Hay 13 Thirty-third Annual Report on the Health of the Urban District of Hayes and Harlington Middlesex J. STANLEY LLOYD, M.D., F.R.C.S.Edin. Medical Officer of Health 1937 THE URBAN DISTRICT COUNCIL OF HAYES AND HARLINGTON PUBLIC HEALTH AND HOUSING COMMITTEE, 1937. Chairman : Councillor P. G. Soulsby. Cllr. Mrs. A. B. Greenhead. Cllr. C. W. F. Newton. Cllr. E. K. Harding. Cllr. A. A. Perry. Cllr. E. G. Hartley. Cllr. G. H. Stinton. Cllr. J. Heyward. Cllr. C. Viveash. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health (part time) : J. Stanley Lloyd, M.D., F.R.C.S.Edin. Medical Officer in Charge of Diphtheria Immunisation Clinic : Guy Bousfield, M.D., B.S.Lond. Chief Sanitary Inspector, Inspector under the Shops Acts and Petroleum Inspector : Richard Bill, Cert.R.San.Inst, and Certified Meat Inspector. Deputy Chief Sanitary Inspector : Laurence Burke. Additional Sanitary Inspector : A. T. Matson. Temporary Sanitary Inspector : R. S. Newsome. Temporary Meat Inspector : E. G. Drayson. (commenced 19th July, 1937.) Clerks : S. Greenhead. C. F. Allard. (commenced 31st May, 1937.) Medical Officer's Annual Report Public Health Department, Town Hall, Hayes, Middx. May, 1938. To the Chairman and Members of the Urban District Council of Hayes and Harlington. Mr. Chairman, Ladies and Gentlemen, I have the honour to submit the thirty-third Annual Report on the health of the Urban District of Hayes and Harlington. The health of this district may be considered to be very satisfactory, in that there has been no considerable outbreak of infectious disease during the year and the death rate at 10.8 per 1,000 is 1.6 less than that of England and Wales as a whole. The live birth rate is 21.42 as against 14.9 for England and Wales. May I thank the members and officials of the Council for their help during the past year ? I have the honour to be, Your obedient servant, J. STANLEY LLOYD, Medical Officer of Health. SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (acres) .. .. .. .. .. .. 5,161 Population (Census, 1931) .. .. .. .. 23,646 Population (Mid-year, 1937) Registrar-General's Estimate : Working Population Figure .. .. 39,770 Present estimated population at 3.75 persons per house .. .. .. .. .. .. 44,419 Number of inhabited houses end of 1937 .. .. 11,845 Rateable value .. .. .. .. .. £273,872 Sum represented by a penny rate .. .. Gross £1,079 Net (Est.) £986 SOCIAL CONDITIONS. The Urban District of Hayes and Harlington is about eight square miles in extent and lies in the western part of Middlesex. It is made up of the parishes of Hayes and Harlington and that portion of Cranford which lies to the west of the River Crane. Its height above sea-level is 182 feet in the north-western part of the district and 70 feet in the south-eastern part. There does not appear to be any halt in the building development of the district; in fact, this is proceeding with even greater rapidity than formerly, 1,997 houses having been added during 1937. A few farms remain in the area, but these are steadily being encroached upon for building ; those that remain are chiefly used for keeping dairy cattle. Market gardening takes up the bulk of the remaining land. About 345 acres (6.7 per cent.) are scheduled as open spaces. The population is chiefly industrial, the bulk of the inhabitants finding employment either in the local or in the neighbouring factories. Unemployment has increased by 22 per cent, during the year, the average number per month being 843 as compared with 691 in 1936. As most of the houses in this Urban District have been built since the war, they are nearly all in good condition. 1,485 houses are owned by the Council, some of them being in process of building in 1937. These were chiefly bungalows built to house old people without families, and are let at a rental of five shillings per week inclusive of rates. 4 Extracts from Vital Statistics of the Year. Total M. F. Live Births— | Birth Rate per 1,000 of the estimated resident ( population .. 21.42 Legitimate .. 826 435 391 Illegitimate .. 26 17 9 Stillbirths 31 14 17 i Rate per 1,000 total (live 1 and still)births 35.1 Deaths 316 163 153 1 Death Rate per 1,000 of the estimated resident ( population .. 7.94 The Comparability Factor for adjusting the local death rate to that for the whole country after taking into consideration age and sex is the same as last year, namely 1.36. The adjusted death rate is, therefore, 10.8. Deaths from puerperal causes :— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis .. .. Nil 0.0 Other puerperal causes 1 1.13 Total 1 1.13 Death rate of Infants under one year of age— All infants per 1,000 live births 66.9 Legitimate infants per 1,000 legitimate live births 66.5 Illegitimate infants per 1,000 illegitimate live births . . 76.9 M. F. Total Deaths from Cancer (all ages) 15 18 33 Deaths from Measles (all ages) — — — Deaths from Whooping Cough (all ages) .. 2 — 2 Deaths from Diarrluea (under 2 years of age) 6 7 13 5 CAUSES OF DEATH DURING 1937. Causes of Death Males Females All Causes 163 153 1. Typhoid and Paratyphoid Fevers — — 2. Measles — - 3. Scarlet Fever 2 - 4. Whooping Cough 2 - 5. Diphtheria — 1 6. Influenza 5 7 7. Encephalitis Lethargica — — 8. Cerebro-spinal Fever — 1 9. Tuberculosis of respiratory system 11 9 10. Other tuberculous diseases 2 3 11. Syphilis 1 1 12. General paralysis of the insane, tabes dorsalis — — 13. Cancer, malignant disease 15 18 14. Diabetes 2 1 15. Cerebral haemorrhage, etc. 4 4 16. Heart disease 32 27 17. Aneurysm 2 - 18. Other circulatory diseases 8 12 19. Bronchitis 3 3 20. Pneumonia (all forms) 11 7 21. Other respiratory diseases 1 — 22. Peptic ulcer 5 3 23. Diarrhoea, etc. (under 2 years) 6 7 24. Appendicitis 1 — 25. Cirrhosis of liver — 1 26. Other diseases of liver, etc. 1 27. Other digestive diseases 3 3 28. Acute and chronic nephritis 7 7 29. Puerperal sepsis — — 30. Other puerperal causes - 1 31. Congenital debility, premature birth, malformations, etc. 32. Senility 16 1 10 3 33. Suicide 1 2 34. Other violence 9 2 35. Other defined diseases 13 19 36. Causes ill-defined or unknown — — Deaths of Infants under 1 year ( Total 31 26 Legitimate 29 26 Illegitimate 2 - Live Births Total 452 400 Legitimate 435 391 Illegitimate 17 9 Stillbirths Total 14 17 Legitimate 14 16 Illegitimate — 1 Population (Mid-Year) 39,770 (Figures furnished by the Registrar-General.) 6 BIRTH-RATES, DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL DEATH-RATES, AND CASERATES FOR CERTAIN INFECTIOUS DISEASES IN THE YEAR 1937. England and Wales, London, 125 Great Towns and 148 Smaller Towns. (Provisional Figures based on Weekly and Quarterly Returns) England and Wales 125 County Boroughs and Great T owns including London 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census) London Administrative County Hayes and Harlington Rates per 1,000 Population BIRTHS :— Live 14.9 14.9 15.3 13.3 21.42 Still 0.60 0.67 0.64 0.54 0.78 DEATHS :— All Causes 12.4 12.5 11.9 12.3 10.8 Typhoid and typhoid fevers Smallpox 0.00 0.01 0.00 0.00 0.00 Measles 0.02 0.03 0.02 0.01 0.00 Scarlet fever 0.01 0.01 0.01 0.01 0.05 Whooping Cough 0.04 0.04 0.03 0.06 0.05 Diphtheria 0.07 0.08 0.05 0.05 0.02 Influenza 0.45 0.39 0.42 0.38 0.30 Violence 0.54 0.45 0.42 0.51 0.35 NOTIFICATIONS:— Smallpox 0.00 0.00 0.00 Scarlet fever 2.33 2.56 2.42 2.09 4.77 Diphtheria 1.49 1.81 1.38 1.93 0.30 Enteric fever 0.05 0.06 0.04 0.05 0.00 Erysipelas 0.37 0.43 0.34 0.44 0.18 Pneumonia 1.36 1.58 1.20 1.18 0.70 Rates per 1,000 Live Births Deaths under 1 year of age 58 62 55 60 66 Deaths from Diarrhoea and Enteritis under 2 years of age 5.8 7.9 3.2 12.0 15.0 MATERNAL MORTALITY:— Puerperal Sepsis 0.97 1 r Not available 0.00 Others 2.26 1.17 Total 3.23 1.17 Rates per 1,000 Total Births (i.e. Live and Still) MATERNAL MORTALITY:— Puerperal Sepsis 0.94 | Not available 0.00 Others 2.17 1.13 Total 3.11 1.13 NOTIFICATIONS:— Puerperal fever } 13.93 17.59 11.52 { 4.15 2.26 Puerperal pyrexia 14.34 5.66 7 STREET ACCIDENTS. The Commissioner of Police for the Metropolis has kindly supplied the following statement respecting traffic accidents in this area during the year. Seven of the accidents were fatal and 308 resulted in personal injuries, last year's figures being 8 fatal accidents and 285 personal injuries. Of the fatal accidents four of the victims were Dedal cvclists and three were pedestrians. In addition, one pedal cyclist died in 1937 as a result of an accident occurring in the previous year. 1937 Personal Injuries Total Serious Slight JANUARY 3 19 22 FEBRUARY 5 11 16 MARCH - 13 13 APRIL 4 26 30 MAY 3 24 27 JUNE 9 18 27 JULY 2 32 34 AUGUST 2 18 20 SEPTEMBER 5 18 23 OCTOBER 9 30 39 NOVEMBER 6 17 23 DECEMBER 6 28 34 TOTAL .. 54 254 308 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. These are the same as in former years. PUBLIC HEALTH OFFICERS OF THE LOCAL AUTHORITY. The Public Health Department is staffed by one part-time Medical Officer, the Chief Sanitary Inspector, three other Sanitary Inspectors, one Meat Inspector and two Clerks. The Chief Sanitary Inspector is also Inspector under the Petroleum Acts and the Shops Acts. The Chief Sanitary Inspector and one other Inspector hold the special Meat and Food Inspector's Certificate of the Royal Sanitary Institute. Contributions to the salaries of these Officers are received from the Exchequer. 8 Dr. Bousfield, Medical Officer in charge of the Diphtheria Immunisation Clinic, attends every week and is paid on a sessional basis. Laboratory facilities are provided at the Clinical Research Association for the examination of sputum, swabs, etc., for the detection of infectious disease. An ambulance is kept at the fire station for all non-infectious cases and is provided free of cost. Infectious cases are removed, also free of cost, by the ambulance kept at the Joint Hospital in Uxbridge. In case of emergency where the ambulance may be out when required, reciprocal arrangements have been made with all surrounding local authorities. There is thus adequate provision in this respect. The district nurse for the parish of Hayes resides at the Cottage Hospital. Applications for her services are made to the Matron of the Cottage Hospital, but no cases are undertaken by this nurse unless a doctor is in attendance. A Queen's nurse lives in Harlington to look after the sick of that parish. Welfare clinics under the Middlesex County Council are held at the Methodist Church Hall in Uxbridge Road, Townfield Council School in Orchard Road, the Queen's Hall at Botwell, and the Village Hall, Cherry Lane. The Diphtheria Immunisation Clinic is referred to later. Hospitals.—Hayes Cottage Hospital, 15 beds, and Harlington Cottage Hospital, 14 beds, are subsidised by the Council to the extent of a penny rate. Hillingdon County Hospital is extensively used for cases arising in this district, and patients are occasionally sent to the West Middlesex County Hospital at Isleworth. The teaching hospitals in London are utilised to a large extent for more serious cases. SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water.—Samples of water have been taken from each of the three different supplies to this area, the Rickmansworth and Uxbridge Valley Water Co., the South West Suburban Water Co. and the Allied Building Corporation water supply. These were examined by the Clinical Research Association Ltd. and the reports showed that the supplies were bacteriologically fit for drinking. 9 o SUMMARY OF REPORTS OF WATER SAMPLES SUBMFrTED FOR BACTERIOLOGICAL EXAMINATION, 1937. Report No. and Date Organisms produced on gelatine plates incubated at 20° C. for 3 days Organisms produced on agar plates incubated at 37.5° C. for 2 days B. Colt. Streptococci Cl. Welchii. (spores) Remarks Drinking Water 24502 22/6/37 46 per c.c. 9 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. There are some coliform bacilli found in quantities from 25 c.c. to 100 c.c. but none of them is of an excremental type. From a bacteriological point of view the water is satisfactory for drinking purposes. 24503 22/6/37 38 per c.c. 6 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. Coliform bacilli are present in the higher quantities tested viz.:—50c.c.—100 c.c. but none of them is of a characteristic excremental type. The water may be considered fit for drinking purposes. 24504 22/6/37 76 per c.c. 16 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The sample contains no organisms of an excremental type and the water may be regarded as satisfactory for drinking purposes. Bathing Water 35362 30/8/37 960 per c.c. 32 per c.c. Present in 100 c.c. Not found in less Present in 10 c.c. — The sample contains small numbers of excremental organisms, but not in excess of the number permissible in the standard for bathing waters. The water may therefore be considered suitable for bathing purposes. The supply of water has always been sufficient, and suitable extensions have been made to serve the 2,000 new houses which have been erected during the year. Drainage and Sewerage.—During 1937, the existing sewer in Dawley Road has been extended from Bourne's Farm, south of the Great Western Railway, to the junction of Dawley Road with Blyth Road, in order to receive the sewage and trade effluent from the new Rudge-Whitworth factory. A branch sewer has been constructed under Balmoral Drive from the main northern trunk sewer, across Messrs. Nash's estate and along Charville Lane to Polehill, and the majority of the houses with cesspools in Charville Lane have been connected to this sewer. A main sewer is now being constructed along Town Planning Road 8 (Staines) from the end of the existing sewer in Oxford Avenue towards Richins' Corner, for the purpose of draining the Cranford Park Estate. The whole of the Hayes sewage is received into the West Middlesex sewers and treated at the County works, Mogden. Rivers and Streams.—No action has been taken in connexion with the pollution of rivers and streams. Closet Accommodation.—The number of pail-closets in the area has been reduced by ten during the year. The number of cesspools discontinued is twelve but actually considerably more than twelve houses have been connected to the main sewer, as cesspools in some cases served more than one house. The estimated number of the various types remaining at the end of 1937 is:— Water-closets 13,024 Closets with moveable receptacles 184 Closets with fixed receptacles 13 Public Cleansing.—An additional refuse-collection vehicle has been added to the fleet during the financial year, making a total of seven. 11 SANITARY INSPECTION OF AREA. 1.-Complaints. During the year 245 complaints were received with respect to the following matters, viz.:— Choked and defective drains 29 Insanitary or dilapidated condition of houses and premises78 Offensive accumulations or deposits19 Cesspools overflowing4 Rats 8 Other nuisances 107 Total 245 2.—Inspectionof District. Number of houses and premises inspected (ordinary)1,633 „ „ houses inspected and particulars recorded (Housing Act, 1936) 108 „ „ houses and premises re-inspected 1,611 „ „ miscellaneous visits 485 „ food inspections 4,507 „ „ visits to slaughter-houses4,152 „ „ „ „ dairies, cowsheds and milk-shops93 „ „ „ „ bakehouses, factories and workshops79 „ „ re water supplies47 „ „ „ re cases of infectious disease434 „ „ „ re offensive trades 82 „ „ re petroleum stores 108 „ „ smoke observations and visits to works19 „ inspections of tents and vans185 „ „ public urinals inspected 157 „ „ verminous premises inspected 32 „ „ premises disinfected198 „ „ inspections under the Shops Acts825 „ „ (Housing Act, 1936 : overcrowding)2,661 Total 17,416 3.—Notices Served. Served. Complied with. standing. Informal notices 385 367 18 Statutory notices— Section 93, Public Health Act, 1936 4 4 — Section 9 Housing Act, 1936 5 5 — 12 4.—Summary of Sanitary Improvements Carried Out. Drainage. Number of drains examined, exposed, etc 26 Drainage systems reconstructed 4 Defective drains unstopped, repaired, etc 25 Manholes built, altered or repaired 8 Fresh air inlets fixed or repaired 5 Glazed sinks provided 6 Cesspools repaired - Water Closets. Defective flushing cisterns renewed or repaired 15 New pans provided 13 W.C. apartment repaired, cleansed, etc. 16 Urinals reconstructed or repaired 2 Privies and pail-closets converted to W.C.'s 10 General Repairs, etc. Roofs repaired and made weatherproof 33 Eaves, gutters, repaired or renewed 33 Damp walls re-pointed or rendered damp-proof 57 Defective brickwork of external walls repaired 25 Defective brickwork and plaster work of internal walls repaired 60 Defective wood floors repaired 17 Defective stairs repaired 17 Handrails provided 24 Lighting and ventilation increased 18 Defective tile, brick or concrete floors repaired 17 Defective doors repaired 23 Defective ceilings repaired 37 Defective windows repaired, made to open or renewed 104 Rooms cleansed 187 Defective stoves, coppers, etc., repaired 40 Sink waste pipes trapped or repaired 13 Insufficient water supply increased 6 Defective yard pavings repaired 27 Offensive accumulations removed 53 New dustbins provided 66 Food stores provided 4 Lighting, etc., of food stores improved 27 5.—Shops. No case has arisen during the year calling for statutory action in respect of lighting, ventilation, temperature, etc., in shops. 13 6.—Smoke Abatement. No statutory notice has been served on account of nuisance from smoke, but nineteen observations have been made, and the owners have, in some cases, been warned to reduce the smoke emitted from their factory chimneys. 7.—Swimming Baths and Pools. The water from one privately owned open-air swimming bath was analysed and found to be satisfactory. 8.—Eradication of Bed-Bugs. No Council house has been found to be infested with bed-bugs. Eight other houses were found to be so infested and were dealt with by the owners satisfactorily. When disinfestation is found to be necessary it is carried out by means of cyanide gas if the premises are badly infested. In other cases use is made of Cimex blocks or an insecticide spray. To ensure that Council houses are not infested by incoming tenants the Housing Manager makes enquiry as to the presence of vermin in the houses previously occupied. If vermin were found to be present, the Public Health Department would be notified and steps would then be taken to deal with the furniture and bedding before entry into the Council house. Disinfestation of Council houses is done by the Council. In the case of other houses this work is done by a contractor. After disinfestation particular attention is paid to the houses concerned by frequent inspections, and the tenants are instructed to be on the look-out for re-infestation. The importance of cleanliness and the use of disinfectants is impressed on the tenants and disinfectants are provided by the Council free of charge. SCHOOLS. With the exception of two, all the public elementary schools in this district have been built since the war. The remaining two schools would hardly be considered satisfactory according to modern standards, and it is hoped that they will soon be replaced by ones of modern construction. When a case of infectious disease occurs in a school in this area, notification is made by the Head Teacher to the Medical Officer of Health, or vice versa, depending upon which person becomes first aware of it. There are three small private schools in the area which are regularly inspected. 14 FACTORIES, WORKSHOPS AND WORKPLACES. Seventy-nine inspections of factories and workshops have been made. There are sixty-two factories and fifty-one workshops on the register, classified as under :— Factories Workshops Aircraft. . 1 Artificial Marble 1 Bakehouses 6 Bakehouse 1 Boot Repairs 11 Boot Repairs 7 Caravans 1 Building Materials Builders' Merchants 1 Cheese 1 2 Cocoa, Chocolates, etc. 1 Chemical Engineers . . 1 Corn Flakes and Potato Crisps 1 Cycle Repairs 13 Corrugated Cardboard, etc. . . 1 Dressmaking 2 Electric Transformers 1 Joinery and Carpentry 3 Engineering 6 Motor Repairs 7 Fire Extinguishers 1 Plumbing 1 Firewood 2 Radio Engineers 3 Furniture 3 Smithies 3 Glazed Tiles, etc. 2 Soft Furnishings 1 Infant Foods 1 Timber 1 Jams, etc. 1 Welding, etc. 1 Joinery 2 Wheelwright 1 Mineral Waters 1 Valet Services 2 Motor Repairs 6 Music Rolls 1 Oil Blending 1 Paint 1 Pavings 1 Pianos 1 Printing 3 Radio, Gramophones, etc. 1 Rubber 1 Slab Partitions 1 Tarmacadam 1 Wire 1 1.—Inspection of Factories, Workshops and Workplaces. Premises Number of I nspections Written Notices Occupiers Prosecuted Factories (including Factory Laundries) 46 12 Nil Workshops (including Workshop Laundries) 10 Workplaces (other than Outworkers' premises) 23 2 Total 79 14 15 2.—Defects Found in Factories, Workshops and Workplaces. Particulars Number of Defects Found Remedied Nuisances under the Public Health Acts:- Want of cleanliness 8 4 Want of ventilation Nil Nil Overcrowding Nil Nil Want of drainage of floors Nil Nil Other nuisances Nil Nil Sanitary accommodation Insufficient 3 1 Unsuitable or defective 4 2 Not separate for sexes Nil Nil Offences under the Factory & Workshop Acts:— Other offences Nil Nil Total 15 7 OFFENSIVE TRADES. Twelve fish friers and four fat extractors are licensed by the Council. Regular inspections have been made and the trades found to be conducted satisfactorily. SECTION D. HOUSING. 1.—Inspection of Dwelling-Houses During the Year— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts)1,741 (b) Number of inspections made for the purpose3,352 (2) (a) Number of dwelling-houses [included under sub-head (1) above] which were inspected and recorded under the Housing Consolidated Regulations, 1925108 (b) Number of inspections made for the purpose175 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation17 (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 54 16 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 Officers37 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 5 (2) Number of dwelling-houses which were rendered fit after services of formal notices— (a) By owners5 (b) 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 1 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 1 (b) 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 19 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 10 (3) Number of dwelling-houses repaired by owner in pursuance of undertaking given 11 (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 17 4.—Housing Act, 1936—Part IV.—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 80 (ii) Number of families dwelling therein 83 (iii) Number of persons dwelling therein 616 (b) Number of new cases of overcrowding reported during the year 47 (c) (i) Number of cases of overcrowding relieved during the year 49 (ii) Number of persons concerned in such cases 322 (d) Number of dwelling-houses which have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil SECTION E. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. The cowsheds and dairies in this district have been inspected on ninety-three occasions, and these inspections show that there has been considerable improvement in the standard of cleanliness maintained. Two dairy farmers have given up business owing to their land having been taken for building purposes, and the number of milch cows has been reduced considerably thereby to approximately one hundred. Inspection of dairy cattle by a veterinary inspector for the detection of tuberculous animals is undertaken by the County Council. Nine samples of milk have been submitted for bacterial count during the year. The reports of the bacteriologist are set out below in tabular form. There is one producer in the district licensed by the County Council under the Milk (Special Designations) Order, 1936, for the production of accredited milk. One milk producer was licensed during the year to produce pasteurised milk. The table below gives particulars of the other twenty licences granted during the year:— Designation Dealer's Licence Supplementary Licence Pasteurised 6 3 Tuberculin Tested 5 4 Tuberculin Tested (Certified) 1 1 No refusal nor revocation of licences to retailers has been made. 18 SUMMARY OF REPORTS UPON THE BACTERIOLOGICAL EXAMINATION OF SAMPLES OF MILK. Report No. Temperature on arrival Bacteria per c.c. or ml. Bacteria per 1/100 c.c. Bacteria per 1/1000 c.c. Bacteria per 1/10000 c.c. B. Coli. Designation 2 Days 3 Days 1/100 1/1000 1/10000 1/100 1/1000 1/10000 16825 — 4,500 — - — — — — — — — Pasteurised 16826 - 395,000 overcrowded 380 41 P P N P p N Ordinary 16827 - 26,660 230 27 3 N N N N N N Ordinary 24501 17°C. 27,660 250 28 3 N N N N N N Ordinary 34231 16°C. 8,230 — — — — — — — - — Pasteurised 34232 16°C. 7,530 56 7 1 N N N N N N Ordinary 34233 16°C. 23,660 190 22 3 N N N N N N Ordinary 34234 16°C. 17,100 143 17 2 N N N N N N Pasteurised 35363 — 16,060 - - - — — - - — — Pasteurised There are now thirty-three persons registered in accordance with the Milk and Dairies (Amendment) Act, 1922, as under:— Wholesale Traders or Producers of Milk9 Retail Purveyors of Milk with premises in the district11 Retail Purveyors of Milk whose premises are outside the district13 Total 33 (b) Meat. During the year the proprietor of the Cherry Farm slaughterhouse notified the Council that he proposed to work in three shifts throughout the twenty-four hours. As it was impossible to make adequate inspection with the staff available, an additional temporary meat inspector was appointed to assist in the task. CARCASES EXAMINED AND MEAT CONDEMNED, 1937. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 28 594 468 2,270 27,105 Number examined 28 594 468 2,270 27,105 A11 diseases except tuberculosis— Whole carcases condemned - 1 3 1 55 Carcases of which some part or organ was condemned - 55 - 3 342 Percentage of the number inspected affected with disease other than tuberculosis - 9.43 0.64 0.02 1.46 Tuberculosis only— Whole carcases condemned 4 - - 7 Carcases of which some part or organ was condemned - 116 - - 432 Percentage of the number inspected affected with tuberculosis - 20.20 - - 1.62 20 Slaughter-Houses. There are nine slaughter-houses scattered throughout the district. Classification in Register:— Registered 1 Permanent Licence 2 Annual Licence 6 (c) Adulteration, Etc. Dr. J. Tate, County Medical Officer, has kindly given me the under-mentioned return of work done during the year by the County Council Inspectors under the Sale of Food and Drugs Acts in this district:— Article No. Taken A dulterated Milk 48 3 Coffee 1 — Gin 1 — Jam 1 — Lamb's Liver 2 — Lemon Curd 2 — Meat 3 — Pepper 1 — Sausages Sheep's Liver 3 — 13 5 Vinegar 4 4 Whisky 8 2 87 14 Number of prosecutions 3 Number of convictions 2 Fines and costs imposed £5 l1s. 0d. SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. General. There is no appreciable alteration in the incidence of scarlet fever during the year. The number of cases of diphtheria fell from 39 in 1936 to 13 in 1937. There was no case of diphtheria amongst the children immunised at the Clinic. The number of cases of diphtheria has fallen by 80 per cent, over the figures for the year 1935, in the end of which year the Diphtheria Immunisation Clinic was started. 21 Diphtheria Immunisation.—During 1937 an extra day each week was allotted for immunisation owing to the large number of names on the waiting list. This number has now been so considerably reduced that a single weekly session has been resumed. It is a matter of regret that there are not more applicants for immunisation. The Clinic meets at the Hayes Cottage Hospital on Saturday mornings; during the year 78 sessions and 3,488 attendances were recorded, and 576 certificates of immunity were issued. Dr. Bousfield's report on immunisation during 1937 is as follows:— " We received some 18 months ago some literature based on work done in Scotland which seemed to indicate that a certain brand of Alum-precipitated toxoid was vastly superior to other makes on the market. The inference was that this particular brand could be used as a single injection with every prospect of good results. A quantity of this brand of A.P.T., made by the Mulford Laboratories in the U.S.A., was accordingly procured from Messrs. Sharp and Dohme Ltd. It was decided to immunise two groups of children by different methods for comparison, the first group by a single injection, as advocated by the manufacturers of the product, the second by means of two injections at fortnightly intervals, a method which had previously given reliable results with other brands of A.P.T. All the children in the two series mentioned were demonstrated to be Schick positive, or susceptible to diphtheria, before the inoculations were given. The figures are given below. It is quite clear that method 1 is too unreliable and therefore not suitable for employment in our area. Method 1. Schick positive children immunised with a single injection of 0.5 c.c. of Mulford A.P.T. Re-tests from 3 to 5 months after injection. Number re-tested to date 422 Numberre-Schicknegative 290 NumberstillSchickpositive1 32 Percentage of failure to immunise by this method 31.2 All the above failures received further treatment, and will be re-tested at a later date. 79 of these failures who were re-immunised have now been re-tested, and 77 have been shown to have become immune. 22 It is nevertheless clear that had we in this district not been testing all the children after inoculation, no less than 31 in every hundred would not have been successfully immunised, and what is even worse, would probably have been misled into believing that they were protected against diphtheria. Method 2. Schick positive children immunised by means of two injections of A.P.T. 0.2 c.c. and 0.5 c.c. at 14 days interval. Re-tests performed from 3 to 5 months after the last injection. Number re-tested to date 143 Number re-Schick negative 135 Number still Schick positive 8 Percentage of failure to immunise by this method 5.9 It is thus clear that the two injection method is very much more satisfactory than the single injection procedure. The work tends to show that the brand of A.P.T. used in these tests has no advantages over other makes we have used, and we find no evidence at all that it is an antigen of greater power than other makes which would render its use as a single injection prophylactic either desirable or even justifiable. For the purpose of making these figures of greater value, it may be stated that primary Schick tests show that the herd immunity in this area is not great, being only in the region of 10 per cent. natural Schick negative rate. Still this is the rate which experience has shown now obtains in and around many areas of London, and the work tends to show that single injection prophylaxis is not satisfactory in the environs of London." NOTIFIABLE DISEASES (other than Tuberculosis) DURING THE YEAR 1937. Disease Total Cases Notified Cases admitted to Hospital Total Deaths Scarlet Fever 190 170 2 Diphtheria 12 12 1 Puerperal Fever 2 2 — Puerperal Pyrexia 5 5 1 Pneumonia 28 22 18 (all forms) Erysipelas 7 5 — Polio-encephalitis 1 1 — Poliomyelitis 1 1 1 Ophthalmia Neonatorum 5 1 23 ANALYSIS OF THE TOTAL CASES. Disease At Ages Under 1 Year 1 2 3 4 5 10 15 20 35 45 65 and over 2 3 4 5 10 15 20 35 45 65 Scarlet Fever 1 4 11 20 13 89 25 7 14 5 1 - Diphtheria — - - 3 1 4 2 1 1 - - - Pneumonia — 1 1 _ 1 2 1 3 9 4 4 2 Puerperal Fever — -- -- -- -- -- -- - 2 - - - Puerperal Pyrexia — - - - - - - - 4 1 - - Erysipelas — - - - - - - 2 - 4 1 Polio-encephalitis — - - - - - 1 - - - - - Poliomyelitis — - - - - 1 - - - - - Ophthalmia Neonatorum 5 - - - - - - - - - - — TUBERCULOSIS. New Cases and Mortality during 1937. Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 0 - - - - - - - 1 1 - - 1 — 1 5 1 — 2 - - - - - 15 4 5 1 2 1 25 7 4 1 1 6 3 - 1 35 4 - - 1 3 2 - 1 45 2 55 1 1 1 1 65 and upwards — — — — — 1 — — Total 19 10 4 2 11 9 2 3 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths is 28.0 per cent. No action has been taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, relating to tuberculous employees in the milk trade, nor under the Public Health Act, 1936, Section 172, for the compulsory removal to hospital of persons suffering from tuberculosis. 24