UXBRIDGE URBAN DISTRICT COUNCIL. Annual Medical Report FOR THE YEAR 1919. .BY ARTHUR J. TURNER, M.B., B.S., (Darh.) M.R.C.S., L.R.C.P. Capt. late R.A.M.C. MEDICAL OFFICER OF HEALTH. Wescott & Son, Printers, Uxbridge Annual Report of the Medical Officer of Health. Sussex Lodge, Uxbridge. June 14th, 1920. To the Chairman and Members of the Uxbridge Urban District Council. Gentlemen, I herewith lay before you my Annual Report on the Public Health of the Uxbridge Urban District for the year ended December 31st, 1919. As instructed by you I have drawn it up on the lines laid down in the "Memorandum as to Contents and Arrangement of the Annual Reports of Medical Officers of Health" issued by the Ministry of Health in January of this year. VITAL STATISTICS. I. Population. Census 1911. Estimated 1919. Uxbridge 3291 356 Hillingdon West 7083 7870 10,374 11,431 4 The area of the district is 868 acres; 87 in Uxbridge Parish, 781 in Hillingdon West. This therefore gives a density of population of 41 persons per acre for Uxbridge, and 10 persons per acre for Hillingdon West. The chief occupations of the inhabitants are: Nursery hands, Mill factory hands, City and Shop workers. There are no particular occupations which appear to have a deleterious influence on public health. There is 110 Hospital or Infirmary within the boundaries of the Urban District, but the Hillingdon Cottage Hospital, the Hillingdon Infirmary and the Uxbridge Joint Hospital for Infectious Diseases are adjacent, and available for use in cases of need. II. Births. The number of Births registered in the district during 1919 was 210 (of which 107 were males and 103 were females), a decrease on the previous year's figures of 9—giving a rate of 18.37 per thousand of the population. The rate in 1918 was 17.93. The estimated population for the calculation of the Birth-rate was 11,431. There were 19 illegitimate births. III. Marriages. The following Marriages took place:— St. Andrew's 19 St. Margaret's 30 St. John's 16 Other Places of Worship 24 5 In addition 158 took place at the Registry Office, but only about 22 per cent. of these belong to the Urban District. IV. Deaths. The total number of Deaths at all ages belonging to the district was 143. This gives a rate of 13.03 per thousand persons living. The estimated population for the calculation of the Death-rate was 10,973. The actual number of Deaths occurring in the Urban District was 96; 47 deaths belonging to the District occurred outside the area, in such places as the Poor Law Institutions, Asylums, and various London Hospitals. This year Bronchitis heads the list of causes of Death with 18 as against 16 last year. Organic Heart Disease comes next with 17, then Influenza and Cancer with 10 each: Tuberculosis also was responsible for 10, eight of these being of the Pulmonary type. V. Infantile Death Rate. The number of Deaths under 1 year of age was 12 (of which 3 were illegitimate children), which gives a rate per thousand births of 57.1. This, compared with 1909 when there were 33 (a rate of 123 per thousand births), and 1911 when there were 31 (a rate of 132 per thousand), shows a considerable improvement, but must yet be regarded as far from ideal, and should stimulate work on the lines of the District's Infant Clinic. 6 TABLE I. CAUSES OF DEATH DURING THE YEAR 1919. Name of District—UXBRIDGE URBAN. Causes of Death (Civilians only-). Males. Females. All Causes 65 78 1 Enteric fever - - 2 Small-pox - — 3 Measles — — 4 Scarlet fever — — 5 Whooping cough 1 — 6 Diphtheria and croup 1 2 7 Influenza 1 9 8 Erysipelas — - 9 Pulmonary tuberculosis 6 2 10 Tuberculous meningitis — — 11 Other tuberculous diseases — 2 12 Cancer, malignant disease 1 9 13 Rheumatic fever — — 14 Meningitis — — 15 Organic heart disease 6 11 16 Bronchitis 11 7 17 Pneumonia (all forms) 3 3 18 Other respiratory diseases 3 2 19 Diarrhoea, &c. (under 2 years) 1 — 20 Appendicitis and typhlitis — — 21 Cirrhosis of liver 1 1 21 a Alcoholism - — 22 Nephritis and Bright's disease 2 1 23 Puerperal fever — — 24 Parturition, apart from puerperal fever — 1 25 Congenital debility, &c. 5 2 26 Violence, apart from suicide 3 1 27 Suicide - — 28 Other defined diseases 20 25 29 Causes ill-defined or unknown — - Deaths of infants under 1 year of age 10 2 Illegitimate 3 - Total Births 107 103 7 SANITARY CIRCUMSTANCES OF THE DISTRICT. Water.—The supply of water, which is obtained mainly from the Council's deep borings, is constant, and the quality satisfactory, but the quantity at present available is inadequate, recourse having to be made at the present time to an additional supply from the Rickmansworth Valley Water Company. Plans are in hand for creating by additional borings an increased supply within the District. There is no known or suspected contamination of the water. Rivets and Streams.—No pollution of the Rivers and Streams within the District has been discovered. Drainage and Sewerage.—There is a complete system of water carriage leading to open "Scum" Tanks with Filter Beds and land treatment. The arrangements are considered sufficient and satisfactory. Closet Accommodation.—With the exception of about 15, all houses in this District are now supplied with Water Closets. There have been no conversions from Conservancy to Water Carriage during the year. (See Housing Report page 17). Scavenging.—The removal of House refuse is effected by horse and cart, and up to the present it is disposed of by dumping on the Council's ground near the Sewage works. I consider that this is an imperfect and unhealthy method of disposal, and urge upon you the necessity of considering the early erection of an efficient Refuse Destructor. The fact that the available ground for dumping refuse will shortly be used up is an additional reason for doing so. Moveable Ashbins with proper covers are in use in the great majority of Houses. No substitution of such for fixed receptacles has been made during the last few years. GENERAL SANITARY WORK. Sanitary Inspection of District.—The following statement comprises that made by the Inspector of Nuisances for the year 1919. Inspections:— No. of premises inspected on Complaint of Nuisance 106 No. of premises inspected in connection with Infectious Diseases 91 8 No. of premises under Periodical Inspections 180 Total No. of Inspections and re-inspections made 2995 325 nuisances were discovered and abated. 115 Intimation notices and 6 Statutory notices were served. The following is a list of the principal items of work which were included in the above figures:— New drainage systems provided 4 Drains cleaned and repaired 27 New sinks and lavatory basins provided 4 W.C's cleansed, repaired or renewed 86 Additional VV.C. and Urinal accommodation provided 7 New soil pipes and vents 4 Waste water preventors repaired or renewed 137 Rain water gutters and pipes ji Defective sink and bath wastes repaired 20 Houses requiring walls, ceilings, floors, roofs, etc. repaired 57 Premises limewashed 4 Verminous conditions remedied 4 Yards paved 18 New inspection chambers, etc. 10 New dustbins provided 98 Damp conditions remedied 36 Foul dung pits and manure heaps remedied 10 Overcrowding remedied 2 DISINFECTION. 105 Rooms were disinfected and 98 Rooms stripped and cleansed. COMMON LODGING HOUSES. There are three within the district. 6 Contraventions of the Bye-laws were discovered and rectified. RAG & BONE STORES. 6 Contraventions of the Bye-laws were discovered and remedied. FACTORY & WORKSHOP ACTS. 4 Contraventions with regard to Bakehouses were discovered and remedied. 9 FOOD. (a) Milk.- The following Report upon the Dairies and Cowsheds in this District has been received from the Veterinary Inspector: April 20th, 1920. To the Chairman and Members of the Uxbridge Urban District Council. Annual Report. Veterinary Inspection. Dairies & Cowsheds. Uxbridge Urban District, 1919. Gentlemen, I beg to report that visits under the above head have been made at frequent intervals to the premises concerned. The state of cleanliness of the premises visited has been found satisfactory. Whitewashing has been carried out regularly. Any suggestions made under this head have been at once carried out to my satisfaction. There are relatively few cows kept in the Urban area at the present time, and the standard of health among the animals is high. No cases of Tuberculosis of the udder or generalised Tuberculosis have been detected. A list of the premises visited is attached. I am, Gentlemen, Your obedient servant, W. A. HANCOCK, Veterinary Inspector. 10 List of Cow Keepers and Dairies, Uxbridge Urban District. Bishop & Son, Hillingdon House Farm. Collins & Bigmoke, Grainge Farm Fassnidge, S. Harefield Road Harding Bros., Highfield, Bawtree Road, (Temporary premises.) Judd A The Lynch Kelly J. Montague Road Pool, C. St. Andrews Saunders, W. Moor Farm Sherwin, G. High Street Milk, (Mothers and Children) Order, 1918.—Action was taken in this matter very soon after the Order was issued, and has been continued up to the present time. On an average about 12 families have constantly been in receipt of a free supply of Milk under this order. (b) Other Foods.—The conditions of storage and exposure for sale of foods have generally been satisfactory. Below are given the principal items of foods condemned as being unfit for human consumption. Cwts. Qrs. lbs. Bacon 14 3 25 Meat,— (Iloiue killed) Beef 7 2 II The whole carcase and all the organs of a Sheep. ,, ,, ,, Pig. Meat (Frozen) Beef 5 Cwts. 2 Qtrs 2 lbs. Kidneys 5 dozen Rabbits 60 Cwts. Corned Beef 19,, Poultry Two Turkeys 11 Fish Wet 308 Cwts. Dry 21 „ Smoked Fillets 4 Boxes. Fruit Dates 12 Tons 2 Cwts. Dried peaches 50 lbs. Butter (Frozen) 116½ ,, There is no Public Abattoir in this District, though it is very desirable there should be one. There are five Slaughter Houses on the Register. They are inspected weekly. Limewashing is carried out twice yearly and the regulations have been carried out satisfactorily. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. The total number of deaths from Infectious Disease was 30. Incidence of Infectious Disease.— Details are given in Table No. II. The total number of cases of Notifiable Infectious Disease was 91. Of these 30 were due to Tuberculosis in one of its many forms : 11 being Pulmonary. The number of cases of Scarlet Fever and Diphtheria, although these diseases were Epidemic in and around London in the latter part of the year, were not excessive in the Uxbridge Urban District, and compared with 1917 and 1918 figured as follows. 1917 1918 1919 Scarlet Fever 39 16 9 Diphtheria 39 20 14 The following diseases were made notifiable under Regulations issued on January 7th, 1919, in addition to those previously notifiable:—Lobar Pneumonia, Influenzal Pneumonia, Malaria, Dysentery and Trench Fever. l2 Of these only one, five, three and one respectively of the four first named diseases have been notified in this district. Measles on the other hand has been withdrawn from the list of notifiable diseases as from December 31st, 1919. Disinfection.—105 Rooms have been disinfected in connection with Infectious Disease and 98 rooms stripped and cleansed. Bacteriological Aids were utilised in 36 cases for the purpose of confirming the diagnosis of the disease: Enquiries were made in every case with the object of finding contacts, and arrangements were made, as far as possible, to keep those found away from work until after disinfection had taken place. The Isolation Joint Hospital has been made use of for cases of Scarlet Fever and Diphtheria. Disinfection of clothing and bedding has been by Steam Steriliser, and of room walls, books and furniture by Formalin Spray and Vapour. No primary vaccinations or re-vaccinations have been performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations 1917, during 1919. 13 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1919. Name of District—UXBRIDGE URBAN. NUMBER OF CASES NOTIFIED. AT AGES—YEARS. Notifiable Disease. At all Ages. Under 1. 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 14 ... 2 8 3 1 ... ... Erysipelas 6 ... ... ... 2 3 1 Scarlet Fever 9 ... 1 7 1 ... ... ... Typhus Fever ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... Cerebro-spinal Meningitis 2 ... ... ... 1 ... 1 ... Poliomyelitis ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 2 2 ... ... ... ... ... ... Pulmonary Tuberculosis 11 ... ... ... 2 7 2 ... Other Forms of Tuberculosis 19 ... 2 5 4 6 1 1 Measles 14 ... 7 5 1 1 ... ... German Measles 2 ... ... 1 1 ... ... ... Encephalitis Lethargica 2 ... ... ... ... 2 ... ... Encephalitis Acute ... ... ... ... ... ... ... ... Pneumonia Lobar 1 ... ... ... ... ... 1 ... Pneumonia Influenzal 5 ... ... 1 2 1 1 ... Malaria 3 ... ... ... 2 1 ... ... Dysentery 1 ... ... ... ... 1 ... ... Trench Fever ... ... ... ... ... ... ... ... Totals 91 2 12 27 19 23 6 2 14 MATERNITY AND CHILD WELFARE. The following is a summary of the work performed by the District Health Visitor during the year. Births notified 157 First visits to Houses 230 Subsequent visits 3247 Children periodically visited 230 Expectant mothers visited 109 Infant Deaths 7 Cases of Ophthalmia Neonatorum attended 0 Total visits of Infants to Clinic 2080 Average visits per week 40 Total number on Register 369 The arrangements made for furthering the health of Expectant Mothers and of Children under 5 years of age are:— Domiciliary Visitation and advice, and the urging of Mothers to attend the Infant Welfare Centre and the Dental Clinic also when necessary. In all cases of Infant Deaths and of Still-births the home has been visited and enquiries made as to the causes. There have been a few cases of births to unmarried mothers; in these the mother has either been treated at home, or admission obtained for her to a lyingin home specially set apart for such. In the case of children deprived of a home with their own parents it is usual for them to be placed out with foster parents. The Council's Creche is able also to take a certain number of children boarders from Monday to Saturday, and this is a convenience to some Mothers who are at work during the week but free at the week-end. (see next page). In addition to the Notifiable Infectious Diseases, particulars of which are given in Table II, there was a considerable number of cases of Whooping Cough and Chicken Pox, specially towards the end of the year. M iss Massie, who had very ably fulfilled the duties of your Health Visitor since October 15th, 1917, resigned her post on September 15th, 1919, and was 15 succeeded by Miss Mark, who has supplied me with the above report of Maternal and Infant Work. THE CRECHE. This was established in June, 1917, and the Staff consists of the Matron (Miss Collins) and 4 untrained Assistants. During the year under review the daily attendances of children amounted to 7,309, an average of 20 per day throughout the year. The children are mostly those of mothers employed during the day. But there are others whose mothers are either working late, doing alternately night and day work, or who live at a distance, and in these cases the children are admitted on Monday mornings and return home on Saturday. The Creche also admits children whose mothers have had to be removed to Hospital, or are lying ill at home, or during their confinement and lying in. On the whole children are sent to the Nursery tidy and clean. They enjoy very good health, due perhaps to the amount of fresh air they get, as they spend most of their time in fine weather on the large lawn. The only cases of illness during the year were two suspected to be mumps. Parents are permitted to see their little ones at any time and are encouraged to do so that they may be satisfied that the children are happy and well cared for. The charges made are, for one child 6/- per week, and for two 11/- per week, or 7d. per day each. For children coming from the Rural District an extra charge of 1d. per day and of 6d. per week is made. SANITARY ADMINISTRATION. 1. Staff.—This consists of one member only, the Inspector of Nuisances. 2. Hospital Accommodation available for Infectious diseases. The Joint Isolation Hospital situated in Hillingdon East, which has in connection with it a small building about 2 miles away for the accommodation, when necessary, of Small-pox patients. The Hospital has proved, I believe, sufficient and efficient during the past year. 3.—Adoptive Acts and Byelaws as previously reported. 4.—Arrangements for Chemical and Bacteriological examination, where necessary, 106 are made with the Clinical Research Association, Ltd., and have been well used during 1919. HOUSING. I. General Housing Conditions. (1) Number of Houses 2475 „ for Working Classes 2180 Number of New Houses „ erected in 1919 None „ „ „ in course of erection None (2) Population, estimated 11431 Changes in 1919—Estimated increase 450 Changes anticipated in the future Slight Increase (3) a. Extent of shortage of Houses 250 b. Measures taken or contemplated to meet this shortage Housing Scheme for 250 houses II. Overcrowding. (1) Extent, a. Tenements with more than two occupants per room 39 b. Number of houses intended for one family only now occupied by two or more 96 (2) Causes, a. General Shortage of Houses. b. Immigration from other districts of a considerable number of people. (3) Measures contemplated to deal with above:—Erection of New Houses. (4) Principal Cases of Overcrowding dealt with in 1919 and action taken:— One case in which Statutory Notice was served under Public Health Acts, and in which the order was complied with. III. Fitness of Houses. (1) a. General Standard of Housing in the Fair 17 b. General character of the defects found to exist in unfit houses Serious. (2) Action taken as regards unfit houses under a. Public Health Acts b. Housing Acts Council Housing Scheme. (See appendices). <(3) Difficulties in remedying unfitness— Shortage of Labour and Material due to the War. Special Measures taken None. Any suggestions — (4) Conditions, so far as they affect housing, as regards— a. Water Supply:—The Supply was sufficient for the needs of the District, and the quality was satisfactory b. Closet Accommodation:—Wilh a few exceptions all houses in the district have W.C.'s. c. Refuse Disposal:—At present House and Shop Refuse is deposited on the Council's Sewage Works land. This is not a satisfactory manner of disposal, and a scheme for the erection of a Destructor is shortly to be laid before the Council. d. Measures taken during the year in the matters of a, b, and c:—None. IV. Unhealthy Areas. (1) Action taken as regards Areas represented before the beginning of the year under Part I. or Part II. of the Housing Act of 1890:—None. (a) Particulars of, and action taken as regards, areas represented during the year:—Five areas consisting of 78 houses were represented 18 as unhealthy. Ninety houses included in the Council's Housing Scheme are intended to accommodate families from these unhealthy areas. (3) Information as to complaints made during the year that areas were unhealthy, and action taken:—No complaints made. V. Byelaws relating to Houses, to Houses let in Lodgings, and to Tents, Vans, Sheds, 81c.:— (1) As to working of existing byelaws:—Satisfactory. (2) As to need for new byelaws, or revision of existing byelaws:—None considered necessary at present. VI. General and Miscellaneous. An account of any action bearing on the public health, not covered by the above particulars, which has been taken during the year by the Local Authority in connection with Overcrowding, Insanitary Property and Housing, whether under the Housing Acts or the Public Health Acts:—None. VII. Appendices. Statistics for the 12 months ended December 31st, 1919:— (1) Number of Dwelling Houses in respect of which complaints were made that they are " unfit for human habitation" by householders None. (2) Action under Sect. 17 of Housing Act, 1909:— a. Number of Dwelling Houses inspected under and for the purpose of the Section 51 b. Number of Dwelling Houses considered unfit for human habitation None. c. Number of Dwelling Houses defects of which were remedied without the making of Closing Orders 52 (3) Action under Sect. 28 of Housing Act, 1919:— a. Number of Orders for Repairs issued 2 19 b. Number of cases in which Repairs were carried out by the Local Authority None. c. Number of Dwelling Houses voluntarily closed on notice by owner that they could not be made fit without reconstruction None. (4) Closing Orders:— a. Number of representations made to Local Authority with a view to the making of Closing Orders None. b. Number of Closing Orders made None. c. Number of dwelling houses in regard to which Closing Orders were determined on the houses being made fit for human habitation .None. (5) Demolition Orders:— a. Number made None. b. Number of houses demolished in pursuance of Demolition Orders None. (6) Number of houses demolished voluntarily None. (7) Obstructive Buildings:— a. Number of representations made (Section 38 of the Housing Act of 1890) None. b. Number of buildings demolished None. c. Number of representations still under consideration None. (8) Staff engaged in Housing work with, briefly, duties of each Officer:—The Inspector of Nuisances appointed Inspector under the Housing and Town Planning Act,1909. I have the honour to be, Gentlemen, Your obedient Servant, ARTHUR J. TURNER, M.B.