HAMPT 13 Hampton Urban District Council. Annual Report of the MEDICAL OFFICER OF HEALTH For the Year 1913. Hampton Urban District Council. MEDICAL OFFICER'S ANNUAL REPORT. Hampton, Middlesex, February, Gentlemen, I herewith submit a Report as your Medical Officer of Health for the period from ist January to 30th September, 1913. PHYSICAL FEA TURES. There has been no change in this respect since my last Annual Report to you, the area being 2.044 acres of which 62 are covered with water. The district is on fairly high ground, nearly the whole being from 55 to 65 feet above Ordnance datum, or. roughly from 35 to 45 feet above the summer water level of the River Thames. The subsoil is gravel, which extends to a considerable depth over the greater portion of the district. A considerable area in the western part of the district is under cultivation—mainly for horticultural purposes and fruit culture—and the principal occupations of the working class section of the community are outdoor ones. VITAL STATISTICS. I have estimated the population of the district at the middle of 1913 to be 9,600. 4 Births. During the period under review 130 births were registered— 62 males and 68 females. This is equal to an annual rate of 18 05 per thousand of the estimated population. Deaths. Eighty-one deaths of residents were registered, 58 occurring within the district, 9 at the Workhouse Infirmary at Kingston, 7 in London Hospitals, 3 at the Teddington Cottage Hospital and 4 at other places outside the district. 1'his is equal to an annual rate of 1125 of the population. As these will be divided at the end of the year into columns showing the various causes and age periods at death, together with those occurring in the last quarter of the year, I simply append a summary of the causes, which are as follows : — Measles, 1 ; influenza, 1 ; phthisis (pulmonary tuberculosis), 5; cancer, 4; tuberculous meningitis, 2; heart disease, 9; bronchitis, 7; pneumonia, 5; diarrhcea, 2; appendicitis, 1 ; nephritis, 2; congenital defects and debility, 6; violent deaths, 6 ; other defined diseases, 30. Seventeen of these persons were between the ages of 60 and 70, seventeen were between 70 and 80, six were between 80 and 90, and two were 90 years of age and over. Eleven children died before attaining the age of one year, which gives a mortality rate among infants of 84.6 per thousand births. INFECTIOUS DISEASE. Forty-four notifications were received during the first nine months of the year, viz :—Scarlet fever, 24 ; diphtheria, 2; 5 erysipelas, 3; pulmonary tuberculosis, 9; other forms of tuberculosis, 6. One patient certified as suffering from diphtheria was treated at the Isolation Hospital and was discharged after a few days detention. Eighteen scarlet fever patients were also treated at the Hospital and all recovered Five of the scarlet fever patients were in one house, three in another and two in a third, the remaining fourteen being isolated cases in households. Tuberculosis. One case was notified in January under the 1911 Regulations. In February new Regulations came into force making all forms of Tuberculosis compulsorily notifiable : and during the eight months following 8 cases of Pulmonary Tuberculosis and 6 cases of other forms of the disease were notified. The Council have provided two portable open air shelters for the use of persons suffering from this disease, and one of these has been in constant use. One patient has also been treated at a Sanatorium at the cost of the Council. Premises occupied by patients are inspected and disinfected, and advice is given respecting the measures necessary to prevent the spread of the disease. Disinfection. All rooms are disinfected after the occurrence of infectious disease by means of Formalin gas, and the rooms are stripped and cleansed when necessary. 6 Bedding and clothing are disinfected at the Isolation Hospital in a steam disinfecting apparatus. The whole of this work is done by the Council's Officers free of charge to the householder. Isolation Hospital. The arrangements mentioned in my last Annual Report with respect to the measures for isolating cases of infectious disease (including small-pox) are still in force. Schools. There are four Public Elementary Schools in the district, which have been kept under constant observation. One of these schools was redrained owing to defects in the existing drainage, which was found to be due to settlement of the subsoil. With this exception, the premises were kept in good repair. The medical inspection of the scholars attending these schools is conducted by officers appointed by the County Education Committee : the County Medical Officer of Health being the chief School Medical Officer. Dwelling Houses. Thirty-two houses have been dealt with under the provisions of the Housing and Town Planning Act, five of which have been closed by the owners. Six houses were represented by me as not being reasonably fit for human habitation, and have been thoroughly repaired. The following is a summary of the works carried out:— Houses closed, 5; sites concreted, 6; damp proof courses inserted in walls, 17; ventilation below floors provided, 18; through ventilation to rooms provided, 6; yards paved, 1; 7 rooms cleansed, 17; roofs repaired, 7; gutters repaired, 15; yards drained, 3; drainage amended, 6; cisterns cleansed and covered, 4. In addition to the inspections mentioned above, a large number of dwellings have been inspected and nuisances arising from defective and choked drains, defective and unclean sanitary conveniences, dirty rooms, defective roofs, gutters, refuse, &c., have been abated; particulars of which will doubtless be enumerated in the annual report of the Inspector of Nuisances. Milk. Supply. There are three cowkeepers in the district, who keep an average of 100 cows, which are inspected quarterly by a Veterinary Surgeon appointed by the Council for the purpose of ascertaining if any case of tuberculosis of the udder exists in the cattle. The premises are under periodical inspection, and have invariably been kept in a cleanly condition, a verbal intimation being quite sufficient to get any defect attended to at once. Regulations under the Dairies, Cowsheds and Milk Shops Orders are in force in the district. Water Supply. The supply to this district is from the mains of the Metropolitan Water Board, and has been maintained at constant and good pressure. The supply has been invariably clear and bright, and is well filtered. Food Supply. The premises where food is prepared for sale hav'e been inspected by myself and the Inspector, and the condition of these premises were found satisfactory. Bye-laws for slaughter-houses are in force, 8 Dust Removal and Scavenging. This work has been satisfactorily performed by the Council's own staff. There is a weekly collection of house refuse throughout the district, and the absence of any complaint of nonremoval shows that the staff carry out their duties satisfactorily. The refuse is disposed of by burning in a destructor of the Horsfall type. Yours obediently, WENTWORTH TVNDALE. The Chairman ami Members, Hampton Urban District Council. Gentlemen, In continuation of the foregoing report by my predecessor, Dr. Tyndale, for the nine months ending September 30th, 1913, I beg to forward a report for the three months ending December 31st, 1913. VITAL STATISTICS. The table (No. 1) which is printed with this report compares the Birth and Death rate for 1913 with the previous five years. 9 TARLE I. Vital Statistics of whole District during 1913 and previoxis Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. of Non-residents 1 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. 1908 8560 206 206 24 0 80 9.3 1 14 16 77.6 93 10.7 1909 8800 217 217 246 87 98 3 9 16 73.7 93 10.5 1910 9040 206 206 22.7 79 8.7 2 17 8 38.3 94 10.3 1911 9280 208 217 233 79 8.6 6 22 24 110.5 95 10.3 1912 9400 164 169 17.9 75 7.9 4 22 11 65.08 93 9.8 1913 9600 178 182 18.9 80 8.3 2 29 14 76.9 107 11.1 Total population at all ages, 9,221 At Area of District in acres (land and inland Number of inhabited houses, 1980 Census water), 2044. Average number of persons per house, 4.6 of 1911, 10 Births and Death Rate. During the last quarter of the year 48 births were registered, and four notifications of births, outside the district, were received from the Registrar General, making a total for the year of 182 births—88 males and 94 females—of whom 10 were illegitimate. This is equal to an annual birth rate of 18.9 per thousand of the estimated population, being a slight increase on last year's rate. Deaths and Birth Rate. Twenty deaths were registered in the district during the last quarter of the year, and six deaths of residents occurred outside the district, making a total of twenty-six deaths. This number added to 81, the total for the previous three quarters, gives a total for the whole year of 107 deaths, 54 males and 53 females, and is equal to an annual rate of per thousand of the estimated population, an increase of the rate for the previous year. The County Medical Officer of Health mentions in his Annual Report for 1912 that the factor for age and sex distribution for the district is 9699, which makes the corrected death rate 10.7 per thousand. Particulars respecting the causes of death, together with the age periods at death, will be found in Table III. attached to this report. TABLE III, CAUSES OF, AND AGES AT DEATH DURING THE YEAR 1913. 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 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 Uncertified 107 14 3 3 2 2 12 20 51 4 Measles 1 ... 1 ... ... ... ... ... ... ... Influenza 2 ... ... ... ... ... ... ... 2 ... Phthisis (Pulmonary Tuberculosis) 6 ... ... ... ... ... 3 3 ... ... Tuberculous Meningitis 2 ... 1 1 ... ... ... ... ... ... Cancer, Malignant Disease 6 ... ... ... ... ... 1 2 3 ... Organic heart disease.. 14 ... ... ... 1 ... 1 3 9 1 Bronchitis. 8 1 ... ... ... ... ... 2 5 ... Pneumonia (all forms) 5 1 1 1 ... ... ... 1 1 ... TABLE III—continued. Other diseases of respiratory organs 1 ... ... ... ... ... ... ... 1 ... Diarrhoea and Enteritis 2 2 ... ... ... ... ... ... ... ... Appendicitis and Typhlitis 1 ... ... ... ... ... 1 ... ... ... Cirrhosis of Liver 1 ... ... ... ... ... ... 1 ... ... Nephritis and Blight's disease 2 ... ... ... ... ... ... 1 1 ... Congenital Debility and Malformation. including Premature Birth 9 9 ... ... ... ... ... ... ... 1 Violent Deaths, excluding Suicide 7 .. ... 1 1 1 3 ... 1 1 Other Defined Diseases 40 1 ... ... ... 1 3 7 28 1 107 14 3 3 2 2 12 20 51 4 13 Below will be found a table showing the distribution of these deaths between males and females and the age periods at death. DEATHS OF RESIDENTS, 1913. Sex. At 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 over Males 54 12 3 2 1 1 2 12 21 Females 53 2 0 1 1 1 10 8 30 Totals. 107 14 3 3 2 2 12 20 51 Of the one hundred and seven deaths recorded, fourteen occurred in infants under one year of age, and fifty-one in persons over sixty-five years of age. There were 10 inquests held during the year. The verdicts were returned as follows :— Natural causes 5 Accidents 4 Drowning 1 10 During the year there were three deaths due to Zymotic diseases, viz.:— Epidemic diarrhoea 2 Measles 1 3 being an annual death rate of 0.3 per thousand. 14 Infantile Mortality. This includes the deaths of children under one year of age for the whole of 1913. Fourteen deaths were recorded, of which number 7 died within one month of birth. The causes of death were as follows •— Bronchitis 1 Pneumonia 1 Diarrhœa 2 Congenital defects 2 Debility 7 Other causes 1 14 The infantile mortality rate for 1913 is 76.9 per thousand births. These figures are arrived at by taking the actual number of births and deaths of infants registered during the year. The rate is slightly higher than last year, but must be looked upon as favourable, when it is seen that half of the deaths occurred within one month of birth from unpreventable causes, such as debility and congenital defects. In Table IV. will be found the full list of the causes of deaths of these infants. 15 TABLE IV. INFANT MORTALITY. Nett Deaths from stated causes at various Ages under 1 Year of Age CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 weeks. 1-3 Months 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under 1 Year. All Causes. Certified Uncertified 2 3 1 1 7 5 1 1 14 Bronchitis ... 1 ... ... 1 ... ... ... ... 1 Pneumonia (all forms) ... ... ... ... ... 1 ... ... ... 1 Diarrhœa ... ... ... ... ... 1 1 ... ... 2 Congenital Malformations 1 ... ... ... 1 1 ... ... ... 2 Atrophy, Debility, Marasmus 1 2 1 1 5 1 ... 1 ... 7 Other Causes ... ... ... ... ... 1 ... ... ... 1 Totals 2 3 1 1 7 5 1 1 ... 14 Nett Births in the year legitimate, 172. illegitimate, 10. Nett Deaths in the year of legitimate infants, 14. illegitimate infants, 0. Notification of Births Act (1907). This Act is not in force in this district. Prevention of Infantile Mortality. Under the provisions of the Infant Life Potection Act, the Board of Guardians has appointed a Trained Nurse to make periodical inspections of those children to whom the Act applies in this district. Midwives Act, 1902. The supervision of Midwives under the above Act is carried out under the direction of the County Medical Officer of Health. 16 Infectious Diseases. In Table II. will be found a summary of the Notifications received during the year under the provisions of the Infectious Disease (Notification) Acts and the Public Health (Tuberculosis) Regulations. TABLE II. CASES OP INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1913. Notifiable Disease Number of Cases Notified. Total Cases Removed to Hospital. At all Ages. At Ages—Years. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Diphtheria (including Membranous croup) 2 ... 1 1 ... ... ... ... 1 Erysipelas 3 ... ... ... ... 1 2 ... ... Scarlet fever 31 ... 3 25 2 1 ... ... 25 Puerperal fever 1 ... ... ... ... 1 ... ... 1 Pulmonary Tuberculosis 13 ... ... ... 1 6 6 ... 3 Other forms of Tuberculosis 7 ... 2 3 1 1 ... ... 2 Totals 57 ... 6 29 4 10 8 ... 32 Isolation Hospital or Hospitals, Sanatoria, &c. Isolation Hospital, Hampton Urban District Council. Small Pox (arrangement with Uxbridge Joint Hospital Board, at Yeading, Middlesex). Kelling Sanatorium, Holt, Norfolk. Frimley Sanatorium, Surrey. Clare Hall, South Mimms. 17 During the last three months of the year, seven cases of Scarlet Fever were notified All the cases were removed to the Isolation Hospital and recovered. One case of Puerperal Fever was admitted into the London Hospital,'and recovery took place. There were also notified during the same period four cases of Pulmonary Tuberculosis and one other form of Tuberculosis. Diphtheria. Only 2 cases were notified during the year. One case was admitted into the Isolation Hospital, and the other was treated at home. Both patients recovered. Scarlet Fever. Thirty-one cases were notified during the year, of this number twenty-five were admitted into the Isolation Hospital, and six cases were treated at home. All the patients recovered. Erysipelas. Three cases of this disease were notified during the year All the patients were adults. Puerperal Fever. One case was notified during the year. The patient had been attended in her confinement by a midwife. She was sent to the London Hospital and made a good recovery. Pulmonary Tuberculosis. During the year thirteen cases of this disease have been notified, three of whom have been sent to Sanatoria. There have been six deaths during the year due to this disease. Many of these cases are now treated under the provisions of the National Insurance Act, and receive domiciliary treatment, 18 The Tuberculosis Dispensary for this district had not been opened at the close of the year. Tuberculosis (other forms). Seven notifications were received during the year, and two deaths are recorded from tuberculosis meningitis, both in children. It will be noticed that from February Ist, 1913, all forms of tuberculosis are compulsorily notifiable. The Council is prepared to provide Sanatorium treatment for early cases of pulmonary tuberculosis for those persons, who are unable to bear the cost themselves and for whom this treatment is not otherwise provided. There have been no cases of any other of the notifiable infectious diseases. Non-notifiable Infectious Diseases. By arrangement with the school authorities, the Medical Officer of Health receives information from the head teachers of the Public Elementary Schools relating to the following diseases. Measles, mumps, whooping cough and chicken pox. During 1913, 104 cases of measles, and 8 cases of chicken pox were notified. Cancer. Six deaths were notified during the year, being a decrease of six as compared with 1912. The Council arrange for the disinfection of rooms, bedding, &c., of all persons dying from this disease. Venereal Diseases. As far as can be ascertained, there is no marked prevalence of these diseases in the district, No local facilities for modern 19 methods of treatment exist. Cases of syphilis are mostly treated in the London Hospitals. Bacteriological Work. The Council has an arrangement with the Clinical Research Association, and pays the cost of the necessary examinations in suspected cases of tuberculosis and diphtheria. Milk Supply. During the last quarter of the year, I visited with the Inspector of Nuisances all the Dairies, Cowsheds and Milkshops in the district. There was no cause for complaint. The milk produced in the district is insufficient for the needs of the inhabitants and a considerable quantity is brought in from neighbouring districts, and also by rail. There are 3 cowkeepers, 6 dairymen, and 9 purveyors of milk on the Register. The Board of Agriculture, under the Contagious Diseases (Animals) Act, made an Order in 1913, for the compulsory notification by cowkeepers of any case of tuberculous disease among their cattle. This Order will tend to improve the purity of the milk supply. The quarterly inspection by the Veterinary Surgeon appointed by the Council is still being carried out. The Inspector of Nuisances invariably notifies milk sellers of the occurrence of infectious disease among their customers, so that precautions can be taken to prevent its spread by means of milk cans. 20 Food Supply. There are at present eight retail bakehouses in the District, none of which are underground ones. On my inspection of these premises I found that most of them had been recently limewashed, and they were all in a cleanly condition. Butcher's shops, slaughter-houses (5 in number), and fishmongers shops have all been inspected, and found in a satisfactory condition. During the year the Inspector of Nuisances seized half cwt. of whiting, and 1 box of kippers, which were unfit for food, and obtained Justice's Orders for destruction. None of the animals slaughtered were found to be tuberculous. The duties under the provisions of the Sale of Food and Drugs Acts are carried out by the County Council. Offensive Trades. The Soap Works, situated in Thames Street is the only trade in the district coming under this heading. At my inspection I found the premises in a cleanly condition, and no nuisance existed. Factory and Workshop Acts. At the commencement of the year there were forty-five workshops on the Register, which is kept in accordance with the provisions of Section 131 of the Act of 1901. Of this number, eight were closed, or ceased to be used as workshops, and ten new ones were registered. This makes a total of forty-seven workshops on the Register on December 31st, 1913. 21 These premises include retail bakehouses, laundries, dressmakers, &c. There were 183 visits of inspections to these premises. Four written notices were served respecting defects, and the Inspector of Factories was notified on four occasions of the failure of the occupiers to keep the abstract of the Factory Act affixed in their workshops. The following works were carried out during the year, viz. : — Six bakehouses were limewashed, seven workshops were cleansed and whitewashed. Two drains were cleared or repaired five sanitary conveniences were amended, and two new ones were provided, and one roof was repaired Four lists of outworkers were received from employers giving out work, and the names and addresses were forwarded to the local authorities concerned as provided for by section 107. The workshops generally are kept in a satisfactory condition, and no case of overcrowding came under notice. A copy of the statistical tables relating to the work under these Acts is appended. Herewith enclosed is the Annual Report of the Inspector of Nuisances (Mr. A Shail). I am much indebted to this officer for the great assistance he has given me since my appointment as your Medical Officer of Health. I am, Gentlemen, Your obedient Servant, A. D. OWEN. To the Chairman and Members, Hampton Urban District Council. 22 Annual Report of the INSPECTOR OF NUISANCES For the year ended 31st December, 1913. ARTHUR 1). OWEN, Esq., M.R.CS., &c„ Medical Officer of Health. Sir, I beg to present to you my Seventeenth Annual Report on the work carried out as Inspector of Nuisances during the year !9!3- Inspections. Complaints received and attended to 42 Number of premises inspected owing to complaints 60 Number of premises inspected re infectious disease 51 Number of premises under periodical inspection 64 House-to-house inspections 84 Other inspections 391 Number of re-inspections after notice 1935 Total inspections and re-inspections 2521 Notices. Letters written 125 Cautionary or intimation notices given 151 Statutory notices served 14 Prosecutions None Dwelling Houses. Premises repaired, cleansed, &c. 27 Houses closed 5 Roofs repaired 12 Rain water pipes repaired 12 Eaves gutters repaired 28 Sites covered with concrete 6 23 Ventilation below floors provided 20 Damp-proof courses inserted in walls 19 Windows made to open 5 Through ventilation to rooms provided 6 Yards paved 12 Yards drained 3 Water laid on from main service 1 Cisterns cleansed and covered 4 New sanitary dustbins provided 18 Schools. Number in District 5 Frequency of inspection Monthly Drain reconstructed 1 New water closet fixed 1 Water closets repaired 3 Slaughter Houses. Number on the Register 5 Number of visits paid 95 Frequency of limewashing Quarterly Contravention of Bye-laws 1 Nuisances abated 4 Unsound Food. Articles seized or surrendered and destroyed 2 1 trunk of whiting about 561bs , box of kippers Dairies, Cowsheds and Milkshops. Number of cowsheds in district 7 Average number of milch cows kept 100 Number of dairies and milkshops 6 Number of visits paid 31 Cowsheds limewashed May and October Contravention of Regulations None Offensive Trades. Number in District 1 Number of inspections 2 Nuisances found None 24 Factory and Workshop Acts, 1901 and 1907. Number of workshops and workplaces on the Register 29 Number of retail bakehouses on the Register 8 Number of laundries 011 the Register 10 Number of visits to workshops and workplaces 88 Number of visits to bakehouses 39 Number of visits to laundries 34 Number of visits to factories 6 Written notices served respecting defects 4 Workshops cleansed and whitewashed 7 Bakehouses limewashed 6 Water closets cleansed or repaired 2 Sanitary conveniences provided 2 Drains amended 2 Roof repaired 1 Flushing cisterns repaired 3 Outworkers' lists received 4 Names of outworkers sent to other Authorities 5 Notices received from Factory Inspector 3 Notices sent to Factory Inspector 4 Drainage. The following is a summary of works executed under this heading :— Drains tested, exposed, &c. 14 Number found defective 8 Drains cleared 134 Drains repaired or trapped 17 Drains reconstructed 5 Disconnecting traps or chambers inserted 7 Soil and ventilating pipes repaired 9 New ventilating pipe fixed 1 New stoneware sinks fixed 2 New sink wastes fixed 3 Waste pipes repaired 2 Urinals cleansed or repaired 4 Rain pipes disconnected from drains 2 25 New water closets fixed 5 Water closets repaired or cleansed 14 Closets supplied with water or supply improved 19 New flushing cisterns fixed 5 Flushing cisterns repaired 14 Sundry other Nuisances Abated. Smoke 1 Animals improperly kept 5 Accumulation of refuse 14 Yard paving repaired 1 Infectious Disease, Disinfection and Cleansing. Premises inspected on notification ... ... ... 51 Patients removed to the Isolation Hospital 28 Rooms disinfected, ordinary infectious disease 49 Rooms disinfected, Tuberculosis 17 Rooms disinfected, Cancer 6 Rooms stripped and cleansed 49 Articles disinfected or destroyed 434 Cana1. Boats Acts, and Regulations. Number of visits to Coal Wharf and dock 99 Number of craft seen 361 Number coming under the Acts and Regulations 4 Contraventions discovered 3 I am, Sir, Your obedient Servant, ALBERT SHAIL. Public Offices, Hampton, 23rd. January, 1914.