TED 9 1896 DISTRICT OF TEDDINGTON. Annual Report of the MEDICAL OFFICER OF HEALTH, to he presented to Urban District Council of TEDDINGTON. 1897. TEDDINGTON: PRINTED BY T. W. CHILDS, CHURCH ROAD. ANNUAL REPORT ON THE SANITARY CONDITION OF THE Urban District of Teddington, For the year 1896. The Urban District Council of Teddington. Gentlemen, I have the honour to present to you my Annual Report on the Mortality, Health and Sanitary Condition of your District for the year 1896. The total number of deaths which occurred and were registered was 136 and included— 3 from Diphtheria 1 „ Enteric Fever 3 „ Whooping Cough 2 „ Influenza 6 „ Diarrhœa 21 „ Phthisis 13 „ Bronchitis and Pneumonia 14 „ Diseases of the Heart 24 „ Diseases of the Nervous System 5 „ Cancer 4 1 „ Injuries 9 „ Debility from Birth 11 „ Old Age 23 „ From various causes 75 were males and 61 females 34 were under 1 year of age and 33 above 65. The population was according to the census of 1891, 10,025, but it is now estimated by a good authority to be 12,100, and taking this figure as approximately correct, the mortality from all causes is at the average annual rate of 11.24 per 1000 persons. Low as the Teddington mortality rate is as a rule, this is exceptionally so. I cannot find that the death rate has been so low in any other year except in 1888 when it was 10.94. The number of births was 260, 141 were males and 119 females. The birth rate was 21.48 and the Infant mortality 130 per 1000 births against 204 of the previous year. This is a considerable decrease, but the rate is still very high. The infant mortalily is considered by the Medical Officer of Health for the County of Middlesex, a delicate test of the sanitary and social conditions affecting infant life. I fear a great number of those deaths have been caused by improper feeding, bad nursing, carelessness and ignorance. INFECTIOUS DISEASES. I.—Not Notifiable. Influenza.—Isolated cases occurred at the beginning and at the end of the year. Two cases 5 proved fatal, which were complicated with heart and lung disease. Measles.—No death was registered, and the number of cases were few and isolated. Whooping Cough.—Three cases proved fatal to infants under six months of age. Many cases occurred during the year. The highly contagious and very often serious nature of this complaint is frequently ignored by the people, and one constantly meets with suffering children exposed in the public streets to the detriment to themselves and others. Diarrhoea.—Six cases were fatal and all were children under rive years of age. II.—Notifiable. Seventy-six notifications were received against 52 in 1895, 63 in 1894 and 184 in 1893. Thirtysix were cases of Scarlatina, 19 of Diphtheria, 3 of Enteric Fever, 1 of Puerperal Fever, and 17 of Erysipelas. Scarlatina.—Thirty-six cases occurred but not a single death. They were fairly evenly distributed throughout the district, but from South Teddington only one case was notified. In several instances there was elear evidence of cases having been imported into the district, in others the infecttion was traced to private schools, but in the majority no cause for the outbreak could be found. One potent cause of the spread of the disease is, that it is not recognized by parents when the type is of a very mild character; and thus the children are allowed to go about and mix with others. How difficult it is to trace the infection and to take measures against the spread, will be illustrated by the following case:—"A gentlemen was 6 ailing from so slight a sore throat that he did not think it necessary to consult his medical attendant. Within a few days he got better and made his usual journey to London, travelling in a railway carriage and performing his daily work in his office. He continued to do so for more than three weeks. Feeling unwell after that time he consulted his medical adviser, who found him in a perfect state of desquamation, and therefore came to the conclusion that the patient was all the time suffering from scarlatina." I then received a notification to that effect. This is by no means an isolated case, as similar cases have previously come under my notice and it proves the difficulty of stamping out this disease, whatever preventive measures may be adopted. In all cases the usual measures were taken to prevent the spread. Diphtheria.—Nineteen cases have been reported and three proved fatal, against 22 with 8 deaths in the previous year. Fourteen were children over 5 years or grown up persons, and this accounts for the small mortality, the disease being more fatal in very young children. Many of the cases were of a mild type and a majority (15) occurred in the first six months of the year, when we had a great deficiency of rainfall. It was observed in other localities that a very dry season is influential in the causation of diseases of the throat and infantile diarrhœa, which are generally prevalent in consequence of the absence of the natural beneficial flushing effects of rain, by which streets, courts, pavements, gullies and drains are frequently cleansed and their accumulations of dirt and decomposing matter more effectually removed than by water cart flushing, although the latter will always prove beneficial. Schools had 7 but little influence on the spread, as proper precautions were taken to exclude all children from infectious houses for a period of six weeks. As in the case of Scarlatina, Diphtheria never appeared in an epidemic form. A case occurred in August in a dairy, and as we have no isolation hospital, the child had to remain in the house, constant and strict supervision had to be exercised to prevent any contamination of the dairy produce. The patient was perfectly isolated at the top of the house which was fortunately very roomy, and other conditions were also favourable to avoid the closing of the business. The milk and butter was removed from the shop and kept in premises apart from the house, and disinfectants freely used. The case occurred in the beginning of August, and no other case was notified for many weeks in the district, and those which were notified afterwards had their milk supplied from other sources. In all cases the usual measures against the spread were taken, personal instructions given for distribution of disinfectants and whenever practicable isolation. Small Pox.—No case. Puerperal Fever.—One case was notified and the patient recovered. Enteric Fever.—Three cases were reported and one was fatal. The patient was brought from a neighbouring district to the Cottage Hospital, and I gave the Medical Officer of Health of that district notice of the outbreak. The two other cases occurred in new houses, in which no fault could be found with the water supply, drains or other sanitary arrangements, and I was unable to detect 8 anything which could account for the origin of the disease. Both cases recovered. Erysipelas.—Of the 17 cases one died, being caused by a carbuncle. INSPECTIONS AND OTHER SANITARY WORK. Apart from special inspections of houses and localities in connection with infectious diseases, a systematic inspection of the district was made in October and November. I was glad to observe many great improvements. The condition of Florence Road, Little Florence Road and Fulwell Road was for many years very insanitary, being damp, muddy and dirty, and in some places made a receptacle for vegetable refuse and house rubbish, therefore becoming a nuisance to the inhabitants and pedestrians. The channelling of the roads and the asphalting of the footpaths will be a great benefit to the occupiers of the cottages, which are in those roads very numerous and will probably increase within a short time. The cottages in Florence Road have also been put in a state of proper repair and many have been connected with the newly laid sewer, while in others the work is in progress. This will remove the former numerous complaints and dangers from overflowing cesspools and stopped drains. At the inspection many cottages were found which were connected with the sewer, but they had no supply of water to flush the closets. Many water-waste preventors were found out of repair, very often caused by carelessness of the occupiers. In a great number of cottages the water cisterns are outside the washhouses or closets, where they are exposed to frost, and if the wooden covers are defective or rotten 9 the water is liable to contamination with dust and other dirt. Wherever practicable the cisterns ought to be placed inside the houses, in places having easy access for cleansing purposes. Attention was paid to defective sinks, drains and gullies, which are often found stopped through inattention. In a few cottages there are still privies, and those ought to be removed, especially where they exist in the centre of the district and where they are surrounded by many houses, as is the case of the American Buildings, Broad Street. Fowls, ducks, rabbits and pigs are frequently found in such a dirty condition as to become a nuisance. In this, like all other cases where insanitary conditions were found, verbal instructions were given and in some cases notices served, which were complied with. Regarding numbers and other particulars, I beg to refer to the report of the Inspector of Nuisances. ALMSHOUSES. I made a special report on the condition of those cottages in May 1895. With the exception o; the repair of the roofing nothing was done, although with very little outlay they can be easily put in a sanitary condition. If no steps are taken to remedy their sanitary defects, I shall be reluctantly compelled to condem them as unfit for human habitation, which would be very hard on the few old people who have inhabited them for many years. The Island opposite the Sewage Works was inspected in May, and I made the following report to the Urban District Council:— Gentlemen, "According to your instructions, I 10 spected the various habitations on the island and I found there 21 structures, partly wooden buildings, partly canvas camps. In nearly all cases I found no person on the premises. The sanitary arrangements were mostly of a very primitive nature Three have proper earth closets; in 6 cases a closet is erected of about 6 fret high and 3 by 3 wide, fitted with a seat, under which a pail of galvanized iron is placed. As the various habitations are not inhabited at the present time, I cannot say whether ashes or dry earth are used in the pails, nor how often they are emptied when in use. Evidently some of these conveniences are used by different parties. Only on one spot I found rubbish thrown on the adjoining land. Some new wooden buildings are in course of erection, and it is probable that the number of camps will increase during the summer. Great supervision has to be exercised to prevent any injury to the public health, which may arise from those habitations, and an arrangement ought to be made with the owner to make proper provision for the systematic and regular cleansing of all the conveniences, and the removal of all excremental matter from the island. The way in which the contents of the conveniences are to be disposed of, ought to be frequently inquired into, The attention of the Thames Conservators ought to be called to those habitations, with a view of preventing the pollution of the river by remnants of food and other house refuse." I am, Gentlemen, etc. 11 The Thames Conservancy in their reply stated, that the river had been carefully watched by their officers, and they had failed to observe any pollution of the river taking place, either from the Island or from vessels moored there, and that any case of pollution bought to the Conservators notice would receive their prompt attention. The Island was frequently visited by your Inspector during the summer and no cause for complaint was found. I understand that it has now become the property of some of the neighbouring land owners, who will probably take care that in the future ho structure will be allowed to be erected. ROADS. I am glad that a number of roads have been scheduled for repair, which they sorely need. Tbe roads are— Elleray Road Royal Road Windsor Road Lodge Road Holmsdale Road Coburg Road Coleshill Road Princes Road I think Lindum Road and School-house Lane in South Teddington also require attention as they are in a very bad condition. DUST-BINS AND HOUSE REFUSE. In some houses dust-bins were required, in others they were found in a dilapidated condition. Orders were given to supply same and to remedy the defects and they were complied with. With a view of obviating the carriage of refuse through houses the Bye-Laws Committee has been instructed to consider the advisability of making a 12 regulation for the construction of Back Lanes to all Terrace property as a secondary means of access. DAIRIES AND COWSHEDS. These have been periodically inspected and have generally been found in a satisfactory condition. The Inspector had to complain of four nuisances which arose from an accumulation of manure, but they were immediately attended to after verbal notice had been given. BAKEHOUSES. They were found generally in good condition; in some cases lime-washing and repairing of roof was required, which was duly attended to. There is one cellar bakery in the district, but such bakeries will not be allowed to be erected in the future, as the Factory and Workshop Act, 1895, prohibits the future provision of cellars for this purpose. SLAUGHTER HOUSES. These have been from time to time inspected and found in a fairly good condition. In one instance accumulation of offal was found, and in another the premises required lime-washing and general cleaning. Both received prompt attention on verbal notice being given to the owners. SCHOOLS. The sanitary arrangements were found in good condition at each inspection. WATER SUPPLY. The work of lowering the mains in order to prevent a water famine caused by freezing of the 13 water in the pipes, was continued during the year. The supply of water by the Grand Junction Water Company was very satisfactory. Five samples of well water were analysed, and in two cases the water was found to be contaminated with organic matter and unfit for ordinary and domestic purposes. In each case orders were served for closing the polluted well and for obtaining a supply of good water, and they were complied with. DRAINAGE AND SEWERAGE. Very little has been done during the year in the extension of the Public Sewerage System. The Park Road Sewer has been continued for the drainage of a portion of the Hampton District, whilst the Nuneham Road Sewer has been relaid. Private Sewers have been constructed on the Manor Park Estate, and in Bushy Park Gardens. A very important decision has been arrived at by the Council as follows:— "That the Surveyor be instructed to require all new buildings where it is proposed to jointly drain two or more houses into a single drain, to insist upon such drain being constructed outside of such houses, otherwise, separate connections for each house to be made." This regulation has since been made to extend to both old and new houses, which will no doubt in many cases prevent the construction of drains through houses. The Bye-Laws Committee will also shortly propose to consider the question of regulation for— 14 a. The provision of a sufficient supply of water to all Water Closets. b. The provision of suitable traps to all waste pipes. c. The issue of Certificates as to occupation of newly built houses. At the inspection many drains were found blocked, and nuisances arose through inattention to gullies, which in many cases are seldom, if ever touched by the occupier of a house from the commencement to the termination of the tenancy. In each case verbal notice was given and the defects remedied. I desire to impress upon the Council the advisability of supporting a measure of a 3-gallon flush in the W.C's., instead of the 2-gallon flush at present allowed by the Water Company. The inquiries promoted by the London County Council have shown that proper and effective cleansing of a W.C. basin cannot be carried out, unless a larger flush is allowed than the so-called 2-gallon flush, which is practically only 1½ to 1¾ gallons. The number of houses which have been connected with sewerage system during the year is 344, and the number of houses to which water has been supplied for the W.C's., 154. During the dry weather in the early part of the summer the sewers were flushed with disinfectants. LEGAL PROCEEDINGS. In September I reported that I had received a certificate from a medical practitioner with reference to a case of scarlet fever which occurred 15 in the district; the head of the family, however, omitted to send me a notice, as required by the Infectious Diseases Notification Act. A letter was sent by your Clerk asking the occupier of the house and head of the family to comply with the provision of the Act. As he failed to do so proceedings were taken before the Justices. The result was dismissal of the summons on the ground that the Bench of Middlesex Magistrates considered the Medical Certificate sufficient for the purpose. ISOLATION HOSPITAL. The Council have no accommodation for the Isolation of Infectious cases, and the want of such a provision has been much felt in many cases during the last year. Both in the interest of the Public Health and in that of many of the patients themselves as well as their belongings, it is very desirable that the Council should give the subject their serious consideration. I remain, Gentlemen, Your obedient Servant, TH. GUNTHER, M.D., Medical Officer of Health. February, 1897. 16 Sanitary Work done by the Inspector of Nuisances. Complaints Received 87 Letters written 72 Cautionary Notices Given 20 Statutory Orders Issued 7 Total number of Inspections 900 Houses, Premises,etc.,cleansed, and repaired 15 Wells closed as polluted 2 New Cisterns provided 4 Cisterns cleansed, repaired, and covered 30 Flush Cisterns provided to W.C's. 24 W.C. New apparatus provided 4 W.C. repaired and cleansed 10 W.C. supplied with water, or supply rendered efficient 138 W.C. ventilated 82 Drains unstopped, repaired, trapped 76 Cesspools emptied and cleansed 115 Dust-bins repaired 13 New Dust-bins provided 30 Guttering and Rain Pipes repaired 9 Ventilation below floor provided 9 Accumulation of manure removed 14 Nuisances from Fowls, pigs, other animals, abated 3 The Nuisances and Sanitary defects were remedied, and in no case has it been necessary to take legal steps to obtain compliance with the notices. 17 Table A of Deaths during 1896. Under one year 34 1 and under 5 10 5 ,, ,, 15 11 15 „ „ 25 5 25 „ „ 65 43 65 and upwards 33 At all ages 136 Causes of Death. Diphtheria 1 under five years. ,, 2 five years and upwards. Enteric or Typhoid Fever 1 five years and upwards. Whooping Cough 3 under five years. Diarrhoea and Dysentery 6 under five years. Phthisis 2 under five years. „ 19 five years and upwards. Bronchitis, Pneumonia and Pleurisy 6 under five years. „ ,, 7 five years and upwards. Heart Disease 14 five years and upwards. Influenza 1 under five years. „ 1 five years and upwards. Injuries 1 under five years. All others diseases 24 under five years. „ 48 five years and upwards. Total 44 under five years. „ 92 five years and upwards. 18 Table B of Population, Births and New Cases of Infectious Sickness. Population, Census 1891 10,025 Estimated to middle of 1896 12,100 Registered Births 260 Cases of Infectious Sickness. Scarlatina 6 under five years. „ 30 five years and upwards Diphtheria 5 under five years. „ 14 five years and upwards. Enteric or Typhoid Fever 3 five years and upwards. Puerperal Fever 1 five years and upwards. Erysipelas 17 five years and upwards. The Notification of Infectious Diseases has been compulsory in the District since February, 1890. There is no Isolation Hospital.