satisfactory result. December. "The nine cases of Scarlet Fever admitted since I last reported, have occurred chiefly amongst scholars attending North Road and St. John's Schools. One child at St. John's School was found by the mistress freely peeling and he had been in continuous attendance, with the exception of one day. Another child attending the same School was kept at home for a week, because of sore throat, again went back to school; his sister contracted Scarlet Fever, and he was found to be desquamating. One other case was traced to this source. Dr. Young, the County Medical Officer, who had occasion to visit the district on another matter, considered with me all the cases recently notified, and he was quite in agreement that the evidence pointed to unrecognised cases being the means of spread. Diphtheria and Membranous Croup. Twenty-six cases of Diphtheria and Membranous Croup were notified, as compared with 27 for 1905. Of these, 17 were males and 9 females. 32 Table of Ages. Under 1 Year. 1—5 years. 5 — 15 years. 15—40 years. 40-45 years. 1 16 6 2 1 The distribution was as follows:— 1906. 1905. 1904. 1903. Cases. Houses. Cases. Houses. Cases. Houses. Cases. Houses North Railway 9 9 12 6 6 6 6 4 South of Railway 17 16 15 14 13 12 12 11 Cases were notified in the following months :— Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. - 3 2 1 2 1 1 - 3 5 6 2 Incidence of Diphtheria per 1,000 of Population. 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903. 1.5 3.2 2.6 0.4 0.5 11.1 9.3 11.7 3.9 1.0 1.3 1.1 3.2 4.7 Average incidence per 1,000 for years 1892—1897. Average incidence per 1,000 for years 1898—1903. The incidence of Diphtheria for the year is 1.3 per 1,000 as compared with 1.5 for last year. The rate is a very low one, considering the character of the population, which contains such a large proportion at susceptible ages. The cases were all of a sporadic nature, and occurred in separate houses except in one case, where the mother took it from her child. Enquiries were made as to the origin of all these cases, but I failed to establish any connection between them, either through personal contact, or the milk supply. The majority of the cases were of a very mild form, so mild indeed that there was apparently nothing the matter except slight sore throat; the diagnosis of Diphtheria being established by means of bacteriological examination, and the only circumstances of any note in connection with many of them was (a) that the majority of the cases occurred in children who attended the elementary Schools in which cases of Scarlet Fever had occurred; (b) that some of the children actually attended School whilst in an infectious condition, and yet there was no spread from these cases so far as we could gather. 33 Probably, had it not been for bacterial examination, they would have been regarded as Scarlatinal sore throat. The mildness of the disease is shown by the fact that there was no death from notified Diphtheria, and only one from Membranous Croup. Typhoid or Enteric Fever. Nine cases of this disease were notified during the year as compared with four for 1905. Of this number four subsequently proved not to be Enteric Fever, but diseases which closely simulated it, so that there were only five undoubted cases during the year. The first case was notified June 30th, in a cottage at Top Locks, which was without drainage, and supplied by very polluted well water. The remaining cases all occurred at North Hyde, two cases in one house notified July 31st and September 1st, respectively. This cottage was in a dirty and insanitary state, and drained into a cesspool but supplied with Company's water. The next case was September 30th, a house on the opposite side of the canal at North Hyde, drained into the council's sewer, supplied with Company's water; house in good sanitary condition. These three patients frequently bathed in the canal. The next case occurred October 17th, in a cottage close to the first two cases. This cottage was not sewered, but supplied with Company's water; the premises were in an insanitary condition. A case was brought to my notice by the County Medical Officer of a patient with Enteric Fever in Harlington, who worked in Southall, and went home for week ends. Full enquiries were made into the circumstances of this case, some minor defects of sanitation in the premises where he worked were found, but there was nothing to show how these could have given rise to Enteric Fever. We ascertained, however, that two weeks before the patient was taken in he had been away for a four days' holiday, but his employer did not know where he went. It is difficult to say how these cases of Enteric Fever arose. I think the well water of the case at Top Docks was undoubtedly responsible; and the grouping of the cases at North Hyde was suspicious of some common factor in operation there. Milk was easily excluded; the water supply was common to all, but had this been responsible we should certainly have had cases in other parts of the District, so I think that may be put aside ; the most probable explanation is that it arose from the insanitary condition of the premises in which the cases occurred. It is generally held that an incidence of Enteric Fever not exceeding 0.5 per 1,000, indicates satisfactory sanitary circumstances; a rate of 1 per 1,000 is considered excessive. 34 Incidence of Typhoid Fever per 1,000 of population in District, 0.2. 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 0.3 0.3 0.9 0.0 0.1 0.2 0.1 0.4 0.2 0.3 0.09 1902 1903 1904 1905 1906 0.08 0.1 0.2 0.1 0.2 Average Incidence for 16 years 0.2 per 1,000. Provision for isolation of cases of Typhoid Fever at the Hospital, will be a matter for your consideration in the near future; since many of the London Hospitals on which we have been dependent for the reception of these cases hitherto, are now refusing to admit them. Measles and Whooping Cough. No outbreak of Measles occurred during the year. Whooping Cough was prevalent, and caused three deaths during the year. Since the disease is not a notifiable one, there are no means of judging the actual extent of the outbreak. It is regrettable, that most parents do not appear to take any steps to isolate their children, or even confine them to the house whilst suffering from the disease, yet Whooping Cough is the most fatal and infectious complaint of childhood, and the utter disregard shown towards this complaint contrasts strangely with the fear which Scarlet Fever and Diphtheria engenders in most people. In concluding this Section, it only remains to be said that the year has been a satisfactory one as regards the incidence of infectious sickness generally. How far this has been due to preventive measures adopted, is difficult to say. There is much evidence that infectious diseases come and go in tidal waves, and when we are congratulating ourselves upon diminished incidence resulting from improvements in housing, drainage, water supply, and preventive measures generally, it is often the result of the subsidence of the epidemic virulence, under conditions of which we are ignorant. Until more is known of the essential causes at work in infectious diseases, it is Utopian to expect to totally eradicate such complaints as Scarlet Fever and Diphtheria. All that can be done is to attempt to minimise their spread, and in this connection there can be little doubt that Medical inspection of School children is one of the best means, and I can only reiterate that some system of this kind is essential in a district like yours which contains an abnormably large proportion of School children. 35 SECTION IV, (a) Isolation Accommodation. (1) Accommodation is provided at the Isolation Hospital for cases of Diphtheria and Scarlet Fever only. The Pavilion Block, which is used for Scarlet Fever, consists of two large general wards and an emergency ward, with a nurse's duty room and kitchen situated between the large wards. Additional accommodation is provided by a Berthon Circular Hospital at the rear of the Pavilion Block, which is of very great service for convalescent patients. The Diphtheria patients are treated in the Isolation Block, which consists of two wards with sufficient accommodation for eight children. (2) There is no hospital for Small Pox in the district. The Council is under an agreement with the Authorities of the South Mimms Hospital for the reception of cases from this district. It is probable in the near future, that the question of providing accommodation for cases of Enteric Fever will arise, since most of the general hospitals now decline to take these cases in, and it is essentially a disease which requires hospital treatment, both from a curative and preventive point of view, unless the patient's domestic circumstances are exceptionally favourable. (3) Ambulance Arrangements. The Ambulance is of the latest Brougham pattern, containing a stretcher bed, which takes out at the back, seat for the nurse, &c. The vehicle is kept at the hospital and horsed by contract. The Inspector has charge of the arrangements and superintends the removal of patients. One of the nurses from the Hospital goes with the Ambulance for every case, provided with requisites for any emergency which may arise during the journey. (b) Methods of Disinfection. (1) In nearly all cases the work of disinfection is done at the cost of the Council, under the supervision of the Sanitary Inspector. As to Rooms: The procedure adopted in disinfecting rooms is as follows:— In all cases the room occupied by the patient is sealed and fumigated with sulphur dioxide gas, cylinders of compressed gas being used. In cases which have been treated at home, and in others kept at home for some days before removal to the Hospital, the fumigation is followed by scraping and stripping of all paper from the walls. This is not done, as a rule, when the 36 patient is removed to Hospital within a day or so of the commencement of the illness. In all cases, again, the walls, floor and ceiling are thoroughly brushed over, and the wood work and fixtures washed with a solution of chloride of lime. Where possible, the room is not occupied for a week, windows in the meantime being kept widely open. (2) As to Articles of Clothing: The clothing, bedding, curtains and other infected articles capable of removal, are taken to be disinfected in the Thresh's apparatus at the Hospital. Two covered hand trucks, one for infected and one for disinfected articles, are used as the means of transport. ISOLATION HOSPITAL. There were 101 patients admitted during the year, of these 80 were sent in as Scarlet Fever and 21 as Diphtheria. The following Table gives the numbers admitted, discharged, and under treatment during each month. Number admitted. Number Discharged. Deaths. Number in Hospital. Scarlet Fever. Diphtheria. Scarlet Fever. Diphtheria. January 1 - 8 2 - 17 February 6 1 5 — — 14 Match 2 1 3 1 — 12 April 2 1 3 — — 10 May 9 1 3 2 — 15 June 12 2 9 1 1 Scarlet Fever. 22 July 16 2 12 1 — 36 August 3 — 18 — — 25 September 5 2 2 3 — 14 October 5 4 2 — — 17 November 15 5 6 4 — 35 December. 4 2 9 5 — 31 Totals 80 21 80 19 1 Average number in Hospital for each month= 20 6. 37 There was only one fatal case in the Hospital during the year, that was a case of toxic Scarlet Fever. A case of Puerperal Scarlet Fever required operation for a large abdominal abscess, and abscess in the shoulder joint. There were more cases of Scarlet Fever with nasal discharge and secondary sore throat than last year, and this I think was largely due to inefficient ventilation of the wards in cold weather. We found it impossible to get the temperature up to fifty degrees, unless all the window ventilators were closed; under these conditions the atmosphere was far from satisfactory, and during the particularly cold weather in December the Hospital was full, and it was then that these complications occurred. As far as practicable convalescents and acute cases are separated, with a view to preventing complications, septic cases with discharges are isolated, either in separate wards, or with "fenders" round the bed according to circumstances. To this end also cases are treated antiseptically throughout. The nurses wear rubber gloves during treatment which are freshly disinfected for each case, and each patient is provided with his own feeding utensils, spatula, nasal douche, etc. Before patients are discharged they are isolated for two or three days in one of the three available rooms we have for this purpose, after having undergone a thorough process of cleansing, disinfection of skin, hair, mouth, nose and ears. I am pleased to say there has been no "return" case of Scarlet Fever again during the past year. With regard to the cases of Diphtheria, 2 cases of Membranous Croup required the operation of tracheotomy, and both recovered. No convalescent from diphtheria is discharged from the Hospital until three consecutive negative reports are obtained from swabs taken from the nose and throat at intervals, during the last ten or fourteen days' stay of the patient in Hospital. By these means we are assured as far as possible that the patient is free from infectious germs. There was one probable return case of diphtheria, the mother of a child recently discharged, was admitted for diphtheria. 38 Expenditure. I am indebted to Mr. Burwell for the following particulars of expenditure on the Sanatorium for the year ending December 31st, 1900: — £ s. d. Approximate Expenditure for 1905. Approximate Expenditure for 1904. £ s. d. £ s. d. Salaries, Wages, etc. (a) 434 9 5 412 15 10 (a) 481 0 0 Provisions (b) 261 1 8 277 13 3 (b) 361 0 0 Fuel, Light, Cleaning, etc. (d) 165 7 11 191 2 3 (c) 155 0 0 Dispensary, Medical and Surgical (d) 83 11 2 43 9 0 (d) 50 0 0 Rates, Taxes and Insurance (e) 46 7 8 42 3 8 (e) 43 0 0 Establishment Charges (f) 87 10 1 79 18 3 (f) 114 0 0 Repairs and Maintenance 63 5 3 — Repayment of Loans and Interest 821 16 10 835 19 5 827 0 0 Capital Charges 33 16 6 22 10 10 433 0 0 £1934 1 3 £1974 17 9 £2464 0 0 It gives me great pleasure to testify to the excellent administrative work of the Matron, Miss Cooke. The Nursing Staff have worked well, and deserve our warmest thanks. The Hospital is a. model of cleanliness and order. 39 SECTION V. GENERAL SANITARY CIRCUMSTANCES AND ADMINISTRATION. (I.) Houses and Housing Accommodation. Mr. Hanson, the Rate Collector, informs me that the number of houses in rating at the end of December, 1906, was 3,876, an increase of 104 during the year. The rapid growth of the District is illustrated by the following table:— Number of Inhabited Houses in District. 1891 Census Return 1,021 1899 Rate Book 1790 1892 „ „ - 1900 „ „ 2,045 1893 Rate Book 1,048 1901 Census Return *1,911 1894 „ „ 1,068 1902 Rate Book 2,536 1895 „ „ 1,115 1903 „ „ 2,684 1896 „ „ 1,291 1904 „ „ 3,328 1897 „ „ 1,425 1905 „ „ 3,772 1898 „ „ 1,634 1906 „ „ 3,876 Year. Total. West Ward. East Ward. 1901 1,911 1,029 882 1902 2,536 1,338 1,198 1903 2,684 1,439 1,245 1904 3,328 1,810 1,518 1905 3,772 2,053 1,619 1906 3,876 2,218 1,658 *At the time of the Census a large number of houses (259) were unoccupied owing to depression of trade in the district. 40 Public Elementary Schools. School. Department. Authotized Accommodation. Average No. on Rolls during Month, Dec. 1906. Average Attendance. Percentage of Average Attendance on No. on Rolls. Featherstone Road P. Boys' 800 756 684 90.4 St. John's (temporary)P. Boys' 120 145 126.1 86.6 Featherstone Road P. Infants' †434 473 409 86.4 Clifton Road P. Infants 400 387 330 85.2 Dudley Road P. Girls' 400 457 377.1 8.24 North Road P. Mixed *298 571 467.7 81.8 286 North Road P. Infants' 265 323 261.4 80.9 Clifton Road Girls' 400 409 329.2 80.3 Totals 3403 3521 2984.5 84.7 Corresponding month of last year (3196) (3396) (2903.6) (85.5) Plans Approved by the Council (1906). Houses 380 Factories 3 Stables 5 Slaughter Houses 1 Shops 14 Church 1 Schools 2 Hotel 1 Workshops 3 Laundry 1 Plans for new streets of approximately 3 miles in length have also been passed and laid out. Houses Certified for Occupation, 1906. Houses 297 Shops 31 Private Streets. I am very pleased to say that during the past year further attention has been given to the making up of Private Streets in the districts. This work is very desirable from a health point of view, and will, I trust, be proceeded with as opportunity offers until completion. The amount expended for this purpose during the past year has been very little short of £3,000. Housing of the Working Classes Act. No proceedings under this Act were taken during the year. 41 Insanitary Dwellings. In July I reported as to the insanitary condition of Stroud's Cottages, Western Road. These three cottages were not connected to the sewer, and in my opinion they constituted a nuisance dangerous to health. Notice was served, and the necessary work has been done. In November I had a formal complaint, as to a nuisance arising from the cesspools of a row of cottages situate at Buckingham Terrace, Top Lock, Havelock Road. As regards drainage, I found them in a very insanitary state indeed ; notice was served on the owners, and the necessary work to abate the nuisance carried out. Until the main sewer is extended to this part of the district, no radical alteration in the drainage of these cottages can be made, and until such are carried out the nuisance is one which is liable to recur. Alleged Nuisance from Brickfields. In February, complaints were made as to a nuisance alleged to be caused from the breeze used in the brickfield adjoining Tudor Road, Uxbridge Road. The complainants were owners of property in Tudor Road, and they stated that the smell from the breeze had been very bad indeed, and that eight of the tenants of the nine occupied houses in Tudor Road had made complaints. At the time of my visit there was an objectionable smell in the immediate neighbourhood of the breeze; but it was not of sufficient intensity, or carried sufficiently far, in my opinion, to constitute a nuisance. There was about half an acre of ground, covered with breeze to a depth of one-and-a-half to two feet. The owner of the brickfield said the breeze was the cleanest and best screened which could be obtained, and that it had been ' rotting ' for a month before being taken to the brickfield. This breeze is made up of ashes from dust bins, and contains small quantities of animal and vegetable matter in a state of fine division ; it is from the decomposition of these substances that objectionable smell arises. In my opinion, nuisance was likely to recur when fresh breeze was deposited. I indicated to the Council the lines of action ; by Section 112 (Public Health Act 1875), the consent of the Urban Sanitary Authority must be obtained before establishing certain scheduled businesses or any other offensive trades. In Section 114, under which the Court may impose penalties where Tiny business process, or manufacture causing effluvia is carried on, unless it is proved that the best practicable means to obviate nuisance have been employed. It would appear that under this Section the use of 'coke' breeze, which is free from any animal or vegetable matter could be insisted upon. Negotiations with the owner of 42 the field led to an undertaking that no nuisance should be caused in future by deposit of breeze or burning of bricks; and so far there has been no cause for complaint. Overcrowding.—Ten cases of overcrowding of dwelling houses came under observation and were dealt with by notice which was complied with in every case. Common Lodging Houses. There are no Common Lodging Houses in the District. Houses Let in Lodgings. There are eleven houses let in lodgings on the register, and four contraventions of the bye-laws in connection therewith, were dealt with during the year. Movable Dwellings—Caravans. Fourteen movable dwellings came under observation during the year. Offensive Trades. No offensive trades as scheduled in the Public Health Acts are carried on in the district. Water Supply. The South-West Suburban Water Company whose resevoirs are at Egham, supply the whole of the district, with the exception, of a small area on the south side of the district (Adelaide Estate), and a few houses at North Hyde. With a view to ensuring a constant and sufficient supply at adequate pressure, the South-West Suburban Company have a water tower on their premises at Southall with a capacity of about 300,000 gallons. Since 1901, the quality of the water supply has engaged the attention of the Council, and periodically samples have been submitted for analysis to the Public Analyst; this has been done with decreasing frequency, as the reports as to its purity were more or less favourable. During the latter part of November, there was an unusual prevalence of cases ef Diarrhoea in the district, many of which were of very severe character, and presented the general features of Cholera. The prevalence of an illness of this character at once aroused suspicion as to the water supply being responsible. I made particular enquiries in a number of these cases which occurred in my own practice, and except in one case there was no evidence forthcoming as to the cause; nothing in common had been consumed by the patients except water from the public supply, but against this being responsible was the fact that there was not more than one case in each house. 43 I sought information from all the medical practitioners in the district (a) with respect to the prevalence of Diarrhoea in their practices, and (b) as to whether they could offer any explanation as to the cause. All very kindly replied, and the replies with one exception were to the effect, that more cases of Diarrhoea had occurred than was usual for the time of year, and the general opinion was, that the complaint was an anomalous form of Influenza. I enquired also as to the relative incidence of Diarrhoea in the areas supplied by the two water companies. It was made clear that the illness was not limited to the area supplied by the South-West Suburban Water Company, and I should say that in proportion to the population supplied, the distribution of cases was approximately equal. My conclusion was, that the water supply could not be held to be responsible. On November 21st, the Superintendent of the Marylebone Schools, informed the Sanitary Inspector that the County Analyst had certified a sample of water taken from the Main at the Schools to be unfit for drinking purposes. I at once submitted a sample to the Public Analyst, who reported as follows:— Laboratories, 3 and 4, New Court, Lincoln's Inn, London, W.C. December 4th, 1906. Certificate of Analysis of a Sample of Drinking Water. Received: November 21st, 1906. From: Mr. H. T. Baxter. Marked: "From Main of the S.W. Suburban Water Co., November 21st, 1906. 19. Portland Road, Southall." H. T. Baxter, Appearance : Clear. Colour: Dark Brown. Smell: None. Parts per 100,000. Total Solids dried at 100° C. 37.10 Total Solids ignited 31.30 Chlorine 2.20 Nitric Acid 1.00 Nitrous Acid Absent. Oxygen absorbed .146 Free Ammonia .004 Albuminoid Ammonia .021 From a consideration of these results, I am of opinion that the water has been imperfectly purified. Edward Bevan. 44 The same day I interviewed the local officials of the Water Company and urged most strongly that they should take immediate measures to ensure a pure supply. I again interviewed the local manager on the 23rd on this matter, and submitted a further sample for analysis. Laboratories, 3 and 4, New Court, Lincoln's Inn, London, W.C. December 4th, 1906. Certificate of Analysis of a Sample of Drinking Water. Received : November 26th, 1906. From : Mr. H. T. Baxter. Marked: "Water from Main of the S.W. Suburban Water Co., taken at South Lodge, The Green, Southall, Nov. 26th, 1906." H. T. Baxter, A.R.S.I. Appearance : Clear. Colour : Dark Brown. Smell : None. Parts Per 100,000. Total Solids dried at 100° C. 39.5 Total Solids ignited 34.9 Chlorine 2.2 Nitric Acid 9 Nitrous Acid Absent. Oxygen absorbed .12 Free Ammonia .006 Albuminoid Ammonia *036 From a consideration of these results, I am of opinion that the water has been very imperfectly purified. Edward Bevan. On the 24th, the Manager of the Works at Egham was written to as follows :— The Medical Officer of Health (Dr. Windle) wishes me to let you know that he has complained to your Officers here as to the very bad quality of the water during the last week or two, and that he has received very many complaints from those living here, and that there is a large amount of diarrhoea in the district which may be attributed to the water, that he must ask you to give this matter your immediate and most serious attention, especially as to the filtration and purification. Yours faithfully, Henry T. Baxter, A.R.S.I. J. Allen, Esq., South- West Suburban Water Co., Egham. 45 Dr. Young, the County Medical Officer of Health, independently received complaints as to the quality of the water supplied by the South-West Suburban Water Company. He came down to Southall on the 26th and went very fully into the question with me, and the matter is being dealt with by him. Further samples were submitted for chemical and bacteriological analysis, and reported on as follows:— Lister Institute of Preventive Medicine. 3rd December, 1906. Report on Examination of Sample of Water (Bacteriological) received from Southall-Norwood District Council, on 27th November, 1906. Labelled Sample of water taken from Main of South-West Suburban Water Company at stand pipe. Belle Charity Cottages, Western Road. H. T. Baxter, Inspector. No. of micro-organisms in 1 C C growing at 37° C = 22. No. of micro-organisms in 1 C C growing at 22° 0 = 73. Typical Bacillus Coli was isolated from 250 C C, but not from 50 C C of the sample. From the Bacteriological Examination of this sample no evidence is afforded of any contamination. J. C. G. Ledingham. Laboratories, 3 and 4, New Court, Liocoln's Inn, London, W.C. December 4th, 1906. Certificate of Analysis of a Sample of Drinking Water. Received November 23rd, 1906. From Mr. H. T. Baxter. Marked: "Sample of Drinking Water from the Main of the South-West Suburban Water Co., at 32, High Street, Southall. November 23rd, 1906." H. T. Baxter, A.R.S.I. Appearance : Clear. Colour: Dark brown. Smell: None. P.T.O. 46 Parts per 100,000. Total Solids dried at 100° C 38.7 Total Solids ignited 347 Chlorine 2.2 Nitric Acid 1.1 Nitrous Acid Absent Oxygen absorbed 174 Free Ammonia .0013 Albuminoid Ammonia .0168 From a consideration of these results, I am of opinion that the water is imperfectly purified. Edward Bevan. Polluted Wells. Enquiries into a case of Enteric Fever at Top Locks, aroused suspicion as to the quality of the well water. The Public Analyst reported it to be a very polluted water indeed. I advised that samples should be taken from all the wells supplying houses at Top Locks. This was done and the Analyst reported that all were bad. I should here say that Top Locks is quite off the route of the Water Company's Main, and the owners have difficulty in complying with the notices which were served on them to provide a supply of pure water, as the Company are reluctant to carry their main so far. The worst wells have been closed, and others have been cleaned out. I am quite satisfied that the owners are doing all they can in the matter, and I fully anticipate that within a very short time the Company's Main will be carried to Top Locks. When this is done there will be no part of the district supplied from wells. Disposal of Refuse. I am indebted to our Engineer, Mr. Reginald Brown, A.M.I.C.E., M.R.S.I., &c., for the following particulars. (a). Sewage Disposal. 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 causes an endless band of wire net to revolve slowly, thus catching and lifting out all 47 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 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 continuous stream into a carrier. Four Precipitation Tanks of 600,000 gallons capacity are in use, 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 passes from the tanks into about f acres of first Contact Beds. The feature of the Works is the ample provision made for the effectual aeration of the whole system. 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 effluent is tested every day, with a view to ascertaining the efficiency of the process. The phenomenal growth of the district even now requires extension of works, and the Surveyor has the matter in hand. The whole of the machinery at the works is driven by gas engines, the gas being at present supplied from a Dowson gas generating plant, but arrangements are now being made for the laying on of town gas. It is also hoped that water will be laid on to the farm at no very distant dale. Much good has been done during the winter in further levelling the land at the Farm so as to improve distributing facilities for the Sewage. 48 (b). Removal of House Refuse. During the year 3,094 loads of refuse have been removed from the houses in the District; the system in vogue is a weekly collection, the refuse from each house, except where unavoidable, being removed once a week on specified days. The refuse of the house is stored in galvanized iron bins, which, when emptied, are dusted with carbolic powder. The dust is removed by means of Glover's covered carts with wind guards. The work is carried out by contract at a rate per day for horse, harness and man ; the Council supplying the cart and one dustman. The District is divided into three Sub-Districts for the purposes of collecting, and reports are made daily to the Surveyor as to the progress of the work for each of these Sub-Districts. It is a pity that with such an efficient method for the removal of refuse, that the method of disposal is so primitive. Under his contract, the contractor is bound to find his own shoot, and this with a rapidly growing district becomes more difficult every day ; the consequence being that the refuse finds its way into the disused sand or gravel pits frequently situate at or near the rear of houses in course of erection, and although constant supervision is exercised to see that no nuisance is created by covering the refuse with earth and gas lime, the practice must be deprecated, inasmuch as a subsoil composed of such material and especially where so short a distance from the house, cannot be conducive to the health of the inmates. Under these conditions a refuse destructor should be erected at the earliest possible moment, so as to dispose of the material collected in the most sanitary manner. In my last Report, I expressed the hope that this object would shortly be attained as the Council has decided to proceed with the erection of a properly designed refuse destructor, but up to the present nothing has been done except plans prepared. Two sites have been purchased, one on the north side of the district adjoining the Canal at Hayes Bridge, with a private dock accommodation. (This site has an area of about 4 acres), and the other on the south side of the District, on the west of Norwood Mill on what is known as the Adelaide Estate. This site has also private dock accommodation, and has an area of about 3 acres. The Council propose utilizing this latter site first, and the Engineer has prepared the necessary plans. Workshops and Workplaces. The Workshops and Workplaces in the district consist chiefly of joiners, carpenters, and other industries connected with the building trade. There is no special workshop industry carried on in the district. Workshops connected with wearing 49 apparel are few in number, and come mainly under the heading of Domestic Workshops. All these various premises have been inspected by myself and the sanitary inspector, and I am satisfied that their sanitary circumstances are suitable; no contraventions under the act of any moment have come under notice. The Workshops and Workplaces in the district are 19 in number, and persons employed in them (but not all constantly employed) are approximately 85 in number. Bakehouses, are designated workshops in the Act; the number on the register is 15, as compared with 14 for last year. The new bakehouses which have been built in the district during the last few years are constructed on model principles. No contraventions of the Act have come under notice, except as regards lime whiteing. Notice has been served in two cases for this to be done. With regard to factories H.M. Inspector is responsible for the sanitary circumstances generally, and in case of default he reports to the Council. No complaint has been received during the year. Factories, Workshops, Laundries, Workplaces and Homework. 1.—INSPECTION. (Including Inspections made by Sanitary Inspector.) Inspections. Written Notices. Prosecutions. FACTORIES (Including Factory Laundries) 18 2 — WORKSHOPS (Including Workshop Laundries) 76 2 — WORKPLACES 12 — — HOMEWORKERS' PREMISES 6 — — Total 112 4 – 2.—DEFECTS FOUND. Nuisances under the Public Health Acts : — Found. Remedied. Prosecutions. Want of Cleanliness 1 1 — Want of Ventilation 1 1 — Overcrowding — — — Want of Drainage of Floors — — — Other Nuisances — — — 50 Sanitary Accommodations :— Insufficient — — — Unsuitable or Defective 1 1 — Not Separate for Sexes — — — Offences under the Factury and Workshop Act:— Illegal Occupation of Underground Bakehouse (S. 101) — — — Breach of Special Sanitary Requirements for Bakehouses (S.S. 97 to 100) 2 2 — Failure as Regards Lists of Outworkers (S. 107) — — — Giving ont Work to be done in Premises which are : — Unwholesome (S. 108) — — — Infected (S. 110) — — — Allowing Wearing Apparel to be made in Premises Infected by Scarlet Fever or Small Pox(S. 109) — — — Other Offences — — — 5 5 — 3.—OTHER MATTERS. Matters Notified to H.M. Inspectors of Factories :— Number. Failure to Affix Abstract of the Factory and Workshop Act (S. 133). — Action taken in matters referred by II. M. Inspectors as remedial under the Public Health Acts, but not under the Factory Act (S. 5):— Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspector — Other — Underground Bakehouses (S. 101): — In use during 1906 1 Certificates granted :— In 1905 — In 1906 — In use at the end of 1906 1 Homework:— Number of List of Outworkers (S. 107): — Lists. Outworkers. Lists received 2 2 Addresses of Outworkers :— Forwarded to other Authorities — Received from other Authorities 2 51 Homework in Unwholesome' or Infected Premises :— Weairng Apparel. Other. Notices Prohibiting Homework in Unwholesome Premises (S. 108) — — Cases of Infectious Disease notified in Home workers' Premises — — Orders Prohibiting Homework in Infectecd Premises (S. no) — — Workshops on the Register (S. 131) at the end of 1906 :— Workshops and Workplaces — 19 Laundries — 5 Bakehouses — 15 Total Number of Workshops on Register 39 Slaughter Houses. The number of Slaughter Houses in the district is 6. I have inspected them all once during the year, and they are all inspected quarterly by the Sanitary Inspector. I found all these premises in a clean and sanitary condition. In one instance lime-washing was required, and this was done. The Butchers' Shops in the district are kept under observation by the Sanitary Inspector. Cow Sheds, Dairies and Milk Shops. The number of Cow Sheds on the register is 7, and the number of Milch Cows is about 317. All the Cow Sheds are attached to farms on the outskirts of the town, and the cattle are only stalled, or partially stalled during winter. There is no Cow Shed in the town where cattle are stalled all the year round, as is the case in many districts. The condition of these premises is probably better than prevails in the country generally; great improvements have been effected during the past few years as regards drainage, lighting, ventilation and water supply. There are ample facilities for keeping the premises in a thoroughly clean and sanitary state, yet I must say that the standard of cleanliness which one would like to see in premises of 52 this character is not observed. All the Cow Sheds have dairies for the storage of milk, cleansing of utensils and so forth ; and all, with one exception are provided with refrigerators. There has been no illness, either amongst the cattle, or those employed about them so far as we could gather. Milk Shops and Dairies. All the Milk Shops in the district have been frequently visited and inspected for the purpose of making enquiries relating to cases of infectious sickness, but in no case was the milk supply under suspicion. Generally speaking the regulations are carried out in a satisfactory manner. In previous reports I have condemned the system of distributing milk to houses in the dealer's cans as a dangerous one, and further experience only confirms me in this view. I repeatedly see these cans being used by'sick persons, and I am sure that unless they are carefully sterilised they must constitute a source of danger. The regulations provide for this being done, but it is impossible to see that the regulations are constantly carried out. In all cases of infectious disease we notify the milk vendor supplying the house, and urge special precautions, so as to protect the milk supply in this way. Contagious Diseases Animals' Act. No outbreak reported during the year. 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) Regulations as to Dairies, Cowsheds and Milk Shops. 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. 53 (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) Slaughter Houses. (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. Mr. H. T. Baxter, A.R.S.I., Sanitary Inspector, has compiled the following :— Summary of his Work for 1906. Premises Periodically Inspected. Totals. Factories 16 Workshops 16 Workplaces 3 Dairies 12 Milksellers 8 Cowsheds 7 Laundries 5 Bakehouses 15 Slaughterhouses 6 Houses let in lodgings (registered) 16 104 Number of Houses and Premises Inspected 540 „ „ ,, Re-Inspected 310 850 Number of Nuisances Reported to Council 287 „ „ not „ „ 23 310 Number of Cautionary Notices Served 302 „ „ Statutory „ ,, 8 310 54 Number of Nuisances abated 307 „ „ ,, in hand January 1st, 1907 3 310 Number of Infectious Cases Removed to Sanatorium 100 „ „ „ „ „ „ W.L. Hospital 3 „ „ „ „ Visited at Home 20 123 Number of Rooms Stripped, Cleansed and Fumigated 16 „ „ „ Fumigated 107 „ „ „ after Phthisis 3 126 Number of Rooms from which Bedding, Clothes, &c., were removed to Sanatorium for disinfection 126 126 Nuisance from Blocked Drains and W.C. 83 „ „ Defective Water Supply to W.C. 50 „ ,, Houses being without Water 19 „ „ Defective Fresh Air Inlet 18 „ ,, Caravans without Sanitary Arrangements 14 „ „ Defective and Broken Drains 12 „ „ „ „ Guttering 11 „ „ Overcrowding 10 ,, „ Houses being Dirty and bad State of Repair 8 „ „ Depositing Refuse 8 „ „ „ Manure 7 „ „ Keeping Fowls 5 „ „ Defective Roofs 5 „ „ Dirty W.C. Pans 5 „ „ „ Passages 4 ,, „ ,, Back Yards 4 „ ,, Butcher's Offal 4 „ „ Burst Water Pipes 3 ,, „ Dirty Urinals 3 „ „ Dead Animals 2 „ „ Keeping Horses in Shed not Drained 2 „ ,, Defective Foul Air Outlets 2 „ „ Fried Fish Shop 1 „ „ Keeping Pig 1 „ „ Smoke 1 ,, „ Other Causes 5 287 55 Summary of Work as Petroleum Inspector. 1906. No. of Petroleum Stores visited 5 No. of Licenses granted 5 Summary of Work as Canal Boat Inspector. No. of Special Visits to Canal for Inspecting 35 No. of Boats Inspected 83 JNIo. or coats found with Infringements 3 „ „ without ,, 80 83 No. of Infringements remedied 3 Wells. Water Report. I have taken 15 samples of well water to the Public Analyst from 13 wells. In all cases (except two) the Analyst reported the water as being unfit for drinking. In two it was suspicious. In two cases the wells were at once closed and filled in, Company's water being provided. In one case the well was closed, and a new one provided. The water from which was also reported as unfit for drinking, but is still being used. In one case the well is closed and water obtained elsewhere. In two cases where the wells were cleansed, the water, on being analysed, was reported as unfit for drinking, but is still being used. In four cases nothing has been done. The water is still being used. Water Company. Two samples of water from the main of the Grand Junction Water Co. (now Water Board), and 5 from the mains of the South-West Suburban Water Co. were also taken to the Public Analyst, and one to the Lister Institute, for Bacteriological Examination. Total Samples Examined, 23. 56 Burial Grounds. The following Table gives particulars of the Burial Grounds in use in this District;— The Cemetery. St. John's. Parish Church. 1.—The Situation of the Ground HavelockRoad.SouthallGreen The Green. Southall. 2.—Total Area About 5 Acres About ½ Acre. 3.—Dates of first use of first entry in register April 2nd, 1883 March 3rd, i860. (Consecrated Jan. 23, 1860). 4.—Total number of Burials to date 2207 1570 5. —No. of Vaults None None. N orwood. 6.— „ Brick Graves Five 13. — 7.— ,, Earth—Private Graves 332 577. 8.—Length and Width of Grave Spaces 8-ft. x 4-ft. Brick Grave Brick Grave, 8-ft. x 4-ft. No particulars. 7-ft. x 3-ft. Earth ,, Earth ,, 6-ft.6-in.x2-ft.6-in. 9-—Depth of uppermost coffin below level of ground Four Feet Four Feet. 10.—Area of unused Ground 2/3rds About I-fifth. (See below). 11.—Distance of nearest dwelling and whether partially or wholly surrounded by houses 20-ft. (partially) Adjoining on North Side. North and West Sides. Memo.—The Ground unused is the front portion of Churchyard and are principally brick grave spaces. 57 TABLE I. Vital Statistics of Whole District during 1906 and previous Years. SOUTHALL-NORWOOD. Year. Population estimated to Middle of each Year. 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. Number. Rate.* Under I Year of Age. At all Ages. Number. Rate per 1,000 P.irths Registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1894 7793 181 31.9 27 146.7 200 25.6 123 123 2 77 9.3 1895 8851 188 28.1 26 139.5 252 28.4 159 159 7 93 10.5 1896 9351 207 28.8 31 149.7 257 27.4 166 166 5 91 9.7 1897 10217 254 32.1 28 110.2 304 29.7 198 198 16 106 10.3 1898 10871 258 30.2 32 112.3 360 33.1 239 239 23 121 11.1 1899 11811 325 34.8 51 156.1 364 30.7 228 228 13 136 11.4 1900 13813 353 31.4 44 124.6 396 28.6 210 230 19 166 12.0 1901 13314 360 34.3 65 180.5 383 28.7 215 215 3 168 12.6 1902 15515 465 36.6 62 133.3 362 23.7 212 212 5 156 10.0 1903 16667 476 34.4 64 134.4 398 23.8 247 217 18 169 10.4 Averages for years 1894-1903. 11820.3 307.0 32.2 43.0 138.7 327.6 27.9 201.7 201.7 11.1 128.3 10.7 1904 18592 578 36.7 85 147.0 385 20.5 203 203 13 195 10.4 1905 19907 576 32.5 58 100.6 431 21.6 247 247 25 184 10.3 1906 22617 621 33.6 96 154 410 18.1 196 196 30 244 10.7 * Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. Area of District in acres (exclusive of area covered by water), 2,525. Total population at all ages 13,200 Number of inhabited houses 1,920 Average number of persons per house 6.8 At Census of 1901. 58 I. Institutions within the District receiving sick and infirm persons from outside the District. II. Institutions outside the District receiving sick and infirm persons from the District. III. Other Institutions, the deaths in which have been distributed among the several localities in the District. London County Asylum, Norwood (Middlesex) Hillingdon Union Workhouse Infirmary Middlesex County Asylum (Wandsworth) The Sanatorium, Southall St. Mary's Hospital (Paddington, W.) West London Hospital Paddington Green Children's Hospital Great Ormond Street Children's Hospital Northern Fever Hospital (Winchmore Hill) North West London Hospital St. Thomas' Hospital Hammersmith Infirmary University College Hospital 59 TABLE II. Vital Statistics of Separate Localities in 1906 and Previous Years. SOUTHALL-NORWOOD. Names of Localities. 1.—Southall-Norwood. 2.—East Ward. 3.—West Ward. 4.—Hanwell Asylum. Year. Population estimated to middle of each year. Births Registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births Registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births Registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of e.ich year. Births Registered. Deaths at all Ages. Deaths under 1 year. a b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 1894 5,756 184 77 27 2,037 ... 123 ... 1895 6,684 188 93 26 2,167 ... 159 ... 1896 7,184 207 91 31 2,167 ... 166 ... 1897 7,913 254 106 28 2,304 ... 198 ... 1898 8,531 258 121 32 Statistics not available, as whole Districts has been taken together. 2,340 ... 239 ... 1899 9,311 325 136 51 2,500 ... 228 ... 1900 11,199 353 166 44 2,614 ... 230 ... 1901 10,479 360 168 65 2,835 ... 215 ... 1902 12,680 465 156 62 2,835 ... 212 ... 1903 13,832 476 169 64 6225 196 71 29 7607 280 98 35 2,835 ... 247 ... Averages of Years 1894 to 1903. 9356.9 307.0 128.3 43.0 ... ... ... ... ... ... ... ... 2465.4 ... 201.7 ... 1904 15,737 578 195 85 7025 289 98 43 8712 289 97 42 2,855 ... 203 ... 1905 17,712 576 184 58 7870 245 80 25 9842 331 104 33 2,855 ... 247 ... 1906 18,777 621 244 96 8075 269 111 43 10702 352 133 53 2,825 ... 196 ... 60 TABLE III. Cases of Infectious Disease notified during the Year 1906. SOUTHALL-NORWOOD. Notifiable Disease. Cases notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality. At Ages—Years. 1 West Ward. 2 East Ward. 3 London County Asylum. 4 St. Marylcbone Schools. 1 West Ward. 2 East Ward. 3. London County Asylum. 4 St. Marylebonej Schools. At all Ages. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 27 1 4 9 2 1 ... 14 8 ... 5 14 7 ... 5 Membranous Croup 4 ... 13 1 ... ... ... 3 1 ... ... ... ... ... ... Erysipelas 25 4 ... 1 2 12 6 11 7 6 1 ... ... ... 1 Scarlet fever 99 ... 27 67 3 2 ... 49 45 2 5 43 37 ... 5 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 9 ... ... 3 2 4 ... 4 5 ... ... ... 4 ... ... Relapsing fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 165 5 44 81 10 19 6 82 64 8 11 57 48 ... 11 TABLE IV. Causes of, and Ages at, Death during the Year 1906. 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. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. East. West. Workhouse. Various London Hospitals. S. Marylebone Schools Sanatorium. Hanwell Asylum Measles — — — — — — — — — — — — — — Scarlet Fever 2 — — 2 — — — — — — 1 — 1 — Whooping Cough 3 3 — — — — — 1 2 — — — — — Diphtheria and membranous croup 1 — 1 — — — — — 1 — — — — — Epidemic Influenza — — — — — — — — — — — — — — Diarrhœa 32 24 3 1 — 1 3 16 15 — 1 — — — Enteritis 7 6 1 — — — — 3 4 — — — — — Dysentry — — — — — — — — — — — — — 2 Puerperal fever 1 — — — 1 — — — 1 — — — — — Erysipelas 3 2 — — — 1 — 2 — — 1 — — 1 Other septic diseases 4 — 3 1 — — — 1 1 — 2 — — 6 Phthisis 13 — 1 2 4 6 — 4 7 1 1 — — 30 Other tubercular diseases 7 1 1 4 1 14 — 3 3 — 1 — — — Cancer, malignant disease 20 — — — 1 3 5 6 10 2 2 — — 5 Bronchitis 10 2 — — — 6 5 5 5 — — — — 9 Pneumonia 19 6 3 3 — — 1 5 13 — — 1 — 11 Pleurisy — — — — — — — — — — — — — 1 Alcoholism 5 — — — 2 2 1 1 2 1 1 — — — Cirrhosis of Liver Venereal disease 1 1 — — — — — 1 — — — — — — Diseases of Parturition 1 1 — — — — — 1 — — — — — — Premature birth 21 21 — — — — — 7 14 — — — — — Heart Diseases 20 5 — — 1 10 4 9 10 — 1 — — 9 Accidcnts 5 1 — — — 4 1 3 1 — 1 — — — Suicides 5 — — — 1 3 1 3 2 — — — — — All other causes 64 23 7 2 2 17 12 22 28 5 9 — — 132 All causes 244 96 20 15 13 67 33 93 119 9 21 1 1 196 62 NOTES. (a) In this Table all deaths of "Residents" occurring in public institutions, whether within or without the district, are included with the other deaths in the columns for the several age groups (columns 2-8). They are also, in columns 9-15, included among the deaths in their respective "Localities" according to the previous addresses of the deceased as given by the Registrars. Deaths of "Non-residents" occurring in public institutions in the district are in like manner excluded from columns 2-8 and 9-15 of this Table. (b) See notes on Table I. as to the meaning of " Residents" and "Non-residents," and as to the "Public Institutions" taken into account for the purposes of these Tables. The "Localities" are the same as those in Tables II. and III. (c) All deaths occurring in public institutions situated within the district, whether of "Residents" or of "Non-residents," are, in addition to being dealt with as in note (a), entered in the last column of this Table. The total number in this column should equal the figures for the year in column 9, Table I. (d) The total deaths in the several "Localities" in columns 9-15 of this Table should equal those for the year in the same localities in Table II., sub-columns c. The total deaths at all ages in column 2 of this Table should equal the gross total of columns 9-15, and the figures for the year in column 12 of Table I. (e) Under the heading of "Diarrhoea" are included deaths certified as from diarrhoea, alone or in combination with some other cause of ill-defined nature ; and also deaths certified as from Epidemic enteritis ; Zymotic enteritis; Epidemic diarrhoea. Summer diarrhoea ; Dysentery and Dysenteric diarrhoea ; Choleraic diarrhoea, cholera, cholera nostras (in the absence of Asiatic cholera). Under the heading of "Enteritis" are included those certified as from Gastro-enteritis, Muco-enteritis and Gastric catarrh, unless from information obtained by enquiry from the certifying practitioner or otherwise the Medical Officer of Health should have reason for including such deaths especially those of infants, under the specific term "Diarrhoea." Deaths from diarrhoea secondary to some other welldefined disease are included under the latter. Under the headings of "Cancer" and "Puerperal Fever" are included all registered deaths from causes comprised within these general terms. In recording the facts under the various headings of Tables I., II., III. and IV., attention has been given to the notes on the Tables. J. D. WINDLE, Medical Officer of Health. Bate—January, 1007,