1 M. Geroges's 2 Library Borough of Brentford and Chiswick Thtdx ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1956 BOROUGH OF BRENTFORD AND CHISWICK ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1956 MARGARET A. GLASS, B.Sc., M.B., Ch. B.(Glas.), D.P.H.(Cantab.) Medical Officer of Health BOROUGH OF BRENTFORD AND CHISWICK PUBLIC HEALTH COMMITTEE Councillor Mis. M Charlton Chairman Alderman P. S. Brierley Councillor Mrs. A, Godfrey " R, S„ Howard, O. B. E. " AD. Harris " C. A. Pocock " L H. Maynard Councillor A. H. Bulmer " C. E. Pocock " M.J. Digby " A. Russell Councillor Mrs. M. G. Saint Ex-Officio: Alderman Mrs, A J Burden J. P. " R L. Avery Councillor T. J. Crispin STAFF - PUBLIC HEALTH DEPARTMENT Medical Officer of Health Margaret A. Glass, B.Sc., M. B., Ch. B. (Glasgow), D.P.H. (Cantab). Chief Public Health Inspector, Slops Inspector, Housing and Canal Boats Officer, and Rodent Officer T, M Johnson, M. A. P„ H. I., AR, S.H., Cert, R. San. I., Cert. Insp. of Meat and Other Foods. Deputy Chief Public Health Inspector and Shops Inspector A. G„ Robinson, M. A, P.H.I,, Cert R.San. I. and S.I E. Joint Board. Cert. Insp, of Meat and Other Poods, Public Health Inspectors and Shops Inspectors R, AG. James, Cert, R, San, I. and S. I„ E„ Joint Board, Cert, Insp. of Meat and Other Foods. C.H. Wright, (resigned 25,11.56) M. A P„ H. I., Cert. R. San. I. and S I. E. Joint Board, Cert. Insp, of Meat and Other Foods, R. & I. Snoke Cert, C. E. Mallett, (resigned 9.12. 56) M..A. P.H. I., Cert. R. San. I. and S, I.E Joint Board, Cert. Insp. of Meat and Other Foods. B E. Martin, (appointed 16.1.56) M A P.H.I., M. R. S. H., Cert, R. San. I. and S.I.E.J. B., Cert.Insp. of Meat and Other Foods. Trainee Public Health Inspector N.J. Rogers, (appointed 1.4.56) Administrative Assistant R. P. Hill. Senior Clerk S. W Trowbridge, Clerks Mrs. M.M. Bishop. Mrs. J. M. Edwards, (appt. 3.12. 56) D.H. Vousden, (resigned 3.11.56) Shorthand Typist Mrs. V.I. Merrifield. Junior Clerk Miss MR. Tindall, (appt. 21.12.56) Disinfector/Rodent Operative C. Clark. Rodent Operative A. Scutchings. BOROUGH OF BRENTFORD AND CHISWICK Public Health Department, Town Hall, Chiswick, 4. To the Mayor, Aldermen and Councillors of the Borough of Brentford and Chiswick. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the 29th Annual Report on the health of the population and sanitary circumstances of the Borough of Brentford and Chiswick. The health of the people continued to be good. There was a slight fall in the death rate, a rise in the birth rate, and although these figures give satisfaction, it is less pleasing to have to record a rise in the infant mortality rate following the record low figure achieved in 1955. The rate in Brentford and Chiswick, however, was below the average for the whole country. The principal causes of death were again heart disease, diseases of the circulation, and cancer, the numbers dying from circulatory diseases and cancer having risen, though the figure for heart disease proper has shown a steady decline since 19 52. There were no maternal deaths and no deaths from diphtheria or poliomyelitis, but the number of deaths resulting from road vehicle accidents increased. The substantial fall in the number of infectious disease notifications was mostly due to a low measles incidence, but a reduction in the numbers of notified cases of poliomyelitis is also to be observed and of the two confirmed cases of this disease occurring in 1956, one reoovered fully during the year and the other was making very satisfactory progress by the end of the year. In June, the Middlesex County Council began to provide sessions for vaccination against poliomyelitis, but as the supply of vaccine was very limited, only a small number of children obtained this vaccination during the year. The only unsatisfactory feature of the infectious disease notifications figures was the outbreak of puerperal pyrexia, occurring at Chiswick Maternity Hospital which, because of the difficulty of control, necessitated the closure of the hospital for a short period in order that the disease might be completely eliminated. There was little alteration in the incidence of tuberculosis during the year, notification figures were increased by one and there was one death fewer than in the previous year, A feature of 1956 was that the Sanitary Inspectors were re-designated as Public Health Inspectors; this seemsavery satisfactory proceeding as it means that the inspector need no longer be considered as only responsible for the physical aspect of sanitation, but takes his place as one of a Health Team, knowledgeable and interested in all matters which are likely to affect the general health of individuals or of the community. -7- Progress was made with slum clearance and the rehousing of slum dwellers and there has been a considerable reduction since 1953 in the number of cases of statutory overcrowding known in the Public Health Department. Also during the year, a considerable plan for the modernisation of the older Council houses was completed so that now all Council houses in the Borough are electrified and have hot water services. New legislation concerned with Food and Drugs and Atmospheric Pollution meant that particular attention was required for these matters, and although the department suffered a temporary shortage of Public Health Inspectors during part of the year, some benefit was obtained by the fact that a Trainee Inspector now on the establishment was able to take some part in this work Acknowledgements are due to the many people who have supplied information for the purpose of this report, and who are listed below In conclusion I should like to thank the Chief Public Health Inspector and all the members of the Public Health Department staff not only for the work they have done in assisting in the preparation of this report, but for their loyal support at all times. I am, Your Worship, Ladies and Gentlemen, Your obedient Servant, Margant G. Gloss Medical Officer of Health - 8 - Acknowledgements to:- Dr. A. Anderson, Area Medical Officer P.R.Jo Arnold, Esq., Group Secretary, South West Middlesex Hospital Management Committee Dr. G Z. Brett, Physician-in-Charge, Mass X-Ray Unit 5A Mrs. E. V. Bruce, British Red Cross Society L, A. Franklin, Esq., County Welfare Officer Dr. R. Heller, Physician, Hounslow Chest Clinic A.A.H. Jackson, Esq. Manager Local Employment Exchange J. A. o. Keefe, Esq., County Public Control Officer Dr. A. C. T. Perkins, County Medical Officer Dr. T. M. Pollock, Medical Research Council H. s. Wright, Esq., Area Welfare Officer Local Medical Practitioners Meals Organiser, Invalid Meals for London Chief Officers of the Council STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH, 19 56 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 - Census 1951 59,367 Population - Registrar-General's Estimate for area (mid 1956) 58,330 Number of Inhabitated Houses according to Rate Book (April 1956) 16,083 Rateable Value at 1.4.1956 £1,233,375 Sum produced by 1d Rate (1955-1956) £3,021 The Borough is divided into nine Wards: BRENTFORD Brentford East Brentford West Brentford Central CHISWICK Chiswick Park Grove Park Bedford Park Gunnersbury Old Chiswick Turnham Green In the Borough of Brentford and Chiswick the eastern half is mainly residential with a certain number of industrial buildings of the smaller type interspersed throughout, while in the western half there is a highly industrialised section chiefly situated along the Great West Road There are 630 acres of open space within the Borough with ample facilities for refreshment and recreation both for the public in general and for the sporting activities of particular groups. The proportion of open space to the total area of the Borough is approximately 25% a very reasonable proportion for an urban area. The residents of the Borough are of mixed categories including professional and clerical people of all grades, artisans factory workers etc, , and the types of dwellings vary from flatted houses and cottages to large detached residences in their own surrounding grounds The amount of slum property is not considerable and progress is now being made with the demolition of houses which are no longer fit for human habitation. The rehousing of the tenants in council houses, details concerning assessment of slum dwellings, demolition and the building of new houses are supplied later in this Report. In the 1955 Annual Report it was possible to state that the number of known cases of overcrowding had diminished and this can again be said in the present Report* There was an increase in the number of new houses built both by the Council and by orivate enterprise in the Borough during 1956, but as the new -9- houses built by the Council were urgently required for rehousing of tenants from slum clearance areas, no effect was obtained from this on the overcrowded families waiting list. The employment figures at the end of 1956 show that there was still a considerable pool of work available and a very low figure of unemployed persons. On 10th December, 1956, there were 184 unemployed altogether, of which 125 were men and 59 women. This compares with 71 men and 44 women unemployed at the end of December, 1955, and 137 men and 71 women unemployed at the end of 1954, On 12th December, 1956, the number of jobs vacant totalled 586 of which 240 were for men and 346 were for women Since a considerable proportion of these unemployed persons were probably in course of changing work, the figures really demonstrate that a condition of full employment existed in the Borough up to the end of the year Parks and Open Spaces controlled by the Council Area in Acres Boston Manor Park and Island 40.7 Carville Hall Parte South 5 8 Carville Hall Park North 10.3 St. Paul's Recreation Ground 4 3 The Ham Recreation Ground 1.3 Chiswick Common South 8.7 Chiswick House 65.9 Stamford Brook Common 2.5 Homefields Recreation Ground 8.7 Strand Open Space 2.5 Turnham Green Common 7.5 Duke's Meadow Sports Ground 25.7 Bnbankment Promenade 12.5 Future Bnbankment Promenade 15.3 Chiswick Open Air Pools Site 1.2 10 4 acres of the above open space land is used as allotments. Swimming Baths controlled by the Council Brentford Indoor Swimming Baths: - Area 2,430 sq.ft. Capacity 12,049 c. ft. Total number .of persons using baths in 1956 65.013 Average number per day 202 Maximum number using baths on one day 561 Chiswick Open Air Pools:- Large Pool Area 7,500 sq.ft. Capacity 33,750 c. ft. Small Pool Area 3,500 sq.ft. Capacity 18,375 c. ft. Total number of persons using baths in 1956 62,873 Average number per day 446 Maximum number using baths on one day 2, 655 -10- There was a heavy fall in the number of persons using the open-air pools during 1956 and the figure showing the maximum number using the baths on any one day to be 2,655 as compared with 4,163 the previous year, marks that the weather was so consistently cold throughout the summer that open air swimming never became really attractive to the members of the public. The purification of the water of these pools is by intermittent chlorination and the amount of free chloride aimed at is 0.6 parts per million. Water samples are taken daily throughout the season. Other Facilities in the Borough for Open Air Recreation Privately owned open spaces and sports grounds 111.71 acres Council owned open spaces and sports grounds leased to private clubs etc. 67.94 " School playing fields 50.50 " Gunnersbury Park (owned jointly by Acton Brentford & Chiswick and Ealing Councils) 186.00 " Public Baths and Washhouses Brentford:- In Clifden Road. Brentford, the Council maintains premises containing 21 slipper baths, 14 for men, and 7 for women. The total number using the baths during 1956 was 25,784 persons. Chiswick: - In Belmont Road. Chiswick the Council maintains premises containing 31 slipper baths, 22 for men, and 9 for women In addition, 2 hip baths are available particularly for the use of elderly persons. The total number using the baths during 1956 was 45,431 persons. In these premises are also 30 washing compartments comprising 30 coppers, a rinsing section, 30 drying horses, hot air drying compartments and 2 mangling machines. Ratepayers are entitled to use these washing facilities at a small charge of 6d. per hour, and during 1956, 2 107 persons took advantage of the service. It is interesting to note the increase in the use of the slipper baths and of the clothes washing facilities. With the gradual demolition of slum property and provision of housing with suitable toilet facilities, the number of houses in the Borough not containing baths is slowly decreasing, yet an increased demand for use of slipper baths, as found, seems to indicate an increase in the general standard of personal cleanliness. Community facilities for clothes washing are becoming increasingly popular as is evidenced by the spread of launderette facilities everywhere, and the figures suggest that the cheapness and facility of the community services supplied in the public washhouses, is becoming more apparent to many housewives. -11- -12- VITAL STATISTICS, 19 56 Live Births Total Male Female Legitimate 766 404 362 Birth Rate per 1,000 of the estimated resident population - 14.13 Illegitimate 58 26 32 TOTAL 824 430 394 Sti11births Total Male Female Legitimate 15 3 12 Rate per 1,000 total (live and still) Births 22.54 Illegitimate 4 3 1 TOTAL 19 6 13 Deaths Total Male Female 6 33 306 327 Death Rate per 1,000 of the estimated resident population - 10.85 Deaths from Puerperal Causes Puerperal Sepsis Rate per l,000 total (live and still) Births Nil. Other Puerperal Causes Deaths of Infants under 1 Year of Age Total Male Female Legitimate 13 8 5 Illegitimate 2 - 2 TOTAL 15 8 7 Deaths and Death Rate A further slight fall in the death rate occurred in 1956, the figure for this year being 10.85 as compared with 10 91 in 1955, The lowest death rate ever recorded in the Borough was 10.16 in 1953. When the totals of deaths are studied it can be seen that the fall during the last two years has been only in deaths of males, there being a slight rise in female deaths. The principal causes of death were:- 1956 1955 1954 1953 1952 Circulatory Disease 224 206 205 173 217 Heart Disease 91 96 98 100 113 Cancer 150 136 159 119 128 Death Rate of all infants per 1,000 live births 18.20 Death Rate of all legitimate infants per 1,000 legitimate live births 16.97 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea or Gastro-Enteritis (under 2 years) Nil Deaths from Cancer (all ages) 150 Deaths from Tuberculosis (all ages) 6 The local Death Rate, 10.85 is lower than the figure of 11.7 which was the Death Rate from all causes in the whole of England and Wales. Table I gives a list of Causes of Death as classified according to the International system agreed by the World Health Organisation and in operation since, November, 1949. The distribution of cancer deaths in sites and ages is shown below, and it can be seen from these figures that again, as in 1955, the number of deaths from lung cancer is slightly lower than in the previous year, and that there is again an increase in the number of cancer patients dying from intestinal forms of the disease. Site of Primary Growth Male Female 1956 1955 1956 1955 Stomach 8 12 11 9 Lung, Bronchus 26 29 6 5 Breast - - 12 12 Uterus - - 6 3 Intestinal 18 13 13 15 Prostate 3 2 - - Bladder 2 3 3 1 Brain 2 2 - 4 Other 19 14 21 12 Totals 78 75 72 61 -13- Age Groups Male Female 1956 1955 1956 1955 Between 10 - 14 years - 1 l - " 15-19 " - 1 - - 20 - 24 ,, - - - - 25 - 29 " 2 - l 1 " 30-34 » - 2 - " 35 - 39 " - - - - " 40-44 " 2 4 3 5 45-49 " 7 3 8 1 " 50 - 54 " 5 7 7 3 " 55-59 " 12 5 4 7 " 60-64 " 11 6 5 7 " 65-69 " 8 18 8 4 70 - 74 " 12 11 15 14 " 75 - 79 " 8 12 7 7 " 80 - 84 " 7 4 5 5 " 85-89 " 4 3 3 5 " 90 - 94 " - - 1 2 " 95 - 99 " - - 2 - Totals 78 75 72 61 There were no maternal deaths. There were 6 deaths from tuberculosis in 1956, as compared with 7 in 1955 and 4 in 1954. Year Number of deaths from tuberculosis Male Female Total 1950 20 14 34 1951 11 14 25 1952 9 6 15 1953 8 1 9 1954 3 1 4 1955 5 2 7 1956 5 1 6 The total number of deaths from violent causes since 1950 is as follows:- 1956 1955 1954 1953 19 52 1951 1950 26 27 27 17 21 23 28 Seven residents died through involvement in road accidents. The ages of these cases were:- males 33, 42, 54, 60, 64 Females 51, 53 Three of these died as a result of accidents within the Borough. In all, - 14- 6 persons, including residents of other places, died as a result of road accidents occurring in Brentford and Chiswick, 1 motor-cyclist, 1 motor cycle pillion passenger, 1 motor assisted cyclist, 1 carthorse driver, 2 pedestrians. No children died on the roads of the Borough during 1956. Birth Rate The Birth Rate rose from 13.41 in 1955 to 14,13 in 1956. This compares with a National Birth Rate figure of 15 6. INFANT MORTALITY During 1956 the number of live births recorded was 824, 766 legitimate and 58 illegitimate. There were 19 still births, 6 male and 13 female. There were 15 deaths of infants under 1 year of age. as compared with 10 in 1955 and 21 in 1954, giving an infant mortality rate of 18 20 for 1956. The local figure compares with an infant mortality rate of 23.8 for England and Wales. The graph on page 16 shows the progress of Infant Mortality since the beginning of the century. The number of premature infants born in 1956 was 54, including premature stillbirths. Of the 43 premature infants born alive, 2 were born at home, both of whom survived to the end of one month, 41 were born in hospital, of whom 37 survived to the end of one month The percentage of premature infants to total births (live and still) is 6.4. This figure has shown a slight drop in 1956 but is still twice as great as it was in 1950 as can be seen by the following figures - 1950 1951 1952 1953 1954 1955 1956 3.3 4.5 5,6 4.9 6 0 6.9 6.4 Causes of infants deaths are shown in Table II on page 59. MATERNAL MORTALITY AND MORBIDITY Deaths from Puerperal Causes Puerperal Sepsis Nil Other Causes Nil There have been no maternal deaths in Brentford and Chiswick for the past four years, and from the year 1947 in which one was recorded, the only other occurred in 1952. During the year 97 cases of puerperal pyrexia were notified, as compared with 6 in 1955. Two cases occurred after home confinement, 95 were mothers confined at Chiswick Maternity Hospital For detailsof this outbreak see page 20. 14 of the cases were residents of the Borough No deaths occurred from this cause, nor were any infant deaths associated with the outbreak. -15- GRAPH "A" GRAPH SHOWING INFANTILE MORTALITY RATES DURING THE PERIOD 1900 - 19 56 -16- PREVALENCE 0F AND CONTROL OVER„< INFECTIOUS AND OTHER DISEASES. CONTROL OF VERMIN AND SCABIES By the courtesy of the School Medical Officer particulars regarding the cleanliness surveys in schools have been obtained, and are as follows: - Number of children examined: - Primary Schools 13,483 Secondary Modern Schools 4,876 18, 359 Number of children requiring treatment 106 Number of children in respect of whom cleansing notices were issued 72 Number of children cleansed by Local Health Authority 48 There was a fall in the number of children found to be infested with head lice, from 131 in 1955 to 106 in 1956, Although this figure is less for the year, the findings are still not to be considered very satisfactory since the number requiring compulsory cleansing appears to be rising annually i. e. 25 in 1953. 29 in 1954, 37 in 1955, 48 in 1956. By arrangement with the Medical Officer of Health of Hammersmith, persons requiring cleansing because of infestation with scabies or vermin, can be treated at the Hammersmith Cleansing Station During 1956., seven persons were referred for cleansing,, five for scabies infestation and two for verminous infestation. All of these cases were cleared quickly. INFECTIOUS DISEASE In the year 1956 there was a marked decrease in the incidence of infectious disease This was due mainly to the fall in measles notifications. Measles is a disease showing a marked biennial fluctuation and the current year was the year of low incidence. The up and down nature of this disease can be observed from the following table of notifications of this disease during the past ten years. 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 438 335 511 269 863 413 810 47 659 107 -17- Poliomyelitis 3 notifications of poliomyelitis were received during the year, and 2 cases were confirmed as paralytic poliomyelitis. Up to date information regarding these cases and those poliomyelitis cases noted in previous years as still showing residual paralysis is as follows. Case notified in 1949 This patient, now a girl of 10 years, still shows some residual paralysis of right leg for which she wears a caliper. Physiotherapy treatment continues and some slight progress has been made. Cases notified in 1950: CASE A - An adult male patient - condition stationary. Wears an instrument to control his drop foot, and suffers from circulatory disturbances, such as chilblains. Otherwise ne is fit to continue his work as a lorry driver. CASE B - An adult female patient - partial paralysis of left biceps - very little limitation of power and movement, Condition appears to be stationary. CASE C - A boy now 15 years of age - paralysis of right leg - still partial paralysis. Condition appears to be stationary. Has now left the district. Cases notified in 1951 No paralytic poliomyelitis occurred in 1951. Cases notified in 1952: CASE D - A boy now 9 years of age - severe case - paralysis of both upper and lower limbs. Left with slight weakness of the right leg and some wasting of the muscles of the right thumb, with little limitation of power and movement. Now moved away from Chiswick, CASE H - A boy now 5 years of age - paralysis of left arm and shoulder. Condition stationary, Cases notified in 1954: CASE M - Girl now aged 10 years - paralysis of right leg. Still some slight weakness, little improvement during the year. Cases notified in 1955: CASE P - Girl aged 6 years paralysis of right leg. Discharged from hospital with paralysis remaining No calipers or special boots required. Condition becoming stationary. CASE Q - Boy aged 11 years - paralysis of chest muscles and of limbs. Respirator case. Left with much weakness in limbs and back. Transferred to Stanmore for further treatment. Making some progress CASE R - Boy aged 5 years - paralysis of both legs. Fully recovered. CASE S - Female aged 19 years - paralysis of palate and left shoulder, right sterno-mastoid, left hip and left thigh. Condition improving, now only slight loss of power left thigh muscles. -18- CASE T - Adult male - paralysis of right arm and leg. Fully recovered. Cases notified in 19 56: CASE U - Boy aged 6 years - paralysis left leg. Residual weakness. Attending Physiotherapy Centre. Improving. CASE V - Girl aged 3 years - minimal weakness both legs. Fully recovered. Poliomyelitis Statistics since 1949 Confirmed cases Di ed Still making progress Condition stationary Fu1ly recovered 1949 4 - l - 3 1950 9 - - 3 6 1951 - - - - - 1952 9 2 l 1 5 1953 6 1 - - 5 1954 3 - l - 2 1955 5 - 2 1 2 1956 2 - 1 - 1 * 1 now left district It can be seen from these figures that of 38 confirmed cases of paralytic poliomyelitis occurring during the past 8 years, 24 have made a complete recovery with full power and normal movement of all muscles. In the early part of the year, a campaign was inaugurated by the County Health Department to obtain the registration of children between the ages of 2 and 9 years, for vaccination against poliomyelitis. Supplies of a British vaccine were beginning to be made available, and as soon as registration was completed, a start was made in the County clinics with the inoculation of selected groups from amongst the registered children. The supply of vaccine was very slow in coming through and although the number of children registered was 1,745, at the end of 1956, 190 children had received two injections and 26 one injection. It had been hoped that the numbers of children inoculated during the year would have given some guidance as to the percentage effectiveness of this treatment, but the number of vaccinations being very low and also the actual incidence of poliomyelitis being low in this year, no conclusions could be drawn from the local findings. -19- Puerperal Pyrexia In June, 1956, two cases of puerperal pyrexia due to the organism B. haemolytic streptococcus Group A, occurred at Chiswick Maternity Hospital. A further seven cases occurred in July. The organism was readily susceptible to penicillin treatment and although the mothers affected by the illness ran high temperature, this did not last for more than 24 hours. Measures were taken in an endeavour to limit the extent of the outbreak. All medical, nursing and other staff had throat and nose swabs taken, and the mothers and babies in the hospital were also investigated. All showing positive results, whetherwith symptoms or not, were isolated and treated Eight members of the staff were found to be carriers of the organism, and eleven of the infants had the infective streptococcus in the umbilical stumps. In spite of all precautions, cases were still occurring and it was decided, therefore, that the Chiswick Maternity Hospital should be closed and no further cases were admitted after 12th September The hospital was emptied by 20th September, cleaned throughout, and on 25th September, the whole of the staff was re-swabbed. The hospital re-opened for patients on 1st October, and those carriers remaining amongst the staff were excluded until free from streptococcal infection. The original carrier, who may have been one of the nursing staff, a patient or a visitor, could not be traced owing to the rapid development of the infection. There is no doubt that the energetic measures taken, although in fact they were not taken at an early enough stage, prevented this outbreak from being a much more dangerous and widely spread epidemic, and indeed no serious illness on the part of any one and no deaths were occasioned by the infection in this outbreak. Smallpox During the year no cases of smallpox occurred in the Borough, nor were there any contacts of confirmed cases Notification of smallpox contacts is always received as soon as, or before they enter the district. Vaccination against Smallpox The following information regarding vaccinations against smallpox carried out in the Borough during 1956 has been supplied by the County Medical Officer. Number of persons who during the year were:- Age groups To t al Under 1 1 2 - 4 5 - 14 15 & over vaccinated for first time 360 13 7 8 30 418 re- vaccinated - 1 1 4 97 103 Total 360 14 8 12 127 521 Total number of first vaccinations 1951 1952 1953 1954 1955 1956 298 373 548 487 438 418 -20- It will be noted that 360 children under 1 year of age were vaccinated out of 824 born during the year, i.e. 43.7%. This figure is falling each year i.e. in 1953 55% of infants under one year were vaccinated, in 1954 50%. in 1955 47. 5%, and now 43.7% in 1956. Scarlet Fever There was again a slight reduction in the number of cases of scarlet fever notified and confirmed as such, the figures being 46 in 1956 as compared with 48 in 1955. 28 of these cases were admitted to hospital. In two instances a second case occurred in the household in which a previous case had been notified, Diphtheria No cases of diphtheria were notified during the year. The last confirmed case of diphtheria in the Borough occurred in 1948 Information concerning immunisation against diphtheria in the Borough during 1956 has been supplied by the County Medical Officer, and is as follows:- Number of children who Age Tota1 Under 1 l 2 - 4 4/ compIet ed a full course of primary immunisation 341 120 34 11 506 received reinforcing injections - - , 197 151 348 Number of children at 31, 12 56 who had completed a course of diphtheria immunisation at any time before that date (i.e. at any time since 1.1.42). Age at 31.12. 56 i.e. born in year Under 1 19 56 1 - 4 1955 52 5 - 9 1951 - 47 10 - 14 1946 - 42 Total under 15 Last complete course of injections (whether primary or booster) A. 1952 - 56 117 1,897 2. 483 1,043 5, 540 B. 19 51 or earlier - - 839 1,988 2, 827 The figures for immunisation against diphtheria show a slight improvement in 1956. The number of primary immunisations in 1956 was 506 as compared with 463 in 1955, but is still considerably below previous years. It is considered that in order to prevent the risk of diphtheria again becoming a danger in the event of a case occurring, the proportion of school children who should be immunised should be not less than 75%. -21- Figures for the number of children under 15 estimated to be living in Brentford and Chiswick at the present time are not made available by the Registrar General, but taking the figure at the 1951 Census as a rough guide, i.e. a population of 11,418 children under 15, the percentage of children of school age who have at some time in their lives received a full course of immunisation against diphtheria and who have therefore reasonable protection, is roughly 73.3. On these calculations, although they are approximate only, there is still reason for concern that the community protection against diphtheria is below the safety margin. The number of children receiving booster injections i.e. the dose given just before school entry to reinforce the effects of the primary immunisation, remains at a somewhat low level, it is not, however, dropping. Whooping Cough 50 cases of whopping cough occurred in 1956. No deaths occurred from this disease. Dysentery and Food Poisoning There was no serious outbreak of dysentery or food poisoning during the year. Eleven notifications of food poisoning were received, and of these four occurred in one family and three in another. The organism identified in two of these cases was Salmonella typhi-murium. No bacterial origin was ascertained in any of the other cases, and although specific foods were blamed by the patients in some cases, bacteriological investigations, when possible, did not confirm. Ten persons were notified as suffering from dysentery, of these eight were confirmed as due to Shigella Sonnei, and one to Salmonella typhi-murium. One case was not confirmed as dysentery. All the cases were single, except for one family carrying Sonne dysentery organisms where four persons were found to be contacts of a positive Sonne case in a neighbouring house. No further spread occurred. Specimens of faeces were obtained from all contacts. Tuberculosis The number of notifications of tuberculosis in 1956 was 95 as compared with 94 in the previous year, the pulmonary cases amounting to 86 and the non-pulmonary to 9. The number of deaths from this disease was six as compared with seven in 1955 and four in 1954. There were two deaths from non-pulmonary tuberculosis, the first since 1952, one was male and one female and both deaths were due to tuberculosis of the kidney. It cannot be concluded from these figures that the fall in tuberculosis incidence and mortality has continued during 1956. The improvement which had been occurring annually slowed down in 1955 and appears to have stopped for the time being. Two of the persons who died from tuberculosis, one from pulmonary disease and one from non-pulmonary, had not previously been diagnosed as tuberculosis. Facilities for diagnosis and treatment of pulmonary tuberculosis as well as prevention and after care are provided by the Hounslow Chest Clinic, and home visiting is carried out by Health Visitors attached to this Clinic. They are also responsible for the examination of contacts and for the B. c. G. inoculation -22- for the prevention of tuberculosis. B, C, G. inoculation is now offered to all the Mantoux negative, i.e. susceptible, contacts of newly discovered tuberculosis cases; 74 residing in this Borough were inoculated during 1956. A prominent part in the treatment is played by domiciliary chemo-therapy (i.e. treatment with suitable drugs or injections given at home) on the recommendation of the Chest Physician, with the aid of the Home Nurses (formerly District Nurses) provided by the Middlesex County Council. Apart from institutional treatment provided by the local Hospital Management Committees of the North West Metropolitan Regional Hospital Board in General Hospitals and in Chest Hospitals, there is also a Middlesex County Council Hostel for chronic ambulant male tuberculous patients. Facilities for convalescence, rehabilitation and training are provided by the Middlesex County Council and the North West Metropolitan Regional Hospital Board. The social side of the treatment and prevention of pulmonary tuberculosis is dealt with by the Welfare Department of the Hounslow Chest Clinic. Tuberculosis Vaccines Clinical Trial The first report of the Medical Research Council's investigation into the value of vaccination against tuberculosis was published during the year. Brentford and Chiswick has been co-operating in this investigation since its beginning in 1951. The first report of the investigation has shown that vaccination for children in their fifteenth year substantially reduces the risk of contracting tuberculosis in adolescence Background of the Investigation The value of vaccination against tuberculosis has been a matter of dispute since its introduction into Prance more than 30 years ago. During this time there has been a gradual accumulation of evidence in favour of the vaccine, and by 1949 its value for those exposed to special risk from tuberculosis, such as nurses and contacts with cases of the disease, was generally recognised. In 1949 vaccination for contacts was authorised by the Ministry of Health, and in 1953 vaccination in older school children was introduced at the discretion of each local health authority. However, until the extent of the contribution which B. C. G. vaccination might be expected to make could be accurately assessed many public health authorities considered that its introduction on a wide scale was not justified, particularly in view of the recent advances made in other aspects of tuberculosis control. The first report establishes beyond question the short-term value of B. C. G. vaccination of young people in this country, and shows that vaccination at the age of 14 and 15 should reduce the number of cases of the disease developing between the ages of 14 and 17 by about half. This represents a valuable contribution to the prevention of tuberculosis. Description of Investigation The effort to establish the value of these vaccines scientifically has necessitated an extensive investigation,, probably the most detailed of its kind ever undertaken. The success achieved has been made possible by close co-operation of Medical Officers of Health and Chest Physicians in many parts of Britain with the Medical Research Council. 23 Beginning in 19 50, three special Medical Research Council teams, each equipped with a mass X-ray unit, visited 22 North London boroughs, including Brentford and Chiswick, and towns in the Midlands and North of England. With the consent of the parents school children in their 15th year were asked to volunteer and a proportion were given tuberculosis vaccines. By December 1952, 56,700 children, of whom 100 came from Brentford and Chiswick, had joined the scheme. Since then the participants had been followed by regular X-ray examinations, postal enquiries and annual home visits. The vast amount of home visiting involved has been carried out by the health visitors and school nurses of the local health authorities,, who have undertaken the work in addition to their normal duties. The follow-up has been very successful and over two-thirds of the participants continue to return for the X- ray examinations, approximately 75% return postal forms and over 90% have a home visit The present addresses of over 99% are known. Continuation of the Investigation The first report included results up to four years, Until the scheme has continued for a further period it will not be possible to say for how long the protection given by each vaccine will last, and whether those protected from tuberculosis in the first few years after vaccination will remain protected in later life. Until more is known of the duration of protection given by the vaccine it is also not possible to decide definitely the most suitable age at which it should be given Provided the scheme can be successfully continued it is probable that information of great value to the future control of tuberculosis, both as regards vaccination and also many other aspects of tuberculosis as a public health problem, will be obtained. This dependson the continuation of support by the many local authorities concerned Investigation of New Tuberculosis in the Adolescent In the Annual Report for 1953 it was reported that a scheme for the investigation of the high incidence of tuberculosis among young adults was begun. The plan was to invite children leaving school to take part in a scheme when they would be X-rayed at once and each year sent for and another X-ray carried out. These annual reviews are to be continued for 10 years from the time of the beginning of the experiment and during 1956, 366 altogether, 146 boys and 220 girls, attended for an X«ray under this scheme,, a percentage of 44 out of a possible attendance i„ e the number invited to take part in the scheme. No positive cases have as yet been found amongst these adolescents. HOUSING CONDITIONS OF CASES OF TUBERCULOSIS NOTIFIED DURING 1956 The housing conditions of 78 of the 95 new cases of tuberculosis were found to be as follows: - 77 patients lived in sufficiently satisfactory housing accommodation, 30 in flats, 27 in houses, 19 in lodgings or furnished rooms, and 1 in a caravan. - 24- In no case was there overcrowding, but one case living in a houseboat was considered to have unsatisfactory housing conditions. The housing particulars of 17 cases were not obtainable either because of removal of patients to other districts or because of resistance of patients to home visiting. 8 new notifications came from homes already returning one or more cases of tuberculosis. None of these came from houses classed as unsatisfactory or dilapidated. There have been 6 notifications of tuberculosis from one house, 3 of them being submitted in 1956. 36 cases were inward transfers from other districts and, therefore, had not developed their illness while resident in Brentford and Chiswick. The position regarding cases living in unsatisfactory or overcrowded conditions, outstanding from previous years, is as follows- Year Cases No. where Conditions improved 1955 2 1954 2 l 1953 7 2 1951 2 1 1950 1 - -25- GRAPH "B" GRAPH OF CASES NOTIFIED AND DEATHS FROM TUBERCULOSIS DURING THE PERIOD 1936 -1956 -26- FOOD CONTROL FOOD HYGIENE REGULATIONS, 1955 The above-named Regulations made under Section 13 of the Food and Drugs Act, 1955, came into force in part on 1st January, 1956. As it had been anticipated that; a good deal of planning and expenditure by shopkeepers might be required to bring some premises up to the new standards laid down in the Regulations, certain sections concerning this did not come into force until 1st July, 1956. Thereafter the lack of provision of suitable and sufficient sanitary and washing accommodation as laid down became an offence punishable with greatly increased severity as compared with previous enactments. Prior to 1st July 1956, when the Regulations became in force in their entirety, all occupiers of food premises in the Borough were sent a printed abstract of the provisions of the Regulations settingout the principal requirements. Visits to food premises have been somewhat curtailed by staff shortages but at the premises visited, the co-operation of the occupiers has been good. These Regulations have enabled the standard in the food premises in the Borough to be improved still further and have supported more vigorous action in a few intransigent cases. NUMBER AND TYPE OF FOOD PREMISES IN THE BOROUGH Bakers and Confectioners 15 Butchers 39 Club Canteens 10 Confectioners (Sweets) 91 Cafes, Restaurants, Dining Rooms & Snack Bars. 57 Factory and Staff Canteens 54 Fishmongers 15 Greengrocers and Fruiterers 52 Grocers and Provisions and General Stores 108 Ice Cream Manufacturers 4 Public Houses and Off Licences 76 School Canteens 19 Total 540 ICE CREAM The Ice Cream (Heat Treatment etc ) Regulations 1947/52 Observations as laid down in these Regulations were made on the four premises where manufacture of ice cream was carried out. • 27- Sampling Increased attention was paid to ice cream sampling in 1956 and during the year 110 samples were taken for bacteriological examination as compared with 46 in 1955. The results of these are as under: - Grade Ice Cream Cream Lollies Satis factory Doubtful Unsatisfactory Satisfactory Doubtful Unsatisfactory Other SampIes taken I 11 - - 1 - - Fruit Juices (2) II 45 - - 12 - - Milk Powder III - 10 - - 2 - Fat Powder IV - - 12 - - 7 Syrups (2) Not Graded - - - 4 - - 6 Totals 56 10 12 17 2 7 6 * * Satisfactory result in all cases It will be observed that the number of samples in Grade I (10%) is considerably lower than in previous years. This has been brought about by the different method of grading instituted by the King Edward Memorial Hospital Public Health Laboratory who substituted an accurate plate count and test for faecal coli for the methylene blue test, and not as a result of a lowering of the standard of purity. An extract from a letter from the King Edward Memorial Hospital Public Health Laboratory, states that "Since the whole purpose of testing ice cream is to discover the amount and nature of contamination taking place, we were obliged to substitute an accurate plate count and a test for faecal coli for the much easier methylene blue test. Following the precedent usual in food testing of making the standard the quality reached by known reliable manufacturers, we set up the following provisional grades* Grade Count Faecal Coli I Below 500 0 II 500 - 20, 000 0 III 20,000 - 100,000 0 IV over 100,000 or present The unsatisfactory samples came from three firms and repeated sampling was carried out until the results were improved. 28 Registered Premises Four new premises were registered during the year in accordance with Section 16, Food & Drugs Act, 1955 for the sale of ice cream. The total number of ice cream premises on the register at the end of the year was as under:- Sale only 171 Manufacture and Sale 4 Storage only 1 176 PRESERVED FOODS The total number of premises registered in connection with the manufacture and/or preparation of preserved foods under Section 16 of the Pood & Drugs Act, 1955 is 41 shown as under:- Sausage Manufacture 11 Sausages and pickled meat 28 Cooking of ham and other meats 2 41 The total number of inspections of registered food premises made during the year was 113. CATERING ESTABLISHMENTS One hundred and twelve visits were made to catering establishments during the year and in 12 cases it was necessary to give written or verbal intimation that work was required. FOOD COMPLAINTS Duringthe year 7 cases concerning food alleged to be unsound were received in the Department. Six cases were substantiated, the details of which are as follows:- Complaint Action taken Thin wire in sweet Warning letter Nail in cake Warning letter Mouldy wrapped sliced loaf No action Paper in milk bottle Warning letter Condition of stopper of mineral water bottle Warning letter Condition of wrapped sliced loaf Warning letter -29- FOOD SAMPLING Pood & Drugs Act, 1955 By the courtesy of the Chief Officer, Public Control Department of the Middlesex County Council, the following details of food sampling within the Borough are available Article Total Samp1es Procured Unsatisfactory Milk, various 64 1 Butter 9 - Cheese 2 - Cooked Meat 2 - Cream 5 - Drugs 7 - Fish 5 - Fish Paste 4 - Fruit 2 - Fruit, canned 4 - Garden Peas 3 - Ground Almonds 2 - Ice Cream 13 4 Jelly 2 - Liver 9 - Margarine 2 - Meat and meat products 11 3 Miscellaneous 9 1 Non-brewed condiment 2 - Preserves 4 - Vinegar 8 - Wines and Spirits 44 2 Totals 213 11 The total number of samples was greater during 1956 and from this larger number, the total of unsatisfactory results was greater than in the previous year, when 169 samples were investigated and only four unsatisfactory samples recorded. The following are the details from the Chief Officer's report on the 11 unsatisfactory samples and the action taken - milk, A bottle of milk contained pieces of glass. It appeared that the top of the bottle had been crushed during the capping process and when the foil cap was removed the spl intered glass fell into the bottle. An official caution was issued to the processors. Ice cream. Three samples of ice cream, from one manufacturer, were all deficient in fat. Proceedings were instituted and a fine of £2.0.0d plus £3. 3. Od costs was imposed, A sample described as "Dairy Cream Ice" contained fat other than milk fat. An official caution was issued. 30 Meat and meat products. Three samples of sausages, from different retail grocers, contained undeclared preservative. Follow-up samples were genuine and no further action was taken. Miscellaneous. A bread rol1 was submitted by a private purchaser with the complaint that it had an unpleasant taste. The roll was found to contain iron salts whichmay have been causedby water condensing on an iron pipe and dripping onto the roll. Although unpleasant to the taste the roll was not harmful to the consumer. An official caution was given to the bakers. wines and Spirits. Two samples of whisky from the same source, contained added water. An official caution was issued, The Food and Drugs Act, 1955. in section 47. contains new provisions concerning the descriptions which can be applied to certain substances which resemble cream in appearance but are not cream. This has necessitated the making of many inspection visits and the giving of advice to all traders likely to be concerned to ensure that they were fully aware of these new requirements. Merchandise Marks Acts, 1887 - 1926 96 inspections of shops were undertaken to ensure that the Marking Orders relating to certain imported foodstuffs made under the Merchandise Marks Act, 1926 were complied with. 1,153 separate displays of meat, apples, tomatoes, poultry and dried fruit were examined. Verbal cautions were given in respect of minor infringements not being found so serious as to warrant more stringent action. No infringements of a serious nature were disclosed. The Labelling of Food Order, 1953 This order requires that, in general, pre-packed foods shall bear on the label a clear statement of the designation of the food and, in the case of compound foods, the ingredients. It also requires that the name and address of the packer or labeller appears. At 57 premises 218 articles of pre-packed food were examined. No proceedings were taken in respect of any of the infringements detected and manufacturers took immediate steps to correct unsatisfactory labels as soon as their attention was drawn to them. False or Misleading Descriptions A considerable amount of work is carried out each year in scrutinising advertisements and the labelling of pre- packed food and taking such action as is possible to secure satisfactory amendments in those cases where a label or advertisement contains a false or misleading description of the food to which it relates. This work is of benefit to all districts of Middlesex, irrespective of where the offending advertisement or label is discovered, and during the year under review corrective action has been taken in respect of cherry wine, biscuits, chocolate Easter eggs, flour and sugar confectionery, imitation caviare, blackcurrant punch, fruit juice drinks and crane de menthe. Special Designated Milk No licences are issued by the Middlesex County Council in respect of Dealers/Pasteurisers or Dealers/Sterilisers in this Borough, Five samples of special designated milk were taken from roundsmen in the Borough during the year and submitted to examination. They proved satisfactory. -31- MEAT AND OTHER FOODS There are now no slaughterhouses operating in Brentford and Chiswick. FOOD CONDEMNED DURING THE YEAR, 1956 Fruit and Vegetables 28 tons Fish 33 stone Meat and Bacon 4½cwts Perishable Goods 5¾ cwts Tinned Goods 3,950 tins There was an abnormal rise in the amount of fruit and vegetables requiring to be condemned, the figures having risen from 8½ tons in 1955 to 28 tons in 1956. Three consignments of oranges which arrived at the Brentford Wholesale Market in an unmarketable condition, formed the bulk of this increase, 22 tons 4 cwts. having to be destroyed. Unsound food is disposed of by incineration, tippingor for animal feeding. MILK During 1956, the following licences were issued under the Regulations mentioned:- Milk (Special Designation) (Pasteurised & Sterilised Milk) Regulations, 1949 to 1953. Dealer's Licences 52 Supplementary Licences 18 Milk (Special Designation) (Raw Milk) Regulations, 1949. Dealer's Licences 22 Supplementary Licences 9 BAKEHOUSES Number in district in use 8 Contraventions of Foods & Drugs Act, 1955 - 32 BRENTFORD MARKET This very large wholesale market for the sale of fruit, vegetables and flowers, covers an area of 11 to 12 acres, and is under the control of the Borough Council, The Corporation employs a staff of 16 and there are 450 holdings with 150 tenants, and roughly 1,500 vehicles pass through the market every day. Improvements have recently been carried out in connection with the parking of vehicles. Modern sanitary conveniences are provided on the West side of the market, and free washing facilities are available at this and other conveniences situated in the market. In an article in "Fruit Trades Journal" it states "As far as sanitary conveniences and wash basins, Brentford Market is probably the best equipped market seen for these pressing needs". The Public Health Inspectors pay frequent visits to the market to confirm the maintenance of good sanitation and the Corporation employ the services of a firm of pest exterminators who pay visits to the market every six weeks to ensure that it is kept free from rodent infestation. Situated in the Market are also wholesalers who deal in groceries, tinned foods, etc., and in this connection the Public Health Inspectors visit for the condemnation of such goods as are reckoned to be unfit for human consumption. -33- HEALTH EDUCATION During the year, work on the education of the general public in matters of health and hygiene continued by means of personal communication between Public Health Department Staff and individuals, talks to Associations illustrated by topical film strips, poster publicity and leaflet distribution. In the Spring of the year, special publicity was given to anti-diphtheria immunisation and for the first time the managers of the local factories were asked to display Public Health publicity material, The response was very good and during the periodof the campaign, posters ware displayed in factory canteens and offices. In February, 1956, the Central Cbuncil for Health Education held a seminar for Medical Officers on the subj ectof Public Relations and the Health Department" at which public relations in its various aspects was discussed. The speakers included a Public Relations Consultant, the Editorsof two newspapers, a Public Relations Officerof the National and Local Government Officers Association, Officers of the Central Council for Health Education and various Medical Officers of Health. Group discussions were held and notes compared as to the value of various publicity methods as assessed from results obtained Results of health education, of course, are not easily assessable as indeed can be said of the results of all preventive health work, since any improvement in the health of the community is not immediately able to be measured by increased height, weight or lessening of the frequency of illness and individual personal well-being is never a measurable factor although it is so important. There was general agreement that there was room for improvement in the public relations work of most Public Health Departments, and that more co-operation between Corporation Departments, and between members of the Department staffs themselves, was desirable. It seems unlikely that the general public will be knowledgeable about public health if the Authority and its Officers are not well aware of all the changing facets of the work in the Public Health Department -34- WELFARE OLD PEOPLE During 1956, 32 cases of old people in need of care and attention were brought to the notice of the Public Health Department. No patient was found to be in such conditions as to require statutory action under the National Assistance Act, Details of the 32 cases are as follows Removed to Hospital 11 Removed to Old People's Homes 3 Remained at Home (a) with Home Help whilst awaiting entry to a Home 2 (b) with District Nursing assistance 1 (c) with Invalid Meals and Home Help 6 (d) no help required 2 (e) refused all help though help desirable 3 Died at Home 4 During the year a total of 284 aged persons or aged chronic sick persons in the Borough received help from the Home Help Service, and the Home Nurses dealt with 575 old people out of a total of 1,084 cases. These figures compare with 284 (the same number) aged persons receiving help from the Home Help Service in 1955 and 545 old persons being visited by the Nurses out of a total of 1,109 cases. Information supplied by the Area Welfare Officer shows that during the year 28 old people from the Borough were admitted to Old People's Homes through the County Welfare Department, amongst them were those in special need of care and attention listed in the above table as having been removed to old People's Homes. The County Council has the duty, under the National Assistance Act, 1948, of providing residential accommodation for aged and infirm persons in need of care and attention which is not otherwise available to them, and it can do this by providing its own Homes or by arrangements with registered Voluntary Organisations. The County Council's Welfare Department administers the County Homes, and one such Home is situated in the Borough, Chiropody A service was maintained throughout the year by the Middlesex County Council whereby old people could have their foot defects treated at reduced cost or free of charge. Figures of the numbers taking advantage of this Service can be found on page 57. Old Folks Friendship Club This is a specially built club house opened in April, 1955, for the use as a social and recreational centre of old age pensioners living in Brentford and Chiswick. The club is open Monday to Friday from 2-5 p.m. and there is a full-time organiser in attendance. The old people are enrolled as members at their first attendance, membership costs only one penny per week, and there are about 230 names on the register. The members can visit for rest room or reading -35- room facilities, or just to meet their friends and talk, but many social occasions are provided for them in the way of concerts, whist drives, etc. A television set is installed in the lounge, and a radiogram in the concert hall. Light refreshments are available in the afternoon. This club also arranges three summer outings on which about 100 travel each time, and an annual Christmas party to which all the members are invited - the majority attend. Through this club the members are also able to obtain information about the special services at reduced rates which are available within the Borough for them, such as laundry, shoe repairs and hairdressing, and they can be given advice on any difficulties that occur in their private lives. This is the only club premises open daily for the use of old age pensioners but there are 9 clubs meeting in different parts of the Borough once a week to which mobile old age pensioners become attached as members, for social and recreational purposes. Slipper Baths Under the scheme for the provision at the reduced rates (2d. per bath) of slipper baths for old people at the Public Baths Establishments, 1,908 baths were taken in Chiswick and 553 in Brentford. Meals on Wheels The service of meals provided by the Invalid Meals for London has proved immensely useful and very popular. These meals were provided on five days per week and special diets could be obtained, i.e. in the case of old people suffering from gastric ulcers, diabetes, etc. The cost of the meal to the old age pensioner receiving it is tenpence and this is supplemented by a grant from the Borough Council to cover part of the remainder of the cost of the meal, overheads and transport are provided by the Invalid Meals for London itself by means of funds raised by voluntary effort. Persons in need of this service and eligible for it were brought to the notice of the staff of the Public Health Department and a certificate signed by the Medical Officer of Health for those who were to be authorised to receive the meals. Unfortunately the number of genuinely needy cases found increased rapidly as the service became known. The main reasons for the need are incapacity following ill-health or hospital treatment lack of cooking facilities, and for old people living alone with the genuine risk of starvation by abstention from food of sufficient nourishing quality. The result was that the waiting list began to grow and by the end of the year amounted to 61 persons. During the year 13,808 meals were provided for 73 old people. Laundry for the Incontinent Aged From various sources enquiries have been made from time to time about the difficulties experienced in obtaining laundry for the incontinent aged, particularly from the hospital almoners and from the Home Help Organiser. In the autumn, it was agreed by the Borough Council that an assisted laundry scheme would be put into operation. Old people in need of the service were to be notified to the Public Health Department and, if considered suitable, arrangements would be made for the department's van to call each week and collect the laundry, deliver it to Spring Grove Laundry which was willing to co-operate in the scheme, and transport the laundry after servicing back again to the old person's dwelling. No charge was to be made for this service but a certificate for each case was to be submitted to the Public Health Committee. -36- Up to the end of the year three old persons had been recommended for, and obtained, this service. Home Safety In March 1956, the North Thames Gas Board offered a free service of inspection of the gas appliances and service pipes in houses of old age pensioners living alone. The reason for this was in order to reduce the risk of gas poisoning, a frequent cause of home accidents and fatalities in old people. The offer was to include free replacement of faulty pipes and the free repair of faulty appliances. To take advantage of this offer lists of old people living alone were submitted from the Public Health Department, and in due course the homes of the persons nominated on the lists were visited by the Gas Board officers. Fresh lists continued to be supplied from time to time. GENERAL The Superintendent of the local St. John's Ambulance Association and the Divisional Director of the British Red Cross Society have kindly supplied information concerning their welfare work in the Borough St. John's Ambulance Brigade (1) Attendance at sports meetings, public gatherings and entertainments to render first aid if required. (2) conveyance of patients by ambulance to supplement the County Ambulance facilities. (3) Maintenance of Comforts Depot from which supplies of medical equipment can be issued on loan. (4) The provision of instructors for classes in first aid and home nursing to Civil Defence volunteers, adult and youth groups, (s) Voluntary aid in hospital wards male and female. (6) Provision of nursing attendants for meetings and outings of old persons organised by the various Old People's Associations. (7) Courses of lectures on first aid to factory staffs and local factory fire brigade personnel. British Red Cross Society (1) The arrangement of sessions for the taking of blood for the transfusion service, and the provision of volunteer assistants during the periods of the blood transfusion service operations. (2) Ambulance transport for the sick to supplement the County Ambulance facilities. -37- (3) The maintenance of a medical equipment loan depot at No. 16 Heathfield Terrace, Chiswick, W.4., open on Mondays and Wednesdays from 7 30 to 8.30 p.m. Emergency contact can be made with Miss Wallace - telephone No. Chiswick 2353. (4) Occupational therapy for the disabled ex-Service pensioners and for Chest Clinic cases. (5) The provision of a library service for home-bound tuberculous patients. (6) Home visiting in cases of distress and the provision of urgently required household articles or home nursing. (7) The provision of volunteer workers to travel to and from hospital with sick, aged, blind people or children, and to give regular blanket baths to the sick and nursing. (8) The supply of instructors in first aid for Civil Defence volunteers, adult and youth groups. (9) The allocation of accommodation in Red Cross Homes, shortorlong stay, for old people and convalescents. (10) Attendance of personnel for First Aid duties every weekend at the Polytechnic Playing Fields. WELFARE OF THE BLIND AND PARTIALLY SIGHTED The County Council is responsible, under the National Assistance Act, 1948, for the provision of welfare services for the blind and parti ally-sighted. There are resident in the Borough 105 blind and 28 partially-sighted persons. 18 blind persons are in full-time employment; of these 3 are in Workshops for the Blind, and receiving augmentation and supplementation of earnings from the County Council, and 2 are working as Home Workers under the scheme of the Royal London Society for the Blind These also receive from the County Council augnentation and supplementation of earnings. The majority of blind people are not available for, or are not capable of, training for employment owing to age or infirmity or for some other reason. The County Council provides a Home Teaching service for the visitation of blind and partially-sighted people in their own homes. The duties of the Home Teachers are to advise blind and partially-sighted persons on all problems relating to their welfare and of all the available social services, to assist them in overcoming the effects of their disabilities, to give instruction in Braille and Moon systems of raised type, in communication by means of the deaf-blind manual alphabet, and in handcrafts. A handcraft class is held fortnightly at the Area Welfare Sub office, 14a, Sutton Court Road, Chiswick, The object of the Home Teaching service is to enable blind people to lead as full and active lives as their severe handicap allows. A number of the blind residents in the Borough attend the County Council Old Time Dancing Class for the Blind, which is held weekly in Ealing. The -38- County Council works in close co-operation with Voluntary Organisations, including the Social Club for the Blind which meets fortnightly at the Christ Church Hall, Turnham Green, and the Middlesex Association for the Blind, who maintain a Holiday Home at Littlehampton, two Residential Homes for the Blind, and assist financially and by way of gifts individual necessitous blind persons. Blind persons are eligible for the loan of a wireless receiver through the British Wireless for the Blind Fund, and the County Council has a scheme for assisting blind and partially-sighted persons in the maintenance of wireless sets. Other services provided directly by the County Council or through a Registered agency, include facilities for the placement of blind persons in employment, courses of residential rehabilitation, training courses for mothers with blind babies, the supply of embossed literature, special equipment and handcraft materials, assistance in the disposal of handcrafts, and assisted holidays for those in need. welfare of handicapped persons other than blind Schemes for the welfare of handicapped persons other than blind and partially-sighted are operated by the County Council's Welfare Department under the National Assistance Act, 1948; these cover the deaf and dumb and hard of hearing, and other persons who are substantially and permanently handicapped by crippling diseases or congenital deformity. Services to the deaf and dumb and the hard of hearing are provided by appropriate voluntary organisations, to whom the County Council makes grants in aid. The County Council's Welfare Department has provided a Welfare Visitor for persons in the Borough who are suffering from substantial and permanent handicaps other than those already mentioned, and she works under the direction of the Area Welfare Officer. She visits such persons in their own homes, with a view to assisting them to obtain from statutory or voluntary sources (or both) facilities, appliances, etc., which may benefit them. The help afforded, may, for example, enable the disabled person to take part in social activities, attend handcraft classes, obtain a needed holiday, or by provision of ramps for mechanical chairs, handrails, and the like, give a previously non-existent measure of mobility to a person who was chair bound or house bound. Advice and guidance regarding personal problems is given and membership of a voluntary organisation catering for a particular handicap is facilitated Residents of the Borough needing any of the County Welfare Services briefly referred to in this Report should apply to the Area Welfare Officer, Mr. H.S. Wright, at the Local County Offices, Great West Road, Brentford. 39 ATMOSPHERIC POLLUTION The three stations set up for the measurement of smoke and sulphur dioxide in the atmosphere by the volumetric method, continued to function throughout the year. In addition to these stations, two deposit gauges were set up on 1st September, 1956, one at the Metropolitan Water Board Works, Kew Bridge, Brentford, and the other at Chiswick House Grounds. Monthly reports of recordings and other particulars were submitted to the Fuel Research Station of the Department of Scientific and Industrial Research for comparison with the rest of the country, and the Officers of the Fuel Research Station were consulted at any time when special problems occurred concerning the readings of results or breakdown of equipment. Bulletins from the Department of Scientific and Industrial Research were received regularly and studied in the Public Health Department so that results could be compared with those in other areas, A brief summary of the year's recordings is to be found in Table XII at the end of the book, and in Graph C which has been prepared from these figures, but as the results obtained from the deposit gauges covered only four months of the year in question, no useful comparison can yet be made, and so the figures are not shown. As will be seen, for most of the year the Chiswick results both for smoke and sulphur dioxide pollution remain slightly higher than those for Brentford. The results obtained from the third station in the Borough, which was set up at Chiswick in August, 1955, at second floor level in the Council buildings do not indicate any great difference from those obtained from the original Chiswick station in the Public Health Department's laboratory, and so far, it has not been possible to explain the higher figures obtained at Chiswick. The figures all over the Borough show some slight improvement for 1956. It is noteworthy that on 5th January, 1956 when thick fog obscured the sky all day, the highest figure yet recorded in the Borough was obtained for smoke in Chiswick, although that in Brentford (where the previous highest figure was obtained on 20th January, 1955), was considerably lower. These figures were obtained during a period of smog', (smoke and fog), when two-hourly readings were being taken following a request received from the Fuel Research Station at Greenwich, Graph 'D' shows the monthly rise and fall in the pollution figures for Brentford and Chiswick, also Leeds, Central London, and Lerwick. These latter places have been chosen in order to illustrate the varying amounts of pollution from a virtually smokeless atmosphere, i.e. Lerwick to an industrial area, i.e. Leeds. During the year, 55 visits or observations were made in connection with cases in which it was alleged that atmospheric pollution was taking place. Work was carried out where necessary, and advice on stoking methods given occasionally. New legislation to abate atmospheric pollution received the Royal Assent as the Clean Air Act, 1956, certain provisions of which were due to come into operation on the last day of the year. 40 graph "c" Variation in average monthly concentrations of smoke And sulphur dioxide in Brentford and Chiswick during 1956 41 graph "d" comparison of concentrations of smoke in the air at brentford, chiswick, central london, leeds and lerwick 42 SANITARY CIRCUMSTANCES OF THE AREA Inspections The total number of inspections and re-inspections made during the year was 5,359 and the following is a summary of these inspections. Inspections Re-inspections Atmospheric Pollution Stations 299 - Accumulations of refuse 45 84 Complaints - condition of house 596 1,975 Caravans, house-boats, etc. 4 40 Catering Establishments 74 48 Drainage works 230 588 Factories - with mechanical power 17 27 Factories - without mechanical power 5 1 Pood premises (excluding catering establishments) 82 49 Food premises - inspection of unsound food 157 8 Houses - Housing Acts 45 67 Houses - Re-housing 8 1 Houses - Overcrowding 13 30 Ice Cream Vendors 79 10 Infectious disease enquiries 109 29 Milk Vendors 4 - Offensive odours 43 24 Rats and Mice 124 123 Shops - Shops Act inspections 24 4 Smoke observations 55 - Vermin, insect pests etc. 31 8 Miscellaneous 160 29 2,04 3,155 Action taken other than Housing Act, 1936 Cautionary or Intimation Notices served 426 Statutory Notices issued (under Public Health Acts) 86 Number of summonses served 7 Number of Disrepair Certificates issued under the Housing Repairs and Rents Act, 1954 6 Number of Revocation Certificates issued - 43 The following list shows the number of defects remedied during the year as a result of notices served:- Brickwork, repaired 13 Choked drains, unstopped 66 Chimney stacks and flues, repaired and made good 10 Ceilings, repaired and made good 98 Doors and frames, repaired 7 Dustbins, supplied 9 Dampness in walls, remedied 150 Fresh air inlets and interceptor caps etc., provided 4 Firegrates, cooking stoves, repaired or renewed 52 Floors, joists and staircases repaired or renewed 73 Gutterings repaired or renewed or cleaned out 50 Inspection covers and frames renewed 15 Leaky roofs and skylights repaired 136 Plaster to walls, repaired and made good 161 Rainwater pipes, repaired or renewed 13 Soil pipe ventilators, repaired or renewed 11 Sinks replaced - Seats to W.C's, repaired or renewed 6 Water waste preventors, repaired or renewed 4 Walls and ceilings, cleansed or redecorated 18 Waste pipes, repaired or renewed 15 Window frames, sash cords, sills, repaired or renewed 146 W.Cs replaced 34 Yard Paving, repaired and made good 7 Miscellaneous items 27 1,125 In addition, the following drainage works were carried out during the year under the supervision of the Public Health Department:- Drains tested (smoke) 39 New soil pipe ventilators fixed 14 New interceptors fixed 1 New surface water and soil gullies fixed 5 New manholes constructed 9 Manholes reconstructed or repaired 8 Soil drainage connections repaired or relaid 29 Soil main drains repaired or relaid 19 New W. C's provided and fixed 37 New sinks provided and fixed 16 New sewer connections 4 New manhole covers fixed 5 New surface water lengths fixed 4 Baths installed (new) 5 Lavatory Basins installed (new) 10 Drain ventilators fixed - 44 All premises in the Borough are provided with water closets and all drain into sewers with the exception of the following:- 1 boathouse and 1 railway signal box which have cesspools and 1 boathouse and 1 sports pavilion which have septic tanks. Arrangements for the regular clearing of the cesspools are made with the Borough Engineer's Department of the Council. Enquiries - Outstanding Sanitary Notices During the year 964 letters were received from the Town Clerk enquiring whether there were any outstanding sanitary notices with respect to certain properties in the district. The necessary searches were made and the required information furnished. SCHOOL SANITATION In the Annual Report for 1954 it was stated that following a survey of the sanitary facilities in the schools of the Borough, it was considered that 9 schools were very much below standard in this respect. It is now possible to report that of these schools, two have had enough work done to bring them up to the standards which were desired, two others are about to be provided with complete new sanitary blocks, one is about to be brought up to standard by the provision of additional W.C' s and wash basins, and one, which is due for demolition, has had temporary improvements made, one other school requiring sanitary improvements is being closed down entirely. WATER SUPPLY AND WATER SERVICES The whole of the district is supplied by the Metropolitan Water Board mains. There is one well still in use in the Borough at Green s Boathouse, Riverside Lands. This well is used for washing purposes only, drinking water is 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 COLLECTION Refuse is collected once per week from each house in the Borough and is disposed of by collecting freighters to a Controlled Tip outside the Borough. 45 HOUSING HOUSING REPAIRS AND RENTS ACT, 1954 Following the survey of unfit houses in the Borough reported in the years 1954 and 1955, it is now possible to state that work is proceeding in a reasonably rapid manner on the comprehensive inspection and representation of slum properties, with the re-housing of their tenants and with the demolition of the condemned properties. Since the end of the Second World War, 170 slum houses have been demolished in the Borough, and 1,184 new houses built either by the Borough Council or by private enterprise, and details of the special work doneonslum clearance during the year 1956 can be found below. 6 applications for Certificates of Disrepair under the above Act were made during the year and 6 certificates were issued 1 application was received fron an owner for the revocationof a Certificate of Disrepair, it was refused. Grants for Improvements and Conversions The Borough Engineer and Surveyor has supplied the following information regarding works carried out since the coming into operationof the Housing Repairs and Rents Act 1954 by the owners for the improvement or conversion of houses and for which grants have been authorised by the Council in accordance with the provisions of the Act. Improvement or Conversion 1 house Extension to premises to form a bathroom. 1 house Conversion into two flats, 12 houses Conversion of third bedroom into bathroom 1 house Forming new bathroom by raising on scullery. 1 house Conversion of ground floor into self- contained flat, 1 house Replanning of kitchen to form a bathroom HOUSING ACT, 1936 Hogarth Lane Re development Area The re-development of this area continued throughout the year and 12 flats were built by the Council, making a total of 94 now erected on the site. Albany Road Re development Area During the year official representation was made to the Council that the nine houses, Nos. 51 - 67 (odd numbers) Albany Road, Brentford, were unfit for human habitation and were declared a clearance area, viz. Albany Road (No.4) Clearance Area, 1956. Albany Road (No 2) Clearance Area, 1954 Nos. 1-12 Paradise Place and Nos. 15 and 17 Oliffe Cottages, Brentford. During the year 16 families (48 persons) were rehoused by the Council from these properties and the houses closed. 46 The Ham (No. 1) Clearance Area, 1955 Nos. 31 - 41 (odd numbers) The Ham, Brentford. The remaining occupants numbering 6 persons (3 families) were rehoused by the Council during the year and the houses closed. Old Spring Gardens (No 1) Clearance Area, 1955 Nos. 1 and 3 New Spring Gardens, Brentford, and Nos. 7-15 (odd numbers) Old Spring Gardens, Brentford. The remaining occupants (14 persons 3 families) were rehoused by the Council during the year Nos. 1 and 3 New Spring Gardens are closed and Nos. 7-15 Old spring Gardens were demolished in October, 1956. Walnut Tree Road Clearance Area, 1955 Nos. 12 - 22 (consecutive) Walnut Tree Road, Brentford. The remaining 8 families involving 19 persons were rehoused by the Council during the year and all the houses are now vacant and will be demolished. Chiswick Common Road Clearance Area, 1955. Nos. 21 - 28 (consecutive) Chiswick Common Road. The Clearance Order in respect of these houses was confirmed without modification, by the Minister of Housing and Local Government on the 3rd February, 1956. During the year under review 10 unfit houses in Clearance Areas were demolished, as under:- No. 2 Devonshire Place, Chiswick Nos. 7-15 (odd numbers) Old firing Gardens, Brentford. During the year 45 families (133 persons) in unfit houses were rehoused by the Council. HOUSING STATISTICS 1. Inspection of Dwelling-houses during the yeans: (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 641 (b) Number of inspections made for the purpose 2,042 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidation Regulations, 1925 Nil (b) Number of inspections made for the purpose Nil (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 9 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 336 47 2. Remedy of Defects during the year without service of formal Notices: Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 370 3. Action under Statutory Powers during the year: (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling- houses which were rendered fit after service of formal notices (i) by owners Nil (ii) by local authority in default of owners Nil (b) Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 66 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (i) by owner 42 (ii) by local authority in default of owners Nil (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil (d) Proceedings under Section 12 of the Housing Act, 1936: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 4. Housing Act, 1936 - Overcrowding: (a) (i) Number of dwelling-houses known to be overcrowded at end of year 46 (ii) Number of families dwelling therein 62 (iii) Number of persons dwelling therein 283 (b) Number of new cases of overcrowding reported during the year 9 48 (c) (i) Number of cases of overcrowding relieved during the year 13 (ii) Number of persons concerned in such cases 66 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil Statement of (a) Rebuilt (war damage) and (b) New Dwellings erected by the Borough Council and Private Enterprise during 1956 Permanent Housing Houses Flats Maisonettes Bungalows Total By Borough Council (a) Rebuilds - - - - - (b) New 8 38 - - 46 TOTAL 46 By Private Enterprise (a) Rebuilds - - - - - (b) New 2 39 - -- 41 TOTAL 41 Statement of (a) Rebuilt (war damage) and (b) New Dwellings erected by the Borough Council and Private Enterprise between the end of the Second World War and the 31st December, 1956 Permanent Housing Houses Flats Maisonettes Bungalows Total By Borough Council (a) Rebuilds 23 11 2 - 36 (b) New 137 468 165 27 797 TOTAL 833 By Private Enterprise (a) Rebuilds 116 135 15 2 268 (b) New 16 65 - 2 83 TOTAL 351 49 Temporary Housing Houses Flats Maisonettes Bungalows Total By Borough Council (a) Rebuilds - - - - - (b) New - - - 150 150 TOTAL 150 During 1956, eight of the foregoing temporary bungalows were demolished to make way for permanent dwellings. It should be noted that the Borough Council's figures include a number of dwellings on the Syon Estate, Isleworth, which is in the adjoining Borough of Heston and Isleworth. Modernisation of Council Houses In the Annual Report for 1955, it was reported that Council houses supplied only by gas would be provided with electricity for lighting purposes and heating where required, and this work has now been carried out. It was also reported that a plan had been prepared providing for the replacement of old fashioned cooking stoves by open fireplaces, and retaining the existing hot water services. This work has also now been completed. Further, some 220 houses with no separate hot water facilities were to be provided with open fireplaces and for either complete hot water installations or alternatively back boilers to open fireplaces, and this again has been completed. Now all Council houses in the Borough are electrified and have hot water services. Overcrowding Sixteen cases of alleged overcrowding were investigated by the Department staff during the year. Of these,, nine were found to be statutorily over-crowded, and were accordingly notified to the Housing Department for consideration by the Housing Committee. It will be seen from the Housing Statistics on page 49 that thirteen cases of overcrowding were relieved during the year. Overcrowding is relieved in various ways, by private arrangements made by the families concerned, by Council rehousing, or by Council nomination under the Industrial Selection Scheme for housing in New Towns. Up to December, 1955, 124 families in the borough have obtained housing accommodation in New Towns under the Industrial Selection Scheme. During the year under review, 63 families resident in the Borough were nominated and rehoused in New Towns, two at Basildon, ten at Bracknell, three at Crawley, eleven at Harlow, one at Hemel Hempstead, one at Hatfield, and thirty-five at Swindon. 50 DISINFECTION Premises disinfected: Ordinary notifiable diseases 41 Tuberculosis 4 Cancer 15 Other diseases 2 Premises treated for vermin 4 Premises treated for other pests (wasps, moths, ants and beetles) 5 An arrangement is in force whereby the South West Middlesex Hospital Management Committee undertakes to carry out emergency disinfection of vermin infested or smallpox-infected clothing and bedding on demand. Routine disinfection of blankets bedding etc. were carried out on the premises in the above table as required - in addition certain articles of clothing, and parcels of clothing destined for countries abroad, were disinfected. When necessary, books for both public and private libraries are disinfected in the Public Health Department. 51 MISCELLANEOUS RODENT CONTROL During the year 2,905 primary visits and re-visits were made by the Rodent Operatives to premises in the district in connection with rodent disinfestation. The number of premises where treatment was carried out is as follows:- Private Houses 331 Factories 24 Slops 22 Schools 13 In addition to the above, two maintenance treatments to the sewers were carried out under the direction of the Ministry of Agriculture and Fisheries during the months of January and May. June and July, and the following shows the number of manholes found to be infested. Date Manholes found to be infested January, 1956 39 May, Junde and July, 1956 48 The work of Rodent Control is carried out under the supervision of the Chief Public Health Inspector by two Rodent Operatives who have the assistance of a labourer during such time as the sewers are being treated. PET ANIMALS ACT, 1951 This Act for the regulation of the sale of pet animals requires all premises in which animals are sold for pets to be licenced by the local authority. 3 licences were issued during the year. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Three premises in the Borough are registered for the purpose of the above Act, in pursuance of the provisions of Section 2 thereof. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT Nine establishments were inspected under this heading and all were found to be satisfactory for the purpose which was intended. Purpose No. of Licences Massage only - Chiropody only 4 Massage and Chiropody - Massage, Chiropcrdy and Electrical Treatment 1 Massage and Electrical Treatment 2 Chiropody and Electrical Treatment. 2 FREE WASHING FACILITIES IN PUBLIC CONVENIENCES Facilities for free hand washing are available in the Kew Bridge both "Ladies' and Men's", High Road "Men's" and Turnham Green "Ladies'" Public Conveniences, paper towels and liquid soap in tilting dispensers being available in each. In addition a wash hand basin is provided in the "Ladies'" convenience in Linden Gardens. 52 During the year 1956, 10,600 paper towels were issued showing a much improved use of the service. In addition those who preferred linen hand towels and tablet soap were able to hire these at a cost of 3d. In the same conveniences 6,749 of these towels were also used. In one other convenience in the Borough - Market Place "Men's and Ladies'", free washing facilities are not available, but 299 linen towels were supplied for use. This convenience is planned to be demolished in connection with the plan for the redevelopment of the High Street (east of the Courthouse) but it is understood that negotiations are in progress for the acquisition of another site in the rear of Thanet House on the west side of the Courthouse, There are no free washing facilities available at the Edensor Road "Ladies' and Men's" nor at the Turnham Green "Men's" conveniences, RIVER POLLUTION Reports continued to be received every three months from the Officers of Middlesex County Council regarding the condition of the River Brent. Samples were taken at points along the stream from Wembley to Brentford High Street; the two sampling points in the Borough being at Gallows Bridge and Brentford High Street. The results of sampling in 1956 were unsatisfactory at the beginning of the year, but in July and October there was considerable improvement attributable in part to the wet cool summer. No new sources of pollution were discovered during the year, and no action was required to be taken against persons using the River Brent for unauthorised discharge of sewage or trade effluents. Pollution of the River Thames from a Chiswick source was confirmed in the summer of 1956 and steps taken to eliminate this source of contamination. STREET TRADING Certain prescribed areas in the district are allocated for street trading purposes, and are frequently visited to ensure that they are being maintained in good condition and in accordance with the Bye-laws. Visits were also paid to the premises of street hawkers who deal in food stuffs. CANAL BOATS Number of boats on register:- Motor propelled boats 93 Other boats 406 53 HEALTH SERVICES PROVIDED BY OTHER AUTHORITIES North West Metropolitan Regional Hospital Board South West Middlesex Hospital Management Committee Brentford Hospital, Chiswick Maternity Hospital and King Edward Memorial Hospital, Clayponds Wing (formerly Clayponds Hospital) are situated within the Borough and are administered by the South West Middlesex Hospital Management Committee under the provisions of the National Health Service Act, 1946. Brentford Hospital is a cottage type hospital, staffed by general practitioners and visiting consultants, and has 33 beds dealing with general medical and surgical cases. This hospital is now a Training School for assistant nurses in conjunction with South Middlesex Hospital. Chiswick Maternity Hospital which is an integral part of the West Middlesex Hospital has 66 maternity beds and 55 maternity cots, but the actual bed complement is at present reduced to 53 in order that 13 single bedrooms may be available for the staff. It is hoped that this is a temporary expedient only. King Edward Memorial Hospital Clayponds Wing, has 127 staffed beds and is classified as dealing with orthopaedic., chronic, general medical and surgical cases. It is just within the Borough and is integrated with the King Edward Memorial Hospital at Ealing. The majority of the patients admitted to Clayponds come through the King Edward Memorial Hospital and the remaining patients are admitted through the West Middlesex and Central Middlesex Hospitals. A considerable number of Brentford and Chiswick people receive their hospital treatment at the West Middlesex Hospital, Isleworth, and the majority of cases of infectious disease requiring hospital isolation are admitted to the South Middlesex Hospital. Isleworth, Chest Clinic patients residing on the north side of the Borough attend the Ealing Chest Clinic for their examinations, X-rays and out-patient treatment, and the patients from the remaining area of the Borough attend the Hounslow Chest Clinic, which is administered by the Staines Group Hospital Management Committee. County Council of Middlesex The County Council of Middlesex is the Local Health Authority under the National Health Service Act 1946 and provides the following services in the Borough:- (a) Care of Mothers and Young Children: Brentford.- Ante-Natal Clinics and Post-Natal Clinics ) Tuesday mornings 9, 30 a. m. to 12 noon. Infant Welfare Clinics Wednesday and Thursday afternoons 2 p.m. to 4 p.m. Diphtheria and Whooping Cough Immunisation and Alternate Friday afternoons Vaccination Clinics 2 p.m. to 4.30 p.m. Day Nursery Portsdown House, The Butts, Brentford. 54 Chiswick:- Ante-Natal Clinics and Tuesday and Thursday mornings Post-Natal Clinics 9.30 a.m. to 12 noon Infant Welfare Clinics Tuesday, Wednesday, Thursday and Friday afternoons 2 p.m. to 4 p.m. Diphtheria and Whooping Cough Immunisation and Monday afternoons 2 p.m. to 4.30 p.m. Vaccination Clinics Priority Dental Service for expectant and nursing mothers and children under school age. (b) Health Visitors: Health Visitors are employed to undertake home visiting for the purpose of giving advice on the care of young children, to persons suffering from illness, to expectant and nursing mothers and on the measures necessary to prevent the spread of infection, (The Health Visitors also act as School Nurses). (c) Home Nursing and Nursing Equipment: Home Nurses are employed to undertake the nursing of persons in their own homes. (This work was formerly undertaken by "District Nurses"), Where nursing equipment is required for use in the home, it is available on loan through the British Red Cross Society, Number and classification of patients visited by the Home Nurses in the Borough during the year are as follows:- Type of case Under 5 years 5 - 64 years 65 years and over Total Grand Total M F M F M F M F Medical 5 10 142 254 188 353 335 617 952 Surgical 5 1 9 25 18 13 32 39 71 Infectious Disease - - - 3 - - - 3 3 Tuberculosis - - 21 26 1 - 22 26 48 Maternal Complications - - - 7 - - - 7 7 Others - 1 - - 1 1 1 2 3 TOTALS 10 12 172 315 208 367 390 694 1,084 55 (d) Vaccination and Immunisation: In addition to the immunisation of infants and young children carried out at the clinics referred to in (a) above, vaccination against smallpox and immunisation against diphtheria are carried out by general practitioners who participate in the County Council's scheme, and in June, vaccination against poliomyelitis was begun in the clinics. (e) Mental Health Service: The County Mental Health Service deals with persons suffering from mental deficiency or mental illness. There is a Divisional Office at the County Offices, Great West Road, Brentford (EALing 1801). where five mental welfare officers and a psychiatric social worker carry out the County's community duties under the Lunacy, Mental Treatment and Mental Deficiency Acts. A twenty-four hour emergency service is also provided. At the Methodist Church Hall, Clifden Road, Brentford, the County provides an occupation centre with 75 places where mentally defective children attend daily from 9.30 a.m. to 3.30 p.m. Mental Health Sessions are held at the Brentford Clinic on the second and fourth Tuesday of each month from 2 p.m. to 4 p.m. (f) School Health Services: The County Council is also the authority responsible for providing the school health service under the provisions of the Education Act. Medical inspection and dental inspection of school children is arranged by the County Council through the Divisional Executive. Medical and dental treatment is provided by the County Council in the Borough at the following clinics:- Minor Ailment Clinic (Chiswick) Monday to Saturday 9 a.m. to 10 a.m. Monday 9.30 a.m. to 12 noon with doctor. Minor Ailment Clinic (Brentford) Monday to Saturday 9 a.m. to 10 a.m. Thursday 9.30 a.m. to 12noonwith doctor. Orthopaedic Treatment Clinic (Brentford) With Surgeon - every first and third Monday in each month from 2 p.m. to 4 p.m. Ophthalmic Clinic (Brentford) Tuesday and Friday 9.30 a.m. to 12 noon. Physiotherapy Treatment Clinic (Brentford) Monday and Thursday 9 a.m. to 4.30 p.m. Speech Clinic (Brentford) Tuesday 1.30 p.m. to 4 30 p.m. Wednesday 9 a.m. to 12 noon, 1.30 p.m. to 4. 30 p.m. Speech Clinic (Chiswick) Tuesday 9 a.m. to 12 noon, 1.30 p.m. to 4.30 p.m. Wednesday, Thursday, Friday 1.30 p.m. to 4.30 p.m. 56 Dental Clinic (Brentford) Daily and alternate Saturdays by appointment. Children with toothache may obtain a form from the Head Teacher and attend on any day the Clinic is open at 11,30 a.m. Dental Clinic (Chiswick) Daily except Saturday by appointment. Children with toothache may obtain a form from the Head Teacher and attend on any day the Clinic is open at 11. 30 a. m. Orthodontic Clinic (Chiswick) Tuesday and Friday 9.30 a.m. to 4.30 p.m. Alternate Saturdays 9. 30 a.m. to 12 noon. Ultra-Violet Light Treatment Clinic (Brentford) Tuesday and Friday 2 p.m. to 4 p.m. (Winter months only) (g) Care of children: In addition to the foregoing services the County Council through the Children's Department is also concerned in caring for children deprived of a normal home life. Area Children's Officers have been appointed to deal locally with such cases as they arise. (h) Prevention of Illness, Care and After-Care: The County Council's scheme includes provision for the admission of suitable cases to recuperative rest homes, (Such cases should not be in need of medical or nursing care). The care and after care of tuberculous persons is dealt with through the Welfare Officers of the Chest Clinics, The Chest Clinics serving the Borough are situated at No. 28 Bell Road. Hounslow. Middlesex, and Green Man Passage, West Ealing, W. 13. (i) Domestic Helps: Home Help for householders where this is required owing to the presence of a person who is ill, lying in, an expectant mother, mental defective, aged or a child not over compulsory school age is provided under the County Council's scheme. (j) Ambulance Service: The County Ambulance Service is provided for the removal to hospital, where necessary, of accident and sickness cases. This service is combined with the County Fire Service. (k) Chiropody Service: Old Age Pensioners are referred to private chiropodists. An assessment scheme is in operation. Number of persons treated during the year 134 Total attendances at Chiropodists 793 Queen Charlotte's & Chelsea Hospitals Board Midwives are employed for attendance on women in their homes in the Borough as midwives or as maternity nurses during childbirth. 57 STATISTICAL TABLES TABLE I PARTICULARS OF DEATHS AS SUPPLIED BY THE REGISTRAR - GENERAL FOR THE YEAR 1956 Cause of Death Males Females 1. Tuberculosis, respirator 4 - 2. Tuberculosis, other 1 l 3. Syphilitic Disease 1 l 4. Diphtheria - - 5. Whooping Cough - - 6. Meningococcal Infections - - 7. Acute Poliomyelitis - - 8. Measles - - 9. Other infective and Parasitic Diseases 1 l 10. Malignant Neoplasm, stomach 8 11 11. Malignant Neoplasm, lung, bronchus 26 6 12. Malignant Neoplasm, breast - 12 13. Malignant Neoplasm, uterus - 6 14. Other Malignant and lymphatic neoplasms 44 37 15. Leukaemia, aleukæmia 2 1 16. Diabetes 3 -• 17. Vascular lesions of the nervous system 32 46 18. Coronary disease, angina 54 38 19. Hypertension with heart disease 10 15 20. Other heart disease 30 61 21. Other circulatory disease 11 18 22. Influenza 1 - 23. Pneumonia 9 18 24. Bronchitis 25 12 25. Other diseases of respiratory system 2 1 26. Ulcer of stomach and duodenum 2 3 27. Gastritis, enteritis and diarrhoea - 1 28. Nephritis and Nephrosis 4 3 29. Hyperplasia of prostate 4 - 30. Pregnancy, childbirth, abortion - - 31. Congenital malformations 1 3 32. Other defined and ill-defined diseases 17 20 33. Motor vehicle accidents 5 2 34. All other accidents 7 8 35. Suicide 2 2 36. Homicide and operations of war - - ALL CAUSES 306 327 58 TABLE II INFANTILE MORTALITY DURING THE YEAR 1956 Net deaths from stated causes at various ages under one year Under 1 day 1 day 2 days 3 days 4 days 5 days 6 days 7-14 days l4 - 21 days 21 - 28 days 1-2 months 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 - 12 months Total under 1 yr. Chicken Pox - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - Diphtheria or Croup - - - - - - - - - - - - - - - - - - - - - - Erysipelas - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - Meningitis (non-T.B.) - - - - - - - - - - - - - - - - - - - - - - Convulsions - - - - - - - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - - - 1 - - - - - - - 1 Pneumonia (all forms) - - - - - - - 1 - - - - - - - - - - - - - 1 Diarrhoea - - - - - - - - - - - - - - - - - - - - - - Enteritis - - - - - - - - - - - - - - - - - - - - - - Gastritis - - - - - - - - - - - - - - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - Suffocation - - - - - - - - - - - - - - - - - - - - - - Injury at Birth 1 - - - - - - - - - - - - - - - - - - - - 1 Atelectasis 2 - - - - - - - - - - - - - - - - - - - - 2 Congenital Malformation 2 - - - - - - - 1 - - - - 1 - - - - - - - 4 Premature Birt 2 - 1 - - - - - - - 1 - - - - - - - - - - 4 Atrophy, Debility and Marasmus - - - - - - - - - - - - - - - - - - - - - - Pemphigus Neonatorum - - - - - - - - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - - - - - - - - - Other Causes 1 - - - - - - - 1 - - - - - - - - - - - - 2 TOTALS 8 - 1 - - - - 1 2 - 1 - - 2 - - - - - - - 15 59 TABLE III NOTIFIABLE DISEASES DURING THE YEARS 1955 AND 1956 Disease Total cases notified Cases admitted to hospital Total Deaths 1956 1955 1956 1955 1956 1955 Scarlet Fever 49(3) 52(4) 28 24 - - Whooping Cough 50 51(1) 2 4 - - Measles 107 659 2 16 - - Pneumonia (notifiable) 17 17 3 7 27‡ 24‡ Dysentery 10 12(2) 3 3 - - Puerperal Pyrexia 97 6 95 2 - - Erysipel as 11 8 3 2 - - Food Poisoning 11 8(1) 2 4 - - Ophthalmia Neonatorum 4 1 2 - - - Acute Poliomyelitis Paralytic 3(1) 6(1) 3 6 - - Non-Paralytic - 5(2) - 5 - - Diphtheria - 1(1) - 1 - - Acute Encephalitis (Infective) - 1 - - - - TOTALS 359 827 143 74 27 24 ‡Includes deaths from non-notifiable pneumonia. Figures in brackets denote number of cases subsequently not confirmed. TABLE IV OPHTHALMIA NEONATORUM Cases Notified Cases treated at home Cases treated in hospital Vision unimpaired Vision impaired Total blindness Deaths 4 2 2 4 - - - 60 TABLE V AGES OF CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1956 Disease Number of Cases Notified At ages - years At all ages Under 1 1 2 3 4 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 Over 65 Scarlet Fever 49(3) - - 1 6 9 22 8 1 2 - - - Whooping Cough 50 3 3 4 6 9 22 2 - - 1 - - Measles 107 5 13 4 9 21 41 4 1 8 1 - - Pneumonia. 17 - - - - - - - - - 1 13 3 Ac. Poliomyelitis Paralytic 3(1) - - - 1 - 1 1 - - - - - Non-Paralytic - - - - - - - - - - - - - dysentery 10 1 - 3 - - 2 - - 4 - - - Puerperal Pyrexia 97 - - - - - - - 10 73 14 - - Erysipelas 11 - - - - - - - - 2 1 6 2 Food Poisoning. 11 1 - - - 1 - - - 6 1 2 - Ophthalmia Neonatorum 4 4 - - - - - - - - - - - Figures in brackets denote number of cases subsequently not confirmed. TABLE. VI CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1956 CLASSIFIED IN WARDS Number of Cases Notified Brentford West Brentford Central Brentford East Bedford Park Chiswick Park Grove Park Gunnersbury Old Chiswick Turnham Green Total Cases Scarlet Fever 5 2 6 3 6 5 7 9 6 49(3) Whooping Cough 2 2 5 3 12 5 4 13 4 50 Measles 41 17 7 3 7 8 5 7 12 107 Pneumonia 10 3 2 2 - - - - - 17 Acute Poliomyelitis:Paralytic 1 - - 1 - 1 - - - 3(1) Non-Paralytic - - - - - - - - - - Dysentery - - 1 - - 2 5 - 2 10 Puerperal Pyrexia - - - - 1 - 1 95 - 97 Erysipelas 3 1 - - 3 1 2 - 1 11 Food Poisoning - 1 - 1 - 3 2 4 - 11 Ophthalmia Neonatorum - - - 1 1 - 1 - 1 4 Tuberculosis: - Respiratory 19 6 3 7 7 7 15 12 10 86 Non-Respiratory 2 - - 1 - 1 3 2 - 9 Figures in brackets denote number of cases subsequently not confirmed. TABLE VII LABORATORY WORK Nature of Specimen Result Positive Negative Total Diphtheria - swabs - 18 18 Scarlet Fever - swabs 3 6 9 Dysentery - faeces 10 60 70 Puerperal Pyrexia - swabs 3 232 235 Food Poisoning - faeces - 9 9 Ophthalmia Neonatorum - swabs - 1 1 Pood poisoning - sample of pie - 1 1 Totals 16 327 343 TABLE VIII TUBERCULOSIS - 1956 Age Groups New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory Male Female Male Female Male Female M ale Female Under 1 year l - - - - - - - 1-5 years l 4 - - - - - - 5-15 years l 1 1 - - - - - 15-25 " 3 15 2 2 - - - - 25-35 " 8 10 1 1 - - 1 - 35-45 " 11 3 - - - - - l 45-55 " 10 4 - - l - - - 55-65 " 6 1 - 1 l - - - 65 years and over 5 2 - 1 2 - - - Totals 46 40 4 5 4 - 1 l Of the 6 recorded deaths, 4 were previously notified as cases of Tuberculosis, 2 had not been so notified. In addition, 3 patients already notified as tuberculosis died from other causes. 63 TABLE IX TUBERCULOSIS CASES IN YEARS Year New Cases Deaths Respiratory NonRespiratory Total Respiratory NonRespiratory Total M F M F M F M F 1936 40 33 4 5 82 26 24 l 2 53 1937 38 46 9 9 102 22 13 l 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 1950 59 39 4 6 108 19 13 1 1 34 1951 49 44 4 6 103 11 13 - 1 25 1952 58 43 1 5 107 9 4 - 2 15 1953 75 41 3 7 126 8 1 - - 9 1954 53 37 - 4 94 3 1 - - 4 1955 49 36 4 5 94 5 2 - - 7 1956 46 40 4 5 95 4 - 1 1 6 64 TABLE X TUBERCULOSIS. REGISTER - AS AT 31.12.56. Pulmonary Non-Pulmonary Total M F M F M F (a) Number of Cases on Register at commencement of year 418 313 24 45 442 358 (b) Number of Cases notified for the first time during year under Regulations 26 24 2 4 28 28 (c) Cases restored to Register during year 1 - - - 1 - (d) Cases added to Register otherwise than by notification under Regulations:(i) Transferred from other districts 18 16 2 - 20 16 (ii) Non-notified deaths 2 - - 1 2 1 (e) Number of Cases removed from Register during year 37 31 3 3 40 34 (f) Number of Cases remaining on Register at end of year 428 322 25 47 453 369 Cases removed from the Register shown under (e) are accounted for as follows:- Found not to be T.B. Re-covered Lost sight of Removed to another area Died at home Died at Sanatorium or other Institution Total M F M F M F M F M F M F M F PULMONARY - - 1 2 - 2 28 27 1 - 7 - 37 31 NON - PULMONARY - - - - l - 1 2 - - 1 1 3 3 The total number of cases on the Tuberculosis Register at the end of 1956 was 822, viz., pulmonary 750, non-pulmonary 72. 65 TABLE XI OCCUPATIONS OF CASES OF TUBERCULOSIS NOTIFIED DURING THE YEARS 1954 - 1956 Occupations 1956 1955 1954 M F M F M F Outdoor (Transport 2 1 2 - 2 - Occupations (Other 5 - 3 - 7 - Indoor (Heavy Manual 6 - 2 - 3 - Occupations (Light Manual 9 3 16 1 13 2 (Clerical or ( Sedentary 7 2 13 13 11 10 (Other 9 4 7 1 3 - Housewife and Domestic - 29 - 20 - 15 School child 2 1 2 3 1 2 Slop Assistant - - 3 - - 3 Under School Age 2 4 - - 2 2 Occupation Unknown 8 1 5 3 11 7 Totals 50 45 53 41 53 41 TABLE XII ATMOSPHERIC POLLUTION RESULTS DURING 1956 Month Highest Daily Heading Monthly Average Sulphur Dioxide Smoke Sulphur Dioxide Smoke Bt fd. Chis. Bt fd. Chis. Bt fd Chis.. Bt fd. Chis. Jan. 0.41 0.13 0.65 0.74 0.08 0.03 0.21 0.23 Feb. 0.22 0.27 0.43 0.52 0.09 0.10 0.16 0.20 Mar. 0.24 0.25 0.28 0.41 0.10 0.10 0.13 0.17 Apr. 0.21 0.17 0. 25 0.26 0.08 0.09 0.12 0.14 May. 0.09 0. 07 0.09 0.19 0.04 0.04 0.05 0.06 Jun. 0.07 0.08 0.06 0.08 0.02 0.04 0.03 0.05 Jul. 0. 09 0.07 0.08 0.10 0.03 0.04 0.03 0.03 Aug. 0.06 0.06 0.12 0.14 0.02 0.03 0.04 0.05 Sep. 0.13 0.18 0.15 0.20 0.04 0.05 0.05 0.06 Oct. 0.14 0.18 0.34 0.36 0.05 0.07 0.12 0.13 Nov. 0.20 0.22 0.45 0.35 0.08 0.09 0.18 0.18 Dec. 0.28 0.34 0.46 0.45 0.06 0.09 0.15 0.18 66 TABLE XIII FACTORIES ACT, 1937 Inspections: Premises Number on Register Number of Inspections made Written Notices Occupiers Prosecuted (i) Factories in which Sees. 1, 2, 3,4 & 6 are to be enforced by Local Authorities 116 5 - - (ii) Factories not included in (i) in which Section 7 is enforced by L. A. 282 17 1 - (iii) Other premises in which Section 7 is enforced by L. A. (excluding outworkers premises). 22 - - - Totals 420 22 1 - TABLE XIV FACTORIES ACT, 1937 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 HMI by HMI Sanitary Conveniences (Sec. 7):Unsuitable or defective. 1 1 - - - Totals 1 1 - - - 67 TABLE XV FACTORIES ACT, 1937 Outwork (Sections 110 and 111): Nature of Work Section 110 Section 111 No. of out workers in Aug. list required by Section 110 (l)(c) No . of cases of default in sending lists to Council No. of prosecutions for failure to supply list No. of instances of work in unwholesome premises Notices aerved Prosecutions Wearing Apparel: Making etc. 64 - - - - - Artificial Flowers 3 - - - - - Stuffed Toys 9 - - - - - Totals 76 - - - - - 68 INDEX Accidents, Road 14, 15 Allotments 10 Ambulance Service 57 Area of Borough 9 Atmospheric Pollution 40,41, 42,66 Bakehouses 32 Baths and Washhouses 11,36 Births and Birth Rate 12, 15 Blind Persons 38 Brentford Market 33 British Red Cross Society 37 Canal Boats 53 Cancer 13, 14 Care of mothers and children 54,57 Catering Establishments 29 Causes of Death 13.58 Chest Clinics 54 Chiropody 35, 57 Circulatory Diseases 13 Clearance Areas 46,47 Clinics 54, 55,56 Condemned Food 32 Deaths and Death Rate 12, 13, 14, 58 Diarrhoea 13 Diphtheria 21 Diphtheria Immunisation 21,34,56 Disinfection 51 Domestic Helps 57 Dysentery 22 Factories Act. 1937 67,68 Food and Drugs Act, 1955 30 Food Hygiene Regulations 1955 27 Food Control 27 Food Hawkers 53 Food Poisoning 22 Food Premises 27, 29 Food Sampling 30 Free Washing Facilities 52,53 Handicapped Persons 39 Health Education 34 Health Services provided by other Authorities 54,55,56,57 Health Visitors 55 Heart Disease 13 Home Helps 57 Home Nursing 55 Home Safety 37 Hospitals 54 Housing 46 Housing Repairs and Rents Act. 1954 43,46 Housing Statistics 47,48,49, 50 Ice Cream 27, 28, 29 Infant Mortality 12, 13, 15, 16,59 Infectious Disease 17, 60 Infectious Disease, Ages of Cases 61 Infectious Disease, Classified in Wards 62 Infectious Disease Prevalence and Control of 17 Inspections 43 Isolation Hospital, Admissions 60 Labelling of Food Order, 1953 31 Laboratory Work 63 Massage and Special Treatment Establishments 52 Maternal Morbidity and Mortality 14,15 Meals on Wheels 36 Measles 13,17 Meat and Other Foods 32 Mental Health 56 Merchandise Marks Act, 1926 31 Midwifery Service 57 Milk Regulations 31,32 Notifiable Diseases 60 Old People 35,36 Ophthalmia Neonatorum 60 Outworkers 68 Overcrowding 9,48,49,50 Parks and Open Spaces 9,10 Pet Animals Act, 1951 52 Poliomyelitis 18, 19 Poliomyelitis Vaccination 19 Population 9 Premature Infants 15 Preserved Foods 29 Prevention of Illness, Care and After-care 57 Public Health Committee 3 69 Puerperal Pyrexia 15, 20 Rag Flock, etc. Act, 1951 52 Rateable Value 9 Redevelopment Areas 46 Refuse Collection 45 River Pollution 53 Rodent Control 52 Sanitary Circumstances of the Area 43,44 Sanitary Services 45 Scarlet Fever 21 School Health 56 School Sanitation 45 Slaughterhouses 32 Smallpox 20 Smallpox Vaccinations 20,56 Smoke Pollution 40 41,42,66 St. John's Ambulance Brigade 37 Staff 5 Statistics and Social Conditions 9 Statistical Tables 58-63 Stillbirths 12,15 Street Trading 53 Swimming Baths 10 Tuberculosis 13,14, 22, 26, 63 Tuberculosis, B. C. G. Inoculations 22,23 Tuberculosis, Cases in years 64 Tuberculosis, in the Adolescent 24 Tuberculosis, Housing Conditions of Newly Notified Cases 24,25 Tuberculosis, Occupations of Newly Notified Cases 66 Tuberculosis Register 65 Unsound Food 29 Unemployment 10 Vermin and Scabies, Control of 17 Vital Statistics 12 Wards 9 Water Supply and Water Services 45 Welfare Old People 35,36 Blind and Partially Sighted 38 General 37 Handicapped Persons 39 Laundry for Incontinent Aged 36 Wells 45 Whooping Cough 13,22 70