WEN 002 Medical Officer's Report. To the Chairman and Members of the Wembley Urban District Council. Gentlemen, I have the honour to present my Annual Report of the Health and Sanitary Condition of the Wembley Urban District for the year 1902. It is not a very difficult matter to estimate the population of the District during the year 1902, being so near the taking of the Census. With these figures, and making allowance for the new houses occupied, and the advent of a considerable number of employees on the Great Central Railway Works, 4,800 is a proper estimate for the middle of 1902. The area of the District is 4,282 acres, less now than an acre to each person. Wembley is still the most sparsely-populated of all the Middlesex districts. In 1900 85 new houses were erected. ,, 1901 59 „ ,, ,, ,, ,, 1902 150 „ ,, ,, ,, VITAL STATISTICS. The Registrar of Deaths has forwarded to me lists of 47 deaths which occurred in the Wembley District during 1902. 17 occurred in the first quarter. 12 „ „ second „ 7„ „ third „ 11 „ „ fourth „ 2 The population being 4,800, the death rate for 1902 stood at 9.7 per 1,000, higher than in 1901, when it was 8.5 per 1,000, but still a good death rale considering the proximity to London and the class of population. Taking an average for the last seven years our death rate is below 10 per 1,000 for the District, which may be considered quite satisfactory. Of these 47 deaths, eight were attributed to some disease of the heart, three to accidents, three to bronchitis, three to senility, three to meningitis, two to influenza, two to scarlatina, two to phthisis, two to gastro enteritis, two to alcoholism, one to small pox, one to pneumonia, one to diphtheria, one to septicoemia, one to melancholia, only one to cancer, one to child-bearing, being the fourth that has occurred in the District during the last eighteen years. The Registrar of Births has forwarded to me a list of 117 births during 1902, 61 boys, 56 girls. This is about the average of boys and girls, and makes a birth rate for the District of 24.4. a rate which if not actually low might reasonably be somewhat higher. Too often, I fear, a low birth rate is regarded by many with approval, if not with considerable satisfaction. It would be well sometimes if our attention was drawn to the other view of the question, for, quite apart from the fact that married people, who intentionally have only one or two children (frequently none) may not fulfil their whole duty to the great Empire to which we are all proud to belong, there is the undoubted fact that those who have fewer children than nature intended them to have (and the normal number is five or six) often diminish their families at the expense of their own good health. I know, of course, that the reverse frequently obtains, and that prevention may in certain cases be necessary and desirable, but the danger is that the practice will become more recognised as legitimate, and be more universally adopted though it be an offence against the laws of nature, and frequently wrong morally and hygienically. One notices, 3 however, that our poorer neighbours have, so far, not become deeply imbued with the Malthusian theory. INFECTIOUS DISEASE. There were thirteen cases of infectious disease in the District in 1901; last year there were 55. Of these 27 were cases of Scarlatina. „ „ 7 „ „ Small pox. „ „ 7 „ „ Chicken pox. „ „ 5 „ „ Typhoid. „ „ 5„ „ Erysipelas. „ „ 4„ „ Diphtheria. 55 The scarlatinal cases occurred during every month from May to December. Some of the Alperton cases were no doubt connected with each other, not so the others apparently. On the whole the type was not severe, except two which proved fatal, one of these being malignant. None of the enteric cases were apparently connected. Three, at least, were imported from London. One of the diphtheritic cases proved fatal, being seen too late for the antitoxin injection. Chicken pox is not now notifiable, it was well to include it whilst there was a danger of small pox. because of the occasional difficulty in diagnosis, and the similarity of the eruption. THE SMALL POX EPIDEMIC Deserves a longer notice, though I will be as brief as possible, all the facts being comparatively fresh in your memory. The first case occurred in Alperton Park in the middle of March, and being a suspicious one, was treated as one of Small pox from the first day, and all precautions taken. On the 4 second day all the household were re-vaccinated, the diagnosis seemed doubtful on the fourth day, but was unmistakeable directly after. The other members of the family were removed immediately by road to a cottage in the country where they were isolated and watched, while the patient remained alone at Alperton with her mother and a trained nurse. Vaccination was offered and generally accepted by the near neighbours, and no fresh cases occurred. The next case, living in Llanover Road, East Lane, was notified on April 4th. The origin was obscure, but we suspected the husband of having had a mild attack from certain symptoms, and we promptly removed both to your Isolation Cottage at Alperton. I had no hesitation in sending in her young baby too, as I had vaccinated it only a month before in four good places, and knew that it could not contract the disease. Here we burnt everything we could lay our hands on, in the front garden. I do not think you or anyone else realized what your Sanitary Inspector and I went through that afternoon and evening up to eleven o'clock, being compelled to actually carrv the patient a considerable distance to the ambulance, and do all the dirty work ourselves, your employees not having consented so far to be vaccinated. The next case was a boy in Totnes Terrace, and was fairly typical, apparently in no way connected with the others. He was removed to the Isolation Cottage and soon recovered. The next two cases also occurred in Wembley, the symptoms were not typical. During the temporary absence from home of the medical attendant, his locum tenens asked me to meet him in consultation, when we agreed that they were really cases of small pox, and acted accordingly, in taking all precautions. The more recent case died, and the doctor returning, called in a consultant from the Metropolitan Asylum Board Hospital who verified the diagnosis. Fortunately no further infection seems to have occurred from these cases. 5 The last case was a young married woman in Alperton. She also was removed to the Hospital Cottage, and everything in her house that could not be properly disinfected or sterilised was burnt. Her little baby was also sent in, but died, not of small pox, but with diarrhoea and vomiting. The Doctor's certificate stating the death to be due to gastro enteritis. All these cases were found either to be without vaccination marks, or only such as had become so faint as to be valueless or unprotective. Viewed as a whole the District is to be congratulated on the few cases, for many were unprotected by vaccination or re-vaccination at the commencement of the epidemic. By May, however, 550 were vaccinated by the Public Vaccinator, and, probably double that number were done privately by their own doctors. All my remarks of last year on vaccination were included in the County Medical Officer's Annual Report, so that I need say little of vaccination again, except to refer to the fact that though the operation was severe in a number of cases, no permanent ill-effect ensued, and only in two cases, have I heard of a thickening of the scars, which will require a slight operation for their removal. You were good enough to acknowledge the timely help of Dr. Mitchel Henderson in attending at the Isolation Hospital, and also your foreman, Mr. Coney, who did yeoman service during the epidemic, in leaving his home and fitting up the Cottages, and in numberless ways assisting the staff and patients at the Hospital. I would like here to state that you probably greatly lessened the epidemic, and really minimised the expense by giving your Sanitary Officers full power to act as soon as a case occurred, and by promptly allowing all expenses necessarily connected with the Hospital, isolation, disinfection of the patients and their relatives, while any less expeditious course would have led 11s into a big epidemic, and possibly into legal difficulties. 6 The Factory and Workshop Act of 1901 came into force on the first of January, 1902, and imposes several new and important powers and duties on the Medical Officer of Health and the Local Authority. Under section 132 every M.O.H. is required in his Annual Report to deal specifically with the administration of the Act, and to send a copy of this part of this report to the Secretary of State. We have now to keep a register of all workshops situated in the District. Lists of home workers are to be sent to the District Council twice a year by owners of factories, workshops, or other places who give out work to be done at home. We, on our part, must inspect the premises as to sanitation and possible sources of infection. The term " Factory " includes all places in which mechanical power is used. " Domestic Factories" include private houses, where members of the family regularly carry on, without mechanical power, any class of work included in Schedule VI., part 1. " Workshops and Workplaces" include laundries, bakehouses, kitchens of restaurants, stable yards, and all places in which people assemble to work permanently. It will be your duty not only to secure proper sanitation and prevent overcrowding, but also to provide for fire escape in all cases. Among other things the M.O.H. must notify the Inspector of Factories whenever he observes that an abstract of the Act is not posted up in any workshop where women and children are employed. By this Act your Sanitary Officers have the same powers of entry as His Majesty's Inspectors, they can take a constable if there is reason to apprehend serious obstruction, to examine all persons found therein, and to require the production of all documents, etc, This, gentlemen, is merely a brief survey of the 163 sections of this important Act, a copy of which is now in our office. It 7 would be well if a printed circular was issued and freely distributed, so as to inform all concerned of their liability. The Cross Country Championship running matches are still held annually at Wembley Park, and appear to be increasing in popularity, but it is very questionable whether this or any other form of forced athleticism deserves so much encouragement from the public. It is true that the ten miles run has been lessened, and that the Ambulance Brigade has had, in consequence, less work to deal with, but I am convinced that the excessive strain entailed, in spite of the careful training that the competition implies, will be found responsible for many damaged hearts in later years, if not to actual physical and constitutional disablement in the immediate future. Chronic Alcoholism. Two of the deaths were attributed to alcoholism. You will be glad to know that (though there is still room for a stricter moderation) there are comparatively few well-known chronic alcoholics in the district, in fact there are hardly any of the shameless drunkards one met in the streets a few years ago, and these are not permanent residents. So that we may be hopeful that in time, education and example will still further lessen this serious menace to the Public Health. Noisy Nuisances. It is required by a memorandum of the L.G.B. that I inform you of all matters affecting, or likely to affect, the health of the inhabitants, either collectively or as individuals. I desire to briefly refer to a few of the oft recurring and ever-increasing sources of nerve irritation in our midst. Those that we find in the home, whether due to the constant reaction of married folk upon each other, to chronic ill-health, to servants, or other domestic worry, we cannot control, though we may be frequently and painfully aware of their existence, but those that are thrust 8 upon us from without we can or ought to be able to check, or certainly to regulate or diminish. I refer to the number of petty annoyances that keep us perpetually on the alert night and day, such as street calls and shouting, whether during the day or at the closing of the public houses, loud, vulgar, insane choruses by half drunken men in vans and brakes, especially on Sunday nights along the main road, the majority coming from the direction of Harrow and the regions beyond, vulgar horse play by lads at or near the station at night, perpetual barking of dogs often all night, especially in Ranelagh Road, epidemic of organ grinders in our streets, fiercely shrill and apparently unnecessary whistling from the railway engines of fast trains approaching or passing through Wembley, add to these a chime of eight bells if not actually discordant, certainly in no way melodious, and you have a few of the noisy nuisances that we could so easily do without. I happen to know a number of nervous people who have come purposely to reside here to be away from the bustle and noise of the great city, to enjoy the quiet and the semi-rural character of the place, to do their gardening or to read in peace, and go to bed at nine or ten, but who often find it impossible or difficult, when even night is made horrid with these nuisances. I suggest that the County Council bye-laws be more rigidly enforced, that the mounted police wait upon the blackguards on the vans, that the Railway Companies be asked to be less vindictive with their whistling, that some concerted action be taken to reduce the number of street organs, householders patronising only one a week instead of three in the space of a few hundred yards, as was seen in Wembley a few days ago. I feel that many of these nuisances could be abolished, and I am sure you will not regard these matters as too trivial for your notice when you come to consider my report in detail. Home Lessons and Overpressure at School. During the past year it has frequently been brought to my 9 notice that children living in the District and attending School here and elsewhere suffer from the burden of having to do home lessons. It seems to me that young children should be completely " off duty," that is, quite free from care and anxiety from the moment they leave school till their return the next day. I have often noticed that various forms of cerebral irritation, mutterings during sleep, night terrors are directly traceable to overpressure at School. Nuisances at Alperton. During the year many inspections were made in Alperton to ascertain and exactly localise the source of a very pungent disagreeable odour like burning indiarubber pervading the district, and evidently coming from Alperton. The deposit of rough dust on the canal side, the Volenite factory, the Bone factory, the piggeries, Mr. Haynes' yards, and in fact all premises have been searched. There can be little doubt that much of the evil smell comes from the refuse gas coke used, and your Sanitary Inspector and others are convinced that it is due also to the burning of a refuse gas wood used by the poorer people there. We shall shortly be asking you to take steps to have this nuisance abated. Cowsheds, Dairies, Laundries, etc. I have visited and inspected the dairies, cowsheds, laundries, arid bakehouses of the District. They are all in fair condition, and the owners give no trouble, and seem ready to carry out all instructions and suggestions. The large bakehouse in Wembley, the plans for which have had your approval, is now completed, and in use. It cannot be considered an underground bakery, though apparently below the roadway, and it answers every sanitary requirement. 10 Overcrowding. We have had a few cases of overcrowding, but prompt action soon disposed of them. In one case, however, we were compelled to go to Edgware and obtain a conviction. We shall always be glad to have information as to alleged overcrowding, so that a strict investigation may be made at once. Housing of the Working Classes. It cannot be said that at the present moment this is a pressing question, but it is a matter for regret that so large a portion of the weekly wage must be spent on the rent. This is, of course, entirely a matter of supply and demand, and is not likely to improve so near the Metropolis, at any rate authorities differ considerably as to the expediency of small municipalities undertaking extensive building operations for the Housing of the Working Classes. I have often thought that the land between Wembley, Stanmore, Kingsbury, and Willesden, including the Kenton district, and all Wembley Park, would be a suitable and typical area for a " Garden City." Even now it would not be too late to consider the matter, if only the landowners had not an exaggerated notion of the value of their property. Mortuary. It will be a matter for satisfaction to the whole District, and especially to the resident medical practitoners to learn that you have been able, at last, to arrange for the erection of a suitable Mortuary, and that the contract for the building has actually been accepted. I understand that you only await the sealing of the lease by the Ecclesiastical Commissioners to the proposed site, and that this document is daily expected in the office. House Refuse Removal. The House refuse is removed periodically at an interval of every ten days from every house, and deposited as you know, at your Sewage Farm. 11 The accumulation there, is undesirable, no doubt, at no distant date you will be able to arrange for a " destructor " of suitable make and size to meet our requirements. Gipsies. During 1902 we again suffered much from the frequent visits of large numbers of gipsies to the District, and the effort to displace them were only temporarily and partially successful until your colleague, Mr. Baldwin, voluntarily undertook to cope with the difficulty. What magical power he brought to bear on the tribe is unknown, but the inhabitants of Wembley Hill will be extremely grateful for his timely, if mysterious influence, especially if the clearance proves to be of a permanent nature! Bad Roads. We have, I believe, only two bad roads left in the District: l'embroke Road, East Lane, and Honeypot Lane, at Alperton. 1 understand you have the repair of both these roads under your consideration, and are determined to proceed shortly with the necessary preliminary steps. Expectoration in the Public Streets. One of your members has referred, and rightly referred, to the danger of the disgusting habit of spitting in the public streets, it being well known that dried sputa is the great source of infection in consumption. It is hoped that all will unite in causing the abatement of this nuisance. Sewage Farm. The Sewage Farm, which has been for the past three years, in so satisfactory a condition under the management of your Surveyor is shewing signs of incapacity for dealing with the storm water. In August last your Sanitary Inspector, Mr. Cecil 12 man, issued in separate form a very valuable report on the subject of sewer ventilation and house drain interceptors, which was read before the Middlesex District Councils' Association. I believe you have already expressed your appreciation of that report. Accompanying this Report is a tabular list of all the visits and inspections of your Sanitary Inspector for 1902. May I here again remind you that I am anxious that you will not forget that I want a small office for the Health Department of your work, a department which, with the increasing population, will annually become more important. Dr. Churchill, your Assistant Medical Officer of Health again acted as my substitute during my summer holiday, and dealt with several of the typhoid cases. In conclusion, gentlemen, I always place on record with this Report my appreciation of the ready help and kindly cooperation which I have ever received from my colleague in the sanitary work, Mr. Cecil Chapman, and in no less degree is that expression of appreciation due for the courtesy and consideration that I have, at all times, received from every member of the Council. I have the honour, to be Gentlemen, Yours faithfully and obediently, CHARLES E. GODDARD. March 25th, 1903. WEMBLEY. Table I.— Vital Statistics of Whole District during 1902 and Previous Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Nett deaths at all ages belonging to the District. Under 1 year of age. At al ages. Number. Rate.* Number. Rate per 1000 Births Reg'd Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 1895 3642 1896 3700 119 27.4 12 100 28 8.9 28 8.9 1897 3740 92 21 12 130 33 10.0 33 10 1898 4000 101 25 9 90 41 10.2 41 10.2 1899 4350 123 24.1 17 138 57 131 57 131 1900 4500 111 24.6 8 72 45 10 45 10 1901 4550 104 22.8 9 86 39 8.5 39 8.5 Averages for years 1892-1901. 1902 4800 117 22.8 9 76.9 47 97 47 9.7 * Rates in Columns 4, 8 and 10 calculated per 1,000 of estimated population. Area of District in acres (exclusive of area covered by water) 4,282 acres. Total population at all ages, 4,519, at Census of 1902. Number of Inhabited Houses, 833 Average number of persons per House, 5.5. At Census of 1901. Table III. WEMBLEY. Notifiable Diseases. Cases notified in whole District. No. of cases removed to Hospital. At all Ages. At Ages—Years. Under 1 1 to 5. 5 to 15 15 to 25. 25 to 65. Small-pox 7 ... ... 1 3 3 7 Patients were removed to Isolation Hospitals (including 4 Small-Pox cases.) Cholera ... ... ... ... ... ... Diphtheria 4 ... ... 4 ... ... Membranous croup ... ... ... ... ... ... Erysipelas 5 ... ... ... ... 5 Scarlet fever 25 1 ... 17 ... ... Typhus fever ... ... ... ... ... ... Enteric fever 5 ... ... 1 ... 3 Relapsing fever ... ... ... ... ... ... Continued fever ... ... ... ... ... ... Puerperal fever ... ... ... ... ... ... Plague ... Chicken pox 7 ... 4 2 ... 1 Totals 53 1 11 25 4 12 Two Cottages at Alperton, in the District, and can send cases to Isolation Hospital, Dog Lane, Willesden. Workhouse at Hendon, Middlesex. WEMBLEY. Table 1V. Causes of, and Ages at, Death during Year 1902. Causes of Death. Deaths in or belonging to whole District at subjoined Ages. All ages. Under 1 year 1 and under 5- 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Small-pox 1 ... ... ... ... 1 ... Measles ... ... ... ... ... ... ... Scarlet fever ... ... 2 ... ... ... ... Whooping-cough ... ... ... ... ... ... ... Diphtheria and membranous croup 1 ... ... 1 ... ... ... Croup 1 ... 1 ... ... ... ... Fever Typhus ... ... ... ... ... ... ... Enteric ... ... ... ... ... ... ... Other continued ... ... ... ... ... ... ... Epidemic influenza 2 ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... Diarrhoea ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... ... Puerperal fever ... ... ... ... ... ... ... Erysipelas 1 ... ... ... ... ... ... Other septic diseases 1 ... ... 1 ... ... ... Phthisis ... ... ... 1 ... ... ... Other tubercular diseases ... ... ... ... ... ... ... Cancer, malignant disease 1 ... ... ... ... ... ... Bronchitis ... ... ... 1 ... ... ... Pneumonia 1 ... ... 1 ... ... ... Pleurisy ... ... ... ... ... ... ... Other diseases of respiratory organs ... ... ... ... ... ... ... Alcoholism, Cirrhosis of liver ... ... ... ... ... ... ... Venereal diseases ... ... ... ... ... ... ... Premature birth 1 1 ... ... ... ... ... Diseases and accidents of parturition 1 ... ... ... 1 ... ... Heart diseases 8 ... ... 1 1 6 ... Accidents 3 ... 1 ... 1 ... Suicides 1 ... ... ... ... 1 ... All other causes 10 ... ... ... ... ... ... All causes 47 7 3 7 4 11 5 c (I). COUNTY OF MIDDLESEX—SANITARY WORK, 1902. Name of Sanitary District. Inspection. Notices. Dwelling Houses. House let in separate Dwellings or Lodgings Movable Dwellings, Caravans, Tents, &c. Complaints Received. Number of Premises periodically Inspected. Total Number of Houses, Premises, ! &c., Inspected. Total Number of Re-inspections after Order or Notice. Total Number of Inspections and Re-inspection. Letters written. Cautionary Notices Given. Statutory Orders Issued. Summonses Served. Convictions Obtained. Houses. Premises, &c., Cleansed, Repaired, &c. Closed as unfit for Habitation. Re-opened after Repairs, Alterations, &c. Number Registered under Bye-laws. Number of Contraventions. Number observed during the Year. Number removed from District. Wembley (Middlesex) Urban District 5 30 280 60 340 50 50 157 1 1 7 1 1 5 4 200 200 C (II). COUNTY OF MIDDLESEX-SANITARY WORK, 1902. Name of Sanitary District. Schools. Workshops and Work-places. Laundries. Bakehouses. Slaughter-houses. Cow-sheds. Daines and Milk-shops. Offensive Trades. Number in District. Number in District. Periodical Frequency or Number of Inspections. Number in District. Periodical Frequency or Number of Inspections. Number in District. Periodical Frequency or Number of Inspections. Number on Register. Periodical Frequency or Number of Inspections. Number on Register. Periodical Frequency or Number of Inspections. Number on Register. Number of Premises in District. Periodical Frequency or Number of Inspections. Wembley (Middlesex) Urban District. 2 5 6o 2 24 5 10 5 10 5 12 5 1 6 C. (III). COUNTY OF MIDDLESEX—SANITARY WORK, 1902. Name of Sanitary District. Water supply and Water Service. Privy and Ash pits, Ash and Earth Closets. Drainage and Sewerage. Houses, Water!laid on to Percentage of Houses supplied from mains Cisterns. Percentage of houses supplied on constant system. Supplied with water, or supply Water rendered efficient. closets Percentage of Houses provided with Water Closets. Drains. Percentage of houses draining into Sewers. Sewers New, Provided. Cleansed, repaired, covered, etc., Overflow pipes disconnected from drains. Above ground receptacles substituted for pits Movable receptacles substituted for fixed. Water closets substituted for dry receptacles. Examined, tested, exposed, etc. Unstopped, repaired, trapped, etc Yards of New Sewers laid. Wembley (Middlesex) Urban District. All 20 s All 70 10 All 30 25 99 300 C (IV). COUNTY OP MIDDLESEX-SANITARY WORK, 1902. Name of Sanitary District. Disinfection. Dust. Sundry Nuisances Abated. Rooms fumigated. Rooms stripped and cleansed. Articles disinfected or destroyed. New bins provided. Movable receptacles substituted for fixed. Periodical frequency of dust removal. Number of complaints of nonremoval received. Overcrowding. Smoke Accumulations of refuse. Foul ditches, ponds, &c., and stagnant water. Foul pigs and other animals. Other nuisances. Wembley, (Middlesex) Urban District. 50 15 50 70 70 About once in 10 days. 2 7 I 20 3 2 30