TED 10 DISTRICT OF TEDDINGTON Annual Report of the Medical Officer of Health, to be presented to THE URBAN DISTRICT COUNCIL of TEDDINGTON. 1898. Teddinghton PRINTED BY T. W. CHILDS, CHURCH ROAD. ANNUAL REPORT on the SANITARY CONDITION of the Urban District of Teddincton, For the year 1897. 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 1897. The total number of deaths which occurred and were registered was 156 and included— 3 from Diphtheria 2 ,, Puerperal Fever 11 ,, Measles 6 ,, Whooping Cough 1 ,, Influenza 10 „ Diarrhoea 2 ,, Rheumatic Fever 10 ,, Phthisis 24 ,, Bronchitis and Pneumonia 7 „ Diseases of the Heart 25 ,, Diseases of the Nervous System 10 ,, Cancer 4 14 from Premature Birth and Debility from Birth. 6 „ Old Age 4 ,, Injuries 21 ,, Various Causes 156 80 were males and 76 females 42 were under 1 year of age and 33 above 65. According to the census of 1891, the population of the district was 10,025, but it is now estimated by the collector of rates to be about 13,000, and taking this number as approximately correct, the mortality from all causes is at the average annual rate of 12 for every 1000 persons living. This rate compares not unfavourably with that of last year (11.22), which was exceptionally low for your district. The death-rate is considerably increased by the number of deaths amongst infants under 1 year of age, which amounted to 42, or over 25%. The number of births was 294,145 were males and 149 females. The birth rate was 22.6 and the Infant mortality 143 lor 1000 births. INFECTIOUS DISEASES. I.—Not Notifiable. Influenza.—One fatal case was registered in May, complicated with pneumonia. At the end of December many cases of Epidemic Influenza occurred and the number increased rapidly in January, 98. The Epidemic was up to the present time evidently of a mild type as no death was registered. 5 Measles.—The Disease appeared in South Teddington at the end of February in an epidemic form, and in the beginning of March the attendances in the Schoolhouse Lane Schools had in a very short time considerably diminished. It was thought advisable to close them as well as the Fairfax Road Schools. Preventive measures are not so successful in arresting the spread of Measles as they are in the case of Scarlatina. One reason of this being that in the former disease the infection commences in the very beginning, before any rash appears, and therefore generally before the disease is recognised and before any steps are taken to isolate the patient. The information relating to the progress of the disease I received from the death returns, from the voluntary notices of Medical Practitioners and from the Masters and Mistresses of the Public Elementary Schools, who invariably adopted my advice to exclude from school all children coming from an infected house. It was difficult towards the end of the Easter holidays, to ascertain whether the epidemic was increasing. In order to form an opinion whether it would be advisable to open the schools after the holidays, I addressed on April 23rd, letters to some of the Medical Practitioners asking for the number of cases they were attending and whether they considered the epidemic on the increase. The majority of the replies led me to the conclusion that it was safe to open the schools and I found that after opening, the attendances had in no way decreased and very few of those who were absent suffered from measles. By some it is contended that no advantage is gained by the closing of schools, that infection is spread equally by the mixing together of the affected and healthy in the streets or in the play-ground. But the conditions are not the same. The infection 6 is much more likely to spread, when the infected and healthy are sitting together for hours in a confined space and in the vitiated atmosphere of a schoolroom. Of the 11 deaths which occurred from this disease, there was only one case over 5 years of age and the cause of death of this child was registered "Measles 10 days, Diphtheria 2 days." Nearly all the others were infants under two years. The figures prove that Measles is not such a trivial disease as it is frequently regarded, and the lower classes ought to realize the fact, that it is more dangerous to infant life than Scarlet Fever. Whooping Cough.—The 6 deaths registered were all very young infants and occurred in February and March. Diarrhœa.—Ten deaths were reported, they were all under 5 years of age and all died in July and August. The connection between infantile diarrhoea and high temperature is a well recognised fact, but many cases are aggravated and lives are sacrificed through ignorance as to the proper feeding of infants. Under the influence of rain and colder weather in the end of August the disease disappeared. II.—Notifiable. Scarlatina.—Twenty-two cases were notified, but there has been no mortality and the type of the disease has been generally a mild one. Many of the cases occurred in the same household, where isolation was impossible. During the prevalence of measles only one case of Scarlatina occurred. Nine cases were reported from Watts Lane, of which 8 were probably due to the same cause. It was the case of a boy residing in Grove Cottages, 7 who suffered from sore throat and general indisposition. He kept at home two days, and then as the mother said, she could not keep him indoors any longer, he went about in the street and attended the Public Elementary Schools. Three weeks after the first symptoms of his illness, the schoolmaster observed that the skin came off his hands and he sent the boy home. I heard of the occurrence and went at once to the boy's residence. I found him in a perfect' state of desquamation, which in connection with previous symptoms pointed distinctly to Scarlatina. He was then kept at home till he was free from infection. In the immediate neighbourhood of the boy's residence 8 other cases of Scarlatina were notified within a period of four weeks, and I think it is highly probable, that they were all infected from the same source. The Master of the School was advised to watch the health of the boys who were sitting near him in School, but no other case resulted. Diphtheria—Eleven Sporadic cases were notified against 19 in 189G, and 22 in 1895. Three proved fatal. They occurred in various localities of the district in 11 different houses. With one exception they were all over 5 years of age and some were grown up persons. None of the cases could be traced to an antecedent case. As in Scarlatina the cases were as far as practicable isolated, the rooms disinfected, and after disinfection white-washed and papered. Puerperal Fever.—The two cases notified proved fatal. Enteric Fever.—Three cases were notified. One case contracted the disease outside the district and the cause of the others could not be traced, All three cases recovered. 8 INSPECTIONS AND VARIOUS SANITARY WORK. Various localities were at different times inspected in connection with infectious diseases or nuisances. Watts Lane, where eight cases of Scarlatina occurred, was several times inspected and no sanitary defect could be found. I received your instructions to report about the drainage of some houses in Florence Terrace, King's Road, where the drainage was faulty. I found the drains stopped and the cesspool overflowing. After some delay and the threat of a summons, the owner of the property remeded the defects by connecting those houses with the main sewer. Some correspondence took place between the Council and the Churchwardens with reference to the dilapidated condition of the Almshouses, on which I made a report in 189b, but the negotiations have led to no practical result, as at my systematic inspection I found those dwellings in nearly the same condition as in former years. With the exception of a few repairs nothing has yet been done to those buildings. An inspection was made in May of a Gravel Pit in Munster Road, where a neighbouring district deposited house refuse. The owner of the land was written to and the objectionable proceeding was discontinued. The drainage of Fern Cottages, Fairfax Road, was found in a very bad condition, the cesspools were full and the drains stopped. Notice was served on the owner who abated the nuisance. Two houses in School House Lane were found in such a dilapidated state as to make them unfit for human habitation. After a notice was served the houses were properly repaired. On special instruction received from your Council I made an inspection of eight dwelling houses, known as American Buildings, Broad Street, in December, 9 and I furnished a special report to the Council in January, 1898, which will appear in the Annual Report for that year. These buildings have besides privies, so many sanitary defects as to make them unfit for human habitation. Besides those special inspections which were reported at the Council's Monthly Meetings, I made, in company with the with the Inspector of Nuisances, a Systematic Inspection of the District in October and November. In many places the recurrent sanitary defects were found, such as defective drains, broken traps, dirty yards, leaky taps, accumulation of rubbish and manure, animals, principally fowls and rabbits kept in a dirty and sometimes too confined space, defective dustbins, etc. Many of these minor nuisances were at once abated by calling the occupiers' attention to their existence, others were removed after the serving of notices. Much good is effected through these inspections as they afford an opportunity of impressing upon the inhabitants the advantage of cleanliness and of getting them to understand, that it is for their own benefit as well as for that of the district, that the Council insists upon their premises being kept clean and sanitary. Advice was constantly given to the occupiers to pay attention to their cisterns and clean them out frequently. ROADS. In addition to the roads mentioned in my last annual report as being scheduled for repair, the following have since been added:—Clarence Road, Cedars Road and Lindum Road, though I am sorry to say the work has not made much progress, whilst the roads are all in a deplorable, dirty and insanitary condition, 10 BAKEHOUSES. They were periodically inspected and were found to be clean. In two cases white-washing was required, and in one case the roof wanted repairing. In each case the needful work was done. The vessels and plant for bread making were all in a satisfactory condition. DAIRIES AND COWSHEDS. Inspections were made from time to time. In three cases the premises were found to be in an insanitary state, owing to an accumulation of manure and their condition generally. Verbal notices were given and the defects remedied. SLAUGHTER HOUSES. The general condition and maintenance of the slaughter houses in the district has been fairly good. In one case the paving required repair and in another lime-washing was neglected. Upon the owners' attention being directed to the requirements of the Bye-laws, the necessary work was duly carried out. WATER SUPPLY. Six samples of well water were analysed. One was found polluted with organic matter and unfit for drinking or domestic purposes. The well was closed upon representation being made to the owner. The Water Supply from the Grand Junction Water Company was very satisfactory. OVERCROWDING. One case of over-crowding came under notice during the year, The lodgers were removed on verbal notice being given to the owner of the house. 11 DUST AND HOUSE REFUSE. The removal of the contents of dustbins is now effected once a fortnight, yet there is a steady application for more frequent attention, especially in those cases where the portable sanitary dustbins are very small. Many of the complainants desire weekly scavenging and a few would like to see the dustman oftener than this. Several complaints have also been received in reference to the practice of tipping house refuse in gravel pits behind houses in course of erection. A further description of this subject however will be found in the special report which will be presented to the Council by the Surveyor. SEWERAGE AND DRAINAGE. No additional main sewers have been laid, though in the connection of house drains a fair amount of work has been executed. 117 old houses and about 129 new houses have been connected. 77 cesspools have been closed and 49 W.C.'s have been fitted with water-waste preventing cisterns. The decision of the Council concerning combined drainage referred to in my last report has been found to answer generally in its practical application. During the summer months frequent complaints were received from inhabitants of Clarence Road, Gloucester Road, Anlaby Road, Stanley Road, Teddington Park Road, and Holmesdale Road, with reference to bad smells emitted from the sewer manholes. In several cases it was found necessary to close the manholes, and to erect ventilating shafts. It is desirable especially during summer to have the sewers in the district frequently flushed, and under certain circumstances disinfectants used with the water, 12 SEWAGE DISPOSAL WORKS. The disposal of the pressed sludge has become a difficulty so much so that the Council are now offering this material free of cost to all inhabitants of the district. There has been but one complaint of any nuisance arising from the works and this was soon removed. NEW BUILDINGS. The erection of new buildings has during the past year rapidly proceeded, and it is questionable if at any time in the history of the Teddington Authorities there have been as many plans of new buildings submitted to them, as in the present year. ISOLATION HOSPITAL. In regard to the provision of Hospital accommodation for the isolation of infectious diseases, I have again no progress to report. I have in several of my last annual reports indicated the opinion, that the difficulty involved in the question of providing accommodation for the isolation for infectious diseases can only be solved by combination with neighbouring Authorities or by the County Council, who are in a much better position of dealing with this difficult subject, than the District Council. I remain, Gentlemen, Your obedient Servant, TH. GUNTHER, M.D., Medical Officer of Health. January 31st, 1898, 13 Sanitary Work done by the Inspector of Nuisances during 1897. Complaints Received 48 Total number of Houses Inspected (about) 1300 Letters written 65 Cautionary Notices Given 18 Statutory Orders Issued 8 Houses, Premises, etc. cleansed, repaired, etc. 37 Periodical Inspections of Schools 14 Periodical Inspections of Slaughter Houses 30 Contraventions of Bye-laws 2 Periodical Inspections of Cow Sheds 36 Contraventions of Bye-laws 3 Periodical Inspections of Dairies and Milk Shops 41 Wells closed as polluted 1 New Cisterns provided 2 Cisterns cleansed, repaired, covered, etc. 44 Water Closets :— New apparatus provided 7 Repaired, cleansed, etc. 12 Supplied with water, or supply rendered efficient 52 Ventilated 8 Drains examined, tested, exposed, etc. 1 ,, unstopped, repaired, trapped, etc. 123 Waste Pipes, Rain-water Pipes, etc., disconnected 9 Soil Pipes and Drains ventilated 18 14 Cesspools emptied, cleansed, etc. 50 Rooms fumigated 34 Rooms stripped and cleansed 34 Dust-bins repaired 40 New Dust-bins provided 30 Roofs of Houses repaired 13 Guttering and Rain Pipes repaired 27 Overcrowding 1 Accumulation of Refuse 23 Stagnant water 2 Foul pigs and other animals 4 Other nuisances 5 The Nuisances and Sanitary defects were remedied, and in no case has it been necessary to take legal steps to enforce notices. 15 Table A of Deaths during 1897. Under one year 42 1 and under 5 26 5 „ „ 15 8 15 „ „ 25 6 25 „ „ 65 41 65 and upwards 33 At all ages 156 Causes of Death. Diphtheria 1 under five years. ,, 2 five years and upwards. Puerperal Fever 2 Measles 10 under five years. ,, 1 over five years. Whooping Cough 6 under five years. Diarrhoea and Dysentery 10 under five years. Rheumatic Fever 2 five years and upwards. Phthisis 2 under five years. ,, 8 five years and upwards. Bronchitis, Pneumonia and Pleurisy 10 under five years. ,, 14 five years and upwards. Heart Disease 7 five years and upwards. Influenza 1 over five years. Injuries 4 five years and upwards. All other diseases 27 under five years. ,, ,, 49 five years and upwards. Total 66 under five years. ,, ,, 90 five years and upwards. 16 Table B of Population, Births and New Cases of Infectious Sickness. Population, Census 1891 10,025 Estimated to middle of 1896 13,000 Registered Births 294 Cases of Infectious Sickness. Scarlatina ,, Diphtheria ,, Enteric or Typhoid Fever Puerperal Fever Erysipelas 8 under five years. 14 five years and upwards. 1 under five years. 10 five years and upwards. 3 five years and upwards. 2 3 five years and upwards. The Notification of Infectious Diseases has been compulsory in the District since February, 1890. There is no Isolation Hospital.