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I attended the Congress on Tuberculosis, held in London last Summer, and shortly afterwards wrote the following leaflet, which has been widely circulated. PRECAUTIONS AGAINST CONSUMPTION. (i.e. tuberculosis of the lungs.) Leaflet issued by the Acton District Council.
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Consumption (with other forms of Tuberculosis) causes one death in every eight in this country, and gives rise to a vast amount of suffering, often long continued.
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Consumption is to a large extent a preventable disease, and might be almost or entirely exterminated if the nature, causes, and means of prevention were generally known, and if the measures required for this purpose were thoroughly and systematically carried out.
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14 The disease is caused by germs or microbes called "tubercle bacilli;" these bacilli are so small that they can only be seen with the most powerful microscopes, and many thousands may be crowded in a few drops of expectoration from the lungs of those suffering from Consumption. Whatever lowers the strength or the vitality predisposes towards the disease.
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Persons who live in damp, dirty, ill-ventilated, over-crowded and badly lighted houses. Intemperance, repeated colds, unwholesome and insufficient food, attacks of measles, whooping cough and typhoid fever. From a patient suffering from Consumption the germs are given off in the expectoration or phlegm.
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Where this expectoration or spit lodges, it dries, and afterwards gets lifted up as dust into the air, the germ thereby reaches the lungs of others.
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For the above reason Consumptive patients should never expectorate on the floors of a house, public conveyance, or into a handkerchief, but either into pieces of rag or paper, which should be at once burned, or into a spittoon or small portable spit bottle containing a little water. The spittoon or bottle should be carefully emptied down the w.c.
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every morning and evening, then scalded and re-charged with fresh water. A Consumptive patient should, if possible, occupy a separate room, which should be supplied with plenty of fresh air and open to sunlight, both of which tend to destroy the germs. No Consumptive patient should give suck. No Consumptive patient should kiss the lips of another person.
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All knives, forks, spoons, and cups used by Consumptive patients should be boiled for at least two minutes. 15 On a Consumptive person ceasing to occupy a room, this will be disinfected free of charge, if application is made to the Sanitary Inspector at his Office, Gothic Villa, Mill Hill Grove.
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In cleansing rooms used by Consumptive patients, all dirt and dust should be removed by damp dusters, which should afterwards be boiled. Any dust from such rooms is liable to contain the living germs of the disease. The milk from Consumptive Cows may contain the germ, and it is dangerous to drink unboiled milk.
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If the above precantions are carried out a Consumptive patient need not be a source of danger to anyone, and he will at the same time materially improve the prospects of his recovery. Medical Officer of Health.
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Public Health Department, Gothic Villa, Mill Hill Grove, Acton, W. I think it imperative that every Sanitary Authority should take active steps with a view of diminishing the suffering and death from tuberculosis, and I beg to offer the following suggestions, which I trust will meet with your approval and consent:β€” 1.
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That medical practitioners be requested to give voluntary notification (with the consent of the parent, or those in charge of the patient) of any case of consumption which may come under their notice. 2. That the fees paid for such notification be the same as those paid under the Infectious Diseases Notification Act. 3.
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The Medical Officer of Health to visit the case with a view of inspecting the surroundings of the patient, the conditions of work, &c., and the detection and removal of conditions likely to promote the disease. 16 4. Verbal advice will be given, and written instructions left at the house. 5.
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An offer will be made, free of all charge, to perform any necessary disinfection of rooms, bedding, &c. 6. The house will be visited from time to time in order to see if the necessary precautions are being observed to prevent the spread of the disease. 7.
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Arrangements will be made by the Medical Officer to examine, without fee, specimens of sputum from persons the nature of whose illness is dubious, in order to bring about a prompt diagnosis of the disease. WHOOPING COUGH. There were sixteen deaths from Whooping Cough.
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The lax way in which parents allow the little patients to mix with other children is the cause of the disease spreading, for it is so notoriously contagious that the most rigid isolation should be insisted upon. Whooping Cough is a serious affection, and with its frequent complica tionβ€”broncho-pneumoniaβ€”a very fatal disease. I purpose shortly to bring out a leaflet on this disease.
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SMALL POX. There was one case of Small Pox notified during the year; a nursemaid who contracted the disease in Paddington. She was promptly removed to the South Mimms Hospital. The outbreak of Small Pox in London is disquieting, but if the public will avail themselves of the protecting power of re-vaccination they need have little alarm.
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17 I find many anti-vaccinists are converted by being told in simple language what vaccination really means. I tell them how in prevaccination days cows suffered from a disease called Cow Pox, which showed itself by vesicles or blisters on the udder or teat of the cow, how Dr.
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Jenner came along and took some of the fluid from the vesicle and injected it into the arms of a few people, and how these people after a few days also got vesicles on their arms. Then Dr.
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Jenner tried to inoculate these same people with Small Pox, and he found they would not take Small Pox, so he found that Cow Pox was a preventative against Small Pox. Small Pox in its natural state is one of the most loathsome, disfiguring, and fatal diseases in the world.
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Not only so, but it is very infectious, and may be caught in a multitude of ways of which most people take no account. The only trustworthy protection is a com paratively recent vaccination, which not only modifies very greatly the severity of an attack, robbing the disease of half its terrors, but, in the vast majority of cases, wards off an attack altogether.
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Under ordinary circumstances re-vaccination should be done between the ages of 10 and 15 years; but there being now immediate danger of Small Pox, it would be well that all persons over 7 years of age who have not already been re-vaccinated should have this operation performed without delay.
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"Of 2,198 persons employed at the Small Pox Hospitals between 1884 and 1900 inclusive, only 17 persons contracted Small Pox, of whom 13 were not re-vaccinated until after they had joined the ship, and four were workmen who escaped medical observation."
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And again:β€”"Not one of the staff of the Hospital Ships has ever died of Small Pox, not one has ever suffered from the disease for the past eight years." It is only necessary to add that these facts are only novel in the sense that they relate to the new epidemic. Exactly similar facts have characterised every previous epidemic. 18 PLAGUE.
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During June a Conference took place between a Local Government Inspector, the Chairman of the Council, the Clerk, and myself, with a view of ascertaining how far we were prepared to deal with cases of Plague, should any cases crop up in the district. It was feared that the return of so many soldiers from South Africa might be a means of importing the disease to England.
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The following points were discussed and arranged:β€” 1. The disease to be made notifiable under the Infectious Diseases Notification Act. This was done, and all Medical Practitioners notified to this effect. 2. In the event of any doubt as to diagnosis, the Local Government Board will send down a Surgeon who has had special experience of the disease in Hong Kong. 3.
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The cases would be isolated at once. 4. All contacts would be taken charge of in a special House which the District Council have secured. 5. The rooms, &c., would be disinfected by formalin and chlorine. 6. Hafkines Inoculation could be used as a prophylactic for those who come in contact with cases. 7.
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Visitation of Common Lodging Houses. S. Warn all Hospitals. 19 9. Destruction of Rats. Rats are very prone to plague. The first warning that plague is incident may be deaths amongst rats. Plague-infected rats leave their runs, they appear dazed, become seized with convulsions and speedily die.
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Whether the rat is seized with plague before man and thus infects him, or whether man infects the rat, is a question as yet undecided. Many epidemics are believed to have been traced to rats, yet in other localities, and markedly so in Glasgow, the rats have not been found infected by plague, either before or after the outbreak.
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It is by the vermin in the rat's coat that infection is probably conveyed to man. The vermin leave the rat soon after the animal dies, and as it is found that the vermin contain the bacilli, the poison may gain entrance to the human body by vermin bites or by the abrasion of skin consequent on the scratching they induce.
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Parasites, such as fleas, bugs, and lice, acquire the bacillus from feeding on plague-sick persons, or they may gather it from clothing, bedding, &c., soiled by excretions. 10. Removal of Nuisances. 11. House to House Visitation. INFECTIOUS DISEASE.
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The following table gives the cases of Infectious Disease notified during the year 1901, and the total cases notified in each locality:β€” 26 NOTIFIABLE DISEASE. CASES NOTIFIED IN WHOLE DISTRICT total cases notified in each locality. CASES OF INFECTIOUS DISEASE NOTIFIED DURING The Year 1901. At all ages Under 1 1
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to5 5 to 15 15 to 35 25 to 65 65 and upwards Acton South Acton Acton Green East Acton Bedford Park Willesden Small-Pox 1 1 – – 1 _ _ _ Diptheria 34 β€” 14 14 2 4 β€” 11 12 8 β€” 2 1 Membranous Croup I
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Erysipelas 26 I I β€” 4 15 5 7 II 4 1 I 2 Scarlet Fever 82 β€” 16 45 16 5 β€” 31 23 16 6 3 3 Enteric Fever 27 β€” β€” 8 8 11 β€” 6 14 5 1 1 β€” Puerperal Fever I β€” β€”
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β€” β€” 1 β€” β€” I β€” β€” β€” β€” Chicken Pox 25 5 12 8 β€” β€” β€” 6 4 10 3 2 β€” Totals 197 6 43 76 3Β° 37 5 61 66 44 11 9 6 21 The number of cases notified during the year was 172,
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a number that contrasts very favourably with 333 cases notified in 1900. The following table gives the number reported each year since the Act came into force :β€” 1890 '91 '92 '93 '94 '95 '96 '97 '98 '99 1900 '01 Small Pox β€” β€” 13 7 2 β€” β€” β€” β€” β€” 2 1 Scarlet Fever
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108 63 74 192 86 67 193 93 167 111 243 82 Diphtheria 14 8 27 41 22 32 23 89 35 49 28 34 Membranous Croup 4 β€” 13 1 β€” β€” β€” 4 β€” β€” 1 1 Typhoid Fever 13 13
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15 19 15 28 14 10 9 46 29 27 Continued Fever β€” β€” β€” 1 β€” β€” β€” β€” β€” β€” 2 β€” Puerperal Fever 1 β€” 1 2 1 3 3 β€” 1 β€” β€” 1 Erysipelas 22 18 37 77 41 31 26 25 22
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31 28 26 162 102 180 340 167 161 259 221 234 239 333 172 The above table does not include 25 cases of Chicken Pox, which on my recommendation you made a notifiable disease last October. Nearly all other districts have followed our example.
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Chicken Pox is a disease that somewhat resembles Small Pox in the early stages. We now receive weekly returns of infectious cases from the Local Government Board of all the principal towns in England and Wales, who have adopted the course of notifying every week to the Local Government Board. 22 DISINFECTION AND METHODS TAKEN TO PREVENT THE SPREAD OF INFECTIOUS DISEASE.
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In my Annual Report of 1899 I drew your attention to the value of Formic Aldehyde as a disinfectant; since then the results of its use have been so praised by Sanitary Authorities that I have finally substituted it for sulphurous gas in the disinfection of rooms, &c., and am very pleased with the change.
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A Lamp is used for generating the Formalin, which consists of three partsβ€”viz., a spirit lamp, an absorbent block, and a container to hold the Formalin fluid. The action is as follows:β€” The fluid is poured into the container, from whence it percolates on to the absorbent block, under which is placed the spirit lamp.
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The block when heated vaporizes the Formalin, which after four hours completely disinfects a room, without damage to pictures or metals, permeating at the same time all woollen and other such articles. A thoroughly up-to-date Brougham Ambulance has been provided. It has every convenience, and patients can now be removed with the minimum amount of discomfort and danger.
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SICK NURSING. The Nurses in connection with the Cottage Hospital have had under treatment 337 patients, and paid 7,926 visits. An average of 23 to each patient. I can but speak in the highest praise of the excellent work done by these ladies, which undoubtedly helps to keep down our death rate.
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23 Nurse Dawkins has paid 1,901 visits, and nursed patients when necessary. She has given out 1,056 bottles of disinfectants, and taken six patients to different hospitals. . DRAINAGE AND SEWAGE DISPOSAL. The Bacterial treatment of a portion of the Sewage delivered to the Sewage Works by means of an open septic tank,
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followed by continuous filtration, having proved successful, the Council undertook to treat the whole of the Sewage in this manner, but instead of delivering the effluent from the septic tank to the filters by a revolving filter actuated by a pulsometer, they decided to deliver it by gravitation. During the year the new filters have been prepared and will soon be at work.
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The work has taken a considerable time to carry out, principally on account of the difficulty of obtaining suitable material for the filters, though the work was impeded by the necessity of carrying on the existing chemical treatment of the Sewage while alterations were being made to tanks, &c. It is hoped that the new installation will be at work at the beginning of the next financial year. DRAINAGE.
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Sewers have been laid by owners of land in the following roads:β€” Length. Albert Villas Road, Surface Water Sewer 70 yds. Graham Road, Soil and S.W. Sewers 230 β€ž St. Alban's Avenue, S.W. Sewer 157 Ramillies Road, Soil and S.W.
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Sewers 630 β€ž Back Way, Mill Hill Grove, Soil Sewer 120 β€ž Bedford Road, Soil and S.W. Sewers 110 β€ž 24 Sewers laid by the Council. Length. Acton Green, 6" Soil Sewer 60 yds. Acton Hill, 9" S.W.
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Sewer 220 β€ž Mill Hill Road, 9" Soil Sewer 325 β€ž Sewers re-laid by the Council. Length. Chiswick High Road, S.W. Sewer 35 yds. Friars Place Lane, S.W. Sewer 35 β€ž Sewers laid by Contractors for the Council. Length.
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Braemar Road, S.W. Sewer 20 yds. Rosemont Road, Soil Sewer 900 β€ž Southfield Road, 6" S.W. Sewer 50 β€ž Reconstruction of S.W. Sewer at Sewage Works 100 β€ž DWELLINGS.
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Considerable amount of building is still going on, and during the year about 450 houses have been erected and inspected by the Building Inspector. Several new roads have been formed and also plans have been passed for the development of several Estates in the West part of Acton. PIGGERIES, SLAUGHTER-HOUSES, AND COW-SHEDS.
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Four Piggeries have been eliminated from the district. The Slaughter-houses are licensed, and when inspected have been found clean and in good order. The Cow-sheds have been inspected from time to time. 25 REMOVAL OF REFUSE. About 10,500 tons of House Refuse have been removed during the year.
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255 Complaints have been received during the year of non-removal of Dustbin Refuse, which received the immediate attention of the Surveyor. BAKEHOUSES. I have personally visited the bakehouses of the district.
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According to Section 101, Sub-section 2, of the Factory and Workshops Act, 1901:β€” "After the first day of January, 1904, an underground bakehouse shall not be used unless certified by the District Council to be suitable for that purpose."
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Personally from a sanitary point of view, I should like to close all underground bakehouses, but, as so many of these exist in Acton, it would mean practically taking the living away from many hard-working and deserving people. Again, many have invested capital in their business, and it would be obviously very hard on them.
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I intend, however, to utilize my power, and exact all I can as regards lighting, ventilation and cleanliness, and unless they comply with my instructions, I shall advise the Council not to grant the required certificates. The following is the Report I have received from Mr. Kinch, Sanitary Inspector.
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26 ANNUAL REPORT OF THE SANITARY INSPECTOR, FOR THE YEAR 1901. To Dr. G. A. Garry Simpson, Medical Officer of Health. Sir, I herewith present the Annual Statement, shewing the particulars of the action taken in the suppression of Nuisances, &c., and various improvements effected by this Department during the year 1901.
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For the greater part of the year this Department had no separate Office and we were working under many difficulties, but about the end of October we moved across to Gothic Villa, and I am now doing all I can to put the Department into that state of efficiency which is necessary for the effectual carrying out of our duties. Mr.
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A. W. Fraser, having been appointed Assistant Sanitary Inspector, commenced his duties at the beginning of September. Systematic Inspection, &c.β€” During the year there were 1,400 Premises inspected. 3,170 Re-inspections of nuisances in course of abatement. 2359 Nuisances were reported. 2128 β€ž abated. 882 Letters written.
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742 β€ž received. 73 Notices were received from H.M. Factory Inspector. 2 Library Books were destroyed. 29 Van Dwellings Inspected. 27 166 Visits were paid to infected houses. 23 Infectious patients were removed to hospitals. 346 Rooms fumigated. 15 tons of bedding disinfected.
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27 Closets disinfected where cases of Enteric Fever were notified, in addition to the ordinary inspections of Cowsheds, Dairies and Milkshops, Bakehouses, Slaughterhouses, Piggeries, and the Common Lodging House, &c. Drainage Examinations.
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β€”The smoke test has been applied to drains 155 times and in addition 31 drains were opened up for examination after formal written complaints had been made, and authority given for that purpose. Workshops.β€”Six workshops, with insufficient w.c. accommodation, erected suitable w.c's so as to provide separate accommodation for persons of each sex in accordance with Sec. 22, Pub.
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Health Amend. Act, 1890. Notices.β€”596 Preliminary Notices and 42 Statutory Notices have been served for the abatement of Nuisances and the necessary works asked for were carried out. No Police Court proceedings in respect of Nuisances have been taken before the Magistrates.
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Dairies, Cowsheds and Milkshops.β€”There are now 68 Dairies and Milkshops and 8 Cowkeepers on the Register. Regulations relating to these premises were printed last June, and a copy left with each dairyman and cowkeeper, and the principal clauses pointed out to him.
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I also send to each every quarter a notice reminding him of the time to whitewash. 131 visits have been paid to the Dairies and Milkshops and 24 visits to the Cowsheds.
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On the 10th June, Police Court proceedings were successfully taken against a Milkman carrying on business in Bollo Lane, for failing to give the necessary one month's notice to the Council before commencing to occupy the premises as a Dairy. Defendant was fined 10/-and 2/- costs.
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28 Bakehouses.β€”The number of Bakehouses on the Register is 23, of which 14 are underground. Notice reminding the occupiers of the time to whitewash is also sent every six months. These have been regularly inspectedβ€”79 visits having been paid them.
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Slaughter Houses and Butchers' Shops.β€”32 visits of inspection were paid to the four Licensed Slaughter-houses, and they were all found in fairly good condition. No unsound meat was found. A notice re the white-washing is also sent to these every quarter. Piggeries.β€”Thirteen piggeries still exist in the District, viz.
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: ten at Old Oak Lane, East Acton, one at Goddard's Farm, Willesden Lane, one at Manor Farm, and one at Elms Farm, Acton Hill. These have been visited 43 times, and it has only been necessary in one case to serve the occupier with a notice to abate any nuisance.
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Early in October the Council summoned four pig-keepers of South Acton for contravening the bye-law by keeping their pigs within 200 feet of a dwelling-house.
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The Magistrate held that in these cases he considered the bye-law reasonable, and an order was made to comply with the same within three months, but as the required distance could not be obtained, the defendants have removed their piggeries out of the parish, which will be highly beneficial to the Bollo Bridge neighbourhood.
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Common Lodging Houses.β€”The one registered has been inspected 24 times, and was always found to be in a satisfactory condition. Smoke Abatement.β€”24 observations have been made of the 10 Factory and Works chimneys during the year, and in one case proceedings were taken before the magistrates, with the result that an Order of Abatement was made and the usual costs allowed.
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Food and Drugs Acts.β€”Samples under these Acts are taken by Mr. W. Tyler, the Inspector, Brentford. No returns as to the number of samples taken and the result of the analysis is supplied to the Council, 29 During the year I seized and took before a Justice :β€” 3 rabbits. 1 box mackerel. 2 boxes kippers.
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1 box bloaters. 6o boxes plums. 2 boxes whiting 1 box mixed fish. 1 box herrings. 18 rabbits. 2 barrels herrings. Orders to destroy were granted in each case. One offender living at South Acton from whom I seized a quantity of bad fish, was written to by the Clerk, and cautioned not to repeat the offence.
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The following Tabulated List gives particulars of Nuisances dealt with :β€” Drains Defective 73 β€ž stopped 67 β€ž want of ventilation to 89 Manholes, want of, and Interceptors . 105 β€ž defective 27 Fresh Air Inlets,
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want of 14 β€ž β€ž defective 10 Soil Pipes defective 7 β€ž want of ventilators to 4 β€ž ventilators defective 48 Ventilating Shafts defective 20 30 Water Closets defective 45 β€ž pans broken or defective 86 β€ž pans, &c.
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foul 24 β€ž Stopped 26 β€ž want of water supply to 13 β€ž flushed directly from drinking water cistern 24 β€ž defective flushing apparatus 139 β€ž additional or separate,
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required in Factories and Workshops 6 β€ž defectiue pan closets and containers 10 Latrines defective 1 Gullies defective 128 β€ž want of 96 β€ž defective cement work around 32 β€ž stopped 22 Yards dirty 12 β€ž defective paving of 140 β€ž want of paving to 36 Stables, defective paving of 13 Laundries,
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defective floors of washhouses 16 Kitchen and Scullery, floors defective 56 Rain Water Pipes connected directly to drain 312 β€ž defective 56 β€ž β€ž want of 16 Eaves Guttering defective 41 β€ž β€ž want of 10 Sinks defective 9 β€ž waste pipes connected to drain 24 β€ž want of wash pipes to 7 β€ž defective waste pipes J9 31 Bath and Lavatory Waste
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Pipes connected directly to drain 10 Walls and Ceilings dirty 136 β€ž β€ž damp 6 Dust Bins, want of 196 Ashpits defective 9 Manure Accumulations 26 β€ž want of receptacles for 43 Refuse, accumulations of 20 Animals and Fowls kept as to be a Nuisance 19 Water Supply, absence of 4 Cisterns defective
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12 β€ž covers required 18 foul 5 Roofs defective 31 Plastering defective 42 Water in Cellars 6 Cesspools defective 14 Urinals defective 3 β€ž want of water sapply to 3 Overcrowding 4 Chimneys emitting black smoke 7 Miscellaneous 70 A great deal of work has been done in connection with the abatement of these nuisances,
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and a large proportion of our time is taken up by the superintendence of this work, but I have to report that there has been improvement in the character of the work done. I am, sir, Yours obediently, MAURICE W. KINCH, Sanitary Inspector. Public Health Department, Gothic Villa, Mill Hill Grove, Acton W.