AC4413(3)TEDDINGTON Teddington Urban District Council PUBLIC HEALTH DEPARTMENT ANNUAL REPORT FOR 1935 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 1935 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, 1935 Chairman—councillor Capt. B. T. harding. Councillor R. h. Berry. ,, J. T. Chell. ,, W. J. Cornwill. (Chairman of the Council). ,, P. H. Durham. ,, W. W. Drury. ,, H. Field. ,, a. G. Greig. ,, h. Harrison. ,, E. G. Ive. ,, a. J. Jones. ,, Miss D. B. L. Marshall. ,, H. W. Peachey. ,, F. W. Tomalin. (Vice-Chairman of the Council). ,, G. E. Weaver. MATERNITY & CHILD WELFARE COMMITTEE. Chairman—councillor Miss D. B. L. marshall. Councillor W. J. Cornwill. (Chairman of the Council). ,, p. H. Durham. ,, H. Field. ,, Capt. B. T. Harding. ,, A.J.Jones. ,, H. W. Peachey. ,, F. W. Tomalin. (Vice-Chairman of the Council). Co-opted Members: Mrs. T. I. Jones, Mrs. P. LangdonDown, 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. (Resigned 31st December, 1035.) 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. slvyer. 3 To the Chairman and Members of the Teddington Urban District Council. Madam and Gentlemen, I submit herewith my Sixth 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, 1935. Area of the District in acres 1,196 land; 18 water Resident Population—Estimated to the middle of year 1935 (as supplied by the RegistrarGeneral) 23,140 Number of inhabited houses (1935) 5,929 Rateable Value (31st December, 1935) £204,727 Product of a penny Rate £799 15s. 4d. Total M. F. Live Births Legitimate 285 139 146 298 Illegitimate 13 8 5 Birth Rate, 1935, per 1,000 population 1287 Total M. F. Still Births Legitimate 8 5 3 8 Illegitimate — — — Still Birth Rate per 1,000 Births (Live and Still) 26.1 M. F. Deaths 135 143 278 Crude Death Rate, 1935, per 1,000 population 12.0 Adjusted Death Rate (Comparability Factor 098) 11.7 Number of women dying in, or in consequence of, childbirth from sepsis Nil j from other causes 1 Deaths of infants under one year of age per 1,000 births: (i) Legitimate 56 (ii) Illegitimate Nil (iii) Total 53 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) Nil 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. It is bounded on the east by the River Thames. About 25 acres of Bushy Park 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. Up to the 31st March, 1935, cases of fever were removed to London Fever Hospital, Tolworth Isolation Hospital, Twickenham Isolation Hospital, or occasionally to one of the L.C.C. Hospitals. The South Middlesex and Richmond Joint Hospital Board, of which the Council is a constituent Authority, took over the provision of Isolation Hospital accommodation as from the 1st April, 193 5. 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 vVest 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. Isolation Ward 2 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, and a Radiologist. The number of in-patients treated during the year 1935 was 604, and casualties 726. Operations performed : Major 196, Minor 211, Dental 96. 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 5th Tuesday of the month at 2 p.m. Teddington U.D.C. Ante-Natal Clinic do. 1st and 3rd Tuesday of the month at 2 p.m. do. Dental Clinic (Toddlers) (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: 1. Staines Road, Twickenham. Monday at 10 a.m. Thursday at 2 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. A motor ambulance is provided by the South Middlesex and Richmond Joint Hospital Board. (b) For Non-Infectious and Accident Cases. A motor ambulance is provided by the Teddington Urban District Council. (c) For Maternity Cases. A motor ambulance is provided by the Hospital, to which the case is removed. MIDWIVES. The Council 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 1935, viz., 23,140, represents an increase of 90 persons since last year. The population, as ascertained by the 1931 Census, was 23,369. (2) BIRTHS. The births registered in the District in 1935 numbered 298, giving a birth rate of 12.87 per 1,000 of the population. The births were made up as follows:— Males. Females. Total. Legitimate 139 146 285 Illegitimate 8 5 13 Total 147 151 298 The birth rate in Teddington during the year 1935 shows a decrease compared with the previous year. The number of illegitimate births has varied very little during the past ten years. 12 Vital Statistics. Table No. 1. Births and Birth Rates, 1926-1935. Year Teddington England and Wales Births Rate per 1.000 living Rate per 1,000 living 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 1935 298 12.87 14.7 (3) DEATHS. The nett deaths registered in the District during 1935 numbered 278, and were made up as follows: males 135, females 143. The crude death rate per 1,000 of the population for the year was 120. The adjusted death rate per 1,000 of the population was 117. (Comparability factor 0.98.) The death rate for England and Wales was 117. (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. Ninety-four deaths during the year were due to heart disease, aneurysm, cerebral haemorrhage and other circulatory diseases. 14 Comparative Analyses, 1931-1935. Deaths from Diseases of the Circulatory System. Year Total Deaths Diseases of Circulatory System Percentage of Total Deaths Death Rate— Diseases of Circulatory System per 1,000 1931 93 34.8 3.9 1932 74 29.1 3.1 1933 78 33.2 3.4 1934 72 30.4 3.1 1935 94 33.8 4.0 % (b) Cancer. Thirty-nine deaths during the year were due to cancer. Of these 26 per cent. were males, and 74 per cent. females. Comparative Analyses, 1931-1935. Deaths from Cancer. Year Total Deaths from Cancer Percentage of Total Deaths Death Rate— Cancer per 1,000 1931 39 14.6 1.6 1932 38 14.9 1.6 1933 38 16.2 1.6 1934 33 13.9 1.4 1935 39 13.9 1.6 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, 1926—1935. Year Teddington England and Wales Deaths Rate per 1,000 living Rate per 1,000 living 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 11.8 (b) 9.9 1935 278 (a) 12.0 11.7 (b) 11.7 (a) Crude (b) Adjusted 16 Vital Statistics. Table No. 3. Causes of Death, 1935. (Registrar-General's Official Returns.) CAUSES OF DEATH Males Females Total 1 Typhoid and paratyphoid fevers — — — 2 Measles 1 — 1 3 Scarlet Fever 4 Whooping Cough — — — 5 Diphtheria 2 — 2 6 Influenza 1 1 7 Encephalitis Lethargica — 1 1 8 Cerebro-spinal Fever — — — 9 Tuberculosis of respiratory system 13 4 17 10 Other Tuberculous Diseases 1 1 2 11 Syphilis — — 12 General Paralysis of the insane, Tabes Dorsalis — — — 13 Cancer, malignant disease 10 29 39 14 Diabetes 1 5 6 15 Cerebral Haemorrhage, etc. 6 12 18 16 Heart Disease 28 38 66 17 Aneurysm 1 — 1 18 Other circulatory diseases 7 2 9 19 Bronchitis 4 5 9 20 Pneumonia (all forms) 8 8 16 21 Other respiratory diseases 1 3 4 22 Peptic Ulcer 4 — 4 23 Diarrhoea, etc. (under 2 years) — — — 24 Appendicitis — 2 2 25 Cirrhosis of Liver — — 26 Other Diseases of Liver etc. — 3 3 27 Other Digestive Diseases 5 3 8 28 Acute and Chronic Nephritis 6 8 14 29 Puerperal Sepsis — — — 30 Other Puerperal causes — 1 1 31 Congenital debility, premature birth, malformations, etc. 9 1 10 32 Senility 3 5 8 33 Suicide 6 2 8 34 Other Violence 5 3 8 35 Other defined diseases 13 6 19 36 Causes ill-defined or unknown 1 — 1 TOTALS 135 143 278 18 19 Vital Statistics. Table No. 4. Birth Rate, Death Rate and Analysis of Mortality during the Year 1935. (Provisional Figures.) Rate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Bate per 1000 Dive Births. Live births Still births All Causes. Enteric Fever Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Influenza. Violence Diarrhoea and Enteritis (under two years) Total Deaths under one year. England and Wales 14.7 0.62 11.7 0.00 — 0.03 0.01 0.04 0.08 0.18 0.52 5.7 57 121 County Boroughs and Great Towns, including London 14.8 0.68 11.8 0.00 0.04 0.01 0.04 0.09 0.16 0.45 7.9 62 140 Smaller Towns (Resident Populations 25,000—50,000) at 1931 Census 14.8 0.64 11.2 0.00 — 0.03 0.01 0.04 0.07 0.17 0.41 3.8 55 London Administrative County 13.3 0.52 11.4 0.00 — 0.00 0.01 0.04 0.06 0.11 0.51 11.2 58 Teddington 12.87 0.34 11.7 0.00 — 0.04 0.00 0.00 0.08 0.04 0.69 0.00 53 Vital Statistics. Table No. 5. Review of the Comparative Vital and Mortality Statistics for the Urban District of Teddington, together with those for England and Wales for the Years 1926-1935 inclusive. Year. Birth Rate Death Rate Infantile Mortality Rate Teddington England and Wales Teddington England and Wales Teddington England and Wales 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 1935 12.87 14.7 (a)12.0 (b)11.7 11.7 53 57 (a) Crude (b) Adjusted 20 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., VIII. 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. Public Library. (2) WATER SUPPLY. A constant and satisfactory water supply over the whole District is maintained by the Metropolitan Water Board. 22 (3) RIVERS AND STREAMS. No complaints regarding the pollution of the River Thames were received during the year. (4) DRAINAGE AND SEWERAGE. The method employed is the water carriage system, and practically all premises are connected to the sewerage system. The Council is a constituent Authority under the West Middlesex Sewerage Disposal Scheme formulated by the Middlesex County Council, and during the past year the abolition of the Disposal Works in Broom Road has been effected, and all foul water sewage connected to the County Council's new Disposal Works at Mogden by means of the latter Authority's new trunk sewer. (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 replaced by an improved type as opportunities occur. (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. The present horse-drawn vehicles used for the removal of refuse are of the old high-loading type, with the exception of two vans of a more modern and sanitary pattern. One motor freighter serves the portions of the District furthest from the Destructor. 23 Notices are served from time to time by this Department for the provision of sanitary dustbins, and during the year a number of new dustbins have been supplied by owners. (7) SANITARY INSPECTION OF DISTRICT. Visits and Inspections, 1935. Visits in connection with Infectious Diseases 360 Houses inspected under Public Health and Housing Acts 526 Inspections under the Rent Restrictions Act 5 Houses re-inspected after notice and re-inspections to work in progress 3716 Food Shops and Stalls 110 Slaughter-houses 1101 Dairies, Cowsheds and Milkshops 81 Bakehouses 79 Factories, Workshops and Workplaces 235 Schools 38 Disused gravel pits and dumps 51 Halls and Cinema 36 Ice Cream premises 18 Sanitary Conveniences 70 Smoke Observations 4 Miscellaneous 284 24 Summary of Work Executed, 1935. Water Supply:— Draw taps fitted to main supply pipes 1 Cisterns cleansed, repaired, covered, etc. 9 Water Closets:— Cleansed 48 Flushing cisterns, repaired or renewed 34 New pans, etc. 10 Ventilated or ventilation improved 1 Separate accommodation for sexes provided 1 Accommodation provided 4 Dampness:— Roofs repaired 161 Brickwork repaired, renewed or rendered impervious, etc. 176 Ventilation to floors 26 Drains:— Cleared and flushed 21 Repaired 13 Examined, tested or exposed 3 Sanitary Dustbins:— Provided 21 Eaves gutters and rain water pipes:— Repaired or renewed 140 Soil Pipes:— Repaired, renewed and ventilated 3 Houses, Workshops, etc:— Rooms cleansed 391 Ceiling plaster repaired 124 Wall plaster repaired 252 25 Floors repaired 85 Windows repaired, sash cords, etc. provided 208 Fire grates repaired or provided 89 Coppers repaired, etc. 31 Sinks:— Provided 13 Repaired or refixed 2 Waste pipes repaired or renewed 19 Yards:— Cleansed 5 Paved or repaired 43 Various:— Nuisances abated from overcrowding 11 Nuisances abated from chimneys sending forth black smoke 1 Nuisances abated from animals being improperly kept - Offensive accumulations removed 11 Offensive smells 2 Miscellaneous 281 Complaints. During the year, complaints were received regarding the following matters:— Accumulations of refuse 5 Choked or defective drains 10 Damp walls 7 Defective ceilings 3 coppers 3 ,, eaves gutters and rain water pipes 11 ,, floors 7 ,, fire grates or kitchen ranges 2 26 Defective roofs 4 ,, sinks 2 ,, sink waste pipes 4 ,, walls 4 ,, water closets 20 ,, water supply 1 Dirty rooms 12 Houses infested with rats 41 Insanitary condition of yards 8 Offensive smells from various causes 2 Overcrowding 8 Smoke nuisances 1 Verminous houses 50 Miscellaneous 16 Schools. The sanitary arrangements and water supply at the Elementary Schools in the District were inspected from time to time during the year. (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 79 27 (9) SLAUGHTER-HOUSES. There are seven slaughter-houses within the District— two registered and five licensed. Six 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 1101 (10) INSPECTION AND SUPERVISION OF FOOD. (a) Milk. Retail Purveyors of Milk on Register, 1935 29 Purveyors of Graded Milk, 1935:— "Certified" 5 "Grade A (Tuberculin Tested)" 9 "Grade A (Pasteurised)" 1 "Pasteurised" 7 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. 28 The veterinary inspection of milch cows within the District is undertaken by the Middlesex County Council. Fifteen samples of milk were submitted for bacteriological examination to the Royal Institute of Public Health, details of which are given hereunder. 29 Table showing the Results of Bacteriological Examination of Milk Samples, 1935. Sample. Organisms per c.c. Minimal amount showing presence of B. Coli. Bacteriologist's Remarks. 1. 1,600 — Conforms to prescribed conditions for Pasteurised milk. 2. 6,100 — Conforms to prescribed conditions for Pasteurised milk. 3. 5,200 — Conforms to prescribed conditions for Pasteurised milk. 4. 8,300 — Conforms to prescribed conditions for Pasteurised milk. 5. None observed — Sterilized milk. This milk appears to have been effectively sterilized. 6. 400,000 Present in 0.0001 c.c. Sealed carton. This milk is probably over two days old, which may partially account for the large number of bacteria and high coliform content. 7. 130,000 Absent in 1 c.c. Not of a pasteurised standard as regards the bacterial count, but of such a standard as regards the presence of coliform bacilli. 8. 66,000 — Conforms to prescribed conditions for Pasteurised milk. 9. 95,000 — Conforms to prescribed conditions for Pasteurised milk. 30 Table showing the Results of Bacteriological Examination of Milk Samples, 1935. Sample. Organisms per c.c. Minimal amount showing presence of B. Coli. Bateriologist's Remarks. 10. 91,000 — Conforms to prescribed conditions for Pasteurised milk. 11. 184,000 Present in 0.0001 c.c. The number of bacteria present is satisfactory, but there is a high coliform content. 12. 260 — Conforms to prescribed conditions for Pasteurised milk. 13. 1,500 Present in 0.1 c.c. A good sample of ordinary milk, comparable to a graded milk. 14. 3,000 — Conforms to prescribed conditions for Pasteurised milk. 15. Nil — Sterilized milk. 31 (b) Meat. Although a large proportion of the meat consumed is brought from the London Markets, there was a total of 8,138 animals slaughtered within the District during the year, every one of which was inspected by the Sanitary Inspectors. This represents a large increase over the previous year, and consequently an increasing amount of the Sanitary Inspectors' time has to be devoted to meat inspection. 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 table shows how this work has grown during the last few years:— Year Beasts Calves Pigs Sheep Total 1931 9 397 2069 259 2738 1932 10 479 3365 680 4534 1933 18 777 4080 2038 6914 1934 18 886 3876 1313 6093 1935 97 1609 4144 2288 8138 Unsound Food. The following articles of food were found to be unfit for human consumption and destroyed:— 32 Articles. Disease. 1 beast's carcase & offal Tuberculosis. 1 quarter of beast Extensive bruising. 14 beasts' lungs Tuberculosis. 2 beasts' lungs Abscess. 1 beast's lungs Inflammation. 1 beast's liver Bacterial necrosis. 1 beast's liver Tuberculosis. 1 beast's liver Cirrhosis. 1 calf's carcase & offal Tuberculosis. 2 calves' plucks Tuberculosis. 1 calf's lungs Tuberculosis. 4 calves' livers Tuberculosis. 2 pigs' carcases & offal Tuberculosis. 1 pig's carcase & offal Peritonitis. 1 pig's forequarter Tuberculosis. 64 pigs' heads Tuberculosis. 34 pigs' plucks Tuberculosis. 150 pigs' lungs Inflammation. 9 pigs' lungs Tuberculosis. 2 pigs' lungs Pneumonia. 22 pigs' Livers Cirrhosis. 2 pigs' livers Tuberculosis. 1 sheep's forequarter Pleurisy. 8 sheep's lungs Strongylus rufescens. 1 sheep's pluck Inflammation. 1 sheep's liver Cirrhosis. 1 sheep's liver Distomum hepaticum. 7 lbs. dried fillets of fish 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 Butter 1 — Cream Pastry 1 — Gin 2 — Hake 1 — Lemon Sole 1 — Milk 56 — Minced Beef 2 — Whisky 1 — 65 — 33 (11) FACTORIES, WORKSHOPS & WORKPLACES. 1 —Inspection of Factories, Workshops & Workplaces. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 67 4 — Workshops (including Workshop Laundries) 110 6 — Workplaces (Other than Outworkers' premises) 58 5 — Total 235 15 — 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 9 9 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors 2 2 — — Other nuisances 14 14 — — Sanitary accommodation— Insufficient 4 4 — — Unsuitable or defective 4 3 — — 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 of Health (Factories and Workshops Transfer of Powers) Order 1921). — — — — Total 35 34 — — *Including those specified, in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 34 (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 43 Scarlet Fever 38 Erysipelas 5 Puerperal Fever 2 Tuberculosis 9 Pneumonia 2 Miscellaneous 66 (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. 35 (18) HOUSING. During the year under review, 117 houses were built by private enterprise. Although there would not appear to be a lack of houses in the District for those people who are in a position to purchase them, nevertheless the problem of the poorer classes of the community in finding houses at an economic rent is still with us. Bound up so vitally as it is with income and the importance of maintaining nutrition, the availability—or otherwise, of houses at an economic rent must have a very definite bearing upon health. Recent investigations in this country have shown that some families who have been moved from slum areas to Council houses have suffered impaired health. This is due to the fact that the rent demanded for their new homes leaves too little for adequate food. In this connection, the policy of the Teddington Council in erecting maisonettes which are let at a weekly rent of 8/4 to 8/7, exclusive of rates, is to be commended. Important legislation was enacted during the year in the form of the Housing Act, 1935. One of the main provisions of the Act was to make further and better provision for the abatement and prevention of overcrowding. The Act sets up a standard by which overcrowding is to be judged and, with safeguards for special cases, makes it a punishable offence to infringe that standard. In order to ascertain the extent of overcrowding, each Local Authority was required to make a survey of their area and, as regards this District, at the end of the year arrangements were being made for this work to be commenced. This subject will be dealt with in my next report. 36 The following statistics show the amount of work carried out by the Public Health Department with regard to housing:— Housing Statistics, 1935. Number of new houses erected during the year:— (a) Total, including numbers given separately under (£) 117 (b) 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) 526 (b) Number of inspections made for the purpose (primary) 526 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 387 (b) Number of inspections made for the purpose (primary) 387 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 37 (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 401 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 341 3. Action under Statutory Powers during the year. A. Proceedings under Sections 17, 18, and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Notices were served requiring repairs 45 (2) Number of dwelling-houses which were rendered fit after service of formal Notices:— (a) By owners 28 (b) By Local Authority in default of owners 5 B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which Notices were served requiring defects to be remedied nil (2) Number of dwelling-houses in which defects were remedied after service of formal Notices:— (a) By owners nil (b) By Local Authority in default of owners nil 38 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 nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders nil 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 roms in respect of which Closing Orders were determined, the tenement or room having been rendered fit nil (19) TROWLOCK ISLAND. This Island—on the River Thames—has been fully described in my previous Reports. There are thirty bungalows and a boathouse belonging to the Royal Canoe Club on the Island. 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. I would again emphasize that 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. 39 (20) SWIMMING BATH, ETC. Excellent facilities for swimming are provided at the Council's modern Open-Air Bath. The water in the Pool (supplied by the Metropolitan Water Board's main) is always flowing and is completely changed, Altered 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. 40 Infectious Diseases (a) NOTIFIABLE INFECTIOUS DISEASES. Diphtheria. There were 52 cases of Diphtheria notified. With few exceptions the type of disease was mild. Scarlet Fever. The number of cases of Scarlet Fever notified (37) was the same as for the previous year. Enteric Fever. No cases of Enteric Fever were notified. Table A. Infectious Diseases. Quarter Diphtheria Scarlet Fever Enteric Fever 1st Quarter 4 4 — 2nd 13 4 — 3rd 27 11 — 4th 8 18 — Totals 52 37 — Smallpox. No case of Smallpox was notified during the year. Four contacts were kept 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 1931 311 198 80 63.6 1932 281 169 83 60.1 1933 249 152 59 61.0 1934 267 162 74 60.6 1935 251 151 69 60.0 42 Encephalitis Lethargica. No case of Encephalitis Lethargica was notified. Puerperal Fever and Puerperal Pyrexia. Three cases of Puerperal Fever were notified during the year. All were removed to Hospital. Ophthalmia Neonatorum. See page 60. Pneumonia, Malaria and Dysentery. PNEUMONIA. There were 20 cases of Pneumonia notified during the year, 10 of which were treated in Hospital. Malaria. No case of Malaria was notified. 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 1935:— Disease Cases notified in District Case rate per 1,000 living in England and Wales Number notified Case rate per 1,000 living Smallpox — — — Diphtheria 52 2.24 1.60 Scarlet Fever 37 1.59 2.96 Enteric Fever — — 0.04 Pneumonia 20 0.86 1.15 Erysipelas 9 0.38 0.42 (6) 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. 43 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. ISOLATION HOSPITAL ACCOMMODATION. The Council is now a constituent Authority of the South Middlesex and Richmond Joint Hospital Board. The Board took over the provision of isolation hospital accommodation as from the 1st April, 1935. During the year, 83 cases, for which the Council were responsible for payment, were removed to hospital as follows:— 1st January to 31st March:— London Fever Hospital 2 cases. Queen Charlotte's Hospital 1 case. Tolworth Isolation Hospital 3 cases. Twickenham Isolation Hospital 2 cases. 1 st April to 31 st December:— South Middlesex and Richmond Joint Hospital Board 75 cases. 44 45 Table D. Infectious Diseases. Cases of Infectious Diseases notified during the Year 1935. 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 3-1 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 2 3 26 9 4 4 2 1 — 52 46* 2 13 20 13 Erysipelas 1 — — — — 1 — — 1 1 4 1 9 6 — 1 5 2 1 Scarlet Fever _ — 2 2 2 13 8 4 4 — 1 1 37 341 — 6 11 18 2 Puerperal Fever _ — _ _ __ _ _ _ 2 1 _ _ 3 3 — _ 2 1 — Puerperal Pyrexia — — — — — — — — — — — — — — — — — — — Enteric Fever — — — — — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — — — — — Cerebro—Spinal Fever — — — — — — — — — — — — — — — — — — Acute Poliomyelitis — — — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum — — — — — — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — — — — — Dysentery — — — — — — — — — — — — — — — — — — — Pneumonia 2 — 2 3 1 1 2 — 2 2 3 2 20 10 16 2 7 5 6 Acute Encephalitis Lethargica — — — — — — — — — — — — — — 1 — — — — Acute Polio—Encephalitis — — — — — — — — — — — — — — — — — — — Tuberculosis— — — — — — — — — — — — — — — — — — — — (a) Pulmonary M 1 — — — — — — 4 3 2 — 10 — 13 1 2 5 2 F — — — — — — — 2 4 2 — — 8 — 4 3 2 2 1 Total _ — _ _ _ _ _ _ _ — — — 18 — 17 — — — — (b) Non—Pulmonary M 1 _ _ _ _ _ _ _ 1 _ — — 2 _ 1 — 2 — — F — — — — — — — — — — — — — — 1 — — — — Total — — — — — — — — — — — — 2 — 2 — — — — TOTALS 4 1 5 7 6 41 19 10 22 11 11 4 141 99 38 26 51 39 25 * Including 2 Observation Cases + Including 2 Observation Cases 47 Table E. Infectious Diseases. Table showing Monthly Incidence of Infectious Diseases and Number of Deaths during 1935. Disease Number of Cases Total No. of Deaths Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. Diphtheria - 2 2 2 10 1 4 3 20 2 — 6 52 2 Erysipelas - — — — — 1 — 1 1 3 2 1 9 — Scarlet Fever 2 1 1 — 4 — 1 5 5 9 8 1 37 — Ophthalmia Neonatorum — — — — — — — — — — — — — — Pneumonia 6 3 3 2 3 - - - - - 2 1 20 16 Enteric Fever — — — — — — — — — — — — — — Puerperal Fever 1 1 — — — — 1 — — — — — 3 — Puerperal Pyrexia - - - - - - - - - - - - - - Cerebro-Spinal Fever - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - Totals 9 7 6 4 17 2 6 9 26 14 12 9 121 18 Tuberculosis. T.B. Table No. 1. New Cases and Mortality during 1935. Age Periods New Cases—20 Deaths—19 Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary Male Female Male Female Male Female Male Female Under 1 year - - 1 - - - - - 1 to 5 years 2 — — — 1 — 1 — 5 „ 10 „ — — — — — — — — 10 „ 15 — — — — — - - - 15 „ 20 „ — 2 — — — 1 — — 20 „ 25 1 1 - - 1 1 — — 25 ,, 35 3 3 1 — 2 1 — — 35 ,, 45 2 2 — — 3 — — — 45 ,, 55 1 — — — 3 — — 1 55 ,, 65 ,, 1 — — — 3 1 — — 65 and upwards — — — — — — — — Totals 10 8 2 - 13 4 1 1 T.B. Table No. 2. Primary Notifications of Tuberculosis, 1926-1935 inclusive. 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Pulmonary 22 22 18 23 19 26 26 24 24 18 Other Forms 6 6 6 6 11 3 3 3 4 2 Totals... 28 28 24 29 30 29 29 27 28 20 T.B. Table No. 3. Deaths from Tuberculosis, 1926-1935 inclusive. Years No. of deaths Pulmonary Tuberculosis No. of deaths Other Forms of Tuberculosis Total Deaths Death Rate All Forms per 1,000 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 1935 17 2 19 82 48 It will be seen from the foregoing tables that during the year 1935, twenty cases of tuberculosis were notified and nineteen deaths recorded from this disease. Nonnotified tuberculosis deaths—cases not notified as tuberculosis and not recorded in the registers of the Department during life—were responsible for 21 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. 49 REPORT ON PUBLIC HEALTH BACTERIOLOGICAL WORK, 1935. All laboratory work is 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 etc., for Tubercle Bacilli 39 3 Positive Throat & nasal swabs for Diphtheria 219 36 „ Miscellaneous 6 Total Specimens Examined 264 B. Number of samples of water submitted for bacteriological or chemical examination 2 50 Maternity and Child Welfare. (1) VITAL STATISTICS. (a) Notification of Births Act. The number of births reported to the Public Health Department in 1935 was as under:— Total Births—Notified by Midwives 165 Notified by Doctors and Parents 140 Total 305 Still Births—Notified by Midwives 6 Notified by Doctors and Parents 3 Total 9 (b) Infantile Mortality in 1935. Nett live births registered 298 Number of deaths of infants under one year 16 Infantile Mortality 53 Nett illegitimate live births registered 13 Number of deaths of illegitimate infants under one year nil Infantile Mortality in illegitimate infants nil 52 Infantile Mortality, 1926-1935. Year Teddington England and Wales Births Deaths under 1 year Rate per 1,000 Births Rate per 1,000 Births 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 1935 298 16 53 57 Despite the fact that there was a rise in the infantile mortality rate, the 1935 figure compares favourably with the infantile mortality rate for England and Wales. An analysis of the causes of death of children under one year again reveals that congenital defects and diseases, malformations and conditions of prematurity have been responsible for a high percentage of the total deaths (62 per cent.). We cannot do so much for this group, but great help can be given by the Public Health Department in such conditions as Bronchitis, Pneumonia, Diarrhoea and Enteritis. 54 (c) Maternal Mortality in 1935. Deaths from puerperal sepsis nil Deaths from other accidents and diseases of pregnancy 1 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. The services of the Council's Consultant under the Puerperal Fever and Puerperal Pyrexia Regulations 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 165, or 54 per cent. of the total notified births for the year. Puerperal Fever and Puerperal Pyrexia Regulations, 1926 and 1928. The services of a Consultant are provided by the Council and are always available at the request of the medical practitioners in the District. 55 (3) HEALTH VISITING. Visits paid during the year:— To Expectant Mothers:— First visits 94 Total visits 176 To children under 1 year of age:— First visits 256 Total visits 1132 To children between the ages of 1 to 5 years:— Total visits 1638 Special visits 30 Children Acts:— Total visits 342 Total visits for year 3318 (4) INFANT LIFE PROTECTION. During the year under review the work under this heading progressed very satisfactorily. No legal proceedings were instituted. Three hundred and forty-two visits were paid by the Infant Protection Visitor. Foster-mothers on Register beginning of year 24 New foster-mothers registered during the year 8 Foster-mothers on Register end. of year 19 NOTE.—Thirteen foster-mothers ceased to have charge of nurse-children. 56 Nurse-children on Register at beginning of year 26 Nurse-children placed with foster-mothers during the year 15 Nurse-children on Register end of year 21 note.—Of the above nurse-children, seventeen were removed by relations; one was legally adopted; one reached 9 years of age; while one was sent to hospital for special treatment by the Middlesex Education Authority. (5) THE MATERNITY AND CHILD WELFARE CENTRE. (a) Infant Welfare Centre. Total attendances 2904 Average attendance per session 409 Individual children attended 433 Tuesdays:— Sessions 25 Average attendance 25.1 Attendances under 12 months 376 First attendances under 12 months 47 Attendances 1 to 5 years 252 First attendances 1 to 5 years 12 57 Thursdays: — Sessions 46 Average attendance 494 Attendances under 12 months 1359 First attendances under 12 months 120 Attendances 1 to 5 years 917 First attendances 1 to 5 years 46 The total attendances at the Centre compare favourably with those of the previous year, the figures generally showing a slight increase. The following table gives a record of attendances at the Infant Welfare Centre during the past five years:— Year Total Attendances First Attendances No. of Children attending 1931 3106 203 416 1932 3031 200 433 1933 2864 192 436 1934 2801 219 417 1935 2904 225 433 Under the Teddington Rotary Club's generous scheme for the provision of convalescent treatment in necessitous cases, arrangements were made for two 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 this 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 58 County Council's School Clinic in Stanley Road. The following cases were dealt with during the year:— Referred for treatment 30 Treatment received 28 ,, postponed 2 (b) Ante-Natal Clinic—Report of Dr. Rose Turner. There were 22 sessions of the Ante-Natal Clinic held during the year 1935. The number of expectant mothers who attended was 107, of whom 34 were primiparæ and 73 multiparæ. Ninety-eight were first attendances. This shows a large increase in the number of Ante-Natal cases attending the Clinic, the increase being due in part to the local midwives, who have very kindly attended at alternate Clinics. Not only is the help given at the Clinics by the midwives very greatly appreciated, but it also encourages their patients to come to the Clinics. In addition to the Ante-Natal cases there were 11 Post-Natal attendances. Several mothers had defective sight. Five had their eyes attended to at the ophthalmic department of the Royal Hospital, Richmond. A large number of expectant mothers have very defective teeth. This constitutes one of the greatest problems at the Clinic. Pyorrhoea is always a serious matter owing to the "poisons" which are liberated and circulate in the blood stream, but it becomes a very dangerous condition in pregnant women. It would be of great value if an arrangement could be made by which mothers with defective teeth could obtain free treatment, or treatment at a nominal charge. The Health Visitor has begun giving "Health Talks" to the mothers this year. These have been most helpful. We are very fortunate in having patients who appreciate the Clinic. 59 Ophthalmia Neonatorum, 1931-1935. Year Cases Notified Cases Treated Vision unimpaired Vision impaired Total Blindness Deaths At honce In hospital 1931 1 1 - 1 - - - 1932 1 — 1 1 — — - 1933 1 1 - 1 - — - 1934 — — — — — — — 1935 — — — - — — — 60 (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. 1933 627¾ 585 5/8 357 356 7/8 1927½ 1934 359 3/8 248½ 255½ 314 3/8 1177¾ 1935 362 290 1/8 306½ 381 7/8 1340½ 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 Maternity 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 - 61 (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. 62 INDEX Page Acts, Adoptive 22 Ambulance Facilities 10 Ante-Natal Clinic 9,59 Bacteriological Examination of Milk 30, 31 Bake-houses 27 Births 12, 13, 14, 52 Birth Control 62 Bye-laws 22 Cancer 14,15 Common Lodging-houses 35 Collection and Disposal of House Refuse 23 Deaths 14, 15. 16, 17, 18, 19, 20 Dental Treatment 9, 58, 62 Diseases of Circulatory System 14 Disinfection 35 Drainage and Sewerage 23 Factories, Workshops & Workplaces 34 Food, Inspection and Supervision of 28 Food and Drugs (Adulteration) Act 33 General Provision of Health Services 7 Health Visiting 56 Hospitals 7, 8, 62 Housing 36 Housing Statistics 37 Illegitimacy 12, 52 Infant Life Protection 56 Infantile Mortality 52, 53, 54 Infant Welfare Centre 9, 57 Infectious Diseases 42, 43, 45, 46, 47 Institutional Provision for Unmarried Mothers, Illegitimate Infants and HomelessChildren 8 Isolation Hospital Accommodation 44 Laboratory Work 50 Page Maternity and Child Welfare Centre 57 Maternity and Child Welfare Committee 2 Maternity and Child Welfare Statistics 52 Maternal Mortality 55 Mental Treatment 62 Midwives Acts, Administration of 55 Midwives 10 Milk, Provision of 61 Milk Purveyors 28 Milk Supply 28 Natural and Social Conditions 7 Nursing Homes 61 Nursing in the Home 8 Ophthalmia Neonatorum 60 Orthopaedic Treatment 62 Population 12 Puerperal Fever & Pyrexia 55 Public Health Committee 2 Rag Flock Acts 35 Rats & Mice (Destruction) Act... 35 Rivers and Streams 23 Sanitary Inspection of District 24 Scavenging 23 School Clinics 9 Slaughter-houses 28 Smallpox 7, 42 Smoke Abatement 35 Staff 3 Statistics, General and Vital 6, 12, 20, 52 Still Births 6, 52 Sun-ray Treatment 62 Swimming Bath, etc. 40 Tents, Vans and Sheds 35 Trowlock Island 39 Tuberculosis 7, 9, 48, 49 Unsound Food 32 Vaccination 42 Venereal Diseases 7, 9 Water Supply 22 63