LIBRARY HAY 14 Thirty-fourth 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 1938 THE URBAN DISTRICT COUNCIL OF HAYES AND HARLINGTON MEMBERS OF THE COUNCIL, 1938. Chairman: Councillor L. M. Graves, J.P. Vice-Chairman: Councillor P. G. Soulsby. Councillors: L. Ayerst, F. C. Barnett, Mrs. I. E. Downer, Mrs. A. B. Greenhead, R. R. A. Johnson, W. C. Mongor, C. W. F. Newton, A. C. Nichols, D. Page, G. Pratt, A. Simpson, W. R. F. Smart, G. G. Smith, G. H. Stinton, L. Stringer, W. Sutcliffe, C. Viveash. PUBLIC HEALTH COMMITTEE, 1938. Chairman: Councillor P. G. Soulsby. Councillors: L. Ayerst, Mrs. I. E. Downer, L. M. Graves, J.P (ex-officio), Mrs. A. B. Greenhead, C. W. F. Newton, G. Pratt, A. Simpson, G. G. Smith, G. H. Stinton, L. Stringer. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health (pari 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 Inspectors: A. T. Matson, R. S. Newsome. Temporary Meat Inspector: E. G. Drayson. Clerks: S. Greenhead. C. F. Allard. Medical Officer's Annual Report Public Health Department, Town Hall, Hayes, Middx. June, 1939. To the Chairman and Members of the Urban District Council of Hayes and Harlington. Mr. Chairman, Ladies and Gentlemen, I have the honour of presenting to you the thirty-fourth Annual Report on the health of your Urban District. There has been no serious outbreak of infectious disease during the year, and the incidence of scarlet fever has fallen by more than 50 per cent. The death rate at 10.1 per 1,000 compares favourably with that of England and Wales as a whole, which is 11.6, while the live birth rate is 20.8 as against 15.1 for England and Wales. I would like to thank the members and officials of the Council for their valuable co-operation in helping me to carry out my duties as Medical Officer. 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, 1938) Registrar-General's Estimate : Working Population Figure 43,930 Present estimated population at 3.4 persons per house 47,580 Number of inhabited houses end of 1938 13,994 Rateable value £320,655 Sum represented by a penny rate Gross £1,294 Net (Est.) £1,130 SOCIAL CONDITIONS. The Urban District of Hayes and Harlington comprises the parishes of Hayes and Harlington together with that portion of Cranford which lies west of the River Crane. It is about eight square miles in extent, varying in height from 70 feet above sea-level in the south-eastern part to 182 feet in the northwestern part. The greater part of the district is flat and has a subsoil of clay with occasional extensive patches of gravel. The population of Hayes and Harlington is chiefly industrial, but four dairy farms and a few market gardens remain. Unemployment has nearly doubled during the year over the figures for 1937. The exact figures are 97 per cent. for the total (male and female) increase ; the percentage of male increase is, however, only 82, while the female increase is 126 per cent. AVERAGE UNEMPLOYMENT PER MONTH. 1938 1937 Males 1,012 555 Females 650 288 Total 1,662 843 Building continues at a great rate, 2,149 houses having been built during the year. About 345 acres (6.7 per cent.) have either been utilised for parks or have been scheduled as open spaces. The main Oxford road runs east to west through the area, and this is now being changed from a narrow road into a wide arterial road with dual carriageways and cycle tracks. 4 Most of the houses are in good condition and have been erected since the War. It has been found necessary from time to time to condemn some of the older cottages; in consequence there is no slum area at all in the district. 1587 houses are owned by the Council and are let at a low rental, preference being given in the allocation of these houses to people who have lived in the district for some years. There is a number of bungalows let to old people without families at a rental of 5s. 0d. a week inclusive of rates. Extracts from Vital Statistics of the Year. Total M. F. Live Births— Birth Rate per 1,000 of the estimated resident population 20.8 Legitimate 881 438 443 Illegitimate 33 22 11 Stillbirths 27 16 11 Rate per 1,000 total (live and still) births 28.7 Deaths 326 168 158 Death Rate per 1,000 of the estimated resident population 7.42 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, 10.1. Deaths from puerperal causes :— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis Nil 0.0 Other puerperal causes 1 1.06 Total 1 1.06 Death rate of Infants under one year of age— All infants per 1,000 live births 59.1 Legitimate infants per 1,000 legitimate live births 59.0 Illegitimate infants per 1,000 illegitimate live births 60.6 5  M. F. Total Deaths from Cancer (all ages) 20 27 47 Deaths from Measles (all ages) 2 1 3 Deaths from Whooping Cough (all ages) — 1 1 Deaths from Diarrhoea (under 2 years of age) 4 4 8 CAUSES OF DEATH DURING 1938. Causes of Death Males Females All Causes 168 158 1. Typhoid and Paratyphoid Fevers - - 2. Measles 2 1 3. Scarlet Fever - - 4. Whooping Cough - 1 5. Diphtheria - - 6. Influenza 2 1 7. Encephalitis Lethargica — — 8. Cerebro-spinal Fever — — 9. Tuberculosis of respiratory system 14 14 10. Other tuberculous diseases 2 2 11. Syphilis 1 1 12. General paralysis of the insane, tabes dorsalis 5 1 13. Cancer, malignant disease 20 27 14. Diabetes 1 2 15. Cerebral haemorrhage, etc. 4 3 16. Heart disease 38 29 17. Aneurysm 1 1 18. Other circulatory diseases 9 15 19. Bronchitis 1 - 20. Pneumonia (all forms) 18 9 21. Other respiratory diseases 3 — 22. Peptic ulcer 1 1 23. Diarrhoea, etc. (under 2 years) 4 4 24. Appendicitis — 1 25. Cirrhosis of liver — — 26. Other diseases of liver, etc. — 2 27. Other digestic diseases 3 2 28. Acute and chronic nephritis — 4 29. Puerperal sepsis — - 30. Other puerperal causes - 1 31. Congenital debility, premature birth, malformations, etc. 16 12 32. Senility 1 4 33. Suicide 2 1 34. Other violence 9 7 35. Other defined diseases 11 12 36. Causes ill-defined or unknown — — Deaths of Infants under 1 year Total 32 22 Legitimate 30 22 Illegitimate 2 — Live Births Total 460 454 Legitimate 438 443 Illegitimate 22 11 Stillbirths Total 16 11 Legitimate 15 10 Illegitimate 1 1 Population (Mid-Year) 43,930 (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 1938. England and Wales, London, 126 Great Towns and 148 Smaller Towns. (Provisional Figures based on Weekly and Quarterly Returns.) England and Wales 126 County Boroughs and Great Towns 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 15.1 15.0 15.4 13.4 20.8 Still 0.60 0.65 0.60 0.48 0.61 DEATHS:— All Causes 11.6 11.7 11.0 11.4 10.1 Typhoid and typhoid fever 0.00 0.00 0.00 0.00 0.00 Smallpox 0.00 - 0.00 - 0.00 Measles 0.04 0.05 0.03 0.06 0.07 Scarlet fever 0.01 0.01 0.01 0.01 0.00 Whooping Cough 0.03 0.03 0.02 0.03 0.02 Diphtheria 0.07 0.07 0.06 0.05 0.00 Influenza 0.11 0.10 0.11 0.06 0.07 NOTIFICATIONS Smallpox 0.00 0.00 0.00 — 0.00 Scarlet fever 2.41 2.60 2.58 2.05 1.98 Diphtheria 1.58 1.85 1.53 1.90 0.48 Enteric fever 0.03 0.03 0.04 0.05 0.00 Erysipelas 0.40 0.46 0.39 0.46 0.09 Pneumonia 1.10 1.28 0.98 0.98 0.36 Rates per 1,000 Live Births Deaths under 1 year of age 53 57 51 57 59 Deaths from Diarrhœa and Enteritis under 2 years of 5.5 7.8 3.6 13.1 8.7 MATERNAL MORTALITY:- Puerperal Sepsis 0.89 Not available 0.00 Others 2.19 1.09 Total 3.08 11.09 Rates per 1,000 Total Births (i.e.. Live and Still) MATERNITY MORTALITY:- Puerperal Sepsis 0.86 Not available 0.00 Other 2.11 1.06 Total 2.97 1.06 NOTIFICATIONSL:- Puerperal fever 14.42 18.08 12.51 3.53 7.44 Puerperal pyrexia 15.46 7 STREET ACCIDENTS. Through the courtesy of the Commissioner of Police for the Metropolis I am able to give below an analysis of the street accidents for the year. One pedal cyclist and one pedestrian were killed as a result of collision with a trolley bus and a private car respectively. There were 51 serious accidents and 250 accidents involving minor personal injury. The reduction in fatal accidents from seven in 1937 to two in 1938 is noticeable. Personal Injuries 1938 Total Serious Slight JANUARY 8 13 21 FEBRUARY 3 13 16 MARCH 3 20 23 APRIL 6 18 24 MAY 4 19 23 JUNE 2 19 21 JULY 6 20 26 AUGUST 3 26 29 SEPTEMBER 1 20 21 OCTOBER 5 30 35 NOVEMBER 7 21 28 DECEMBER 3 31 34 TOTAL 51 250 301 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 staff consists of one Medical Officer (part time), a 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. All the Sanitary Inspectors hold a Meat Inspector's certificate. Contributions to the salaries of these Officers are received from the Exchequer. Dr. Guy Bousfield is the Medical Officer in charge of the Diphtheria Immunisation Clinic and attends at the Hayes Cottage Hospital every Saturday. Laboratory facilities are provided at the Clinical Research Association for the examination of sputum, swabs, etc., for the detection of infectious disease. 8 SUMMARY OF REPORTS OF WATER SAMPLES SUBMITTED FOR BACTERIOLOGICAL EXAMINATIONS, 1938. Report No. and Date Organisms produced on gelatine or agar plates incubated at 20°C. for 3 days Organisms produced on agar plates incubated at 37.5°C. for 2 days B. Coli. Streptococci CI. Welchii. (spores) Remarks 1965 15/1/38 4 per c.c. 3 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The sample has a very low bacterial count and no organisms of an excremental type are present. The water is quite safe for drinking purposes. 1966 15/1/38 27 per c.c. 3 per c.c. Present in 100 c.c. (not found in less) Not found in 30 c.c. Not found in 100 c.c. The results show the presence of a few excremental organisms, they are only present, however, in quantities of 100 c.c., and although the water is not of the highest degree of purity it might be considered reasonably safe for drinking purposes. 1967 15/1/38 12 per c.c. 2 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The total number of organisms present is low and no excremental types are present. From a bacteriological point of view the water is quite satisfactory for drinking purposes. 5073 31/1/38 20 per c.c. 2 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The bacterial counts are low and the sample contains no excremental organisms or objectionable bacteria. The water is excellent for drinking. 5074 31/1/38 5 per c.c. Less than 1 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The bacterial counts are very low and indicate exceptional purity. It is an excellent water for drinking purposes. 18112 4/4/38 1,028 per c.c. 102 per c.c. Present in 1 c.c. Present in 10 c.c. Present in 25 c.c. From the examination of this sample and data obtained, it will be seen that the water at present in this well contains many excremental organisms and therefore is not in a fit condition for drinking purposes. 18113 4/4/38 390 per c.c. 8 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. No excremental organisms are found in this sample and from a bacteriological point of view the water is suitable for drinking in its present condition. In view of the surroundings it might be considered advisable to see that the well is properly constructed. 22277 30/4/38 19 per c.c. 3 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The total number of bacteria present is low and no excremental types are found. The results show that the water is quite safe for drinking. 22278 30/4/38 12 per c.c. 9 per c.c. Not found in 100 c.c. Not found in 30 c.c. Present in 100 c.c. (not found in less) The bacterial counts are low and the presence of a few B. Welchii spores is not of serious significance. From a bacteriological point of view the water may be regarded as suitable for drinking purposes. 22279 30/4/38 7 per c.c. 2 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The total number of bacteria present is very low and no excremental types are found. The result shows that the water is quite safe for drinking. 27203 28/5/38 34 per c.c. 18 per c.c. Not found in 100 c.c. Not found in 30 c.c. Present in 50 c.c. In chlorinated river water B. Welchii spores are often present, but in the absence of non-sporing excremental organisms the water can be regarded as suitable for drinking purposes. 38237 2/8/38 38 per ml. 6 per ml. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The bacterial counts are fairly low and there are no excremental organisms present. From a bacteriological point of view the water is satisfactory for drinking purposes. 38239 3/8/38 43 per ml. 10 per ml. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c The bacterial counts are not high and there are no excremental types of micro-organisms present. The water is satisfactory for drinking purposes. 52528 31/10/38 6 per ml. 2 per ml. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The bacterial counts are very low and no excremental types of organisms are present. The water is of excellent quality for drinking purposes. 52529 31/10/38 60 per ml. 5 per ml. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The agar count at 20°C. is rather higher than usual, but the 37°C. count figure is satisfactory. No organisms of an excremental character are present and the water is safe for drinking purposes. SUMMARY OF REPORTS OF WATER SAMPLES SUBMITTED FOR BACTERIOLOGICAL AND CHEMICAL EXAMINATION BY THE JOINT COMMITTEE OF SIX AUTHORITIES WITHIN THE SUPPLY AREA OF THE SOUTH WEST SUBURBAN WATER COMPANY. Report No. and Date. Authority taking sample CHEMICAL BACTERIOLOGICAL Remarks Total solids (dried at 120°C.) Combined chlorine (as CI.) Equivalent to Sodium Chloride (Na CI.) Nitric nitrogen (Nitrates) Nitrous nitrogen (Nitrites) A mmoniacal nitrogen Albuminoid nitrogen Oxygen absorbed in 4 hours at 27°C. Lead or Copper Temporary hardness (equivalent to CaCO3) Permanent hardness (equivalent to CaCO3) Total hardness (equivalent to CaCO3) Organisms produced on agar plates incubated at 20°—22°C. for 3 days Organisms produced on agar plates incubated at 37.5°C. for 2 days B. coli Streptococci Cl. Welchii (Spores) 38236 2/8/38 Hayes and Harlington U.D.C. Parts per 100,000 33.0 2.30 3.80 0.18 Nil 0.0004 0.0044 0.076 Nil 17.0 2.5 19.5 52 per c.c. 11 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The results show this water to be quite satisfactory for drinking purposes. Grains per Gallon 23.1 1.61 2.66 0.13 Nil 0.0003 0.0031 0.053 Nil 11.9 1.8 13.7 43504 3/9/38 Egham U.D.C. Part per 100,000 33.5 2.90 4.79 0.26 Nil 0.0010 0.0048 0.054 Nil 20.5 3.3 23.8 15 per c.c. 4 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The results show this water to be satisfactory for drinking purposes. Grains per Gallon 23.5 2.03 3.35 0.18 Nil 0.0007 0.0034 0.038 Nil 14.3 2.3 16.6 44864 12/9/38 Feltham U.D.C. Parts per 100,000 30.0 2.50 4.13 0.32 Nil 0.0004 0.0034 0.066 Nil 20.5 3.0 23.5 14 per c.c. 5 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The combined chemical and bacteriological results show that this water is suitable for drinking purposes. Grains per Gallon 21.0 1.75 2.89 0.22 Nil 0.0003 0.0024 0.046 Nil 14.4 2.1 16.5 46962 26/9/38 Bagshot R.D.C. Parts per 100,000 31.50 2.60 4.29 0.28 Nil Nil 0.0066 0.057 Nil 20.0 2.5 22.5 625 per c.c. 82 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. In regard to the bacterial content the figures compare somewhat unfavourably with the previous sample, but the interval of time in transit of this present sample is much longer and might account for most, if not all, of the increase in numbers. There are no excremental organisms found in the quantities examined and the chemical figures are approximately much the same as in the previous sample. From consideration of the combined results the water is safe for drinking purposes. Grains per Gallon 22.05 1.82 3.00 0.20 Nil Nil 0.0046 0.040 Nil 14.0 1.7 15.7 48896 10/10/38 East- hampstead R.D.C. Parts per 100,000 31.0 2.80 4.62 0.34 Nil 0.0004 0.0048 0.075 Nil 21.0 4.0 25.0 11 per c.c. 14 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The results show this water to be of very good quality and quite satisfactory for drinking purposes. Grains per Gallon 21.7 1.96 3.23 0.24 Nil 0.0003 0.0034 0.053 Nil 14.7 2.8 17.5 52351 28/10/38 Windsor R.D.C. Parts per 100,000 34.0 2.80 4.62 0.32 Nil 0.0010 0.0066 0.125 Nil 22.3 6.0 28.3 26 per c.c. 4 per c.c. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. The bacteriological results show no excremental organisms and the combined results indicate that the water is safe for drinking purposes. Grains per Gallon 23.8 1.96 3.23 0.22 Nil 0.0007 0.0046 0.088 Nil 15.6 4.2 19.8 53915 7/11/38 Hayes and Harlington U.D.C. Parts per 100,000 36.5 2.70 4.46 0.40 Nil 0.0006 0.0052 0.092 Nil 23.0 6.0 29.0 8 per ml. 5 per ml. Not found in 100 c.c. Not found in 30 c.c. Present in 100 c.c. (not found in less) The combined results show that the water is satisfactory for drinking purposes. Grains per Gallon 25.6 1.89 3.12 0.28 Nil 0.0004 0.0036 0.064 Nil 16.1 4 2 20.3 57707 28/11/38 Egham U.D.C. Parts per 100,000 33.5 2.20 3.63 0.40 Nil 0.0006 0.0054 0.114 Nil 22.5 5.5 28.0 56 per ml. 19 per ml. Not found in 100 c.c. Not found in 30 c.c. Present in 100 c.c. (not found in less) The results obtained show this water to be safe for drinking purposes. Grains per Gallon 23.5 1.54 2.54 0.28 Nil 0.0004 0.0038 0.080 Nil 15.7 3.9 19.6 60611 12/12/38 Feltham U.D.C. Parts per 100,000 39.0 2.20 3.63 0.34 Nil 0.0010 0.0098 0.170 Nil 20.5 8.8 29.3 42 per ml. 13 per ml. Not found in 100 c.c. Not found in 30 c.c. Not found in 100 c.c. From a consideration of these results we are of opinion that this water is satisfactory for drinking purposes. Grains per Gallon 27.3 1.54 2.54 0.24 Nil 0.0007 0.0069 0.119 Nil 14.3 6.2 20.5 63584 2/1/39 Bagshot R.D.C. Parts per 100,000 37.0 1.90 3.14 0.40 Nil 0.0044 0.0058 0.120 Nil 22.0 6.0 28.0 9 per ml. 11 per ml. Not found in 100 ml. Not found in 30 ml. Present in 50 ml. The bacteriological results show that this water is safe for drinking purposes. Grains per Gallon 25.9 1.33 2.20 0.28 Nil 0.0031 0.0041 0.084 Nil 15.4 4.2 19.6 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 case is 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, the Village Hall, Cherry Lane, and Grange Park School, Lansbury Drive. A clinic to immunise children against diphtheria is provided by the Council at the Hayes Cottage Hospital. Hospitals.—The Hayes Cottage Hospital was enlarged during the year from 15 beds to 22 beds. The Harlington Cottage Hospital has 14 beds. Both these institutions are subsidised by the Council to the extent of a penny rate, the rate from Hayes Parish going to the Hayes Cottage Hospital and the remainder to the Harlington Cottage Hospital. Hillingdon County Hospital, on the borders of the Urban District, serves the inhabitants of Hayes and Harlington, and the teaching hospitals in London are also 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. Samples were also submitted from two private wells and the results showed that in one case the water was decidedly unfit for drinking and, in the other, of doubtful quality. In the former case the well has been closed and in the latter a supply has been obtained from the company's mains. 9 New mains have been provided to supply the new houses which have been erected during the year. The water supply is of good quality and adequate in amount. Following a conference between this authority and five neighbouring ones, it was arranged that samples should be taken every quarter by each Council served by the South West Suburban Water Company. The reports are then circulated to each of the six authorities and the result is that bacteriological and chemical reports, together with a report on the hardness, of this water are obtained every fortnight. Drainage and Sewerage.—There has been no important extension of sewers during the year. All new houses have been connected to the sewer and the whole of the sewage from the area is received 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.—Twenty-seven pail-closets have been abolished during the year and eleven cesspools discontinued. As some of these cesspools served more than one house, the number of houses connected to the sewer is greater than the number of cesspools discontinued. The estimated number of the various types remaining at the end of 1938 is:— Water-closets 15,374 Closets with movable receptacles 157 Closets with fixed receptacles 13 Public Cleansing.—There are six freighters which are used for collection of house refuse. SANITARY INSPECTION OF AREA. 1.—Complaints. During the year 282 complaints were received with respect to the following matters, viz.:— Choked and defective drains 24 Insanitary or dilapidated condition of houses and premises 114 Offensive accumulations or deposits 12 Cesspools overflowing 2 Rats 23 Other nuisances 107 Total 282 10 2.—Inspection of District. Number of houses and premises inspected (ordinary) 1,708 ,, ,, houses inspected and particulars recorded (Housing Act, 1936) 82 „ „ houses and premises re-inspected 1,942 ,, ,, miscellaneous visits 725 „ „ food inspections 6,754 „ „ visits to slaughter-houses 5,844 „ „ dairies, cowsheds and milk-shops 89 „ ,, ,, „ bakehouses, factories and workshops 48 „ „ re water supplies 19 „ „ re cases of infectious disease 205 „ „ „ re offensive trades 100 „ „ re petroleum stores 54 ,, ,, smoke observations and visits to works 15 ,, ,, inspections of tents and vans 330 „ „ public urinals inspected 167 „ „ verminous premises inspected 29 ,, „ premises disinfected Ill „ ,, inspections under the Shops Acts 336 ,, ,, ,, (Housing Act, 1936: overcrowding) 2,961 Total 21,519 3.—Notices Served. Served. Complied with. Outstanding. Informal notices 258 234 24 Statutory notices— Section 50, Public Health Act, 1936 1 1 - Section 75, Public Health Act, 1936 2 2 Section 93, Public Health Act, 1936 5 3 2 Section 10, Shops Act, 1934 15 7 8 Section 59, Housing Act, 1936 4 4 — Section 66, Housing Act, 1936 2 2 — 11 4.—Summary of Sanitary Imrovements Carried Out. Drainage. Number of drains examined, exposed, etc. 35 Drainage systems reconstructed 4 Defective drains unstopped, repaired, etc. 36 Manholes built, altered or repaired 3 Fresh air inlets fixed or repaired 2 Glazed sinks provided 2 Cesspools repaired 1 Water Closets. Defective flushing cisterns renewed or repaired 17 New pans provided 5 W.C. apartment repaired, cleansed, etc. 24 Urinals reconstructed or repaired 2 Privies and pail-closets converted to W.C.'s 27 General Repairs, etc. Roofs repaired and made weatherproof 19 Eaves, gutters, repaired or renewed 12 Damp walls re-pointed or rendered damp-proof 41 Defective brickwork of external walls repaired 8 Defective brickwork and plaster work of internal walls repaired 26 Defective wood floors repaired 23 Defective stairs repaired 1 Handrails provided 7 Lighting and ventilation increased 16 Defective tile, brick or concrete floors repaired 2 Defective doors repaired 20 Defective ceilings repaired 26 Defective windows repaired, made to open or renewed 61 Rooms cleansed 113 Defective stoves, coppers, etc., repaired 19 Sink waste pipes trapped or repaired 7 Insufficient water supply increased 2 Defective yard pavings repaired 2 Offensive accumulations removed 32 New dustbins provided 25 Food stores provided 2 Lighting, etc., of food stores improved 9 12 5.—Shops. Six notices were served requiring the provision of sanitary accommodation in shops, and of these four have been complied with. A few notices were also served in regard to temperature, ventilation, lighting and washing facilities. Most of these have been complied with and the remainder are receiving consideration. Three certificates of exemption were granted during the year in respect of sanitary accommodation. 6.—Camping Sites. There are no camping sites in the area. 7.—Smoke Abatement. Fifteen smoke observations and visits to factories have been made during the year. No statutory notices were served. 8.—Swimming Baths and Pools. The only open-air swimming bath has been demolished. 9.—Eradication of Bed Bugs. Six Council houses were found to be infested with bed bugs and have now been disinfested. Nine other houses were found to be similarly infested and were dealt with by the owners. The following method is employed for freeing infested houses. Firstly, houses are sprayed with Vermicine or Pyagra, picture rails, skirtings and other wood fixtures are removed and the premises sealed and fumigated—usually with sulphur candles. In addition, and as an added precaution, any likely places harbouring vermin are treated with a blow lamp. The incoming tenant of a Council house is visited to make as certain as possible that his furniture and belongings are free from vermin before he enters a Council house. The work of disinfestation in Council houses is carried out under the supervision of the Estate Manager, who employs his own men for this purpose. In the case of other houses, the landlord usually makes arrangements with a contractor for this to be done. Houses found to be infested with vermin are, as a rule, empty. The incoming tenant is always informed that although the house has been disinfested he may find occasional bugs appearing and requested to notify the public health department immediately. With the co-operation of the tenant, premises are easily cleared of vermin. 13 SCHOOLS. There are eight public elementary schools which have been built since the War and two dating back a few score years. The sanitary condition and water supply of these schools are satisfactory. 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 four small private schools in the area, which are regularly inspected. THE FACTORY AND WORKSHOP ACT, 1901, AND THE FACTORIES ACT, 1937 (WHICH SUPERSEDED THE ACT OF 1901 ON 1st JULY 1938). Forty-eight inspections of factories with and without mechanical power have been made. There are sixty-four factories with mechanical power and forty- seven factories without mechanical power on the register, classified as under:— Factories with mechanical power. Factories without mechanical power. Aircraft 1 Artificial Marble 1 Bakehouses 6 Boot Repairs 7 Bicycles 1 Building Materials 1 Boot Repairs 12 Builders' Merchants 2 Caravans 1 Chemical Engineers 1 Cheese 1 Cycle Repairs 13 Cocoa, Chocolates, etc. 1 Joinery and Carpentry 3 Corn Flakes and Potato Crisps 1 Motor Repairs 7 Corrugated Cardboard, etc 1 Plumbing 1 Electric Transformers 1 Radio Engineers 3 Engineering 6 Smithies 3 Fire Extinguishers 1 Soft Furnishings 1 Firewood 2 Timber 2 Furniture 3 Valet Services 2 Glazed Tiles, etc. 2 Hardwood Floors 1 Jams, etc. 1 Joinery 2 Mineral Waters 1 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 14 1.—Inspections. Premises Number of Inspections Written Notices Occupiers Prosecuted Factories with mechanical power 34 5 Nil Factories without mechancial power 14 — Other Premises under the Act (including works of building and engineering construction but not including Outworkers' premises) - - Total 48 5 2.—Defects Found. Particulars Number of Defects Found. Remedied. Nuisances under the Public Health Acts:— Want of cleanliness 5 4 Want of ventilation Nil Nil Overcrowding Nil Nil Want of drainage of floors Nil Nil Other nuisances Nil Nil Sanitary accommodation [Insufficient Nil Nil Unsuitable or defective Nil Nil Not separate for sexes Nil Nil Offences under the Factory & Workshop Acts:— Other offences Nil Nil Total 5 4 OFFENSIVE TRADES. Twelve fish friers and three fat extractors are licensed by the Council. Regular inspections have been made and the trades found to be conducted satisfactorily. 15 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) 1,790 (b) Number of inspections made for the purpose 3,732 (2) (a) Number of dwelling-houses [included under sub-head (1) above] which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 82 (b) Number of inspections made for the purpose 145 (3) Number of dwelling-houses fouud to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 (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 43 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 25 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— (a) By owners Nil (b) By local authority in default of owners Nil 16 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 8 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 8 (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 3 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 17 (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—Part IV.—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 26 (ii) Number of families dwelling therein 26 (iii) Number of persons dwelling therein 222 (b) Number of new cases of overcrowding reported during the year 38 (c) (i) Number of cases of overcrowding relieved during the year 95 (ii) Number of persons concerned in such cases 732 (d) Number of dwelling-houses which have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil 17 Eleven licences for the temporary use of houses by persons in excess of the permitted number were issued under section 61 of the Housing Act, 1936. Under the same section, seven notices covering copy of licence authorising persons in excess of the permitted number to sleep in house were served on landlords. Sixty-eight notices requiring statement of persons sleeping in house were served under section 66 of the Housing Act, 1936 ; all the notices were complied with. SECTION E. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. There are four dairy farms in this district and these have been regularly inspected. 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. Two milk dealers were licensed during the year to produce pasteurised milk. The table below gives particulars of the other thirty-five licences granted during the year :— Designation Dealer's Licence Supplementary Licence Pasteurised 15 8 Tuberculin Tested 6 6 No refusal or revocation of licences to retailers has been made. 18 SUMMARY OF REPORTS UPON THE BACTERIOLOGICAL EXAMINATION OF SAMPLES OF MILK. Retort No. Temperature on arrival Bacteria per ml. or c.c. Bacteria per 1/100 c.c. Bacteria per 1/1,000 c.c. Bacteria per 1/10,000 c.c. B. coli. Designation Remarks 2 Days 3 Days 1/100 1/100 1/100 1/100 1/100 1/100 1963 14°C. 6,630 — — — N N N N N N Pasteurised The centrifugalised deposit of this milk contains a few leucocytes and squames, but specially stained preparations made from the cream and c.d. fail to show any tubercle bacilli. The sample satisfied the prescribed test. 1964 14°C. 16,660 — — — N N N N N N Pasteurised The centrifugalised deposit of this milk contains a slight excess of leucocytes, some squames and a trace of detritus, but specially stained preparations made from the cream and c.d. fail to show any tubercle bacilli. The sample satisfied the prescribed test. 5075 13°C. 73,500 — — — P P P P P P N Pasteurised The centrifugalised deposit of this milk contains a slight excess of leucocytes, some epithelial squames and a trace of detritus, but tubercle bacilli are not detected in preparations made direct from the cream and c.d. The guinea-pig inoculated with this milk fails to show any signs of a tuberculous infection on post-mortem examination. The sample satisfied the prescribed test. 11863 11°C. 3,560 — — — N N N N N Pasteurised The centrifugalised deposit of this milk contains a few leucocytes and squames, together with a trace of detritus, but specially stained preparations made from the cream and c.d. fail to show any tubercle bacilli. The sample satisfied the prescribed test. 11864 11°C. 2,050 — — — N N N N N N Pasteurised The centrifugalised deposit of this milk contains a few leucocytes and squames, but specially stained preparations made from the cream and c.d. fail to show any tubercle bacilli. The sample satisfied the prescribed test. 11865 11°C. 2,160 — — — N N N N N N Pasteurised The centrifugalised deposit of this milk contains only a few leucocytes and some epithelial squames, but tubercle bacilli are not detected in specially stained preparations made from the cream and c.d. The sample satisfied the prescribed test. 27204 17°C. 7,500 55 7 1 N N (1/1000) N (1/10000) N N (1/1000) N (1/10000) Raw The centrifugalised deposit of this milk contains a slight excess of leucocytes and some squames, but specially stained preparations made from the cream and c.d. fail to show any tubercle bacilli. 52526 12°C. 3,700 — — — — — — — — — Pasteurised The centrifugalised deposit of this milk is small in amount and contains a few leucocytes and squames, but specially stained preparations made from the cream and c.d. fail to show any tubercle bacilli. The sample satisfied the prescribed test. 52527 12°C. 1,990 — - — — — — — — — Pasteurised The centrifugalised deposit of this milk contains a marked excess of leucocytes and some squames, together with a fair number of long chains of streptococci possibly of the bovine mastitis type, but tubercle bacilli are not detected. The sample satisfied the prescribed test. There are now thirty persons registered in accordance with the Milk and Dairies (Amendment) Act, 1922, as under Wholesale Traders or Producers of Milk 7 Retail Purveyors of Milk with premises in the district 10 Retail Purveyors of Milk whose premises are outside the district 13 Total 30 (b) Meat. The Cherry Farm slaughter-house has required very close attention from the meat inspectors during the year, slaughtering having been carried out up till the early hours of the morning. In October, 1938, eight emaciated cows were discovered in the orchard of Cherry Farm. The Ministry of Agriculture was immediately notified and the Ministry's inspector, Mr. Wooff, came and inspected the animals. Four of the cows were slaughtered and inspected by the veterinary inspector, together with an inspector of the public health department; all four carcases showed evidence of generalised tuberculosis and were removed for destruction. The remaining cows, on the instruction of the veterinary inspector, were sent to a knacker's yard at Sunbury-on-Thames, where they were slaughtered and postmortem examination was made. All these cows also showed evidence of generalised tuberculosis. Six weeks later two emaciated cows were found at the same slaughter-house. The veterinary inspector of the Ministry of Agriculture was notified and these animals were also removed to Sunbury-on-Thames for slaughter and post-mortem examination. Both carcases had generalised tuberculosis. No prosecution was made in respect of these animals. This is a matter which is in the discretion of the Ministry of Agriculture and the County Council. It would appear that stricter means of safeguarding the slaughter of diseased animals is necessary. Some of the animals had apparently been brought here from places as far distant as Wales and Devonshire. This seems to indicate that there is an underground traffic in the purchase of diseased animals and their slaughter for human consumption. The proprietor of one slaughter-house was prosecuted in June for failure to remove slaughter-house refuse; he was fined £1. 19 CARCASES EXAMINED AND MEAT CONDEMNED, 1938. Cattle, excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 104 892 1,730 3,034 20,409 Number examined 104 892 1,730 3,034 20,409 A11 diseases except tuberculosis— Whole carcases condemned 1 1 34 Carcases of which some part or organ was condemned 44 - 2 25 Percentage of the number inspected affected with disease other than tuberculosis - 5.05 - 0.09 0.29 Tuberculosis only— Whole carcases condemand - 9 - - 3 Carcases of which some part or organ was condemned - 71 - - 310 Percentage of the number inspected affected with tuberculosis - 8.96 - - 1.53 20 Slaughter-Houses. The number of slaughter-houses subject to annual licences has been reduced by two; in one instance the premises have been demolished and in the other case the occupier failed to carry out the required improvements in order to obtain his licence. Classification in Register:— Registered 1 Permanent Licence 2 Annual Licence 4 (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 Adulterated *Milk 79 1 *Chocolate Cakes 5 4 Gin 2 — Hake 3 — Lemon Sole 1 — *Meat 4 — Sardines 2 — *Sausages 3 — Sheep's Liver 2 — Whisky 3 — 104 5 Number of prosecutions 2 Number of convictions 2 Fines and costs imposed £7 12s. 0d. Artificial Cream Act, 1929. Public Health (Condensed and Dried Milk) Regulations, 1923. Inspections were made under the above in order to see that the requirements with respect to labelling were complied with, but no infringements were discovered. Public Health (Preservatives, Etc., in Food) Regulations, 1925 and 1927. In the foregoing table, the articles marked * were also examined for the presence of preservatives. 21 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. General. Cases of scarlet fever have dropped from 190 to 86 during this year. Diphtheria cases notified have increased from 12 to 21, but of this number 8 were not confirmed on admission to hospital and were discharged in 3 or 4 days. There has been no case of diphtheria amongst the children immunised at the clinic. Diphtheria Immunisation.—A clinic was held at Hayes Cottage Hospital every Saturday morning, with the exception of certain holiday periods. During the year 47 sessions and 2,291 attendances were recorded, and 480 certificates of immunity were issued. I append Dr. Bousfield's report on the work done during the year "During the year we have been using Alum-precipitated Toxoid as a two-injection procedure. The product employed has been that of Messrs. Evans, Sons, Lescher & Webb. Two injections of 0.5 c.c. have been given at an interval of 14 days, and the figures have been extremely satisfactory when these children were re-Schick tested from 3 to 5 months later. It must be made clear that all children inoculated were previously shown to be Schick-positive or susceptible to diphtheria. Of children treated in this manner, 231 have been re-tested. Of these, 224 proved to be Schick-negative (successfully immunised). Seven were found still to give a positive result to the test. The percentage of failure to immunise 3.03 per cent. Successfully immunised 96.97 ,, The 3.03 per cent. of children who did not respond to the standard course of treatment received further injections of A.P.T. It is interesting to compare these results with those obtained in the use of the Mulford brand of A.P.T. which we used in 1937. The testing of these cases after treatment was partly completed in 1938 and the following figures are available. The method used was two injections at 14 days' interval, the dosage in some cases being 0.2 c.c. and 0.5 c.c., and in others 0.5 c.c. and 0.5 c.c. Of 238 cases re-tested, 227 were found to be negative, while 22 11 gave a positive result. The percentage of failure was therefore 4.62 per cent., as compared with the 3.03 per cent. found in the case of Evans, Sons, Lescher & Webb product. In series of cases of only a little over two hundred, the results are virtually comparable. Both methods are quite satisfactory and probably cannot be bettered. It was shown last year that the Mulford product, given as the single injection recommended by the manufacturers, produced a total failure on re-Schick test amounting to 31.2 per cent. The method was condemned out of hand, the makers communicated with, through their agents, and the single injection procedure has not been resumed. As has been shown above, the same product given as two injections is perfectly satisfactory." NOTIFIABLE DISEASES (other than Tuberculosis) DURING THE YEAR 1938. Disease Total Cases Notified Cases admitted to Hospital Total Deaths Scarlet Fever 86 69 - Diphtheria 21 20 - Puerperal Pyrexia 7 7 1 Pneumonia 16 15 27 (all forms) Erysipelas 4 3 — Poliomyelitis 1 1 — ANALYSIS OF THE TOTAL CASES. Disease At Ages Under 1 Year 1 2 2 3 3 4 4 5 5 10 10 15 15 20 20 35 35 45 45 65 65 and over Scarlet Fever 1 1 6 3 8 44 12 6 4 1 - - Diphtheria — 2 - 1 2 10 3 3 — - - - Pneumonia — - - - - 2 1 - 3 6 4 - Puerperal Pyrexia — - - - - - - 1 5 1 - - Erysipelas — - - — - — 1 - — - 3 - Poliomyelitis - - - 1 - - - - - - — 23 TUBERCULOSIS. New Cases and Mortality during 1938. Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory Non- Respiratory M. F. M. F. M. F. M. F. 0 - - 1 - 1 - - - 1 — — 1 - 1 - - 1 5 — — 1 1 - - 1 — 15 3 4 — — 1 7 - 1 25 6 4 2 — 3 4 - — 35 4 3 - - 3 1 - - 45 2 1 - - 2 - 1 - 55 1 1 - - 3 2 - - 65 and upwards 1 - - - - - - - Total 17 13 5 1 14 14 2 2 The ratio of non-notified tuberculosis deaths to total tuberculosis deaths is 18.75 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 Chas. Knight & Co., Ltd., Suffolk Lane, E.C.4.