WIL 1 WILLESDEN LOCAL BOARD. SANITARY REPORT FOR THE YEAR, 1893. by D. S. SKINNER, M.D., Member of the Royal College of Surgeons, Eng.; Licentiate of the Royal College of Physicians, London; Fellow of the Society of Medical Officers of Health; Medical Officer of Health for Willesden. Hendon: J. H. Warden & Co., " Hendon & Finchley Times" Office. 1894. CONTENTS. Pages. 45 Appendix Bakehouses 39 Births 17 ,, Illegitimate 18 Canal Boats 40 Cemeteries 36 Chart 23 Cholera 33 Common Lodging Houses 40 Cowsheds 37 Dairies and Milkshops 38 Deaths ,, (Infants) 21 ,, (Illegitimate) 21 ,, (not Certified) 21 Description of Sub-Districts 9 Diarrhœa 34 Diphtheria 29 Erysipelas 33 Factory and Workshops Act, 1891 38 Hospital Report 46 ,, Expenses 52 Houses Let in Lodgings 40 House Refuse and Scavenging 40 Infant Protection Act 40 Influenza 35 Inquests 21 Introductory 5 Legal Proceedings 41 Marriages 17 Measles 31 New Drains 41 Notification of Infectious Diseases 26 Open Spaces 13 Phthisis 34 Population 15 Privy Council Order, 1885 37 Puerperal Fever 32 Recurrent Cases 29 Sanitary Inspections 36 Scarlet Fever 28 Sewerage 11 Sewage Field 12 Special Complaints 42 Slaughter Houses 39 Small Pox 26 Soil 8 Street History 13 Summary of Systematic Inspection 45 The Brent 8 Typhoid Fever 32 Vaccination Return 37 Wards 9 Whooping Cough 31 Water Supply 12 SANITARY REPORT, 1893. To the Chairman and Members of the Willesden Local Board. Gentlemen, I have the honour to present my report of the sanitary state of the district daring 1893. The year has been a remarkable one in some respects— for its long dry weather, small rainfall, extra sunshine, the prevalence of scarlet fever and small-pox over great part of the country ; increased illness and a high death rate during the third quarter which is usually the healthy one. From the Registrar-General's quarterly reports it appears that the long spell of fine weather commenced on March 1st., the temperature for that month being 5.2 above the average; during the succeeding quarter it was 47, and in the third quarter 2.2, being 1.5 in July, 4 6 in August, and 0.5 in September. During eight consecutive months, ending with September, the temperature was above the average by 3.5 degrees. The amount of sunshine was above the average in each of the eight months except July, when it was 15.0 per cent. below. 6 Willesden Local Board. The annual average rainfall for London is about 25 inches. The amount that fell in the three quarters was just under 12 inches; it was above the average by 1.18 inches in February and 076 in July, but much below it in March, April, May and June, the amount that fell in those months being 1.47 inches, or about one-fourth below the ordinary amount. There were 27 days on which it fell. In the fourth quarter the temperature was 1.0 above the average. October was generally fine and warm, but there was rain about the middle of the month. November was cold and dull. The amount of rain in the quarter was 8.19 inches, above the average by 1.12 inches; the total rainfall, therefore, for the year was 20 inches, about five inches less than usual. A depth of rain of one inch means a fall of 100 tons over each square acre of ground. During its fall it absorbs various impurities in the air and so washes and cleanses it. A deficiency of five inches in the year would consequently mean a deficiency of 500 tons of rain on each acre; the enormous amount that represents in our own district, an area of 4,383 acres, would not be difficult of calculation. In a district where the water for drinking and domestic purposes is supplied to each house from a long distance the amount of rainfall is practically immaterial as far as storage purposes are concerned, but it becomes important when the cleansing of the air and the surface of the ground is considered, in the amount, the manner of its fall, and the number of days on which it falls. In tropical countries, after a long dry season, the first fall is generally a verv heavy downpour which washes the ground; if, on the contrary, it falls gently, as it more generally does in this country, there is no cleansing of the surface, but any impurities are more likely to be brought into a state of activity by the warmth and moisture. Sanitary Report, 1893. 7 The death rate throughout the country was 19.7 in the first quarter, being below the average by 2.3; 17.9 in the second, or below by 12, but in the third quarter it was 19.1, or 2.1 above. In Willesden, including a portion of the deaths occuring in the Workhouse, the death rate in the first quarter was 13.3 per 1,000, in the second 14.5, and in the third 17.4. It will be interesting to seek the cause why, after four months ending with June of such fine weather, there should have been such an increase of sickness and mortality in the third quarter. As might have been expected, summer diarrhoea prevailed, 35 deaths of infants under one year of age being due to it; there were also 10 deaths of infants due to inflammation of the mucous membranes of the intestines, and 30 due to debility, atrophy and inanition. These figures are sufficient to account for the increase. As I have explained on a former occasion, diarrhoea prevails when the temperature of the ground four feet below the surface reaches to about 56 degrees. The action of the long dry season and the heat of June would have raised the ground temperature sooner than usual; it would also tend to produce large cracks in the clay soil of this district, so that when the rains of July fell, dampness, warmth, and aeration of the ground were just the conditions most favourable for the production of the disease The meteorological condition appears to havehad little or no influence on Typhoid Fever, although in many instances it would appear that hot and dry summers have been followed by a decided increase of this disease on the occurrence of rain; but a glance at the chart will show that no such increase occurred, the exceptional rise in the last week of August being otherwise accounted for. 8 Willesden Local Board. SOIL. The soil of the district is a thin superstratum of loam on a variable thickness of stiff clay, with the exception, perhaps, of a small patch of land at the top of Dollis Hill, which seems to have no clay. When the foundations for the permanent buildings of the Isolation Hospital were being dug, I observed gravel at about two feet, or perhaps rather more, below the surface, there being about 18 inches of clay on it. THE BRENT. This small river forms the north-west boundary of the district, the reservoir at the Welsh Harp forming the northern point. The reservoir is formed by collecting the waters of the two streams coming from the northward. Below the reservoir there is a small stream coming from the north-west which has been made use of for the formation of a small lake in the ornamental grounds of Wembley Park, the overflow coming into the Brent as before. There is but a very small amount of water, which, in very dry seasons, seems to be lost altogether. Mr. Bobson and myself accompanied Dr. Copeman, of the Local Government Board, on June 29th, when he made his inspection of the river. The ground immediately under the dam of the reservoir was perfectly hard and covered with grass, the feeder, which conveys the water from the reservoir to the canal, had taken all the water for a longtime, none being allowed down the stream, the latter consequently forming a series of stagnant pools By collecting, by means of a dam across the river, the effluents of the sewage field with the waters of the stream, the engineer is enabled to let down a small flow through a sluice at stated intervals, which has Sanitary Report, 1893. 9 prevented the pools from being quite so stagnant. It is most essential that a certain proportion of the water of the reservoir should be sent down the river at stated times. WARDS. A proposal has been submitted for altering the distribution of the Wards, but as nothing has as yet been done, I append the description of the Wards which I have used on former occasions:— DESCRIPTION OF SUB-DISTRICTS. North Ward. No. 1 District.—This comprises the portion of the North Ward south of Willesden Lane and the frontage to Paddington Cemetery. No. 2 District is the portion north of Willesden Lane and Paddington Cemetery. East Ward. No. 3 District (Kensal).—This is the western portion of the EastWard within the Metropolitan drainage area. No. 4, Willesden Green District.—This comprises all that portion of the East Ward south of the Metropolitan Railway within the Brent drainage area. No. 5, Mapesbury District.—This is the eastern portion of the East Ward draining into the Metropolitan area. 10 Willesden Local Board. No. 6, Cricklewood District is all that portion of the East Ward draining to the Brent area north of the Metropolitan Railway and the Mill at Cricklewood. West Ward. No 7, Church End District is that portion of the West Ward draining into the Brent system east of the Church path ditch and the Midland and South Western Railway. No. 8, Harlesden District is the portion of Harlesden draining into the Metropolitan system. No. 9, Harlesden Brent is that portion of the West Ward draining into the Brent area west of the Church path ditch and bounded by the Midland Railway. No. 10, Lower Place District is within the Brent area to the south of the London and North Western Railway. No, 11, Stonebridge District is within the Brent area, and is bounded on three sides by the Metropolitan, Midland, and North Western Railways, and on the fourth by the River Brent. No. 12, Neasden District is within the Brent area to the north of the Metropolitan Railway. South Ward. No. 13, Kilburn Sub-district comprises that portion of the South Ward north of Carlton Road up to Salusbury Road. Sanitary Report, 1893. 11 No. 14 being the portion south of Carlton Road and the London and North Western Railway beyond Salusbury Road. The district is undulating with a distinct ridge dividing the parish into two unequal portions, which determines the drainage areas, about two-thirds of the houses draining into the Metropolitan system, and the remainder into a local system, terminating in a sewage farm. SEWERAGE. With the formation of new roads, with houses and increase of population, there must of necessity be a great increase of sewage; that flowing into the Metropolitan area does not call for comment, but that into the Brent system is an ever-increasing difficulty. During the long dry summer there were complaints of some of the ventilators in the roads, though the causes of such complaints are very seldom found in the sewers but in the house drains leading into them. The sewers are flushed regularly every week, and more frequently where found necessary (see the Surveyor's Report). If house drains were more thoroughly flushed I have no doubt many of the complaints would cease. So many people think that by letting water flow through the drains for a certain time they are doing a most useful thing, but if a quantity of water were emptied suddenly it would effect what a small flow of water never will, that is, a thorough cleansing of the drain. In many instances house drains have been flushed under the direction of the Surveyor, with complete relief from any bad odours rising from the road ventilators. Ventilating shafts, carried up well above the windows of houses, have acted favourably; about 60 are in operation at present, and I am of opinion that if 12 Willesden Local Board. such shafts could, in more instances, be made to supercede the ventilators in the roads, it would be a still greater advantage. SEWAGE FIELD. I estimate that the houses in the Brent area draining into the sewage field represent a population of over 22,000, a fact which seems to render satisfactory purification an impossibility with the present tank accommodation and the difficulties attending filtration through a stiff clay soil. The expense of increased tank accommodation would no doubt be considerable but it is evident that the present state of things cannot long be continued. As I understand the question is under the consideration of the Surveyor I need say nothing further. The chemicals at present in use are lime, 8½ grains to the gallon, and alum, l.8 grains. WATER SUPPLY. There has been no change in the water supply, the district being supplied by the West Middlesex Water Works; the reservoir that the Company have made at Willesden Green enabled the supply to be maintained during the dry season, so that I heard of no complaints of want of water. That the cisterns in many of the houses are too small to contain a sufficient supply I have before remarked upon, and have recommended a continuous supply in consequence. Communications with reference to this desirable condition have been held with the Company, but the difficulties in the way, the necessity of altering the fittings in the houses to satisfy the requirements of the Company,have prevented it from being carried out. In my report for 1891 I gave a detailed statement of the size of the cisterns in Sanitary Report, 1893. 13 many houses and the amount of water which should be supplied for the number of inmates, but the quantity available fell far short of the estimate. Failing the continuous supply it would be an advantage if the water could be turned on in such streets twice in the day. STREET HISTORY. The record which has been kept during the last three years of each street, shewing the mortality and cause of death of each person, and the notifications of infectious diseases that have been received is becoming a source of very valuable information, and will increase in value from year to year. It can be seen at once when a notification is received whether the disease has recently prevailed in that house or the adjacent ones; likewise, with regard to deaths from diseases that are not notified, if two or three deaths occur in a house within a comparatively short time, though not of the same family, attention would be drawn to it. Pneumonia, for instance, is not a disease requiring to be notified, but it occasionally assumes a very infectious character and might be due to some sanitary defect, or possibly to an unobserved apparently mild form of Typhoid Fever. OPEN SPACES. The importance of securing as many of these as possible has been taken advantage of during the year by the purchase of 26 acres of land in the open part of the district while the opportunity still remained of acquiring it. The site is in the West Ward but near the boundary of the East, and is practically about midwaybetween Harlesden,Willesden, and Willesden Green. It consists of sloping 14 Willesden Local Board. ground, with a knoll in the centre from which an excellent view of the surrounding country can be obtained; the top of it is about 50 feet above the neighbouring land. Queen's Park Consists of about 30 acres in the North Ward, the southern boundary being near to the North Western Railway, and the northern near the North London Railway; it is within easy access of the populous part of South Kilburn; it is divided into two parts, the lower portion of an ornamental character, and the upper a recreation ground, greatly taken advantage of by children for cricket and games. The Harlesden portion of the West Ward has also a distinct advantage in having the large open space of Wormwood Scrubs immediately to the south of it, which is never likely to be built upon. Although not perhaps of much advantage as a recreation ground for the youth of our district, yet that there should be such an open space within a short distance will be a great gain as buildings increase. There is also Old Ooak Common adjoining the north-western side of the Scrubs which it is to be hoped will likewise remain unbuilt upon. Paddington Recreation Ground. This ground, which consists of about 22 acres, has been preserved for recreation by the joint action of the local authorities contiguous to it. It is situated in Paddington, but is near to the southeastern border of the South Ward, and preserves an open space in a thickly populated part. Under the Paddington Recreation Act of 1893 the Local Board subscribed the sum of £1,000 towards the purchase of the ground. The total amount required was £33,000. Sanitary Report, 1893. 15 POPULATION. The population at the middle of the year is estimated at 69,159. In making this estimate the same plan of calculating from the number of houses has been adhered to as on former occasions. Taking the number of houses which have been added to the rate book, and making the same allowance for empties—6.9 per cent.—which was found at the time of the census, then multiplying by the average number of people in each house, a fairly correct estimate can be obtained, the result is also corroborated by the birth rate for the year. The average increase each year from 1881 to 1891 was 3,365, and that is about the rate of increase that has been maintained. I explained in my report for 1891 how I considered too high an estimate would be obtained by logarithms; Dr. Sykes in his report to the County Council, calculating in that way, gives 67,682 as the estimated population of Willesden at the middle of 1892, but adopts for his general calculations the estimates given by the Medical Officers of Health in their various reports; my estimate for that year was 65,744. According to a return received from Mr. Seabrook, the Clerk to the Board of Guardians, there were 178 inmates of the Workhouse belonging to Willesden who should be added to the estimate— 64 males, 94 females, and 20 children; this makes the estimated population 69,337. 16 Willesden Local hoard. TABLE NO. 1. Area in acres. Wards. Population at Census, 1891. Houses placed on Rate Books since Census, less 5 9% for empties. Average number of persons to each house at Census. Increase of Population since Census. Estimated Population at middle of 1893. Number of Persons per acre. 349 North 8679 266 6.2 1655 10334 29.6 2137 East 14698 473 6.9 3259 17957 8.4 1744 West 16856 462 6.2 2869 19725 11.3 152 South 21033 10 11.03 110 21143 139 4382 Totals 61266 1211 7893 69159 Total Estimated Population at middle of 1893, after deductions for empty houses. 69,159. Table No. 2. The Metropolitan District comprises:— North Ward 1,666 houses Population 10,334 East „ 1,375 „ „ 9,487 West „ 1,043 „ „ 6,436 South „ 1,919 „ „ 21,143 47,400 The Brent District comprises:— East Ward 1,227 houses Population 8,470 West „ 2,138 „ 13,289 21,759 47,400 69,159 Sanitary Report, 1893. 17 Totals:—  Population. Area in Acres. Metropolitan District 47,400 1,080 Brent „ 21,759 3,302 Which will give an average of 43.8 persons per acre in the Metropolitan, and 6.58 per acre in the Brent Drainage Districts. Table No. 3. Marriages celebrated in Churches:— First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. St. Mary's 6 8 8 12 34 All Souls 5 10 15 13 43 St. Andrew's 6 6 3 9 24 Christ Church 3 9 8 9 29 Holy Trinity 9 17 26 19 71 St. John's 20 26 23 22 91 St. Michael's 1 4 5 4 14 50 80 88 88 306 Table No. 4. BIRTHS. The number of Births registered during the year has been 2,256. 1893 Boys. Girls. Total. First Quarter 299 284 583 Second Quarter 316 264 580 Third Quarter 274 261 535 Fourth Quarter 273 281 554 1162 1090 2252 Willesden Local Board Table No. 5. Births distributed in Wards as follows:— Wards. First Quarter Second Quarter. Third Quarter. Fourth Quarter. Total. Rate. North 78 73 67 61 279 27 East 139 154 147 153 593 33 West 169 176 150 166 661 33.5 South 197 177 171 174 719 34 583 580 535 554 2252 In Table 7 I have divided the Wards into subdivisions so as to be able to shew more minutely the details of each locality, its births, deaths, and notifications of infectious diseases. The natural increase by births over deaths has been 1,180. Birth rate for the year 32 5 „ „ Boys 1675 Girls 1672 The birth rate for England and Wales has been 30'7. In the great towns of the country the birth rate has been as nearly as possible 32.0 per 1,000 Illegitimate Births. There were 45 registered during the year (25. boys and 20 girls), being 2 per cent. of the total births. DEATHS. With the increase of population there is also an increase in the number of deaths, but not necessarily an increase of the average. There have Sanitary Report, 1893. 19 been 1014 deaths registered (exactly 507 of each sex), and there have been also 45 (males 13, females 18, children 14) which have occurred at Edgware among the inmates of the Hendon Union Workhouse, and 13 fatal cases of infectious diseases in various Metropolitan hospitals; this will make the total deaths amount to 1072, equal to a death rate of 15.46 per 1,000. The rate for each year for the last ten years is as follows:— 1884 14.67 1885 16.24 1886 15.46 1887 14.28 1888 15.78 1889 12.00 1890 14.36 1891 13.82 1892 14.37 1893 15.46 There have no doubt also been deaths which have taken place outside the district of people belonging to it, and some that have occurred within of those not belonging to it. Anything like a correct number I have been unable to ascertain, and have consequently omitted them in calculating the average, but I do not imagine it would make much material difference in the death rate. 20 Willesden Local Board. The average rate for England and Wales during the year has been 191 In 33 great towns the average has been 21.5. In 67 other large town districts, in which Willesden comes about fourteenth in amount of population, the death rate comes to 19.1. I find in looking through the Registrar General's quarterly reports that he makes the total number of deaths belonging to Willesden come to 1,077, and adds the following note in reference to the 67 large town districts:— " The deaths in these towns have been " corrected by the exclusion of a proportional " number of deaths occurring in hospitals and " lunatic asylums situated within the dis" tricts or sub-districts here taken as repre" senting the towns, or by the exclusion or " addition of a proportion of the deaths in " Union Workhouses." I do not know how many deaths may have occurred in lunatic asylums, but the total is only five in excess of my own information, making the death rate equal 15.5. Deaths due to Specific Febrile or Zymotic Diseases 200 „ „ Parasitic and Dietic Disease 5 ,, ,, Constitutional Disease 159 „ „ Developmental „ 89 Sanitary Report, 1893. 21 Local— Nervous 104 Circulation 67 Respiration 170 Digestive 80 Urinary 26 Others 11 458 „ ,, Violence 28 Ill-defined and not specified causes, such as Debility 75 1,014 Infant Deaths. The deaths of infants under one year of age amount to 345, which gives a death rate of 153 per 1,000 births, and a per centage of 32 2 of total deaths. Of children under five years of age there were 475, equal to 44 3 per cent of total deaths. Illegitimate Children. Thirty-three deaths occurred. Inquests were held in two cases, the verdict of one being Homicide, the other from Natural Causes. Both the births and the deaths were less than last year. Inquests. There have been 60 inquests held. The verdicts were: 30 from Natural Causes, 17 Accidental, 11 Suicide, and 2 Homicide. Deaths not Certified. There were 12 deaths which were not certified and no inquest was held. The causes given were: Premature Birth, 6; Epilepsy, 1; Consumption of Bowels, 1; Convulsions, 2; Weak Heart, 1; Senile Decay, 1. 22 Willeeden Local Board. Table No. 6. No. of Deaths. I.—SPECIFIC FEBRILE, OR ZYMOTIC DISEASES. 1. Miasmatic Diseases 132 2. Diarrhoeal ,, 52 3. Malarial „ ... 4. Zoogenous „ ... 5. Venereal „ 5 6. Septic ,, 11 II.—PARASITIC DISEASES 1 III.—DIETIC DISEASES 4 IV.—CONSTITUTIONAL DISEASES 159 V.—DEVELOPMENTAL DISEASES 89 VI.—LOCAL DISEASES. 1. Diseases of Nervous System 104 2. Diseases of Organs of Special Sense ... 3. Diseases of Circulatory System 67 4. Diseases of Respiratory System 170 5. Diseases of Digestive System 80 6. Diseases of Lymphatic System .. 7. Diseases of Gland-like Organs of Uncertain Use ... 8. Diseases of Urinary System 26 9. Diseases of Reproductive System ... (a) Diseases of Organs of Generation 2 (b) Diseases of Parturition 3 10. Diseases of Bones and Joints 3 11. Diseases of Integumentary System 3 VII.—VIOLENCE. 1. Accident or Negligence 18 2. Homicide 1 3. Suicide 9 4. Execution VIII.-ILL-DEFINED AND NOT SPECIFIED CAUSES 75 Total 1014 WILLESDEN LOCAL BOARD Chart of Notifications for 1893. Notes: In the above Chart I think it is very noticeable how Diphtheria and Scarlet Fever have frequently risen and fallen together; if not actually in the same week, yet in a short time there has been a corresponding rise or fall, excepting during the autumn rise of Scarlet Fever, and even then there are slight rises of Diphtheria to a certain extent with it. It will be observed that when Scarlet Fever, on the last week in August, was lower than it had been at any previous time, there were no cases of Diphtheria,, but Typhoid Fever reached its highest point in the year, this was due to four members of one family being taken with it, and the Doctor who notified was of opinion that the disease was contracted at the seaside. Sanitary Report, 1893. 23 WARDS. SubDivi sion. Population at census Estimated Population middle of 1893. Births. Deaths. Deaths from Zymotic Diseases. Notifications. Ward Totals. Smallpox. Scarlet Fever. Diphtheria. Membr. Croup. Typhoid Fever. Puerper'1 Fever Cholera. Erysipelas. Measles. Whoop'g Couch Diarrhœa. Totals. Ward Totals. Smallpox. Scarlet Fever. Diphtheria. Membr. Croup. Typhoid Fever. Puerper'l Fever Cholera. Erysipelas. Typhus Fever. Totals. NORTH South Portion 1 6004 7126 215 93 1 8 1 2 3 15 51 25 2 1 5 84 North Portion 2 2675 3208 63 46 3 3 1 1 8 2 40 7 2 8 59 Total 8679 10334 279 139 23 2 91 32 4 1 13 143 EAST Kensal Green 3 5863 7342 321 103 1 1 4 1 7 8 22 9 72 17 4 1 3 1 107 Willesden Green. 4 5903 6451 220 90 2 2 1 5 2 29 7 2 1 5 46 Mapesbury 5 2028 2145 13 14 1 1 11 7 1 2 4 25 Cricklewood 6 904 2019 39 17 1 1 5 1 1 7 Total 14698 17957 593 224 29 11 117 32 1 8 2 13 1 185 WEST Church End 7 4129 4309 169 72 1 1 2 1 1 3 9 21 8 2 8 39 Harlesden (Metropolitan) 8 5914 6436 201 90 1 1 5 7 14 55 11 3 1 1 14 85 Ditto (Brent) 9 4007 5578 190 62 3 1 2 3 9 1 40 21 1 10 20 93 Lower Place 10 430 517 19 13 1 1 1 3 1 13 1 3 3 20 Stonebridge 11 1628 2045 56 31 1 1 3 4 9 1 52 3 2 1 8 66 Neasden 12 748 840 26 17 6 1 7 10 2 3 15 Total 16856 19725 661 285 51 1 191 46 1 20 2 1 56 318 SOUTH Northern Portion 13 11660 11715 393 223 7 5 6 9 14 41 3 87 60 6 2 1 40 199 Southern Portion 14 9373 9428 326 143 2 3 4 1 2 5 6 23 6 103 51 13 17 190 Total 21033 21143 719 366 64 9 190 111 6 15 1 57 389 Grand Totals 61266 69159 2252 1014 1 15 32 6 9 4 3 11 34 52 167 23 589 221 8 47 6 1 139 1 1035 TABLE No. 8. Table of Deaths during the Year 1893, in the Urban Sanitary District of Willesden, classified according to Diseases, Ages and Localities. Wards. Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 5. 6 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Smallpox. Scarlatina. Diphtheria. Mem. Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Injuries. All other Diseases. Total. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. North 139 29 15 7 5 53 30 under 5 ... 2 6 ... ... ... ... ... ... ... ... 3 ... 3 ... ... ... 3 1 3 23 44 5 upwds. 2 5 2 9 15 10 52 95 East 224 87 22 10 10 71 24 under 5 1 1 3 ... ... ... ... ... ... ... ... ... 9 9 ... ... 2 17 ... 2 65 109 5 upwds. 3 2 1 2 14 20 16 57 115 West 285 98 40 13 10 74 50 under 5 6 1 1 ... ... ... ... ... ... 1 ... 11 18 ... ... 3 21 2 1 73 138 5 upwds. 2 4 3 2 1 1 2 12 14 17 9 80 147 South 366 131 53 21 9 106 46 under 5 1 6 3 ... 1 ... ... ... ... ... 8 14 20 ... ... 3 29 2 2 94 183 5 upwds. 1 4 2 3 1 2 30 37 13 3 87 183 Totals 1014 345 130 51 34 304 150 under 5 1 10 16 4 1 1 11 34 50 8 70 5 8 255 474 5 upwds. 5 16 2 8 4 2 2 6 65 86 56 12 276 540 24 Willesden Local Board. Sanitary Report, 1893. 25 TABLE No. 9. Table of Population, Births, and of New Cases of Infectious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1893, in the Urban Sanitary District of Willesden; classified according to Diseases, Ages, and Localities. Wards. Population at all ages. Registered Births. Aged under 5 or over 5. New cases of Sickness in each locality coming to the knowledge of the Medical Officer of Health. Number of such cases removed from their homes in the several localities for treatment in Isolation Hospital. Smallpox. Scarlatina. Diphtheria. Mem. Croup. Fevers. Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Mem. Croup. Fevers Cholera. Erysipela. Census 1891. Estimated to middle of 1893. Typhus. Enteric or Typhoid. Continued Relapsing. Puerperal. Typhus. Enteric or Typhoid. Continued Relapsing. Puerperal. North 8679 10334 279 Under 5 ... 23 6 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 5 upwds. 2 68 26 ... ... 4 ... ... 1 ... 12 2 6 ... ... ... ... ... ... ... ... ... East 14698 17957 593 Under 5 2 40 7 ... ... 2 ... ... ... ... 3 1 2 ... ... ... ... ... ... ... ... ... 5 upwds. 9 77 25 1 1 6 ... ... 2 ... 10 9 14 ... ... ... ... ... ... ... ... ... West H. 16856 19725 661 Under 5 ... 74 5 ... ... 3 ... ... ... ... 8 ... 9 ... ... ... ... ... ... ... ... ... 5 upwds. 1 117 41 1 ... 17 ... ... 2 1 48 1 26 ... ... ... ... ... ... ... ... ... South 21033 21143 719 Under 5 1 59 49 5 ... ... ... ... ... ... 12 ... 15 ... ... ... ... ... ... ... ... ... 5 upwds. 8 131 62 1 ... 15 ... ... 1 ... 45 8 34 ... ... ... ... ... ... ... ... ... Workhouse Hendon Union 178 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 61266 69337 2252 Under 5 3 196 67 5 ... 5 ... ... ... ... 24 1 27 ... ... ... ... ... ... ... ... ... 5 upwds. 20 393 154 3 1 42 ... ... 6 1 115 20 80 ... ... ... ... ... ... ... ... ... Isolation Hospital is in the West Ward. 26 Willesden Local Board. NOTIFICATION OF INFECTIOUS DISEASES. The Local Act requiring the above came into force in October, 1887, and has been in operation, therefore, for over six years. I do not think that any difficulty has arisen in the working of the Act, either in the time of my predecessor, the late Mr. Branthwaite, or since you did me the honour t,o appoint me as your Medical Officer in 1889, but that it has been most loyally and willingly carried out by the medical men of the neighbourhood. Having myself given up general practice in the district at the beginning of the year, there has been, I think, a disposition on the part of some of the medical men to ask my co-operation in cases presenting doubts and difficulties (and there must be always such) and an expression of satisfaction that there should be some one of an independent position whose assistance they can ask under such circumstances There has been a large increase in the number of notifications, the total being 1,035, giving an average of 14.92 per 1,000 of the population. The number of deaths from zymotic diseases has been 167 including 13 that have occurred in the Metropolitan hospitals, this gives an average death rate of 2.41 which is lower than the zymotic rate for the country generally, which is about 3.25, but is of course liable to vary. Small Pox. Small Pox has broken out twice during the year, several cases having been notified on each occasion; the first was in the spring, when there were nine cases, and the second at the end of the year, when there were fourteen. The first case in the spring was a young man who was partially imbecile, and on that account could not be received into the Highgate Hospital; he 27 Sanitary Report. 1893. had to be isolated in his own home under great difficulties. No actual proof of origin could be found, but he was a member of the Salvation Army and had been attending their meetings at Notting Hill. The second case, an unvaccinated child, was found to have been visited, contrary to express instructions, by people from the first case; it proved fatal. The child could not be removed to Highgate, their rule being not to receive cases under seven years of age. Two other cases occurred in the same locality. There was, a little later, small pox in another part of the district with a distinct origin. This was due to the fact of a young man living in Islington being sent to his mother's house in Willesden, because of illness which soon proved to be small pox; a lodger in the same house took it. There were other cases, the origin of which I was unable to trace. The second outbreak was in November, all the patients living in the southern boundary of the parish. There had been several cases of small pox in the Metropolis adjoining. The otdy death was the unvaccinated child above mentioned; the other cases, as far as I have been able to ascertain, were not of a severe character, and had all been vaccinated in early life but not since. As each case occurred I strongly advised all the other inmates of the house to be vaccinated, and second cases only occurred in those instances where persons refused to be done. In several cases the vaccination marks covered a good-sized area, and the cases were very slight. Many of the cases were removed to the Highgate Small Pox Hospital, but the expense attending it— seven shillings a day for each patient—and the rule not to admit any patient under seven years of age, made it imperative for the Board to provide accommodation of their own, which was done in the spring in tents, and subsequently by an iron building on the 28 Willesden Local Board. hospital ground. In order to take precautions against the disease spreading in the hospital, I vaccinated all the staff and some of the convalescent patients who expressed a wish to be done, and no one connected with the hospital suffered. All the vaccinations done by me were with calf-lymph and proved successful, so that I feel if such precautions had not been taken some of the staff might possibly have contracted the disease. The total number of cases notified was 23, of whom 10 were sent to the Highgate Hospital, 4 were treated at home, 8 at the Isolation Hospital, and 1 at the Small Pox Hospital at Fulham. Scarlet Fever Prevailed extensively all through the year till the last few weeks, the number of cases notified being 589; they amounted to 10 and upwards per week during 34 weeks, but not consecutively. The deaths have been 15 which gives a rate of 0.21 per 1,000, which is below the general average. From the weekly published reports in the papers of the health of London it was evident that scarlet fever was not excessive in the earlier part of the year, but prevailed very extensively during May, June and, July; there was a fall during August till the second week of September, and a very high rate during the remainder of that month and October with a great decline during November and December. The chart will show how nearly that coincides with our own experience. The North Ward, after being clear for eight weeks had a sudden outbreak of eleven cases on one morning, which led me to question the milk supply, but on careful enquiry I found that milk was not the cause, but some accidental communication by school children; the numbers very soon declined. Shortly before Easter a considerable number of children attending the Roman Catholic Schools in the 29 Sanitary Report, 1893. West Ward, Harlesden, were reported as being absent from school on account of scarlet fever. I inspected the children at the school, and in my report to the Board, advised that the school should be closed at once instead of wailing for the holidays. This was done, and the school kept closed between four and five weeks, three of which were holidays. During the interval the school rooms were thoroughly disinfected, and I inspected them again before advising that the school might be reopened. No complaints were received afterwards of fresh cases among the children. Recurrent Cases. On May 4th four notifications from one house were received, and on referring to the Street History it was found that two of them were notified as having had scarlet fever in the previous September. Diphtheria. Diphtheria has been very prevalent in many parts of the country, and there has been a considerable increase of the disease in our own district. It has been a subject of frequent observation how diphtheria is becoming so much more prevalent in towns than formerly; during the year 1893 London and other towns have had a large increase. Our own experience for some years was that the rural portion of the district had more than the thickly-populated urban part, the West Ward having the largest proportion. This condition has been entirely changed this year, the number of persons attacked being in the Persons per acre. North Ward 3.0 per 1,000 29.6 East „ 1.7 „ 8.4 West „ 2.3 „ 11.3 South „ 5.2 „ 139.0 30 Willesden Local Board. There were 221 cases notified, half of them being in the South Ward. The number notified last year was 141, very nearly half of which were in the South Ward, so that the tendency for it to be settled in the more populated parts is more pronounced. No doubt many of the cases were of a very mild nature and would not be classed by all medical men as Diphtheria, but in some cases the disease proved its virulent character by the number attacked in the house. In my report for 1891 I referred to the condition of school attendance as being conducive to the spread of the disease, the school age being the one most liable to attack. The present increase showing itself so much more in towns seems again to point to the schools as the principal source. No particular school in the district has been associated with any special preponderance. I have great hopes that the opportunities of isolation which the completion of the hospital will afford may have good results in reducing the number of cases. I am satisfied that the improvement in the drainage of the High Street, Harlesden, which the Board had carried out about three years ago, has had a decidedly beneficial effect on the number of cases in the neighbourhood, only one case having been notified in 1892 and 1893. At one house in the South Ward eight cases occurred. I visited the house on two or three occasions, the drains were tested, and the house was examined by the Sanitary Inspector, but no defects were found; I can only think that the importance of absolutely keeping the children apart was not fully realized. The number of deaths, including 12 in the Metropolitan hospitals, has been 44, which gives a rate of 0'63 per 1,000. This is above the general average of a few years ago. The rate for London has averaged about 0.75. 31 Sanitary Report, 1893. In making these calculations of the death rate of each zymotic disease I have excluded the residents in the Hendon Workhouse, as I am not aware of the causes of the 45 deaths that occurred there. Measles. This disease has been less prevalent than last year; the deaths due to it have been 11, equal to a rate of 0.15 per 1,000, which is considerably below the average 0.41. Last year the deaths were 48. Generally I have found the deaths from Measles to exceed the deaths from scarlet fever, but it is not so this year. No deaths occurred in the East or West Wards. Whooping Cough. This has maintained about its usual rate, the deaths numbering 34. In the year 1890 the deaths were 43 1891 „ 42 1892 „ 36 1893 „ 34 Taking the increased population into consideration the death-rate from this disease during the last four years has decreased, it was in excess of the general average but this year is about equal. It is to be hoped that this gradual improvement is due to a better appreciation on the part of the public of the care and treatment requisite in these cases. It was for a long time the practice among parents not only to allow but to send their children out in the open air regardless of weather and cold winds, and totally disregarding the stage which the disease had reached and ignorant of the very infectious nature of it. 32 Willesden Local Board. The idea was that fresh air was the cure, but it resulted in severe attacks of bronchitis and many deaths. It is now more generally understood that keeping the children warm, isolating and keeping them in one room and disinfecting the air of that room by carbolic vapour is a quicker and more effective plan of treatment. Typhoid Fever. One notification was received of a case of typhus fever. The patient had but two days before returned from a provincial town where he had been acting in a circus; he died by the time the notification was received; the death however was registered as typhoid fever. The total number of cases of typhoid fever notified hare been 47, being 19 more than last year; the greatest increase was in the West Ward. The deaths have been nine. None in the North Ward, two in the East, three in the West, and four in the South Ward, this is equal to a rate of 0.13 per 1,000, being below the general average of the country, which is 0.22. On referring to the Chart it will be seen that four cases in one house in the West Ward were attributed to the disease having been taken while away at the seaside, the other cases were single ones at different periods of the year in separate localities; defects in the houses were found in a few instances and remedied. Puerperal Fever. Four deaths have occurred, two in the North and two in the West Ward, one in each Ward in the second quarter, and one in each in the third quarter, but several weeks between. 33 Sanitary Report, 1893. Erysipelas. There have been several cases of Erysipelas during the year but many have been of a slight character. This disease and puerperal fever with some others come under the head of septic diseases, or the more generally familia???term of blood poisoning; they are of a highly infectious nature. Erysipelas, especially in a severe form, may be due to insanitary condition, and if brought in contact with a patient in child-birth is extremely liable to give rise to puerperal fever; they require therefore to be guarded against by the most perfect antiseptic precautions which a person can take who might be brought in contact with them. The antiseptic precautions in the treatment of wounds as introduced by Professor Lister are most especially necessary in regard to these diseases of a septic nature. Cholera. This disease again caused a great deal of anxiety during the Summer. It made its appearance in England, chiefly at Grimsby, but at other places also. On Sunday, September 10th, a case of cholera was notified in Harlesden, and as the patient had just come from Grimsby, the Sanitary Inspector very rightly thought it necessary to telegraph for me as I was away for my holiday at the time. I returned and saw the patient the same night with the doctor who was attending. Every precaution was taken in keeping the patient away from other people ; there were no children in the house and the accommodation was good. Some of the secretions were forwarded to the Medical Officer of the Local Government Board and everything was thoroughly 34 Willesden Local Board. disinfected. Dr. Klein's report of the secretion was that it undoubtedly contained the Cholera Bacillus, but there were also so many different kinds of Bacillus present that no cultivation could be obtained. The patient recovered. No other cases were notified. Last year I issued a placard of precautions advisable to be observed but did not think it necessary to do so again. Diarrhœa. The number of deaths due to diarrhoea has been 52, infantile summer diarrhoea having been very prevalent in the third quarter of the year, 38 deaths of children under 5 years having taken place in those three months, three of them only being over one year ; there was one death of a person over 65 years of age making the total for the quarter equal 39. The 52 deaths give a death-rate of 0 75 per 1,000 which is slightly in excess of the general rate 0 65 for some years, but below it for this year. The general rate of the whole country for the year was 0.96. In 33 great towns 1.22; in the 67 other town areas 1.24. In the third quarter, when the disease mostly prevailed, the rate for the country generally was 2.81: in 33 great towns 3.48; in 67 other large town districts 3.73; in Willesden 2.25, so that although the number of deaths in Willesden for that quarter was undoubtedly high, yet that the same causes were in operation throughout the country. The West and South Wards had the largest number of the cases, but they were by no means clustered together as 10 roads in the West Ward had one death each. Phthisis. The deaths numbered 73, equal to a rate of 1.05 per 1,000 which is below the general rate for the 35 Sanitary Report, 1893. country which is about 1.75. Dampness of soil and want of fresh air and ventilation in rooms are great aids in the production of Phthisis. The warmth and dryness of the spring may have had beneficial influence. Influenza. Influenza has prevailed again to about the same extent as last year, the deaths due to it numbering 30 in the year; there being 7 in the first quarter. 7 in the 2nd, none in the 3rd, 16 in the 4th. Although no deaths occurred in the third quarter it was not altogether absent, as some cases came under my own notice in the month of August, so that it would almost appear as if it had taken up its permanent abode amongst us; there is also an unpleasant fact in connection with it, that no matter how severe an attack may have been it in no wav assures a patient against a recurrence of the illness, or a severe relapse before convalescence is established; it also assumes to itself as many peculiarities and idiosyncrasies in its symptoms as indigestion does; no doubt chest affections are its most frequent associates, but brain symptoms, inflammation of the intestines, and of the kidneys, are recorded in the death certificates among its after effects; or it may be followed by a general debility, without any positive lesion of any organ, which may take a long time to recover from; it is therefore a disease that should not be ignored at its onset, but the patient should at once take such precautions as would tend to keep off any secondary illness and recognize the susceptibility to such attacks which the illness predisposes to. From the above statistics of the diseases referred to it will be seen that small pox, scarlet fever, 36 Willesden Local Board. measles, typhoid, and phthisis were below the general average ; whooping cough was about equal to it, and diphtheria and diarrhoea were above, though the latter was below the general average for the year. CEMETERIES. The new Cemetery of 27 acres was opened during the year, and interments are now taking place in it instead of the Churchyard. The drainage from the Paddington Cemetery in the North Ward has been put into a more satisfactory condition. There is a special cemetery belonging to the Jews which is near the new Willesden Lemetery. The new cemetery adjoins in one part the new Recreation Ground. There will be thus about 70 acres of ground in the West Ward which will remain unbuilt upon. SANITARY INSPECTIONS. I cannot speak too highly of the necessity and great importance of this work. Owing to the urgency of other work that has fallen upon the Sanitary Inspectors through the rapid increase of the district and the multiplication of duties by Acts of Parliament the inspection is not able to be gone through so frequently as is desirable, but at the same time it will be seen from the summary that a great deal has been done, the number of houses inspected during the year having been 2,104. 37 Sanitary Report, 1893. VACCINATION RETURN. No. of Births in the Year. Successfully Vaccinated. Insusceptible to Vaccination. Dead unvaccinated. Postponed by Medical Certificate. Remov'd to other Districts Gone away, Address not known. Still unvaccinated. 2225 1517 20 209 21 6 160 292 The above return is in accordance with the one always added in my Annual Report. It accounts for all the children born and propably the greater number, if not all, of those in the last column are children under three years of age. I have no doubt there are children brought into the parish who have not been vaccinated, and of whom no information is available. The importance of vaccination and revaccination I think is shewn in my Report with regard to Small Pox. PRIVY COUNCIL ORDER, 1885. Under the above Order inspections were made of the various premises registered in the District. These comprise the Cowsheds, Dairies and Milkshops. COWSHEDS. There are twelve separate stables for cows in the District. Of these seven are in connection with farmed land, and five are kept by dairymen in close contiguity with their premises for the supply of special milk for customers. In the aggregate about 500 cows are kept, when the sheds are occupied, which is only for a portion of the year, the animals being turned out in the fields when circumstances are suitable. 38 Willesden Local Board. Advantage is taken of this to serve notices to cleanse and whitewash in accordance with the Regulations. These were seen to have been complied with on inspection after occupation, and also the cubic space required for each animal. All these Cowsheds have now a proper water supply laid on from the West Middlesex Water Company. DAIRIES AND MILKSHOPS. The number of Dairies and Milkshops on the Register is 64. These were periodically inspected, and again when any suspicious circumstance arose to excite inquiry. They were generally found to be kept scrupulously clean, and the utensils properly scalded and washed. FACTORY AND WORKSHOPS ACT, 1891. Inspections were made of the Workshops in the District, 156 in number, which under the above Act include the Laundries With the exception of the Metropolitan Railway Works at Neasden, the the Signal Works at Kilburn, and the Steam Laundries at Barry Road, Stonebridge, Dyne Road and Kilburn Lane, they are of miniature proportions, only three of them employing more than twenty hands. Notices were served on several to cleanse and whitewash, and in one instance to provide additional sanitary accommodation which were complied with. 39 Sanitary Report, 1893. At the Kilburn Signal Works a new system of automatic trough closets and urinals were constructed in a more suitable position to replace obsolete arrangements which were a nuisance. The Workshops within the Order of the Secretary of State of November, 1892, employing Outworkers were visited and the names and addresses of Outworkers taken and duly registered in the Local Registry. BAKEHOUSES. The Bakehouses in the District, numbering 41, were under inspection. Of these 19 are below the ground level and mostly under the shops. Ventilation is provided by means of hanging lights under the shop windows, sloping to bakehouse ceiling. They were all called upon to whitewash in accordance with the Regulations which require this to be done twice in a year. In a few cases the sweepings were found under the troughs, and in one instance a dog was found to have access to the bakehouse which was ordered to be discontinued. SLAUGHTER-HOUSES. There were no new Licenses issued during the year. The existing licensed premises were periodically under observation, and were found to be managed well and in accordance with the Bye-laws. In one instance owing to the Report of the Inspector, the premises were visited by the Outdoor Committee, which did not report unfavourably. 40 Willesden Local Board. COMMON LODGING HOUSES. These were inspected from time to time and found to be well managed. They, however, are not of the usual type, being only coffee houses, where a few beds are let, and in many cases the lodgers are continuous. CANAL BOATS. During the year 49 visits were made to the Canal within the District by the Inspector and inspections were made of 105 boats. There were 29 cases of contravention, notices of which were served on the owners requiring amendment, all of which were complied with and duly vouched for. INFANT LIFE PROTECTION ACT. There are now no licensed premises under this Act in the District, as no renewals were taken up and no new premises were licensed. HOUSES LET IN LODGINGS. Under Section 90, 320 houses were registered during the year. They were visited and the Byelaws found to be generally complied with. HOUSE REFUSE AND SCAVENGING. The details of these works will be found in the Reports of the Engineer. I may state that the Dusting is carried out by two Contractors for a section of the District each for a lump sum, which includes the provision of a shoot. This is mostly by Canal to the Brickfields a few miles out. 41 Sanitary Report, 1893. The scavenging is managed by the Engineer's Department under the horse hire system and the shoots are mostly in the fields in the rural portion of the District. NEW DRAINS. New drains were constructed after notice under Section 23 as follows:— Willesden Lane 2 Harlesden Lane 1 Meyrick Road 2 Canterbury Road 4 Charlton Road 13 Church End 1 Harrow Road 1 Craven Park Road 2 Church Road 1 Princess Road 1 Albert Road 1 Denzil Road 1 Victoria Road 1 Rudolph Road 1 Cambridge Avenue 1 Oxford Road 1 Stracey Road 1 35 LEGAL PROCEEDINGS. During the year Legal Proceedings were taken to enforce the Orders of the Board in the following cases:— Houses in such a state as to be a nuisance 3 Animals kept in such a manner as to be a nuisance 2 5 42 Willesden Local Board. SPECIAL COMPLAINTS, 1893. Insanitary condition of houses 55 Defective water closets 35 Offensive odours 53 Offensive accumulations and deposits 41 Defective drains 59 Animals kept a nuisance 13 Drains choked 37 Smoke nuisances 7 Offensive cesspools 4 Polluted ditches 8 Damp floors 1 Foul cisterns 5 Water in cellars 7 Manure 6 Intimations from the West Middlesex Water Works of water cut off *360 Dirty yards 3 Stagnant pools 1 Gipsy caravans 2 Ballast burning 7 Overcrowding 11 Fried fish shops 3 Slaughterhouse 1 Cellar dwelling 1 Urinals offensive 2 Total 722 * Water cut off from houses included a great many empty ones. 43 Sanitary Report, 1893. The following four tables have been supplied in order to assist in the compilation of the Middlesex County Council Annual Report. Table No. 1. Complaints received 722 Cases of Infectious Diseases notified 1035 House inspection, from house to house 2104 Premises periodically inspected 282 Total number of Inspections Total number of Re-inspections after order of notice 5216 Letters written 1020 Cautioning Notices given 625 Statutory Orders issued 261 Summonses served 6 Convictions obtained 5 Houses and Premises cleaned and repaired 29 Houses let in separate dwellings registered 320 Number registered 4 Canal Boats inspected 105 Number of Contraventions 29 Movable Tents, Caravans, Ac. observed 45 Ditto removed from district 45 Table No. 2. Cisterns, new, provided 8 Cisterns cleaned, repaired, and covered 37 Flush Cisterns provided to w.c.'s 106 Water Closets, new, constructed 22 Ditto new apparatus provided 62 Ditto repaired and cleaned 26 Ditto supplied with water 280 Percentage of Houses supplied with w.c.'s All. Drains examined, tested, &c. 305 Ditto repaired and trapped 127 Waste Pipes disconnected 26 Soil Pipes and Drains ventilated 10 Ditto reconstructed 68 Ditto new laid 35 Cesspools abolished 2 44 Willesden Local Board. Table No. 3. Number of Workshops 6 Contravention of Factory Act 1 Number of Laundries 156 „ Inspections 156 „ Sanitary defects 21 „ Bakehouses 41 „ Sanitary defects 16 „ Inspections 62 „ Slaughterhouses on register 9 „ Inspections 18 Contravention of Bye-laws 2 Number of Cowsheds on register 12 „ Inspections 20 Contravention of Bye-laws Nil. Number of Dairies and Milkshops on register 64 „ Inspections 96 Contravention of Bye-laws 11 Unsound Food Articles condemned 3 Bodies removed to Mortuary 5 Table No. 4. Booms fumigated 561 Dustbins repaired 71 ,, provided (new) 25 Periodical removal of House refuse Weekly Number of Complaints of Non-removal 230 Hoofs repaired 7 Gutterings and Bain Pipes repaired 16 Yards paved and drained 133 Ventilation below floors provided 23 Overcrowding 9 Smoke Nuisance 4 Accumulations 55 Foul Ditches, Ponds, &c. 9 Pigs and other Animals kept as a Nuisance 20 Summary of Systematic Inspection, 1893 LOCALITY. Defective Water Supply. Cisterns dirty and uncovered. Drains choked. Defective and foul w.c.'s Dilapidated Guttering and Rain Pipes. Damp Walls. Defective Traps. Waste pipes in Drains. Animals kept a nuisance. Offensive accumulations. Defective joints to vent pipes. Leaky Cisterns. Dilapidated Ashpits. Leaky Roofs. Cellar Dwellings. Dilapidated Yard Paving Dirty Rooms. Dirty Yards. Overcrowding. Total number of Houses. Albert Road 8 .. 1 1 3 .. 3 .. .. .. .. .. 7 .. .. 3 .. .. .. 116 Greyhound Road 11 .. .. 1 .. .. .. .. .. .. .. .. 4 .. .. 1 .. .. .. 62 Felixstowe Road 13 2 1 .. 1 .. .. .. .. .. .. .. .. .. .. 4 .. .. .. 51 St. Anne's Terrace 4 3 3 2 .. .. 3 .. .. .. .. .. .. .. .. 9 .. 1 .. 16 Ravensworth Road 7 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 3 .. .. 51 Earlsmead Road 15 .. .. 1 .. .. .. .. .. .. .. .. 3 .. .. 5 .. .. .. 44 Denmark Road 7 .. 1 .. 3 .. 2 .. .. .. .. .. .. 1 .. 6 4 .. 108 Hiley Road 9 3 1 .. .. .. .. .. .. .. .. .. 8 .. .. 7 .. .. .. 53 St. Margaret's Road 8 1 .. .. .. .. .. .. .. .. 2 .. 2 .. .. 4 .. .. .. 48 Canterbury Road 12 .. .. .. .. .. 3 .. 1 .. .. .. .. .. .. 4 4 .. 3 152 Carlton Vale 7 3 .. 2 .. .. .. .. .. 2 .. .. 4 .. .. .. .. .. .. 112 Granville Road 14 .. .. 5 .. .. .. .. .. 4 .. .. 7 1 .. 10 .. .. 4 90 Salusbury Road 6 .. .. 1 .. .. 2 .. .. .. .. .. 3 .. .. .. .. .. .. 31 College Road 8 2 .. .. .. .. 1 .. .. .. 3 .. 2 .. .. 8 .. .. .. 52 Hazel Road 6 4 .. .. .. .. 3 .. 2 .. .. .. 2 .. .. 3 .. .. .. 54 Disraeli Road 7 .. 1 1 .. .. .. .. .. .. .. .. 2 .. .. .. 4 .. .. 26 Steele Road 4 .. 3 2 .. .. .. .. .. .. .. .. 2 .. .. 3 .. .. .. 35 Albert Gardens 3 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 2 .. .. .. 18 Percy Road 5 .. .. .. .. .. 2 .. .. .. .. .. 3 .. .. .. 2 .. .. 58 Gordon Road .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 4 .. .. 11 Canterbury Terrace 2 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 16 Villiers Road 15 2 .. .. .. .. 5 .. 1 2 .. .. 6 .. .. 16 .. .. .. 132 Malvern Road 6 .. 1 .. .. .. 3 4 .. 2 .. .. 1 .. .. .. .. .. .. 102 Malvern Terrace 1 .. 6 .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. 6 Connaught Terrace 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 8 Victor Road 6 .. .. .. .. .. 2 .. .. .. .. .. 5 3 .. 4 .. .. .. 86 Napier Road 3 2 .. .. .. .. .. 2 .. .. .. .. .. 1 .. 3 .. 3 .. 45 Avenue Close 4 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 26 Alpha Place 2 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 3 .. .. 14 Ditto (North) 2 .. .. .. 2 .. .. 5 .. .. .. .. 3 .. .. .. .. .. .. 26 Ditto (West) 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 3 .. .. 11 Alpha Mews 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 3 .. .. .. 15 Purves Road (West) 11 4 1 .. 2 .. .. 5 .. .. .. .. 2 .. .. 3 1 .. .. 105 Malvern Mews .. .. .. .. .. .. .. .. .. 3 .. .. .. .. .. .. .. .. .. 30 Cardigan Road 2 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 7 Canterbury Terrace 3 .. 1 .. .. .. .. 1 .. .. .. .. 1 .. .. 2 .. .. .. 17 Rupert Road 2 .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. 1 .. .. 8 Victoria Place 8 .. .. .. 1 .. 1 .. .. .. .. .. 4 .. .. 5 .. 1 .. 25 Kilburn Park Road 16 .. .. .. .. .. .. 2 .. .. .. .. 12 .. .. 2 .. .. .. 84 Cambridge Road 25 14 2 4 3 .. 3 2 .. .. .. .. 7 .. .. 12 .. .. 2 120 Pember Road 7 1 1 .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. 23 Parkfield Road 13 2 .. .. .. .. .. .. .. .. .. .. 3 .. .. 4 .. .. .. 38 Oak Road 3 .. .. 2 .. .. .. 2 .. .. .. .. .. .. .. 1 .. .. .. 17 Church Road 4 2 .. .. 1 .. .. 1 .. .. .. .. .. .. .. 4 .. .. .. 23 46 Sanitary Report, 1893. In conclusion, I beg to express my thanks to he Board for their continued kindness and confidence, and my thanks are also due to the officers generally and to the Sanitary Inspectors for their ready assistance at all times. I am, Gentlemen, Your obedient Servant, D. S. SKINNER, Medical Officer of Health. Willesden, February, 1894. 46 Willesden Local Board. HOSPITAL REPORT, 1893. Gentlemen, I beg to present my report of the hospital for the year. The accommodation available at the end of the year consisted of two iron buildings, one being used for the isolation of scarlet fever and the other, recently erected, for small pox; for the isolation of cases of the latter disease, tents were provided in the earlier part of the year. The space in the block for scarlet fever consists of two wards, with eight beds in each; a sitting room, kitchen, bedroom, and passage between the wards occupy the centre of the building; there is a bath room, with movable bath, and water closet at each end, a well-ventilated passage dividing the latter from the Ward. The bath-room at the end of the Women's Ward was obliged to be fitted for the accommodation of the Assistant Nurse. A detached iron room is used as a sleeping room for the Ward Maid and Laundry Maid. There is also a small iron room for Laundry and a Store room, and another for a Mortuary. In the earlier part of the year a woman came every day to do the washing, but the arrangement was not considered satisfactory, and a Laundry Maid who lives on the premises was substituted. A piece of ground 60 feet square was concreted for the tents, and was afterwards used for the new iron building. The tents were constructed of double roofs with openings for ventilation, double walls and a boarded floor; they were warmed when necessary by Oil Stoves. 47 Sanitary Report, 1803. Thanks are due to the Hendon Rural Sanitary Authority for having kindly lent a complete tent. Earth Closets were used for these patients, and the soil, after disinfection, was buried. The food was prepared in the kitchen and taken to a small tent intended for sleeping, from whence it was fetched by the Nurse. Five patients, four males and one female, were treated at the same time in the tents in the Spring, the Nurse in attendance sleeping in the tent with the female patient. On the occurrence of the second outbreak of small pox in November, several cases, as I have mentioned in the Sanitary Report, were sent to the Highgate Small Pox Hospital, but on information being sent to me that only a very limited number of cases could be received from this district at one time, and in consideration of their rule not to receive patients under seven years of age, the Board decided to erect another iron building for the isolation of these cases. This consists of two Wards for three beds each with a Nurse's room between, with a window looking into each Ward, and an extension at the back for a sink and an earth closet for each Ward. There is also a small ante room in which a movable bath can be kept. All the Wards in these iron buildings are warmed by slow combustion stoves; during some very cold nights it has been found difficult to maintain a sufficient degree of warmth. Hot water in the No. 1 or Scarlet Fever Block is conveyed by pipes from the boiler of the kitchen range to the bath room; but it is carried when necessary to No. 2 Block, the water not having been laid on there. 48 Willesden Local Board. As will be seen on referring to the subject of small pox in the Sanitary Report, precautions were taken by vaccination to protect the staff and some of the patients convalescent from scarlet fever. I am extremely glad to say that the permanent buildings for the Hospital are making good progress; there will be accommodation in the permanent and iron buildings for 60 beds in twelve Wards. In the Reports of Dr. Power to the Local Government Board in the years 1884-85, attention is drawn to the possible effect of small pox on the community dwelling in the neighbourhood of a small pox Hospital, and it would appear that where large numbers of patients suffering from the disease are congregated, there is, in the opinion of some Authorities on the subject, a possibility of those dwelling in immediate contiguity to the Hospital being to some extent liable to its influence, but there are others who hold the opinion that the question is not proved and who do not apparently agree with it. There is the undoubted fact that small pox makes its appearance in separate houses first and spreads, when precautions are not taken, among the populace and becomes epidemic without any special aggregation of cases, so that it is evident that the disease is present among the people before it is present in the Hospital. For instance, the cases of small pox that occurred in the late Autumn, on the adjacent borders of the Metropolis and Willesden, did not arise from the collection of cases in a small area or building such as a Hospital, but spread by intercourse among the people. If any deleterious atmospheric influence is exercised, it is only when Sanitary Report, 1893. 49 many cases are brought together and I felt quite satisfied that no ill effects would happen to the other inmates of the Hospital by having a very few cases isolated in tents or a separate building in the Hospital ground. A great amount of anxiety was expressed by the men employed on the permanent buildings at the idea of cases of small pox being admitted, and some friction was threatened in consequence, but the fears all subsided and at the time of writing this, nearly three months after the first case was admitted, no case of small pox has been brought to my notice among the men employed on the buildings, and there has not been any among the inmates of the Hospital. The position of this No. 2 Block is to the East and South East of the permanent ones so that the prevailing wind, South West, would keep them clear to a large extent of any possible atmospheric infuence ; it is 160 feet East of one block, and 106 feet South East of another; with regards to the other iron building it is due South at a distance of 208 feet. I do not say I should not object to a large number of small pox cases, counting by scores for instance, being located in close proximity to the isolation Hospital because I undoubtedly should. The information and the Report given by Dr. Power must necessarily carry great weight. Owing to the continued presence of scarlet fever in the district, No. 1 Block has been kept full, in fact, 011 several occasions there were more cases than could possibly be accommodated, and the Hendon Local Board most kindly came to our 50 Willesden Local Board. assistance and received some of our cases. Of the 119 admitted 7 were small pox cases, and these all recovered. One child who was notified as having scarlet fever appeared to the Sanitary Inspector, when he arrived with the ambulance to remove him, so very ill that he objected to taking him till the doctor in attendance had again seen him and advised the removal, which was done. The child died within three hours of admission. On arriving at the hospital I found the child in a dying state from diarrhoea. Four of the deaths were due to diphtheritic complications. These cases were found on admission to be so suffering and caused great anxiety lest the second disease should spread, but I am glad to say it did not do so in any instance ; the patients were cut off by screens from the other patients, and the air of the ward purified and rendered as much as possible antiseptic by carbolic acid spray. No death occurred, with the exception of the child above mentioned, from early in July till the end of the year. The average cost of each patient per day, including maintenance, staff and medical attendance, was 2s. 2d., but including the outlay on repairs, furniture, and interest at 3½ per cent. on building expenses for the year, it comes to 2s. 8½d.; if interest on £l,036 (last year's outlay on buildings, etc.) is also included, together with an allowance of 5 per cent. for wear and tear, the cost of each patient per day would be three shillings. I estimate the total cost of the five small pox patients in tents in the spring at £102 which includes maintenance, nursing, and furnishing; the latter item includes special arrangements and apparatus for the laundry so as to keep the clothing of these cases separate from the scarlet fever. It Sanitary Report, 1893. 51 can only be an estimate as the food was all from the one supply. I also estimate the expense for three-and-a-half weeks in December at £8 7s. 6d., but there was no outlay in providing furniture, making a total cost of £110 7s. 6d. I anticipate the cost of the patients at the Small Pox Hospital at Highgate will not be less than £125. The average cost of each patient per week for Medical Attendance, Staff, and £ s. d. Maintenance was 0 15 2 The Charge at Hendon was l 11 6 And at Highgate 2 9 0 In conclusion, I desire to express my approval of the way in which the Nurses have performed their duties. Mrs. Murlagh, as the Acting Matron, has always endeavoured to carry on the management with economy. I have the honour to be, Gentlemen, Your obedient Servant. D. S. SKINNER, Medical Superintendent. Willetden Local Board. Grocer. Coal. Batcher. Baker. Gr'ngrocer. Wines, Beer. Dairyman. Fishmonger. Chemist. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. First Quarter 16 18 1½ 12 4 0 13 7 10½ 5 16 5 4 17 4 0 9 0 22 18 10 ... ... ... 5 15 2 Second Quarter 21 10 9 4 16 9 15 11 3 5 18 6 5 14 10 5 3 6 22 7 2 3 7 7 5 17 2 Third Quarter 13 8 3½ 7 2 2 11 18 9½ 6 18 3 2 7 8 2 11 0 18 0 2 3 16 6 1 14 8 Fourth Quarter 18 16 0 21 18 0 17 8 7 6 1 1 4 4 2 0 7 6 24 4 2 2 18 1½ 1 14 11 71 3 2 46 0 11 58 6 6 24 14 3 17 4 0 8 11 0 87 10 4 10 2 2½ 15 1 11 Expenses connected with Hospital. Furniture, &c. £ s. d. £ s. d. Humphrey—Iron Hospital for Small Pox 86 15 0* Timber and Repairs 8 13 3 Iron Rooms for Servants 15 0 0 Ironmongery 51 4 5 Beeson-—Timber 12 17 1* Ditto 18 7 10* Rent of Land 23 6 0 Shells for the Mortuary 9 1 6 Ballast 25 6 0 Tables 3 18 6 Lime and Cement 23 15 0 Refrigerator 10 0 0 Ditto 11 6 8* Clothing 45 0 6 \Vages (Labourers) 26 0 0 146 6 11 Ditto 6 11 0* Sundries 18 12 0 349 9 7 £349 9 7 £ s. 495 15 6 Items marked * have not been sent in by the end of the year. Maintenance 338 14 3 Staff 207 16 0 Medical Attendance 100 0 0 646 10 3 Grand Total £1,142 5 9 52 INFECTIOUS DISEASES EXPENSES. Patients remaining in Hospital on January 1st, 1893 16 Home Nursing and Maintenance £ 144 s. 14 d. 0 Disinfecting Bedding, &c. 257 6 6 Ditto admitted during the year 1893 119 Medical Certificates 119 5 8 Ditto discharged during the year 1893 111 Disinfection of Rooms (labour) 124 16 0 Disinfectants 110 0 0 Ditto Died 8 Compensation for Bedding, and New Bedding supplied 22 3 4 Ditto remaining December 31st, 1893 15 Removal of Patients 35 8 0 Drain Tests 12 0 0 Average number of cases daily 16 5 Removal to Mortuary 3 0 0 £828 13 6 Sanitary Report. 1893, 53