TED 017 Urban District of Teddington. Annual Report OF THE Medical Officer of Health E. G. GIBBS-SMITH, M.D., D.P.H. FOR THE YEAR 1917. Teddington: Printed by W. F. Parrott, The Causeway. 3 ANNUAL REPORT UPON THE VITAL STATISTICS AND PUBLIC HEALTH ADMINISTRATION OF THE URBAN DISTRICT OF TEDDINGTON FOR THE YEAR 1917. PRINCIPAL STATISTICS. Area 1,196 acres of land and 18 acres of water. Population Estimated for 1917, 21,451 Census for 1911, 17,847. Civil Population as estimated by the Registrar General 19,243. Birth Rate 17.5 per 1,000. Death Rate 13.1 per 1,000, Zymotic Death Rate .8 per 1,000. Infantile Mortality 69 per 1,000 births. Notifications of Infectious 353, including 28 cases of OrDiseases ganic Heart Disease, 23 of Tuberculosis and 281 cases of Measles. Last year 201, including 36 cases of Tuberculosis and 122 cases of Measles. Number of Inhabited Houses (1916), 4,261. (1917), 4,311 Average number of Persons per house (1916), 4.73. (1917), 4.99. Rateable Value £113,500. 4 To the Chairman and Members of the Urban District Council of Teddington. Gentlemen, I have the honour to present for your consideration my Ninth Annual Report upon the work of the Public Health Department for the year 1917. The Local Government Board's further appeal for economy in, and limitation of Annual Reports, necessitates a similar curtailment of this Report as last year. The table dealing with the causes of death has been amended in accordance with the Board's instructions, with a view to the saving of labour in compilation and to ensure statistical uniformity. I am pleased to state that, on the whole, the Sanitary condition of your district is satisfactory. The Birth Rate has further declined and is lower than it has been since the year 1898, showing a percentage of 17.5 per thousand of the population, last year's figure being 20.7 per thousand. I attribute this further decrease to the following two causes:— (1). The large proportion of women who are filling the labour market, and (2). The prevailing reluctance that exists to undertaking the responsibility of Motherhood, largely on account of the high wages to be earned under War conditions. The Death Rate of 131 per thousand of the population shows an increase as compared with last year's figure of 10.7, but I would point out that although there is this increase, your District is more or less uniform with the statistics for the smaller towns of the United Kingdom of similar population. 5 The Infantile Mortality statistics viz.69 per thousand births, show an increase on the figure of 57 per thousand births for 1916. Notwithstanding the fact that this year's rate is higher than last, it is low compared with the figures for England and Wales, and compares very favourably with the rates for the rest of the County. The number of notifications of Infectious Diseases for the year under consideration is 353—a somewhat large increase on the notifications for last year. It must be remembered however, that Measles, as last year, is still compulsorily notifiable and an epidemic of Measles occuring in April and May, forms a very large proportion of the number of Infectious Cases notified. With the exception of Measles, the figures show a gratifying decrease as compared with those for last year. Since my last Report, a part-time Health Visitor—Miss Naylor—has been appointed. She has worked in conjunction with the Voluntary Maternity and Child Welfare Centre, and has paid an average of 60 visits per month to mothers, etc. As only the initial part of her work comes within the period covered by this Report, I am not in a position to report at any length upon it. I should, however, like to take this opportunity of expressing my complete satisfaction with the way in which Miss Naylor has performed her various duties and also for her extremely useful work and assistance both in connection with the Medical Department and the Maternity and Child Welfare Centre, which I much appreciate. As you are aware, the Council has under consideration a scheme providing for the taking over of the present Voluntary Welfare Centre, establishing a second Clinic and Day Nursery and the appointment of a whole-time Lady Superintendent, a whole-time Health Visitor and a Nurse Attendant for the Day Nursery. I am convinced that the Council, acting upon my suggestion, have taken a step in the right direction and that the arrangement contemplated for the extension of this very important part of our work will justify its inception. 6 The Voluntary Welfare Centre has proved a very great success. The average attendance works out at 26 children per week, which commencing with an attendance of 14 at the end of the year had increased to 40 per week. The valuable services of the Lady Doctor who makes fortnightly attendances is greatly appreciated. As regards the question of Housing—with the exception of the houses occupied by Belgian Refugees, we have no Military Camp, or Soldiers billeted, in the district. Subsequent to the preparation of the Draft of this Report, I find that a V.A.D. Auxiliary Hospital is being established at Ferry Road, Teddington. Finally, I wish to express through the medium of this Report, my thanks for your continued confidence, consideration and support in the Health work of the District. I also take this opportunity of expressing my appreciation of the services rendered by Mr. Salmons the Clerk, Mr. Hainsworth the Surveyor, the Rate Collectors and their respective staffs, and for the ready co-operation and assistance they have always given me in the work of the Health Department, also to Mr. Shervill, who fills the post of Sanitary Inspector in such an efficent and satisfactory manner. Mr. Shervill has recently secured a Meat Inspector's Certificate, which will prove an additional valuable help to the Department. I have the honour to be, Gentlemen, Your obedient servant, EDWD. G. GIBBS-SMITH, Medical Officer of Health. 7 BIRTHS. 367 births were registered for the district during the year, showing a rate of 17.5 per 1,000 of the population. The births were made up thus:— Males. Females. Total. Legitimate 189 157 346 Illegitimate 13 8 21 Total 202 165 367 DEATHS. The number of deaths belonging to the district was 262 and made up as follows:— Males. Females. Total. Deaths registered in the District 120 98 218 Deaths of Teddington Residents outside the District— In the Kingston Union Infirmary 12 19 31 In Hospitals 4 1 5 In Asylums 5 6 11 In Nursing and other Homes 3 8 11 By Accident and Otherwise 2 0 2 146 132 278 Deaths of Non-Residents— In the Teddington and Hampton Wick Cottage Hospital 3 2 5 In Private Institutions 4 2 6 In Private Houses (Asylum) 2 3 5 Total of deaths of Non-Residents registered in the District 9 7 16 Deducting this Total from the Complete Total, we obtain the Nett Total of all Deaths belonging to the District 137 125 262 8 Death-rate and Analysis of Mortality during the Year 1917. Annual Death-rate per 1,000 living.* Annual Death Rate per 1C00 Births. Percentage of total Deaths. All Causes. Enteric Fever Small-Pox Measles Scarlet Fever Whooping Cough Diphtheria Violence. Diarrhoea and Enteritis (under two years) Total under one year. Deaths in Public Institutions. Certified Causes. Inquest Cases. Uncertified Causes England and Wales 14.4 0.03 0.00 0.30 0.02 0.13 0.13 0.52 12.18 97 25-7 91.5 7.0 1.5 96 Great Towns, including London (Census Populations exceeding 50,000) 14.6 0.02 0.00 0.41 0.03 0.15 0.13 0.53 16.14 104 31-2 91.5 7.6 0.9 148 Smaller Towns (Census Populations 20,000—50,000) 13.2 0.03 0.00 0.30 0.02 0.15 0.13 0.45 10.08 93 1-75 92.8 5.4 1.8 London 15.0 0.02 — 0.48 0.02 0.13 0.14 0.59 18.70 103 471 90.5 9.4 0.1 Teddington 13.1 0.10 0.00 — 0.57 — 0.62 — — 25 — — — * The death-rates for England and Wales are based upon deaths in the whole population and upon an estimated total population of 36,250,000. The birth-rate similarly calculated is 210 per 1,000. The death-rates for the towns are based upon civil deaths and estimated civil populations. The birth-rates cannot be stated. In all cases the population used relates to the year 1915. 9 CAUSES OF DEATH. The diseases which caused the greatest number of deaths were: — No. of deaths. Rate per 1,000. Percentage of deaths from all causes. Organic Heart Disease 28 1.28 8.6 Cancer 25 1.48 9.7 Bronchitis 24 1.56 8.8 Pulmonary Tuberculosis 24 Pneumonia 20 1.31 9.9 INFANTILE MORTALITY. The number of deaths of infants under one year of age belonging to the district was 25. This gives a rate of 59 per 1,000 births registered. PRINCIPAL EPIDEMIC DISEASES. The diseases which come under this category are: Small-Pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, the fevers (Typhus, Enteric and Continued), and Diarrhoea. The total number of deaths resulting from these diseases was 4, viz.:— Measles 11 Whooping Cough 2 Diarrhoea (under 2 years) 2 Diphtheria 1 16 This shows a Zymotic death rate of .81 per 1,000, and 16.1000 and percentage on deaths, a percentage of .808 of the deaths from all causes. For comparative rates of other districts see table on page 7. 10 NOTIFICATION OF INFECTIOUS DISEASES. In all, 353 cases have been notified, made up as follows:— Enteric 2 Scarlet Fever 11 Diphtheria 12 Erysipelas 4 Pulmonary Tuberculosis 34 Other forms of Tuberculosis 2 Cerebro Spinial Meningitis 1 Poliomyelitis 3 Measles 166 German Measles 116 Ophthalmia Neanotonim 1 Total 353 11 Vital Statistics for the Whole District of Teddington, during 1918 and previous 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. Number. Rate. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. No. Rate. Number. Rate per 1000 Births registered Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1911 17,847 (Census Yr.) 402 410 22.9 192 10.7 13 40 47 114 219 12.2 1912 18,000 386 396 22.0 197 10.9 24 34 39 96 207 11.5 1913 18,500 443 453 24.4 178 9.6 19 49 36 79 208 11.2 1914 18,500 410 422 22.8 171 9.2 19 50 32 75 202 10.9 1915 18,282 419 424 23.2 252 13.7 15 47 44 103 284 15.6 1916 ‡l8,436 417 417 20.7 198 10.7 15 47 24 57 198 10.7 1917 19,243 367 367 17.5 262 13.1 2 60 25 69 262 13.1 * Rates in columns 5 and 13 calculated per 1,000 of estimated population. Area of District in acres (exclusive of area covered by water), 1,196. † Civil Population as estimated by the Registrar General. Total population at all ages, 21,451. Number of Inhabited Houses, 4,311. Average number of persons per house, 497°. Census, 1911. 12 CAUSES OF DEATH (Civilians only). Males. Females. All Causes 137 125 1 Enteric Fever — — 2 Small-pox — — 3 Measles 7 4 4 Scarlet Fever — 5 Whooping Cough 2 — 6 Diphtheria and Croup 1 — 7 Influenza 6 6 8 Erysipelas — — 9 Pulmonary Tuberculosis 11 12 10 Tuberculous Meningitis 1 1 11 Other Tuberculous Diseases. 3 1 12 Cancer, Malignant Disease 10 15 13 Rhuematic Fever — 1 14 Meningitis — 1 15 Organic Heart Disease 16 12 16 Bronchitis 13 11 17 Pneumonia (all forms) 8 12 18 Other Respiratory Diseases 3 3 19 Diarrhoea, &c. (under 2 years) 1 1 20 Appendicitis and Typhlitis 2 — 21 Cirrhosis of Liver — — 21a Alcoholism — — 22 Nephritis and Bright's Disease 3 2 23 Puerperal Fever — — 24 Parturition, apart from puerperal fever — 1 25 Congenital debility, &c. 8 4 26 Violence, apart from (suicide 3 1 27 Suicide 1 — 28 Other defined diseases 37 37 29 Causes ill-defined or unknown 1 — Special Causes (included above) Gerebro-spinal Fever — 1 Poliomyelitis — — Deaths of infants under 1 year of age 15 10 Total Births 202 165 Legitimate 189 157 Illegitimate 13 8 Population for Death-rate 19,243 Population for Birth-rate 21,451 13 District of Teddington. 1 —Inspection of Factories, Workshops & Workplaces. Including Inspection made by Sanitary Inspectors or Inspector of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) Frequent. 0 0 Workshops (including Workshop Laundries) Frequent. 0 0 Workplaces Frequent. 0 0 Total 2 Defects found in Factories, Workshops & Workplaces. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector Nuisances under the Public Health Acts — Want of cleanliness 3 3 0 0 Want of ventilation 0 0 0 0 Overcrowding 0 0 0 0 Want of drainage of floors 0 0 0 0 Other nuisances 0 0 0 0 Sanitary accommodation— Insufficient 2 2 0 0 Unsuitable or defective 1 1 0 0 Not separate for sexes 0 0 0 0 Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (s. 101) 0 0 0 0 Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 0 0 0 0 Other offences 0 0 0 0 Total 6 6 0 0 14 District of Teddington. 3—Home Work. Outworkers' Lists, Section 107. Addresses of Outworkers recived from other Councils. Wearing Apparel— (1) Making, &c. 5 (2) Cleaning and Washing 0 Lace, Lace Curtains and Netts 0 4—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. Bakehouses 12 Dressmakers 12 Tailors 4 Various 13 Total number of workshops on Register 41 5—Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 0 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Worshop Act (s. 5) :— Notified by H.M. Inspector 0 Reports (of action taken) sent to H.M. Inspector 0 Other 0 Underground Bakehouses (s. 101):— Certificates granted during the year 0 tn use at the end of the year 0 *N.B.—(3) Includes all classes of premises under periodical supervision, such as Cowsheds, Dairies, Slaughterhouses, Workshops, and Work-places, &c. (5) Includes all visits and re-visits made by Sanitary Inspector in connection with 1-4. No. 1. COUNTY OF MIDDLESEX.—SANITARY WORK, 1917. District of Teddington. Enumerate (1) Adoptive Acts, (2) Bye-laws, in force in district. Particulars as to Staff employed in Sanitary Department, specify if Inspectors are engaged in any other duties, and if so, what. Inspections.* Action taken. (Other than under H. and T.P. Act.) Dwelling Houses and Action under H. and T.P. Act, 1909. Houses let in Lodgings. (Tenement Houses.) Common Lodging Houses. Public Health Acts Amendment Act, 1890, Parts II, III and V. Part time Medical Officer of Health, One whole time Sanitary Inspector, who only has help when disinfecting premises. Number of Premises inspected on Complaint. (2) Number of Premises Inspected in connection with Infectious Diseases. (3) Number of Premises under Periodical Inspection. (4) Houses inspected from House-toHouse (H. and T.P. Act.) (5) Total Number of Inspections and Re-inspections made. Cautionary or Intimation Notices Given. Statutory Orders Issued. Summonses Served. Convictions Obtained. Number of Houses found to be in a state Dangerous or Injurious to Health (Section 17). Number of Representations made by M.O.H. (Section 17). Number of Houses made Habitable without Closing Orders. Number of Closing Orders made by L.A. (Section 17). Number of Houses closed Voluntary. Number of Closing Orders determined after repairs (Section 17). Number of Houses demolished (a) by order of L.A. (Section 17), (b) Voluntarily. Illegal Underground Rooms vacated. Number Registered under ByeLaws. Number of Contraventions. Number Registered under ByeLaws. Number of Inspections made. Number of Contraventions. Infectious Diseases (Notification) Act, 1899. Housing of the Working Classes Act, 1890 (Part III) Public Health Act (Amendment) Act, 1907. Part II Streets and Buildings, Part III Sanitary Provisions, Part IV Infectious Diseases, Part VI Recreation Gravel, Part X So much as is contained in Sections 92, 93 and 95. Canal Boats Act, 1877 and 1884. Public Libraries Act, 1892. Private Street Works Act, 1892. Infectious Diseases Prevention Act, 1890. Contagious Diseases (Animals) Act, 1886. Infectious Diseases Notification Act, 1890, extended to Acute Poliomyelitis, Cerebro-Spinal Fever, Tuberculosis and Measles. Bye-laws as to:— Dairies, Cowsheds and Milk Shops. New Streets and Buildings. Squatters, Gipsies and Tent Dwellers. Slaughter Houses. Regulating Street Cleansing. 42 311 194 98 2019 156 3 0 0 It has not been necessary to take any action under this act. No Bye- laws. None in district. Removal of Refuse. Cleansing and Emptying Private Ashpits and Cesspools. Keeping of Animals. No. 2. COUNTY OF MIDDLESEX.—SANITARY WORK, 1917. District of Tedding ton. Canal Boats used as Dwellings. Movable Dwellings, Caravans, Tents, &c. Bakehouses. Slaughterhouses. Cow-sheds. Dairies and Milkshops. Unsound Food. Adulterated Food. Offensive Trades. Water Supply and Water Service. Wells. Percentage of Houses supplied from Public Water Service. Cisterns. Draw Taps placed on Mains. Percentage of Houses supplied on Constant System. Number of Samples obtained for analysis, (a) from Local Wells (6) from Public Supply. Number registered under the Acts. Number of Contraventions of Regulations. Number Observed during the Year. Number of Nuisances therefrom Abated. Number Removed from District. Number in District. Contraventions of Factory Acts. Number on Register. Number of Inspections made and frequency of inspection. Contraventions of Bye-Laws. Number on Register Number of Inspections made and frequency of inspection. Contraventions of Regulations. Number of Milch Cows in District. Number on Register. Number of Inspections made and frequency of inspections. Contraventions of Regulations. (a) Animals seized. (b) Articles or Parcels seized. Condemned by Magistrate, (a &b). Articles or Parcels surrendered. Samples taken (if any) by the District Local Authority. Found Adulterated. Number of Premises in District. Number of Inspections made. Contraventions of Bye-Laws. New Sunk. Cleansed, Repaired, &c. Closed as Polluted. New Provided. Cleansed, Repaired, Covered, &c. No. Frequency No. Frequency No. Frequency a b a b a b 0 0 0 0 0 12 2 4 18 3 times a year. 0 5 26 Any time. 6 38 23 100 Weekly and Monthly. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 99 0 21 4 99 0 0 No. 3 COUNTY OF MIDDLESEX.—SANITARY WORK, 1917. District of Teddington. Drainage and Sewerage of existing Buildings. Disinfection. Dust. Sanitary Nuisances Abated. Remarks as to anyother matters or in explanation of previous columns. Water Closets. Drains. Cesspools. Number of Water Closets substituted for Dry Receptacles. Repaired, Supplied with Water or otherwise improved. Percentage of Houses provided with Water Closets, Examined, Tested, Exposed, &c. Unstopped, Repaired, Trapped, &c. Waste Pipes, Rain Water Pipes, Disconnected, Repaired, &c. New Soil Pipes or Ventilating Shafts fixed. Existing Soil Pipes or Ventilating Shafts Repaired. Disconnecting Traps or Chambers Inserted. Reconstructed. Rendered Impervious, Emptied, Cleansed, &c. | Abolished, and Drain connected to Sewer. Percentage of Houses Draining into Sewers. Rooms, Disinfected (a) Ordinary infectious diseases, (b) Phthisis, (c) Various Causes. Rooms Stripped and Cleansed. Articles disinfected or Destroyed, (a) Ordinary infectious disease, (b) Phthisis. New Bins Provided. How frequently is dust removed from each house ? Number of Complaints of NonRemoval received. Method of Disposal (a) Destructor (b) by Tipping, (c) Other, state method. Overcrowding Smoke. Accumulation of Refuse, Foul Ditches. Ponds, &c., and Stagnant Water. Foul Pigs and other Animals. Dampness. Yards repaved or repaired Other Nuisances. Under "Other Nuisances" the following are included: — Broken Floors repaired 20 Broken Gullies ,, 4 Insanitary Yards cleansed 8 Ventilation under floors 5 Defective Roofs and Cuttings repaired 18 Dirty Rooms cleansed 91 Sink Water Pipes Repaired 16 Insanitary Urinal Cleaned 3 Water in Basement 3 Verminous Bedding Destroyed 4 a b c a b a b c 0 121 100 22 168 30 3 18 6 8 1 2 99 64 14 3 31 8 3 33 Daily 7 Destructor. 5 2 20 2 6 20 22 135 • These are disinfected in the rooms and not counted.