UXBR 4 THE RURAL DISTRICT COUNCIL OF UXBRIDGE. Annual Medical Report FOR THE YEAR 1913. by FREDK. E. WALKER, M.B., B.S., medical officer of health. Wescott & Son, Printers, Uxbridge. Annual Report Medical Officer Health, 1913. 113, High Street, Uxbridge, February, 1914. To the Chairman and Members of the Uxbridge Rural District Council. Gentlemen, I beg to lay before you my Report on the Public Health of your District for the the year 1913. A.—NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. 1.—Physical Features and General Character of the District. The Uxbridge Rural District lies in the North-West Angle of Middlesex, and consists of the Parishes of Harefield, Northolt, Ickenham, Hillingdon East, West Drayton and Cowlev. On the East of the District runs the River Colne and its branch the Frays. The Yeading Brook rises between Harrow and Pinner and runs into the Cran. The Pinn also rises near Pinner, and flows in a South-Westerly direction through the District into the Colne at Yiewsley. A portion of the Grand Junction Canal traverses the Western boundary of the District. The District is mostly flat, but hilly in parts, the highest points being Harefield 291 feet and Hillingdon 188 feet above sea-level. The soil consists chiefly of London Clay, with occasional patches of plastic clay and gravel, and at Harefield an outcrop of chalk. 2.—Population. Estimated at middle of 1913 9600 Inhabited Houses 1966 Deducting 320 for Hillingdon Workhouse and Infirmary, this makes an average of 4.72 per house. The working class population are engaged chiefly in Agricultural and Small Business pursuits, there being only 9 Factories and 15 Workshops registered in the District. 4 POPULATION AND HOUSES of the Several Parishes Comprised in the Uxbridge Rural District. Parish. Inhabited Houses. Estimated Population. COWLEY 1911 226 869 1912 218 1026 1913 216 1030 WEST DRAYTON 1911 371 1668 1912 390 1720 1913 402 1770 HAREFIELD 1911 522 2402 1912 500 2450 1913 522 2530 HILLINGDON EAST Including Workhouse 1911 609 3068 1912 594 3120 1913 596 3136 ICKENHAM 1911 89 396 1912 85 400 1913 85 404 NORTHOLT 1911 124 685 1912 128 714 1913 145 730 The figures given for Inhabited Houses, 1911, are taken from the Census returns, and include Canal Boats and Caravans, about 40. The 1912 and 1913 figures do not include these. B.—SANITARY CIRCUMSTANCES OF THE DISTRICT. Water Supply. The Rickmansworth and Uxbridge Valley Water Company supplies Hillingdon East, West Drayton, Cowley, Harefield and Ickenham. The water is of good quality, though hard, and no complaints have been received this year as to its taste. Complaints are still being made in Harefield that the Public Water Service is at times insufficient, and now and then cut off without warning, for portions of the day. The Colne Valley Water Company supplies Northolt. In Harefield and Ickenham are still many wells, which are always liable to pollution, and no opportunity should be lost of prohibiting the use of water from them for drinking purposes. In the two Parishes above named, only So per cent of the houses are supplied from the Public Water Service. 5 Rivers and Streams. No pollutions of these have been reported during the year, and their condition is at the present time good. Drainage and Sewerage. Hillingdon East, Cowley, and West Drayton are drained by a Sewage system to the Works at Cowley Peachey, which are now worked jointly with the Urban District of Yiewsley, and I have received no complaints this year as to defects or smells. The Salt Hill connection to the Urban District has now been made. The note that I made in my last report respecting the Drainage and Sewerage of Ickenham and Northolt still holds good. Closet Accommodation and Scavenging. I can record this year fewer complaints and better work in this department than during 1912, but so long as earth closets and cesspools remain as numerous as at present, very strict supervision is necessary to avoid danger and nuisances. Movable Ashbins have been provided or substituted for fixed receptacles in 60 houses. Sanitary Inspection of District. The details of the Inspections made are set out in the Tables on pages 14, 15, 16. Complaints are still being received of the smell from Squire's Fat Factory at Yiewsley. A curious feature about this seems to be that when the Factory is visited, the offensiveness is not so noticeable as it is when smelt at a good distance from the factory, e.g., at Little Britain. Premises and Occupations which can be Controlled by Bye-laws or Regulations. There are no Registered Lodging Houses in the District. Fat-boiling, an offensive trade, is conducted on four premises : three at Northolt and one in Hillingdon East. The Bye-laws are conformed with, and no complaints have been received. No underground Sleeping-rooms exist in the District so far as 1 know. 6 Schools. These have been visited during the year, and are in good condition as regards Sanitation and Water Supply. FOOD. Milk Supply.—The Milk consumed is practically all produced within the District or near by, and is of good quality. Samples have been reported on from time to time by the County Council Inspector. The Dairies have been periodically inspected. There are upwards of 350 milch cows in the District, and 23 Registered Dairies and Milkshops. It would be a distinct advantage, in view of the present effort to stamp out Tuberculosis, if the Council appointed a Veterinary Inspector, as the examination of the live animals is work which should be done by a Specialist. Under the present arrangements if the Sanitary Inspector comes across a suspicious case, he has to report to the County Council, which then sends down a Veterinary Surgeon. This involves a certain amount of delay. This procedure was adopted for a case at Northolt, and two cows were destroyed as a result. I take the liberty of quoting from the Report of the Veterinary Inspector of the Uxbridge Urban District Council for 1912:— "As regards the cases of Tuberculosis in Stock, the approach of more efficient legislation with regard to those cases in which the Udder itself has not been involved and has not hitherto been notifiable, will undoubtedly prove to be of incalculable benefit to all users of milk. "It means that every animal suspected of suffering from the disease has to be notified to the Authorities; an investigation will then take place on behalf of the County Council; animals found affected, valued, slaughtered, and partial compensation to the Owner. Milk from suspected quarters examined, and where Tubercle Bacilli are found these animals are also condemned, and the milk supply from such a source permanently stopped. "To my mind the value of the new Act which will be coming into operation on May Ist, 1913, is very much enhanced by the fact that the whole of the stock on the holding is inspected, it is not merely confined to an investigation concerning the particular Cow or Cows first suspected. "One or two matters will probably be introduced later on; the one omission in the new Order seems to my mind of very great urgency—viz.: the inspection of all the Cows by Veterinary Inspectors regularly, on behalf of 7 all the Urban and Rural Authorities. At present some do it, others do not, and of course the sequel to this lack of uniformity is the introduction of suspected animals into areas where no supervision by Veterinary Officers exists." Other Foods.—The usual Inspections of premises have been made by your Inspector, who has found no cause for complaint during the year. The Medical Officer of Health for the County has specially drawn my attention to the fact of the possibility of the disease known as Actinomycocis, which is caused by the Ray Fungus, and which is known to affect cattle in some parts of the British Isles, but most commonly in Russia, being conveyed to human beings through the medium of Ox Tongues imported from South America, where the disease is widely prevalent. I have accordingly instructed your Inspector to be on the watch for any signs of the diseases in tongues, and we have for our guidance a Special Report on the subject drawn up by the Corporation of London. Sale of Food and Drugs Act.—No action has been taken under the Act, the County Council's Inspectors doing what is necessary in the District. Milk and Cream Regulations, 1912.—No action has been taken. HOUSING. The Surveyor has given me the following figures:— Houses Erected duriug 1913. Houses in course of Erection at end of 1913. Overseers' Returns of new houses Occupied during 1913 Harefield 9 6 14 Northolt 7 2 8 Ickenham 4 — 2 Hillingdon East 2 — 2 Cowley — 2 — West Drayton — - — 22 10 26 8 The number of Inspections under the Housing and Town Planning Act, 1909, for the year is 140. 73 defects were found and have been or are in the course of being remedied by the owners. The remedies are however in many cases likely to be temporary only, and to last at most for a few years. Rebuilding on modern principles will have to be done ultimately. In response to the demand for more Houses for the Working Classes in Ickenham and Harefield, the two special inquiries which the Council held undoubtedly confirmed the same, and I understand that the principle that the Council should take steps to supply the deficiency is now agreed upon. I hope to be able to report next year that the difficulty of the acquisition of suitable sites has been surmounted, and the work in hand or completed. At Ickenham, where it is proposed to erect two cottages only, the very small piece of land required apparently adds to the difficulty, for owners are more inclined to sell a larger plot, when they will not willingly part with small pieces only. I am still of opinion that were a larger number of workmen's cottages put up, no great difficulty would be found in letting them. WORKSHOPS, WORKPLACES, ETC. The table at the end of this Report gives details as to these. Further extensions of the Harefield Asbestos Works have been made, and the question of the housing accommodation of the work-people has become more urgent. C.—SANITARY ADMINISTRATION OF THE DISTRICT. 1.—Staff. Your Staff was as in 1912. 2.—The Hospital accommodation has proved quite adequate for the calls on it. Fifteen cases were admitted to the Infectious Hospital. One of these, a case of diphtheria, proved fatal. Number of available Beds 32 which in emergency can be increased to 72. No case of Small Pox has occurred. The Hospital at Yeading remains closed. 9 3.—Adoptive Acts and Bye-laws in Force. Acts:— Infectious Disease (Prevention) Act, 1890. Public Health Act Amendment Act, 1890, Part III. It would facilitate the work of your Inspector and Medical Officer if the Public Health Acts Amendment Act, 1907, were adopted by the Council. Bye-laws:— Cleansing and Removal of Refuse (P.H.A., 1875, Sec. 44). Prevention of Nuisances (P.H.A., 1875, Sec. 44). Keeping of Animals (P.H.A., 1875, Sec. 44). New Streets and Buildings (P.H.A., 1875, Sec. 157, and P.H.A.A.A., 1890, Sec. 23). D.—PREVALENCE OF AND CONTROL OVER ACUTE INFECTIOUS DISEASE. (See Table II). Nineteen cases of Notifiable Infectious Disease other than Tuberculosis have occurred during the year, eleven less than in 1912, which is satisfactory. Three of the ten cases of diphtheria occurred in one house. There has been no epidemic of importance, though Measles and Whooping Cough were, as usual, prevalent in the first half of the year. Several Medical Practitioners have availed themselves of the help which the Council gives as to the Bacteriological Diagnosis of Diphtheria. E.—PREVALENCE AND CONTROL OVER TUBERCULOSIS. Eleven cases of Pulmonary Tuberculosis were notified, and nine cases of other forms of the same disease. All these cases were visited by your Inspector or myself, or by both of us, and leaflets, disinfectants and appliances supplied in most of the cases. F.—INVESTIGATION OF OTHER DISEASES. There has been no excessive prevalence of any other form of disease. On and after April 1st, 1914, the Notification of Ophthalmia Neonatorum will be Compulsorily Notifiable by Medical Practitioners and Certified Midwives. G.-VITAL STATISTICS. (Tables I. to IV.) 10 TABLE I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1913 AND PREVIOUS YEARS. Name of District—UXBRIDGE RURAL. Year. Populaestimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths‡ Nett Deaths belonging to the District. Uncorrected Number Nett. Number. Rate. Of residents registered in the District. Of dents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number Rate per 1000 Nett Births. Number Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1908 13570 341 25.1 199 14.6 43 5 34 99 161 11.8 1909 13620 374 27 206 15.1 44 13 31 80 175 12.8 1910 13666 336 24 200 14.5 29 18 24 71 184 13.4 1911 9275 248 25 162 17.4 56 17 28 119 106 11.4 1912 9420 174 169 17.9 150 15.9 60 12 17 100.6 102 10.8 1913 9600 216 207 21.6 144 15 60 17 16 77.3 99 10.3 Area of District in acres (land and inland water) 12623 Total Population at all ages 9240 Number of Inhabited Houses 1941 Average number of persons per house 4.7 At Census of 1911 11 TABLE II. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1913. Name of District—UXBRIDGE RURAL. Notifiable disease. Number of Cases Notified. Total Cases notified in each Locality. (e.g. Parish or Ward) of the District. Total cases removed to Hospital. At all ages. At all ages. Under I. 1 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. Harefield. Hillingdon Fast. West Drayton. Cowley. Northolt. Ickenham. Small-pox … … … … … … … … … … … … … … … Cholera (C) Plague (P) … … … … … … … … … … … … … … … Diphtheria (including Membranous croup) 10 … 2 7 1 … … … 1 6 1 ... 1 1 9 Erysipelas 2 … … 1 … … 1 … … … … 1 1 … … Scarlet Fever 7 … 2 5 … … … … 2 2 … 2 1 … 6 Typhus Fever … … … … … … … … … … … … … … … Enteric Fever … … … … … … … … … … … … … … … Relapsing Fever (R) Continue( Fever (C) … … … … … … … … … … … ... ... … … Puerperal Fever … … … … … … … … … ... … … … … … Cerebro-spinal Meningitis … … … … … … … … … … … … … … … Poliomyelitis … … … … … … … … … … … … … … … Pulmonary Tuberculosis 11 … 1 2 2 5 1 … 5 4 2 … … … … Other forms of Tuberculosis 9 … 1 3 3 2 … … 2 4 2 … … 1 ... Total 39 … 6 18 6 7 2 … 10 16 5 3 3 2 5 Isolation Hospital-Name and Situation. Joint Hospital, Hillingdon; Small-pox Hospital, Yeading. Total available beds, 32. TABLE III. CAUSES OF, AND AGES AT DEATH DURING THE YEAR 1913 Name of District—UXBRIDGE RURAL. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District (a). Total Deaths whether of "Residents" or "non-Residents" in Institutions in the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All Causes Certified (c) 98 16 2 4 3 8 16 21 28 71 Uncertified 1 … ... … … ... … … 1 … Enteric Fever ... … … … … ... ... … … … Small Pox … … ... … … … … … ... ... Measles ... ... … … … … … … … ... Scarlet Fever … … … … … … … … … … Whooping Cough 1 1 … … … … … … … … Diphtheria and Croup 1 ... … 1 … … … ... … 2 Influenza 4 ... … ... … … 1 1 2 … Erysipelas … … … … … … … … … … Phthisis (Pulmonary Tuberculosis) 9 … … 1 … 3 4 l … 11 Tuberculous Meningitis … … … … … … … … … … Other Tuberculous Diseases … … … … … … … … … … Cancer, malignant disease 7 l … … ... 1 1 3 1 11 Rheumatic Fever … … … … … … ... … … … Meningitis … … … … … ... … … … 1 Organic Heart Disease 12 … ... … 1 … 3 5 3 4 Bronchitis 4 … … … … … ... … 4 5 Pneumonia (all forms) 3 2 … … … … 1 … … 1 Other diseases of respiratory organs 1 2 ... ... … 1 ... … … … Diarrhoea and Enteritis 4 2 1 … … ... … 1 … … Appendicitis & Typhlitis … ... … … … … … … … … Cirrhosis of Liver 1 … … … … … … 1 … … Alcoholism … ... ... … … … … … … … Nephritis and Bright's Disease 2 … … … … … 1 1 … 1 Puerperal Fever … … … … … … … … … … Other accidents and diseases of Pregnancy and Parturition 1 … … … … … 1 … … 1 Congenital Debility and Malformation, including Premature Birth 9 9 … … … … … … … 1 Violent Deaths, excluding Suicide 8 ... … … ... 2 2 3 1 2 Suicide … … … … … … … … … … Other Defined Diseases 31 1 1 2 1 1 2 5 18 29 Diseases ill-defined or unknown 1 … … … 1 … … … … 2 Totals 99 16 2 4 3 8 16 21 29 71 TABLE IV Name of District—UXBRIDGE RURAL. INFANT MORTALITY. 1933. Nett Deaths from stated causes at various Ages under 1 Year of Age. Causes of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 Year. All Causes Certified. 6 2 1 … 9 2 1 2 2 16 Uncertified. … … … … … … … … … … Small-pox … … … … … … … … … … Chicken-pox … … … … … … … … … … Measles … … … … … … … … … … Scarlet Fever … … … … … … … … … … Whooping Cough … … … … … 1 … … … 1 Diphtheria and Croup … … … … … … … … … … Erysipelas … … … … … … … … … … Tuberculous Meningitis … … … … … … … … … … Abdominal Tuberculosis … … … … … … … … … … Other Tuberculous Diseases … … … … … … … … … … Meningitis (not Tuberculous) … … … … … … … … … … Convulsions … … … … … … … … … 1 Laryngitis … … … … … … … … … … Bronchitis … … … … … … … … … … Pneumonia (all forms) … … … … … … … … … … Diarrhoea … … … … … … 1 … … 2 Enteritis … … … … … … … 2 … 2 Gastritis … … … … … … … … … … Syphilis … … … … … … … … … … Rickets … … … … … … … … … … Suffocation, overlying … … … … … … … … … … Injury at birth … … … … … … … … … … Atelectasis … … … … … … … … … … Congenital Malformations (c) 1 … … … 1 … … … … 1 Premature birth 3 1 … … 5 … … … … 5 Atrophy, Debility and Marasmus 2 1 … … 3 … … … 1 4 Other causes … … … … … … ... … … … Total 6 2 1 … 9 2 1 2 2 16 Nett Births in the year, Legitimate 196 Illegitimate 11 Nett Deaths in the Year of Legitimate infants 15 Illegitimate infants 1. H SANITARY WORK FOR THE YEAR 1913. Cowley. Harefeild. Hillingdon. Ickenham. Northolt. W. Drayton. Total Inspections:— Number of Premises Inspected on Complaint 1 6 2 1 1 3 14 „ „ „ in connection with Infectious Diseases 3 8 13 2 2 3 31 Number of Premises under Periodical Inspection 10 22 20 9 9 9 79 Houses Inspected from House-to-House (H. and T.P. Act.) 23 52 15 22 22 6 140 Total Number of Inspections and Re-inspections made— 40 249 108 53 78 108 636 Notices:— Cautionary or Intimation Notices Given 3 8 3 2 3 2 21 Statutory Orders Issued 1 3 3 2 5 – 14 Summonses Served – – – – 1 – 1 Convictions Obtained. – – – – 1 – 1 Dwelling-Houses:— Number of Houses dealt with under Section 15 10 32 7 6 3 6 68 Number of Houses found to be in a state Dangerous or Injurious to Health (Sect. 17) – 3 2 – – – 5 Number of Representations made by M.O.H (Sect. 17) – 3 2 – – – 5 Number of Houses made Habitable without Closing Orders 4 35 13 2 – 8 62 Number of Houses closed Voluntarily – – 2 – – – 2 Bakehouses:— Number in District 2 3 2 – 1 2 10 Contraventions of Factory Acts 1 1 – – – – 2 Slaughter-houses Number of Inspections made 1 4 2 – – 5 12 Cow-sheds:– Number on Register 2 10 3 2 6 1 24 Number of Inspections made 8 40 12 8 24 2 94 Number of Milch Cows in District 16 200 37 19 154 3 429 15 SANITARY WORK FOR THE YEAR 1913. Cowley. Harefield. Hillingdon. Ickenham. Northolt. W. Drayton Total Dairies and Milk Shops.— Number on Register 2 10 3 2 6 2 25 Number of Inspections made 8 40 12 8 24 8 100 Offensive Trades:— Number of Premises in District – – 1 – 3 – 4 Number of Inspections made – – 3 – 12 – 15 Water Supply and Water Service:— Wells: Cleansed, Repaired, &c. – 8 – – – – 8 Percentage of Houses supplied from Public Water Service 95 80 95 80 95 90 – Percentage of Houses supplied on Constant System 95 80 95 80 95 90 – From Local Wells – 10 – 1 – – 11 Drainage and Sewerage of Existing Buildings :— Water Closet : * Repaired, Supplied with Water, or otherwise Improved 2 4 3 2 2 1 14 Percentage of Houses provided with Water Closets 95 80 95 80 95 90 – Drains : Examined, Tested, Exposed, &c. 2 1 3 – – 1 7 Unstopped, Repaired, Trapped, &c. 2 1 4 – – 1 8 New Soil Pipes or Ventilating Shafts fixed – 2 – 2 – – 4 Disconnecting Traps or Chambers Inserted – 1 – I – – 2 Reconstructed – 2 – – – – 2 ‡ Cesspools: Rendered Impervious, Emptied, Cleansed, &c 12 82 30 – 5 10 139 Percentage of Houses Draining into Sewers 95 50 90 – – 95 – Disinfection:— Rooms Disinfected : Ordinary Infectious Diseases 2 3 9 1 2 2 19 Phthisis 1 7 3 – – 1 12 Rooms Stripped and Cleansed 4 1 4 – – – 9 Articles Disinfected or Destroyed: Ordinary Infectious Disease 1 – – – – – 1 Phthisis — 2 2 – – 1 5 * Include 9 new. ‡ Emptying only. One Cow observed to be apparently diseased and voluntarily killed by Owner. 16 SANITARY WORK FOR THE YEAR 1913. Cowley. Harefield. Hillingdon. Ickenham. Northolt. W. Drayton Total Dust:— New Bins Provided 4 40 17 – – 10 71 How frequently is Dust Removed from each House ?— Fortnightly. Number of Complaints of Non-Removal received 1 3 6 – – 11 21 Method of Disposal ?—By Tipping. Sundry Nuisances Abated:— Overcrowding – 3 – – 3 – 6 Foul Hitches, Ponds, &c., and Stagnant Water – 2 – 4 1 – 7 Foul Pigs and other Animals – 1 1 1 – 1 4 Other Nuisances 1 1 – – – 1 3 17 FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. I.—INSPECTIONS. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. No of Inspections. No. of Written Notices FACTORIES (Including Factory Laundries.) 18 3 WORKSHOPS (Including Workshop Laundry.) 26 – WORKPLACES (Other than Outworkers' Premises included in Part 3 of this Report.) 17 – 61 3 III.-HOME WORK. Number Wearing Apparel (Making, &c.):— Lists received from Employers 22 II.—DEFECTS FOUND. Nuisances under the Public Health Acts:— Found. Remedied. Want of Cleanliness 2 2 Want of Ventilation – – Overcrowding – – Want of Drainage of Floors – – Other Nuisances 1 1 Sanitary Accommodation: Insufficient 1 1 Unsuitable or Defective – – Not Separate for Sexes – – Insufficient means of Escape in case of Fire 1 1 5 5 18 IV.—REGISTERED WORKSHOPS. Number. Workshops on the Register (s 131) at the end of the year:— Factories 9 Bakehouses 10 Laundries 3 Workshops 17 Total 39 V.—OTHER MATTERS. Number. Matters notified to H.M. Inspector of Factories Failure to affix Abstract of the Factory and Workshops Act (s. 133, 1901) – Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Act (s. 5, 1901):— Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 3 Other – Underground Bakehouses (s. 101):— Certificates granted during the year – In use at the end of the year –