HAMPT 12 Hampton Urban District Council. Annual Report of the MEDICAL OFFICER OF HEALTH For the Year 1911. Hampton Urban District Council. MEDICAL OFFICER S ANNUAL REPORT. Hampton, Middlesex, March, 1912. Giontlemen, I herewith submit ray Annual Report for the year ended 31st December, 1911. PHYSICAL FEATURES. The district comprises an areaof 2,044 acres, of which 62 acres are covered with water ; and is of an open character. The subsod is gravel, which extends to a considerable depth over the greater portion of the district. About nine-tenths of the district is situate at an elevation of from 55 to 65 feet above Ordnance datum, or from 33"5 feet to 43'5 feet above the summer water level of the Thames ; the remaining portion adjoining the Thames varies from 26 to 55 feet above Ordnance datum ; so that, for the Thames Valley, Hampton lies comparatively high. 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 4 recreation grounds are under the control of the Council; while the River Thames flows along the whole of the southern boundary; a distance of nearly two-and-a-half miles. A considerable area of the district is under cultivation, mainly for horticultural purposes, and the principal occupations of the working class section of the community are out-door ones. VITAL STATISTICS. In 1910 I estimated the population of this district to be 10,000. This was evidently an excessive estimate; as when the census was taken in April, 1911, the population was given as 9,221. The average rate of increase of population during the ten years 1901 to 1911, was at the rate of 240 persons per annum. Assuming that the population is increasing at the same average rate; the number of inhabitants at midsummer 1911 would be 9,280; and this is the figure I am using for the purpose of these statistics. BIRTHS AND BIRTH RATE. The total number of births registered in the district was 208 ; to which must be added 9 born outside the district to Hampton parents (the latter particulars being furnished by the Registrar General) making a total of 217 births—107 males and 110 females—of whom eleven were illegitimate. 5 This is equal to a birth rate of 23'3 per thousand of the estimated population: and is a slight increase on the previous year's rate. The rate for England and Wales for 1911 is 24.4 per 1000. DEATHS AND DEATH RATE. The total number of deaths registered as having occurred in the district during the year from all causes was 79. This number includes six non-residents; the particulars of whose deaths were forwarded to the Medical Officers of Health in whose districts these persons had previously resided. The Registrar General has furnished particulars of the deaths of twenty-two residents which occurred outside the district, distributed among outside institutions as follows :— Union Infirmary, Kingston, 12; Asylums, 2; London Hospitals, 3; Teddington Cottage Hospital, 2; other places, 3. After correcting these returns by deducting the deaths of the six non-residents and adding the deaths of the twenty-two residents who died at hospitals or other places beyond the district, we arrive at a nett total of 95 deaths of residents, 45 males and 50 females, the causes of whose deaths, together with the age-periods at death are shown in the tabular statement below. I also append a table showing the distribution of these deaths among males and females with the age periods at death. 6 TABLE III. CAUSES OF, AND AGES AT DEATH DURING THE YEAR 1911. CAUSES OF DEATH. Nett deaths at the Subjoined Ages of "Residents" whether occurring in or without the District. All Ages. Under 1 year 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards All causes:— Certified 94 24 2 2 4 1 6 18 37 Uncertified 1 ... ... ... ... ... 1 ... ... Influenza 3 ... ... ... ... ... ... 1 2 Organic heart disease 7 ... ... ... ... ... ... 2 5 Phthisis (Pulmonary Tuberculosis) 4 ... ... ... ... ... 3 1 ... Tuberculous Meningitis 1 1 ... ... ... ... ... ... ... Other Tuberculous Diseases 1 1 ... ... ... ... ... ... ... Cancer 10 ... ... ... ... ... 1 4 5 Bronchitis 2 ... ... ... ... ... ... ... 2 Broncho- Pneumonia 2 1 ... 1 ... ... ... ... ... Pneumonia (all other forms) 2 ... ... ... ... ... ... 1 1 Other diseases of Respiratory Organs 1 ... ... 1 ... ... ... ... ... Diarrhœa and Enteritis 12 11 1 ... ... ... ... ... ... Appendicitis 2 ... ... ... 1 ... ... 1 ... Alcoholism 1 ... ... ... ... ... ... ... 1 Cirrhosis of Liver 1 ... ... ... ... ... ... 1 ... Nephritis and Bright's Disease 3 ... ... ... ... ... 2 1 ... Congenital Debility and Malformation, including Premature Birth 7 7 ... ... ... ... ... ... ... Violent Deaths 3 2 ... ... ... ... ... 1 ... Other Defined Diseases 33 1 1 ... 3 1 1 5 21 Totals 95 24 2 2 4 1 7 18 37 7 Table showing the distribution of the above between males and females. Sex. All ages. Under 1 year. 1 to 2. 2 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Males 45 14 1 1 - 1 2 10 16 Females 50 10 1 1 4 — 5 8 21 Totals 95 24 2 2 4 1 7 18 37 Taking the collected number of Heaths of persons belonging to the district at 95, as set out in the foregoing tables, this gives a death rate of 10.3 per thousand of the population. The rate for England and Wales for 1911 is 146. Thirty-nine of these deaths were of persons 60 years of age and upwards, of whom 11 were between 60 and 70, 21 between 70 and SO, 6 between 80 and 90, and 1 was 90. Seven deaths were the subjects of Inquests by the Coroner during the year, and the verdicts of the juries were as follows:—Drowning, 1; accidental suffocation, 2; natural causes, 4. Twelve deaths were due to Diarrhœa and Enteritis, and there was no other death from any of the principal Zymotic diseases. This is equal to a rate of 1.2 per thousand of the population, an increase on the 1910 rate. 8 INFANTILE MORTALITY. Twenty-four deaths of infants under one year of age were registered during the year, and of these two were illegitimate. The causes of these infants' deaths were as follows:— Diarrhoea and enteritis, 11; Tubercular diseases, 2; Premature birth, 4; Congenital defects and debility, 3; Convulsions, 1; Pneumonia, 1; and Suffocation (overlying), 2. Twenty-two of these babies died within the district, one in the Union Infirmary, and one at St. Bartholomew's Hospital. The infantile mortality rate is calculated on the actual births and infantile deaths registered during the year, and for the year under review is 110.5 per thousand births, a considerably increased rate compared with the previous year. The rate for England and Wales for 1911 is 130 per 1000 births. The increased rate is mainly due to the mortality from Diarrhoea, which was considerably above the average. The disease was markedly prevalent during the month of August, and was undoubtedly accentuated by the very hot weather prevailing at the time. The Notification of Births Act has not been adopted. The work of inspection under the Infant Life Protection Act is performed by a trained Nurse employed by the Board of Guardians. 9 To enable you to make a comparison between the various rates given in the preceding pages with those of previous years, I have revised the estimated population for the previous five years, and append a table showing the rates for those years as they are affected by the revised estimates. TABLE I. Vital Statistics during 1911 and previous years. Year. Population estimated to middle of year. Births. Nett deaths belonging to the District. Number. Rate. Under 1 year. At all ages. Number. Rate per 1000 births. Number. Rate. 1906 8080 198 24.5 18 90.9 95 10.5 1907 8320 186 22.3 20 107.5 96 11.4 1908 8560 206 24.0 16 77.6 93 10.7 1909 8800 217 24.6 16 73.7 93 10.5 1910 9040 206 22.7 8 38.3 94 10.3 1911 9280 217 23.3 24 110.5 95 10.3 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 :— 10 TABLE IT. Cases of Infectious Disease notified during the year 1911. Notifiable disease. Number of cases notified. At all ages. At ages Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Diphtheria 24 - 5 15 4 - - - Scarlet fever 18 — 4 9 3 2 - — Enteric fever 3 — — 1 — 1 1 — Puerperal fever 1 — — — — 1 — — Erysipelas 6 — — 1 1 2 2 — Phthisis, under Tuberculosis Regutions, 1911 4 — — — 1 3 - — Totals 56 9 26 9 9 3 - Diphtheria. Nineteen of the cases notified as Diphtheria were treated at the Isolation Hospital and one at the South Western Hospital, Fulham. Two of these patients, aged 4 and 5 years respectively, were discharged after a few days' treatment, the illness being other than Diphtheria. One other patient, aged 21, was discharged in three days, and the notification was withdrawn. This latter case is not included in the above table. Twenty of the cases notified occurred in the first quarter of the year, six of which were in one house and three in another. 11 The cases were spread over the whole district, and at no time was the disease epidemic. In connection with this disease, I would urge upon parents and others having the charge of young children, the importance of having early medical attendance in all cases of affections of the throat, as the patients have a much greater chance of recovery when treatment is commenced in the early stages. 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 possible moment. By this means potential carriers may often be discovered, who might otherwise continue to be centres of infection, and become the cause of an epidemic. All patients who are scholars are excluded from school for four weeks after discharge from Hospital, and for the same period after recovery when treated at home. All contacts attending school are excluded for fourteen days. Enteric Fever. Three cases of this disease were notified. Two of the cases were traced to the consumption of shell fish, and the remaining patient evidently contracted the disease while on a holiday in Switzerland. Scarlet Fever. Eighteen cases were notified, five of which were in one house; and eight patients were treated at the Isolation Hospital. 12 The cases were spread over the whole area, and the disease was quite sporadic in character. Small-pox. One patient was certified to be suffering from this disease in March; and was removed to, the hospital at Cheam. The illness from which the patient was suffering was found to be a very severe attack of chicken-pox, and the patient was discharged in a few days. The notification was cancelled; and is therefore, not included in the table. Puerperal Fever. The patient affected with this disease was removed to the East Molesey Cottage Hospital. Measles. Fifty-two cases of this disease were notified by the Head Mistresses of the Girls' and Infants' Schools at Hampton Hill. I visited the schools several times, and, as the disease was spreading somewhat rapidly among the infants; I advised the closure of the infants' department for a period of ten days as a means of preventing further spread. My advice was endorsed by the County Schools Medical Officer and acted upon at once. This had the effect of checking the outbreak. Phthisis. The only form of notification in force at the commencement of the year was under the Public Health 13 (Tuberculosis) Regulations of 1908; relating to poor persons only. There were no cases notified under these Regulations. A new set of Regulations were made by the Local Government Board in March, termed the Public Health (Tuberculosis), Regulation 1911; which made provision for the notification of cases occurring in Hospitals. These came into force on May 1st, and four notifications were received. Four deaths were registered from this disease during the year. Premises occupied by patients are inspected and disinfected, and advice is given respecting the 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 unable to bear the cost themselves; and when, in the opinion of the Medical Officer of Health, such treatment is likely to prove beneficial. The diagnosis is always confirmed by the bacteriological examination of the sputum, before any of these patients are sent away for Sanatorium treatment. Four persons were treated under the arrangement during the year. Two have returned improved in health; one is still under treatment at home and is steadily improving, but the remaining patient returned to his home at his own request after a short stay at the Sanatorium. The Council undertake to have all rooms which have been occupied by persons suffering from tubercular 14 disease in any form, disinfected free of cost upon receipt of a request from the medical practitioner in attendance. Nine rooms so occupied have been disinfected by the Inspector; and the rooms are also stripped and cleansed. Disinfection. All rooms which have been occupied by persons suffering from infectious disease are disinfected with formalin gas 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 disinfecting apparatus at the Isolation Hospital. The work of disinfecting rooms, bedding and clothing is carried out by the Council's own officers without any charge being made to the householder. In connection with this work 57 rooms have been disinfected by the Inspector of Nuisances; and a large number of articles have been disinfected by steam. Rooms which have been occupied by persons suffering from cancer are also disinfected by the Inspector ; when requested to do so by the medical man in attendance on the patient. Isolation Hospital. This building was erected by the Council in 1904, and stands on a site of some seven acres abutting on the Uxbridge Road, Hampton Hill. A portion of the site at present not required for the purpose of the Hospital is let for horticulture. The accommodation provided consists of a pavilion block containing four wards, with kitchen, bath rooms and 15 the necessary lavatory accommodation; an administrative block with nurses' quarters: porter's lodge with discharging rooms, laundry and disinfecting chamber, coach house and mortuary. A covered verandah runs practically the whole length of the pavilion on the south-eastern side. In my report for 1909, I advocated the provision of a small ward or wards for the purpose of observation wards for doubtful cases, and mentioned the matter again in my last report; but this has not yet been provided. The establishment is in charge of a Medical Superintendent, with a staff of two trained nurses (supplemented by the engagement of a temporary nurse when occasion requires) two maids and a porter; and is connected with the residence of the Medical Superintendent, the Council Offices, the Fire Brigade and the Police by telephone. An ambulance with two beds is provided for the removal of patients. The arrangement made in 1905 with the Croydon and Wimbledon Joint Hospital Board for the reception of small-pox patients from this district was determined by the Board in March. The Council were, however, able to make new arrangements with the Uxbridge Joint Hospital Board for the treatment of cases of this disease from this district at their Hospital at Yeading. Schools. There are four Public Elementary Schools in the district, which have been under constant observation and are kept in good repair. 16 The sanitary accommodation in each school is ample, and defects which have been found in the sanitary fittings have been promptly remedied. The medical inspection of the scholars in attendance at these schools is conducted by officers specially appointed by the County Education Committee, the County Medical Officer of Health 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 an 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 which covers the incubation period of the disease. The School Medical Officer is also informed of notifications received respecting scholars, and of the contacts who are attending school, with particulars of the school attended and the length of time for which each contact is excluded. The Head Teachers also kindly co-operate by informing me of any abnormal absence through illness, especially from such diseases as Measles, Whooping Cough, ChickenPox, and Mumps. Under the system I received information of 12 cases of Chicken-pox and 52 cases of Measles during the year. I have dealt with the outbreak of Measles in the earlier part of this report. Dwelling Houses. In my opinion the accommodation provided is quite sufficient for the present needs of the district, and overcrowding is quite a neglible quantity. 17 There is plenty of land available for the development of the district, and there is no doubt that, with an improved train service, a large portion of this undeveloped area would speedily be built upon. The houses 65 in number—erected by the Council a few years ago under the provisions of the Housing of the Working Classes Act, have been almost fully occupied during the year, proving that the erection of these houses met a demand for houses of that class. Thirty-three houses have been dealt with under the provisions of the Housing and Town Planning Act, and over 400 re-inspections have been made by the Inspector to supervise the execution of works in connection with these houses. These houses comprised 7 two-roomed tenements, 1 of three rooms, 16 with four rooms, 5 with five rooms, and 4 six-roomed houses, let at rentals varying from 3s. 6d. to 9s. per week. A number of these were in a more or less unsatisfactory condition, but no representations were made to the Council, as the works necessary to remedy the defects were promptly put in hand by the owners on the service of intimation notices. The works carried out include the following:—Damp proof courses inserted in walls, 9; sites of rooms concreted, 8; through ventilation to rooms provided, 5; lighting of rooms improved, 4; new floors laid, 7; ventilation below floors provided, 10; new sanitary convenience provided, 1; new sanitary dustbins, 7; rooms stripped and cleansed, 25; drains amended, 3; ventilating shafts repaired, 8; floors repaired, 2; roofs repaired, 2; and rain water pipes repaired, 2. 18 In addition to the above a considerable amount of work was in course of execution at the close of the year. Apart from the inspections under the above Act, a considerable number of other houses have been inspected and nuisances arising from defective and insufficient sanitary conveniences, choked and defective drains, refuse, animals, defective roofs, gutters, &c., have been promptly remedied, details of which will be found in the report of the Inspector of Nuisances. Building operations have been very quiet during the year, a very small number of plans for new buildings having been submitted to the Council. The work of supervision over the erection of all new buildings is carried out by the Surveyor to the Council. Milk Supply. The milk supply in the district is partly home produced and partly supplied from neighbouring districts. There are three cowkeepers in the district, who keep an aggregate of from 100 to 120 cows, which are grazed during the greater portion of the year. All cows are inspected at quarterly intervals by a Veterinary Surgeon for the purpose of detecting any case of tubercular disease of the udder that may exist. He reports the result of his inspections to the Council at an early date after each inspection, and these reports have been uniformly satisfactory during the past year. This inspection of cattle applies only to the animals actually in the district at the time of inspection, and is, of course, no guarantee that the milk imported into the district from outside sources is free from infection. 19 To make the inspection of cattle thoroughly effectual, I am of opinion that Veterinary supervision should be marie compulsory throughout the whole country, as it is quite easy at the present time for a cowkeeper who is in possession of an affected animal in a district where such inspection is carried out to dispose of it into an area where Veterinary supervision of the cattle is not in force. 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 intimation being sufficient to get any requirement attended to at once. One milkshop was closed upon request, as the premises were quite unsuitable for the sale of milk, the shop being used as a general store wherein were sold paraffin and vegetables. Regulations under the Dairies, Cowsheds and Milkshops Orders are in force in the district. To prevent the transmission of infection by means of milk cans, an enquiry is made respecting the milk supply at each house visited on account of infectious disease, and the dairyman is warned to desist from leaving cans at the house for a given period. Food Supply. The various premises in the district where food is prepared for sale—which include Slaughter-houses, Bakehouses and Fishmongers—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. 20 Three of these are brick-built structures; one is partly constructed of brickwork and the remaining one is timberbuilt entirely. The Inspector holds the Certificrte of the Royal Sanitary Institute as an Inspector of Meat and other Foods, and is frequently in attendance during the process of slaughtering. The carcases of animals killed for food in the local slaughter-houses are of good quality. One pair of ox lungs were found affected with tuberculosis, and were at once surrendered and destroyed : and a number of livers showing parasitic lesions were disposed of so as to prevent their use for human food. Bye-laws for slaughter-houses are in force. One trunk of catfish fweighing about one hundredweight) and three boxes of kippers have also been found to be unfit for human food, and were at once seized and destroyed by order of a magistrate. The administration of the Sale of Food and Drugs Acts is carried out by the County Council. Water Supply. The whole of this district is supplied on the constantservice system from the mains of the Metropolitan Water Board; and the supply has been maintained at good pressure notwithstanding the drought of last summer. The water has been at all times clear and bright, and is well filtered. The Board draw a considerable proportion 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 storage reservoirs and filter beds. 21 Offensive Trades. The only business which comes within this category is the Soap Works, which is under periodical inspection. Complaint was made to the proprietor by the Inspector, of a nuisance arising from the inefficient cremation of the fumes arising from the tallow melting pans, and the nuisance was immediately abated. With this exception the business has been conducted satisfactorily. Factory and Workshop Acts. The various trade premises in the district which come under the provisions of these Acts; and which include retail bakehouses, workshops and laundries, have been inspected at irregular intervals during the year by myself and the Inspector; and a register of these premises is kept in conformity with section 131 of the Act of 1910. Thirty-nine workshops were on the register at the commencement of the year, and four factories were also under inspection. Four new workshops have been added to the register; one has been converted into a factory by the introduction of power: one workshop has been closed; and there remain forty-one workshops registered at the close of the year. Factories are also under periodical inspection. The total number of inspections to these premises during the year was 149, and the following works have been executed, viz.:—Six bakehouses have been limewashed, four workshops have been cleansed and whitewashed, defective sanitary conveniences has been amended 22 in five instances, three flushing cisterns were repaired three accumulations of refuse were removed, three drains were cleared and the paving of a wash house was repaired. The list of outworkers have been obtained from employers giving out work (in each instance the making of wearing apparel) and the names and addresses of the outworkers have been forwarded to the Local Authorities in whose districts they resided. The name of one outworker was received from another authority, and the workshop was inspected. One notice was sent to the Factory Inspector respecting failure to keep the abstract of the Act affixed in a workshop where women were employed. 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; and a boiler is installed in connection with the destructor for use as an adjunct to the existing boilers which supply steam to the air compressing engines for lifting the sewage. A serious nuisance was caused in the summer by the deposit of house refuse from an adjoining district into a gravel pit on the border of this district. This pit contained several hundred thousand gallons of water which had become polluted by the decomposing refuse, and the odour arising from the water gave rise to serious complaints. 23 Prompt measures were taken to abate the nuisance, and the tip was at once closed for house refuse. The face of the refuse already there was sealed by the deposit of a thick bank of earth and the water was deodorized with over a ton of chloride of lime, which effectually remedied the nuisance, and in a short time the water became quite clear. Drainage, Sewerage and Sewage Disposal. During the past few years practically the whole of the drains of the older houses in the district have been reconstructed and connected to the public sewer, with the consequent abolition of cesspools and privy pits and the installation of water closets. All new houses are so connected at the time of erection. The work of construction is under frequent inspection and all drains are laid on a concrete foundation, with inspection chambers at each change of direction. The drains are tested with water pressure before being covered in and with smoke on completion. 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 Hanworth Road. The installation at the sewage disposal works comprises a screening chamber, detritus tanks, a hydrolitic tank, and triple contact beds. The sewage is delivered on to the primary and secondary contact beds by means of a travelling distributor. 24 There is also a settling tank between the secondary and tertiary contact beds to arrest the suspended matters remaining in the sewage after its passage through the primary and secondary beds. The sludge is buried in trenches on the land, and 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. Appended hereto is a tabular statement showing the work carried out by the Inspector of Nuisances during the year, which is to be incorporated in this report, in accordance with the order of the Local Government Board. The work of the Public Health Department has shown signs of steadily increasing and growing in importance: and in concluding this report it gives me an opportunity of expressing my sincere thanks to my Inspector of Nuisances —Mr. A.Shail—for many acts of assistance and support which have been loyally given to me during the past year. I am, Gentlemen, Your obedient servant, WENTWORTH TYNDALE. The Chairman and Members, Hampton Urban District Council. 25 Annual Report of the INSPECTOR OF NUISANCES For the year ended 31st December, 1911. WENTWORTH R. TYNDALE, Esq., M.B, &c., Medical Officer of Health. Sir,— I beg to present to you my Fifteenth Annual Report on the work carried out as Inspector of Nuisances during the year 1911. Inspections. Complaints received and attended to 59 Number of premises inspected owing to complaints 67 Number of premises inspected owing to infectious disease 44 House to house inspections 59 Other inspections 350 Premises under periodical inspection 65 Number of re-inspections after order or notice 1707 Total inspections and re-inspections 2227 Notices. Letters written 99 Cautionary or intimation notices given 138 Statutory notices served 2 Prosecutions None Dwelling Houses. Premises repaired, cleansed, etc. 24 Roofs repaired 10 Eaves gutters repaired 11 Rain water pipes repaired 9 Sites covered with concrete 5 26 Ventilation below floors provided 10 Damp proof courses inserted in walls 9 Through ventilation to rooms provided 5 Lighting of rooms improved 3 New movable dustbins provided 25 Schools. Number in District 6 Frequency of inspection Monthly New water closets fixed 2 Water closets repaired 4 New flushing tanks fixed 2 Flushing tanks repaired 3 Slaughter Houses. Number on the Register 5 Number of visits paid 83 Frequency of limewashing Quarterly Yard paved and drained 1 Paving repaired 1 Drain cleared 1 Unsound Food.— Articles seized or surrendered and destroyed:— 1 trunk of catfish weighing about 1 hundredweight 3 boxes of kippers 1 pair of ox lungs (tubercular) Dairies, Cowsheds and Milkshops.— Number of cowsheds in the Districts 7 Number of milch cows kept 104 Number of dairies and milkshops 6 Number of visits paid 39 Cowsheds cleansed and limewashed All half-yearly Sale of milk discontinued—unsuitable premises 1 Manure removed 2 Drain cleared 1 27 Offensive Trades.— Number in district 1 Number of inspections 2 Effluvium nuisance abated 1 Factory and Workshop Acts. 1901 and 1907. Workshops and workplaces on the Register 26 Laundries on the Register 7 Retail bakehouses on the Register 8 Number of visits to workshops and workplaces 63 ,, ,, laundries 23 „ ,, bakehouses 33 „ „ factories 14 Workshops cleansed and whitewashed 4 Bakehouses limewashed 6 Water closets cleansed 4 Water closets repaired 1 Flushing tanks repaired 3 Refuse removed 3 Drains cleared 3 Outworkers lists received 2 Names of outworkers to other Authorities 4 Notice sent to Factory Inspector 1 Drainage and Water Supply. The following is a summary of the work done under this heading.— Drains tested, exposed, etc. 11 Number found defective 8 Drains cleared 107 Drains repaired 13 Drains trapped 4 Drains re-constructed 1 Disconnecting traps or chambers inserted 2 Soil pipes or ventilating shafts repaired 11 New waste pipes fixed 2 28 Waste pipes repaired 4 Urinal cleansed 1 Rain pipes disconnected from drains 2 New water closet erected 1 New water closet apparatus fixed 3 Water closets cleansed or repaired 15 Closets supplied with water or supply improved 22 Cisterns cleansed 4 New water waste preventers fixed 4 Water waste preventers repaired 18 Draw off taps placed on mains House—water laid on to 1 Sundry other Nuisances Abated. Smoke 1 Overcrowding 1 Accumulations of refuse 11 Animals improperly kept 10 Stagnant water Infectious Diseases and Disinsection. Premises inspected on receipt of notification 44 Patients removed to hospital 30 Notices sent to school teachers 37 Rooms disinfected 57 Rooms stripped and cleansed 49 Articles disinfected or destroyed 143 1 am, Sir, Your obedient servant, ALBERT SHA1L. Public Offices, Hampton, 29th January, 1912. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH ON THE Sanitary Condition of the District FOR THE YEAR 1911. To the Chairman and Members of the Urban District Council of Hampton Wick. Mr. Chairman and Gentlemen, I have the honour to present to you my Third Annual Report on the Sanitary Circumstance, the Sanitary Administration and the Vital Statistics of the Urban District of Hampton Wick for the year 1911. The chief features of interest in this Report include a description of the outbreak of Epidemic Diarrhoea in the summer which caused a high Infantile Mortality, also of the Housing Accommodation and the Water Supply, and the fact that your Council have acquired a Formalin Sprayer for disinfecting purposes. SITE, AREA, PHYSICAL FEATURES AND GENERAL CHARACTER OF THE DISTRICT. The District is situated in the southern part of the County of Middlesex, and is bordered on its southern and eastern aspects for a distance of over three miles by the River Thames. A towpath extends along two and two thirds miles of this distance. 4 The boundaries are as follows: — On the North.—The Urban District of Teddington. On the West.—The Urban District of Hampton. On the East and South. — The River Thames separating the District from the County of Surrey. There is also a detached portion of the District of about three acres in extent enclosed between the Urban Districts of Hampton and Teddington. The position of this small area is about 200 yards north of the north-west corner of the rest of the District. The Postal District of Hampton Wick includes the greater part of South Teddington, but excludes that portion of the District which is adjacent to Hampton Court Palace. That part of the District is in the Postal District of Hampton Court. During the year the District Councils of Hampton Wick and Teddington applied for an alteration of the boundary between their respective districts. This formed the subject of a Public Inquiry by Mr. Harold Squire, Barrister, at the Council Offices, on November 3rd, 1911. Boundaries are not often altered now-a-days, and the reason for this application was somewhat unusual. Along a small portion of the northern boundary of the District runs a road known as Normansfield Avenue. This road lies wholly in the District of Teddington. It connects the Upper Teddington Road, which is a main road, with Glamorgan Road, which is a road situated wholly in Hampton Wick, and on which residential properties abut. Thirty years ago what is now known as Normansfield Avenue was part of a long field with a right of way through it, connecting the Broom Road with the Upper Teddington Road. This field was enclosed by a fence and stile at each end. T believe that the original intention was to have a road where the field 5 was, but for some reason this was never carried out. It was grass grown, and was used for grazing purposes. In the early eighties the Glamorgan Road was formed, and as houses sprung up along it the road approached this field and finally opened into it near its centre. Finally the fence, stile and hedge abutting on the Upper Teddington Road disappeared, and traffic began to proceed through the field from Glamorgan Road to the Upper Teddington Road. At the same time a fence with gate and stile was erected across the field just east of where Glamorgan Road entered it. This road as it had now become was never properly made up. A footpath was constructed on the south side, and this was kerbed, but otherwise there was not much done. It became overshadowed by trees which bordered the road on either sids. The road was not lighted; it was full of holes, and in wet weather almost impassible on account of the mud. It was now called Normansfield Avenue. The reason why the road was not properly made up was because the Hampton Wick authorities could not spend money in making up a Teddington Road and the Teddington Authorities could not recover from owners of property on the Hampton Wick side if they made the road up. It was, therefore, felt that if the boundary were altered to run along the centre of the avenue, the owners of property on both sides could be compelled to contribute towards the making up of the road. At the Public Inquiry evidence was given by various residents as to the deplorable condition of the avenue at the present time. The upshot was that in the beginning of the year 1912 Mr. Squire reported to the General Purposes Committee of the Middlesex County Council. He said he thought a case had been made out for the alteration of the boundary for the following reasons:— (1) The imperative necessity of making up Normansfield Avenue in the interests of the inhabitants of the districts, and of common decency. 6 (2) The difficulty of effecting such making up under existing conditions. (3) The unanimous wish of the two District Councils concerned as well of the ratepayers generally of their respective districts. and he recommended that an Order be made for the removal of that portion of the existing boundary between the Hampton Wick District and the Teddington District which runs along the boundary fences of the property on the Hampton Wick side of Normansfield Avenue from the junction of that avenue with the Upper Teddington Road eastwards to a point 200 feet beyond Glamorgan Road and for the substitution thereof of a boundary running down the centre of the said avenue from its junction with the said Upper Teddington Road eastwards to a point 200 feet beyond the said Glamorgan Road, then southward at a right angle to a point where the existing boundary leaves the boundary fence of Normansfield Avenue and crosses a field in a south-easterly direction. The Committee recommended and the Council agreed that an Order be made accordingly. I am sure that if this road be made up, it will be greatly to the benefit of both districts. The area of the district is 1,315 acres, 80 of which comprise water. A large portion of the District is included in the Royal Gardens at Hampton Court and in Bushey Park and Home Park. It is almost level. The soil is gravelly, and this accounts for the fact that the ground dries very quickly after rain. I am again indebted to Mr. Shorter, a gentleman residing in the District, for an account of the rainfall. I have inserted a table of his observations at the end of this report. It will be seen that the total depth of rain amounted to 24.60 inches. This is nearly 4 inches less than the total depth of the rainfall last year, when it amounted to 28.49 inches. The rainiest months were 7 November and December, the total depth of rain in the latter month amounting to 4'95 inches, and on 22 days in that month more than 01 inches of rain were recorded. The greatest fall of rain in the 24 hours was reported on October 24th. The driest months were July and August; this coincided with the greatest amount of heat. VITAL STATISTICS. In January, 1911, a letter was received from the Local Government Board stating that the Tables for insertion in the Annual Reports of Medical Officers of Health would be revised and modified. The new Table I. is so arranged that accurate corrected statistics of births and deaths in the District can be given. The necessary corrections are supplied to me by the Registrar-General through the medium of the County Medical Officer. Table II., which deals with infectious disease, is very similar to the corresponding table last year. Tables III. and IV. deal with causes of and ages at death, and these have been considerably remodelled. Statistics for Births and Deaths and of certain causes of death for Sanitary Districts in England and Wales will be published by the Registrar-General in his Annual Report for 1911, and subsequent years. INHABITED HOUSES. In the Preliminary Census Report of 1911 the number of families or separate occupiers is given as 552. This number refers to April 3rd, 1911. Last year I gave the number of inhabited houses as 554 on the June 30th, 1910. There is no great discrepancy in these numbers. According to the rate books the number of occupied houses on June 30th, 1911, was 559. Since April, 1911, 5 new houses have been erected in the High Street on land formerly belonging to the Tramway Company. 8 POPULATION. The population as enumerated on April 5th amounted to 2,417 persons, being a decrease of 189 since the last census. This gives an average of 4'378 persons each house. In previous years I have reckoned that the average number of persons living in each house was 5, hence the discrepancy in the enumerated population and in the estimated population. There were 520 inhabited houses in 1901. In the following table is given the enumerated population at the date of the Census for the years 1881, 1891. 1901 and 1911: — POPULATION (Enumerated). 1881 1891 1901 1911 2162 2378 2606 2417 Increase 216 228 — Decrease — — 189 The decrease in the population is partly due to the fact that many houses were pulled down in the year 1903, when the tramways were formed, and also to the fact that the average number of persons living in each house is less than ten years ago. Hampton Wick is the only district in Middlesex which shows a decrease in the population in the intercensal period, and the neighbouring district of Ham is the only district in the County of Surrey which registers a decrease. BIRTHS. Thirty births were registered in the district during the year. The Registrar-General now supplies Medical Officers of Health through the medium of the County Medical Officer with the number of births needing to be added to or subtracted from the total supplied by the Local Registrar. The births added to this total are 9 known as "Inward Transfers," and the births subtracted from that total are known as "Outward Transfers." So that now, children born in Public Institutions are credited to the district where the parent is resident. One Inward Transfer has been recorded for the year for this District. No Outward Transfer has been recorded, as there are no Public Institutions situated in this District. The following Table gives the details of the Births: Registered in the District. Inward Transfers. Total. Males. Females Males. Females Legitimate 21 8 - - 29 Illegitimate - 1 — 1 2 Total 21 9 0 1 31 The Birth Rate is now calculated on the nett number of Births. This amounts to 31, making a Birth Rate of 12.83. This is the lowest Birth Rate ever recorded for this District, and in spite of the fact that in previous years these rates have never been corrected by the addition of transferred births. The Birth Rates for various localities are set out in the following table: — 1909 1910 1911 England and Wales 25.6 21.8 24.4 London 24.2 23.6 25.0 County of Middlesex 25.9 24.7 District of Hampton Wick 17.7 14.1 12.8 District of Hampton Wick, average for preceding 10 years 18.05 17.96 17.28 10 DEATHS. Twenty-six deaths were registered in the District. The nett number of deaths belonging to the District amounts to 25, and this number is made up as follows:- M. F. Total. Deaths registered in the District 18 8 26 Deaths of Hampton Wick Residents (a) In Public Institutions (l) Kingston Union Infirmary — 1 1 (2) Teddington Cottage Hospital — 1 1 (3) St. Luke's Home for the Dying Poor - 1 1 (b) By Sudden Death in another District 1 - 1 Complete Total 19 11 80 Deaths of Non-Residents occurring— (a) By Drowning 3 — 3 (b) By Sodden Death in the District 1 1 2 Total 4 1 5 Deducting the deaths of NonResidents from the Complete Total we obtain the Nett Total of all deaths belonging to the District 15 10 25 This gives a nett Death Rate of 10.34, as against 91 last year and as against 11.67 for the previous ten years. I have had to recast the Death Rates for previous years on account of the diminution of the population as shown by the last Census. When a large population such as the County of Middlesex increases, one assumes that the rate of increase is by geometrical progression, but when a very small population decreases there is no object in applying such methods to the various years. 11 As most of the decrease in the population occurred about the year 1903, I have estimated the populations for the years 1903 to 1910 at 2,417, the number obtained at the last census. The Death Rates for these years are therefore all increased, and the average Death Rate for the last ten years works out to 11.67. As the age and sex distribution of the population of this District has not yet been issued by the Census Authorities, I have made use of the same factor which was obtained on the results of the Census of 1901 in order to obtain the Corrected Death Rate. This amounts to 10'62. In the following table are given the Death Rates for various localities: — 1901 1910 1911 England and Wales 16.9 13.4 14.6 London 18.7 18.4 15.8 County of Middlesex 14.0 10.4 - Hampton Wick— Recorded Death Rate 18.8 9.1 10.3 Corrected Death Rate 14.2 9.3 10.6 Average Death-rate for preceding 10 years 12.9 11.8 11.7 It will be seen on looking at the above table that these Death Rates have a downward tendency, and that the Death Rate for this District for this year is lower than the average Death Rate for the previous ten years. The various causes contributing to the deaths belonging to the District are shown in Table III. This table is now so arranged that it is condensed from the Detailed International List of Causes of Death which has just been issued by the Registrar-General in a manual. This list has 14 General Headings and 189 Sub-Headings for Causes of Death, and in many cases 12 the sub-headings are again sub-divided. I have here classified the deaths according to this table, giving all the headings and those sub-headings which refer to such causes of death as occurred in the District during the past year. The numbers refer to the numbers of the sub-headings in the International List: — Under 65 years of age. 65 years of age and over. Total. I. General Diseases. 4 8 Whooping Cough 1 - 28a Pulmonary Tuberc'l'sis - 1 40 Cancer of the Stomach, Liver, etc. 1 - 43 Cancer of the Breast 1 II. Diseases of the Nervous System and of the Organs of Special Sense. 2 63a Diseases of the Spinal Cord other than Locomotor Ataxy - 1 66c Paralysis without Specified Cause - 1 111. Diseases of the Circulatory System. 5 79 Organic Disease of the Heart a Valvular Disease - 4 b Other Organic Disease of the Heart - 1 IV. Diseases of the Respiratory System. 3 89, 90b Bronchitis - 3 V. Diseases of the Digestive System. 5 104a Infective Enteritis under 2 years 3 - 105b Diarrhoea not returned as infective. Over 2 years of age 1 - 113a Cirrhosis of the Liver (not returned as alcoholic) 1 - 13 Continued. Under 65 years of age. 65 years of age and over. Total. VI. Non-Venereal Diseases of the Genito-Urinary System and Annexa. VII. The Puerperal State. VIII. Diseases of the Skin and of the Cellular Tissue. IX. Diseases of the Bones and of the Organs of Locomotion X. Malformations. 1 150c Congenital Malformation of the Heart 1 - XI. Diseases of Early Infancy. 2 151a Premature Birth 2 - XII. Old Age. 1 154b Senile Decay — 1 XIII. Affections produced by External Causes. 2 155 Suicide by Poison 1 - 169 Accidental Drowning - 1 XIV. Ill Defined Causes. Total 12 13 25 On looking at this table, it will be seen that a large proportion of deaths occurred in persons over the age of 65 years. Seven deaths of infants under one year of age were registered, so that only 5 deaths were registered in persons of over one year of age and under 65. With regard to the causes of death, the chief points of interest in the table are firstly the large number of deaths from Diarrhœa in infants, and secondly that Diseases of the Heart were again responsible for the 14 greatest number of deaths occurring in the District. I here classify the deaths of Non-Residents in accordance with the International List: — Under 65 years 65 years and over. II. Diseases of the Nervous System and of the Organs of Special Sense. 64e Cerebral Hæmorrhage 1 - III. Diseases of the Circulatory System. 81a Aneurysm 1 - XIII. Affections produced by External Causes. 158 Suicide by Drowning 1 - 169 Accidental Drowning 2 - 5 - There is rather a larger number of these deaths than usual. One of the deaths classed under Residents was really that of a Non-Resident. The person poisoned himself, but was never identified, so he has to be classed among Residents. INFANTILE MORTALITY. Seven deaths occurred: two in February, two in August, and three in September. Of the last five, the first occurred on August 19th and the last on September 26th. The intense heat was partly but not wholly responsible for this high mortality. Of the five deaths which took place during the hot weather, one was an illegitimate child, two of the others had been feeble since birth. Three of the deaths were due to Epidemic Diarrhoea, and three took place in cottages. The deaths did not take place in any particular road or area in the District. 15 The following Table gives the Infantile Mortality rates for several localities: — 1909 1910 1911 England and Wales 106 109 130 London 108 103 128 County of Middlesex 89 77 — Hampton Wick 21 0 226 Hampton Wick, average for preceding 10 years 96 97 84 It will be seen that the Infantile Mortality of all these localities has risen this year. Small districts such as Hampton Wick are liable to extreme variations. For the past two years the mortality has been very low. PRINCIPAL EPIDEMIC DISEASES. The Zymotic Death Rate is based on the principal infectious diseases, including Epidemic Diarrhoea. Five deaths of this nature occurred during the year, giving a zymotic mortality of 2.07. This is exceptionally high, and is due to the excessive mortality from Epidemic Diarrhoea. The following Table gives the Zymotic Mortality for various localities: — 1909 1910 1911 England and Wales 1.12 0.99 — London 1.31 1.14 — County of Middlesex 1.07 0.54 — Hampton Wick 0.75 0.00 2.07 16 NOTIFIABLE INFECTIOUS DISEASES. The diseases compulsorily notifiable under the Infectious Diseases Notification Act, 1889, are Small-Pox, Cholera, Diphtheria, Membranous Croup, Scarlet Fever or Scarlatina, and the fevers known as Typhus, Typhoid or Enteric, Relapsing, Continued and Puerperal. Since the year 1909 Pulmonary Tuberculosis is in certain circumstances notifiable and will become generally so on January 1st, 1912. Towards the end of the year a circular letter was received from the Local Government Board suggesting that your Council should order the Infectious Diseases (Notification) Act, 1889, to apply to Acute Poliomyelitis and Cerebrospinal Fever. I reported in favour of the recommendation, and these diseases will be added to the list of diseases notifiable in this District during the ensuing year. 15 cases of Infectious Disease were notified during the year, one of these, a case of Pulmonary Tuberculosis in a pauper, being notified doubly. Of these, 10 were cases of Diphtheria, 2 of Scarlet Fever, 1 of Erysipelas, and 2 of Phthisis. None of these cases proved fatal. SMALL-POX and VACCINATION. No case of Small-Pox appeared in the neighbourhood during the year, but a notice was received from the Port of London Sanitary Authority in April informing me that a passenger had landed in London from a ship on which a case of Small-Pox had occurred during the voyage, and that he was proceeding to this District. I visited the passenger in question, and he was kept under observation. The Vaccination Officer has kindly informed me that during the year 16 successful primary vaccinations were registered, and that 8 children were exempted through the agency of "Conscientious Objection" certificates. I am sorry to observe that there is a marked decline in the amount of Vaccination in this District. 17 SCARLET FEVER. Two cases were notified as against one last year. Both cases were very mild. They occurred in adjoining houses, one of which was disinfected on July 14th, while the other case was notified on September 3rd. No cause was found for the outbreak. DIPHTHERIA. Ten cases were notified as against four last year. The incidence of Diphtheria has been much greater in this District than Scarlet Fever during the past two years. Five cases were notified in February, and the others occurred in March, May and November. With regard to the cases occurring in February, four were in a Scattered Home belonging to the Guardians of the Kingston Union. One of the inmates had been ill for some time previous to a medical man being called in. She was suffering from the nasal variety of the disease and she infected the others. All the girls in the house were prophylactically injected with Antitoxin Serum. The first case was severe but the others were mild. These cases were removed to Tolworth Isolation Hospital. The girls attended the Girls' Elementary School and were in various standards. None of the other children attending this school were infected. One other case occurred in February. It was a child who was attending the Infants' School. No connection between this case and the others could be traced. In March, about a month after the last of the above-mentioned cases had been notified, a boy who had left school and who worked in another District developed the complaint. His sister developed the disease next day. Both they and the rest of the household were injected with Antitoxin. About the same time a case was notified from Hampton Court. The child attended the Palace School. The child and the rest of the household were injected with serum. Two months 18 later, in May, another case occurred in a child attending the Infants' School. No other case was notified until November, when a child who did not attend school developed the complaint. The child and the rest of the household were injected. About the same time two persons, a young man and a child, developed sore throats of a suspicious character. They were at once injected and the throats were swabbed, but the diphtheria bacillus was not detected. Excluding the cases occurring in the Scattered Homes, six were notified, only two of these occurring in the same house. The others appeared to have no connection with one another. In this District most cases of suspicious sore throat are at once injected with Antitoxin Serum and then swabbed, and the swabbing sent to the Clinical Research Association for examination. If the result turns out to be negative, no harm results; if positive, great advantage accrues by having the Antitoxin injected early. Whenever a case of Diphtheria has been diagnosed, I always recommend the rest of the household to be prophylactically injected with small doses of Antitoxin Serum. 34,000 units of Antitoxin Serum were used by your Council during the year for these purposes. ENTERIC AND PUERPERAL FEVER. No cases were notified during the year. ERYSIPELAS. One case was notified. It is important persons in contact with a case of Erysipelas should not attend maternity cases. That is one reason why this disease should continue to be notifiable. 19 PULMONARY TUBERCULOSIS. Three notifications were received during the year; two referred to the same person. Two were Infirmary Notifications, and one was notified by the District Medical Officer. The rooms which these persons had occupied were cleaned and disinfected. One case of Pulmonary Tuberculosis proved fatal. It occurred in an elderly man. The case was not notified. Notification of this complaint has been in force to a limited extent since the year 1909. On December 18th, 1908, the Local Government Board issued Regulations to the effect that paupers suffering from this complaint were to be notified. If they happened to be inmates of an Infirmary the Medical Officer of Health of the District in which the Infirmary is situated, as well as the Medical Officer of Health of the District to which the pauper belonged, were notified. In April, 1909, your Council decided to receive Voluntary Notifications of Pulmonary Tuberculosis, and to pay the medical man notifying such cases the usual fees. On the 22nd of March, 1911, the Local Government Board issued Regulations as to the notification of Pulmonary Tuberculosis occurring among patients in hospitals. Such notifications are sent to the Medical Officer of Health of the District in which the hospital is situated, who in turn notifies the Medical Officer of Health of the District in which the patient is resident. On November 16th, 1911, the Local Government Board issued further regulations to come into force on January 1st, 1912, to the effect that all cases of Pulmonary Tuberculosis are to be notified. Paupers and Hospital Patients will continue to be notified as before, but the system of Voluntary Notification initiated by your Council in April, 1909, disappears. 20 I here add a table showing the number of cases notified under these various regulations: 1909 1910 1911 Under Tuberculosis Regulations, 1908, commencing Jan., 1909. From Infirmary 3 2 2 From District Medical Officer — 1 1 Voluntary Notification, April, 1909 0 0 0 Under Tuberculosis Regulations, 1911, commencing May, 1911 - - 0 Under Tuberculosis Regulations, 1911, commencing Jan., 1912 — — — There are nine notifications in all, of which seven are from the Infirmary. Four persons are concerned. It will be seen that two sets of Regulations as to the Notification of Pulmonary Tuberculosis were issued by the Local Government Board during the year. The one referring to notification of inmates of Hospitals came into force in May, and the other, the notification of Private Patients suffering from this complaint, comes into force on January 1st, 1912. These regulations confer special powers on Councils. (1) Disinfection of infected premises and infected articles. (2) Supply for the use of patients of any appliance which may be of assistance in preventing the spread of infection. (3) Hospital provision for the treatment of Pulmonary Tuberculosis. (4) Provision of temporary shelters. (5) Provision of Handbills setting out information and instruction respecting the complaint and precautions to be taken against the spread of infection. 21 Stress is also laid on the fact that the Notifications are strictly confidential. At present no arrangements have been entered into by your Council for Sanatorium and Hospital accommodation, but a project is on foot to utilise a portion of the Small-Pox Hospital at South Minims for cases of this nature. This District contributes towards the upkeep of this Hospital, and would no doubt take advantage of any arrangements which may be made. In company with your Vice-Chairman, I attended a meeting at Caxton Hall, Westminster, on April 28th, 1911, and various resolutions were passed dealing with such matters as the provision of Antituberculous Dispensaries, Sanatoria, Compulsory Notification of Phthisis, and the utilisation of the Small-Pox Hospital at South Mimms for cases of Pulmonary Tuberculosis. On the 25th day of May, 1911, the Local Government Board issued a Provisional Order for altering certain Conferring Acts of the Middlesex Districts Joint Small-Pox Hospital Orders, 1905-1910. This Order, among other things, provides that when the Small-Pox Hospital is not required for the reception and treatment of cases of Small-Pox, cases of Pulmonary Tuberculosis may be admitted on the Order of a Constituent Authority or of a Medical Officer of Health of a Constituent Authority. The charges suggested amount to 5s. for every day during which the patient is in the hospital. At the present time your Council provides for the bacteriological examination of sputum. Handbills giving instruction to persons suffering from Consumption are also provided. Utensils such as sputum boxes, paper handkerchiefs and disinfectants can easily be supplied when necessary, and temporary shelters with the necessary furniture may have to be supplied in certain cases. 22 NON-NOTIFIABLE INFECTIOUS DISEASES. Measles. Although this complaint was prevalent in the neighbouring Districts in the beginning of the year, comparatively few cases came under my notice. This was clue to the fact that there had been a severe outbreak in this District in the year 1909, and in consequence most of the children had had the complaint. Whooping Cough. There were a few sporadic cases of this complaint. There was one death. Epidemic Diahrhœa. The very hot and dry summer was responsible for a large amount of diarrhoea and enteritis. This occurred both in adults and in children. The complaint did not appear at all generally in this District until the middle of August, although the weather had been extremely warm ever since the end of June. The weather became cooler in the middle of September, and then the disease began to abate. There were in all four deaths, three occurring in infants under one year of age and one in a child of three who was an invalid. The first death occurred on August 19th, and the last on September 8th. On August 18th the Local Government Board issued a circular advocating advice as to the feeding and management of children during the hot weather, also that special attention be given to scavenging, especially in areas where diarrhoea was prevalent. Your Sanitary Inspector made frequent inspections of such areas occupied by the labouring classes, and house refuse was not allowed to accumulate. Diarrhoea was prevalent all over the District, both in the bouses of the rich and of the poor. Advice was also given as to the feeding and management of children, but leaflets were not published in this connection on account of the smallness of the District. This disease can be conveyed from person to 23 person by means of flies through the medium of food. Luckily flies were not very plentiful in this District during the summer, and I imagine it may be due to this fact that the disease did not make its appearance until two months after the hot weather had begun. No doubt other agencies helped to spread the complaint. Cancer. Two deaths were registered; one of these took place in a public institution in London. I always advise that rooms which have been occupied by persons suffering from this complaint be disinfected. BACTERIOLOGICAL EXAMINATION IN CONNECTION WITH INFECTIOUS DISEASE. During the year 12 specimens of secretions in patients suspected to be suffering from Diphtheria were examined at your Council's expense. Five gave positive results and seven negative. No specimens were examined for Enteric Fever or for Pulmonary Tuberculosis. ISOLATION HOSPITAL ACCOMMODATION. There is nothing to add to the remarks I made on this subject in my last report beyond the fact that four patients were sent to Tolworth Isolation Hospital suffering from Diphtheria, but as they were inmates of one of the Scattered Homes belonging to the Guardians of Kingston Union, they were not sent there at your Council's expense. DISINFECTION. I am pleased to be able to report that your Council has provided a Formalin Sprayer for the disinfection of rooms, etc., after the occurrence of Infectious Disease. The sprayer in use is the Invicta Disinfecting Sprayer made by Messrs. Lumley & Co. It is easy to manipulate, and has given so far every satisfaction. The apparatus 24 is made of copper and consists of a cylinder which is fitted with pressure gauge, and into which air is forced by means of a pump until a pressure of 15 pounds to the square inch is recorded. The same pump is employed, without disconnecting it from the tank, to next force in the fluid until the gauge shows a pressure of 45 pounds. The amount of fluid used for this purpose usually amounts to about 1½ gallons. A tap is then turned and compressed air forces out the fluid in a flue spray, and this spraying action lasts for about 20 minutes. The fluid used is 6 ozs. of Schering's 40 per cent. Formalin mixed with water up to 1½ gallons. Infected linen, bedding and articles of that nature are steeped in a solution of Izal. We have no steam disinfector. MIDWIVES ACT, 1902. Midwives practising in this District mostly reside in the County of Surrey. HOUSING. In company with your Sanitary Inspector, I made a careful inspection of the houses occupied by the Working Classes. Three such houses were found to be in a state so injurious to health as to be unfit for human habitation. The Sub-Committee appointed to deal specially with the question of the Housing of the Working Classes also inspected them. Two of the houses had been used for some years past as one house being occupied by one tenant. The ceilings and floors of the upper rooms were defective, the walls in one case being perforated with large holes. This had arisen because an adjoining house had been taken down and the wall had been injured in the process. The other dwelling house was over a stable. The rooms, two in number, were badly lighted and ventilated. This dwelling place was also declared to be unfit for human habitation. Closing Orders were made, 25 but the dwelling houses have not since been rendered fit for human habitation. The question of the demolition of these buildings will engage the attention of your Council during the ensuing year. The other houses inspected were found to be in fair repair. The special points observed when inspecting these are as follows (1) The arrangements for preventing contamination of the water supply were in all cases satisfactory. (2) The closet accommodation was generally speaking good. In a few cases cracked pans and broken seats were discovered, but were quickly repaired on notice being given to the owners. The fhislies were in some cases found out of order but were promptly repaired. (3) No defects in the drainage of these houses came under our notice. (4) Generally speaking there is plenty of light and free circulation of air in the cottages. In several instances dampness was found. This is in most cases due to leaky stack pipes or roofs. These were repaired on representations being made to the owners. Cleanliness depends to a large extent on the tenant. With few exceptions this was satisfactory. (5) The paving, drainage and sanitary condition of the yards and outhouses belonging to or occupied with the dwelling houses were in most cases good. A few representations were made which were attended to. (G) Most of the cottages have sanitary dustbins. The brick ones are not satisfactory, and are gradually diminishing. 26 (8) No room was found which was being used as a sleeping place the floor of which was more than three feet below the surface of the part of the street nearest to the room. (9) No case of overcrowding was encountered. Sections 14 and 15 of the Housing, Town Planning, &c., Act, 1909, provides that landlords shall undertake to keep houses, let at a rent not exceeding £16 per annum, that is 6s. 2d. per week, reasonably fit for human habitation. The regulation applies to this District, as it is not in the County of London, and as it has not a population of 50,000 inhabitants or upwards. There are from 50 to 60 such dwelling houses in this District. TENEMENT HOUSES OR HOUSES LET IN LODGINGS. There is one such house in the District. It was periodically inspected, and the rooms were found to be kept in good repair. COMMON LODGING HOUSES. There is one in the District. It was inspected periodically, and the special regulations were carried out to my satisfaction. WATER SUPPLY. On the 1st of March the Local Government Board forwarded a form to your Council to be filled in relating to the water supply of this District. The following questions were asked and the following replies were g-iven : — Questions 1, 2 and 3 referred to the area, population and number of houses in the District. 27 (4) Is the District within any statutory limits of Water Supply ? If so, state the name of the undertakers and the short title of any Local Act or Provisional Order defining the limits. If the whole district is not within the statutory limits, what parishes or parts of parishes are ? Within the district supplied by the Metropolitan Water Board. (5) Is the whole of the district supplied with water from a piped service, either direct to the houses or by means of stand pipes ? No. (6) Name of the Local Authority, Company or Private Proprietor by whom the district or any part of it is actually supplied. Metropolitan Water Board. (7) If the whole of the district is not supplied from a piped service, what is the approximate number of houses and population in the district not so supplied. Approximate number of houses. Approximate Population. Name or description of district not supplied. 25 100 Various parts of the district. 10 50 In Royal Parks. (8) Fill up the following1 particulars in respect of houses not supplied from piped service: — Houses supplied from Number of houses and their situation. General quality and adequacy of supply. Wells 30. Various parts of the district and in Royal Parks. Good and adequate. Springs — - Rivers or Streams (Name of River or Stream) 5. Hampton Court Longford River (This is piped). Unfiltered adequate. . Ponds — — Rain Water Tanks — - Other sources of supply, specifying them. - - 28 In my last report I commented at some length on the Longford River Water Supply. In the beginning of the year I wrote to the Secretary of H.M. Office of Works stating that it had been brought to my notice that several bouses situated close to Hampton Court Palace were supplied with water from the Longford River, and that the water was unfiltered. I asked for a complete list of premises so supplied, and also for permission to view tbe Pumping Station and other sources of the water supply from the Longford River. In the reply to this letter there was enclosed by direction of the First Commissioner of H.M. Works a schedule of the premises situate in the district of Hampton Wick supplied wholly or partially witb unfiltered water from the Longford River, and I was also informed that in any case where I found that such supply was being used for drinking purposes, the Board would be prepared to withdraw tbe supply and terminate the licence. The Board also kindly granted me permission to view the pumping station and the other sources of the Water Supply from the Longford River. Mr. Chart, the Resident Surveyor at Hampton Court Palace, very courteously afforded me the necessary facilities for this, and lie accompanied the Sanitary Inspector and myself, showing us over the various arrangements for this water supply. The sources of this water supply are from two places. One is from the pond in the pheasantry in Bushev Park; tbe Longford River flows through this pond. The other is from the Pumping Station. This is situated near the Hampton Isolation Hospital, but although the water is pumped to certain houses and to the parks and gardens of Hampton Court Palace from this water mill, the water is extracted from the Longford River higher up at Hanworth. The pumping is carried out by means of a water mill, the water power being derived from a small waterfall in the Longford River. 29 The list of premises submitted to me by H.M. Office of Works amounted in all to 12. Two premises and one stand pipe were found to be supplied with water from the Pumping Station. One premises had a double supply, both from the Pumping Station and from the Pheasantry. Eight premises were supplied from the pond in the Pheasantry. Several of these premises were in addition supplied with water from the Water Board's Main or with water from wells. In company with your Sanitary Inspector I inspected these premises, and I suggested to H.M. Office of Works that the supply be withdrawn from three dwelling houses, two of which were restaurants. In three cases where taps opened on to sinks situated inside houses, I informed the occupiers that the pipes leading to such taps should be sealed and the taps removed, as although the water was not supposed to be used for drinking purposes, it was easily accessible and might inadvertently be used in that way. In three cases where the taps were situated in yards, I suggested to the owners that a label be affixed "Not to be used for Drinking Purposes." Eight notifications were received from the Engineer's Office of the Metropolitan Water Board of cessation of water supply to unoccupied houses. Such houses were kept under observation, and no nuisance was created. SEWERAGE AND SEWAGE DISPOSAL. No nuisance was caused in this connection during the hot weather. During the year no serious breakdown occurred in connection with the ejectors. Slight stoppages occurred on one or two occasions in the Tipper Teddington Road and near Newman's Cottages, but were quickly rectified. The compressed air for the 30 system is now being supplied from Kingston. The Council's gas engines are still available in case of a temporary breakdown of the engines at Kingston. The existing agreement with the Kingston Corporation comes to an end in June, 1912. A new agreement has been concluded, and the sewage will continue to be dealt with at the Kingston Sewage Works. There is one privy in the district and also a closet without ail automatic flush. This is connected with the main drainage system. ROADS. At the present time the roads are all in good repair with the exception of Church Grove, which is to be taken in hand shortly. During the year the Hampton Court Road and Park Road have been repaired. Sandy Lane, Park Road and Lower Teddington Road were tarred in the early summer. The principal roads in the District are at the present time either macadamised, wood-paved or tarred. A great deal of heavy motor traffic now passes through the district, and it is most important that the roads should be in good repair, otherwise holes quickly form, and this prevents water draining away quickly after rain. I am sure that tarring the roads is very beneficial in keeping the dust down and draining water away quickly. There is not nearly so much horse traffic on the roads now, and the diminution of the amount of horse-droppings must have a beneficial effect on the health of the District. HOUSE REFUSE COLLECTION AND DISPOSAL. The house and dust refuse is collected weekly. It it disposed of by tipping on some land near the allotments at some distance from a dwelling house. No complaint was received of any smell arising from this during the hot weather. A good many bricked dustbins still exist, but they are gradually being supplanted by sanitary ash-bins made of' galvanised iron. 31 DAIRIES, COWSHEDS AND MILKSHOPS. There is one cowkeeper in the District. About twelve cows usually occupy the two cowsheds owned by him. These were periodically inspected. The sheds have a cement flooring, they are well drained, and the cows are kept in a cleanly condition. The cows are examined by a Veterinary Inspector every three months, and he reports the result of' his examination to your Council. These reports have been satisfactory. Towards the end of the year a letter was received from the Thames Valley Councils Association with regard to Milch Cows suffering from Tuberculosis. One of the suggestions in this letter was that dairymen should be requested to at once notify the Authority of every fresh cow placed in the milking sheds, so that such cow could be examined at an early date by the Veterinary Inspector. Your Council on my advice endorsed this suggestion. There are two dairies, one of which is kept by the above-mentioned cowkeeper, and also a milkshop. These were frequently inspected, and were always found to be kept in a cleanly condition. The milk consumed in this District, with the exception of that supplied by the cowkeeper, mostly comes from the Salisbury Dairy Company. SLAUGHTER HOUSES. There is one in the District, and it is kept in a cleanly condition. It was frequently visited. No carcases or parts of carcases were condemned for Tuberculosis. OFFENSIVE TRADES. There are none at the present time. An Order was made by your Council in the early part of the year, and confirmed by the Local Government Board, declaring each of the following trades, 32 namely, Blood Drier, Tanner, Fat Melter or Fat Extractor, Glue Maker, Size Maker, and Gut Scraper, carried on within the District, to be an offensive trade. Fish frying has not been included in this Order. It is possible to include this trade among offensive trades should it be considered to be necessary at any future time. At the present time there is one fried fish shop in the District. I have visited it on several occasions, and have invariably found that it is kept clean. It is well conducted, and does not give rise to any nuisance. UNSOUND FOOD. No food of this description was dealt with during the year. A memorandum was issued by the Local Government Board in September detailing the methods to be employed in investigating outbreaks of illnesses suspected to be due to Food Poisoning. Where considerable numbers of cases of food poisoning occur in a District, the Medical Officer of Health has to report the occurrence at once to the Local Government Board, and copies of any special report or reports are to be enclosed. The Local Government Board will be glad of prompt information if, for example, one or two members of a household are suffering in consequence of the consumption of canned food from a particular tin. Any such case occurring in the District should be promptly reported to me so that the necessary investigations can be taken in hand. FACTORY AND WORKSHOP ACT, 1901. The Workshops and Workplaces were regularly inspected, and they were found to be in a satisfactory condition. One notice of occupation of a workshop was received, but the total number of these premises remain the same as last year. 33 BAKEHOUSES. The two Bakehouses in the District were regularly inspected. Both are kept clean and are well ventilated. LAUNDRIES. There are now no Workshop Laundries in the District. The Domestic Laundries are mostly situated in Park Road. They were all inspected, and were found to be in a satisfactory condition HOME WORK. Three lists were received, two in the latter part of the year and one in the early part of the year. All related to one outworker. I visited his premises periodically, and they were found to be in a satisfactory condition. OUT-WORKERS. One notification was received from an employer with regard to an Out-worker. The Medical Officer of Health of the District in which the Out-worker resided was informed. ADOPTIVE ACTS AND BY-LAWS. There has been no alteration in these for some years. MEDICAL INSPECTION OE SCHOOL CHILDREN. This work is carried out by the Middlesex County Council. The County Medical Officer of Health is the School Medical Officer, and the has several assistants. There is no special provision for medical treatment of children found on examination to be defective. Certain diseases very common in childhood are not easy to treat in the case of Elementary School Children, chiefly 84 because time and money are necessary to carry out such treatment efficiently. The diseases I am referring to more particularly are the following: — Ringworm. Tonsils and Adenoids. Discharging Ears. Caries of the Teeth. Defective Vision. The sanitary arrangements of the schools were inspected at various times and were found to be satisfactory. LEGISLATION. Two sets of Regulations have been issued by the Local Government Board during the year: — (1) "The Public Health (Tuberculosis in Hospitals) Regulations, 1911," issued on March 22nd, 1911. (2) "The Public Health (Tuberculosis) Regulations, 1911." This Order was issued on November 15th, 1911. These regulations have been commented on at some length under the heading of Pulmonary Tuberculosis. Iu conclusion, I must express my thanks to the Chairman and Members of your Council for the careful way in which they have considered the various suggestions I have put forward during the year, and also to your Officers for the very efficient services they have rendered me in the carrying out of my duties, and here I should also like to thank the Chairman, the Members of the Council and the Officers for the appreciative references they made last October on the occasion of the death of my father, Dr. Theodore Gunther, which occurred on the sixth day of that month. He had been your first Medical Officer of Health, and held the post for a period of over 42 years. He settled in Hampton Wick towards the end of the year 186.3, and was elected Medical Officer 35 of Health to this District 011 August 2nd, 1866. He held numerous other Public Appointments, among which may be mentioned Medical Officer of Health to the neighbouring District of Teddington and District Medical Officer and Public Vaccinator for Hampton Wick. Owing to ill-health he resigned his Public Appointments in the year 1908, and soon afterwards entirely relinquished his private practice. During his long tenure of office, very great improvements were carried out in the sanitary condition of this District. He took a prominent part in effecting these changes, and lived to see the benefits which resulted therefrom. I am, Mr. Chairman and Gentlemen, Your obedient Servant, H. A. GUNTHER, M.B. Lond., M.R.C.S.Eng., L.R.C.P.Lond. Medical Officer of Health. March, 1912. 36 INQUESTS IN 1911. Date. Age. Sex. Verdict. Jane 4th 23 M. Accidental Drowning. June 9th 45 (about) M. Suicide by taking Oxalic Acid Poison. (No evidence as to the state of his mind). P.M. Jane 15 th 53 M. Rupture from Aneurism of the Aorta. P.M. July 8th 32 M. Drowning, caused accidently by falling from a boat. August 9th 71 M. Pound drowned. October 1st 39 M. Suicide by drowning himself, whilst temporarily of unsound mind. Dec. 22nd 69 F. Syncope, Valvular disease of the Heart. P.M. RAINFALL IN 1911. At Park House, Hampton Wick, in the County of Middlesex. Rain Gauge, Diameter of Funnel, 5 inches. Height of Top of Funnel Above Ground 1 foot. Above Sea Level, 28 feet. Month. Total Depth. Greatest Fall in 24 hours. Number of Days with .01 or more recorded. Inches. Inches. Date. Jan. 1.28 .27 11th 15 Feb. 1.20 .32 27th 12 Mar. 1.57 .42 12th 16 April 1.95 .85 1st 12 May 2.08 .84 31st 9 June 2.23 .74 23rd 10 July .78 .49 25th 6 Aug. 1.00 .36 21st 6 Sept. 1.26 .38 13th 10 Oct. 2.98 1.07 24th 15 Nov 3.32 .61 11th 16 Dec. 4.95 .53 20th 22 Total 24.60 149 Signed, ARTHUR SHORTER. 87 ANNUAL REPORT OF THE SANITARY INSPECTOR FOR THE YEAR ENDING 31st DECEMBER, 1911. To the Chairman and Members of the Hampton Wick Urban District Council. Gentlemen, I beg to present to you my second Annual Report of the work carried out by me as your Sanitary Inspector. Inspections— Complaints received and attended to 1 Number of premises inspected owing to complaints 1 Number of houses inspected owing to infectious disease 10 House to house inspections 77 Premises under periodical inspection 28 Total inspections and re-inspections 226 Notices— Letters written 42 Roofs repaired 1 Eaves gutter repaired 1 Rainwater pipes repaired 3 New dust bins provided 3 Schools— Number of district 3 Frequency of inspection monthly Number found defective none Slaughter Houses— Number on register 1 Number of inspections 16 Frequency of limewashing 6 88 Dairies, Cowsheds, Milkshops— Number of cowsheds in distriet 1 Number of cows kept 12 Number of dairies and milkshops 3 Number of visits paid 6 Drainage and Water Supply— Drains tested 2 Drains cleared 2 New waste pipes fixed 2 Waste pipes repaired 2 New water closet apparatus fixed 0 Infectious Diseases— Number of cases notified 16 Rooms disinfected 14 Rooms stripped 0 Factory and Workshops Act— Number in district 16 Number of inspections 32 Urinals Available for the General Public— Number in district 5 Inspected periodically and found satisfactory I am, Gentlemen, Your obedient Servant, PERCY TAYLOR, M.R.San. Inst. Sanitary Inspector. DISTRICT OF HAMPTON WICK, COUNTY OF MIDDLESEX—SANITARY WORK, 1912. i. Enumerate (1) Adoptive Acts, (2) Bye-laws in force in District. Particulars as to Staff employed in Sanitary Department, specify if Inspectors are engaged in any other duties, and if so, what? Inspections.* . Action taken (other than under H. and T.P. Act). Dwelling Houses and Action under H. and T.P. Act, 1909. (1) Adoptive Acts. Number of Premises Inspected on Complaint. Number of Premises Inspected in connection with Infectious Diseases. Number of Premises under Periodical Inspection. Houses Inspected from Houseto House (H. and T.P. Act.) Total Number of Inspections and Re-inspections made. Cautionary or Intimation Notices Given. Statutory Orders Issued. Summonses Served. Convictions Obtained. Number of Houses dealt with under Sect. 15. Number of Houses found to be in a state Dangerous or Injurious to Health (Sect. 17). Number of Representations made by M.O.H. (Sect. 17). Number of Houses made habitable without Closing Orders. Number of Closing Orders made by L.A. (Sect. 17). Number of Houses closed Voluntarily. Number of Closing Orders determined after Repairs (Sect. 17). Number of Houses Demolished (a) by order of L.A. (Sect. 17), (b) Voluntarily. Illegal Underground Rooms Vacated. Public Health Acts Amendment Act, 1890 (Part III). One Sanitary Inspector who also holds the post of Surveyor Infectious Disease (Prevention) Act, 1890. Housing of the Working Classes Act, 1890 (Part III). Public Health Acts Amendment Act, 1907 (Parts II., III., IV., V., VII. (Sections Si (parts) and 86), VIII. and IX). (2) Bye-Laws. 1894—Slaughter Houses. 1894—Prevention of Nuisances arising from :— (1) (2) (3) (4) (5) (a) Snow, tilth, dust, ashes and rubbish : (b) The keeping of animals on any premises so as to be injurious to health. 1 10 28 /1 226 14 o - 0 8 3 3 0 3 0 0 0 0 1901—Part II. Public Health Acts Amendment Act, 1890 (posts, wires, tubes, etc., in Public Streets). 1905—New Streets and Buildings. 1906—Common Lodging Houses. 1 *N.B.—(3) Includes all classes of premises under periodical supervision, such as Cowsheds, Dairies, Slaughterhouses, Workshops and Workplaces, <fcc. (5) Includes al visits and re-visits made by Sanitary Inspectors in connection witli 1—4. ii. DISTRICT OF HAMPTON WICK, COUNTY OF MIDDLESEX.—SANITARY WORK. 1912. Houses let in Lodgings. (Tenement Houses.) Common Lodging Houses. Canal Boats used as Dwellings. Movable Dwellings, Caravans, Tents, &c. Bakehouses. Slaughterhouses. Cow-sheds. Dairies and Milkshops. Unsound Food. Number Registered under ByeLaws. Num' er of Contraventions. Number Registered under ByeLaws. Number of Inspections made. Number of Contraventions. Number registered under the Acts. 1 Number of Contraventions of Regulations. Number Observed during the Year. Number of Nuisances therefrom Abated. Number Removed from District. Number in District. Contraventions of Factory Acts. Number on Register. Number of Inspections made. Frequency of Inspection. Contraventions of Bye-Laws. Number on Register. Number of Inspections made. Frequency of Inspection. Contraventions of Regulations. Number of Milch Cows in District. Nuinber on Register. Number of Inspections made. Frequency of Inspection. Contraventions of Regulations. Animals seized. Articles or Parcels seized. Animals condemned by Magistrate. Articles or Parcels condemned by Magistrate. Articles or Parcels surrendered. ... ... 1 2 ... ... ... 0 ... ... 2 0 1 2 twice a year 0 1 2 twice a year 0 12 3 6 twice a year 0 0 0 0 0 0 iii. DISTRICT OF HAMPTON WICK, COUNTY OF MIDDLESEX.—SANITARY WORK, 1912. iii. Adulterated Food. Offensive Trades. Water Supply and Water Service. Drainage and Sewerage of existing Buildings. Wells. Percentage of Houses supplied from Public Water Service. Cisterns. Draw-Taps placed on Mains. Percentage of Houses supplied on Constant System. No. of Samples obtained for analysis. Water Closets. Percentage of Houses provided with Water Closets. Drains. Cesspools. Percentage of Houses Draining into Sewers. Samples taken (if any) by the District Local Authority. Found adulterated. Number of Premises in District. Number of Inspections made. Contraventions of Bye-Laws. New Sunk. Cleansed, Repaired, &c. Closed as Polluted. New Provided. Cleansed, Repaired, Covered, &c. From Local Wells. From Public Supply. Number of Water Closets substituted for Dry Receptacles. Repaired, Supplied with Water, or otherwise Improved. Examined, Tested, Exposed, &c. Unstopped, Repaired, Trapped, &c. Waste Pipes, RainWater Pipes Disconnected, Repaired, &e. New Soil Pipes or Ventilating Shafts fixed. Kxisting Soil Pipes or Ventilating Shafts repaired. Disconnecting Traps or Chambers inserted. Reconstructed. Rendered Impervious, Emptied, Cleansed, &c. Abolished, and Drain connected to Sewer. 0 ... 0 ... ... 0 0 0 90 0 3 0 90 1 0 0 5 100 2 3 4 0 0 0 0 0 0 98.5 iv. DISTRICT OF HAMPTON WICK, COUNTY OF MIDDLESEX—SANITARY WORK, 1912. Disinfection. Dust. Sundry Nuisances Abated. Remarks as to any other matters, or in explanation of previous columns. Rooms Disinfected. Rooms Stripped and Cleansed. Articles Disinfected or Destroyed. New Bins provided. How frequently is dust removed from each hou.«e ? Number of Complaints of NonRemoval received. Method of Disposal. Overcrowding. Smoke. Accumulations of Refuse. Foul Ditches, Ponds, &c., and Stagnant Water. Foul Pigs and other Animals. Dampness. Yards repaved or repaired. Other Nuisances. Ordinary Infectious Diseases. Phthisis. Ordinary Infectious Disease. Phthisis. Destructor. By Tipping. Other, state method. 13 1 0 0 0 3 Weekly 6 By Tipping 0 0 0 0 0 3 1 ... 89 TABLE I.—For the Whole District of Hampton Wick. Year. Population estim'ted to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. of NonResidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 7 8 9 10 11 12 13 1906 2417 40 16.55 21 8.69 2 8 1 25.00 27 1117 1907 2417 38 — 15.72 30 12.41 3 6 7 184.21 33 13.62 1908 2417 40 — 16.55 30 12.41 3 9 6 150.00 36 14.89 1909 2417 47 — 19.45 32 13.24 4 7 1 21.28 35 14.48 1910 2417 39 — 16.18 20 8.27 3 5 0 0 22 9.10 1911 2417 30 31 12.83 26 10.76 5 4 7 225.81 25 10.34 Area of District in acres (exclusive of area covered by water), 1235. Total population at all ages, 2,417 Number of Inhabited Houses, 552 Average number of persons per house, 4.4 Census, 1911. 41 TABLE II.—Cases of Infectious Disease Notified during the Year 1911 Hampton Wick District. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in Each Locality No of Cases Removed to Hospital from Each Locality. At all Ages. At Ages—Years. Total cases Removed to Hospital. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. Small-pox Cholera Diphtheria (including Membranous Croup) 10 9 1 4 Erysipelas 1 1 Scarlet Fever 2 1 1 Typhus Fever Enteric Fever Puerperal Fever Plague Phthisis Under Tuberculosis Regulations 1908 2 1 1 ,, ,, 1911 Others Totals 15 1 10 2 1 1 4 Isolation Hospital Hampton. Total available beds, 4. Tolworth. „ „ „ No definite Number. Number of Diseases that can be concurrently treated, 3. ,, ,, ,, ,, ,, 3. 43 TABLE III. Causes of, and ages at, Death during Year 1911. Causes of Death. Nett Deaths at the subjoined Ages of " Residents" whether occurring within or without the district. Total Deaths whether of "Residents " or "NonResidents" in Institutions in the District. All ages. Under 1. 1 & under 2. 2 & under 5. 5 & under 15. 15 & under 25. 25 & under 45. 45 & under 65. 65 & upwards. All Certified 24 7 1 4 12 Causes Uncertified 1 1 Enteric Fever Small pox Measles Scarlet fever Whooping-cough 1 1 Diphtheria & Croup Influenza Erysipelas Cerebro-Spinal fever Phthisis (Pulmonary Tuberculosis) 1 1 Tuberculosis Meningitis Other tuberculous diseases Rheumatic fever Cancer, maglignant disease 2 2 Bronchitis 3 3 Broncho-Pneumonia Pneumonia Other diseases of respiratory organs Diarrhtea and Enteritis 4 3 Appendicitis and Typhlitis Alcoholism Cirrhosis of liver 1 1 Puerperal fever Congenital Debility & Malformation, including Premature Birth 3 3 Violent Deaths, excluding Suicide 1 1 Suicides 1 1 Other Defined Diseases 8 8 25 7 1 4 13 45 TABLE IV.—Hampton Wick District. Infantile Mortality during the year 1911. Nett Deaths from stated causes at various ages under One Year of Age. Cause of Death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3 4 Weeks. Total under 1 Month. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. All Causes Certified, Uncertified 7 0 Small-pox Chicken-nox Measles Scarlet Fever Diphtheria and Croup Whooping Cough ... 1 1 Diarrhoea 2 1 3 Enteritis Tuberculous Meningitis ... Abdominal Tuberculosis ... Other Tuberculous Diseases Congenital Malfoi mations.. 1 1 Premature Birth i i 2 Atrophy, Debilit and Marasmus Atelectasis Injury at Birth Erysipelas Syphilis Rickets Meningitis (not Tuberculous Convulsions Gastritis Laryngitis Bronchitis Pneumonia (all forms) Suffocation, overlying Other Causes 1 1 1 1 2 2 7 Nett Legitimate, 29. Nett I Legitimate Infants, 6 Births in the year Illegitimate, 2. Deaths in the year of Illegitimate ,, 1 47 FACTORIES, WORKSHOPS, LAUNDRIES, WORK PLACES AND HOMEWORK. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 10 Workshops (Including Workshop Laundries) 22 NIL. Workplaces . (Other than Outworkers' premises included in Part III. of this Report) 22 Total 54 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions Found. Remedied. Referred to H.M. Inspector. Nuisance under the Public Health Acts:—* Want of Cleanliness Want of Ventilation Overcrowding Want of drainage of floors Other Nuisances Sanitary accommodation— Insufficient Unsuitable or defective NIL. Not separate for sexes Offences under the Factory and Workshop Act:— Breach of special sanitary requirements for bakehouses (ss. 97 to 100). Total * Including those specified in Sections 2, 3, 7, and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 49 8—HOME WORK. OUTWORK IN UNWHOLEOUT WORKERS' LISTS, SECTION 107. SOME PREMISES, SECTION 108. NATURE OF WORK. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Twice in the year. Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Instances. Notices served. Prosecutions. Lists. Outworkers. Lists. Outworkers. Wearing Apparel— (1) making, &c. 2 2 2 2 (2) cleaning and washing Total 2 2 2 2 51 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the Year. Number. Important classes of workshops, such as workshop bakehouses, may be enumerated here. ' Bakehouses 2 Boat Building Yards 2 Dressmakers and Milliners 4 Upholsterers 2 Photographic Printing Works 1 Total number of workshops on Register 11 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (S. 133) Action taken in matters re- Notified by H.M. Inspector ferred by H.M. Inspector as remediable under the Public Health Acts, but NIL. not under the Factory and Reports (of action taken) Workshop Act (S. 5) sent to H.M. Inspector. Other Underground Bakehouses (S. 101):— Certificates granted during the year In use at the end of the year 58 Hampton Wick Urban District. PHTHISIS: SANATORIUM AND HOSPITAL ACCOMMODATION. Classes for which accommodation is provided. By whom provided. Where situated. Total number of Beds. How are patients selected ? Are patients under the care of a resident Medical Officer. What charge, if any, is made for the use of Beds. Do the Sanitary Authority use— (1) their Isolation Hospital, or (2) their Smallpox Hospital, for cases of Phthisis? Do the Sanitary Authority reserve Beds in any Phthisis Sanatorium; If so, how many, and in what Sanatorium ? Do the Sanitary Authority provide portable open-air Shelters or Tents ? (a) Early cases (1) No. (h) Intermediate cases -No arrangements made yet (2) A project is on foot to use the Small - pox Hospital at South Minims for cases of Phthisis. No. No. (c) Advanced cases Have the Council, or any Private Body, provided a Dispensary? If so, give particulars No.