TED 2 M AC(3)TEDDIWAM 4413(3) Ceddingtion Urban District Council PUBLIC HEALTH DEPARTMENT ANNUAL REPORT FOR 1934 JOHN YOUNG, M.B., Ch.B., D.P.H.Camb. Medical Officer of Health W. F. Parrott, Ltd., Teddington. Teddington Urban District Council PUBLIC HEALTH DEPARTMENT ANNUAL REPORT FOR 1934 JOHN YOUNG, M.B., Ch.B., D.P.H. Camb., Medical Officer of Health Teddington Urban District Council PUBLIC HEALTH & HOUSING COMMITTEE. as at 31st December, 1934 Chairman—councillor p. h. durham. Councillor R. H. Berry. ,, J. T. Chell. ,, W. J. cornwill. (Vice-Chairman of the Council) ,, W. W. Drury. ,, H. Field. ,, A. G. Greig. ,, Capt. B. T. Harding. ,, H. Harrison. ,, E. G. Ive. (Chairman of the Council) ,, A. J. Jones. ,, Miss D. B. L. Marshall. ,, H. W. Peachey. ,, F.W. Tomalin. ,, G.E. Weaver. MATERNITY & CHILD WELFARE COMMITTEE. Chairman—councillor Miss D. B. L. marshall. Councillor R. H. Berry. ,, J. T. Chell. ,, W. J. Cornwill. (Vice-Chairman of the Council) ,, H. Field. ,, E. G. Ive. (Chairman of the Council) ,, A. J. Jones. ,, G. E. Weaver. Co-opted Members: Mrs. P. Langdon-Down, Mrs. T. I. Jones, Miss H. Styles, and Mrs. Raymond Taylor. 2 Teddington Urban District Council PUBLIC HEALTH DEPARTMENT. Staff. Medical Officer of Health : John Young, M.B., Ch.B., D.P.H. Camb. Medical Officer to Ante-Natal Clinic: Rose Turner, L.R.C.P.S. Senior Sanitary Inspector : J. shervill, A.R.S.I., Cert. R.S.I, as Sanitary Inspector and Meat and Foods Inspector. Additional Sanitary Inspector: H. W. Monks, M.S.I.A., Certified Sanitary Inspector and Meat and Foods Inspector. Chief Clerk: Horace J. Pugh. Assistant Clerk: Miss W. F. E. Mackway. Health Visitors: Miss E. M. Clarke, C.M.B., Cert. S.I.E.B., Health Visitor's Certificate. (Whole time.) MlSS E. E. H. Schlund, C.M.B., New Health Visitor's Certificate of the Royal Sanitary Institute. (Part time.) Disinfector: G. Sivyer. 3 To the Chairman and Members of the Teddington Urban District Council. Madam and Gentlemen, I submit herewith my Fifth Annual Report on the health and sanitary condition of your District, together with vital statistics. I take this opportunity of recording my grateful thanks to all the members of my staff for their loyal services during the year. I am, Madam and Gentlemen, Your obedient Servant, Medical Officer of Health. 5 STATISTICAL SUMMARY FOR THE YEAR, 1934. Area of the District in acres 1,196 land; 18 water Resident Population—Estimated to the middle of year 1934 (as supplied by the RegistrarGeneral) 23,050 Number of inhabited houses (1934) 5,782 Rateable Value (31st December, 1934) £201,525 Sum represented by a penny Rate £782 Total m. f. Live Births Legitimate 312 152 160 | 325 [ Illegitimate 13 7 6 Birth Rate, 1934, per 1,000 population 14 09 Total m. f. Still Births j Legitimate 13 5 8 13 Illegitimate - - Still Birth Rate per 1,000 Births (Live and Still) ... 384 m. f. 117 120 237 Death Rate, 1934, per 1,000 population 10.2 Adjusted Death Rate (Comparability Factor 098) 99 Number of women dying in, or in consequence of, childbirth from sepsis 1 from other causes Nil Deaths of infants under one year of age per 1,000 births : (i) Legitimate 32 (ii) Illegitimate 76 (iii) Total 33 Deaths from Measles (all ages) 3 Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under 2 years of age) Nil 6 NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. Situated 12 miles south-west of London, the Urban District of Teddington has an area of 1,196 acres of land and 18 acres of water, making a total of 1,214 acres. About 25 acres of Bushy Pavk are within the District. The subsoil is almost entirely composed of gravel and sand. The altitude above sea-level ranges from 20 feet at Broom Road to 55 feet at Fulwell Golf Course. Teddington is largely a dormitory town and there are no industries within the District. GENERAL PROVISION OF HEALTH SERVICES. Hospitals provided or subsidised by the Local Authority or the Middlesex County Council. Fever. Cases of fever are removed to London Fever Hospital, Tolworth Isolation Hospital, Twickenham Isolation Hospital, and occasionally to one of the L.C.C. Hospitals. See page 41 regarding South Middlesex and Richmond Joint Hospital Board. Smallpox Accommodation. The Middlesex County Council are responsible for the provision of hospital accommodation for the treatment of Smallpox in the District. Tuberculosis. Residential institutional treatment and dispensaries are provided by the Middlesex County Council. Venereal Diseases. Arrangements have been made by the Middlesex County Council for the treatment of these diseases at various London hospitals. Maternity. Urgent cases for the treatment of Puerperal Fever and Puerperal Pyrexia are admitted to the West Middlesex County Hospital, Isleworth, and Queen Charlotte's Hospital, London. 7 Other Hospitals Teddington, Hampton Wick and District Memorial Hospital. This Hospital, built in 1928—9 to replace the old Cottage Hospital, and recently added to, is a voluntary institution. A contribution of £25 was made by the Council during the year. The accommodation is as follows : — Male Ward 12 beds. Female Ward 12 beds. Children's Ward 5 beds and 5 cots. There are also eight private wards, each containing one bed. The beds are available for most cases, with the exception of pulmonary tuberculosis, advanced pregnancy, puerperal fever, and incurable diseases. The Hospital is equipped with two up-to-date operating theatres, X-ray and sun-ray departments. There are six visiting Consultant Surgeons, three Consultant Physicians, two Honorary Dental Surgeons, and a Radiologist. The number of in-patients treated during the year 1934 was 463, and casualties 710. Operations performed : Major 178, Minor 167, Dental 116. INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ILLEGITIMATE INFANTS AND HOMELESS CHILDREN. There are no institutions in the District for unmarried mothers, illegitimate infants and homeless children. NURSING IN THE HOME. The Teddington and District Nurse Fund provides a trained Nurse for attending cases of sickness in the home—other than maternity cases—within the District. The Council make an annual subscription of 25 guineas to the Fund. 8 9 CLINICS AND TREATMENT CENTRES. Name of Clinic. Where held. Day and hours of attendance. By whom provided. Infant Welfare Centre Adult School, Clarence Road. Every Thursday; and 2nd, 4th and 5 th Tuesday of the month at 2 p.m. Teddington U.D.C. Ante-Natal Clinic do. 1 st and 3rd Tuesday of the month at 2 p.m. do. Dental Clinic (Toddlers) I Maternity & Child Welfare) Stanley Road School, Teddington. As required. do. (as per arrangement with Middlesex County Council). School Clinics do. Tuesday and Thursday at 10 a.m. Middlesex County Council. Tuberculosis Dispensary Head: 28, Bell Road, Hounslow. Branch : I. Staines Road, Twickenham. (Monday at 10 a.m. (Thursday at 2.30 p.m. Wednesday at 10 a.m. do. Venereal Diseases London Hospitals (various) Daily, 8 a.m. to 10 p.m. do. AMBULANCE FACILITIES. (a) For Infectious Diseases. Each Isolation Hospital provides a motor ambulance in which the cases are removed. (b) For Non-Infectious and Accident Cases. A motor ambulance is provided by the Teddington Urban District Council. 0) For Maternity Cases. A motor ambulance is provided by the Hospital, to which the case is removed. MIDWIVES. The Council now undertake the provision of midwives for necessitous women when the conditions of the home are suitable for confinement therein. 10 Vital Statistics (1) POPULATION. The Registrar-General's estimate of resident population for the mid-year 1934, viz., 23,050, represents a decrease of 160 persons since last year. Thus for the second year in succession the population of the District has shown a decline. (2) BIRTHS. The births registered in the District in 1934 numbered 325, giving a birth rate of 14-09 per 1,000 of the population. The births were made up as follows: — Males. Females. Total. Legitimate 152 160 312 Illegitimate 7 6 13 Total 159 166 325 The birth rate in Teddington during the year 1934 shows an increase compared with the previous year. The number of illegitimate births has varied very little during the past ten years. 11 Vital Statistics. Table No. 1. Births and Birth Rates, 1925—1934. Year Teddington England and Wales Births Rate per 1,000 living Rate per 1,000 living 1925 389 17.7 18.3 1926 337 15.4 17 .8 1927 360 16.5 16.7 1928 336 15.3 16.7 1929 336 15.0 16.3 1930 325 14.5 16.3 1931 371 15.8 15.8 1932 343 14.6 15.3 1933 296 12.7 14.4 1934 325 14. 09 14.8 (3) DEATHS. The nett deaths registered in the District during 1934 numbered 237, and were made up as follows: males 117, females 120. The crude death rate per 1,000 of the population for the year was 10.2. The adjusted death rate per 1,000 of the population was 9.9. (Comparability factor 0.98.) The death rate for England and Wales was 11-8. The crude death rate of the District is not strictly comparable, from a mortality viewpoint, with the crude death rate of the country as a whole or with the mortality of any other local area. This could only be so if the populations of all areas were similarly constituted as regards the proportions of their sex and age group components. It is owing to the fact that there is this dissimilarity in the constitution of populations, i.e., excesses of males or females, young people or elderly people, that renders it necessary to arrive at a factor which, when applied to the crude death rate for the District, modifies the latter so as to make it comparable with the crude death rate for the country as a whole or 12 with the similarly adjusted death rate for any other area. The comparability factor used in the preceding paragraph has been supplied by the Registrar-General. (4) MAIN CAUSES OF DEATH. An analysis of the death returns shows that the main causes of death in this locality are (a) diseases of the heart and circulatory system and (b) cancer. There has been no change in the relative positions of these first two main causes of death for a number of years. (a) Diseases of the Circulatory System. Seventy-two deaths during the year were due to heart disease, aneurysm, cerebral haemorrhage and other circulatory diseases. The majority of the deaths in this group were over 65 years of age. Comparative Analyses, 1930-1934. Deaths from Diseases of the Circulatory System. Year Total Deaths Diseases of Circulatory System Percentage of Total Deaths Death RateDiseases of Circulatory System per 1,000 1930 75 28.4 3 .3 1931 93 34.8 3.9 1932 74 29.1 3.1 1933 78 33.2 3.4 1934 72 30.4 3.1 (b) Cancer. Thirty-three deaths during the year were due to cancer. Of these 61 per cent. were males, and 39 per cent, females. Although cancer continues to figure prominently in the death returns, the number of deaths in 1934 was the lowest for five years. 14 Comparative Analyses, 1930-1934. Deaths from Cancer. Year Total Deaths from Cancer Percentage of Total Deaths Death Rate— Cancer per 1,000 1930 40 15.1 1.7 1931 39 14.6 1.6 1932 38 14.9 1.6 1933 38 16.2 1.6 1934 33 13.9 1.4 The mortality from tuberculosis is referred to in a special section dealing with this subject. Infantile and maternal mortality are dealt with under the Maternity and Child Welfare section. 15 Vital Statistics. Table No. 2. Deaths and Death Rates, 1925—1934 Year Teddington England and Wales Deaths Rate per 1,000 living Rate per 1,000 living 1925 264 12.0 12.2 1926 209 9.6 11.6 1927 229 10.5 12.3 1928 239 10.9 11.7 1929 270 12.1 13.4 1930 264 11.8 11.4 1931 267 11.4 12.3 1932 254 10.8 12.0 1933 235 10.1 12.3 1934 237 (a)10.2 (b) 9.9 11.8 (a) Crude (b) Adjusted 16 Vital Statistics. Table No. 3. Causes of Death, 1934. (Registrar-General's Official Returns.) CAUSES OF DEATH Males Females Total 1 Typhoid and paratyphoid fevers - - - 2 Measles 1 2 3 3 Scarlet Fever - 4 Whooping Cough — 2 2 5 Diphtheria — 3 3 6 Influenza 1 1 7 Encephalitis Lethargica — — 8 Cerebro-spinal Fever — 9 Tuberculosis of respiratory system 8 11 19 10 Other Tuberculous Diseases 1 1 2 11 Syphilis — — — 12 General Paralysis of the insane, Tabes Dorsalis 2 2 13 Cancer, malignant disease 20 13 33 14 Diabetes 3 3 6 15 Cerebral Haemorrhage, etc. 3 5 8 16 Heart Disease 25 35 60 17 Aneurysm 1 — 1 18 Other circulatory diseases 1 2 3 19 Bronchitis 4 8 12 20 Pneumonia (all forms) 10 4 14 21 Other respiratory diseases 1 1 2 22 Peptic Ulcer 4 — 4 23 Diarrhoea, etc. (under 2 years) — — — 24 Appendicitis 1 — 1 25 Cirrhosis of Liver 1 1 26 Other Diseases of Liver etc. 1 1 27 Other Digestive Diseases 3 3 6 28 Acute and Chronic Nephritis 3 — 3 29 Puerperal Sepsis — 1 1 30 Other Puerperal causes — — 31 Congenital debility, premature birth, malformations, etc. 1 6 7 32 Senility 3 2 5 33 Suicide 1 — 1 34 Other Violence 7 1 8 35 Other defined diseases 11 17 28 36 Causes ill-defined or unknown — — — TOTALS 117 120 237 18 Vital Statistics. Table No. 4. Review of the Comparative Vital and Mortality Statistics for the Urban District of Teddington, together with those for England and Wales for the Years 1925—1934 inclusive. Year. Birth Rate Death Rate Infantile Mortality Rate Teddington England and Wales Teddington England and Wales Teddington England and Wales 1925 17.7 18.3 12.0 12.2 49 75 1926 15.4 17.8 9.6 11.6 68 70 1927 16.5 16.7 10.5 12.3 28 69 1928 15.3 16.7 10.9 11.7 80 65 1929 15.0 16.3 12.1 13.4 54 74 1930 14.5 16.3 11.8 11.4 43 60 1931 15.8 15.8 11.4 12.3 40 66 1932 14.6 15.3 10.8 12.0 47 65 1933 12.7 14.4 10.1 12.3 57 64 1934 14.09 14.8 (a) 10.2 (b) 9.9 11.8 33 59 (a) Crude (b) Adjusted 19 General Sanitary Administration (1) LOCAL ACTS, SPECIAL ORDERS, GENERAL ADOPTIVE ACTS AND BYE-LAWS IN FORCE IN THE DISTRICT. Baths and Wash-houses Acts, 1846-1899. Public Health Acts Amendment Act, 1890—Parts II., III. and V. Infectious Diseases (Prevention) Act, 1890. Public Libraries Act, 1892. Private Street Works Act, 1892. Small Dwellings Acquisition Acts, 1899-1923. Public Health Acts Amendment Act, 1907—Parts II., III. (Sections 52, 53, 54, 55, 56, 57, 58, 59, 60, 62, 63, 64, 65 and 68), IV., VI. and X. (Sections 92, 93 and 95). Local Government and Other Officers' Superannuation Act, 1922. Public Health Act, 1925—Parts II., III., IV. and V. Sunday Entertainments Act, 1933. Bye-laws as to: — New Streets and Buildings. Slaughter-houses. Tramways. Public Library. (2) WATER SUPPLY. A constant and satisfactory water supply over the whole District is maintained by the Metropolitan Water 20 Board. Despite the exceptionally dry summer, no drastic restrictions were imposed by the Board regarding the use of water for domestic purposes. The public were, however, asked to co-operate by avoiding unnecessary waste. (3) RIVERS AND STREAMS. During the year two complaints were received by the Council from the Thames Conservancy regarding pollution of the River Thames by oil or paraffin discharging through the surface water sewers. This was a matter difficult to trace. The complaints were, however, promptly attended to, and in one or two instances the oi' was traced to public garages. Steps were immediately taken to prevent any recurrence of the trouble. In these days a certain amount of pollution of this kind is inevitable owing to droppings of oil, etc. on the public highways. (4) DRAINAGE AND SEWERAGE. The method employed is the water carriage system. The District is, on the whole, flat, and as a consequence approximately half the sewage of the area flows by gravitation to a point where it must be raised, this being effected by ejectors working by compressed air. The sewage of the remaining half flows by gravitation direct to the disposal works. Practically all premises are con nected to the sewerage system. The Council is a constituent Authority under the West Middlesex Sewerage Disposal Scheme formulated by the Middlesex County Council. Operations are now in progress in the District, which will result—during the coming year—in the abolition of the present Disposal Works in Broom Road, and the conveyance of all foul water sewage to the County Council's new Disposal Works at Mogden. (5) SCAVENGING. The main roads throughout the District are swept daily and the less important several times weekly, according to requirements. The street gullies are emptied, disinfected and flushed when necessary, and where they are of unsuitable pattern, are gradually being replaced by an improved type. 21 (6) COLLECTION AND DISPOSAL OF HOUSE REFUSE. Refuse is removed thrice weekly in the shopping areas and twice weekly in the residential areas, and is disposed of by tipping and burning in a destructor. Although the majority of the present horse-drawn vehicles used for the removal of refuse are of the old high-loading type, the Council have during recent years purchased two horse-drawn vehicles of a more modern and sanitary type, and one motor freighter which is serving the portions of the District furthest from the Destructor. Notices are served from time to time by this Department for the provision of sanitary dustbins, and during the year a large number of new dustbins have been supplied by owners. (7) SANITARY INSPECTION OF DISTRICT. Visits and Inspections, 1934. Visits in connection with Infectious Diseases 447 Houses inspected ordinarily or on complaint 707 Houses inspected and recorded under the Housing Regulations 47i Inspections under the Rent Restrictions Act 5 Houses re-inspected after notice and re-inspections to work in progress 3622 Food Shops and Stalls 128 Slaughter-houses 973 Dairies, Cowsheds and Milkshops 110 Bakehouses 76 Factories, Workshops and Workplaces 205 Schools 66 Disused gravel pits and dumps 65 Halls and Cinema 68 Ice Cream premises 22 Sanitary Conveniences 93 Smoke Observations 9 Miscellaneous 160 Total 7227 22 Summary of Work Executed, 1934. Water Supply:— Draw taps fitted to main supply pipes 5 Cisterns cleansed, repaired, covered, etc. 11 Water Closets:— Cleansed 50 Flushing cisterns, repaired or renewed 53 New pans, etc. 16 Ventilated or ventilation improved 1 Separate accommodation for sexes provided 1 Accommodation provided 6 Dampness:— Roofs repaired 124 Brickwork repaired, renewed or rendered impervious, etc. 154 Drains: — Cleared and flushed 24 Repaired 7 Examined, tested or exposed 4 Sanitary Dustbins: — Provided 195 Eaves gutters and rain water pipes: — Repaired or renewed 152 Soil Pipes: — Repaired, renewed and ventilated 4 Houses, Workshops, etc. : — Rooms cleansed 231 Ceiling plaster repaired 84 Wall plaster repaired 215 Floors repaired 81 Windows repaired, sash cords, etc. provided 171 Fire grates repaired or provided 73 Coppers repaired, etc. 34 23 Sinks:— Provided 20 Repaired or refixed 5 Waste pipes repaired or renewed 24 Yards:— Cleansed 10 Paved or repaired 39 Various:— Nuisances abated from overcrowding 16 Nuisances abated from chimneys sending forth black smoke 2 Nuisances abated from animals being improperly kept 3 Offensive accumulations removed 5 Offensive smells 6 Miscellaneous 171 Complaints. During the year, complaints were received regarding the following matters:— Accumulations of refuse 6 Choked or defective drains 13 Damp walls I Defective ceilings 6 ” coppers 2 ” eaves gutters and rain water pipes 6 ” floor 1 ” fire grates or kitchen ranges 2 ” roofs 7 ” sink 1 ” sink waste pipes 6 ” walls 6 ” water closets 21 ” water supply 5 24 Dirty rooms 10 Houses infested with rats 32 Insanitary condition of yards 4 Offensive smells from various causes 2 Overcrowding 15 Smoke nuisances 1 Verminous rooms 35 Miscellaneous 31 Total 213 Schools. The sanitary arrangements and water supply at the Elementary Schools in the District were inspected from time to time during the year. Notices Served. Preliminary Notices 775 Statutory Notices 51 Total 826 (8) BAKEHOUSES. There are twelve bakehouses on the register of the Department, and these have been kept satisfactorily throughout the year. Factory Bakehouses 5 Workshop Bakehouses 7 Total 12 Number of inspections 76 25 (9) SLAUGHTER-HOUSES. There are seven slaughter-houses within the District— two registered and five licensed. Five were in use during the year and, although most of them are old buildings, they are kept in a satisfactory condition. Registered Slaughter-houses 2 Licensed Slaughter-houses 5 Total 7 Number of inspections 973 (10) INSPECTION AND SUPERVISION OF FOOD. (a) Milk. Retail Purveyors of Milk on Register, 1934 30 Purveyors of Graded Milk, 1934:— "Certified" 5 "Grade A (Tuberculin Tested)" 9 "Grade A (Pasteurised)" 1 "Pasteurised" 6 All dairies within the District are inspected regularly by the Sanitary Inspectors. Practically the whole of the milk supplied to Teddington is imported and has been pasteurised before delivery. Towards the latter part of the year the Milk Marketing Board inaugurated a scheme for the supply of cheap milk to school children. In this connection the County Medical Officer of Health asked for my concurrence 26 (which was given) to a suggestion that the source and quality of the supply of milk to school children should be limited to the supply of pasteurised milk, sold as such, and obtained from dairymen registered as retailers of pasteurised milk within the District. The veterinary inspection of milch cows within the District is undertaken by the Middlesex County Council. Twenty samples of milk were submitted for bacteriological examination to the Royal Institute of Public Health, details of which are given hereunder. 27 Table showing the Results of Bacteriological Examination of Milk Samples, 1934. Sample. Organisms per c.c. Minimal amount showing presence of B. Coli. Bacteriologist's Remarks. 1 950 - Sample conforms to prescribed conditions for Pasteurised milk. 2 26,000 Present in 0.1 c.c. A good type of ordinary milk. 3 2,250 Present in 0.1 c.c. An example of a clean milk of Grade "A" type. 4 104,000 Absent in 1 c.c. . The absence of Coliform bacilli suggests Pasteurisation; therefore this sample almost conforms to standard of such. 5 1,500 - This sample complies with prescribed conditions for Pasteurised milk. 6 18,800 Present in 1 c.c. A milk comparable to a Certified milk on bacteriological grounds. 7 39.800 Present in 0.01 c.c. This milk shows a good bacterial count and the coliform content is not unduly high for an ordinary milk. 8 22,980 - This sample complies with prescribed conditions for Pasteurised milk. 9 22,600 - This sample complies with prescribed conditions for Pasteurised milk. 10 8,800 - This sample complies with prescribed conditions for Pasteurised milk. 28 Table showing the Results of Bacteriological Examination of Milk Samples, 1934. Sample. Organisms per c.c. Minimal amount showing presence of B. Coli. Bateriologist's Remarks. 12 599,000 Present in 1 c.c. This milk has probably been pasteurised but has a very heavy bacterial content. 12 1,640 - This sample complies with prescribed conditions for Pasteurised milk. 13 384,000 Absent in 1 c.c. Most probably a pasteurised milk with a high bacterial content. 14 11,200 - This sample complies with prescribed conditions for Pasteurised milk. 15 60,600 - This sample complies with prescribed conditions for Pasteurised milk. 16 82,600 - This sample complies with prescribed conditions for Pasteurised milk. 17 106,000 Present in 1 c.c. A type of milk comparable to a Grade "A" but suggests pasteurisation. 18 2,400 - This sample complies with prescribed conditions for Pasteurised milk. 19 50,000 - This sample complies with prescribed conditions for Pasteurised milk. 20 44,000 - This sample complies with prescribed conditions for Pasteurised milk. 29 (6) Meat. Although a large proportion of the meat consumed is brought from the London Markets, there was a total of 6,093 animals slaughtered within the District during the year, every one of which was inspected by the Sanitary Inspectors. The Local Authority, under existing legislation, has no power to fix the day or hour at which slaughtering shall take place at the various slaughter-houses, and, in order to ensure that all animals slaughtered for human consumption are inspected before removal, the Sanitary Inspectors are often called upon to attend at the slaughterhouses quite late at night and on Saturday afternoons and Sunday mornings. The following is a table showing the number of animals slaughtered and inspected during the year:— Beasts Calves Pigs Sheep Total Total inspected 18 886 3,876 13 13 6093 Unsound Food. The following articles of food were found to be unfit for human consumption and destroyed:— 30 Articles. Disease. 2 beasts lungs Tuberculosis. 1 calf's carcase & offal Tuberculosis. 1 calf's leg Fracture. 3 calves' lungs Tuberculosis. 4 calves' livers Tuberculosis. 25 sheep's lungs Strongylus Rufescens. 4 sheep's livers Cirrhosis. 1 sheep's liver Distomum Hepaticum. 1 sheep's liver Hydated Cysts. 3 pigs' carcases & offal Tuberculosis. 1 pig's carcase & offal Oedema. 1 pig's hindquarter Tuberculosis. 33 pigs' heads Tuberculosis. 130 pigs' lungs Inflammation. 15 pigs' lungs Tuberculosis. 2 pigs' lungs Strongylus Paradoxus. 34 pigs' livers Cirrhosis. 16 pigs' livers Tuberculosis. 2 pigs' livers Distomum Hepaticum. 1 pigs' plucks Tuberculosis. 3 boxes of fillets of dock Unsound. 1 box of cod Unsound. (c) Other Foods. Frequent visits were made, to butchers' and other shops where food is prepared or exposed for sale. (d) Food and Drugs (Adulteration) Act, 1928. Dr. J. Tate, County Medical Officer of Health, has kindly supplied the following information relating to samples taken in this District during the year:— Article. Number Taken. Adulterated Hake 5 1 Lemon Soles 3 - Meat 1 — Meat Pies 2 - Milk 53 1 Minced Beef 1 - Sausages 4 - 69 2 31 (11) FACTORIES, WORKSHOPS & WORKPLACES. 1 —Inspection of Factories, Workshops & Workplaces. Premises. Number of Inspections. Written Notices. Prosecutions. Factories 66 3 - (including Factory Laundries) Workshops 120 5 - (including Workshop Laundries) Workplaces (Other than Outworkers' premises) 65 6 — Total 251 14 -- 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 8 8 - - Want of ventilation — — — — Overcrowding - - - — Want of drainage of floors 1 1 — — Other nuisances ... 10 10 — — Sanitary accommodation— Insufficient 6 6 — — Unsuitable or defective 5 4 — — Not separate for sexes 1 1 — — Offences under the Factory and Workshop Act— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences (excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry cf Health (Factories and Workshops Transfer of Powers) Order 1921). - - - - Total 31 30 - - Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 32 (12) TENTS, VANS AND SHEDS. No trouble from caravan dwellers on land within the District was experienced during the year. (13) SMOKE ABATEMENT. There are very few factories within the District, and consequently the question of smoke abatement did not present a difficult problem. Occasional complaints were received during the year regarding nuisances from smoke, and in each case the matter was promptly dealt with. (14) COMMON LODGING-HOUSES. There are no common lodging-houses situated within the District. (15) DISINFECTION. During the year the following premises were disinfected after cases of infectious disease or for verminous conditions, etc.:— Diphtheria 13 Scarlet Fever 36 Erysipelas 4 Puerperal Fever 1 Tuberculosis 9 Pneumonia 1 Miscellaneous 59 (16) RATS & MICE (DESTRUCTION) ACT, 1919. The administration of the above Act in this District is undertaken by the Middlesex County Council. All complaints and enquiries are sent to the appropriate Department. (17) RAG FLOCK ACTS, 1911 and 1928. There are no premises in the District upon which rag flock is manufactured, used or sold. 33 (18) HOUSING. Although a number of houses and flats have been built during the year, there is still a shortage of workingclass dwellings available at economic rents. During 1934, demolition orders were made on 23 houses, 22 of which were demolished (one by the owner and 21 by the Council). The owner who demolished his house has utilised the site for the erection of four houses. The sites of the other houses, comprising two small areas, have been purchased by the Council and will be) used for re-housing purposes. The other house was demolished early in 1935. The Council erected 30 maisonettes during the year, these being chiefly occupied by displaced tenants from the above-mentioned demolished houses and by families removed from overcrowded conditions. These maisonettes are let at a weekly rent of 8/4 to 8/7, exclusive of rates, and meet the needs of a class who could not afford the rent of a Council house. To some extent, therefore, they may be said to have assisted in overcoming the housing shortage. A large estate of houses for sale (occupation can be made on payment of a small deposit) is being developed by private enterprise on the edge of the District, while other groups of similar houses have been erected in various parts of the District. Pending the issue of further information by the Ministry of Health on the overcrowding question, the Council deferred consideration of the adoption of byelaws dealing with houses-let-in-lodgings. Overcrowding cases brought to the notice of the Department are reported to the Public Health and Housing Committee, who give special consideration to such cases when allotting Council houses. 34 The following statistics show the amount of work carried out by the Public Health Department with regard to housing:— Housing Statistics, 1934. Number of new houses erected during the year:— {a) Total, including numbers given separately under (i) 90 (6) With State assistance under the Housing Acts:— (i) By the Local Authority nil (ii) By other persons or bodies nil 1. Inspection of Dwelling-houses during the year:— (1) (a) Total number of dwelling-houses spected for housing defects (under Public Health or Housing Acts) 897 (1b) Number of inspections made for the purpose 4519 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 471 (.b) Number of inspections made for the purpose 3241 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 23 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subhead) found not: to be in all respects reasonably fit for human habitation 786 2. Remedy of defects during the year without service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 701 3. Action under Statutory Powers during the year. A. Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— 35 (1) Number of dwelling-houses in respect of which Notices were served requiring repairs 46 (2) Number of dwelling-houses which were rendered fit after service of formal Notices:— (a) By owners 39 (b) By Local Authority in default of owners nil B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied 5 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices:— (a) By owners 5 (<V) By Local Authority in default of owners nil C. Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 23 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 22 D. Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit nil 36 (19) TROWLOCK ISLAND. There are on the Island thirty bungalows built of wood, corrugated iron or asbestos. There is also the boathouse belonging to the Royal Canoe Club. Most of the bungalows stand on piers of brick or wood about 1ft. 6ins. high. Six are occupied all the year, the remainder only during the summer and autumn. These dwellings do not comply with the Council's Building Byelaws. The Island is not connected with the Council's sewerage system. Elsan and pail closets are used with chemicals for deodorising purposes. The containers are collected frequently and the contents dug into the earth on the Island. The sinks, wash-basins, urinals and bath waste pipes, etc., discharge into soakaways consisting of shallow holes made in the ground, usually lined with brickwork and filled with clinker. A tap—connected to the Metropolitan Water Board's main—has now been fixed on the Island. A number of the bungalows have a pump and storage cistern with taps to sink, lavatory basin and bath, water being drawn from the river for purposes other than drinking. On the mainland adjoining the Island there are two bungalows, the Bailiff's dwelling over the boathouse, a Tea Room, the Tamesis Club and other boathouses. There are also large motor launches moored in the backwater. The large vessels have chemical closets installed, the containers being emptied and1 dug into the land adjoining the mooring. It is desirable that all the bungalows should be connected to the Council's sewer and the Metropolitan Water Board's supply laid on to- each dwelling. 37 (20) SWIMMING BATH, ETC. Swimming is one of the healthiest of exercises, and it is to be hoped that the public will continue to take the fullest advantage of the excellent facilities provided at the Council's Open-Air Bath. The water in the Pool (supplied by the Metropolitan Water Board's main) is always flowing and is completely changed, filtered and aerated every six hours by means of a filtration and pumping plant, thus maintaining it quite pure. In addition, the water is constantly under observation, and tests are made from time to time to determine its condition, particular nature and extent of the chemical and other purification needed. Slipper Baths. The Council still have under consideration the question of the provision of slipper baths. At present I estimate that about 40 percent, of the houses in the District are without fixed baths, which indicates that slipper baths are very necessary. I feel sure that such a provision would be welcomed by the public. 38 Infectious Diseases (a) NOTIFIABLE INFECTIOUS DISEASES. Diphtheria. The number of cases notified (14) was again low, and with few exceptions the type of disease was mild. Scarlet Fever. There were 37 cases of Scarlet Fever notified, as compared with 70 for the previous year. A mild type of disease still persists. Enteric Fever. No cases of Enteric Fever were notified. Table A. Infectious Diseases. Quarter Diphtheria Scarlet Fever Enteric Fever 1st Quarter 4 8 — 2nd 2 8 — 3rd 5 16 — 4th 3 5 — Totals 14 37 — Smallpox. No case of Smallpox was notified during the year, neither were there any contacts under observation by the Department. Table B. Vaccination. The information in the table given hereunder has kindly been supplied by the Vaccination Officer. Year Births Successful Primary Vaccinations Conscientious Objectors Percentage of Births Vaccinated 1930 271 154 81 56.8 1931 311 198 80 63.6 1932 281 169 83 60.1 1933 249 152 59 61.0 1934 267 162 74 60.6 39 Encephalitis Lethargica. No case of Encephalitis Lethargica was notified. Puerperal Fever and Puerperal Pyrexia. Two cases of Puerperal Fever were notified during the year. Both were removed to Hospital. Ophthalmia Neonatorum. See page 56. Pneumonia, Malaria and Dysentery. PNEUMONIA. There were 32 cases of Pneumonia notified during the year, 20 of which were treated in Hospital. malaria. One case of Malaria, believed to be contracted abroad, was notified during the year. Dysentery. No case of Dysentery was notified. Table C. Infectious Diseases. The following table shows the case rate of certain infectious diseases notified in Teddington compared with that for England and Wales for the year 1934:— Disease Cases notified in District Case rate per 1,000 living in England and Wales Number notified Case rate per 1,000 living Smallpox — — 0 004 Diphtheria 14 0.60 1.70 Scarlet Fever 37 1.60 3.76 Enteric Fever — — 0.03 Puerperal Fever 2 0.08 0.06 Puerperal Pyrexia — — 0.15 Erysipelas 16 0.69 0.51 (b) NON-NOTIFIABLE INFECTIOUS DISEASES. Measles, Whooping Cough, Influenza, Chickenpox, and Mumps are included in the group of diseases under this heading. The first three—Measles, Whooping Cough and Influenza—are frequently responsible for a high mortality rate and serious complications which may persist throughout life. It will be seen, therefore, that from a public health point of view they are often of greater importance than the notifiable diseases. 40 It is very difficult—if not impossible—to estimate the exact incidence of these non-notifiable infectious diseases in the District. Some indication, however, may be had from the number of cases notified from the schools, viz.:— Mumps 125 Measles 124 Whooping Cough 101 Chickenpox 21 Influenza 4 ISOLATION HOSPITAL ACCOMMODATION. The provisions made by the Council for isolating cases of infectious diseases have worked satisfactorily throughout the year. Thirty-five cases were removed to hospital as follows:— London Fever Hospital 13 cases. Tolworth Isolation Hospital 12 cases. Twickenham Isolation Hospital 6 cases. Mogden Isolation Hospital 2 cases. Western Hospital (L.C.C.) 1 case. Grove Hospital (L.C.C.) 1 case. Each hospital provides an ambulance in which the cases are removed. The Council is a participating Authority under the South Middlesex and Richmond Joint Hospital Board Order. This Order was, during the year, confirmed to operate as from the 1st April, 1935. 41 Table D. Infectious Diseases. Cases of Infectious Diseases notified during the Year 1934. Disease Cases notified at various ages (years) Total cases notified No. of cases admitted to Hospital Total Deaths Ward Distribution Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and upwards Fulwell Upper Teddn. Lower Teddn. South Teddn. Smallpox - - - - - - - - - - - - - - - - - - - Diphtheria — — 1 1 1 7 1 2 — 1 — — 14 12 3 4 2 2 6 Erysipelas — 1 1 1 — — — — 4 2 6 1 16 8 — 5 9 2 Scarlet Fever — 1 1 2 3 16 6 3 2 2 1 — 37 20 — 6 10 9 12 Puerperal Fever - - - - - - - - 2 - - - 2 2 1 1 - 1 - Puerperal Pyrexia - - - - - - - - - - - - - - - - - - - Enteric Fever — — — — — — — — — — — — — — — - — — — Continued Fever - - - - - - - - - - - - - - - - - - - Cerebro-Spinal Fever - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - Malaria — — — — — — — — 1 — — — 1 1 — 1 — — — Dysentery - - - - - - - - - - - - - - - - - - - Pneumonia — 2 3 2 3 7 2 1 2 2 7 1 32 20 14 1 17 9 5 Acute Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - Acute Polio-Encephalitis - - - - - - - - - - - - - - - - - - - Tuberculosis— (a) Pulmonary M - - 1 — — 2 1 — 6 3 1 — 14 — 8 3 3 5 3 F - - - - - 1 - 3 3 1 2 - 10 - 11 - 4 3 3 Total - - - - - - - - - - - - 24 - 19 — - - - (b) Non-Pulmonary M — — — — — — — — 1 — — — 1 — 1 1 — — — F - 1 - - - - 1 - 1 - - - 3 - 1 - - - 3 Total 4 - 2 - - - - TOTALS - 5 7 6 7 33 11 9 22 11 17 2 130 63 39 22 45 31 32 4* 4*- Table E. Infectious Diseases. Table showing Monthly Incidence of Infectious Diseases and Number of Deaths during 1934. Disease Number of Cases Total No. of Deaths Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. Diphtheria - 4 - 1 - 1 4 - 1 2 — 1 14 3 Erysipelas 1 3 2 1 - 1 1 - — 2 3 2 16 — Scarlet Fever 2 3 3 4 1 3 9 7 — 4 — 1 37 — Ophthalmia Neonatorum — — — — — — — — — — — — — — Pneumonia 5 — 1 5 5 7 2 — 2 2 — 3 32 14 Enteric Fever — — — — — — — — — — — — — — Puerperal Fever — — 1 — — — — — 1 — — — 2 1 Puerperal Pyrexia - - - - - - - - - - - - - - Cerebro-Spinal Fever — — - - - - - - - - - - - - Malaria 1 - - - - - - - - - - - 1 - Totals 9 10 7 11 6 12 16 7 4 10 3 7 102 18 Tuberculosis. T.B. Table No. 1. New Cases and Mortality during 1934. Age Periods New Cases—28 Deaths—21 Pulmonary N on- Pulmonary Pulmonary N on-Pulmonary Male Female Male Female Male Female Male Female Under 1 year - - - - - - - - 1 to 5 years 1 — — 1 — — 1 1 5 ” 10 ” 2 1 - — — — — — 10 ” 15 ” 1 — - 1 — — — — 15 ” 20 ” - 3 - - 1 1 — — 20 ” 25 ” 2 1 - 1 — — — — 25 ” 35 ” 4 2 1 - 1 4 — — 35 ” 45 ” 3 1 - — 4 3 — — 45 ” 55 ” - 1 - — 2 2 — — 56 ” 65 ” 1 1 - - — 1 - — 65 and upwards — — — — — — — — Totals 14 10 1 3 8 11 1 1 T.B. Table No. 2. Primary Notifications of Tuberculosis, 1925-1934 inclusive. 1925 1926 1927 1928 1929 1930 19311932 1933 1934 Pulmonary 24 22 22 18 23 19 26 26 24 24 Other Forms 13 6 6 6 6 11 3 3 3 4 Totals 37 28 28 24 29 30 29 29 27 28 T.B. Table No. 3. Deaths from Tuberculosis, 1925-1934 inclusive. Years No. of deaths Pulmonary Tuberculosis No. of deaths Other Forms of T uberculosis Total Deaths Death Rate All Forms per 1,000 1925 18 3 21 .96 1926 8 2 10 .45 1927 16 2 18 .82 1928 10 1 11 .5 1929 10 1 11 .49 1930 15 6 21 .93 1931 15 4 19 .81 1932 15 2 17 .72 1933 9 2 11 .47 1934 19 2 21 .91 45 It will be seen from the foregoing tables that during the year 1934, twenty-eight cases of tuberculosis were notified and twenty-one deaths recorded from this disease. On two other occasions only during the last ten years has the mortality been so high, i.e., in 1925 and 1930. Non-notified tuberculosis deaths—cases not notified as tuberculosis and not recorded in the registers of the Department during life—were responsible for 28 per cent, of the total tuberculosis deaths. The Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not necessary to take any action under the above Regulations regarding persons suffering from tuberculosis and employed in the Milk Trade. The Public Health Act, 1925, Section 62. No action was taken under this Section, which is concerned with the compulsory removal to a Hospital of persons suffering from tuberculosis. 46 REPORT ON PUBLIC HEALTH BACTERIOLOGICAL WORK, 1934. All laboratory work was carried out by the Royal Institute of Public Health. During the year the practitioners within the District were, upon request, provided with a suitable supply of specimen containers for throat swabs and sputa. Diphtheria Anti-toxin supplies were also issued as required. The following table shows the useful work carried out under this heading:— Source of Specimens Nature of Specimens Number Result A. General Practitioners Sputum for Tubercle Bacilli 47 4 Positive Throat & nasal swabs for Diphtheria 144 10 Miscellaneous 7 Total Specimens Examined 198 B. Number of samples of water submitted for bacteriological and chemical examination 2 47 Maternity and Child Welfare. (1) VITAL STATISTICS. (a) Notification of Births Act. The number of births reported to the Public Health Department in 1934 was as under:— Total Births—Notified by Midwives 172 Notified by Doctors and Parents 141 Total 313 Still Births—Notified by Midwives 4 Notified by Doctors and Parents 7 Total 11 (b) Infantile Mortality in 1934. Nett live births registered 325 Number of deaths of infants under one year 11 Infantile Mortality 33 Nett illegitimate live births registered 13 Number of deaths of illegitimate infants under one year 1 Infantile Mortality in illegitimate infants 76 48 Maternity and Child Welfare. Table No. 1. Infantile Mortality, 1925-1934. Year Teddington England and Wales Births Deaths under 1 year Rate per 1,000 Births Rate per 1,000 Births 1925 389 19 49 75 1926 337 23 68 70 1927 360 10 28 69 1928 336 27 80 65 1929 336 18 54 74 1930 325 14 43 60 1931 371 15 40 66 1932 343 16 47 65 1933 296 17 57 64 1934 325 11 33 59 With the exception of the year 1927 the infantile mortality rate was the lowest on record. The 1934 figure compares very favourably with the infantile mortality rate for England and Wales. This gratifying result, I think we may reasonably assume, is due in no small measure to the Maternity and Child Welfare facilities provided by the Council. An analysis of the causes of death of children under one year (Table No. 2) again reveals that congenital defects and diseases, malformations and conditions of prematurity have been responsible for a high percentage of the total deaths (63 per cent.). 49 Maternity and Child Welfare. Table No. 2. Infantile Mortality. 1934. Nett deaths from stated causes at various ages under one year of age. Compiled from the Official Registrations. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year All Causes:- Certified 6 - - 1 7 - 1 - 3 11 Uncertified - - - - - - - - - - Smallpox - - - - - - - - - - I Chicken-pox - - - - - - - - - - J Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Whooping Cough - - - - - - - - 2 2 Diarrhoea - - - - - - - - - - Enteritis - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Congenital Malformations 3 - - - 3 - - - - 3 Premature Birth 3 - - 1 4 - - - - 4 Atrophy, Debility & Marasmus - - - - - - - - - - Atelectasis - - - - - - - - - - Injury at Birth - - - _ _ - - - - - Erysipelas - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - Convulsions - - - - - - - - - - Gastritis - - - - - - - - - - Laryngitis - - - - - - - - - - Bronchitis - - - - - - 1 - - 1 Pneumonia (all forms) - - - - - - - - 1 1 Suffocation (overlying) - - - - - - - - - - Other Causes - - - - - - - - - - Totals 6 - - 1 7 - 1 - 3 11 50 (c) Maternal Mortality in 1934. Deaths from puerperal sepsis 1 Deaths from other accidents and diseases of pregnancy nil One death occurred as a result of, or in connection with, reproduction. A thorough investigation was made into the probable influencing factors and the information transmitted to the Ministry of Health. During the year the services of the Council's Consultant under the Puerperal Fever and Puerperal Pyrexia Regulations were extended to include consultations in respect of cases of difficult confinement. (2) ADMINISTRATION OF MIDWIVES' ACTS. The administration of the above Acts, within the District, is carried out by the Middlesex County Council. There were three midwives practising in the District at the end of the year. The total number of births notified by midwives was 172, or 54.9 per cent. of the total notified births for the year. Puerperal Fever and Puerperal Pyrexia Regulations, 1926 and 1928. Urgent cases are admitted to the West Middlesex County Hospital, Isleworth, and also to Queen Charlotte's Hospital, London. The services of a Consultant are provided by the Council and are always available at the request of the medical practitioners in the District. (3) HEALTH VISITING. The Council in considering a successor to Miss E. G. Rickeard (whose death is recorded on another page), reviewed the whole question of Health Visiting in order to relieve to some extent the pressure of work on the 52 Health Visitor. Subsequently, Miss E. E. H. Schlund was appointed to carry out Health Visiting duties on one half-day per week (commencing April, 1934), in addition to assisting in the work at the Infant Welfare Clinics. Visits paid during the year:— To Expectant Mothers:— First visits 91 Total visits 168 To children under 1 year of age:— First visits 252 Total visits 1158 To children between the ages of 1 to 5 years:— Total visits 1493 Special visits 15 Children Acts:— Total visits 363 Total visits for year 3197 (4) INFANT LIFE PROTECTION. The work under this heading progressed very satisfactorily during the year. No legal proceedings were instituted. Two mothers were cautioned and subsequently complied with the necessary regulations. Three hundred and sixty-three visits were paid by the Infant Protection Visitor. Foster-mothers on Register beginning of year. 21 New foster-mothers registered during the year. 12 Foster-mothers on Register end of year . 24 NOTE.— Four foster-mothers (together with nursechildren) left the District, while 3 foster-mothers ceased to have charge of nurse-children. 53 Nurse-children on Register at beginning of year 21 Nurse-children placed with foster-mothers during the year 23 Nurse-children on Register end of year 26 NOTE.—Of the above nurse-children, five left the District with foster-mothers, while thirteen were removed by relations. (5) THE MATERNITY AND CHILD WELFARE CENTRE. (a) Infant Welfare Centre. Total attendances 2801 Average attendance per session 40 Individual children attended 417 Tuesdays:— Sessions 24 Average attendance 27.2 Attendances under 12 months 386 First attendances under 12 months 45 Attendances 1 to 5 years 269 First attendances 1 to 5 years 9 Thursdays:— Sessions 46 Average attendance 46.6 Attendances under 12 months 1200 First attendances under 12 months ill Attendances 1 to 5 years 946 First attendances 1 to 5 years 54 The total attendances at the Centre compare favourably with those of the previous year, and the average attendance per session was maintained at the same level. 54 I much regret to record that Miss E. G. Rickeard, who acted as Assistant Nurse for work at the Infant Welfare Clinics for a number of years, died in January, 1934. Miss E. E. H. Schlund was appointed in her place. Under the Teddington Rotary Club's generous scheme for the provision of convalescent treatment in necessitous cases, arrangements were made for four mothers and four children to be sent away during the year. All cases derived great benefit and there was a marked improvement in their general health. Four mothers received assistance in the obtaining of dentures through the Ivory Cross Society. Each mother has to make a contribution towards the cost of the necessary dental treatment in all cases helped by his Society. The Council have an arrangement with the Middlesex County Council whereby children under five years of age attending the Centre may receive dental treatment at the County Council's School Clinic in Stanley Road. The following cases were dealt with during the year:— Referred for treatment 28 Treatment received 25 ,, refused 2 ,, postponed 1 The work of the Centre is strictly of a preventive and advisory nature, and any children needing treatment are referred to their own doctor. Under this heading several cases of tonsillectomy and circumcision were treated at the Teddington, Hampton Wick & District Memorial Hospital. Sunlight treatment was also provided at this Hospital. A number of cases attending outside hospitals were kept under observation during the year. {b) Ante-Natal Clinic—Report of Dr. Rose Turner. There were twenty-one sessions of the Ante-Natal Clinic held during the year 1934. The number of expectant mothers who attended was forty, of whom 55 eleven were primiparœ and twenty-nine multiparœ. Thirty-six were first attendances. There were in addition thirteen Post-Natal cases; the number of attendances being twenty-one. Several of the mothers were found to require special treatment. Seven were referred to the Ophthalmic Department of the Royal Hospital, Richmond, and one to the Tuberculosis Clinic. Two mothers obtained dentures through the Ivory Cross Society. In two cases the mother's private doctor was communicated with, and in seven others the midwife. The importance of a little time of rest for some of the expectant mothers is a matter that requires attention. A little respite from the work-a-day routine in health-giving surroundings, before the baby comes, would be most beneficial in many cases. There is a little difficulty, however, in finding Convalescent Homes which will take expectant mothers, but) the advantage to the future child, as well as to the mother, if such an arrangement were possible, is obvious. Ophthalmia Neonatorum, 1934. Year Cases Notified Cases Treated Vision unimpaired Vision impaired Total Blindness Deaths At home In hospital 1934 — — — — — — — 56 (6) SUPPLY OF MILK FOR EXPECTANT AND NURSING MOTHERS AND FOR INFANTS. The following table shows the amount of free milk granted for necessitous, expectant or nursing mothers and for infants, under the Maternity and Child Welfare Act, 1918, as compared with the two previous years. Year Quantity of Milk issued per quarter (galls.) Total 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. 1932 427 7/8 450 1/8 446 3/8 505 5/8 1830 1933 627¾ 585 5/8 357 356 7/8 1927¼ 1934 359 3/8 248 ½ 255½ 314 3/8 1177¾ Since October, 1929, the milk ordered has been "Grade A (Tuberculin Tested)". (7) NURSING HOMES (REGISTRATION) ACT, 1927. The administration of the above Act is carried out by the Middlesex County Council. The following table shows the nursing homes situated within the District:— Name of Proprietor Address Total No. of Beds No. of Mat ernity Beds Hadfield, Mrs. Maud 140, Stanley Road, Teddington 8 - Marshall. Mrs. Kate E. Oketon Nursing Home, 26, Hampton Road, Teddington 13 3 Moss, Miss Lilian R. "Gloucester Lodge," 175, Waldegrave Road Teddington 3 3 Normansfield, Ltd. (Dr. Langdon-Down, Chairman) "North Villa," Normansfield, Kingston Road, Teddington 2 57 (8) SPECIAL TREATMENT. (a) Dental Treatment: Arrangements have been made with the Middlesex County Council for the treatment of toddlers. In my opinion, a similar arrangement should be made for the treatment of expectant and nursing mothers. (b) Orthopaedic Treatment. Suitable cases are referred to the Royal National Orthopaedic Hospital, London, and the Red Cross Curative Post, Norbiton (c) Sun-ray Treatment. Suitable cases are referred for admission to the Teddington, Hampton Wick & District Memorial Hospital. (d) Mental Treatment. Cases are sent to the University College Hospital, London. (e) Birth Control. Appropriate cases are sent to a special Mothers' Clinic in London. In addition, cases are sent from time to time to the following hospitals:— Teddington, Hampton Wick & District Memorial Hospital. Richmond Hospital. West Middlesex County Hospital, Isleworth. Hospital for Sick Children, London. The London Hospital. Vincent Square Hospital for Infants. 58 INDEX Page Acts, Adoptive 20 Ambulance Facilities 10 Ante-Natal Clinic 9, 55 Bacteriological Examination of Milk 28, 29 Bake-houses 25 Births 11, 12, 13, 48 Birth Control 58 Bye-laws 20 Cancer 14, 15 Common Lodging-houses 33 Collection and Disposal of House Refuse 22 Deaths 12, 14, 15, 16, 17, 18 Dental, Treatment 9, 55, 58 Diseases of Circulatory System 14 Disinfection 33 Drainage and Sewerage 21 Factories, Workshops & Workplaces 32 Food, Inspection and Supervision of 26 Food and Drugs (Adulteration) Act 31 General Provision of Health Services 7 Health Visiting 52 Hospitals 7, 8, 58 Housing 34 Housing Statistics 35 Illegitimacy 1148 Infant Life Protection 53 Infantile Mortality 48, 49, 50, 51 Infant Welfare Centre 9, 54 Infectious Diseases 39, 40, 42, 43, 44 Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children 8 Isolation Hospital Accommodation 41 Laboratory Work 47 Page Maternity and Child Welfare Centre 54 Maternity and Child Welfare Committee 2 Maternity and Child Welfare Statistics 48 Maternal Mortality 52 Mental Treatment 58 Midwives Acts, Administration of 52 Midwives 10 Milk, Provision of 57 Milk Purveyors 26 Milk Supply 26 Natural and Social Conditions 7 Nursing Homes 57 Nursing in the Home 8 Ophthalmia Neonatorum 56 Orthopaedic Treatment 58 Population 11 Puerperal Fever & Pyrexia 52 Public Health Committee 2 Rag Flock Acts 33 Rats & Mice (Destruction) Act 33 Rivers and Streams 21 Sanitary Inspection of District 22 Scavenging 21 School Clinics 9 Slaughter-houses 26 Smallpox 7, 39 Smoke Abatement 33 Staff 3 Statistics, General and Vital 6, 11, 19, 48 Still Births 6, 48 Sun-ray Treatment 58 Swimming Bath, etc 38 Tents, Vans and Sheds 33 Trowlock Island 37 Tuberculosis 7, 9, 45, 46 Unsound Food 30 Vaccination 39 Venereal Diseases 7, 9 Water Supply 20