C.439(1) BRENTFORD LIBRARY CHISWICK 2 CHISWICK BRE 17 Borough of Brentford and Chiswick REPORT ON THE Health of the District during 1949 MARGARET A. CLASS, B.Sc., M.B., Ch.B.(GIas.), D.P.H.(Cantab.) Medical Officer of Health The Brentford Printing & Publishing Co.. Ltd. BOROUGH OF BRENTFORD AND CHISWICK PUBLIC HEALTH COMMITTEE Councillor Copp, Chairman. Alderman Fullerton-Bustard. „ Howard. „ Leahy. Councillor Brenton. „ Brierley. „ Mrs. Buck. Councillor Crispin. „ Deane, P. „ Digby. „ Rudderham. „ Samels. Ex-Officio: Councillors Fry, J.P., Sinclair, J.P., and Mrs. Burden. STAFF—PUBLIC HEALTH DEPARTMENT MEDICAL OFFICER OF HEALTH (Part-Time). Miss M. A. Glass, B.Sc., M.B., Ch.B. (Glasgow), D.P.H. (Cantab.). SANITARY INSPECTORS. L. C. Webb, A.R.San.I., Certified Inspector of Meat and Other Foods, etc., Certificates of Royal Sanitary Institute, Chief Sanitary Inspector, Inspector for Shops Acts, Factory Acts and Canal Boats. T. M. Johnson, A.R.San.I., Certified Inspector of Meat and Other Foods, etc., Certificates of Royal Sanitary Institute, Sanitary Inspector, Inspector for Shops Acts. A. G. Robinson, M.S.I.A., Certified Inspector of Meat and Other Foods, etc., Certificates of Royal Sanitary Institute, Sanitary Inspector, Inspector for Shops Acts. R. A. G. James, Cert. S.I.B., Sanitary Inspector and Inspector for Shops Acts. CLERICAL STAFF. R. Hill, Senior Clerk. D. G. Hill, Deputy Senior Clerk. N. J. Rogers. Clerk. Mrs. B. E. Clark, Clerk. (Resigned, 12.2.49). Mrs. V. I. Merrifield, Shorthand-Typist (with effect from 28.2.49). BOROUGH OF BRENTFORD AND CHISWICK REPORT ON THE HEALTH OF THE DISTRICT DURING THE YEAR 1949 MARGARET A. GLASS, B.Sc., M.B., Ch.B.(Glas.), D.P.H.(Cantab.), Medical Officer of Health. 3 ERRATA Page 5, line 12 (from foot). Delete "corresponding" Page 6, line 2 (from foot). Delete "epidemics" and insert "outbreaks". BOROUGH OF BRENTFORD AND CHISWICK Public Health Department, Town Hall, Chiswick, W.4. To the Mayor, Aldermen and Councillors of the Borough of Brentford and Chiswick. Mr. Mayor, Ladies and Gentlemen, 1 have the honour to present the 22nd Annual Report on the Health and Sanitary circumstances of the Borough of Brentford and Chiswick. The health of the population continued to be good. The Birth Rate continued to fall as it has been doing since 1946. It was 16.19 in 1949 compared with 17.9 in 1948. This is very little different from the average Birth Rate for the rest of the country, which was 16.7. The Death Rate of 10.98 was a reduction from 11.5 in 1948. The average Death Rate for the whole of the country was 11.7. The main causes of death were cancer and heart disease, both of which caused higher numbers of deaths than in 1948, i.e., heart disease was the cause of 188 deaths in 1949 as compared with 165 in 1948, and cancer 122 in 1949 as compared with 115 in 1948. Two satisfactory points to note about the statistics of the causes of death are the reduction in the number of deaths from tuberculosis which were 25 in 1949 a drop of 35 per cent. from the 1948 figure of 39, and the lower figure for deaths from violence of all kinds from 45 in 1948 to 26 in 1949. Comparison of the tuberculosis death rate with the figure for the tuberculosis notifications shows a corresponding decrease there from 115 total notifications in 1948 to 110 in 1949. An analysis of the occupations of the newly notified cases of tuberculosis shows a slight preponderance in the notifications in the case of Factory Workers, Clerical Workers and Housewives. I consider that a figure of 16 pre-school and schoolchildren notified as suffering from tuberculosis is rather a high proportion of the total figure. Six of these were cases of pulmonary tuberculosis, i.e., suffering because of human infection, 10 were non-pulmonary. There was a minor rise in the notification rate of measles during the months of March and April, 1949, but apart from this, the incidence of infectious disease was lower than in 1948 5 and no deaths from infectious diseases were reported. Four cases of poliomyelitis occurred, all of which made good recovery from the acute stage. The residual paralysis occurring in these four cases was treated by physiotherapy, two of them have recovered completely. The Infant Mortality Rate fell from 28.7 in 1948 to 23.78 in 1949. This is the lowest Infant Mortality Rate ever recorded in the Borough and one satisfactory point to be noted in the details of causes of infant deaths is the reduction from 9 in 1948 to 4 in 1949 of the incidence of premature births. The Infant Mortality Rate for the rest of the country was 32. The graph on page 12 illustrates the fall in Infant Mortality in the Borough since 1900. The total amount of visiting carried out by the Sanitary Inspectors was approximately the same in 1949 as in 1948, but again as in 1948 it can be reported that there was a higher number of premises found to be satisfactory from the point of view of the public health practitioner. Twenty ascertained cases of overcrowding were reported to the Housing Committee. Legal action was required after failure to comply with two Statutory Notices for repairs to unsound property, but improvement was obtained most frequently by informal action and cautionary notices. The new Milk and Dairy Regulations introduced during 1949 resulted in a transfer of certain responsibility from the Borough Council to other Authorities but the duty remained for the Health Department staff to ensure that all persons selling milk should have each premises licensed, and the supervision of these premises remains an important part of the Sanitary Inspectors' functions. Visits to food shops and places where food is prepared were made to 177 individual premises. One matter with which the Department became particularly concerned during the latter part of the year was the possibility of nuisance being caused by Caravans or Moveable Dwellings in certain sites in the Borough and a survey was made. Most of the Caravans and Houseboats were found to be in good condition and free from nuisance, those found to be deficient are being dealt with. Although Food Poisoning has been a notifiable disease since the Food and Drugs Act of 1938 came into force, special provision for making returns of food poisoning figures to the RegistrarGeneral was not made until 1949. The particulars of these cases occurring throughout the country as well as locally are now to be shown in the Registrar-General's weekly and quarterly statistics. There were two epidemics of food poisoning during the year affecting fairly large numbers of persons, although the 6 illness in all cases was transient. As both of these resulted from community meals, it seemed desirable that a survey should be commenced of the whole of the catering establishments in the Borough for the purpose of making improvements in hygiene, both of premises and of staff, and, also for the purpose of propaganda by word of mouth to the food handlers in all such places. Health propaganda was carried out continuously during the year by the staff of the Health Department and the Poliomyelitis films were shown to an audience of persons who were likely to be called upon to diagnose or treat such cases. I should like to take this opportunity of thanking all the members of the Health Department staff, not only for their assistance in the preparation of this report, but for all their efficient and willing service throughout the year. I am. Your Worship, Ladies and Gentlemen, Your obedient Servant, Imangand a. Glass Medical Officer of Health. 7 1.—GENERAL STATISTICS, 1949. Area in acres (including 116 acres of foreshore of River Thames and 24 acres of inland water) 2,449.5 Population—Census 1931 62,617 Population—Registrar-General's Estimate for area (mid 1949) Total 59,750 Civilian 59,700 2.—VITAL STATISTICS. Live Births. Total Male Female Legitimate 918 484 434 Birth Rate per 1,000 of the estimated resident population = 16.19 Illegitimate 49 24 25 - - - TOTAL 967 508 459 Stillbirths. Total Male Female Legitimate 14 4 10 Rate per 1,000 total (live and still) Births = 14.27 Illegitimate — — — - - - TOTAL 14 4 10 Deaths. Total Male Female 634 318 316 Death Rate per 1,000 of the estimated resident population = 10.98 Deaths from Puerperal Causes. Puerperal Sepsis — Rate per 1,000 Other Puerperal Causes — total (live and Still) Births NIL 8 Death Rate of all infants per 1,000 live births Death Rate of all legitimate infants per 1,000 legitimate live births Death Rate of all illegitimate infants per 1,000 illegitimate live births Deaths from Measles (all ages) Deaths from Whooping Cough (all ages) Deaths from Diarrhoea (under 2 years of age) Deaths from Cancer (all ages) Deaths from Tuberculosis 23.78 23.96 20.4 Nil Nil 1 122 25 9 Deaths of Infants under 1 Year of Age. Total Male Female Legitimate 22 13 9 Illegitimate 1 1 — TOTAL 23 14 9 TABLE I. PARTICULARS OF DEATHS AS SUPPLIED BY THE REGISTRAR-GENERAL FOR THE YEAR 1949. Cause of Death Males Females All causes 318 316 1. Typhoid Fever, etc. - - 2. Cerebro-Spinal Fever — — 3. Scarlet Fever — — 4. Whooping Cough — - 5. Diphtheria — — 6. Tuberculosis of the respiratory system 13 7 7. Other forms of Tuberculosis 3 2 8. Syphilitic Diseases 3 1 9. Influenza 3 4 10. Measles — — 11. Acute Poliomyelitis and Polio-Encephalitis — — 12. Acute Inf. Encephalitis — — 13. Cancer b. Cav. and Oesophagus (M), Uterus (F) 1 8 14. Cancer of Stomach and Duodenum 16 5 15. Cancer of Breast — 12 16. Cancer of all other sites 43 37 17. Diabetes 3 5 18. Intra-Cranial Vascular Lesions 22 43 19. Heart Disease 94 94 20. Other disorders of the circulatory system 14 13 21. Bronchitis 25 18 22. Pneumonia (all forms) 15 16 23. Other respiratory diseases 1 5 24. Ulcer of Stomach or Duodenum 4 1 25. Diarrhoea under 2 years 1 — 26. Appendicitis 2 — 27. Other digestive diseases 5 6 28. Nephritis 4 6 29. Puerperal and Post Abortive Sepsis — — 30. Other Maternal Causes - — 31. Premature Births 1 3 32. Congenital Malformation, Birth Injury, Infantile Disorders 7 6 33. Suicide 4 1 34. Road Traffic Accidents 4 1 35. Other Violent Causes 9 7 36. All other causes 21 15 ALL CAUSES 318 316 10 TABLE II. INFANTILE MORTALITY DURING THE YEAR 1949. Net deaths from stated causes at various ages under one year. Cause ok Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 1—3 months 3—6 months 6—9 months 9—12 months Total under 1 year | 1. Smallpox - - - - - - - - - - 2. Chicken Pox - - - - - - - - - - 4. Scarlet Fever - - - - - - - - - - 5. Whooping cough - - - - - - - - - - 6. Diphtheria or Croup - - — - - - - - - - 7. Erysipelas — — - — — — — — — — 8. Tuberculous Meningitis - - - - - - - - 1 1 9. Abdominal Tuberculosis - - — - - - - - - - 10. Other Tuberc. Diseases - - - - - - - - - - 11. Meningitis (Non-T.B.) - - - - - - - - - - 12. Convulsions - - - - - - - 1 — 1 13. Laryngitis - - - - - - - - - - 14. Bronchitis - - - - - - 1 - - 1 15. Pneumonia (all forms) — — — — — 1 3 — 1 5 16. Diarrhoea - - - - — - - - - - 17. Enteritis — — — — - 1 1 — — 2 18. Gastritis — — — — - — — — — — 19. Rickets - — — — - — — — — - 20. Suffocation 1 — — — 1 — — — — 1 21. Injury at Birth 1 — — — 1 — — — — 1 22. Atelectasis 1 1 — — 2 — — — — 2 23. Congenital Malformation 1 1 — 1 3 1 — — 1 5 '24. Premature Birth 4 — — — 4 — — — — 4 25. Atrophy, Debility and Marasmus - - - - - - - - - - 26. Pemphigus Neonatorum - - - - - - - - - - 27. Other Causes - - - - - - - - - - TOTALS 8 2 — 1 11 3 5 1 3 23 BIRTHS—Legitimate 918 DEATHS—Legitimate 22 Illegitimate 49 Illegitimate 1 INFANT MORTALITY RATE. PER 1,000 BIRTHS =23.78. 11 GRAPH SHOWING INFANTILE MORTALITY RATES DURING THE PERIOD 1900—1949 BRENTFORD U.D CHISWICK U.D * YEAR OF AMALGAMATION BRENTFORD CHISWICK 12 TABLE III. Maternal Mortality and Morbidity. Deaths from Puerperal Causes:— Puerperal Sepsis None Other Causes None The following table shows the number of maternal deaths connected with pregnancy daring the last 10 years:— Year Died from Sepsis Died from other causes connected with pregnancy 1940 — — 1941 — — 1942 — 2 1943 3 2 1944 - 2 1945 — — 1946 — 3 1947 - 1 1948 - — 1949 - — During the year 3 cases of puerperal pyrexia were notified; there were no maternal deaths. All cases occurred in institutions, one being a resident of another borough who had been admitted to Chiswick Maternity Hospital. 13 TABLE IV PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. —Notifiable Diseases during the Year 1949. Disease Total cases notified Cases admitted to hospital Total Deaths Scarlet Fever 64* (78) 39 (70) - (—) Whooping Cough 45 (36) 8 (3) - (1) Diphtheria — (1) — (1) — (-) Measles 511 (335) 18 (21) — (-) Pneumonia 22 (13) 14 (5) 31 (33) Paratyphoid Fever — (1) — (1) — (—) Acute Poliomyelitis 4† (1) 4 (1) — (—) Dysentery — (4) — (4) — (—) Ophthalmia Neonatorum — (7) — (1) — (-) Puerperal Pyrexia 3 (15) 3 (15) — (-) Small-pox — (-) — (-) — (—) Erysipelas 2 (4) 2 (—) — (-) Malaria — (-) — (—) — (—) Ac. Polio-encephalitis — (-) — (-) — (—) Food Poisoning 1 (-) — (-) — (—) * In addition, four cases originally notified and admitted to Hospital were subsequently diagnosed not Scarlet Fever. † In addition, one case originally notified and admitted to Hospital was subsequently diagnosed not Poliomyelitis. (1948 Figures in brackets). TABLE V. Ophthalmia Neonatorum Cases notified Cases treated at home Cases treated in hospital Vision unimpaired Vision impaired Total blindness Deaths — — - — — — — 14 15 TABLE VI. Ages ok Cases of Infectious Disease Notified during the Year, 1949. NUMBER OF CASES NOTIFIED At ages—years Disease At all ages Under 1 1 2 3 4 5 and under 10 10 and under 15 15 and under 20 20 and under 35 35 and under 45 45 and under 65 65 and over Scarlet Fever 64* — — 3 7 9 39 3 — — 2 1 - Whooping Cough 45 4 8 6 7 6 12 2 - - - - - Diphtheria — — — — — — — — — — — — — Measles 511 11 61 72 73 71 209 6 1 2 4 — 1 Pneumonia 22 1 1 1 1 — 2 — — 1 3 8 4 Paratyphoid Fever - - - - - - - - - - - - - Acute Poliomyelitis 4† — 1 — 1 - 1 — — 1 — — — Dysentery - - - - - - - - - - - - Ophthalmia Neonatorum - - - - - - - - - - - - - Puerperal Pyrexia 3 - — — — - — — — - 1 — — Smallpox - - - - - - - - - - - - - Erysipelas 2 - - - - - - 1 - - - - 1 Malaria - - - - - - - - - - - - - Acute Polioencephalitis - - - - - - - - - - - - - Food Poisoning 1 - - - - - - - - - - - - * In addition, four cases originally notified were subsequently diagnosed not Scarlet Fever. † In addition, one case originally notified was subsequently diagnosed not Poliomyelitis. TABLE VII. Cases of Infectious Disease Notified during the Year, 1949. Classified in Wards. Disease NUMBER OF CASES NOTIFIED Brentford West Brentford Central Brentford East Bedford Park Chiswick Park Grove Park Gunnersbury Old Chiswick Turn ham Green Total cases Scarlet Fever 2 1 9 2 4 11 16 12 7 64 Whooping' Cough 11 16 — 3 2 1 — 7 5 45 Diphtheria — — — — — — — — — — Measles 94 81 30 45 41 42 61 77 40 511 Pneumonia 9 6 6 — — — — 1 — 22 Paratyphoid Fever — — — — — — — — — — Acute Poliomyelitis — — — — — 1 2 — 1 4 Dysentery — — — — — — — — - — Ophthalmia Neonatorum — — — — — — — — - — Puerperal Pyrexia — — 1 — — — — 2 - 3 Erysipelas — — — — — — 1 — 1 2 Malaria — — — — - — — — — — Acute Polioencephalitis — — — - - — — — — — Food Poisoning — 1 - — - — — — — 1 Tuberculosis— . Respiratory 15 7 11 8 4 13 12 11 16 97 Non-Respiratory - 1 - - - 1 3 3 5 13 TABLE VIII. The following table shows the incidence of Infectious Disease in schools during the year 1949. Jan. Feb. Mar. Apl. May Jun. Jly- Aug. Sep. Oct. Nov. Dec. Tot. Scarlet Fever 2 - 1 1 3 9 9 - 2 8 4 5 44 Diphtheria - - - - - - - - - - 1* - 1* Chicken-pox 20 3 2 4 12 6 24 — 2 26 18 18 135 Measles 15 32 62 30 12 6 41 — — — 13 3 214 Whooping Cough — 3 2 - 4 4 2 - 2 5 - - 22 Mumps 43 11 8 4 5 9 3 — — — — 1 84 Ringworm — — — 1 8 2 1 — — — — 1 13 Impetigo — — 1 1 1 1 1 — — 3 1 1 10 Eczema - - - - - - - - - - - - - Verminous 2 — — — 2 6 — — — — — — 10 Scabies — — 2 — 3 — — — — — 1 1 7 Other Skin Diseases - - - - 2 - - - - - - 1 3 German Measles 7 - 1 - - - 1 - - 3 - 1 13 Other causes 1 — 2 19 1 - 2 - — 3 1 2 31 TOTALS 90 49 81 60 53 43 84 - 6 48 39 34 587 * Child attending school in Borough but resident in another area. CONTROL OF LICE INFESTATION. The figures of verminous infestation of school children obtained by the courtesy of the County Medical Officer seem to demonstrate a very low level of infection. There are no Statutory Powers whereby any of the population other than school children can be examined for head lice, and as there is no cleansing station in the Borough it is impossible to estimate the cleanliness of the public through the use made of such a station. It is to be presumed, however, that the low level of infestation of school children will be reflected in a clean condition of the public as a whole. Factory Welfare Officers and other persons likely to be required to deal with cases of verminous infestation are encouraged to obtain advice and help from the Public Health Department staff. 17 Infectious Diseases. The total number of cases of infectious diseases notified during the year 1949 was 652 compared with a figure of 495 total in 1948. The increase was mainly due to measles notifications which were high particularly during the months of March and April. There were fewer cases of scarlet fever, 64 as compared with 78 in 1948 and four cases of poliomyelitis were confirmed during the year. There were no deaths from any of the infectious diseases other than pneumonia and tuberculosis. TABLE IX. Laboratory Work. The following table sets out a record of the bacteriological work during the year 1949. Nature of Specimen Result Positive Negative Total Diphtheria—swabs — 137 137 Tuberculosis—sputa — 10 10 Scarlet Fever Contacts —swabs 14 37 51 Blood, faeces, etc. — 2 2 TOTALS 14 186 200 TABLE X. Tuberculosis—1949 Age Groups NEW CASES DEATHS Respiratory NonRespiratory Respiratory NonRespiratory Male Female Male Female Male Female Male Female Under 1 year - - 1 - - - 1 - 1—5 years 1 1 2 3 — — - - 5—15 years 1 3 1 3 - — - - 15—25 years 13 8 1 1 1 1 — — 25—35 years 10 16 — — 3 3 — — 35—45 years 12 11 — — 3 2 1 — 45—55 years 7 2 — — 1 1 — — 55—65 years 5 2 — — 3 — — — 65 years and over 4 1 1 — 2 — 1 — TOTALS 53 44 6 7 13 7 3 2 Of the 25 recorded deaths, 19 were previously notified as cases of tuberculosis, 6 had not been so notified. 18 TABLE XI. Table of Tuberculosis Cases in Years. Year NEW CASES DEATHS Respiratory NonRespiratory Total Respiratory NonRespiratory Total M. F. M. F. M. F. M. F. 1930 37 37 5 10 89 20 22 2 3 47 1931 38 34 7 6 85 24 17 1 7 49 1932 40 31 8 8 87 28 12 3 4 47 1933 34 44 10 2 90 33 26 5 1 65 1934 49 4.2 4 7 102 49 42 3 3 97 1935 46 47 3 5 101 21 15 5 1 42 1936 40 33 4 5 82 26 24 1 2 53 1937 38 46 9 9 102 22 13 1 3 39 1938 54 39 8 7 108 29 8 2 2 41 1939 36 33 9 7 85 18 18 2 3 41 1940 42 27 7 7 83 20 10 3 5 38 1941 52 25 3 3 83 23 12 5 2 42 1942 42 36 1 8 87 14 12 — 2 28 1943 52 29 3 5 89 25 11 — 1 37 1944 57 39 3 7 106 16 11 3 4 34 1945 46 41 9 6 102 18 11 1 2 32 1946 68 49 5 7 129 23 6 2 5 36 1947 62 36 4 4 106 30 8 — — 38 1948 61 47 1 6 115 18 16 2 3 39 1949 53 44 6 7 110 13 7 3 2 25 This table shows that the incidence of tuberculosis in the Borough began to rise during the war in the year 1942 and increased to a peak year in 1946. It is noteworthy that the death rate did not increase proportionately with the notification rate, and it may be that the discovery of cases in the earlier stages and more amenable to treatment was the reason for the increase in the notification figure. The figure for 1949 while still 23.4% higher than that for 1930 corresponds with a very much lower death rate, i.e. 25, as compared with 47 or 46.8% of the 1930 figure. The following graph illustrates the progress of tuberculosis notification and death incidence during the past 20 years. The occupations of all newly notified cases of tuberculosis have been tabulated and are shown in Table XII. 19 GRAPH OF CASES NOTIFIED AND DEATHS FROM TUBERCULOSIS (1930—1949) 20 TABLE XII. Occupations of All Newly Notified Cases of Tuberculosis. Male Female Advertising Agent 1 — Bar-tender 1 — Civil Servant 4 — Clerk 4 1 Coach Finisher 1 — Craftsman (L.T.E.) 1 — Crane Driver 1 — Dairyman 1 — Draughtsman 1 — Dressmaker — 1 Electrical Engineer 2 — Factory Hand 1 6 Fur Merchant 1 — Furniture Remover 1 — Filing Clerk — 1 Hospital Domestic — 1 Housewife — 18 Instrument Maker 1 — Laboratory Assistant — 1 Laundry Packer and Sorter ... - 1 Lorry Driver 1 - Machine Operator 2 — Mess Supervisor 1 — Milk Roundsman 1 — Milling Setter 1 — Minister 1 — Musician ... 1 — No Occupation 8 Painter 1 — Planning Engineer 1 — Plasterer 2 — Policeman 1 — Railway Inspector 1 — Salesman 1 — Scaffolder 1 — Schoolchild 2 6 Secretary 1 1 Sheet Metal Worker 1 — Shoe Machine Operator 1 — Steward 1 — Student Artist 1 — Stoker 1 — Storekeeper 1 — Switchboard Operator — 1 Teacher 1 — Under School Age 4 4 TOTALS 60 50 21 TABLE XIII. Food Poisoning Outbreaks. Total Number of outbreaks Number of cases Number of deaths Organisms or other agents responsible with number of outbreaks attributable to each Foods involved with number of outbreaks associated with each Outbreaks due to Identified Agents. 1 7 - Staphylococcus Aureus (i) Stewed lamb (i) Outbreaks of Undiscovered Cause. 1 64 — Not known — Single Cases. 2 1 1 Salmonella Group — 1 — Organism Unknown cause. 22 CLEAN FOOD CAMPAIGN. There was only one notified case of food poisoning in the Borough during the year, but two outbreaks of intestinal disturbance attributable to food were investigated by the staff of the Department because cf reports made by the School Meals Organiser in one case and as a result of a telephone message from an Engineering Repair Shop in the other. Outbreak (1). At the School 64 teachers and pupils were affected with, symptoms of colic, vomiting and diarrhoea commencing 2—12 hours after a mid-day meal on two separate occasions at five days' interval. The symptoms cleared up in every case within 24 hours. The school kitchen was visited and the food handlers inspected. A though no specific organisms were traced and no source of infection certain, improvements in the preparation and handling of food and in the methods of washing up were recommended and obtained and no further cases were reported. Outbreak (2). This outbreak followed a meal at a works canteen. Seven persons were affected with symptoms of colic and diarrhoea commencing ½ to 2 hours after the meal. The only food that had been eaten by all the patients w as stewed lamb and the remainder of this was seized and subjected to bacteriological examination. Staphylococcus Aureus was isolated but the source of infection did not appear to be in the Works kitchen and no further trouble arose. Propaganda concerning clean food was maintained by personal talks from members of the staff of the Health Department, and by poster propaganda concerning protection from flies, the covering of food, and other topical and seasonal subjects. Commencement w as made on the survey of the whole of the catering establishments within the Borough and it is hoped that with an increase in the staff of the department this work may be completed during 1950. It is anticipated that the adoption of Bye-Laws by the Borough Council on the lines of the "Eye-Laws relating to the Handling, Wrapping and Delivery of Food and the Sale of Food in the Open Air", issued by the Ministry of Food, will strengthen the hands of the Public Health Department Staff in its endeavours to secure hygienic handling of all food. GENERAL HEALTH PROPAGANDA During the year continuous propaganda was carried out bv means of poster displays, personal talks to small groups, and lectures to clubs and youth groups. A showing of the Poliomyelitis 23 short film "His Fighting Chance" was arranged at the local cinema and a demonstration of the technical Poliomyelitis film, "Poliomyelitis Diagnosis and Management," was arranged and shown to a professional audience of Medical Practitioners, Hospital Matrons, Nurses and all likely to be dealing with cases of the disease. An enquiry was made whether this film could not be shown to a wider audience, and arrangements were put in hand for a showing to be given to the Public Relations Council and representatives from various social services' societies of the Borough during the New Year. It was hoped that Dr. Bradley of the Ministry of Health would attend to make the film more intelligible to a non-technical audience. NATIONAL ASSISTANCE ACT. Section 47.—Removal to suitable premises of persons in need of care and attention. During 1949 eight cases of elderly people living in neglected conditions and likely to be in need of removal under this Section were investigated. No Statutory Action was required as by means of the Home Help Service and by the assistance of the County Council Welfare Officer and the Geriatric Department at West Middlesex Hospital other methods of alleviating the distress were used. It has become apparent that a great deal more could be done for the Aged Persons who are found to be living in neglected conditions if it were possible to supply them rapidly with bedding, crockery or other household requirements needed to replace faulty or damaged articles. In most cases there is no immediately available money for the purchase of these articles and the process of obtaining assistance from the Charitable Societies is at times a slow one. The Home Help Service is handicapped in its work by the absence of these articles. The provision of meals for the aged and chronic sick is also of inestimable value in the prevention of deterioration in the health of many. This need has been brought to the attention of the Council and it is hoped that by the setting up of a special committee, funds may be made available for a full meals service and for an equipment pool from which necessities could be drawn either free of charge or on a deferred payments system. CARAVANS AND MOVEABLE DWELLINGS. A survey was undertaken of the whole of the Caravans and Moveable Dwellings normally sited on premises within the Borough or in waters within the Borough in order to ascertain the nature of the living conditions in these dwellings and the figure of overcrowding. 24 Twenty barges and house-boats, etc., and forty-seven caravans were inspected. It was ascertained that in eight cases the water supply was unsatisfactory or insufficient. In eight cases the methods of refuse disposal and in eleven cases the methods of sewage disposal were unsatisfactory, and there were four families considered to be living in overcrowded conditions. Action was taken with regard to the insanitary dwellings and the cases of overcrowding were brought to the notice of the Housing Department for attention. In the case of a specific area (Workhouse Dock) conditions were considered to be extremely bad as it appeared that the waters of the Dock were being fouled by the tipping of refuse and sewage from the barges situated in that water. This was confirmed by a bacteriological examination of the dock water which showed heavy contamination with faccal organises. The Borough Council has this matter under review. SMOKE POLLUTION. The Borough of Brentford and Chiswick is comparatively free of trouble caused by heavy atmospheric pollution from factory chimneys but there are occasional complaints in certain areas of pollution by grit and fumes and during 1949 the Council decided to set up two stations for observations to be made on the quantity and quality of atmospheric pollution, one in Brentford and one in Chiswick. Up to the end of the year the full equipment had not been received for the stations to be completed and observations to be taken. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT. Seven establishments were inspected for licence under this heading and all were found satisfactory for the purpose which was intended. Details are as follows:— Purpose No. of Licences Massage only — Chiropody only 2 Massage and Chiropody — Massage, Chiropody and Electrical Treatment 2 Massage and Electrical Treatment 2 Chiropody and Electrical Treatment 1 25 SANITARY INSPECTION OF THE AREA. Inspections. Number of primary inspections made:— (a) On complaint 1780 (b) Routine 880 (c) In connection with infectious disease 78 Total 2738 Number of re-inspections 2745 Total number of inspections and re-inspections 5483 Action Taken (other than Housing Act, 1936). Cautionary or intimation notices served 812 Statutory Notices issued (under Public Health Acts) 22 Summonses served 2 Number of Certificates under Rent and Mortgage Interest (Restrictions) Acts issued to tenants 2 Number of Clearance Certificates issued to owners 2 Particulars of Sanitary Defects referred to in Notices served and other matters. New W.C.s provided, repaired, supplied with water or otherwise improved 115 Drains tested (smoke) 23 Drains unstopped, trapped, etc. 43 Waste pipes, rainwater pipes, disconnected, repaired, etc. 71 New soil pipes and ventilating shafts fixed 5 New sinks provided 21 Disconnecting traps and chambers inserted 5 Manholes reconstructed, repaired, etc. 31 Reconstructed (whole system) 4 Soil drains repaired or reconstructed 49 Surface water drains repaired or reconstructed 6 New draw traps on mam provided 3 Percentage of houses draining into sewers 99.9% Percentage of houses supplied from Public Water Service 100% Percentage of houses provided with water-closets 100% 26 Water Supply and Water Services. The whole of the district is supplied by Metropolitan Water Board Mains. There are no standpipes now remaining in the district for the supply of persons inhabiting dwelling houses. There are two wells in the Borough and the following is the position with regard to these wells. (i) Mr. A. Knapp, 21, Grove Park Gardens—well working, but used for washing purposes only. Drinking water obtained direct from mains. (ii) Green's Boat House, Riverside Lands—well working, but used for washing purposes only. Drinking water obtained direct from mains. The mains water supply is satisfactory both in quality and quantity and reports of the bacteriological and chemical analyses carried out by the Metropolitan Water Board are issued from time to time. Refuse. New bins provided 28 Frequency of refuse removed from each house weekly Method of disposal—carried by collecting freighters to Controlled Tip outside the Borough. Sundry Nuisances. Overcrowding (urgent cases reported to Housing Committee) 24 Smoke Minor complaints only Accumulation of rubbish 5 Foul ditches, ponds, etc., and stagnant water 1 Dampness 317 Yards requiring repair or repaving 9 Leaky roofs and eaves gutterings 387 Defective flooring, joists and skirtings 145 Defective plasterwork to walls and ceilings 429 Premises cleansed and redecorated 381 Other defects 720 Housing. It has not been possible yet to carry out a house-to-house survey to ascertain the real figure of Statutory Overcrowding within the Borough. Cases coming to the notice of the department from time to time are investigated and notified to the Public Health Committee for the attention of the Housing Committee and these cases receive high priority for rehousing. 27 The number of cases investigated by the Public Health Department Staff as a result of complaints received of alleged overcrowding of living conditions, resulted in the reference of twenty families to the Housing Department including eleven as cases of statutory overcrowding. It will be noted from the statistics that the number of Notices requiring to be served for sanitary defects in property dropped from 1,049 in 1948 to 834 in 1949. This is a healthy sign and seems to demonstrate that wi'.h the removal of the difficulties in obtaining licences for repair work, property is being kept in better condition. Disinfection. Premises disinfected:— Ordinary notifiable diseases 61 Phthisis 12 Cancer 29 Other diseases 6 Rooms stripped and cleansed (Section 167, Public Health Act, 1936) - Premises treated for vermin 23 Premises treated for other pests (wasps, moths, ants, beetles) 25 Slaughterhouses. Number on Register (including one Knacker's Yard) 5 Contravention of Byelaws Slaughter of Animals Act, 1933. (vide Livestock (Restrictions on Slaughter) Order, 1940) Number of Licences to slaughter animals issued during the year:— New Licences - Renewed Licences 2 Food and Drugs Act, 1938. During the year 13 specimens of tainted food or milk or food containing foreign bodies were brought to the Department by complainants. In 6 cases the complaint was not substantiated, in 2 warning letters were sent out to the firms concerned and in 3 cases prosecutions were successful, the offending firms being penalised by fines. 28 Milk and Dairies Regulations, 1949. Milk (Special Designation) (Pasteurised & Sterilised Milk) Regulations, 1949. Milk (Special Designation) (Raw Milk) Regulatons, 1949. During 1949 new regulations were issued by the Ministry of Food with regard to the designations of milk and its supervision. The control of premises for pasteurisation of milk was transferred from the Local Authority to the Food & Drugs Authority (in this area the County Council of Middlesex). A new special designation "Sterilised Milk" was introduced and the special designations to be used after 1st October, 1949, were ''Pasteurised", "Sterilised", "Tuberculin Tested (Pasteurised)", "Tuberculin Tested (Sterilised)" and "Tuberculin Tested". All licences authorising the use of a special designation were to be issued by the Food & Drugs Authorities. Other important points from the new regulations were: — I. No fees to be payable in respect of Dealers' Licences. II. A licence to be issued in respect of every premises used for the sale of milk, i.e., an individual dealer not to have one licence to cover any number of shops. III. Provision now to be made for all designated milk to be kept separate from non-designated milk or milk with other designation. IV. A Regulation to extend the powers of the Medical Officer of Health to take action in case of suspected or confirmed infectious disease associated with the sale of milk. The designations "Accredited" and "Standard", while permitted for a time, are to be excluded from the list of designations after five years from the passing of the Act. Ice Cream—Sampling of Ice Cream. One hundred and twenty-four samples of ice cream were taken from thirty-four premises and examined bacteriologically. a result of these tests the ice creams were graded as follows:— Grade I 62 Grade II 51 Grade III 6 Grade IV 5 No cases occurred during the year of ice cream in such poor bacteriological condition as to require the stoppage of sale. 29 Bakehouses. Number in district in use 17 Contraventions of Factory Acts — There is one underground bakehouse in the Borough which is under observation and which is kept in satisfactory condition. Brentford Market. The Brentford Market which is a large centre for the wholesale distribution of fruit, vegetables and flowers, was kept under supervision by the District Sanitary Inspectors. Meat and Other Foods. During the year under review a total of 44 pigs were slaughtered in the Borough. These were all slaughtered under licences issued by the Ministry of Food, were inspected at the time of slaughter, and were all found to be in good condition and passed fit for human consumption. No beasts or sheep were slaughtered in the Borough during the year. 30 31 TABLE XIV. Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed — — — — 44 Number Inspected — — — — 44 All Diseases except Tuberculosis : Whole carcase condemned — — — — — Carcases of which some part or organ was condemned — — — — — Percentage of the number inspected affected with disease other than Tuberculosis - - - - - Tuberculosis only: Whole carcase condemned — — — — — Carcases of which some part or organ was condemned — — — — - Percentage of the number inspected affected with disease other than Tuberculosis - - - - - A total of 928 inspections of Food Shops and places where food is prepared were made to 177 individual premises and a summary of foods condemned is tabulated below. Not all this food, however, was destroyed; where possible it was released for animal feeding or salvage. UNSOUND FOOD. Food Condemned During the Year 1949. Fruit and Vegetables 193 cwts. Fish 344¾ stone Meat 8 cwts. Perishable Goods 86 cwts. Tinned Foods 4693 tins OFFENSIVE TRADES: Number of premises in district 3 Nature of Trades:— One Soap Boiler. Two Rag and Bone Dealers. CANAL BOATS: Number of Boats on Register:— Motor Propelled Boats 94 Other Boats 408 TABLE XV. Inspections: FACTORIES ACT, 1937. Premises Number on Register Number of Inspections Made Written Notices Occupiers Prosecuted (i) Factories in which Secs. 1, 2, ,3. 4 and 6 are to be enforced by Local Authorities 153 28 1 - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authority 303 116 1 - (iii) Other premises in which Section 7 is enforced by Local Authority (excluding outworkers' premises) - - - - TOTALS 456 144 2 - 32 TABLE XVI. Cases in which Defects were Found : Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M.I. By H.M.I. Want of cleanliness (Sec. 1) 4 3 - 4 - Inadequate ventilation (Sec. 4) 1 - - 1 - Sanitary conveniences (S c. 7)— (a) Insufficient 1 1 — 1 — (b) Unsuitable or defective 2 2 - 2 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) 1 - - 1 - TOTALS 9 6 - 9 - TABLE XVII. Outwork (Sections 110 and 111). Nature of Work Section 110 Section 111 No. of outworkers in August list required by Section 110 (1) (c) No. of cases of default in sending lists to Council No. of prosecutions for failure to supplylist No. of instances of work in unwhole some premises Notices served Prosecutions Wearing Apparel: Making, etc. 42 — — — — — Cleaning and Washing - - - - - - Making of boxes, etc. of Paper 1 - - - - - Stuffed toys 16 — — — - — Lampshades 1 — — — — — TOTALS ... 60 | — — — — — 33 Rodent Control. A staff of two Rodent Operators working under the control of the Rodent Officer and with the District Sanitary Inspectors, is maintained by the Public Health Department for the control and clearance of rat and mice infestation. During the year 296 complaints of rat infestation were received. The premises were visited and, where infested, treatment was carried out or advice given. Two large-scale sewer treatments were carried out under direction of the Ministry of Agriculture & Fisheries during p.riods January to March, and June to August, 1949. 34 index Page Area of Borough 8 Bakehouses 30 Births and Birth Rate 8 Brentford Market 30 Canal Boats 32 Cancer 5, 9 Causes of Death 10 Caravans and Moveable Dwellings 6, 24 Clean Food Campaign 23 Deaths and Death Rate 8, 9 Diphtheria 14 Disinfection 28 Factories Act 32 Food Poisoning 6, 22 Food Shops 6, 32 Food & Drugs Act, 1938 28 General Statistics 8 Health Propaganda 7, 23 Housing 27 Ice Cream Sampling 29 Infant Mortality 6, 11 Infectious Disease in Schools 17 Infectious Diseases, Prevalence and Control of 14 Infectious Diseases, Ages of Cases 15 Isolation Hospital—Admissions 14 Laboratory Work 18 Lice Infestation 17 Massage and Special Treatment Establishments 25 Maternal Morbidity and Mortality 13 Meat and Other Foods 30 Milk and Dairies Regulations 6, 29 Milk (Special Designation) (Pasteurised & Sterilised) Milk Regulations, 1949 29 Page Milk (Special Designation) (Raw Milk) Regulations, 1949 29 National Assistance Act (Sec. 47) 24 Notifiable Diseases 14 Offensive Trades 32 Ophthalmia Neonatorum 14 Outworkers 33 Overcrowding 6, 28 Poliomyelitis 6, 14, 18 Population 8 Premature Infants 5, 6 Public Health Committee 1 Puerperal Pyrexia 13 Rats and Mice 34 Refuse 27 Rodent Control 34 Sanitary Circumstances 26 Sanitary Defects 26 Sanitary Inspection 26 Scarlet Fever 14, 18 Shops 6, 32 Slaughterhouses 28 Small-pox 14 Smoke Pollution 25 Staff 2 Statistics General and Vital 8 Stillbirths 8 Sundry Nuisances 27 Tuberculosis 5, 18 ,, Occupations of newly notified cases 21 Unsound Food 32 Vermin 28 Vital Statistics 8 Water Supply and Water Services 27 Wells 27 35