TW 1042 Twickenham Urban District Council. HEALTH COMMITTEE. Councillor R. MORROW, (Chairman). „ S. S. EARLE. „ A. W. H. LOVELESS. „ W. J. PALMER, „ W. POUPART. „ W. WEBB. „ R. W. SWAKER. „ F. J. GOODMAN. „ F. AYLAND, (Ex-oficio). „ W. A. SLADE, J.P., (Ex-oficio). W. MARSTON CLARK, D.P.H., Lond., Medical Officer of Health. A. G. KNIGHT, Inspector of Nuisances. G.W. STREATFIELD, M.R.S.I. Assistant Inspector of Nuisances. ELIZABETH QUICK, Matron at Infectious Diseases Hospital. Twickenham Urban District Council. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, 1908, Mr. Chairman and Gentlemen, I have the honour to submit to you my twenty-fifth Annual Report as to the Health and Sanitary condition of the Parish of Twickenham. Appended to the Report are five tables received from the Local Government Board. Table I comprises the vital statistics of the whole District for 1908, and previous years extending, from 1898. Table II consists of the Births and Deaths registered, and with a view to giving more concise information, such table has been sub-divided corresponding with the four Wards of the District, viz.:—South, East, West, and Central. I have estimated the population at 27000, comprising 5263 in the South Ward, 7414 in the East Ward, 8792 in the West Ward, and 5531 in the Central Ward. Table III shows the cases of Infectious Diseases notified during the past year. Of the total cases 24 were in the South Ward, 17 in the East Ward, 47 in the West Ward, and 12 in the Central Ward. The removals to the Infectious Diseases Hospital, were 19 from the South Ward, 12 from the East Ward, 33 from the West Ward, and 5 from the Central Ward. 3 Table IV embraces the causes and ages at death for the same period. There were 331 deaths; of these 69 occurred in the South Ward, 84 in the East Ward, 111 in the West Ward and 67 in the Central Ward. Table V gives the Infantile Mortality sub-divided into weekly periods up to one year of age. In addition to the foregoing, there are three tables furnished by the Middlesex County Council, viz.:—Tables I, II and III. Table (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., Workshops and Workplaces, Inspections generally, and notices served. Table (II) contains the Inspection of Laundries, Bakehouses, Slaughter-houses, Cowsheds, Dairies and Milksliops, Unsound Food, Adulterated Food, Offensive Trades, Water Supply, and Water Service. Table (III) relates to Water Closet accommodation, Drains, Cesspools, Disinfection, Dust Collecting, and sundry other Nuisances, such as Overcrowding, smoke, &c., &c. Population. The Vital Statistics are in this report calculated on an estimated population of 27,000. The population at the time of the Census of 1891 was 16,026, and at the Census of 1901, 20,991. Having regard to the large number of uninhabited houses and the conclusions drawn from the number of births and deaths, I have not felt justified in basing my calculations on any other estimate. The new houses finally inspected prior to occupation during the year were considerably below the average of preceding years. 4 Births. During the year there were 751 births, 405 were males and 346 females, giving a birth rate of 27'8 per 1000. The total number of births for 1902 was 596 „ „ 1903 „ 615 „ „ 1904 „ 723 „ „ 1905 „ 713 „ „ 1906 „ 811 „ „ 1907 „ 774 The births were distributed as follows:— Southward 126 Central ,, 129 East „ 168 West „ 328 Deaths. With an estimated population of 27,000, the number of deaths within the district 289, is 13 below last year. The death rate is at the average of 10.7 per 1,000 as against 11.2 per 1,000 in the preceding year. The number of deaths of residents, whether occurring in or beyond the district is as follows:— 1902 was 264 equal to an average 12"0 1903 „ 254 „ 10.5 1904 „ 319 „ „ 12.2 1905 „ 301 „ „ 11.5 1906 „ 334 „ 12.3 1907 „ 302 „ „ 11.2 Of the deaths registered in the district and as takingplace among the residents in Twickenham, 91 exceeded 65 years of age. 16 were between the age of 65 and 70 years. 51 „ „ 70 „ 80 „ 21 „ „ 80 „ 90 „ 5 One died at the age of 90, one at 91 and one at the very advanced age of 97. Three uncertified deaths were recorded, one due to Senile decay, one to Influenza and one to Premature Birth. Amongst the deaths from all causes were 7 from Diarrhoea, 7 other Diarrhœal Diseases, 25 from Phthisis, 8 from other forms of Tuberculosis, 11 from Cancer, 24 from Respiratory Diseases, 35 from Heart Disease, 9 from Accidents, and 16 Premature Births. With reference to compiling the death returns for the district the Local Government Board insists that regard should be had to the following points:— "By the term 'Non-resident' is meant persons brought "into the district on account of sickness or infirmity, and "dying in public institutions there; and by the term " 'Residents' is meant persons who have been taken out of " the district on account of sickness or infirmity, and have " died in public institutions elsewhere." "The 'Public Institutions' to be taken into account for "the purposes of these Tables are those into which persons "are habitually received on account of sickness or infirmity, "such as hospitals, workhouses and lunatic asylums." It will be observed that the death of any person really belonging to an outside district must however be classified as " Resident " unless such person dies in a Public Institution, i.e., as regards Twickenham, St. John's Hospital, Nightingale Nursing Home and Carpenters' Almshouses. Fifty deaths of residents occurred outside the District in the undermentioned places:— Isleworth Infirmary 26 Richmond Hospital 6 Wandsworth Asylum 4 Devonshire Street, Marylebone 1 6 Elbrook Road, Paddington 1 St. Peter's Hospital West London ,, 1 Children's ,, Gt. Ormonde St. Brompton 1 Guy's1 „ King's College „ 1 St. Thomas' „ 2 Salop County Asylum 1 Seamen's Hospital 1 Long Water, Home Park, Hampton Court 1 Richmond Bridge 1 This number is less than last year's return by 10. The corrected "average" of deaths is ascertained by including deaths of residents who have died outside the district and deducting those of non-residents dying within the district. Therefore the corrected average is 331, which is represented by 12 2 per 1000. There were eight deaths of non-residents which took place within the district, viz.:—four at St. John's Hospital, and four at the Nightingale Nursing Home. The epitome of ages at death including the foregoing is as follows:— Under 1 year 74 Over 1 year and under 5 years 23 Over 5 years and under 15 years 12 Over 15 years and under 25 years 20 Over 25 years and under 65 years 92 65 years and upwards 110 The deaths in the various Wards were as follows:— Southward 69 Central „ 67 East „ 84 West „ 111 7 Twenty-six deaths took place in St. John's Hospital, five in the Nightingale Nursing Home, one in the married quarters of the Royal Military School of Music, Kneller Hall, one in the Metropolitan and City Police Orphanage, three in the Carpenters Almshouses, and one in the parish Almshouses, Church Street. The following Table summarises the Mortality from the principal Zymotic diseases happening during the last 10 years:— 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 Small Pox 0 0 0 1 0 0 0 0 0 0 Measles 0 8 2 8 1 2 0 13 4 3 Scarlet Fever 2 0 3 1 1 1 0 1 0 0 Diphtheria 6 3 3 3 3 2 1 3 2 1 Whooping Cough 3 7 9 9 10 13 6 3 4 10 Enteric Fever 0 1 2 0 0 2 1 0 1 1 11 19 19 22 15 20 8 20 11 15 Infantile Mortality. As previously mentioned, the total number of deaths of children under one year of age was 74. Of these 18 occurred under the age of one week, 4 between one week and two weeks, 2 between two and three weeks, and 1 between three and four weeks, a total under one month of 25. Four occurred between one month and two months, 5 between two and three months, 7 between three and four months, 7 between four and five months, 6 between five and six months, 3 between six and seven months, 4 between seven and eight months, 4 between eight and nine months, 2 between nine and ten months, 6 between ten and eleven months, and 2 between eleven and 8 twelve months. Included in the above figures are 16 premature births. The Infantile Mortality is equal to 9'3 percentage of births. This is a decrease of 1.9 on the previous year. The attention of the Council is again directed to the deaths which have taken place amongst infants under one year of age as compared with the number of births in all Wards. The returns shew that about one death occurs in every ten births. The Council was invited to attend the National Conference on Infantile Mortality at Westminster, but it was decided not to take any action in the matter. I drew the attention of the Council to the deaths amongst infants under one year of age since 1901, the statistics being as follows, viz.:— South Ward. East Ward. Central Ward. West Ward. 1901 11 17 13 27 1902 10 19 20 36 1903 7 22 11 31 1904 13 14 23 59 1905 10 8 21 48 1906 13 16 26 67 1907 12 12 11 52 From these figures it would appear that about 50 per cent, of the infantile mortality in the whole district arose in the West Ward. Water Supply and Analyses. Five samples of water drawn from wells were analysed and with one exception were found to be good, and fit for drinking and domestic purposes. The Metropolitan Water Board have from time to time reported that the water service to several houses had ceased. Upon an inspection of the premises being made and enquiries 9 instituted, it was found that in a large number of cases the supply had been discontinued because the water rate had not been paid. It would appear that the Water Board adopt that course preferably to taking proceedings for the recovery of the rate. The steps thus taken not only render the premises in a sense uninhabitable, but cast a large amount of labour upon the officers of the Council. It may be the Water Board are strictly within their legal rights, still the matter is one of importance, and will I trust be dealt with by the Council. Factory and Workshop Acts, 1901-7. During the year each of the factories and workshops have been inspected as required by the statutes. The system of notifying Sanitary Authorities of other Districts as to Outworkers residing therein, has necessitated additional enquiries and resulted in the discovery of several additional workrooms where work is taken from businesses in London and elsewhere. It is again my pleasing duty to note that in the District the utmost courtsey is shewn and every facility is given for inspection and any reasonable request is readily complied with. A large number of the work places are inspected at intervals throughout the year. The following is a list of work-shops registered in the District and the number of employees, together with a list of sanitary defects discovered, &c. Trades represented. No. of Premises. Employees. Bakers 20 53 Boot Makers 7 17 Boat Builders 2 9 Carriage Builders and Wheelwrights 4 21 Cycle Makers 2 8 Dressmakers 33 129 Dyers and Cleaners 2 4 10 Engineers 2 8 Harness Makers 2 6 Joiners 1 4 Laundries 23 286 Milliners 10 31 Picture Frame Makers 2 5 Tailors 13 38 Umbrella Maker. 1 2 Upholsterers 2 5 Watchmakers and Repairers 8 14 134 640 Sanitary defects and other matters Premises requiring cleansing 22 Unsuitable or defective Sanitary Accommodation and Drains 6 Other Nuisances 15 Notice to H.M. Inspector of Factories as to Failure to affix Abstract of Act 4 Repeated inspections were made and works of whitewashing and cleansing executed in the following buildings:— Laundries 23 Slaughter houses 10 Dairies and milk shops 24 Workshops and workplaces 22 Bakehouses 20 Cowsheds 9 By the provisions of the Factory and Workshop Act, 1907, the Factory and Workshop Act, 1901 is to be applied to Laundries carried on by way of trade, or for the purpose of gain, or carried on as ancillary to another business or incidentally to the purposes of any public institution. In laundries, other than laundries ancillary to a business carried on on any premises which, apart from the provisions 11 of the Act are a factory or workshop, the hours of employment of women and young persons may be varied. Special regulations are to be complied with in laundries where mechanical power is used, by providing a fan, &c., for regulating the temperature of every ironing room. Stoves for heating irons are to be separated from the ironing room. Floors must be kept in a good condition and drained. Wherein premises, forming part of an institution carried on for charitable or reformatory purposes, any manual labour is exercised in the making, altering, repairing, ornamenting, finishing, washing, cleaning or adapting for sale of articles not for use in the Institution, the provisions of the Factory and Workshop Act, 1901 are applicable to those premises. The duties occasioned by this statute have been again satisfactorily performed by the Assistant Sanitary Inspector. Slaughter Houses. These have been carefully inspected. The Council caused to be sent to every slaughterer in the district a circular letter issued by the Local Government Board as to the methods of slaughter, and requested that the suggestion as to the humane slaughtering of animals should receive careful consideration. Inspection of the Parish. Over 6761 houses, premises, &c., have been inspected and re-inspected. The following is an analysis of the work accomplished:— Houses, premises, &c., cleansed, repaired, whitewashed, &c. 98.1 „ roofs repaired&c. 137 „ gutterings and rain pipes repaired, &c. 74 „ ventilation below floor provided 6 „ yards paved, drained, repaired, &c. 97 12 Accumulations of manure removed 34 Urinals repaired 11 Nuisances arising from overcrowding 16 ,, ,, pigs, other animals, and fowls 27 Other Nuisances not included in the above 175 Water—Wells closed 1 Laid on to houses with no supply 0 Cisterns—New provided 7 Cleansed, repaired, covered, &c. 76 Flush to W.C.'s 37 Water-closets—New constructed 8 New apparatus provided 23 Repaired, cleansed, &c. 184 Supply with water or supply rendered efficient 12 Ventilated 8 D traps and containers abolished 2 Stables—Impervious paving provided 1 Unsound Food—Articles surrendered 14 Disinfection—Rooms fumigated 112 Stripped and cleansed 51 Drains- Examined, tested, exposed, &c. 114 Unstopped, repaired, trapped, &c. 176 Waste pipes, rain pipes, &c., disconnected 51 Soil pipes and drains ventilated 22 Disconnecting traps and chambers inserted 12 Reconstructed 16 Cesspools filled in 0 „ cleaned out 6 Gullies fixed in lieu of "Bell-Traps" 7 Dust—Number of complaints of non-removal 5 New dustbins provided 347 Movable receptacles substituted for fixed 14 Sanitary orders issued 1406 Dairies, Cowsheds and Mlilkshops Orders. Eight applications were received for the registration of persons for the sale of milk and the registrations were made. The whole of the cowsheds, dairies and milkshops were frequently inspected, and works of cleansing were carried out where necessary. 13 The Council furnished the Middlesex County Council with a return of all dairies, cowsheds, and milkshops registered. The London County Council enquired whether the milch cows in the district were examined by a veterinary surgeon. As no such inspection was made the Council subsequently and rightly in my opinion appointed a veterinary surgeon for that purpose, as suggested by me in a previous annual report. Housing of the Working Classes Acts. A house to house inspection was made oE the following streets :—Milford Road, Orleans Road, Fourth Cross Road, St. Margaret's Grove, Warwick Road, Hamilton Road, South Western Road, St. Margaret's Road, Rutland Road, Nelson Road, Hounslow Road (part), Second Cross Road, Third Cross Road, Athelstan Road, Norcutt Road, Gould Road, Mereway Road, Chapman's Place, Colne Road, Stuart Place, Holly Road, Canaac Road, Brook Road, Gravel Road, Lion Road, Andover Road, Talbot Road, and Cole's Buildings. Where nuisances or defects were found to exist, notices to abate the causes of complaint, were: served. In one instance only proceedings had to be taken before the Justices who made an Order directing the premises to be closed until they were rendered fit for human habitation. The satisfactory results thus attained are in great measure due to the procedure adopted by the Health Committee in causing letters in the first instance to be addressed by the Clerk to the Council to owners of property drawing their attention to the existing defects. Diseases of Animals Acts. At the request of the Board of Agriculture and Fisheries the Council caused notices to be furnished to all persons carrying on slaughter houses or knackers' yards as to the necessity in the event of their having in their possession a 14 carcase of any horse, ass, or mule, affected with or suspected with glanders or farcy to report at once to the police. Glanders broke out at four premises and certain horses had to be slaughtered. There was one case of swine fever. The respective premises where these diseases occurred were subsequently thoroughly cleansed and disinfected. The Customs and Inland Revenue Act. Under section 26 of 53 and 54, Vic. c. 8, exemption from the Inhabited House Duty is granted to houses divided into tenements of the annual value of less than £20, provided the Medical Officer of Health certifies that they afford suitable accommodation for each of the families or persons in respect of their sanitary arrangements. By section 11, 3 Ed. VII. this provision was extended to houses of the annual value of not more than £40. During the year applications were received in respect of the flats situate in Katherine Road, and certificates were granted in all instances. Street Noises. Representations were made to the Council as to the inconvenience and annoyance occasioned by hawkers and others shouting in the streets. The Health Committee drew attention to the following bye-law made by the Middlesex County Council on the 28th June, 1906, which was in force in the district. "No person shall, for the purpose of hawking, selling, or advertising any newspaper, or goods, or for the purpose of purchasing, collecting or exchanging rags, bones, old clothes, bottles, and similar articles, call or shout in any street so as to cause annoyance to the inhabitants of the neighbourhood. 15 Any person who shall offend against the foregoing Byelaw shall be liable for every such offence, to a fine not exceeding forty shillings." The Council wisely intimated that if a majority of residents in a street made complaint it would be sufficient evidence or grounds for the Council to enforce the Bye-law. Notification of Births Act, 1907. The Clerk of the Council again drew attention to the provisions of the Notification of Births Act, 1907, whereby the Council might provide for the early notification of births within their district. He also reported the receipt of a circular letter dated the 27th Sept., 1907, from the Local Government Board with reference to the matter. "The Board stated that in their opinion there was no occasion for imposing upon parents and others the obligation of notifying births unless steps were taken to carry out the ultimate object of the measure, viz.:— the giving of advice and instruction to those who had charge of the infants, and in ordinary circumstances they would not be prepared to consent to the adoption of the Act, unless it appeared that arrangements had been made for that purpose. The arrangements would usually be best carried out by local agencies under the Medical Officer of Health. The Board trusted that the Council would consider the question of adopting the Act and of co-operating with any agency that may exist, so as to secure its successful operation. Should the Council propose to apply to the Board for consent to the adoption of the Act, they should be in a position to shew that the necessary arrangements for carrying out its object had been or would be made if they became the authority for executing it." The Council again decided not to take any steps for the present. 16 Notifiable Diseases* Subjoined is a Table of the Scheduled Notifiable Diseases with the number of cases occurring in each year for the past ten years. 1899 1900 1901 1902 1903 1904 1905 1906 1907 1908 Small Pox 0 0 0 10 0 0 0 0 0 0 Scarlet Fever 142 97 105 57 23 101 41 82 64 72 Diptheria and Membranous Croup 29 27 31 12 18 30 10 25 18 16 Typhus Fever 0 0 0 0 0 0 0 0 0 0 Enteric or Typhoid Fever 9 6 9 9 3 7 2 6 5 1 Continued Fever 1 7 2 0 0 0 1 0 1 0 Relapsing Fever 0 0 0 0 0. 0 0 0 0 0 Puerperal Fever 0 4 2 2 0 2 5 2 2 0 Cholera 2 0 0 0 0 0 0 0 0 0 Erysipelas .. 11 12 10 4 4 8 11 17 8 11 194 153 159 94 48 148 70 132 98 100 This year's return shews an increase in comparison with the previous year of 2 cases only. Measles. This disease was prevalent during the month of October, and I had occasion to advise the closure, of St. Mary's School, Infants' Department. Small Pox. No case of this disease was notified during the year 1908. 17 Whooping Cough. Whooping cough accounted for ten deaths, all of which were under 2 years of age, and each case was attended by complications such as broncho-pneumonia or convulsions. Scarlet Fever. Seventy-two cases were recorded during the year as compared with 64 for the preceding year; of these 20 took place in the South Ward, 12 in the East Ward, 34 in the West Ward, and 6 in the Central Ward. I had occasion to advise the Council to close the public elementary schools, Archdeacon Cambridge Girls' and Infants Departments, and Trafalgar Infants. The Council acted upon such advice and the outbreak was limited. During the progress of the Medical Inspection of school children it was discovered that some children were in the desquamating stage of the fever. It was upon this evidence that I advised the Council to close the above schools for 14 days, which schools were subsequently thoroughly fumigated and cleansed throughout. At the end of this period every child was examined upon re-admission. No child was then detected suffering from the disease, although a few other cases were notified during the period of closure. Diphtheria. The number of cases notified amounted to 16 as compared with 18 in the preceding year. One case terminated fatally. The method of dealing with the disease was exactly the same as in previous years, viz., the examination gratis of swabs taken from the affected part and the free distribution of Anti-Diphtheritic Serum. The use thereof undoubtedly had the effect of deterring the spread of the disease and effecting cures. Infectious Diseases Hospital. Sixty-nine cases of Scarlet Fever were admitted into the temporary Hospital, the Council still continuing their tenancy 18 of this building. There were three cases treated at the patients own homes. Of the sixty-nine cases, 33 were removed from the West, 5 from the Central, 12 from the East, and 19 from the South Wards respectively. Nurse Quick continued in charge, and the manner in which she fulfilled her duties gave me every satisfaction. The work in connection with the erection of the new Isolation Hospital on the land at Whitton acquired by the Council for this purpose was completed, and steps had already been taken for the furnishing and general equipment of the buildings. The Council installed Nurse Quick as the Matron, and appointed two nurses, a cook, a ward maid, a laundress and a general help, also a man to attend to the garden and to carry out any odd work that might be required. Tuberculosis. During the year there were 25 deaths registered in the District due to Phthisis, and 11 to other tubercular diseases, a total of 36 deaths due to tuberculosis. The Council considered Regulations received from the Local Government Board which were to take effect on January 1st, 1909. Notificatcon by Medical Officers of Poor Law Institutions. Article IV. of the Order directs that the Medical Officer of a Poor Law Institution, as defined by Article I., shall, within 48 hours after his first recognition of the symptoms of pulmonary tuberculosis in the case of a poor person who is an inmate of the institution post to the Medical Officer of Health for the sanitary district in which the person resided immediately before he became an inmate of the institution a notification of the case. 19 The notification must be made on a printed form as set out in the Schedule to the Order. Notification by District Medical Officers. Article V. directs that a similar notification shall be posted to the Medical Officer of Health by the District Medical Officer in the case of any poor person suffering from pulmonary tuberculosis on whom he is in medical attendance according to his agreement with a Board of Guardians. The notification must be posted within 48 hours after the District Medical Officer has first recognised the symptoms of pulmonary tuberculosis, and must be addressed to the Medical Officer of Health acting for the sanitary district in which the residence of the poor person is situate. Notification by Superintending Officers of Poor Law Institutions. Under Article VI. it will be the duty of the Superintending Officer of a Poor Law Institution to post to the Medical Officer of Health on a printed form as set out in the Schedule to the Order a notification of the actual or intended place of destination and address of that place of any person leaving the institution in respect of whom a notification has been made by the Medical Officer of the institution under Article IV. The notification must be posted within 48 hours after the departure of the person to whom it relates, and must be sent to the Medical Officer of Health of the sanitary district in which the intended destination of the person is situate. Notification of changes of address by Relieving Officers. Article VII. provides that a Relieving Officer shall notify any change of address (other than by admission to a Poor 20 Law Institution) of a person in respect of whom a notification has been made under Article V. by a District Medical Officer. The notification must be made on a printed form as set out in the Schedule to the Order, and must be sent to the Medical Officer of Health for the sanitary district in which the address to which the person moves is situate. The notification must be posted within 48 hours after the Relieving Officer has obtained accurate information respecting the change of residence. Remuneration to be Allowed. Provision is made by Article VIII for the remuneration of the Officers who have to make notifications under the Order. In the case of a Medical Officer of a Poor Law Institution or a District Medical Officer, the remuneration will be at the rate of one shilling for every notification, but where in relation to any one case two or more notifications have been posted by the Medical Officer to the same Medical Officer of Health, his remuneration will be at the rate of sixpence for every such notification after the first. In the case of a Superintending Officer of a Poor Law Institution or a Relieving Officer, the remuneration will be at the rate of threepence for every notification. The remuneration will be payable by the Council of the sanitary district for which the Medical Officer of Health acts, It will be deemed to cover the cost of postage, and it will be payable in the manner and subject to the conditions prescribed by the Article. Supply of Forms. It will be the duty of the Poor Law Authorities referred to in Article III. to supply to the officers concerned printed 21 copies of the appropriate forms set forth in the Schedule to the Order. Exception and Application of Enactments. Some of the provisions of the Public Health Act, 1875, and of the Public Health (London) Act, 1891, relative to infectious disease are not usually appropriate in cases of pulmonary tuberculosis. The Board have, therefore, provided by Article IX. (1) that nothing in the Regulations shall have effect so as to apply or to authorise any one to put in force with respect to a person in relation to whom a notification has been made any enactment which renders him or any other person liable to a penalty or subjects him to any restriction, prohibition, or disability affecting him or his employment, occupation, means of livelihood, or residence on the ground of his suffering from pulmonary tuberculosis. Special Powers of Councils. Subject to what is stated in the preceding paragraph, it is desirable that Sanitary Authorities acting on the advice of their Medical Officers of Health should utilise their powers for the purpose of preventing the spread of infection from pulmonary tuberculosis. The Order confers some special powers which the Board are advised are suitable for this purpose, and which are set out in Article IX. (2) of the Order. The Board propose to issue for the use of Sanitary Authorities and Medical Officers of Health a memorandum by their Medical Officer setting out the appropriate action that can be taken under these powers. Copies of the memorandum will be sent to the Council in due course. The Council gave instructions that all requisite books should be procured, and for a report to be made thereon at a later date respecting the cases notified, and as to the condition of the houses of the patients. 22 Inquests. During the past year 27 inquests have been held. The findings of the juries were as follows:— 5 Syncope. 1 Want of attention at birth. 1 Spasm of glottis. 1 Found drowned. 1 Suicidal drowning. 4 Heart disease. 8 Accidental. 1 suffocated in bed. „ 1 killed by motor car. „ 1 fracture of skull from fall. „ 1 killed by tram. „ 1 burnt. „ 1 drowned. „ 1 knocked down by horse and cart. „ 1 fall at birth. 6 Pneumonia. There were 18 post mortem examinations performed at the mortuary out of 22 bodies which were received therein. Buildings and Sewers. 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) 105 Plans for alterations and additions to existing buildings 21 Houses connected to soil sewers 102 Houses connected to surface water sewers 84 Houses completed for occupation 132 Number of yards of new sewers constructed 796 Number of yards of surface water sewers constructed 304 New manholes constructed 12 23 New Streets. The following new streets have been made up under the provisions of the Private Street Works Act, 1892:— Copthall Gardens. Andover Road. Hartington Road. Public Health Acts Amendment Act, (907. The Council made application to the Home Office for an order conferring upon the Council the powers contained in Part VII. (Police) Part VIII. (Fire Brigade) and Part IX. (Sky Signs,) of the Act. Representations were also made to the Local Government Board requesting that an order might be made giving the Council powers under Part II. (Streets and Buildings), Part III. (Sanitary Provisions), Part IV. (Infectious Disease), Part V. (Common Lodging Houses), and Part VI. (Recreation Grounds). It is to be desired that the Local Government Board will accede to the application, as there has been a long felt difficulty experienced in dealing with "cisterns" used for the supply of water for domestic purposes being so placed or constructed or kept as to preserve the water from impurities. The provision and conversion of water-closets is most important, and has from time to time given considerable trouble, therefore powers giving the Council larger jurisdiction will be beneficial. The question of dealing with urinals opening on the streets has caused some trouble, and any new enactment will be of great service, as will powers enabling the Council to deal with urinals attached to inns, public houses, beer houses, eating houses, refreshment houses or places of public entertainment. 24 The power of testing of drains in order to discover defects is badly required. The removal of trade refuse by the Council upon the payment of a reasonable sum is a step in the right direction, and should add greatly to the sanitation of a district. I cannot emphasize too much the desirability of the Council having powers compelling the provision of proper sinks and drains for buildings. It will be recollected that the Council have had difficulty in dealing with the establishment of businesses likely to be of an offensive character, and the power to declare a business to be an offensive business will probably settle any prospective issues. As regards the sections having reference to Infectious Diseases it is perhaps quite unnecessary for me to say that the powers have long been desired, and should be of great service to the district. Although the district may not have common lodginghouses as are generally considered under such a term still I think that Part V. dealing with these matters may be of considerable help. Speaking generally, I think that perhaps excepting a few sections the whole of the Act should be of great service to the district. Small Holdings Allotments Act, 1907. The Board of Agriculture and Fisheries issued a series of proposed regulations in respect to the letting, &c., of allotments, but as the same did not appear to make any material alterations in the regulations now in force the Council considered that there was no necessity for making any revision. 25 I am pleased to record the fact that the Council provided about 1¼ acres of land, which allowed for the provision of 20 additional allotments. The Clerk obtained a return of the glebe lands in the district, with their acreage and gross estimated rental. It would appear that the whole of the allotments now provided have been let nearly throughout the year. Keen competition prevailed amongst the tenants for prizes given by the local Horticultural Society for the best produce and well cultivated garden. Midwives' Act, 1902. The Supervising Authority under this Act is the Middlesex County Council. During the year 1908, there were 5 Midwives on the Rolls as practising in this District. Periodically, their homes have been visited viz., Eaton, E. R., 25, Arragon Road; Lenton, L. S., 20, Gravel Road; Lyndon, M. A., 3, Elizabeth Cottages, Holly Road; Silvester, E., 7, Crane Road; Warden, M., 38, Chestnut Road. Pigs, Keeping of. In three instances pigs were found to be kept in styes within short distances of dwelling-houses, and as the animals were kept in contravention of the Bye laws pressure had to be brought to bear upon the owners, and the pigs were then removed. Re-drainage of Premises. By reason of defects existing in 102 premises, notices had to be served upon the persons by whose acts, sufferance, or 26 default the nuisances existed to make good the defects. The notices were all complied with, with the exception of four instances, and the Council consequently entered upon the premises and did the necessary work. House Refuse. The house refuse of the district is collected weekly by the Council's own staff, and the arrangements in connection therewith continue to give every satisfaction. Only five complaints were received with respect to non-removal, such complaints being chiefly due to the collectors not being able to obtain admission at the proper time. During the year 15,648 cubic yards of refuse, or an average quantity of 50 cubic yards per day, were collected, and disposed of in the Refuse Destructor. I have on several occasions visited these works and was much pleased with the results attained. The Surveyor reported that on certain occasions explosives had been found in the house refuse at the Refuse Destructor Works, but that these had fortunately been detected before the refuse bad been put on the fire. As, however, there was considerable risk of damage and possible injury to the men being caused in the event of any of such explosives being overlooked and placed on the fire, it was considered advisable to deal with the matter. The Clerk reported that by an order dated 28th October, 1904, of the Secretary of State, relating to the deposit of explosives for conveyance as refuse it was ordered as follows, viz. : " Explosives shall not be deposited in any receptacle or place appropriated for refuse, and shall not be handed or forwarded to any dustman or other person employed in the removal of refuse, unless due notice has been given to such dustman or person, or to the dustman or person whose duty it is to remove refuse from such receptacle or place." "The person committing an offence shall be liable to a penalty not exceeding, in the case of the first offence £10, and in the case of the second offence, or any subsequent offence, £20." The Council directed that a circular be sent to all Occupiers of premises advising that precautionary measures should be taken. Sewage Disposal Works. Several visits have been made to these works. Specimens of the effluent have been seen, and I have been particularly struck with its clearness and almost complete absence of odour. General. I would here observe, which fact must have been within the cognisance of the Council, that the numerous statutes of recent years have vested the Council with far greater powers, and have consequently thrown larger responsibilities and more duties upon the officers and staff generally, and as the district increases in population these will continue to grow. I am indebted to the Health Committee for the careful consideration given to all matters brought under their notice, and for the firm support given to my various recommendations. I desire also to record my appreciation of the consistent work carried out by the Sanitary Inspectors, and all others who have assisted in matters appertaining to my department. 27 28 In conclusion I would observe that the past year has not been attendant by any prejudicial feature as affecting the sanitary condition of the district, and I think the Council may congratulate themselves upon the continued good health and the progress made generally. 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. Town Hall, Twickenham, April, 1909. TABLE I. Vital Statistics of whole District during 1908 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. Death of Non residents registered in Public Institutions the District. Deaths of Residents registered in Public. Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number. j Rate. Under 1 year of Age At all Ages. Number. Rate per 1000 Births registered. Number. j Rate. Number. Rate. 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 2 252 12.0 1902 22000 596 27.04 83 139.0 264 12.0 8 0 5 269 12.2 1903 24000 615 26.7 71 115.4 254 10.5 11 1 9 262 10.9 1904 26000 723 27.8 109 150.7 319 12.2 13 6 11 324 l'2.4 1905 26000 713 27.04 87 122.0 301 11.5 14 2 43 342 13.1 1906 27000 811 30.08 108 133.1 334 12.3 23 5 44 373 13.8 1907 27000 774 23.6 87 112.4 302 11.2 23 6 60 356 13.1 Averages for years 1898-1907. 23300 632 27.5 82 130.8 286 12.3 14.5 — - — - 1908 27000 751 27.8 70 93.2 289 10.7 37 8 50 331 12.2 Area of District in acres (exclusive of area covered by water), 2415 Total population at all ages, 20,991 At Number of inhabited houses, 4224 Census Average number of persons per house, 4.99 of 1901. p.t.o.] TABLE I.—continued. I. Institutions within the District receiving sick and infirm persons from outside the District. II. Institutions outside the District receiving sick and Infirm persons from the District. III. Other Institutions, the deaths in which have been distributed among the several localities in the District. St. John's Hospital Nightingale Nursing Home Carpenters' Alms Houses Isleworth Infirmary Richmond Hospital King's College Hospital Brompton Hospital Wandsworth Asylum Salop County Asylum West London Hospital Children's Hospital, Great Ormonde Street St. Peter's Hospital St. Thomas's Hospital Seaman's Hospital Guy's Hospital Metropolitan and City Police Orphanage Royal Military School of Music, Kneller Hall The Parish Almshouses TABLE II. Vital Statistics of separate Localities in 1908 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 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. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. 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 12b 63 17 6122 215 75 27 4282 122 53 13 1902 22000 596 269 85 4989 121 46 10 6076 149 65 19 6400 214 100 36 4895 109 54 11 1903 2400C 615 262 71 5434 110 53 7 6619 158 74 22 7052 238 81 31 4895 109 54 23 1904 26000 723 324 109 5889 116 58 13 7165 165 64 14 7688 298 134 59 5258 149 72 21 1905 26000 713 301 87 5800 120 59 10 7200 130 59 8 7725 314 111 48 5278 149 72 13 1906 27000 811 373 109 6050 134 69 13 7429 180 76 16 8040 355 157 67 5481 146 69 11 1907 27000 774 356 87 5263 125 63 12 7414 176 69 12 8792 327 155 52 5531 146 69 11 Averages of Years 1898 to 1907. 23300 632 286 82 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1908 27000 751 331 74 5263 126 69 12 7414 168 84 14 8792 328 111 33 5531 129 67 15 TABLE III. Cases of Infectious Disease notified during the Year 1908. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. No. of Cases removed to Hospital, from each Locality. At all Ages. At Ages—Years. SOUTH WARD. H EAST WARD WEST WARD. CENTRAL WARD. SOUTH WARD. H EAST WARD. WEST WARD. CENTRAL WARD. Total cases removed to Hospital. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 16 ... 5 11 ... ... ... 4 1 9 2 ... ... ... ... ... Erysipelas 11 1 ... 1 ... ... 3 ... 3 4 4 ... ... ... ... ... Scarlet fever 72 ... 14 51 6 1 ... 20 12 34 6 19 12 33 5 69 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 1 ... ... 1 ... ... ... ... 1 ... ... ... 1 ... ... 1 Relapsing fever 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 100 1 19 64 6 7 3 24 17 47 12 19 13 33 5 70 Isolation Hospitals:—Cross Deep House (for Scarlet fever) (Temporary) ; Mereway Hospital (for Small Pox). Total available beds, 45. Number of Diseases that can be concurrently treated, Two. TABLE IV. Causes of, and Ages at, Death during Year, 1908. 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 ... ... ... ... ... ... ... ... ... ... ... ... Measles 3 ... 2 1 ... ... ... ... 1 2 ... ... Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... Whooping-cough 10 6 4 ... ... ... ... 1 1 7 1 ... Diphtheria and membranous croup 1 ... 1 ... ... ... ... ... ... ... 1 ... Croup ... ... ... ... ... ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... ... ... Enteric 1 ... ... 1 ... ... ... ... 1 ... ... 1 Other continued ... ... ... ... ... ... ... ... ... ... ... ... Epidemic influenza 6 2 ... ... ... 1 3 2 1 2 1 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa 7 7 ... ... ... ... ... ... 1 5 ... ... Enteritis 7 7 ... ... ... ... ... ... 1 5 1 ... Puerperal feve ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... Other septic diseases ... ... ... ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 25 ... 1 1 6 16 1 4 4 8 9 ... Other tuberculous diseases 11 4 3 1 2 1 ... 4 1 3 3 3 Cancer, malignant disease 24 ... ... ... ... 15 9 7 4 9 4 2 Bronchitis 23 4 1 ... ... 2 16 4 10 5 4 1 Pneumonia 17 6 3 ... 1 3 3 3 6 4 4 2 Pleurisy 2 ... ... ... ... 2 ... 1 1 ... ... ... Other diseases of Respiratory Organs ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism 3 ... ... ... ... 2 1 ... 1 ... 2 1 Cirrhosis of liver Venereal diseases ... ... ... ... ... ... ... ... ... ... ... ... Premature birth 16 16 ... ... ... ... ... ... 5 9 2 ... Diseases and accidents of parturition 2 ... ... ... 1 1 ... ... 1 1 ... ... Heart diseases 35 1 ... 1 3 15 15 11 7 11 6 5 Accidents 9 2 2 ... ... 2 3 ... 2 4 3 5 Suicides 2 ... ... ... ... 2 ... 1 1 ... ... ... All other causes 127 19 6 6 7 30 59 30 35 36 26 17 All causes 331 74 23 12 20 92 110 69 84 111 67 37 TABLE V. Infantile Mortality during the Year 1908. CAUSE OP DEATH. 1 Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. j 11-12 Months. Total Deaths under One Year. All Causes Certified 17 4 2 24 4 4 7 7 6 3 3 4 2 6 2 72 Uncertified 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 2 Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... 1 1 ... 2 ... ... 2 ... 6 Diarrhœa Diseases. Diarrhcea, all forms 1 1 1 1 1 ... 1 1 1 ... ... ... 7 Enteritis ... ... ... ... ... ... ... l l 1 ... ... 2 1 1 ... 7 Muco-enteritis, Gastro-enteritis Gastritis, Gastrointestinal Catarrh ... ... ... ... ... ... ... l ... ... ... ... ... ... ... ... 1 Wasting Diseases. Premature Birth 14 1 1 16 ... ... ... ... ... ... ... ... ... ... ... 16 Congenital Defects 2 ... ... 2 ... ... ... ... ... ... ... ... ... ... 1 4 Injury at Birth 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus l ... ... ... 1 ... 1 2 1 ... ... ... ... 1 ... 1 7 Tuberculous Diseases. Tuberculous Meningitis Tuberculous Peritonitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Tabes Mesenteriea Other Tubereulous Diseases ... ... ... ... ... ... ... ... l ... 1 1 ... ... ... ... 3 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 Bronchitis ... ... ... ... ... 1 ... ... 1 1 ... ... ... ... 1 ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... 1 ... 1 1 1 1 ... 1 1 ... ... ... ... ... 6 Suffocation, overlaying ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Other Causes ... 2 ... ... 2 2 ... ... 1 2 ... ... ... ... 1 ... 8 18 4 2 1 25 4 4 7 7 6 3 4 4 2 6 2 74 Deaths from all Causes at all Ages, 331 Births during the year, 751 Population, 27,000. TABLE I. NAME OF Sanitary District TWICKENHAM. COUNTY OP MIDDLESEX—SANITARY WORK, 1908. Inspections. Notices. Dwelling Houses. Houses lot in Lodgings (Tenement Houses). Common Lodging Houses. Canal Boats used as Dwellings. Moveable Dwellings, Caravans, Tents, &c. Bakehouses. Particulars as to Staff Employed in Sanitary Department, specify if Inspectors are engaged in any other duties, and if so what. Number of Premises Inspected on Complaint. Number of Premises Inspected in connection with Infectious Diseases Number of Premises under periodical Inspection. Houses inspected from House-toHouse. Total number of Inspections and re-inspections made. Cautionary or Intimation Notices given Statutory Orders Issued. Summonses Served. Convictions Obtained. Houses, Premises, &c., Cleansed, | Repaired, &c. Closed as Unfit for Habitation. (a) As result of action under H. W.C Acts. (b) Otherwise. Re-opened after Repairs, Alterations, &c. Demolished. Illegal Underground Dwellings Vacated. Number Registered under Bye-laws. Number of Contraventions. Number Registered under Bye-laws. Number of Inspections. Number of Contraventions. Number Registered under the Acts. Number of Contraventions of Regulations. Number Observed during the Year. Number of Nuisances therefrom Abated. Number Removed from District, Number in District. Contraventions of Factory Acts. I?e Inspector of Nuisances 6 Assistant Inspector of Nuisances 41 123 177 3539 6761 1280 126 1 1 981 (a) 1 - - - - - - - - - - - - - 20 - TABLE II. Name of Sanitaby Distbict:-TWICKENHAM. COUNTS' OF MIDDLESEX.—SANITARY WORK, 1908. Slaughterhouses. Cow-sheds. Dairies and Milkshops. Unsound Food. Adulterated Food. Offensive Trades. Water Supply and Water Service. Wells. Percentage of Houses supplied from Public Water Service. Cisterns. Draw-Taps placed on Mains. Percentage of Houses supplied on Constant System. Number of Samples obtained for analysis, (a) from Local Wells, (b) from Public Supply. Number on Register. Number of Inspections mado and frequency of inspection. Contraventions of Bye-laws. Number on Register. Number of Inspections made and frequency of inspection. Contraventions of Regulations. Number of Milch Cows in District. Number on Register. Number of Inspections made and fiequency of inspection. Contraventions of Regulations. (a) Animals seized, (b) Articles i or Parcels seized. Condemned by Magistrate (a & b) Articles or Parcels surrendered. Samples taken (if any) by the District Local Authority. i Found adulterated. Number of premises in District. Number of Inspections made. Contraventions of Bye-laws. New Sunk. Cleansed, Repaired, &c. Closed as Polluted. New, Provided. Cleansed, Repaired, Covered,&c. 10 234 2 9 203 3 112 31 121 - - - 16 - - - - - 1 - 1 99.5 7 76 - 99.5 (a) 5 TABLE III. Name of Sanitary District TWICKENHAM. COUNTY OF MIDDLESEX. —SANITARY WORK, 1908. Drainage and Sewerage of existing Buildings. Disinfection. Dust. Sundry Nuisances Abated. Water Closets Percentage of Houses provided with Water Closets. Drains. Cesspools. Percentage of Houses Draining into Sewers. Rooms Disinfected («,) Ordinary infectious diseases, (b) Phthisis. Rooms stripped and cleansed. Articles disinfected or destroyed, (a) Ordinary infectious disease, | (6) Phthisis. New bins provided. How frequently is dust removed from each house. Number of complaints of nonremoval received. Method of Disposal (a) Destructor, (6) by Tipping, (c) Other, state method. Overcrowding. Smoke. Accumulations of refuse. Foul ditches, ponds, &c., and stagnant water. Foul pigs and other animals. Dampness. Yards repaved or repaired. Other nuisances. Number of Water Closets substituted for Dry Receptacles. Repaired, Supplied with Water, or otherwise Improved. Examined, Tested, Exposed, &c. Unstopped, Repaired, Trapped, &c. Waste Pipes, Rain Water | Pipes, Disconnected, Repaired, &c. New Soil Pipes or Ventilating Shafts fixed. Existing Soil Pipes or Ventilating Shafts repaired. Disconnecting Traps or Chambers inserted. Reconstructed. Rendered Impervious. Emptied, Cleansed, &c. Abolished, and Drain connected to Sewer. - 137 99.5 114 176 51 22 8 12 16 - - 99-5 (a)103 (b)9 51 (a)396 347 Weekly 5 a & b 16 - 34 15 27 137 97 475 table i. Vital Statistics of whole District during 1909 and previous years. Year. Population estimated to middle of each year. Births. Total Deaths Registered is 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 Institutions 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. 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 — 252 120 1902 22000 596 27.04 83 139.0 264 12.0 8 — 5 269 12.2 1903 24000 615 26.7 71 115.4 254 10.5 11 1 9 262 10.9 1904 26000 723 27.8 109 1507 319 12.2 13 6 11 324 12.4 1905 26000 713 27.04 87 122.0 301 11.5 14 2 43 342 13.1 1906 27000 811 30.03 108 133.1 334 12.3 23 5 44 373 13.8 1907 27000 774 28.6 87 112.4 302 11.2 23 6 60 356 13.1 1908 27000 751 27.8 70 93.2 289 10.7 37 8 50 331 12.2 Averages for years 1899.L908. 23350 661 27.4 82.5 125.3 288 12.0 17.1 - - - - 1909 27000 703 26.03 56 79.6 311 11 5 30 5 56 362 13.4 Total population at all ages, 20,991 At Area of District in acres (exclusive of area covered by water), 241 5 Number of inhabited houses, 4224 Census Average number of persons per house. 4.99of 1901. p.t.o.] TABLE I.—continued. I. II. III. Institutions within the District receiving sick and infirm persons from outside the District. Institutions outside the District receiving sick and infirm persons from the District. Other Institutions, the deaths in which have been distributed among the several localities in the District. St. John's Hospital Nightingale Nursing Home Isleworth Infirmary Richmond Hospital King's College Hospital Brompton Hospital St. Thomas's Hospital Westminster Hospital Eriedenheim Hospital Evelina Hospital St. Bartholomew's Hospital St. Joseph's Hospital Cancer Hospital, Chelsea University College Hospital Queen Charlotte's Hospital St. Luke's House Middlesex County Asylum Peckham House Asylum Herbert Hospital Metropolitan and City Police Orphanage The Parish Almshouses Isolation Hospital TABLE II. Vital Statistics of separate Localities in 1909 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 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. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. 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 1902 22000 596 269 85 4989 121 46 10 6076 149 65 19 6400 214 100 36 4495 112 58 20 1903 24000 615 262 71 5434 110 53 7 6619 158 74 22 7052 238 81 31 4895 109 54 11 1904 26000 723 324 109 5889 116 58 13 7165 165 64 14 7688 298 134 59 5258 144 68 23 1905 26000 713 301 87 5800 120 59 l0 7200 130 59 8 1125 314 111 48 5278 149 72 21 1906 27000 811 373 109 6050 134 69 13 7429 180 76 16 8040 355 157 67 5481 142 71 13 1907 27000 774 356 87 5263 125 b3 12 7414 176 69 12 8740 327 155 52 5531 14b 69 11 1908 27000 751 331 74 5263 126 59 12 7414 168 81 14 8/92 328 111 3b 5531 129 67 15 Averages of Years 1899 to 1908. 23350 661 303 83 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1909 27000 703 362 61 5200 123 72 10 7500 168 80 12 8800 284 135 30 5500 128 75 9 TABLE III. Gases of Infectious Disease notified during the Year 1909. Notifiable Disease Cases Notified in Whole District. Total Cases Notified in each Locality. No. of Cases removed to Hospital, from each Locality. At all Ages. At Ages—Years. SOUTH WARD. H EAST WARD WEST WARD. CENTRAL WARD, SOUTH WARD. H EAST WARD. west ward. CENTRAL WARD. Total cases removed to Hospital. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 30 ... 6 21 1 2 ... 7 8 10 5 ... ... 1 ... 1 Erysipelas 3 ... ... ... ... 3 ... 1 1 1 ... ... ... ... ... ... Scarlet fever 102 ... 23 63 9 7 ... 27 23 43 9 17 20 37 7 81 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 1 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 136 ... 29 84 11 12 ... 35 32 54 15 17 20 38 8 83 Isolation Hospitals Nelson Road, Whitton, (for Scarlet fever and diphtheria); Mereway Hospital (for Small Pox). Total available beds, 40. Number of Diseases that can be concurrently treated, Three. table iv. Causes of, and Ages at, Death during Year, 1909. CAUSES OP DEATH. Deaths at the Subjoined Ages of residents whether occurring in or beyond the District. Deaths at all ages of residents belonging to localities whether occurring in or beyond the district. 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 ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 1 ... 1 ... ... ... ... ... 2 ... ... Scarlet fever 4 ... 2 2 ... ... ... 1 1 2 ... 2 Whooping-cough 6 2 4 ... ... ... ... ... 2 2 2 ... Diphtheria and membranous croup 5 ... 2 3 ... ... ... 2 2 ... 1 ... Croup ... ... ... ... ... ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... ... ... Enteric ... ... ... ... ... ... ... ... ... ... ... ... Other continued ... ... ... ... ... ... ... ... ... ... ... ... Epidemic influenza 9 ... ... ... ... 3 6 3 2 3 1 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea 4 3 ... ... ... 1 ... 1 ... 3 ... ... Enteritis 5 3 2 ... ... ... ... 1 2 2 ... ... Gastritis 1 1 ... ... ... ... ... 1 ... ... ... ... Puerperal fever ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 27 ... ... ... 8 17 2 6 6 8 7 ... Other tuberculous diseases 13 1 5 ... ... 3 1 ... 2 9 2 4 Cancer, malignant disease 25 ... ... ... ... 11 14 7 8 5 5 1 Bronchitis 25 3 6 ... ... 6 10 5 4 14 2 1 Pneumonia 25 4 5 ... ... 9 5 3 2 11 9 2 Pleurisy 2 ... ... ... 2 ... ... ... ... 1 1 1 Other diseases of Respiratory Organs ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism Cirrhosis of liver 6 ... ... ... ... 6 ... ... 3 1 2 1 Venereal diseases 1 1 ... ... ... ... ... ... ... ... 1 ... Premature birth 11 11 ... ... ... ... ... 3 ... 6 2 ... Diseases and accidents of parturition 2 ... ... ... ... 2 ... ... ... 1 1 ... Heart diseases 34 1 1 ... ... 13 18 5 1 12 10 1 Accidents 12 1 2 ... ... 4 5 3 1 4 4 6 Suicides 6 ... ... ... ... 5 1 1 1 3 1 ... All other causes 137 29 8 2 2 39 57 30 37 46 24 11 All causes 362 61 37 14 12 119 119 72 80 135 75 30 table v. Infantile Mortality during the Year 1909. CAUSE OP DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under One Year. All Causes. Certified 14 6 3 3 26 8 6 3 4 6 4 1 ... ... 1 2 61 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria: Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 2 Diarrhœal Diseases. Diarrhoea, all forms ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 3 Enteritis Muco-enteritis, Gastro-enteritis ... ... 1 ... 1 ... 2 ... ... ... ... ... ... ... ... ... 3 Gastritis, Gastro- intestinal Catarrh ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 Wasting Diseases. Premature Birth 10 1 ... ... 11 ... ... ... ... ... ... ... ... ... ... ... ... Congenital Defects 1 1 2 1 5 4 ... ... ... ... 1 ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast-milk ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility, Marasmus 1 1 ... ... 2 3 3 2 1 ... ... ... ... ... ... ... 11 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 2 Convulsions ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 2 Bronchitis ... 1 ... 1 2 ... ... ... ... 1 ... ... ... ... ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... 1 2 ... ... ... ... ... 1 4 Suffocation, overlaying 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Other Causes 1 ... ... 1 4 ... 1 ... 1 ... ... ... ... ... ... ... 6 14 6 3 3 26 8 6 3 4 6 4 1 ... ... 1 2 61 Deaths from all Causes at all Ages 361 Births during the year, 703. Population, 27,000. table i. Name of Sanitary District:—TWICKENHAM. COUNTY OF MIDDLESEX—SANITARY WORK, 1909. Particulars as to Staff mployed in Sanitary department, specify if nspeetors are engaged in ???y other duties, and if so what. Inspections. Notices. Dwelling Houses. Houses let in Lodgings (Tenement Houses). Common Lodging Houses. Canal Boats used as Dwellings. Moveable Dwellings, Caravans, Tents, &c. Bakehouses. Number of Premises Inspected on Complaint. Number of Premises Inspected in connection with Infectious Diseases Number of Premises under periodical Inspection. Houses inspected from House-toHouse. Total number of Inspections andl re-inspections made. Cautionary or Intimation Notices given Statutory Orders Issued. Summonses Served. Convictions Obtained. Houses, Premises, &c., Cleansed, Repaired, &c. Closed as Unfit for Habitation. (a) As result of action under H. W.C Acts. (b) Otherwise. Re-opened after Repairs, Alterations, &c. Demolished. Illegal Underground Dwellings Vacated. Number Registered under Bye-laws. Number of Contraventions. Number Registered under Bye-laws. Number of Inspections. Number of Contraventions. Number Registered under the Acts. Number of Contraventions of Regulations. Number Observed during the Year. Number of Nuisances therefrom Abated. Number Removed from District. Number in District. Contraventions of Factory Acts. One Inspector of Nuisances One Assistant Inspector of Nuisances 37 172 183 3241 7204 2015 231 - - 1244 (а) 4 (б)- 1 2 - - - - - - - - - - - 20 - TABLE II. NAME OF Sanitary District TWICKENHAM. COUNTS OF MIDDLESEX.—SANITARY WORK, 1909. Slaughterhouses. Cow-sheds. Dairies and Milkshops. Unsound Pood. Adulterated Food. Offensive Trades. Water Supply and Water Service. Wells. Percentage of Houses supplied from Public Water Service. Cisterns. Draw-Taps placed on Mains. Percentage of Houses supplied on Constant System. Number of Samples obtained for analysis, (a) from Local Wells, (b) from Public Supply. Number on Register. 1 Number of Inspections made and frequency of inspection. Contraventions of Bye-laws. Number on Register. Number of Inspections made and frequency of inspection. Contraventions of Regulations. i Number of Milch Cows in District. Number on Register. Number of Inspections made and fiequency of inspection. Contraventions of Regulations. (a) Animals seized. (6) Articles or Parcels seized. Condemned by Magistrate (a & b) Articles or Parcels surrendered. Samples taken (if any) by thS District Local Authority. Found adulterated. Number of premises in District. j Number of Inspections made. Contraventions of Bye-laws. New, Sunk, Cleansed, Repaired, &c. Closed as Polluted. New, Provided. Cleansed, Repaired, Covered,&c 10 272 2 9 221 - 144 42 263 - - - 23 - - - - - - 1 - 99.5 1 81 - 99.5 (а) 5 (b) - fortnightly foi tnightly TABLE III. NAME OF SANITARY DISTRICT: TWICKENHAM. COUNTY OP MIDDLESEX.—SANITARY WORK, l909. Drainage and Sewerage of existing Buildings. disinfection. Dust. Sundry Nuisances Abated. Water Closets Percentage of Houses provided with. "Water Closets. Drains. Cesspools. Percentage of Houses Draining into Sewers. Rooms Disinfected (a) Ordinary infectious diseases, (b) Phthisis. Rooms stripped and cleansed. Articles disinfected or destroyed, (a) Ordinary infectious disease, (b) Phthisis. New bins provided. How frequently is dust removed from each house. Number of complaints of nonremoval received. Method of Disposal (a) Destructor, (b) by Tipping, (c) Other, state method. Overcrowding. Smoke. Accumulations of refuse. ^ Foul ditches, ponds, &c., and stagnant water. Foul pigs and other animals. Dampness. Yards repaved or repaired. Other nuisances. dumber of Water Closets substituted for Dry Receptacles. Repaired, Supplied with. "W ater,\ or otherwise Improved. Examined, Tested, Exposed, &c. Unstopped, Repaired, Trapped, &c. Waste Pipes, Rain Water Pipes, Disconnected, Repaired, &c. New Soil Pipes or Ventilating j Shafts fixed. Existing Soil Pipes or Ventilating Shafts repaired. Disconnecting Traps or Chambers inserted. Reconstructed. Rendered Impervious. Emptied, Cleansed, &c. Abolished, and Drain connected to Sewer. - 217 995 96 195 26 14 5 7 10 1 - 99.5 (a) 172 (b) 21 96 (a)978 (b) 86 310 Weeekly 4 a & b 26 - 28 13 32 161 117 383