YIE 1 Yiewsley Urban District Council. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, FOR THE YEAR 1920. uxbridg: King & Hutchings, Ltd., Printers. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, 1920. To the Chairman and Members of the Yiewsley Urban District Council. Gentlemen, I beg to submit to you my Tenth Annual Report as your Medical Officer of Health. NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. The population at the census of 1911 was 4,321. Estimated (by the Registrar-General) for the middle of 1920 it is 5,146. The area of the district is 899 acres. Physical Features and General Character of the District. The district is flat, low-lying, open on all sides, and the air good. The soil is clay (in many parts removed) with a gravel subsoil. Social Conditions. The population consists chiefly of the artisan class, with an increasing number engaged in clerical occupation. VITAL STATISTICS. Births. The increase in the birth-rate all over the country in 1920 is also noticeable in the Yiewsley area, there being 134 births in 1920, as compared with 89 in 1919. Of these 134 births, 71 were males and 63 were females. Only one birth was registered outside the district. 4 There were 10 illegitimate births, four of which were male and six female. The birth-rate for 1920 works out at 26.03 per thousand—a considerable increase on last year's rate of 17 26 per thousand. Sixty-nine births were notified by County Council Midwives. Deaths. Male. Female. The number of deaths registered in the district 16 23 The number of deaths of non-residents registered in the district (to be subtracted) 3 1 The number of deaths of residents registered outside the district 9 5 Nett deaths belonging to the district 22 27 These 49 deaths give a crude death-rate of 9.52 per thousand, or, corrected for age and sex distribution, a rate of 9 55 per thousand —a slightly higher rate than that of the previous year, which was 8 49 per thousand. Causes of Death— Male. Female. Whooping Cough 1 1 Diphtheria and Croup 1 - Influenza 1 - Pulmonary Tuberculosis 1 3 Cancer (Malignant Disease) 1 4 Organic Heart Disease 3 2 Bronchitis 1 2 Pneumonia 1 — Other Respiratory Diseases — 1 Cirrhosis of Liver 1 — Nephritis — 1 Congenital Debility, etc. 2 4 Violence, apart from Suicide 1 — Suicide 1 — Other defined Diseases 7 9 Total 22 27 Infant Mortality. The number of deaths of infants under one year of age was eight. This gives an infant mortality rate of 59.7 per thousand— a slight increase on the rate of the previous year, which was 43 82 per thousand, while in 1918 the rate was 97.83 per thousand. As five of these deaths occurred in premature babies the rate is remarkably low. 5 The causes of death were as follows:— Male. Female. Inanition — 1 Premature Birth 2 3 Whooping Cough 1 — Convulsions 1 — Total 4 4 Owing to the greater attention given to Infant Welfare, there has, during recent years, been a steady decline in the infant mortality rate, which is regarded as a valuable index of sanitary efficiency. Poor Law relief is adequate. The London hospitals are available for suitable illnesses and are chiefly utilised for serious surgical cases. The Poor Law infirmary at Hillingdon provides accommodation for cases unsuitable for hospital treatment. SANITARY CIRCUMSTANCES OF THE DISTRICT. Water. The supply is constant and sufficient. Its source is from deep wells sunk in the chalk locally. Its good points are its purity, its freedom from risk of contamination, and the absence of any solvent action on lead pipes. Its great defect is its hardness, which is not excessive. The London water supply is often taken as a fair standard, and the water supplied in this district is slightly less hard than that in London. About 10 per cent. of the houses (these are in outlying parts of the Yiewsley area) are supplied by shallow wells. No complaints as to the character of the water were received during the year. No cases of contamination occurred. To a limited extent the Frays is unwisely used as a source of drinking water, and was apparently the source of a case of typhoid fever some years ago, so that the question is of some importance. Rivers and Streams 6 Drainage and Sewerage. Ninety per cent. of the houses are connected to the public sewer, and the sewage disposed of by broad irrigation at Cowley, after treatment in coke beds. The remaining 10 per cent. of the houses, owing to their outlying position, rely on the conservancy system. Closet Accommodation. All closets are connected to the sewer, unless in outlying parts of the Yiewsley Urban area. In the case of those which are not connected, there are— 60 privies with fixed receptacles; 8 privies with movable receptacles ; 2 waste water and hand-flushed closets. No conservancy closets were converted to the public sewage in 1920 owing to their distance from the same, but they were all cleansed and disinfected at necessary intervals during the year. Scavenging. This is done fortnightly by the Council throughout the year. When more prosperous times return the present service should be accelerated—weekly removal of refuse being very necessary, combined with the provision of covered receptacles. SANITARY INSPECTION OF THE DISTRICT. The total number of premises visited during the year (i.e., inspections and re-inspections) was 235. The following defects and nuisances were discovered, action taken, and the trouble abated :— Movable Dwellings, Caravans, Tents, etc. One case of overcrowding. After notice the van left the district. Canal Boats used as Dwelling Houses. One case of overcrowding and four dirty cabins, 7 Bakehouses. Four contraventions of the Factory Act (i.e., need of limewashing). Slaughter Houses. No contravention of bye-law—all clean and satisfactory. Cow Sheds. Cleaning required in one instance only. Dairies and Milkshops. No defects discovered. Water Closets. Nine were repaired, supplied with water, or otherwise improved. Drains. Seven were examined and tested ," two exposed. Three waste pipes and rain water pipes were disconnected, repaired, etc. Fifteen were unstopped, repaired, trapped, etc. Two new soil pipes were fixed. Two existing soil pipes (or ventilating pipes) were repaired. One disconnecting trap and chamber was inserted. Cesspools. Twenty-four were emptied, cleansed, etc. Smoke. The smoke nuisance previously complained of at the Water Company's Pumping Station has been effectively remedied. Accumulation of Refuse. Fifteen accumulations were discovered. Foul Ditches, Ponds, etc., and Stagnant Water. One cleaned out. 8 Foul Pigs and Other Animals. Four pigsties cleansed and repaired. Dampness. Sixteen cases were discovered. One hundred and twenty-seven sundry nuisances were also dealt with and remedied. (a) The total number of inspections and re-inspections made during the year was 235. These include:— Fourteen premises inspected on complaint. Twenty-seven premises inspected in connection with infectious disease. Fifty-four periodical inspections. Twenty-nine house-to-house inspections. (b) No statutory orders were issued, but sixty-seven informal or cautionary notices were given. (c) All defects are remedied or being remedied. PREMISES AND OCCUPATIONS CONTROLLED BY BYE-LAWS OR REGULATIONS. These comprise :— (a) Two houses let in lodgings ; and (b) One offensive trade, viz., that of tallow melting and fat boiling. As regards the former very little trouble has been caused at any time, and none during the year. The latter has occasionally given rise to objectionable effluvia when not in good working order, and the removal of the products in open casks is unpleasant and should be regulated by bye-laws insisting on the use of closed receptacles, though recently the receptacles have been improved and less spilling occurs. SCHOOLS. There are three public elementary schools in the district, in all of which the sanitation and water supply are satisfactory. There is quite adequate accommodation for the scholars. 9 Any suspected cases of infectious disease are reported by the teachers to the Medical Officer of Health, and the children excluded from school if necessary. All confirmed cases of infectious disease are reported to the head teachers by the Medical Officer of Health, together with a list of the names of contacts to be excluded from school for the necessary period. The School Medical Officer attends the schools periodically for the purpose of examining the scholars, and in this way many minor defects in the children are indicated to the parents. FOOD. (a) Milk Supply. There are two cow-keepers, and an average of about a hundred cows in the district. Much of the milk is supplied by local farms and some from outlying farms. Thirty-two inspections were made during the year. Only one contravention of regulations was discovered (i.e., cowshed required cleaning). The milk is generally of good quality and no complaints have been received. The most important point is the insistence of cleanliness of the cows, premises, and utensils—but this has greatly improved of recent years. There is great difficulty in the outlying parts of the district in securing fresh milk, and condensed milk has to be used instead. Milk (Mothers and Children) Order, 1919. Doctors and Midwives have been authorised to recommend the supply of. milk to suitable cases, but there appears to have been very little need for this. (b) Meat. Inspection is made periodically by the Sanitary Inspector. Four carcasses of frozen mutton were voluntarily surrendered and buried. There is no public abattoir, but the private slaughterhouses and the facilities for inspecting meat at the time of slaughter are satisfactory. Thirty-one inspections were made during the year. 10 The carcasses of two sheep and two lambs, in an emaciated condition and flabby from cold storage, were voluntarily surrendered and destroyed. Two slaughter-houses are in use in the district. In 1914. In January, 1920. In December, 1920. Registered 1 — — Licensed 3 2 2 Total 4 2 2 (c) Other Foods. Food inspection is made periodically by your Sanitary Inspector. In regard to the sanitary condition of premises where food is manufactured, stored, etc , no defects were discovered. Adequate powers exist for dealing with sanitary conditions in premises where foods are stored or exposed for sale. The condition of the bakeries in the district is generally satisfactory, but four contraventions of regulations were discovered and one bakehouse required white-washing. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. There were forty-three cases of infectious disease notified during 1920—a decrease of nineteen on those notified during the previous year. These include twenty-three cases of scarlet fever and thirteen of diphtheria. A supply of diphtheria anti-toxin is kept, but not much used. No cases of encephalitis lethargica occurred. Return cases of scarlet fever occurred in two houses. In regard to the more recently notifiable infectious diseases, i.e., pneumonia, malaria, dysentery and trench fever, only one case of pneumonia was notified. Bacteriological aids to diagnosis are now freely utilised. In cases of suspected diphtheria numerous swabs were taken and sent away for examination. In al notified cases enquiries were made to discover contacts, and the throats of contacts swabbed and bacteriologically examined. Most cases of scarlet fever and diphtheria are sent to the Isolation Hospital at Hillingdon. Those treated at home are 11 isolated for the necessary period, and in all cases the occupied rooms are afterwards disinfected. Carriers of diphtheria bacilli are isolated. No vaccinations were performed by the Medical Officer of Health under the Public Health Regulations, 1917, no necessity arising. Towards the end of the year a comparatively slight epidemic of measles occurred, extending to the beginning of the present year. School intimations of infectious disease are freely utilised. Only one death occurred from influenza. No noticeable epidemic of this complaint occurred requiring an enquiry. No arrangements have been made for the purpose of cleansing and disinfecting verminous persons and their belongings, as the need for this does not seem to exist. No doubt such treatment, if found necessary, would be available at the Poor Law infirmary or workhouse. The notification of cases of tuberculosis appears to be properly effected and no action has been necessary to enforce the regulations. The following is a list of infectious diseases notified during the years 1920 and 1919:— 1920. 1919. Diphtheria 13 8 Erysipelas 1 3 Scarlet Fever 23 37 Pulmonary Tuberculosis 3 3 Other Forms of Tuberculosis 1 1 Pneumonia 1 2 Ophthalmia Neonatorum 1 — Enteric Fever — 1 Measles (not now notifiable) — 1 Malaria — 4 Influenzal Pneumonia — 2 Total 43 62 MATERNITY AND CHILD WELFARE. Clinics are held by the Assistant School Medical Officer and are attended by expectant and nursing mothers, and children under five years of age. The only criticism I have to make of the local Infant Welfare Scheme is that the medical treatment is not, as it should be, in the hands of the local doctors. Their experience specially fits them for the work, and they are much more likely to retain the confidence of the mothers than is 12 a stranger. This fact was especially emphasised by the Chief Medical Officer of the Ministry of Health in his scheme for a public medical service, when he stated that no method could succeed without the whole-hearted co-operation of the general practitioner. No case of puerperal fever was notified, and only one of ophthalmia neonatorum, the latter without any permanent injury resulting. With the exception of a slight epidemic of measles there was no noticeable incidence of infectious diseases of infants (i.e., whooping cough, epidemic diarrhoea, poliomyelitis, etc.). 1. The Sanitary Staff consists of the Surveyor, who acts also as Sanitary Inspector, and a part-time Medical Officer of Health. The former resigned during the year, and for the last three months your Clerk did valuable work in his stead. 2. The hospital accommodation available for infectious diseases is quite adequate. It consists of the Isolation Hospital at Hillingdon and the Small-pox Hospital at Yeading. 3. In regard to the local Acts, etc., in force in the district, the Bye-laws of the Uxbridge Rural District (of which this district formed a part prior to 1911) were adopted on acquiring Urban powers, and are still in force. 4. Pathological specimens may be sent to a laboratory for examination by any medical man in the district. The cost of these examinations is borne by the Council. FACTORIES AND WORKSHOPS. Two additional workshops were established during the year. The following is a complete list of the factories and workshops in the district:— SANITARY ADMINISTRATION. 4 Engineering Works. 3 Plumbers. 2 Boot Repairers. 2 Upholsterers. 2 Canal Boat Works. 1 Smith. 1 Printer. 1 Firewood Factory. 1 Wheelwright. 1 Milliner. 1 Cycle Shop. 4 Bakehouses. 1 Millboard Works. 1 Constructional Works. 1 Laundry. 1 Foundry. 1 Chemical Works. 1 Engraver and Metal Worker 1 Button Factory. 1 Record Works. 1 Tin Box Factory. 1 Photographic Works. 1 Tallow Factory. 13 HOUSING. (1) General Housing Conditions in the District. 1. The Council's Housing Scheme is now in operation, and some houses are nearly completed. 2. (a) Extent of shortage or excess of houses.-At present a considerable shortage exists, but it is possible that the previous shortage of "houses for the working classes" will be abolished on completion of the Council's scheme. (b) Measures taken or contemplated to meet any shortage. A complete scheme is, as stated above, in process of completion. 3. No important change of population has occurred during the year, nor is anticipated. (2) Overcrowding. 1. Extent: The actual overcrowding of rooms is not frequent, but many cottages are occupied by more than one family. 2. Causes : The cessation of building operations during recent years. 3. Measures taken or contemplated to meet any shortage : A few houses have been erected by private enterprise and the Council's scheme provides for 208 houses. (3) Fitness of Houses. 1. (a) The general standard of housing is low. (b) The character of the existing defects consists of a general deterioration in the structural condition of the older cottages and of excessive dampness. The following is a table of the defects found:— Blocked drains 11 Defective floors 10 Defective W.C.'s 9 Defective R.W. pipes 2 Defective roofs 14 Dirty walls and ceilings 41 Defective windows 23 Ash bins required 8 Excessive dampness 16 Structural defects 60 Defective drains 2 - Total 196 14 (c) Many of these defects are due to lack of proper management and supervision by owners, owing to the cost of labour and materials, coupled with high rates and low rents. 2. General action taken as regards unfit houses under— (a) The Public Health Acts. Nil. (b) The Housing Acts. Thirty-two orders for repairs were issued under Section 28 of the 1919 Act, and twenty-four defects were remedied under Section 17 of the 1909 Housing Act. 3. Difficulties in remedying unfitness, special measures taken, etc.—The chief difficulty is the excessive cost of repairs, coupled with the fact that cottages do not pay an economic rent. The owners are often unable to pay the price of repairs. Defects were remedied 4. Conditions so far as they affect housing as regards water supply, closet accommodation, and refuse disposal. The water supply is good, closet accommodation generally adequate and refuse disposal does not adversely affect the housing question. (4) Unhealthy Areas. No complaints were received nor representations made under Parts 1 or 2 of the Housing Act of 1890. (5) Bye-laws relating to Houses, to Houses Let in Lodgings, and to Tents, Vans, Sheds, etc. 1. The existing bye-laws operate satisfactorily. 2. There is no urgent need of new bye-laws. APPENDICES. Statistics.—Year ended 31st December, 1920. 1. General. 1. Estimated population 5146 2. General death-rate (per thousand) 952 3. Death-rate from tuberculosis 78 4. Infantile mortality 597 5. Number of dwelling houses of all classes 900 6, Number of working class dwelling houses 800 7. Number of new working class houses erected 2 15 2. Unfit Dwelling Houses. I.—Inspection. 1. Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 62 2. Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 62 3. Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — 4. Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 32 II.-Remedy of Defects without Service of Formal Notices. Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their Officers 24 III.—Action under Statutory Powers. A. Proceedings under section 28 of the Housing, Town Planning, etc., Act, 1919. 1. Number of dwelling houses in respect of which notices were served requiring repairs 32 2. Number of dwelling houses which were rendered fit— (a) by owners 32 (b) by Local Authority in default of owners — 3. Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — B. Proceedings under Public Health Acts. 1. Number of dwelling houses in respect of which notices were served requiring defects to be remedied 17 16 2. Number of dwelling houses in which defects were remedied— (a) by owners 17 (b) by Local Authority in default of owners C. Proceedings under sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909. 1. Number of representations made with a view to the making of Closing Orders nil. 2. Number of dwelling houses in respect of which Closing Orders were made nil. 3. Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit nil 4. Number of dwelling houses in respect of which Demolition Orders were made nil. 5. Number of dwelling houses demolished in pursuance of Demolition Orders nil. 3. Unhealthy Areas. Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I., or (b), Part II., of the Act of 1890:— 1. Name of area nil. 2. Acreage nil. 3. Number of working class houses in area nil. 4. Number of working class persons to be displaced nil. 4. Number of houses not complying with the building bye-laws erected with consent of Local Authority under section 25 of the Housing, Town Planning, etc., Act, 1919 1 5. Staff engaged on housing work with, briefly, the duties of each officer— The Housing Inspection of the district is done by the Surveyor and Inspector of Nuisances, who holds the dual appointment. A. HITCHINGS THOMAS, M.B., B.S„ D.P.H Medical Officer oj Health.