TED 4 Teddington Urban District Council PUBLIC HEALTH DEPARTMENT ANNUAL REPORT FOR 1936 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 1936 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, 1936 Chairman— councillor miss D. B. L. marshall. Councillor R. H. Berry. „ Mrs. M. F. Bligh. „ W. J. Cornwill. „ J. U. Dale. P. H. Durham. „ H. Field. A. G. Greig. „ Capt. B. T. Harding. E. G. Ive. „ H. W. Peachey. (Chairman of the Council). „ E. Taverner. F. W. Tomalin. (Vice-Chairman of the Council). G. E. Weaver. L. C. Williams. MATERNITY & CHILD WELFARE COMMITTEE. Chairman—councillor miss D. B. L. marshall. Councillor Mrs. M. F. Bligh. „ J.U. Dale. „ H. Field. „ H. W. Peachey. (Chairman of the Council). „ E. Taverner. „ F. W. Tomalin. (Vice-Chairman of the Council). „ L. C. Williams. Co-opted Members: Mrs. D. Jones, Mrs. H. A. M. Langdon-Down, Mrs. N. K. Taylor, and Mrs. E. M. Williams. 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.San.I., Cert. R.S.I, as Sanitary Inspector and Meat and Foods Inspector. Additional Sanitary Inspector: W. F. NEWPORT, A.R.San.I., Certified Sanitary Inspector and Meat and Foods Inspector. (Commenced March, 1936.) Chief Clerk: Horace J. Pugh. Assistant Clerk: Miss W. F. E. Mackway. (Resigned August, 1936.) Miss D. Powell. (Commenced September, 1936.) Health Visitors: Miss E. M. Clarke, C.M.B., Cert. S.I.E.B., Health Visitor's Certificate. (Whole time.) Miss A. M. S. Mathews, S.R.N., C.M.B., Cert. R.S.I. Health Visitor, M.I.H. (Whole time.) (Commenced December, 1936.) Miss E. E. H. Schlund, C.M.B., Cert. R.S.I. Health Visitor. (Part time.) (Appointment terminated November, 1936.) Disinfector: G. sivyer. 3 To the Mayor, Aldermen and Councillors of the Borough of Twickenham. Ladies and Gentlemen, I submit herewith my Report for 1936 on the health and sanitary conditions of the late Teddington Urban District, together with vital statistics. The health of the District during 1936 was very satisfactory. The incidence of infectious disease was slight and the general death rate figure low. It is particularly gratifying to report that the Infantile Mortality Rate fell to the remarkably low figure of 28 per 1,000 and, further, that there were no Maternal Deaths. I am pleased to acknowledge gratefully the support accorded to me in my work by the members of the Council, the valuable assistance of lady voluntary workers at the Clinics, and the loyal help given to me by all the members of my Staff. I am, Ladies and Gentlemen, Your obedient Servant, John Young 5 STATISTICAL SUMMARY FOR THE YEAR, 1936. Area of the District in acres:— Land 1188.828 Inland Water 25.291 Foreshore and Tidal Water 8.572 Total 1222.691 Resident Population—Estimated to the middle of year 1936 (as supplied by the RegistrarGeneral) 23,360 Number of inhabited houses (1936) 6,189 Rateable Value (31st December. 1936) £208,608 Product of a Penny Rate £810 Total M. F. Legitimate 328 167 161 Live Births 347 Illegitimate 19 6 13 Birth Rate, 1936, per 1,000 population 14 8 Total M. F. Still Births, Legitimate 15 10 5 5 Illegitimate Still Birth Rate per 1,000 Births (Live and Still) 414 M. F. Deaths 140 120 260 Crude Death Rate, 1936, per 1,000 population 111 Adjusted Death Rate (Comparability Factor 0.98) 10.8 Number of women dying in, or from sepsis Nil in consequence of, childbirth from other causes Nil Deaths of infants under one year of age per 1,000 births : (i) Legitimate 30 (ii) Illegitimate Nil (iii) Total 28 Deaths from Measles (all ages) 3 Deaths from Whooping Cough (all ages) 3 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 1188.828 acres of land, 25.291 acres of inland water, and 8.572 acres of foreshore and tidal water, making a total of 1222.691 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, but there are now a number of flourishing industries which absorb several hundreds of workers. The National Physical Laboratory, which is of world renown, adjoins the District. The residents are fortunate in the social amenities which the District possesses. The river frontage, with its clubs, gardens and boathouses, and the famous Teddington Locks, is one in which we may take pride. Bushy Park, too, offers excellent facilities for healthy recreation and leisure. During the year the Council transformed a piece of vacant land in Grove Gardens into a pleasant Recreation Ground—complete with Pavilion, Bowling and Putting Greens. GENERAL PROVISION OF HEALTH SERVICES. Hospitals provided or subsidised by the Local Authority or the Middlesex County Council. Fever. 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, 1935. 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. 7 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. Other Hospitals. Teddington, Hampton Wick and District Memorial' Hospital. This Hospital, built in 1928-29, is a voluntary institution. It has been added to from time to time, and during 1936 the verandahs at the ends of male and female wards were built in, giving three more beds to each ward. The accommodation is now as follows:— Male Ward 15 beds. Female Ward 15 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 has, therefore, a total accommodation of 50 beds, having practically doubled in size during the past live years. It 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 1936 was 691 and casualties 762. Operations performed: Major, 233; Minor, 218. Dental, 130. The Council made a contribution of £25 during the year. Several cases were referred to the Hospital from the Clinics for surgical treatment, and I am pleased to report that they were dealt with in a very satisfactory way and received every attention. 8 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. AMBULANCE FACILITIES. 0) For Infectious Diseases. A motor ambulance provided by the South Middlesex and Richmond Joint Hospital Board. (b) For Non-Infectious and Accident Cases. A motor ambulance provided by the Teddington Urban District Council. (c) For Maternity Cases. A motor ambulance provided by the Hospital, to which the case is removed. MIDWIVES. The Council have undertaken the provision of midwives for necessitous women when the conditions of the home are suitable for confinement therein. 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. 1st and 3rd Tuesday of the month at 2 p.m. 2nd, 4th and 5th Tuesday of the month, 10.30 a.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. 10 Vital Statistics (1) POPULATION. The Registrar-General's estimate of resident population for the mid-year, 1936, viz., 23,360, represents an increase of 220 persons since last year. The population, as ascertained by the 1931 Census, was 23,369. (2) BIRTHS. The births registered in the District in 1936 numbered 347, giving a birth rate of 14.8 per 1,000 of the population. The births were made up as follows : — Males. Females. Total. Legitimate 167 161 328 Illegitimate 6 13 19 Total 173 174 347 The birth rate in Teddington during the year 1936 shows a satisfactory increase compared with the previous year. In fact, it is the highest recorded since 1931. The number of illegitimate births has varied very little during the past ten years. 12 Vital Statistics. Table No. 1. Births and Birth Rates, 1927-1936 Year Teddington England and Wales Births Rate per 1,000 living Rate per 1,000 living 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 1936 347 14.8 14.8 (3) DEATHS. The nett deaths registered in the District during 1936 numbered 260, and were made up as follows: males 140, females 120. The crude death rate per 1,000 of the population for the year was 11.1. The adjusted death rate per 1,000 of the population was 10.8. (Comparability factor 0.98.) The death rate for England and Wales was 121. (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. 0) Diseases of the Circulatory System. Ninety-three deaths during the year were due to heart disease, aneurysm, cerebral haemorrhage and other circulatory diseases. 14 Comparative Analyses, 1932-1936. 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 1932 74 29.1 3.1 1933 78 33.2 3.4 1934 72 30.4 3.1 1935 94 33.8 4.0 1936 93 35 7 3 9 (d) Cancer. Forty-one deaths during the year were due to cancer. Of these59 per cent, were males, and 41 per cent, females. Comparative Analyses, 1932-1936. Deaths from Cancer. Year Total Deaths from Cancer Percentage of Total Deaths Death Rate— Cancer per 1,000 1932 38 14.9 1.6 1933 38 162 1.6 1934 33 13 9 1.4 1935 39 13-9 1.6 1936 41 15.7 1.7 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, 1927-1936. Year Teddington England and Wales Deaths Rate per 1,000 living Rate per 1,000 living 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 1936 260 (a) 11.1 12.1 (b) 10.8 (a) Crude (b) Adjusted 16 Vital Statistics. Table No. 3. Causes of Death, 1936. (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 1 3 5 Diphtheria — — — 6 Influenza 2 1 3 7 Encephalitis Lethargica — - — 8 Cerebro-spinal Fever — - — 9 Tuberculosis of respiratory system 8 6 14 10 Other Tuberculous Diseases 1 1 2 11 Syphilis — — — 12 General Paralysis of the insane, Tabes Dorsalis 1 1 2 13 Cancer, malignant disease 24 17 41 14 Diabetes 4 3 7 15 Cerebral Haemorrhage, etc. 8 9 17 16 Heart Disease 28 36 64 17 Aneurysm — — — 18 Other circulatory diseases 6 6 12 19 Bronchitis 5 5 10 20 Pneumonia (all forms) 6 3 9 21 Other respiratory diseases 1 1 2 22 Peptic Ulcer 2 — 2 23 Diarrhoea, etc. (under 2 years) — — — 24 Appendicitis — 1 1 25 Cirrhosis of Liver — — — 26 Other Diseases of Liver etc. 1 — 1 27 Other Digestive Diseases 4 5 9 28 Acute and Chronic Nephritis 11 3 14 29 Puerperal Sepsis — — — 30 Other Puerperal causes — — — 31 Congenital debility, premature birth, malformations, etc. 3 - 3 32 Senility ... 2 2 4 33 Suicide ... 3 1 4 34 Other Violence 6 1 7 35 Other defined diseases 11 15 26 36 Causes ill-defined or unknown — — — TOTALS 140 120 260 18 Vital Statistics. Table No. 4. Birth Rate, Death Rate and Analysis of Mortality during the Year 1936. (Provisional Figures.) Rate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate 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 14.8 0.61 12.1 0.01 — 0.07 0.01 0.05 0.07 0.14 0.52 5.9 59 122 County Boroughs and Great Towns, including London 14.9 0.67 12.3 0.01 - 0.09 0.01 0.06 0.08 0.14 0.45 8.2 63 143 Smaller Towns (Resident Populations 25,000—50,000) at 1931 Census 15.0 0.64 11.5 0.00 - 0.04 0.01 0.04 0.05 0.15 0.39 3.4 55 London Administrative County... 13.6 0.53 12.5 0.01 — 0.14 0.01 0.06 0.05 0.14 0.52 14.4 66 Teddington 14. 8 0.64 10.8 0.00 - 0.12 0.00 0.12 0.00 0.12 0.47 0.00 28 19 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 1927-1936 inclusive. Year. Birth Rate Death Rate Infantile Mortality Rate Teddington England and Wales Teddington England and Wales Teddington England and Wales 1927 16.5 16.7 10.5 12.3 28 69 3928 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 10.8 120 47 65 1933 12.7 14.4 10.1 12.3 57 64 1934 14.09 14.8 (a) 10.2 11.8 33 59 (b) 9.9 1935 12.87 14.7 (a) 12.0 11.7 53 57 (b) 11.7 1936 14.8 14.8 (a) 11.1 121 28 59 (b) 10.8 (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 Rivef Thames were received during the year. (4) DRAINAGE AND SEWERAGE. The Council is a constituent Authority under the West Middlesex Sewerage Disposal Scheme, formulated by the Middlesex County Council. Early in the year when certain of the Council's sewers were first connected to the Middlesex County Council's Trunk sewer, complaints of offensive odours were received from several parts of the District. The nuisances were quickly remedied upon being reported to the County Authority. (5) SCAVENGING. The main roads throughout the District have been swept daily and the less important several times weekly, according to requirements. The street gullies have been emptied, disinfected and flushed when necessary, and where of unsuitable pattern, have been replaced by an improved type as opportunities occur. (6) COLLECTION AND DISPOSAL OF HOUSE REFUSE. Refuse has been removed thrice weekly in the shopping areas and twice weekly in the residential areas, and disposed of by tipping and burning in a destructor. 23 Notices were served from time to time by this Department for the provision of sanitary dustbins, and during the year a number of new dustbins were supplied by owners. (7) SANITARY INSPECTION OF DISTRICT. Visits and Inspections, 1936. Visits in connection with Infectious Diseases 320 Houses inspected under Public Health and Housing Acts 519 Inspections under the rent Restrictions Act 4 Houses re-inspected after notice and re-inspections to work in progress 3187 Food Shops and Stalls 107 Slaughter-houses 1063 Dairies, Cowsheds and Milkshops 72 Bakehouses 63 Factories, Workshops and Workplaces ... ... 232 Schools 38 Disused gravel pits and dumps 53 Halls and Cinema 29 Ice Cream premises 14 Sanitary Conveniences 61 Smoke Observations 29 Miscellaneous 313 24 Summary of Work Executed, 1936. Water Supply :— Draw taps fitted to main supply pipes 6 Cisterns cleansed, repaired, covered, etc. 17 Water Closets:— Cleansed 55 Flushing cisterns, repaired or renewed 35 New pans, etc. 20 Ventilated or ventilation improved 1 Separate accommodation for sexes provided 1 Accommodation provided 1 Dampness:— Roofs repaired 180 Brickwork repaired, renewed or rendered impervious, etc. 175 Ventilation to floors 36 Drains: — Cleared and flushed 19 Repaired 12 Examined, tested or exposed 2 Sanitary Dustbins: — Provided 21 Eaves gutters and rain water pipes:— Repaired or renewed 121 Soil Pipes:— Repaired, renewed and ventilated 4 Houses, Workshops, etc:— Rooms cleansed 320 Ceiling plaster repaired 105 Wall plaster repaired 211 25 Floors repaired 105 Windows repaired, sash cords, etc. provided 216 Fire grates repaired or provided 99 Coppers repaired, etc. 43 Sinks:— Provided 12 Repaired or refixed 4 Waste pipes repaired or renewed 10 Yards:— Cleansed 7 Paved or repaired 64 Various — Nuisances abated from chimneys sending forth black smoke 2 Nuisances abated from animals being improperly kept Offensive accumulations removed 17 Offensive smells 3 Miscellaneous 322 Complaints. During the year, complaints were received regarding the following matters :— Accumulations of refuse 14 Choked or defective drains 7 Damp walls 24 Defective ceilings 6 ,, coppers 1 ,, eaves gutters and rain water pipes 7 ,, floors 8 ,, fire grates or kitchen ranges 13 26 Defective roofs 18 ,, sinks 3 ,, sink waste pipes 4 ,, walls 15 ,, water closets 26 ,, water supply 3 Dirty rooms 21 Houses infested with rats 28 Insanitary condition of yards 14 Offensive smells from various causes 5 Smoke nuisances 7 Verminous houses 24 Miscellaneous 45 Schools. The scheme for the reconstruction and enlargement of Station Road Schools came into effect during the latter part of the year. Temporary accommodation for the displaced children has been arranged at St. Mary's and St. Peter's School, Church Road, and the Art School, Church Road, whilst the alterations are being executed. It is anticipated that the works will be completed and the schools ready for occupation after the summer vacation. Periodic inspections of the other schools within the District have been carried out during the year, and conditions found to be satisfactory. (8) BAKEHOUSES. The bakehouses in the District have been inspected frequently and, with the exception of minor defects which have been remedied immediately, have been kept in a satisfactory condition. Factory Bakehouses 5 Workshop Bakehouses 7 Total 12 Number of inspections 63 27 (9) SLAUGHTER-HOUSES. There are seven slaughter-houses within the District— two registered and five licensed. Six were in use during the year. These premises are constantly being inspected, and it has been found that the various provisions of the Bye-Laws and Public Health (Meat) Regulations have been observed. Numerous complaints have been received respecting Sunday and evening slaughtering of animals. The Council have no power to prevent this practice, but in an effort to meet the situation have had under consideration the provision of a Public Abattoir, where all slaughtering in the District could be centralised and more readily controlled. Registered Slaughter-houses 2 Licensed Slaughter-houses 5 Total 7 Number of inspections 1063 (10) INSPECTION AND SUPERVISION OF FOOD. (a) Milk. Of the 31 Retail Purveyors of Milk on the Register, only four are themselves bottling milk. The remainder purchase their supply already bottled. The bottling establishments are regularly inspected and are kept in a satisfactory condition. Practically the whole of the milk supply to Teddington is imported and has been pasteurised before delivery. At the same time in order to ensure, as far as possible, that the public are safeguarded, informal samples are taken frequently of milk on sale in the District, and submitted for bacteriological examination to the Royal Institute of Public Health. Details of the Bacteriologist's reports are given on page 30. Graded Milk. An adequate supply of graded milk has always been available. 38 Purveyors of Graded Milk, 1936:— "Certified" 3 "Grade A (Tuberculin Tested)" 7 "Grade A (Pasteurised)" 1 "Pasteurised" 5 These grades were revised during the year under the Milk (Special Designations) Order, 1936, the new designations being (1) Tuberculin Tested, (2) Tuberculin Tested (Certified), (3) Accredited, (4) Pasteurised. Only two new licenses have been issued since these amendments came into force on the 1st June, 1936, viz. :— "Tuberculin Tested"1 "Pasteurised" 1 29 Table showing the Results of Bacteriological Examination of Milk Samples, 1936. Sample. Organisms per c.c. Minimal amount showing presence of B. Coli. Bacteriologist's Remarks. 1 8,500 Absent in 1 c.c. Obviously a Pasteurised milk from absence of B. coli in i c.c. 2. 9,000 Absent in 1 c.c. Obviously a Pasteurised milk from absence of B. coli in i c.c. 3. 7,000 - Conforms to prescribed conditions for Pasteurised milk. 4. 6,000 Absent in 1 c.c. Figures suggest that this milk has been Pasteurised. 5. 50,000 Present in 1 c.c. Comparable to a Pasteurised milk of standard grading. 6. 35,000 Present in 0.1 c.c. Comparable to a Pasteurised milk of standard grading. 7. 800,000 Present in 0.1 c.c. Milk shows high coliform and bacterial content, and does not approach standard of any graded milk. 8. 34,200 Present in 0.1 c.c. Comparable to a Pasteurised milk of standard grading. 8. 5,500 Present in 0.1 c.c. Comparable to a Pasteurised milk, but evidently not efficiently heated. 10. 16,000 Present in o.o1 c.c. Comparable to a Pasteurised milk, but evidently not efficiently heated. 11. 250 — Conforms to prescribed conditions for Pasteurised milk. 12. 4,000 — Conforms to prescribed conditions for Pasteurised milk. 30 (b) Meat. There was a total of 9,425 animals slaughtered within the District during the year. This represents a considerable increase over the previous year, and consequently an increasing amount of the Sanitary Inspectors' time has to be devoted to meat inspection. The carcases and offal of all animals slaughtered were subjected to a strict routine inspection, and the diseased parts surrendered for destruction. The men engaged in the slaughtering and dressing of the animals all conducted themselves satisfactorily, and it was not necessary to recommend cancellation of any licenses. The following table shows how this work has grown during the last few years:— Year Beasts Calves Pigs Sheep Total 1932 10 479 3365 680 4534 1933 18 777 4080 2038 6914 1934 18 886 3876 1313 6093 1935 97 1609 4144 2288 8138 1936 65 1489 5715 2156 9425 Unsound Food. The following articles of food were found to be unfit for human consumption and were surrendered to be destroyed. It was not necessary to exercise powers of seizure in any case. 31 Article. Disease. 1 beast's carcase and offal Tuberculosis. 2 beasts' forequarters Tuberculosis. 3 beasts' heads Tuberculosis. 1 beast's tongue Tuberculosis. 10 beasts' lungs Tuberculosis. 4 beasts' livers Tuberculosis. 2 beasts' livers Cavernous Angiomata. 1 beast's liver Bacterial Necrosis. 2 beasts' mesenterys Tuberculosis. 2 calves' carcases and offal Tuberculosis. 1 calf's head Tuberculosis. 2 calves' plucks Tuberculosis. 4 calves' lungs Tuberculosis. 1 calf's lungs Inflammation. 6 calves' livers Tuberculosis. 1 pig's carcase and offal Fever and Dropsy. Portion of pig and offal Tuberculosis. 1 pig's forequarter Tuberculosis. 100 pigs' heads Tuberculosis. 32 pigs' plucks Inflammation. 13 pigs' plucks Tuberculosis. 311 pigs' lungs Inflammation. 8 pigs' lungs Tuberculosis. 2 pigs' lungs Strongylus Paradoxus. 2 pigs' lungs Pleurisy. 179 pi&s' livers Cirrhosis. 4 pigs' livers Fatty Degeneration. 3 pigs' livers Tuberculosis. 2 pigs' livers Milk Spots. 1 pig's liver Inflammation. 36 pigs' hearts Pericarditis. 30 pigs' mesenterys Tuberculosis. 3 pigs' mesenterys Inflammation. 1 pig's kidney Cysts. 1 pig's kidney Nephritis. 2 pigs' spleens Inflammation. 1 pig's spleen Tuberculosis. 23 sheep's lungs Strongylus Rufescens. 20 sheep's livers Degenerated Cysts. 12 sheep's livers Distomum Hepaticum. 2 sheep's livers Bacterial Necrosis. 1 sheep's liver Fatty Degeneration. 21 lbs. smoked fillet Unsound. (c) Other Foods. Frequent visits were made to butchers' and other shops where food is prepared or exposed for sale. 32 (d) Food and Drugs (Adulteration) Act, 1928. Dr. J. Tate, County Medical Officer of Health, has kindly supplied the following information relating tc samples taken in this District during the year:— Article. Taken. Adulterated. Milk 29 - Castor Oil 1 - Cream Pastry 1 - Gin 1 1 Ginger, Ground 1 - Lard 1 1 Lemon Curd 1 - Meat Paste 6 2 Minced Beef 3 - Mincemeat 1 - Olive Oil 1 - Pepper 1 - Sausages 8 - Whisky 9 1 64 5 33 (11) FACTORIES, WORKSHOPS & WORKPLACES. 1—Inspection of Factories, Workshops & Workplaces. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 56 8 - Workshops (including Workshop Laundries) 105 5 — Workplaces (Other than Outworkers' premises) 71 7 - Total 232 20 — 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 10 10 - — Want of ventilation 1 1 - — Overcrowding — — — — Want of drainage of floors 3 2 - — Other nuisances 15 13 — — Sanitary accommodation— Insufficient 3 1 — — 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) . - - 1 - Total 38 32 1 - *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 complaints have been received, or nuisances arisen, in respect of such dwellings in the District 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, ETC. During the year the following premises were disinfected after cases of infectious disease or for verminous conditions, etc. :— Diphtheria 41 Scarlet Fever 27 Enteric Fever 1 Puerperal Pyrexia 1 Tuberculosis 7 Miscellaneous 39 Disinfestation. Considerable attention has been given to this subject during the year, and a special report dealing with the problem was presented to the Public Health and Housing Committee in December. The conclusion reached was that, generally speaking, if occupiers are determined to rid their homes of vermin, they will—by assiduous cleansing and regular spraying of the affected premises with insecticides supplied by the Council—eventually be successful. (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, 176 houses were built by private enterprise. A survey was carried out early during the year, as required by the Housing Acts, to determine the amount of overcrowding existing in the working-class dwellings in the District. Altogether 3,365 working-class houses were dealt with, and of this number 199 were measured up as possibly or definitely overcrowded. The final figures revealed that 53 families were overcrowded, distributed as follows:— Fulwell Ward 7 cases. Upper Ward 26 ,, Lower Ward 12 ,, South Ward 8 ,, The above figures include 301 Council houses in which eight cases of overcrowding were disclosed. At the end of the year, nine cases of overcrowding had been abated. All the working-class houses have now been measured up, and the number of persons (the "permitted number") who may occupy each, determined. It becomes an offence if the "permitted number" in respect of any dwelling is exceeded after the 1st January, 1937, and by enforcing this requirement it is anticipated that future overcrowding will thus be prevented. The reconditioning of working-class dwellings under the repair sections of the Housing Acts has progressed steadily throughout the year, and considerable improvement in the housing conditions in our working-class areas has been effected, notably in such roads as Church Lane, North Place, Fulwell Road, West Road, York Road, Springfield Road, Field Lane, etc. The Council has maintained its policy of erecting cheap maisonettes wherever suitable land has been available, thus putting into practical effect the wishes of all its members for the proper housing of the working-classes at economic rents in Teddington. 36 The following statistics show the amount of work carried out by the Public Health Department with regard to housing : — Housing Statistics, 1936. Number of new houses erected during the year:— (a)Total, including numbers given separately under (£) 176 (b) With State assistance under the Housing Acts :— (i) By the Local Authority nil (ii) By other persons or bodies nil 1. Insfection of Dwelling-houses during the year :— (1) (a) Total number of dwelling-houses spected for housing defects (under Public Health or Housing Acts) 519 (b) Number of inspections made for the purpose (primary) 519 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 333 (b) Number of inspections made for the purpose (primary) 333 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation nil 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 451 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 345 3. Action under Statutory Poivers 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 65 (2) Number of dwelling-houses which were rendered fit after service of formal Notices : — (a) By owners 32 (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 rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit nil 4. Housing Act, 1935: Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 46 (ii) Number of families dwelling therein 46 (iii) Number of persons dwelling therein 328J (b) Number of new cases of overcrowding reported during the year 55 (c) (i) Number of cases of overcrowding relieved during the year 9 (ii) Number of persons concerned in such cases 40 (19) TROWLOCK ISLAND. This Island—on the River Thames—has been fully described in my previous Reports. I can only repeat that it is most 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. The Council's Open-Air Bath in Vicarage Road offers excellent facilities for swimming. It is regularly attended by children from the schools. The water in the Bath is filtered constantly, after which it is completely sterilised to ensure that it is always clean and safe. As a further precaution it is tested frequently to determine the amount of treatment that is necessary. Infectious Diseases (a) NOTIFIABLE INFECTIOUS DISEASES. Diphtheria. There were 39 cases of Diphtheria notified, as compared with 52 for the previous year. With few exceptions the type of disease was mild. There were no deaths. Scarlet Fever. The number of cases of Scarlet Fever notified was 29, as compared with 37 for the previous year. There were no deaths. Enteric Fever. Two cases of Enteric Fever were notified, and admitted to Mogden Isolation Hospital. Both cases occurred in the same household. Table A. Infectious Diseases. Quarter Diphtheria Scarlet Fever Enteric Fever 1st Quarter 5 10 - 2nd „ 10 7 - 3rd „ 3 5 2 4th ,, 21 7 - Totals 39 29 2 Smallpox. No case of Smallpox was notified during the year. No 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 1936 277 168 77 60.6 42 Encephalitis Lethargica. No case of Encephalitis Lethargica was notified. Puerperal Fever and Puerperal Pyrexia. Two cases of Puerperal Pyrexia were notified during the year. Both were treated in Hospital. Ophthalmia Neonatorum. See page 59. Pneumonia, Malaria and Dysentery. Pneumonia. There were 38 cases of Pneumonia notified during the year, 27 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 Teddmgton compared with that for England and Wales for the year 1936 :— 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 39 1.66 1.39 Scarlet Fever 29 1.24 2.53 Enteric Fever 2 0.08 0.06 Pneumonia 38 1.62 1.11 Erysipelas 2 0.08 0.40 43 (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. Cases have been regularly notified to the Department from the schools throughout the year. ISOLATION HOSPITAL ACCOMMODATION. The Council is a constituent Authority of the South Middlesex and Richmond Joint Hospital Board. During the year, 67 cases, for which the Council were responsible for payment, were removed to hospital. 44 45 Table D. Infectious Diseases. Cases of Infectious Diseases notified during the Year 1936. 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 — 2 10 6 6 4 2 — — 39 40* — 15 18 4 2 Erysipelas — — — — — — — — 1 — 1 — 2 — — 1 — 1 — Scarlet Fever - - 1 1 1 8 5 3 7 2 1 - 29 25 — 6 12 4 7 Puerperal Fever - - - - - - - - - - - - - - - - — — - Puerperal Pyrexia - - - - - - - - 2 - - - 2 2 - — 2 - - Enteric Fever — — — — - 1 — — 1 — — 2 2 — — — — 2 Continued Fever — — - — - — — — — — — — — — — — — — — Cerebro-Spinal Fever - - - - - - - - - - - - - - - - - - - Acute Poliomyelitis... — — — — — — — — — — — — — — — - — — — Ophthalmia Neonatorum - — — — — — — — — - — — — — — - — — — Malaria - - - - - - - - - - - - — - - - - - - Dysentery - - - - - - - - — - — - - - — - — - - Pneumonia — 3 1 4 4 6 — 3 6 2 6 6 38 27 9 4 20 7 7 Acute Encephalitis Lethargica — — — — — — — — — — — — — — 1 — — — — Acute Polio-Encephalitis — - — — — — — — — — — — — — — - — — — Tuberculosis— (a) Pulmonary M - - - - - - - 1 4 2 6 — 13 — 8 - 6 6 1 F - - - - - - - - 9 - 3 - 12 - 6 3 3 3 3 Total - - - - - - - - - - - - 25 — 14 — — - - (b) Non-Pulmonary M — - — - - - 1 — 2 - - - 3 - 1 2 1 - - F - - - - - 2 - 1 2 - - - 5 - 1 1 2 1 1 Total - - - - - - - - - - - - 8 - 2 - - - - TOTALS 1 4 3 5 7 33 12 14 34 9 17 6 145 96 25 32 64 26 23 * Including 2 Observation Cases 47 Table E. Infectious Diseases. Table showing Monthly Incidence of Infectious Diseases and Number of Deaths during 1936. Disease Number of Cases Total No. of Deaths Jan. Feb. Mar. Apl. May June July Aug. Sept. Oct. Nov. Dec. Diphtheria 2 3 1 2 6 1 1 - 2 3 12 6 39 Erysipelas — — — 1 — — — - 1 — — — 2 — Scarlet Fever 5 1 4 4 2 1 2 1 2 2 2 3 29 — Ophthalmia Neonatorum — — — — — — — — — — — — — — Pneumonia 9 4 6 2 2 — — 2 2 4 1 6 38 9 Enteric Fever — — — — — - — — 2 — — — 2 — Puerperal Fever — — — — - - - - - - - - - - Puerperal Pyrexia — — — — — — — — — — 2 — 2 — Cerebro-Spinal Fever — — - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - Totals 16 8 11 9 10 2 3 3 9 9 17 15 112 9 Tuberculosis. T.B. Table No. 1. New Cases and Mortality during 1936. Age Periods New Cases—33 Deaths—16 Pulmonary Non-Pulmonarv Pulmonary Non-Pulmonary Male Female Male 1 Female Male Female Male Female Under 1 year — — - - - - - - 1 to 5 years — — — — — — — — 5 „ 10 „ — — — 2 — — — — 10 ,, 15 — — 1 - — — — — 15 „ 20 ,, 1 — — 1 — — — 1 20 ,, 25 „ — 5 1 - 1 1 1 — 25 ,, 35 „ 4 4 1 2 1 4 — — 35 ,, 45 „ 2 — — - 3 1 — — 45 ,, 55 „ 4 1 — — 1 — — — 55„ 65 „ 2 2 — - 2 — — — 65 and upwards — — — — — — — — Totals 13 12 3 5 1 8 6 1 1 T.B. Table No. 2. Primary Notifications of Tuberculosis, 1927-1936 inclusive. 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Pulmonary 22 18 23 19 26 26 24 24 18 25 Other Forms 6 6 6 11 3 3 3 4 2 8 Totals 28 24 29 30 29 29 27 28 20 33 T.B. Table No. 3. Deaths from Tuberculosis, 1927-1936 inclusive. Years No. of deaths Pulmonary Tuberculosis No. of deaths Other Forms of Tuberculosis Total00 Deaths Death Rate All Forma per 1,000 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 1936 14 2 16 68 48 It will be seen from the foregoing tables that during the year 1936, sixteen deaths were recorded from this disease—as compared with nineteen for the previous year. Non-notified tuberculosis deaths—cases not notified as tuberculosis and not recorded in the registers of the Department during life—were responsible for 25 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, 1936. 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 etc., for Tubercle Bacilli 62 8 Positive Throat & nasal swabs for Diphtheria 209 17 Miscellaneous 23 Total Specimens Examined 294 B. Number of samples of water submitted for bacteriological or chemical examination 1 50 Maternity and Child Welfare. (1) VITAL STATISTICS. (a) Notification of Births Act. The number of births reported to the Public Health Department in 1936 was as under:— Total Births—Notified by Midwives 177 Notified by Doctors and Parents 169 Total 346 Still Births—Notified by Midwives 4 Notified by Doctors and Parents 10 Total 14 (,b) Infantile Mortality in 1936. Nett live births registered 347 Number of deaths of infants under one year 10 Infantile Mortality 28 Nett illegitimate live births registered 19 Number of deaths of illegitimate infants under one year nil Infantile Mortality in illegitimate infants nil 52 Infantile Mortality, 1927-1936. Year Teddington 1 England and Wales Births (Deaths under 1 year Kate per 1,000 Births Rate per 1,000 Births 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 1936 347 10 28 59 54 (c) Maternal Mortality in 1936. Deaths from puerperal sepsis nil Deaths from other accidents and diseases of pregnancy nil No deaths occurred as a result of, or in connection with, reproduction. 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, has been carried out by the Middlesex County Council. There were two midwives practising in the District at the end of the year. The total number of births notified by midwives was 177, or 51 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. The total visits show an increase of 200 compared with the previous year. The appointment of an additional whole-time Health Visitor was made in the latter part of the year, and it was then found possible to pay much more attention to the health of toddlers than previously. It is of the utmost importance that children between the ages of one and five years shall be kept under close supervision so that any defects found may be treated and cured while in their earliest stages. Visits paid during the year:— To Expectant Mothers:— First visits 90 Total visits 157 To children under 1 year of age:— First visits 299 Total visits 1356 To children between the ages of 1 to 5 years:— Total visits 1645 Special visits 16 Children Acts:— Total visits 344 Total visits for year 3518 (4) INFANT LIFE PROTECTION. All foster-mothers in the District were kept under strict supervision, and pressure was at once brought to bear when the home conditions were found to be in any way unsatisfactory. Various minor contraventions of the Children Acts 1908-1932 were found and dealt with from time to time, but it was not found necessary in any case in institute legal proceedings. Three hundred and fortyfour visits were paid by the Infant Life Protection Visitors. Foster-mothers on Register beginning of year 19 New foster-mothers registered during the year 13 Foster-mothers on Register end of year 20 note.—Eleven foster-mothers ceased to have charge of nurse-children; one left the District with nurse-child. 56 Nurse-children on Register at beginning of year 21 Nurse-children placed with foster-mothers during the year 19 Nurse-children on Register end of year 22 Note.—Of the above nurse-children, 16 were removed by parents, one was legally adopted, and one left the District with foster-mother. (5) THE MATERNITY AND CHILD WELFARE CENTRE. (a) Infant Welfare Centre. Total attendances 2792 Average attendance per session 382 Individual children attended 478 Tuesdays:— Sessions 25 Average attendance 253 Attendances under 12 months 374 First attendances under 12 months 47 Attendances 1 to 5 years 259 First attendances 1 to 5 years 15 57 Thursdays:— Sessions 48 Average attendance 45 Attendances under 12 months 1276 First attendances under 12 months 137 Attendances 1 to 5 years 883 First attendances 1 to 5 years 48 The total attendances at the Centre show a slight decrease compared with previous years, but this is due to better spacing of the attendances by older children. The number of first attendances has shown a steady increase during the past three years, and the number for 1936 is the largest on our records. The number of children attending in 1936 is the largest number of individual children who have attended the Centre in one year. Although Teddington has not had the advantage of a modern scientifically equipped Clinic, the mothers have co-operated willingly and happily in making the best of existing facilities. The physique of the children generally is good, and I have noticed particularly the low incidence of rickets and impetigo. The Teddmgton Rotary Club continued their good work of previous years by providing funds for sending away two mothers and two children for convalescent treatment. This generosity was much appreciated and of practical value. Dental Treatment.—The following cases of children under five years of age were dealt with at the County Council's School Clinic: — Referred for treatment 44 Treatment received 41 ,, postponed 2 ,, refused 1 (b) Ante-Natal Clinic—Report of Dr. Rose Turner. During the year twenty-four Ante-Natal Clinics were held. The number of expectant mothers who attended was 58 149, of whom 65 were primiparae and 99 multiparae. In addition to these there were 8 Post-Natal attendances. This year has shown a large increase in the number of mothers who have attended, and much appreciation has been expressed by many for the attention they received at the Clinic. They now respond more readily to advice given to them, and have come to realize more fully that— as in other things in life—it is the little things that count, such as attention to personal hygiene, fresh air, exercise and care of the teeth, etc. During the year five mothers had their eyes attended to at the Ophthalmic Department of the Royal Hospital, Richmond, and one has been referred to the Tuberculosis Officer. Two local midwives have kindly helped at the AnteNatal Clinics each at alternate sessions. This has helped to increase the number of mothers, as they appreciate having present the nurse who will attend them at their confinement. Ophthalmia Neonatorum, 1932—1936. Year Cases Notified Cases Treated Vision unimpaired Vision impaired Total Blindness Deaths At home In hospital 1932 1 — 1 1 — - — 1933 1 1 — 1 — - - 1934 — — — — — — — 1935 — — — — — — — 1936 — — — — — — — 59 (6) SUPPLY OF MILK FOR EXPECTANT AND NURSING MOTHERS AND FOR INFANTS. There is no doubt as to the value of granting free milk in necessitous cases where the health of mother or infant is unsatisfactory. Milk is an absolute necessity for the growing child, and in many cases where milk has been given to the nursing mother she is able to continue breast feeding—otherwise her breast milk fails and she is forced to buy artificial substitutes. The health of both mother and child is safeguarded, and often much benefited by the provision of an adequate supply of milk. 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. 1984 359 3/8 248½ 255½ 314 3/8 1177|¾ 1935 362 290 1/8 306½ 381 7/8 1340¼ 1936 461½ 378 5/8 376 7/8 355 5/8 1572 5/8 The milk supplied has been "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. (а) Dental Treatment. Arrangements have been made with the Middlesex County Council for the treatment of toddlers. (b) Orthopaedic Treatment. Suitable cases have been referred to the Royal National Orthopaedic Hospital, London, and the Red Cross Curative Post, Norbiton. (c) Sun-ray Treatment. Suitable cases have been referred for admission to the Teddington, Hampton Wick & District Memorial Hospital. (d) Mental Treatment. Cases have been sent to the University College Hospital, London. (e) Birth Control. Appropriate cases have been sent to a special Mothers' Clinic in London. In addition, cases have been 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 Page Acts, Adoptive 22 Maternity and Child Welfare Ambulance Facilities 9 Centre 57 Ante-Natal Clinic 10, 58 Maternity and Child Welfare Committee 2 Maternity and Child Welfare Bacteriological Examination of Statistics 52 Milk 30 Maternal Mortality 55 Bake-houses 27 Mental Treatment 62 Births 12, 13, 14, 52 Midwives Acts, Administration Birth Control 62 of Bye-laws 22 Midwives 9 Milk, Provision of 61 Cancer 14, 15 Milk Purveyors 28 Common Lodging-houses 35 Milk Supply 28 Collection and Disposal of House Refuse 23 Natural and Social Conditions 7 Nursing Homes 61 Deaths 14, 15, 16, 17, 18, 19, 20 Nursing in the Home 8 Dental Treatment 10,58,62 Diseases of Circulatory System 14 Ophthalmia Neonatorum 60 Disinfection 35 Orthopaedic Treatment 62 Drainage and Sewerage 23 Population 12 Factories, Workshops & Work- Puerperal Fever & Pyrexia 55 places 34 Public Health Committee 2 Food, Inspection and Supervision of 28 Rag Flock Acts 35 Food and Drugs (Adulteration) Rats & Mice (Destruction) Act 35 Act 33 Rivers and Streams 23 General Provision of Health Sanitary Inspection of District 24 Services 7 Scavenging 23 School Clinics 10 , Slaughter-houses 28 Health Visiting 56 Smallpox 7, 42 Hospitals 7, 8, 62 Smoke Abatement 35 Housing 36 Staff 3 Housing Statistics 37 Statistics, General and Vital 6, 12, 20, 52 Still Births 6,52 Illegitimacy 12,52 Sun-ray Treatment 62 Infant Life Protection 56 Swimming Bath,etc. 40 Infant Welfare Centre 10, 57 Infectious Diseases Tents, Vans and Sheds 35 42, 43, 44, 45, 46, 47 Trowlock Island 39 Institutional Provision for Un- Tuberculosis 7, 9, 48,49 married Mothers, Illegitimate Infants and Homeless- Unsound Food 31 Children 8 Vaccination 42 Isolation Hospital Accommoda- Venereal Diseases 7, 10 tion 44 Laboratory Work 50 Water Supply 22 63