Tw 1037 TWICKENHAM URBAN DISTRICT COUNCIL. Annual Report of the Medical Officer of Health, 1900. Mr. Chairman and Gentlemen, I have the honour to submit to you my Seventeenth Annual Report as to the Health and Sanitary condition of the Parish of Twickenham. The Report will embrace the vital statistics of the year, which terminated on December the 31st last, and a summary of the measures taken for the prevention of the development and dissemination of disease. Appended to the report are four tables received from the Local Government Board viz: Table 1 comprises the Population and the Birth and Death rate calculated per 1,000 of estimated population for the past 10 years. Table II comprises the Births and Deaths registered, and Deaths under 1 year of age. Table III comprises cases of Infectious disease, notified during the past year. Table IV comprises the causes of deaths, and ages at death for the same period. In addition to the above are four tables furnished by the Middlesex County Council viz:—Table C (I, II, III, IV.) For the convenience and information of the Council, I have embodied all the particulars contained in the above tables in the text of this report. Births. The vital statistics are computed on an estimated population of 21,000. The Births during 1900 were 531, of which 260 were Males, and 271 were Females, giving a Birth rate of 25.3 per 1,000. The total number of Births for 1899 was 521. „ „1898 „ 466. „ „ 1897 „ 495. „ „ 1896„ 455. At the last census the population was 16,026, and at the previous census it was 12,500. The district comprises 2,477 acres, and this works out at about 8.4 per acre. Deaths. In reviewing the past year, I have to record an increase amounting to 19 in the number of deaths from all causes to that of the previous year. There has been however an increase of 8 in the number of deaths from the Zymotic Diseases This is accounted for by an increase in deaths from Measles and Whooping Cough, which were chiefly prevalent in the summer and autumn. I he mean death rate for the past 10 years is 13.6 per 1,000. 2 The number of deaths recorded was 295, this equals 14.0 per 1,000. In the first quarter there were 87 deaths. „ second „ 65 „ „ third „ 66 „ „ fourth „ 77 „ The number of deaths in 1899 was 276 Average rate 13.8 per 1,000. „ „ 1898 „ 266. „ „ 14.0 „ „ „ 1897 „ 256. „ „ 13.8 „ „ „ 1896 „ 203. „ „ 11.27 „ An epitome of the ages at death is as follows Under 1 year 82 Over 1 year and under 5 years 19 Over 5 years and under 15 years 11 Over 15 years and under 25 years 16 Over 25 years and under 65 years 91 Over 65 years 76 Amongst the deaths from all causes were 16 from Epidemic Influenza, 13 from Diarrhæa, 15 from Phthisis, 13 from Cancer, 36 from Bronchitis and Pneumonia, 19 from heart Disease, 11 from Accidents, and 13 Premature Births. Fifteen of the deaths occurred in St. John's Hospital, 17 in the hamlet of Whitton, including 1 at Kneller Hall, and 1 at Highshot House. Subjoined is a Table of the mortality from the six principal diseases of the Zymotic class occurring in the last ten years:— 1900 1899 1898 1897 1896 1895 1894 1893 1892 1891 Small Fox 0 0 0 0 0 0 0 0 0 0 Measles 8 0 15 0 1 3 11 0 3 2 Scarlet Fever 0 2 1 0 0 0 0 4 2 1 Diphtheria 3 6 2 4 4 2 14 0 9 7 Whooping Cough 7 3 9 8 6 0 4 10 1 7 Enteric Fever 1 0 0 2 1 0 1 3 0 1 19 11 27 14 12 5 30 17 15 18 A few remarks are necessary with reference to:— Measles. There was an outbreak of Measles, particularly in the East and West portions of the District, and I considered it advisable to close two of the Public Elementary Schools. There were 7 deaths of children under 5 years of age, and 1 above that age. 3 Diphtheria. Of the 27 cases recorded, 3 only ended fatally. Every house in which a case occurred was carefully inspected and wherever any insanitary condition existed remedial measures were taken. Several specimens taken from the throats of the patient were submitted to the Clinical Research Association for analysis. In many instances the cases proved not to be Diphtheria, the specific organism not being present. Adverting to my last annual report and in accordance with my recommendation contained therein, the Council have supplied through myself, Anti-diphtheritic serum to the Medical Practitioners in the District free of expense to all patients not in a position to pay. This has been a preventative, and a means of diminishing the death-rate from this disease. Diarrhœa This was the cause of 14 deaths all of which occurred in children under 5 years of age. Particular attention was given to the cleansing and disinfection of the streets and gullies, and also to the regular removal of house refuse. Inquests. There was an unusually large number of Inquests held during the year:—viz. 37. The findings of the Juries were as follows:— 1 Sucidical by taking laudanum. 2 Convulsions. 1 Drowned, (query by accident or purposely), child, 4 to 6 months of age. 1 Concussion from accidental fall. 1 Suicidal by taking carbolic acid whilst of unsound mind. 1 Rupture of aneurism of aorta. 1 Rupture of blood vessel on brain. 1 Accidentally fell down stairs. 1 Syncope from fatty degeneration of heart. 1 Obstructed respirations probably due from convulsions. 1 Fatty degeneration of internal organs. 1 Strangulation of the gut. 2 Apoplexy. 1 Asphyxia. 1 Congestion of the lungs. 1 Accidentally suffocated in bed. 1 Syncope from heart failure. 2 Accidentally killed by a horse. 1 Fracture of leg. 1 Rupture of heart. 1 Asphyxia from overlaying. 2 Suffocated accidentally. 1 Wilful murder against some person or persons unknown. 1 Syncope from fatty heart. 1 Accidentally run over by a cart. 4 1 Endocarditis. 2 Syncope following pneumonia. 1 Concussion of brain accidentally knocked over by a train. 1 Rupture of bowels accidental fall. 2 Accidentally drowned by upsetting of a boat. 1 Accidentally knocked over by a trap. Infectious Diseases (Notification) Act. Of the diseases in this Act 153 cases have been notified. Hereunder is a Table of the scheduled notifiable diseases, with the number of cases occurring in each year since the adoption of the Act in 1890. 1900 1899 1898 1897 1896 1895 [894 1893 1892 1891 Small Pox 0 0 0 0 0 0 1 1 0 0 Scarlet Fever 97 142 31 34 44 28 43 187 59 38 Diphtheria & Membranous Croup 27 29 19 20 22 21 45 28 31 25 Typhus Fever 0 0 0 0 0 0 0 0 0 0 Enteric or Typhoid Fever 6 9 6 11 l2 12 9 13 7 8 Continued Fever 7 1 1 0 2 0 0 0 0 4 Relapsing Fever 0 0 0 0 0 0 0 0 0 0 Puerperal Fever 4 2 0 4 4 2 3 3 4 3 Cholera 0 0 0 1 0 0 1 1 2 0 Erysipelas 12 11 8 7 25 15 17 30 20 16 153 194 65 77 109 78 119 263 123 94 With reference to the 97 cases of Scarlet Fever 30 occurred in the Public Institutions. Cottage Hospital. During the year, 57 patients suffering from Scarlet Fever were admitted into the Cottage Hospital, all of whom were discharged cured. I regret to have to record the death of Mrs. Rogers, who acted as matron for many years. At such convenient time, not only the apartments of the nurses, but the whole hospital internally was re-decorated. Nurse Quick, who was appointed to the vacancy, has fulfilled her duties to the satisfaction of the Health Committee of the Council, and to all the Medical Practitioners attending on their respective patients. It should be acknowledged that several gifts of books, toys, etc., have been sent to the hospital by residents of the District, for the benefit of the patients. Water Analysis. Analyses of 12 specimens of water drawn from wells, were made and found to be good and fit for drinking purposes. Two wells supplying 8 cottages were closed owing to insufficient supply of water. The Company's water was laid on to these 5 premises. The supply of water to the Superintendent's house at the Hounslow Cemetery, within this district, although not free from suspicion, was not of such a character as to justify the condemnation of the well. The Burial Board was communicated with, suggesting that another supply should be provided. In the meantime a filter has been supplied, and the matter is still under my observation. On several occasions I have analyzed samples, drawn from various places, supplied by the Grand [unction Water Works Company, and the same continues to be of exceptional purity. Bathing. It is very gratifying to report that owing to the accommodation afforded for bathing at the Mereway being so severely taxed, the Council took steps to improve and materially increase the facilities. The usual swimming competition held towards the close of the season was a marked success. Smoke. I directed my attention to several chimneys (not being chimneys of private dwelling houses), sending forth black smoke in such quantities as to be a nuisance. These were connected with Breweries, Laundries, and Greenhouses. In some case the nuisance arose by reason of the quality of fuel used, in others structural alterations had to be adopted. Schools 15. Workshops and workplaces 25. Laundries 15. Bakehouses 17. Slaughter Houses 12. Cowsheds 9. Dairies and Milk Shops 20. The whole of the foregoing have been frequently inspected and the necessary works of whitewashing and cleansing were carried out, and in addition, in the case of the Schools, which were closed in consequence of the outbreak of Measles before mentioned, were also disinfected. Mortuary. There were 25 bodies received into this building during the year. There is accommodation for four bodies at one time. Petroleum Acts. The stores of those persons holding licenses have been inspected from time to time and found satisfactory; the four applications for the renewal of licenses, were acceded to for a further period of one year. Contagious Diseases (Animals) Act. Two notifications of Swine Fever were received as occurring on two farms, 40 pigs were killed and 4 died. The styes were subsequently cleansed and lime-washed. There were two cases of suspected glanders in horses, one horse was killed. Housing of the Working Classes Act. The Council had under consideration the question of erecting 36 houses at a rental of 7/6 per week and 13 houses at 8/6 per week respectively, being a part of a 6 scheme, upon a piece of land situate in a growing portion of the district. Tenders were invited for the erection of the houses and the construction of the necessary roads and sewers. It was found however that by reason of the high quotation given by builders for the various works and the market price of money, it was impossible to erect the cottages at the proposed rental without making a loss. Representations were made to the Local Government Board suggesting that the period of repayment actually granted to Local Authorities for buildings under Part 3 of this Statute should be extended to the full statutory period of 60 years. By reason of the reply, the Council were compelled to let the matter remain in abeyance for future consideration. I may point out that a considerable number of houses have been built, the majority of which are small villa residences. I made representations to the Council under Part 2 of this statute, as to two houses being in such a condition as were in mv opinion unfit for human habitation. In each of these instances the premises were closed and remain so at present. Removal of House Refuse. During the year there were comparatively few complaints received of the weekly non-removal by the Contractor of the refuse. In one or two instances, parishioners objected to the shoots which the Contractor was using, means were taken to orevent any nuisance arising. Sanitary Conveniences. Those attached to the various licensed premises have been under close observation. and disinfectants plentifully used. In those cases where a flushing apparatus has been faulty, remedial steps have been taken. Sewage Disposal. The Council have purchased additional land after an Inquiry was held by the Local Government Board for the further treatment of Sewage. Up to the present the experimental bacteriological system which was adopted is from the expert analysis of the effluent most satisfactory. Vaccination Act 1898. I have received only one notice of the postponement of Vaccination, the reason assigned being the recent prevalence of infectious diseases in the house. Inspection of the Parish. Upwards of 1,000 houses have been inspected, followed in 600 cases by reinspections. In only two instances was it necessary to have recourse to legal proceedings, one by reason of the owner making default in whitewashing and cleansing to houses, and the other because the owner permitted a new house to be occupied before the drains were connected to the Council's sewer, and a sufficient supply of water for drinking and domestic purposes provided. In both cases penalties were imposed by the Justices. 7 The following is an analysis of the work accomplished:— Houses, Premises, &c., cleansed, repaired, whitewashed, &c. 125 „ Roofs repaired, &c. 41 „ Guttering and Rain Pipes repaired, &c. 38 „ Yards paved and drained 4 Nuisances arising from Overcrowding 6 „ „ Smoke 6 „ „ other Animals, and Fowls 120 „ „ Squatters or gipsies 4 Other Nuisances not included in the above 71 Water—Pumps cleaned, repaired, &c. 4 Wells closed 2 Water laid on to houses with no supply 8 Cisterns—New provided 15 Cleansed, repaired, covered, &c. 20 Flush to w c.'s 25 Water-Closets—New constructed 8 New apparatus provided 30 Repaired, cleaned, &c, 112 Supplied with water or supply rendered efficient 49 Ventilated 25 Unsound Food—Articles seized 2 Disinfection—Rooms Fumigated 85 „ Stripped and Cleansed 30 Articles disinfected or destroyed (several) Drains—Examined, tested, exposed, &c. 25 Unstopped, repaired, trapped, &c. 156 Waste Pipes, Rain Pipes, &c., disconnected 17 Soil Pipes and Drains ventilated 20 Disconecting Traps or Chamber inserted 8 Reconstructed 85 Dust—Dustbins repaired 15 Number of complaints of non-removal 96 New dustbins provided 54 Statutory Orders issued 324 I am obliged to the Surveyor to the Council for the following statistics which I consider are of interest. Plans of houses approved (excluding those known to be abandoned) 275. Plans for alterations and additions to existing buildings 23. Connections to soil sewers 141 Connections to surface water sewers 101. 8 Number of New Streets laid or re-constructed in pursuance of the Private Street Works Act, 1892, include New May Road, Seymour Gardens, Morley Road, and Alexandra Road. In addition, the Council have effected many important improvements in York Street, Richmond Road, London Road, Cross Deep, Staines Road, Whitton Road, and King Street. The number of yards of new sewers constructed 1275 Number of yards of surface water sewers constructed 2206. New manholes constructed 54. Sewers have been laid in the following roads, Morley Road, London Road, Southfield Gardens, Andover Road Denton Road, Colne Park Road, Oak Lane, Devencroft Gardens, Kneller Road, and Hounslow Road. I have the honour to be Mr. Chairman and Gentlemen, Your obedient Servant, W. MARSTON CLARK. Diplomate in Public Health, London. Medical Officer of Health. March, 1901. Williams & Walker, Printers, 40, Church Street, Twickenham.