TED 7 DISTRICT OF TEDDINGTON. Annual Report OF THE MEDICAL OFFICER OF HEALTH, TO BE PRESENTED TO Urban District Council OF TEDDINGTON. 1 896. TEDDINGTON: PRINTED BY T. W. CHILDS, CHURCH ROAD. ANNUAL REPORT ON THE SANITARY CONDITION OF THE District of Teddincton, During the year 1895. The Urban District Council of Teddington. Gentlemen, I beg to place before you my Annual Report on the Mortality, Health and Sanitary Condition of your District for the year 1895. The total number of deaths which occurred and were registered was 178 and included— 9 from Influenza 8 ,, Diphtheria 1 ,, Membranous Croup 4 ,, Diarrhoea 2 ,, Puerperal Fever 15 ,, Phthisis 1 ,, Rheumatic Fever 30 ,, Bronchitis and Pneumonia 19 ,, Diseases of the Heart 12 ,, Diseases of the Nervous System 10 ,, Cancer 4 „ Injuries 4 21 „ Debility from Birth and Premature Birth 13 ,, Old Age 29 ,, Various Causes 178 95 were males and 83 females 55 were under 1 year of age and 42 above 65. The estimated population to the middle of 1895 is 11,187 and assuming this figure to be approximately correct, the mortality from all causes was at the average annual rate of 16.00 for every 1000 persons living. Comparing this mortality with the average mortality of the last 10 years, of which I enclose a table, I find that it is the highest during that period, and exceeds the average mortality by 2.19. The high mortality in 1895 was attributable to two causes; one was due to the high mortality amongst infants which amounted to over 30 per cent, and the other to the great number of deaths which occurred during the first G months of the year, and which without doubt were caused by the severe continuous frost in January and February when Influenza became very prevalent, and although the actual number of deaths from that disease was not abnormally large, it left in many persons after-effects which resulted fatally in diseases of the respiratory organs. The number of births was 269 of which 144 were males and 125 females. The birth rate was 24.05 and the Infantile mortality 204.6 per 1000 births. TEDDINGTON DISTRICT. MORTALITY OF THE LAST TEN YEARS. 1886-1895. Year 1886 1887 1888 1889 1890 1891 1892 1893 1894 1895 Number of Deaths. 131 122 104 139 144 135 140 163 140 178 Annual Deathrate. 14.55 13.53 10.94 14.6 14.4 13.36 13.33 14.81 12.72 16.00 Average Annual Death-rate for the last Ten Years 13.81. The calculation is made on the census and on the estimated increase of the population in various years. TH. GUNTHER, M.D. 6 INFECTIOUS DISEASES. I.—Not Notifiable. Influenza.—At the end of February Influenza became very prevalent. It did not appear of a specially malignant type, nor did the worst symptoms shows themselves in the early stages of the disorder. The recovery may to all appearances have been complete, but the patient's constitution has been weakened and he is thus exposed to danger from some after attack. Although the deaths attributed directly to Influenza were only 9 in the district, there has been a great increase in the deaths (30) referred to diseases of the respiratory organs, and it is probable that the cause of this must be sought partly in the severe weather in the beginning of the year, and partly in the bronchial weakness, which often follows, when Influenza which has led to it, has disappeared. From January to June the deaths from diseases of the respiratory organs were 25, and from July to December only 5. Measles.—Few isolated cases occurred. No death was registered. Whooping Cough.—No death occurred and cases of illness were scarce. Diarrhoea.—Four deaths occurred and all were infants. The district was during the Summer and Autumn singularly free from this disease which is generally so common in a hot and dry season such as we experienced last year. II.—N otifiable . Fifty-two notifications were received against 63 in 1894 and 184 in 1893. Fifteen were cases of Scarlatina, 22 of Diphtheria, 2 of Membranous Croup, 4 of Puerperal Fever, 8 of Erysipelas, and 1 of Typhoid Fever. 7 Small Pox.—No case. Scarlatina.—Fifteen cases were notified. They were all isolated and no particular locality was affected; they appeared in nearly all months of the year, but the majority occurred from September to the end of the year. Diphtheria.—Of the 22 cases 14 were persons of 5 years and upwards, including a woman of 60, and the remaining 8 were children under 5 years of age This is a large increase compared with former years. The disease never appeared in an epidemic form, it never attacked special localities, and the majority of cases occured in small cottages at no particular season of the year. It is well known that the specific diphtheritic bacillus is often found in the throat as long as 6 or 7 weeks after recovery, and it is also known that as long as the bacillus is present, the danger of infection has not passed. Such being the case, it is not safe to allow a child who may appear quite well at the end of a fortnight to mix with others as the disease might thus be spread. Two such cases happened during the year; in each case the child suffering from the disease was isolated and every precaution taken to prevent infection, but notwithstanding in the first case another child was attacked after four weeks, and in the second case after five weeks lapse of time. Experience thus shows that it is not advisable to allow children who have been suffering from diphtheria to mix too soon with other children, and they ought to be excluded from school for at least 7 to 8 weeks after the beginning of the illness. Diphtheria being an eminently infectious disease, Isolation is the only effective remedy against its spread, but this cannot be accomplished under ordinary circumstances in the patient's house, but can easily be effected in an Isolation Hospital where the mischief of allowing 8 infection to spread from first cases will be avoided, and where the requisite preventive measures are carried out to the letter. Cases of propagation of this disease are sometimes due to the milk supply, but in no instance could the disease be traced to this cause. Inquiries were made whether cows were in a healthy condition and whether the people employed in the cow sheds and dairies were in good health, but in neither instance did the inquiries lead to any result. It is advisable that people should, where there has been an out-break of diphtheria, take the precaution of having the milk boiled. Infection in school was clearly established in one case, where two children were attacked who sat next to each other; both children were day pupils. No boarders suffered from the disease and the sanitary arrangements of the school were all in good order. As in the case of Scarlatina, Diphtheria never appeared in an epidemic form. In three cases more than one person in the same family was attacked. The majority of cases (14) occured during the second half of the year, and the increase of diphtheria during that period was also noticed in neighbouring districts and especially in the metropolis. Diphtheria does not obey the same law which determines the prevalence of other diseases of the zymotic group ; formerly it prevailed more in the country than in the towns, but there has been observed during the last few years an increase of diphtheria in the more densely populated districts, and in some instances, also in places where the disease had prevailed in an epidemic form shortly after the substitution of the new and elaborately constructed sewerage system for the old cess-pool. I cannot disguise the fact that in this district the number of cases of diphtheria has 9 increased during the last few years, as proved by the following figures DIPHTHERIA. OTHER NOTIFIABLE DISEASES. 1890 2 cases 65 cases 1891 2 „ 20 „ 1892 4 „ 21 „ 1893 14 „ 170 (Scarlatiua Epidemic) 1894 12 „ 41 cases 1895 22 „ 30 „ I can only hope that the new anti-toxin treatment of diphtheria will greatly reduce the mortality. To judge from my own experience and that of my colleagues the results of that treatment have been very encouraging. Membranous Croup.—Two cases were notified, one ended fatally. Puerperal Fever.—Four cases were notified. One case must have been of a doubtful character, as the woman who was on a visit in Teddington was able to travel home 9 days after her premature confinement, but in this case, as well as in the other 3, the nurses or mid-wifes were advised not to attend any case for two months. Two cases proved fatal. Typhoid Fever.—The only case notified was of a very mild type, as the patient was able to leave his home before three weeks had elapsed. No sanitary defects were found in the house, and as the patient was staying very often away from home before his illness, it is very probable that his opinion of having contracted the disease out of the district was correct. INSPECTIONS AND OTHER SANITARY Special inspections in connection with infectious diseases, unsanitary localities and houses, bad roads, etc., were made at various times. A systematic inspection of the district was made in WORK. 10 October and November; the same sanitary defects were found as in former years. The supply of dustbins was made compulsory some years ago, and the owners of houses in most cases did their best to comply with the regulations; I found at the inspection that in many cottages the dust-bins were in a very dilapidated condition, and that they have in many instances entirely disappeared, especially those of galvanized iron. At present the dust-cart calls at every house once a fortnight: this would answer the purpose if the dust-bins were sufficiently large and the contents consisted only of dust and ashes, but many organic substances, such as potatoe peelings, tea leaves, decayed vegetables, etc., are often found. In about 410 cases this rubbish has to be carried through the houses. To prevent such unsatisfactory arrangements, I submit for the consideration of the Council, whether a method to collect the refuse daily would not be preferable ; for this purpose only small receptables would have to be used, and placed by the inhabitants daily at a certain time in front of their premises where they could be easily accessible for the collector. I am not in a position to form an opinion whether such a plan would add considerably to the present expenses. The disposal of ash-pit refuse has again given trouble, as objection was raised to the burning in the Council's ground in Broom Road. The burning was discontinued and the refuse is now deposited in a trench at the Sewage Purification Works, where it is covered with road-sweepings. Many defects were also found at the inspection in the waste-water preventors of closets, and many notices were served for repair. Another constantly recurrent nuisance is caused by keeping domestic animals, such as fowls, ducks and rabbits, in improperly drained and badly 11 ventilated out-buildings, where in many cases no protection is given against rain. Very few pig-styes are now found in the district and those were kept fairly clean. Special attention was paid at the inspection to the schools, and I am glad to report that the sanitary arrangements are now in good condition, and the automatic flushing system is a great improvement. The roads have greatly suffered by the constant breaking up. I beg to call your attention to the filthy and unsanitary condition of Florence Road, Fulwell Road, Clarence Road, Coleshill Road, and Fairfax Road. In order to secure greater cleanliness, the General Purposes Committee recommended in June that printed notices should be served on the tenants of all shops in the town, calling their attention to the nuisance caused by the throwing out of saw-dust, shop-sweepings, etc., into the road, thus blocking the course of the channelling, and also to remind them of the penalties to which they are liable for so doing. ALMSHOUSES AND DWELLINGS UNFIT FOR HUMAN HABITATION. A special inspection of the almshouses was made in May, and I submitted to the Council the following report:— There are 5 cottages, each inhabited by one person, and each has one room and a wash-house attached. In No. 1 the floor and brick-hearth are dilapidated, the ceiling is black and the paper dirty. The back-room or wash-house has damp walls and dilapidated ceiling. No. 2 has no ventilator for the floor. 12 No. 3. The front door is very defective, wind and rain water can come through, and the backdoor has the same defects. The wall in front-room is very damp. No. 4. Front and back rooms have damp walls. No. 5. Same condition. The sanitary defects of all 5 cottages are:— 1. Dilapidated roof. 2. The guttering in front and back is in a very defective condition and causes dampness of the walls. 3. There is no W.C. A double privy is in the garden. All can be remedied by the following alterations and improvements:— 1. To repair the roof and point the tiles. 2. To make a good and substantial guttering in front and back, in order to keep the walls dry. 3. To repair the ceilings and the wall papers where they are defective. 4. To remove the privies and erect closets with proper flushing cisterns. 5. To supply a guttering for the coal shed. 6. To ventilate floors of No. 2 and 5. If these alterations are carried out, the cottages are quite fit for human habitation, especially as they are always occupied by only one person. In September I reported about 8 cottages in Cranmer Place and gave the following certificate, "I have this day inspected Marian Cottages, Cranmer Place, Teddington, and I have found those 8 cottages in a state so dangerous and injurious to health as to be unfit for human habitation." 13 DAIRIES AND COWSHEDS. These were periodically visited. In two cases the paving of the cowsheds was found defective, in one case there was accumulation of manure, and with one exception, each of the cowsheds required lime-washing. Verbal notices were given and the necessary work was duly carried out. SLAUGHTER HOUSES. At different times inspection was made of the slaughter houses, and these, with two exceptions, were found to be in a fairly good condition. In one case a quantity of offal and other offensive matter was placed with the manure close to the road. The owner's attention having been directed to this nuisance, it was forthwith removed. Another slaughter house was found in a dirty state with defective flooring. Verbal notice was given and the necessary work of cleansing the premises and repairing the floor was duly complied with. An application was made by Mr. Scoles for a license for a new slaughter house, and according to your instruction I visited the localities with the Surveyor and Inspector of nuisances, and we presented in August the following special report:— 1. With reference to the site in Broad Street, we are of opinion that the proposed premises are very objectionable for the erection of a slaughter house, as the premises are in close proximity to inhabited houses and in the midst of a densely populated district. 2. Site in Florence Road. The proposed site in this locality is surrounded by houses and building land, the latter of which will probably be built on within a short time. Several houses are within 100 feet of the proposed site, which also 14 adjoins neighbouring gardens. Even the best-kept slaughter houses create bad smells and other unavoidable nuisances, and it is therefore advisable to place them in localities where they are distant from dwelling houses. We know from experience that complaints constantly arise with reference to nuisances connected with well conducted slaughter houses. We are also convinced that property in the neighbourhood of the proposed site would be greatly deteriorated if this site were adopted. Under those circumstances we oannot recommend the Urban District Council to accede to the grant of a license in this locality. BAKEHOUSES. All have been periodically inspected during the year. In some cases white-washing was required, otherwise they were found in a satisfactory condition. THE ISLAND AND LAND ABUTTING ON THE RIVER. The increase of the number of house-boats and of the camps, some of the latter consisting of erections partly of wood and partly of galvanized iron, presents a feature of some gravity; the primitive sanitary, or rather unsanitary arrangements calling for active supervision on the part of the Council. WATER SUPPLY. The water of 9 wells was analysed and 4 were found unfit for domestic use. Notices for a proper supply were served and complied with. After the severe frost had lasted several weeks, many houses in the district were without 15 water. The Grand Junction Water Company erected stand-pipes, but the number was quite insufficient, and as the frost continued matters became worse after the first week in February. On February 10th I addressed a letter to the Water Company, calling their immediate attention to the danger to health which might arise from the scarcity of water; nearly all the connections were frozen and the majority of houses were without any water. The staff attending the stand-pipes was quite inadequate. After a few days many of the stand-pipes became useless, the water being frozen in the mains. At the Council Meeting of February 11th, the Surveyor was instructed to supply water, using the water carts, 4 or 5 in number. The water was taken from hydrants, which in some roads were still unfrozen. In this deplorable condition the district was placed for over two months. After the thaw set in, the mains burst, and the whole system of water supply was disorganized. I have to congratulate the Council on the prompt measures they took, without regard to expense, to alleviate the sufferings of the inhabitants. Even so, it was only procurable to furnish a very limited supply considering that the absolute wants of 11,000 people had to be met by means of cartage. When at last water was obtained, measures had to be taken to cleanse sewers and drains which were in a foul condition, in order to avoid any injury to health. Printed instructions for this purpose were circulated and disinfectants distributed. During the frost special attention was paid to the sanitary arrangements in the schools, where the drains were regularly flushed with water and disinfectants. The pitiable state to which this district was reduced, was entirely due to the shallow depth of the mains, which were in many roads only a foot or even less below the surface. I am glad to see 16 that the work of lowering the pipes has commenced, but at present it is only in about 10 roads that the lowering of the mains has been completed. DRAINAGE AND SEWERAGE. At the end of the year the sewerage of private roads was completed, and some house-holders in those roads have connected their houses. The system worked well during the year, and I hope with a greater number of connected houses, the flushing of the sewers will be effected without the help of water supplied by carts, as more effectual flushing will minimize the smells from the manholes, which still cause numerous complaints. In some places more ventilating shafts will probably be necessary. The system at the Sewage Disposal Works answers very well, only one complaint of an offensive smell has been received during the year. In August the Thames Conservancy Inspector pronounced the effluent unsatisfactory. The Council instructed the Surveyor to arrange that the effluent from the precipitation tanks should be more regularly and evenly distributed over the purification area, and this has been done with satisfactory results. With this exception, the Thames Conservancy Inspector who visits the works very frequently, has pronounced the effluent to be satisfactory. In reference to house drainage, the Council took a very important step, with a view to ensure efficient drainage in the future by passing a resolution to the effect that the drains of all new houses shall be submitted to the dydraulic test before being passed by the Council's Surveyor. 17 ISOLATION HOSPITAL. With regard to an Isolation Hospital, 1 beg to refer to former annual reports. 1 regret that at present no steps have been taken by the Council to secure a suitable site for a Hospital. 1 remain, Gentlemen, Your obedient Servant, TH. GUNTHER, M.D., Medical Officer of Health. January, 1896. 18 Sanitary Work done by the Inspector of Nuisances. Complaints Received 70 Cautionary Notices Given 46 Statutory Orders Issued 160 Inspection Made of Houses, Premises, etc., (Systematic Inspection with Medical Officer) 1238 Inspection with reference to Schools 12 ,, ,, Slaughter-houses 24 ,, ,, Cowsheds 40 ,, ,, Dairies and Milk- shops 48 ,, ,, Wells and Cisterns 34 ,, ,, Water-waste Pre- ventors 70 ,, ,, Closets 87 ,, ,, Stopped drains and ,, ,, faulty traps 112 ,, ,, Overflowing Cesspools 101 ,, ,, Insanitary Privies 13 ,, ,, Dilapidated Dustbins 38 ,, ,, Erection of New Dust-bins 58 ,, ,, Roof Guttering and Rain Pipes 25 ,, ,, Accumulated manure 16 Pig Styes 17 „ ,, Water in Cellar 1 Rooms disinfected 31 19 Table A of Deaths during 1895. Under one year 55 1 and under 5 15 5 ,, ,, 15 7 15 ,, ,, 25 12 25 „ „ 65 47 65 and upwards 42 At all ages 178 Causes of Death. Diphtheria 4 under 5 years. ,, 4 five years and upwards. Membranous Group 1 under five years. Puerperal Fever 2 five years and upwards. Diarrhoea and Dysentery 4 under five years. Rheumatic Fever 1 five years and upwards. Phthisis 7 under five years. ,, 8 five years and upwards. Bronchitis, Pneumonia and Pleurisy 19 under five years. ,, ,, 11 five years and upwards. Heart Disease 1 under five years. ,, ,, 18 five years and upwards. Influenza 2 under five years. ,, 7 five years and upwards. Injuries 2 under five years. ,, 2 five years and upwards. All other diseases 30 under five years. ,, ,, 55 five years and upwards. Total 70 under five years. „ 108 five years and upwards. 20 Table B of Population, Births and New Cases of Infectious Sickness. Population Census 1891 10,025 Estimated to middle of 1895 11,187 Registered Births 269 Cases of Infectious Sickness. Scarlatina ,, Diphtheria ,, Membranous Croup Enteric or Typhoid Fever Puerperal Fever Erysipelas ,, 8 under five years. 12 five years and upwards. 8 under five years. 14 five years and upwards. 2 five years and upwards. 1 five years and upwards. 4 five years and upwards. 1 under five years. 7 five years and upwards. The Notification of Infectious Disease has been compulsory in the District since February, 1890. There is no Isolation Hospital.