UXBRS THE RURAL DISTRICT COUNCIL OF UXBRIDGE. Annual Medical Report FOR THE YEAH 1919. . . BY . . W. TOWNSEND DOBSON, m.r.c.s., l.r.c.p., MEDICAL OFFICER OF HEALTH. King & Hutchings, Ltd., Printers, Uxbridge. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, 1919. The Red House, Uxbridge. May 3Oth, 1920. To the Chairman and Members of the Uxbridge Rural District Council. Madam and Gentlemen, I beg to lay before you my Report on the Public Health of your District for the year 1919. 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 Cowley. 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 3 4 Clay, with occasional patches of plastic clay and gravel,'and at Harefield an outcrop of chalk. Population. The estimated population is 10,160 for the whole district. This figure includes the number estimated for the Uxbridge Poor Law Institution, but does not include the members of the Royal Air Force quartered in that part of the depot which is within the Rural District Boundary. COWLEY 1,035 WEST DRAYTON 1,860 HAREFIELD 2,855 HILLINGDON EAST 3,160 ICKENHAM 450 NORTHOLT 800 The working-class population are chiefly engaged in Agriculture, Factory, and small business pursuits. There are a number of factories in the district, e.g., Asbestos Works, Furniture Factories, Cardboard and Cement Factory. B.—SANITARY CIRCUMSTANCES OF THE DISTRICT. Water Supply. The Rickmansworth and Uxbridge Valley Water Company supplies Hillingdon East, West Drayton, Cowley, Harefield, Ickenham and part of Northolt. The water is of good quality, though hard, and no complaints have been received this year as to its taste. The Colne Valley Water Company supplies part of Northolt. In Harefield and Ickenham are still many wells, which are always liable to pollution, and several of these have been condemned and the houses supplied off the main. Still more will have to be condemned in the near future. Rivers and Streams. No pollutions of thesa 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 by the Joint Drainage Committee, and I have received no complaints this year as to defects or smells. 5 Hospitals. The Uxbridge Cottage Hospital, containing 12 beds, serves for any suitable cases in the Uxbridge Rural district, and during the year, several cases have been admitted from Harefield, West Drayton, Hillingdon, and Hillingdon Heath. A private ward is now obtainable for one patient. For infectious cases, there is the Joint Hospital, Kingston J.ane, Uxbridge, where there is adequate accommodation for the reception and treatment of cases of Scarlet Fever and Diphtheria. The Small Pox Hospital at Yeading is available in case of need. The Uxbridge Poor Law Institution at Hillingdon, has, during the year, to some extent served as a General Hospital. Patients suffering from Influenzal Pneumonia, other acute illnesses, and many cases of accident (broken limbs, etc.) have been treated there. Maternity and Child Welfare Work. During the year " Centres " have been opened at Yiewsley and Harefield, and another Centre is being planned for the Hillingdon and Hillingdon Heath districts. These Centres are some of the 13 being opened in the County, by the Middlesex County Council. Weekly or fortnightly, these Centres open early in the afternoon, so that the mothers can bring their children (up to the age of 5) to the Medical Officers for free advice as to the welfare of their children, mainly as regards their feeding. Other defects, if present, are pointed out. and they are referred to their own doctor for treatment. It is not often that they take this advice, and I should like to see a note sent with them to their private doctor, and observation made as to whether they have been or not, on their next visit to the Centre. Failing this, the defect should be remedied, if possible at the Centre. There are three Health Visitors working in the Uxbridge Rural District, namely, Nurse Ward, for Hillingdon, Cowley, and West Drayton ; Nurse Davison for Harefield area and Nurse Hands, for Ickenham and Northolt. You will notice that Yiewsley and Uxbridge are not situated in the Uxbridge Rural District, but mothers can take their children to any centre that is convenient. For instance, in practice the Yiewsley Centre serves for Cowley Peachey and West Drayton. In cases of need, free, half-price, or cost price milk (or dried milk) can be obtained through these centres on the advice of the Medical Officer in charge of the Centre. Some difficulty arises in obtaining exact evidence of the money that comes into the home, and abuse will probably arise in a few cases, unless carefully guarded against. All Birth Notifications received by me, are copied out and sent weekly to the Medical Officer of Health for the county, and the Health Visitor receives a copy of the births weekly. Schools Medical Inspection and Clinics. There are three serving the district, namely : Whitehall Council School, Uxbridge, Tuesdays at 9.30 ; Providence Road School, Yiewsley, on Fridays at 9.30 ; and 6 Harefield Council School on alternate Wednesdays at 9.30. The children are examined at these clinics, by the school Medical Officer, and minor complaints, mainly skin disorders, Ringworm, Impetigo and Scabies (all these are contagious), also slight inj uries. Representation has been made to me by three Local Medical Practitioners that this rather tends to affect their practices. I consider all those who can afford to pay for treatment, should go to their own doctor. The clinics are of great value to children whose parents would not, in the ordinary way, trouble to take them to a private doctor at all. All these Centres, both for child welfare, and for school children, are staffed by full time M.O's, paid by the Middlesex County Council. I have no hesitation in saying that we shall see great benefit arise from these schemes. The Health Visitors visit the children from about the fourteenth day onward, then the child is under observation at the Child Welfare Centres, until the age of 5. From the age of 5 to 15 the child is under observation of the School Medical Officer From the age of 15 to 16 he or she (if in a factory) comes under the observation of the Certifying Factory Surgeon. At the age of 10, if he or she are employees, they come under the care of the doctors of the National Health Insurance Act. This continues up to the age of 70, and a period of years beyond that in some cases. Births. Total, 173. Legitimate 165 Illegitimate 8 Males 87 Females 86 Infant Mortality (under one year). Legitimate 6 Illegitimate nil On the estimated population, the above figures give a birth rate of 17.03 per 1,000. According to the above, the birth rate for all England and Wales was 18.5 and for the Uxbridge Rural District 17.03, which is a little below the average. The number of deaths were 104 (59 males and 45 females), being a death rate of 11.13 per 1,000, whereas again, according to the above table the death rate of the whole of England and Wales was 13.8. It will therefore be seen that our death rate is considerably below the average. Table of Infectious Diseases in each of the Parishes in the District. Scarlet Fever. Diphtheria. Erysipelas. Ophthalmia Neonatorum. Puerperal Fever. Measles. German Measles. TuLerculc sis of Lungs. Other fcrms of Tuberculosis. Cerebro-spinal Fever. Acute PolioMyelitis. Enteric. Pneumonia. Chicken Pox. Dysentery. Malaria. Cowley 7 ... ... ... ... ... ... 1 2 ... ... ... 1 ... ... ... Hillingdon 6 4 ... 2 1 5 2 7 4 1 ... ... 14 ... ... 2 Harefield 6 1 ... ... ... 9 ... 3 ... ... ... ... ... 2 ... 2 Ickenham ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... Northolt 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... 5 2 West Drayton 1 2 ... ... ... ... ... 3 ... ... ... ... 1 ... ... ... Total 21 7 1 2 1 15 2 16 6 2 ... ... 16 2 5 6 Birth.rate, Death.rate, and Analysis of Mortality during the Year 1919. (Provisional figures. Populations estimated to the middle of 1919 have been used for the purposes of this Table.) Birthrate per 1,000 Total Population. Annual Death.rate per 1,000 Civilian Population. Rate per 1.000 Births. Percentage of Total Deaths.* All Causes. Enteric Fever. Small.pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria Violence. Diarrhoea and Enteritis (under 2 Years). Total Deaths under One Year. Deaths in Public Instit't'ns. Certified Causes. Inquest Cases. Uncertified Causes of Death. England and Wales 18.5 13.8 0.01 0.00 0.10 0.03 0 .07 0.13 0.47 9.59 89 23.9 92.5 6.2 1.3 96 Great Towns, including London (Census Populations exceeding 50,000) 19.0 13.8 0.01 0.00 0.13 0. 04 0. 07 0.14 0.45 12.24 93 29.2 92.3 6.9 0.8 148 Smaller Towns (Census Populations 20,000—50,000). 18.3 12.6 0.01 0. 00 0.10 0.03 0. 08 0.12 0.39 8.67 90 16.6 93.6 4.9 1.5 London 18.3 13.4 0.01 0. 00 0.08 0 .03 0 05 0.18 0.47 16.22 85 44.7 91.2 8.6 0.2 * Non.civilians are included in these figures for England and Wales but not for other areas. 9 Cause of Death. Male. Female. Scarlet Fever 1 nil Diphtheria 2 nil Influenza 9 2 Pulmonary Tuberculosis 1 2 Cancer or Malignant Disease 4 2 Rheumatic Fever 3 nil Meningitis nil 1 Organic Heart Disease 4 7 Bronchitis 6 3 Pneumonia 1 3 Other Respiratory Diseases 2 nil Nephritis & Bright's Disease 2 2 Congenital Debility, etc. 3 1 Other defined diseases 21 22 Infectious Diseases, Total Notification—102. In the middle of Octobcr a baby died of Enteritis at Northolt. As I thought there might be a connection between this case and other cases of Enteritis occurring just outside the Uxbridge Rural Area, I at once visited the home: The father of the deceased child was a milker, so I issued an order for him to refrain from milking. Between the 15th and 29th of October, 5 more cases occurred, the last being the milker himself. By several tests done by the Clinical Research Association, and the Ministry of Health, it was proved to be Bacillary Dysentery—a rare disease in this country. I was much relieved by getting these cases removed to the Joint Hospital (Observation Block) and all the patients recovered. The conclusion arrived at as to the source of the original infection, was that a soldier brought back the infection from overseas. In February a case of Cerebro Spinal Meningitis (Spotted Fever) was reported at Northolt. The case occurred in one of the better class houses. I regret to say that the case ended fatally, but although there were several contacts no further cases occurred. Housing. There is a great shortage of houses. Overcrowding has been noticed on very many occasions, and there appeared to be no immediate remedy. I reported to you that Harefield needed 100 new houses, and all the other parishes were also in need of houses. On the map of the Rural District sent to the Ministry of Health, I was asked to colour in anv part of the District that was particularly unhealthy. I was very glad to be able to avoid colouring the map as suggested. I have seen the plans of the houses submitted to you by your architects, and they appear everything that 10 is desirable from a sanitary point of view. I very much admired the two houses built by the Bell's United Asbestos Company, above their works at Harefield. Your Inspector's (Mr. Freeman) report is given below in table form, in which all details of inspection from a sanitary point of view, and of food can be seen. As regards housing inspection, the work has been a bit depressing, for any pressure brought on the landlords, creates a wish on their part to close the premises entirely. This course woul be a very serious matter until the new houses are erected. I should like to congratulate you on having such a capable and painstaking Inspector. Workshops, Workplaces, etc. Further extensions of the Harefield Asbestos Works have been made, and the question of the housing accommodation of the workpeople has become more urgent. W. TOWNSEND DOBSON, M.R.C.S., L.R.C.P. Medical Officer of Health. SANITARY WORK FOR THE YEAR 1919. Inspections :— Cowley. Harefield. Hillingdon Ickenham Northolt. w. Drayton Total. Number of Premises Inspected on Complaint 2 4 1 2 4 3 16 „ ,, in connection with Infectious Diseases 11 23 40 3 13 8 98 Number of Premises under Periodical Inspection 10 22 20 9 9 9 79 Houses Inspected from House-to-House (H. and T.P. Act) 8 13 22 — 6 3 52 Total Number of Inspections and Re-Inspections made 113 180 250 41 88 181 853 Dwelling Houses and Action under H. and T.P. Act, 1909 :— Number of Houses dealt with under Section 15 — 1 10 — — — 11 Number of Houses Demolished Voluntarily — 1 — — — — 1 Action Taken (other than under H. and T.P. Act) :- Cautionary or Intimation Notices Given 5 12 16 5 14 7 59 Statutory Orders Issued 1 15 7 — 4 1 28 Summonses served — — — — — 1 1 Canal Boats used as Dwellings Number Registered under the Acts 49 Boats Inspected 49 Number of Contraventions of Regulations Nil 0 Bakehouses— Number in District 2 3 2 — 1 1 9 Contraventions of Factory Acts 1 2 — — 1 — 4 Slaughterhouses :— Number of Inspections made — 24 12 — — 42 11 12 SANITARY WORK FOR THE YEAR 1919. Cowley. Harefield. Hillingdon. Ickenham. Northolt. W. Drayton Total. Cowsheds :— Number on Register 2 8 8 5 4 1 28 Number of Inspections made 14 32 32 20 16 6 120 Frequency of Inspection—Quarterly Contraventions of Regulations — — — 1 — — 1 Number of Milch Cows in District 21 151 136 30 73 18 429 Dairies and Milk Shops :— Number on Register 2 8 8 5 3 — 26 Number of Inspections made 8 16 16 4 — 8 52 Frequency of Inspection—Quarterly Contraventions of Regulations — — 1 — — — 1 Unsound Food 309 lbs. Bacon, 9G lbs. Mutton, and 45 lbs. Rabbits seized and destroyed by consent. Offensive Trades :— Number of Premises in District — — 1 — 2 1 4 Nature of Trades—Fat Boiling, etc., and Guano Works — 3 — 4 12 19 Number of Inspections made — — 3 — 4 12 19 Contravention of By-laws — — — — — 1 1 Water Supply and Water Service :— Wells : Cleansed, Repaired, etc. — — — — — — — Closed as Polluted — 1 — — — 1 2 Percentage of Houses supplied from Public Water Service 95 80 95 95 95 95 — Percentage of Houses supplied on Constant System 95 80 95 95 95 95 — Numbers of Samples obtained for analysis : From Local Wells — 1 — — — 1 2 From Public Supply — — — — — — — Drainage and Sewerage of Existing Buildings :— Water Closets : Number of Water Closets substituted for Dry Receptacles Repaired, Supplied with Water, or otherwise Improved 8 2 11 — 1 14 36 Percentage of Houses provided with Water Closets 95 80 95 50 50 95 — Drains : Examined, Tested, Exposed, etc. 1 1 1 — — 1 4 Unstopped, Repaired, Trapped, etc. 2 3 10 1 3 3 22 Waste Pipes, Rain Water Pipes Disconnected, Repaired, etc. 1 — — — — — 1 Existing Soil Pipes or Ventilating Shafts Repaired — —. — — — — — Reconstructed — — — — — — — 13 SANITARY WORK FOR THE YEAR 1919. Cowley. Harefield. Hillingdon. Ickenham. Northolt. w. Drayton Total. Cesspools : Rendered Impervious, Emptied, Cleansed, etc *8 76 14 - 8 8 114 Abolished, and Drain connected to Sewer — 1 — - — — 1 Percentage of Houses Draining into Sewers 95 50 90 - — 95 — 96 Earth Closets are emptied twice weekly at Harefield by Contract. * Emptying only. Disinfection :— Rooms Disinfected : Ordinary Infectious Diseases 6 6 8 1 9 5 35 Phthisis — — 1 - — 1 2 Rooms Stripped and Cleansed — — — - 1 1 2 Articles Disinfected or Destroyed : Ordinary Infectious Diseases — — 6 - 3 1 10 Phthisis — — 1 - — 1 2 Dust :— New Bins Provided 3 84 6 - — 8 101 How frequently is Dust Removed from each House ?—Fortnightly. Number of Complaints of Non-Removal received 2 2 20 - 1 3 28 Method of Disposal ?—By Tipping. Sundry Nuisances Abated :— Overcrowding - - - - - - — Smoke - - - - - - — Accumulations of Refuse 3 — 1 - 1 1 6 Foul Ditches, Ponds, etc., and Stagnant Water 1 1 1 - 1 — 4 Foul Pigs and other Animals — 1 1 - - — 2 Dampness 1 — 1 - — — 2 Yards Re-paved or Repaired 1 — — - — — 1 Other Nuisances — 4 5 - — 4 13 14 FACTORIES, WORKSHOPS, PETROLEUM STORES, AND HOMEWORK. Factories 10 Workshops 28 Petroleum Stores 11 Homework 12 Number of Inspections 62 . Defects Found and Remedied 4