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. A.R.332. BS X 1/18 ACT 1 ACTION LOCAL BOARD. REPORT OF THE Medical Officer, For the year 1893. Printed at the ACTON VALE PRINTING PRESS, Acton Vale, W. ACT 1 ACTON LOCAL BOARD. REPORT OF THE Medical Officer, For the year 1893.

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Printed at the ACTON VALE PRINTING PRESS, Acton Vale, W. Acton Local Board. Report of the Medical Officer of Health, For the year 1893. To the Chairman and Members of the Acton Local Board. Gentlemen, I beg to present to you my report on the health of Acton for the year 1893.

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This is my first year of office, and I am therefore dependant very largely on the reports of my predecessors for obtaining a comparative idea of the progress of Acton in matters of Sanitary Science.

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On referring to the papers that have been handed over to me, I find that the earliest statistics are those of 1884, 1885 & 1886, and the earliest report is that of 1885, which has been printed. They are as follows:— 1885 is printed. 1886 1887 is written, but incomplete. 1888 is printed. 1889 is written.

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1890 is written and one copy type-written. 1891 is printed. 1892 is written. 4 Several copies of 1892 have been lithographed, but all of these have been given away to various authorities. They are all of various sizes. I mention this because I wish to point out how important it is that all annual reports of the Medical Officer should be printed.

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I think it is very desirable also that all these reports should be printed on the same sized paper, and I think the time is not far distant when the Local Government Board will desire that all districts should have their reports printed on paper of the same size and shape. The year has been remarkable for a great drought more or less all over Europe.

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Coincidentally with this there has been in London a prevalence of certain zymotic diseases, such for instance, as Scarlet Fever and Diarrhœa. Small-pox has been prevalent in some parts of the country. Cholera visited some of the ports and a few cases occurred in inland towns.

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In connection with this, I believe the opinion is that it may break out again next year, in those places where it was most prevalent. The Influenza also visited the country during the autumn and winter months. In accordance with the plan of my predecessor, I have divided the district into six sub-districts, corresponding with the Ecclesiastical divisions of the district.

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As, however, they have never been exactly defined, I have thought it best to describe the boundaries as near as I can, 5 S. Mary's, or Acton proper.

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This is bounded on the south by the houses on the north side of the Avenue Road, and a straight line continuing from the Avenue Road at the corner of Nevill's Bakery to the North London Railway, following the course of the Stamford Brook. On the east by a line drawn along the North London Ry.

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from where it crosses the Stamford Brook, to Shakespeare Road, thence along Shakespeare Road to Myrtle Road, thence it courses northwards along Myrtle Road as far as Acacia Road, and along Acacia Road to Horn Lane, then following along Horn Lane as far as the northern Boundary of the Parish. On the west it is bounded by the boundary line separating Acton from Ealing.

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At the present time, the houses do not extend in the northernly direction much beyond the Great Western Railway. All Saints' Parish, or South Acton. Is bounded on the north by the houses on the south side of Avenue Road. On the south by a line drawn horizontally through Steele and Berrymede Roads to Bollo Lane and the western extremity of Marlborough Road, respectively.

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On the east by the North & South Western Junction Ry. On the west by Bollo Lane. S. Dunstan's, or East Acton.

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Is bounded on the east by the eastern boundary of the Parish, which separates it from the Parish of Hammersmith; this is a line drawn down Old Oak Lane and continued straight on 6 till it cuts Uxbridge Road, and from thence to the Junction of the North & South Western Junction Railway with Woodstock Road. The western boundary corresponds with the eastern boundary of S. Mary's Parish—already described.

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The southern boundary corresponds with the curve of the North & South Western Junction Railway, dividing All Saints from this Parish. S. Albans', or Acton Green. Is bounded on the north by the southern boundary of All Saints' Parish, already described. On the south by a line drawn from South Parade, Bedford Park, to Cleveland Villas, High Road, Chiswick.

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On the east by a line running north and south through a point to the east of S. Alban's Church. S. Michael's, or Bedford Park.

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Comprises that part of it which is situated in Acton Parish and is bounded on the north by Southfield Road; on the south by the South Parade; on the east by a line running down the centre of the Woodstock Road; and on the west by the eastern boundary of S. Alban's Parish. All Souls, or Harlesden.

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Comprises that portion of it which is situated in Acton Parish and at present consists of a number of cottages belonging to the London & North Western Railway Company. It is situated at the extreme northern portion of the Parish. 7 VITAL STATISTICS. Population. I estimate the population at the middle of 1893 to be about 26,000.

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The following table shows the number of population and inhabited houses at the four preceding censuser. Year. Inhabited houses. Population.

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1861 610 3,151 1871 1,568 8,306 1881 2,844 17,110 1891 4,084 24,207 The number of deaths registered throughout the district was 451, in addition to this there were 35 deaths of residents belonging to the district who died in public institutions outside the district, making altogether 486.

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The population being reckoned at 26,000 in the middle of the year, the death rate calculated on this basis would be 18.6 per thousand, as against 17 per thousand last year. I see that the average death rate for London during the year has been 20.9.

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If we consider what a large population of poor people we have residing in one district of the Parish, and the number of poor children that died during the summer of diarrhœa and sickness, I think, that we need hardly consider this a high rate. If we did not include the 35 deaths which occurred in public institutions, the death rate would be 16 per thousand.

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A great many districts do not include these deaths although they no doubt ought to, and probably will be found to do so much more than they do at present. The 486 deaths comprised 228 males and 258 females, inclusive of 21 males and 14 females, who applied in public institutions.

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There have been 18 inquests, 8 The total number of births registered was 831, viz., 422 males and 409 females. Of these 29 were illegitimate children. The total number of births last year was 763. These figures give a birth rate of 31.9 per thousand persons living as against 30.5 per thousand last year.

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The annual birth rate for London last year was 30.9 per thousand persons living. The number of deaths of children under 1 year of age was 160, being at the rate of 192.5 to one thousand births. Our infant mortality is therefore very high. It is explainable only by the large number of children who died during the summer from diarrhœa and dysentery.

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The following table shows the various ages at which death occurred in the district:— Under one year 160 under 5 years. 222 Over one year and under five years 62 ,, five „ „ fifteen „ 17 over 5 years.

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264 „ fifteen „ twenty five 15 „ twenty five „ sixty five 132 „ sixty five and upwards 100 486 486 The following table compares the death rate of children under one year per thousand registered births, and the birth rate for the last seven years. Birth Rate Per Thousand. Deaths of Children under 1 year Per Thousand Registered Births.

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1887 28.7 147 1888 31.1 182 1889 34.1 175 1890 28.3 151 1891 30.8 146 1892 30.5 185 1893 31.9 192.5 9 We thus see that the number of deaths of infants increases almost every year.

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(Last year it was represented as being 152, this was I think a mistake.) I see that almost every year it has been remarked by your medical officers how great this death rate is, and various proposals have been made to try and lessen it. I am of the opinion that this is greatly due to the parents using feeding bottles with india rubber tubes.

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These tubes are very difficult to clean and a little sour milk remains in them. This forms a nidus for germs to grow in, and so pass into the child's stomach where they set up fermentation within. The old fashioned boat shaped bottles are much eaiest to clean, and for this reason are to be recommended much more.

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The only trouble being that the mother must hold the bottle while the child is fed. ZYMOTIC DEATH-RATE. The total number of deaths registered for the principal zymotic diseases was 89, as compared with 91 last year. This gives a zymotic death rate of 3.4 per thousand, as against 3.6 per thousand last year.

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The following table compares the total deaths and the zymotic deaths as they occurred in the principal districts:— Acton. S.Acton. E.Acton. Acton Green. Willesden Bedford P'k. Total Deaths. 171 131 42 85 9 13 Deaths from zymotic disease.

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22 32 11 19 4 1 In the following table the death rate and the zymotic death rate are so arranged that a comparison can be made for the last six years.

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By it, also will be seen that although the death rate is higher than that of last year by 1.6 per thousand, the zymotic death rate is a trifle lower, and that wheareas measles, whooping 10 cough and diarrhœa were the most prominent features of the zymotic deaths in 1892; Scarlet Fever and diarrhœa were those of 1893.

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Considering that nearly twice as many cases of infectious diseases were notified this year as last year, we may conclude that the diseases although more numerous were not so severe in character. 1888. 1889. 1890. 1891. 1892. 1893. Small Pox — — — — — — Measles 1 25 11 9 24 2 Scarlet Fever 2

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1 3 4 — 10 Diphtheria 2 8 7 2 4 2 Whooping cough 9 13 3 6 25 5 Typhoid Fever — 1 1 — 3 4 Diarrhœa & Dysentery 10 12 18 24 34 60 Puerperal Fever — — — — 1 6

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Total number of deaths from seven zymotic diseases 24 60 43 45 91 89 Deaths from other causes 282 377 298 368 334 396 Total deaths 306 437 341 413 425 486 Death rate from the 7 zymotic diseases per 1000 1.09 2.8 1.9 1.8 3.

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6 3.4 Death rate from other causes per 1000 12.9 16.1 12.0 15.3 13.4 15.2 General death rate per 1000 13.99 18.9 13.9 17.1 17.0 18.6 GENERAL REMARKS.

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No deaths have occurred from small-pox, and only two deaths from measles. This disease was not so prevalent this year. Two deaths occurred this year from diphtheria. One was a little boy at Willesden. The only cause I could discover for this case 11 was a dirty dustbin at the end of the yard.

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The children were accustomed to play near this, and I was told that it frequently smelt very badly. The second death from diphtheria occurred in Stanley Gardens. The man was a policeman. The drainage in this road has always been a scource of trouble. This year a considerable number of these houses have been redrained.

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I believe there are still some of these houses that require seeing to and I would urge the Board to have them all inspected, and those houses that have not been already treated, seen to. As I have already mentioned, 60 deaths were caused by diarrhœa. 59 of these occured in children' under five years of age.

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The hot and dry summer has no doubt a good deal to account for this high mortality, milk food becoming more easily sour. The bottles from which infants are fed being an additional cause. Four deaths occurred from Typhoid Fever, out of 19 cases reported. Two of these occurred at Willesden in different houses one at South Acton, and one in S. Mary's Parish.

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Six deaths were caused by Puerperal Fever, while only two cases were notified. Ten deaths occurred from Scarlet Fever out of 192 cases which were notified. NOTIFICATIONS OF INFECTIOUS DISEASES. During this year, I caused a circular, a copy of which is appended, to be distributed to each house in which any infectious disease occurred.

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On one side of this circular the householde 12 is informed that an inmate of his house is suffering from an infectious disease, naming it, and stating the length of time he is likely to be ill, during which the patient is to be kept isolated.

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On the other side of the circular is a copy of the Public Health Act, 1875 Section 126, informing them of the penalty they occur if they expose the patient unnecessarily. I have hopes that this circular will prove of great service. The following corrected table shows how the number of cases of Infectious Diseases which have been reported during the last four years since the adoption of the Act by this district.

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1890. 1891. 1892. 1893. Small Pox — — 13 7 Scarlet Fever 108 63 74 192 Diphtheria 14 8 27 41 Membranous Croup 4 —.

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13 1 Typhoid Fever 13 13 15 19 Continued Fever — – – 1 Puerperal Fever 1 – 1 2 Erysipelas 22 18 37 77 162 102 180 340 The population being estimated at 26,000,

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would give a rate of 13 persons per thousand who have had some infectious disease whereas last year it was reckoned to be 7.2 per thousand. SMALL-POX. Seven cases were reported. Two isolated cases in the spring of the year and five cases in the autumn. Of the first two cases one died in the Highgate Hospital.

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Of the remaining five cases four occurred in connection with a man who carried on a business of disinfecting; and a special report was made to your board on 13 the subject. In it, I reported that he had recently been disinfecting the clothing of small-pox patients living in a neighbouring parish.

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I am strongly of the opinion that, if possible, the Sanitary Authorities should endeavour to prevent other districts sending their infectious clothes into this parish to be disinfected, and that all clothing ought to disinfected in the parish in which the disease is contracted, before being sent away. Five out of the seven cases were removed to Highgate Hospital. SCARLET FEVER.

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Scarlet Fever was very prevalent in this parish and was with us, more or less throughout the year. In this, we were no exception, in that scarlet fever was very much about all over the metropolitan area. This disease was principally confined to Acton proper, although South Acton and Acton Green had their share of it.

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The following table shows how the infectious diseases were distributed over the different parts of the parish:– Acton. S. Acton. E. Acton. Acton Green. Bedford P'k. Willesden Small-pox. 5 1 — 1 — — Scarlet Fever. 88 44 6 34 9 11 Diptheria 19 13 3

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4 — 2 Croup — 1 — — — — Typhoid Fever 3 1 1 2 1 12 Continued „ — -— — 1 — — Puerperal „ — 1 1 – — — Erysipelas 39 22 6 9 — 1 Totals 155 82 17 51 10 25 Number of cases:– Small

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pox 7. Scarlet Fever 192. Diptheria 41. Croup 1. Typhoid Fever 19. Continued Fever 1. puerperal Fever 2. Erysipelas 77. Total 340 cases. 14 To continue.

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We see that 192 cases of Scarlet Fever occurred in the parish, nearly half of which occurred in one division of the parish. The majority of the cases were mild, and it is questionable in my mind whether some of the cases were not a form of influenza with a rash. DIPHTHERIA. 41 cases of diphtheria were reported. These were mostly very mild.

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It is the general opinion that this disease is on the increase. In its mild form it is very difficult sometimes to distinguish it from an ordinary sore throat. This being the case, these cases are very liable to be spread by children in schools. I do not think, therefore, that we ought to discourage mild cases of this disease being notified. TYPHOID FEVER.

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19 cases altogether were reported; 12 of these occurred in Willesden, and 7 out of the 12 occurred in one house in Railway Cottages. One case occurred in the adjoining house and one in the next house but one. These nine cases occurred therefore in one block of houses.

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These houses had a distinct and separate drain, which I had reason to suspect to be the cause of the disease and in as far as no more cases occurred after this drainage was altered I am confirmed in my opinion. One case of Typhoid Fever in Burlington Gardens was imported from Worthing.

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PUERPERAL FEVER, Only two cases of Puerperal Fever were reported, although six deaths were attributed to symptoms of Puerperal Fever. We may therefore conclude that at least four cases were not reported and probably a good many more cases occurred which recovered, 15 ERYSIPELAS. Was very prevalent in the autumn at the time that a keen wind was blowing.

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Some of these cases were rather severe. I am of opinion that not much good is done by notifying these cases unless it be in houses in which lying-in women are expecting to be confined. CHOLERA. No real case occurred in Acton, although one of the inhabitants is said to have died from this disease while staying at Cleethorpes. INFLUENZA.

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The Influenza was prevalent this year again and several deaths were caused by it, and a good many more accelerated by it. GENERAL CHARACTER OF THE DISTRICT. Acton town is situated in the Thames Valley on the northern side. The soil is a light red clay, on the surface of which in many parts a good depth of gravel soil is to be found.

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It is one of the few districts round London possessing gravel. The only stream passing through the district is a small portion of the old Willesden Canal. It obtains its water supply from the Grand Junction Water-Works Company. It is supplied on the continuous supply system.

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16 Some cottages belonging to the London & North Western Railway Company and situated at Willesden are supplied by the Railway Company with water pumped from a deep well in the chalk somewhere near Watford. The Company report it as being exactly of the same quality as that supplied by the Colne Valley Water Works Company.

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On reaching Willesden it is softened by the Porter Clarke process, by means of lime water, and filtered, the filters of necessity being cleaned twice daily. The principal Industry of one portion of the District is Laundry Work. This is carried on chiefly in South Acton and Acton Green in the southern portion of the Parish. A large number of women are employed in this work.

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In the winter time in consequence of their having to go in and out of the drying rooms saturated with steam, into the cold air, they are very liable to get rheumatism, bronchitis and pneumonia. The poorer women have frequently to leave their children at home to be looked after by the elder children or by neighbours.

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The result undoubtedly tends to cause an increased death rate amongst the younger children in the summer from diarrhoea and in the winter time from lung diseases. The Scavenging of the district is done by dust contractors. Every house in the Parish is supposed to be visited once a week, and on a certain day of the week. During the year there have been 225 complaints.

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I think that the only efficient manner is that the Board should themselves undertake the removal of refuse. The difficulty of getting rid of vegetable matter, rubbish, dust, &c., is becoming every year a more important problem.

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In the summer time a large quantity of green vegetable matter collects on the 17 premises of small greengrocers; this is not removed by the dust contractors but has to be got rid of by the tenants. I am of the opinion that it is a scource of great danger to the neighbourhood.

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The only efficient manner of getting rid of it, is for the district to have a dust-destructor, where all such refuse can be burnt. BURIAL GROUNDS. During the past year a new burial ground has been formed in the northern district of the Parish. It is situated on the east side of Horn Lane. It is a large piece of ground, about 12 acres in extent.

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The soil is a light clay. Two Chapels are being erected on the ground. ISOLATION HOSPITAL. At present there is no Isolation Hospital for Infectious Diseases.

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During the latter part of the year, the Acton Local Board have united with the Chiswick Local Board and the Hanwell Local Board to form a Joint Hospital Board for the purpose of erecting a Hospital suitable for accomodating the three districts. DISINFECTING APPARATUS. The Board have taken steps to provide themselves with a superheated steam disinfector.

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Hitherto the disinfection has been carried out by a contractor in the district employing heat only. BAKEHOUSES. An inspection of the bakehouses in this district was made by me during the year. In several, alterations had to be insisted on as regard trapping of drains.

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In one bakehouse I had to order 18 that a new concrete floor should be made as the place was swarming with rats. Most of them are in the basement under the ground floor. A few are on the ground level. These are much easier to keep clean. In one house I found that the coals were shot into the bakehouse. A cellar was made under the pavement to remedy this.

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DAIRIES AND COWSHEDS. Dairies and Cowsheds were visited. In several untrapped drains were discovered. These were at once remedied. I would recommend that all Dairies and Cowsheds be registered annually. SLAUGHTER HOUSES. There are five in this district. STREET IMPROVEMENTS.

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During the year, a number of houses on the north side of the High Street, near the Parish Church, have been pulled down, with the result that the High Street is widened and a fresh air inlet made in the centre of the town. SANITARY INSPECTIONS. This important part of the work of the department has been energetically carried out by the Sanitary Inspector.

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Every opportunity has been seized to make an inspection wherever possible. A house-to-house inspection is the only methodical manner of having this work efficiently done, and I would strongly urge the Board to sanction it. A summary of the Sanitary work done in this District has been appended to my report.

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19 In conclusion, gentlemen, I have to express to you my thanks for the kindness and confidence you have shown me, and to the officers of the various departments for their hearty co-operation. I am, Gentlemen, Your obedient servant, W. T. GARDNER. Medical Officer of Health. 10, Avenue Crescent, Mill Hill Park, Acton, W. 20 For the Yeah 1893.

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QUERIES FOR SURVEYOR. Required for tabulating in Medical Officer's Annual Report to the County Council. 1.—Q. How many removals of Gipsies by Hustwitt? A. 31 that I know of. 2.—Q. How many cesspools done away with under your order? A. 13. 3.—Q.

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How many yards of new sewers laid? A. 371 yards. 4.—Q. How many reconstructed? A. 412. 5.—Q. How many drains tested in your department? A. 595. 6.—Q. What number of dust complaints? A. 225. 21 SUMMARY OF SANITARY WORK For the Year 1893.

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Bottles of Disinfectants supplied in cases of infectious diseases 250 Number of Rooms disinfected 158 „ House Inspections 465 „ Tests applied to Drains 43 „ House Drains remedied and relaid 137 „ Sanitary Additions and Improvements 244 Revisits for inspecting work in progress, etc. 807 Inspections of accumulations and deposits 43 Sundry Nuisances

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60 Nuisance from Stables 5 Foul Ditches 7 Water in Cellars 5 Stagnant Water 2 Burning Refuse 2 Fowls and Rabbits 2 Cats 1 Rats 1 Non-supply of water to dwellings 4 Overcrowding 7 Keeping swine within 100 feet of dwellings 2 Number of complaints registered 91 Inspections of Slaughter houses and

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Piggeries 260 „ Bakehouses 32 „ Cowsheds and Dairies 47 Articles of Food condemned:— 22 60 stone Colonial Mutton 3 quarters ox beef 11 stone 2 lbs. Bacon 1 Carcase of Pig 16 stone 2 lbs.

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2 small lots of Beef 1 case of Cod 2 cases of Haddock 1 Cask of Cherries Number of Notices served. 186 These were supplemented by letters and personal interviews with owners and their representatives. Number of prosecutions 1 „ cesspools abolished 21 23 Acton Urban Sanitary Authority. To Mr.

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of It having come to the knowledge of the Urban Sanitary Authority of Acton that , an inmate of your house, is suffering from a dangerous disorder, , I beg to call your attention to Section 126, Public Health Act, directing you to take certain precautions to prevent the spread of infectious diseases.

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The period during which this disease is infectious, and during which you must not allow the patient to be exposed, lasts weeks from the commencement of the disease, in this case until unless otherwise determined by a Medical Certificate. By order of the Urban Sanitary Authority, Signed W. T. GARDNER, M.B. Lond., Medical Officer of Health.

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Acton Local Board, High Street, Acton, ,189 24 PUBLIC HEALTH ACT, 1875. Sec. 126. Any person who— (1) While suffering from any dangerous (a) infectious disorder wilfully exposes himself without proper precautions against spreading the said disorder in any street, public place (b), shop, inn, or public conveyance,

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or enters any public conveyance without previously notifying to the owner, conductor, or driver thereof that he is so suffering; or (2) Being in charge or any person (c) so suffering, so exposes such sufferer; or (3) Gives, lends, sells, transmits, or exposes without previous disinfection, any bedding clothing, rags or other things which have been exposed to infection from any such disorder,

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shall be liable to a PENALTY not exceeding FIVE POUNDS; and a person who, while suffering from any such disorder, enters any public conveyance without previously notifying to the owner or driver that he is so suffering,

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shall in addition be ordered by the court to pay such owner and driver the amount of any loss and expense they may incur in carrying into effect the provisions of this Act with respect to disinfection of the conveyance (a) Dangerous Infectious Disorders include any of the following diseases:— Small-pox, Cholera, Diphtheria, Membranous Croup, Erysipelas,

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the Disease known as Scarlatina or Scarlet Fever, and the Fevers known by any of the names: Typhus, Typhoid, Enteric, Relapsing, Continued or Puerperal, and also any Infectious Disease to which the Act has been applied by the Local Authority in manner provided by the Act.

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(b) School, Church, &c.. (c) This person may be an adult as well as a child.

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Act 2 THE Urban District Council of Action ANNUAL REPORT OF THE MEDICAL OFFICER FOR THE YEAR 1894. ACTON: Printed by J. Knowles, Market Place & Hooper's Mews. Act 2 THE Urban District Council of Acton. ANNUAL REPORT OF THE MEDICAL OFFICER, FOR THE YEAR 1894.

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ACTON: Printed by J. Knowles, Market Place & Hooper's Mews. The Urban District Council of Acton. ANNUAL REPORT OF THE MEDICAL OFFICER FOR THE YEAR 1894. To the Chairman & Members of the Acton District Council.

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Gentlemen, I beg to submit to you the required Annual Report of the Health and Sanitary progress of Acton for the year 1894, but as I have only held office since Oct. 23rd, I have had to rely on my predecessor for much valuable information in its compilation.

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With regard to Meteorological Observations, the Autumn of the year was remarkable for an excessive rainfall, the result was a disasterous flood in the Thames Valley, which rendered the water turbid and overcharged with organic matter, this placed a great strain on the filtering beds of the various Water Companies, but on the subsidence of the flood the water soon regained its normal condition.

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4 Among the chief works of Sanitary importance is the erection in the grounds of the Sewage Works of a Lyons' Patent Steam Disinfector by which all infected beds, bedding and clothing are subjected to super-heated steam, experiments have conclusively proved that steam at 2120 destroys all contagia. The new Burial Ground has been opened in the Northern district of the Parish.

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It is situated on the East side of Horn Lane. The widening of the High Street has been completed, and the benefit to the Town is apparent, a large fresh air inlet being thus provided. The question of providing a Hospital for Infectious Diseases still remains in abeyance, and I would suggest this matter should engage your early attention.

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I take this opportunity of suggesting the erection of a Destructor Furnace, fitted with a fume Cremator, by which the dust bin refuse, including vegetable organic matter, can be completely destroyed, without the production of any nuisance ia the neighbourhood of the Destructor. Under the present system the difficulty of dealing with this rubbish is becoming daily more apparent.

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There was an epidemic of Measles during the Spring, necessitating closing of the Schools, and causing thirteen deaths of children under five years from Bronchitis and Pneumonia. Many of the poorer class look upon Measles as a trivial disease, and ia many cases never seek Medical advice, whereas the patients 5 require the greatest care to prevent the serious lung complications that may supervene.

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I am pleased to state that the death rate is the lowest since 1890, and the zymotic lower than the two preceeding years. You will notice that as usual the infant mortality is very high, no less than 133 deaths under one year, a death rate of 159.4 per thousand births.