4*8008 UXBRIDGE URBAN DISTRICT COUNCIL. Annual Medical Report FOR THE YEAR 1921. BY ARTHUR J. TURNER, M.B., B.S., (Durh.) M.R.C.S., U.R.C.P., Capt. late R.A CTVC. MEDICAL OFFICER OF HEALTH. Wescott & Son, Printers, Uxbridge. Annual Report of the Medical Officer of Health. Sussex Lodge, Uxbridge, May 1st, 1922. To the Chairman and Members of the Uxbridge Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to submit my Annual Report on the Health of the Uxbridge Urban District for the year ended December 31st, 1921. The Minister of Health has indicated that Annual Reports of a full and detailed character known as "Survey Reports" will be required henceforth only at intervals of five years. The Report for 1920 is to be considered as a "Survey Report," and the present one the first of a series to be known as "Ordinary Reports" of a more simple character and leaving out information which would only be a repetition from year to year. The contents of this, my report for 1921, and its arrangement, are therefore as suggested in the Ministry of Health's Circidar 269, dated December 28th, 1921. 4 1. GENERAL STATISTICS. Area (acres) 868 Population (1921, Census figures) 12913 No. of Inhabited Houses (1921) 2559 No. of families or separate occupiers (1921) Unknown: Census figures not available. Rateable Value £57,814 Sum represented by a penny rate £214 2. EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total. M F. Births Legitimate 249 122 127 1 Illegitimate 16 10 6Birth Rate (R.G.) 20.36 Deaths 119 Death Rate (R.G.) 90.14 No. of Women dying in, or in consequence of childbirth: From Sepsis—None. From other causes—None. Deaths of Infants under one year of age per 1,000 births:— Legitimate 5283. Illegitimate 1132. Total 64-15. Deaths from Measles (all ages) None. „ „ Whooping Cough (all ages,) None. ,, „ Diarihœa (under two years of age) 4 5 Causes of Death (Chilians only). Males. Females. All Causes 66 53 I Enteric fever - - 2 Small-pox - — 3 Measles - — 4 Scarlet fever - 1 5 Whooping cough — — 6 Diphtheria and croup 2 1 7 Influenza 1 1 8 Encephalitis Lethargica 1 — 9 Pulmonary tuberculosis 6 3 IO Tuberculous meningitis - - n Other tuberculous diseases - 1 12 Cancer, malignant disease 7 7 *3 Rheumatic fever 1 1 14 Diabetes 1 — x5 Organic heart disease 10 8 16 Bronchitis 7 7 17 Pneumonia (all forms) 1 3 18 Other respiratory diseases 1 - 19 Diarrhoea, &c. under 2 years) 1 3 20 Appendicitis and typhlitis — 21 Cirrhosis of liver — — 2 2 Nephritis and Blight's disease 1 — 23 Cerebral Hæmorrhage 1 2 24 Arterio Sclerosis 3 1 25 Ulcer of Stomach or Duodenum 1 — 26 Puerperal Sepsis — — 27 Parturition, apart from puerperal fever — — 28 Congenital debility, &c. 3 2 29 Violence, apart from suicide 1 — 3° Suicide — 1 31 Other defined diseases 17 11 32 Causes ill-defined or unknown - — Deaths of infants under 1 year of age 7 10 Illegitimate 1 2 Total Births 132 133 Legitimate 122 127 Illegitimate 10 6 6 3. NOTIFIABLE DISEASES DURING THE YEAR. Notifiable Disease. NUMBER OF CASES NOTIFIED. Cases admitted to Hospital. Total Deaths. At all Ages. AT AGES—YEARS. Under 1. 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Diphtheria 19 ... 7 11 1 ... ... ... 19 3 Scarlet Fever 53 ... 11 37 3 2 ... ... 52 1 Enteric Fever(including Paratyphoid) 0 ... ... ... ... ... ... ... ... ... Puerperal Fever 0 ... ... ... ... ... ... ... ... ... Pneumonia 15 1 3 3 ... 1 5 2 2 4 Erysipelas 4 ... ... ... ... ... 1 3 ... ... Encephalitis Lethargica 1 ... ... ... ... 1 ... ... ... 1 Dysentery 1 ... ... ... 1 ... ... ... ... ... Malaria 1 ... ... ... 1 ... ... ... ... ... T uberculosis (a) Pulmonary M 10 do. F 7 6 — 3 Total 17 ... ... 1 3 9 4 ... 11 ... (b) Non-pulmonary M 0 ... do. F 2 1 Total 2 ... ... 1 ... ... 1 ... ... ... Ratio of non-notified Tubercular deaths to total Tubercular deaths 3:7. Ophthalmia Neonatorum CASES. Vision Unimpaired Vision Impaired Total Blindness Deaths Treated. Notified. At Home In Hospital 1 1 0 1 0 0 0 7 4. CAUSES OF SICKNESS. Apart from the considerable number of cases of Diphtheria and Scarlet Fever which occurred chiefly in the earlier part of the year and the epidemic of Influenza of low mortality (principally in the early and late months, but which was present more or less throughout the year) there have been no very noticeable or unusual causes of sickness. 5. SUMMARY OF NURSING ARRANGEMENTS, HOSPITALS AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. (a) Professional Nursing in the Home. (1) General.—No nursing arrangements are provided by the County Council or the Local Authority, but a District Nurse is supported by the Uxbridge Urban District Nursing Association, which is maintained by voluntary subscriptions. (2) Midwives.— 'The Public Health Authority does not employ or subsidise practising Midwives, but the following Midwives have given notice that they intended to practise during 1921: Collins, Mrs. Dunstans, High Street. Compton, Mrs. Norwood Villa, Norton Road. Franklin, Miss Hilda Hillingdon Road. Franklin, Miss Muriel do. (3) Clinics and Treatment Centres.— Pre-Natal and Child Welfare Centre. A large iron and poilite Hut with two rooms has been erected during 1921 in the grounds of the Children's Nursery. This is heated by three gas fires, and a Pram Shelter has been placed near the entrance. To this a w.c. should be added. 8 Statistics, (a) Welfare Centre. Mothers on Register 188 Visits of Babies 2,030 Visits of Expectant Mothers 27 (b) Dental Clinic. Nursing and Expectant Mothers attended to 22 New Dentures supplied 4 Children under five years of age inspected 5 Day Nursery. The District Council's Nursery is at "Dunstans," High Street, where satisfactory work has been carried on throughout the year. 85 children received the benefits of the Institution. The average daily attendance was 31. Both the above are provided by the Local Authority with the assistance of the Ministry of Health. School Clinics. School Clinic. Where held. How often held. When held. No. of cases dealt with in 1921. Minor ailment Whitehall School (The Hut) Weekly Tuesday and Friday morning 9.30 a.m. 703 Dental ditto Twice daily 9.30 a.m. and 2 p.m. 1940 Tuberculosis Centre. Dr. Atkinson attends once a week for the purpose of seeing patients referred to him. Venereal Diseases. There is no Centre in this District for advice or treatment. Patients have the opportunity of attending one of the London Hospitals' Clinics if desired. 9 (4) Hospitals in the District provided by or subsidised by the Local Authority or by the County Council— Tuberculosis, none. Maternity, none. Children, none. Fever, none, omallpox, none. (Hospital of the Joint Board available situated in Uxbridge Rural District). Other, none. (Hillingdon and Uxbridge Cottage Hospital, situated in Uxbridge Rural District, is supported by Voluntary contributions. Accommodation 15 beds, available to residents of this as well as several other districts in the neighbourhood). (5) Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children—None. 6, Ambulance Facilities— (a) For Infectious cases, that of the Joint Hospital Board, on application. (b) For Non-Infectious and Accident cases, that of the Urban District Council, which has been used during 1921 for 138 patients, conveyed distances totalling 2,558 miles. 6. LABORATORY WORK. Pathological and Bacteriological Examinations are made, as required, by the Clinical Research Association, London. During the year 68 such examinations have been made at the expense of the Urban District Council. Adoptive Acts, Bye-Laws and Local Regulations relating to the Public Health in force in this District— The Baths and Washhouses Acts, 1846 to 1889. T he Infectious Disease (Notification) Act, 1889. I he Infectious Disease (Prevention) Act, 1890. The Public Health Acts Amendment Act, 1890. 10 The Museums and Gymnasiums Act (Gymnasiums only), 1891. The Private Street Works Act, 1892. The Public Health Acts Amendment Act, 1907. Parts II., III., V., VI., and. sections 52, 53, 54, 55, 56, 57, 58, 59, 60, 62, 63, 64, 65, 66 and 67 of Part IV. 7. SANITARY ADMINISTRATION. (1) Sanitary Inspection of District.—The following statement is supplied to me by the Sanitary Inspector, Mr. T. C. F. Paige: Inspfctions— No. of premises inspected on Complaint of Nuisance 140 No. of premises inspected in connection with Infectious Diseases 104 No. of premises under Periodical Inspections 211 Total No. of Inspections and re-inspections made 2,798 Nuisances discovered and abated 588 Informal notices 588 Statutory notices served 69 No. of Factories, Workshops and Workplaces inspected 188 The following is a list of the principal items of work included in the above figures:— New drainage systems provided 20 Drains cleaned and repaired 47 New sinks and lavatory basins provided 28 W.C.'s cleansed, repaired or renewed 98 Additional W.C. and Urinal accommodation provided 27 New soil pipes and vents 27 Waste water preventors repaired or renewed 136 Rain water gutters and pipes 18 Defective sink and bath wastes repaired 9 Houses requiring walls, ceilings, floors, roofs, etc., repaired 105 Premises limewashed 11 Verminous conditions remedied 21 11 Yards paved 25 New inspection chambers, etc. 23 New dust bins provided 231 Damp conditions remedied 39 Foul dung pits and manure heaps remedied 10 Overcrowding remedied 3 Various 27 (2) Sewerage.— No. of conservancy closets converted to W.C. None All houses in the district are supplied with water closets except 15. (3) Disinfection.— 93 rooms were disinfected and 10 rooms stripped and cleansed. Disinfection of clothing and bedding has been by steam sterilizer, and of room walls, books and furniture by Formalin spray and vapour. (4) Common Lodging Houses.— There are three within the district. Six contraventions of the Bye-laws were discovered and rectified. (5) Rag and Bone Stores.— Six contraventions of the Bye-laws were discovered and remedied. Six Stores, established without permission of the Council, were abandoned after action taken by the Inspector. (6) Food.— (a) Milk. The following Report upon the Dairies and Cowsheds in this District has been received from the Veterinary Inspector: 12 April loth, 1932. To the Chairman and Members of the Uxbridge Urban District Council. Gentlimen, During the past year the health of the cows in the Urban District supplying part of its milk has remained quite satisfactory, and not a single case of contagious or infectious disease has been brought to my notice. The housing sheds have been found quite clean, and have been kept up to as good a standard as possible as regards disinfection. The lighting and ventilation has been quite adequate. As regards the Dairies and places used for storage of milk these have been found quite clean and drainage, etc., found quite adequate. I remain, Yours obediently, W. A. HANCOCK, Veterinary Inspector. (b) Other Foods. The conditions of storage and exposure for sale of foods have been generally satisfactory. Below are given the principal items of food condemned as being unfit for human consumption. 1. Bacon 318 lbs. 2. Tinned Foods, Beef, etc. 222 tins weighing 583 lbs. Condensed Milk 29 tins 3. Fish, wet 184 lbs and one cask 13 In addition nine tons and 120 bags of Unsound Flour and 60 tons of Rice were dealt with in conjunction with the Port of London Authority and the Bermondsey Borough Council. (7) Slaughter Houses.— In 1914. In January, 1921. In December, 1921. Registered 7 5 5 Licensed 0 0 0 Total 7 5 5 I hey are inspected weekly and whenever slaughtering is known to be going on. Limewashing is carried out twice yearly, and the regulations have been carried out satisfactorily. There is no Public Abattoir. 8. PUBLIC HEALTH STAFF. Medical Officer of Health. Part time. Sanitary Inspector. Whole time. (Cert, of Sanitary Inspectors Board. Cert, of Royal Sanitary Institute). Health Visitor. Whole time. (Cert, of Central Midwives Board. Cert, of Metropolitan Asylums Board. Cert, of three years General Hospital I raining. Cert, of three years Children's Hospital Training). Matron of Creche. Whole time. (Cert, of Belfast Maternity Hospital. Cert, of Central Midwives Board. Cert, of Royal Sanitary Institute). 14 9. HOUSING. Number of New Houses erected in 1921— (a) Total 54 (b) As part of Municipal Housing Scheme 48 (1) Unfit Dwelling Houses.— Inspection— 1. Total number of Dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 367 2. Number of Dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 367 3. Number of Dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 4. Number of Dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 78 (2) Remedy of Defects without Service of Formal Notice.— Number of defective Dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 51 (3) Action under Statutory Powers.— a. Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919. 1. Number of Dwelling-houses in respect of which Notices were served requiting repairs 78 15 2. Number of Dwelling-houses which were rendered fit— (a) by owners 53 (b) by Local Authority in default of owners None 3. Number of Dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close None b. Proceedings under Public Health Acts. 1. Number of Dwelling-houses in respect of which Notices were served requiring defects to be remedied 299 2. Number of Dwelling-houses in which defects were remedied (a) by owners 299 (b) by Local Authority in default of owners None c. Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. 1. Number of representations made with a view to the making of Closing Orders None 2. Number of Dwelling-houses in respect of which Closing Orders were made None 3. Number of Dwelling houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit None 4. Number of Dwelling-houses in respect of which Demolition Orders were made None 5. Number of Dwelling-houses demolished in pursuance of Demolition Orders None 16 On presenting my Report to the Council last year I was asked to include in future Reports some suggestions as to ways in which the health of the Town might be advanced. In addition to the constant watchfulness of the Council's Public Health Committee and its officers that the present Regulations and Bye-laws be not contravened, it seems to me that there are some directions in which the Council may take thought to obviate dangers which are either imminent or to be feared in the future. The first relates to the better supply of fresh air to the inhabitants, and it should be considered whether the Urban District has not been sufficiently built upon and whether future building should not be allowed to spread only on adjacent areas where streets may be planned to be broader, houses erected detached or semi-detached, and each with a sufficient space attached for its garden. Houses should, for the sake of the very young and the very old, have as few stairs as possible, or the erection of bungalows be encouraged. Open spaces for parks and pleasure grounds should be secured where possible with the same object in view. Next in importance to secure clean air must come the adequate removal and treatment of waste products. Plant life deals naturally with the carbonic acid gas of the atmosphere, but if the air of our streets is to become purer house and animal refuse of every kind must be adequately dealt with. One portion of this viz., human excreta and slops, are already well treated by our land and filter bed system, but manure heaps are still allowed to lie and breed flies by the hundred thousand and the dry refuse from our houses is dumped down on a site not far from houses, whereas it should be either sorted and the unusable portion burnt, or the whole of it destroyed beyond power to revive disease. It is to be hoped that the cleansing of the streets, especially of the yards behind the main road, not seen by many beside the residents of those yards, may be made more efficient. Dust bins are too small, and the refuse often overflows them before the weekly or fortnightly collection is made, the consequence being that a certain proportion is blown by the wind into the air of street and house with dire results. Other ways in which the general health may be promoted is by the establishment of Building Societies so that the Housing problem may be assisted in 17 solution, and men may obtain the house they fancy not only to occupy but to own, by Flower Shows to stimulate interest in out-door work and the love of beautiful things, a Picture Gallery and Art Museum for the same purpose, a Public Library and the encouragement in every way of work as opposed to idleness, since undoubtedly work, provided the surroundings are conducive to well-being, assists mental as well as physical well-being and development. For this reason the Council should do what it can to conciliate trade disputes and to prevent those disastrous spells of unemployment which lead to poverty, under-nourishment and disuse atrophy, which in their turn entail intellectual and physical degeneracy. I have the honour to be, Gentlemen, Your obedient Servant, ARTHUR J. TURNER, M.B. THE RURAL DISTRICT COUNCIL OF UXBRIDGE. Annual Medical Report FOR THE YEAR 1921. . . 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, 1921. The Red House, Uxbridge, June, 1922. 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 1921. 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 following Parishes, ranged according to size of population: Hillingdon East, Harefield, West Drayton, Cowley, Northolt and Ickenham. On the East of the District runs the River Colne and its tributary, 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. 4 Population. The estimated population for the whole district is 10,700, which is an increase of 558 on the figure for year ending 1920. The figure 10,700 includes the number for the Uxbridge Poor Law Institution, which with staff amounts to about 240, but does not include members of the Royal Air Force quartered in that part of the Uxbridge Depot which is within the Rural District Boundary. COWLEY 1,089 HAREFIELD 3,035 HILLINGDON EAST 3,312 ICKENHAM 495 NORTHOLT 851 WEST DRAYTON 1,918 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, Harefield, West Drayton, Cowley, Ickenham and part of Northolt. The water, though hard, is of good quality 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 a few wells which are always liable to pollution. Some we.Is in Harefield were condemned during the year, and the houses supplied from the main. 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, West Drayton and Cowley are drained by a Sewerage 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. The new houses at Ickenham drain into a large cesspool, and periodically this has to be pumped on to the land at the back of these houses. The sewage to be disposed of amounts to thousands of gallons and some complaints of the offensive smell arise during the pumping operations. At the end of the year a scheme was considered to get the Royal Air Force to take this sewage. This would solve the problem. A nuisance must arise at times when the pumping is proceeding, and a difficulty arises regarding the amount of land available for receiving the sewage. 5 At Harefield, the new houses in Park Lane are drained in a similar manner, but a portable petrol motor-pump is being purchased, which ought to deal with the sewage quickly and efficiently. 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. An X-Ray Apparatus has been installed at the Hospital and is a great benefit to the district. For infectious cases there is the Joint Hospital, Kingston Lane, Uxbridge, where there is adequate accommodation for the reception and treatment of cases of Scarlet Fever, Diphtheria and Typhoid. Cases of Measles cannot be admitted. The Small-Pox Hospital at Yeading is available in case of need. The Uxbridge Poor Law Institution at Hillingdon has, during the year, dealt with a large number of cases in a satisfactory manner. The Hospital portion is a training school for nurses where about 15 probationer nurses obtain their nursing certificate after a three-years' course. Maternity and Child Welfare Work. The Maternity and Child Welfare Centres have done good work. There are centres at Uxbridge, Hillingdon Heath, Yiewsley, Harefield, Ruislip and Northolt. It will be noted that three of the centres are not in the Rural District, but mothers in your area may attend their nearest centre. These Centres are open weekly or fortnightly, and a Medical Officer of the Middlesex County Council attends to give advice to the mothers concerning their babies. Persons eligible are expectant mothers, and children up to the age of five. In cases of need, free, half-price or cost price milk (or dried milk) is supplied through these Centres. There is a tendency for mothers to bring their children only when they need actual advice, but the purpose of the Centre is to keep all children under observation and give periodic weighing, etc. The Creche at Uxbridge is open to all babies residing in the Rural District. The charges are 12s. 6d. per week, or 9s. 4d. from Monday to Saturday, so that mothers can take their young children to the Creche early on Monday morning, then proceed to work from Monday to Saturday mid-day, and resume the care of their children over the week-end. Thus a widowed mother or unmarried mother may earn her own living and leave her child in safe hands. There are no proper lying-in homes in the area at present, but the Maternity Block at Hillingdon Infirmary (Uxbridge Poor Law Institution) does excellent work and deals with about 20 cases per year. Sometimes the Guardians permit a mother to resume outside work and they take charge of the baby—there being a Children's Home on the premises at Hillingdon in which, on an average, there are about 22 children. There are three Health Visitors working in the Uxbridge Rural District. 6 Schools Medical Inspection and Clinics. Clinics are held at Uxbridge, Yiewsley, Harefield and Northolt Schools. All school children are periodically examined by the Medical Officers appointed by the Middlesex Education Committee. Many defects are pointed out to the parents, viz., presence of enlarged tonsils and adenoids, defective vision and teeth, etc. The question of vision and teeth are attended to by specialists in these departments, Tonsils and adenoid cases are referred to a Hospital or usual medical attendant. Skin troubles such as Scabies, Impetigo and Ringworm are treated, and the children are excluded from the school classes, but attend for treatment by the Medical Officer or School Nurse. Minor injuries are also attended to. At the hut attached to Whitehall Schools, Uxbridge, many children living near Uxbridge in the Rural District are medically inspected. Births. 1921 1920 1919 Total 201 284 173 Legitimate 193 273 165 Illegitimate 8 11 8 Total Males 103 132 87 Total Females 98 152 86 The increase of 1919 will be noticed. The figure for 1920 was naturally high, the Great War being over and the huge Army practically disbanded. The figure for 1921 gives a birth rate of 18.8 per 1,000, compared with 17.03 per 1,000 for 1919, and 28 per 1,000 for 1920. The birth rate for the whole of England and Wales was 22.4 per 1,000. It will be seen that the figure for your district is slightly lover than the average for the whole country, but last year it was considerably higher. Infant Mortality (under one year). 1921 1920 Total 22 14 This is rather a high figure for 1921, but I find that of these, 5 babies died of Prematurity and 3 of Congenital Heart Disease. Other causes of death were Enteritis 4 and Tuberculosis 3. Deaths. The number of deaths for 1921 was 126—10 more than last year The above statement concerning deaths of children under one year practically accounts for the increase. Sixty-six were males and 60 females. This figure gives a death rate per 1,000 of 1921 1920 England and Wales, 1921. 11.8 11.44 12.1 which shows that the death-rate in Uxbridge Rural District is less than the average for England and Wales. Table of Infectious Diseases in each of the Parishes in the District. Scarlet Fever. Diphtheria. Erysipelas. Ophthalmia Neonatorum. Puerperal Fever. Cerebro Spinal Fever. Tuberculosis of Lungs. Other forms of Tuberculosis. Enteric. Pneumonia. Dysentery. Malaria. Encephalitis Lethargica. Cowley 14 3 ... ... ... ... 2 ... ... 1 ... ... ... Hillingdon 7 1 3 1 2 ... 13 4 ... 13 ... 1 ... Harefleld 19 ... ... ... ... ... 5 ... 1 ... 1 ... 1 Ickenham ... ... ... ... ... ... 1 ... ... ... ... ... ... Northolt 1 6 ... ... ... ... 1 1 ... 1 ... ... ... West Drayton 4 2 ... ... ... ... 1 1 ... ... ... ... ... Total 45 12 3 1 2 ... 23 6 1 15 1 1 1 The figures for Hillingrion include the Uxbridge Poor Law Institution. Actually, Hillingdon figures were— Erysipelas 1. Tuberculosis 5. Pneumonia 3, 8 Causes of Death. Male. Female. Scarlet Fever nil nil Diphtheria nil nil Influenza 1 2 Pulmonary Tuberculosis 6 5 Other Tuberculous Diseases 1 2 Cancer or Malignant Disease 4 6 Rheumatic Fever nil nil Meningitis nil nil Organic Heart Disease 10 4 Bronchitis 3 2 Pneumonia 3 3 Other Respiratory Diseases 1 2 Nephritis & Bright's Disease nil 1 Congenital Debility and Prematurity 6 2 Other defined diseases 14 21 Encephalitis Lethargica nil 1 Arterio Sclerosis 3 1 Diarrhoea (under 2 years) 1 3 Appendicitis 2 1 Puerperal Sepsis — 1 From Violence 1 — Cerebral Hæmorrhage 6 3 Infectious Diseases. Total Notifications, 111, as compared with 135 for year 1920. Table XV.—Birth-rate, Death-rate, and Analysis of Mortality during the Year 1921. (Provisional figures. Populations as enumerated in 1921 have been used for the purposes of this Table 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 1,000 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 2 Years). Total Deaths under One Year. Deaths in Public Instit't'ns. Certified Causes of Death. Inquest Cases. Uncertified Causes of Death. England and Wales 22.4 12.1 0.02 0.00 0.06 0.03 0.12 0.12 0.23 0.44 15.5 83 25.5 92.5 6.4 1.1 96 Great Towns, including London (1911 Census Populations exceeding 50,000). 23.3 12.3 0.01 0.00 0.08 0.04 0.13 0.15 0.23 0.40 19.3 87 33.2 92.5 6.8 0.7 148 Smaller Towns (1911 Census Populations 20,000.50,000) 22.7 11.3 0.01 0.00 0.05 0.03 0.11 0.11 0.26 0.35 15.6 84 17.7 93.5 5.1 1.4 London 22.3 12.4 0.01 0.00 0.05 0.06 0.12 0.25 0.23 0.42 21.3 80 49.2 91.6 8.2 0.2 10 The outbreak of Scarlet Fever at Harefield which started in November, 1919, continued on into 1921, but ceased in the first week of the year. The presence of the Hospital at the Uxbridge Poor Law Institution accounts for the high numbers of infectious diseases attributed to Hillingdon. Many of these cases came from Hayes, Southall, etc., which are outside your area. Cowley, with its 14 cases, was rather unfortunate as regards Scarlet Fever. Most of the cases were very mild. There must have been one case so slight as to be unnoticed by the parents, and in consequence attendance at school was continued and thus infection was spread. Refuse Dumping. The dumping of refuse at Northolt continued throughout the year. I made a large number of inspections and frequently reported on the state of affairs there. The result of all this was that the Marylebone Council were strongly written to on the subject, and in response, improved matters to a very slight degree ; but pressure had to be continued on my adverse reports. The burning which I mentioned was likely to take place, started during the hot summer and still continues. The Canal was dredged and the material placed on the Dump, which improved matters slightly. Flies were extraordinarily prolific and swarmed in the houses. I am looking forward to the day when by-laws can defeat, from the first, those people who desire to bring their loathsome refuse into your District. At Cowley Peachey, the Canal Transport Company brought down huge quantities of crude refuse and sweepings and dumped it on to Mr. Wingrove's land on the canal bank. I made frequent reports on the nuisance arising there and after action in the court, costs were paid and promises definitely mad • that the whole should covered with soil directly* the barges were unloaded. These promises were not fulfilled in the true sense of the word, but a month afterwards the material ceased to arrive and the nuisance was abated. Soon after this the dump became harmless. Housing Scheme. Good progress was made at Harefield, Ickenham, Hillingdon and Northolt. The houses built are well-designed and healthy dwellings. I am indebted to your Surveyor for the exact figures for the number of houses completed by the end of the year. Houses erected and occupied, year ending December 31st, 1921:— Northolt 10 Ickenham 18 Hillingdon 14 Harefield 27 Total 69 11 Other Houses. Cowley 2 Harefield 5 Hillingdon 9 Northolt 4 Total 20 Overcrowding was still present at the end of the year, and many houses are practically beyond repair. Your Inspector's report is given overleaf in table form, in which all details of inspection from a sanitary point of view, and of food, can be seen. Mr. Freeman's work has been excellent. This, Madam and Gentlemen, concludes my Report. W. TOWNSEND DOBSON, M.R.C.S., L.R.C.P., Meefical Officer of Health. 12 SANITARY WORK FOR THE YEAR 1921 Inspections:— Cowley. Harefield. Hillingdon Ickenham. Northolt. W. Drayton. Total. Number of Premises Inspected on Complaint 6 3 7 2 1 1 20 in connection with Infectious Diseases 18 38 8 - 4 7 75 Number of Premises under Periodical Inspection 6 21 20 9 9 9 74 Houses Inspected from House-to-House (H. and T.P. Act) 66 6 14 6 55 69 216 Total Number of Inspections and Re-Inspections made (including 144 Scavenging Inspections) 139 146 112 66 169 163 795 Dwelling Houses and Action under H. and T.P. Act, 1909:— Number of Houses dealt with under Section 15 - - - - - — — Number of Houses Condemned — — 1 4 6 — 11 Action Taken (other than under H. and T.P. Act):— Cautionary'or Intimation Notices Given 9 11 18 6 15 9 68 Statutory Orders Issued 2 2 2 1 2 — 9 Canal Boats used as Dwellings:— Number Registered under the Acts 48 Boats Inspected 48 Number of Contraventions of Regulations 5 5 Notices Served 5 5 Number of Defects Remedied 7 7 Bakehouses:— Number in District 2 3 2 — 1 1 9 Contraventions of Factory Acts 1 1 — — — — 2 Slaughterhouses:— Number in the District 1 3 1 — 2 — 6 Butchers' Shops 1 4 2 — — 1 8 Frequent Inspections of Slaughterhouses and Butchers' Shops have been made during the year. 13 SANITARY WORK FOR THE YEAR 1921. g Cowsheds:— Cowley. Harefield. Hillingdor Ickenham Northolt. W. Drayti Total. Number on Register 2 8 9 3 6 3 31 Frequency of Inspection—Periodical. Contraventions of Regulations — — — — — — — Number of Milch Cows in District 25 134 156 35 146 16 512 Dairies and Milk Shops:— Number on Register 2 8 11 3 6 5 35 Frequency of Inspection—Periodical. Contraventions of Regulations - - - - - - —- Unsound Food:— Not any Condemned and no Complaint received. Offensive Trades:— 6 Number of Premises in District — 2 1 — 2 1 Number of Inspections made — 10 5 — 18 6 39 Contravention of By-laws — — — — — — — Water Supply and Water Service:— Wells : Cleansed, Repaired, etc. 1 — — — — — 1 Closed as Polluted — — — 1 — — 1 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 — Houses supplied from Main, previously from Wells condemned 1920 — 4 — 2 — 3 9 Numbers of Samples obtained for analysis: From Local Wells 1 2 3 1 — — 7 Drainage and Sewerage of Existing Buildings Water Closets: Repaired, Supplied with Water, or otherwise Improved 4 4 8 - - 2 18 Percentage of Houses provided with Water Closets 95 80 95 50 50 95 — 14 SANITARY WORK FOR THE YEAR 1921. Cowley. Harefield. Hillingdon Ickenham Northolt. W. Drayt< Total. Drams : Examined, Tested, Exposed, etc. — — 2 1 - 2 5 Unstopped, Repaired, Trapped, etc. 3 — 5 - 4 4 16 Waste Pipes, Rain Water Pipes Disconnected, Repaired, etc. — — 4 - — 4 8 Existing Soil Pipes or Ventilating Shafts Repaired 1 — 5 - — 3 9 Reconstructed — — - - - 1. 1 Cesspools: Rendered Impervious, Emptied, Cleansed, etc. *8 102 39 4 12 8 173 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 17 26 7 - 6 6 62 Phthisis — 7 - - - - 7 Rooms Stripped and Cleansed - - - - - - Articles Disinfected or Destroyed : Ordinary Infectious Diseases — 3 16 — 1 1 21 Phthisis — — — — — — — Dust :— New Bins Provided 2 8 22 - 11 5 48 How frequently is Dust Removed from each House ?—Fortnightly. Number of Complaints of Non-Removal received 4 — 6 — — 7 17 Method of Disposal ?—By Tipping. Sundry Nuisances Abated:— Accumulations of Refuse 1 1 - - - 1 3 Foul Ditches, Ponds, etc., and Stagnant Water 1 2 - 4 4 1 12 Foul Pigs and other Animals — 1 2 - — 2 5 Dampness 1 1 — - — — 2 Other Nuisances 7 12 8 3 3 2 35 FACTORIES, WORKSHOPS, PETROLEUM STORES, AND HOMEWORK. Factories 10 Workshops 30 Petroleum Stores 15 Homework 11 Number of Inspections 76 Defects Found and Remedied 4 Number employed in Factories 1,129