Sout 33 THE SOUTHALL-NORWOOD Urban District Council. Annual Report OF THE Medical Officer of Health FOR THE YEAR 1925. The Southall Norwood Urban District Council Southall,Middlesex. J.D.Windle M.D. MEDICAL OFFICER OF HEALTH 19 With the Medical Officer of Heath's Compliments. THE SOUTHALL-NORWOOD Urban District Council. Annual Report OF THE Medical Officer of Health FOR THE YEAR 1925. 2 PUBLIC HEALTH STAFF. Salary Contributions made under Public Health Acts. Medical Officer of Health— J. D. Windle, M.D., Ch.B., M.R.C.S. (Part time). Chief Sanitary Inspector— T. A. Drew. Assistant Sanitary Inspector— J. W. Cronk, A.R.San.I. Salary Contributions made by Exchequer Grants. Superintendent Health Visitor—Miss Boyd, C.M.B., S.R.N. Health Visitors— Miss Stanbridge, H.V.Cert., R.S.I., S.R.N. Miss Perrett (fully-trained Nurse), S.R.N. Physician for Infants and Children— Dr. Alice Calman (part time). Physician for Pre-Natal Clinic— Dr. Bell (part time). Clerk (Maternity and Child Welfare)— Miss K. Francis. 3 To the Chairman of the Southall-Norwood Urban District Council. Sir, I have pleasure in presenting to you my Annual Report on the Health of the District for 1925. The gross death-rate for the year is only 8.2, which is a fall of practically one per 1,000 compared with last year. I often wonder about our low death-rate which, for the past five years, has ranged between about 7.9 to 9 per 1,000 of the Population. In a working-class population such as ours, where there is a great deal of overcrowding, this low rate is a puzzle which I have not yet been able to solve to my satisfaction, but I think the main contributing factors are as follows. In the first place, we have a young population ; but a young population would not continue to show a low deathrate for long, if the sanitary circumstances of the homes and of the district as a whole were unsatisfactory. Taking the homes, I should say that 99 per cent. are in a cleanly and sanitary state. Further, the water supply of the district is excellent, while the methods of dealing with sewage, refuse and scavenging are exceedingly good. We have unusually good provision for cases of infectious disease, and the work done in the prevention of infectious illness is very satisfactory. Again, our population is a sober one; there may be plenty of drinking, but it has been said by the local Bench that the charges of drunkeness are the lowest from Southall than from any other district. Our Population, therefore, live under unusually good circumstances. It is a young one and sober, and housed under the best conditions at present available, and it is to these factors 4 I think that we must look for the very low rates of mortality which have continued for some years. The birth-rate for the year is unsatisfactorily low, being only 15.95, which is practically the same as for last year. I think the main cause of the low birth-rate is want of housing accommodation. There are hundreds of young couples who would get married if they could find houses or rooms to live in. The Infant Mortality Rate this year is only 50.58, as compared with 62.6 for last year. I have said for many years that the ideal infant mortality rate for a population like yours should be something like 50 per 1,000, but I never thought that we could attain it. No doubt it will continue to rise and fall in future under certain circumstances, but I now think it is on a basis ranging between 50 and 80 per 1,000, as compared with years ago of a basis ranging from 130 to 150 per 1,000 and over. The decline in the number of infectious diseases has been one of the most marked features of the statistics for the past live years. We have never had a period in which the incidence has been so small, and the large majority of these diseases, viz. : Scarlet Fever and Diphtheria, have not been nearly so severe or pronounced in their characteristic symptoms. Whether in any future recrudesence of Scarlet Fever or Diphtheria will revert to type cannot be said, but however that may be, it is quite sure we shall be better able to control their incidence than we can at present. For example, in the case of Diphtheria, if this breaks out in a family, it is now possible to say which members of the family are susceptible or immune, and further, by simple and safe innoculations, we can be practically sure that none of the contacts will develop it. It is much the same with Scarlet Fever. It is 5 now almost sure that in the near future we shall be able to deal with Scarlet Fever much in the same way that can now be done in Diphtheria. Reverting for a moment to the death-rate, there is one fact relating to it I should like to emphasise. It is this: within recent years, the death-rate of all persons at all ages, and from all causes has shown a very large fall. On the other hand, the death-rate from child-birth and its diseases, and of infants under one month, has remained practically the same. I have no figures at hand at the moment to prove this, but it certainly indicates that we are not getting the results we should from our pre-natal work. I have considered this question with my Maternity and Child Welfare Committee, and at a meeting of all the doctors in the District, and modifications in the administration of our Maternity Centre will be very shortly established. With regards to the needs of the District, the most urgent are: adequate housing accommodation; a general Hospital, which the present Committee hopes to see in being within the next year or so; re-organization of the work generally in connection with Maternity and Child Welfare. In conclusion, I beg to thank the Council for their helpful and courteous consideration of the proposals I have had to submit to them from time to time during the year, and I express my grateful appreciation of the excellent work done by the different branches of the Public Health Staff. I beg to remain, Your obedient Servant, J. D. WINDLE, Medical Officer of Health. 6 THE SOUTHALL-NORWOOD URBAN DISTRICT COUNCIL. :o: ANNUAL REPORT of THE MEDICAL OFFICER OF HEALTH for the Year 1925. SUMMARY OF STATISTICS, 1925. Area (acres): Land, 2,575; Water, 50. 1925. 1924. Population—Estimated 32,220 — Population — 31,800 Number of Inhabited Houses 5,843 5,758 Number of Families or Separate Occupiers 6,438 6,363 Rateable Value £184,147 — Sum represented by a Penny Rate £680 — Births— Males (Legitimate) 268 239 „ (Illegitimate) 7 3 275 242 Females (Legitimate) 232 246 „ (Illegitimate) 7 7 239 253 Total Births 514 495 7  1925. 1924. Birth-rate per 1,000 Population 15.95 15.57 Total Deaths belonging to District 245 287 (Civilians only: Registrar-General's Figures)— Males 135 145 Females 110 142 Death-rate per 1,000 of Population 8.2 9.03 Number of Infant Deaths under 1 year 26 31 Legitimate 24 30 Illegitimate 2 1 Infant Mortality per 1,000 Births 50.58 62.6 Legitimate 46.69 61.8 Illegitimate 142.8 1.0 Still-births Notified 4 0 Death-rates from:— Zymotic Disease .186 — Respiratory Disease 1.3 — Tubercular Disease .83 — Cancer 1.24 — Influenza .15 — NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. Population 1921 and Estimated 1925. The official census of the District was taken in April, 1911. The following are the particulars of the enumeration. The totals include the inmates of Institutions, viz.: Hanwell Asylum, 2,801; and St. Marylebone Schools, 309:— 8 Ward. Separate Occupiers. Population. East 2,800 14,575 West 3,310 15,686 Total 6,110 30,261 The estimated population for 1925 is furnished by the Registrar-General, namely 32,220. The inmates of the Hanwell Mental Hospital are not included in these figures. The population of the former Institution is:— Males. Females. Patients 999 1,372 Resident Staffs 20 240 1,019 1,012 2,631 The only means we have of checking the figures is an estimate based on the number of houses in the District. There are 5,843 houses in rating, and allowing an average of 5.5 persons per house, the population is 32.136. East Ward, 2,520 X 5.5= 13,860. West, 3,323 X 5.5= 18,276. It is probable the number is greater than this, the average of 5.5 persons per house being too low since a large number of houses are let to more than one family, or lodgers are taken.* PHYSICAL FEATURES AND GENERAL CHARACTER OF THE DISTRICT. 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 *The total population, as shown by records of a house-to-house inspection of the district made during 1919 was 35,865. 9 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 exteme 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 is about 15¼ miles. The mileage of private roads in the District is about seven miles. No plans for new roads have been passed since the last Report. PUBLIC OPEN SPACES. Acres. Norwood Green 8 Recreation Ground (Southall Green) 11 Southall Park 14½ The latter open space was bought by the Council in 1908, at a cost of £9,776 12s. 6d., towards which the Middlesex County Council contributed £2,285. 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. All to the left of the line is East Ward, and all to the right West Ward. 10 The majority of the houses in the District are occupied by good class working people, chiefly engaged in the local factories and workshops. These comprise food factories, chemical, engineering, paint, and wood works, employing approximately 3,150 males and 1,390 females. There are no trades carried on which are scheduled as offensive trades, but at times there has been cause for complaint of public nuisance from some of the works, which necessitated action by the Council. POOR LAW RELIEF. I am informed the amount of poor law relief is less than would be expected in a working-class neighbourhood. The amount expended in money was £6999: 3s: 7dand in kind £1068: 11s: 0d HOSPITAL ACCOMMODATION. There is no Hospital in the District for cases of accident or ordinary sickness. Patients have to be sent to London Hospitals, which is costly, inconvenient, and sometimes not without risk. Not seldom it is difficult to get beds for cases urgently requiring immediate operation which cannot be done in poor homes ; less urgent cases have to wait their turn on a long list. The Hillingdon Workhouse Infirmary has 257 sick beds and 36 cots; well equipped wards and operating theatre; excellent nursing staff; there is no resident surgeon. Cases are admitted on the recommendation of a medical practioner. The patients admitted from Southall during the last five years were:— 1921 1922 1923 1924 1925 Male 67 50 55 51 52 Female 60 65 56 53 80 Children 36 38 51 44 49 Totals 163 153 162 148 181 Grand Total 807. 11 Hospital provision for infectious diseases, maternity cases and infants, existing and contemplated, is mentioned further on in the Report. SICK NURSING. There is need for further provision of skilled home nursing in the District. The Local Nursing Association provides two nurses for the home nursing of cases of ordinary sickness and accidents, but manifestly more are needed for a population of approximately thirty-two thousand. STATISTICS. MARRIAGES Application has been made for the number of marriages of Southall people, but the necessary information cannot be obtained. BIRTHS AND BIRTH-RATE. The total number of births belonging to the District was 514; the number registered in our books, however, was 478. The illegitimate births were 14, whereas only 6 were registered in the District. The birth-rate per 1,000 population is 15.95. Distributed in Wards, the Births are as follows: EAST. WEST. Males. Females. Males. Females. 119 108 143 108 227 251 478 12 MONTHLY REGISTRATION OF BIRTHS. East Ward. West Ward. Totals. M. F. M. F. January 7 6 11 11 35 February 13 11 12 8 44 March 15 14 8 14 51 April 9 11 9 2 31 May 3 5 7 12 27 June 10 6 10 10 36 July 9 7 13 11 40 August 20 6 10 4 40 September 13 12 18 12 55 October 3 11 14 10 38 November 6 10 8 6 30 December 11 9 23 8 51 Totals 119 108 143 108 478 COMPARATIVE TABI,E. Year Births Rale Population 1920 716 23.4 28,787 1921 581 18.86 30,261 1922 576 18.6 30,261 1923 537 17.12 31,360 1924 495 15.57 31,800 1925 514 15.95 32,220 13 DEATHS AND DEATH-RATE. The local returns are used for calculating the death-rate, since the number of deaths registered in and transferred to the District exceeded the Ministry figure by one, at all ages. Whole District. Total, 246 (Males, 1.35; Females, 111) , Rate, 8.2per 1,000. The total number of deaths registered of persons dying within the District at all ages and from all causes was 158 (males, 84 , females, 74). For statistical purposes it is necessary to add to this figure the deaths of persons from your District who died in the Hillingdon Infirmary, the various London Hospitals, and Middlesex County Asylums. These "outside” deaths were 88 in number (males, 51; females, 37). The total number of deaths, therefore, belonging to the District is 246, and the death-rate 8.2 per 1,000. The deaths in Hanwell Asylum were 208 (males, 113; females, 95). Deaths and Death-rates—East and West Wards. In the East Ward the deaths registered in the District were 90 (males, 46; females, 44). The "outside" deaths numbered 39 (males, 22; females, 17). Total deaths belonging to this Ward, 129. In the West Ward deaths registered in the District were 68 (males, 37; females, 31). The "outside" deaths were 49 (males, 32; females, 17). Total deaths belonging to this Ward, 117. For the purpose of comparison the following table is shown, giving the birth and death-rates and the rates of infantile mortality in England and Wales during the year 1925, the figures being provisional. 14 Table X.—BIRTH-RATE, DEATH-RATE, & ANALYSIS of MORTALITY during the YEAR 1925 [Provisional figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1925, while those for the towns have been calculated on populations estimated to the middle of 1924. The mortality rates refer to the whole population as regards England and Wales, but only to civilians as regards London and the groups of towns). Birthrate per 1000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births Percentage of Total Deaths. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under Two years). Total Deaths under One year. Causes of Death certified by Registered Medical Practitioners. Inquest Cases. Uncertified Causes of Death. England and Wales 18.3 12.2 0.01 0.00 0.13 0.03 0.15 0.07 0.32 0.47 8.4 75 92.1 6.9 1.0 105 County Boroughs and Great Towns, including London. 18.8 12.2 0.01 0.00 0.17 0.03 0.18 0.09 0.30 0.43 10.8 • 79 92,1 7.3 0.6 157 Smaller Towns (1921 Adjusted Populations 20,000-50,000). 18.3 11.2 0.01 0.00 0.15 0.2 0.14 0.06 0.31 0.38 7.6 74 93.0 5.9 1.1 London 18.0 11.7 0.01 0.00 0.08 0.02 0.19 0.11 0.23 0.46 10.6 67 91.1 8.9 0.0 Southall-Norwood 15.95 8.2 - - - - 0.09 - 0.15 0.37 5.8 26 92.27 7.73 0.0 15 THE AGES AND CAUSES OF DEATH ARE SHOWN IN THE SUBJOINED TABLES FOR TEE WHOLE DISTRICT, AND SEPARATELY FOR THE EAST AND WEST WARDS Causes of Death. Deaths in or Belonging to whole District at Subjoined Ages. Deaths in or Belonging to Localities (at all Ages) . Total Deaths in Public Institutions in the District. All Ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. Over 65. East. West. Outside Deaths. St. Mary lebone Schools. Sanatorium. Hanwell Asylum. Enteric Fever — — - - - - - - - - - - - - - Measles — — — - - - - - - - - - - - - Scarlet Fever — - — - - - - - - - - - - - - Whooping Cough ... 3 - 1 2 - - - - - 1 2 3 - - - Diphtheria and Croup - - - - - - - - - - - - - - - Influenza 5 - - - - - 1 3 I 1 4 - - - - Diabetes 1 - - - - - 1 - - - 1 - - - 1 Pulmonary Tuberculosis. 25 - - - 1 5 11 7 1 16 9 8 — . — 13 Tuberculous Meningitis. - - — — — — — — - — — — — — — Other Tuberculous Diseases. 2 - — 1 - 1 — - — 1 1 9 — - 3 Cancer 40 - — — — 1 6 15 18 21 19 17 - - 13 3 Heart Disease 25 l 1 — 2 3 1 9 8 13 12 7 - - Bronchitis 22 2 — — — 2 7 11 8 14 4 - - 1 Pneumonia (all forms) 16 5 — 1 1 1 1 5 2 8 8 2 - - 13 Diarrhoea & Enteritis 3 3 - - - - - - - 2 1 1 - - - Cerebral Haemorrhage 13 — — - — — — - 13 7 6 1 - - 2 Congenital Debility— Prem. Birth. 10 10 - - - - - - - 8 2 1 — — — Nephritis & Bright's Disease. 6 — — — — — 2 3 1 4 2 5 — — 3 Puerperal Fever 1 - - — — — 1 — - 1 - 1 - - - Parturition — - - - - - - - - - - - - - - Other Accidents 1 - - - - - 1 - - 1 - - - - - Violence 11 - — — 1 1 4 2 3 4 7 7 - - - Suicides 11 - — — — — — 1 - - 1 - - - - Other Defined Diseases 44 5 1 1 3 — 3 . 8 23 29 15 29 - - 152 Ill-defined Diseases — — — .— - - - - - - - - - - - Arterio Sclerosis 12 - - - - - - 2 10 3 9 - - - 3 Other Respiratory Diseases. 5 - - - - - - 4 1 1 4 - - - 1 All Causes 246 26 3 5 8 12 34 66 92 129 117 88 — — 208 16 deaths, and death-rates distributed into wards. Causes of Death. EAST WARD. Causes of Death. WEST WARD. All Ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. Over 65. All Ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. Over 65. Enteric Fever - - - - - - - - - Measles — — — — - — - — - Measles — — — — — — — — — Enteric Fever — — — — — — — — — Scarlet Fever — — - - - - - - - Scarlet Fever - - - - - - - - - Whooping Cough 1 — — 1 — — — — — Diphtheria and Croup - - - - - - - - - Diphtheria & Croup - - - - - - - - - Influenza 4 — — — — — — 3 1 Influenza 1 — — — 1 — — — — Erysipelas — — — — — — — — — Erysipelas - - - - - - - - - Pulmonary Tuberculosis. 9 — — — — 3 4 2 — Pulmonary Tuberculosis. 16 — — — — 2 8 5 1 Tubercular Meningitis - - - - - - - - - Tubercular Meningitis - - - - - - - - - Other Tubercular Diseases 1 — — 1 — — — — - Other Tubercular Diseases. 1 — — — — 1 — — — Cancer... 19 - - - - - 1 9 9 Cancer... 21 - - — 1 - 5 6 9 Heart Disease 12 — — — 1 2 1 4 4 Heart Disease 13 1 1 — 1 1 — 5 4 Bronchitis 14 2 — — — — — 5 7 Bronchitis (all forms) 8 - - - - 2 2 4 Pneumonia 8 4 — — 1 — 1 — 2 Pneumonia 8 1 - 1 — 1 — 5 - Diarrhoea 1 1 - - - - - - - Diarrhoea & Enteritis 2 2 - - - - - - - Congenital Debility Premature Birth 2 2 - - - - - - - Other Respiratory Diseases. 1 - - - - - - 1 - Nephritis and Bright's 2 - - - - - - 2 — Nephritis & Bright's 4 — — — — — 2 1 1 Puerperal Fever — — — — — — — — — Puerperal Fever 1 — — — — — 1 — — Other Accidents - - - - - - - - - Parturition - - - — — — —. — — Violence 7 — - — 1 — 3 2 1 Congenital Debility 8c Premature Birth 8 8 - - - - - - - Other Defined Diseases 31 2 1 1 2 — 4 3 18 Ill-defined Diseases — — — - — — — — — Violence 4 — — — — 1 1 — 2 Whooping Cough 2 — 1 1 — — — — — Suicide — — — — — — — — — Other Respiratory Diseases. 4 - - - - - - 3 1 Other Defined Diseases 39 3 — — 1 - 1 11 23 Other Accidents and Diseases of Pregn'cy 1 - - - - - - - - Suicide 1 - - - - - - 1 - Totals 129 15 1 2 4 6 21 36 44 Totals 117 11 2 3 5 5 14 34 43 17 DEATHS—COMPARATIVE TABLE (a). DEATHS. 1924. 1925. Increase over 1924. Decrease. Comparative Table. Sanatorium. Hanwell Asylum. Outside Deaths. Meningitis - - - - - - - Enteric Fever 1 — - 1 -— — - Measles 4 - - 4 - - - Whooping Cough 1 3 2 — — — 3 Diphtheria and Croup - - - - - - - Diabetes 1 1 - — — 1 - Dysentery — — — — — — - Heart Disease 35 25 - 10 - 3 7 Pulmonary Tuberculosis 28 25 - 3 - 13 8 Other Tuberculous Diseases 11 2 - 9 - 3 2 Cancer 38 40 2 — — 13 17 Bronchitis 19 22 3 — - 1 4 Pneumonia (all forms) 13 16 3 — — 13 2 Respiratory Diseases 3 5 2 — — 1 - Diarrhoea and Enteritis 2 3 1 — — — 1 Appendicitis and Typhlitis 5 - - 5 - - - Cirrhosis of Liver 1 — - 1 — — — Nephritis and Bright's Disease 8 6 - 2 - 3 5 Premature Births 20 10 — 10 — — 1 Violent Deaths, excluding Suicides 10 11 1 - - - 7 Suicides 4 1 - 3 — — — Other Defined Diseases 43 44 1 —. — 152 29 Ill-defined Diseases - — — — — — — Influenza 7 5 — 2 — 3 — Arterio-Sclerosis 15 12 — 3 — — — Scarlet Fever - - - - - - - Puerperal Fever — 1 1 — — — 1 Accidents and Diseases of Pregnancy 1 1 - - - - - Cerebral Haemorrhage 15 13 - 2 " 2 1 18 COMPARATIVE TABLE (b). Year. Deaths. Rate. Population. 1920 237 8.2 28,787 1921 269 8.7 30,261 1922 269 8.6 30,261 1923 246 7.8 31,360 1924 287 9.03 31,800 1925 245 8.2 32,220 INFANT MORTALITY DURING 1925. Whole District. The total number of deaths under one year of age was 26. Rate per 1,000 births, 50.58. The rate in England and Wales was 75, and for the 157 smaller towns, 74 per 1,000. TABLES OF INFANT DEATHS FROM STATED CAUSES IN WEEKS AND MONTHS UNDER ONE YEAR OF AGE. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. Premature Birth 7 1 1 — 9 — — - - 9 Bronchitis — — — — — 1 — 1 1 3 Pneumonia — — — 1 1 2 — 2 - 5 Diarrhoea — — 1 — 1 — 1 1 - 3 Other Accidents - - - - - - - - - - Measles - - - - - - - - - - Pulmonary Tuberculosis - - - - - - - - - - Other Defined Diseases 3 - - 1 4 1 - - - 5 Whooping Dough - - - - - - 1 - - 1 Totals 10 1 2 2 15 4 2 4 1 26 19 EAST WARD. Infantile Mortality during the Year 1925, 61.67 per 1.000. Net Deaths from stated causes at various ages under one year of age. Cause of Death Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. Measles - - - - - - - - - - Premature Births 6 1 1 — 8 - - - - 8 Pulmonary tuberculosis - - - - - - - - - - Bronchitis - - - - - - - - - - Other Defined Diseases 3 - - - 3 1 - - - 4 Diarrhoea — — 1 — 1 — 1 — — 2 Totals 9 1 2 - 12 1 1 - - 14 WEST WARD. Infant Mortality during the Year 1919, 40.80 per 1,000. Net Deaths from stated causes at various ages under One Year of Age. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. Premature Births 1 - - - 1 - - - - 1 Bronchitis - - - - — 1 - 1 1 3 Pneumonia - - - 1 1 2 - 2 - 5 Diarrhoea - - - - — — - 1 - 1 Other Accidents - - - - - - - - - - Measles - - - - - - - - - - Other Defined Diseases - - - 1 1 - - - - 1 Whooping Cough - - - - - - 1 - - 1 Totals 1 — - 2 3 3 1 4 1 12 20 COMPARATIVE TABLES (a). Whole District. year. Deaths under 1 year. Births. Birth-rate per 1,000 Living. Infant Mortality Rate. 1911 81 689 29.2 129.3 1912 73 660 25.5 110.6 1913 70 711 26.5 98.4 1914 50 698 25.7 71.6 1915 69 610 22.2 110.3 1916 41 625 22.9 65.6 1917 55 491 16.5 112.0 1918 39 517 15.5 75.4 1919 33 479 16.5 68.8 1920 45 716 23.4 66.8 1921 38 581 18.86 66.1 1922 26 576 18.6 45.1 1923 21 537 17.12 39.1 1924 31 495 15.57 62.6 1925 26 514 15.95 50.58 The rate of infant mortality is a delicate statistical index of sanitary and domestic circumstances. When it consistently exceeds the average for the country it tells of unsatisfactory sanitary conditions—not only of defective sanitation, as generally understood—bad drainage, scavenging, house construction, and so forth—but also of maternal ignorance and neglect of baby management, the prevalence of improper artificial feeding, and of unsatisfactory domestic environment. The following table gives the average rates for the past 30 years:— (b). Years. Average Rate Of Infant Mortality. Average Birth-rate per 1,000 Population. 1892-1901 135.3 32.2 1902-1911 117.7 32.2 1910-1914 100.4 26.9 1915-1919 86.4 18.7 1920-1925 55.04 18.25 21 COMPARATIVE TABLE OF DEATHS OF INFANTS UNDER ONE MONTH DURING THE PAST 6 YEARS. Year. No. of Deaths. Rate per 1,000 Births. 1920 22 30.72 1921 22 37.86 1922 10 17.36 1923 7 13.03 1924 19 38.38 1925 15 29.18 COMPARATIVE TABLE OF DEATHS DUE TO ACCIDENTS AND DISEASES OF PREGNANCY AND PARTURITION DURING PAST 6 YEARS. Year. No. of Deaths. Rale per 1,000 births. Remarks. 1920 2 2.79 — 1921 4 6.8 Includes 2 of Sepsis. 1922 1 1.73 — 1923 Nil. — — 1924 1 2.02 — 1925 2 3.89 One Puerperal Sepsis. INFANT AND CHILD WELFARE. The Clinic for infants and children is held on Thursdays, 2 to 4 p.m., and Fridays, from 10 to 11 a.m. and 2 to 4 p.m. Dr. Caiman is in charge. She is assisted in the work by the two Health Visitors, and by voluntary workers, who admit cases, provide tea, etc. The examination of the babies and children is very thorough, and a full record is made of the condition at every visit. Cases requiring medical treatment 22 are referred to their family doctor or a Hospital, but many with minor ailments are provisionally treated at the Centre. Sodium citrate, grey powder, malt extract, cod liver oil, and dried milk are sold at cost price, or given in necessitous cases. While the work at the Centre is of instructive value, and calls for every encouragement and effort, it is supplementary to what is nevertheless the most important part of infant welfare work from a preventive point of view. This lies of necessity in the homes, in the continuous supervision of the infants' domestic environment, and clearly the work of the Health Visitors should be largely in the poorer districts and streets. This matter is being revised. MATERNITY AND INFANT WELFARE CENTRE. Summary of Infant Welfare Work for 1925. (Miss Boyd and Miss Stanbridge.) Number of Infants Notified— Males 205 Females 160 Number or Illegitimate Infants Notified 9 Number of Still-births Notified 4 Number of Visits paid to— Infants (1st) 380 Children (1st) 1,672 Re-visits— Infants 680 Children 2,374 Ineffectual Calls 687 23 Method of Feeding— Breast 397 Bottle 73 Breast and Bottle 38 Total number of Visits paid during year— Mother and Infants 5,909 Attendances at Infant Clinic 3,854 The number of visits paid by the Health Visitors was 380, which is less than last year. The number may seem small, but it must be remembered that the hours at which visits may be paid to suit the convenience of working-class mothers is limited and further, the details to be noted and recorded are many. There must be no hurry if the observations are to be of value. The aim is useful calls, and it is much better that the time should be spent in additional visits to those homes where all is not well, and particularly to the homes in the streets of the worst part of the District. SALE OF DRIED MILK. Cost. Amount Received. Amount Sold. £218 4s. 6d. £218 4s. 6d. 2,929 lbs. DEATHS OF BABIES ATTENDING CENTRE DURING THE YEAR 1925. Name. Age. Cause of Death. Number of Attendances at Centre. e.m.c. 8 months Zymotic Enteritis 4 24 SUPERVISION OF ILLEGITIMATE INFANTS. No. Mother Living. Baby Living. Cause of Death. Occupation of Mother. Remarks. 1 Mother Living Baby Living — Cleaner Child with Mother. 2 Do. Do. — Factory Do. do. 3 Do. Do. — Housekeeper Do. do. 4 Do. Do. — Factory Do. do. 5 Do. Do. - Do. Do. do. 6 Do. Do. — Flower Sorter Do. do. 7 Do. Do. — Cook Do. do. 8 Do. Do. — Housekeeper Do. do. 9 Do. Do. — Do. Do. do. 10 Do. Do. — Do. Do. do. 11 Do. Do. — — Do. do. and Grandmother in another District. 25 SUMMARY OF ANTE-NATAL WORK. (Miss Boyd.) Visits paid— Ante-Natal 116 Number of Attendances at Ante-Natal Clinic 27 Miss Boyd is Superintendent Health Visitor, and visits sick children between ages of 1 and 5. Records of these cases are now being kept. There were no operation cases attending the Clinic. The attendances at the Pre-Natal Clinic is very low. So far as I can gather there were only 35 mothers attending this Centre, whereas the number of births were over 500. I am quite satisfied that we are not getting the best out of the work at the Pre-Natal Clinic. I have had a meeting with the local doctors, and we have drawn up a scheme which I shall shortly put before the Committee to improve the attendances. Day Nurseries. (None). School Clinics. These are under the control of the Middlesex County Education Committee, and are held at the Beaconsfield Road School, Southall. Tuberculosis. The Tuberculosis Dispensary is held at Ealing, under the jurisdiction of the Middlesex County Council. Venereal Disease. The County Council have made arrangements for the. treatment of this disease at various London Hospitals. 26 Hospitals Provided or Subsidised by the Local Authority or by the County Council. (1) Tuberculosis. The Middlesex County Council have built and opened a Sanatorium at Harefield, Middlesex. In addition an Institution under the M.C.C. has been opened at Isleworth for some years for advanced cases; also an agreement exists between the M.C.C. and the authorities at Clare Hall Sanatorium for receiving patients at this Sanatorium. (2) Maternity None. (3) Children None. (4) Fever. The Council's Isolation Hospital admits cases of Scarlet Fever and Diphtheria. Full particulars will be found elsewhere in the Report. The expenditure for the Hospital during the year was £2,560. (page 00). (5) Smallpox None. (6) Others None. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children in the District. None. AMBULANCE FACILITIES. (a) For Infectious Cases. A motor ambulance, specially constructed for the Council, is in use for conveying infectious patients to Hospital, which is a marked improvement on the old arrangement, and greatly facilitates speedy removals. 27 (b) For Non-infectious and, Accident Cases. A properly equipped motor ambulance is provided by the Council for the use of residents to remove non-infectious and accident cases to Hospital. Table of Year's Working of Motor Ambulance. Ordinary cases removed to Hospital 385 Accidents 54 Out of District cases 32 Total 471 Miles travelled 8,425 Cash received £53 1s. 6d. Total expenditure £166 16s. 3d. NOTIFIABLE DISEASES. The number of notifications during the year was 232. Of these, 26 were reported from Institutions in the District, viz.: 8, London County Asylum, Hanwell; and 15 from the St. Joseph's School. Compared with last year there is an increase of 35 Scarlet Fever, 6 Diphtheria, and a decrease of 24 cases of Chicken-pox. 28 The following is a table giving the number and nature of the notifications received during the year per month. Diseases. January. February. March. April. May. June. July. August. September. j October. November. December. Totals. Scarlet Fever 3 5 6 8 2 4 8 - 5 9 - 9 59 Diphtheria and Croup - 2 1 1 1 2 2 - 1 - 1 - 11 Enteric Fever - - - - - - - - - - - - Malaria - - - - - - - - - - - - - Typhoid and Paratyphoid Fevers - - - - - - 1 1 - - - - 2 Pneumonia 1 - - - - - - - - 1 - - 2 Dysentery - - 1 - - - - 2 - 1 - - 4 Tuberculosis 4 1 4 3 6 4 - 5 3 4 4 1 39 Erysipelas 2 - 1 1 1 - - - - - - - 5 Puerperal Fever - - - - 1 - - - - - - 1 Ophthalmic Neonatorum - - - - - - - - - - - - - Chi ken Pox 12 9 5 4 27 12 8 4 2 4 7 14 108 German Measles - - - - - - - - - - - - - Poliomyelitis - - - - - - - - 1 - - - 1 Totals. 22 17 18 17 37 23 19 12 12 19 12 21 232 29 NOTIFICATION CLASSIFIED IN LOCALITIES FOR 1925. Diseases. Total for District. East Ward. West Ward. Admitted to Hospital. Deaths. Scarlet Fever 50 21 38 36 - Diphtheria 11 6 5 11 - Enteric Fever - - - - - Malaria - - - - - Typhoid Fever 2 1 1 2* - Pneumonia 2 2 - - 16 Dysentery 4 4 - - - Membranous Croup - - - - - Erysipelas 5 3 2 - - Puerperal Fever 1 1 - - 1 Ophthalmic Neonatorum - - - - - Chicken-pox 108 53 55 - - Tuberculosis 39 15 24 - 27 Poliomyelitis 1 - 1 - - 232 106 126 49 44 * To London Hospitals. SCARLET FEVER. The number of cases reported during the year were 59. The incidence rate is 1.5 per 1,000 population. 18 cases occurred on the North Side of the railway, and 41 on the South. Cases treated in the Sanatorium were 36, the rest were isolated at home for special reasons. 30 NOTIFICATIONS CLASSIFIED PER MONTH. Month. North Side. South Side. Total. January 2 1 3 February 1 4 5 March 4 2 6 April 4 4 8 May 1 1 2 June 1 3 4 July 5 3 8 August - - - September - 5 5 October - 9 9 November - - - December - 9 9 18 41 59 SCARLET FEVER. Table of Ages. 1-5 Years. 5-15 Years. 15-25 Years. 25-45 years. Total. East Ward 4 11 4 2 21 West Ward 3 30 4 1 38 7 41 8 3 59 Case-rate of certain Infectious Diseases compared with England and Wales :— Disease. Rate per Local. 1,000 living. Eng. and Wales. Smallpox 0.00 0.14 Scarlet Fever 1.83 2.36 Diphtheria 0.34 1.23 Enteric Fever 0.00 0.07 Erysipelas 0.15 0.39 31 DIPHTHERIA AND CROUP. Eleven cases of Diphtheria were notified. Month. North Side. South Side. Total. January - - - February - 2 2 March 1 - 1 April - 1 1 May 1 - 1 June - 2 2 July 1 1 2 August - - - September - 1 1 October - - - November - 1 1 December - - - 3 8 11 TUBERCULOSIS. Domestic and industrial circumstances and housing are the main channels for preventive means in relation to this disease. How they operate we have evidence in a small way (see Table), in so far the Tuberculosis notification and mortality centres round those parts of our District where these circumstances are most unfavourable, and that is the reason why our present methods of dealing with Tuberculosis have no effect in reducing its incidence and so little on its rate of mortality. NEW CASES AND DEATHS FROM TUBERCULOSIS 1925. Disease. New Cases. Deaths. North Side. South Side. North Side. South Side. M. F. M. F. M. F. M. F. Pulmonary Tuberculosis 2 1 16 15 4 7 9 5 Other Tubercular Diseases - - 2 3 2 - - - 3 36 13 14 32 In addition, one female, suffering from Pulmonary Tuberculosis, was transferred to the South Side of the District, from Essex. TUBERCULOSIS—NEW CASES AND AGES AT DEATH. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. 0-1 - - - - - - - - 1-5 - - - - - - 1 - 5-10 - 1 - - - 1 - - 10-15 1 - - 1 - - - - 15-20 2 2* 2 1 - 1 - - 20-25 1 3 - - 1 3 1 - 25-35 7 5 - - 3 4 - - 35-45 2 4 - 1 3 1 - - 45-65 5 - - - 5 2 - - 65 and Upwards - 2 - - 1 - - - Total 18 17 2 3 13 12 2 - * This figure includes a Patient transferred to this District from Essex. ENTERIC OR TYPHOID FEVER. There was one case of Enteric Fever amongst the civilian population, the source of which could not possibly be traced. There was one case notified amongst patients in the Hanwell Asylum. The circumstances of this case was enquired into by the Medical Staff of the London County Council. OPHTHALMIA NEONATORUM. There were no cases notified during the year. Treatment is done by the Health Visitors, except in severe cases, when they are sent on to an Ophthalmic Hospital. ISOLATION HOSPITAL. There were 47 patients admitted during the year. Of these, 36 were sent in as Scarlet Fever and 11 as Diphtheria. 33 The following table gives the numbers admitted and discharged each month :— Number Admitted. Number Discharged. Deaths. Sc. Fev. Diph. Sc. Fev. Diph. Diph. Sc. Fev. January 3 - 1 - - - February 5 2 3 1 - - March 4 1 2 2 - - April 7 2 5 2 - - May 3 1 7 2 - - June 1 2 4 2 - - July 4 2 2 - - - August - - 1 1 - - September 2 1 3 2 - - October 2 - 2 1 - - November 1 - 1 - - - December 4 - 1 1 - - Total 30 11 32 14 - - Expenditure for Hospital. I am indebted to Mr. Potter, the Accountant Clerk, for the following particulars of expenditure in connection with the Hospital for the year 1925 :— £ s. d. Salaries, Wages, etc. 1,088 15 6 Provisions 449 7 1 Fuel, Light, and Cleaning 378 1 5 Dispensary, Medical and Surgical 29 12 7 Rates and Taxes' 67 3 5 Establishment Charges 110 6 3 Furnishing and Repairs 23 15 2 Repayment of Loans and Interest 413 11 1 £2,560 12 6 The expenditure for the Hospital for the last five years was :— 1920, £4,098. 1923, £3,162. 1921, £4,451. 1924, £2,275. 1922, £4,107. 1925, £2,560. 34 ISOLATION. (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, consistes of two large general wards and an emergency ward, with a Nurses' dutyroom and kitchen situated between the large wards. Additional accommodation is provided by a Berthon Circular Hospital at the rear of the Pavilion Block, which has proved of service for convalescent patients. The Diphtheria patients are treated in the Isolation Block, which consists of two wards with accommodation for eight children. Nursing Staff.— The permanent staff at the Isolation Hospital is as follows: Matron, head nurse, three probationer nurses, and ward maid. In the Administrative Buildings : Cook, housemaid, and laundry maid. Lodge : Man and wife (the man acts as gardener, attends to the boilers, and works the disinfecting apparatus, etc.). A motor ambulance, specially constructed for the Council, is in use for conveying infectious patients to Hospital, which is a marked improvement on the old arrangement, and greatly facilitates speedy removals. The Inspector has charge of the arrangements for removal of the patients from their homes to the Hospital. One of the nurses goes with the ambulance for every case, provided with requisites for any probable emergency which may arise on the journey. The Hospital requires considerable extension. We require provision for Measles and Enteric Fever. During the war, the gate lodge was converted into Measles wards, now it is occupied by the Porter, and we have no Measles beds at all. We require a Measles block of 12 beds. It is only rarely we get Enteric Fever in the District, but it is essential that every case should go to Hospital. The general Hospitals now refuse to take in Enteric; we need an Enteric block of four beds. We have not enough beds per 1,000 of population for Scarlet Fever. A second pavilion for convalescent cases is urgently needed. METHODS OF DISINFECTION. In all cases the work of disinfection is done at the cost of the Council, under the supervision of the Sanitary Inspector. 35 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 Formalin. 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 patient is removed to the Hospital within a day or so of the commencement of the illness. As to Articles of Clothing.— The clothing, bedding, curtains, and all infected articles which can be removed are taken to be disinfected in the Thresh's apparatus at the Hospital. SUMMARY OF ZYMOTIC DISEASE VISITS. (Miss Perrett.) Visits paid to Infectious Cases :— Scarlet Fever 31 Swabs Taken 155 „ ,, Contacts 360 Sore Throats 257 Diphtheria 10 Septic Foot - ,, Contacts 154 Whooping Cough - Chicken- Pox 354 Malaria - Measles 261 Eyes - Eczema - Small-Pox Contacts - Impetigo - Erysipelas - Ringworm - Enteritis - Ophthalmia Neonatorum - Miscellaneous Visits 694 Tubercular 83 Discharging Ears - Total Visits paid during year 2,696 Scabies 27 Mumps - Schools Visited 15 Number of Children Excluded 207 36 Reasons for Exclusion :— Chicken- Pox Contacts 43 Measles Contacts 53 Sore Throat 48 Enlarged Glands 9 Suspicious Rash 11 Miscellaneous 46 Number of Absentees Visited 58 Suspicious Illness at Home (Visited for enquiries) Number of Children inspected after return to School 203 LABORATORY WORK. The Council provides Antitoxin free, and a nurse to inject it if desired. The diagnosis of Diphtheric-Croup and Diphtheria is often doubtful for a time. In the meantime no harm can come from a big dose of Antitoxin, and this may and often will obviate operation later; in any case it enhances the patient's prospects of recovery. I am glad to say that we now get very early applications from all the doctors for Antitoxin injections, and I think this has largely reduced the incidence of Diphtheria. The Council afford facilities to all medical men practising in the District for the gratuitous examination of pathological specimens. The examinations are made at the Lister Institute. The following are the figures for the year:— Positive. Negative. Swabs for Diphtheria, etc. 14 131 Sputa for Tubercle 13 99 Blood Count 2 3 Blood for Typhoid - 1 Faeces - 2 Pus 2 1 Gonococci 1 - 32 237 Total 269 37 VACCINATION. Total number of successful Vaccination Certificates received during the year was 184. Total number of Exemptions, 232. Only about 45 per cent. of children under ten years of age have been vaccinated. Dr. Reece, in the Medical Report of the Local Government Board, 1918-19, writes: "The unprotected state of the child population of this county against attack and death by Smallpox should be fully known and understood, and the possibility of extensive spread of the disease among children unprotected by vaccination, and the heavy mortality which is known to occur at such ages, should should be realized." The fact that the Vaccination Acts are administered by the Poor Law Guardians is responsible for a large proportion of exemptions. Apart from this, Vaccination is essentially preventive medicine, and should be carried out by the sanitary authority. This, no doubt, will come about eventually, but in the meantime I am sure a much larger proportion of babies would be vaccinated if the Ministry made the Vaccination Grant to Medical Officers of Infant Welfare Centres, so that vaccination could be done gratuitously at the Centres. WATER SUPPLY. The principal Water Supply for the District is that of the South West Suburban Water Company, whose reservoirs are at Egham. A considerable number of houses at North Hyde and on the Adelaide Estate are supplied from the mains of the Metropolitan Water Board. There are only a few isolated houses in the District which obtain water from wells. The South West Suburban Company have a water tower on their premises at Southall, with a capacity of about 300,000 gallons, in order to ensure a constant supply. SEWERAGE AND DRAINAGE. Method in use in the District:— Water Carriage System. The rainfall is conveyed by separate sewers to the natural watercourses. Practically all the houses in the District are drained into the public sewers, except a group of cottages and 38 a few isolated houses adjoining the canal at Top Locks. Building operations are proceeding in the vicinity, and it is probable that in the near future the sewers may be extended to drain this area. I am indebted to our Surveyor and Engineer, Mr. J. B. Thomson, A.M.I.C.E., for the following particulars :— 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 all suspended matter 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 inches 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 inches 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 (300,000 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 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 39 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. Some years ago, about three-quarters of an acre of first contact were constructed, but owing to the phenomenal growth of the District, further extensions have recently been carried out. These extensions take the form of ten percolating beds, one 40 feet diameter, one 00 feet diameter, and eight 80 feet diameter, and the whole of the tank liquor is dealt with on these beds, the result being a good effluent. The whole of the machinery at the Works is driven by gas engines, the gas being obtained from the town mains. REMOVAL OF HOUSE REFUSE. During the year, 4,931 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, supplied by the Council, which, when emptied, are dusted with carbolic powder. The dust is removed by means of covered carts with wind guards. The work is carried out by the Council. The District is divided into four Sub-Districts for the purpose of collecting, and reports are made daily to the Surveyor as to the progress of the work for each of these Sub-Districts. The refuse is deposited under contract in a brickfield on the western borders of the District. ELEMENTARY SCHOOLS. There are eight public elementary Schools on the south of the Railway, with authorised accommodation for 3,844 pupils; on the north side there are five Schools, with accommodation for 2,496 children. The County Council Secondary School has accommodation for 430 scholars. The sanitary circumstances of the public Schools are excellent. There are four private schools in the District. Generally speaking, there is overcrowding, and the sanitary accommodation insufficient for the number of pupils. 40 SOUTHALL— PROVIDED SCHOOLS. No. School. Department. Authorised Accommodation. Average No. on Roll. Average Attendance. 1. South of Railway. 23 Featherstone Road Boys' 800 539 506 24 Clifton Road Girls' 400 310 274 25 Dudley Road Girls' 400 343 308 26 Clifton Road Infants' 400 316 277 27 Featherstone Road Infants' 374 335 291 28 Clifton Road Boys' 420 309 286 29 Western Road Girls' 400 254 223 30 Western Road Infants' 400 274 236 (6) Non-provided School. 31 St. Anselm's Mixed & Infants' 250 196 172 (c) Provided Schools. 2. North of Railway. 32 North Road Mixed 648 328 291 33 Tudor Road Senior (Mixed) 400 308 278 34 Tudor Road Junior 400 258 241 35 North Road Infants' 247 147 132 36 Tudor Road Infants' 400 209 181 37 Beaconsfield Road Junior & Infants' 400 253 225 Totals 6339 4379 3921 ADOPTIVE ACTS IN FORCE IN THE DISTRICT. (1) Infectious Diseases (Notification) Act, 1889. (2) Infectious Disease Prevention Act, 1890. (3) Public Health Acts Amendment Act, 1890. (4) Housing of the Working Classes Act, 1890 (excepting Part IV of this Act). (5) Public Libraries Act, 1892 and 1893. (6) Public Health Acts Amendment Act, 1907, as to Parts II, III and IV (except Sections 61 and 66, V, VI, VIII, IX and X). (7) Notification of Births Act, 1907. (8) Public Health Act, 1925 (Parts II, III, IV and V). 41 The Bye-laws of this Authority, recently revised, are based on the Model Bye-laws of the Local Government Board and relate to :— (1) Cleansing of Earth Privies, Ashpits and Cesspools. (2) For the prevention of Nuisances arising from snow, filth, dust, ashes and rubbish, and for the prevention of the keeping of animals on any premises so as to be injurious to health. (3) Common Lodging-houses. (4) New Streets and Buildings. (5) Slaughterhouses. (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 Wash-houses. (10) Open Spaces. (11) Tents, Vans, Sheds, etc. (12) Regulations as to Dairies, Cowsheds and Milk Shops. REPORT OF THE SANITARY INSPECTOR. INSPECTION OF THE DISTRICT. Inspection of the District has been carried out during the year, both systematically and at certain intervals as occasion required, in order to comply with the general Orders of the Ministry of Health, the Public Health Acts, and Housing (Inspection of the District) Regulations, 1910, and all necessary steps have been taken to secure the abatement of any nuisance found to exist. In all, 4,385 visits to houses and premises have been paid during the year. This figure includes houses from which complaints of nuisance have been received, and in which cases of infectious disease have occurred, visits to works in progress, inspection of houses under the Housing (Inspection of the District) Regulations, 1910, Dairies, Cowsheds, Milkshops, Food Shops, Sale of Food and Drugs Acts, Bakehouses, Slaughterhouses, Piggeries, Bedding Stores, Petroleum and Carbide, Canal Boats, Factories subject to Notice by H.M.I., Workshops, Workplaces, Outworkers, after Infectious Disease, and the Early Closing Regulations. 42 The following table shows the number and nature of such inspections :— No. of Notices served: Preliminary, 317; Statutory 96 No. of Houses and Premises Inspected 330 No. of Re-inspections of Houses and Premises 922 Miscellaneous 51 Bakehouses 132 Slaughterhouses 208 Factories subject to Notice by H.M.I.F. 4 Workshops 393 Workplaces Outworkers 28 Canal Boats 116 Bedding Stores 12 Infectious Disease 39 Petroleum and Carbide Stores 500 Dairies, Cowsheds and Milkshops 389 Early Closing of Shops 51 Piggeries and Pig Keepers 52 Inspections of Carcases 298 Food Shops 860 Total Number of Inspections 4,385 DAIRIES, COWSHEDS AND MILKSHOPS. There is one person, residing outside the District, registered under the Dairies, Cowsheds and Milkshops Orders as Purveyor of Milk, and twenty other persons registered as Purveyors of Milk, who reside within the District. Two persons are registered as Cowkeepers, the average number of cows kept by the persons registered being 130. During the year, one cow was found to be suffering from Tuberculosis and Emaciation, but at the time was not producing milk. Registered Purveyor of Milk residing outside District 1 No. of Persons Registered as Dairymen and Purveyors of Milk 20 Cowkeepers 2 Total 23 43 All the dairies, cowsheds and milkshops were visited on an average once and twice per month. Inspections were also made at irregular intervals to ascertain if they were kept in clean and sanitary condition ad in accordance with the Regulations. The two cowkeepers are farmers on the outskirts of the District. The general state of the farms, on the whole, is satisfactory, and certain improvements have been effected with regard to the cowsheds during the year. The milk of one cowkeeper is disposed of outside the District, and the remaining cowkeeper retails his milk within the District. During the year, one licence was issued for the sale of Pasteurised, Grade A, and Tuberculin Tested Milk. CANAL BOATS. During the year, 116 boats were inspected. The general condition of the boats and their occupants were satisfactory. The infringements of the Acts and Regulations were not of a serious nature, and were as follows : Re-painting and general renovation—2. No legal proceedings were taken in respect of any infringement. There were no complaint notes issued by other Authorities, and no cases of infectious disease were notified upon any of the boats. It has, therefore, not been necessary to detain any vessel for the purpose of cleansing and disinfection. The following table illustrates the increased attention given to this work during the last 9 years :— Year. Boats Inspected. 1917 11 1918 18 1919 20 1920 54 1921 36 1922 97 1923 89 1924 114 1925 116 44 The following table shows the number and nature of complaints received during the year :— Number. Choked Drains 36 Dampness 8 Accumulations of Manure 1 Nuisance caused by the keeping of Animals and Fowls, etc. 2 Smells from Public Sewers 2 Defective Dustbins or absence thereof 31 Overcrowding 5 Non-removal of House Refuse 1 Offensive Smells from various causes 3 Defective Paving of Yards 1 Defective Pail Closet 1 Defective Floors 1 Defective Roofs 7 Dirty Condition of House 11 Defective Condition of House 44 Defective Kitchen Range 1 Defective Copper 2 Accumulation of Refuse 6 Defective Lavatory Fittings 6 Defective Fireplaces ... 1 Erection of Shed (Referred to Surveyor) 1 Defective Water Fittings 4 Flies 4 Miscellaneous 1 Smoke Nuisances 3 Rat Infestation 1 Total Number of Complaints Received 184 45 UNSOUND FOOD SEIZED AND SURRENDERED DURING 1925. Month. Fruit (lbs.) Tinned Goods (lbs.) Vegetables (lbs.) Fish (lbs.) Meat (lbs.) Miscellaneous (lbs.) Total. Tons. Cwts. Qtrs. lbs. January 84* - 450 70 - - - 5 1 16 February - - - 324 - - - 2 3 16 March - 336 (Milk) 380 464 - - - 10 2 4 April - - - - - 74 (Offal) - - 2 18 May - - - 120 - 6 (Offal) * - 1 - 14 June 3;125 - - 290 - 34 galls. Milk 1 10 1 27 July 12,200 12 (Salmon) - 282 103 (Beef) - 5 12 1 25 August 7,616 - - - - - 3 8 - - September - - - 768 274 (194 Beef, 80 Pork) - - 9 1 6 October - - - 200 - - - 1 3 4 November - - - - - - - - - - December - - 2,532 240 - - 1 4 3 - Total 23,025 348 3,362 2,758 377 80 lbs. & 34 gallons. 13 7 1 18 +34 gallons Milk. * Included in these figures are two seizures :— (a) 45 Bananas (12 lbs. (b) 6 lbs. Pigs' Pluck ) Total 18 lbs Remaining amounts are all surrenders. 46 INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply— The wholesomeness of the milk supply, 95 per cent. of which is produced and imported from outside sources, is shewn by the table under the heading of Sale of Foods and Drugs Acts, for the respective months during the year. The old method of supplying milk from open cans is rapidly disappearing, distribution of milk in bottles taking its place, and this largely minimises the risk of contamination by dirt and dust as compared with supplying from open receptacles in the streets. (1) No action has been taken re Tuberculous Milk or Tuberculous Cattle. (2) Two licences for the sale of Pasteurised and Grade "A" Tuberculin Tested Milk were granted during the year. The type of apparatus used for the pasteurisation of milk is Burrell's internal tubular heater and cooler, and tarbet holding tanks. (3) There were no refusals or revocations of registrations of retailers or of licences for graded milk during the year. (4) No action has been taken with regard to the bacteriological examination of samples of graded and other milk. (b) Meat Inspection— (1) The number of carcases inspected during or after slaughter were 298. Inspections are made as far as possible during the time when slaughtering is in progress. No action is being taken with regard to marking under the Public Health (Meat) Regulations, 1924. Diseased meat is disposed of by burning. (2) The administration of the Public Health (Meat) Regulations, 1924. The Regulations are being enforced in all instances as far as practicable as embodied in the Regulations. 47 (b) Meat Inspection—contd. (3) Private Slaughter-houses. Below is given in tabular form, the number of private slaughter-houses in use in the District on the dates mentioned :— In 1920. January, 1925. December, 1925. Registered 3 3 3 Licensed - - - - - - Total 3 3 3 (c) Other Foods— Separate tables showing how unsound food and food inspection has been dealt with during the year are given later. The general condition of food shops, etc., is good. (d) No food poisoning cases have been reported during the year. SALE OF FOOD AND DRUGS ACTS. The following is a table of the samples taken during the year :— Month. Article. No. of Samples Results. January. Milk 50 One sample contained 2% of added water. One sample contained 3% of added water. The Council decided to take no action; vendors warned. Water 1 - 48 February. Milk 108 One sample contained 2% of added water. One ditto 3% do. One ditto 18% do. One ditto 4% do. Proceedings taken re 18% sample; case dismissed the defence being that milk delivered was as coming from the cow. Council decided to caution vendor re 4% sample. March. Milk 192 Two samples 3 % deficient in fat One sample 29% added water and 15% deficient in fat. Proceedings taken; defendant fined 3 guineas and costs. There were two samples taken for analysis at the Railway Station simultaneously by the Southall-Norwood U.D.C. and the Middlesex County Council. On analysis, the sample showed 13% of added water. The Southall-Norwood U.D.C. suspended action for M.C.C. to take proceedings. Case dismissed. April Milk 111 Six samples showed slight adulteration; no action was taken. May Milk 82 One sample 3% deficient in fat. No action taken. 49 June Milk, 120 Vinegar, 1 ; Margarine, 1; All genuine. Tinned Milk, 1. July Milk 130 All genuine. August Milk,56 ; Vinegar, 1 Five samples slightly adulterated. No action taken. September Milk,54; Fishpaste,2 All genuine. October Milk 138 Five samples slightly below legal standard in fat and one showed 17% of added water. No proceedings were taken on account of provisions of M.&D. (C) A., 1915, .Section 8. November Milk 94 All genuine. December Milk, 185; Preserved Cream, 1; Ham and Chicken Paste, 1. Eleven samples of milk were slightly below legal standard, but not sufficient to warrant proceedings. During the year 39 of the samples analysed were found to be below the legal standard. Proceedings are not taken unless adulteration of milk exceeds 3% of added water. The following is a comparative table showing the number of Samples taken for analysis during the past 10 years :— 1916 18 samples. 1917 25 „ 1918 30 „ 1919 51 ,, 1920 55 „ 1921 83 „ 1922 131 „ 1923 184 „ 1924 222 „ 1925 1,333 „ 50 No. of samples submitted to the Public Analyst during the year— Milk 33 Other 11 No. of samples analysed by the Southall-Norwood U.D. Council's Inspector in the Public Health Department 1,3 22 No action has been taken under the Public Health (Condensed Milk) Regulations, 1923, or the Milk and Cream Regulations, 1912 and 1917. ARTICLES DISINFECTED DURING 1925. No. of Rooms Disinfected 96 Rooms stripped and cleansed, as required by the provisions of the Infectious Diseases (Prevention) Act, 1890, Section 5 1 Beds 71 Blankets 211 Bolsters 54 Books 11 Covers 17 Eiderdowns 25 Mattresses 33 Pillows 166 Quilts 46 Rugs and Shawls 12 Sheets 86 Wearing Apparel 49 Total Number of Articles Disinfected 781 51 The following articles were destroyed :— Beds 5 Blankets 5 Bolsters 2 Pillows 1 Sheets 2 Eiderdowns 1 Total Number of Articles Destroyed 16 PETROLEUM ACTS, 1871-1881, AND ORDERS IN COUNCIL THEREUNDER. The Acts provide for the safe keeping of Petroleum and Carbide of Calcium. Petroleum when tested in the manner prescribed by Schedule I of the Act, gives off an inflammable vapour at a temperature below 73 degrees Fahr. Petroleum having a flash point below this figure, must be stored under the provisions of a licence, except when kept in separate pint vessels; the quantity kept not exceeding 3 gallons, or when kept for fuel for light locomotives under the Secretary of State's Regulations, the limit then being 60 gallons; to be stored in 2-gallon iron vessels, in a storehouse, specially constructed and ventilated. Petrol gas, being two and a half times heavier than air, ventilation should be arranged as far as possible near the floor. During the year 26 applications for renewals of Licences to keep Petroleum, and one for permission to increase the number of gallons of Petroleum kept by 50 gallons, were received and reported upon. In each instance the applications were granted, subject to the regulations being strictly observed. Two applications were received for Licences to store Carbide of Calcium; the applications were granted subject to the regulations being strictly observed. All the licensed premises have been regularly inspected, and no infringement of the terms of the Licences was recorded. 52 The number of Licenses in force at the end of 1925 within the District were 26 for Petroleum and 2 for Carbide of Calcium, and the number of gallons covered by the Licences is 69,180 gallons. HOUSING. 1. General Housing Conditions in the Area— (1) Except for a small number, the general housing conditions are good. (2) (a) The extent of the shortage of houses in this District is given as about 600. (b) Since 1919, 564 houses have been erected, 370 by State aided schemes, and 194 by private enterprise towards alleviating the housing conditions. At the end of the year under review, a further scheme for the erection of 45 houses was before the Ministry of Health. 2. Overcrowding— The extent of overcrowding is comparable with that for the year 1919, when it was ascertained through a house-tohouse visitation that the number of houses overcrowded in the East and West Wards were 76, caused by the scarcity of houses. The Council by State aided schemes have erected 144 houses since that date, the occupation of which to a small extent may have relieved the overcrowding. No action has been taken daring the year regarding overcrowding. 3. Fitness of Houses— (1) (a) With the exception of about 60 old type of cottages, the general standard of houses is satisfactory, being mainly built of brick, slates and tiles, with three bedrooms, two living rooms and scullery. (b) The defects found to exist consist chiefly of defective roofs, dampness and dilapidations generally. 53 Fitness of Houses—Contd. (c) In a few cases defects are due to lack of proper management, but generally owners are prepared to carry out works as specified for the repair and cleansing of houses; in some cases defects and dilapidations which occur are due to careless tenants, but not to any great extent in this District, being more or less a town of recent development. (2) General action taken as regards unfit houses under :— (a) The Public Health Acts, and (b) The Housing Acts :— No action taken other than the usual notices served on owners for repairs and cleansing. (3) No difficulties were encountered necessitating legal action or special measures. (4) The general conditions are fair as applying to the sanitary circumstances. There is a public constant supply of water to all houses in the District. Excepting about 50 houses, all have water-closets. Pail closets are dealt with by two weekly collections and disposals. 4. Unhealthy Areas— There is no unhealthy area scheduled in this District. 5. Bye-laws Relating to Houses, Houses Let in Lodgings, and Tents, Vans and Sheds, etc. :— The Bye-laws of the Council are enforced in this District. New Bye-laws re tents, vans and sheds are in course of preparation. 6. General and Miscellaneous— The matters contained under this heading have been dealt with by the Statutory Powers vested in the Council through the Housing and Public Health Acts. HOUSING STATISTICS FOR THE YEAR 1925. Number of new houses erected during the year:— (a) Total (including numbers given separately under (b) 207 54 Number of new houses erected during the year—Contd. (b) With State assistance under the Housing Acts :— (1) By the Local Authority Nil. (2) By other bodies or persons 150 1. Unfit Dwelling-houses— Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 305 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 120 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 59 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably tit for human habitation 317 2. Remedy of Defects without Service of formal Notices— Number of defective dwelling-houses rendered tit in consequence of informal action by the Local Authority or their Officers 176 3. Action under Statutory Powers— (a) Proceedings under Section 3 of the Housing Act, 1925 :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners Nil. (b) By Local Authority in default of owners Nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 4 55 Action under Statutory Powers—Contd. (b) Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 93 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 82 (b) By Local Authority in default of owners Nil. (c) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 :— (1) Number of representations made with a view to the making of Closing Orders 4 (2) Number of dwelling-houses in respect of which Closing Orders were made 4 (3) Number of dwelling-houses in respect of which Closing Orders were determined, dwelling-houses having been rendered tit *1 *Ceased to be a dwelling. (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil BROAD & CO. Printers, 331-333 High Road, Chiswick, W.4