To the Chairman and Members of the TWICKENHAM URBAN DISTRICT COUNCIL. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH, 1896. Mr. Chairman and Gentlemen, I have the honour to submit to you my Thirteenth Annual Report as to the Health and Sanitary condition of the Parish of Twickenham. The Report will embrace the vital statistics of the year 1896, which terminated on December 31st, and a summary of the measures taken for preventing the devolopment and dissemination of disease. The forms supplied by the Local Government Board (Tables A and B) accompany ; the former, Table A, is that of the deaths ; the latter, Table B, that of the population, births, and new cases of infectious sickness, these tables are both classified according to diseases, ages and localities. Appended also to this Report are the forms supplied by the Middlesex County Council ; Table C (i., ii., iii., iv.) An analysis of the information required and the sanitary work accomplished during the year will be embodied in the text of this Report, under the respective headings, dealing with the various details as set forth in the columns of the above Table. During the past year I am happy to record a large decrease, amounting to 32, in the number of deaths from all causes, as compared with 1895. There has however, been an increase, amounting to seven, mainly attributable to deaths from Whooping Cough, in the number of deaths from the Zymotic Diseases. The death rate for the present year is 11.27 per 1,000, and the mean for the past five years is 13'4 per 1,000. With the exception of an outbreak of Measles in the Whitton district in the early part of the year there has been no prevalence of disease in more than usual proportions. Speaking of the health generally of the parish, the year on the whole may be considered above the average. The vital statistics for the year are calculated upon an estimated population of 18,000. The total number of deaths for 1896 was 203, which is at the average rate of 11.27 per 1,000. This number includes 10 at Whitton, eight at St. John's Hospital, one at the Powder Mills, and one at the Military Quarters at Whitton. TWI 035 2 The number of deaths in 1895 was 235, average rate 13*8 per 1,000. 1894 „ 207, „ 12.1 1893 „ 230, „ 13.6 1892 „ 250, „ 15.2 The deaths of persons of 65 years of age and upwards numbered 44, or 21.67 per cent. of the total number of deaths. The deaths of children under five years of age numbered 79, or 38.91 per cent. of the total number of deaths. There were five uncertified deaths. The causes of death, independent of those included in the six principal Zymotic Diseases, and as recorded in the table in the text of this Report, are 15 from Phthisis, 22 from Bronchitis, Pneumonia, or Pleurisy, 13 from Heart Disease, three from Puerperal Fever, four from Diarrhoea, four from Injuries, and 130 from all other causes. The total number of Births for 1896 was 455 ; 214 males, 241 females, which is at the average rate of 25.27 per 1,000. The Total number of Births for 1895 was 456. 1894 „ 486. 1893 „ 468. 1892 „ 406. Subjoined is a Table of the Mortality from the six principal diseases of the Zymotic class occurring in the last 10 years. 1896 1895 1894 1893 1892 1891 1890 1889 1888 1887 Small Pox 0 0 0 0 0 0 0 0 0 0 Measles 1 3 11 0 3 2 2 5 0 0 Scarlet Fever 0 0 0 4 2 1 2 3 1 0 Diphtheria 4 2 14 0 9 7 9 2 2 2 Whooping Cough 6 0 4 10 1 7 11 2 7 3 Enteric Fever 1 0 1 3 0 1 2 1 0 2 12 5 30 17 15 18 26 13 10 7 In addition to the above table there have been 4 deaths from Diarrhaea (3 of infants under 5 years of age, and one of a person upwards of 65 years of age), and 3 from Puerperal Fever. A few remarks are necessary upon some of the above diseases. Measles.—Owing to an outbreak of Measles at Whitton in the month of March, a considerable number of children attending the schools in that district being afflicted, I recommended to the Managers the advisability of closing the Schools. This was done, and they remained so until after the Easter holidays, a 3 period of about three weeks. The Schools were in the meantime fumigated and cleaned. The death of an infant occurred in this district. Scarlet Fever.—There has been no death recorded from Scarlet Fever since 1893. Diphtheria.—There were two deaths from Diphtheria, and two from Membranous Croup, all of these of children under 5 years of age. Fumigation and disinfection of the four houses in which these cases occurred was performed and there was no further case in either house. Whooping Cough caused six deaths, all of children under 5 years of age, and all with some Pulmonary complication. I have before observed that this always distressing malady is not sufficiently appreciated by parents, who in very many instances pay scant attention to an ailment which they deem at once inevitable and seldom dang'erous. The most commonly fatal termination is from some disease of the respiratory organs. These secondary diseases cannot always be prevented ; but the occurrence of Bronchitis or Pneumonia, for instance, is often owing to want of care in the management of the sufferers. The children, it may be, are not, as they should be, confined to the house. They catch colds and coughs, and medical treatment is often enough not sought until they are obviously very ill and too frequently beyond the reach of help. Enteric Fever was the cause of one death, although twelve cases of this disease were notified under the Act. Many of these were of a mild character. The Company's water was laid on, with one exception, to each house in which the disease occurred. The water drawn from the well in this instance proved on analysis to be good. There was nothing deficient in the sanitary conditions of any house to account for the disease. In two cases the origin of the disease was assigned to the eating of oysters. Three of the cases were treated in St. John's Hospital and made good recoveries. Puerperal Fever was the cause of three deaths. Disinfection and destruction of articles, where desirable, was executed, compensation being given when recommended. Inquests.—Ten Inquests have been held during the year. 3 from Pneumonia. 3 from Apoplexy. 3 Accidental : 1 from injuries received by being crushed between the buffers of two coal waggons. 1 killed by a horse. 1 from shock following a compound fracture of leg. 1 Suicidal: by hanging. Eight of the above bodies were removed into the Mortuary. 4 Cottage Hospital.—Twenty-three cases of Scarlet Fever have been admitted into the Cottage Hospital, against 16 admitted in 1895;19 of these have been discharged cured, and four remained under treatment at the beginning of this year. The following parts of the Hospital have been painted and whitewashed: kitchen, bathroom, Nurse's sitting room, one ward, the two lavatories and the whole of the exterior of the building and outhouses. Tar paving has been laid under the swing, and at the whole of the back of the Hospital. A new mangle and wringing machine has been ordered. New uniforms, etc., supplied to both Nurses. Parcels of books for the use of the patients have been kindly sent by the Rev. E. H. Brown, of the Green, and Mrs. West, of Amyand Park Road. Infectious Disease Notification Act.—Of the diseases in this Act 109 cases have been notified. The subjoined table of the scheduled notifiable diseases, with the number of cases occurring in each year since the adoption of the Act in 1890, will be of interest. 1896 1895 1894 1893 1892 1891 1890 Small Pox 0 0 1 1 0 0 0 Scarlet Fever 44 28 43 187 59 38 43 Diphtheria & Membranous Croup 22 21 45 28 31 25 27 Typhus Fever 0 0 0 0 0 0 0 Enteric or Typhoid Fever 12 12 9 13 7 8 12 Continued Fever 2 0 0 0 0 4 0 Relapsing Fever 0 0 0 0 0 0 0 Puerperal Fever 4 2 3 3 4 3 2 Cholera 0 0 1 1 2 0 1 Erysipelas 25 15 17 30 20 16 13 109 78 119 263 123 94 98 Water Analysis.—Thirteen specimens of well water have been analysed by me, with the result that ten were found to be good and fit for drinking purposes, and three bad and unfit. In two cases the Company's water has been laid on and the wells closed, and in the other, that of the pump on the Green, the well has been closed. Frequent analyses of the Company's water have also been made and have always proved satisfactory. The reports of the analysis of the Public Analysts, submitted to me every month, have always shown the water of the Grand Junction Water Works to be of excellent quality, proving the excellence of the Company's filtering and storage appliances. 5 Laundries.—Throughout the Parish there are ten Laundries which come within the Act relating thereto. These have all been primarily inspected by myself, and as the past year has been the first year in which these have come under a special section of the Factory and Workshop Act, it will be well to give an account of each inspection with the defects and improvements and alterations which have since taken place. I. Oak Lane. Six to eight women employed. Sanitary arrangements defective. A new closet with water laid on thereto has been erected, this and the drainage of the house, connected with the main sewer. The Company's water has been laid on for drinking purposes. The stove for heating irons separated from the ironing room. II. Grown Road. The sanitary arrangements and general condition of this property was so bad as to be unfit to be used as a Laundry. Proceedings were instituted under the Housing of the Working Classes Act, before the Brentford Bench of Magistrates. The premises have since been unoccupied. III. Station Road. Five women employed. The floor of wash house and drainage generally defective. The floor has since been cemented, the drains and water closet reconstructed, and the same ventilated. IV. Fourth Cross Road. Steam Laundry. Fourteen women employed. The sanitary arrangements here defective. Ventilation of Laundry also defective, and many other dilapidations also existed, all of which have since been altered and made good. The stove for heating irons has also been separated from the ironing room. V. Bedford Road. Eight women employed. Sanitary arrangements defective, since made good. The stove for heating irons has been separated from the ironing room. VI. Colne Road. Steam Laundry. A new Laundry ; the building alterations now completed. VII. Second Cross Road. Three women employed. Everything was found in conformity with the Act. VIII. Fifth Cross Road. Five women employed. Everything was found in conformity with the Act. IX. Fifth Cross Road. Three women employed. With the exception of the ventilation being slightly defective, and which has since been remedied, everything was found in conformity with the Act. X. Amber Cottage, Heath Road. Eight to ten women employed. The ventilation, which was very defective, has since been remedied, and the stove for heating the irons has been separated from the ironing room. 6 Cowsheds, Dairies and Milkshops.—Of these there are 24 throughout the parish. These are frequently inspected by the Sanitary Inspector and a record kept of each visit paid, and the condition in which each was found to be in. Bakehouses.—There are 15 Bakehouses at the present time throughout the parish. These are periodically inspected twice a year, in April and October, when the necessary cleansing and whitewashing is required to be done under the Act relating thereto. Many of these however require more frequent visits to keep them up to a standard of cleanliness. Three bakehouses have been vacated, and have since remained closed for the purposes of the trade. Slaughter Houses.—Of these there are 12 throughout the parish. These are frequently inspected by the Sanitary Inspector, and a record kept of each visit paid and the condition in which each was found to be in. These are limewashed generally once a month, and oftener if required. Nuisances in some have been found to exist, but in the great majority of instances when visited they have been found to be in a cleanly state. Local Government Board.—In accordance with the desire of this Council to take part in the scheme, under which the Board tabulate and distribute weekly returns of the cases of Infectious Disease notified in this and other towns, I have made a weekly return in respect of this district. Any benefit to be derived from this scheme as far as this town is concerned can only be by all the neighbouring towns also making returns of the Infectious Disease occurring in their respective districts. At present the Heston and Isleworth District Council is the only participator. Contagious Diseases (Animals) Act.—Under this Act I have received declarations from the County Inspector of Swine Fever existing in three piggeries, and from the Inspector under the Board of Agriculture of the same disease existing in one other piggery. In two instances the keeping of pigs was discontinued, and in the others the styes were disinfected, cleaned and limewashed. 41 pigs suffering from the disease were killed and buried. The County Inspector reports that no beasts (cattle) were destroyed, but that there were slaughtered four horses suffering from Glanders, and one dog suffering from Rabies. Infant Life Protection Act.—The premises at Whitton, licensed under this Act, were vacated in the early part of the year. One other application was made and the necessary certificates sent in for examination. The Health Committee did not recommend that the license be granted. Inspection of the Parish.—The total number of houses, premises, etc., primarily inspected was about 620. The total number of re-inspections, after order of notice, was approximately 400. 7 The following is an analysis of the work accomplished : Houses, premises, etc., cleansed, repaired, whitewashed,etc. 52 „ Closed as unfit for habitation 5 „ Re-opened after repairs, alterations, etc. ... ... 4 „ Roofs repaired, etc. 15 ,, Guttering and Rain Pipes repaired, etc. 11 „ Yards paved and drained 6 „ Overcrowding 4 Nuisances arising from Caravans, etc. 2 „ ,, Accumulation of Refuse 31 „ „ Foul Ditches, Ponds and Stagnant Water 10 „ „ Foul Pigs and other Animals and Birds 7 Other Nuisances not included in the above 12 Water—Pumps repaired 12 Wells closed as polluted 3 Water laid on to houses with no supply 3 ,, new houses and premises 109 Cisterns, new provided 3 ,, cleansed, repaired, covered, etc. 35 ,, flush to w.c.'s 2 „ to new houses 109 Water Closets, new constructed 6 ,, „ new apparatus provided 8 ,, ,, repaired, cleansed, etc. 58 ,, „ supplied with water, or supply rendered efficient 5 ,, ,, to new houses 109 ,, ,, ventilated 18 Drains—Examined, tested exposed, etc. 33 Unstopped, repaired, trapped, etc. 146 Waste Pipes, Rain Pipes, etc., disconnected 21 Soil Pipes and Drains ventilated 21 Disconnecting, Traps or Chambers inserted 19 Reconstructed 13 Cesspools—Abolished and connected to Sewer 1 Dust—Dustbins repaired 21 Movable receptacles substituted for fixed 93 Number of complaints of non-removal 124 Statutory Orders issued 205 8 New Sewers 2,050 yards in length were laid in the following roads: Amyand Park Road, Gothic Road, Cole s Bridge, St. Margaret's Road, Sherland Road, Strawberry Hill, Cole Park Road, Third Cross Road, St. Stephen's Gardens. A new Sewer 270 yards in length re-constructed in the Amyand Park Road. Plans submitted and approved for 109 houses, all of which are connected with the main Sewer, and water laid on to each house and closet. Legal proceedings were taken in respect of a nuisance arising from the keeping of pigs, one from a collection of manure, one from a collection of houserefuse, and one under the Housing of the Working Classes Act in respect of the insanitary condition of a house and premises used as a Laundry. In two of the above, convictions were obtained, and in the two others orders were made. I have the honour to be, Mr. Chairman and Gentlemen, Your obedient Servant, January, 1897. W. MARSTON CLARK, D.P.H., Medical Officer of Health.