Twi 038 1902. TWICKENHAM URBAN DISTRICT COUNCIL ANNUAL REPORT of W. MARSTON CLARK, Diplomate in Public Health, Lond., Medical Officer of Health. Twickenham: Williams & Walker, Electric Printing Works, Church Street. Twickenham Urban District Council. ANNUAL REPORT of the Medical Officer of Health, 1902. Mr. Chairman and Gentlemen, I have the honour to submit to you my Nineteenth Annual Report as to the Health and Sanitary condition of the Parish of Twickenham. Appended to the Report are four tables received from the Local Government Board. Table I comprises the vital statistics of the whole district during 1902 and previous years extending from 1892. Table II consists of the Births and Deaths registered, and with a view to give more concise information, such table has been sub-divided corresponding with the four Wards of the District, viz:— South, East, West, and Central. Since the Census of 1901 I have estimated the population at 22,000, comprising 4,989 in the South Ward, 6,076 in the East Ward, 6,440 in the West Ward and 4,495 in the Central Ward. 2 Table III shews the cases of Infectious Diseases notified during the past year. Of the total cases 94, ten were in the South, 14 in the East, 48 in the West, and 22 in the Central Wards respectively. The removals to the Infectious Diseases Hospitals were two from the South Ward, seven from the East Ward, thirty-three from the West Ward, and fifteen from the Central Ward. Table IV embraces the causes and ages at death for the same period. There were 269 deaths; of these 46 occurred in the South Ward, 65 in the East Ward, 100 in the West Ward and 50 in the Central. The compilation of the tables has necessitated very great care in order to ensure accuracy. In addition to the foregoing, there are four tables furnished by the Middlesex County Council, viz:— Tables C (I, II, III, IV.) Tables C (I) refers to Inspections of Dwelling Houses, Houses let in separate Dwellings or Lodgings, Common Lodging Houses,Canal Boats used as Dwellings, Movable Dwellings, Caravans, Tents, &c. Inspections generally and notices served. Table C (II) contains the Inspection of Schools, Workshops, and Work-places, Laundries, Bakehouses, Slaughter-houses, Cowsheds, Dairies and Milkshops, Unsound Food, Adulterated Food, Offensive Trades and Mortuaries. 3 Table C (III) relates to Water Supply and Water Service, Closet-accommodation, Drains, Cesspools, Sewers and Ash-pits. Table C (IV) deals with Disinfection, Dust Collecting, Dampness, Contagious Diseases of animals and sundry other nuisances, such as overcrowding, &c. Population. The Vital Statistics are calculated on an estimated population 22,000. The population at the time of the Census of 1891 was 16,026, Census 1901, 20,991. As nearly as can be computed the number of inhabited houses was 4,400. Births. During the year there were 596 births, 309 were males and 287 were females, giving a birth rate of 27 04 per 1000. The total number of births for 1897 was 495 ,, ,, 1898 ,, 466 „ 1899 „ 521 1900 „ 531 1901 »» 576 Deaths. Although there has been an estimated increase or 1,000 in population since the census of 1901, the number 4 of deaths 264 is ten only in excess of last year. The death rate is at the average of 1200 per 1,000 as against 12.09 per 1,000 in the preceding year. The number of deaths for 1807 was 256 equal to an average rate of 13.4 per 1000 1898 „ 266 „ „ 13.6 1899 „ 276 „ „ 13.8 1900 „ 295 „ „ 14.3 1901 „ 254 „ „ 12.9 The epitome of the ages at death is as follows:— Under 1 year 85 Over 1 year and under 5 years 23 Over 5 years and under 15 years 9 Over 15 years and under 25 years 12 Over 25 years and under 65 years 59 65 years and upwards 81 There were 4 uncertified deaths occurring in infants under 1 year. Amongst the deaths from all causes were 2 from Epidemic Influenza, 7 from Diarrhoea, 18 from Phthisis, 11 from Cancer, 42 from Respiratory diseases, 28 from Heart Disease, 7 from Accidents and 12 Premature Births. Eight deaths occurred in St. John's Hospital; and two in the Infectious Diseases Hospitals. 5 The following table summarises the mortality from the 6 principal Zymotic diseases occurring during the last 10 years. 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 Small Pox 0 0 0 0 0 0 0 0 0 1 Measles 0 11 3 1 0 15 0 8 2 8 Scarlet Fever 4 0 0 0 0 1 2 0 3 1 Diphtheria 0 14 2 4 4 2 6 3 3 3 Whooping Cough 10 4 0 6 8 9 3 7 9 9 Enteric Fever 3 1 0 1 2 0 0 1 2 0 '7 30 5 12 14 27 11 19 19 22 Diphtheria. Diphtheria was the cause of three deaths. A feature in connection with the treatment of the disease has been the continued distribution of Anti-diptheritic Serum by the Council to any Medical practitioner applying for it in cases occurring in the parish. The Serum has been supplied and used in several cases. It is gratifying to report that a rapid recovery has in most instances ensued, and the possible mortality from Diphtheria has in consequence been probably reduced. It should be known that this treatment may be adopted with perfect safety as a prophylactic measure to any case which has been in immediate contact with the disease. 6 Measles. The prevalence of this disease necessitated the closure of three of the Public Elementary Schools at different periods. The advisability of this step was taken only after due consideration, the principal being the number of absentees, many of them not necessarily suffering from the disease, but in houses where other members of the family were afflicted. Small Pox. Owing to the prevalence of Small Pox in London and the Districts immediately adjoining Twickenham the Health Committee and the Council acting under my advice prepared for any case or cases which might occur. Scarlet Fever cases which at that time were isolated at the Mereway Hospital were removed to an isolated house then being rented by the Council and used for convalescent patients (Scarlet Fever). The Mereway Hospital having been thoroughly disinfected was in readiness to receive Small Pox patients on the 19th Jauuary, 1902 Such building was visited on the 11th February, 1902, by an Inspector appointed by the Local Government Board. On the 22nd February, 1902, I sent the following letter to all the Medical Practitioners in the neighbourhood drawing attention to the difficulty in some cases of differential diagnosis in Small Pox, Chicken Pox, and other exanthematous diseases. 7 "Private. Cross Deep, Twickenham, 22nd February, 1902. Dear Sir, You are probably aware that any case of Small Pox which may be notified in this District will be removed to the Hospital, The Mereway, Twickenham. Realising the anxiety which sometimes occurs in arriving at a correct diagnosis in the early stages of Chicken Pox and other cutaneous eruptions I wish to intimate to you that I will visit any doubtful case you may have in my District at any time and although possibly I may not be able to throw any further light on the case, I shall be glad to share the responsibility with you in deciding as whether it should be removed to the Hospital or not. I am, Dear Sir, Yours faithfully, W. MARSTON CLARK, Medical Officer of Health." The offer was taken advantage of by several Medical Practitioners, and was it is believed the means of detecting all the cases. The first case of Small Pox occurred on the 10th March. Source of contagion, Nice, or travelling therefrom. The case, a female, 26 years of age was removed to the Mereway Hospital. The patient had been vaccinated in infancy. All contacts were re-vaccinated and kept under supervision with most effectual results. 8 On the 11th April an adult male was found to be suffering from Small Pox. He was at once removed to the Hospital. A house to house inspection of the road where this case occurred was made by myself in conjunction with the Public Vaccinator, resulting in two other cases being discovered on the 12th and other two cases on the 13th in the same block of houses. All these cases, adult males, were working for, or indirectly employed by one Contractor. Over one hundred and twenty persons were vaccinated or re-vaccinated in this road and the immediate neighbourhood. The street which is a cul-de-sac with 19 houses and about 100 inhabitants was strictly quarantined for 16 days after the last case occurred. Two inspectors were appointed to alternately keep the road under supervision. All persons resident in the infected houses were supplied through the inspectors with provisions, &c, at the cost of the Council, and other men and women who had been temporarily suspended from their employment were also supplied at the cost of the Council and Poor Law Authorities. Intimation of the outbreak was given to the Contractors who gave orders for all their men to be immediately re-vaccinated. The Medical Officers of Health in whose districts these men were working received written notification and the Employers also as to contact cases. One man removed to the Mereway Hospital who had not been vaccinated died on the 1st April. He was buried the following morning before 7.30. The other four cases had been vaccinated in infancy only, one, a severe case very imperfectly. Another case was that of an adult male a commercial traveller who had been in contact with a case which occurred in a warehouse in London in which he was employed. 9 Three other cases made their appearance two being male adults engaged on the railway and removed to the Hospital. The last case was an adult female who was removed to the Cheam Small Pox Hospital. Thanks are due to the authorities of that Hospital for the assistance afforded under the circumstances in which I was at that time placed. Disinfection of the infected houses, clothes, bedding, &c., was carried out at the expense of the Council. The infected houses were also whitewashed and cleansed. With the exception of the one death mentioned above all the other cases recovered. The L.S.W. Railway Company furnished me with the names and addresses of the whole of their employees, over 150 in number, who had possibly been in contact with the two cases before mentioned- The Railway Company on my advice further issued an Order strongly recommending that the men for their own sakes and for the sakes of their families should be re-vaccinated at once. The District should feel very grateful for the ready assistance rendered by the said Contractors and Railway Company generally. I am pleased to be able to record that a very large number of persons in the District availed themselves of the protection afforded them by vaccination or re-vaccination and it is a fact that not a single case of disease gave rise to any second case in the District. My thanks are tendered to the Public Vaccinator for his cordial co-operation. In February the Council expressed the opinion that in the interests of the Public Health, Clause 2 of the 10 Vaccination Act, 1898, relating to the conscientious objector should be repealed and the Local Government Board was informed of the decision arrived at. The Council was represented at a Conference held at the Guildhall, Westminster, to take into consideration the desirability of dividing the County into districts for providing hospitals for the accommodation of Small Pox patients. This question is still under consideration. Subjoined is a table of the scheduled notifiable diseases, with the number of cases occurring in each year for the past 10 years. 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 Small Pox 1 1 0 0 0 0 0 0 0 10 Scarlet Fever 187 43 28 44 34 31 142 97 105 57 Diptheria & Membranous Croup 28 45 21 22 20 19 29 27 31 12 Typhus Fever 0 0 0 0 0 0 0 0 0 0 Enteric or Typhoid Fever 13 9 12 12 11 6 9 6 9 9 Continued Fever 0 0 0 2 0 1 1 7 2 0 Relapsing Fever 0 0 0 0 0 0 0 0 0 0 Puerperal Fever 3 3 2 4 4 0 0 4 2 2 Cholera 1 1 0 0 1 0 2 0 0 0 Erysipelas 30 17 IS 25 7 8 11 12 10 4 263 119 78 109 77 65 194 153 159 94 11 With reference to the 57 cases of Scarlet Fever, 3 cases occurred in the South Ward, 8 in the East Ward, 29 in the West Ward, and 17 in the Central Ward. It is gratifying to be able to record a considerable diminution in the number of notifiable diseases as compared with the previous three years. Infectious Diseases Hospital. During the past year 47 cases of Scarlet Fever were admitted into the temporary hospital referred to in my last report The Council wisely effected an extension of the tenancy, thus leaving free the Mereway Hospital for the admission of Small Pox cases. Of the 47 cases, 25 were removed from the West Ward, 14 from the Central, 6 from the East, and 2 from the South. Since my last Annual Report the Council have applied to the Local Government Board for sanction to a loan for the purpose of acquiring land in the most eligible part of the district whereon may be erected a hospital most suitable for the requirements of the district. The site selected comprises about 7 acres, satisfactorily isolated, within easy access to the main sewer and an efficient water supply. Inquests During the past year 14 inquests have been held. The findings of the juries were as follows :— 3 Heart Disease. 1 Fracture of Skull. Bicycle accident. 12 2 Convulsions. 1 Killed on the railway whilst shunting, 1 Suicide by hanging, 1 Killed by a passing train. 1 Want of proper attention at birth, 1 Fractured Skull through accidental fall, 1 Cerebral Hoemorrhage. 1 Accidentally killed on the railway. 1 Pleurisy. Pleasure Grounds. The Council, realizing the importance of providing Open Spaces for the health and welfare of the district, acquired the Radnor House grounds and a large portion of its pleasure grounds on the banks of the Thames. I feel sure that the Council will in future so improve this property as to induce the public to avail themselves of the benefits and use of it and to be justly proud of it. Water Anayses. Fourteen samples of water drawn from wells were analyzed and found to be good and fit for drinking purposes. In thirty-two houses supplied with pump water to which no objection could be taken, an additional supply of the Company's water was laid on by the owners simultaneously with the laying on of the water to the closets. In two other houses the Company's water was laid on owing to an insufficient supply from the wells. 13 Baths and Washhouses Act. Mereway Bathing Place. The Bathing Place was closed for the season on September 30th. The number of bathers attending the Bathing Place during the season is as follows:— Total number attending during May 486 Highest attendance on any one day 183 Total number attending during June 4167 Highest attendance on any one day 658 Total number attending during July 8093 Highest attendance on any one day 600 Total number attending during August 1679 Highest attendance on any one day 130 Total number attending during September 723 Highest attendance on any one day 136 The Bathing Place has been considerably improved and extended. Mortuary. There were ten bodies received into this building during the year. Petroleum Acts. The persons holding licences under these statutes again applied and had their licences renewed, prior to which the premises were inspected. Application for licences in respect of additional premises were received and after certain structural works had been executed the same were granted, but the quantity to be stored was limited. 14 Sanitary Conveniences. Great attention was again paid to the Urinals attached to the premises licensed for the sale of intoxicating liquors. In twenty-four instances these were found to be in an insanitary condition. The defects were all subsequently remedied, a statutory notice being issued in one instance only. The Justices of the Brentford Division, in which Twickenham is situate, were apprised of the general sanitary condition of the licensed premises prior to the renewal of the licences. Factory and Workshop Act, 1901. This Act, which came into force on the 1st January 1902, imposes several new and important powers and duties on Medical Officers of Health and Local Authorities. (1)— Under Section 132 every Medical Officer of Health is required in his Annual Report to deal specifically with the administration of this Act in workshops and workplaces, so far as his duties connected with such premises are concerned, and he must send a copy of this part of his report to the Secretary of State. (2) A register must be kept of all workshops &c., within the District. (3) A list of Home Workers connected with certain trades must be supplied by the employers of such workers and kept by the District Council. 15 (4) Other duties of the Local Authority in connection with workshops are directed to the following points. (1) Sanitary Accommodation. (2) Air Spaces. (3) Cleanliness. (4) Ventilation. (5) Safety from Fires. In discharge of this Act the following steps have been taken:— (а) A register has been compiled and contains particulars of 75 premises where work is carried on. (b) A list of Home Workers, obtained from the employers is kept. Information was received from the Borough of Richmond as to Home workers living within this District. One outworker resided outside this District and the Local Authority of such District was informed. No case of Infectious Disease occurred at the house of a notified Home Worker. (a) Sauitary Accommodation. In the course of inspection of the Workshops, &c., attention was paid to the sanitary accommodation and with two exceptions was found to be sufficient and suitable. In the first case the extra accommodation was provided after service of notice, and work in the second case is at present in progress. The conveniences at one Factory were found to be in a dirty state on two occasions but were cleansed without service of notice in both instances. 16 (d) Overcrowding;. The cubic capacity of a number of Workshops, Bakehouses, &c , has been taken, and it is anticipated that this branch of work will shortly be completed, so that a complete list of particulars of all Workshops, Bakehouses, &c. within the district will be obtained. No case of overcrowding has been detected. (e) Cleanliness. The Workshops have been found in a cleanly state with six exceptions. Notices to cleanse, were served in three instances and were complied with, in the three other cases the cleansing was done without formal notice. (f) Ventilation No case of insufficient ventilation has been observed. (g) Safety from Fire. In cases where more than 40 persons are employed the Local Authority must satisfy themselves that sufficient means of escaping in case of Fire are provided, and if satisfied must grant a certificate to that effect. No building was found within the District at which more than 40 persons are employed. (h) Underground Bakehouses. Under Section 101 of the Act, it will not be legal to use an underground Bakehouse after the 1st January, 1904, unless such Bakehouse, be certified by the District Council to be suitable for that purpose. One underground Bakehouse has been enlarged and improved and the Council expressed satisfaction, as to its suitability. 17 Midwives Act, 1902. This Act, which comes into force on the 1st of April of this year, 1903, is intended for the regulation and supervision of the practice of Mid wives For this purpose women pursuing this calling will be required to register their names. I have caused a list of midwives practising in the district to be forwarded to the Middlesex County council. Inspection of the Parish. Over 2100 houses have been inspected, followed in 1936 cases by re-inspections. The following is an analysis of the work accomplished :— Houses, Premises, &c., cleansed, repaired, whitewashed, &c. 234 ,, Roofs repaired, &c. 54 ,, Guttering and Rain pipes repaired, &c. 56 ,, Ventilation below floor provided 10 ,, Yards paved and drained 36 Foul ditches and stagnant water 8 Nuisances arising from Overcrowding 3 ,, ,, Smoke 5 „ ,, Pigs, other Animals & Fowls 6 „ ,, Occupants of a Stable 1 Other Nuisances not included in the above 72 18 Water— Wells closed Nil. Water laid on to houses with no supply 32 Cisterns— New provided 86 Cleansed, repaired, covered, &c. 62 Flush to W.C.'s 230 Water-Closets— New constructed 98 New apparatus provided 39 Repaired, cleansed, &c. 24 Supplied with water or supply rendered efficient 239 Ventilated 5 Unsound Food— Articles seized 8 Disinsection— Rooms fumigated 54 Rooms stripped and cleansed 41 Articles disinfected or destroyed, a large number Drains— Examined, tested exposed, &c. 19 Unstopped, repaired, trapped, &c. 117 Waste pipes, rain pipes, &c., disconnected 36 Soil pipes and drains ventilated 25 Disconnecting Traps or Chamber inserted 14 Reconstructed 14 Relaid 14 Cesspools filled in Nil. Cesspools cleaned out 2 19 Dust—Dustbins repaired 12 Number of complaints of non-removal 150 New Dustbins provided 133 Movable receptacles substituted for fixed 37 Statutory Orders issued 602 In addition to the foregoing, repeated inspections were made and work of whitewashing and cleansing executed in the following buildings:— Contraventions. Laundries 36 3 Slaughter Houses 11 nil. Dairies and Milk-shops 30 nil. Workshops and Workplaces 75 4 Bakehouses 17 1 Cowsheds 8 nil. Housing of the Working Classes Act. I had occasion to report to the Council respecting 7 houses being in such a condition as in my opinion to be unfit for human habitation. Notices were served in pursuance of the statute and in every case the Owners complied with the requirements demanded of them by the Council without recourse to legal proceedings. Water Closets. There were 239 cottages which were deemed to be without a sufficient water closet accommodation by reason of there being no water laid on for flushing purposes. In all these cottages the requirements have been complied with. This matter is still receiving my attention and that of the Sanitary Inspectors. 20 Sewers and New Streets. I am indebted to the courtesy of the Surveyor to the Council for the following particulars:—Plans of houses approved (excluding those known to be abandoned) 420. Plans for alterations and additions to existing buildings 41. Connections to soil sewers 169. Connections to surface water sewers 150. The following new streets have been made up under the provisions of the Private Street Works Act 1892: Sherland Road (Section 2), Mereway Road (Section 2), Creswell Road (Section 1), Denton Road (Section 1), Morley Road (Section 2) and Albert Road. The number of yards of new sewers constructed 1,317. Number of yards of surface water sewers constructed 1,290. New manholes constructed 42. Sewers have been laid in the following roads:— Staines Road from Fifth Cross Road to entrance to Fulwell Park, Athelstan Road, Norcutt Road, Colonial Avenue, Little Ferry Road from Lebanon Park to Riverside, Edwin Road, Moor Mead Road, Heathfield South, and Lebanon Park. Sanitary Department. In consequence of the growth of the District and the increased clerical work it was considered advisable to appoint an additional Sanitary Inspector. A selection was made from a large number of candidates. The appointment, followed by a re-adjustment of the duties of the Saintary Department has, I feel confident given satisfaction to the Council as also to myself. 21 In conclusion I wish to observe the year under review has been attended by a large increase of work and one of the most anxious since my appointment now nearly 20 years ago, and I much appreciate the confidence nd firm support accorded to me. 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. TABLE I. Vital Statistics of Whole District during 1902 and Previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions in the District. Deaths of residents registered in Public In stitutions beyond the District. Nett Deaths at all Ages belonging to the District. Number. Rate. Under 1 Year of Age. At all Ages. Number Rate per 1000 Births registered. Number. Rate. Number. Rate. 1892 16500 406 246 42 103.4 250 15.1 10 1893 17000 468 27.4 62 132.4 230 15.1 14 1894 17500 486 277 53 109.05 207 12.5 11 1895 18000 456 25.3 65 142.5 235 13.05 8 1806 18500 455 24.5 58 127.4 203 10.9 8 1897 19000 495 26.05 82 165 6 256 13.4 8 1898 19500 466 28.8 69 148.06 266 13.6 11 1899 20000 521 26.05 60 115.1 276 13.8 11 1900 20500 531 25.9 82 154.4 295 14.3 16 1901 21000 576 27.4 68 118.0 254 12.09 15 2 249 11.8 Average for years 1892-1902 18250 486 26.3 64.1 132.1 243.2 14.3 11 — — — — 1902 22000 596 27.04 83.0 13.9 264 12.0 8 0 5 269 12.2 Total population at all ages 21,000 Area of District in acres (exclusive of area covered by water). 2415. Number of Inhabited houses, 4224 Average number of persons per house, 4.99 At Census of 1901. TABLE II. Vital Statistics of separate Localities in year 1902 and previous years. Names of Localities. WHOLE DISTRICT. SOUTH WARD. EAST WARD. WEST WARD. CENTRAL WARD. Year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at ail ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births Registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. 1892 16500 406 250 42 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1893 17000 468 230 62 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1894 17600 486 207 52 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1895 18000 456 285 65 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1806 18500 455 203 58 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1897 19000 495 256 83 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1898 19500 466 266 69 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1899 20000 521 276 60 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1900 20500 531 295 82 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1901 21000 576 249 68 4775 113 58 11 5811 126 63 17 6122 215 75 27 4282 122 53 13 Average for Years 1892 to 1901. 18750 486 246.7 64.1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1902 22000 596 269 85 4989 121 46 10 6076 149 65 19 6440 214 100 35 4495 112 58 20 TABLE III. Cases of Infectious Disease notified during the Year 1902. Notifiable Diseases. Cases Notified in Whole District. Total Cases Notified in each Locality. No. of Cases removed to Hospital from each Locality. SOUTH WARD. EAST WARD. WEST WARD. (H.H.) CENTRAL WARD. SOUTH WARD. EAST WARD. WEST WARD. CENTRAL WARD. At all Ages. Small-Pox 10 ... 1 8 1 ... 1 8 1 Cholera ... ... ... ... ... ... ... ... ... Diphtheria 12 3 1 6 2 ... ... ... ... Membranous croup ... ... ... ... ... ... ... ... ... Erysipelas 4 ... ... 3 1 ... ... ... ... Scarlet fever 57 3 8 29 17 2 6 25 14 Typhus fever ... ... ... ... ... ... ... ... ... Enteric fever 9 3 3 2 1 ... ... ... ... Relapsing fever ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... Puerperal fever 2 1 1 ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... Totals 94 10 14 48 22 2 7 33 15 Isolation Hospitals:—Mereway Hospital (Small-pox) ; Cross Deep House (Scarlet fever). TABLE IV. Causes of, and Ages at, Death during Year, 1902. CAUSES OF DEATH. Deaths in or belonging to whole District at Subjoined Ages. Deaths in or belonging to Localities (at all ages.) Total Deaths in Public Institutions in the District. All ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. South Ward. East Ward. West Ward. Central Ward. Small-pox 1 .. .. .. .. 1 .. 1 .. .. .. 1 Measles 8 4 4 .. .. .. .. .. 2 4 2 .. Scarlet fever 1 .. 1 .. .. .. .. 1 .. .. .. 1 Whooping-cough 9 5 3 1 .. .. .. 1 .. 7 1 .. Diphtheria and membranous croup 3 .. 2 1 .. .. .. 1 .. 1 1 .. Croup 1 .. 1 .. .. .. .. .. 1 .. .. .. Fever Typhus .. .. .. .. .. .. .. .. .. .. .. .. Enteric .. .. .. .. .. .. .. .. .. .. .. .. Other continued .. .. .. .. .. .. .. .. .. .. .. .. Epidemic influenza 2 .. .. .. .. 1 1 .. 2 .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 7 6 .. .. .. .. .. 1 2 4 .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 7 6 .. .. .. .. .. 1 .. 2 4 .. Enteritis .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 1 .. .. .. 1 .. .. .. 1 .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. Other septic diseases .. .. .. .. .. .. .. .. .. .. .. .. Phthisis 18 .. .. .. 5 11 2 5 3 7 3 .. Other tubercular diseases 4 1 1 4 .. .. .. 1 2 1 .. .. Cancer, maligant disease 11 .. .. .. .. 6 5 .. 4 6 1 .. Bronchitis 13 6 1 .. .. 1 5 2 5 3 3 .. Pneumonia 25 7 8 1 .. 6 3 2 2 14 7 1 Pluerisy 1 .. .. .. .. 1 .. .. .. 1 .. .. Other diseases of Respiratory organs 3 .. .. .. .. .. 3 .. .. 3 .. .. Alcoholism 6 .. .. .. .. 4 2 .. 2 1 3 .. Cirrhosis of liver Venereal diseases .. .. .. .. .. .. .. .. .. .. .. .. Premature birth 12 12 .. .. .. .. .. 2 4 5 1 .. Diseases and accidents of parturition 1 .. .. .. 1 .. .. .. .. .. 1 .. Heart diseases 28 1 .. 2 .. 11 14 6 8 5 9 3 Accidents 7 2 .. .. 2 2 1 1 3 3 .. 1 Suicides 1 .. .. .. .. .. 1 .. .. 1 .. .. All other causes 106 41 2 1 3 15 44 22 26 36 22 3 All causes 269 85 23 9 12 59 81 46 65 100 58 10 c (I). COUNTY OF MIDDLESEX.—SANITAEY WORK, 1903. Name or Sanitaby District: TWICKENHAM. Inspections. Notices. Dwelling Houses. Houses let in separate Dwellings or Lodgings. Common Lodging Houses. Canal Boats used as Dwellings. Movable Dwellings, Caravans, Tents, &c. Complaints Received. Cases of Infectious Disease Notified. Number of Premises periodically Inspected. Houses Inspected from Houseto-House. Total Number of Houses, Premises, &c., Inspected. Total Number of Re-inspections after Order or Notice. Total Number of Inspections and He-inspections. Letters Written. Cautionary Notices Given. Statutory Orders Issued. Summonses Served. Convictions Obtained. Houses, Premises, &c., Cleansed, Repaired, &c. Closed as Unfit for Habitation. Re-opened after Repairs, Alterations, &c. Demolished. Illegal Underground Dwellings Vacated. Number Registered under Bye-laws. Periodical Frequency or Number of Inspections. Number of Contraventions. Number Registered under Bye-laws. Periodical Frequency or Number of Inspections. Number of Contraventions. Number Registered under the Acts. Periodical Frequency or Number of Inspections. Number of Contraventions of Regulations. Number Observed during the Year. Number of Nuisances therefrom Abated. Number Removed from District. 163 94 164 2196 1936 4132 772 160 602 - - 234 7 - 1 - - - - - - - - - - - - - C (II). COUNTY OF MIDDLESEX.—SANITARY WORK, 1903 Name of Sanitary Distict : TWICKENHAM. Schools. Workshops and Work-places. Laundries. Bakehouses. Slaughter-houses. Cow-sheds. Dairies and Milkshops. Unsound Food. Adulterated Food. Offensive trades. Mortuaries. Number in District. Periodical frequency or Number of Inspections. Number found defective. Number in District. Periodical Frequency or Number of Inspections. Contraventions of Factory Acts. Number in District. Periodical Frequency or Number of Inspections. Contraventions of Factory Acts. Number in District. Periodical Frequency or Number of Inspections. Contraventions of Factory Acts. Number on Register. Periodical Frequency or Number of Inspections. Contraventions of Bye-laws. Number on Register. Periodical Frequency or Number of Inspections. Contraventions of Bye-laws. Number on Register. Periodical Frequency or Number of Inspections. Contraventions of Bye-laws. Animals seized. i Articles or parcels seized. Samples taken. Found adulterated. Number of premises in District. Periodical Frequency or Number of Inspections. Contraventions of Bye-laws. Accommodation. Number of bodies received. 16 Occasionally. - 76 Frequently. 4 36 Frequently. 3 17 Monthly. 1 11 Frequently. - 8 Frequently. - 30 Frequently. - - 8 - - - - - 4 10 C(III) COUNTY OF MIDDLESEX.—SANITARY WORK, 1903. Name of Sanitary District: TWICKENHAM. Water Supply and Water Service. Privy and Ash Pits, Ash and Earth Closets Drainage and Sewerage. Wells. Houses, Water Laid on to. Percentage of Houses Supplied from Mains Cisterns. Flush Cisterns Provided to W.C.'s. Draw-Taps Removed from Cisterns to Mains. Percentage of Houses Supplied on Constant System. Water Closets. Percentage of Houses Provided with Water Closets. Drains Cesspools. Percentage of Houses Draining into Sewers. Sewers. New, Sunk. Cleansed, Repaired, Etc. Closed as Polluted. New, Provided. Cleansed, Repaired, Covered, Etc. Overflow Pipes Disconnected from Drains. Above Ground Receptacles Substituted for Pits. Movable Receptacles Substituted for fixed. Water Closets Substituted for Dry Receptacles. New, Constructed. New Apparatus Provided. Repaired, Cleansed, Etc. Supplied with Water, or Supply Rendered Efficient. Ventilated. Examined, Tested, Exposed, Etc. Unstopped, Repaired, Trapped, Etc. Waste Pipes, Rain Water Pipes, Etc., Disconnected. Soil Pipes and Drains Ventilated. Disconnecting Traps or Chambers Inserted. Reconstructed. New, Laid. Rendered Impervious. Emptied, Cleansed, Etc. Abolished, and Drain Connected to Sewer. Yards of New Sewers Laid. Yards of Sewers Reconstructed. - 4 - 32 98 per cent. 86 62 - 230 - 98 per cent. - - - 24 98 39 239 5 80 per cent. 19 117 36 25 14 14 14 2 2 99.5 per cent. 1317 - C (IV). COUNTY OF MIDDLESEX.—SANITAEY WORK, 1903. Name of Sanitary District: TWICKENHAM. Disinfection. Dust. Dampness. Sundry Nuisances Abated. Contagious Diseases of Animals. Infant Life Protection Act. Rooms fumigated. Rooms stripped and cleansed. Articles disinfected or destroyed. ! Dust-bins repaired. New bins provided. Movable receptacles substituted for fixed. Periodical frequency of dust removal. Number of complaints of nonremoval received. Roofs repaired, &c. Guttering & rain-pipes repaired, &c. Gardens, Areas, &c., levelled and drained. Yards paved and drained. Surface adjoining houses paved. Dry areas provided. Ventilation below floor provided. Basements rendered impervious. Overcrowding. . Smoke. Accumulations of refuse. Foul ditches, ponds &c., and stagnant water. Foul pigs and other animals. Other nuisances. Outbreaks. Animals infected. Animals destroyed. Number of licensed premises. Number of children. Number of deaths. 54 41 A large number. 12 133 37 Weekly. 150 64 56 - 30 - - 10 - 3 5 32 8 0 72 1 10 10 - - -