HAMPTON URBAN DISTRICT COUNCIL. Medical Officer's Annual Report. Hampton, Middlesex, 20th February, 1911. Gentlemen, I herewith submit my Annual Report for the year ended 31st December, 1910. PHYSICAL FEATURES. The district comprises an area of 2,036 acres, and is of an open character. The subsoil is gravel, which extends to a considerable depth over the greater portion of the area. The District is fortunate in the possession of ample open spaces with entirely free access; a large portion of Bushy Park being included in the area: and several small recreation grounds and gardens are under the control of the Council; while the River Thames flows along the whole of the southern boundary. A considerable area of the District is under cultivation—mainly for horticultural purposes—and the principal occupations of the working class section of the inhabitants are outdoor ones. VITAL STATISTICS. At a date so remote from the last Census it is somewhat difficult to arrive at a true estimate of the population of a District. There has been little change in this District since last year; so I have estimated the population to be 10,000; calculated to the middle of 1910. Births and Birth Rate.—The total number of births registered during the year was 206—100 males and 106 females—of whom four were illegitimate. This is equal to a birth rate of 20.6 per thousand of the estimated population, and is slightly lower than the rate for 1909 which was 21.7. The birth rate for England and Wales for the year 1910 was 24.8 per thousand. Deaths and. Death Rate.—The total number of deaths registered from all causes during the year was 96. This number includes two non-residents ; the particulars of whose deaths were forwarded to the Medical Officers of Health in whose districts they had previously resided; and seventeen deaths of residents which occurred outside the district, distributed among outside institutions as follows:—Union Infirmary, Kingston, 6; London Hospitals, 6; Richmond Hospital, 1; County Asylum, 2; other places, 2. After correcting these returns by deducting the deaths of the two non-residents and adding the deaths of those residents who died at Hospitals or other places outside the District; this brings the nett total of deaths of persons belonging to this district to 94—42 males and 52 females—the causes of whose deaths, together with the age-periods at death are shown in the tabular statement below. 2 I also append a table showing the distribution of these deaths among males and females; with the age periods at death. Causes of Death. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Cancer 16 — — — — 9 7 Heart Diseases 15 — — 1 — 5 9 Phthisis 6 — — — 1 5 — Other Tubercular Diseases 1 — — — — 1 — Pneumonia 6 1 1 — — 2 2 Bronchitis 7 — — — — 2 5 Disease of Parturition 1 — — — 1 — — Premature Birth 3 3 — — — — — Cirrhosis of Liver 3 — — — — 2 1 Scarlet Fever 1 — — 1 — — — Accidents 4 — 1 — — 3 — Suicide 1 — — — — 1 — All other causes 30 4 — 1 2 7 16 Totals 94 8 2 3 4 37 40 Distribution of Deaths among Males and Females. Sex. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Males 42 4 1 1 2 14 20 Females 52 4 1 2 2 23 20 Totals 94 8 2 3 4 37 40 Taking the corrected number of deaths of persons belonging to the district at 94; as set out in the foregoing tables; this gives a death rate of 9.4 per thousand of the estimated population; an increase of 0.1 per thousand compared with the previous year. The death rate for England and Wales for the year 1910, is 13.4 per thousand. Hampton Urban District Council. ANNUAL REPORT OF THE INSPECTOR OF NUISANCES For the Year ended December 31st, 1910. To the Chairman and, Members of the Hampton Urban District Council. Gentlemen,— I beg to present my Fourteenth Annual Report on the work carried out as your Inspector of Nuisances during the year 1910. Inspections: Complaints received and attended to 39 Number of premises inspected owing to complaints 42 Number of houses inspected owing to infectious disease 69 House-to-house inspections 95 Other inspections 301 Premises under periodical inspection 62 Number of re-inspections after order or notice 1919 Total inspections and re-inspections 2426 Notices: Letters written 105 Cautionary or intimation notices given 156 Statutory notices served 4 Prosecutions None Dwelling-Houses: Premises cleansed, repaired, etc. 27 House demolished 1 Roofs repaired 8 Eaves gutters repaired 23 Rain-water pipes repaired 13 Sites covered with concrete 2 Ventilation below floors provided 8 Damp-proof courses inserted 6 Washhouses paved 6 New movable dustbins provided 30 Schools: Number in district 6 Frequency of inspection Monthly Number found defective 2 Slaughter-Houses: Number on the Register 5 Number of visits paid 68 Frequency of limewashing Quarterly Refuse removed 1 Water closets amended 2 2 Unsound Food: Articles seized or surrendered and destroyed:— 1 trunk of codfish about 6olbs. 1 mat of cauliflowers. 1 ox liver, 1 pair of ox lungs, 1 Mesentery. Dairies, Cowsheds, and Milkshops. Number of cowsheds in the district 7 Number of milch cows kept 122 Number of dairies and milkshops in District 6 Number of visits paid 21 Cowsheds cleansed and limewashed 5 Nuisance from pigs abated 1 Drains amended 2 Offensive Trades: Number in District 1 Number of inspections 2 Nuisances found None Drainage and Water Supply: Drains tested, exposed, etc. 10 Number found defective 4 Drains cleared 121 Drains repaired 21 Drains trapped 3 Drains reconstructed 8 Disconnecting traps or chambers inserted 16 New soil pipes or ventilating shafts fixed 6 Existing soil pipes or ventilating shafts repaired 16 New stoneware sink fixed 1 New waste pipes fixed 6 waste pipes repaired 3 Urinal cleansed 1 Waste and rain pipes disconnected from drains 5 Cesspools emptied and abolished 11 New water closets erected 3 New water closet apparatus fixed 13 Water closets cleansed or repaired 13 Closets supplied with water or supply improved 26 Cisterns cleansed or covered 6 New water waste preventers fixed 9 Water waste preventers repaired 17 Tents, Vans, &c.: Number observed during the year 37 Number removed from the District 37 The ground used as a camping place by gipsies is now enclosed by a wire fence. Sundry other Nuisances abated: Smoke 1 Overcrowding 2 Accumulations of Refuse 8 Animals improperly kept 8 Foul pond 1 Stable paved and drained 1 3 Infectious Diseases and Disinfection: Cases of Scheduled diseases notified 77 Cases of Pulmonary Tuberculosis notified 2 Patients removed to the Isolation Hospital 67 Notices sent to School Teachers 89 Rooms disinfected 105 Rooms stripped and cleansed 75 Articles disinfected or destroyed 296 Factory and Workshop Acts, 1901 and 1907: Workshops and workplaces on Register 24 Retail bakehouses on Register 8 Laundries on the Register 7 Number of visits to workshops and workplaces 65 Number of visits to bakehouses 31 Number of visits to laundries 25 Number of visits to factories 23 Workshops whitewashed 6 Bakehouses limewashed 6 Water closet cleansed 1 New closet provided 1 Flushing tank fixed 1 Overcrowding abated 1 Smoke nuisance abated 1 Nuisance from animal abated 1 Defective urinal removed 1 Outworkers' lists received 3 Name of outworkers forwarded to other Authorities 4 Notice sent to Factory Inspector 1 Notices received from Factory Inspector 9 In concluding this Report, I beg to tender my sincere thanks to the Council for their continued confidence, and for the hearty support accorded me in dealing with any matter reported to them in the course of my duties during the year. I am, Gentlemen, Your obedient Servant, ALBERT SHAIL. Public' Offices, Hampton, Middlesex, i6th January, 1911. Hampton Urban District Council. Annual Report of the Inspector of Nuisances FOR THE YEAR 1910. H. C. FRANKLIN. PRINTERS TWICKENHAM. 3 The average death rate for this district for the previous decade is 10.94 per thousand. Fifty-three of these deaths were of persons 60 years of age and upwards, of whom 19 were between 60 and 70; 19 between 70 and 80; and 15 between 80 and 90. Eleven deaths were the subjects of Inquests by the Coroner during the year, and the verdicts of the juries were as follows:—Natural Causes, 5; Accidents, 4; Drowning, 1 ; Suicide, 1. The only death recorded as being due to one of the principal zymotic diseases was one from Scarlet fever. This is equal to a rate of 0.1 per thousand of the population ; an exceedingly low rate. Infantile Mortality.—Eight deaths of infants under one year of age were registered during the year; of whom two were illegitimate; these latter being infants born in the Union Infirmary and boarded out in this District. The causes of these infants' deaths were certified as follows: -Premature birth, 3; Convulsions, 2; Debility, 1; Congenital defects, 1; and Pneumonia, 1. Seven died within the District, and the remaining one at the Children's Hospital. Great Ormond Street. The infantile mortality rate is calculated on the actual births and infantile deaths registered in the District during the year; and for the year under review is the low one of 33.9 per thousand births This is the lowest infantile mortality rate recorded for this District. The rate for England and Wales for 1910, is 106 per thousand births. There have been no deaths from Diarrhœa, Whooping Cough or Measles; diseases which are particularly fatal to very young children. The Notification of Births Act of 1909, has not been adopted. The work of inspection under the Infant Life Protection Act is carried out by a trained nurse employed by the Board of Guardians. Infectious Diseases. I append a tabular statement showing the notifications received during the year under the provisions of the Infectious Disease (Notification) Acts: with the age periods of the patients:— Disease. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Scarlet Fever 20 1 3 14 1 1 — Diphtheria 49 — 10 37 1 1 — Continued Fever 1 — — — — 1 — Enteric Fever 1 — — 1 — — — Erysipilas 6 — — — 1 4 1 Totals 77 1 13 52 3 7 1 4 The whole of the Diphtheria patients, and eighteen of the Scarlet Fever patients, were treated at the Isolation Hospital. Three of these patients—two certified as suffering from Diphtheria and one Scarlet Fever—were discharged after a few days treatment; the illness proving to be other than that certified. Enteric Fever.—The only case of this disease was evidently contracted abroad; or while the patient was on board ship on the voyage home from Sweden. Scarlet Fever.—This disease was prevalent in the early part of the year; only three cases being notified during the latter six months. The cases were simply sporadic ones. One death occurred from this disease; this being the only case of death from Scarlet Fever among the residents of this district during the last fourteen years. Diphtheria.—An outbreak of Diphtheria commenced at the beginning of September, and continued to the close of the year. The outbreak was evidently the result of contact among the children attending the Public Elementary Schools at Hampton Hill; accentuated by a number of unrecognised carrier cases, particularly among the boys. With a view to stamping out the outbreak and to find any carrier who might be attending school; the whole of the scholars at the boys' school were examined by the School Medical Officers and myself; and a number of swabs were taken during this examination; and at other inspections by the Medical Inspector. Prompt measures were taken to isolate the patients; all being removed to the Isolation Hospital; and the schools were cleansed and all utensils, desks, etc. were disinfected. In addition all contacts from infected houses were excluded from school for fourteen days. All patients treated in the Hospital for Diphtheria are excluded from school for four weeks after the date of discharge, With a view to the early detection of cases of this disease, the Council are prepared to pay for the bacteriological examination of swabs from patients who are not in a position to meet the expense of such examination, so as to obtain a definite diagnosis at the earliest moment. This is of the utmost importance, as the patient has greater likelihood of recovery when the treatment is commenced in the early stages of the disease. Phthisis.—There is no system of notification—either voluntary or compulsory—for cases of this disease in the District, beyond that provided for poor persons by the Public Health (Tuberculosis) Regulations of 1908. Six deaths were registered from this disease during the year. Two persons were notified under the Regulations mentioned; one of whom was already in the Infirmary, and the other was removed to the same Institution a few days after notification. 5 The premises occupied by the patients were inspected and disinfected; and advice given respecting measures to be taken to prevent the spread of the disease. The Council are prepared to provide treatment at a Sanatorium for persons in the early stages of the disease, providing the patients are not in a position to bear the cost themselves; and when, in the opinion of the Medical Officer of Health, such treatment is likely to prove beneficial. Two persons were treated under this arrangement during the year. One has improved and was still under treatment at the end of the year, but the other patient unfortunately did not respond to the treatment, and died a few months after discharge. The Council undertake to have all rooms which have been occupied by persons suffering from Tubercular disease in any form disinfected free of cost upon receipt of a request from the Medical Practitioner in attendance. Ten rooms so occupied have been disinfected by the Inspector; and the rooms are also stripped and cleansed. Disinfection.—All rooms occupied by persons suffering from infectious disease are disinfected with Formalin immediately after the removal or recovery of the patient, and the rooms are stripped and cleansed when necessary. Bedding and clothing are disinfected in a steam disinfector at the Isolation Hospital. The work of disinfecting rooms and bedding is carried out by the Council's officers free of cost. In connection with the work 105 rooms have been disinfected by the Inspector; and 75 rooms have been stripped and cleansed. Rooms which have been occupied by persons suffering from Cancer are also disinfected by the Inspector, when requested to do so by the Doctor in attendance on the patient. Isolation Hospital.—This building was erected in 1904, and stands in a site of some seven acres abutting on the Uxbridge Road, Hampton Hill. A portion of the site at present not required for Hospital purposes is let for the purpose of horticulture. The accommodation provided consists of a pavilion of four wards, with kitchens, bath rooms and lavatories; an administrative block with nurses' quarters; porters' lodge with discharging rooms; laundry and disinfecting chamber; coach house and mortuary. The small ward or wards I advocated last year for the purpose of observation wards for doubtful cases have not yet been provided. The establishment is in charge of a Medical Superintendent, with a staff of two trained nurses (supplemented by a temporary nurse when occasion requires), two maids and a porter, and is connected to the residence of the Medical Superintendent the Council Offices Fire Brigade and Police by telephone. An ambulance with two beds is provided for the removal of patients. The arrangement made with the Croydon and Wimbledon Joint Hospital Board in 1905 for the reception of Small Pox patients into their Hospital at Cheam is still in force. Schools.—These have been under constant observation and are kept in good repair. 6 The Medical Inspection of the children in attendance at the Public Elementary Schools is conducted by officers especially appointed by the County Education Committee; the County Medical Officer being the chief School Medical Officer. In order to prevent the spread of infectious disease among the scholars, a system of notification is in force, whereby the Head Teacher of any school at which any infected child is a scholar, is at once informed of the illness, and notices are also served where there are contacts attending school, excluding the particular scholars for a period. The School Medical Officer is also notified of infected scholars and contacts with particulars of the school attended, and the period for which any child is excluded from school. The Head Teachers of the various schools also kindly co-operate by informing me of any abnormal absence through illness, especially such diseases as Measles, Whooping Cough, Chicken Pox and Mumps. / Dwelling Houses.—In my opinion the accommodation provided is quite sufficient for the present needs of the district. The houses erected a few years ago by the District Council, under the provisions of Housing of the Working Classes Acts 65 in number—have been almost fully occupied during the whole of the year. One house which was closed in 1908, has been demolished, and two new ones have been erected on the site. A considerable number of houses have been inspected during the year; and a further number have been entirely re-drained and connected to the sewer, while all new houses are so connected at the time of erection. A number of houses have been repaired and cleansed; and various nuisances arising from dampness: defective and insufficient sanitary conveniences: choked drains, refuse, animals, &c., have been promptly remedied. Building operations have been very quiet during the year and only a small number of plans for new houses have been submitted to the Council. The work of supervision over the erection of all new buildings is in the hands of the Surveyor to the Council. Milk Supply.—The milk supply in this District is partly home produced and partly imported from the neighbouring districts. There are three cowkeepers in the district, who keep an aggregate of 122 milch cows: which are grazed during the greater portion of the year. The cowsheds, dairies and milkshops are under periodical inspection by myself and the Inspector of Nuisances, and have been kept in good condition, a verbal request being at all times sufficient to get any requirement attended to at once. The Council have appointed a Veterinary Surgeon to make a quarterly examination of all milch cows in the district for the purpose of detecting any case of Tubercular disease of the udder that may exist. In his last report to the Council just before the close of the year, he stated that the whole of the cows were in a healthy condition, and that no case of Tubercular udder was found. 7 Food Supply.—The various premises in the district where food is prepared for sale—and which include Slaughter-houses and Bakehouses—have been constantly inspected during the year by myself and the Inspector. There are five slaughter-houses in the district, and they are kept in a satisfactory condition. Three of these are brick structures; one is partly constructed of brickwork and one is a timber structure. The Inspector holds the Certificate of the Royal Sanitary Institute as an Inspector of meat and other foods ; and is frequently in attendance during the process of slaughtering and dressing. The carcasses of animals killed for food in the slaughter-houses in the district are of good quality. One ox liver, one set of lungs and an ox mesentery were found to be affected with Tuberculosis and the organs were at once surrendered and destroyed. Several livers affected with fluke disease have been disposed of to prevent their use for human food. Bye-laws for slaughter-houses are in force in the District. One trunk of codfish weighing about 60 pounds, and 1 mat of cauliflowers were found to be unsound and were destroyed. The administration of the Food and Drugs Acts is carried out by the County Council. Water Supply.—The whole of this District is supplied on the constant service system from the mains of the Metropolitan Water Board, and the supply has been well maintained at good pressure. The water is clear and bright and is well filtered. The Board draw a considerable portion of their supply from the River Thames at Hampton and have several large pumping stations here, while a very large area is covered by their filter beds and reservoirs. Factory and Workshop Acts.—The various premises in the District which come under these Acts, and which include retail Bakehouses, Laundries and Workshops, have been inspected during the year by myself and the Inspector and a register is kept of these premises as required by section 131 of the Act of 1901. There were 46 premises on the register at the commencement of the year, including 4 Factories. Four new workshops have been added, one has been converted into a factory, six workshops have been closed, one factory has been closed, and there remain thirty-nine workshops and four factories under inspection at the close of the year. One notice has been sent to the Factory Inspector respecting failure to keep the Abstract of the Act affixed in the workshop. Six bakehouses have been limewashed, six workshops have been cleansed and whitewashed, one case of overcrowding has been abated, unsuitable or defective sanitary conviences have been amended in two instances and five other nuisances have been abated in connection with these premises. The lists of outworkers have been obtained from employers giving out work (in each instance the making of clothing) and the names and addresses of the Outworkers have been forwarded to the Local Authorities in whose districts they resided. 8 Offensive Trades.—The only business which comes under this heading is the Soap Works, and I am satisifed that the business is carried on in a most careful and efficient manner, and with an entire absence of nuisance of any kind. Dust Removal and Scavenging.—This work is carried out by the Council's own staff in a very satisfactory manner. There is a weekly collection of house refuse throughout the District. The refuse is disposed of, by burning in a two cell Horsfall Destructor at the Sewage Disposal Works, in connection with which a boiler is installed for use as an adjunct to the existing boilers which supply steam to the air compressing engines for lifting the sewage. Sewerage and Sewage Disposal—The district is divided into areas for the purpose of sewerage: each area discharging its sewage by gravitation into a Shone Pneumatic ejector: from which the sewage is lifted by compressed air to the Disposal Works in Han worth Road. Nearly the whole of the properties in the district are connected to the public sewer: all drains are laid on concrete: with inspection chambers at each change of direction. The work of construction is under frequent inspection, and the drains are tested with water pressure before being covered in and with smoke on completion. The installation at the Sewage Disposal works comprises a screening chamber, detritus tanks, a hydrolitic tank and triple contract beds. The sewage is delivered on to the primary and secondary contact beds by means of a travelling distributor. There is also a settling tank between the secondary and tertiary contact beds to arrest the suspended matters from the primary and secondary beds. The effluent is discharged by gravitation into the Thames at the south-eastern boundary of the District. The works have been carried on in a very efficient manner during the year. I enclose the returns for the Local Government Board, the Home Office and the County Council, and a tabular statement of the work carried out by the Inspector of Nuisances. Finally, I beg to express my great thanks to the Inspector of Nuisances, Mr. A. Shail, for the loyal and efficient assistance I have had from him at all times during the past year; particularly in times of stress and anxiety. I am, Gentlemen, Your obedient Servant, WENTWORTH TYNDALE. To the Chairman and Members, Hampton Urban District Council. HAMPT 11 Hampton Urban District Council. Annual Report of the Medical Officer of Health FOR THE YEAR 1910. H. & C. FRANKLIN. PRINTERS. TWICKENHAM.