TED 019 DISTRICT OF TEDDINGTON. Annual Report OF THE Medical Officer of Health, TO BE PRESENTED TO THE URBAN DISTRICT COUNCIL OF TEDDINGTON. 1899. Teddington: PRINTED BY T W. CHiLDS, CHURCH ROAD. ANNUAL REPORT ON THE SANITARY CONDITION OF THE Urban District of Teddincton, For the year 1898. To the Chairman and Members of 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 1898. The total number of deaths which occurred and were registered was 149 and included— 2 from Influenza 3 ,, Enteric Fever 4 ,, Diphtheria 2 ,, Whooping Cough 10 ,, Diarrhæa 12 ,, Phthisis 11 ,, Diseases of the Nervous System 24 ,, Bronchitis and Pneumonia 7 ,, Diseases of the Heart 13 ,, Cancer 7 ,, Injuries 4 18 from Debility from Birth and Premature Birth 5 ,, Old Age and 31 „ Various Causes 149 75 were males and 74 females 41 were under 1 year of age and 32 above 65. When the census was taken in 1891, the population of Teddington was 10,025, but it has since then rapidly increased and it is now estimated to be quite 14,000. Taking this number as approximately correct and deducting 2 deaths of persons, who died, but did not reside in the District, the mortality from all causes is at the average annual rate of 10.5 for every 1,000 persons living. This rate compares very favourably with that of last year, which was 12, and very low for your district. The number of births was 284, of which 151 were males and 133 were females. The birth rate was 20.28 and the infantile mortality 144 per 1,000 births. This mortality of children under one year of age is very high, nearly 28 per cent. of the total number of deaths. If we add the 19 deaths of children under five years, we find that over 47 per cent. of the total number of deaths were infants. Infantile mortality is always a fair test of the general social and sanitary conditions affecting infant life, but the high mortality for the past year was not due to any prevalent epidemic; but was in a great part due to bad nursing and improper food, which the infants could not digest, and which acted as an irritant to the stomach and intestines. Most of the deaths were certified, diarrhoea, marasmus, inanition, convulsions, and rachitis. 5 INFECTIOUS DISEASES. I.—Not Notifiable. Influenza. Many cases occurred in December, 1897 and the number increased in the early part of 1898. Two cases of persons over 60 proved fatal. Measles. Many cases came under notice in January, and till the beginning of June isolated cases occurred. The disease was never distinctly epidemic as only the average number of children were absent from the schools, from which every child coming from an infected house was excluded. The disease was of a mild type and no case was fatal. Whooping Cough. Isolated cases occurred in spring and towards the end of the year, and two proved fatal. Diarrhæa. This disease was prevalent during the hot season and there were 10 deaths of children under 5 years. These fatal cases occurred amongst the poorer classes, and were principally due to causes to which I have drawn your attention in my remarks about Infant Mortality. II.—Notifiable. Forty-one Notifications were received and the same number were notified last year. Scarlatina. There were 17 notifications of this disease. They occurred in various places in the District, principally in January and February, and again in September. In only two cases was more than one person attacked in the same house. They were generally of a mild type, and none of the patients died. All cases were as far as practicable isolated and the other usual precautions taken to prevent the spread. 6 Diphtheria. Ten cases were notified and 4 proved fatal. One case was notified in 1897 and the patient died in January, 1898 of diphtheritic paralysis. Nearly all the cases occurred either in the beginning of the year or in November and December. There was never more than one case in the same house. The disease ran in several of the fatal cases a very rapid course, before the most reliable treatment with anti-diphtheritic serum could be adopted. It sometimes happens that the Medical Practitioner who is suddenly called to a case of diptheria, has no supply of fresh serum; he has to write to London for it and much valuable time is lost. It is of the greatest importance in this mode of treatment, that it should be commenced at the very earliest moment. In order to avoid any delay I should advise the Council to keep constantly a small and fresh supply of the serum either at the Council's office, or at the residence of the Medical Officer of Health, or Inspector of Nuisances, where it would be available at any time. The expense would be very small, as Medical Practitioners have to pay the cost price, and lives could be saved by such an arrangement. The importance of early treatment with anti-diphtheritic serum is shown by the following statistical table of percentage mortality:- 1st day 2nd day 3rd day 4th day 5th day or later. Anti-diphtheritic Serum used 4.7 12.8 17.7 22.5 24.6 Without Serum 22.5 27.0 29.4 31.6 30.8 Every room occupied by a diphtheric patient was disinfected, white-washed and papered. Enteric Fever. For many years only 1 to 3 cases occurred annually in our district, but in 1898 7 four cases were reported, of which 3 died. One death occurred after 8 weeks' duration, and was complicated with tubercular meningitis. In another fatal case the patient was 76 years old, which is an exceptional high age for enteric fever. In two cases defective ventilating pipes were found, in the other two no cause for the out-break could be detected. The water supply was in every case examined and found good. Attention was called in all cases to the disinfection of the excreta. Enteric Fever is essentially a communicable disease, but the way by which it is usually communicated differs considerably from that of some other communicable diseases. The infecting agent is the excreta from the bowels. The infection is not given by breath or skin. The manner in which it is most frequently communicated is by drinking water, which has been contaminated by the excreta from a person suffering from enteric fever. It may also be carried by milk. In this case it is generally due to the fact, that the vessels containing the milk have been washed with water containing enteric fever germs, or as has been proved, similar water has been added to dilute the milk. It may also, but less frequently, be carried by sewer-gas, but only if the gas comes from a contaminated source and carries the specific germs. There was no case of Small Pox or Puerperal Fever. INSPECTIONS AND OTHER SANITARY WORK. A systematic Inspection of the District was made in October and November, but various inspections were made where nuisances existed which might affect the public health. In May a number of gipsies pitched on a vacant piece of land 8 behind Clareville and the wall of Bushy Park, and they caused an intolerable nuisance to the inhabitants near the encampment. Early in the morning and late at night they disturbed their rest and the children of the gipsies went constantly to the houses in Upper Teddington, begging for water. As our bye-laws regarding those encampments make provision that they shall not be nearer than 100 yards from an inhabited house, the gipsies kept just outside the boundary. The land belongs to various owners, and where the address of the owner could be ascertained they were requested to remove the intruders. After some delay and threats of prosecution, the gipsies departed. I think the limit of 100 yards is insufficient and a distance of 200 yards or more would be a better measure to prevent a recurrence of this nuisance. Many inspections were made of the Gravel Pit adjoining Munster Road, where house refuse was deposited, which was carted there by the Corporation of Kingston. In the first instance the owner of the land covered the refuse with earth, but as the quantity of refuse accumlated the covering was partly neglected or so imperfectly carried out, that the fumes of the fermenting vegetable and animal matter penetrated the thin layer of earth and caused bad smells, of which the neighbouring inhabitants made complaints. The attention of the owner of the land was repeatedly called to the nuisance and the covering was for a time more effectually done. After a few weeks there was a recurrence of the nusiance and a statutory notice was served, after which he discontinued to deposit the refuse in our district. I am glad to report that the sanitary defects of the Almshouses have now been remedied. W.C.'s have been erected and connected with Sewerage 9 System, the roofs have been repaired, dustbins provided, and all wood and iron work painted. The inside of those buildings has also been repaired, and they are now much more habitable than they were for many years. I reported on former occasions on the A merican Buildings in Broad Street and I made again in February a report, in which I stated that the eight buildings in their present condition were unfit for human habitation. A notice was served on the owner to put them in a habitable state. The notice was withdrawn, as the owner promised to pull down 5 cottages and to erect other buildings within 6 months from Lady Day, 1898. For the other 3 cottages he asked for 12 months' delay. Plans of 4 new shops to be erected on the site of 5 of those cottages have been submitted and approved, but the work has not yet been proceeded with, and four of the cottages are still inhabited. The cottages in Cranmer Place were several times inspected. Although improvements in the footpath and in the back-yards were made by the owner, nuisances were repeatedly found, which were caused by leaky water pipes, damp walls, defective W.C.'s and flushing arrangements, and dilapidated floors. The owner's attention was called to these defects and he had the necessary work carried out. Those buildings have however, a dead wall in front, so high as to shut out light and seriously interfere with ventilation, and no effectual remedy is possible with the present buildings remaining as they are. Several houses in School-house Lane were found in a dilapidated condition. After notice on the owner the necessary repairs were carried out. 10 At the inspection the inhabitants were particularly advised to have the cisterns and receptacles in which water is kept properly and frequently cleansed. Statutory notices have been given as occasion required, besides numerous verbal notices for minor nuisances. ROADS. Of the roads mentioned in my former reports, Holmesdale Road, Lindum Road, Elleray Road, Coleshill Road and Clarence Road are now nearly put in proper repair, whilst the others mentioned, namely Coburg Road, King's Road, Princes Road, Royal Road and Windsor Road have been the subject of a magisterial inquiry, and will shortly be the subject of an inquiry by the Local Government Board, as to the granting of sanction to a loan for carrying out of the necessary works during the spring. SEWERAGE AND DRAINAGE. Extensions of the Sewers in Langham Road and Princes Road were made during the year. The connection of house drains to the Sewerage System is steadily continuing, as the following numbers will show. 79 old houses and 254 new houses connected. 41 cesspools cleansed. 35 W.C.'s fitted with waterwaste preventing cisterns and water supply. VENTILATION OF SEWERS. The complaints received during the year concerning offensive smells from the Street Ventilators have not exceeded the usual number, and with a 11 view of removing the cause of the complaints six shaft ventilators have been erected at various points, and greater attention during the hot weather was given to the flushing and disinfecting of the sewers, as suggested in my last annual report. HOUSE DRAINS. Many of the blockages we find in the private drains, to which I have referred in former years could in my opinion, be obviated in a great measure by the appointment of an official whose duty it should be to cleanse all gullies and traps connected with every house in the district, say once a quarter, as also by the framing of some regulation for the better flushing of the W.C. apparatus in houses. SEWAGE DISPOSAL WORKS. The disposal of the pressed sludge has again during the year been a difficulty, so much so that your Committee took into consideration the advisability of adopting some progress of enriching . such residual, in order to enable the same to be disposed of for manurial purposes. The Committee inspected the works at Kingston, where the A.B.C. process is in vogue, but did not appear to find any solution to their difficulty in the scheme in operation in that town. Perhaps when the question of the extension of the Works is under consideration, the bacteriological treatment of sewage as now in use at Hampton may be found of one of the means of solving this problem, in any case, it is certain that considerable additions will require to be made to the works at no distant date. 12 DUST AND HOUSE REFUSE. There has been a more or less continuous application made for a more frequent call from the scavengers, although the regulation period of cleansing, once in fourteen days, has been fairly well maintained. Some of the applicants suggest once a week, whilst others ask that attention should be given to the bins even oftener. The suggestions were considered by your Committee, and your Surveyor prepared a report upon the daily collection of refuse. The matter is still under consideration of the Committee. BAKEHOUSES. The Bakehouses were periodically inspected and were found in a good condition. In some of them white-washing was neglected, and in two the ceilings wanted repairing. In all cases the necessary work was carried out. DAIRIES AND COWSHEDS. These have been visited at various times. In five oases the premises were found to be in an insanitary condition, one due to defective drainage, and two to an accumulation of Cow manure. In two other instances the cowhouses required limewashing. The attention of the various owners was called to those defects, which were remedied in due course. SLAUGHTER HOUSES. The condition of the slaughter houses in the district has been well maintained, in only one case has it been necessary to make any complaint, which referred to defective paving, and was attended to upon verbal notice being given to the owner. 13 WATER SUPPLY. The supply from the Grand Junction Water Company was very satisfactory. Five samples of well water have been taken during the year, four of which were found on analysis to be good, and one was contaminated with organic matter and unfit for domestic purposes. The owner's attention was called to it, and he closed the well and provided a supply from the Grand Junction Water Company. OVERCROWDING. One case of over-crowding came under notice. The attention of the agent for the property was directed to the matter and he at once took steps to have the number of inmates reduced. ISOLATION HOSPITAL. No provision is yet made for the Isolation of Infectious Disease, and the remarks I made in many former reports still apply. I remain, Gentlemen, Your obedient Servant, TH. GÜNTHER, M.D., Medical Officer of Health. January, 1899. 14 INQUESTS DURING 1898. Date. Age. Verdict. May 13 22 years Suicide by drowning Unsound mind. June 12 Newly born Want of proper attention at birth.- ,, 27 67 years Rupture of Heart - July 22 49 ,,Suicide by Carbolic Lead Unsound poisoning mind. Aug. 12 52 ,, Syncope — Sept. 10 51 ,, Shock from injuries by being knocked down by a locomotive engine Accident Oct. 7 45 „ Asphyxia, following concussion of brain Accidental Dec. 26 48 „ Suicide while of unsound mind, by placing herself in the way of a passing train — 15 Sanitary Work done by the Inspector of Nuisances during 1898. Complaints Received 32 Number of Premises periodically inspected 1425 Houses inspected from House to House 200 Total number of re-inspections after order or notice 120 Letters written 108 Cautionary Notices Given 16 Statutory Orders Issued 12 Houses, Premises, etc. cleansed and repaired 40 Periodical Inspections of Schools 18 Periodical Inspections of Slaughter Houses 33 Contraventions of Bye-laws 1 Periodical Inspections of Cow Sheds 45 Contraventions of Bye-laws 5 Periodical Inspections of Dairies and Milk Shops 33 Wells closed as polluted 1 Cisterns cleansed, repaired, covered, etc. 37 Water Closets:— New apparatus provided 1 Repaired, cleansed, etc. 9 Supplied with water, or supply rendered efficient 68 Ventilated 10 Drains examined, tested, exposed, etc. 3 ,, unstopped, repaired, trapped 133 Waste Pipes, Rain-water Pipes, etc., disconnected 13 16 Disconnecting Traps or Chambers inserted 9 Cesspools emptied, cleansed, etc. 36 Rooms fumigated 24 Rooms stripped and cleansed 30 Dust-bins repaired 86 New Dust-bins provided 22 Roofs repaired 12 Guttering, Rain Pipes repaired, etc. 87 Gardens, Areas drained 8 Yards paved and drained 8 Overcrowding 1 Accumulation of Refuse 19 Stagnant water 1 Foul pigs or other animals 3 Other nuisances 14 The Nuisances and Sanitary defects were remedied, and in no case has it been necessary to take legal proceedings to obtain compliance with the notices. (A) TABLE OF DEATHS DURING THE YEAR 1893, Classified according to DISEASES, AGES and LOCALITY. Mortality from all causes, at subjoined ages. At all ages. Under 1 year. 1 and under 5 5 and under 15 15 and under 25 25 and under 65 65 and upwards Teddington 149 41 19 10 9 38 32 Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Typhus Fever. Enteric or Typhoid Fever. Puerperal Fever. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhæa and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia and Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Under 5 years. 1 1 10 4 12 1 1 30 60 5 years and upwards. 3 3 1 8 12 6 2 6 48 89 18 (B) TABLE OF POPULATION. BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, Classified according to DISEASES, AGES and LOCALITY. Population at all Ages. Area in Acres. Registered Births. New Cases of Sickness in the Locality. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Typhus. Fever. Enteric or Typhcid Fever. Puerperal Fever. Cholera. Erysipelas. Last Census. Estimated to middle of 1898. Under 5 years. 1 2 1 Teddington... 10025 14000 1120 284 5 years and upwards. 16 8 4 9 The Notification of Infectious Diseases has been compulsory in the District since February, 1890. There is no Isolation Hospital.